I let my mind drift as Emma dutifully began reciting the mnemonic MUDPILES, resolving the next chance I got, I’d confront her to get some help. Nobody could endure such a loss without support.
Dr. Elsdon was winding down with no noticeable dimming of his fervor, despite his having given this particular lecture dozens of times before. Well, obviously some things just stir the human heart. The students might have been slow to realize the inherent beauty of acid-base disorders in the beginning, but now everyone was swept away with passion. Toxic alcohols! Respiratory alkalosis! This was exciting stuff!
At eight o’clock, Emma nodded at me and headed home to sleep for the day. I waited until she was gone and waylaid Dr. Elsdon as he packed up his lecture materials.
“Zadie,” I began, pointing at myself in case he didn’t remember my name.
“Bernard,” he said, pointing at himself. “Glad we got that straightened out.”
“Sorry to bother you, ah, Dr. Elsdon, but I was wondering something.” I collected my thoughts. “If you thought a person might need medicine for, ah, sadness, would you bring them to the ER?”
His expression changed. “Do we think this person might be having a reaction to a recent tragedy?”
“Yes! A grief reaction.”
“Are you— Does this person have any thoughts of harming themselves?”
“Oh! It’s not me,” I said. “I’m asking for a friend.”
He waited, his face kind. Then he nodded, extracting a small piece of paper from his pocket. He scribbled something on it. “Okay,” he said. “Take her to Dr. Butler today. She’s our best staff psychiatrist, and she sees students through the clinic. She’ll help your friend.”
—
I trotted out to the ED main desk and signed myself in, then grabbed the first chart in my section. Today I was paired with a third-year resident I didn’t know named Dr. Alanna Tamara, who went by the nickname Sensei. Apparently she was really good at martial arts of some kind. I looked around but didn’t see anyone who could possibly be Dr. Tamara, so I scooted toward room 35, reading the triage sheet as I went.
The patient’s name was Jack Dmitriy-Rau and he had ankle pain. This sounded boring, but easy enough. Today I was going to be a model of efficiency; I was not going to allow myself to be bogged down in inane conversation. Starting right now, with Mr. Dmitriy-Rau.
I tapped on the door and entered. Mr. Dmitriy-Rau, a portly gentleman sporting a relaxed expression, was sitting fully dressed in a business suit. The patients were all given a gown and asked to disrobe when they were brought back to the exam rooms, but many of them misunderstood or ignored these instructions, leading to a bottleneck as the day progressed. In Mr. Dmitriy-Rau’s case, however, fully undressing in the chilly exam room did seem superfluous for an ankle injury.
After introductions, he stood and extended a lavish hand to me, launching unbidden into a thorough account of his day.
“. . . And then after the breakfast, which was a bit heavy, to be true—I am the early riser, yes, but I do not often care for the full breakfast. But my wife, she like to cook, so sometimes I have quite more than I mean. So. I must be more careful in future with my figure, you can see”—here he rubbed his ample belly—“but is done with love, so how can I refuse?”
I politely attempted to bring the train back to the station. “It sounds delicious. How did you hurt your ankle?”
“Well. I take my time with the breakfast, proper compliment to the chef, so, and then we have the full tea. Also I watch the early-morning newscast. To see the weather, the traffic, you know. But this often lead to the argument. My wife, she does not like news, until Today Show. She like the man newscaster there.” He chuckled. “Maybe she like him little too much.”
“Is that when you sprained your—”
“No, no. That come later. First, she make me stay until the Today Show start. So. Also have more of the tea.” He gestured expansively. “Why not? By now is too late for the moderation, so may as well enjoy. Right?”
“Right, but—”
“Yes, so, and then dog start to bark. We have little dog, ‘yap, yap, yap’ all the time, yap-yap, is enough to drive you crazy. Yap, yap. I say if you are going to have the dog, why not have the more man dog? This dog, it sound like the little bird.”
“Did you—”
“Yap-yap-yap-yap. I cannot stand it. Finally, I say I must go to work. And my wife say, ‘Wait. You must walk dog.’ I do not wish to walk dog. I do not even like dog, now the yap-yap is going to make me late for work? Intolerable. But she is very strong personality, my wife.”
