So there I am, in the fierce lights of the OR, as bright as an interrogation room in some third-world police station, and Dr. Jenkins and the resident are using laparoscopic cameras to mush through this lady’s belly. We’re all staring at her juicy insides, and Dr. Jenkins says, Mr. Shapiro, what happens if you cut the vagus nerve? (It can’t secrete gastric acid and you freeze motility from the stomach.) What’s the most common malignant gastrointestinal tumor? (Colon cancer.) Second-most common? (Stomach.) Another name for stomach cancer? (Signet ring cell carcinoma.) What’s a carcinoid tumor? (A neuroendocrine malignancy most commonly found in the ileum that secretes excess levels of serotonin leading to the carcinoid syndrome.) How do you test for it? (Serotonin metabolites in the urine.) Nailed it, nailed it, nailed it. Dr. Jenkins was impressed. After the surgery, he invited me into the doctors’ lounge where no med students ever get to go, and he put his feet up on the table, told me to help myself to coffee while he ate a package of graham crackers, breakfast of champions, he said, and he asked me what I wanted to do with my life. I said I wanted to be a CT surgeon, and he said, You’ll make a fine one, and offered me any help I needed getting into a surgical residency. I told Serena I loved her that night. I was so fucking happy. I was going to be a CT surgeon, and I had the most beautiful girlfriend in the world.
The rest of the month was awesome. I scrubbed in on a liver transplant, a thoracotomy, and this amazing procedure for esophageal cancer where you take the esophagus out and replace it with a piece of the small intestine—metaphor again, the poor guy has to eat through his crapper for the rest of his life—but the body’s smart, it turns it into an esophagus, and voilà, he’s chewing and swallowing and getting on with life, seeing his kids grow up, walking his daughter down the aisle—the whole life shebang—when otherwise it would be certain death. I saw a Whipple procedure, a nine-hour surgery to save another dude with pancreatic cancer, watched some surgeon take out these black lymph nodes filled with melanoma—that guy was fucked, no saving him—tacked up some bladders, tossed a few more appendices and gallbladders. It rocked.
The next month I was back on medicine wards—yawn. But I still had to suck up, had to get those A’s for the surgery residency. Then pediatrics, you could have shot me, sick, snotty kids. Only one of them needed surgery; at least they let me go see that. The peds attending, Dr. Waltzer, said, Shapiro, I’m going to reward you for always being here on time and knowing what you need to know. I can see you are not a great lover of children and you have done due diligence despite that, so I am excusing you to go see them fix this baby’s complex transposition of the great vessels, with the requirement that you will follow him during his ICU stay and through the remainder of your rotation. That baby was named Ethan Madsen, and he was the bravest little guy in the world. He had a heart the size of a walnut, with the arteries turned backward and a hole so small you couldn’t fit a pinky through it that was killing him. He died, but I was okay with that because we tried, and if we hadn’t tried, he would have died for sure, so there wasn’t anything to lose by trying. It would have been awesome if he’d survived, and I felt really bad for his mom and dad; they cried and cried and cried. Dr. Gruber wants to think that my depression started when Ethan died, but she’s wrong. I was really okay with it. I know it should have made me sad, but it just seemed like part of being a doctor. It didn’t make me not want to be a surgeon or anything, though for a second during Ethan’s operation, I had thought it might be cool to do pediatric CT surgery, and maybe Ethan’s death, along with the fact that adult CT surgeons make way more money and there are only, like, ten peds CT surgery fellowships in the country, made me dismiss that thought before it was fully formed.
Serena was probably more upset about Ethan’s dying than I was. She had watched his delivery on her ob-gyn rotation, and when she found out I was taking care of him, she came to the ICU one day after rounds to check on him. She walked in wearing her green scrubs and a little camisole—that was, like, my favorite outfit of hers; for one thing, it’s incredibly easy to take off a pair of scrub pants—and she gave me a little wave. I was rounding with the ICU team, so I couldn’t take time to talk to her, and I was actually a little nervous since she wasn’t supposed to be there because, in a way, I had violated patient confidentiality by telling her the name of the little boy with the fucked-up heart, and they were nuts about patient confidentiality at Emory.
