The Real Doctor Will See You Shortly

by Matt McCarthy

  It was an object lesson in the appalling limitations of medicine. I followed the proper technique—compress at least two inches, allow for full chest recoil—and the patient either lived or died. There is no art to it, no nuanced way to inject life into a lifeless body. Just mash on the chest and hope it works out. Looking at Dan Masterson’s body, I made a fist with my left hand and smashed it into my right. What was the point in having all of this training and technology if we couldn’t make it work?

  I had seen so many patients brought back from the edge of death, so many saved when all hope was lost, but not this time. Baio had showed me what it was like to be special, to be a lifesaver, but tonight I was part of the losing team. And it made me wonder if I wasn’t all that special without him. Or Don. Or Ashley. Or Moranis. Maybe I needed these more experienced doctors to effectively do my job. My arms and back ached, but my heart ached for Dan Masterson’s family more. Why did this happen?

  I stepped away from the body, and Dr. Jang put his arm around my sweaty shoulder. He could tell I was upset. “Did everything we could,” he said.

  “I know,” I said, my eyes welling with tears. “Just fucking sucks. You know?” I couldn’t quite explain why I was so emotional. What was it about this Dan Masterson? I had seen many patients die—at times it could be an everyday occurrence—and I rarely got choked up. The fiftieth death just doesn’t jar you the way the first or second one does. But most of the people I saw die were elderly, or had been sick for a long time. I had participated in several failed resuscitations before this, but they had involved octogenarians who probably shouldn’t have had to go through getting their ribs cracked at all. Dan Masterson was a young, good-looking guy who’d just walked in off the street and died. “I know,” I said again. I wiped tears on my sleeve.

  We looked back at Masterson’s body as a nurse picked up the paper and plastic that had been chaotically strewn about the floor during the arrest, vial after vial of medication that had been administered in vain. There is something strange about acknowledging that life has exited a body. I don’t believe in spirits fluttering up to the heavens or anything like that, but it did feel like something palpable had been taken away, extinguished and removed from the room as the pall of death slipped in. Soon, rigor mortis would set in and Dan Masterson’s limbs would become stiff, his body cold. I focused for a moment on these biochemical processes to stave off the mental torment of his death and our failure.

  “There’s some paperwork that needs to be done,” Jang said. He pulled a scut list from his white coat and put on a pair of tortoiseshell glasses. The man had clearly moved on to his next task. Was this me in a few years? I didn’t want to know what it took to get there. “Do you know how to formally perform a postmortem exam?” he asked.

  “Yeah.”

  “You also need to notify next of kin and request an autopsy,” he said. “Have you done that before?”

  “Yes.” Death was a common, rarely unexpected part of my job, and a family member was usually nearby so the news could be broken in person. But I realized this next-of-kin conversation was going to be very different. I was about to call someone who didn’t even know her husband was in the hospital. “I’ve never done it over the phone,” I said. “Never called someone I haven’t met.” I tried to imagine how this might play out. Every scenario was horrible.

  “You just gotta do it.”

  “Right.”

  “I know it’s not helpful,” Jang said more firmly, “but you just gotta do it.”

  As I tracked down Masterson’s wife’s name in the chart, my heart started to race. What would I say to her? These are the tasks—the heinous duties of being a doctor—that were never fully fleshed out in medical school, the awful moments you might never be comfortable with no matter how long you practice. We did occasionally practice delivering bad news—a new cancer diagnosis, or something equivalent—but nothing like this.

  In that moment, as I slowly dialed her phone number, I wanted to disappear. I looked up at Jang after the final digit had been dialed. I felt like I was going to vomit. What should I say? What would I want to hear? If I received a call like this, I’d probably drop the phone and lose my fucking mind.

  I heard the phone ring and took a deep breath. I still had no idea what I was going to say. Deliver the news fast, like ripping off a Band-Aid? Or slow, to give the woman time to wrap her brain around her new, horrific reality? The phone rang again, and I felt my pulse go even faster. I was now breathing rapidly and irregularly. Jang sat next to me, cracking his chubby knuckles.