I abandoned politeness. “Mr. Dmitriy-Rau, where are you hurt?”
“This I am getting to. Yap, yap. The leash we have misplaced. Everywhere we look; all the while, yap, yap. Enough to make you tear out the hair. Or maybe you give the very small nudge.”
“Nudge?”
“With the foot. Certainly not a . . . injury nudge.”
“You have no injury?”
“Certainly I have the injury. I am telling you it now.”
Desperately: “Yes, but what is the injury?”
“Well, so. The dog, he is fine. I do not harm him. Smallest nudge only, with little bit of the foot.” Mr. Dmitriy-Rau nodded in agreement with himself.
“You kicked the dog?”
“‘Kick’ is too strong. I nudge him. With the foot.”
“Can I see?”
“Certainly you must see; this is why I come to the hospital.”
I rolled up Mr. Dmitriy-Rau’s pant leg, discovering the imprint of a tiny row of teeth.
“Ah! The dog bit you!”
“Yes. It was unprovoked bite. Very painful. Perhaps you will have to do stitching?”
I peered at the bite. It looked as if Mr. Dmitriy-Rau had been lightly drilled at regular intervals with a toothpick. There was no tearing of the skin.
“I don’t think so. Let me grab the other doctor, but I think we will be able to get you out of here quickly, assuming your dog has had all his shots.”
“Yes, yes, he go to the vet quite often. All the time, really. Perhaps some issues there. So I will wait for you and then we will do the ass rape. Then I will go home.”
“I’m sorry?”
“Soon we will do the ass rape. Then I may go.”
“The ass . . . what?”
“Ass rape. No?”
“No, I . . .” Cautiously: “Can you describe it?”
“Well, so. You are the doctor here, no? But I will try. It is the very tight rape, for the pain, the swelling. It goes like so”—he motioned in a circular fashion—“and then you may apply metal bits for completion.” He regarded me, adding kindly, “Well, perhaps you do not do this here.”
“I don’t—”
“Is okay. The brown fabric? No?”
“Ace wrap!” I shouted triumphantly. “Yes! Yes, I will get you an Ace wrap.”
“Thank you, dear. You are the very nice student doctor. Keep up with studies.”
I stood in the D hallway, watching the bustle of the ER. The layout was essentially a large square; there were four long hallways at perpendicular angles, which contained the patient rooms, with a huge blocky desk in the center comprising the departmental workstation. There were unit secretaries seated at computers, armed with telephones and intercoms, and radiating out next to them were areas for the doctors to chart. In the central square of the department there was a closed cube manned by radiology residents, which contained lighted screens to view X-ray films. I felt a tad anxious. I had yet to present my first patient to my upper-level resident, and truth be told, that was going to be one very sparse presentation. I had spent nearly twenty minutes in the room and yet completely failed to obtain most of the required elements: no past medical history, no allergies, no medication list, no review of systems, and no exam of any bo
dy parts other than the bitten ankle. Well, so, perhaps I could write “yap-yap-yap” on the chart. No, no, no: focus. I’d better get Dr. Tamara located posthaste, and see how to fill in the details without (a) completely fabricating them or (b) getting sucked back into Mr. Dmitriy-Rau’s flood of extraneous information.
I found Dr. Tamara yukking it up with some nurses at the main desk. She turned out to be an enormous brunette in her mid-thirties who was embarking on a second, or possibly third, career, which explained the odd nickname. Having just met her, I found it awkward to refer to her as “Sensei,” even though Dr. Tamara explained she preferred it. “No need to be formal,” she blared, unself-consciously tugging at her bottom in an effort to dislodge some migrating underwear.
I couldn’t resist. “Yes, Sensei,” I said, bowing deeply, which caused Dr. Tamara to howl and offer up a stout hand for a high five.
“Atta girl!”
“Yes, er, thank you,” I said. The ER certainly seemed to have its share of eccentric characters. “What do the patients call you?”
