by Harry Kraus
What is going on around this house? Can’t he dress himself?
Eventually, he appeared in the hallway again, slowly moving toward her, his gait wide-based and insecure, his hands reaching for first one wall and then the other. That’s when Claire noticed the bare walls. Once, dozens of family pictures had lined the hallway. It had been a constant joy for Della to show off the family to her friends. No longer. The pictures were gone, apparently to keep Wally from knocking them down during his clumsy passage through the hall.
To Claire, just the fact that her mother had taken down the pictures reeked of codependency. Why was her mother facilitating his self-destructive behavior?
Her heart was in her throat. She watched his lips twitch, as if he wanted to speak but didn’t know how to begin. She stood to greet him. “Hi, Daddy.”
“Hi, Claire.” His speech was thick.
Her hand was against her mouth. “Oh, Daddy.”
He stumbled forward and on into the den. There, he collapsed onto the couch and stared at the floor. His arm lurched outward, then slowly descended to a resting place behind his head. He appeared to be chewing gum, his mouth in constant motion. His cheeks were sunken and his shirt hung on him limply, failing to conceal his wasting frame.
“Con—con—congratulations.” His head swayed gently.
“Dad, are you okay?” It was a dumb question. Claire regretted it instantly, but she didn’t know what else to say.
“I’m fine.” He looked up from the floor. “I thought you were heading off to be a surgeon. No time for your family anymore, is that right?”
“I want to be a surgeon. But not everyone makes it, Dad.” She paused, trying vainly to hold his gaze for more than a second. “But I did want to come and say good-bye. I wanted to see you before I left.”
“I—” He halted as his head jerked forward. “Hope you’re happy now.” His voice was flat, his face expressionless. It was as if his brain hadn’t notified his face of the emotions he should feel.
Claire looked at her mother. Della shrugged and pursed her lips, not speaking. She didn’t have to. Her look said it for her: “I told you this wouldn’t be a good idea.”
“Daddy, how long have you—uh—” Claire stuttered and looked at her mother. “How long’s he been this way?”
“Going downhill for months. Years, really,” Della responded.
“I’m fine. I need a little drink is all.”
Claire shook her head. “Let me take you back to Brighton. They have a detox unit there. You can dry out. They can take care of you.” She attempted a smile. “Maybe fatten you up a bit.”
“I got all I need right here. Leave me be.”
“Daddy, you need help.”
He waved his fingers in the air, pointing first at Claire and then the floor. “Stop playing doctor, Claire. It’s okay for you to play that in the hospital, but you leave it at the door when you see me. I’m fine!”
“But Daddy—”
Della stood up. “Leave it alone, Claire.”
“Is that what you want? For me to leave him like this?”
“Shut up, Claire! Shut up!” he screamed. “First my mother, and now my daughter. And neither of you can leave me in peace.” His hands were flying around him again, this time one coming to rest on the couch, and the other onto an empty beer bottle on a side table.
“Just look at yourself, Daddy,” she cried, her voice breaking. “You used to be so much more.”
His fist closed around the bottle. “I said—said—said—” He lurched forward to the edge of the couch and threw the bottle over Claire’s head. It shattered loudly against the wall behind her. “Get out!”
She shrieked, ducked, and watched her father tumble into a heap on the carpet in front of the couch.
Immediately Della was at his side.
“I want her out!” he cried.
Her mother looked up. “You’d better go. I’ll take care of this.”
“But—”
Wally mumbled something unintelligible.
“Go,” her mother urged. “I’ll take care of him. We’ll be okay.” She nodded. “Really, it would be best if you’d leave.” Della turned her attention to Wally, leaving Claire standing by the front door, her mouth open in disbelief. “There, there,” Della said softly. “Just a little fall. Let me help you up, dear.”
Claire wanted to scream. What about me? He could have killed me with that bottle! And you just get down and comfort him?
She reached for the door and moved numbly to the car. In a minute, with gravel spraying behind her, she turned onto Route 319 to take her back to the interstate.
