Tooth and Nail

by Linda D. Dahl

  The Bronx was a different kind of complicated, and no matter how hard I tried, I kept getting it wrong. I couldn’t understand the place or the people or the culture. Hell, I couldn’t even understand my own husband anymore. I just wanted to learn medicine without the crazy social rules that shouldn’t have mattered anyway. But I was stuck there for five years. And unless some miracle occurred, they were going to eat me alive.

  3

  The subsequent ten months were a blur. Images and smells blended together like a montage from a horror movie: patients with missing limbs, intubated and unconscious, handcuffed to beds for crimes they would no longer be able to commit. Federal marshals, lazily guarding them, more concerned about the answer to 2-Down on the daily crossword. Baby mamas and large extended families crowded into curtained hospital rooms, feeding their dying loved ones more fried chicken. The pervasive stench of urine filling hallways, diluted by the sharp coolness of peppermint-scented floor cleaner. It was one long nightmare punctuated by crumbs of sleep, not the residency I bragged about matching into.

  The irony was that, after all the hard work it had taken to get there, I had little more to show for it than twenty extra pounds and a healthy dose of bitterness. I didn’t know if it was the Bronx or that particular hospital, but my training program felt like war. Unlike the majority of my peers, I didn’t come from a medical family, so I hadn’t known what to expect. So far, I had learned that I was trapped in a military-like hierarchy with no way out until the bitter end. In medicine, if you don’t complete the entire training process, you can’t practice anything.

  The lowest rung on the ladder was internship, where I currently stood. Come to think of it, it didn’t seem like it was on the ladder at all: it felt like the ground beneath the ladder. That first year, things like sleep, food, time, coping skills and bodily hygiene were luxuries, not rights. As interns, we learned that our only redeeming value was to serve everyone who wasn’t us, which included other doctors, janitors, nurses, social workers, patients, patients’ families and the rest of humanity. As such, we spent most of our time doing non-doctor work, like drawing blood, filling out paperwork and figuring out how to get patients prepped for surgery and discharged as soon as possible. I had to make it through the year without killing anybody, and that included myself.

  Rungs two and three were occupied by junior residents, who could safely maneuver from inside the General Surgery program. They were still controlled by those above them, but there were fewer people up there. And since they had stepped up the ladder, everyone beneath them was fair game for abuse. Especially the interns, who reminded them of their weak former selves and therefore deserved extra punishment. Once, I witnessed an intern blurt out the answer to an anatomy question faster than the junior resident, only to find himself emptying liquid stool out of colostomy bags for the rest of the rotation.

  The fourth rung, and arguably the best, was occupied by the senior residents. With little responsibility, rare call nights and plenty of daytime rest, they had time to translate the three years of indignity they had been made to suffer into megalomania. They were easily identifiable by their unlaundered scrubs and lack of human decency. When addressing a senior, it was good practice to look down at the floor to avoid eye contact. Or, better yet, speak through a junior resident so you wouldn’t offend them with the sound of your inexperienced voice. The only desire of the senior resident was to improve their surgical skills, which meant searching for patients who needed surgery but didn’t yet know it. They mined the hospital wards like hogs hunting for truffles, discovering gifts like the cardiac patient whose hemorrhoids happened to be bleeding or the eighty-five-year-old immobile diabetic whose left toe looked a little pale.

  Chief residents occupied the fifth rung. Delirious with power and responsibility, they unburdened themselves by barking out orders, screaming incoherently and throwing tantrums. Invariably, six months into the year, after performing hundreds of surgeries, the chiefs became confused. Delusional from hospital staff continually cowering in their presence, they believed they were at the top of the ladder. Until one day, when they happened to look up and catch a glimpse of the real bosses.

  The top rung was populated by the general surgery attendings. These were the doctors who had completed their training and had made it out alive. They were untouchable and, as such, could be calm or bold, show mercy or abuse, be demanding or thankful. They could do whatever they damn well pleased.

