Baseline

This is the second season of this blog. To your immediate right you can select highlights from last season. This season I’m telling a more specific story. It starts here, but you can skip ahead to the following day, the exhilarating prodrome, when the symptoms begin, or the fulminant end…

My name’s Erik, I’m a physician—a doctor—in my third year of residency. After I got my undergraduate degree I spent a couple of years managing a restaurant on South Beach. South Beach was exciting, and it was there that I learned the difference between exciting and interesting.

I had a pre-filled role to play—or not—as a doctor. I started taking pre-med classes and ended up going to med school. But when it came time to decide where to do my residency, I fucked up. I applied to only two programs, both of them quite late in the application process and ended up in a Southern town that I never imagined myself living in—400 miles from anyone I knew or cared about.

I found myself here—in exile—and free to reinvent myself. Or so I thought. While I was reshaping myself in some ways, I found I had a pre-filled role to play—or not—as a doctor. Playing a doctor changed how people interacted with me and changed the way I interacted with people.


I thought I was getting it down pretty well, when things took some strange turns several months ago.

This is the story of me changing—in the space of a few months—from this guy:












to this guy:








And it’s more than just a moustache and a black eye. So, if you’re ready, we’re going to start a few months back, right before this all began…

The good news is that when I see a lawyer I’m no smarter or honest than you are when you go to see a doctor.


The bad news is that when you see a doctor, you’re probably a moron.

The worse news is that if you aren’t a moron, then you’re a liar. The worst possible news is that you might—unfortunately—be both.


The reason doctors are always interrupting you is that:

• You’re pointing at your pelvis and saying your thyroid hurts.
• You’re explaining you were diagnosed during the Vietnam War with a disease that was discovered in the early nineties.
• You’ve had a sore throat for two days and are demanding an MRI because the internet says a sore throat might be caused by nasopharyngeal carcinoma.
• You’re telling me in terrific—imaginary—detail what your neighbor’s friend was diagnosed with fourteen years ago.
• You’ve refused to quantify ‘a while,’ and despite being asked to clarify your answer five times, you insist on saying ‘quite a while,’ ‘for a long time,’ repeated ‘a while,’ and ‘seems like forever.’ Then, when pushed with a choice of ‘one week, one month, one year, or one decade?’ you begin an argument with your husband that lasts fifteen minutes if the answer should be ‘one year and sixteen days’ or ‘one year and seventeen days.’

Now, don’t get me wrong.

I know you’re sick. You’re afraid of misspeaking and have no idea what’s important, so you error on the side of too much of the irrelevant—while, unfortunately, leaving out the relevant.

I know you’re not feeling well and that you’re willing to say anything to have me tell you that everything’s going to be okay. Alternatively, you could be aching for some bizarre and incurable malady. But I know that you’re doing the best you can.

It’s my job to ‘redirect’ your answers as gently as possible. And I do. And I often succeed in redirecting without being rude.

But often, I have already shifted into veterinarian mode. Knowing that your answers are confabulations and half-truths, I’ll gather information from what your body can tell me.

My examination will become like a magician’s show: constant misdirection and subterfuge. My stethoscope becomes the medical equivalent of a magic wand and my ophthalmoscope becomes a rabbit I can pull from your ear.

It’s a curious thing. I’ll do these things benevolently. I do them to get your intellect—or lack thereof—and motivation—as ulterior as it may be—out of the way for the benefit of your healing and relief from pain.



I’m not sure which part of this makes me more of an asshole: my understanding of your incompetence or my acceptance of it.

It might be the higher road to expect more and become angry with you, instead of pretending to believe the things you tell me, all the while offering my smiling reassurance until I can figure out why you are ill, so that I can try to heal you.

While there is certainly no geographical concentration of people appearing to have potential only to reveal themselves to be jackasses, there do seem to be concentrations of certain strains of these people from place to place.

In this town, you might be out to dinner with this charming man. You may even be pleasantly amused when he tells you his parents gave him the choice of a summer in Europe or a college education.

‘How 1890’s!’ you think to yourself, remembering the other fellow from this town who had been given the choice of an education or a Porsche.

Why don’t these parents just eat their young? I mean, actually cut off their arms with a hack saw and put them on the grill with a delicious barbeque sauce. Because really, once you buy your child a sports car instead of an education, what’s even the point?

It’s the lack of insight and not the lack of an education that you have a problem with. The most enjoyable dates in this town have been with butchers—guys whose families didn’t have the means to send them to college, or Europe, or the Porsche dealership. (More on the butchers later)

Someone so unaffected can smell the stink of cynicism on you. So this guy begins to tell you about his summer in Europe and you’re listening and when he tells you what a great time he had in Madrid, you grow a bit more interested and think things may be looking up.

‘I hadn’t even wanted to go to Spain, but I had a great time,’ he says. And then ruins it all, as it always becomes ruined. This time when he says, ‘the people there aren’t at all what you’d expect: they’re not fat and lazy like you’re always hearing.’

And you aren’t sure if you should help him understand that he’s confusing stereotypes of Mexicans with stereotypes of Spaniards, or if you should just leave the whole mess alone, because you’ve gotten into enough trouble calling people out on more egregious forms of bigotry.

But at that point you know the night will go no further than a make out session in the parking lot or maybe you’ll let him give you a blowjob, at most. But frankly you’re thinking about finding an earlier exit than even that.

