The Real Doctor Will See You Shortly (9 page)

A week later, Baio was in our lounge drawing a grid with the word
SHOCK
at the top when I decided to ask him a question that had been gnawing at me since we'd met. “How do you know so much shit?”

He kept writing, putting the finishing touches on his grid.

“It's like in one year,” I went on, “you've—”

He spun toward me. “Okay, five minutes on the basics of shock.”

“Photographic memory? Read a bunch of textbooks? What?”

“Flattery will get you nowhere, Dr. McCarthy. And sadly, medicine changes so fast most textbooks are irrelevant the day they're printed.”

I thought of the textbook chapter I had slaved away at for months in medical school. “So what is it?” I persisted. Why was he being so opaque? I wanted to know what intern year had done to his psyche and how he'd apparently emerged unscathed.

Baio shrugged and stared out the window at a ship sailing south down the Hudson. “I guess you just see a lot intern year. And these little teaching things help. They help. You have to know your shit if you're going to teach.”

“Definitely.”

He slapped me on the shoulder. “Have to prepare yourself for all sorts of stupid questions.”

“You know what they say,” I said, “there are no stupid questions.”

“Just stupid people,” he concluded with a chuckle. “You know, you should be teaching.”

“Me? Who?”

“Teach the medical student something. Anything. And never underestimate,” Baio said, still fixated on the ship, “the power of humiliation. I still clam up when I see Jake. When I see some of the other docs. But they taught me so much it's absurd.”

Was it enough to just show up every day? Were the daily experiences so dynamic and transformative that you had no choice but to learn medicine? I hoped so.

“I'll be right back,” Baio said, leaping toward the door.

A moment later, Diego entered. He grunted in my direction and spent the next thirty seconds trying to decide if he wanted to eat an apple muffin or a cluster of grapes. I watched him from across the room. Diego commanded a lot of respect in our group. His not being Baio or the Badass put him in a position above me without quite being in charge of me, and though we didn't have a close relationship, I admired his intelligence. Diego's research had been published in some of the most prestigious cardiology journals in the world, but he preferred not to talk about it, telling me once that his work was “mostly boring bullshit.”

Suddenly I heard myself speaking.

“Diego, do you, ah, do you remember Carl Gladstone? The professor from a few weeks ago?”

Diego selected the muffin and spun in my direction. “I do.”

I held my breath, feeling like I'd just plunged deep underwater without an oxygen tank. Diego took a seat next to me.

“Do you know what happened to him?” I asked.

“Indeed, I do.” His eyes grew wide, breaking through the squint. I waited for him to continue, but he didn't. I had considered every conceivable response to this question but still wasn't prepared for the answer.

“Is he okay?” I finally asked.

He put down the muffin and sighed. “Do you realize, Matt, that I
was in the ER when Gladstone first arrived, or that I was the one who wheeled his ass to the cath lab or that I was the one who first noticed the pupils and called neurosurgery?”

I flinched and took in a short, quick breath, almost a gasp. “I had no idea.”

Diego was right, I wasn't really sure how the CCU admission process worked. And I wasn't certain what Diego did with his day other than correct me on rounds. So what was Sothscott yelling about? Why that awful phone call?

“I got a call from one of the neurologists,” I said meekly.

“Who was probably very fucking confused after reading your note. It was nonsense.”

I tried to put the pieces of that first evening back together. Why hadn't Diego told me? Why hadn't I brought it up the next day?

“Why are you asking about him now?” Diego asked. “This went down weeks ago.”

“I don't know.” Why had it taken so long? Shame and insecurity.

Diego folded his arms and leaned back in his chair. “There's layer upon layer of supervision here, Matt. Even when you don't think anyone's watching…”

I folded my arms, mirroring him. “When did the neurosurgery consult happen?”

“While you were bullshitting with Benny.”

Pressure rose in my head; my breathing became irregular as I thought of Gladstone's wife, Sasha. Things still weren't adding up. “What about my presentation on rounds? The Badass said to scan his head.”

“I told him to cancel it. It had already been done.” I recalled them whispering during rounds. “He went to the operating room right after your presentation—”

“Were you going to tell me any of this?”

Diego lowered his head. “Were you going to ask?”

I looked out of the window, thinking of Gladstone's pupils. What
was the point in not telling me? It would've saved weeks of torment, weeks of anxiety. Was it just a test? Proving some kind of point? “Look, Matt,” he said, “I'm not going to scream. I'm not going to throw things. But it's ridiculous that it took this long for you to ask about Gladstone.”

