Necessary Medicine

by M. K. York

  Neil looked at his documentation grimly. “Yeah. Just means this’ll be waiting for me when I get back.”

  “When isn’t paperwork waiting for you?”

  “Good point. Death by a thousand paper cuts.”

  “I’ve heard that joke many, many times, but it’s still true.”

  They walked together back to the Cardiothoracic surgical offices, where Wei was buried among stacks of unread journal articles, and then to the cafeteria. Wei spent a sizable chunk of the lunch complaining about how the patient hadn’t gotten follow-up.

  “They told him, you have Marfan! And what does he do? Does he take himself to the optometrist, who tells him, yes, you have iridodonesis, you have Marfan? No. Does he take himself to a cardiologist, who tells him, you have aortic-root dilation? No! He goes to a clinic where they tell him, you have high blood pressure, you must be careful. And then, is he careful? No! He is not careful! He does not take his meds!”

  “So are you thinking a complete valve replacement,” asked Eli, forkful of macaroni and cheese dangling forgotten, “or a mitral clip?”

  “Complete replacement. Have you seen this valve? I have seen firmer spaghetti. I do not trust it to stand up to a mitral clip.”

  Neil watched Eli and Wei arguing, and tried not to smile.

  * * *

  It took weeks before that patient recovered enough to go home. Eli had become a quiet but regular presence on rounds, as if he had antennae tuned to their presence in the patient’s room.

  When Neil realized he was standing in the patient’s room on Valentine’s Day, looking across the patient’s bed at Eli, he could barely stifle the urge to laugh at himself.

  Finally, the patient was discharged, with a stack of instructions and referrals, warnings and new medications. He didn’t resemble the belligerent, stoic patient in his records anymore—he was weaker, paler, thinner. He still needed to be on fairly massive doses of stool softeners to keep him from hurting himself and possibly tearing more sutures with bowel movements. He’d looked for a couple of days like he might come down with hospital-acquired pneumonia.

  “I’m serious.” Neil sat next to his bed on the day of discharge. “This could have been much worse than it was. If you can’t take your blood-pressure medication, you need to talk to us so we can find a way to get you on a medication that you can take. And you need to follow up with the appointments we talked about.”

  The patient nodded, looking down at his hands. The blue veins stood out on their backs. His eyes looked sunken behind his glasses.

  “I get it,” said the patient.

  * * *

  The day after they discharged the patient, Pete called Neil. “Hey, there’s another Nets versus Blazers game tomorrow. Want to come over and watch it again?”

  “Sure, sounds good. I’m not off until pretty late.”

  “That’s what DVR is for. You and Eli still good?”

  “Yeah, we’re still good.”

  “Great. I’ll see if he’s around.”

  Eli texted Neil the next day. Got a ride in this afternoon, could you give me a ride to Pete’s and home after that?

  Sure, said Neil.

  Great. Just come grab me when you’re ready to head over.

  Will do

  Just come grab me, indeed.

  There was light showing through the cracked door of Eli’s office when he went by after he finally finished up with his patients for the night. He rapped on the door.

  “Come in,” called Eli, and when he walked in, Neil was hit with a sudden sense of nostalgia. How long had it been since he’d seen that room for the first time? Over two years. And he could remember that feeling, helping Eli with the whiteboard, charmed by him, the big-shot cardiologist.

  “You know,” said Neil, leaning his shoulder against the door frame, “I used to think you were pretty intimidating, before I knew what a huge nerd you are.”

  Eli laughed out loud, setting down the article he was circling things on in red pen. “To be fair, cardiologists are all huge nerds. It’s how we end up here.”

  “Are you about ready to go?”

  Eli was already getting to his feet, reaching for his coat on the hook next to the door. “Yes. I need an excuse to get away from that article. I’m reviewing it for a journal.”

  “You’re a reviewer?”

  “Whenever I can’t avoid it. I find it depressing.”

  “Not much good research coming down the turnpike?”

  Eli shook his head. “Plenty of good work, but very few people are any good at writing, so it comes out as a hash.”

  They walked out to the parking garage chatting about the patients on their services. “One of my residents is presenting at ACC this year,” said Eli. “We had an interesting case—that HOCM I talked about? She got interested in that surgery and sequelae, and she’s going to be presenting a case series on all of our HOCM patients.”

  “That sounds interesting.”

  “It is. At least, I think so.”

  The drive over to Pete’s was quiet. The weather was warm for the time of year, but still chilly enough that Neil was glad for his windbreaker.

  When they walked into Pete’s condo, the smell of wings was in the air and Pete greeted them with a beer in each hand. “Neil? One for you?” asked Pete, handing one to Eli.

  “Yeah, just one, I think.”

  “They’re in the fridge.”

  Pete took the best spot on the couch again, and Eli took the armchair, so Neil settled back into the same spot he’d had the last time.

  The game was tight again—the Blazers edged out the Nets, but it wasn’t by too wide a margin. They were mostly riveted by the game on the screen.

  “You guys have that meeting with the administration coming up—when? Next month?” asked Pete, once, when there was a lull in the action.

