I get down to the resident lounge six minutes later, part of the chicken pesto sandwich still lodged in my throat. Naturally, Alyssa is already waiting for me, and looks at her watch pointedly when I arrive. She seems furious. I play a little game where I try to guess what made her so angry before she has a chance to tell me.
โDid you evenย examineย Mrs. Vargas?โ she asks me.
I just stare at her for a minute until I realize this wasnโt a rhetorical question.
โUm, yeah. I did.โ
โHer pupils areย huge,โ Alyssa practically spits at me. โSheโs high as a kite! How could you not notice that?โ
Her pupils are huge? Wow, I completely missed that finding. Her pupils looked completely normal to me. Well, I guess S*xy Surgeon is getting to second base.
โOh,โ is all I say.
Alyssa nods as if she expected nothing less of me at this point. I sit down on the couch across from her and fold my hands together. My knees are shaking a little so I try to steady them with my folded hands.
โSo letโs do some feedback,โ Alyssa says.
โOkay,โ I say. I tug on my scrub top, which suddenly feels much too
hot.
Alyssa tucks her index cards away in her white coat pocket and
stares at me intently. Itโs a little unnerving. โSo how do you think youโve been doing?โ
โIโll be honest,โ I say. โItโs been a rough transition. I did mostly electives and traveled during my fourth year of med school, so I lost some of the knowledge I had since my sub-internship. But I feel like Iโm getting back up to speed.โ
Alyssa nods. โYes, Iโd agree with that.โ Then she starts in with, โNo offense, butโฆโ
Immediately, I brace myself. Whenever someone starts a sentence with โno offense but,โ it means theyโre going to say something really offensive. I hate that phrase. No offense, but if you say that, youโre a jackass.
In any case, pretty much everything Alyssa has ever said to me has been offensive. So if she thinks itโs particularly offensive, then I am definitely worried.
โNo offense,โ Alyssa says, โbut your knowledge and skill level is more likeโฆ well, like a medical student.โ
Hey, Alyssa, newsflash: I was a medical studentย two weeks ago.
Sheesh.
โYou need to be constantly reading,โ she says. โEvery night. You need to read vehemently.โ
Readย vehemently? What the hell does that mean? How do you read vehemently? โOkay,โ I say.
โBecause your knowledge level is really pretty poor,โ she says. โUh huh.โ
โCompared with your peers like Connie, youโre really not up to par,โ she says.
I glare at her. Hereโs the thing: My medical board scores? You know, the ones that objectively test your knowledge of the field of medicine? Pretty high. Maybe not as high as S*xy Surgeon or Connieโs scores, but I have a feeling that I could give Alyssa a run for her money. So my knowledge level isnโt bad. Itโs probably over one standard deviation above average, if the medical licensing board is to be trusted. But thereโs a huge difference between having knowledge and feeling comfortable using that knowledge on actual human beings who couldย dieย if you do the wrong thing.
But all I say is, โOkay.โ
I sit there, waiting for Alyssa to ask me for feedback on herself. It seems like sheโd want to know how sheโs performing as a senior resident, and in my experience, thatโs always been part of the feedback process. But she doesnโt ask me and I donโt offer.
I guess sheโs comfortable in the knowledge that sheโs perfect.
My pager goes off and Alyssa nods consent that I may answer. I feel like I only vaguely remember what it was like to be able to do things like eat, pee, and make a call without first asking permission. โThis is Dr. McGill,โ I say.
โHello, Doctor,โ a nurse says. โI have a question on Mr. Stevens in Room 428B. He says he keeps a gun by his bed at home and he wants it now.โ
โYeah, thatโs not going to happen,โ I say.
โHe says he doesnโt want to use it,โ the nurse explains. โHe just wants to keep it by his bed.โ
โThe answer is still no,โ I say. Are they seriously calling me about this?
โWait,โ the nurse says. โAnother nurse wants to talk to you.โ
I hang on the phone while Alyssa checks her watch. Finally, a second nurse comes on the line. โDoctor,โ she says. โThomas Jefferson is here and really wants to talk to you.โ And then she dissolves into giggles. Appropriately so.
I sigh and look up at Alyssa. โI have to go,โ I say to her.
