by Harry Kraus
Claire felt her cheeks burn. She was thankful for the surgical mask. “Yes, sir,” she responded quietly.
She turned on her heels and stepped back into the main OR hallway, trying not to lose her cool in front of the attending. She slowly unfolded her clenched fists, pulled off her mask, and trudged back to the front desk, shaking her head.
Donna looked up. “He did the case without you, eh?”
“Not exactly,” Claire huffed. “The other intern on the service scrubbed in and did the case that I worked up.”
“Oh.” Donna raised her eyebrows.
Claire sighed. It was one A.M. She had been up since five. She was tired. She was angry. “I’m gonna try and get some sleep.”
“There will be other appendectomies, Dr. McCall. You won’t remember this long.”
“It was going to be my first one.” Claire felt her eyes begin to sting. She couldn’t let herself cry over a lousy missed appendectomy. Not in front of an OR nurse.
Donna pushed her chair back from the desk and locked eyes with Claire. “I’ve been here for fourteen years, and I’ve seen a lot of females in surgery, fighting for a chance to operate in a male-dominated world.” She paused. “And I’ve only seen a few make it through this program.”
“I can make it.”
“But you won’t make it if you pout over every missed appendectomy.”
“I’m not p—” Claire’s denial caught in her throat. She pressed her hand to her upper lip. What could this nurse know about the pressures Claire felt as a surgical resident? What did she know about being a doctor? “Okay,” she responded. “I’m sure you have an opinion.”
“There are two ways for a woman to make it in surgery residency.” She held up a finger. “Sleep your way to the top.”
Claire’s head snapped back.
“Don’t look at me like you haven’t heard the stories. There are a few powerful men in this program who would love to lay a hand on you. And you have the goods to make it that way.”
“I have no intentions of making it to chief resident by sleeping around.” She turned to leave.
“You haven’t heard the second way.”
“I’m listening.”
“Be a man.”
Claire leaned forward, not speaking.
“There are ten men in your intern group. Beat them by being more of a man than they are.”
Claire sighed.
“Not every woman is cut out for this. I’m sure you heard about Lisa Dunn.”
Claire shook her head. “No.”
Donna raised her eyebrows in surprise. “She was an intern last year. I thought she had what it took. She was brilliant, but after six months, she snapped.”
“She quit?”
“Yes. She got gun-shy, didn’t trust her instincts.”
“Hmm.”
“She was frightened.”
“Frightened? Why?”
“She claimed she was being threatened, but the word around the hospital was that the girl just got paranoid. She worked way too hard, stayed here even on her nights off.”
“As if every other night isn’t enough torture.”
“You’ll do okay, girl. Just be a man.” Donna broke her gaze and pulled her chair back up to the OR desk, signaling the end to the conversation.
Claire nodded and walked away. She didn’t feel like a man.
And, at this moment, she didn’t want to fight like a man.
She plodded numbly toward the emergency room, hoping to find that the med students had taken care of getting Mr. Davis safely home.
Once there, she was greeted by Glen Mattingly, studying a patient record. He shook his head. “I’d never have believed it.”
Claire didn’t feel like guessing. “What?”
Glen handed her a computer printout of Mr. Davis’s labs.
She looked at the alcohol level: “None detected.” Her eyes widened. “Are you sure you didn’t get his blood sample mixed up with someone else?”
“I don’t think so. I gave the blood to the ward clerk myself.”
Cliff, a ward clerk with a large dragon tattoo on his forearm, leaned over the counter. He’d obviously been listening. “And I labeled it with his name sticker and tubed it up to the lab.”
Glen scoffed. “The guy couldn’t even walk straight. He had to be drunk.”
Cliff shook his head. “You guys would learn a thing or two if you just talk to the patient. Paul Davis isn’t a drunk. I’ve seen him in here a hundred times in the past decade that I’ve manned this desk.” He lifted a stack of charts, volumes one through four, all belonging to Paul Davis. “It’s customary for the doctors to review the patient record.”
