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 last summer…
Dr Pasteur tells me the emphysema lady has failed several attempts to wean her from life support. She’s been lucid enough to refuse a tracheostomy, a surgery required for long-term mechanical ventilation, and has asked to be removed from the machine, understanding that this will likely result in her death.
Intubated patients typically have their wrists tied to the bed and require huge amounts of sedation to tolerate the tube that goes 23 centimeters down their throat and the machine forcing air in-and-out of their lungs. Here’s an interesting thing about the long-term effects of smoking: emphysema patients often find the experience of being intubated refreshing compared to their typical sensation of suffocation. Because of this, they don’t require much sedation and are able to communicate and interact while intubated.
When I swing by her room, her family is at her bedside. The nurse tells me they’re waiting for the arrival of one more family member before removing the tube. I go in and talk to the woman for a moment. She recognizes me and writes the words ‘how long’ on a legal pad.
‘Before they take the tube out?’ I ask.
‘No,’ she writes, ‘after.’
She’s asking me how long she’ll have until she dies. She has more foresight than many people. Most people wait until after the tube is out to ask this, imaging it will occur right away.
‘I can’t say ma’am. It might be hours. It could be months. Physicians are notoriously bad for those kinds of estimates,’ I tell her. Then I lean in and—in sotto voce—say, ‘We’re not really God, we just think we are.’
The ventilator alarms go off when she bucks it, laughing. Her family laughs too. Even lame jokes go off like gangbusters in a room like this, everyone aching for a moment of life as they await death.
After a moment she writes, ‘how long really?’
She stares at me for a moment then underlines the word ‘really.’ I look at her husband and then her. They both stare at me expectantly. I pick up the vent sheet to check her blood gas and the vent settings. I give a little shrug, then say, slowly, ‘between six and twelve hours, probably.’
Everyone closes their eyes.
She writes ‘thank you’ on her legal pad.
Her husband shakes my hand.
Two hours later, I receive word that she died while her family was in the cafeteria, thinking they had more time.
Fuck, I think. God fucking damn it.
When you returned the Fireman’s call he suggested you have dinner with him, so two nights later you find yourself knocking at his door, ready to pick him up. You can hear his shoeless feet padding toward the door and see the handle turn and the door opens a bit.
‘Hey Buddy,’ he says, already padding back toward the bathroom, turning his head to make brief eye contact, wearing only his white BVD’s. ‘I’ll be ready in just a sec.’
As you open the door and walk into his living room, you watch him walk. His back is more muscular than it used to be. He’s been working out.
It’s going to be a long night.
You’re looking at his fish tank, talking to him as he finishes dressing in the other room. You ask him about his father’s health. How his brother’s doing, the one that likes Elvis Costello. You tell him he’s still wrong and his brother’s still right: there’s no such thing as too much Elvis Costello.
You head to Mudville, a sports bar, and share a pitcher of Bud and 25 wings—volcano style with blue and celery. You’re not talking about a year ago. There are two moments when he turns from the pre-season football show and catches you staring at him.
The first time he politely ignores you.
‘You’re staring at me,’ he says when he catches you the second time, ‘like you’re thinking about fucking me.’
Fifteen months ago, long before you broke up—or rather before he broke up with you—and even before a curious half-second pause preceded his voice before saying ‘I love you’ and before the timbre of his voice changed when he said it, you knew he was slipping from you.
When someone pulls away from you, you usually deal with it in an obvious and predictable manner: you become surely, you raise the stakes. If someone’s getting shaky, you make certain to rattle them loose.
But the Fireman was a grand experiment: you stayed the course, you didn’t waver. When it became clear you were going to lose him, you did what was either the single most heroic or idiotic act of your life.
In the moment when you knew yourself to be the most vulnerable, you didn’t lash out or walk away. You didn’t do any of the tricks that would keep you safe. Instead, you just told him you loved him and you’d do what you could to make it work, if he thought it was possible to make it work.
Though you didn’t realize it at the time, at that moment, you were Obi-Wan Kenobi powering down his lightsaber and allowing himself to be slain.
