“What? A CD player?” I ask, not really that surprised. I’m not even sure my laptop has a CD player. And come to think of it, I don’t really know how I’d go about burning a mix tape onto a CD with the technology I have on hand…
But then he says, “Afraid I don’t exactly have a name at the moment either.”
Chapter Two
Doctors can be the worst gossips, often using patient files as stories in the break room. But unfortunately UWV/Mercy’s only neuro attending, Dr. Raj Pawar, isn’t one of those doctors. Stiff and easily irritated, he’s known around the hospital as a brilliant cutter with zero bedside manner. And I’ve consulted with him on enough brain tumor cases to know he’s completely uninterested in contributing to patient gossip. In fact, I doubt he’d say hello to me in the hallway, much less give me information on a patient who falls nowhere near my jurisdiction. Which is as it should be.
I’ve been working my ass off to prove that me getting into this combined med school/residency program wasn’t a joke on the University of West Virginia’s part. After seven years in the program, I’ve finally managed to garner the respect of the hospital staff and my peers. So I have no business wondering about the sexy head trauma patient, much less seeking out more information about him.
I know that.
I know that.
Yet somehow, I find myself rushing into work two hours early on Wednesday to attend Ken’s bi-weekly staff yoga class.
What are you doing? What are you doing?! I shriek at myself through all the up and down dogs I could be doing just as easily at home.
You are an idiot and you need to stop this right now, I tell myself even as I pretend to stay in savasana way longer than I need to, just to allow all the other students to file out before I finally sit up.
“You were really feeling it today, huh?” Ken says with a sympathetic smile as I roll up my mat. “Hard week?”
I nod, because that much is true. Today’s the day I have to sit in on a consult with Ronnie and her mother, regarding a new palliative care plan. Which is the nicest way of saying Ronnie’s leukemia has progressed to the point that chemo is no longer working, and it’s time to start thinking more about her quality of life than trying to sustain it.
Yet another reason I shouldn’t be here. But I smile back at Ken and answer, “I don’t know why I don’t come every Monday and Wednesday.” Because I know how much my fellow yogi appreciates any feedback on his sparsely attended classes.
“I keep telling Dushner we should make it an official hospital requirement,” Ken complains as we leave the activity room, “But he said no, because then he’d have to attend.”
Dushner is the hospital administrator. A number of staff members refer to him as Douche-ner behind his back, which should give you an idea of his charming personality.
“Speaking of Dushner,” I say as a way to transition into what I’m really after. “How does he feel about this amnesia case of yours?”
And that’s how—a few minutes later—I find myself in Ken’s closet-turned-office, leafing through his scant file on the John Doe. I was right about the head injury. After losing a fight with a drunk driver going the wrong way on a back country road, John Doe was knocked off his motorcycle. Now that would have been bad enough. But apparently he hadn’t bothered to secure the strap on his helmet, so hello traumatic brain injury.
Fortunately, the drunk driver had been enough of a good Samaritan to call 9-1-1. But the hospital in Wheeling was full and diverting cases that night, so John Doe ended up at our humble patchwork of departments, and just in time, too. He’d had a few hematomas on his brain, which explained the surgery.
And the retrograde amnesia.
But that’s where John’s case stops making sense.
He’d had no ID on him, and when the police attempted to trace the bike’s plates, it led to an abandoned coal mining town in the middle of the state.
“So he’s like in a motorcycle gang or something?”
Ken considers my question with a tilt of his head. “Well, that’s what the police wondered. And they’ve been by a few times to question him. But I’ve seen my share of bikers around here, and he doesn’t have the usual tells. No tats, and according to Glenna, his rehabilitation nurse, he was a whole lot prettier when he came in here. Clean-shaven and, well, you’ve seen those eyes—kind of dreamy, right?”
