The Real Doctor Will See You Shortly

by Matt McCarthy

  “Jesus,” I murmured.

  “It’s allegedly anonymous, but we can usually figure out who’s responsible. Makes for high drama. Tempers flare, egos are crushed.” Baio made a fist. “It’s tragedy with a healthy mix of unintentional comedy. I’m always on the edge of my seat.”

  “Sounds awful.” How could he be so fucking cavalier?

  “Don’t worry,” he said. “I’ll remind you about it later in the week. But back to the task at hand.”

  “Yes. Point me in the right direction of the rectal exam. I’m ready.”

  “Here’s some guaiac juice,” he said, handing me the developer that was to be applied to the stool. If blood were present, the brown fecal material would turn a brilliant blue.

  “Thank you.”

  “No, thank you.”

  A nurse tapped Baio on the shoulder and whispered something in his ear. I applied a few drops of the developer to my finger to ensure there would be no mishaps with the actual stool sample. I sensed a moment to pick his brain.

  “You said the lows this year would be really low.” I rubbed the developer between my thumb and forefinger.

  “Yep.”

  “But everyone says it gets better. Right? That it gets a bit better every year.”

  He scratched his chin. “They do say that, don’t they? Well, I want you to know that they’re wrong.”

  I wrinkled my brow. “Seriously?”

  “All year people will reassure you that next year will be better. And the year after that. Trust me, it doesn’t get better.”

  “Come on.”

  “Nope.”

  “I look forward to the day when I will actually feel like I know what I’m doing around here.”

  “That day ain’t comin’. With more knowledge comes more responsibility.”

  “I suppose.”

  “You start taking your work home with you,” he said, staring blankly at the computer screen. I wanted access to his inner world. Was he struggling in a way I didn’t realize? Was he thinking of Carl Gladstone? Or was he just messing with me? I studied his face, but it offered no clues. Unlike so many doctors, Baio appeared unencumbered by anxiety or self-doubt. But what was beneath that highly competent exterior?

  “Fine,” I said, “I’m fine with that.”

  “Not fine. Okay, focus, Dr. McCarthy. I need you to rectalize room fourteen. Go with God, my friend.”

  —

  The elevator door was closing several days later as Baio and I approached. He extended a hand and sprang it open, revealing a dozen white coats on their way to M and M—the Morbidity and Mortality conference. I thought about what I might say if Gladstone came up. I’d be contrite, certainly, but not defensive. I would acknowledge my mistake and accept the punishment and embarrassment that came with it. What else could I do?

  “You can tell what type of doctor someone is by what they stick in a closing elevator door,” Baio said as we squeezed inside.

  “Oh yeah?”

  “An internist sticks his hand. Surgeon sticks his head.”

  “And a social worker,” said a woman in the back, “sticks her purse.”

  A six-three, rotund, bearded man in jeans and unlaced white tennis shoes flashed a grin and placed his hands on Baio’s shoulders.

  “Look who it is,” he said, grinding his hands into the base of Baio’s neck. “My first, my last—”

  Baio wiggled out from underneath his grasp like a younger brother escaping a headlock. “What’s up, Jake?” Baio threw a thumb in my direction. “This is my intern, Matt. Big Jake here was my first resident. Taught me everything I know—”

  “When this guy showed up last year,” Jake interrupted, placing a paw on my tricep, “he didn’t know his ass from his elbow!”

  It was impossible to imagine. “It’s true,” Baio said. “I was a mess.”

  “No,” I said breezily. “No way.”

  “Oh yeah,” Jake said, laughing to himself, “this guy was a total disaster!”

  The rest of the elevator remained silent as I tried to imagine what his incompetence would look like. Baio racing around with fear in his eyes instead of assurance. Baio fumbling helplessly with primary care patients. Baio sitting on the other end of that miserable phone call from Sothscott. No mental image would stick.

