The Real Doctor Will See You Shortly (11 page)

“Where do you think you're going?”

It was Baio.

“Too many people,” I said, throwing a thumb toward the crowd.

He shook his head. “You never leave an arrest. Never.” He escorted me toward the room. “If someone tells you to leave, you move behind a curtain. If someone pushes you back, stand in the doorway. You need to see as many of these as you can. Let's go.”

We stood in the doorway, watching the madness unfold. “Michael Jordan said the game would slow down for him,” Baio whispered, “when he was in the zone. The more of these you see, the slower things will move.”

I nodded, watching an anesthesiologist place a breathing tube down the throat of a middle-aged Dominican man while a nurse attempted to insert an IV.

“Keep an eye on the arrest resident,” Baio said and nodded toward the physician at the foot of the bed. “He's in charge. How do you think he's doing?”

“I can't really tell.”

I peered around the crowd as someone beat on the man's chest. I thought I heard a rib crack.

“Exactly, you can't tell because he hasn't established that he's in charge. You have to take command of the room.”

“Got it.” I reached for my pen.

“Don't fucking write this down. Just watch.”

The arrest resident began to address the room.

“Speak up,” Baio shouted.

The resident's voice rose.

“Second, you have to find out what happened,” Baio continued. “First thing you ask is: Did someone witness the arrest? If someone was there to say ‘I saw this guy swallow a marble' you've got your answer.” Blood splattered near my feet; placing an IV in this man was proving to be difficult. “You know more than you think you do.”

It was the second time I'd heard that this morning. “This is getting messy,” I whispered back. After a month in the CCU, the sight of blood flying across a room didn't freak me out, but this still seemed like a lot. It was enough to fill a small coffee cup. If I'd seen it in a movie or on television a few months ago, I would've cringed. But it no longer bothered me, and no one else acknowledged the mess coagulating under our shoes. We were a roomful of people comfortable with projectile blood splatter.

“Check out the guy doing chest compressions,” Baio said. “How's he doing?”

“Fine, I think.”

“Stayin' alive?”

I watched and hummed to myself. “No, he's going too fast.”

“Exactly, so if you're in charge you tell him to slow down.”

“Should we tell him?”

“No, definitely not. There needs to be one person in charge.”

“This is gruesome,” I said after blood again splashed in my direction, landing on my scrubs, just below the knee.

“How long has it been?” one of the nurses asked me.

“Fourteen minutes,” Baio said softly. While I had been dodging blood, he had been quietly keeping time.

“Yikes.”

“Always keep an eye on the clock. This is a ghastly funeral.”

I looked up at the small black and white clock above the patient's
bed. It was the kind my high school had used, and for a brief moment I was transported back to a senior-year classroom, wishing the clock would move more quickly, wishing time would speed up so I could go off to college and start
real
life. Now I was trying to figure out a way to make time slow down. “Should he stop?” I whispered.

Cardiac tamponade was what the more senior doctors in the room suspected, a condition in which blood accumulates around the lining of the heart, leaving it unable to pump properly. The only way to urgently correct it is via pericardiocentesis, a procedure in which a doctor blindly plunges a needle under the patient's rib cage and into the lining of the heart so the fluid can be drained. In this case, it would be done while chest compressions were being performed, making the heart a moving target. Anxious physicians looked back and forth, wondering who should attempt the procedure. It was dangerous. Inserting the needle in an inch too far would pierce the ventricle, almost certainly killing the patient.

“This is not the way you want to go,” Baio whispered.

“Should the arrest resident stop?” a nurse quietly asked me. “The guy's been dead for twenty minutes and now they want to stick a needle where?”

“I would,” Baio murmured. “I'd stop. But funerals are like weddings—you have to ask if there are any objections before you go through with it.”

The pericardiocentesis began and the room fell silent. The physician performing the procedure, a slight Asian man, held the large needle with both hands as it pierced the skin and gradually sunk into the chest. I held my breath as the needle disappeared. The thought of doing this procedure terrified me.

Drops of sweat beaded on the man's wisp of a mustache as the needle submerged deeper. He bit his lip as the needle fully disappeared under the ribs. He pulled back on the syringe, first gently and then with great force, hoping to obtain fluid. But there was nothing. I craned my neck to get a better view.

“I didn't get it,” the man said after several minutes and stepped away from the body. Chest compressions continued unabated. A second physician took the needle and prepared to repeat the procedure. A wave of nausea cascaded over me.

“Okay, stop,” the arrest resident shouted. “Resuscitation efforts appear futile.”

CPR had been attempted for twenty-two minutes.