  After five rings, an answering machine picked up and I hung up the phone. “Do I leave a message?” I asked.

  Jang shook his head. “Try again.”

  I called back, and a woman immediately answered the phone. “Mrs. Masterson?”

  “Speaking.”

  “This is, ah, Dr. McCarthy from Columbia…from the Columbia University Medical Center. I’m calling about your husband.”

  “Is he there? What happened? Is he okay?” A television could be heard in the background. You just gotta do it.

  “What’s wrong with my husband?” she said quickly. “Tell me what’s happening.”

  Much like I had done for her husband, I started to imagine what this woman might look like—confused, exhausted, frazzled—perhaps as a way of stalling. Was she holding one of her kids? What did her hair look like? “Tell me,” she said again.

  I looked at Jang, and he nodded. I turned away from him and bowed my head, staring down at my shoes, which were caked with Dan Masterson’s blood. In the final instant, that last moment before I explained what had happened, my thoughts faded to black and I felt nothing. “Mrs. Masterson, your husband came to our emergency room earlier tonight.”

  “Oh, god,” she whispered into the receiver. “Is he…Please tell me—”

  “He had a cardiac arrest shortly after arrival and passed away ten minutes ago. We did everything we could. I am so sorry.” I pushed the phone a few inches from my ear, but she didn’t say anything. So I spoke to fill the void. “We attempted to resuscitate him for almost an hour, but our efforts were unsuccessful.”

  A muffled, bloodcurdling scream could now be heard in the background. For an unquantifiable unit of time I heard nothing but screams. I closed my eyes and fought off the urge to cry, to run away as ugly thoughts fluttered through my head. I failed her. I failed her family. The world is an awful place. Her children will never know their father, and I played a role in that. Life is so fucked up.

  “Mrs. Masterson,” I said eventually, “I want you to know that Dan, Mr. Masterson, is at the Allen Hospital.”

  “What is your name?” she asked softly.

  “Matthew McCarthy,” I said. “He…Mr. Masterson is at the Allen Hospital on Two Hundred Twentieth Street. Not the hospital on One Hundred Sixty-Eighth Street.”

  “And are you responsible?” she said more loudly. “Are you responsible for this?”

  “I am one of the physicians who attempted to revive him, yes.”

  “I am coming in now,” she said. “I am coming in now to find you, Dr. McCarthy.” She hung up the phone, and I began to wait.

  41

  Jang patted me on the back and whispered, “Good job,” as I hung up the phone and replayed the conversation in my head. Was she threatening me? It sure sounded like it. What would she do? Should I be worried? I tried to block her words out of my mind. I had work to do.

  I sat down at a computer in the center of the ICU and prepared to write a death note—a medical-legal document explaining what had happened to Dan Masterson and what we had done about it—but I found myself unable to focus, not wanting to relive the failed resuscitation.

  I turned away from the computer and leaned back in my chair. What would I say to Darby Masterson? And what about the hep C? Was I supposed to tell her about that, too? How much shit could I drop on one person? Your husband is dead, Darby, and oh by the way, I think he had hepatitis. I checked my pager and s
aw that while I was performing CPR, I’d missed nearly a dozen messages.

  As I scrolled through the missed pages, I struggled to go back about my business as though nothing had happened. But that was what I needed to do. That hour with Dan Masterson was an hour where I had not been thinking about my other critically ill patients, and when I looked up from my pager, a line of nurses had formed to tell me what was happening around the unit. The Italian man had spiked another fever, and the Vietnamese woman had too much carbon dioxide in her blood. Oxygen was getting into her lungs, but carbon dioxide wasn’t getting out, and that mismatch would soon cause her blood to become dangerously acidic.

  I leapt out of my chair as a series of blood-gas equations flashed across my mind, like breaking news interrupting regularly scheduled programming. I needed to adjust both the frequency and amount of air being delivered by her ventilator, and quickly.

  “Get some air,” Jang said, intercepting me as I approached her room. “Take a breather.”

