Necessary Medicine

by M. K. York

  “Yes, sir.”

  So he went around to try to find Eli. He could have paged, or emailed, or called, but they were already so close—the patient was on the Cardiology service. Maybe Eli was in his office. No, the door was closed and locked. A passing nurse said, “Are you looking for Dr. Newcombe? He’s in with 603.”

  “Thank you!” Neil was already heading off down the hallway.

  Eli looked up as Neil stuck his head around the corner. He was sitting next to the patient’s bed, loosely holding the patient’s hand. Neil felt an immediate sense of guilt at interrupting them. They both looked calm, though, so at least it probably wasn’t a bad news kind of talk.

  “Just wanted to discuss a case with you,” said Neil. “Find me when you’re done?”

  “Of course. I should be out in five minutes, if you can wait.”

  Neil nodded and went to stand by the nursing station. Eli was out in more like two minutes. “Sorry about that,” Neil started, and Eli shook his head.

  “I have trouble disengaging from her sometimes, that was helpful. Who’s the case?”

  “Chaudry’s heart transplant?”

  “Oh, of course! She’s in dire straits.”

  “Yeah, he wanted me to get the dirt on her workup for a pacemaker.”

  Eli smiled faintly. “He hates reading notes, doesn’t he? Can’t he put a med student on that?”

  “I don’t think he has any right now.”

  “Well, the good news is I remember that one. She’s got scarring and probably adhesions from hell to breakfast from her valve repair. We started in on the workup as soon as we got her. Her heart failure is so bad it was pretty clear she was going to need a transplant anyway by the time we had the echo and got the records on her valve, and if we can switch out that monster for a heart that’s human-size, that should take care of her electrical difficulties.”

  “But should we be considering it as a bridge if she can’t get a heart?”

  Eli’s face was somber. “I don’t think she’d gain enough time from it, considering the challenges of the surgery, that it would be worthwhile. Hospice would be the next appropriate step.”

  “Chaudry was wondering whether the anticoag was a factor.”

  “Well, no, not really. I mean, I’m not afraid she’s going to clot in the time she’d be off warfarin for the surgery.”

  “Okay, thanks.” Neil knew he should go—he’d gotten what he’d come for—but he lingered for a minute. “Is there anything else I should know that would make me look good in front of Chaudry?”

  Eli laughed, and he put a hand on Neil’s elbow for a second before saying, “No, I think you’ve covered it,” and walking away.

  * * *

  He made it out to Nevada for Bobby’s wedding. He was so sleep deprived he didn’t really register most of it, but he’d written his toast ahead of time, he got everybody into the appropriate limos at the appropriate times, and he didn’t lose the rings. He was ready to call it a success.

  Bobby and Karen looked so fucking happy together. He watched them, and he wondered if maybe he’d look like that if he’d gone into family medicine instead of surgery.

  Too late now, he thought to himself. When Bobby turned to smile at him, his round face alight with happiness, Karen’s red hair glowing in the evening light, he found himself smiling back and even meaning it.

  * * *

  General Surgery at County meant a lot more trauma than Neil saw at Kingsland Medical Center. Every time he turned around there was a bullet wound or stab wound to evaluate, or some idiot kids setting off firecrackers and blowing up their hands, and since he was rapidly approaching his fourth year, people were starting to think he knew how to do something about it.

  It was getting easier to take control. The surgery itself had always been the fun part; standing around watching other people do it wasn’t fun, waiting for pages wasn’t fun, sleeping in the call room definitely wasn’t fun. (Trying to sleep, while clutching the pager and knowing that any second now it was going to go off.) But he was getting to the point where even when there were fellows around, who’d already finished their residencies and were getting additional training, he got to do some of the more interesting procedures.

  He sent Pete an email a couple of weeks into his rotation at County: Hi Pete, just letting you know I’m not dead. Sincerely, Neil

  He got a response almost a week later: Good. Just one word. He laughed out loud.

