A History of the Present Illness

by Louise Aronson

  The aide across the way turned on the light behind her patient’s bed so he could read despite the fading daylight. Marta looked at her watch. Nick and the kids should have been at the hospital over an hour ago.

  “I have no hunger,” Mercedes said. Her eyes filled, and she clamped them closed. They had agreed not to cry in front of Ricardo, not that he would know the difference, as Marta alone knew because she had overheard the residents rounding that afternoon, saying things no one had told the family after the surgery, such as how the team had had trouble restarting Ricardo’s heart and the number of minutes his brain had gone without blood and oxygen. It had never occurred to the young doctors that a family member might understand their jargon. At their stage, Marta probably hadn’t realized either that doctors were people too.

  She wondered what Sophie had done this time. Snippets of the morning’s conversation had haunted her in quiet moments throughout the day. Once, remembering Nick’s nod toward the stairway after Sophie’s exit and her own decision not to follow their daughter upstairs, she’d groaned aloud, sending Mercedes into a panic about Ricardo. She’d have to make amends, she knew, but hopefully not that evening.

  “Dr. Perez?” said a voice.

  Marta recognized the nurse who’d worked the same unit with the same chipper attitude nearly twenty years earlier when she was a resident. The woman had aged, her hair shorter and more gray. But the same could be said of Marta.

  “Your family’s here. In the waiting room. I can’t let the kids in. Policy. You know how it is.” She rolled her eyes before fading back into the hallway.

  “I should come?” asked Mercedes.

  “No, stay with Dad. I’ll be back.” More likely she’d send in Nick. Marta needed a break. She imagined that five minutes on the roof screaming at the top of her lungs might help, but how would she explain it to the children?

  “Mommy!” Olivia shouted, and threw herself at Marta. “She’s gone. She’s really, really gone!”

  Marta hugged the little girl’s body to her own and kissed the top of her head, smelling chalk and shampoo and sweat.

  Around her, the busy waiting room seemed glacial, all white walls and haunting silence. Families sat in small clusters separated by one or two empty chairs, and in a far corner, light blinked from a soundless television hung from the ceiling by thick metal cables. Outside the lone window, the sky had turned black.

  Gone?

  Jason stood beside his father, his eyes huge and his cheeks wet.

  Gone.

  Marta put an arm out for Jason, who wrapped himself around her and his little sister. She backed up, pulling them with her until she felt the cool of the wall against her legs and shoulders. Finally, she looked at her husband.

  “I’ve called everyone,” Nick said. “All her friends. The neighbors. The school. And I tried to file a police report, but it’s too soon.”

  Jason’s body heaved against hers. Marta couldn’t catch her breath.

  “Hospitals?” she asked.

  Nick shook his head. He looked pale but composed. “But that’s good, right?”

  She wished he would come closer, encircle them all. When he didn’t, she said, “How can you be so sure? Sophie has keys to neighbors’ houses. She could be hiding. Getting back at us—at me. She went to school this morning, Nick. I saw her get in your car.”

  Marta kept her voice low, but the pitch rose as she spoke. Around the room, a few people looked up, then away.

  “Her drawers are empty,” Nick said. “Her iPod is gone. Kurt Cobain is gone.” He might have been reciting a grocery list.

  Suddenly he lurched forward. In the second before she felt his breath on her neck and understood what he had said, his face shattered.

  “Marta. She’s gone.”

  Over the next week, as Ricardo failed to regain consciousness, as Mercedes agreed to withdraw life support, as they prepared Jason and Olivia for their grandfather’s funeral and heard nothing from or about Sophie, Marta couldn’t eat. She couldn’t sleep. She turned off her pager, threw bills and catalogs unopened into a pile on the front-hall floor, and erased phone messages as soon as she was certain they had nothing to do with Sophie. She didn’t know what was happening at work, and she didn’t care.

