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.
“Did you even examine Mrs. Vargas?” she asks me.
I just stare at her for a minute until I realize this wasn’t a rhetorical question.
“Um, yeah. I did.”
“Her pupils are huge,” Alyssa practically spits at me. “She’s high as a kite! How could you not notice that?”
Her pupils are huge? Wow, I completely missed that finding. Her pupils looked completely normal to me. Well, I guess Sexy Surgeon is getting to second base.
“Oh,” 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.
“So let’s do some feedback,” Alyssa says.
“Okay,” 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. It’s a little unnerving. “So how do you think you’ve been doing?”
“I’ll be honest,” I say. “It’s 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 I’m getting back up to speed.”
Alyssa nods. “Yes, I’d agree with that.” Then she starts in with, “No offense, but…”
Immediately, I brace myself. Whenever someone starts a sentence with “no offense but,” it means they’re going to say something really offensive. I hate that phrase. No offense, but if you say that, you’re a jackass.
In any case, pretty much everything Alyssa has ever said to me has been offensive. So if she thinks it’s particularly offensive, then I am definitely worried.
“No offense,” Alyssa says, “but your knowledge and skill level is more like… well, like a medical student.”
Hey, Alyssa, newsflash: I was a medical student two weeks ago.
Sheesh.
“You need to be constantly reading,” she says. “Every night. You need to read vehemently.”
Read vehemently? What the hell does that mean? How do you read vehemently? “Okay,” I say.
“Because your knowledge level is really pretty poor,” she says. “Uh huh.”
“Compared with your peers like Connie, you’re really not up to par,” she says.
I glare at her. Here’s 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 Sexy Surgeon or Connie’s scores, but I have a feeling that I could give Alyssa a run for her money. So my knowledge level isn’t bad. It’s probably over one standard deviation above average, if the medical licensing board is to be trusted. But there’s a huge difference between having knowledge and feeling comfortable using that knowledge on actual human beings who could die if you do the wrong thing.
But all I say is, “Okay.”
I sit there, waiting for Alyssa to ask me for feedback on herself. It seems like she’d want to know how she’s performing as a senior resident, and in my experience, that’s always been part of the feedback process. But she doesn’t ask me and I don’t offer.
I guess she’s comfortable in the knowledge that she’s 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. “This is Dr. McGill,” I say.
“Hello, Doctor,” a nurse says. “I 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.”
“Yeah, that’s not going to happen,” I say.
“He says he doesn’t want to use it,” the nurse explains. “He just wants to keep it by his bed.”
“The answer is still no,” I say. Are they seriously calling me about this?
“Wait,” the nurse says. “Another nurse wants to talk to you.”
I hang on the phone while Alyssa checks her watch. Finally, a second nurse comes on the line. “Doctor,” she says. “Thomas Jefferson is here and really wants to talk to you.” And then she dissolves into giggles. Appropriately so.
I sigh and look up at Alyssa. “I have to go,” I say to her.
She nods. Thomas Jefferson is a true American hero. First he helped found the country and now he’s 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, he’s a tiny fellow. He’s 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. “I am so sorry, Dr. Jane,” Mrs. Jefferson says when I walk into the
room. “I told him not to bother you when you’re working.” “That’s all right,” I say. “I was happy to come here.”
Mrs. Jefferson beams at her husband. “What did I tell you? Isn’t she a sweetheart?”
“Marquette tells me she’s in capable hands,” Thomas Jefferson says in a deep, crackly voice. He reaches into a bag he’s holding and pulls out what looks like a cake box. “I brought you this.”
I take the box from him and peer inside. It’s 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. “What is it?”
“Fruit custard pie,” Thomas Jefferson says proudly. “It’s my sister’s specialty. She made it up just for you.”
I look up at Mrs. Jefferson, who is shaking her head. “Alma and those pies…”
Not wanting to get involved in a family argument, I clutch the pie to my chest and say, “Thank you very much.”
“See?” Thomas Jefferson says. “She likes it!” “She’s just being nice!” Mrs. Jefferson retorts.
“That pie won a contest once!” Thomas Jefferson argues.
“What contest was that?” Mrs. Jefferson shoots back. “Pie most likely to give you the runs?”
“I better go,” 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 I’ve left the room to realize that Thomas Jefferson has followed me outside. He’s got a worried look on his small face.
“Dr. Jane,” he says. “Can I talk to you?”
I put the cake down at the nurse’s station and nod at him. “Sure.
What’s up?”
He heaves a sigh. I can see tears forming in his brown eyes. “It’s all my fault that this happened to Markie.”