We had to go to these stupid ethics conferences, where some prissy attending would remind us not to talk about the size of some patient’s dick or how fat some other patient was while we were in the elevator. The ethics conferences were the biggest waste of time. I tried to sit in the back and study note cards because the class suck-ups would always come up with some supposed ethical conflict that really just involved some attending or resident being an asshole and were in no way ethically ambiguous. One girl, Jane Martin, always sat in the front of the class and asked questions even if what the professor had just said was patently obvious. (Two plus two is four. Ooh, Professor, is that true if the patient is in renal failure? Yes, Jane, you idiot, two plus two is four regardless of the function of your kidneys or your uterus or your cerebellum.) Jane always had observed someone doing something terrible who she was in a big hurry to rat out, like a resident saying a patient was nothing but a drug addict or a whore or a piece of shit from the county jail (which they said all the time, but only when it was true), and then the attending teaching ethics would say, Is that an appropriate thing for a health care professional to do? And everyone who was awake or paying attention (usually Jane and the Jane clones) would say, Oh, no. One day, for some unexplained reason, Dr. Greene, the chief of neurosurgery, was leading the ethics seminar—I am sure he had better things to do—and when Jane brought up whatever scenario she had saved for the day, Dr. Greene said, Well, Jane, that is really not an ethical conundrum, is it? It was beautiful.
But I was pretty sure Dr. Greene would not have wanted me telling my girlfriend the name of the little baby whose life was leaking away in the cardiac PICU no matter how hot said girlfriend was. I calculated what I would do if I got in trouble. I would say, Well, it was just really emotionally draining, and I had to share it with someone. They would love that. I was still a med student, and I was allowed to let my emotions get the better of me. Not just allowed, encouraged.
Serena came out from Ethan’s room and put her face in her hands and cried really loudly. The rounding team could hear her. She locked eyes with me, but I couldn’t leave rounds. One of the nurses comforted her. After work, I met her at a bar where a bunch of us were hanging out, and she said she understood why I couldn’t come over to her, but she didn’t understand why I hadn’t told her how bad off he was. She said, I wasn’t prepared, and I let Roberta down. Roberta was Ethan’s mom. I said, Roberta doesn’t know who you are. She said she recognized me. I said, Roberta does not count on you in any way. She said, I went in there all smiley with a little present, and she looked at me like I was an idiot. I said, You didn’t let Roberta down, you’re just embarrassed. She called me an asshole and left the bar and didn’t return any of my calls. When she saw me in the cafeteria a few days later, she said I was immature and spoiled and that I would need to grow up if we were going to have a future together. I said, It’s not like I’ve asked you to marry me. I tried to pretend she was being a crazy girl, you know, the kind who starts sketching her wedding dress after the first date, but she knew I was full of shit, because once, in a state of postcoital delirium, I said, I think we should have three kids, two boys and a girl.
Serena and I stayed together, but then we had to decide where to do our residencies. She was doing ob-gyn, but in true Serena fashion, she wanted to go to the best program possible even though it’s not a superhard residency to get. I had to go to an awesome program, because it’s really hard to get into a CT surgery fellowship, and they’re not going to take losers from some crappy program. Here’s how the residency thing works. You have to apply to these programs
and go on interviews. If you are doing something that’s really competitive, like you want to be a cardiothoracic surgeon, you apply to all the top programs, and then you try to do some away rotations at those places. I went to Mass General, Vanderbilt, and UCLA. (Though I went to that one only because Serena was from California, and she said she might want to train near home since a lot of people end up practicing in the city where they train. I should have known she wasn’t going to do the couples match, because when I told her I was going out there, she just shrugged her shoulders and didn’t tell me to call her mom and dad or anything, even though the med school put me in these crappy dorms with graduate students, where I managed to be surrounded by the only ugly people in California, and I really could have used a home-cooked meal, courtesy of Maria, their Mexican housekeeper, and a dip in the heated pool or a couple of rounds with Señor Goldstein on the golf course at the Bel-Air Country Club.)