  I wasn’t sure why he was still in the ICU; he had patients to see in other wings of the hospital. “I’m okay,” I said.

  He grinned and gently placed his hand on my chest. “I know you are. Just take five. Really. This is why I’m here.”

  “I’m fine. I promise you I’m fine.”

  He pointed at the exit. “Go.”

  I reluctantly stepped out of the unit, in search of food and a place to eat it, and noticed that my underarms were soaked with sweat. There were dark stains on my scrub pants—presumably blood or some other bodily fluid once belonging to Dan Masterson—and I still had a dozen more hours on call and untold obstacles to hurdle before I would be able to take a shower.

  What did Mrs. Masterson mean by I am coming in now to find you? As I stood staring into the abyss of a vending machine several minutes later, my mind wandered across the hundreds of family members I had interacted with over the year. They were so unpredictable, so different. It was from them I learned that Carl Gladstone was a Yankees fan, that Denise Lundquist’s best friend was her brother. Families provided invaluable windows into our patients’ lives, transforming two-dimensional stories about chest pain into three-dimensional experiences for us to dissect and analyze as we went about our days. Peter Lundquist never left Denise’s side, gently weeping as he watched her sleep. He prefaced every inquiry with I don’t want to bother you, Dr. McCarthy, but I have a tiny question about Denise. Then he’d ask something that was not a tiny question, something like Do you think we’ll still be able to have children? (They would.)

  Families, in some ways, became our second set of patients. They needed time and attention, and if you failed to provide that, things could deteriorate quickly. Medicine is complicated and it is a skill to simplify things in a way that doesn’t oversimplify, to accurately convey in plainspoken language what is actually happening inside another person’s body. I made a conscious effort to do it, so it was irritating to see others doctors use medical jargon with families. Just talk like a normal person, I wanted to say. Pretend you’re not a doctor. But for some, that simply wasn’t possible.

  Half an hour later, the nurse manager paged me that Dan Masterson’s next of kin had arrived and had asked for me by name at the front desk. I passed Dr. Jang as I reentered the ICU—he was being called away to the emergency room—and as I sat down at a computer and waited for Darby Masterson to arrive, her voice began playing on a continuous loop in my head: I am coming in now to find you, Dr. McCarthy. You. The one responsible.

  What if she had a gun? There was no metal detector at the front desk, just a drowsy security guard. And if she used it, would she even be guilty of anything? Wasn’t this a heat-of-the-moment thing? A doctor told me my husband was dead, Your Honor, and I went temporarily insane. I just started firing and now I throw myself at the mercy of the court.

  When Darby Masterson entered the intensive care unit, a trio of nurses met her at the door. I eyeballed her from a distance—about twenty feet away on the other side of the unit—and quickly discovered she wasn’t quite what I had imagined. She was tall with very pale skin and had the soft paunch of a new mother. Long, dark black hair fell to her mid-back. She wore blue jeans, a dark blue sweatshirt, and gray tennis shoes. She did not look like a woman about to commit a violent act; she looked more like a victim, which she was.

  As the nurses guided her into the room where her husband’s body had been placed, we did not make eye contact. The room was closed off with a curtain, and the nurses stepped outside to give her privacy. I stared at the partition, trying to imagine what was happening on the other side and what I would say to her. Not long after she entered the room, I could hear the wails—the same sounds she’d made on the phone when I told her what had happened—but they were an octave lower now. I took a few steps back, as though the added distance might give her more privacy.

  As the minutes ticked by, I tried to busy myself with other work—adjusting ventilators, writing notes, entering orders—but I couldn’t focus. I kept waiting for Darby Masterson to emerge from her husband’s room, but she never did. Hearing her unending sobs through the curtain, I knew this was not a woman who planned to attack me; this was a devastated widow who was here to grieve. And she deserved some semblance of an explanation, even if it was incomplete. I had to go in there; I had to talk with her. But given the amount of work that lay ahead of me, it couldn’t be on her schedule. I needed to get this over with, and soon.

