The Real Doctor Will See You Shortly

by Matt McCarthy

  “But the dye they have to use might screw up my kidneys.”

  “Right.”

  “The cardiologist says I might need preemptive dialysis. But the kidney doc tells me that won’t do any good and is refusing to do dialysis. So, here I am.”

  “Here you are.”

  Moranis had warned me that this day was coming; Sam’s heart and kidneys were on a collision course, and we agreed the kidneys would have to be sacrificed. Sam and I had discussed this extensively over the past few months, and although I wasn’t a kidney or heart specialist, he knew I was his advocate.

  To fully explore the anatomy of Sam’s injured heart, the cardiologists would need to inject a special dye into him. But that dye was known to harm the kidneys, and the nephrologists warned that his already damaged organs couldn’t handle the insult. Injecting the dye could destroy his kidneys and force him to go on dialysis. He’d need to visit a dialysis center three times per week for a long time—possibly the rest of his life—and might lose the ability to urinate on his own.

  If that happened, the cardiologists might get in trouble—the need for dialysis after cardiac catheterization was a reportable offense—so there was talk of starting dialysis prior to injecting the dye. But the data supporting such a maneuver was sparse, and the nephrologists weren’t interested in doing it. So we were at a crossroads, one that left me utterly perplexed. Moranis told me that if anyone suggested there was an easy answer for Sam, they didn’t appreciate the complexity of his situation.

  “Stuck in the middle,” I said, fingering the loose flesh on my neck. “This is a tough one.” I imagined Sam’s heart and kidneys in a boxing ring, fighting it out as Axel’s words once again wafted into my head: Do not fuck with the pancreas. “You shoulda called me,” I added, “directly.”

  Because my hours in the primary care clinic were so limited, Sam was in the habit of texting me when he got his blood pressure checked at the grocery store. Moranis had warned against doling out my cell phone number to patients, but it was the only way to keep tabs on everyone. I thought about Jim O’Connell and what he did for his patients, wading out into the night, searching for life, searching for illness. Giving out my phone number seemed like the least I could do. I had spent so much of the year trying to connect with patients, but when I gave Sam and others my personal number, they were able to feel a connection with me. “I’m serious,” I added.

  “Any chance,” Sam said, “any chance you guys can put your heads together and sort this one out?”

  “I’ll see what I can do.”

  “Thank you,” he said, putting a hand on his chest. “I’ll just hang here, having a heart attack.”

  —

  I walked across the emergency room and returned to Don. “Got a hypothetical for you,” I said. “My clinic patient over there is having a heart attack. Needs a cath but no one wants to touch him. Cardiology’s afraid they’ll destroy his kidneys, and the nephrologists don’t want to dialyze him preemptively. What do we do?”

  Don stared at my chest. “Again, not a hypothetical if it’s actually happening.”

  “What do you think?”

  “It’s a tough one.”

  “Right? I can see both sides.”

  We looked at Sam, who was now reading The New Yorker. It must have been an exceedingly light heart attack, I thought. “Remember,” Don said, “you’re not the first to encounter whatever situation is stumping you. Never forget that.”

  “Good point.”

  “Could mention it to Dave,” he said, pointing at our chief resident, who was moonlighting in the ER to make a few extra bucks. I hadn’t had a one-on-one meeting since that encounter in his office, the one where he expressed concern that five interns were leaving our program and I admitted I was struggling. It had been an uncomfortable inter-action—I had replayed the dialogue in my head dozens of times—and I was left with the impression that Dave was trying to make my life more difficult. That belief may have been misguided, but it was how I felt, and even the improvement of my station at the hospital in subsequent months hadn’t quite dislodged the feeling.

  I also wasn’t excited to venture over to Dave’s section of the emergency room, Area B, which held a large pit of dangerously inebriated or psychotic men and women. These erratic patients were monitored by a half dozen improbably large security guards, and in my brief experience, it was nearly impossible to set foot in Area B without having some sort of bodily fluid flung at you.