“Time of death is eleven-fifty-two
A.M.
Thanks everyone.”

And with that, it was over. Nurses and doctors stepped away from the bloodied, lopsided chest and stoically filed out of the room. There were no conversations, no eye contact. Everyone calmly returned to their scut lists and the next task at hand. Baio shook his head and disappeared down a long corridor.

It was the first failed resuscitation that I had witnessed. As the crowd thinned, I moved in and peered over the body. Eventually the room was vacant except for me, the corpse, and another intern. She closed the eyes of the dead man and then softly said, “I would've kept going.”

The next day I was back on infectious disease rounds, presenting a patient to the team. In contrast to cardiac care unit rounds, this discussion took place around a conference table. Glazed donuts were passed as I spoke.

“So,” I concluded, “the patient is doing really well. I actually think he's ready to go home today.” David was thirty-four and had walked into our emergency room a few days earlier covered in painful purple and yellow abscesses. A simple staph infection was the cause, but his immune system, ravaged by HIV, was unable to fight it off. It was the third time in the past year that he had come to our hospital with these erupting, rancid skin lesions.

Dr. Chanel ran her hand through her ponytail. “I agree,” she said, “but I'd like to get one more set of labs. I'd like to see how the liver is doing before we send him out into the great unknown.”

It was 10:15, and morning labs had already been drawn; a phlebotomist would not be on the floor for six more hours. “I'll just draw the labs myself,” I announced. I'd come a long way from those first few incompetent days in the CCU. I wasn't ready to do a pericardiocentesis, but I could draw blood.

“Can I join you?” Carleton asked.

“Make it quick,” Ashley said, “we've got two waiting for us down in the ED.”

I slipped on my white coat, put the dark green stethoscope around my neck, and walked with Carleton across the hall to David's room.

“So exciting,” Carleton said. He was far better at faking enthusiasm than I would ever be, which irritated me. My colleagues could sense my hesitancy the moment I walked into the hospital's lobby. But Carleton was the kind of kid who could adapt, who could play the role that was required of him. He was a medical school chameleon; if he needed to be passive—like during psychiatry, where more of the time was spent listening—he could, and if he was called on to be assertive, perhaps during the surgery rotation, he could do that, too. He was the student who would breeze through medical school and residency free from torment, free from anguish. A few years from now he would summer with other beautiful, carefree people in the Hamptons, tossing back cocktails on a private beach.

I tapped on David's door as I pulled it open. A large man with thinning brown hair, he mock-cringed when he saw me.

“Not you again,” David said. He shook his head and reached for a magazine.

“Me again,” I said cheerily. “This time I have company. I've brought along a medical student, if that's okay.”

“This guy tortured me yesterday!” David said with a smile to Carleton. He put the back of his hand to his forehead and added, “I don't know if I'll ever recover.”

A day earlier, I'd spent hours lancing every one of his abscesses with a small scalpel and even more time scooping up the pus with gauze. In college, even in medical school, the sight and smell of those abscesses would've made me nauseated, but not anymore. I had been told that every doctor eventually discovers which bodily fluid he or she finds most disturbing, and this realization helps guide the choice of a subspecialty. I didn't mind blood, spit, piss, or pus. I did mind diarrhea, which meant I wasn't destined to become a gastroenterologist.

“Antibiotics weren't going to work,” I said. “You know that. I had to open those things up.”

“I know, I know,” David said, waving his hand dismissively, “you
had to do it. But why the CAT scan? That took up my whole afternoon!”

I flashed to Gladstone and shook my head. I was now ordering potentially unnecessary head scans several times a week and neurosurgical consults nearly as frequently. “The good news is you're getting better. The CAT scan was normal and you're going home soon.” Even though I suspected that Gladstone was going to be okay, his image haunted me. Whenever I felt like I was starting to get the hang of things, like I was starting to become a real doctor, I was reminded of him and my colossal oversight. More than anything, I was reminded that I needed supervision. Fortunately, Columbia had a structure in place that provided it. But what would happen when I was the supervisor? It was okay to practice defensive medicine for now—I had people like Ashley to tell me when I was being overly cautious—but eventually I'd need to cut the safety net.

“Thank God,” David said.

“I'm proud of you for starting the HIV medications. Your numbers were through the roof.” I set down the equipment for the blood draw and turned to Carleton.

“You know, it's actually better today to have HIV than diabetes.”

“But I have diabetes,” David said.

I frowned. “Let's get started.”

