by Anthony Youn
A month later, Tim and I are lounging on the living room couch when the mail carrier delivers the results. We tear open the envelopes like nervous Academy Award presenters. I don’t believe it. I’ve passed! Even better, I beat Tim by five points.
And that concludes medical school, year two.
Now I can finally play doctor.
For real.
IV Third Year
11
First Do No Harm . . . Oops
Confession.
I hate hospitals.
Question.
Is this going to be a problem?
What do I hate specifically?
I keep a list.
First, the smell. You step off the elevator and it hits you, acidic and icy and metallic with a hint of disinfectant, designed to distract you, make you think you’ve wandered into a rather large janitorial closet instead of a planet of sick people. Same idea as that pine-scented strip the guy at the carwash hangs on your rearview mirror. You get into your car, and ahhh, you’re transported into a fresh pine forest in the middle of some glen. Your nose buys the deception for exactly two seconds before you’re down to earth, back behind the wheel of your Ford Tempo, the air laced with something vaguely mint-green, artificial, and chemical. Hospitals can go as heavy as they want on the ammonia and mask it with Old Spice for all I care. We’re not fooled. We know where we are.
Second, the air. Illness, disease, and, especially, death rise up from the afflicted and bounce off the shiny linoleum in a mist, hovering above us in a pale haze. The hanging cloud comes with an odor, the smell of brown, a musty odor I previously associated with a dank, forgotten corner of our cellar, piles of clothes unworn and packed away in the back of a dark closet, and my grandparents.
Third, the sound. An off-key stew of humming, whirring, beeping, metal chair legs scraping, wheelchair wheels creaking, human groaning, moaning, and howling, rumbling sporadic voice-overs pouring through overhead speakers, green-paper footsteps, coarse breathy inappropriate laughter, urgent, sad, whispered plans, the occasional scream, the scratching of forks and spoons along unbreakable plates, the swish of blood pressure cuffs, the crackle of blinding and sporadic fluorescent lighting, muffled shrieks, and mumbled prayer. I do have potential, because to me, this mash-up sounds like music.
Fourth, the fear. Wide-eyed and breathless. Swirling down the corridors, oozing through walls.
Theirs. And mine.
DAY ONE, THIRD year. My first of five two-month clinical rotations in the hospital.
Internal medicine.
Elevator at my back, I turn down the corridor, walk like a gunslinger. Well, in my mind. In reality, I inch forward in my short white coat that barely conceals my quivering chest. I feel like a nervous waiter. In slow motion, I bang into the nurses’ station and hold up my hand.
Tony Youn here. Reporting for duty.
I don’t say this. I can’t speak. I’m struck momentarily mute. A robotic nurse, eyes down, mumbles the particulars. Where to park (Lot C, Level 3, Aisle 2; I will never find my car). Where to eat (gag-a-teria, second floor, or the sketchy Burger King across the street, or the best bet, vending machine belly-up to the bathroom). Where to sleep (on-call room, next to the elevators, featuring a bowed metal bunk bed with cement mattress, choose up or fight for the bottom with the intern I’m assigned).
“Is this him?”
Voice like a bartender. I search for where it came. Look left, right, finally down. Find someone in a long white coat. Female, but that’s a guess. Wearer of a permanent pirate’s scowl. A dark bush of a unibrow that stretches ear to ear and shades two purple eyes like an awning. I’m still going with female. Or Danny DeVito in drag. Okay, I’m right. Female. Beneath her long white robe, I recognize a definite female configuration, breasts and such. Her hair is the clincher, pulled back in a tight black ponytail that she swings like a machete. She speaks again and confirms.
“I’m Nancy. And you are?”
“Tony. Anthony. Tony.”
“Wild guess. Are you Tony?”
A roll of her purple pin eyes. Then a sigh that could blow out a birthday cake. “Here’s the deal.”
She sizes me up, which makes me uncomfortable, because the top of her head barely reaches my chest.
“I am your mother.”
She may not mean it, but she shouts this, causing a work stoppage in the entire area code. I nod, or try to. Midnod, my head jiggles out of control. For a moment I’m a bobblehead. Nancy’s gin-soaked alto hones in.