  Twice daily, Nick checked the bus depots and youth shelters. He organized groups of their friends to methodically canvas the Haight, Golden Gate and Buena Vista parks, the Tenderloin, SoMa, and every other part of the city where teenagers were known to sleep in doorways and under bushes. Every three days, they went to the police. “With this type of kid . . . ,” said one officer, shrugging his shoulders and not even bothering to finish his sentence, much less write down Sophie’s most distinctive characteristics. They stared at him, speechless, coming up with suitable retorts only much later. “Your father would have known what to say,” Nick told Marta as they drove home, and his use of the past tense hit her like a blow.

  They hired a private detective who repeatedly claimed he found signs of Sophie—in Seattle, then Phoenix, then L.A.—but it was always some other chubby teen with brown hair, pimples, and black clothes. They learned that the country was full of runaway kids prostituting themselves, doing drugs, and somehow getting by on the streets. Before Sophie left, Marta would have converted her new knowledge into donations to charities and letters to the editor about the precious individuality of the nation’s faceless, voiceless youth. Now she knew all that social passion was just a role she’d played for her own selfish gratification, a persona she’d invented that had fooled everyone but Sophie.

  When Marta finally went back to work, she found she’d lost her taste for the sorts of patients who reminded her of herself in that long stretch of her life she thought of as before. Within weeks of her return, she resigned. She could no longer bear the commute across town to the group practice affiliated with the city’s best private hospital or the lovely, renovated Victorian with its hushed modern decor and well-heeled patients scheduled every fifteen minutes. Instead, each morning she walked up Glen Canyon Park and through the divide between Twin Peaks and Mount Davidson to the chaotic campus of century-old, crumbling California mission style buildings with red-tiled roofs, where she had enough time to debate the meaning of life and the purpose of medicine with the Americanized children of gravely disabled elderly immigrants and to provide thoughtful, compassionate care for people so down on their luck they put her own life into perspective.

  For weeks after Ricardo’s death and Sophie’s disappearance, friends and colleagues asked how Marta was, openly inviting discussion of her losses. For a few months after that, they graciously excused late school pickups and incomplete patient notes, acknowledging indirectly the dramatic changes in her life. And then they moved on, as she had, at least superficially. At home and at work, she did what needed doing for life to continue for the living and present. She said nothing as Nick took on more and more cases, as Jason, quieter than before, did his chores and Sophie’s without ever being asked to pick up the slack, and as Olivia cried at the slightest provocation, since their youngest also continued to laugh as easily as before and so remained their happiest and most carefree child. But Marta felt Sophie’s absence as she might feel an amputation. The sensation, relentless and persistent, resembled less the loss of a hand or foot, which would be immediately evident to others and alter her ability to do even the simplest things, and more the loss of an ear or breast, a fundamental and defining feature she could function without but would never stop missing.

  Becoming a Doctor

  THE THIRD WAVE

  I’d been accepted everywhere—all five of the top-ranked medical schools and each of the four second-tier places I’d applied to just in case. Admissions deans or alums called me from four of the top five. All had the same pitch, talking up their school and praising my defense of my roommate’s headscarf in a YouTube video that went viral. Only San Francisco didn’t call.

  So at orientation, when Dean Rosenthal told our class of one hundre
d and fifty-two future doctors that although our ambitions might feel as cozy and warm as old fleece sweaters, they were in fact as common as pigeons at Fisherman’s Wharf and as cold and slick as late-summer fog through the Golden Gate, I laughed. We all did. Four years later, I know better.

  THE SECOND SEX

  I come from a family of surgeons—my dad, my grandfather, my older brother—so we all just assumed I’d be one too.

  All of us, that is, except for my grandfather, who said the operating room was no place for a girl.

  “If that were true,” said my father, “none of the rest of us would be here.”

  My grandparents had met in the OR, where my grandmother had been her future husband’s scrub nurse.

  “That’s different,” said my grandfather.

  “Right,” said my brother. “But only because if you’d been born a few decades later, it would have been Gram giving you orders in the OR instead of vice versa.”

  “Now, now,” said Gram. She stood behind our grandfather with her hands on his shoulders. Then she winked.

  From the time I learned to walk and talk, our family had remarked on my astonishing resemblance to my gram, a woman who somehow fulfilled all conventional expectations while also never doing anything quite the way she was supposed to.