  “Dave,” I called out as I approached the pit. “Hey.”

  “Big guy!” he said, sticking out a hand. “How are things?”

  “Fine. Quick question.”

  He curtsied. “How may I be of service?”

  It wasn’t clear if chief residents were the select few who truly retained the pseudoenthusiasm of intern year or were simply the best at faking being fake. “I got a bit of a situation.” I quickly recounted Sam’s scenario and asked for Dave’s advice.

  “Let’s set up a talk!” Dave said. “We’ll get a cardiologist and a nephrologist to come and duke it out.” He pretended my belly was a punching bag and threw a few light taps to my midsection. It was weird. “It’ll be great, Matt!” He typed a few words into his phone and smiled.

  “But, Dave, what do we do now? Like, right now.”

  “Let’s talk it out,” he said, putting an arm around me. “Introduce me to Sam.”

  I still didn’t know what to make of Dave. I couldn’t say why, but he rubbed me the wrong way. Like he’d sell me out if we were both suspected of a crime or squash me if it meant professional advancement. But why? He hadn’t really done anything to me. Maybe he had just been worried I was going to leave medicine. What if I was a bad judge of character? What if Dave was one of the guys in my corner and I didn’t realize it?

  I stared intently at him, hoping his facial expression would tip me off. Was this guy on my team? As I glared at his thin lips, I wondered how often I had rubbed people the wrong way—and not just doctors but patients. How often did they find my probing questions too much? How frequently did my attempts to connect with people backfire?

  Dave and I walked toward the other end of the ER, and I pointed out Sam. He looked calm, almost like he was on vacation and the stretcher was a chaise lounge.

  “Hard to believe,” Dave said, “that a new crop of interns will be taking your place soon. You ready to have your own intern to boss around?”

  “Ha. What do you think?”

  “I think you’ve come a long way from those mopey days…after the needle stick.”

  “Mopey?”

  “I kid, I kid. I think you’re doing great.” My index finger still had the occasional phantom pain where I’d jabbed myself, but I appreciated the compliment. Dave always caught me off guard. “I’ve seen your faculty evaluations, Matt. Really strong. I was actually wondering,” he said, “if you’d be a tour guide for the new interns. And for next year’s applicants. We think you’d be perfect.”

  We? I fought off a grin. “I’d be delighted.”

  At some point I had apparently quantum-leapt into the body of a reasonably competent, capable doctor. I could feel it was true, but couldn’t quite figure out when it had happened. When had I gone from we’re worried you’re decompensating to wanna be a tour guide? Where was that transformative scene, like Don’s master diagnosis? Maybe it was something more gradual, like demonstrating that I could consistently function on eight minutes of sleep or that I could navigate a needle under duress. Perhaps, like Don, I had cemented my reputation with just one patient—but who?

  “Awesome,” Dave said, “just give people a sense of what it’s actually like to work here.”

  I looked over at the pit of dangerous patients in Area B and smiled. “Sure.”

  My mind began to wander, as it often did late at night. Could I accurately represent the diorama of hospital life at Columbia? Or the strange enchantments of practicing medicine? Could I explain how wonderfully insane it all is? I t
hought back to the first few weeks with Baio in the CCU; did the tribulations of intern year appear different now than they had in July? I didn’t think so, but I couldn’t be certain. “So,” I said, transitioning out of my neurotic inner monologue, “my patient Sam. Let me give you the full story.”

  39

  Walking out of the ED hours later, after further testing revealed that Sam wasn’t having a heart attack—not even a light one—I saw another old friend sitting alone in the waiting room. “Dre?” I whispered to myself.

  She had put on some weight—at least twenty pounds, maybe more—but there was no mistaking her. She was wearing a bright green sundress, large sunglasses, and slippers; it was probably forty degrees outside, but she was dressed for summer. “Dre?” I said, somewhat louder. So much had happened since she’d walked out on me, and I still had many questions. She still had those bumps on her face, but they were smaller and there were fewer of them.