The med student scoffed. “What’s to review? He fell and hit his head.”
The ward clerk frowned. “Mr. Davis has HD.”
Glen wrinkled his brow. “HD?”
Claire was relieved that he had asked the question, so she wouldn’t have to.
“Huntington’s disease. His old man had it. So did his brother.”
Glen smiled and poked a finger toward Claire. “Everyone teaches a tern.”
Huntington’s disease. Claire remembered hearing about a patient with HD back during her medical school neurology rotation. It was some kind of movement disorder, but she remembered little else. All she knew was that it was rare and that you couldn’t cure it with a scalpel, so she had little interest. “Oh sure,” Claire responded, “HD.”
“His brother Rufus died last year,” Cliff added. “He was in a nursing home, only forty-five. Rufus was always comin’ in here all bruised up or cut from falling down. Huntington’s robbed him of his life.” Cliff pointed at the stack of Mr. Davis’s records. “And now it’s doing the same thing to Paul.”
Claire nodded and made a mental note to look the disease up later. She turned away and surveyed the ER for signs of the O-man. A child was screaming in the first cubicle. A respiratory technician held an oxygen mask over the face of an elderly man in the second cubicle. The patient’s chest was exposed and so thin it reminded Claire of an old birdcage. Another man, apparently asleep, slumped awkwardly on a stretcher in the hall. He snored gently as Claire passed. An ER resident was sewing up a hand laceration in the trauma bay, and an ortho resident was applying a splint in the cast room. Claire yawned. Then, satisfied that there didn’t seem to be any current action for the trauma intern, she retreated to a call room with an empty bed and collapsed.
Fifteen minutes later, she awakened to the sound of the door. Beatrice stumbled into the dark room and turned on the light.
Claire resisted the urge to scream and feigned sleep. She didn’t want to talk to Beatrice in her present state of mind.
Bea mumbled something about Claire sleeping while she worked, then noisily climbed onto the top bunk and promptly fell asleep, her breathing coming in rhythmic faint whistles, just loud enough to keep Claire from slumber.
In five minutes, Bea’s beeper sounded. Instead of touching the top of the beeper to silence it after one or two shrill tones, she allowed the obnoxious beeping to continue until it stopped on its own. She reached for the phone, a wall-mounted model beside the bed. Claire listened to the onesided conversation. Bea had obviously forgotten to leave orders for pain medication for the appendectomy patient.
Claire pulled the pillow over her head. Come on, Beatrice, everyone knows you have to write complete post-op orders or you’re gonna get tortured by the nursing staff.
In a few minutes the whistling noises resumed above her. Claire tossed in frustration for the next hour before exhaustion led her from her anxiety again, and brought a temporary respite with sleep.
Chapter Seven
In the morning, Claire crawled from the call-room bed thirty minutes before rounds, only to find Bea already locked in the adjoining bathroom. Claire waited a few minutes before rapping on the door. “Bea?”
She listened for a reply. When she heard none, she spoke again, “Bea? I need to use the sink.”
> There was no answer, only the sounds of running water.
Claire sighed and waited. And waited. When the water stopped, Claire knocked again. “Bea, can you let me in?”
The sound of a blow-dryer was the only response.
Claire opened a small compact mirror and resorted to applying her mascara with the small mirror propped on the top bunk. She pulled a brush through her blond bangs and listened to the noise in the bathroom. Finally, with only five minutes left until rounds, Bea appeared, looking like she was ready for a fashion magazine. She brushed past Claire and glanced pointedly at her watch. “Don’t be late again,” she tossed over her shoulder. “You never know what you’ll miss the next time.”
Claire clasped her hand on Bea’s shoulder. Bea spun around. “Don’t touch me.”
Claire lifted her hand. “I was late because I was taking care of your ER patient, Bea. You wouldn’t have gotten to do my OR case if you’d been doing what was right for Mr. Davis.”
“I did what was right.”
“He had a gaping wound. It would have taken forever for that wound to heal without sutures.”
