A History of the Present Illness (22 page)

I smiled and introduced myself without using the word
doctor
, motivated by the absurd and very green belief that the physician was just one member of the health care team and that the gorgeous nurse standing before me had chosen to ask me for the Tylenol because she found me as attractive as I found her.

The nurse blinked twice and glanced down at my ID badge.

“Just Tylenol,” she said. “That's all I need.”

The patient's name didn't sound familiar. I flipped through the index cards I'd inherited from an outgoing intern.

“He's not yours,” she said.

“Who's taking care of him?”

“Does it matter?”

I thought, Is this her way of flirting? What if the patient had liver disease? Weak kidneys? What if his fever was the first sign of serious infection? I said, “I'll need to examine him.”

The nurse shook her head, air huffing through her nostrils, and walked away.

Knowing I had failed some sort of test, but certain I was in the right, I decided to go after her, to protest and also to defend myself in case our encounter had been some bizarre San Francisco–style foreplay. I grabbed my cards and stethoscope off the table and pushed back from the desk.

I didn't see the second nurse until my rolling stool slammed into his legs. A medication tray fell, its hard plastic making a single sharp clap against the linoleum. Liquid medication spilled out of the little plastic cups and mixed together, a strangely beautiful blend of bright purple and lime green, of dark yellow and red and blue.

“I'm sorry—” I started.

“Oh, yes,” the nurse said. “You are.”

He was exactly my height and twice my age, with graying brown hair pulled back into a ponytail and cartoon-character tattoos down both forearms. I started laughing. Maybe it was the late hour or the sugar high or simply the release of all the tensions accrued during that long and stressful first day, but I laughed and laughed. At first the nurse just watched me, his mouth slightly open. Then he smiled. Not a friendly,
poor you
type smile, but a sadistic grin that darkened his eyes and revealed no teeth.

“Great,” he said, projecting his voice as if he had an audience in that dim abandoned hallway at two A.M. “A blind
and
crazy new doctor. Just what we need around here.”

I wish I'd thanked him. I rode the furious adrenaline he'd inspired in me through the next hour while Rayshawn cried, “Why, Mommy, why?” and I stuck him, over and over, until on my fourteenth try I finally hit a vein and restarted the antibiotics that kept him alive.

Our first intern outpatient clinic began during my thirtieth consecutive hour awake and in the hospital and ended four hours later when Dr. Westphall gathered the ten of us together for our inaugural monthly check-in. These were hour-long, after-clinic pizza-and-bitch sessions he claimed to have instituted by popular demand, as if our predecessors had begged him to let them spend more time in the hospital. In the small, windowless conference room, we interns sat upright in curved plastic chairs on three sides of the rectangular table, and Dr. Westphall lounged solo on the fourth side, a greasy paper plate in his lap, his black dress socks and Birkenstocks resting comfortably on the tabletop.

His topic was stress, anticipating it and coping with it.

“Anyone can start,” he said. “This is meant to be informal.”

No one spoke. We took huge bites of pizza, filling our mouths and then arranging our faces to suggest that we knew good manners precluded speech.

I ached to go home. The room was too hot, the chairs too hard, and what fool would discuss his secret fears with a group of strangers destined to become rivals for the chief residency and jobs? Dr. Westphall lifted a stray mushroom off his plate
and dropped it into his mouth. Sprawled serenely at his end of the table, he didn't seem to mind waiting for a response to his question. Josette nudged me with her elbow. In medical school, I'd often announced events: the children's health advocacy group, the poverty 911 project, the family medicine interest group, and the homelessness outreach coalition. She knew I wasn't shy.

“Sleep,” I said, ending the unpleasant silence. “I love to sleep.”

Josette smiled and nodded. I winked at her. Dr. Westphall took a deep breath, then another bite of pizza.

“Like-wise,” Lamar said. His New Orleans drawl made two words out of one. Like me, he had been on call the previous night, but in the morning he'd changed back into his dress shirt and slacks while I was still in rumpled scrubs.

Nam said, “I like to dive into a job headfirst, no worries.”

“What about seeing your wife?” Dr. Westphall asked.

