Necessary Medicine

by M. K. York

  When he opened the envelope on Match Day and saw Kingsland Medical Center in bold black letters, he pumped his fist and whooped. His first-ranked choice had been such a reach, he’d figured he was looking at maybe his fourth choice, realistically. Second was like winning.

  * * *

  It turned out there was a mentorship program for new interns. After a few days of feeling like he was drowning, struggling through rounds every morning with his handful of notes only to forget the most critical things on any given patient, Neil did end up emailing the mentorship program coordinator. It seemed like a good idea.

  He got assigned an interventional radiologist. “I hope you’re not disappointed,” said Dr. Wendling, paying for his coffee and croissant without asking.

  “Not at all.” Neil’s stomach rumbled.

  “Right now most of the surgeons feel pretty crushed for time. I, on the other hand, am only a slave to my pager.”

  Neil smiled politely, hand going almost unconsciously to his pager, but it was still silent.

  “They have you starting out on what? A Gen Surg block?”

  “Yeah, a month here and then a month at the VA.”

  “That’s good. Dunk you right in.” Dr. Wendling switched his own croissant to his left hand to get the stairwell door. “You can get to know your friend the abdomen.”

  “So.” Neil followed him up the stairs at a pace that seemed brisk for a man of Dr. Wendling’s size. “How did you choose interventional radiology?”

  Dr. Wendling gave him a little sidelong smile. “Good opener. The short answer is I liked it. The longer answer is it gives you the interest factor of doing procedures, the excitement of emergency medicine without the pain-in-the-ass factor, and I’m just good at it, which always helps.”

  “Was there a track for it when you started?”

  “God, no. We made it up out of whole cloth. It’s evolved over the years, you understand. When I started out in medicine we didn’t have some of the tools we’d consider crucial now for IR.”

  “I can imagine.” Neil was starting to get short of breath, and Dr. Wendling was openly puffing with exertion but just kept going at top speed.

  “This is our floor.” He took off through the double doors, and Neil hurried after him. “Cardio and Nephrology offices are that way. Just down this hallway—okay, here we go. Interventional Radiology, our small but mighty department.”

  Dr. Wendling fumbled out a key with his spare hand and let them into the cramped office. “It doesn’t look like much,” he said, “because it isn’t much, but it suits me.”

  Neil could see why. There was a view—it was on the southwest corner of the complex and there wasn’t another building its height for quite a distance, so there was a feeling of floating in the sky.

  “So what are your deepest fears? Come on, spit them out. The sooner you tell me what worries you, the sooner we can hammer out a strategy.”

  “Well. Uh. I’d really—I’d like to meet somebody, settle down.”

  “Yeah, good luck with that your first year. Maybe your second or third, you know, that might be a more realistic goal. Your first year’s going to be a bit rough on you.”

  “Oh,” said Neil, a little startled.

  “Did Pearn tell you it was going to be rainbows and sunshine? He means well. But he tends to be overly optimistic.”

  * * *

  At the weekly Morbidity & Mortality conference—fondly known as the M&M, mandatory for all surgery residents, filled with whatever surgeons and specialists couldn’t escape its gravitational pull—Neil settled in among the rows. At least it was in a lecture hall with padded seats.

  “Is anyone sitting here?” asked Claudia, one of the cardiothoracic fellows, doing training post-residency for high-level specialization. They’d been introduced a few days before.

  “No, no.” He waved at it. She sat down and smiled tightly at him. “Are you presenting on anyone?”

  “Thank God, no. I had call.”

  “I’m sorry.”

  “It’s all right. It just means this conference feels like someone clawing down the backs of my eyelids.”

  He laughed a little, nodding at her coffee. “You get it by the gallon?”

  “How else?” She tipped her head onto the padded back of the seat. “If I start snoring, kick me. Otherwise, let me be.”

  “Will do.”

  “Not really. You can talk to me.”