That they were, though I doubted Ken’s “roommate,” a nerdy Lockheed Martin aerospace engineer, would appreciate hearing Ken describe his current patient like that. After all, he had absolutely no reason other than love to share a house with Ken, or live in Wheeling, which was halfway between the towns where they both worked. But I kept that observation to myself.
Like me, Ken prefers to keep his private life very private, which was one of the reasons we got along so well.
Ken strokes his chin thoughtfully. “A few of our organ donors have found abandoned motorcycles and fixed them up as projects. Maybe this was a home project gone really, really wrong?”
Organ donors were what most of the staff called motorcycle riders, but in this instance, the term made my heart clench. Looking at John Doe’s PT case file, which I knew wouldn’t be nearly as grisly as his patient file, I couldn’t help but think how close this guy had come to dying.
If the drunk driver hadn’t gotten out of his car, or hadn’t had enough presence of mind left to call 9-1-1. If Dr. Pawar hadn’t been on hand that night to take John Doe straight into surgery. Well, those dreamy blue eyes would most likely be six feet under right now.
But I force myself to stop thinking about that as I observe, “Maybe, but he doesn’t exactly sound like he’s from around here.”
Ken greets my observation with a huge smile. “Oh my! Look at Ms. Nitra, finally learning to tell us West Virginia folk apart from everybody else.”
I roll my eyes. My continued inability to distinguish between Pittsburgh, Ohio, and West Virginia accents after living my entire life in California, was a constant source of amusement around the hospital. Right along with the past I was still trying to live down.
“Yeah, yeah, yeah,” I say to Ken. “But seriously, he’s from the South, right? I mean deeper South than here?”
Ken picks an invisible piece of lint off his t-shirt. “Well…I may or may not have put $10 down on Arkansas in the pool me and some of the nurses got going.”
“Seriously? The poor guy’s in here with amnesia and you’ve created a betting pool on him? Real professional,” I say, shaking my head as I continue to flip through his file. The file I’m technically not supposed to have access to. Talk about the pot calling the kettle black.
Before Ken can comment, I quickly circle back to the main reason I’m in his makeshift office. “How about fingerprints?”
“The police ran them but nothing came back.”
I thought of the family I’d left behind in California and asked, “And no one’s stepped forward to claim him? No family or maybe a girlfriend? Kind of finding it hard to believe this guy doesn’t have a girlfriend out there somewhere.”
“Me, too,” Ken answered. “It’s a real struggle to keep it professional, especially when he gets all sweaty while he’s lifting…” Ken gets a faraway look in his eyes, which I once again doubt his nerdy boyfriend would appreciate. “But so far no one’s contacted us. We’ve called in social services, and they’re still working on it. But for now, the guy’s a complete mystery, and he’s here on nobody’s dime since we don’t have a social security number on file. So we’re already getting pressure from Douche-ner to release him sooner rather than later.”
“What?! But he has a traumatic brain injury!” I protest on the John Doe’s behalf, and because I’ve had more than one run in with Douche-ner over his bad habit of focusing on the bottom line rather than on patient needs. I can’t even count the number of times he’s tried to push me to release the kids with shitty insurance sooner than anyone with a conscience would recommend.
“Actually, John
Doe is recovering faster than you’d expect—at least from the physical stuff…”
Ken looks over both shoulders as if we’re on some sort of reality show, before leaning in to impart, “But the traumatic brain injury is turning into something else. I’m not exactly a doctor here, but at the last team meeting about John Doe’s case, Dr. Pawar and the psych team went on for a while with the social worker. Pawar’s saying his head scans are checking out, but then psych’s concerned because he’s still got amnesia, yet he knows a lot of general stuff, and check this out…”
Ken takes the file and flips through a number of typed documents to a page of handwritten notes from the last meeting of John Doe’s team.
“One of the third-year med students decided to run a Neuropsych Evaluation on him for one of her class projects. Look at these scores.”
My eyes widen when I see the numbers, some in the three digits. Except for his complete lack of historical and cultural memory, there’s nothing on this report to indicate these scores belong to someone with a TBI, rather than, say, someone looking to get into medical school. Or become a rocket scientist.
