My name’s Erik, I’m a physician—a doctor—doing my residency in a Southern town. When I got here I found I had a pre-filled role to play—or not—as a doctor. I thought I was getting the role down pretty well, when things took some strange turns several months ago…
Monday morning I was driving into work when my pager began beeping. I recognized the number as pre-op holding.
About thirty minutes earlier, after Birmingham left and as I was putting the finishing touches on this post, my intern paged me to say that our pancreatic cancer man was heading down to the O.R. So I’m not surprised when I called and my intern picked up the phone. There had been several traumas brought in and our man’s surgery got bumped to the afternoon. My intern wanted to know if that was alright.
The most unpleasant thing about vomiting is its semblance to a heightened emotional state.‘There’s not much we can do about it,’ I told him.
When I got to the hospital, the patient told me he’d been having cramps and vomiting occasionally over the weekend. The weekend physicians, he said, had treated him well. Since the last time I had seen him, he had started hiccupping, badly.
I apologized about the surgery being postponed. He was rather stoic about the delay, but started asking questions that had clearly been weighing on him over the weekend.
‘Do you think this surgery will relieve this cramping and vomiting?’ he asked. ‘Cause if it doesn’t, I’m going to walk out of this hospital, get my pistol, and take myself behind the garage.’
‘I hope it will,’ I said, ‘there aren’t any guarantees, but our goal is making you comfortable.’
That seemed to be what he wanted to hear. He seemed to relax some and started asking about possible treatments, chemo, or radiation if he did turn out to have cancer.
‘I can understand your wanting to think ahead,’ I told him, ‘but today let’s just get you through your surgery and hopefully get you some relief.’
He paused for a moment while a wave of hiccups made it impossible for him to speak.
‘I understand that there isn’t a cure if this is what you think it is,’ he said. ‘It’s not that I want to die; I’m just not afraid of it. I got right with the lord a long time back.’
He stopped for a moment while another wave of hiccups overtook him. ‘My wife took off and left me with five children to raise. I was in a car wreck when my youngest was eleven. I told God then that if he let me live for long enough to raise my children, when he was ready for me I wouldn’t complain.’
He stopped for a moment as the hiccups returned again. ‘My youngest is twenty-three now, with a baby of her own.’ He paused here, but he was not hiccuping. ‘I’ve seen three of ‘em graduate from college, something I never did. He kept his end of the bargain and I’ll keep mine.’
I shook his hand and told him I’d see him after the surgery. I walked into the nurses’ station, into the restroom, locking the door behind me. I lifted the lid to the toilet as I felt a wave of nausea overwhelm me.
Hanging my head over the basin with my left hand pressed against the wall and my right hand keeping my tie out of the way, the reflex hyper-salivation started and poured from my mouth. There were no heaves, the coffee in my stomach stayed there. I was not hung-over. I waited for the next wave and when it came, the saliva poured out again.
I tried to focus my thoughts away from here, away from the hospital. I focused on Stockholm’s hair, on Chicago’s skin, on Birmingham’s eyes.
The nausea abated.
Was one of them going to be the key? Was it going to be this easy? Would the simple act of falling in love complete me? Would it soften my edges and allow me to become both human and doctor?
But surely you know by now that it’s going to be more complicated than that to unlock a better version of me.
The most unpleasant thing about vomiting is its semblance to a heightened emotional state. The nose runs. The eyes water and flow. The cheeks become flushed and there’s an unpleasantness occurring in the gut.
I’m wiping away the spittle from my chin and splashing cold water on my face when my pager goes off. It’s the ED’s ICU. I blow my nose into my hands and then wash them again. I adjust my tie, unlock the bathroom door and walk over to the phone in the nurses’ station.
I call the ED and the resident tells me about a patient that needs to be admitted: She’s a woman who’s ingested an unknown amount of an unknown drug and washed it down with a generous amount of alcohol. She’s not lethargic, in fact she’s struck one nurse and nearly kicked another in the head. She’s currently in four-point soft-restraints, meaning her wrists and ankles are all tied to the gurney. I can hear her in the background screaming variations on a theme of Fuck You in E minor.
He tells me her MedRec number and name. When I hear the name I say, ‘I think she went to charm school with my sister!’
‘Really?’ the resident asks, surprised.
‘No,’ I say flatly, signaling my intern and heading to the stairwell.
In the ED, our charmer does not disappoint.
When I see her wearing an N95 mask over her face, I know she’s started spitting at people. The ED resident confirms this without my asking. He also tells me they held off on giving her another round of sedation until I could evaluate her.
I approach the patient in veterinarian mode. I use her first name. I speak in soothing tones. I explain how worried we are about her safety and want to make sure she’s okay. I ask her if she has any pain anywhere.I reprimand him the way we do in medical culture: I start testing his knowledge.
This is all just a stall. She’s going to have it in for me. I’m just trying to keep her calm long enough to make sure she’s not acutely ill. She’s a thin white woman, sitting up, looking at me with only a fair amount of anger. Her pupils are dilated and sluggish but equal, disc margins sharp, no lymphadenopathy, thyromegaly, nuchal rigidity or cervical tenderness.
‘Can you breathe okay?’ I coo.
She takes a few deep breaths and her lungs are clear. I skip ahead because I see she is started to tire of me. Her belly is soft and bowel sounds are normal. I go back to her heart and she is only a bit tachycardic; no murmur, rub, or gallop.
‘I need to go home and take care of my kids,’ she says.
I have already checked her pedal pulses and examined her legs for edema. Her skin is warm and dry.
I walk to her side as I again scan her skin for any rash or evidence of trauma. I take her hand, pretending to sooth her, but really I’m checking her nail beds and palms which are negative for stigmata of disease. She has no track marks.
‘Your husband knows you’re here’ I say, ‘he’s taking good care of them.’
‘I need to leave. Now!’
‘I know, but that isn’t safe.’ I tell her, removing my hand from what is soon to become her grasp. ‘We need to watch you a bit longer and make sure you’re okay.’
She rev’s up rather quickly and before you can say bobs-your-uncle she’s flailing around in the bed. She’s spitting at me. Nonsensically, as the mask is effectively catching it and her saliva rolls down her jaw. I turn and walk away as she begins a reprise of her variations on a theme. This time directed at me.
‘You can sedate her now,’ I say to the nurse as I head into my workroom. Within a few moments, her screech quiets and I can hear her peaceful snore. I grab her chart and look at the photocopy of her driver’s license. The photo was taken three years ago. She was a beautiful women then. The difference is not unlike the progression seen here and here.