  Rarely is a physician able to pinpoint someone who leaves such a lasting impression, but she, like Benny, was one of them for me. “Hey,” I said, taking a seat next to her, “it’s Dr. McCarthy.” She didn’t respond. Perhaps Dre was a pseudonym she’d made up on the spot and didn’t remember using. “I was your doctor a few months ago.”

  Seeing her allowed a tangle of buried thoughts to emerge. I remembered how much I’d felt like a failure when she vanished. I was just another person in her life who didn’t get it, another stiff in a white coat who wasn’t worth her time. Part of the process of rebuilding my confidence in the months that followed had entailed learning how to avoid taking failures personally. But like a first love lost, Dre’s departure still stung. It was hard to be rational about it, even in retrospect. What had I done wrong? I still desperately wanted to know.

  After her middle-of-the-night departure, I did some digging and discovered that Eminem and Dr. Dre had done a duet called “Forgot About Dre.” I’d occasionally played it when I took my HIV pills and had the lyrics tucked away for a moment such as this. I knew she was battling several chronic illnesses and would inevitably pop up in our emergency room again. But I didn’t expect it to be now, just before dawn on a chilly night in March. Her eyes were closed, so I gave her a gentle nudge. She looked better—not great—and the added weight suited her well. Did she remember me? I quietly said the lyrics in her direction:

  “Everybody wanna talk like they got somethin’ to say…” I scanned the room; no one was watching us. “But nothin’ comes out when they move their lips just a bunch of gibberish.”

  Dre flinched and her jaw went slack; it was a preposterous thing to say to a patient, but it’s what I said.

  “Em?” Her frown gave way to a wide-ranging smile.

  “In the flesh,” I said. She did remember.

  “No shit.”

  “Indeed.” I gave her a once-over. “You doing okay?”

  “Yeah, yeah. Just need a checkup.”

  “In the ER?”

  She didn’t respond.

  “Well,” I said, “you look good.” I lightly touched the fabric of her dress as she tapped a matching handbag at her feet, and she whispered, “Calfskin.”

  I thought back to that agonizing moment when I’d discovered she had vanished. “So, where in the world did you go that night?” I asked. “The last time I saw you. Why did you leave the hospital? How did—”

  “Long story, Em.”

  “I got time.” My pager vibrated as I spoke. Don was summoning me to see a young man with priapism—that dreaded scenario where an erection lasts more than four hours. It is an excruciating condition, one that on occasion necessitates an injection directly into the penis to prevent dangerous blood clots. I had a minute with Dre, maybe less.

  “I just want to know,” I said, “why you chose to—”

  “Em, you a real doctor?”

  “Yes, of course.”

  She grinned. “Just checkin’.”

  “Please tell me you’re taking the…the meds. All of them.”

  “I am!” She extended an arm and squeezed my shoulder. “Started seeing Dr. Chanel. She hooks me up.”

  “Wonderful.” She felt my other shoulder and gave it a squeeze. “You’re bigger than I remember, Em.”

  We both had put on a bit of weight. “You wanna hear something funny?” I asked. “In med school, one of my instructors told me my physicality was intimidating to other students.”

  “Physicality?”

  “Yeah.”

  “Who uses that word?”

  “Weird, right?”

  She held up her hand and counted out the syllables. “Phys-i-cal-i-ty.”

  “So honestly, Dre, where did you go that night?”

  “Out.”

  “I know this is kind of a weird thing to say, but I was really hurt. Seriously.”

  She touched my leg. “I’m taking the pills. But I had to go. I had to. I’m sorry.” Many of my poorer patients temporarily disappeared on the first or fifteenth of the month to collect unemployment or disability, but they usually came back the same day. It wasn’t an ideal situation, but my hands were generally tied. “Chanel hooked me up,” she added. “I’m good.”

  “Well, you look good.”