  “I’ll—oh, they’re starting,” he said, suddenly uncomfortably aware that she might have been under the impression they were flirting. He was rescued by the first presentation, on a case from Vascular where a patient had come in with a ruptured Stanford A aortic aneurysm. There wasn’t much to say about it. The patient had been as good as dead when he ruptured miles from the hospital, and getting him opened up on the table had just confirmed it.

  Next to him, Claudia made a noise that at first he thought was a sigh, but after a minute, when it happened again, he realized it was a snore. He thought about kicking her after all, but settled for gently touching her arm. She startled and sat upright, smiling ruefully over at him.

  After that, they had a couple more deaths presented—one case where a fourth-year resident had made a questionable call on pressors, and their attending stood behind them as they took the heat; one Neuro case where a patient had insisted on a surgery after being warned repeatedly that they were likely too frail for it, and the surgeon had grudgingly acquiesced, and now was visibly angry at himself for agreeing. It wasn’t until the lights came up at the end, when Neil was gathering his bag and standing to go, that he looked around the room and saw Dr. Newcombe in the back of the room, talking intently to one of the other doctors.

  As he was looking, Dr. Newcombe’s eyes came up and met his. The air went out of Neil’s lungs, and his cheeks flamed up.

  “Coming?” asked Claudia, and he glanced at her.

  “Yeah,” he said, “sure,” and didn’t look back, trying furiously to will his face to normalcy.

  * * *

  The residents’ call room—for sleeping in, on nights on call—was a little less than fantastic. He took to stripping the bed and putting on fresh bedding, nights when he knew he was going to need it, or talking one of the volunteers into it.

  “I’m not sure I’m supposed to go in there,” said the high school girl with braces, dubiously.

  “I’m giving you permission.” He smiled winningly at her. “Please?”

  “Okay. If you say it’s all right.”

  The room still smelled like a potent combination of antiseptic and sadness, but it was easier to live with when the sheets were fresh from the hospital laundry.

  The worst part was the insistent screech of his pager. He’d get maybe two, three hours at a stretch if he was lucky, but then it would wake him up again. He’d be staggering through another encounter, trying to decide whether the attending needed to be called over, whether a patient needed emergent surgery, or whether a medication refill was wise, when he could barely remember his own name.

  He was at the main hospital for his rotation in Cardiothoracic Surgery. It remained impressive, after all this time since his first glimpse of a surgery, to see a CT surgeon go from the first cut—neat, tidy, just a line pressing into the scrubbed skin, beading up with rubies—to touching the heart itself.

  He started to get used to the M&M conferences. Maybe two-thirds of the time, Dr. Newcombe was there, always in the back row, sometimes sitting with another doctor, sometimes not. He tried not to look. Well. Too much.

  Occasionally Dr. Newcombe would prop his feet up on the chair in the row in front of him, and his eyes would drift shut. It was sweetly human and oddly endearing, watching the frown lines on his forehead smooth out.

  * * *

  “So,” said Mark, one of
the other interns, who reminded him of Bobby in a way that ached on long days, “are you going to ask Claudia out?”

  “I—what? No. Uh.” Neil shook himself like a dog. It was hard to keep thinking straight; they were all out at happy hour, and he hadn’t had a drink in weeks, because he hadn’t had a night off that he could really afford to put into socializing in weeks, and besides, it was usually better to just go home and go to sleep. It was taking all his willpower to stay awake and try to socialize.

  Mark raised his eyebrows. “Really? Because she is, like, super hot, and I hear she’s pretty into you. She’s only—I think like two, three years older than you? She went right through from undergrad. And it’s not like she’s your boss.”

  “No, it’s—” said Neil, and he wanted very badly to cover his face with his hand, but he figured it was a sign of his great maturity that he did not. “I’m gay, Mark.”

  “Oh! Oh.” Mark nodded slowly, staring off into space with a suddenly speculative look on his face.

  “What’re you thinking?” Neil asked, feeling a blooming dread.