  There were days when it was impossible to laugh. He saw three hemorrhagic strokes in forty-eight hours, never leaving the hospital. This was what he hated about Neuro, anything even close to it—the sound of the drill cutting through the skull wasn’t so bad, but the look of blank shock on the family members’ faces when he told them that even though the person they loved looked whole, they were never coming back.

  He sat down heavily after one of the conferences with the family. They were refusing to allow care to be withdrawn. He wanted to shout; he wanted to say, Don’t you understand that there are worse things than being dead?

  He didn’t, because he was a goddamn professional. A surgeon. He wasn’t there to make the family’s decision for them. He was there to facilitate.

  The patient ended up lingering in the hospital for a week, until their attending sat down for the ninth conversation with the family about the patient’s chances. The prognosis was simple—he wasn’t going to wake up, and even if he did, it would be without the higher brain functions that had made him who he was.

  Neil watched from his seat, to the left of the attending and behind him, as the wife shuddered, finally, crying as she agreed to withdraw life support.

  The patient passed away almost immediately. Neil signed the death certificate. At the M&M that week—of course County had their own—they had to talk about the patient who might have done better if he’d been decompressed sooner.

  * * *

  Neil was happier when that rotation ended and he switched back to Kingsland.

  “What are you on now?” asked Eli as they puttered around the conference room after his first meeting back.

  “Two months on the SICU.”

  “Oh, that’s...well, I don’t think I can say fun and mean it.”

  “It could be worse. I could still be on peds.”

  Eli winced, nodding. He was stowing the conference phone back in the cabinet where it lived. “It’s always rough to see sick kids. No way around it.”

  “I don’t know how people do it.”

  “I did some pediatric cardiology in residency—it was brutal. I mean, a lot of my patients had congenital defects, but either they saw someone else as kids or it isn’t diagnosed until they’re adults.”

  “Yeah.”

  Eli paused, hand on the cabinet door. “Are you all right?”

  Neil shook his head a little, tightly. “I guess so. I just...kept thinking this was going to get easier, and it doesn’t. It hasn’t.”

  “It has.” Eli came around and perched on the edge of the table next to him, where Neil was leaning. He met Neil’s eyes, tilting his head and dipping until he was in Neil’s sight line. Neil sighed, blinking, his eyes meeting Eli’s against his will. “It doesn’t feel that way, because it’s designed not to. It’s designed to keep getting harder, to make you keep working for it. But you are getting better at it.”

  Neil laughed harshly, running a hand across his face. “Sure. That’s why I got reamed at the M&M.”

  “Everyone does, sooner or later. We all lose patients. We all even fuck up, sometimes.” Eli’s face was impossibly kind.

  Neil pushed off the table, standing up, looking away from Eli. “Right. Think you can get the whiteboard yourself tonight?”

  “Yeah,” said Eli. His voice was gentle.

  “Great.” Neil left. In the hal
lway, he had to rub at his eyes briefly, fiercely. He wasn’t going to cry over this.

  * * *

  It was Mark’s birthday in June. Well, not strictly speaking his birthday; he had to work on his birthday. But close enough, and they managed to find a night where they could all get a chunk of free time. And they went to karaoke.

  “Oh, no.” Mark started laughing when he realized where they’d taken him. “You bastards! You motherfuckers.”

  “Birthday boy incoming!” shouted Neil as they wrestled him through the door, pulling the sash over his head as he struggled.

  A few hours in, one of the guys was hitting on Kristi with increasing intensity, she looked like she was at least considering making that particular bad decision, and a pretty fifth-year was sitting in Mark’s lap. Neil was onstage, and this time he went for a song about grinding on a married man—and when he finished, he swept a magnificent bow, to scattered applause and loud hooting.

  When he got back to the table, Mark was almost crying with laughter. “Shit, man, Kristi recorded that all.”

  “What? No! Kristi! Gimme that!”

