Tooth and Nail

by Linda D. Dahl

  “Oh God, it’s you,” he said, extending the word you into a near whine and rolling his eyes when he saw me. “They said Dr. Marsh was out, but I didn’t realize you were the only one left.”

  I hadn’t realized I had made such a strong impression. Seeing there was little I could do to salvage the relationship, personal or professional, I decided to just attend to him and get it over with. I had treated dignitaries and rock stars in residency because it was my duty. How hard would it be to treat an angry diva.

  “What’s going on with your ear? Is it still hurting?”

  “I was kind of skeptical when you prescribed the drops. They worked at first, but then they stopped. Dr. Marsh usually gives me different ones, but you got so worked up on the phone I couldn’t think straight and forgot to tell you.” He stuck his index finger into his left ear and twisted it back and forth. When he pulled out the tip, it was coated with a sticky substance that had the faint odor of sulfur.

  Concealing my revulsion, I peered into his ear. Thick white mucous coated his irritated canal like milk pudding. His eardrum was covered in tiny red bumps, which meant he had tried to relieve the itching by scratching it with a foreign object. “What did you put in your ear? Did you use Q-tips?”

  “Well, it itches like hell. What do you expect me to do? It’s driving me crazy! I used Q-tips, bobby pins, pens and whatever else would fit in there.” He was getting more upset and defensive with each question, as if I were to blame for his infection.

  “It looks like you still have an external otitis—I mean swimmer’s ear. Did you keep your ear dry?” I was trying not to talk down to him, but the medical words came out faster than the lay ones.

  “You didn’t tell me to keep my ear dry.” He was right. In my frenzy over his phone call, I had forgotten to give him that instruction. Usually the drops worked, but if his ear had been subject to additional water, I wasn’t surprised it was still infected.

  “It looks like the dampness and Q-tips prevented the infection from healing. Now you are growing fungus. It’s like athlete’s foot in your ear.” That was an awful comparison, but it was true.

  “In my ear? That’s disgusting!”

  “It happens—”

  “Oh my God, what do I do? I can’t live like this, with this itching and the smell...” He was nearing the point of hysteria, when I realized the real problem. He was scared because he didn’t trust me.

  I sat back down on my stool so I could look him straight in the eye. “This infection is very treatable,” I said. “It may take some time, but we can get rid of it.”

  “How in the hell are we going to do that!?” he nearly yelled, snapping out the words with liquid spittle that landed on my face. He hated me, but I had to keep going. If I let his anxiety get the better of me, I would fail him. I could live with his never wanting to be my friend, but I couldn’t live with being an inadequate doctor.

  “I will prescribe a different medication for you. The drops may burn a little at first, but you have to use them so you get better. And you have to keep your ears completely dry. If you must use Q-tips, put some cortisone on them first so it calms down the itching.” He quieted and continued listening, finally looking me in the eye.

  “Next week, you can come back and see Dr. Marsh so he can make sure everything has healed.” I knew he never wanted to see me again, and I wanted him to see that I understood that.

  When he finally left, he was less agitated but hardly serene, clutching my prescription in his hand like divorce papers. At that moment I took hold of my ego, blindfolded and silenced her, and put her in the corner.

  8

  Every breed of doctor has a national organization. My own specialty has the American Academy of Otolaryngology, whose yearly meetings alternate between the East and West Coasts and draw in many of the country’s over 9,000 practicing ENTs. I shouldn’t have been surprised to learn that fight doctors have their own group: the American Association of Professional Ringside Physicians, or AAPRP for short. They also have an annual meeting. When I had first heard about it, I laughed. Not only because I confused it with the similar sounding association for retired persons, the AARP. I also couldn’t see how the unofficial, hands-on New York style of fight doctoring could translate into a lecture format. For all I knew, we would be trapped in an over-air-conditioned conference room for two days, talking about boxing stats and trading Outback Steakhouse coupons.

