Tooth and Nail

by Linda D. Dahl

  The team scattered according to rank. Dr. Davis led a group of junior residents to assist him in the operating room. The senior resident, Dr. Cohen, who had barely said a word during rounds, went to the call room to sleep. The remainder of us, three interns and two medical students, stared at each other in the hallway.

  “GI rounds?” I asked, meaning it was time for breakfast. It was the only break I allowed myself each day.

  * * *

  The hospital cafeteria, unlike the McDonald’s that was located in the hospital lobby, was a quarter mile away in a building called the Nurses’ Residence. Although no one lived there anymore, the name had stuck. I imagined young women, living away from home for the first time, clad in white nurse’s caps and tights, with dreams of serving the sick and wounded. The purity of this image made the place feel holy and full of hope. It also filled me with sadness. Although the inhabitants had long fled this dilapidated construction, they would have been disappointed to see the empty carcass it had become.

  Nearing the cafeteria, the acrid bouquet of overboiled eggs and burned toast calmed me with its familiarity. I grabbed an orange tray and dragged myself through the food selections: cardboard pancakes, a wallpaper-paste type substance labeled grits, pastel-colored watermelon and burned tubes of meat. I settled on oatmeal, coffee and orange juice and approached the cash register. After the cashier had rung me up, I handed her my meal card and grabbed a creamer.

  “Fifty cents,” the cashier said, dropping her chin and raising her gaze. Her scowl was framed by a matrix of tiny black braids.

  “But I gave you my meal card.”

  “Your card doesn’t pay for that,” she said, pointing a long acrylic fingernail at the creamer.

  “You can’t be serious. Fifty cents for creamer? It’s creamer!” Before I could unleash, a male voice behind me spoke.

  “Here’s fifty cents. Just let it go, Linda. This is probably the only place in her life she gets to be in control. Let her have it.” It was Dr. Gross, the urology intern and the hottest, most delicious man in the hospital. I watched in awe as he dropped two coins on the register.

  I was stunned. Everyone in the hospital lusted after him, including Dr. Elizabeth Carlisle, the most callous of the chief residents. Nearing forty and still without a prospective husband, she had once confessed her true feelings.

  “I walked into the call room, and he was just there. Asleep. He looked like a little baby without his shirt on,” she had cooed, her eyes glazing over into her younger self and a time when she was allowed to feel vulnerable and attracted, when men were still potential companions and not just the competition.

  Even if Dr. Gross was feeling sorry for me, his attention made me so happy I forgot about the creamer. Men like that never paid attention to me. And he even knew my name! But before my internal teenager could fully relish in her visibility, my pager went off.

  “Code blue. Code blue.” It was the Emergency Room. The real torture of the day was about to begin.

  * * *

  When it comes to the trauma bay, rules of decorum do not apply. In fact, they only get in the way. Things like personal space and modesty, which our parents and the civilized world took pains to teach us, are hindrances that must be unlearned so everyone can do their job.

  Today’s trauma victim was a young man who had been stabbed repeatedly in the abdomen. I watched as the trauma team went to work stabilizing him. An older woman, probably close to my grandmother’s age, was cutting off his clothes with huge trauma shears. A younger man was holding down the patient’s right arm while another implanted an IV in his vein. A female nursing student awkwardly grabbed his manhood with one hand, struggling to insert a lubricated catheter into his urethra with the other. Looking around at the team’s faces, I was stunned at how calm they seemed. The patient was naked, screaming obscenities and flailing wildly, but they were too busy sticking tubes in holes and creating new ones with needles to notice or care.

  “You—you’re the trauma intern?” An ER resident—or attending, I could never tell—accosted me. “He needs a CT scan. Stat. No other injuries so far. He’s going on your service.” That was code for You will be stuck babysitting this guy in radiology all afternoon to make sure he doesn’t tank. And, while you’re sitting there, you can fill out a mountain of admission paperwork.