“Oh, I try to avoid the patients as much as possible. That’s what you’re for. Now tell what you’ve got in twenty-five there.”
I filled Dr. Tamara in on the yapping and the nudging and the ass rape. This resulted in such mirth I was forgiven for my otherwise shoddy history and physical exam; Sensei said she would handle it. “Laurie, get the man in twenty-five an ass rape, stat!” she bellowed at a passing nurse, who glanced quizzically at us but did not break stride. “Huh,” said Dr. Tamara, undeterred. “Guess we’ll have to do the ass rape ourselves.”
Just then my pager sounded. I gave it a quick glance: it was my home number. I excused myself and trotted to a phone in the doctors’ charting area.
It was Emma, and she sounded strained. I resolved to try to put her at ease.
“Well, hello there,” I boomed.
There was a brief hesitation. “Zadie?” asked Emma. “Are you drinking?”
“What? No. Actually, I’m seeing patients. I was . . . trying to sound cheery. How are you?”
“I’ve been better,” Emma said.
Breakthrough! I decided to let her take the lead on this one. “Yeah,” I agreed.
“I think,” Emma said in a small voice. “I think I want to tell you why Graham died.”
I was stunned. “Right now?” I asked.
“No, no, not on the phone. I have to work overnight, but I’ll call you if it gets slow. You can come in. Uh, if you will.”
“Of course. Of course I will, Emma. I’m so sorry I’m not home right now. Do you want me to try to get out of here?”
“No,” said Emma, her voice stronger. “No. You can’t leave the hospital in the middle of a shift. We’ll talk tonight, one way or another. It’s important that I commit to this, before anything else happens. I’m sorry to call. I just . . . I wanted to hear your voice for a second.”
Tenderness engulfed me. Emma was finally reaching out! Whatever had happened with Graham, at least she’d get it off her chest, and I would be there for her.
“Okay,” I told her. “I’ll be there tonight, late, once it calms down. And I got the name of a doctor who can help you too. Everything’s gonna be okay, Emma. I’m with you, no matter what.”
Emma sounded sad. “Don’t say that,” she said, “until you’ve heard what I have to say.”
Chapter Thirty-four
AN ETERNAL GASP
Zadie, Present Day
A shining disk of moon hung suspended above Nick, Emma, and me, emerging in the little window of night sky visible between the spiky tops of the skyscrapers. The three of us stood voiceless in the courtyard of the Ritz as I looked at the object Nick had handed me.
It was a photograph.
After thrusting it into my hand, Nick took a small step backward, breathing like an angry elephant. I ignored him and stared at the picture in my hand, my disbelief so profound it seemed possible the image would rearrange itself into something else. But the people in the photograph remained immutable, even though I stared until they blurred into fuzzy blobs.
The picture was old; it curled at the corners. Years of someone’s fingerprints rubbing across it had dulled the glossy sheen of the photographic paper, but the image was still visible. Taken from the vantage point of someone standing in a doorway, it showed a cheap, utilitarian twin bed, with a twist of dingy sheets. The subjects of the photo—standing in front of the bed—had clearly been photographed against their will; both of them faced the camera, the slight blurring of their torsos indicating motion as if they’d just heaved themselves upright. The woman looked disheveled: her hair blowsy and askew, her face red, her hands clutched defensively just above her unbuttoned shirt. Mascara was beginning to pool underneath her eyes, giving her a trampy, intoxicated look. Additional moisture leaked out of her nose; her mouth was frozen in an eternal gasp.
Emma.
Nick fared better; his face blended surprise with a little hostility, but I knew him well enough to recognize a calculating appraisal too. I’d be willing to bet if another picture had been snapped a moment later, his expression would have morphed to a grinning, sheepish okay-dude-you-caught-me look.
Emma’s skin shone with the kind of dewy radiance you never see in people over thirty, no matter how good they look. Her hair tumbled down her back in a luxuriant gold waterfall, errant wisps dive-bombing across her horror-struck face. I cast my mind back, rewinding through memories like an unspooling reel of film, until I reached our third year of medical school: she’d cut her hair just after Graham died, and she’d never grown it long again.