  She held her phone out of his reach and tapped a few more buttons frantically. “Okay, it’s shared on Facebook. Sorry, buddy, that was too good to miss.”

  “Fuck you so hard!” he gasped in outrage. “I was having a moment!”

  “Yeah, you were,” slurred the girl in Mark’s lap, grinning. “It was inspirational.”

  He had to go in the next morning with an awful hangover; he thought about hooking himself up to IV fluids but dismissed the idea as impractical, because he was already behind by the time he got in.

  Pete emailed him halfway through the afternoon. Hell of a performance there.

  Oh, not you too, he replied.

  Pete just sent a blank email with the video file attached.

  On a sober viewing, Neil still thought he’d sounded pretty damn good. And goddamn it, he looked good; his biceps under his tight T-shirt hadn’t been this cut in months. His weight bench, at least, was a familiar friend, always ready to support him.

  * * *

  After the next work-group meeting, Eli murmured with a very straight face, “I was wondering if you were planning on pursuing a career in music next.”

  Neil just made a rude noise, rolling his eyes at Eli, and Eli burst into laughter that he tried to stifle, grinning madly.

  “I take it that’s a no on Broadway?” Eli asked, trying and failing to sound innocent.

  “Oh, you’re just jealous I can hit the high notes,” said Neil, sweeping a pile of muffin crumbs off the table where Dr. Sisk had been sitting.

  After a moment, Eli said, “Actually, I sang in high school.”

  “What, really? Me too!”

  “I guessed that,” said Eli, smiling wryly. “Yes. I was a baritone.”

  “That’s cool! I was a tenor.”

  “From what I heard, you still are. You could consider a career in pop music.”

  “I don’t know, I’m not sure I’m enough of a douchebag for it.”

  Eli laughed again. “You’ve got me there. I don’t think you could be that much of a douchebag.”

  “Then again, maybe you’ve just never seen me at full douchebag potential.”

  “Maybe,” said Eli, a little smile playing around his lips.

  “Need a hand?” He nodded at the whiteboard.

  “If you’ve got time.”

  “I think I do.”

  In the elevator, Neil said, “So, why did you stop singing?”

  “Oh, the usual, I suppose. I got busy with school. College was harder, I had less time.”

  “Me too.”

  “And karaoke wasn’t something we did back then.”

  Neil snorted. “‘Back then.’ You make it sound like the Stone Age.”

  “Well, I don’t remember roasting any mammoths, but it has been a while.”

  “How old are you? Ten, fifteen years older than me?”

  “I’m, uh, let me see, I turned forty-three last year.”

  “See? You’re twelve years older than me. I call bullshit.”

  “Have it your way,” said Eli as they got to his office. “I’ll see you next week.”

  “Yeah.” Neil paused in the doorway, reaching out to put a hand on the frame for a moment. “Eli?”

  “Yes?”

  “There’s no reason you couldn’t go to karaoke. I bet Pete would go and have a blast.”

  “That’s exactly what I’m afraid of,” said Eli with such muted horror that Neil had to laugh.

  “All right. Good night.”

  “Good night.” Eli turned on his desk lamp.

  “What do you even do here this late at night?”

  Eli looked up. “Tetris, mostly,” he said deadpan, and then laughed at the look on Neil’s face. “No, no. I’m always playing catch-up with my notes.”

  “Oh. Me too.”

  They looked at each other for a minute until Neil cleared his throat. “Right. Well, good night for real, this time.”

  “You too.” Eli looked like he was holding in a smile.

  * * *

  “Are you going to sign the card for Eli’s birthday?” asked Pete.

  “Uh—sure. I didn’t know it was his birthday.”

  “It’s not, it’s the eleventh. I’m just getting it done early.”

  “You?” Neil raised his eyebrows. The August heat had their coats wilting, and Pete looked like hell, sweaty and annoyed in the hallway where he’d stopped Neil as he passed. “Ahead of schedule?”