She nods. Thomas Jefferson is a true American hero. First he helped found the country and now heโs getting me out of a conversation with Alyssa.
I can hardly believe it when I lay my eyes on Thomas Jefferson. I expected him to be big and boisterous like his wife Marquette, but instead, heโs a tiny fellow. Heโs only maybe an inch or two taller than me and skinny as a rail. His black hair is cropped very close to his skull, but he makes up for it with a graying beard that goes down to his shirt collar. โI am so sorry, Dr. Jane,โ Mrs. Jefferson says when I walk into the
room. โI told him not to bother you when youโre working.โ โThatโs all right,โ I say. โI was happy to come here.โ
Mrs. Jefferson beams at her husband. โWhat did I tell you? Isnโt she a sweetheart?โ
โMarquette tells me sheโs in capable hands,โ Thomas Jefferson says in a deep, crackly voice. He reaches into a bag heโs holding and pulls out what looks like a cake box. โI brought you this.โ
I take the box from him and peer inside. Itโs a mishmash of different fruits placed haphazardly in a grayish custard, enveloped by a slightly blackened crust. It looks like it was made by a couple of overly zealous kindergarteners. โWhat is it?โ
โFruit custard pie,โ Thomas Jefferson says proudly. โItโs my sisterโs specialty. She made it up just for you.โ
I look up at Mrs. Jefferson, who is shaking her head. โAlma and those piesโฆโ
Not wanting to get involved in a family argument, I clutch the pie to my chest and say, โThank you very much.โ
โSee?โ Thomas Jefferson says. โShe likes it!โ โSheโs just being nice!โ Mrs. Jefferson retorts.
โThat pie won a contest once!โ Thomas Jefferson argues.
โWhat contest was that?โ Mrs. Jefferson shoots back. โPie most likely to give you the runs?โ
โI better go,โ I say abruptly.
I scurry out of the room, holding the pie (which there is no way in hell I am eating). It takes me several seconds after Iโve left the room to realize that Thomas Jefferson has followed me outside. Heโs got a worried look on his small face.
โDr. Jane,โ he says. โCan I talk to you?โ
I put the cake down at the nurseโs station and nod at him. โSure.
Whatโs up?โ
He heaves a sigh. I can see tears forming in his brown eyes. โItโs all my fault that this happened to Markie.โ
I stare at him. โWhat?โ
He wipes his left eye with the back of his hand. โWhen she had that infection,โ he says, โshe didnโt want to get the amputation. She didnโt want to lose her leg. But I talked her into it. I told her sheโd get home faster if she did what the doctors said. I didnโt know theyโd end up taking the whole legโฆโ A tear rolls down his cheek. โAnd now it looks like she ainโt never coming home, Dr. Jane.โ
โThatโsโฆโ I hesitate, the words catching in my throat. โThatโs not necessarily true.โ
โI canโt take care of her, Dr. Jane,โ he says. โIโm not a young man and I got heart problems of my own. She wantsย so badย just to come home and see her grandkids.โ
We want it bad too. Living in the hospital is not the most cost- efficient thing Mrs. Jefferson could be doing. She should be going home. Weโve got social workers trying to navigate the system, trying to find a way to make it happen. But I donโt have much hope right now. We canโt even send her to a nursing home because her insurance wonโt pay for it, so none of them will accept her.
โWeโre doing our best,โ is what I say to Thomas Jefferson.
He nods and pats my shoulder. โI know you are,โ he says. โI just had to say my piece.โ
Then he turns and I watch his narrow shoulders as he disappears back into his wifeโs hospital room.
Thereโs a quiet room on the fourth floor of the hospital that contains four computers and three phones, where residents often go to check labs. The computers are very slightly faster than the one in the lounge,
although still significantly slower than anything that could be purchased on the market today. Iโm at one of the computers, waiting for it to log me in, and Nina is next to me talking on the phone. I canโt help but listen in to her conversation.
โNo, I discharged him!โ Nina is yelling into the phone, her tiny elfin face red. โHe has to go home. Now.โ She rolls her eyes at me. โI donโtย careย if he doesnโt have shoes! Not having shoes isย notย a reason to be hospitalized.โ
I cover my mouth to suppress a laugh. Nina scribbles something on a sheet of paper then passes it in my direction.