  OUTRAGEOUS ACTS AND EVERYDAY REBELLIONS

  In anatomy lab the first day of medical school, I marveled at the views of the city and ocean seen from the lab’s big windows, the shiny metal instruments, and the crisp snap of surgical gloves against my skin. I felt proud in my pressed white lab coat and blue polyester scrubs, though even one of the lab instructors laughed when he saw me. It seemed the scrubs came in just three sizes, the smallest of which didn’t take into account that a person might be only five feet tall and barely in the triple digits for weight. Not that I really minded. I tucked the top that otherwise hung to my thigh into the bottoms, triple cuffed the pant legs, and got to work.

  The school assigned four students to a table, which meant four students per cadaver. My group consisted of me and three guys—the Wong twins, who had matching class rings from Berkeley, and a preppy wearing penny loafers and a head of long, tight dreads that danced when he spoke.

  I wanted to know if he’d interviewed for medical school looking like that, but I couldn’t think of a polite way to ask. Instead, I shook Hank’s hand and traded answers to the usual questions—hometown, college, anticipated specialty. He had grown up in Seattle, where I went to college, double majored in engineering and biology at Michigan, and planned on surgery too. More surprising was his smell, a mix of cloves and vanilla with an undercurrent of evergreen.

  From those first minutes when the four of us introduced ourselves, Hank behaved as if he’d already been selected as our team leader. Pulling the sheet off our cadaver, he correctly diagnosed her as female and said, “Our first patient. Let’s call her Cherry.”

  “Wink, wink,” he added, and David and Daniel Wong laughed.

  I forced a smile. The dead woman’s hands had jagged yellow nails and long, elegant fingers draped in thin, wrinkled skin. I’d never seen hands so pale, so still, and so completely human.

  That first morning, according to the anatomy guidebook, we were to fillet Cherry.

  “Heads or tails for the first cut,” David said, throwing a quarter into the air. The winner would get the privilege of pulling a scalpel from the base of Cherry’s neck to her pubis. Daniel called heads, then shoved his brother and grabbed the coin midair. “Oh, yeah,” he said. “This is so mine!”

  It was tails. I lost next, and David came up short in the final round. Hank opened the manual to the correct page, drew a line along the torso with a black marker, and handed me his scalpel. “Because I know I’m sometimes an asshole,” he said.

  My first incision didn’t even sever the skin. I made a second pass, then a third before the job was done. The texture was nothing like real skin. The preservative had made it tougher and more rubbery, which turned out to be useful; the harder I pressed, the less my hand shook as I cut.

  After that, we divided the work geographically. Up top, Dan and Dave cut along the rim of Cherry’s sparse hair. They planned to lift off a window of skull and harvest the brain. A bucket of formaldehyde stood waiting on the counter behind our table. Farther down, Hank and I worked separately, he in Cherry’s chest and me in her abdomen. He cut with surgical deliberation; I figured she was already dead, and all that mattered was getting inside.

  My hands began to itch in the latex gloves. The smell of formaldehyde, pungent and noxious, seeped into my clothes and hair. I kept glancing at the ridge of thick brown moles under Cherry’s right breast, and also at her feet, the gnarled toes heaped upon one another like stacked corpses.

  “You okay?” Hank whispered.

  I nodded, afraid to speak.

  Pulling back flaps of skin, I lifted internal organs to feel each one’s heft in my palm. I had so much to learn, and found that my memory worked best through my eyes and hands. I held Cherry’s bilobar liver, purple and cobbled when it should have been reddish and smooth; a small, dense kidney, curled up on its side like a sleeping fetus; heaped, pallid coils of intestine—enough, we’d been told, to cover the length of a football field end zone; and, finally, Cherry’s uterus, shrunken to a nubbin the size of my thumb.

  “Wow,” Hank said, moving closer. “Is that what I think it is?”

  The guys were all staring.

