Hundreds of Interlaced Fingers

by Vanessa Grubbs, M. D.

  Big Mama.

  Big Mama would be mad and she would yell at him for sure. But Big Mama would not tell his parents, at least not right away. And, most importantly, Big Mama knew people in positions to help him that she could call on. He called her to pick him up.

  As they left the police station, he told her what the other boys were saying. “I need to be younger, Big Mama.” He looked at her, eyes pleading.

  She looked back at him with knowing eyes. “I’ll help you,” she said, and Robert exhaled.

  The next day, Big Mama filed a birth certificate. One that said he was fourteen.

  9

  Knuckleheads and Nerds

  As traumatic as the near prison experience was for Robert—enough for him to drop his hustle for good—it was not the most pivotal one in his teenage years. The most pivotal experience involved a girl he met in the spring of his sophomore year of high school. It would shape the man he would become.

  Jennifer was a preacher’s kid and a year ahead of Robert in school. She was the one in a clique of giggling girls who was bold enough to start talking to him. He wasn’t particularly drawn to her, but he knew a couple of the older boys she had dated.

  “If you get with her she’ll fuck,” they told him.

  To dismiss a girl who clearly liked you after receiving that kind of information was to be a punk.

  “Oh, you scared?”

  “You still a virgin?”

  These were the taunts from boys and girls alike that pressured him into his first sexual encounter at age twelve. To say no, to walk away, was to have your budding manhood called into question, you would be considered a punk. By boys and girls alike. Everybody talked. Robert had learned not to walk away, to always oblige a girl offering sex. He could think of nothing worse than being a punk. So when Jennifer persisted, he responded in kind. Within the month, her past boyfriends’ prediction proved true.

  They dated the rest of that school year and into the summer, longer than he had dated any girl before, so despite his multiple past encounters, it was with Jennifer that Robert learned about foreplay in order to get the response he wanted. He liked Jennifer, but by July, the relationship had lasted as long as he believed a high school relationship should.

  “I think it’s time for us to move on and start seeing other people,” he said when she came to his home one afternoon.

  “Why?” she protested, and started to cry.

  He consoled her.

  The following March, as a result of that consolation, Jennifer gave birth to a baby boy named Cameron.

  Robert felt the gravity of Cameron coming into the world and a strong sense of responsibility for him—but not for his mother. Jennifer, on the other hand, wanted to be a family. She and Cameron were a package deal, she told him. So Robert continued to make mistakes—he tried to be a family when his heart wasn’t in it; he told her he loved her when he didn’t; he even gave her one of Big Mama’s old rings as a promise ring for marriage someday, when he was spending time with other girls. When he could no longer pretend, she became angry. Cameron became her leverage to make Robert be with her. When he wouldn’t, she became angrier. She and Cameron were a package deal, she told him again. Eventually, Robert’s involvement in his son’s life was reduced to financial. His greatest regret was not having the presence of mind and maturity to negotiate a different outcome. One that included knowing his son and his son knowing him.

  Had I met Robert when we were teenagers, I doubt there would have been any falling in love or kidney donating in our future. His world was foreign to me. A boy cutting school would not have appealed to me. Sneaking out of the house at night, like I learned my sisters did only after I was grown, did not occur to me. And while I was not a virgin on my wedding night, my deflowering was much later than Robert’s. I didn’t even take my first drink until I was twenty-one. I was a good girl, a nerd.

  However, I must admit that the Richmond in Robert appealed to me, the grown-ass woman, when we did start dating. Perhaps because the Richmond was wrapped up in his metrosexual-ness—his fashion sense, the love of mani-pedis, facials, and really anything “spa”—and his nerd, the thuggish tendencies seemed to complete the picture. Equal parts nerd, metrosexual, and thug. What every straight girl needs in her life, because that’s a man who will always have a job, who you won’t have to dress for any event, and who would know how to protect you if needed.

