Sometime in July
Time: 3 a.m.
Hours awake: 21 Chance of quitting: 75%
This patient is the fattest man I’ve ever seen in my life. His name is George Leeman and he’s got fat folds on his belly that are so deep, I think I could stick my whole fist inside. Hell, I think I could stick my whole arm inside. I think I might be able to set up a tent in his belly button with an adjacent fireplace. The nurses had to get him an extra- large bed because the regular hospital beds were too small to fit his massive frame.
Before we got him in the bed, the nurses weighed Mr. Leeman on our bariatric scale. It’s a scale we use for people who are either really obese or are in a wheelchair. The scale has a platform that’s about the size of an elevator and you can wheel or waddle onto it. We got a weight for Mr. Leeman and used it to calculate his body mass index (BMI). The BMI is a calculation based on a patient’s weight and height, and tells us scientifically exactly how fat a patient is.
For example, before I started medical school, my BMI was 24. That put me square in the middle range of “normal.” Now, less than one month into my intern year, my BMI is 26, which puts me just on the edge of “overweight,” kind of like the rest of the country. If I continue to eat primarily junk food, which is likely given how the last few weeks are going, I might get up to 3O, which would make me officially “obese.”
Mr. Leeman’s BMI is about five trillion.
Not really. But it’s high. He’s what we’d call “morbidly obese.” That’s a real medical diagnosis, you know. It’s not just something you say to make fun of the fat kid in the playground.
I’ve been sitting here talking to Mr. Leeman for about thirty minutes, scribbling notes on a piece of paper about his heart disease, his medications, his other medical problems. I actually sort of like the guy. He’s got a big toothy smile and he calls me “honey.” I should probably
be insulted by the “honey” thing since he’s supposed to call me “doctor” and he’s just being disrespectful and sexist, but at this hour of the morning, any kind words make me feel a little less awful.
My senior resident Alyssa particularly dislikes obese patients. When the emergency room calls her about an obese patient, she sighs extra loudly. I’m not as bothered, and it’s not just because I automatically like anything that makes Alyssa unhappy. But I figure nobody gets to 6OO pounds just by eating a bunch of bacon double cheeseburgers. People who are that big must have a disease, just like the patients with pancreatic cancer or multiple sclerosis. And I’m not going to throw stones. After all, I like my bacon double cheeseburgers too.
“Do you have any more questions, sweetheart?” Mr. Leeman asks me. I’ve now graduated to sweetheart. He’s making me feel all of twelve years old.
I look down at my page of chicken scratch. I can make out exactly five words on the page. I’ve been a doctor less than a month and I already got the handwriting down pat.
“No, I think that’ll be all,” I say. Then I add, “For now.”
As a lowly medical intern, I must discuss every patient I see with my senior resident—and odds are twenty to one that Alyssa will send me back in here to ask something else I forgot. No matter how thorough a history I think I got, she always comes up with something. What’s the patient’s shoe size? What did he eat for dinner last night? What was the middle name of his best friend in third grade? Alyssa demands a very thorough history.
I find Alyssa sitting in the resident lounge, which is her working area of choice when we’re on call. She’s wearing blue scrubs that make her eyes look bluer. Alyssa isn’t beautiful, although sometimes I wish she were because it would give me another reason to hate her. She’s on the cusp of beautiful, but she’s a little too skinny, a little too tall, her forehead a little too long. My mother always says that the forehead is what makes the face. I’m not sure I agree with that one, but Alyssa’s forehead definitely isn’t doing her any favors.
Alyssa must be as sleep deprived as I am, but she doesn’t look it. Her straight brown hair is swept back into… I think it’s a chignon, although I truthfully don’t know what the hell a chignon is. Not one little hair is out of place. Her eyes aren’t bloodshot and don’t have little purple circles under them, like I know mine do without even looking in a mirror. And she smells good. Nothing in this hospital smells good, except somehow Alyssa does.