And when he starts talking about Banana Republic like it is haute couture, and referring to himself as a fashionista, you decide to make your exit and wonder why he felt he had to stuff his own self into an inappropriate stereotype.


And when you’re politely pocketing the number he’s giving you (again), and he’s saying ‘you’re not going to call me, are you,’ and you’re wondering how to answer such a question, and instead you’re reaching for your keys and maybe thinking of a Ryan Adams song, and you just stupidly say ‘I don’t even know what I’m doing now let alone what I’m going to do.’


And most nights usually play out like this, in one way or another, going home alone, with the unfortunate combination of being angry, bored, and horny.



But occasionally, things work a bit differently. You go out, let’s say with a butcher, and he’s neither bigoted nor confined by assumptions of how he should be or behave simply because he likes to kiss boys.

But someone so unaffected can smell the stink of cynicism on you.

He can sense what you know and what you think about your fellow man, and you understand that he is thinking that the night will go no further than a make out session in the parking lot or maybe he’ll let you give him a blowjob, at most. But frankly he’s thinking about finding an earlier exit than even that...

When you first arrived in this town, a senior physician said, ‘watch out, women here will see you as a ticket out of this place.’

You remember thinking, derisively, ‘I didn’t see any gates or parameter fence.’


But you remember the comment when you’re out and this pretty redhead starts talking to you.

‘What kind of medicine do you specialize in?’ is the first and only question she asks.

You think about asking her if she’s kidding.

But it’s at that moment—even while feeling the softness of her neck and much before the 2 am drive home in your boots, boxers, and t-shirt—you realize even then that fucking this girl will debase you more than it will her.

But you go home with her just the same.

You find yourself walking through unmown grass into a house that reminds you so much of your own childhood it makes you a bit nauseous. It’s cluttered with lacey things that try to disguise its poverty. The walls are brightly painted, but the cheap construction shows in the uneven corners and low ceilings. Not even the dim lighting can hide it.

A little Paris Hilton dog runs up and begins barking, trying to entice the redhead into picking him up, but she goes into the bedroom instead.

Her bedroom smells of supermarket candles, so you focus on the feel of her skin instead. As your clothes come off, you hear a odd sound in the corner, and you think about looking—fearing a feng shui fountain—but your positioning makes such investigation difficult, and you ignore it and—thankfully—she already has a condom open and ready and so you continue what you are doing.


Briefly—later—thirty minutes? two hours?—you wake up, groggy, confused, and still a little drunk. By the time you figure out what you’re saying, you’ve already let out a sigh of a profanity.

You get out of the bed and start searching for your clothes. You have your boxers and t-shirt on by the time you pick up your jeans and find they are soaked. You had thrown them into the corner where she kept the dog’s water bowl—who keeps the water bowl in their bedroom?—and as you pick up your jeans, your wallet falls from the pocket and directly into the water, making a second splash.

You are looking at this enormous water bowl. It’s big enough for two of her little dogs to bathe in. You shake your head and again let out a profane sigh.

You put on your boots, tuck your cold wet wallet into the elastic strap of your boxers, ball up your soaked jeans, and walk out into the cold night, as she asks you if you really have to go.


And you drive home, half-naked, feeling both debased and vampiric, wondering where this all is going, but knowing that it is not going well.

There is this very nice woman who works for the hospital. Very nice. She was tasked with informing us that the program cancelled an internet service that tracked a lot of our clerical information. It was apparently expensive and had some other issues. So the program cancelled it. Reasonable enough. No big deal.

So this nice woman was informing us of the change at a meeting of about 50 physicians. She went on to say that now the information would be collected by hand and conveyed to us by monthly printed handouts, so we could have ‘real time access to the information.’

Without thinking, I interrupted her, saying ‘monthly handouts haven’t been considered “real time” since seventeenth century London.’

This got a good laugh from the crowd, which made me immediately feel guilty. I don’t really care about this internet service. I just saw a poor choice of words and preyed upon this woman.

Unfortunately, she tried to defend the ‘real time’ access, and though I looked for a way to stop, I didn’t let her out. Finally the Program Director intervened and parried with, ‘we’re working on getting a new online service. This is just a temporary fix.’

After the meeting I got a lot of back slaps from the other physicians for my outburst, because we are assholes. And I seem to be working on becoming the King asshole.

I’m in my outpatient clinic and running behind, as usual, and walk into the exam room and meet a new patient, which requires far more work than an established patient.

This is a 78 year old anglo woman who had vomited blood 2 months ago. She had a gastric ulcer that bled, was admitted to the MICU, and had an endoscopy, a procedure where a tube with a camera is put down the throat to examine the esophagus, stomach and the beginning of the small bowel. They found the ulcer, injected it with epinephrine and cauterized it. She is in my clinic for her follow-up appointment.

I am writing down this history and cataloging all the different surgeries she has had, trying my best to interpret them. She has a list that is very particular about dates and surgeons, and very vague about what was done:

1938: Mouth, Dr. Hunter
1956: Female, Dr. Semmelweis
1983: Cancer, Dr. Morgagni
1995: Leg, Dr. Virchow
1999: Cancer, Dr. Morgagni


After much effort and conversation, I figure out she had a tonsillectomy, hysterectomy, a knee replacement, and two simple skin cancers removed. I am writing this down when she leans over and says, ‘I like the color of your skin.’