That got our attention. Nam didn't wear a ring, and it was the first we'd heard about him being married.

“Same deal,” he answered with a grin. “Dive in, headfirst . . .”

“Yo,” said Sumita with an exaggerated swagger of her shoulders. “That's my line.”

Dr. Westphall blushed. Of the interns, only Marc didn't laugh. “Does anybody ever do such a bad job you have to kick them out?” he asked.

Dr. Westphall wiped his mouth with a torn paper napkin and straightened his legs, visibly relieved to be back on safe conversational territory. “Never. And it's not that we wouldn't make other arrangements if a resident really couldn't do the work.”

“Do we talk about medicine at all at this conference?” Darius asked.

“Not much,” Dr. Westphall conceded before turning back to Marc. “Residency is tough but totally doable. People who get into med school generally have what it takes to be doctors. In my day, we lost about a quarter of the class. Still, if a man made it to the clinical years, as you all have, he knew he'd go the distance. What it comes down to is how much you want it.”

I glanced at Josette, sure we were thinking the same thing: an old-timer's war story, a bullshit waste of time.

“
If a man
. . . ,” Tea echoed, gazing at Dr. Westphall with her huge, unblinking eyes. “Wasn't there even one woman in your class?” She was so beautiful that three weeks of residency passed before any of us could have a normal conversation with her. I nudged Josette's arm with my elbow.

“Four, actually,” said Dr. Westphall. “One of whom was my wife until she was killed by a drunk driver.”

“Ouch,” Josette whispered. “Also, touché.”

Althea's brows lifted and her eyes widened as she gave the rest of us what we'd already come to call her “more later” look. Having gone to medical school in San Francisco, Althea could provide biographical sketches complete with bed partners for all the attending physicians we'd be working with.

Dr. Westphall moved his pizza plate onto the table and sat up. “Okay. If there's another topic you guys would like to discuss—”

Lamar held up a hand. “Sorry, Ernie. We're acting like children. We can do better with this topic. C'mon guys.”

Ernie?
I put down my slice.

“Down boy,” Josette whispered.

“Seriously,” Nam said. “We all knew what we were signing up for. Right? Now we just need to do the job.”

“Or not,” said Marc. “People do quit.”

Sumita shook her head. “Yeah. Like one in a hundred thousand.”

Perla leaned out over the table so she could see all of us and we could all see her. “I'm worried I don't know enough,” she said. “Not that I'm stupid or careless, but that I won't even realize the mistake while I'm making it.”

“Good,” Dr. Westphall said. “Now we're talking.”

But of course,
we
weren't. Darius doodled in the pepperoni grease on his plate. The rest of us studied the table.

Nam said, “You ask your resident.”

Tea nodded. “Or your attending.”

“You stuh-dy,” Lamar drawled, looking only at his best pal
Ernie
. “And you question yourself and your actions at every branch in the decision-making tree.”

I still hadn't thought of anything worth saying aloud, but it didn't matter: problem solved, case closed. Most of us relaxed a little.

“And what if you make a mistake anyway?” Perla asked.

Someone groaned. I couldn't tell who.

“Luckily,” I said, “you'd only be killing a fellow human being.”

Only Josette laughed.

Dr. Westphall turned to me. “Possibly, Dr. Bautista. And let's say that's exactly what happened. Then what?”

Lamar and I answered simultaneously. “You keep going.”

For the remainder of the session, Dr. Westphall lectured us on the moral and legal benefits of admitting to one's missteps. Later, as we walked to our cars, Josette wondered whether Marc was depressed or just uptight. The idea of quitting was
insane. We'd already devoted so many years to get to this point. Not just the four of medical school but all the years leading up to that, years when some people partied every weekend and traveled around the world with backpacks, years we couldn't get back.

For the next twelve months, turnover defined our lives. Daily, we sent patients home only to admit new ones, and every four weeks, we changed services, taking care of patients from newborns to the elderly and moving from wards to ER to intensive care. But it was only Perla for whom the theme extended to personal life and possessions as well; her boyfriends, stethoscopes, and even apartments also came and went with astonishing rapidity.