  * * *

  “Oh look, it’s the doctora. Hey, I need ya to get my stretcher.” It was the orderly from the trauma night, mocking me. Since our first encounter, I had become as resigned to the orderly’s goading as I had to be in my position as an intern. But, with him, the abuse was different. It wasn’t about medicine or hierarchy. It was about the way I behaved as a woman. And unlike residency, his torment had no graduation date.

  When I didn’t respond, the orderly tried again. “You tink you so smart. But you don’t like to be a woman. You even make yourself like a man.”

  He was right. Although I had never been girly, I had become a bossy, uncompromising bitch to survive. I no longer had the luxury of being a “normal” woman, whatever that meant. If I seemed too female to my surgical colleagues, I was considered weak. And the very traits that made my colleagues respect me made this orderly hate me. I was a woman gone man. Over the last ten months, I had rid myself of all notions of femininity, including emotions, vulnerability and long hair.

  A few weeks prior, I had taken a short trip back to Minneapolis. I needed some perspective, a dose of the familiar, and I wanted to see my classmates from medical school. My last stop was the Aveda salon school, my favorite place for cheap haircuts.

  “Cut it all off,” I had said to the purple-haired student. She looked somewhere between 19 and 26. It was hard to tell through all her eyeliner.

  “You mean, like, a pixie cut? That would be cute.” Even her Midwestern version of female was too soft for what I had become. I needed to go back to the hood with something harsher.

  “No, more like GI Jane. Maybe half an inch longer than that.” I had watched the movie, in bits and parts, a dozen times since it had come out. At first it seemed like a desperate cry from Demi Moore for legitimacy as an actor. But, as my internship wore on, I understood her character more and more. In a world dominated by men, to get what they had, she had to turn against herself. Her femininity became the enemy.

  I watched in the mirror as sections of my hair fell to the ground. The pain of its loss was replaced by an icy kind of strength.

  When I returned to work, I was met with exactly the reaction I had hoped for. Amid the labels of dyke and lesbo were hints of fear from the men who used them.

  I stared down at my ugly green scrubs and uglier plastic shoes, stained with bits of Jamaican spiced bun. What I had become disgusted me, stripped of parts that I treasured but were threatening here. The part who liked flowy dresses and twisted her hair into complicated French braids. The part who tilted her head to the side and glanced coyly at a man whose attention she sought. The part who reveled in baking cookies for friends and gossiped with other women in quilting groups. I had bought into the belief that a woman can do anything a man can do, only to find that it came at a cost. I had lost the parts that gave me joy.

  I ignored the orderly and walked to the back section of the ER, where two residents were spraying down a patient with a hose. He looked to be in his midsixties, with a body the size and shape of the Elephant Man. His ankles, swollen larger than his knees, were covered in spongy, suppurating tissue. The skin on the rest of his body had collected huge keratin scales. Although he appeared naked, it was possible that some type of eroded underwear was still trying to keep him decent.

  “What’s happening?” I asked the EMT. He was standing against the wall, arms crossed, enjoying the spectacle.

  “Retired guy. He’s a drunk and, one day, he just decided he di
dn’t wanna get up no more. So he just stayed there. In his living-room chair. For a year. Talk about a La-Z-Boy.” He laughed to himself.

  “For a year? How did he go to the bathroom?” After all my time on the general surgery service, my first thought now went straight to the bowels.

  “He didn’t go anywhere. He just did his business right there—in his chair. I guess the grandkids were complainin’ about the smell or somethin’, so his wife finally called us. He was screamin’ at her when we got there, callin’ her names, refusin’ to leave. He said she was causin’ a problem for nothin’. Can you imagine?” He shook his head, as if he were talking about silly teenagers having a spat, not the tragedy of what was in front of him.

  Internship in the inner city had taught me a lot of things: that the festering feet of homeless men are a treatable condition; that just because a patient is passed out, face-first, in his own pool of urine, one cannot assume he is well hydrated; and that pit bulls make better weapons than pets. But this was something new. This was the farthest limit of the human condition. He was alive and dead at the same time, existing in his own rotting corpse.