“So he’s close to being a genius even after the TBI?” I murmur. “That’s a seriously unexpected result.”
“Right?” Ken agrees, nodding. “The team is having a real hard time figuring it out, so now they’re calling it Focal Autobiographical Amnesia. I haven’t had time to look it up on Wikipedia, but best I can tell, they’re saying there might be something more than a hit to the head going on here.”
It takes me a moment of mulling over Ken’s words and comparing them to what I learned during my fourth year psych rotation to figure out, “They think he’s not remembering on purpose?”
“Or that something traumatic happened before his accident. He’s got a few older fractures according to the x-rays. The kind of ribs and arm stuff you see when Mom doesn’t bring her kid in after Dad’s had too many and decides to downsize his beating victims…”
Hearing this, my heart pangs for the John Doe. “All the more reason not to release him. I mean, where is he going to go if he doesn’t have anybody to help with his recovery?”
Ken nods. “That’s the only thing keeping him in here considering he has no insurance to bill. Truth is, we don’t have anywhere to send him.”
I shake my head in disgust. “So we’re just going to kick him out? When?”
Ken thinks about it and shrugs. “Now that he’s pretty much healed…I’d say he’s here one or two more weeks, tops. Since his injury is no longer looking like a neuro case, Pawar doesn’t care too much, and psych’s psych—already too overwhelmed to take on any new cases—especially the ones without insurance. Social’s looking for a men’s shelter who can take him in.”
“Okay…okay…” I say, getting it. John Doe has no name so every minute he spends here is costing our already over-stretched regional hospital money.
“But there’s got to be some way to help him,” I say to Ken. “I mean, we just can’t kick him out...”
I gaze down at the linoleum, trying to figure out a solution to this dilemma, only to find Ken smiling when I look back up at him.
“What?” I ask him.
“I haven’t seen one of your kind in quite a while. A doctor who cares more about the patient than the patient’s condition. Pawar and psych have spent more time tangling over his official diagnosis than worrying that this guy is going to end up in a homeless shelter in a couple of weeks if no one steps up to claim him. But you really care about his well-being, and not just because he’s cute, but because underneath that medical degree, you’re a decent person.”
A small smile whispers across my lips. “Well, I did get into UWV-Med off the wait list.”
Ken lifts his eyebrows. “Then maybe they should let more people in off the wait list.”
I’m not sure how to respond. I know a few of my fellow program mates, many of whom are now fellow residents, think I was let into the program for not the best reasons. One guy outright asked if this was a joke when I walked into Brain and Behavior on the first day of winter semester and it was announced I’d be taking the place of a med student who’d dropped out.
It doesn’t surprise me that same guy is now the senior neuro res here. Anyone who works with doctors knows neurologists have a reputation for not being the most sensitive or socially clued in people. Truth is, he might have been right about the program’s intentions when it came to my acceptance. But it doesn’t matter why I was accepted. I chose to come here, and that’s the only thing that matters to me at the end of the day. Still, I can’t help but feel flattered by Ken’s approval. It’s nice to know at least one person at UWV/Mercy thinks I deserve to be here.
Still, the John Doe upstairs is totally effed. We both know it.
“The best any of us could do for that guy right now is hope he remembers who he is,” Ken tells me before I leave his office. “Because at this point, that’s the only thing’s going to keep him out of a homeless shelter.”
Chapter Three
So yeah, John Doe has a sad story. A really sad story. But you know, shit happens. Believe me, I know that after Chanel’s death. Just this week alone, my attending resident had to pass on two heartbreaking preliminary diagnoses to families who could barely afford to take time off of work to talk with us, much less find the money to pay for what could amount to months or years of treatments.