After you apply, they tell you if they want to interview you. You have to pay for all of this yourself, so the poor kids are kind of screwed, but, hell, that’s only one of the many ways they are screwed in life, so I’m not going to cry for them. Then you fly all over the country kissing various people’s asses. Finally, you make a list of where you want to go, and all the programs make a list of who they want to have come train there, and then some computer matches it up, and one day in March you find out where you are going to spend the next three to ten years of your life. Some poor fuck always ends up in Peoria or Omaha, but you work so hard in residency that you might as well be in Siberia, so it doesn’t really matter.
Serena didn’t say anything about whether we were going to do a couples match so we could be together after med school until I finally had to ask her. She showed me her match list. It was nothing like mine. I said, I don’t want to go to UC San Diego, their surgery program sucks. Well, she said, I don’t want to go to Northwestern. It’s too cold. She said, My career is really important to me, and yours is to you, so let’s just do our own thing, and if we make it, then we make it. I said that we could be apart for nine years. She shrugged; she was one cold bitch.
I said, Are we breaking up? And she shrugged, and said, Why not? That’s how she ended three years of love. Why not? There would always be a guy willing to grovel at her feet like I did, willing to lick her pussy and rub her back and make her a bubble bath. All the shit I did for her, a million other guys would do it too. All she had to do was ask. She went to the senior banquet with this loser gastroenterology fellow and wouldn’t even look me in the eye. Fuck her. I matched at Mass Gen, my number one choice, and she ended up in Dallas, which was like her sixth choice. Fuck her.
I can tell by the music and the general shuffle that the wedding has ended. I don’t want anyone to see me here leaning on this tree. The old foreign lady is wandering in this direction, talking to herself and shaking her hands at the sky. At first, I thought she was looking for me because I am the reason she dropped whatever she’d been holding on to so tightly, but she is walking in no particular direction. In fact, she looks like she is lost, like she was not invited to the wedding but instead just came out of the woods after being asleep for a hundred years. She looks into the woods, past where I am, and I can see she is crying. For some reason, she takes off her shoes and sits in the grass, still looking at the woods. She lies on her back, and if I were still a doctor, even a doctor in training, I would run over to her, take her pulse, see if she is having a heart attack or a stroke or a syncopal episode. I would start CPR; I would save her life. I don’t remember how to do any of that, but I walk over to her anyway. She looks up at me, and says, “My sister, Eva, never had a wedding. She was in love with a boy named Elias Auerbach.”
I say, “Okay.”
“He kissed her in the woods.”
Behind her, people are streaming into the tent. The ceremony is over, and it’s time to get this party started. The waiters have sprung to life and are carrying around trays of champagne. Some guy is laughing really loudly, a fake loud laugh. Maybe he was in love with Elizabeth, and now he knows he’s screwed; she’s married someone else. Or maybe he’s telling someone about Elizabeth’s crazy weird tits. The lady says, “I can’t see. You.” I move aside, and she stares up at the sky. I look up too, thinking maybe there’s something there, though I am not sure what would be in the sky that is interesting—a hot-air balloon, maybe a plane trailing a banner that says, CONGRATULATIONS ELIZABETH AND HANK. There is nothing there, not even a cloud. This lady is crazy, I think, and then I start to laugh, because so am I, and neither of us belongs here with all the people who are managing to live normal lives. I shuffle behind a few other trees, crush a pinecone, and then find myself at the edge of the Gottliebs’ steep driveway. I am not going back to the wedding. I walk down the driveway into the road, then past the rows and rows of parked cars, past all the big houses.
Every once in a while, maybe just once a year, you’ll see a guy walking on the highway. I mentioned this to Dr. Gruber once, and she said she had never seen anyone walking on the highway, but I said, You must not be looking. It’s not often, but everyone has seen it at least once, someone just walking on I-85 or I-285, not hitchhiking, not carrying a gas can, just walking. The cars whoosh past the guy (or girl, once I saw a girl); their clothes are whipped by the hot breeze and the car exhaust, and they disappear in the shadows of giant semis and then reappear. I walk to the end of the Gottliebs’ street and then onto a busier street. There is no sidewalk, and I have to jump onto the scraggly grass of no-man’s-land. A dog barks at me from behind a tall gate.