I knelt down by the side of the bed and again turned to Carleton. “The key to drawing blood is finding a vein. Help yourself out by using a tourniquet.” He quickly scribbled on a notepad as I spoke. “Sometimes one isn't available, so I just tie a latex glove around the patient's arm.”

“Technically they're latex-free gloves,” Carleton said. “Because so many people have latex allergies.”

“Right.” Fastening the glove, I felt for veins. “His veins aren't great,” I said as David wrinkled his brow and looked at his arm. “Have you ever heard of the intern's vein?”

Carleton shook his head. “What's that?”

“It runs along the thumb. Works every time.”

Enjoying my new role as teacher, I took out an alcohol swab and wiped down the vein as David looked away. I uncapped the butterfly needle and attached it to a thin plastic tube. The tube was fastened to a small vial and placed in a bucket next to the patient's right leg.

“Before you do a procedure, any procedure,” I said, “you should do a time-out. Before you do something to a patient, no matter how trivial, you should bring someone else into the room.”

“Got it,” he said, writing that down. His copious copying reminded me of myself. But I doubted Carleton ever needed someone to tell him not to write on his hands. He probably already knew about the time-out. He was probably only taking notes to placate me.

I tilted my head at his notepad. “First, confirm that you have the correct patient. Then, double-check that you are, in fact, doing the appropriate procedure to the proper body part.”

I confirmed the information and plunged the needle into David's thumb. He reflexively pulled his hand back an inch as blood flowed through the tubing and the vial filled.

“All done,” I said a moment later and held up the vial.

With my left hand I withdrew the needle from his thumb and with my right I reached for a Band-Aid. Blood oozed where the needle had been. Not wanting it to drip on the floor, I quickly moved the Band-Aid toward David's thumb.

But the Band-Aid never reached its intended destination. My right hand's path was intercepted by the butterfly needle, and in an instant I had impaled my index finger with the blood-filled needle. I dropped the needle and ripped off my glove. Blood dripped out of my hand as Carleton looked on, mouth agape. Hundreds of thousands of copies of the human immunodeficiency virus had just been injected into my bloodstream.

Darkness.

That is all I remember until I heard Carleton's voice.

“Holy shit!” he was shouting, shaking me from a tranquil haze. I dropped to my knees and squeezed the finger, trying to expel the infected blood. My breathing was ragged. I squeezed so hard my finger turned white—I didn't mind if it fell off. “No, don't,” Carleton said, inching toward the door. “Don't cause inflammation. It'll draw white cells to the virus and—”

I stared at him blankly. He was an amorphous WASP blob. But he seemed like he knew what to do.

“Sink,” he said. “Sink! Wash it out!”

How did Carleton know what to do? Was this a scenario they covered in medical school? I contemplated putting the finger in my mouth. Could I suck the virus out? I looked down at my palm and licked my lips. In my peripheral vision, I caught a glimpse of David. Both of his hands were on his face like Macaulay Culkin in
Home Alone
.

“Wash it out!” Carleton implored.

I felt like I was going to pass out or vomit. Time was somehow simultaneously speeding up and slowing down. I was unable to move, trapped in quicksand just a few feet from the needle, from the blood, and from David. I wanted to scream but I had nothing to say. I wanted to run but I had nowhere to go.

Carleton turned on the faucet and guided my hand toward the stream. We looked at the finger, which was still oozing blood, and
looked at each other. His placid face was without a single crease, without a single wrinkle. I wondered what he saw in mine.

I waved my hand under the icy water, and the cold snapped me back into the awful present. Bursting out of the room, I lunged toward a nearby conference room where a group of HIV doctors were known to have lunch. “I'm sorry,” I said, frantically throwing the door ajar as six gray heads turned to me. “I just stuck myself. With HIV. Drawing blood I stuck myself.”

Dr. Chanel popped up from her chair and gasped, “What?” I cradled my right hand in my left like it was Axel's banana peel. She rushed over and put her hand on my shoulder as the others returned to their conversations. “Are you okay?” she asked slowly.

I wasn't. I couldn't speak. Staring at the finger, I wondered if a scab was forming, sealing the virus inside of me.

“You're going to be okay, Matt,” she said deliberately. “You need to go to Employee Health. Okay?” She scanned my eyes to see if this had registered.

“Okay. Where, uh, is that?”

My teeth felt heavy; my lips were numb. I felt like a small child, wanting to run, to disappear, and unable to formulate words.

Chanel grabbed her purse. “Let's go.” She put her hand on the small of my back and gave me a gentle nudge out of the conference room. We passed a sheet-white Carleton recounting the event to Ashley, who mouthed “What the?” as we proceeded toward the elevators.