I look at her, not exactly sure what she is talking about, and decide the best thing to do is go back to writing and ignore the comment.

‘I haven’t said one racist thing,’ she says, looking at me, smiling. I’m still not sure what to say, so I think for a minute and then say:

‘Look, you’re going to have to cut that shit out,’ I say. ‘The whole point of this is how becoming a doctor has turned me into an asshole, unable to relate to other people. If you start talking like a racist, it’s going to complicate the narrative.’

‘What are you talking about?’ she asks, smiling, but a little confused.

She screeches like an orangutan being poked with a stick: staccato and high-pitched. ‘If my patients start making racist comments in the middle of their exam, the disconnect I feel can be explained because of you being an asshole,’ I say. ‘Calling attention to your flaws gives me a moral out. But I’m going to need to take responsibility for this. To make excuses won’t do. I may not be responsible for who I was, but I have to take responsibility of whom I’m becoming.’

‘So I’m supposed to lay back and pretend to be the helpless victim of a patient? You want me to get a stroller in here, or maybe complain about how I can’t afford my medications?’

‘Lie back,’ I correct. ‘And if you don’t start behaving I’ll meld you with a patient that has pancreatic cancer and is going to die a pretty horrible death, despite all my efforts to make him comfortable. I can do it with a stroke of the keyboard, and don’t think I won’t do it.’

She stares me down for a moment, but then looks down into her purse, pulling out her bottles of meds, listing them as she sets them on the small counter, ‘Nexium, Hyrdo-something-or-other, lisinopril, and the aspirin, which I don’t take anymore. They told me not to.’

I begin transcribing the list and hear her mutter, ‘people are going to spot this cribbing from Eggers. Postmodern crap is what it is. Laziness on your part, I should say.’

I ignore her and complete my exam.

When I tell her she is going to need another endoscopy she screeches, loudly for about two seconds.

She does not holler or gasp. She screeches. She screeches like an orangutan being poked with a stick: staccato and high-pitched. Then she stops and looks at me.

I try to maintain composure, explaining we need to ensure the ulcer healed. Oddly, given a simple explanation of why she needs it, she agrees.

As I walk her out I hand the nurse the chart and say goodbye to the patient, ‘nice bit with the screeching. It almost makes up for the other.’

‘You didn’t write that bit. I did that on my own,’ she said, proudly. ‘It just came to me.’

‘Well, thank you. I found it quite alarming at the time, but it was funny. Not many patients make animal noises when I tell them they need procedures,’ I said. ‘Anything else?’

‘There is one more thing,’ she said, leaning in toward me and eyeing the black nurse, ‘When I moved here, there wasn’t one black in this part of town. It used to be so nice.’

I'm in the office waiting for my attending to meet me for my evaluation and I’m talking to the two assistants while I wait. They’re asking me how I’m getting along in this town.

‘I’m coming to realize,’ I tell them, ‘that I need a Hillary.’

‘A Hillary?’ Thalia asks.

‘A Hillary,’ I say, ‘is someone to push me to be a better version of myself, to do more than drink and hangout, someone to get me to fix up my house, submit articles, and apply for grants and fellowships.’

Thalia starts nodding, apparently thinking that this would be a good idea, so she asks, grinning, ‘what qualifications are you looking for?’

‘I don't have much,’ I say, ‘some accounting skills mostly. Someone who can tell me I'm not allowed to spend money on CD’s or D&D figures. And she has to be willing to sweep every couple of weeks, cause I'm not good at sweeping. That's pretty much it.’

‘I suspect your standards are a little higher than that,’ Thalia said, ‘what if she weighed 400 pounds.’

I’m standing on the stage of MTV’s Video Music Awards, handing an award to Green Day for being the Most Boring Pop Band of All Time. ‘I know how to cook.’

‘What if Hillary turned out to be a man?’

‘Not an issue.’

They laugh, I guess assuming I’m joking.

‘What if she had bad skin?’

‘Well,’ I admit, because they know how I love nice skin, ‘I guess I do have some deal breakers. But depending on her accounting skills...’

‘Erik, I don't believe you,’ Melpomene says, laughing. ‘You're lucky you’re a doctor, cause you’re kind of a nut job. Instead of a Hillary, I think you need a Laura, someone to soften you and keep you grounded. You need someone to love.’

‘Yes. Well, thank you Grace Slick. I’ll take that under advisement.’

With this, the door to the attending’s office opens, and I am called in. I sit down and the attending begins to go over the standardized evaluation form, each category has a possible score of 1 through 9.

‘Let me tell you how I work this,’ she says. ‘I consider five the standard for a resident. I usually give fours through sixes. Three is failing in my mind. I give sevens if I think a resident functions as an equal to me. I only give eights if I think the resident is better than me. I don’t give nines or ones.’

We start going over the form. Six, six, seven. Then an eight, then an other. Overall she averaged me at about seven and a half.

Now, let me tell you something that you’ve probably have already figured out. I don’t praise or compliment someone lightly. I don’t tell people they look nice unless I’m actually struck by how nice they look. It doesn’t occur to me to get into someone’s good graces through flattery. In my mind, it just complicates things. So when someone gives me a compliment, I assume the person complimenting me believes I have excelled.

But sometimes a compliment just leaves me feeling strange and out-of-place. I like believing that I am underappreciated, but this has been an untenable belief for some time now. With this evaluation, I finally have to admit that I’m over-appreciated. This, unfortunately, will necessitate me being far more critical of myself.