  The elevator reached the ground floor, and as we stepped out I realized Jake looked more like an offensive lineman than a physician. Perhaps he had been a football player; Columbia was full of ex-athletes. He slapped himself on the knee. “And now,” he said to Baio, “you’re telling an intern, another doctor, what to do? Amazing.”

  “Circle of life,” Baio said flatly.

  Jake turned to me. “Did he tell you about M and M?”

  “A bit, yes.” I didn’t know what to make of this enormous oracle. “He said people get worked up. Something about egos getting crushed.”

  “And tears,” Jake said, “don’t forget about the tears.”

  “I’ll keep my eyes peeled.”

  “Piece of advice,” Jake said as he leaned in and nodded toward Baio. “Don’t believe a word that guy says.”

  We took our seats in the auditorium, and I braced myself. Rapid-fire, shorthand conversations took place all around me, but a hush fell over the sea of doctors when a physician stepped onstage and tapped on the lectern’s microphone.

  “Welcome,” she said, “to M and M.”

  I looked around the room, searching for signs of distress. I prayed they would not be discussing Carl Gladstone. It’s been said that the first half of life is boredom and the second half is fear. If that’s the case, I’d just reached middle age.

  “Today, we’re going to discuss a case with an unfortunate outcome. As always, I remind everyone that today’s conference is confidential and—”

  My pager went off: LUNDQUIST FAMILY WOULD LIKE TO DISCUSS DISCHARGE PLANNING. RETURN TO UNIT ASAP.

  I took a deep breath, and another. I had to go but I couldn’t get up. My ears were perked as the speaker ran through generalities pertaining to the M and M conference, tuned to any mention of the words “Gladstone” or “anisocoria.” But the intro just dragged on. Baio looked over at me as I scanned the room, searching for other sets of eyeballs that might have drifted in my direction. The pager buzzed again. I had to go. I showed the message to Baio, shrugged, and excused myself, wondering if I was about to be lambasted in absentia.

  13

  I walked into Denise Lundquist’s room and found her husband, Peter, seated next to her, gently stroking her hand with his own. Denise was asleep, and Peter, wearing a charcoal gray mock turtleneck and a pair of green jeans, had a legal pad in his lap. He was a young guy, probably in his early thirties, and he stood up quickly as I entered the room. I could tell he was flustered.

  “Are you the attending?” he asked.

  “No,” I said, shaking his hand. “I’m the intern, Matt. I work with the attending.”

  I took a seat next to him, and he nodded, interlocking Denise’s limp fingers with his. Something about his gentleness touched me. He was a solid, well-built man, but his voice was soft, almost a whisper, as if he were afraid he might wake his wife up.

  “I have a bunch of questions,” he said, touching the yellow pad. “Do you have a few minutes?”

  “Of course, fire away.”

  I was conscious of my naturally somber demeanor and tried to lighten the mood with a large smile, but I wasn’t entirely sure what I was smiling at. Denise was improving, but in rough shape. The hue of her skin still did not look human; it looked like it had been peeled from a mannequin. The situation didn’t exactly call for confetti. Was there a proper physician’s facial expression, I wondered, for a cautiously hopeful moment? Something that conveyed guarded optimism? I’d have to start watching Baio and the Badass for this.

  Peter reached for his reading glasses on a small nightstand but, realizing he would have to let go of Denise to put them on, decided against using them. I motioned toward the bifocals,
but he waved me away and cleared his throat.

  “Today someone mentioned a possible heart transplant. Does she need a new heart?”

  I stared at the young woman and squinted. Despite her terrible color, Denise was gradually improving, and on rounds we’d discussed transitioning her to a general cardiology floor in the coming days. Had Peter heard us talking about someone else?

  “I’m not sure,” I said. “I don’t recall anyone mentioning a heart transplant for your wife. But I don’t want to give you bad information.”

  “Understood.” He checked off the first question and took a deep breath.