It says: โCode Dinner!โ I nod.
โSo why wonโt he wear the shoes you offered him?โ Nina says into the phone. I hear her groan loudly. โThey smell like chemicals and he thinks theyโre unsafe? Seriously? Isnโt this the guy who overdosed on heroin? Tell him the shoes are safer than heroin.โ
I turn my attention back to my computer, which has finally logged me on. Mrs. Vargasโs labs are back from earlier, including her urine tox. Considering Alyssaโs observation about her pupil size, Iโm expecting to see a positive result for amphetamines. But instead the urine tox is completely negative. I was rightโMrs. Vargas is drug-free.
Holy crap, I was right!
And now Ryan Reilly has to take me out to dinner. Which is great, but really, Iโm mostly looking forward to telling Alyssa I was right. That, let me tell you, will be sweet.
Nina gets off the phone and I can see sheโs trying to compose herself. โI need food,โ she says. โStat.โ
I nod. โLetโs hit the cafeteria.โ
Maybe Iโll see Alyssa there and get to rub it in her face that she was wrong wrong wrong.
Nina and I pass the resident lounge on the way to the cafeteria. The door is slightly ajar and I suddenly hear Alyssaโs voice coming from inside.
I tap Nina on the shoulder, โYou go ahead. Iโll catch up with you.โ โNo, please come, Jane,โ she whines. โI donโt want to get stuck
sitting with Julia.โ
โTwo minutes,โ I say. โI promise.โ
Nina has no choice but to acquiesce. I push my hand against the door to the lounge and Alyssaโs voice gets louder. I realize that sheโs talking on the phone. I enter the room, but sheโs turned toward the window and doesnโt notice me.
โCan you say โbye byeโ to mama?โ Alyssa is saying into the phone in that high, sweet voice. Itโs her son, I guess. โPlease, sweetie, just say something to mama.โ She pauses. โPlease, say something. Sayย anythingโฆโ
Thereโs a long pause and I shift where Iโm standing. I left the Jeffersonsโ pie in here earlier for residents to graze on. Despite how disgusting it looked to me and the real possibility of it being a source of gastroenteritis, thereโs now only one sliver of pie remaining in the box. I wonder if Alyssa ate any pie.
I turn my attention back to Alyssa, who is now quiet. Finally she speaks again in a normal voice. โI know, heโs shy on the phone,โ she says. โI know. Just tell him Iโll be home tomorrow. Maybe Iโll make it for lunch.โ
When she puts down the phone, her narrow lips are set in a straight line. The smart thing for me to do would have been to get the hell out, but I seem to be frozen in place. She whirls around and catches me standing there. โJane!โ she snaps at me. โWhat are you doing here?โ
Wishing I were anywhere else. โMrs. Vargasโs urine tox came back,โ I say lamely. โIt was negative.โ
She nods, as if this is the least interesting piece of news sheโd heard all day. She doesnโt apologize to me for saying I was wrong, thatโs for sure.
โBy the way, Jane,โ she says. โIโve been meaning to talk to you about your white coat.โ
I finger the stiff material of the coat covering my scrubs. Itโs a bit big and the sleeves come down nearly to the tip of my thumbs. โWhat about it?โ
โLook at it!โ Alyssa snaps at me. I look at the coat. โUmโฆโ
โLook how wrinkled it is!โ she says. โI would say itโs at an unacceptable level of wrinkles. Is this the level of professionalism you want to show?โ
Is she kidding me? Am I supposed to be spending my timeย ironing
my white coat? Seriously, itโs notย thatย wrinkled.
โAnd whatโs this?โ Alyssa asks, pointing at a faded yellow spot on my left sleeve, about a centimeter in diameter.
โI guess itโs a stain,โ I admit.
Alyssa shakes her head in disbelief, as if sheโs too disappointed to speak. But what can I do? The hospital only gave me two white coats, and I canโt wash them daily, especially with the bathroom cleaning I have to do every other day.
I just have to accept that no matter what I do, I can never meet Alyssaโs standards
Hours awake: 13 Chance of quitting: 65%