  Getting a CT scan sounded easier than it actually was. Just because the patient was in the ER, he wasn’t guaranteed priority. Now that he was on my service, I would have to beg or otherwise coerce the radiology resident into letting him jump the line which, in this community hospital, could be anywhere from two hours to two days. I eyed a stretcher near the ER entrance and the orderly standing next to it. I recognized him from my other visits to the ER, although I’d never engaged him in conversation.

  “Excuse me, can you bring me that stretcher?” I asked. He was in his midforties, brown skinned and with an accent unlike anything I’d heard before—more distinct for the parts of the English words he left out than what he left in.

  “Ya see it. Don’ ya got two legs?” he asked, not moving. Each phrase peaked in the middle of a crescendo and decrescendo.

  “But you’re the orderly. It’s your job,” I said, shocked he would talk to me that way when I was just asking for help.

  “Oh, really? It’s ma job? Wot, ya too good ta gi’it yo’self, mami?” he asked, incredulous.

  “I’m not your mommy! I’m the doctor!” My voice rose in wounded pride. Did I look like I was old enough to have a child?

  “Ohh, Doctah. Scuuuuse me! Ya tink ya betta dan me, wooman? Ya give me ordas?” He was raising his voice, growing increasingly offended at how I was addressing him.

  I was confused. Wasn’t it his job to get the stretcher? Why was asking for his help pissing him off? A few months in, I was seeing that, in the Bronx, besides the hospital rules, there was yet another set of rules in play.

  The Bronx had a culture that was completely different than surgical residency or even the Midwest, where I grew up. From what I had gleaned so far, Bronx women were supposed to be more flirtatious and coy. When they played the game correctly, they were rewarded with things like gaudy clothes, acrylic fingernails and little else that pertained to me. In the Midwest, it was different. The sparse population and brutal climate made defined gender roles a luxury few could afford. Women had to work just as hard as men. If there was snow to be shoveled or a tire to change, you did it regardless of what was between your legs.

  I looked into the orderly’s eyes, realizing there was nothing I could say to bridge the gap of our perspectives. No matter what I thought was right, at that moment, to him, I was wrong. And this was his world, not mine. My pride started forming words in defense, but I knew they would only make things worse. I pushed the stretcher back to the trauma bay myself.

  By the time I returned to the patient, everyone else had gone. Now I had to figure out how to move him to the stretcher.

  “Hi, um, can you move over here onto this bed?” I asked, which was a weird thing to say because trauma patients were rarely conscious. Even though he was lean, I knew I wouldn’t be able to pull him over alone without causing yet another injury.

  “It hurts,” he said, eyes closed.

  “You were stabbed,” I said.

  “No. This thing in my dick. It hurts.” I glanced at the catheter. There were tinges of blood in the proximal part of the tube, but the bag it was attached to was filled with yellow urine. Although it had a rough entry, it was definitely in the right place.

  “You’ll get used to it. We have to keep it there to measure your intake and output.” I explained his plight in the simplest medical terms I could muster. He just looked ahead, ignoring me. “Can you move over to the stretcher?”

  “Jerome,” he said.

  “What?” I asked.

  “My name’s Jerome.”

  Hearing his nam
e suddenly made him a real person, which upset me. I didn’t want to see a naked man with puncture wounds like closed eyelids scattered across his bloodied abdomen. I didn’t want to smell his alcohol breath or look into his dark, bloodshot eyes to see how he was feeling. And I definitely didn’t want to think about the plastic tube inflicting pain inside his penis. I only wanted to see him as my patient so I could do my job, like the surgeon I was training to be.

  “Okay, Jerome, it’s time for your CT scan.” I awkwardly covered him with a white sheet and watched as he transferred himself to the stretcher, lifting the bag attached to his catheter so it wouldn’t tug. The catheter was kept in place by a small inflated balloon inside his bladder. Pulling it out would make his current discomfort feel like a love tap in comparison.

  Waiting for the scan, we sat in silence for the entire three hours. I didn’t want to know anything else about him.

  * * *

  After a long day of admissions, discharges, post-ops and bowel preps, I had to draw Jerome’s next set of labs before evening rounds. Much like in the situation with the orderly, I couldn’t depend on the phlebotomy team to do their job either. “You ready for another blood draw?” I asked.