I wanted to disappear. “I'm really sorry,” I murmured. “I was embarrassed. I thought about Gladstone all the time.”

Diego stared out onto the Hudson and took another bite of the muffin. “You have to ask yourself some tough questions in this job. But before you can do that you have to ask yourself a very basic one: Who are you looking out for?”

I slouched in my chair.

“Yourself?” he asked.

I extended my neck and shook my head. “Of course not. I—”

“Your reputation?”

“I just—”

“Or the patient?”

Searching for words, I thought about the promising medical student I had once been. I recalled the look on Charlie McCabe's face when I first sutured up the banana peel in his office and the disappointment, months later, when I told him I did not want to be a surgeon. And as I sat there, head in hands, I realized I had forgotten to send flowers to McCabe's funeral service, which had taken place earlier in the week.

As I sat there trying to process it all, Baio reentered the room.

Diego shook his head and stood up. “You really think we're gonna leave all the decisions to you two bozos?”

In medical school, after I'd broken the news to Charlie McCabe that I'd chosen internal medicine over surgery, he'd grimaced and said, “Let me introduce you to someone.” I followed him across the Mass General lobby to another set of offices where a man named Jim O'Connell was embracing a middle-aged woman in pink tights, a pink sweater, and bright red lipstick that had been haphazardly applied far beyond her lips. O'Connell was about the same age as Charlie McCabe and looked like a dad on a network television show: neatly parted gray hair, kind eyes, cardigan sweater, and a broad, welcoming smile. He immediately put me at ease.

“Jim!” McCabe exclaimed as we caught sight of him. McCabe turned to me and threw a thumb at Jim. “Someone should write a book about this guy.” Jim O'Connell waved McCabe's suggestion away and extended a hand.

Both men had done their residencies at Massachusetts General Hospital, and like it had with McCabe, life had thrown Jim a curveball when he finished his training. He had planned to begin an oncology fellowship at the Memorial Sloan-Kettering Cancer Center in Manhattan, but at the conclusion of his three-year internal medicine residency, Jim had been asked by an MGH administrator if he'd consider spending a year assisting with a new program bringing health care to the homeless. He agreed, and his one-year stint with the homeless turned into twenty-five. And in the process, he cofounded Boston's
Health Care for the Homeless Program and revolutionized the way health care was delivered to the indigent.

“Until next week, Jimmy,” the patient said as she leaned in to hug him.

“Wouldn't miss it, Sheryl.”

After the woman in pink stepped aside, McCabe asked Jim to explain his work to me. O'Connell summarized his career in the way one learns to do when soliciting donors is a way of life: after receiving a master's degree in theology from Cambridge, O'Connell came to a crossroads; he joked that his liberal arts education had left him “uniquely prepared for bartending and driving cabs.” After bouncing around the country—teaching high school in Hawaii, waiting tables in Rhode Island, baking bread and reading in a barn in Vermont—he did the improbable and went to medical school. He arrived at Harvard Med at age thirty, around the time that Charles McCabe developed that first tingling sensation in his hands.

“Come out in the van with me,” Jim said as I scanned his spartan office and he prepared to see his next patient. “Come out tonight and meet our patients.”

It wasn't clear why he was making the offer, and I wasn't sure, as a medical student, what I could bring to his program. Perhaps he had a deal with McCabe—maybe guys who turned their backs on surgery had to pay penance by riding in the van with Jim. I turned to McCabe, who was smiling. “Do it.”

Later that evening, I met Jim at one of Boston's well-known homeless shelters, the Pine Street Inn, wearing a crisp white button-down shirt, khakis, and a new Calvin Klein tie. Taking a seat in the corner, I looked on as Jim, dressed like Jerry Seinfeld in jeans, white sneakers, and a navy blue polo shirt, tended to a long line of men and women who were there to get their routine checkups. His unique skill, I soon discovered, was that he never cut anyone off. He let his patients ramble on about anything they wanted, mostly issues wholly unrelated to their health, while he poked and prodded, quickly and quietly looking into
ears, noses, throats, and any other orifices in need of inspection. He was able to time the cadence of a story, applying his stethoscope when someone paused to catch his or her breath and removing it when the story resumed.