“Who was it?” Dr. Chanel asked. “Which patient?”

The image of Macaulay Culkin's face reentered my consciousness. “David,” I mumbled. “It was David.”

“Okay,” she said, “I'll have to…I'll need to make a few phone calls.”

A moment later we squeezed into an elevator full of patients and doctors.

“Matisyahu!” a cadre of interns in the back howled, referring to the Jewish rapper and a nickname I had received at a karaoke orientation
event. I held up my scut list and shook my head. We were on the ninth floor. Every button had been pressed. On eight I felt a wave of heat rush over me; on seven I got chills. I was going to shit myself.

“You're okay,” Chanel whispered.

“Yep.” Like a vampire I covered my mouth with the bend of my arm and quietly retched. Sweat gathered around every orifice. The crowd edged away, giving me space to dry-heave.

“Almost there,” she said, as the elevator gradually thinned out.

When we arrived at Employee Health, Dr. Chanel removed her hand from my back and spoke to the clinic administrator. The only words I heard were “can't wait,” and a moment later I was in a doctor's office, sitting across from a physician from South America who looked like a young Antonio Banderas. Why did everyone at work remind me of an actor? Perhaps it was because hospital life often took on a cinematic quality and I was subconsciously casting a film—one that had just transitioned from drama to tragedy.

Banderas's broad smile and well-coiffed black hair projected an air of genial confidence; he looked like he could be Diego's older brother. He began saying words, but I didn't hear them. There were lots of nods and smiles. I considered his hair gel. He became more animated as I stared at my hands, tracing the creases. Eventually isolated, vexing words from Banderas began to register:

hazard, unfortunate, change, feel, sleepless, fine, support, prophylaxis

It was a new experience to flip back and forth between such unwelcome extremes. One moment I was wholly and vividly present; in the next I was rendered senseless, lost in a fog. I squeezed the finger over and over. First it was to match my surprisingly sluggish heart rate, and then it was to the beat of an eighties song I couldn't get out of my head—“Your Love” by the Outfield. Banderas put a hand on my shoulder and lyrics breezed through my head.

Josie's on a vacation far away…

“Matt,” he said.

What was the Outfield up to now? I wondered. And who was this man before me and where did he go to medical school? Could I trust him? Was his life, like mine, a series of flashbacks to movies and sitcoms? Did he have hobbies? A mixed martial arts enthusiast, perhaps? Someone who might wear a blouse to a nightclub?

“Matt!” he shouted. “This is important.”

I snapped back, as if a train had unexpectedly passed going the opposite direction. “Yes. Yes. What?”

“Matt, do you know if the patient has hep C?”

I shook my head. “I'm sure we checked, but I'm not positive.”

Why was he bringing up hepatitis?

“This isn't meant to alarm you.” He motioned to a chart on the wall. “But I want you to have all of the information.” The chart showed a large syringe with a stream of statistics. Hepatitis C was an order of magnitude more contagious than HIV via needle stick.

“I don't know about the hepatitis,” I said. “I'll find out, obviously.”

“In addition, Matt, I highly recommend you take the postexposure prophylaxis.”

He stepped out and returned a moment later with pills, the same medications I'd spent the morning reciting to myself on the subway, trying to drill their confusing names into my head to impress Ashley. Truvada. Lopinavir. Ritonavir. They sounded like villains in a comic book, each with a bright color and a unique shape. The conversation with Banderas concluded a few minutes later and we shook hands, agreeing to follow up later in the week. He said it was impossible to prognosticate; I might be fine, but I might not. But I didn't want to leave until I had an answer. How could I?

As I stepped out of his office, I imagined the virus frantically swimming like a legion of sperm toward the lymph nodes in my armpits, and from there, racing to my neck and groin. Was HIV starting to replicate inside me? Or was my immune system destroying it? And how would I be able to tell what was happening in my body a day, week, or
month from now? Banderas had said there was no way to know; I just had to take the pills and wait. Blood tests with an answer were more than a month away.

I tried to think of something else—anything else—but I couldn't. I imagined a priest reading me my last rites as I writhed in bed. Then an artist's rendering of the human immunodeficiency virus from a textbook appeared. Soon, pill bottles and syringes were dancing across my mind. But the thing that mattered—the scientific realities of viral transmission—remained elusive. The enzymes, the blood cells, the biochemical reactions…all of that suddenly seemed hazy. Why couldn't I remember what I needed to remember? I craved clarity but the only thing I could easily picture was a giant question mark blinking atop my head.

Out in the waiting room, Dr. Chanel was standing ramrod straight with her arms behind her back.