  I could feel the nurses watching me as I slowly made my way across the unit toward Masterson’s room. You just gotta do it. There was no way around this. It felt like I was about to do something very bad, as though my slow steps reflected inner turmoil. My mind wanted one thing—to enter the room—but my body wanted something else. When I was a few feet from the curtain, I announced myself and asked if I could enter. A faint voice said I could.

  I opened the curtains to find Darby Masterson weeping at her husband’s side. “I’m sorry to interrupt,” I said, gently approaching the bed, “but I believe you were looking for me. I’m Dr. McCarthy.” She stood up and turned away from her husband’s body. She ran her hands through her dark hair and walked toward me. We stood a few feet apart, two strangers inexplicably thrown together through catastrophe. It took everything I had not to run away from her. “I am so sorry,” I said.

  She lunged at me and I briefly flinched, but chose to stand my ground. There was no violence, of course. Mrs. Masterson threw her arms around me and gave me a hug. I closed my eyes as her wet cheek met my collarbone and our abdomens lightly touched. Again my eyes glazed with tears. “I just want someone here to know about my husband,” she whispered. “That’s all I want.”

  “We did everything we could. We’re still sorting everything out. I am so sorry for your loss.”

  “I just want someone to know.”

  “Tell me…tell me about him.”

  She took a seat and cried for several minutes. I wiped my eyes on my scrubs sleeve as I sat next to her and tried to imagine what she was going through. I simply couldn’t. I ached for a blanket or a towel to cover my pants, to hide her husband’s blood splatter. “My husband,” she said, as she wiped the tip of her nose with a tissue, “I loved him so much.”

  I nodded, still not sure what I should say. “What was he like?”

  Darby smiled through the tears and looked over at him. “He was a weird guy.” She let out a sound that could almost be described as a laugh, and I tried to match her facial expression. “He wasn’t a people person, he wasn’t someone with a lot of friends. He was just a quirky guy who made me smile. No matter what kind of day I had, I knew he’d make me laugh when I got home.”

  “Sounds like a wonderful man.” I wondered what tense I should use. Was it cruel to use the past tense, or simply accurate? “I wish I’d known him.”

  “He could also be moody,” she said. “Lock himself in a room and surf the Internet for hours. Probably do it for days if I didn’t stop him.” I bowed my head and thought of D
an stumbling on nitric oxide therapy, reading the testimonials, ordering the package, hiding it away, and somehow inhaling the stuff into his body. This funny, moody guy had a secret, and I still wasn’t sure if it was my job to reveal it. “I just don’t understand,” she said. “How could this happen?”

  I looked at her and asked, “What do you know about your husband’s medical conditions?”

  She shook her head. “He was a pretty healthy guy.”

  “And did he take any medications?”

  “Not that I know of. Maybe a multivitamin or something.”

  I paused, and tried to summon the wisdom to handle this properly. On the one hand, she deserved to know everything. On the other, I hadn’t seen documentation that he actually had hep C or any other disease. It was something that had been told to me by another doctor; something that Dan Masterson said about himself, but he didn’t arrive with any medical records to prove it. What if he hadn’t used nitric oxide? What if he didn’t have hepatitis? “Your husband lost consciousness shortly after he arrived in our emergency room. We still don’t know why, but it appears he was using an alternative medicine to treat a medical condition. An infection. We weren’t able to test him for it before—”

  Her face went blank. “An infection?”

  “Yes.”

  “What infection? What alternative medicine?” She shook her head. “What are you talking about?”

  “He mentioned something to a doctor in the ER about nitric oxide therapy.”

  “Nitric oxide?” She straightened her back and looked at the ceiling. “For what?”

  This was it. Darby Masterson deserved the truth, but I wasn’t certain what the truth was. “People are trying it for all sorts of things,” I said. “I didn’t get to speak with your husband and he didn’t come with any medical records, so we don’t know for sure. But you’re going to need to get tested—”

  Darby flinched. “Tested for what?” We both looked at the corpse, and I considered my words. “Tested for what, Dr. McCarthy?”