“I own you. You do exactly what I say. You have questions? Keep them to yourself. I’m not interested. I don’t have time. Just follow my orders and stay out of my way. Understood?”
“Got it. Yes.”
“Good. A smart one.” A violent jerk of her head, and she sucker-slaps me across the face with her ponytail. “And that was your orientation. Let’s go, Tony-Tony. We got sick people backed up like a pileup on the I-96.”
She’s on the move, ponytail slicing the air. I match her stride for stride, too scared to lag behind, adrenaline pumping, keeping us neck and neck. She motors down the corridor, puffing like a tractor. We stop at door number one. She grinds her palm into the molding, sneaks a shot back at the nurses’ station. “Here’s the deal.”
I lean in. Nancy checks me into the door frame. “I don’t know you, but I don’t like you.”
“That was fast,” I say.
“Nothing personal. I don’t like anybody. I’m married, and I seriously don’t like him. He’s a lawyer.”
She spits the word out like a mouthful of shell. She pulls back an inch, gives me space to breathe. Not much space. The width of a tie.
“Not gonna lie,” Nancy growls. “I hate this. All of it. The job, this place, these people. This job? Want to know what they pay me? Shit. They pay me shit. Actually, that’s not true. They pay me less than shit. I’d kill to get paid shit. You getting this? Am I getting through?”
“Oh, yes. Definitely.”
“Good. I thought you took a dive on me there.”
“I’m totally with you.”
“We’ll see. Because that would be a major change from the usual line of third-year numbnuts they give me. Okay, Tony. Here’s the drill. Take the pulse, draw the blood—”
“Wait. I thought the phlebotomist drew blood.”
“Every day but today. We’re not waiting around for her lazy ass. So you lucked out. Do the draw, mark the chart, and move on. Don’t waste time making small talk with the gomers. Got it?”
“Gomers?”
“The chronically ill who end up here and waste our time. They never leave and they never die. That’s a GOMER. Stands for GET OUT OF MY EMERGENCY ROOM. Read House of God, lame-o.”
She puts her shoulder to the door.
“Uh, Nancy, thing is, I’ve never actually drawn—”
I’m too late. She’s barged into the room and is charging toward the first patient on the shift. Old guy sitting in a chair, gown pulled up to his waist. Lovely way to start the day.
She wraps her thick fingers around his wrist, her eyes beamed off into space, imagining, I presume, a different career choice. She drops his wrist as if it’s a slimy dog bone, scribbles something on a chart. “Do the draw,” she says to me.
“As I mentioned a moment ago—”
“Do the draw! We don’t have all day.”
Hands shaking, mouth dry and tasting of paste, I fumble with the needle kit she hands me.
Word of advice.
When you’ve got a razor-sharp implement in your hand and your job is to puncture someone’s flesh, take your time. Not great to search for a vein when you’re on the clock.
Put another way, there’s no such thing as a speed blood draw.
“Ow! Goddammit! Fuck you doing?” Gomer with the gown yanked up. Screaming as I stab his biceps. “OWW!”
“Sorry, sir, I just—”
Pay dirt.
“Yessss!” Needle in one hand, I fist-pump with the other.
“How about you dial it down a notch, Tony?” Nancy, under her breath.
“What’s with him?” Gomer. Using his free hand to take a side trip inside his gown. Wow. This I don’t need.
“It’s his first day,” Nancy says. Follows with a mumble to the universe, “Fucking third-year pain in my balls.”
“Pardon my enthusiasm,” I say to the vial of gomer blood rising. “I love my job.”
AN HOUR LATER, we’ve run through eleven patients, most of them gomers. We double up on some. Nancy listens to heart and lungs while I draw blood. Without a word, we’ve become an efficient tag team. Leaving door eleven, speeding down the corridor, dodging her kung fu ponytail, I wheeze, “You are fast.”
“I should get paid on commission. By the head. Speaking of which.”
She’s gone, ramming into the restroom.