  While Robert was being a knucklehead, I was daydreaming about being a doctor, about “helping people.” As I headed off to Duke in Durham, North Carolina, for college, I saw myself becoming a country doc, tending to whatever ailed. Sore knees. A cough. High blood pressure. But like a fickle college kid changing majors with the seasons, once I started medical school, becoming an obstetrician/gynecologist was the goal. How I came to that decision I can no longer remember.

  Duke had an unusual curriculum in that by eliminating summers off, the third year was time designated for earning a master’s in public health or completing a research project anywhere in the world the student could find a legitimate and willing mentor. The first year was all lectures, the second year required clinical rotations, and the fourth and final year was clinical rotations of the student’s choosing. For my third year, I found a mentor willing to work with me on a gynecology-related project at the University of California, San Francisco. I don’t even remember considering anywhere else.

  In the summer of 1995, my country-girl self with no sense of direction piled into my little burgundy Geo Metro with a couple of suitcases, a United States map, and my first cell phone—a huge apparatus that had its own black canvas shoulder bag and was so expensive that I intended to use it only in case of emergency—and headed to San Francisco alone. I took the northern route via Interstate 80. I approached it like it was a job. I drove all day and stayed in modest hotels at night, where I bought postcards to mail to my mother on my way out the next morning. It took me five days to get there. I stared in awe at the Bay Bridge as I drove across it. My heart quickened with excitement and anticipation of what was to come.

  That was the summer after the one Ginger spent in the hospital, when Robert, knucklehead no more, spent the months afterward in a labor of love. It was a demonstration of how close he felt to his mother.

  But their relationship wasn’t always that way.

  He remembered a time when he was mean to her, because she had done things to anger his seven- or eight-year-old sensibilities. A Mother’s Day card that initially read I love you and You’re the best mom ever was revised to I hate you and You’re the worst mom ever. Another time there were tacks placed strategically under covers on Ginger’s side of the bed.

  But he also remembered her giving it back in spades during that time. For stealing ten dollars from her purse, his consequence was her complete silence. He couldn’t even get tucked in or get read a bedtime story—for two months. It hurt him to his core.

  It was years into our marriage before I realized that it was this experience that made him immune to my comparatively sad attempts to give him the silent treatment. Before twenty-four hours passed, I would be the one writhing in my own silence while Robert was just settling down into another good book as if to say Twenty-four hours? Girl, please. You gotta do better than that.

  By the time Robert entered high school, his relationship with Ginger had shifted. They had more time alone together, and he realized he liked her. There were long talks. She talked to him about her relationships with her parents, her siblings . . . his father. He came to her and told her about getting Jennifer pregnant while his father heard about it from somebody in the neighborhood. It was her words, “I’m so disappointed,” every time he behaved very badly that hurt him more than any punishment ever could.

  I’m so disappointed. The words came with a slow shake of the head and a deep sigh.

  It was these words that led to his decision to go to Morehouse College. He knew that if he stayed at home he would continue to do things to make her say them ag
ain. So because she spoke many times of four men she had met and admired—Martin Luther King Jr., whom she met once in Los Angeles; Richard Caesar, a dentist in San Francisco and the son of his namesake, Robert Louis Caesar, who was an educator and like a second father to her; Benjamin Elijah Mays, the seventh president of Morehouse College; and Howard Thurman, who pastored the Church for the Fellowship of All Peoples, the first integrated interfaith religious congregation in the United States—who were all Morehouse men, Morehouse was where Robert wanted to go. He wanted to be like the men Ginger admired.

  By the time I had to go back to Durham to complete my fourth and final year of medical school, I had become seriously involved with Avery’s father, so my return to California was already planned. As I rotated through a new specialty every month of that last year of medical school, I learned that each one attracted a fairly distinct personality. It is a certain type of young doctor who is attracted to pediatrics. She can engage children in a way that eludes the internist. It is a very different type who is attracted to surgery—she wants to fix things. Still another to anesthesiology—she gets a thrill out of putting people to sleep. And yet another to internal medicine—making the diagnosis turns her on.