“Hi,” I say timidly.
Alyssa is flipping through her index cards. She carries around a pack of index cards on which she catalogues information about all our patients, and possibly one about me too. My biggest fantasy is stealing her index cards and watching her flounder. Then I get disgusted with myself that stealing index cards has now become my biggest fantasy. In any case, she doesn’t look up from her cards when she speaks to me.
“Are you ready?” she asks me.
She’s not really asking me if I’m ready. She’s really saying to me, “You better be ready and not be wasting my time, girlie.” I wring my fists together and in the process, I crumple my notes slightly. Even though it’s three in the morning, I’ve got a little surge of adrenaline going.
“I’m ready,” I say, with all the finality of someone pledging her marriage vows.
Alyssa gestures at the couch across from her. I’m not allowed to actually sit next to her while we talk. I’m lucky she lets me sit at all. I can imagine her forcing me to stand at the doorway, maybe on one foot.
Before I can open my mouth, Alyssa says, “What took you so long?”
“Huh?” I say. I have no clue what she’s talking about.
Alyssa finally raises her eyes from her index cards. “What took you so long?” she says again, louder this time.
My hands are sweaty. I wipe them on the couch and leave behind two little sweat stains. I’d be embarrassed if I wasn’t so tired and also this couch is very possibly the dirtiest couch in the history of the world. Probably 2O years’ worth of cafeteria food stains this couch. If anything, my sweat made it cleaner.
“I don’t know what you mean,” I finally admit.
“Connie got her last patient after you did, yet she presented him to me ten minutes ago,” Alyssa says. She puts down her index cards and folds her arms across her chest. “Why are you so slow, Jane?”
Connie, like me, is a lowly intern in her first year of post medical school training. I secretly suspect that Connie and Alyssa are twins separated at birth. They even have that secret twin language where they look at each other and I can tell they’re exchanging sentiments of how incompetent I am. Connie has conveniently provided Alyssa with a model of how to correctly do all the things I’m doing wrong.
“What are you doing that’s slowing you down so much?” Alyssa says. It’s three in the morning, yet she won’t let this go.
I wrack my brain to think of an answer I can give that will end her line of questioning. I can’t think of anything. I honestly didn’t think I was that slow. Mr. Leeman is a complicated patient, more complicated than Connie’s guy with chest-pain-that-was-clearly-indigestion. But I know that isn’t going to be an acceptable answer for Alyssa.
“You need to work on being faster,” Alyssa finally says. She clucks her tongue. “Well, go ahead.”
I clear my throat. Around midnight, my throat always starts feeling scratchy and dry. I suppose it’s just my naïve body telling me I need sleep. “Mr. Leeman is a 56-year-old man with a history of heart failure and diabetes who has been having increased shortness of breath for the last week…”
Alyssa takes notes as I talk about how the emergency room discovered that Mr. Leeman was having an exacerbation of his heart failure and his lungs were basically floating around in a swimming pool. He got a strong diuretic that turned the swimming pool into a small Jacuzzi, and he is now doing okay, but still needs some oxygen. We’ll probably need a few more days to clear out the pool. Then we’ll send him home.
I launch into my physical exam findings. He has a heart murmur and lungs that sounds… well, wet. There’s a sound that fluid-filled lungs make that now makes me think of the ocean. The ocean. I wonder if I’ll ever have time to go to the beach again. Maybe Ryan and I can take the subway out to Brooklyn and… no, best not to think about it.
“What about his bottom?” Alyssa interrupts me.
“Huh?” I say. This seems to be my response to 9O% of her questions.
“How did his buttocks look?” she says. “Any skin breakdown?” “Uh,” I say. “I didn’t really…” I lower my eyes so that all I can see
is my hands. “I didn’t look.”
“You’re presenting a patient to me and you didn’t even look at his buttocks?” Alyssa’s usual monotone raises in intensity a few decibels. I can’t imagine her being any angrier if I had suffocated the patient with his own pillow.