I became aware of my breathing, which was harsh, bullish, scary. I was trembling, an unforeseen rage somehow intensifying even as it became dwarfed by a miserable all-encompassing feeling with no name. This was a betrayal I had never seen coming.
A tear fell from my eye and landed on Emma’s beautiful, traitorous twenty-four-year-old face, smearing it into an unrecognizable blot. I swiped my thumb across the teardrop, melting Nick’s face as well, and handed the photo back to him. “Here you go,” I said.
“Zadie, wait,” he said.
“No, no, no,” I yelled, stumbling away from them. I kicked off my high heels and bent to retrieve them. “You two deserve each other. Why would you show me this? Why did you even bring it here? Did you plan this?”
To his credit, he looked chastened. “I didn’t plan to show it to you,” he said. “I always carry it.”
This stopped me. I straightened up. “Why?”
He shifted his eyes slightly in Emma’s direction. She stood in exactly the same position she’d been in when Nick first handed me the picture, an unblinking statue.
“To remind myself,” he said, so quietly I had to strain to hear him, “of the photographer.”
“Who was the photographer?” I asked, but even before he spoke, I knew the answer.
Graham.
Chapter Thirty-five
STOP HITTING ON MY MED STUDENT
Late Autumn, 1999: Louisville, Kentucky
Zadie
I returned from my call with Emma preoccupied but still eager to see more patients. Up next: a soft-spoken biology teacher in his early forties who said he’d coughed up some blood. “You get his chest X-ray back?” Dr. Tamara asked, rocking back and forth on her heels a little.
“It’s up on the board,” I said, gesturing toward the radiology reading area.
“And?”
“It’s normal?”
“Hmmm. Okay. Order a scan. What’s up next?”
“A kid with a bean in his nose. I’ve got the nasal speculum, forceps, lidocaine ointment, and a teeny bendable retractor. Oh, and some cautery sticks, in case of bleeding. I took a peek, but it’s hard to see and this kid is hysterical. I’m concerned we may have to sedate him.”
“Well, aren’t you the little
Boy Scout? Giddyap.”
We entered. The child, who was blond and about three, caught sight of me and pointed a pudgy accusatory finger. “No more her!”
The mother eyed us. She was young, with fluorescent bleached hair and a tattoo of what appeared to be a crack pipe on her forearm. “Quit that hollerin’,” she mumbled to Nose Bean.
“Right. Here you go, Mom. Let’s have you hold him on your lap. Yep, good. Can you hold his arms too? Great,” barked Dr. Tamara. I stood at the ready, armed with the nasal speculum, curious to see the extraction technique. As lowly a procedure as this was, it was still something I wanted to do competently, and I’d been baffled by how to accomplish it. That sucker was way up there.
“Okay, Zadie, wave your equipment around in the air. No, bigger,” instructed Dr. Tamara. Baffled, I did as instructed and began pinwheeling my arms, dragging the forceps through the air like a demented little airplane.
Dr. Tamara eyed me with what looked suspiciously like amusement. “Great. Now maybe add in some zoomy noises,” she said.
“Whoosh,” I said, feeling ridiculous.
Nose Bean stared at me, so captivated he forgot to yell. Quick as a wink, Dr. Tamara leaned in and kissed him hard on the mouth. The bean shot out of his left nostril and hit the floor with a tiny clack. Dr. Tamara picked it up and handed it with a flourish to the mom, who immediately let it drop back to the floor.
“Wha— How did you do that?” I asked as soon as we’d left the room.
“You forcefully exhale into their mouth while occluding the other nostril,” said Dr. Tamara. “Normally you have the mom do it, but did you see the size of the canker sore on that ho’s lip? Kid was better off with me. I’m celibate.”
Well, any reply to this statement would be fraught with potential missteps, no? Agreeing a herpes-infested crack ho wasn’t fit for kissing seemed easy enough, but wasn’t it kind of judgmental to assume Nose Bean’s mom was actually that degenerate? And there was no good way to touch the celibacy declaration. Maybe honesty was the best policy.
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