I’m writing the orders to admit her into the hospital. I do not feel nauseous.
Inside the sanctum of our workroom I ask my intern to tell me what he’s able to pick up from my exam of the patient, hoping he noted the details I intentionally omitted from you.
He tells me, importantly, that: she reeks of alcohol; she’s hypervigilant but not tremulous; her speech is not dysarthric; she moves all four extremities against her restraints with appropriate and equal force.
‘Before seeing her lab results what does that make you suspect?’ I ask.
‘She’s drunk off her ass with some stimulant onboard, likely cocaine.’
I scrunch my nose and give a tight nod.
‘Most likely,’ I say.
The ED resident comes in and tells us her drug screen just came back positive for cocaine and benzodiazepines and her blood alcohol level came back at 262 mg/dl—about half the level needed to kill most people.
‘That’s it?’ my intern says, ‘we had a guy two days ago with one above 350.’
I look at my intern, consider telling him not to show off about things no one cares about, but instead reprimand him the way we do in medical culture: I start testing his knowledge.
‘What are her blood chemistries going to show us?’
This was a low-ball question and he’s smart enough to tell me an osmolar gap. Their faces betray a fear of its larger significance. They are cut off from the world they knew when they arrive in here.
‘Will she be acidotic?’
‘No,’ he answers, correctly.
‘And if she were?’
He reviews the possible agents that could cause a osmolar gap with an acidosis and tells us what studies he would order to make his diagnosis.
I grin at him and turn back to the ED resident, who knew the answers to the questions as well as I did, if not better, but still—that’s what you show off. Not what you’ve seen, but what you understand.
This is mere pageantry. It’s not the panache of noting a physical finding that gives the diagnosis or ordering a test that was missed, but it’s important to play these games. Next year he’ll be the senior resident. He has to have thought out patients he hasn’t yet seen. But maybe the difference between pageantry and panache is a matter of degree and opinion.
I thank the ED resident, go to the computer and start flipping through the chart while waiting for her labs to come up on the screen.
‘What am I going to be looking for and order if I don’t see?’ I ask my intern.
He rattles off the labs and studies.
‘Do we need to tap this woman?’ I ask.
‘No. We’ve got a clinical scenario that can be explained by toxic ingestion and confirmed the ingestion with lab results. She’s afebrile, with no elevation in her white count and no nuchal rigidity.’
I give him another tight nod.
‘You’re doing a good job,’ I tell him. ‘You’ve got a good knowledge base and—more importantly—you’re applying that knowledge appropriately. Not just to expand the differential, but to narrow it also.’
I guess that’s the important part of panache. It’s not knowing what tests to order and procedures to perform, but knowing what doesn’t need to be done as well.
That’s the real trick—not just in medicine, but in life. Doing and saying just the right amount. Communicating competence without appearing a braggart. Demonstrating interest without appearing desperate. It is a trick, isn’t it?
In the pilot episode of ER, a popular television show in the early nineties, there were lots of statistics about ER’s. Characters would mention that ‘80% of emergency departments were…’ or ‘over half of all emergency physicians report that…’ It’s odd that the story got off to such a clumsy start, because the ED is, for me, where stories begin.
What they did well, at the beginning, was their portrayal of an urban ED’s griminess and denizens. Unfortunately, as ER cleaned up its exposition style, it also cleaned up its furnishings and structure as well as its patient population. Urban ED’s are, uniformly, grimy and smelly. Because of my time there I’m on a first name basis with more crack whores than school teachers, although to them my first name is simply ‘boo.’
There, amid the homeless having chest pain and teenage girls with babies and purulent discharges, laying in the gurneys between the splashes of vomit and blood, absorbing the stench of the senile men who have feces—both dried and fresh—being slowly and carefully removed—attempting to leave the friable skin intact, listening to the angry—sometimes cogent, sometimes profanely random—tirades, are the people who are going to come into my care, who will become my patients.
I suppose what strikes a newcomer when they look across the ED is the shabbiness of the curtains. They are the only thing that separates the patients, and they are usually left half open so we can see if they are pulling out their IV or Foley catheter, eating their diaper, having a seizure, falling out of their bed, or having anything else befall them.
The plaster on the walls is peeling and cracked. Every wall, door frame and counter has a dent about three feet off the ground from where the gurneys hit as the patients are brought to CAT scan or Ultrasound, up to their room or down to the morgue. Despite the appearance of the plaster, the structure is solid. Many ED’s are in old radiology suites and the walls are lined with lead.
Because of the lead walls, cell phones do not work in here. Despite the signs, people new to the ED are surprised at this. Their faces betray a fear of its larger significance. They are cut off from the world they knew when they arrive in here. ‘This conversation is going to exhaust me really quickly if we have to recite lyrics to one another,’ she says. ‘You’re cool already. I get it.’
They are in the shadowlands.
I had already noticed the man who would become my next patient, laying thin and gaunt, struggling a bit for his breath as a small group of plump women stood around his gurney. They were not un-goose-like, these women. Their necks outstretched and on the lookout, turning from him to the desk, from him to anyone who might help their fallen gosling. I—as always—avoided making eye contact with random ED patients or their families.
I would become involved in his care in a few hours, after lunch, after the ED had done the work that they do. I mention him now, because he and his gaggle of women are going to factor fairly large into the story, and this was the first time I saw them—refugees from the land of the healthy, taking their first step into the new country: The Land of 1000 Diseases.
They would come to hate me. All of them would. This man’s last act—for he won’t have air in his lungs for words—will be one of contempt for me, a last ditch effort of defiance before his breath stops and he dies.
But at this moment, I did not know them and they did not know me.
It was simply time for lunch and I was finishing my admission of our drunken friend. I grabbed my lab coat and flung it on. The weight of the pocket-guides and pens and penlights in its lower pockets gave it the weight needed to arc up and fall against me in an—admittedly ridiculous—flourish. I dropped drunky’s completed orders and chart into the clerk’s rack and headed out of the ED, leaving the blood and vomit, the odors of shit and piss, the echoing tirades, the dingy curtains, the falling plaster, the regulars—whom I count as my friends, the crack whores and homeless, the senile, invalids and infirm—as well as its newest gaggle of citizens, whom I would be shortly meeting.
I was heading into the sanctum of the doctors’ lounge. Barbeque pork and banana pudding, served on Mondays, with coca-cola in glass bottles.