  Eli nodded. “We’ll be presenting the individual stories to the admins, and the whole thing will be covered by the campus paper. We’re still trying to get one of the reporters at the city paper on board.”

  “Bringing out the big guns?”

  “If we can.”

  Pete glanced over at Neil. “How are you feeling about it all?”

  Neil shrugged. “I’m not thrilled, but I’ll do it. It’ll be fine. Worst-case scenario, the admins flip, but I’m still out of here in June.”

  “Got a handle on what’s next for you?”

  “Not yet.” Neil kept his eyes on the screen, not looking over at Eli. “I’m weighing my options.”

  “You want my advice, don’t put too much weight on what the recruiters tell you. They’re not your friends.”

  “Yeah, thanks.”

  Pete flinched suddenly, hand going to his breastbone, rubbing in small tight circles. “Damn heartburn. Gets me every time I have a beer lately.”

  “There’s a solution for that,” said Eli.

  “I know, I know. But a man needs his little joys in life.”

  * * *

  On the way to Eli’s house, Neil tried to keep the conversation light, and it wasn’t until they were almost there that Eli said, “Are you—making this easy on purpose?”

  Neil stared straight ahead out the windshield. “Maybe.”

  Eli blew out a sigh. “Thank you.”

  “It’s just—you were right. We had to work a case together. And maybe that would have been fine, I want to think it would have, but. It’s important to you. So.”

  Out of the corner of his eye, he could see Eli smile faintly.

  “It is important,” said Eli. “This is—this is my life.”

  There were things Neil wanted to say about that. But instead, he just pulled the car up to the curb in front of Eli’s townhouse.

  “Here we are.�
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  Chapter Twenty-Two

  He kept things like that with Eli for the next couple of weeks. They had the meeting with the administration to think about, the work-group members sending flurries of emails. Chaudry asked him, lips pressed tightly together, if he could look over the written version of Chaudry’s account of discrimination. He agreed, and reading it over, it made him feel faintly sick; his own handful of experiences paled in comparison to getting called a terrorist by a patient, and having a nurse insist he wasn’t finished scrubbing in for surgery because his palms were “too dark,” and being detained for searches every time he tried to get on a plane to a conference.

  He asked Pete to look over his own story, and Pete sent it back with a couple of minor grammatical suggestions and the note, Sounds like a real motherfucker, hope he gets hit by a bus.

  The morning of the meeting, he spent longer than he usually did getting ready. Mark was covering for him on what should have been Mark’s day off, so he could spend as long as he needed dealing with this.

  They were in a much nicer conference room than he’d ever gotten to sit in before. It was high up in one of the main university buildings, with an almost 180-degree view of the surrounding city through floor-to-ceiling windows, and everything was wood paneled, like a 1980s boardroom.

  Eli started out with the introductions, making sure the admins (who had expressions on their faces ranging from polite interest to sour bitterness to profound discomfort) knew which of the group arrayed opposite them at the table would be presenting, and who the reporters were. The student reporter had her laptop open and was already busily tapping out notes, while the reporter from the city paper hadn’t promised anything and was scribbling on a legal notepad.

  When it was his turn, Neil stood up. “Hello, I’m Dr. Neil Carmona, MD. I’m the Chief Resident for General Surgery at Kingsland Medical Center. I think the fact that I’ve become Chief Resident speaks to my dedication to medicine, as well as my academic success. With that in mind, I want to talk about a time that made me question whether I was welcome in medicine, particularly surgery, at all.”

  He told them about the doctor who hadn’t wanted “sissies” in his OR. “I want to point out that in third and fourth year, medical students receive their clerkship grades, which are vital to their success in applying for residencies, from the attendings they work with. So, if I had confronted this surgeon, I would have risked the future of my medical career. At that point I’d already taken out some seventy thousand dollars in loans. There is no exit ramp from medical education. I had to choose between standing up for myself, with the risk of losing my future in surgery, and tacitly accepting a slur on my sexual orientation and on myself as a person. I didn’t speak up, and although I don’t regret that decision—after all, it led me here, where I’ve had the opportunity to get an incredible education—I do wonder whether any future students also suffered because of that.”

  He finished up, said, “Thank you for listening, and thank you for your continued support of the diversity initiative, which is already helping to make medical education a better experience for candidates like me,” and sat back down. There was a smattering of polite applause.

  He couldn’t help but notice that neither Chaudry nor the black woman, Dr. Ofili, got as much applause for their descriptions of overt and sustained harassment. Pete might be a cynical bastard, but he’d been right. The admins liked the fresh-faced white boy. He was glad he’d taken pains to shave.

  After the last person, Dr. Iglesias, had stood up and gone through his story, Eli said, “I was hoping we could take some time here to discuss any concerns the administration had about the diversity initiative. I know there’s been some discussion of defunding it, which I have to say, I think would be a mistake. We’re relatively inexpensive for a program that has the potential to have a huge impact on the next generation of physicians and the competitiveness of this institution as an employer.”