  She touched my face, like she had in the hospital. “So do you.”

  “One more thing,” I said, quickly scanning another text on my pager. “Did you start taking the pills because of…because of me? Because of the conversations we had?”

  “Honestly?”

  “Yes, honestly.” I closed my eyes. I never willed my patients to answer questions the way I wanted them to, but I was now.

  “Oh, Em.”

  “Be straight with me.” Or just humor me.

  Dre turned her head slightly. “Honestly, no.” She stood up, straightened her dress, and patted me on the leg. “I’ve got to go. Good-bye, Em.”

  PART VI

  40

  After my two-week stint of nights with Don—he and I had exhausted hundreds of hypotheticals during our fortnight together—I was shipped uptown to work a monthlong rotation in the intensive care unit of the Allen Hospital. Located near the northern tip of Manhattan, the Allen was a three-hundred-bed community hospital on 220th Street where Columbia interns spent one month learning the art of geriatric medicine and a separate month running the intensive care unit. The structure of supervision was a bit different uptown because in contrast to the Columbia behemoth on 168th Street—a topflight international referral center—patients at the modest, three-story Allen Hospital tended to have less acute, less complex medical conditions. And for that, we were all thankful.

  At first blush, the assignment seemed somewhat contradictory. If patients at the Allen weren’t that sick, why have an ICU? On an interminable northbound subway ride to 220th Street in early April, I wondered if, like Sam’s allegedly light heart attack, I was about to begin work in a light intensive care unit. As the subway approached the hospital I considered how odd it was to think of humans in this way—as medically simple or complex, the chronically ill or the worried well—rather than as funny or kind or annoying. I was struck by how differently my mind worked now than it did just a few years ago. When did I begin to identify people first on the basis of physiology rather than personality? When did that accountant I was caring for become Salmonella Lady or Diarrhea Guy?

  After ten months of being an intern, I no longer experienced life like a normal person. I couldn’t watch a movie or read a magazine without drifting off to the hospital—to a procedure or an ambiguous diagnosis or a patient encounter—to relive the moment again and again, until something shook me out of the moment. I now found it hard to have a conversation without mentioning something I had seen or done at work. Ordering lunch at a deli, I’d be thinking about the patient who claimed he sat on a jar of Grey Poupon. Checking out at a grocery store, I’d be thinking about the lung blebs.

  I now viewed everything through the lens of medicine. It wasn’t something I had planned or particularly wan
ted, it just happened. When I saw someone on the street with a limp, I now fixated on how it might have happened—stroke? fractured bone? muscle-wasting disease?—until I felt confident in my armchair diagnosis. I found myself staring at oddly shaped moles on the subway and at low-set ears in the park. What caused these things? I couldn’t let it go until I’d formulated some sort of hypothesis.

  I desperately wanted to become a superb doctor, but as the year wore on I also found myself wanting to remember what it was like to not be a physician—to just be a guy going for a stroll with an uncluttered mind and an armful of groceries. A guy who didn’t act quickly and decisively, someone who could make eye contact without thinking about ophthalmology. I wanted to be a doctor and a normal person. Was that possible? Or were the two mutually exclusive? I hoped I would never have to choose, but in some ways it felt like I already had.

  When I stepped into the Allen ICU for that first thirty-hour shift in April, I discovered that my pod would be supervised by just one third-year resident (rather than four second-year residents) and that this resident would be supervised by two attending physicians. This had presumably been explained to me months earlier, during orientation, when intern year had been laid out in a series of presentations, but I had forgotten the details. I had become remarkably nearsighted over the course of the year, focused on what I needed to know to get through the day, rather than what might take place in the weeks and months ahead.

  The entire Allen ICU team was to go home at 8:00 P.M., meaning I was left to hold down the fort on my own overnight. I would have backup, of course, in the form of an overnight attending physician who was admitting his or her own patients in another part of the hospital. But once the sun went down, I was essentially alone.