Her first apartment, a newly remodeled Victorian in the Castro, sold within two weeks of her arrival, subjecting her to that now-ubiquitous con, the fake-owner eviction. Though the new owner claimed he'd be living in what had been Perla's apartment, when she drove by a few months later, she took note of the red BMW convertible with Florida plates parked in the drive, and she knew the owner—a local—had found himself a more lucrative tenant. Her second place, the top floor of a single-family home in Cole Valley, was flooded after the homeowner fell asleep while smoking. (Josette, rotating at the university hospital, saw the blaze from the fifteenth-floor labor and delivery unit.) Next Perla moved to Golden Gate Heights, where she lived for nearly four months in a converted garage she entered and exited with the push of a button, her life-size Amelia Earhart and Marion Carstairs posters temporarily coming to rest on the ceiling. She settled in, let down her guard, and then the shortage of street parking pitted neighbor against neighbor, and snitching to the
housing department led to a crackdown on illegal units. After seven months in San Francisco, she found herself homeless for the third time, camping out on Josette's living room floor in the Inner Richmond.

At first I thought the stress and drama of her housing and other upheavals explained what Perla did a few weeks later. She and Nam were the two interns in the ER on the night in question. In Nam's version of the events, it was a challenging shift but in no way exceptional.

Their evening began with the death of an eighty-year-old on home hospice whose children panicked at the last minute and brought him in. The next patient was a teenage girl who'd been raped at school but hadn't told anyone until—waiting with her family in their car in the Burger King drive-through line—she burst into tears. Then came the usual: shortness of breath and chest pain, sickle-cell exacerbations, fevers and overdoses and asthma attacks. Five hours later, the ER took the fallout from the latest Mission District gang showdown. In Trauma 1, Nam and the third-year worked on a corpse. Perla went into Trauma 2, where a sixteen-year-old with just the beginnings of a mustache lay curled up, clutching a blood-soaked pressure dressing to his side. There was one cop in the room and another at the door. The boy's left wrist was handcuffed to the side rail, and he cursed and thrashed as the nurse tried to take his pulse and blood pressure. Perla introduced herself, then began a head-to-toe survey to see if there was more than one wound.

“
Puta
,” the kid said. “Don't fuck with me.”

Before she could say that it might not be the best idea to call the doctor trying to help you a whore, the building shook. At first, Nam said, they all thought it was an earthquake. But the shaking continued at regular intervals, and soon they
heard sirens and a voice shouting over a bullhorn. Later they learned that the dead guy's crew had pushed a Dumpster into the steel doors of the delivery bay over and over, trying to force their way through the back after being turned away at the ER's main entrance.

Perla stayed focused. She put a hand on the boy's cuffed wrist. “You're hurt,” she said in Spanish, “and I want to help you.”

“
Pinche cabrona
,” he answered with a lewd wag of his tongue.

Nam said he thought that was the key moment, though a nurse later told me she wasn't sure. And Perla? She said she asked for the cops' help and, without uttering another word, did what needed doing. Then she wrote some orders and a quick note, and although the ER was overflowing, she turned off her pager, dropped it into Dr. Westphall's mailbox along with her ID badge, handed a two-word message for the ER attending to one of the nurses (“Quitting. Sorry.”), got in her car, and drove away, leaving medicine for good.

Thirty-five minutes after Perla's departure, Josette's pager went off. She was in the outpatient clinic that month, which made her the jeopardy intern called in to take Perla's place. Since Perla was supposedly working that night, I'd slept over at Josette's. At the time, we still thought our relationship was secret, though it turned out that everyone in the program knew we'd hooked up, including Dr. Westphall.

As Josette dressed, I announced that Perla would head south toward sunshine but come to her senses by San Luis Obispo and turn around. In fact, Perla drove to a downtown hotel and went to bed. “Like a regular person does in the middle of the night,” she told me when she finally resurfaced. “Just exactly like a regular person.” The next day, she drove north, crossing
the borders of California, Oregon, and Washington, and, fifteen hours after she left San Francisco, onto the ferry in Seattle that took her home to Whidbey Island.