“You didn't have to wait for me,” I said, touched and relieved that she had.

“Matt,” she said, lowering her head, “I spoke to a few people.”

“You look worried,” I said abruptly. “I mean more worried. What's happening?”

“I spoke to one of our experts. You're going to need to come with me. We can talk on the way.”

“I'm sorry?”

She put her hand on my shoulder and her fingernails inadvertently scratched my skin. The tactile sensation cut through my fog. I started to feel uncomfortably present again. “You are going to be okay, but things are a bit more complicated than we realized.” Pure, unalloyed fear coursed through me. “Whatever he just gave you for postexposure HIV prophylaxis is insufficient. David has such a highly resistant strain of HIV that you're going to need an extensive regimen of medications.”

Her lips went on moving, but I heard nothing. My thoughts turned to the handful of facts I'd learned about HIV in medical school.
Needle sticks were rare, but they happened. Someone did a study and found that of six thousand pricks with HIV-positive blood, the virus was transmitted twenty times. Those were decent odds, but far from perfect. I thought of myself as number twenty-one, which was my old baseball number. I pictured a jersey, a scarlet letter of sorts, with the virus on the front and my name on the back, announcing to the world that I'd contracted a deadly disease through my own incompetence.

I wasn't sure how long Dr. Chanel spoke or how far we walked, but my sensorium cleared when we hit the waiting room of the Columbia outpatient HIV clinic. A handful of men and women were reading magazines and chatting on cell phones, not unlike any ordinary waiting room. What I knew about this patient population had largely come from more senior residents. Based on their salacious anecdotes, I had expected the AIDS clinic waiting room to look like something out of a zombie movie, with drug addicts and the mentally ill shouting and spitting at one another. But these were just regular people—people with families and jobs and pets and credit card bills—who were trying to coexist with a virus. And I was now possibly one of them.

“Come to my office,” Dr. Chanel said. “This way.”

As we walked down that interminable hallway, time slowed down, just as Baio had said it did for Michael Jordan when he was in the zone. But this felt like the Twilight Zone.

“Take a seat,” Dr. Chanel said.

I looked out of her office window. A storm was gathering. My body tingled as the enormity of the moment finally set in.
I might have just given myself HIV. Because of a mistake.
A second's carelessness and I had possibly altered the trajectory of my life. I might have to travel with pill bottles. I might become sickly. I could die. And drawing David's blood wasn't even my responsibility. I had
volunteered
.

Suddenly I was on fire. Rage rippled through my entire body like a shock wave. I looked into Dr. Chanel's aqua eyes and screamed, “Fuck!”

She stared right back at me, unflinchingly holding my gaze.

“I can't fucking believe this! Fuck!” I wanted to hit something as a slew of compound, unimaginative curse words rushed out of me. I wanted to flip over Chanel's desk and break a window. I wanted to channel all of my rage into something else, some other object that was not me. If I broke a window, the shards of glass would also be implicated in this ordeal. I would have something else to blame, something other than my own incompetence. I screamed again. It sounded like a bullhorn, low-pitched and distorted. I imagined the sound waves smacking into the concrete walls of her small office.

Never could I have imagined behaving this way in front of a senior physician, but here I was, scared and unhinged. I felt like I'd just climbed up ten flights of stairs and been kicked in the face. Eventually I paused to catch my breath, aware that I had rather successfully transitioned from the first stage of grief (denial) to the second (anger). Chanel, to her credit, was unfazed. A few hours ago she had been the teacher and I the student. Now she was the doctor; I was the patient.

“Okay, Matt,” she said calmly, “you're going to need to be on several medications. Some are once a day, some are twice a day, and one is three times a day. One needs to be refrigerated. I will write you the prescriptions after we go over the side effects, which can be significant.”

I had heard her say these very words to the young woman on rounds, the patient who sobbed after Ariel gave her the new diagnosis of HIV. I was thankful that a roomful of medical students and young doctors wasn't here to watch me. I wasn't handling this well. I wanted privacy. I wanted to disappear. I couldn't imagine dealing with this in front of a roomful of strangers. “I'm ready,” I said. I wasn't ready. But there was nothing else to say.

I'd often wondered, Why don't HIV patients just take their damn meds? It was something we encountered surprisingly often, and it didn't make sense to me. Even if the side effects were awful, taking the pills was still better than the lethal alternative. Most patients
understood the consequences of going off their meds, but many did anyway, and I rarely got a straight answer when I asked why. To skip even one dose seemed incomprehensible to me. Why even think about avoiding something that could save your life?

I was about to find out.