  When he saw me, Jerome said nothing and held up his arm. His veins, thick like cords, reminded me of the boxers on television. He shared the same body type: lean and muscular. I easily entered the vein in his antecubitis—the inside of his elbow—with a butterfly needle and watched as the maroon liquid filled the glass tube.

  “You nice,” he said, drawing his tongue across his lower lip.

  “I’m just doing my job. I have to draw your blood every four hours to make sure you’re not bleeding internally. Even though you were stabbed, it’s really hard to actually pierce the bowels because they kind of slide out of the way when the knife goes in. You’re probably going to be fine. Your labs are good so far. I just have to keep checking your blood to be sure there’s not some slow leak somewhere...” I was rambling, uncomfortable with the look he was giving me, somewhere between hunger and lust.

  He stared at me, not acknowledging anything I was saying. A tiny smile grew on the edge of his lips. “No, you nice. You thick.”

  I couldn’t be sure, but I thought he had just complimented me for being fat. “Are you talking about my body?” I asked, certain I should have pretended not to hear him. He was attracted to the very part of me that I hated the most.

  But something in me appreciated the attention anyway. Growing up, I had been so unpopular with boys that if one became the object of my desire he was harshly ridiculed. This hadn’t changed in college, where the only men who had hung out with me had ultimately rejected me for other men. It wasn’t until I met Adam that I finally found someone who wouldn’t leave me. But that didn’t necessarily mean he found me attractive. Not like Jerome. Far from lusting after my body, my husband was more fascinated by its unusual shape. He was an artist who appreciated discord.

  “Yo’ ass is fiiiine. The kind o’ junk make a brotha wanna come home, ya know what I mean?” He closed his eyes and made a motion with his hips, causing the catheter to tug with each tiny movement.

  Junk? Come home? Was he saying I was garbage? Raunchy or affectionate, I had no idea what his words meant. Rather than make a bigger fool of myself, I just left with his blood.

  I came and went several more times through the night, each visit welcomed by Jerome’s grunting and murmured approval. After the last draw, when all of my overnight duties were done, I passed out on a stretcher in an empty patient room for the forty-five minutes I had left until morning rounds.

  * * *

  “Where’s Dr. Davis?” I asked, when my team arrived with Dr. Cohen. Regardless of the day, Dr. Cohen was usually hungover on morning rounds. Napoleonic in stature, his body reminded me of a superhero figurine with tiny, tight muscles. I simultaneously hated him and wanted him to like me, the way nerdy kids felt about bullies in school. His presence was a constant reminder of how eager I was to be cool and how unlikely I was ever going to be.

  “It’s Saturday, Dr. Dahl, which means I’m on call. Can we please proceed with rounds so I can go lie down?” He pursed his full lips and swayed a little, holding on to the nurses’ station counter so he wouldn’t fall.

  “We had six admissions. Bed 3 is out of bed, passing gas. Her X-ray was clear, so no pneumonia. She’s ready to go. Bed 4 is post-op day 1. His osteotomy put out 30 cc of green mucous, so—” My litany of disgusting facts was interrupted by a commotion down the hall. I turned to see Jerome, clad only in a towel, charging toward our group. The elderly security guard, asleep at the nurses’ station, snorted, rousing slightly from the noise.

  By the time Jerome reached us he was yelling, “I gotta get outta here! Where the fuck my clothes?” Shocked by his sudden personality change, I thought, like Dr. Cohen, that maybe the alcohol and drugs from the night before had worn off.

  “Who are you?” Dr. Cohen asked Jerome as he approached, backing away slightly. As a senior resident, he was not accustomed to direct contact with patients.

  “Who the fuck is you? Gimme my clothes!” Jerome was still yelling, stepping closer to Dr. Cohen, who was a good seven inches shorter than him.

  I moved to the front of the group, thinking that if Jerome saw me he would calm down. After last night, I was practically his girlfriend. “Jerome,” I said. “We are just here to help you. Relax.”