“That drunk wasn’t worth my time.” She backed to the door of the small call room. “I made a disposition. You shouldn’t have been involved.”
“He wasn’t drunk,” Claire countered. “Your patient had Huntington’s disease, a fact you’d have known if you’d read his chart like you should have!”
“It doesn’t take a chart review to diagnose his problem.” Bea turned and slipped through the doorway.
Claire watched Bea’s back disappear down the hall. She gritted her teeth and hurried to the ICU.
Outside the SICU, the trauma team gathered around Dr. Dan, who stood grinning, with a Nike shoe box in one hand. He extended his free hand to Rick, who surrendered a large Styrofoam cup. “Aah, Rick, how thoughtful.” He held the cup into the air. “There is a tradition here at Lafayette. Every time an intern manages to nab his or her first major case, we offer a toast.” He looked at Beatrice Hayes. “For your appendectomy.”
Jeff, Elaine, and Basil lifted their coffee cups. “First blood!”
Dan smiled and echoed the phrase, “First blood.” He held up the shoe box and handed his coffee back to Rick. “And for the first intern in a new year to draw first blood,” he said, lifting a tarnished trophy from the shoe box, “this prestigious award.” He held up a trophy that appeared to be a crude modification of an old sports award. At the top, where you might expect to find a little baseball player or perhaps a bowler, stood a large scalpel dripping with red plastic. On the base, “FIRST BLOOD” was printed in red letters. “This year’s recipient is our very own trauma tern, Dr. Beatrice Hayes.” He held out the award to Bea.
She gripped the award and laughed, while the other members clapped.
Everyone except Claire.
Dan explained. “This award is to be kept on display in the surgery resident’s lounge.” He turned the trophy around to reveal a series of smaller engraved nameplates listing the names of interns from prior years. “As you can see, you are joining a highly select group of individuals.” He pointed his index finger to his own name.
Beatrice read off the names.
“We’ll see to it that your name gets added to the list,” he added.
Beatrice clutched the front of her scrub top. “I’m honored.”
Claire forced a smile and clenched her jaw. Stupid award. What do I care?
Dan put the trophy back in the shoe box. “Okay, team, let’s get this show on the road.” He punched the small panel on the wall to activate the door to the ICU. “Who’s presenting the first patient?”
By midday, Claire was relieved to be officially off duty. Before heading home, she stopped at the medical school library to see what she could find out about Huntington’s disease, the mysterious illness that had afflicted her ER patient, making him look for all the world like a common drunk. She was troubled by the encounter, and hoping to dispel her anxiety with knowledge, she opened a neurology textbook and began to read.
Unfortunately, the written descriptions about the disease only tightened the growing knot in her stomach. Huntington’s disease, or simply HD, had been first described by Dr. George Huntington in 1872. It was a degenerative disorder with catastrophic, progressive effects on movement, emotions, and the intellect. Originally known as Huntington’s chorea, it was named for a Greek word for “dance,” because of the repetitive, dancelike movements of the arms and legs which characterized the disease.
Claire read on about the early signs of the disease, which often included subtle changes in emotional stability, with patients showing irritability and angry outbursts. Just like Daddy. As the disease progressed, patients experienced more and more involuntary movement until they were no longer able to walk, dress themselves, or even sit in a chair without support or restraints. With each new paragraph she read, she saw her father. Every symptom seemed to fit. Patients with HD often appeared inebriated, and in the alcohol user, symptoms were confused with signs of intoxication.
The problems usually surfaced in midlife, she learned, and progressed to death in ten to twenty-five years. The disease was inherited. Children of patients with HD had a fifty-fifty chance of inheriting the disease. The worst part was that there was no cure, and most people who came down with the illness had already had children, who would be at risk for inheriting it.
Claire sat back in relief. The descriptions had sounded so much like her father. But since her grandparents didn’t have HD, it would be impossible for her father to have it.