I’m stranded and confused. Do I chance a pee break? Earlier this morning I dropped my pager into the urinal. Which, given Nancy’s charming personality, remains the highlight of my day. No. Best to hang here and loiter by the restrooms like a drunk. I bend my forehead to the cool bathroom wall and peer down at my formerly crisp short white coat, no longer remotely crisp or white. I’m now wearing a rumpled multicolored heavily weighted sack, crumpled from leaning against a morning’s worth of gomers, multicolored from intermittent fountains of bodily fluids, blood, pus, urine, and swill, otherwise known as breakfast, contributed mostly by patients with a splotch of my own flop sweat, and weighted down from accumulated stuff I’ve jammed in my pockets—new pager, hammer for banging on knees, stethoscope, pens, prescription pads, three-by-five notepad, yellow highlighters, hand sanitizer, and one medical how-to book, which I have yet to crack open and doubt I ever will.
Nancy bursts out of the ladies’ room as if sprung from a slingshot. She chicken-wings her arms. I fall in step next to her.
“Hour two,” she says, whipping me twice with her ponytail. “The fun never sets.”
She hauls ass around the corner and skids to a stop at door number twelve. I think. I have lost count. I know this: the patients’ faces have started to flip around into a psychedelic circle. I’m briefly light-headed and momentarily lost. Chalk it up to two years of eating nothing but crap, doing little exercise, the shock of facing an hour straight of nonstop sick people, and trying to keep up with Intern Nancy. I vow to start running and lifting again. Why do I decide this now? Is it because I’m gasping for breath before each blood draw?
I feel the death stare on me.
I crash-land back to earth. “Yes?”
I don’t know what Nancy’s thinking, but I don’t like the look on her face. She offers up a smug smile as if she’s just figured out the punch line to a private joke. She jabs her ponytail at me, which I manage to duck. I smugly smile back, but she doesn’t notice. She consults her clipboard, tinkles her fingers over a name. “Zingerman,” Nancy says.
“Gomer?”
“Probably. New admit.” Flicks at the name as if it’s a speck of lint. Furrows her furry unibrow.
“What?” I say.
“Stop that. I told you, no questions.”
“Sorry.”
She swats the air as if striking a mosquito. “Here’s the deal.”
I lean forward precariously. I’m an inch away from tipping over.
“You do the medical history. I’ll hit the gomer next door and the one across the hall. Couple of drive-bys. Meet up with me two doors down.”
“Wait, wait, wait. You want me to go in there alone?”
“Duh-uh.”
“This is my first day. I’ve been doing rounds for exactly one hour. I’m a little green.”
Nancy’s not buying. Or caring. “Don’t go near her with anything sharp. Take her history and get the hell out. Bang-boom. Tell me you can’t handle that, and I’ll bust you down to another tern, someone who, unlike me, will be a bitch.”
I must be gaping because Nancy says, “Close your mouth.”
“I didn’t expect to be thrown into the fire the first day—”
“Don’t be a wuss.”
Eyes staring up, locking to mine. I feel myself flush. I spin away, face the door. Hesitate.
“Give her hell.”
Nancy growls and slaps my ass.
I OPEN THE door to Mrs. Adele Zingerman, seventy-eight, my first live patient ever. She sits across the room in a chair, legs folded at purple ankles.
“MRS. ZINGERMAN!” I shout. “HELLO!”
Okay, a little less volume. Let’s start with that.
I cross the room in two steps. I arrive and hover over Mrs. Zingerman. I sing softly, “Good morning, good morning.”
What the hell am I doing, Singing in the Rain?
I ease onto the edge of the bed, fumble in my pocket for a pen and a three-by-five. I grin at Mrs. Zingerman. I try to remember my class in clinical skills. Step one. Put her at ease. Ask an open-ended question.
“Hello, Mrs. Zingerman.”
She coughs, grimaces, grins back.
“So what brings you here today?”
Textbook. Doctor Talk 101. How I’ve been trained. All that time I put in with dead bodies and live actors is kicking in.
I flash a broad smile. Click the pen. Poised to write. Mrs. Zingerman again grins, grimaces, says nothing.
I speak again, slower and louder. “WHAT BRINGS YOU HERE TODAY, MRS. ZINGERMAN?”
Nothing.
I scratch my head with the pen. Mrs. Zingerman laughs. What the hell? Might as well keep scratching. She got a kick out of it. Scratch, scratch, scratch. I make a silly yet kind face. She stares through me, creases her mouth into a frown. Maybe she doesn’t speak English.