I leave the office feeling, not elated, but worn-out and frustrated, wanting to leave the program, the hospital, and the whole damn city.

I’m standing on the stage of MTV’s Video Music Awards, handing an award to Green Day for being the Most Boring Pop Band of All Time when my code blue pager goes off, waking me from my enjoyable dream to find myself in the ninth floor call room.

I throw on my shoes, grab my lab coat, and run up the three flights of stairs to the twelfth floor, where the code blue is occurring.

When I get into the room, there are a group of nurses and nursing assistants crowded around a young man wearing a nonrebreather mask gasping for breath.

The nurse tells me the man has AIDS—freshly diagnosed—and PCP, a vicious form of pneumonia. He had been complaining of worsening shortness of breath that evening, and she walked in and found him laying half-off the bed.

As she speaks, I survey the available information. The patient is still conscious, though in severe distress, with the skin behind his clavicles tenting inward when he inhales, neck veins bulging. His skin is wet. He has a peripheral I.V. in his right arm. Standing at the foot of his bed, I touch his foot—which is cold—and feel a strong pulse. The pulse Ox monitor is attached. It should read above 95% in someone healthy, 87% in a severely debilitated person. His is reading 72%. I see the respiratory therapist preparing the Ambu Bag.

I have been in the room approximately 20 seconds when the patient begins to seize.

The surgery intern walks into the room.

‘This is not a code,’ the surgery intern barks. ‘This man is just having a seizure.’

Everyone ignores him, instead the nurse prepares the five milligrams of diazepam I order.

‘This is not a code,’ the surgery intern tells the emergency department team as they enter the room.

‘Mike, glad to see you,’ I say to the Emergency senior, again ignoring the surgeon. ‘Can you secure his airway?’

‘Got it,’ Al says and moves to the head of the bed.

The nurse pushes the diazepam through the peripheral in his arm and the seizure starts to subside. The respiratory therapist is Ambu Bagging the patient and his pulse ox now reads 93%.

‘What are we doing?’ The surgery intern continues to bark, ‘This man is not coding.’

‘Can someone please give this surgeon a triple lumen kit?’ I ask.

The nurse already has the kit ready and hands it to him. Another nurse prepares the 20 of etomidate that I’ve requested for the intubation.

‘He has access in his arm,’ the surgery intern says.

‘Your role here,’ I tell him, ‘is to secure venous access. What size gloves do you wear?’

The surgeon asks the nurse for size 8 gloves and begins working on access.

Mike gets the airway. The surgeon gets vascular access. We have stabilized the patient. Guys who I thought wanted to sell me drugs only wanted to suck my cock.



Outside, I pull the surgery intern aside.

‘At this institution,’ I tell him, ‘we ask the nurses to call a code before the patient’s heart actually stops. Once a code is called, your role is to establish secure access so the nurse can give any medications I think are necessary. A 22 gauge in his forearm is not what most of us would call secure. If you are not willing to secure central access, give the code pager to a surgeon who is.’

I have said this quietly in the nurses’ station, but the ICU nurse is there with the Code Log, asking me to sign it and has overheard my comments.


A bit later, the nurse and I are moving the patient into the ICU.

‘Dr. Erik,’ She says, causing me to look sideways at her, because she doesn’t usually refer to me with the mixed formality of my title with my first name. ‘Don’t take this the wrong way, but you really need to get laid.’

I can usually spot people with ulterior motives easily enough. I am drawn to them. But distinguishing those motives has taken time to refine.

Girls who I thought wanted to suck my cock only wanted to sell me drugs. Guys who I thought wanted to sell me drugs only wanted to suck my cock. Guys who I thought wanted to suck my cock only wanted to shove Christ up my ass.

So when someone from the gym started talking to me and invited me to his house for ‘a dinner with some friends’ I was intrigued. Pyramid scheme? Orgy? Real Estate deal? Designer drugs? Who knew? But it was worth an evening to find out.


Due to a rain storm, I arrived quite late. When I got there, the salad had already been finished and the beef stroganoff was being served. I looked at the people seated around the table. I wasn’t exactly surprised or disappointed, but a bit uncertain what to think. The surgeon and I met with the interventional radiologist and found a liver mass that looked amenable to percutaneous biopsy.

My seat was at the head of the table. To my right was Don, the forty year-old exec who invited me, a nineteen year-old software engineer who worked for Don, the engineer’s elderly mother, a man in his thirties who taught drums at the local music shop, and a single mother with her fourteen year-old son.

We looked rather like we were having a big meal before heading out to the comic book convention. I checked my pocket half expecting to find a twenty-sided die.


As the not awkward small talk continues, someone asked what I did for a living and I began the conversational dance I have fairly well rehearsed:

‘I work at the hospital.’

‘What do you do there?’

‘I work for the internal medicine department.’

‘What do you do for them?’

‘I help out with patients, what ever needs doing, really. Are those Wasabi peas? Could you pass them down? Are they terribly spicy?’

By that point, I hope, people figure I am ashamed of whatever it is that I do, and let it drop.

This time, they didn’t. The questioning continued with an endgame confrontation, ‘Are you a doctor?’

‘Yes,’ I confess.

‘Oh,’ the drummer exclaimed, ‘I have something I want to ask you.’

When this happens, you have to take your lumps. I prepare myself to hear about a mysterious ache or look at a rash, but instead he asks, ‘have you ever watched Scrubs?’