  I leaned close to him and saw that he had written down thirteen questions. Instinctively I guessed that I’d be able to answer four, maybe five of them at best. I felt bound to disappoint Peter, or worse, leave him more confused, like I had Sam. As my jaw tightened for another round of teeth grinding, I suddenly became aware that I was moving almost imperceptibly away from Peter, toward the door. I had unconsciously sat back in my chair and could feel my legs tense, ready to rise; my body was beating an involuntary retreat. So this is what Benny meant, I thought. Looking at Peter looking at me, I could imagine what Benny saw: a doctor shutting down and going through the motions. A doctor who maybe didn’t care enough. A doctor who was so afraid he might be wrong that he couldn’t properly care for his patients. I caught myself and leaned forward, looking Peter in the eyes.

  “I will obviously find out for you whether any heart procedure is being discussed,” I said. “But I don’t think there is.”

  Peter nodded. He stared down at the words he’d written on the legal pad but didn’t speak. He simply stroked his wife’s hand and watched her breathe. She made a faint gargle, and he parted his lips expectantly. I tilted my head to look at the questions, hoping I could read and answer them on my own. Squinting, I could just make out the next one.

  Why did God let this happen?

  Nope. I moved to the next one. Scanning down the sheet, I saw that he’d scribbled a heart and inside it written

  Denise + Peter

  I looked at this grief-stricken husband and then back at the sheet. In the bottom corner, he’d drawn a smaller, broken heart without names in it. Raising my eyes up from the drawing, I looked on as Peter wiped the bangs away from Denise’s eyes.

  And then, I burst into tears.

  Not “eyes welled up” tears but genuine, blubbering, sloppy tears, heaving breaths, quivering shoulders. Perhaps it was the fear of what was being discussed that very moment at M and M, or perhaps it was being in the presence of such profound love and heartache. Maybe it was the lack of sleep. But the act of being there for Peter, of facing his pain and need, was simply too much. I had taken it all on myself and it flattened me like a pancake.

  Peter led me by the shoulder to the corner of the room, gentle but urgent. “Matt,” he said quickly, “is she…dying?”

  I struggled to pull myself together. “No,” I said through sobs. “Peter, she’s doing amazing. Amazingly well.”

  He struggled to read my face. “Well then, what is it?”

  My thoughts were with this grieving man, but they were also somewhere else. I ached to know what was being discussed at the Morbidity and Mortality conference. How many heads were shaking? Who was cursing my name?

  “Denise is expected to make a full recovery.” As the words exited my mouth, I wanted to snatch them back. I wasn’t sure I was supposed to present such a rosy picture. On rounds, we agreed that Denise was improving, but she was still critically ill.

  “Oh, thank God,” he said, taking a step back. “Thank God.”

  “Yes.”

  My words belied my emotional state. Peter was very confused.

  “You love your wife,” I wanted to say.

  I turned my blurry eyes in the direction of Denise and said, “It all got to me just now. I’m sorry.”

  He patted me on the shoulder. “We’ve all been through a lot.”

  I laughed the way one does through tears at a funeral. Here was another tip they’d omitted at medical school: when you can’t comfort the patient, make the patient comfort you. Peter and I sat back down, and he once again took Denise’s hand.

  “Can we just sit?” he asked as he put the legal pad on her bed. “Just the three of us?”

  “Yes, of course.”

  I was unaccustomed to such wild emotional swings; I wondered if I was developing a mood disorder. How did senior physicians build up enough emotional calluses to avoid bawling without becoming automatons?

  “You know,” Peter said, “it kills me to know I played a role in this.” He touched the lobe of her ear with the back of his hand and frowned. “That I’m the one who told her about her brother. I keep replaying the scene in my mind, thinking I should’ve done it differently.”

  I wiped my eyes on my white coat as more tears trickled down my cheeks. I was a fucking mess. Everyone breaks, Baio had said. I just never guessed that I’d break so soon.

  14

  When I reconvened with Baio an hour later, I carefully watched his eyes for any sign that I had been the subject of M and M. But he never mentioned what was discussed at the conference and I never asked. I was too scared to. Its uneventful passing came to seem an absolution. We talked about our new patients, and that was it. Gradually, as the hours ticked by, Sothscott receded from the forefront of my consciousness.