Now, you could argue that you were being sadistic, that you were making things difficult, raising the bar to prevent the breakup. But that argument would be wrong. You weren’t thinking of even the simplest of Jedi mind tricks.
You could also argue that you were being masochistic. You were allowing him to brand you, knowing how much it would hurt, knowing how many months you’d spend alone and watching Netflix, reading Harrisons, and thinking of last year’s roses. But that argument would be wrong as well. You derived no pleasure or thrill from it. You were, in full possession of mind, not outfoxing, not controlling, not manipulating. You were admitting to another human that he controlled the situation.
If you knew an onomatopoeia for the powering down of a lightsaber, you’d type it into this point of the story…
So when he told you that he couldn’t do this anymore, that he couldn’t continue leading a double-life and hiding you—and what he was doing—from his friends and family, that he ‘had to stop,’ there was nothing left for you to say but ‘okay’ and walk out of his apartment.
It was this year of isolation—not fucking him—that you thinking of when you were staring at him.
‘We’re out of beer,’ you say, pouring the last of the pitcher into his glass.
‘How’s Becky?’ you ask.
‘She’s fine,’ the Firefighter says, pausing before continuing, ‘I broke up with her a long time ago. I didn’t see the point in stringing her along.’
Your glass is half-full but the second pitcher is nearly empty. You’re both a bit drunk.
‘Stringing her along?’ you ask and then wait. There’s a long moment of what seems to be silence despite the music and conversations going on around you. You’re drunk, but not so drunk that you’re going to start shooting your mouth. You wait him out.
‘Yeah,’ he says, taking a huge breath and saying, improbably, ‘I wasn’t really going to tell you about this.’
It seems unlikely that he would have dinner with you and not mention the decision you can already see coming. You continue to wait in silence. You bounce your fork off the table once and hold it between thumb and forefinger, your elbow anchored to the table and the base of the fork hovering a few centimeters above menu encased under the glass tabletop. Your eyes half-down—avoiding contact with his—emulating a pack animal reassuring a sub-dominant. You can see he looks at your face briefly before continuing.
‘You’ve heard Donald Rumsfeld say, “You go to war with the army you have, not the army you wish you had,”’ he says pausing again. You make a brief, reassuring glance to his shoulder, not even looking at his face. ‘I’ve realized I—I’ve been trying to live my life as I wished I was, not as I was.’
He’s stopped talking again and there’s a light curiousness in your gut during this silence. At this point, he’s committed to finishing, so you make eye contact again and give a reassuring nod. But you can’t quite gestalt his voice breaking the silence with the words ‘I’m gay.’
You become the character in a science fiction movie who’s introduced to the fantastic creature—or the man out of time—and has to go through all the predictable and formulary disbelief of how this affects what you thought to be immutable reality and transition into the character who gets his shit together and jump on that motorcycle and drive, goddamnit, drive!
You’re in your car in front of the Firefighter’s apartment and looking out at the river as he’s talking, but you’re not really listening. You’re trying to figure out if you can kiss him. You weigh the everything, how he answered the door in his underwear, the invite to dinner, the confession. When I say you weigh everything, I mean you consider all the data that supports the decision you’ve already made and ignore all the signs he’s actively giving you that he does not want you to kiss him. His hand is resting on his knee, so you put your hand on his.
‘When you broke up with me,’ you say, ‘what made it so difficult for me was that you did it because you couldn’t continue to lie to your friends and family. Your integrity was at stake. Your integrity and belief in a definable, knowable truth are part of what I loved about you. It put me in the precarious position of loving you more for having the integrity to break up with me.’
You lean your head out the window and look up at the moon. He doesn’t say anything. He doesn’t remove his hand from yours.
‘But that was countered,’ you say, ‘with my suspicion that you were turning your back on a larger truth. You could stop seeing me, but that wouldn’t change that you wanted to. If that were true, you’d still be lying to your family and, more importantly, yourself. But arguing that you loved me was too self-serving a position for me to make. Even though I had tangible evidence that it was true: My shirt was soaked with your tears when I left your apartment that night… Unless they were crocodile.’