I’ve had patients a lot worse off than John Doe. Ronnie Greenwell’s mother broke down crying, even as her daughter sat there and nodded, when the peds attending and palliative care counselor told them we’d run out of treatment options later that day. And this is only a small hospital in West Virginia. I can imagine the number of difficult conversations I’d be sitting in on at a larger facility.
In fact, I won’t have to imagine it for much longer. Because two weeks ago, I received news that I’d defied the odds of my upbringing, and been matched with a Pediatric Hematology-Oncology Fellowship at The Children’s Hospital of Seattle.
Which means in two months, I’ll be out of this backwater regional hospital, and moving on to a new life in the Emerald City after a short visit with my family in California.
So I really shouldn’t be losing much thought or sleep over an amnesia patient. I mean, yeah…it sucks. As close as my family is, just the thought of John being here in this hospital, all alone, without anyone to help or advocate for him, makes me feel pretty bad. But he’s still alive. He’s not dead or dying, which is way more than some of my past and current patients can say.
I should be doing any number of things during my lunch hour, including searching for apartments in Seattle. Or getting my monthly call home to my family out of the way. Sandy’s always complaining about me putting it off until the last second.
So yeah, John Doe’s case is none of my business. He is none of my business. And this morning, when he came down with Ken to watch the kids again, he settled for standing near the doorway and leaving before rehearsal was done. No more “Free Bird” requests, and absolutely no reason for me to get too wrapped up in a patient completely outside my field of residency.
But instead of calling my dad, instead of looking at cute apartments in a cute city that I can’t wait to call home after I’m done with my three-year residency in June, I find myself outside a certain door on the eighth floor.
Don’t knock. It’s not too late to turn back. Go! Go now! I tell myself, even as I raise a hand and knock on the partially closed door.
“I’m doing something, but come on in if you have to,” a gruff voice on the other side calls out. He sounds more authoritative than I would have guessed. Like he’s used to being in charge.
Maybe he was a cop, I muse as I slide inside.
The room, not surprisingly, is the smallest one in this wing, with a view of the parking lot rather than the Appalachian foothills. There’s barely enough room for a single visitor recliner, and I highly doubt the thing could actually recline with so few inches between it and
the bed. The curtains are open, but the room is still dim, thanks to the relentless West Virginia gray, which still hasn’t quite given over to spring sunshine. Even worse, his radio is turned on and a classic rock song is playing. I don’t know the band, nor can I see them, but I swear I can hear their mullets loud and clear.
After a moment of adjustment, my eyes find John on the bed, his half a head of blond locks hanging down as he finishes writing in what looks like one of the cheap, brown kraft-paper journals the psych counselors are always issuing to our older kids. So they have someplace to put their feelings while they go through treatment.
That would explain his rather reluctant response to my knock.
“Sorry, I’m interrupting. I’ll come back later,” I say and start to back the very short distance toward the door.
But when he hears my voice, he looks up. And his entire face softens when he sees me standing there.
“Hey, Doc! You finally came to visit me,” he says, like my arrival in his room was long overdue. He closes the journal and reaches over to his cabinet night stand to switch off the radio.
Even with the snaked head scar, he is so freaking handsome. So much so that it’s kind of hard to look at him without feeling flustered. To distract myself, I reach into my bag and pull out a recyclable sandwich container.
“I…um, brought you a sandwich.”
I hand it to him, and he appears delighted, but then baffled when he gets a look at the sandwich itself.
“Where’s the meat?” he asks, like that’s a way bigger mystery than his identity.
“There isn’t any,” I answer with a small laugh. “It’s hummus, cucumbers, and tomatoes with a drizzle of pomegranate molasses on top.”
My explanation doesn’t put a dent in his perplexed look. “They make sandwiches without meat?”
“Sure they do,” I answer. But then have to admit. “Well, maybe not in West Virginia. Which is why I had to make these for us at home. The hospital cafeteria doesn’t have anything but peanut butter and jelly, and I don’t love all that sodium…”
His Forbidden Bride: 50 Loving States, West Virginia Page 2