I wanted to take notes but there was nothing to write; he simply knew how to interact with each and every patient. And he was especially adept at interacting with people who clearly had mental illness. He knew the names of distant family members and the details of obscure conspiracy theories. His method was remarkable—there was something almost religious to it—like he was the priest and his patients were the confessors.

Hours later, after the last patient had been seen, Jim went behind the counter of the soup kitchen and loaded up two dozen Styrofoam containers with chicken noodle soup. From there, I tagged along as he hopped in a van and began seeking out Boston's homeless who, in Jim's words, were “temporarily off the grid.”

Our driver, a Haitian man named Pierre, followed his normal route, stopping at ATM branches, abandoned subway stops, and indeterminate New England wastelands searching for people who might appreciate a warm meal, a pair of socks, or their blood pressure medication. We were seeking out the people I actively avoided in everyday life, the ones wearing rags who hadn't bathed in months. I couldn't believe there was a man—a Harvard Medical School faculty member, no less—who was on a first-name basis with the scores of otherwise nameless people we encountered. And without fail, they were glad to see him.

“Tell them something about yourself,” Jim advised that first night as we walked with flashlights, searching for a man known to sleep near a riverbank. “Tell 'em anything. Just be yourself and be honest.” Jim cut a solitary figure as he forged ahead to where water met land, waving his flashlight back and forth like a tiny lighthouse. He spotted a pile of blankets next to the Charles River and motioned me over. There was a shine on the water from distant construction lights, and I could feel
my heart thumping with every anxious exhalation. Lifting his index finger to his lips, Jim whispered “All yours” and disappeared in search of others.

“Sir?” I said, staring at the pile of blankets that was gently oscillating like an accordion. “Hello? Hello there? Anybody?” I looked out over the river and frowned. “My name is Matt,” I said, rubbing my hands together. “Just here to check in.” I inched closer and placed my right hand on the pile of blankets. “I'm working with Jim O'Connell and Health Care for the, uh, do you know Jim?”

At that point in medical school, I was several months removed from the banana peel; there was no chance that Axel ever had to seek out patients like this. I began grinding my teeth as McCabe's voice trickled into my head:
Ask yourself a deceptively simple question: Can I imagine myself being happy as anything other than a surgeon?
Like a sine wave, the blankets bounced up and down as I considered my words. “Hello? Anyone?”

I was preparing to turn around when a voice emerged. Soon a pair of eyeballs was staring back at me.

“Hey,” I said, “I'm Matt.”

“You work with Jim? Is he here?”

I leaned in, trying to make out a face. “He is. Would you like me to get him?”

“Who are you?”

“I work with Jim,” I said tentatively. “I'm a student. I brought socks and soup.”

“Can I…can I talk to Jim?”

“Yes, I'll get him.”

“Can he take a look at this?” The man emerged from under the blankets and pointed to an open sore on his left shin. The skin was dark and mottled, with pus weeping from the borders. The stench was overpowering and unforgettable; I fought the urge to turn my head away. “Let me get Jim,” I said softly.

As I headed back to the van, I thought of the material I'd been stuffing in my brain during medical school and compared it with what was floating through Jim's head. He held in his mind an intricate map of the city's homeless, a human atlas that few, if any, possessed. Jim O'Connell was undoubtedly the only physician who could tell you why one overpass was preferable to another for a good night's sleep or why Copley Square was better than Faneuil Hall for panhandling.

And like Axel, Jim was happy to dispense wisdom. “The key,” he said later that night as we walked with flashlights under a condemned bridge, “is to build a relationship. It's easy to condescend. Resist that urge.” And after a challenging interaction, “The problem is us, not them.” Between stops, Jim and I talked about Whitey Bulger, Boston's enigmatic criminal, and baseball. “Dennis Eckersley,” Jim said, referring to the former Red Sox pitcher, “his brother was homeless. Who knew?”

I found myself coming back to my apartment in Brookline raving about the experiences. I wanted to be like Jim. I wanted to
be
Jim: an unconventional, understated, brilliant doctor who played by his own set of rules, engaging patients in ways I'd never seen or considered. His method tapped powerfully into my own self-image as an outsider—the pre-med who was a ballplayer, the Ivy Leaguer in the minor leagues. In medicine, too, I knew I wanted to be something different but I wasn't sure what that something was until I met Jim.