The Doctors’ Lounge is not different in appearance from the rest of the run-down hospital. But there is a difference when we walk in. Amongst ourselves, we don’t worry about being overheard. Some, if not most, are still assholes, talking about investment opportunities and streamlining the business of being a doctor. But a near majority talk about their weekend, their dogs or kids, movies or music.
I make small talk with the doctors at the buffet, getting my pulled pork, baked beans, cornbread muffin, and a side-plate overflowing with banana pudding. I grab a bottle of coca-cola, put a straw in it and look around for someone to sit with.
I see the surgeon who will be operating on my pancreatic cancer man this afternoon, Dr Merteuil, sitting alone and I join her.
‘I left you with your nose bleeding and your toes creeping round,’ I tell her, gliding past her onto a chair.
‘Sometimes I wish that I could stop you from talking,’ she says, ‘when I hear the stupid things that you say.’
I look at her, eyebrows up.
‘This conversation is going to exhaust me really quickly if we have to recite lyrics to one another,’ she says. ‘You’re cool already. I get it.’
Dr Merteuil is a fairly brilliant surgeon. She is smart, no-nonsense and with common sense. Her hands are good, by reputation and from what I’ve seen during codes. We’re also each other’s confidant at work, exchanging information on both the politics of the hospital and our personal lives.
She’s married—happily, she says. She’s also sleeping with an OR Tech. A six-foot-two, muscle-bound blondie.
She takes home-call, meaning she only comes into the hospital if she’s needed. For a while now, the Tech would page her at pre-arranged times and she would leave the house and have a rendezvous and head back home: A perfect situation, really.
While we have the table to ourselves, she gives me an update. Recently he’s been calling at times that were not prearranged. Taking the call in front of her husband, she couldn’t really argue.
‘He has me by the balls,’ she said. ‘I’m about over this shit.’
A bite to the foot is unlucky. A bite to the hand means someone was fucking with a snake. ‘You gonna break it off?’ I ask.
‘Hell no. I like making the bitch say my name,’ she says, getting a laugh from me. ‘I just want to be in the driver’s seat.’
I fill her in on my weekend. I tell her about Chicago, Stockholm, and Birmingham.
‘You have—like—a dream situation,’ she says. ‘God I wish I were you.’
‘I don’t follow.’
‘Whenever I go out, I have to figure out where I am not going to run into anyone my husband knows. If we ran into anyone from the hospital things would get complicated. With you, if Stockholm sees you with Chicago or Birmingham you can be like “I’m not allowed to hang out with my buddies?” and if either of them sees you with her they are unlikely to ask questions.’
‘Take a good look at my face,’ I say, laughing and taking a bite of my cornbread muffin. ‘You'll see my smile looks out of place,’
‘No more tear-stained makeup,’ she says, getting up as her pager goes off, ‘Motherfucker.’
I laugh and take another bite of my muffin.
I do love a good cornbread.
Dr Merteuil is walking away from the table as I sop my cornbread muffin into the baked beans and return a page from my cell phone. It’s the ED, telling me there’s an emphysema patient in the emergency department. I’m told she’s stable, so I send my second intern to evaluate her while I finish my lunch. Dr Semmelweis sits down at the table and joins me.
‘What were you guys talking about?’ he asks, motioning at Dr Merteuil as she puts her labcoat back on and leaves the lounge.
‘Rap music,’ I say, as a little dig at him. At the beginning of our residency we were at a meet-and-greet where someone asked him what kind of music he liked.
‘All kinds of music,’ he said. Causing me to pity him, but then he transformed the pity into hatred by saying, ‘except Rap and Country.’
The questioner turned to me and asked me what kind of music I liked.
‘Mostly Rap,’ I said, ‘and Country.’
That laid the foundation for our relationship.
‘Yeah, those rappers lead some fucked up lives, huh?’ Semmelweis says as Dr Pasteur sits down, joining us.
‘Yes, Semmelweis,’ I say, ‘they do. Like that “Can I Get a Butt-Plug” song? I’m still amazed they played that on the radio so much.’
‘I guess I don’t know that one.’
‘Erik, what the fuck are you talking about?’ Dr Pasteur says. ‘There is no ‘Can I Get a Butt-Plug’ song.’
‘I think it’s Jay-Z. It was popular about 6 years ago I think.’
‘You’re on crack, Erik.’ Dr Pasteur says. ‘It’s whoop whoop’
‘I think he says butt-plug,’ I say, digging into my banana pudding.
‘Lisa Lisa Cult Jam isn’t Rap, why were you talking about her?’
‘We weren’t talking about Lisa Lisa Cult Jam,’ I say.
‘When I was walking over to the buffet I heard Merteuil mention You Got It All Over Him.’
‘That wasn’t about Lisa Lisa,’ I say, getting up as my pager goes off. ‘I gotta return this page. Good seeing you, Dr Pasteur.’
I return the page. It’s the ICU telling me that a snakebite patient is stable enough to transfer to my service. I leave the lounge and press the call button for the elevator.
There are two types of snakebites: Those to the foot and those to the hand. The treatment is identical for both, but the sympathy level is different. A bite to the foot is unlucky. A bite to the hand means someone was fucking with a snake.
Snakes do not like to be fucked with.
The risk factors for a snakebite to the hand are easily remembered as the five T’s. In order of predictive value they are: Testosterone, Tattoos, Toothlessness, Toxins, and Trailer. The patients are almost uniformly male, and not just male but stupidly so. They typically have tattoos and poor dental hygiene. They are usually drunk or high. And they typically live in trailers near a gulch or junkyard.
Often the patients will bring the dead snake with them. A fun trick to show people is to cut the head off the snake, and, while wearing gloves, hold the—headless—snake by the tail and drop your hand down quickly. A snake’s strike instinct is, literally, ingrained in muscle memory. The snake will twist around as it falls and the headless stump will strike your glove.
These are some of the many useless things I can tell you about snakes and the people they bite.
My best snakebite story is about two good ol’boys who’d caught themselves a rattler and were playing catch with it. They’d hold it by the tail and toss it to each other.
You know how all games of catch end.
You move farther apart. You try fancy catches. You try a behind-the-back toss.
In normal catch—with a ball and not a snake—the game ends when you finally drop the ball. In snake-catch, the game ends when the snake hits you in the chest and bites your hand as you fumble for it and you—in your anger—throw the snake back at your friend and it bites him in the hand, too.
Still, I bet snake-catch feels pretty amazing and superhuman while you’re doing it.
I’m thinking about the way people tempt fate—and the high you feel when you do so—when the doors to the elevator open and I look out into the bustling ICU.
