by Anthony Youn
“I’m Dr. Youn.”
“Monty.”
Two minutes, thirty seconds.
“So, Monty, what would you like to talk about today?”
Good. Points there. Always ask open-ended questions. It’s a better way to gather information. Patients will talk more if you are less specific. That’s the key here—get the patient talking.
I prod him again gently. “So why are you here today?”
“I dunno.”
Not good. May have lost a point there. Let me try this again. “How are you doing today?”
“Fine.”
“Fine?”
“Yuh.”
“There’s nothing wrong with you?”
“Nope. I mean, other than, you know, a little bloody diarrhea.”
Two minutes, fifteen seconds.
“What do you mean by a little? How often?”
“Four, five times an hour.”
“And how long have you had these tarry bowel movements?”
“The what now?”
“Diarrhea. The bloody diarrhea.”
“Oh.”
“How long have you had bloody diarrhea?”
“I dunno.”
This guy’s killing me. He must see the sweat stains that have begun to form under my arms. Hard to miss. They look like the Great Lakes.
“Approximately how long? Take a guess. Doesn’t have to be exact. This isn’t a test or anything.”
Big laugh. Monty looks like he’s about to crack. He pulls himself together. “A guess-ti-mate,” he says.
“Exactly.”
Two minutes.
“I’m gonna guess-ti-mate . . . couple of years.”
“Couple of years?”
“Yuh. Give or take.”
“That’s a long time.”
“Expensive, too. I’m always running out of underwear. Have to buy new u-trow every other day. I get the twelve-pack at Kmart. Sets me back six bucks a pack.”
“Wow. Fifty cents a pair. Quality stuff.”
“Oh, yuh. The bloody shitting is not the only thing, either.” He sniffles. Swipes a tear. Pauses long enough to park a truck.
One minute, forty-five seconds.
I shift my weight. I’m nervous as hell about the time. “What did you want to tell me?” I say. “What else is going on?”
“Well, Dr. Youn, see, it’s like this. I was molested as a child.”
This is his story? Bloody diarrhea and child molestation? It’s a trick. I’m a doctor, not a social worker. He’s trying to distract me. I have to get him back on track. Determine the condition. That’s my job. That’s the test.
One minute, thirty seconds.
“My stepfather. He was brutal. A animal. He come home drunk. First he beat up my mom. Then—”
“I’m sorry, Monty. Very sorry. We’ll talk about your childhood in a minute. I want to get back to the bloody diarrhea.”
“So gross.”
“I’m sure. If you’re buying a pack of underwear every other day—”
“I’m talking about my stepfather.”
One minute.
Will I be marked down if I go for the guy’s throat? Does throttling the patient count against you?
I want to run out of here. I want to rip off my white coat and bolt. Run the hell away. This is a nightmare. The hell with my grade. Screw it. I don’t care anymore.
Okay, I’m lying. I care. I am not a gunner. But I care. How do I get through this?
Forty-five seconds.
I can’t speak. I’ve gone mute. I can only stare. I stare at Monty with ferocity. Maybe I can divine the answer to his bloody-diarrhea symptom psychically. Stare into his mind and pull it out. Mind to mind. I stare harder. I must have wriggled my way inside his head because Monty blinks, looks away, pecks at some invisible lint on the exam table. I’ve gotten to him.
What’s your condition, Monty? What do you have? Tell me. Just tell me.
Thirty seconds.
Deep breaths. Relax. Why does this course scare the hell out of me? Is it because I know I’m being filmed and that I will be dissected in front of the whole class later like a frog? Is it because I know Monty is an actor and is deliberately trying to throw me off? Is it because I know if I don’t determine his disease within three minutes, I will be marked down?
Yes. To all of it.
You can do this, Tony. This isn’t the hard part. This isn’t brain surgery. This is a game. You’re good at games. You’re just taking a bloody medical history. Any moron can do this. Get a grip—
Wait a minute.
Bloody medical history.
“How’s your mom?”
My voice is trembling.
“Huh?”
“Your mom. Your mother. How is she?”
Fifteen seconds.