  I learned my personality did not jibe well with ob-gyn. While I loved the women’s health and outpatient clinic aspect of the field, I hated the hospital side. My love-hate attitude clearly showed on my face and in my demeanor. My evaluations from clinic doctors were glowing. Those from the hospital doctors? Not so glowing. The doctors I was exposed to on the hospital side were wonderful with their patients but always seemed angry and sleep-deprived. They also wore a bit of a chip on their shoulder, a chip that seemed to leave them trying to prove to the general surgeons that they were real surgeons too—by venturing outside the pelvis to remove appendixes and gallbladders for no other reason than it might cause problems for the patient later. Occasionally the wrong tube would be cut, resulting in a long, complicated hospital course for the patient and reinforcement of the negative stereotype of the gynecologic surgeon.

  Mostly I knew ob-gyn was not for me because I couldn’t get through the surgeries. After a couple of hours behind the surgical mask and under the hot surgical gown, performing the medical student’s primary task of pulling back on the metal retractor that held the skin, fat, and muscle layers so the surgeon’s field of operation remained in constant, unwavering view, the light in the room would fade for me. I would have to ask to sit down or risk passing out face-first into the surgical field. Looking like a wimp who couldn’t even stay upright for a few hours was bad. Contaminating the patient would have been far worse. Perhaps internal medicine would be a better fit for me, I thought.

  I ended up in a primary care–focused internal medicine residency at Highland Hospital in Oakland, California, where Robert happened to serve as treasurer of the board of trustees.

  So entranced by my involvement with Robert, I clearly forgot about the “every specialty has a personality” lesson when I made the decision to become a nephrologist. Unlike the usual nephrologist in the making, I was not fascinated with everything kidney by the end of my intern year. Early in my second year, as a resident, I did not seek out patients admitted for anything kidney-related. I did not use what I had learned from various cases of kidney problems to impress nephrologists and I did not ask to work the renal service at two or three hospitals late in my second year. I did not spend months of my third and final year of residency in a black skirt suit and sensible shoes traveling from city to city, hoping to convince the best nephrology training programs to offer me a fellowship position.

  Rather, I was fascinated with how going through the process of becoming Robert’s kidney donor gave me a glimpse of the kidney transplant system that being a primary care doctor did not provide. Though at the time I was working on research projects on the effects of language barriers on health outcomes, my experience with Robert inspired me to change my research focus to what made some people much more likely to get a kidney transplant than others. Donating my own kidney was my solution for Robert. I saw research as the way to help other people like him.

  I arranged to meet with nephrologist Dr. Michael Chort to get started on my new research interest. Dr. Chort’s pale face was pleasant without effort. He reminded me of Humpty Dumpty with a receding hairline, but his status as master clinician and internationally renowned researcher made him a rock star in the world of academic medicine. I was honored he agreed to meet with me.

  “You should become a nephrologist,” he said, his clasped hands resting on the conference table between us. “I can’t tell you how many journal articles I read by non-nephrologists and think, ‘They just don’t get it,’” he said with a wave of his hand. He might as well have been wearing a T-shirt that said it’s a nephrology thing. you wouldn’t understand. “For just one tough clinical year, you could really strengthen your research depth and perspective . . . and how your work would be received.”

  It hadn’t occurred to me to specialize in anything, let alone nephrology. Nephrology was considered one of the most, if not the most intellectually difficult of specialties. However, the notion that becoming a nephrologist would get me and my work taken more seriously resonated with me. For all I knew, Chort’s words You should become a nephrologist may just have been the generic recruitment pitch he delivered to anyone interested in kidney research, but I took them as a vote of confidence that I, the little Black girl from Spring Lake, North Carolina, could be a nephrologist. A request and a couple of interviews later, I was accepted to begin the UCSF nephrology fellowship in July 2007.

  Part III

  She Is a Thing of Beauty

  10

  Her

  It was a Friday night in a week of sixteen-plus-hour workdays and the work was done. All my patients had been seen and examined. All the labs checked. All the notes written and all the recommendations communicated. My shoulders ached. My feet hurt. My eyeballs hurt and the edges of my brain felt blurry.

