Tooth and Nail

by Linda D. Dahl

  The liquid fell in thick drops, landing on the paper in front of me, obscuring some of the words on the page. I stared at them, unable to move. I hadn’t been in the presence of violent blood since residency. But now, instead of feeling disgusted, I was excited. I had never wanted to physically beat a man myself, but watching them hit each other felt cathartic. They were like living avatars for my own dark, internal video game.

  Juan’s opponent lost his footing, trying to walk backwards while his body moved in the opposite direction. He dropped to one knee and lowered his head, his upper body swaying from side to side, disconnected. Then the referee, who had been watching from a few feet away, walked over and stood in front of him, waving his arms and shaking his head that the fight was over.

  I was rapt. Seeing the fight live and up close was nothing like watching it on television. The difference was like comparing tasting food made by a master chef to merely watching him prepare it through a glass screen. I almost felt like I’d knocked the guy out myself.

  Dr. Aziz stood and grabbed me by the elbow, lifting me up from my seat. “We have to make sure he’s okay. We have to go into the ring,” he said, climbing onto his chair and stepping onto the table in front of us to reach the platform. Spreading the stretchy ropes wide, he climbed between them and held them open for me. I struggled, gracelessly contorting my body to fit through the narrow opening. I was glad I had taken Dr. Roy’s advice about the shoes. It would have been impossible in heels.

  Once inside the ring, I bristled, realizing my ineptitude now had a stage. I didn’t know what to do with myself. If I stood and did nothing, my ignorance would be obvious. If I tried to help out, I would just get in the way. So I hovered behind, watching as Dr. Aziz helped the fighter to a stool and examined his eye movements. Dr. Aziz yelled questions I couldn’t hear over the noise of the crowd. They sounded like the neuro exam from the night before, but simpler. The fighter was dazed but able to answer and still breathing heavily. As he swayed on the seat, officials stood behind him to prevent him from falling.

  “We have to help him off, but first we have to see if he can do it himself. If we carry him off the stage, he’ll lose his dignity. And that’s even worse than losing the match,” Dr. Aziz said, whispering close to my ear.

  The fighter stood with the help of two men and wobbled a bit. Then he closed his eyes, took a deep breath and gathered his strength to walk across the platform and down the stairs. No one else seemed to notice his courage. The crowd was focused on the winner, cheering and clapping at his triumph.

  Back at our seats, I could no longer hide the buzz of emotions that swept over me. I felt raw and alive. This violence didn’t seem wrong. It seemed honest. It gave these men an outlet I didn’t have—that very few in the professional world did. They got to express what the rest of us had to repress.

  Dr. Aziz must have sensed my revelation. “Pretty cool, isn’t it? I know we’re here to patch them up and make sure they can fight, but our real job is to make sure they don’t die. It’s like we’re doctors of war. Kind of antithetical to med school, huh?”

  “Is it wrong to love the violence?” I asked, needing confirmation that I wasn’t somehow breaking my Hippocratic Oath. I wasn’t doing the actual harm, but I was condoning it, aiding and abetting like an accomplice.

  “It’s not wrong. You’re just doing your job. Without us, it would just be barbaric. Sure, they have inspectors and judges, but we make it humane. New York is pretty strict, but other states let them get away with anything. Deaths still happen in boxing. Heck, there was a fight a couple of years ago on the Intrepid—” He stopped, realizing he had already said too much.

  “Whaddya think, Dr. Aziz?” the Chairman asked. He seemed to have come out of nowhere. “Is he gonna be okay?”

  “Yeah, Fred is back there now checking on him. He was a little shaky though.” They were talking about the loser, who was getting his final check in the locker room before being released home.

  “This may be his last bout. He’s been losing a lot lately, and each time he goes down a little quicker. I don’t think I’ll be able to let him keep fighting.” The Chairman shook his head, saddened by his own words. He knew a lot about this fighter, and his concern seemed genuine. Maybe he really was the godfather of boxing but, instead of deciding who would die, he chose who to save.