‘They weren’t,’ he says.
And that’s all you need. You reach across his neck and pull his face into yours and kiss his cheek. Your right and his left hand continue to rest on his knee, but he uses his right hand to half-hug you. You move your mouth to his lips. He kisses you back, briefly, before his right arm changes from a hug to a lever to separate you.
He gets out of the car, saying ‘I’ll call you’ before half-slamming the door shut and walking up the lawn into his apartment.
In the still of the night, on the empty street, you look up at the moon. You look out on the river.
You close your eyes and fight off the nausea.
I’m in my clinic finishing a note on an obese, hypertensive, diabetic patient. My attending is reviewing a case with Pasteur. His patient’s come in with lower back pain and Pasteur renewed his antihypertensives and, after a bit of arguing, Lortabs.
Our attending is pointing out that the patient’s hypertension is uncontrolled and needs a third blood pressure agent. She asks when the patient’s last mammogram and colonoscopy were. Pasteur doesn’t know. The attending asks if I am done with my chart. I hand it to her.
‘She how nicely he does this,’ she says, looking over my documentation, referring to me by my title and surname in her thick German accent.
She points out how I’ve documented discussing the importance of blood pressure control when I prescribe a new medication, telling my patient that “every point over 130 systolic blood pressure increases your chances of having a stroke or heart attack in the next year.”
I’ve included obesity as a diagnosis and set a goal of one to two pounds weight loss per week for the next two years. Recording the phone number for the YMCA that I have given the patient so she can participate in water aerobics. I’ve given her a script for a mammogram in October, a referral for Ob/Gyn—who have special equipment for performing Pap smears on the morbidly obese—and document that she had a negative colonoscopy in 2002.
Pasteur is staring at the two of us. If I am reading his face right, he is trying to decide which of the two of us he hates more. I smile at him.
‘Yes, Erik,’ he says in a way that I should probably call drolly, but I’ve never liked the word. Let’s say sardonically, an awkward and perhaps archaic word, but one I prefer. ‘Sometimes I lay in bed at night, wishing I could be more like you.’
‘You know, Dr Pasteur,’ I say, laughing, ‘sometimes I wish I could be more like me.’
[At a bar, Merteuil is telling Pasteur and I about how the tech she's having an affair with has a new girlfreind. I haven't figured out how to write that bit, so I’ll do it over the weekend, rather than holding the rest of the post. Check back for that it if you’re interested...]
‘Hello, my Hipsta’, how’s it hanging?’ Stockholm says, surprising me in the bar.
‘You’re so wrong,’ I say, laughing.
‘It’s not the racism he has a problem with,’ Dr Merteuil says, ‘It’s the graffiti.’
‘Absolutely fucking brilliant, the both of you,’ I say, kissing Stockholm and introducing her to Merteuil and Pasteur.
‘I’ve heard so much about you,’ Merteuil says.
I buy Stockholm a drink and the four of us move to a table. Pasteur begins lightheartedly exacting his revenge on me for the episode this morning in clinic.
‘Have you seen the two reactions he has for stories he’s not telling?’ Pasteur asks Stockholm about me. ‘He has “fascinating” and “interesting.” If you get an “interesting,” you’re okay, as he deems your conversation worthy of listening to…’
‘Nice,’ I say, harshly, interrupting him.
‘Oh, I’ll get to your “nice” in a minute,’ Pasteur reclaims the talking stick and shifts his attention back to Stockholm, ‘but when you finish telling him your story, he was interested in some stupid bit about your word choice or the tense of a verb or the alloy they make streetlights out of and where it’s mined.’ Merteuil laughs and Pasteur continues. ‘But God help you if you get “fascinating” because, should you chose to brave ahead, his eyes glaze over for a bit and he won’t say anything until he snaps out of it and does this…’
Pasteur does this performance peice, half imitation of me, half zombie routine, suddenly snapping awake and looking confused. Merteuil and Stockholm are laughing. I’m trying to look bemused.