  “Listen,” Baio said a few days later, “I got another person for you to rectalize. Room sixteen.”

  “Sure thing,” I said and popped out of my chair. In those intervening days, I became increasingly proficient in a half dozen skills around the unit. Placing an IV was now a breeze, and I’d finally gotten the feel for dropping a nasogastric tube into a patient’s stomach. “I can probably get it done before rounds.” A modicum of proficiency in this task left me feeling exuberant. I pulled out the guaiac card and developer and shuffled toward room 16.

  Baio’s lips were pursed when I returned.

  “What’s up?” I asked. I caught the Badass out of the corner of my eye; rounds were about to start.

  “That was fast,” he scoffed.

  I smiled. “No bleeding.”

  “You know you didn’t even ask why you were doing that rectal.”

  “Check for bleeding,” I replied. “And you asked me to.” At this point, the job description seemed quite clear: carry out the will of the supervisor. Considering my relative ignorance, following his instructions to the letter was the safest course for my patients and for me.

  “Right.” We stood in silence, and he folded his arms. “And?”

  I wasn’t sure where this was going. “You ask me to do dozens of things.”

  “I do.”

  “And I try to do them as quickly and efficiently as possible.”

  Baio half-grimaced. “Enthusiasm is appreciated. But you’re not thinking. You’re doing.”

  “Yeah, lots of doing. Don’t think. Do.”

  “Look, Matt, you’re gonna spend the entire year being told what to do. A good intern will perform every task quickly and accurately.”

  “I’m certainly trying.”

  “But a great intern will pause and ask, ‘Do these orders make sense?’ ”

  “What do you mean?”

  “Is it even necessary to guaiac someone before starting a blood thinner?” he asked.

  I looked around the room. “Seems to be the standard practice in the unit.”

  “Are there any established guidelines that recommend it?” he asked disapprovingly.

  It seemed like a reasonable thing to do, but I wasn’t certain. I had learned a lot about advanced cardiac care in the unit, but I was no expert. “I’m not sure.”

  “Of course you’re not. The point is that at some stage, you’re going to be instructed to do something you shouldn’t be doing.”

  What was he talking about? It was a frightening thought. What if all of my supervisors weren’t as sharp as Baio? They were just one year ahea
d of me, and still in training. What if they struggled to perform procedures or were paralyzed by indecision? The implications were terrifying.

  He patted me on the back and smiled. “I pray that you’ll be able to identify those moments.”

  —

  Rounds started a few minutes later. Ariel, the post-call intern, who’d been awake for twenty-seven hours, began by detailing the unusual condition that had brought the first of five new admissions to the unit. “Forty-one-year-old woman with nonischemic dilated cardiomyopathy and bipolar disorder on lithium was admitted to the CCU at four o’clock this morning.”

  Ariel had worked in consulting before applying to medical school, making the career switch in her mid-twenties. She was a star on rounds; her presentations were crisp, without a single wasted word. I imagined her in her previous life, standing before a boardroom in a pantsuit, telling executives that their company needed to cut out middle management and use less paper.

  I sidled up to Lalitha’s jet-black ponytail. “Hey,” I whispered. “How’s it going?” We’d been so busy paired off with our respective second-year physician-supervisors that there hadn’t been much time for chitchat.

  Lalitha stared ahead at Ariel and out of the side of her mouth whispered, “Barf.” With her accent—was it Cockney?—the word sounded more like boff, which was slang for sex, and I bit my bottom lip so I wouldn’t giggle. I, too, kept my eyes on Ariel—she was saying something about peaked T-waves found on the EKG—and wondered what Lalitha meant. What was “barf”? Was she feeling ill? Or was she referring to our jobs? Out of the corner of my eye the expression on her face was indecipherable. Was I barf? I was taking everything personally. Had I inadvertently done something to upset her? I glanced at Baio and thought about his “bumpy ride” comment.

  I scribbled What’s barf? in my notebook and placed it under her eyes.