  “Trying to—I don’t know if any of the Surgery guys are gay, but I’m pretty sure there’s a guy over in Internal Medicine, wants to be a nephrologist—”

  “I’m not going to date anyone!” Neil threw his hands up in the air. “I don’t have time. Look at me. This is as close as I have been to a social life in months.”

  Mark sighed. “Okay, but listen, if you ever change your mind, hit me up. I’ll try to hook you up with Hot Internal Medicine Dude.”

  “Do you even know if he’s hot?”

  “He’s probably hot. If he isn’t I’ll find a hot guy for you from another department.”

  “Your dedication is admirable but unnecessary.”

  * * *

  They had a holiday party. The nurses had done up the halls—swags of tinsel everywhere, blue and white—and there was a tree with nothing but white lights and ornaments. “Wouldn’t want Dr. Rosenbaum to feel out of place,” one of the medical assistants confided to him over her third cup of punch. “Don’t tell him, but we love him.”

  Neil smiled at her. “Don’t worry, I won’t tell. I think it looks great.”

  She hiccupped while beaming with pleasure.

  Dr. Wendling was there, and Neil spent a couple of minutes saying hi to him; he was halfway through asking Dr. Wendling about a tumor he’d seen a few weeks back when a voice interrupted them.

  “Pete!”

  It was Dr. Newcombe, slapping Dr. Wendling’s back. Neil’s heart went abruptly into double time.

  “Eli!” Dr. Wendling pulled Dr. Newcombe into a one-armed hug, careful not to spill his beer. “How have you been? Haven’t seen you in at least a week.”

  “Oh, fine, fine.” Dr. Newcombe smiled at Neil. Neil managed to smile back. “Hi, I’m one of the cardiologists.”

  “I’m Neil,” he said, switching his glass of red wine into his left hand so he could shake the offered hand. “General Surgery intern.”

  Dr. Newcombe nodded. “I think I’ve seen you at the M&Ms.”

  “Yes, that’s me. Dr. Wendling is mentoring me.”

  “Pete, you? A mentor? They must have lowered their standards.” Dr. Newcombe’s eyes sparkled as he glanced back at Dr. Wendling.

  “They’re just not desperate enough to ask you yet,” Dr. Wendling retorted. His face got more serious. “How’s Tricia?”

  Dr. Newcombe gave a little attempt at a smile that didn’t reach his eyes. “She’s well. We’re—she’s going to see her parents for the holidays.”

  “Good. I’m glad she’s got plans.”

  “Well, of course she does. She was always the people person.”

  “Yeah, but what was it last year? Cancún?”

  “With her friends. Not exactly something to pity her for.”

  “Still.” Dr. Wendling sighed heavily. “You got plans?”

  “I’m going to see my cousins again.”

  “Good. You ought to be with family.”

  “That’s what you always say, and yet who do I see writing the notes for the ER on holidays?”

  “Ah.” Dr. Wendling waved his hand benevolently. “Old farts like me have to be around for the excitement, it’s the only excitement we get.”

  “You know, I was going to talk to Sean about the—oh, there he is! Look, Pete, I’ll see you later. Nice meeting you, Neil.”

  “You, too, sir,” said Neil, and Dr. Newcombe went to put his hand on the Cardiology chair’s arm.

  Dr. Wendling was looking after Dr. Newcombe, a small frown on his face.

  “That man does not take care of himself,” he muttered. “Don’t turn into one of us. You need a life.”

  “Mmm-hmm.” Neil was still cringing inwardly at sir.

  “Anyway, what were you saying? Tumors?”

  Chapter Three

  He made it home for Christmas. They’d gotten the tree up, and his sisters were home already, just waiting on his brother, who was only driving in from Gresham and wouldn’t be long.

  “Neil!” His mother pulled him into a hug as soon as the door opened. “Angie’s here.”

  Angie’s kid, Devon, came tearing out to greet Neil, who was reaping the benefits of being the cool uncle. He scooped up the three-year-old and spun him around before setting him down. “You’re getting big!”