‘Yes,’ I say, ‘I have.’

‘I love that show,’ he says, and that’s it.

I think about pointing out that he didn’t ask me anything, but decide against it when I realize he, technically, did ask me something.


The dinner continues in this way. I get to dust off my Monty Python and Dr. Who jokes that I haven’t used since sophomore year—and even then with nostalgia. I am a little disturbed that the two teenagers find them as funny as the rest of us. I’m not sure if it’s healthy to expose young geeks to the same material we were exposed to, but whatever.


The evening ends with us spending several hours playing in the guest bedroom that has been entirely converted into a model train diorama. We have to crawl on the floor under the platform to pop up in the separate control centers. Don tells us which ones are limited edition and which ones were made in which factory.


All in all, a more enjoyable evening then I could have ever hoped.

Given the scope of things I might have been exposed to that night, model trains and a return to über geekdom were not illegal, not something that required me to shower afterwards, did not need a $12,000 initial down payment or cause me to blackout and wake up in a Puerto Rican transvestite bar.

Unfortunately, they also held no interest for me.


I did not return any of Don’s other calls.

This man is an ex-Army man and he’d been our patient for several days. He’d come to the hospital because of vomiting and severe belly pain. Abdominal X-rays showed a partial small bowel obstruction. Surgery was consulted, but it was agreed that he did not require emergent surgery. So he’d been admitted to us, had an NG tube placed on intermittent suction, was given IV fluids, antiemetics, and pain meds.

A CT scan gave us the likely diagnosis, a large mass in the tail of the pancreas with multiple nodules within the liver and lung—very suspicious for metastatic pancreatic cancer. My intern and I told the man of his probable diagnosis, but also emphasized that cancer is diagnosed with tissue under the microscope, not with an X-ray.

If you told him you liked The Golden Palominos, would he think you were a cowboy? The surgery team and I were both in complete agreement about the next move, but we were agreeing that the next move was ambiguous. If this man did have pancreatic cancer, he would not have long to live. We didn’t want to make him spend his last weeks on earth recovering from abdominal surgery. If we were wrong, if the masses were a different form of cancer or possibly a bizarre presentation of an infection, not making a tissue diagnosis would be allowing him to needlessly die. We decided to meet with an interventional radiologist in the morning for a possible alternative to surgery.


The next morning, the man continued to have pain and to dry heave, despite the NG tube keeping his stomach empty. I changed antiemetics and reformulated his pain regimen. The surgeon and I met with the interventional radiologist and found a liver mass that looked amenable to percutaneous biopsy.


I stopped by later to check on him, his pain was now ‘tolerable’ and he was no longer heaving. I patted myself on the back for my acumen in knowing how to rewrite palliative regimens and told him the plan for the biopsy in the morning.


I went in to see him the next day after the procedure. He was vomiting and wracked with pain. He had felt well enough that morning that his NG tube had been removed and he was allowed to have a little Jell-O. I looked at the cherry Jell-O and bile in his vomit. I was grateful I didn’t see blood, but still, my overwhelming thought was simply: Fuck. Fuck, fuck, fuck.

It’s far easier to keep pain under control than it is to relieve it. This is doubly true for vomiting. What’s worse is that we were now well into his second day of hospitalization. If a small bowel obstruction is going to resolve, it almost invariably does so in the first 72 hours. It was starting to look like he was going to require surgery simply for palliation.

I rewrote a pain and nausea regimen, this time with less confidence that it would relieve his suffering, realizing that things were not going well for the patient and that they were probably going to get far, far worse.

---

Two hours later, I’m having dinner with friends and pretending to care about the conversation as we complain about the waiter, their jobs, and the traffic.

When I am accused of being too quiet, I grin and tell the joke about the woman who has been in a coma for two months. Her nurse notices some signs of wakefulness when she’s bathed between her legs. I tell the joke as if I’m the doctor taking care of the patient: ‘So I call the woman’s husband and tell him to come to the hospital and tell him if he has oral sex with his wife, it might help wake her from the coma. So he goes into the room and after ten minutes, he comes out and tells us that she’s dead. I ask what happened as I rush in to see my patient. The husband says, I think she choked to death.’

Much laughter.


But in my mind, I have gotten up out of my chair, walked away from the table, and told everyone there—including—no—especially myself—to just shut the fuck up.

Well, right about now things sure is looking a might rough for that Erik boy.

What with feeling as worn-out as a Roomba on a dirt floor and as out of place as a Dixie Chicks shirt at a Toby Keith fan club, his mind’s in a fit of trouble. And that’s got him about as ornery as a possum that done been caught rooting through your huckleberry pie.

I reckon he’s bound to realize something’s gotta change if he’s gonna make it, but it don’t seem he’s quite there yet.


But what’s this? If’n you look over yonder, there’s about to be some goings on at the bar that just might present, well, opportunities for some such change.

Stay set, folks, and we’ll see if our ol’ buddy Erik can rustle a way out of the mess he done got his self into.

Two technical notes:

This post has a soundtrack listen to it here.
It augments the writing, so if it didn't work, try this link instead.

There are several links in this post that open up small images.
Unless you are a physician, audiologist or anatomist, you will
likely need those images to appreciate what is going on.

The smoke is thick in the bar, but you can’t pretend your eyes are unaccustomed to such smoke. The friends you’re with are keeping your glass full and the occasional hand on your shoulder belongs to attractive people walking past and saying hello.