  “How’s it going, Dr. Dahl? You learn something tonight?”

  “Yes,” I said, self-consciously. I had learned more about myself than boxing, but he didn’t need to know that.

  “So, it wasn’t too much for you? The hitting? The blood?” he asked, ironic given my reaction.

  “No, not too much at all. I loved it, actually. It reminded me of the Bronx, except back then I never got to see what happened to my patients to land them in the hospital.” I smiled, trying to make light of the trauma.

  “Listen, we know you’re just figuring things out. Hell, I’m surprised you even applied for the position. I don’t know any women who’d want to do this. We just needed to know you were tough enough to handle it,” he said. I was both surprised and relieved. I had wasted the night trying to look smart, but all I really had to do was enjoy the violence.

  “Oh, I’m tough enough to handle anything,” I said, looking him straight in the eye. “I want to be here. This is where I belong.”

  7

  “Let’s go over some patients who may contact you over the weekend. I want to make sure they’re well taken care of,” Dr. Marsh said.

  It was Friday afternoon, and we were sitting in the kitchen area of the office, reviewing the week’s happenings. I was on call for the group, which meant I was covering patients usually seen by the other three doctors in addition to my own. This was not an easy feat. With 30,000 demanding, high-profile patients, I would be managing phone calls all weekend without access to their records. Dr. Marsh alone was expecting calls from one of the Kennedy clan, a major news reporter and a famous actor. I was looking forward to two and a half days of pure hell.

  “Don’t worry. They usually have their people call. They never do it themselves, so you’ll have time to get a clear history,” he said, making me feel more nervous than comforted. Although I wasn’t impressed by people famous for the sake of fame, everyone in the office made such a fuss over them it stressed me out.

  I had asked Dr. Marsh once how he dealt with it, and he’d explained, “That depends on what you consider famous. I once treated a musician I really admired. No one else knew who he was, but to me he was so impressive, I was a little nervous. But he was cool. We ended up having a lot in common and later became pretty good friends. I still see him whenever he’s in town.”

  He was right. What was fame, really? In the most basic sense, it was familiarity: recognizing someone who didn’t recognize you back. And since I didn’t know who most of these people were, it didn’t matter as much to me.

  On my way home, minutes after stepping out of the office, my pager went off. I cringed. Sensitized by five years of residency, the beeping was like an invisible, electric dog collar. Every time it went off, I was stunned into stopping whatever I was doing and submitting to its high-pitched whine. Nothing that was happening in my life trumped its urgency. Not eating. Or using the toilet. Or sex. Once, in my third year, I’d had to hang up on my crying husband, who had just lost his mentor, because the recovery room needed me. All these years later, I still had mini panic attacks every time it went off.

  Pulse escalating, I glanced at the screen to make sure it wasn’t one of Dr. Marsh’s important ones.

  Patient call. Ear pain. Please call back.

  A pit of dread collected in my stomach. I needed to calm myself, so I ignored the page for the time it took me to get home. Ear pain was not an emergency, so a few minutes wouldn’t make a difference. When I reached the lobby of my apartment, the pager went off again.

  Patient call. Ear pain SEVERE. Pleas
e call.

  This patient was relentless. But weren’t they all? Couldn’t it wait five minutes? Suffocating a scream, I took a deep breath and dialed the number.

  “Hello, this is Dr. Dahl. I’m on call for the weekend. How can I help you?” I asked, my mouth automatically forming the words while my brain replayed Juan’s magnificent knockout punch.

  “Hello, is this the doctor?” a man’s voice said on the other line. I was shocked. It was the effeminate and undeniable voice of my favorite fashion designer. I went silent.

  When I had been accepted to medical school, I was in my senior year of college at the University of Minnesota. Because I was responsible for my own tuition, I worked two to three student jobs at a time to make ends meet. In the name of efficiency, these jobs, which ranged from administering heroin and cocaine to lab rats, to squashing fruit flies for their DNA, had doubled as résumé builders. Once I had reached my goal of getting into med school, I’d decided to indulge in a job that didn’t entail killing or maiming. As luck would have it, there had been an opening in the costume department of the theater—a job that would inspire a whole new side of me.