  Devon just flung his arms up and said, “Again!”

  After Devon was in bed, Neil sat out in front of the TV with Angie, The Muppet Christmas Carol movie playing softly. Liz was in the kitchen with their mother, putting together the ham for the next day.

  “So how’s residency?” asked Angie, propping her feet up on the coffee table.

  “Get your feet off that, Ma’ll kill you.”

  “She doesn’t have to know.”

  “It’s your funeral. Anyway, it’s fine.”

  “Fine? You’re, what, saving lives, and it’s fine?”

  “It’s... Look, I don’t get much in the way of breaks anymore. I don’t sleep. I feel like crap. But it’s interesting, and I’m learning, and I like most of the people I work with. So. It’s fine.”

  “Anybody special?”

  “Ange...”

  “I wouldn’t ask if I didn’t want to know,” she said with unexpected gentleness. She hadn’t taken it well when he was eighteen and he’d come out to them. His father had gone stony faced, his mother had cried briefly before wiping her eyes and brightly declaring that at least he was tall. Angie had been oddly disappointed in him, as if he’d failed her, somehow, failed to be the role model she’d expected.

  He shook his head. “No time for it.”

  “That sucks.”

  He laughed a little. “It really does.”

  He had to take some time over that break to study for the ABSITE, the exam designed to grill residents on surgery so they could be ranked against one another. He couldn’t say it was thrilling, but he did survive it.

  * * *

  The news that Neil was gay permeated through the layers of the hospital, so that every now and then, he’d get stopped with a proposed blind date. (It was better than the sidelong glances and sideways shuffles he got sometimes when he ducked into the locker room with the showers to change.)

  “Uh,” he found himself saying to Dr. Li from Anesthesiology, who he got along with just fine, even liked, though people found her prickly. “I don’t really know if—”

  “Come on, he’s my brother, so I have to think he’s a total drip, but other people seem to like him.”

  “Okay?” he said, out of confusion and despair.

  Li’s brother was a handsome man, self-assured and pleasant over dinner in a well-tailored suit. It was a nicer restaurant than Neil had ever been to. There wer
e multiple forks at the place settings, and he’d had to wear a tie.

  “So that’s the story of how I went into finance.” Ming smiled and rolled his eyes self-deprecatingly. “It’s not exactly gripping, but it suits me.”

  “I think it’s very interesting.” Neil was still trying to figure out what exactly Ming did in finance.

  “What about you? How did you get interested in medicine?” Ming had gorgeous eyes, dark and expressive, and he was leaning forward intently.

  “Oh.” Neil laughed a little. He set down his fork. (God, he hoped it was the right fork.) “That’s easy. I was majoring in English lit, and I had to take some science classes.”

  “Of course.”

  “I took one titled The Human Body for Non-Anatomists. It was really geared toward people like me, you know, who didn’t have the science background for regular classes.”

  “Makes sense, if you’re going to make it a requirement.”

  “Right? So I took this class, and it wasn’t so much focused on systems as on interesting facts. Since they weren’t worried about teaching us the stuff pre-meds were learning, they had time to talk about all kinds of things bodies do. We learned about cancers, and the gut biome, and—it was just remarkable.”

  “A gateway drug?”

  “It really was! After that I just started taking more and more bio classes so I could take Human Biology, and then I was a goner. I kept saying I wasn’t going to go to med school, it was too long, too hard, I wasn’t a science major.”

  Ming smiled. He had such a nice smile. “And yet, here you are.”

  “Here I am. It took me a while to get all the prereqs done for med school, and then to get in, but I worked at a hospital after I graduated and I think that helped convince them to take a chance on me.”

  “I think that’s so interesting.” Ming swirled his wine in his glass.

  But when they left that night, he just dropped Neil off at his apartment and didn’t even go in for a kiss. Neil wasn’t that surprised when he didn’t call, and he didn’t answer Neil’s text about going out again sometime.

  * * *