Five minutes later, she slowed at the paved lane leading up to her grandmother McCall’s mansion. She thought momentarily about stopping, then stepped on the gas. She couldn’t stand any more heavy conversation. Her short visit to Stoney Creek had already exhausted her, and it wasn’t even nine A.M. She could handle her grandmother with a letter. At least that way she wouldn’t have to listen to more foolishness about the town curse.
It was time for Claire to move on. She needed to be far away. Far away from the distractions of this crazy family and from the small-town atmosphere that fostered it. And, as much as she loved him, she wanted time away from John Cerelli, time to sort out her feelings and gain some objectivity.
She purposefully loosened her death grip on the steering wheel. “Just calm down, girl,” she said softly to herself. “Just calm down.”
Some things you can’t change. But you can take charge of your own future.
She thought about her father’s outburst, then brushed back tears so she could drive. She had wanted so much more from her visit.
So much for closure!
Part Two
Chapter Three
June 30, 2000
There is a deceptive softness to the mountains viewed from my bedroom window at my father’s house. When I was just a little girl, I used to imagine the tree-covered peaks as a colorful blanket cradling my body as I nestled into the wrinkled terrain. The illusion is only appreciated from a distance, however. Like life, my fantasy of pampered comfort dissipates with closer inspection. Thick prickly pinecones and briars appear. Jagged rocks come into view. Huge ones, the kind Easterners call boulders, with outcroppings the size of Uncle Leon’s Cadillac.
Tomorrow, I think I’ll miss those mountains. Tomorrow, July first, the day that strikes terror into the hearts of sick and dying patients in teaching hospitals everywhere. At least terror for those who are lucky enough to know. You see, July first is the day new doctors begin their training, unleashing their fresh degrees and arrogance, their clumsiness and naïveté, their aspirations for diagnostic greatness, all upon the innocent patients, none of whom volunteered for illness on the first of July.
Terror grips not only the hearts of the patients, but claws the soul of the intern as well. I know because I will be one: Dr. Claire McCall, intern, department of surgery
I feel sick. I bet I’ve forgotten everything. Tomorrow. Everything changes tomorrow, the day when I’ll be expected to know what to do when the nurses call.
Yep, I’m gonna miss those Blue Ridge Mountains tomorrow. Tomorrow? Who am I foolin’? I miss ‘em now. Today.
Claire closed her diary and slid it beneath the residency handbook in her lap and sighed. If surgery internship was anything like she’d been told, there wouldn’t be any more time for this. Recording her thoughts would be a thing of the past.
Her thoughts evaporated as the conference room erupted in laughter. Dr. Dan Overby, the administrative chief resident in surgery, smiled broadly before chuckling at his own joke, the last in a string of one-liners about those physicians who had chosen the field of internal medicine. “Fleas,” he called them: the last ones to leave a dying dog.
Claire smiled nervously and wondered what she’d missed. She focused on the overweight man at the podium. He had short brown hair, moist either from grease or hair gel, and little round wire-rimmed glasses that sat
halfway down his pudgy nose. Along with his enormous size, rumors about Dr. Overby’s feats within the university hospital made him legendary among the house staff. All the new interns had heard of his operative speed, his finesse under the attending’s glare, and his memorization of the current surgical literature. “Dr. O,” the patients called him. To the house staff, he was just “Dan,” or “O,” or “Dan-the-man,” or “the O-man.”
“Welcome to the medical Mecca,” Dan chuckled again, straightening his tie and pulling his white coat lapels forward in a futile attempt to cover his expansive abdomen. “Your mother may think that the Cleveland Clinic or the Mayo Clinic represent the pinnacle in medicine, but I’m here to inform you otherwise.” He made eye contact with Claire. “Being a surgical intern in this university places you among the elite.” He paused, taking time to look at each of the twelve new recruits seated in front of him.
The chief resident continued. “Dr. McGrath has already explained the division of services. Now I’m here to tell you how to survive.”