It’s a good night.

You’ve been looking for an excuse to talk to this guy at the bar so you make it your turn to buy the drinks. You order, in order—beers, bottled before draws, then soda mixes, juice mixes, finishing the order with a Woodford Reserve for yourself, a small batch bourbon, neat. You’re handing off the drinks to your friends and start talking to the prospect.

‘You having fun?’ you ask.

‘Not too bad a time,’ he says. He’s wearing glasses and the beginnings of a relaxed smile. He takes a draw of his off-brand cigarette. ‘And you?’

‘It’s a good night,’ you say and clink your glass against his.

You discover he’s just moved here from Chicago. You discuss that town and this one and contrast and compare the two.

‘One of the nice things about this bar,’ you say, ‘is the music is pretty interesting. There’s some eighties pop and early nineties dance stuff mixed in, which you’d expect, but what’s most interesting is all the Europop. It doesn’t make any sense that it’s played here but it gives this joint some character.’

You talk about music for a while and he tells you he can’t find the alt/indie station on the radio. You explain the reason for that and you both laugh for a while. You ask him why he moved from Chicago.

‘This is not amateur night,’ she says. ‘I work for the Boys & Girls Club, I transferred to this branch,’ He explains his job helping at-risk children. His eyes light up when he talks about his job and you realize he’s not talking about his job, he’s talking about his vocation. When you realize this your heart kind of feels—what? You aren’t really sure what just moved in your chest, but you decide its best to ignore it.

‘Listen,’ you say, shaking his hand, ‘it’s really great to meet you, but I’ve got to get back to my friends.’


You return to the table and rejoin the conversation more than halfway through a very tasteless joke. You enjoy the laugh and more of your friends show up. The conversation is good, and despite yourself, you glance over at Chicago, who’s still at the bar. He’s resumed a conversation with the bartender, but catches your glance and his face opens into a smile. You give him the upward nod and return to your conversation.

Your friend George leans in and asks, ‘You making friends tonight?’

‘They say,’ you tell him, ‘you can never have too many friends.’

‘He’s still looking at you.’

‘I’m sure he is.’

‘If you told him you liked The Golden Palominos, would he think you were a cowboy?’

‘No,’ you say, shaking your head and smiling. ‘And his skin is fucking flawless.’

‘He,’ George says, ‘might be interesting.’

‘Has he stop looking yet?’

‘Not yet. I think he—wait, there. He stopped.’


You check your watch: twenty-two seconds. You double it and wait the forty-four seconds before scanning the room to spot a friend. You wave and get up and walk—past Chicago without making eye contact—to her. You kiss her cheek and begin to talk. It’s good to see her, but you don’t really remember her name.

While you talk, you glance at the mirror behind the back bar to confirm that Chicago is watching you. You look at your friend and then, in a manner so natural it could even be construed to be human, glance up directly at Chicago and give him a smile.

You finish your conversation and make promises to have dinner with her soon. You start to return to your group of friends. When you walk past Chicago he keeps his back to you. This pleases you: He’s no rube. He knows what he’s doing.

You stop, put your hand on his shoulder and lean in, your lips not touching his ear when you say, 'why don't you join me and my friends?'

He turns to you, gives you the upward nod and a closed-lipped smile, while getting up from his chair.

When he is talking to your friends you notice his laugh. Natural and given freely, neither reserved nor overwhelming. His laugh is infectious and you see your friends’ grins widening and the mood—which was good before—loosening and growing even more festive.

When he looks over at you, you return the wink.



Round midnight, you walk him to his car. You make dinner plans for the next weekend.

You lean in to his left ear, ostensibly to whisper something, softly exhaling—not blowing—as your mouth passes his tragus—understanding the sensitivity of the malleus—allowing your lips to almost graze the anti-helix as you say, ‘this was a pleasure.’ You reach up with your left hand and, using the lateral rim of your distal thumb, apply a soft pressure as you trace the outline of the lower branch of his facial nerve, hoping that messages will bleed over in the nerve root, where the facial and vestibulocochlear share a narrow space and use that bleed to disturb the messages of balance sent from the labyrinth of canals as they enter the utricle. Will that make him feel as dizzy as you’re feeling now?

‘I’m not quite ready,’ he says, ‘for this night to end.’

You smile as he unlocks his car door and you climb into his passenger seat.


The next morning, you wake softly to the white of the sky from his open window. You roll over and see his empty pillow and there’s a brief moment of panic before you smell the fresh coffee. He walks in wearing boxers and a plain white tee carrying two coffee mugs.

He hands you a mug and you sip the dark, rich, strong coffee.

No cream, no sugar.

‘Excellent,’ you think and realize—tongue and teeth still warm from the first sip of coffee—that you—undeniably, irrevocably, and unfortunately—have fallen in love.

A technical note:

This post has a soundtrack click here to hear it.
It augments the writing, so if it didn't work, try this link instead.


You’d made arrangements that morning to meet Chicago again next weekend, but it’s only Saturday and when he said, ‘maybe I’ll see you out tonight,’ you contrived it into a delicate promise of a meeting that night.

So you shave and wear nice underwear and around 10 o’clock you head out to the bar, looking for the heart of Saturday night.

There’s a decent size crowd out tonight, but Chicago and his friends aren’t there. You sit at the bar and begin talking to a guy from Georgia.