  But it was no TGIF moment for me. It was July 2008 and my first weekend on call as a renal fellow at the University of California, San Francisco—the hospital of the often rich, sometimes famous, and usually complicated people of an entire region. It was a demographic that frequently created high levels of anxiety for the doctors in training and an abnormally high anal sphincter tone among administrators and attending physicians, making UCSF the most demanding of the three hospitals we rotated through as fellows.

  This weekend would be spent seeing all of my patients and those of the two other fellows so that we each would only be on call every third night and have one weekend of the month completely free of the hospital. I would find out how much fluid was pumped into the patient’s bodies in the last day. How much pee had come out. What their lungs sounded like. How their lab values had changed since they were last checked four hours, eight hours, twelve hours earlier, and discuss it all with the attending along with my thoughts on how their care should proceed for the next several hours. I would see every new patient any other medical team asked for nephrology input on. If a patient came in at any time during the night that any doctor in the hospital thought might need dialysis, I would return to the hospital for the minimum of two hours it would take to review the medical chart, examine the patient, talk through the case with my attending, communicate recommendations to the team requesting the nephrology consultation, and leave a note on the chart. And since even the most empathic of us devolve into a basic selfish human in the face of severe exhaustion and sleep deprivation, I would be thankful that my to-do list in the middle of the night would not include talking to the patient, as most would be comatose. Having to talk to the patient would add a half hour or so. A half hour or so that I wanted to be asleep.

  So the work was only done for the moment. I hoped, no, prayed, the work would stay done long enough for me to shovel some dinner into my face and get a few hours of uninterrupted sleep before the piercing beeeeep, beeeeep, beeeeep of my pager began agai
n, demanding my attention.

  I walked to Fourth and Irving, but there was no seafoam green Prius. Don’t panic, I told myself. Maybe it was Fifth and Irving? No, no seafoam Prius there. Maybe I just didn’t see it before. I walked back to where I thought I had left my car. Then to where I might have left my car. Sixth and Irving? How about closer to Hugo? Or maybe as far down as Seventh? Then back again. And again. For an hour. Feet throbbing with every step. Where was my car? Had it been stolen? Tears began to roll down my cheeks.

  I called Robert.

  “I can’t find my fucking car. I don’t know if I’m cut out for this.” Not that I had never forgotten where I had parked my car in the past, but in that moment with my sore feet and eyeballs, losing the car was about so much more than the car. It was a metaphor for my life. Who did I think I was anyway? I had no business venturing into this strange land, so far away from Spring Lake, North Carolina, I told myself. I wanted to retreat.

  “No, I wouldn’t say that. It’s going to be OK,” said Robert, his baritone voice almost purring. Like he believed it really was going to be OK. I almost believed him.

  “Call the police,” he said.

  “OK,” I sniffled, happy to have someone to do the thinking for me. Happy to have Robert to balance me. I’ve always admired his evenness. No dramatic swings from feeling like the world was tolerable to equating a missing car with the meaning of life. I have often wondered how much of the evenness was just Robert and how much of it was an adaptation to living with a serious illness. One that had the power to end his life. At any time. Without warning. I imagine it helped him put things into perspective.

  From the police based at UCSF I learned that my car had been towed. My rear bumper had jutted several inches into someone’s driveway and that someone was teaching me a lesson. Just one tough clinical year, Dr. Chort’s words came to mind. Now they sounded like the painfully understated warning of the doctor, poised with a huge needle in hand: This might pinch a bit. Can’t say I wasn’t warned. But if it had rained, or if I didn’t have the three hundred dollars to get my car out of the impound, or if my pager had sounded before I could get home and get a nap—just one more insult that I would construe as yet another sign from God and the entire universe that this was not the path I was supposed to be on—I might not be a nephrologist today. Perhaps too much for even Robert to reel me in from. But no downpour matched the tears streaming down my cheeks, my bank account still had a few hundred dollars in it, and I got to sleep three whole hours before my pager went off, so I stuck through that one tough year, entrenching myself in everything kidney for the first time in my medical training.