There was more nervous laughter from the twelve interns. Claire watched the others from the corner of her eyes and fought the urge to pull out a legal pad to take notes. The last thing I want is to look like a medical student again.
“Rule number one. Eat when you can.” He looked around the room before pulling a pack of crackers from his pocket. “Here,” he added, tossing it to the closest intern. “There will be many days and nights with too much to do, when you think that you can’t make time for a meal.” He smiled. “But don’t believe it. If you don’t eat, you can’t work to your potential.
“Rule number two. Everyone teaches a tern.”
Claire nodded. It was apparent that this was a term of endearment to the chief resident. It was his slang for “intern.”
“You can and will learn from everyone around you. Your patients are your teachers. Their families are your teachers. The nurses, as irritating as they can be, are your teachers. Even the medical students, as exasperating as they will be, have more time to read than you do. Treat them right, let them help you with a procedure, and they might be willing to find an article that will help you on rounds.
“Conversely, come in here with a God complex …” He paused and turned his nose in the air and imitated the attitude he discouraged, “I’m a surgical intern in the Mecca.” He shook his head. “Come in here with that attitude, and you won’t be around long enough to see what it looks like from the top of the pyramid.”
The pyramid. It wasn’t a word Claire wanted to be reminded of. Half of the interns audibly groaned. It referred to the structure of the surgical residency. There were twelve spots for interns, eight spots for second-year residents, five for third-year residents, and four spots each for the fourth year and the fifth, or chief residency, year. There were also a variable number of research lab spots when grant money was available for residents who had academic or research aspirations. The lab also served as a holding tank, a place for residents to study to improve their in-service test scores in the hopes that they could propel themselves back into a coveted third-, fourth-, or fifth-year clinical position. Almost everyone spent time in the lab, making the residency a six-year program for many, and a seven-or eight-year marathon for some. The pyramid fostered competition. The pyramid prompted long hours, desperate commitment, and ruthless back-stabbing. You needed to shine, to perform, above the level of your peers, or you might not be promoted to the next year.
“Rule number three. If you don’t know, ask. We won’t tolerate lone rangers. Anyone acting like a cowboy or a loose cannon is sure to sit before the residency review board before next May when we select the second-year residents. It’s better to ask than guess. You’re not taking a test on paper anymore. Tomorrow, you will have real patients, God help them, and what you don’t know will hurt them!”
Claire ran her fingers through her newly cut hair. Even though it had been a week, the absence of her long blond hair still surprised her. She had traded her flowing locks for a more efficient style, just off the collar. Feminine, for sure, but without the time hassle that long hair required. She looked at her fingers, long and spindly, adept at the craft she pursued. Her styled nails were the last thing she’d given up. She’d cut them last night and removed the last traces of the chartreuse polish she loved so much. She clicked her fingernails on the resident handbook in her lap and winced at their appearance. Oh well, she thought, surgery isn’t the place for attractive nails. And internship isn’t about fashion; it’s about survival.
Claire quietly studied the faces of her fellow interns, vaguely aware of Dan’s voice saying something about “chain of command.” The other terns seemed relaxed, laughing at the O-man’s expressions. She forced herself to smile, belying her anxieties. There are twelve of us. Only eight next year. A third of us will be cut! And there are only two women here … Beatrice Hayes and me! Have they ever had two female chief residents in one year before?
Beatrice was well-moneyed. Her father was an academic dermatologist across town, a fact Claire learned in the first two-minute conversation with “Bea.” “And what does your father do?” Beatrice’s eyes had seemed to focus on a spot two inches above Claire’s forehead.
“He’s retired Navy.”
Claire’s gut churned with the memory. Why did I say that? It’s technically the truth, I suppose. My father was in the Navy once.
Bea was composed, reeking of self-confidence. Here, at an informal gathering of the new house staff, she was dressed in a sharp gray business suit. We’re in the minority here, Bea. And they won’t likely finish us both. So it’s you or me. One of us is going to get the axe … and it’s not going to be me! Claire pulled her eyes from her competition, abruptly aware that she had been clenching her jaw.