  The conference was held in Las Vegas, the boxing epicenter of the country. I had been there only once, a few years prior, when my conservative older sister had invited me. After perusing indoor shopping malls and sunning by the pool, she had insisted we retire to our prospective beds by 8:00 p.m. The very sins she wanted to avoid were the only reasons anyone visited the city in the first place. More than a small part of me hoped this trip would make up for my last train wreck.

  The conference room the AAPRP had reserved at the Luxor Hotel was tiny, with only five or six round tables, a small projection screen and no refreshments. Taking a chair next to Dr. Gonzalez, I berated myself for not stopping at the Starbucks kiosk on the way in. Even with coffee, staying awake would present a challenge. I counted a total of twenty people at the tables. The only other woman was the conference assistant, who was checking everyone in.

  “Did you get any rest on the plane?” Dr. Landau asked, joining us at the table. He was in his mid- to late-fifties, with chin-length gray hair that he tucked behind his ears and a drawn-out New York accent.

  “I always sleep on planes. It’s a gift, really,” I said. Sleep was one thing that never escaped me, but it wasn’t always a gift. I remembered a middle-of-the-night laparoscopic bowel case in residency when I had fallen asleep. It wouldn’t have been so bad if I hadn’t been standing up, holding the camera. But even the bumpy ride the surgeons endured from my narcoleptic bobs hadn’t been enough to excuse me from the case.

  “That schmuck from Ohio’s here. Who the hell boxes in Ohio?” Dr. Landau asked, looking around the room at the empty tables. I had no idea who he was referring to.

  “Don’t they box in all the states?” I asked. I assumed that this national organization represented the whole country. It hadn’t occurred to me that some states didn’t have boxing. Places like North Dakota could have used it. There was plenty of time to train, especially when wheat surpluses meant farmers were paid by the government not to farm. And the men were burly enough. I used to call them corn-fed.

  “No, only in twenty-odd states. New York, New Jersey and Nevada are the big ones, but there’s also Connecticut because of the casinos. The rest of them—agh—I don’t know why they even bother,” he said, pushing his glasses up to meet his face. “You’re probably the only ENT, did you know that?”

  “Really?” I asked. I was so conscious of being the only female ringside doctor in New York, it hadn’t occurred to me that I was another kind of only. “What other types of doctors are there?”

  “Lots: orthopedics, rehab, family practice, internists,” Dr. Gonzalez piped in.

  “There’s even a psychiatrist,” Dr. Landau said.

  “How does that work? If a fighter gets knocked out, does he run into the ring and ask about his childhood?” I realized as soon as I had said it that it was probably a fitting approach.

  “There’s also a radiologist. What do you think of that? Personally, I don’t think it really matters. If you’re a doctor, it means you’ve made it through med school and you’re smart, and if you’re willing to work for the peanuts they pay us, you’re obviously a huge boxing fan. You’ll make sure no one gets hurt,” he said.

  He had a point. For a whole night’s work, the doctors were paid less than a single patient visit in the office. I disagreed with the rest of his argument, but I didn’t dare say it out loud. Getting into medical school didn’t automatically translate into genius. Not all doctors are created equal, nor does their purported inte
lligence mean they have common sense. There is a running joke that goes: Do you know what they call the person who graduates last in their medical school class? Answer: Doctor. I had already heard of one death in New York on a ship, called the Intrepid, and many others injuries, fatal and otherwise, in Las Vegas. And although I didn’t know the rules of boxing, thanks to the Bronx I knew more about head trauma than I ever wanted to know. With all the other injuries boxers sustained, head trauma was the one that could kill them, yet very few of these specialists were trained in that.

  We sat through the first lecture about the history of the AAPRP by its founder, Dr. Michael Schwartz, the chief medical examiner of the Connecticut Athletic Commission. Still a young organization, the AAPRP had only been around since 1997, hence the sparse membership and lack of free coffee. It turned out that every state operated its commission with their own set of rules. Dr. Schwartz’s main goal was to establish bare-minimum medical standards for boxers that would be adopted by commissions of every state. Although the federal Professional Boxing Safety Act had been passed in 1996, there was no national governing body to enforce it. I was surprised to learn that most states didn’t even do basic evaluations, like eye exams and MRIs. And the regulations differed so much from state to state that promoters used that disparity to their advantage, holding risky fights in states with lenient rules. Apparently, New York was known as having the toughest commission of all. And here I was, thinking it was lax.