  Weeks in, I was already questioning my career choice. Hours of pinning, cutting and sewing flew by like minutes as we sculpted three-dimensional pieces of art from flat pieces of fabric, art that danced around the stage on the bodies of actors. I’d been smitten. I wanted to spend the rest of my life making clothing. I couldn’t see myself doing anything else.

  After graduation, I had given up my acceptance to medical school and went to work in a costume shop. But it was a far cry from my college job. Countless hours in a windowless warehouse gave me plenty of time to consider my end game. My father’s voice grew louder in my head. With each bleeding finger, he reminded me I was no one without money. No matter how creative I thought I was, no one else cared. The world was full of starving artists betraying their art with side jobs. If I wanted to be anybody, I had to go to medical school. So that’s what I did.

  But my dream hadn’t died there. I’d clung to it like the Vogue magazines I carried on hospitals rounds, inspecting the anatomy of dresses as meticulously as I did bodies, and studying prêt-à-porter collections so I could copy them with my sewing machine. I memorized the name of each model, deluded that the clothes draped on their emaciated frames would look the same on my stout one. Of all the designers I had worshipped, there had been two who had impacted me the most. One was now dead. The other was on the phone with me at this very moment. I felt like the Beatles’ biggest groupie being summoned by John Lennon.

  Forgetting myself, I dissolved into starstruck madness. “Is this really you? Oh my God. I love you! I mean, wow, am I really talking to you? You’re the reason I got through med school...” Compliments poured from my mouth like waste from an ostomy. I gushed over his designs: “Understated, yet sophisticated.” I blathered about his “genius, utter genius!” of incorporating a box pleat into a high-waisted pant. I told him how I used to sew clothes from fabric scraps to look like his because I couldn’t afford the “good stuff.” I even talked about how I would visit the Fashion Institute of Technology on rare days off during residency, dreaming of one day attending classes. When I finally paused, there was quiet on the other end.

  “I trained at Parson’s. I can’t tell you anything about FIT,” he said, more than a little annoyed. Parson’s School of Design was high-end. It was like comparing Harvard to a state school. “Can I tell you about my ear now?”

  “Yes, uh, sorry. I’m all ears. Get it? Ears?” I joked, struggling to make light of my blunder. But he didn’t laugh. I simultaneously wanted to pass out and to puke.

  As he spoke, I tried hard to focus on his complaints. I heard words like pain and ear and smelly discharge, but my mind was elsewhere. I was thinking that, if I helped him, he would be so grateful he would grow to like me, like Dr. Marsh’s musician patient. He may even invite me to visit his studio so I could see what I had missed by becoming a doctor. We could become friends. The possibilities were endless.

  There was another pause on the phone. “Hello, Dr. Dahl? Are you there?”

  “Yes,” I said. I couldn’t believe he had just said my name. “It sounds like you have an ear infection. Let me call in some drops, and you can come in and see me in the office on Monday.” My heart was pounding. As the words left my mouth, I realized there was a very good chance that once he met me in person, he would forgive me. There was still hope for our friendship.

  “Okay. Here is my pharmacy number. Thanks,” he said, spitting the number into the phone before hanging up.

  The abrupt click of the receiver triggered a litany of shame. I had completely screwed up. Instead of acting cool, I had been needy like a groupie. Barely registering his symptoms, I had probably misdiagnosed him. Or worse—I had diagnosed him too quickly. I had told him to come to the office Monday, but what if he was better by then and didn’t need me? I had just spoken to the one person I had wanted to meet more than anyone, and he probably hated me.