Though the snakebite is to the patient’s hand, he turns out to be a nice enough guy. When I mention the words Crotalus and Agistrodon, I win his confidence. This, clearly, is a guy who loves snakes.
He’s a paramedic who has three pet rattlers. He got bit, apparently, when he was cleaning out the cage on a hot day and the snake moved faster than he was used to. It was the pygmy that bit him. Pygmies are mean motherfucking snakes, far more then their larger counterparts. We hear stories of people who were repeatedly bitten when a pygmy chased them. Big snakes do not do chase people.
Still, he’s a relatively uninteresting patient: he’s stable and improving. His coagulation studies were never elevated and the swelling has been steadily subsiding. He doesn’t even have signs of an untoward reaction from the antivenin. I write an acceptance note after examining him.
The idea of keeping snakes is a curious one. This man certainly held no illusion that the snakes felt anything for him; He was not keeping them as one would keep a poodle or a child. And it wasn’t like keeping a rottweiler or a gun collection that would confer a concomitant illusion of protection. [It’s here that I originally delved off into a thirteen paragraph digression about why he might keep rattlers for pets. And I don’t mean the staccato bi-sentenced pairings that I usually pass off as paragraphs, but actual, fully-formed expansion of ideas and fleshing out of concepts before the next [Enter] [New Line] [New Paragraph]
It started with a nod to Freud’s Totem and Taboo, given with oblique references so that those familiar with it would nod and smile in a way that acknowledged they were clever enough to not only have read Freud but to recognize when he was referenced. Those unfamiliar with it would—I hoped—appreciate the ideas and not notice the references they missed. I moved forward to a compare and contrast of the concepts of fetishes by Frued and de Brosses. I even gave a knowing wink to Queer theorist Leo Bersani, with a play on ‘is the rectum a grave.’ So tangential I was, everything beneath a layer of innocuous prose, hoping for an informed smile from kindred minds.
Trying to keep things interesting, I referenced R.E.M.’s Automatic for the People, Death Cab for Cutie’s Plans, and Neutral Milk Hotel’s ‘The King of Carrot Flowers, pts. 1 & 2-3.’ I ended all this with a few sentences comparing myself to the paramedic and mentioned the way people collect different things as fetishes, as emblems of power, again with an obsequiously oblique style heaped with pride at my post-graduate version of Hide and Seek. Me smiling for my clever hiding; you for your clever finding. However, it was so excruciatingly dull and nauseatingly stilted that, had you been reading it aloud to someone, they would have cut out your fucking tongue.
If they were merciful, they would have then butterfly-filleted it along the genioglossus and used it as a blindfold to prevent you from seeing the dullardly words upon your screen. Things started to become readable again after that point…] Which left him here getting bit by his fetish and receiving the antivenin. Now, mere hours later, he’s watching the Sports Illustrated Swimsuit Model Search contestants parading on a talk show. Swimsuit models and cheating death, all in one morning.
He’s a paramedic: his job’s running in and pulling people back from death’s precipice. Was the bulk of his life a refutation of his own death? Getting in Death’s face. Pissing Death off and taunting him.
If his hand wasn’t so swollen and sore he’d probably be beating off right now. With Death walking by his ICU room, avoiding eye contact with the paramedic—afraid of him—looking like Jody Foster as she left Hannibal Lecter’s underground cell, the paramedic would finish himself off with a flourish, snapping his hand, and let his jizz fly from his fingers into the eyes of death.
Is that why he keeps Rattlers?
Or maybe, he just likes snakes.
I leave the Intensive Care Unit through the front entrance, where the patients’ families enter and exit. It’s Monday, and I proceed with the routine I follow every Monday after lunch.
I go to the ICU waiting room and collect the various tracts from the Jehovah’s Witnesses and throw them in the trash. I walk down the stairway to the Cardiac Critical Care unit’s waiting room and collect them—The Watchtower and Awake!—and throw them in the garbage. I take the other stairway down three more flights to the Surgery Waiting room and do the same.
I’ll knock on the Women’s room door and if there’s no answer, I’ll go through the stalls and remove the tracts—‘What does God require of us?’ ‘Should you believe in the Trinity,’ and ‘Jehovah’s Witnesses: Who are they? What do they believe?’—that have been tucked into the toilet paper dispensers.
They do not leave tracts in the Men’s room. I’m not certain if this is because the people leaving the tracts are women, because men use religion rather than are used by religion, or because they simply don’t think that men are worth saving.
In any case, the Trauma waiting room is a secured location, so I don’t have to include it on my Monday rounds as I take the staff stairway into the ED.
For the entirety of this month I’ve been working the night shift. Going in at seven pm, working until eight am, and then doing it again. 13 on, 11 off, 5 days a week.
I would usually get a few hours of disjointed sleep between one and five am. I’d go home, be up for a while, and then sleep from ten until two. After a bit, I grew used to the split schedule of sleeping four hours, twice a day.
I say this for both your pity and as a way of offering a possible explanation for the way time has slowed down in the story. I think my constant twilight left me in a perpetual limbo where time moved forward in ultra-slow-motion. This entire month has been spent covering a rather uneventful 7 hours from Monday on July 18th of last summer.
At this point, I am left with a decision. I can either stop this little mini-arc of a day within the story that is, in fairness to myself, setting things up nicely. Or I can finish this day before progressing through the story.
My decision is to finish the day. It will introduce the one other character that plays an important role but whom you have not met: My other intern, the bumbling one. After that, the only person yet for you to meet is a bit part and his role is solely as an object for my (mis)diagnosis.
So there you are, and here we go.
When I get to the ED, I see my other intern, the bumbling one, arguing with our drunken, cocaine-induced-psychosis friend. The two of them are going back and forth about why she cannot leave. He’s trying to explain to her the rationale for her restraints and mask. He is speaking so loudly it could nearly be construed as shouting. She is repeating the word fuck, in a loud, but quieter voice, enunciating behind the mask, like a syncopated metronome: ‘Fuck. Fuck. Fuck. Fuck. Fuck. Fuck.’ Sometimes she accents the f, sometimes the u, rarely the k.
I pull my intern into our workroom.
‘What are you doing?’ I ask him.
‘She was wanting to leave,’ he says, ‘I was explaining to her why she had to stay.’
‘Were your arguments logically sound?’ I ask.
He nods.
‘I told her about cocaine induced vasospasm and how it could affect her heart.’
‘Good, good.’ I say flatly. ‘Did you use Venn diagrams or simple theorems to explain your rationale?’
He looks at me, blankly.