“I guess…” I bite my lip. “The thing is, he’s really obese.” “All the more reason to look at his buttocks!”
“Yeah, but he can’t roll over,” I explain.
Alyssa gives this really loud sigh. Even Mr. Leeman one flight up can probably hear her sigh. “Well, I don’t know, Jane. How would you look at the backside of a patient who can’t roll over on his own?”
“Huh?” I say.
Alyssa sighs again. She puts her pen down on the couch next to her and sits up a notch straighter. The girl always looks like she has a rod up her spine. When she speaks again, it’s very slow, like the way she’d talk to a small child, if a small child had the misfortune of somehow getting into a conversation with her. “How. Would. You. Look. At. His. Backside. If. He. Can’t. Roll. Over.”
It’s like one of those riddles where you’ve got two boats and five people and each boat can only fit two people and they have to get across a river in three steps or less. I was always terrible at those. “Um, how?”
“You ask a nurse to help turn him,” she says, shaking her head at
me.
A nurse. Great. Because they don’t already hate me enough without
my forcing them to turn a 6OO-pound man with about a trillion tubes and wires coming out of him.
“Okay,” I say.
Alyssa has gone back to sifting through her index cards and I get a bad feeling. “You mean now?” I ask.
“When do you think, Jane? Next week?”
I can’t believe Alyssa isn’t going to let me finish presenting my patient to her. I can’t believe I’m going to have to figure out a way to turn 6OO pounds of flesh and bones (and lung fluid). This bites. All I can think of is my bed back home. My cozy bed with my down comforter and fluffy pillow.
I heave myself off the couch, resigning myself to the fact that not only am I not going to see my bed at home, I likely won’t even get to see the creaky cot in the call room tonight. “Okay,” I say. “I’ll be back.”
Alyssa doesn’t even lift her eyes to acknowledge me.
When I get back upstairs to the floor where Mr. Leeman is staying, I head over to the nurse’s station to recruit help. I see Rachel, a youngish nurse who doesn’t seem to actively dislike me. Unlike Alyssa, Rachel really is beautiful, all dark and exotic. She has long black hair that she probably should wear in a ponytail, but it would be a crime not to leave it lush and flowing around her face.
“Hi, um, Rachel…” I begin.
Rachel smiles radiantly at me. “What can I do for you, ’Doctor’?”
Yeah, all the nurses call me “doctor” and I always, always hear the scare quotes. I don’t blame them. I’ve been a doctor less than a month and I think it’s kind of ridiculous they have to call me that while I call them by their first names.
“I need to turn Mr. Leeman to look at his backside,” I say. I lower my eyes. “I’m so sorry.”
Rachel whips her head around as she turns to the rest of the nurses, and her long black hair nearly smacks me in the face.
“We need to turn Mr. Leeman!” she calls out. “I’m going to need some help. Angie, Maxine, Anthony, Katie, Julio, Jenny…”
I swear to God, she called out about ten names before she was done. A few minutes later, a parade of us are marching into Mr. Leeman’s room. I’m still not entirely sure if we have enough manpower.
“Hello, Mr. Leeman,” I say as we come into the room. “Hi, sweetheart,” he says as Rachel snickers.
“We’re going to turn you and look at your back,” I explain to him. “Knock yourself out, kid.”
Kid. Even better than sweetheart.
We arranged five people on one side and five on the other. After some degree of heaving, we manage to turn Mr. Leeman approximately 9O degrees. “Is that okay, ’Doctor’?” one of the nurses asks me.
As I draw my face closer, I smell it. It’s not fungus. I know the smell of fungus better than I know my own name right now, being one of the most recognizable smells in the hospital (more on that later). But this is something else. Something horrible.
And then a second later I see it: a wound just at the base of his spine and to the left that is angry red and dripping with pus. God knows how deep that thing is. It may go down to the muscle or even the bone.