More than a few times, my roommates were subjected to my theory that Jim O'Connell was doing for Boston's poor what Paul Farmer, the subject of Tracy Kidder's book
Mountains Beyond Mountains
was doing for Haiti. “Do you know what he's building?” I'd ask Heather, referring to the centerpiece of O'Connell's oeuvre, a massive medical complex that included a 104-bed inpatient clinic and dental clinic designed for the homeless. “Do you realize,” I'd say, time and again, “just how incredible that is?” My friends quickly tired of hearing about it, but I never tired of telling them.

One morning, I found myself in the corner of Jim O'Connell's small office at Mass General, looking on as he examined the middle-aged woman with smeared lipstick, the one he'd been speaking with when McCabe introduced us. This time Sheryl was wearing dirty gray sweatpants and a blue Tasmanian Devil sweatshirt. Neon lipstick was smudged across her lips and cheeks.

After removing his stethoscope from her chest, O'Connell sat down in a black plastic chair a few inches from Sheryl and took one of her hands in his. “Everything looks good,” he said. “Very good. Things are trending in the right direction.”

She looked over at me and in a stage whisper said, “I was hoping for great.”

“Everything looks great,” Jim added warmly. “Blood tests, urine test, heart and lungs. I couldn't be happier.”

I had seen Sheryl at the Pine Street Inn several times and learned from Jim that she'd been living on the streets of Boston for nearly a decade. Sheryl tended to ramble about her ex-husband and occasionally burst into fits of laughter for no apparent reason. She once shouted at me about the television show
Designing Women.

Jim gently pulled Sheryl's hand in his direction to regain her attention. “You know what I'm going to bring up next,” he said. “And just because you say no doesn't mean I'm ever going to stop asking.”

She leaned toward him and their knees almost touched. “Lay it on me, Jimmy.”

He took a deep breath. “I would like you to speak with one of our mental health professionals.” Sheryl pulled back slightly but left her hand resting in his. “This is not a judgment against you,” he said. “I just think you'd benefit from talking to someone. Someone with more expertise than me.” She closed her eyes as he continued to speak. “We've been talking about this a long time and I think it would really help. And the clinic actually has an opening today. You could be seen this afternoon.”

I stared at Sheryl, wondering what was going through her head, as
my eyes fixated on the lipstick. Why not talk to someone? What's the harm? I straightened my freshly starched white coat and folded my arms.

“I understand why you don't want to go,” Jim said, edging closer to her. “Really. But this is important, and I'm not going to stop bringing it up.”

She shook her head. “I'm not crazy.”

“I know that. I know you're not crazy. But I still think this could help.”

Sheryl looked down at the floor, and my eyes drifted in the direction of her gaze. What was she thinking?
Was
she crazy? In our brief interactions, it had kinda seemed like it.

“It's important,” Jim added. “Really important.”

Sheryl looked over at me, and I gave a gentle nod.

“Please consider it,” he said.

She gave him an exaggerated smile and softly said, “Fine.”

My eyebrows raised, and so did Jim's.

“I'll do it, Jimmy. Whatever you want.”

“You will?” he asked.

“I will.” Sheryl looked at me, grinning. “He has been a pain in my ass about this for years. Years! Never shuts up about it.
Go see someone. Go talk to someone.
Well, I'm talking to you, Jim! I'll talk all you want.”

I wanted to respond but wasn't sure what to say. “Is that right?” I muttered.

“I'll make the referral now,” Jim said, flashing a flicker of a smile. “Right now.”

A moment later the appointment was over. Sheryl grabbed her belongings, gave Jim a hug, and said, “To be continued,” as she sauntered out of his office toward the mental health clinic. When the door closed, I noticed that O'Connell was staring at a blank sheet of paper on his desk.

“Interesting lady,” I said, approaching him. “Really interesting.” I took a seat where Sheryl had been. “Lot going on there.”

Jim sighed and looked at me. “That woman has had her life ruined because of mental illness,” he said. “Her marriage, her job, every interpersonal relationship. All destroyed.” His eyes became moist and his voice soft. “I have been trying for six years to get her to see a psychiatrist and she has always refused. Every single office visit for six years. Always said no.”

I studied his face, trying to think of something significant to say. But I could only offer a single sound. “Huh.”

“She has never given herself a chance.” Jim pounded his right hand on his thigh and smiled. “Until today
.
”

“Incredible.” His eyes bounced from left to right, and I tried to follow them. I could hear voices just outside of the office discussing a new coffeemaker. “Why today?” I took out a pen and a small notebook from the front pocket of my white coat and started to jot down the details of the exchange. “Wonder what changed,” I said.