‘When someone is spitting at me and in four-point restraints,’ I say, ‘I find arguments using Aristotelian space to more effective than thesis/antithesis/synthesis. I think it’s because of their heightened capacity for abstract reasoning and mathematic ability.’
He continues to stare at me, but under his blankness I sense an undercurrent of something else. I cannot tell if he is simply angry or if he has actually crossed the line into hating me.
I smile.
‘Do you remember when we declared her incapacitated? That meant—specifically—that she was not able to understand or make judgments regarding her own safety: That is, that she was irrational. Explaining our rationale to someone who is irrational, is not going to be... Do you see where I am going with this?’
He stops staring at me and looks at his shoes. I cannot tell if this is because of shame or because he does not want to give me the satisfaction of answering the question.
‘Not going to be... rational.’ I say. ‘That's right. Do me a favor: let her be; Do not try to reason with her. Almost by definition, her psychosis means she can’t be reasoned with. If you expect your arguments to sway her, you’re as delusional as she is.’
I send my intern to get the chart so he can present the emphysema patient. While he does this, I look in on our drunken friend and see she has quieted down. Her eyes are closed and she is no longer talking. Her eyes are moving under their lids rapidly and she is mugging a bit. I imagine she is having quite a conversation inside her head, or maybe she is dreaming of chasing rabbits. Seeing how quickly she quieted down, I feel a bit badly for laying so hard into my intern.
I go back into the consult room and listen as my intern presents his patient. She is, he tells me, a 65 year-old white woman with a profound smoking history, uses oxygen at home, and comes to the ED with a worsening of her shortness of breath.
There are two things about smokers that are very boring that my intern confuses with very interesting.
The first boring thing about smokers is that they tell you they have quit. Medical students fall for this all the time, I am a little disappointed that my intern fell for it. The important follow up question is, ‘how many hours ago?’
The other boring thing about them is that they still smoke. When family and friends complain that a patient hasn’t quit smoking despite slowly suffocating, I feel sleepy.
He finishes telling me about the patient, making a few minor errors. I correct his terminology and we progress. His assessment is that the patient has multilobar pneumonia and an exacerbation of her emphysema. He feels she is stable, but needs to be admitted to our service for IV fluids & antibiotics, steroids, nebulizer treatments, oxygen and monitoring.
This next bit hinges on a technical detail. I will try to keep it as streamlined as possible.
The reason my intern and the emergency resident felt the patient was stable was despite her looking sick, her arterial blood gas looked good.
A blood gas tells us a patient’s pH, oxygen, carbon dioxide, and bicarb levels. The body regulates these very stringently and fluctuations in any of them have a profound effect on the others.
Her numbers were pretty normal, aside from a slightly low oxygenation. This was what they were taking comfort in.
But what they didn’t consider is that patients with severe emphysema often have very abnormal results. They typically show a high carbon dioxide and bicarb. A normal lab in an abnormal patient can signal a problem. That both values had normalized suggested to me that she had been having a lot of trouble oxygenating her blood for at least several days. For her to resolve her compensatory metabolic alkalosis as well as her respiratory acidosis suggested to me that she would be reaching the point of exhaustion and would likely require intubation soon.
I was concerned and suggested we examine the patient together...
We go out and examine the patient. She’s leaning forward with pursed lips, able to speak in short sentences without much difficulty. She’s so thin I can nearly see her first rib in the space between her clavicle and sternocleidomastoid when she inhales. On auscultation she doesn’t move much air through her lungs. Her toes were not cyanotic or cold, which was about the only good sign I could see on her.
I ask her if I can sit on the side of her bed and talk to her. I ask her if she had ever needed to be put on a ventilator. She nods.
‘I hope that never happens again,’ she says.
‘That’s what I am asking you, Ma’am. If it comes to the point that we think you need it,’ I ask her, ‘do you want us to put that tube down your throat and put you on the breathing machine again?’
‘Only if you thought I was going to die without it.’
That’s what I needed to hear. We went back in the consult room and I had my intern page the MICU resident while I ask the ED senior to move the patient to the Resus area, adjacent to the trauma bay.
I look at Resus, which has room for 4 stretchers. Five patients are there already. Three are already on vents. I look at the other two. Admittedly, they look sicker than my lady. As I’m presenting the patient, a stroke alert goes off. The stroke alert trumps her also.
‘She’s going to need intubation soon,’ I concede, ‘but not at this moment. Move her closer to the nursing station so you can keep your eye on her and I’ll be happy.’
She agrees. My intern has informed the MICU. Everything seems to be under control.
‘Erik, I have one for you.’ I look over and see another resident calling me. He’s telling me he is consulting me on a patient. I look at the bed number on the outside of the chart in his hands. I match it to the stretcher and see the thin man surrounded by his gaggle of plump women.
I was about to meet him.
This man is my age. He’s taller than me, thinner than me, and sick.
He has a nest of black curly hair and if you examine his hairline you’ll see his temporal muscles have atrophied. His eyes dart around, both tired and anxious. He’s wearing a nasal cannula—giving him two liters of oxygen per minute—below it his lips are dried and cracked. His hospital gown is ill-fitting and hangs half-off his left shoulder. Half-normal saline runs through an intravenous line into his thin left arm below a nondescript bluish tattoo. The Foley tubing emerges from the sheets and there’s a small amount of sweet-tea colored urine in the bag.
The ladies that surround him are, in their own way, dressed nicely: clean slacks and pull-over shirts, a bracelet here, a necklace there, make-up appropriate for a family picnic. Their hair is frizzy and gelled or moussed. Not fancy, just a bit overdone. They vary in age by—I would guess—ten years older than me to ten years younger than me.
They are all eyeing me. This is the moment they have all been waiting for.
Before I can introduce myself, the women attack me—not like women attack George Paul and Ringo in A Hard Day’s Night—but like magpies, crowing out a barrage of questions and forceful supplications.
I say nothing, tighten my lips and wait for them to quiet.
When they do, I introduce myself and ask, ‘What brought you to the emergency room today?’
This, admittedly, is an odd question. I ask it because what seems obvious is often wrong. Sick people find different things intolerable, and there’s no guessing how many things are wrong with this gentleman. Diarrhea? Foot pain or double vision? Not able to pee? Vomiting? I try to start with what is bothering them most and this question usually reveals it.
‘Sheri’s car,’ he says, gesturing to, I assume, Sheri. It takes me a second to figure out why he has said this.
‘What I’m asking is,’ I say, smiling, ‘why did you decide to come to the hospital today?’