Beep.
The warning shot.
If I don’t get the answer right now—
“My mom?”
“Yes! Your mom. How is your mom?”
“Not that great.”
“What’sthematterwithher?”
“She got the cancer.”
“Rectal cancer. She has rectal cancer. Doesn’t she?”
Ten seconds.
“I think that’s the one.”
“Have you had your prostate checked?”
“Yuh. Checks out. I’m clean.”
“THEN YOU HAVE RECTAL CANCER!”
“I think I do.”
“GREAT! THAT’S SO GREAT! NOW LET’S GO TALK TO THE DOCTOR! YESSSS!!!”
I point a finger to the sky, raise both hands above my head, lift the roof, pound my chest, slap five with Monty.
I win! I’ve done it! I’ve diagnosed his disease!
With two seconds to spare.
And no points deducted from my grade.
Eat my dust, gunners.
CLINICAL SKILLS. FIRST we talk to actors while being videotaped. Then we examine actors. Yes. We examine actors. We give them rectal exams, pelvic exams, groin checks. We use gloves and speculums. The exams weird me out, push me way beyond uncomfortable. Up until now I’ve seen three people naked in my entire life. And only one of those I wanted to see naked. Now I have strangers dropping trou in front of me on an hourly basis. One dude, guy in a Hells Angels T-shirt, Mohawk haircut, wearing no underwear, drops his pants, and his penis immediately—like instantly—rises and becomes erect. I look around the room to determine the object of his affection and, for the life of me, don’t see what might cause such an extreme . . . reaction.
“Look out,” Mohawk says. “Mr. Happy got a life of its own.”
He snickers like a porn star as the entire class looks away. Two or three girls duck.
It’s stunning what people will do for twenty dollars. No skill required, a major selling point. Just drop your pants and allow a bunch of medical students to stick their fingers up your ass and poke around with a speculum.
How was work today, hon?
Hard.
I ASK BIANCA out. I decide to go for it. Why not? We totally connected that one night at the USA Café. Not to mention she’s drop-dead gorgeous. I hear she’s not dating anyone, and since I have no prospects—I admit that I’m attracted to Amy, but she’s got that nasty case of ILS, so no sense wasting my time—I call Bianca late one night from the Nerd Room. I suggest dinner and a movie. She’s in.
I prep for this date. I swipe away a spiderweb the size of a tablecloth blocking the laundry room, put my head down, and take an extra-long ice shower, keeping my screaming down to the bare minimum. I floss, gargle, sculpt my hair. I douse my body with a quart of irresistible aftershave I steal from James and head out for my date with Bianca, dressed to kill in pressed khakis and starched white shirt purchased for the occasion at Macy’s. I pick her up in the Ford Tempo, freshly run through a carwash, the inside cleared of all old Cosmos, empty paper cups, and balled-up fast-food wrappers, spotless enough to preen as a contender in a used-car lot. We drive to a restaurant I’ve meticulously research
ed, a place that takes reservations as opposed to giving out numbers.
Bianca seems a little distant at dinner. Tense. I’m not surprised. We’re having our first real date. You have to expect an awkward moment here and there. Things improve by the main course. We’ve loosened up, the conversation flows easier. By coffee, we’re laughing freely, even touching a little here and there. I’m starting to feel the old sparks fly.
“So, what movie do you want to see?” I’ve paid the check. I’ve almost recovered from the small heart attack that gripped my chest like a vise when the bill came. I had no idea that a plate of spaghetti and a dinner salad could set you back over twenty bucks. All told, with tip, the meal costs fifty dollars.
Bianca fiddles with her spoon. “Actually, I have to call it a night.”
“Really? No movie?”
“I need to go home and call my mom. I call her every Friday night. If I don’t, she worries.”
“I didn’t know you and your mom were so close.”
“Oh, very close. So, yeah, another time, okay?”
“Sure. No worries.”
“You’re so sweet.” She squeezes my hand.
I squeeze back. She pulls her hands away as if they’ve landed on a hot stove.