  “Oh, man,” Dan said. “Is that possible?” He pointed at what appeared to be a single strand of shredded dental floss dangling from the tiny organ. Maybe Cherry had had only one fallopian tube, the other taken in surgery or atrophied to invisibility. More likely, I’d severed it without even noticing.

  Hank’s shoulder pressed into mine and he shrugged.

  A handful of students, all women, cried during the two-month anatomy course. They left the room, missed entire organ systems. Not me; to those who weren’t looking closely, I was as tough as any guy.

  PERSONAL POLITICS

  Twice a month during that first year, as part of a pi lot program to get beginning students out of the classroom and into the real world of medicine, I followed Dr. Bernard Nercessian on rounds on the Rehab and Extended Care Building of the veterans hospital. At one P.M. on alternate Thursdays, he greeted me with an enthusiastic handshake and handed me his spare stethoscope. As we rounded, he introduced me to his patients, lowering his voice to name my medical school, as if the honor was his and my presence beside him proof positive of his own competence and stature.

  Dr. Nercessian’s patients were mostly returned from Iraq and Afghanistan, and they followed military etiquette despite being so damaged that dispositions other than discharge were out of the question. They said, “Yes, sir, doctor”; “Copy that, doctor”; “Thank you, doctor, sir.” Sometimes they thanked me also, even though almost all I did was watch. But sometimes, too, after Dr. Nercessian was out the door, the patients looked at me and said, “Miss, I need a blanket”; “Miss, change the channel”; “Miss, yo, get the bedpan—hurry.” I found blankets, changed channels, and slipped plastic bowls under waiting buttocks of every color, size, and shape before racing to catch up with Dr. Nercessian.

  Usually, busy with orders and his notes, he didn’t notice my absence. Then one day, I got held up by a guy named Rodney. He was about my age, and his body was so trashed—no right leg or arm; limp, mangled limbs on the left; and half his face missing—that he’d been there for months, and I’d met him on several of my previous Thursdays at the VA. While I struggled to place a bedpan under Rodney, Dr. Nercessian came back into the room, and as soon as I succeeded at what felt to me like my first real clinical challenge, he pulled me into the hallway. “What were you thinking?” he said without letting go of my sleeve.

  I had been thinking that the bedpan seemed the very least I could do under the circumstances. I had been thinking that maybe bedpans came in different sizes, but with Rodney praying frantically not to
wet himself, I had decided to use the only one I could find in his room.

  I was about to explain this to Dr. Nercessian, when he finally let go of my sleeve and said, “Next time, you tell them to call the nurse.”

  The patient’s call light had been on for ten minutes before our arrival and during the entirety of our visit with him.

  Dr. Nercessian looked at his watch and shook his head. How was it possible that he couldn’t imagine what it might be like to be sick and helpless and desperate to pee?

  I followed him down the hallway, smiled when he introduced me to our next patient, and nodded attentively as he pointed out a non-healing amputation stump, a murmur, a nerve palsy, and the tightening scar tissue from a massive chemical burn. I didn’t know what I’d do the next time someone asked for a blanket or a bedpan, until two weeks later, when a veteran who’d tried to kill himself and failed—he’d aimed at his temple, not his brain stem—did ask, and I went to get him a blanket. Early the following week, I was informed that Dr. Nercessian had called to resign as a preceptor for the pilot program because, in his estimation, first-year medical students didn’t know enough about professional behavior to be allowed near patients.

  INTERCOURSE

  My girlfriends and I all agreed that it would be a really bad idea to date a member of one’s anatomy team, since if you broke up before the course ended, lab would be awkward at best and at worst someone’s grade would be affected, and that someone would almost certainly be the girl.

  So Hank flirted with me and I flirted with him, but whenever he asked me out, I said no. It got so I knew without looking if he’d entered a room. When he stood near me in lab, I felt as if I had to pull myself in the opposite direction just to remain upright.

  Sixteen minutes after the anatomy final, we locked ourselves in the handicapped bathroom on the second floor of the medical sciences building. The odors of hospital soap and piss didn’t matter. Nor did the filthy sink and floor. We didn’t make it farther into the small room than the two steps needed to clear the door.