  “Welcome, Dr. Dahl. Just in time for your new admission,” Dr. Haven said, twirling a strand of hair in her fingertips as she spoke. The shift-work schedule of her ER rotation, twelve hours on, twelve hours off, with no overnight call, seemed to be serving her well. She was back to her over-primped self, donning butterfly bobby pins and a sequined hoodie that read Holla in scripted letters. She was even wearing fuchsia lipstick. I both envied and hated her for being so female. I couldn’t even remember the last time I wore mascara, wanting to avoid the inevitable black smudge after a forty-hour shift. The only accessory I allowed myself anymore was glasses.

  “What’s the diagnosis?” I asked, thinking I could somehow deflect this failure of the social-security system onto another service. I was already thinking that Internal Medicine made more sense. He was obviously having issues with fluid distribution.

  “He has hypertension, fatty liver, type 2 diabetes and lymphedema. We are still waiting on his echocardiogram to rule out congestive heart failure. Oh, and he has maggots,” she said.

  “Excuse me?” I thought she was describing his apartment. “What does that have to do with his admission?”

  “No, he has maggots, like, in his lower extremities, which is good and bad. On the one hand they’re great because they eat away the dead flesh, so...less work for you. On the other hand, well, that’s just obvious. Throw on some gloves so you can help smother them. In a few days, you guys are gonna have to start the revolving door to the OR for wound debridement. His backside, where he sat in the chair all that time, is eroded down to the bone.”

  Maggots were an unanticipated trump card on her part. There was no way I could deflect him off my service with that diagnosis. Defeated, I covered my scrubs with a yellow gown and tied a surgical mask to my face, preparing for what lay ahead. Even though smothering maggots disgusted me beyond anything I had ever known, I was determined to do it. I was just as tough as the men, wasn’t I? I had made it this far without giving in or showing signs of weakness. If there were maggots to be killed, then I would handle those little fuckers like I had handled Murda King.

  When I approached the barely conscious patient, a medical student was already in position, kneeling on the floor like he was praying to the huge rotting altar in front of him. With assertion, he scooped a handful of Vaseline out of a plastic jar and smeared it up and down on what used to be the man’s calves. Trying to mimic his enthusiasm, I pulled on latex gloves and dropped to my knees. The smell easily penetrated my mask, kind of a sweet, decaying odor. I had to fight back a gag by breathing through my mouth, which made things worse because the smell turned into a taste—the taste of necrosis. I slowly rubbed the Vaseline into the moist flesh, trying to block the feeling of squirming maggots under my fingertips. The flesh was soft and almost weightless, like the warm dough I used to knead every Sunday morning growing up. The incongruous association created a pause in my movement, a pause just long enough to allow the weight of my fingers to sink through the fluffy tissue to the underlying bone.

  The gag that was caught in my throat leapt forward. Panicked, I stood and frantically tried to rip off my gear, which now clung to me like a straitjacket. Partially successful, I ran down the hall, past the technician and orderly, who were laughing hysterically. When I reached the front door, I thrust it open and bent forward, hyperventilating to clear the rancid air out of my body.

  It was in that moment that I realized I had lost. This place, this internship, these people had finally broken me. No matter how hard I tried to be tough, I wasn’t. Underneath it all, I still had emotions and weaknesses and limits. I was still human. And no matter how short my hair, I was still female.

  My breakdown awoke the critical voices of every teacher and admissions-committee member over the last twenty years. In their well-meaning ways, the message was always the same: being tough was the only option. Girls can do anything boys can. Not to mention my father, who spent years lecturing my sisters and me on the fatal flaws of weakness, which he blamed on our unfortunate gender. He wanted us to be strong, which in his eyes meant behaving like men, competing with men and being emotionally impenetrable. But now that my tough, manly act had betrayed me, I felt like a failure. I would have to come up with another way to survive, but I had no clue where to start.