‘He didn’t want to come,’ Sheri offers. ‘We’ve been after him for weeks, but he refused. He was coughing so bad today that he started vomiting. When we saw blood in it, we drove him here.’
I looked in the emesis basin by the bed: A lot of spittle, a few streaks of blood. Nothing of import.
‘How long have you been sick?’ I ask.
‘About six weeks. I went to Boston and ate at a Burger King. I think the chicken was bad and got diarrhea from it. I’ve been sick ever since then. When the diarrhea got better, I got a head cold. Then the diarrhea came back.’
‘Have you been vomiting before today?’
‘Doctor, he hasn’t been able to hold down any fluids in over three weeks,’ one of the older ladies, not Sheri, says.
I nod, knowing that he would have died a week ago if this were true, but understanding that vomiting daily-or even every other daily-can seem overwhelming.
I continue getting the history and then ask the ladies to wait outside so I can examine him.
‘Doctor, can I talk to you for a minute?’ one of the younger ladies, also not Sheri, asks.
‘When I’m finished examining him,’ I say, looking at her. She is not satisfied with my answer. I tighten my lips and raise my eyebrows, one hand on the shabby curtain, ready to pull it closed between us, and hold her stare.
We stand like this for a few seconds.
‘Okay’ she relents, and I pull the curtain closed.
With the curtain closed I turn and face my patient. I walk to his side, lean against the bedrail and lower my voice.
‘How long have you been sick?’
‘It got bad six weeks ago, after my trip.’
I run the side of my thumb along the belly of his temporal muscle, feeling how thin it is. I repeat the question.
‘How long have you been sick?’
‘I don’t know,’ he says, pausing a bit. ‘A long time.’
‘Open,’ I say. The back of his mouth is covered in white. Thrush.
I place the stethoscope to his chest and look up at him, asking, ‘You have sex with girls, boys, or both?’
‘Boys, um,’ he says, ‘I mean men.’
His lungs are clear.
‘When was your last H.I.V. test?’
‘About eight years ago.’
‘You use condoms?’
‘Usually.’
I close one eye and cock my head. I continue my exam. His testes are mildy atrophied and he has several pathologically large muluscums.
‘You live with anyone?’
‘My friend, Roger.’ He says. ‘We used to go out, but now we’re just friends.’
‘I don’t think this is likely to be needed today, but if it gets to the point that you can’t make decisions, who do you want to make them for you?’
He thinks for a few seconds. His eyes resting on the bag of IV fluids running into his arm.
‘Roger, I guess.’
I have the primary diagnosis already. Everything now is just detail work and protocol.
‘You have much doubt about what we’re going to find when the results come back?’ I ask.
‘Not really.’
‘What do you want me to tell the ladies?’ I ask.
‘Everything.’
As I walk out to meet with the ladies I tell the nurse to put the patient into respiratory isolation.
Whoever said there’s no such thing as a stupid question was probably the one asking the question.
It must have been repeated by junior high teachers who were desperate for any interaction with students. It’s like Michael Jackson says, ‘if you repeat a lie often enough, people consider it to be true.’
I emerge from my encounter with the ladies forty-five minutes later, hen-pecked, chick-pea’d, and pigeon-toed. And while that doesn’t make any sense, neither did these ladies.
Now, understand, I’m used to dealing with people who finished school during the sixth grade. It’s not unusual for patients to tell me that they cannot read. These patients ask—comparatively—good questions: Am I going to die from this? Is there a cure? How long will I have to take these pills? Did I do something to bring this on myself? How can I ever thank you?
These women had clearly tried to figure out what was wrong with my patient, and had come up with some diagnoses that made less sense than a thalidomide baby at an arm wrestling competition.
We began with me explaining that the patient showed signs of severe immunocompromise, that he hadn’t been tested for HIV in many years despite risk factors—which I did not specify—and while I did not yet know what was causing his diarrhea, my larger concern were his lungs. I explained the two things I was most concerned about were Tuberculosis and PCP.
There was a moment’s silence. Then it began.
‘Could he have cancer?’
Well, yes, he could, I explained. I didn’t have any evidence of it, but it is possible that there was also an underlying carcinoma, as HIV patients are at high risk for some forms of cancer.
‘So he’s tested positive for HIV?’ one of them asked
‘No.’ I resisted the impulse to say that I had just explained that he had not been tested. ‘He shows signs of it, but we haven’t tested him for it yet.’
‘Why not?’
‘Because I’m in here talking to you first. We’re going to do a full battery of tests to sort out the diarrhea and the cough and everything else.’
‘Shouldn’t you be doing that now?’ another one asked.
‘The lab runs the test in the morning. I’ll have the orders written by then without difficulty.’
‘What about Hirschsprung’s disease? Have you considered that?’
This catches me by suprise. Hirshsprung disease is usually diagnosed several days after someone is born. It is not a subtle diagnosis and is usually quite evident for the entriely of one’s life.
‘Does he have a history of Hirschsprung?’ I ask
‘No.’
‘Well, Hirschsprung disease causes constipation, so I don’t think—’
‘It also causes malnourishment. Are you telling me he’s not malnourished?’
I begin to explain the way that Hirschprung disease causes malnourishment when another of the ladies cuts me off.
‘Could he have DiGeorge’s syndrome?’
I suddenly realized they had consulted a book of pediatric diseases. I attempted to smile beneficently.
‘No.’ I said.
‘Shouldn’t you run tests to make sure?’
‘Are his ears normal?’
‘Yes.’
‘Is he retarded?’
‘No.’
‘Did he live past the age of two?’
She looks at me, not saying anything.
‘He doesn’t have DiGeorge’s. But I tell you what: if everything turns out negative, I’ll do a chromosomal analysis for you.’
‘Why don’t you do it now, to speed things up?’
This continued for an excruciating forty-five minutes. I felt like Sebastian in Suddenly Last Summer. Thankfully my pager started going off.
I apologized for having to ‘cut things short’ and made my exit.
My intern is paging with questions about the Trimethoprim/Sulfamethoxazole dosing and whether or not we should start treating for TB empirically. Did I show you the chest X-ray yet?
I see Dr Merteuil and she taps the corner of her mouth with two fingers together, signaling a smoke break.
‘Five mg’s per kg Q six of the trimeth component,’ I tell him, heading out with Merteuil. ‘And no.’
She tells me the pancreatic cancer man’s surgery revealed omental caking. I scrunch my nose at the bad news. We walk into the smoking garden the hospital furnishes us; this generosity is to prevent patients from seeing our hypocrisy.