  The admins looked awkwardly at each other at that. Barry McLennan leaned forward after a minute of silently exchanging looks with administrators.

  “I’m concerned,” said McLennan, “that the money being spent on the diversity initiative might be better spent on facilities expansion, if we’re talking about recruiting top faculty.”

  “With all due respect, sir,” Eli returned immediately, “our institution already has top-of-the-line facilities, particularly in Interventional Cardiology, which had a complete remodel only a couple of years ago. What we don’t have is a compelling case for minority candidates to come to us for residency or employment, or even medical school.”

  This back-and-forth went on for a while; occasionally one of the other attendings would chime in. Neil kept his face schooled to impassivity, periodically nodding if someone made a good point.

  By the end, McLennan was turning red, but several of the other administrators were leaning forward with visible interest, some tapping pens and others cupping their faces in their hands, watching Eli.

  “But how important, really,” McLennan was saying, “is diversity in retaining top people once we have them?”

  Eli met his stare and said, without turning a hair, “Well, as loath as I am to call myself ‘top people,’ I am a nationally highly ranked transplant cardiologist, and I am also bisexual. So, for my own retention, I would say diversity is very important. If this initiative is defunded, it’s a clear signal to me and to other ethnic, racial or sexual minority physicians that we are not valued here, and we should look for alternative employment.”

  It took Neil a second to process what had just happened, and judging by the look on McLennan’s face, he wasn’t the only one. Did he really just—did Eli—he did, didn’t he. Damn.

  Leave it to Eli to do it with style if he was going to do it at all.

  McLennan didn’t seem to know what to do with himself after that, and retreated to more stammering about the importance of maintaining competitive facilities with other institutions, which Eli kept tearing into little pieces.

  The meeting finally, finally ended, and as people shuffled out the door, Neil found that one of the administrators, a woman he dimly recognized as chairing a committee on finding the interim university president, had caught his arm. She wanted to talk about his experiences in surgery—it turned out that her son was thinking about going into surgery and had recently come out to her. Neil laid it on thick, yanking on every heartstring she had available as they stood outside the conference room, near the elevators. Eli passed him without making eye contact or acknowledging him.

  * * *

  He went back to the hospital and took over from Mark, letting Mark head home. He wondered, for hours, whether to track down Eli or not. Would he want to talk? Would he be concerned that other people were talking now?

  Pete texted him. How did meeting go?

  Long and heavy. Ask Eli

  don’t be coy

  Not trying to, just think you’ll get better info from him

  A few hours later Pete texted him again. I see what you meant

  He didn’t reply. He wasn’t sure what to say.

  Pete was a smart man, after all.

  * * *

  That night, after he got home, he texted Eli, Doing ok?

  The writing bubble came up, went away, came up again. Finally, he just got Yes.

  Good

  I think so

  * * *

  If Neil had been expecting a welter of gossip over it, he was disappointed. He supposed it was probably a hotter topic over in Cardiology—people in Surg knew Eli, but not as well. Less at stake.

  Dr. Li, of all people, found him. She came by while he was trying to dictate. “Neil!” She clapped him on the back. “Saw the article. Good statement.”

  “Thanks.” He tried not to wheeze. She’d caught him by surprise.

  “I
heard Dr. Newcombe came out at the meeting?” There was nothing more in her face than mild, pleasant curiosity.

  “Yeah,” he said. “Came as a surprise, I think. He hadn’t talked about planning to do it at work group. I think McLennan just pissed him off.”

  She laughed. “Good for him. Barry’s a grade-A asshole. I can’t believe that guy sometimes. More space for Interventional Cardiology! Stupidest idea ever. They already get all the toys, and they don’t even pay attention to the national guidelines. But our door-to-balloon times are fantastic, I will admit.”

  “Yeah, it seems like gilding the lily.”

  She patted his shoulder, more gently that time. “Anyway, it’s good to see you.”

  “You too. How’s Ming?”

  “Married!” That was her cue to pull out her phone and start showing him pictures—apparently Ming had found a man who wanted a family, and they had gotten married the year before. “I can’t believe he went for a fall wedding. It’s a little less expensive, but the color palette is so much more limited.”

  “That’s great,” said Neil. “I’m really happy for them.”

  And the hell of it was, he was happy for them. Ming in the pictures was grinning, a huge smile he certainly hadn’t seen on their date five years ago; the man beside him was (Neil thought meanly) perhaps not as handsome as Neil, but he had a matching grin on his face.

  “The ring bearer was their dog.” She rolled her eyes, continuing to scroll through the pictures. The Chihuahua looked pretty good in a tux.

  The announcement that the funding wasn’t being cut after all came less than a week later.

  * * *

  Pete called him the next week. “Hey, Eli’s off working on something, but I am in the mood for a drink, maybe some peanuts. You want to go out and get a beer?”

  Neil glanced up at the clock. He didn’t have that much longer before he could bail. “Sure. Let me just wrap stuff up.”

  Pete came by half an hour later, and Neil grinned. “Perfect timing.” He pulled on his coat over his scrubs.

  “I was thinking the place down the street. No need to get fancy.”