  * * *

  Very quickly, boxing moved from my husband’s fling to a full-on girlfriend: the annoying kind who stayed over all the time but didn’t pay rent. And she was getting more and more demanding by the minute.

  “Listen to this. You get the prefight weigh in, three lower-card bouts, celebrity interviews and the main event for only $50! Can you believe that?” Adam’s excited words woke me from a deep sleep. Although he had managed to find some consulting work, his earnings weren’t even enough to cover the cost of the additional equipment he needed to do the work. Despite his efforts, we were even more broke.

  I turned over and covered my head with a pillow, hoping to suffocate my budding awareness. But he wouldn’t stop talking.

  “De La Hoya is an Olympic gold medalist. His first and only professional loss was to Felix Trinidad, but that was bullshit,” he continued, spouting statistics and facts, as if building a case would somehow justify spending money we didn’t have on something I didn’t care about. I groaned under the pillow.

  These types of discussions usually ended in one of two ways: a huge fight or my relenting. I wasn’t up for either, so I closed my eyes tighter and stared into the backs of my eyelids.

  “Baby, you will love this! He’s the best-looking guy in boxing. They call him the Golden Boy. Did I mention he also recorded an album? He’s a rock star.” I could hear him prancing around the bedroom, manic.

  Pretending to ignore him wasn’t working, so I opened my eyes and tried another approach. “Adam, why do we need to pay for this fight? Can’t you just watch it on HBO?”

  “Noooo. This is pay-per-view. It’s the only way to see it. It’s like having a private ticket with ringside seats! Jose told me everyone is pooling together to watch it in his cousin’s apartment.”

  “Who the hell is Jose?” I asked. I knew Adam didn’t have any friends. I was worried he was starting to think the characters in his Grand Theft Auto video game were real.

  “He works at the bodega. We have breakfast together every morning. Good guy. He’s from Puerto Rico. Then there’s Manuel, he works the night shift. I like the way he makes the coffee because when I say regular he knows not to make it too sweet.” He was referring to the fact that, in the Bronx, regular coffee meant that it was so drowned in whole milk and sugar it tasted more like sweetened condensed milk.

  I couldn’t believe it. Even spending most of his time at the apartment, the only Midwesterner on Wayne Avenue, Adam had still managed to create a community here. He knew p
eople’s names and where they were from. He was even developing something in common with them. With all of my interactions at the hospital, the only connections I had managed to make were the bad kind.

  The Bronx reminded me of how I had felt when my family had first moved to North Dakota. Even at age eight, I knew that my parents’ choice to reside in that part of the country wasn’t logical, not for us anyway. They chose that state for its wholesome values, assuming those values would somehow leak into our family by osmosis. But they were wrong. North Dakota was so homogenous there was no way for Middle Easterners to blend in. Everyone was blond and large and spoke with strange accents, pronouncing open as like long as so the word flag sounded more like something that happened to old paint than something you pledge your allegiance to. And since I couldn’t adapt to their strange dialect, I was the laughingstock of the fourth grade for speaking what I thought was proper English. The disparity between us and them penetrated everything, especially food choices.

  One night, a few months after moving there, my parents insisted I invite a classmate to dinner. I had no friends at my new school, so they thought dinner would help me get over my shyness. The truth was, I was quiet on purpose. The more visible I was, the more the other kids would be aware of my existence—which was too short, too dark and way too ethnic.

  I resisted inviting anyone at first, using the excuse that American kids didn’t eat the same foods we did. “Don’t worry,” my father said. “Your mother’s a great cook. She will make American spaghetti.”

  Cautiously optimistic, I invited Wendy Helmsrud. I chose her because, unlike the other kids, she hadn’t expressed open disdain for me. Yet. Perhaps it was because she was too tall for the fourth grade and therefore felt just as awkward. Or maybe she hated me, too, but simply wanted to enter the foreign people’s house out of curiosity. Nonetheless, she seemed the least likely to tease me at recess if it all went south.