Dan’s wild gesticulations prompted her to refocus. “There are no guarantees that you will make it. But you wouldn’t be here if you weren’t the best. All of you represent the cream of your medical schools, the pride of your hometowns.”
He obviously hasn’t visited Stoney Creek. Claire looked at the interns again. We’re the cream?
Dan seemed to be wrapping things up. “Let me conclude with a quote from Dr. Jonas Salk, the man responsible for the polio vaccine. ‘The reward for work well done is the opportunity to do more.’” He pounded the podium with a meaty fist, jerking his small audience to attention. “And remember what Arthur Rubinstein replied when questioned by a passerby, ‘How do you get to Carnegie Hall?’ ‘PRACTICE, PRACTICE, PRACTICE!’” Dan’s voice was near stadium volume. “And so it is here,” he preached, towering forward over his underlings. Then, abruptly, he lowered his voice and glared at the terns, who were all pressed back into their seats. “Practice,” he whispered. “Practice.”
The chief resident paused for a moment, as if waiting for applause.
There was none. In fact, the terns were so silent, apparently shocked by Dan-the-man’s theatrical conclusion, that they just sat, unsure of their next move.
After the awkward pause, Dan cleared his throat and pointed to a side table, where a dark-haired man in a three-piece suit offered a nod. “Bill Joiner, our Ethicon suture rep, has brought each of you a knot-tying board. I would strongly suggest that you take one home and don’t waste any time before you become proficient at one-and two-handed ties. The surest way to be tossed from a case is to show a deficiency at the basics.” He held up his hands. “That’s it. Make sure you know where you are supposed to report in the morning. And the tern reception tonight at the Bay Club is not optional.” He paused for a moment, as if caught in a memory of his own. “Take it from me. Stay away from the punch. Getting drunk is no way to make a first impression on Dr. Rogers.”
The crowd started dispersing as Dan added, “Let me see Doctors McCall, Hayes, Button, and Neal.”
Claire gathered her things and joined the other named physicians in front of the small podium. She held her hand up to Dan. “I’m Claire McCall.”
“I’m Dr. Hayes,
” Bea responded, following Claire’s lead.
The two other interns nodded. “Wayne Neal.”
“I’m Howard Button.”
The large resident beamed. “My new terns. You four have been assigned to the trauma team. And for the next three months, it’s my trauma team, and you’re my terns. We’ll rotate every other night with two terns on each night. We only have one call room for the terns on this team, so I’d suggest keeping McCall and Hayes on the same night. Not that you’ll ever see the inside of a call room,” he added with a tense smile.
“I don’t mind sharing call quarters with a guy,” Bea interjected quickly. “I don’t want any special treatment.”
Claire stayed quiet. I’m not sharing my call room with a man.
Dan raised his eyebrows. “Uh. Okay. I’ll decide how to divide the duties in the morning. We need to meet by six A.M. in the SICU.”
“The SICU?” Howard scratched his forehead.
“As in Surgical Intensive Care Unit. Second floor, directly across from the MICU, the Medical Intensive Care Unit. Come early and wear scrubs. This isn’t a street clothes type of rotation.”
The four nodded. Bea leaned toward Dan. “See you tonight?”
“Wouldn’t miss it. The Bay Club has great food. And this reception is your first chance to meet the house staff outside the confines of this place.”
Claire made her way to the Ethicon display to receive a knot-tying board. She already had one, but another would be nice. Besides, maybe she’d send it back home to her cousin who was showing an interest in medicine. The board had several tall thin cylinders mounted on a plastic base. At the bottom of the transparent cylinders, a small hook had been mounted. The object was to tie a knot around the small hook, simulating the placement of a knot within a small body cavity or through a small incision. Claire had been tying practice knots since the first week of medical school. Surgery was the whole reason for her medical training. She’d never considered anything else.