  “I know, I know. Don’t get used to it. Here.” He pulled out a manila envelope. “Just sign it and pass it on.”

  The handful of other messages were all cheerful, polite and bland. Neil agonized for an embarrassingly long time before writing, Happy birthday, I hope it’s a great year! Thanks for everything!—Neil

  It felt inadequate, but it would be strange to get him a present. Wouldn’t it? He decided that it would.

  Chapter Eleven

  Neil was in the SICU, checking a patient’s chart, when his chief stuck his head in. “Hey, did you hear Mark passed out?”

  “What?”

  “Yeah, he went vasovagal during a surgery. Patient’s okay. Mark is getting an ECG.”

  Neil went to see him as soon as he could—Mark was occupying an ER room, complaining weakly, splotches of color on his cheeks. “Come on, guys,” he was saying as Neil walked in. “My heart’s fine, I just haven’t eaten in like a day.”

  “So drink up,” said one of the nurses firmly, holding out one of the protein shakes they kept on hand for the patients.

  Mark made a complaining noise as he took it, but then he glanced up and saw Neil. “Aw, man. They’re sending in the cavalry?”

  “I thought we all got this out of our systems first year.”

  “Not me, I was saving it for a special case.” He winced as the nurse ripped off an ECG lead snap, the sticker probably taking some chest hairs with it. She briskly wiped off the gel with the edge of his hospital gown, open over his bare chest.

  “You really didn’t eat?”

  Mark’s eyes slid sideways. “I just kept forgetting and running out of time. And then we had an emergency appy come in and I thought it would be fine.”

  “Do I need to hire you a personal assistant?”

  “Feel free, man.” Mark gestured expansively. “I could probably use one.”

  “When are they letting you back up?”

  “I figure as soon as Cardio reviews the ECG and reassures them I’m fucking fine,” he called after the nurse who had vanished with the printout.

  “Don’t get vulgar or they’ll restrain you.”

  “I think t
hey’ve just been looking for an excuse to do that, honestly. How’s the SICU?”

  “Same ol’, same ol’. Ascites as far as the eye can see.”

  Mark laughed without much humor. “Go figure.” He took a long drink of the protein shake.

  “You want another one of those?” Neil nodded at the bottle.

  “God, no, it tastes like crap. I just figure if I get my blood sugar up I’ll feel human again.”

  “You’re a moron. You need food, it’s a fact of life.”

  “Hey, I thought my liver could keep up.”

  “It’s just one organ, Mark. It can only do so much.”

  Mark stuck out his tongue. “Thanks, Mom.”

  “You’re welcome, asshole.”

  “Mark?” They both looked up, guiltily; it was Eli, standing in the doorway with a hint of a smile on his face, hands in the pockets of his white coat.

  Mark cleared his throat. “Hello, Dr. Newcombe.”

  “Please, call me Elias. I took a look at your ECG. It’s totally normal.” Eli raised his eyebrows. “Unlike your blood sugar. How long, exactly, did you go without eating? Are you diabetic?”

  “A long time, and no.”

  “I’m going to tentatively clear you to go back to work, but I don’t want to see this happen again.”

  “Understood,” said Mark, already sitting up, starting to pull off the Band-Aid from the blood draw.

  “And no surgery until you get some food in you.”

  “Yes, sir.”

  Eli glanced at Neil and rolled his eyes—it was so classic, Neil found himself smirking back at Eli as they shared a moment of get a load of this guy.

  “I thought you couldn’t pass out from hypoglycemia,” Mark muttered as he got his shirt back on. “I swear they told us that in med school.”

  “No, but your counter-regulatory hormones—”

  “Oh, God,” said Mark to Neil in an aside. “I didn’t realize I was asking for a lecture.”

  Eli said, “Any more sarcasm and I’ll tell the nurses to put you in the drunk tank.” The glass-walled room that locked and kept the noise from permeating the rest of the ER too badly was popular for people who came in intoxicated.