I drive her home. I park in front of her apartment. She smiles, tells me what a wonderful evening she’s had, and gives my hand another affectionate squeeze. I lean over to kiss her. I come up with air. She’s already gone, dashing up her sidewalk.
“That’s one,” Tim says.
An hour later, we’re spread out on our mattresses in our Gitmo-like quarters, dissecting the date.
“I know,” I say. “The two-date rule.”
“She ices you again, game over.”
“You know, it is possible that she’s my dream girl and I’m her dream guy. She just can’t handle it.”
“It’s too much for her,” Tim says, considering.
“Overwhelming. At such a young age.”
“Could be. Doubtful.” He fluffs his pillow, casually reaches for the phone. “Would you mind taking a walk?”
“Jane,” I say. “You got her number.”
“The poor girl.” A wicked smile. “It’s all over now.”
IF TIM CAN wear down Jane, I can get through to Bianca. All I need to survive the two-date rule is some minor action. A lingering good-night kiss. I’ll even dispense with lingering. As long as we lock lips for at least the count of three. Then we can trash the stupid rule.
For date two, we reprise date one—dinner and a movie. No sense in reinventing the wheel. Bianca chooses the same restaurant; the meal again tastes delicious and again ravages my wallet. The conversation flows even easier this time. We’re sillier, flirting more, laughing louder. I’m feeling good, even though I’m out over a hundred bucks total, and all I have to show for it is a series of hand squeezes you could get out of your cousin. No worries. I’ll make my move later. I’ve been planning it according to a recent magazine article I read in Cosmo—“Making Your Move in the Movies.”
Alone, the two of us, only the receipt and one wilting rose between us, Bianca reaches across the table and grabs both my hands. She squeezes lovingly and looks into my eyes. “I have to pass on the movie.”
“You do? Why?”
“I have to call my mom.”
“But it’s Saturday night. I thought you called her Friday nights.”
“I do. I forgot to call her last night. I have to get home.”
“You can’t call her later or tomorrow morning?”
“Oh, no. She’ll worry. She’ll probably call the police to see what happened to me. I’m sorry. I’m having such a lovely evening.”
Lovely evening. Code for dinner with a schmuck.
“Me, too,” I say, frustration cutting through me like a saw. Then she tilts her head and hits me with a bedroom smile. Slight flutter of her lashes. Lips parting. Crimson fingernail notched suggestively into her teeth. I’m dying here. How can you not be crazy for someone who’s this hot and this close to her mother? I’m tempted to ask Tim for a reprieve, to establish a three-date rule just this once.
“If you want to go to the movie yourself, I’ll take the campus bus home,” she says.
Yeah. Like I’m going to put her on a bus. “No, no, I’ll take you home. You should call your mom. I don’t want her to worry. And I don’t care about the movie. Next time—”
I catch myself.
There will be no next time.
Not according to Tim’s rule. And not according to the silence that fills the car. I drive Bianca home and this time receive not even a squeeze good night. It’s over. Two and out.
10
Second-Year Crush
Second year worse.
Way worse.
I’m ambushed by the sheer volume of information we have to memorize. At least I know what’s on each exam—everything.
Second year, we move from traditional lecture classes in which professors spoon-feed us material that we regurgitate at exam time (I regurgitate with the best of them) to problem-based learning, or as we nimbly refer to this style, PBL. We split into groups of ten and, guided by professors who aren’t doctors and seem to have no clue about teaching us medicine, we realize we have to learn this stuff ourselves.
Every couple of weeks, PBL courses focus on a different body system, called problem domains, which include: infectious disease and immunology (bugs); disorders of development and behavior (birth defects and crazy people); major mental disorders (even crazier people); hematology/neoplasia (cancer); urinary tract; pulmonary; cardiovascular; neurology/musculoskeletal; digestive; and metabolic/endocrine/reproductive (sex—yeah, I wish). At the start of each domain, we receive a list of required reading and an outline of learning objectives. These couldn’t be more vague or diabolical. A favorite that Tim and I quote for weeks in a game-show announcer’s voice: “Know the physiology of digestion.”