I stare at him. “What?”
He wipes his left eye with the back of his hand. “When she had that infection,” he says, “she didn’t want to get the amputation. She didn’t want to lose her leg. But I talked her into it. I told her she’d get home faster if she did what the doctors said. I didn’t know they’d end up taking the whole leg…” A tear rolls down his cheek. “And now it looks like she ain’t never coming home, Dr. Jane.”
“That’s…” I hesitate, the words catching in my throat. “That’s not necessarily true.”
“I can’t take care of her, Dr. Jane,” he says. “I’m not a young man and I got heart problems of my own. She wants so bad just to come home and see her grandkids.”
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. We’ve got social workers trying to navigate the system, trying to find a way to make it happen. But I don’t have much hope right now. We can’t even send her to a nursing home because her insurance won’t pay for it, so none of them will accept her.
“We’re doing our best,” is what I say to Thomas Jefferson.
He nods and pats my shoulder. “I know you are,” he says. “I just had to say my piece.”
Then he turns and I watch his narrow shoulders as he disappears back into his wife’s hospital room.
There’s 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. I’m at one of the computers, waiting for it to log me in, and Nina is next to me talking on the phone. I can’t help but listen in to her conversation.
“No, I discharged him!” Nina is yelling into the phone, her tiny elfin face red. “He has to go home. Now.” She rolls her eyes at me. “I don’t care if he doesn’t have shoes! Not having shoes is not a reason to be hospitalized.”
I cover my mouth to suppress a laugh. Nina scribbles something on a sheet of paper then passes it in my direction.
It says: “Code Dinner!” I nod.
“So why won’t he wear the shoes you offered him?” Nina says into the phone. I hear her groan loudly. “They smell like chemicals and he thinks they’re unsafe? Seriously? Isn’t this the guy who overdosed on heroin? Tell him the shoes are safer than heroin.”
I turn my attention back to my computer, which has finally logged me on. Mrs. Vargas’s labs are back from earlier, including her urine tox. Considering Alyssa’s observation about her pupil size, I’m expecting to see a positive result for amphetamines. But instead the urine tox is completely negative. I was right—Mrs. 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, I’m 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 she’s trying to compose herself. “I need food,” she says. “Stat.”
I nod. “Let’s hit the cafeteria.”
Maybe I’ll 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 Alyssa’s voice coming from inside.
I tap Nina on the shoulder, “You go ahead. I’ll catch up with you.” “No, please come, Jane,” she whines. “I don’t want to get stuck
sitting with Julia.”
“Two minutes,” I say. “I promise.”
Nina has no choice but to acquiesce. I push my hand against the door to the lounge and Alyssa’s voice gets louder. I realize that she’s talking on the phone. I enter the room, but she’s turned toward the window and doesn’t notice me.
“Can you say ’bye bye’ to mama?” Alyssa is saying into the phone in that high, sweet voice. It’s her son, I guess. “Please, sweetie, just say something to mama.” She pauses. “Please, say something. Say anything…”
There’s a long pause and I shift where I’m standing. I left the Jeffersons’ 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, there’s 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. “I know, he’s shy on the phone,” she says. “I know. Just tell him I’ll be home tomorrow. Maybe I’ll make it for lunch.”
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. “Jane!” she snaps at me. “What are you doing here?”
Wishing I were anywhere else. “Mrs. Vargas’s urine tox came back,” I say lamely. “It was negative.”
She nods, as if this is the least interesting piece of news she’d heard all day. She doesn’t apologize to me for saying I was wrong, that’s for sure.
“By the way, Jane,” she says. “I’ve been meaning to talk to you about your white coat.”
I finger the stiff material of the coat covering my scrubs. It’s a bit big and the sleeves come down nearly to the tip of my thumbs. “What about it?”
“Look at it!” Alyssa snaps at me. I look at the coat. “Um…”
“Look how wrinkled it is!” she says. “I would say it’s at an unacceptable level of wrinkles. Is this the level of professionalism you want to show?”
Is she kidding me? Am I supposed to be spending my time ironing
my white coat? Seriously, it’s not that wrinkled.
“And what’s this?” Alyssa asks, pointing at a faded yellow spot on my left sleeve, about a centimeter in diameter.
“I guess it’s a stain,” I admit.
Alyssa shakes her head in disbelief, as if she’s too disappointed to speak. But what can I do? The hospital only gave me two white coats, and I can’t 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 Alyssa’s standards
Hours awake: 13 Chance of quitting: 65%