‘How’s Georgia?’ you ask.

‘It’s a peach,’ he says flatly, and you laugh. A nice enough fellow to pass the time with, and from this chair you can see out the window into the parking lot. Every time a red SUV pulls in, you eye the tags to see if it’s from Illinois.

You fear you’re being rude. Every time the door opens you glance at the door. You’re looking for someone and trying not to stare, but your mind singles in on details that match the person you are looking for. When a short man walks in, you note his hair color and you have to glance again to be certain you have not missed Chicago. A bald man will walk in and all you catch with your—briefest of—glances is that his height and bulk seem approximately right.

You begin to wonder—having only spent one night with Chicago—if you’re sure you’d recognize him if you saw him again and you occasionally scan the entire room wondering if he’s somehow evaded your sentry.


Two or three drinks into the evening, you tell the Georgia boy you want to wonder around the bar, but you invite him to join you. The drinks are good; they’ve relaxed you and you find yourself not looking out the window or checking the door with the frequency you were. You realize this while giving a second glance to someone with the right face, but no, Chicago’s jaw is different, isn’t it? You scan the room again.

Maybe it’s time for a fourth drink.


There’s a crowd at the bar and—while waiting for the bartender—you somehow find yourself entered into a small group. You introduce Georgia to the two waitresses and three boys somehow connected with them. Drinks are bought. You begin to talk to one of the waitresses.

She’s from Charlotte, or rather just moved from Charlotte. She grew up in Stockholm, Sweden and came to this country in her late teens. Her friend suggests shots. She agrees to Tequila. You do also, being the good sport that you are. She signals the bartender, declining lime and salt.

‘This is not amateur night,’ she says.

You hear Georgia order something involving Southern Comfort, the rest of them have a gaggle of assorted colors and textures, at least two of which seem to involve Baileys.

‘I think you may have been wrong,’ you say, motioning your head to the snow globe collection of shots on the bar.

She laughs and—to hide her face—looks down and rests her forehead on your shoulder, then turns away from the group and regains her composure. You feel Georgia’s hand on the small of your back. You shoot him a friendly smile. For all the strides the gay movement’s made, you understand what it threatens: Good ol’boys don’t have to think about what their options and choices are.

You eye the parking lot and the door. Nothing.

The shots feel good in your belly.

It’s the point in the evening when you wonder why you don’t do shots more frequently. You—thankfully—stop checking the door.

It’s also the point in the evening when you stop respecting other people’s personal space. You tap Georgia boy on the shoulder with every syllable of particular import and it’s not too long after that you find yourself touching Stockholm’s hair.

‘I can’t believe how curly your hair is,’ you announce a little too loudly.

She eyes you sideways, then she rolls them at you, snorting, ‘thanks.’

But she does have blond hair that’s impossibly long and curly. It’s then you notice how full her lips are. She has that European woman look about her: tall and strong; thin but somehow with curves.

Your tone softens, ‘No, you really are exceptionally beautiful.’

She casts her eyes down so you see her cheeks and eyelids in quarter profile, suddenly becoming a Japanese line drawing. When she looks back up, you move your face in and kiss her on the mouth. Hard.

Too hard? You hope not.

Apparently not, because she kisses you back.

You kiss her standing at the bar for what feels like a long time. You reach your arm around her waist and pick her up and put her on the bar stool so she can sit. A maneuver that is not difficult, but not something you would do if you were sober, because it’s cheesy and way too private a thing to be done in public, and not something you would do if you were any more drunk, because you would not have the coordination and balance to perform the feat.

There is more talking and more making out, you are a bit unclear on how long it continues, but suddenly the bar is closing and some stranger walks up to you and says, ‘You made my night. The look on that Georgia boy’s face when you started kissing her was priceless.’

You scrunch your face at the man who says this. But when you look around you see that, in fact, Georgia is no longer there. You look around for Chicago, but don’t see him either. The stranger is shaking your hand and you are too confused to object. You’ve lost Stockholm in all this glad-handing, and you’re relieved when you see her talking to her friends by the exit. You join them.

‘Okay, looks like we found the real amateur,’ she says to you. ‘How are you getting home, drunky?’

‘You’re,’ you ask, ‘taking me?’

Stockholm laughs and grabs her keys.

God love a woman that can hold her liquor.



The next morning, you’re grateful you don’t have to be at the hospital for another twenty-four hours. You brew some strong, dark coffee. When Stockholm wakes, you fix her a French omelette with brie and tomatoes.

‘I woke up in the night and went outside for a smoke. I was in your back porch and thinking this was a sluttish thing to do and beginning to regret it.’ she says. ‘Then I saw the Nietzsche quote you have on your kitchen door. When I saw that, I thought that maybe this wasn’t such a bad thing after all.’

You’re looking at her and her eyes are looking down again—the kind of eyes that got someone to compare to a doe’s eyes—and realize—head still pounding from the night before—that you—undeniably, irrevocably, and unfortunately—have fallen in love, twice.

A technical note:

This post has a soundtrack click here to hear it.
It augments the writing, so if it didn't work, try this link instead.



It’s Sunday evening and Stockholm has driven home after several naps and you’re lying in bed with the windows open, trying to make sense of the weekend. Chicago hasn’t called, but you weren’t really expecting a call from him anyway.