She yawned and closed the reference book. Poor Mr. Davis. He has an incurable progressive disease that will certainly kill him. And while he’s on the downhill slide, everyone who doesn’t know him thinks he’s a common drunk … like my dad.
Claire stepped out the large glass doors at the entrance of Lafayette University Hospital and held her hand up to cover her eyes. It was sunny and hot, the kind of a day made for sand castles and cool surf. She paused and lifted her face to the wind. There was salt in the air, a light scent of the ocean. Yes, this day, Claire resolved, would be about relaxing. She’d spent the last eight weeks holed up in her brownstone cramming for her internship. Maybe she should grab a towel and some sunscreen rather than a textbook for a change.
Some good all that studying did, she mused. Internship survival seems to have little to do with how much you know. It’s more about following the Oman’s stupid rules. She smiled. Eat when you can. Everyone teaches a tern. If you don’t know, ask. Her smile left as she thought of the latest rule. Keep the fleas away from my patients.
Maybe I should add my own. Never turn your back on Beatrice Hayes.
She trudged to her car alone, longing for a few hours away from Beatrice, uncooperative ER patients, and the medical Mecca.
She drove home in a daze, her little car finding its way through the city streets with minimal input from Claire. She had turned her thoughts to John Cerelli. Their summer separation had been helpful, in a way. At least she knew that her love for John would outlast a physical separation. But, she was discovering, long-distance communication did not seem to be his strong suit. She e-mailed and called, expressing her feelings about everything she experienced. He returned e-mail with short reports of his activities or calendar. He tells me what he does. Not what he feels. And a nagging anxiety remained: John seemed better able and more willing to communicate with his clothes off.
She thought back to her last night with John and frowned. How come all my friends think sex is so great, when all I seem to get out of it is guilt? She thought through the virtues her mother had instilled in her: Good Christian girls don’t smoke. They don’t drink. And they wait until marriage to surrender their virginity. Is two out of three really so bad? She tapped the steering wheel, hoping the traffic light would turn green, and promised herself that she would do better. But she knew the true test was yet to come, when John would come to Lafayette for a visit.
Claire arrived home and pulled a single letter from the mailbox. Her excitement disappeared when she saw the address label for “occupant.” She checked her answering machine and e-mail with similar deflating results.
She walked through the house telling her plants she didn’t care that John hadn’t called. “I’m sure he just didn’t want to leave a message. He wants to hear me in person,” she said. “I’ll just go on to the beach like I planned.”
She selected a revealing two-piece suit, something she used only for tanning, not social events. She held it up to the mirror. I’ll find a quiet spot to myself.
Claire changed and put John’s football jersey over her swimsuit. She grabbed her sunscreen and a pair of sunglasses and looked at her desk. An old Bible, her Sabiston’s surgery textbook, and a National Geographic seemed to be the only options for beach reading. She paused a moment, heaved a sigh, and hoisted the large textbook. “Let’s go, Sabiston,” she whined. “You knew I wouldn’t be able to spend a few free hours without you.”
She drove to a sandy cove ten miles southeast of Lafayette and parked at a public beach access. The lot was crowded with cars from Pennsylvania, New York, and Massachusetts. She’d forgotten that school was out for everyone else, and her hopes for a secluded getaway diminished. She exited her car and glanced at the sun before picking up her beach bag and her surgery textbook.
At the end of the parking lot, she noticed a man about her age waxing an old orange pickup. As she passed, he smiled, and she quickly diverted her eyes. He was blond, shirtless, and well-tanned, and would have looked at home on a lifeguard stand. Claire moved on, not wanting to initiate a conversation with the handsome stranger.
She picked her way through beach towels and sunbathers, the scent of suntan lotion and surf urging her forward, the sand quickly getting between her feet and her flip-flops. She slipped them off and dug her toes into the sand, feeling herself beginning to relax for the first time since leaving the hospital. She trudged slowly to the end of the beach, where she spread out her towel and slipped off John’s jersey. She applied her sunscreen and lay down on the towel.