  “Relax? What the fuck wrong with you, white bitch? My name is Murda King, not no damn Jerome.” He got very close to me. So close I could feel his warm breath on my cheeks.

  I had spent most of my life being ridiculed for trying, and failing, to pass as white in the Midwest. The irony of finally being hailed as such when it was meant as an insult didn’t escape me. Ultimately, the classification of color was more about power than ethnicity.

  I tried again. “We are rounding now, Mr., um, Murda King. We will get to you when it’s your turn. This is really disrespectful.” I was starting to think he’d lost his mind. Maybe he was trying to show how tough he was around the other men.

  “I tol’ you, gimme my clothes, bitch!” He was not calming down. In fact, the more I spoke, the more agitated he became.

  I looked into his eyes, the same eyes that were so rapt with me the night before, and searched for something, anything that made sense. “Jerome, I want you to get back to your bed right now. We will get to you shortly,” I said sternly, hardly noticing that Dr. Cohen and the rest of the team had made their way over to the nurses’ station, behind the security guard.

  Jerome moved even closer to me, so close I could feel the warmth of his body against mine. Even barefoot, he was much taller, so he had to look down to see my face.

  “I will hit you. I don’t care if you is a woman.”

  I was terrified, but I refused to let him or anyone else see it. We stared each other down, neither of us willing to relent. Then I found what I was searching for. It was fear. He was afraid.

  “Do you think you’re gonna die?” I asked. “I told you, you’ll be fine.”

  “How you know? I ain’t seen no damn doctor all night! Just you—the damn nurse!” he said, nearly spitting the last word at me.

  I was speechless. All the care and explanation I gave him about his medical condition, and it still hadn’t occurred to him that I was the doctor. What an asshole! My fear morphed into indignant pride. I stopped caring about being right. Or being the doctor. Or getting hit. I let my pride finally have control of my mouth for the first time since I landed in this miserable place. “No. You won’t hit me,” I said. “Now get back to your room. We will be there shortly.”

  Our eyes locked for another ten seconds, neither of us backing down. Finally, he relented. As he walked slowly back to his room, the rest of the team audibly exhaled.

  “You are crazy, Linda. Did they teach you that in South Dakota, or wherever the hell you�
��re from?” Dr. Cohen asked, more animated than I had ever seen him. I couldn’t tell if he was concerned for my safety or just upset that all the excitement had made his headache worse.

  I was too angry to answer, so he continued.

  “You really are clueless, aren’t you? He’s worried the guys who tried to kill him are gonna find him here and finish the job. His street name is Murda King. You can’t call him by his real name. It shows weakness. And he probably has a record, so even if his rival gang doesn’t come and get him, the cops will. ‘This is really disrespectful’—are you serious? You think the world works that way?” He was mocking me, and he was right. Everyone understood the dynamic except me. In the Bronx, I was the one who was clueless and disrespectful.

  * * *

  I decided to walk the three miles home, in no hurry to get back to Adam. I wandered down Arthur Avenue, past Italian shops, filled with aged cheese and salty meats, and cafés with wrinkled men drinking espresso from tiny cups. This place was so foreign to me, I may as well have been in another country. I had no idea how to behave and, when I tried to draw on what I knew, I ended up even more confused. I had come to New York to learn how to be a surgeon, but how useful was my training when I couldn’t navigate the culture? With my background, so used to feeling out of place, I should have been good at figuring out how to act.

  When my family had first moved to North Dakota, I had to learn about things like country music and tobacco chew. I grew to tolerate grotesque food substances, like ambrosia salad and tater tot casserole. By high school, I had learned to back-comb my hair into the same eighties lion’s mane as all the other girls. But despite spending ten years in the frozen tundra, I had never managed to fit in.

  When I moved to Minneapolis, I fared somewhat better. Without the constant reminder of my family’s Middle Eastern culture, I adapted more easily by mimicking my classmates. I studied how they behaved in class and maneuvered my way into medical school despite my obvious eccentricities. By the time I had graduated, I thought I had it all figured out. But it, apparently, was only time-and place-dependent.