The phone rings and it’s the Marquee telling you to meet him at the local dive bar for a pool tournament. You walk over to the bar. He orders you both beers and you sign up on the roster.

He loses the first round to this good ol’boy from Birmingham.

You, by simple luck, win your first game.

The Marquee’s a good sport and the two of you continue to hang out and drink beer with this good ol’boy. You begin your next game while they talk. It turns out that Birmingham’s a special agent for the local ATF field office. He seems to be a good guy. He doesn’t seem to be sharking the tournament, but just here to hang out and relax.

A redhead walks by—what is it with the South and beautiful redheads?—and the Marquee opens with the impressive gambit of: ‘Hey, hey. Didn’t I see you out last week?’

But, somehow, the Marquee is charming enough to pull this off and she stops and starts talking to us.

‘My name’s Lisbon,’ the Marquee says, which is true.

There’s a story behind his parents naming him that, but knowing the story makes the name even more idiotic. You’ve grown used to it and the obvious jokes people make when they hear it. If an attractive female falls for the obvious Lisbon/Lesbian Maneuver, the Marquee can play that one backwards and blindfolded. If a guy makes the joke, he doesn’t find it that funny.

‘As in Germany?’ the redhead asks.

‘Wow,’ you say, sucking your teeth.

Birmingham’s eyes widen briefly and turns to face the bar, mumbling to me, ‘good thing she has nice tits.’

The Marquee gives her some slack, knowing that geography is not everyone’s forte. Everyone’s bad at something. You, for example, are having your ass handed to you in this round of pool and lose quite quickly.

The Marquee’s game also sucks, yet the redhead doesn’t seem to mind. You and Birmingham are still quietly heckling him.

Birmingham wins his next round. So does the Marquee, who makes his goodbyes and leaves with the redhead.

Birmingham says he’s going outside for a smoke. You ask if you can bum one.

The back smoking patio is warm and empty and he’s telling you stories about his life as an agent. You’re enjoying the stories, but your mind starts to wonder.


The average American male, you are remembering, falls in love six times in his lifetime. You knew you were past the halfway point in that calculus. It had been a while, and you’d suspected that it wouldn’t happen again until you left this town.

Then, this weekend, it happened to you. Not once, but twice.

And now you’re hanging out with this guy who could easily become your new best friend. You can’t believe how great this weekend has turned out.

If you’re anything like me—and I suspect you are—you’re feeling like a twelve year-old girl who just won a guest spot on The O.C. and your parents celebrated by buying you your very own pony.

You feel relaxed. You chuckle thinking about how, for all the strides that the gay movement has made, you understand what it threatens. Good ol’boys share this relaxed relationship with each other with no sexual tension. They have the purity of not having to think about what their options and choices are. They can simply exist and not have to clarify their intensions.

You’re enjoying that instinctual relaxedness, just smoking behind the bar, cigarette dangling from your lip. There’s a purity about the moment, like a Rockwell by way of Kerouac.


‘You know what a redneck says before he gets injured?’ Birmingham says, putting his hand on your shoulder and leaning in for effect for the punch line: ‘“Watch this.”’

You laugh, but he doesn’t take his hand off your shoulder. You turn to look at his hand and then turn your head just in time for your face to meet his as he leans in and kisses you. You, stunned, neither kiss nor resist him.

With him still kissing you, you open your eyes and look at him. He has dark black hair and pale skin. His cheeks are flushed. He is, you realize, quite handsome. His eyes are still closed. ‘Please don’t have blue eyes,’ you think.

The previous 48 hours loom large in your head. Chicago. Stockholm. And now Birmingham? What kind of fucked up world tour are you on? How is it that you can be in a town for two years and have a small handful of people you have found interesting for friends, and now all this in a single weekend?

You’re thinking of every cliché and folk wisdom in the book, birds in bushes, hands, and everywhere else seem to be flocking this weekend. You know you’re likely to loose Chicago or Stockholm, if not both. But this is just too much. You step back.

He opens his eyes which are, of course, pale blue. You both soften and thicken.

‘So,’ you ask, chuckling, ‘is a boy like you looking to take me to dinner sometime or to take me home tonight?’

‘Do they have to be mutually exclusive?’ he says, smiling.

Even if he’s taking you for a ride, it looks like it’d be a fun one.


When you get home, he’s following you through the darkened house, and kissing the back of your neck. You stop walking and let him fall against you. He kisses your ear and then stops. He turns you around and faces you. His game face drops and he’s suddenly awkward.

‘I don’t go out with guys,’ he says, stammering. ‘I mean, I haven’t dated a guy before.’

He pauses again and kisses your neck, this time a bit clumsily. You’re thinking, not moving, analyzing the situation. He stops kissing you and looks at you again.

‘You can send me home if that’s not alright,’ he says. You’re trying to get a read on him. You think about Stockholm and Chicago, but you’re looking into pale blue eyes—admittedly somewhere you think about the possibilities of his badge and gun and—do ATF agents carry handcuffs?

You let your head lull back and let him nuzzle against your neck.


In the morning, he wakes up before the alarm goes off at 5:15. You open your eyes and see him slipping on his khakis and white Hanes tee.

‘I’m brewing us some coffee,’ he says as you climb out of bed. ‘Hope that’s alright.’

‘It’s fine,’ you say, trying not to look at him as you realize—naked and scratching your ass as you walk into the bathroom—that you—undeniably, irrevocably, and unfortunately—have fallen in love, thrice.