‘Then he’ll look at you and go “What? Hunh? Are you still talking?” This,’ Pasteur says, ‘like many of the things he does, is funny, but only the first two or three dozen times he does them. If he’s really feeling threatened he goes with…’
He holds his hands out presenting me.
‘I’ve no idea what you’re talking about,’ I say shaking my head and smiling.
‘Merteuil?’ Pasteur, switching the direction of his presenting hands, now shaking them like a carny barker.
Merteuil deepens her voice and adds a nasal element to imitate me, ‘That’s great material. You should take that shit on the road.’
The three of them are laughing and enjoying this. I sigh, loudly.
‘That line was funny in,’ Pasteur says, ‘what was it 1997?’
‘Yeah,’ I attempt to usurp, ‘it’s almost as old as your bleating of “more cowbell.” Which was funny for what? Three and a half minutes?’
‘That cowbell shit is already played,’ Stockholm agrees.
‘It was already played two fucking years ago, when I first met him’ I say.
‘Nice,’ Pasteur says, harshly, adding the nasal element to imitate me.
They all laugh but, under the table, Stockholm puts her hand on my knee.
Now, folks, you might know a mess about pride and uppitiness, but I tell you what… our boy Erik’s ’bout one queen shy of a royal flush in that department. And the thing about all this pride, what the fancified like’n to call narcissism, is it’s a fragile house of cards and his’s ’bout as high as Babel’s tower.
What he don’t know is, his best hand’s already been played. The cards he thinks he’s got in his hand are about to be played against him and there’s a breeze starting to blow.
Do you see some of those cards startin’ to waver? How many you think need give way before the whole mess tumbles down?
Stay set, folks, and we’ll see how it’ll play out.
I'm standing in line at the Walgreen's, buying yet another padlock. I’m forever leaving them on the bench at the locker room and though there’s always a large collection of padlocks in the lost and found box, none of them are ever mine. So I’m continually replacing them.
I’m also buying a box of condoms.
This is the second time in as many months that I’ve been at this drugstore buying this combination of items. When I get to the teller it’s the same woman who rang up my padlock and box of condoms as last time.
She gives me a dirty look.
‘Oh,’ I say, refusing to be shamed be this half-toothless ashtray of a woman. I grab a bag of taffy from the display and place it on the counter, ‘I'll also take one of these.’
When I get outside, I check my messages. Again. Still nothing.
Chicago hasn’t returned my calls since our last date, which is not that big of a surprise.
But neither has Birmingham, and I have no idea why. Things were cool the last time I saw him, but he hasn’t returned my calls in over a week.
‘Perhaps he’s working on an undercover case,’ I tell myself, even though I know he doesn’t work undercover.
I know that both of them will be the roads less traveled, at least traveled by me.
I pop some taffy in my mouth and think of the toothless drugstore clerk, while dialing Stockholm’s number to confirm our date for tonight.
Stockholm and I are supposed to meet tonight, but when I get home from work the Firefighter calls.
‘Hey Erik,’ he says and asks me for a favor. ‘This is rather embarrassing.’
He tells me he’s developed a rash ‘down there.’ He has several painless bumps over a single red area at what sounds like the corona. He noticed it about five days ago. He admits to only one sexual encounter in the past six months and it occurred one week before the rash came up.
‘Do you want me,’ I ask, ‘to look at your penis?’
We both laugh, uncomfortably.
‘Well, I can see my doctor tomorrow,’ he says, ‘but the more I think about it, the more I’m freaking out about it.’
I tell him to come over, then call Stockholm and reschedule our date for tomorrow, telling her something’s come up. I don’t tell her it’s my ex-boyfriend’s diseased penis.
When the Firefighter gets to my house he tells me the full story.
He knows exactly one other firefighter whom he suspected to be gay and they’ve always been friendly, if not exactly friends. So he suggested they meet for a beer and ended up meeting the firefighters’s ‘friend.’ So far reasonable enough, right? But then he and the other guy’s friend start playing footsie under the table. At some point they exchange numbers and the friend started text messaging him the next day, eventually texting him an invitation to his apartment.