My phone receives a clear signal for the first time in hours. It begins a polyphonic verisimilitude of Pedro the Lion’s ‘I Am Always the One Who Calls’ to alert me that I have new messages. I check the display. Three new messages—I like that number.
I autodial voicemail and sit next to her on the bench. The first message is Stockholm telling me she had a nice time on Saturday.
‘Stockholm doesn’t have to work tonight,’ I tell Merteuil while listening to the message. She lights a cigarette, taking a long drag from it. ‘She wants to have dinner.’
I press nine. The next message is Birmingham.
‘Birmingham wants to grab a beer tonight before meeting some friends,’ I say, raising my eyebrows at Merteuil.
She nods, looking at something on her cigarette or her fingers, I can’t tell which. I press seven.
The third one is my mom.
‘And my mom loves me.’
‘That’s the only one worth talking to the bank,’ she says, pointing at me with her cigarette.
I take the cigarette and inhale a slow drag from it. I hold the smoke deep within my lungs—absorbing its cancer-inducing goodness—and hand the cigarette back to her.
No word from Chicago, I think, scratching my neck. I should have shaved today.
‘Must have been a rough one,’ she says, mocking me, ‘bad boy. Don’t pick up my filthy habits.’
I exhale, glancing at the brief cloud of sparrows crossing overhead.
‘You know the type that deals with illness by deciding that the doctor needs to read WebMD?’ I ask her.
She nods.
‘I’ve got a flock of them. I spent the past forty-five minutes explaining the difference between MRI’s and CAT scan’s, when I should have been the discussing epistemology of disease, the scientific method, and the percentage of the GNP that’s spent on useless medical tests.’
‘I’m done with my cigarette,’ she says, standing up, ‘and you’re boring me now.’
I laugh and we head back inside.
The MICU resident, Dr Pasteur, is explaining to me why he’s not taking the emphysema patient onto his service.
‘I talked it over with the ED and we all think she’s stable,’ he says. ‘Did you see her blood gas?’
I frown. I explain my interpretation of it, but he doesn’t buy it.
I consider asking him to page his attending and discuss the case with him, knowing the attending will side with me. But I don’t have the stomach to be such an outright asshole to a friend.
‘Just keep a close eye on her tonight, will you?’ I say, after more discussion, finally relenting.
But then, after saying that, I cheat. Pretending to trust him to watch the patient, I write my admission orders in such a way that she will not be allowed to be moved to her hospital bed. Stuck in the ED overnight, the ED docs will see her deteriorate and be able to intervene.
My interns and I finish our work and sign out our patients, turning over the collection of pagers we carry. I explain to the overnight physician why I had written an impossible order for the emphysema patient. I tell him not to change it and defer any questions to me in the morning.
Then I get in my car, throwing my white coat and stethoscope in the trunk, and head to the bar to meet Birmingham for a beer.
I walk into the bar and squint, trying to adjust my eyes to the light. I see Birmingham sitting at the bar and I saddle up next to him, lean in and say, ‘Hey, Popeye.’
He gives a slow turn of his head, sees me and gives a half grin, saying, ‘You still picking your feet in Poughkeepsie?’
I give him a full laugh, but it shouldn’t surprise me that he gets the reference. Law enforcement types should, right?
I order a bottle of Budweiser and the bartender—an over-tanned blonde in her late forties wearing a dirty tan t-shirt depicting two lobsters playing tug of war with what looks like a piece of licorice—says, ‘coming right up.’
When she brings it, Birmingham calls her by name and tells her to put it on his tab. I’m amused by this.
‘Thanks.’ I say, giving him an air toast.
We talk for a bit, minimally referencing what we did at work.
‘Worked on a case,’ he says.
‘Saw patients,’ I say.
It’s relaxed and casual, this give and take. Easy like Sunday morning, you might say. We make plans. I finish my beer and say goodbye.
I extend my hand and he shakes it firmly. I give him a wink. He pretends to look panicked for a half second, then his face opens into a laugh and he returns the wink.
I’m smiling as I walk out the door.
I get home and shed my scrubs as I walk in the door, as I do at the end of every day. I remove my socks and hold the pile against my side walking to the bathroom in my boxers. I throw the contaminated clothes in the laundry bin, toss the boxers in too, turn the shower on and climb under its stream.
After the initial layer of methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa and Stenotrophomonas maltophila has hopefully been rinsed from by body and gone down the drain, I flip the lever and begin filling the tub. I lay myself down and allow the water, warm and calming, to slowly fill around me. I close my eyes, trying not to think of the patients I’ve seen today.
Inhale. Exhale.
In the tub, with the water running, I fall asleep…
I inhale with a start before I open my eyes. I’m up to my neck in warmth. I turn off the faucet and soak, listening to Creeper Lagoon’s Take Back the Universe and Give Me Yesterday. I get out, towel off, wrap the towel around my waist and stir up a pitcher of limeade, pouring myself a tall cool glass and topping it off with vodka.
I respond to some emails and begin a rough draft of this entry. I lose track of time and am still in a towel when Stockholm knocks at my porch door.
I kiss her briefly and apologize for being undressed. Kirsty MacCall’s Titanic Days is playing now. I pour her a vodka limeade and walk into the bedroom to dress.
I’m trying to figure out what shirt to wear. I’m staring at seven different shirts, but have no idea what they will look like on me. I hear her ask, ‘So what’s your story?’
I lean back out the hall, still naked from the waist up, and see she’s browsing through my bookshelf. I instinctively say, ‘huh?’
‘What’s you’re story?’ she says.
‘Me?’ I say, chuckling. ‘I have no story.’
I lean back into the bedroom. The red shirt is a too red, I think, and the zippered front looked fifties-bowling-retro in the store, but every time I’ve put it on its looked McDonald’s drive-through-cashier.
I can hear her walking through the dining room toward my room. Her footsteps hesitate. The cadence of the aquarium pump deepens: She must be leaning against its glass.
‘Is this shirt too blue?’ I ask, coming out of the bedroom and changing the subject. I furrow my brow a bit, quizzically, squinting my left eye. She’s leaning against the aquarium. She smiles at my apparent confusion. She takes a half step forward and kisses me.
‘It’s fine,’ she says. The cadence of the aquarium deepens again as I kiss her neck and she leans her hand against the aquarium.
‘Why do you have such a huge tank with no fish in it?’ she asks, her eyes searching the water for any sign of life.
‘I’ll tell you about it at the restaurant,’ I say, laughing and grabbing my keys.