“What kind of problem are you having today? Can you tell me?”
Mrs. Zingerman opens her mouth. A sound trickles out. Half a grunt, half a croak. Not a sound I’ve heard before. She pushes herself to her feet, stands unsteadily. I stand, too, extend my arms, ready to guide her. She takes a step. Weaves.
“Do you—are you—where are you going—?”
She lurches forward, takes two more shaky steps.
“Do you need to use the bathroom?”
She freezes. Her eyes bulge. She gasps, gurgles, takes another step, and falls to the floor. She lies there, motionless, soundless.
“Mrs. Zingerman?”
She doesn’t move. She doesn’t grin, gurgle, or gasp.
“Are you okay?”
Wait a minute. Is she—? No. She can’t be.
“Mrs. Zingerman? Hello?”
Are you SHITTING me?
I drop down, feel for a pulse.
No pulse. No heartbeat. No breath. No sign of life.
I’m new at this doctor stuff—I’m still a medical student—but I’m pretty sure this means that Mrs. Zingerman is dead.
I have killed my first patient.
This can’t be good.
It may be some sort of record, but I know it can’t be good.
Will I get marked down for this?
I crouch over Mrs. Zingerman, thinking, What do I do?, and then Nancy’s tanklike frame fills the doorway and I hear “Youn, what the fuck is taking you so long . . . SHIT!”
Time stops. Fractured words dance across the room, saddle pulmonary embolus, screams of “Code! Code!”, then whirring of machinery, crashing of footsteps, a tide of white-coated bodies surging in, and one man, Dr. Ed Moncrief, exuding a steady cool, pushes through the crowd to take over. He wears a long white coat, but he may as well have on a leather jacket. He is that cool. I stand to the side and watch in some state of awe, still stunned but no longer afraid. Unlike Nancy, who’s a terrorist, and me, who’s a rookie, Dr. Moncrief is a doctor, and everyone in the room knows it, defers to him, and gets the hell out of his way. He is the star in the room, and the light shines only on him as he works over poor dead Mrs. Zingerman, checking for her nonexistent breath and pulse, jolting her nonbeating heart with paddles, pounding her lifeless chest. We stand in the shadows, helples
s observers, his audience in the dark. Finally, after five minutes of literally trying to revive the dead, Dr. Moncrief calls it a day. “No cure here.” Sung in a glee-club baritone.
Moncrief stands, making sure we all notice that he towers over everyone in the room. He pronounces Mrs. Zingerman officially deceased and announces her official time of death like a news anchor. Pin eyes blinking contempt, aimed at me, Nancy scribbles a frazzled something onto her clipboard. Moncrief spins out of the room, halts at the doorway to again check the time. “Lunch,” he says, and pivots toward the gag-a-teria.
Nancy, I know, will have to answer for this. Not that she could have stopped Mrs. Zingerman from dying, but she should not have left a third-year medical student alone with a patient—even a gomer—on his first day. Hell, in his second hour. She will have some explaining to do.
She starts after Moncrief. I step toward her. She whirls and bumps me with her hefty shoulder, then eyeballs me with a laser look designed to reduce me to a pile of ash. “Good job,” she says, forming a blockade with her body. “I don’t know what you said, but you killed her.”
“You actually think it was something I said?”
Hand up. A stop sign. “No—fucking—questions.”
Some emotion Nancy vaguely recognizes—fear, horror, sadness, helplessness—passes across my face, because her eyes widen and glisten. “Oh, fuck. Okay, look. It was a blessing in disguise.”
I nod, understand. “She had a fatal illness and it was just a matter of time.”
Roll of her eyes for the five hundredth time of the morning. “No, dipshit. It’s a blessing that you got your first one out of the way. Patients die. Get used to it. This is a hospital.”
This begs for a response, but I have temporarily turned to stone. Meanwhile, Nancy’s moment of humanity passes.
“Meet me back here after lunch for round two. Thirty minutes. Let’s see what kind of damage you can do this afternoon.”
“I can’t do any worse.”
She’s gone, rumbling down the corridor toward a burrito.