So he goes over, expecting to meet—he tells me—them both, but it’s just the friend. Blah blah-blah. Now he has a rash.
The differential for sexually transmitted diseases that cause a rash is not terribly long: Syphilis, Chancroid, Herpes, Donovanosis, Lymphogranuloma venereum. Some things can also enter the differential, depending on the history and appearance of the lesion: Mulluscum contagiosum, HPV, Scabies and trauma (carpet burn/denim sore).
Of those, what will you actually see in practice? Well, in my practice, I see none of them. Right now, I specialize in sepsis, crack chest pain, and brain hemorrhages. I only see STD’s in patients with advanced AIDS, where they take on Three Mile Island proportions.
But doctors who do see genital rashes mostly see rashes caused by Herpes. The next most common thing they see is—well—herpes. After that, they occasionally see herpes. Syphilis and what-have-you are all pretty rare. Herpes is pretty common.
We go into my bathroom and I turn the lights up bright, I get gloves out of my medical bag and put them on. I sit on the edge of the bathtub and have him drop his shorts while standing directly in front of me.
The Firefighter’s lesion looks worse than this but not as bad as this. There’s a collection of clear vesicles over an area of erythema, but the whole thing looks crusted over. The vesicles look like herpes. But herpes doesn’t crust over.
‘Have you been putting anything on this?’ I ask.
‘Most everything I can find in the medicine cabinet,’ he says, embarrassed and horrified at the situation.
That would explain the crusting. Convincing for herpes now, except for one thing.
‘It doesn’t hurt or sting or even itch?’ I ask.
‘Nope,’ he says.
Herpes hurts. It’s painful. I roll the shaft of his penis up with my gloved hand. I also check for any inguinal lymphadenopathy. Nothing.
I sigh his name sadly, squinting at the lesion, and say ‘this looks like herpes.’
He grunts, numbly.
I have him pull his shorts up as I remove my gloves and wash my hands. He walks back into the den.
‘Mind if pour myself a drink,’ he asks and pours us both some scotch.
I check my copy of Fitzpatrick’s Atlas of Dermatology and my Hopkins ABX Guide. I call the Marquee and run the case by him, hoping I can come up with a convincing alternative diagnosis.
‘I don’t know, dude,’ the Marquee says, ‘it sounds pretty convincing.’
I tell the Firefighter that I might be wrong and that he should see his family practitioner the next day. He agrees to do so, but I know he doesn’t take my protest very seriously.
‘I suspect you’re right,’ he says. Mulling some idea, while the scotch warms his mouth. He laughs a bit. He tells me a story from his college years about a friend who pursued someone for nearly two years and when she finally slept with him, ‘all she got out of it was a bad case of herpes. We laughed about it then… I’m feeling a little differently about that story now.’
‘I don’t mean to sound,’ he says, ‘like I am feeling a lot of self-pity here. But since I decided to come out, I’ve been thinking how I was finally going to explore this and have some fun. That’s not going to happen now.’
I refill our glasses.
‘I even rented some gay porn last Saturday. It was good’ he says, with strong emphasis on the word good. ‘It was called The Young Gods. I was jerking to it for over two hours.’
‘Two hours?’ I say, incredulously, ‘porn flicks don’t last two hours.’
‘Um,’ he says, shamefacedly, ‘I rewound some of the scenes and watched them twice.’
‘Two hours?’ I say. ‘What’d you use for lube?’
‘Spit and pre-cum’
‘For two hours?’ I say, trying not to sound like a parent scolding a child. A friction rub wouldn’t explain the vesicles, but it might explain some of it. ‘Make sure you tell your doctor tomorrow about that.’
He remains unconvinvced and by the end of the evening, we polish off most of my bottle of Glenlivet 21.
When the Marquee’s in the Men’s room, Dr. Pasteur walks into the bar and joins me and Merteuil. I call for an extra mug and pour him a beer as he tells us about a primary adrenal insufficiency he diagnosed today. He tells us about the patient’s symptoms and how he figured out it was adrenal insufficiency, but then he told me about the lab results.
‘That isn’t primary,’ I correct him, ‘it’s secondary.’