Stockholm and I go to a nearby restaurant that has half-price wine on Monday nights. She defers the wine choice to me, I order the Murrieta's Well White Meritage 2003. It’s sweeter than the 1998 bottle I was thinking of and it occurs to me that it was the Vendimia that Murrieta's Well did so, well, well.
‘It’s nice,’ she says, being a good sport. ‘I’m sure it will go fine with the food.’
The menu is curious. I don’t say anything, not wanting to appear a snob, but I smirk when she points out what’s so weird about the menu.
‘The ingredients are everything you’d hope for: deep six arugula, flown-in Wahoo, black-bean sauce, morel mushrooms, red-curry coulis, Maytag blue cheese,’ she says. ‘But, it's like they were put together by a computer. On this menu, they’re a single dish.’
‘You might get away with it on Veal,’ I say, laughing, ‘but how would you even taste the Wahoo?’
‘It’s like using Belvedere to make a Bloody Mary,’ she says, almost apologetically.
I’m staring into the menu, letting her take the lead in this dissection, trying not to mock their creamy French onion soup.
I order the Vichyssoise. She orders the chicken and chèvre pizza.
She tells me she can’t stop listening to a Newcastle band called Maxïmo Park.
‘I haven’t heard of them,’ I say.
‘I’ll burn you a sample,’ she offers.
‘What else are you listening to?’
‘Well,’ she says, grimicing, ‘I’ve heard some of the Liz Phair album that’s coming out soon. It’s even worse than last year’s overproduced piece of crap.’
I have to adjust the napkin in my lap hearing her talk like this.
‘I think the overproduction was part of the point,’ I say.
She leans over the table and whispers ‘bullshit.’
‘I’ll be the first to admit that I’d be her battered husband,’ I say, smiling. ‘She could heap abuse on me and I’d make every excuse for her in the world. But this is my take on the album: she declares herself in the opening verse. When she says “I burn letters that I write to make you love me” the letters are songs and the “you” is her audience. She’s setting the album up as a metaphor: Pretending it’s about her approach to relationships, she’s wrestling with who she is and who she wants to be.’
‘I never thought about it like that,’ she says, nodding. Then she stops, leans forward and, while laughing, hisses, ‘bullshit. It’s a sellout album.’
‘It’s not a sellout if nobody buys it.’ I say, pouring her more wine. ‘More Meritage, cutie?’
‘Are you intentionally quoting Juliana Hatfield?’ she asks, laughing.
‘Did Hatfield sing about Meritage?’ I ask, blankly.
She laughs.
‘If you keep talking dirty to me,’ I say, ‘I will mount you on this table.’
She laughs as the waiter places our food on the table.
We begin eating. My soup is decent.
‘There’s something strange about this pizza,’ she says.
I place my soup in front of her and eat a piece of her pizza.
‘The crust,’ I say. ‘It’s Boboli.’
I explain Boboli to her.
‘I guess,’ I say, ‘we should be grateful that at least the vichyssoise was cold.’
‘You need to listen to this,’ Stockholm says, getting a disc out of her car when you return home from the restaurant.
‘What do you know about the things I need?’ you ask, grinning, holding the kitchen door open for her, and kissing her neck as she walks past you.
You pour two glasses from the remains of an open bottle of 2001 Muscat de Rivesaltes by Château de Jau, adjust the lighting in the house and start the disc.
‘Hit track eleven,’ she says, slipping behind you.
‘It goes all the way to eleven?’ you find yourself saying before you can hide your geekiness. She ignores the comment.
You begin to listen, your back to both her and your bed.
She slides her left hand along your waist and under your shirt. You turn the music up and your body to the right; her hand holds its place and runs along your left lower ribcage as you turn.
You place your left hand on her upper sacrum and apply a constant, gentle pressure. You kiss her neck to distract her from the pressure for a slow thirty seconds. You hold your lower lip over her carotid artery, feeling the pulse at first quicken, then slow as the sacral pressure causes a parasympathetic release.
With your right thumb you hit the replay button on the remote. Then, with the same thumb, press firmly against her sternal notch, remote still in hand.
You run the knuckles of your left hand up her spine, opening and turning your hand at the top of her scapula to support her neck. You lean into her and—just before she looses her balance—you throw yourself onto the bed, turning as you fall, pulling her on top of you…
The first time you saw a woman have an orgasm, you were frightened by it. The way her face contorted and the wounded rabbit-like noises convinced you that she was having a seizure. You were halfway to the kitchen to get a spoon for her to bite by the time you figured out what was going on. You now know that the fear of swallowing one’s tongue is a myth, and you are no longer afraid of orgasms.
‘Want some cake?’ you ask her afterwards, getting up to serve some cake.
She puts on an oversized tee from your drawer. You hand her the plate of chocolate and walk out into the porch. The two of you sit, enjoying the night air. She eats some and feeds you some. When the cake is gone, she lights a cigarette.
‘So,’ she says. ‘Really, what’s your story?’
And between the wine, the sex, the chocolate, the night air, and the exhaustion of the day, you tell her your story. You tell her things you wouldn’t tell the internet, tell the world, that you wouldn’t tell—perhaps—even your friends and family.
‘Okay,’ she says, pausing, when you’re finished, ‘just don’t break my heart.’
You take her hand and lead her back to your bed. You close your eyes and kiss her forehead. She nuzzles against your chest as you both prepare for sleep.
‘I feel like this day has lasted eight weeks,’ you mumble as you fall into sleep.
I’m at concert, but I can’t see the stage. I’m shoving my way through the crowd until I’m at the foot of the stage and see Tim Finn. He seems to recognize me and pulls me onstage. He tells me we’re going to duet XTC’s Ten Feet Tall. We start and I’m letting him hit the high notes while I stick with the gravelly parts. The crowd seems to love it, but when I look over at Mr. Finn, I can tell something is very, very wrong. I mouth the words, ‘what’s wrong?’
I can see his lips pantomime the words ‘you can’t sing.’
I wake up laughing. I have the worst reoccurring dream in the world. Phantasms of Tori Amos, Bob Mould, Kelly Clarkson, and Sinead O’Connor have all told me that I can’t sing. But still, my id persists in putting me on stage to be deflated again and again. For the record, Sinead was the rudest: A wall of bricks, indeed.
I look at the clock. It’s just before midnight. Stockhom is still asleep.
I get up and go to the bathroom to micturate. As I’m standing there and playing with the stream, I think about my HIV patient. I call the nurse to ensure the urine studies have been sent to the lab, then crawl back into bed with Stockholm.