I had a great apartment in Copley Square in Boston. My mom and dad and Debbie and I spent a week on Cape Cod drinking craft beer and complaining about the rocky beaches the week before I started residency. Then they deposited me in my apartment and took a cab to the airport. I could see this huge flashing sign outside my window. My mom had stocked my refrigerator because she said there wouldn’t be time for me to do anything. I had milk and eggs and frozen dinners and ten different kinds of cereal. She had bought like a hundred pairs of underwear and socks so I wouldn’t have to worry about laundry. The last thing they did before they left was take a picture of me in my white coat with my name embroidered on it, STEVEN SHAPIRO, MD. My dad said he was proud of me. My mom had tears in her eyes. She said I was so handsome. Debbie told me to find a cute doctor for her to marry.
The next day was orientation, and something was not right from the very beginning. For one thing, the chief surgical resident was this fat bald guy who talked like Elmer Fudd and had some indeterminate stains on his coat pocket. He said, We follow the ACGME standards, and you will have an eighty-hour week. When I was a resident we sometimes had to work over a hundred hours a week. This does not mean you will work less, so you will have to work smarter. Be organized. He said the first-year residents mostly just change catheters and place central lines, so don’t get any illusions that you’re going to be some great surgeon at the end of the year. He told us to be respectful to our attendings, to one another, and, above all, to our patients. He sounded like Jane Martin, another prissy suck-up. I looked around, and most of the other residents were taking notes. Be organized, the guy next to me had written down. Seriously.
We got our assignments. I was starting out at Dana-Farber, the cancer hospital. Tumor call. I reviewed my anatomy textbooks that night, set my clock radio, set my watch alarm, set my cell phone alarm, and then slept right through every fucking one of them. It was light when I woke up, which meant I was screwed, since I was due at the hospital at 5 a.m. I saw my pager blinking; I had missed, like, a hundred pages. I jumped into my scrubs and ran to the T stop, thought better of it, got a cab, which was a mistake since it was rush hour in Boston; and I didn’t get to the hospital until 8:45. I paged my resident, and a nurse answered and said he was scrubbed in surgery. I heard the resident shout, Tell that dumb fuck to wait outside OR 8. I didn’t know where OR 8 was. We’d had orientation on all the hospitals, but all the different maps had b
lurred in my head, and I had to ask, like, five nurses how to find the operating rooms, then got scolded for entering the OR area without shoe covers and a hat, and this nurse slapped one of those bouffant things on me that fry cooks wear since I had forgotten my cool surgeon’s scrub hat, and then she finally let me through the swinging doors, and I found OR 8 and looked through the window in the door just in time to see blood spurting straight in the air.
It was quiet. No one said shit or what the fuck. I heard the suction machines and the cautery buzzing and the ping of the heart monitor. I wasn’t sure if I was supposed to go in or not. A team came up to the sinks outside OR 7 next door and started scrubbing. They looked me up and down, and dismissed me. The smell of the surgical soap made me queasy. I had not had time for breakfast. I had no idea how long I was going to have to stand there. The light was crazy bright. It was cold. Orderlies walked by with stretchers, and I was suddenly certain that everyone on the stretchers was dead. Or if they weren’t dead yet, we were going to kill them; that was what we were there for, not to save lives but to end them, first by gas, and then by cutting open these stunned bodies and removing whatever essential organs we could find. I had a flash of thought that we would cut open some old man, and inside we would find not heart, lungs, and kidneys but a carburetor, a bicycle wheel, a broken doll, a wedding ring. Serena told me once about how they had to induce labor in this lady who had been carrying twins, and they had died when she was twenty-nine weeks pregnant. She said, We could have put her to sleep and done a C-section, but then if she got pregnant again, she’d probably have to have another C-section, so she decided to be awake, and she had to push, and out plopped these two warm blue babies, warm but dead, with their eyes closed and their mouths open. They were boys. She asked if she could hold them, so the doctor wrapped them up in blankets and gave them to her.
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