The nebulousness of the PBL domains shakes us up. Gunners start to crack. Ass kissers don’t know which asses to kiss. Some students lighten the intensity of second year by extending classes into a third year. Not a bad idea if you have the money or don’t mind owing $150,000 after medical school instead of the more common knee-buckling amount, a mere $100,000. I don’t have the stomach for that kind of debt.
Six weeks into second year, I have my schedule down. A typical day:
6:30 A.M. Wake up. Consider showering. Stare at laundry room and tiny portable shower. Envision myself running naked through massive cobwebs, swarms of venomous, undocumented insects, gritting my teeth as I furiously soap up and shampoo while intermittent darts of ice stab my skin. Screw showering.
7:30 A.M. Attend PBL small group. Eat breakfast on the way—coffee and Mars bar.
10:30 A.M. Study in Nerd Room.
12:00 P.M. Lunch, throw down three PB&J sandwiches made at home, complain.
12:15 P.M. Study in Nerd Room.
4:00 P.M. Work out (I’m lifting weights and getting ripped, abs of steel).
4:05 P.M. End workout. Kidding. Not really.
5:00 P.M. Dinner. More complaining. Some seething.
5:30 P.M. Study at home. Unless there’s an exam. Then study in Nerd Room.
12:00 A.M. Wind down. Take two ibuprofens. Drink a beer. Stare at TV. Feel guilty for (A) not returning phone calls from parents and (B) not studying enough.
12:15 A.M. Sleep. Well, try to sleep. Usually stare at ceiling and fight off more venomous, undocumented insects and giant spider.
3:00 A.M. Cry.
. . . .
THE WEEKS BLUR. Among my housemates—Tim, Ricky, and James—I struggle the most with adjusting to the PBL style. These guys seem to be able to isolate what’s crucial in each domain. Unlike me, they sift out the unimportant stuff.
I’m not used to crystallizing and compartmentalizing. I much prefer the shotgun approach: blast away at everything. I just don’t have enough time. This causes me to freak out before every test. Even though I st
udy more than any of my housemates, I sleep the least. I try to sleep. I drink tea, listen to soothing music, attempt yoga, meditation tapes, sleeping pills. I even try a phone session with a shrink. Nothing helps. My stress level increases. I sit down at each test, stare at the bubble sheet, and watch the multiple-choice questions swim across the page. Words float. Letters scramble. I feel as if I’m looking at an eye chart. I lurch through each test, barely scoring enough points to pass. Even Tim outpoints me. After one especially frustrating exam, I stagger home and look at myself in the mirror. I’m pale, wild-eyed, hair sailing off in ten different directions as if I’ve shoved my fingers into a light socket. I’ve turned flabby, having abandoned weight training. Replaced it with a regimen of candy bars. I wear a pathetic, blotchy Fu Manchu mustache to cover a field of newly sprouted acne. My shabby clothes fall off my body. I’m wiry as a coat hanger.
Ricky walks by, stops, stares. “I’d say you look like a homeless person, but that would be an insult to homeless people.”
Second year. Taking its toll.
“The problem is all you do is study and worry.” Tim, lying in bed, fiddling with the phone cord. He’s just hung up from a revoltingly gushy phone conversation with Jane. The phone is still steaming.
“What else is there?”
“A social life, dude. You need to find yourself a wo-man. Take your mind off things.”
I have to admit that since things with Jane have amped up, Tim has seemed more relaxed. He certainly doesn’t stress over PBL tests the way I do. Well, nobody does.
“And where would I find such a wo-man?”
“Let me think about it. What about—Oh, wait a minute, I forgot to tell Jane something.”
But even as Tim redials her number, I know.
ONE DAY THE ice thaws. Crack. Just like that. With the shock of a ninety-degree day in January.
A week ago. A chance encounter in the hall outside the gross-anatomy lab.
I see the ghoulish shadow of Dr. Gaw as she places a liver on every desk—I’m amazed she even has a shadow—and hurry by only to find myself face-to-face with her as she heads into the classroom.
“Hi, Tony.”
Bright, warm, ice-melting smile.
“Amy. Hi.”