  * * *

  Just before Thanksgiving, the other doctors were away, so my schedule was, once again, bombarded by their overflow. More seasoned by time, I had become adept at handling their patients’ exhausting expectations. One strategy I utilized was answering their questions with more questions. If they were skeptical about my experience and asked how many procedures I had done, I would laugh, batting back, “You mean this year?” Another strategy was sarcasm. When accused of being too young to know what I was talking about, I would steal a phrase from my boxing friends. “I may look young, but I’m wrinkled on the inside.” False confidence was another gem. “When I operate, everyone in the room stops to observe,” I would say. “I settle for no less than perfection.” I got so used to fielding criticism, I treated every patient encounter like a game of tennis. And, so far, I was ahead a few points.

  * * *

  “I have the worst ear pain. When the plane landed it was the most excruciating thing I’ve ever felt. Also, I can’t hear, and there is this terrible ringing.” The man seated in the exam chair was impeccably dressed. He wore a pressed white shirt, wool pants and a cashmere sweater tied around his shoulders. His blond hair, peppered with silver and gray, topped a cleanly shaven face that could have been the focal point of a Ralph Lauren ad.

  Dressed in my usual boxy Ann Taylor suit, I felt self-conscious. I appreciated the brand because it catered to mature women with inflated sizing. In Ann’s world, I was a perfect size six with a waistband that didn’t cut off the circulation to my lower body. But my outfit was far from sophisticated. Next to this patient, I looked like an amateur.

  “Where were you flying from?” I asked, forgetting myself. It didn’t really matter, but I loved hearing about these people—how they spent vacations, who they knew, what they did for work. It made the windows of my prison more transparent. Even if I couldn’t live their lives, I could at least imagine them.

  “Well, I started off in London. Then I flew to Switzerland, and we went skiing at St. Moritz. Have you ever been there? The next time you go, I’ll tell you where to dine.” I had never been to St. Moritz, but not only because I’d never been to Switzerland: I had also never been skiing and wouldn’t have had a clue how to act or dress on the slopes. But I nodded anyway, playing the game the only way I knew how.

  “So you flew, and then went skiing. Did you have a cold?” I was relatively certain he had an ear infection. But because it rarely happened in adults, there had to be extenuating circumstances, like stuffy sinuses, coupled with extreme changes in barometric pressure.

  “Yes I did! How did you know?” he asked, surprised and almost giddy. “I’m impressed that someone so young and new in practice would know something like that,” he said, inadvertently turning his compliment into an insult.

  I reeled internally, then proceeded with the exam. I would have to prove myself another way.

  I peer
ed into his ear, at one of the worst middle-ear infections I had ever seen. His drum was thick and red and oozing with pus. Although it wasn’t cancer, the diagnostic term for his condition underscored its seriousness: malignant otitis media. Without immediate intervention, he could permanently lose his hearing, but I didn’t want to alarm him. I kept my statements simple and calm. “I’m gonna have to drain your ear,” I said. “It’s really infected.”

  “What do you mean drain it? Like with a suction?” he asked, smiling like I had just told him he was getting candy. His responses were so odd, I couldn’t tell if he was confused or delirious from pain medication.

  “Not exactly. I’ll have to numb your eardrum and then puncture it to drain the fluid.” I expected him to refuse or at least show some fear, but he just nodded, like a little boy accepting directions from his teacher.

  “I trust you,” he said. His words were powerful, filling my tragic ego with real confidence.

  I forged on without words, numbing his eardrum with topical lidocaine, then magnifying it with a microscope. Using a tiny scalpel, I pierced the drum, releasing thick, yellow pus through the hole, and draining it with a metal ear suction. Once cleared, I placed a plastic, bobbin-shaped tube into the hole and dripped antibiotics into his middle ear. Altogether, it took less than ten minutes.

  “Wow, I feel better already!” he said, as I was returning his chair to the upright position. “I have to say, you are just spectacular. I am just so, so impressed.” His enthusiasm was so robust, I thought he was mocking me. People like him usually made me work hard to earn their respect. He was actually being nice.

  “Let me ask you something. Do you think you would be free for lunch sometime this week? I really want to thank you, and I know this great little Italian place around the corner.”