  More lectures followed: lectures on hand trauma, head trauma, eye trauma. A former boxer talked about his relationship with the commission. He explained that boxers didn’t see the doctors as protectors. They saw us as enforcers. They often lied about injuries so we wouldn’t pull them out of fights for medical reasons. For the boxers, the goal wasn’t safety. The goal was to stay in the ring. At any cost.

  The memory center of my head was spinning, searching for a place to store all I didn’t know, when I noticed a woman standing near the podium. Tall and lanky, she had a shock of unnaturally red hair that lay limp on her shoulders. It was the great Dr. Margaret Goodman. She was the only other female fight doctor I had ever heard of and, although women were usually marginalized in medicine, she was, ironically, the most famous fight doctor in Nevada. If there was ever a role model for me in this sport, it was her. She had worked some of the biggest fights in recent history, and there she stood, at the front of the room. We were on a break between lectures, so all I had to do was go up and talk to her. I couldn’t pass up the opportunity.

  “Hi, Dr. Goodman. I’m Linda Dahl. I’m a doctor in New York,” I said, extending my hand, nervously.

  She looked up, briefly making eye contact, and offered a reluctant handshake. When she looked away without speaking, I tried again, assuming she hadn’t heard me. Maybe I was too vague.

  “I’m a fight doctor in New York,” I repeated. “I really admire your work. You’re so well respected—” I stopped speaking when she turned to engage the man next to her in conversation. It was like I was invisible. Stunned and embarrassed, I couldn’t understand why she wouldn’t talk to me. Maybe she was shy. Or perhaps I expected too much.

  During residency, when I had been rotating through a hospital in Long Island, Hillary Clinton had paid a visit to a neighboring hospital. She and Bill had occupied the White House during my entire medical training, and I was a huge fan. She was such a strong woman, the way she held her own with her philandering husband and ran for Senate while he was finishing his term in office. So, when I had heard she was speaking, I bartered, negotiated and lied to get away long enough to hear her. I wanted to bathe in her presence.

  Still in scrubs and praying I wouldn’t get caught, I arrived just in time. The event was held under an outdoor tent on the hospital lawn, and I found a chair in the back row. I felt so proud to be there—rooted like the legs of my chair, which were sinking into the damp grass under my weight.

  Hillary stood at the front of the room in a cornflower-blue suit, hair perfectly coiffed and helmet-shaped. Although she looked the part of a political wife, she operated like a senator. Every statement, every comment was immaculately crafted. She referenced personal comments from the crowd and earlier speakers, seamlessly weaving them into her responses. She was a genius negotiator and powerful figure in Congress. I was infatuated.

  After the speech, standing in line behind other hospital workers, I prepared my five-second blurb. I couldn’t believe I had the chance to meet her, and I wanted her to see how important she was to me and other female surgeons. We were invading fields of men like she was.

  I approached the table, ready with words strung into sentences. “I am so happy to meet you, Senator Clinton. I’m a surgical resident at the hospital, and I wanted you to know how much I admire you. There are so few women in the program, and you’re such an inspiration to all of us.” I was so nervous, my eyes darted around the tent as I spoke, looking up when I said the words admire and inspiration. When I finished, I finally met her gaze, excited to see her reaction. But instead of the raised eyebrows and prideful smirk I was expecting, her expression was cold and empty. Her tight lips wouldn’t even part for a fake smile. She was so bored she may as well have been listening to her housekeeper talk about laundry detergent.

  In that instant, I had lost my crush on her. It’s true that public figures don’t always live up to our individual needs, but this seemed basic. And not unusual when it came to women in male-heavy environments. When we reach more powerful positions, women rarely champion other women. In my own specialty, women didn’t band together to support each other. In fact, we did the opposite, getting out of the line of fire, or aligning ourselves with supportive men instead.

  There was one woman in my program who was sick of the sexist comments and offensive requests that we all faced every day. But, unlike the rest of us, she’d chosen to fight back. When one attending nuzzled his nose into her neck during a case, she called him a creep and shoved him off. When another intertwined stories of his philandering with surgical instruction, she refused to listen and scrubbed out of the case. But there were consequences to her actions. The men labeled her a troublemaker and blackballed her in all the hospitals. Even after graduation, every time she applied for privileges, she had to send a letter of recommendation from the department chair. But it was never a real recommendation. It was no surprise that she ended up in a small-town hospital in New Jersey.

  But the rest of us had done nothing to support her. We were all out for ourselves. When a powerful surgeon told me to Come and sit on Papa’s lap if I wanted to perform the surgeries, I had obliged. When another told me to make sure my husband knew not to get me pregnant during residency, I had laughed it off and agreed. Other women used different tactics, like acting matronly or pretending they didn’t understand jokes about rabbits having quiet sex because they have cotton balls. We saw who had the power, and we also saw what happened to those who tried to fight back. In medicine, no one can hear you scream.

  * * *

  “If every state makes up their own rules, why do we even need commissions? Other sports, like baseball and football, they don’t have sanctioning bodies, do they?” I asked Dr. Landau. The conference was over for the day, and he had invited a group of us out to a Mexican restaurant for a lesson on tequila. It was one of those indoor–outdoor Vegas places, where the outside was still inside, under a ceiling of fake clouds. Since it was only four thirty in the afternoon, the place was almost empty.

  “Commissions and sanctioning bodies are two different things. The commissions are how boxing is even allowed to happen. It’s illegal to fight another person with the intent to do harm. It violates criminal law, even if they are consenting adults,” he said. “So the commissions are the states’ way of getting around the law.”

  “Did you know that if a professional fighter gets into a street fight, it’s considered assault with a deadly weapon?” Dr. Gonzalez added.

  “N
o way!” I said, incredulous.

  “Yeah, a fighter has to announce it before he fights, or he could get in trouble for attempted murder,” Dr. Gonzalez said. “Back in the day, fighting and killing in public was normal if you had a good reason. Duels used to be legal, remember?”

  “Thankfully, not anymore,” said Dr. Rosenberg, an orthopedic surgeon from Westchester.

  “Sanctioning bodies are the groups that give out belts and titles and things. And here’s where it gets really complicated. There are—get this—four sanctioning bodies. There’s the World Boxing Council, the World Boxing Association, the World Boxing Organization and the International Boxing Federation,” Dr. Landau said, pressing his right forefinger onto the fingers of his left hand as he counted them off.

  “Why are there so many?” I asked.

  “Because everyone needs to be the king,” said Dr. Rosenberg. “It’s how they get rich. Each sanctioning body has its own rankings and titles, so every time there is a championship fight, they can advertise and make money on pay-per-view. And now there are—what, fifteen to seventeen weight classes? Every weight class has a world title, and there are four titles for each division. It’s sad, really. There’s no such thing as a real champion of the world.”

  The tequila arrived on two tasting trays, with three glasses each of translucent liquids of differing hues. Dr. Landau explained the differences between each. “For every tequila, there are three main types. First is the silver.” He lifted up two glasses of clear liquor. “This is the agave spirit in its purest form. It is bottled straight from the distillation process, so you can taste its sharpness.”

  The four of us each took a sip from the first glass. It burned my throat, reminding me of the last night I had forced down tequila.

  One summer night, I had downed two shots of Jose Cuervo, before driving up and down the main strip in Minot to advertise a party I was throwing to anyone and everyone in my path. The party, which concluded with a knocked-down chimney and a raid by the cops, was a thank-you present to my mother. I had wanted to punish her for giving me one of the greatest scares of my life.