‘No,’ he explains to me how he and his attending had discussed the results and made the diagnosis.
‘Your attending’s wrong,’ I say. ‘It’s secondary.’
Pasteur asks Merteuil what she thinks.
‘I haven’t thought about it for a long time,’ she says. ‘I think it’s secondary, but I’m not sure.’
‘A Goddamn surgeon can recognize it’s secondary,’ I tell Pasteur.
The Marquee comes back and Pasteur tells him the lab results.
‘Primary,’ Pasteur asks, ‘or secondary?’
‘Secondary,’ the Marquee says definitively. I raise my eyebrows at Pasteur and hold my hands palms up, come-unto-me style.
Merteuil changes the subject, telling us her tech is going out tonight with his new girlfriend. She knows that two of his regular hook-up chicks are going to be out tonight too.
‘I’m going to be starting some shit tonight,’ she says, smiling. She explains she’s going to make sure his other girls find out he has a new girlfriend, effectively knocking them out of his picture. ‘Once I’ve junked his other options for regular poozle, he can’t fuck things up for me and my husband, cause it’ll fuck things up for him and his girlfriend.’
Pasteur grunts. We look at him.
‘You guys are right,’ he says. ‘It is secondary.’
There’s a moment of silence while we figure out he’s talking about our last conversation.
‘Erik,’ the Marquee says, setting me up to do the Broadcast News bit, ‘it must be nice to always believe you know better, to always think you're the smartest person in the room’
‘I rather enjoy it’ I say, laughing. ‘How is it for you?’
‘Quite nice,’ he says, ‘thank you for asking.’
‘You guys are assholes,’ Pasteur says, pouring himself the remainder of the pitcher of beer.
‘He’s drinking our beer,’ the Marquee says, ‘and somehow we’re the assholes?’
‘Typical,’ I say, reaching into my pocket as my cell phone issues its voicemail tone. I look at the screen and see it’s from the Firefighter.
He went to see the doctor, who told him it wasn’t herpes. The relief and elation in his voice is as jubilant as the bass guitar in XTC’s Garden of Earthly Delights. He says his doctor told him it was bullous impetigo.
I think it out: clear vesicles on a crusty erythematous base. Fuck me. How fucking obvious. How could I have missed it?
And while I’ve never been so delighted to be wrong, I’m horrified at the night I’ve put the firefighter through. My stomach turns inside out. Misdiagnosing an STD kind of cuts into your chances of winning back someone’s heart.
I tell Merteuil and Pasteur what happened with the firefighter last night and give the Marquee the update.
‘Those Family Practitioners,’ the Marquee says when I tell him the diagnosis, ‘see so much of that shit.’
‘On the plus side,’ Pasteur says, delighted at my shame, ‘after he finishes the antibiotics, you can go back to sucking it.’
‘Ever the charmer,’ I say to him, laughing half-heartedly, closing my eyes to think.
‘You know your problem?’ Pasteur asks me.
I open my eyes and look at him.
‘You believe your own hype,’ he says to me. ‘I’ll give it to you, a good portion of the time you’re right. You pick up on things I miss. But you miss things, too. You’re wrong a significant portion of the time. So you save some lives,’ he leans in and quiets his voice. ‘Guess what, Erik? It’s your fucking job. There’d be something wrong if you didn’t have rescue stories to tell. You think I don’t have families that kiss my ass when they see me? We all do. But we don’t let it go to our head the way you do. We don’t pretend that we’re gods from on high, giving fire to mankind like we’re Proteus.’
‘You mean Prometheus,’ I say, finishing my beer and getting up from the table, ‘I’ve got to go meet Stockholm. Merteuil, good luck with your plan tonight.’
As I’m walking out the door, I hear Merteuil say, ‘I can’t believe none of us have worked in a good Stockholm Syndrome joke.’
Frank Sinatra used to say he orchestrated his albums so their timing would match the timing of bringing a date home.
You walk into your apartment, put on the LP and pour the drinks, make some small talk, then move to the couch and slip off your shoes as the conversation becomes more intimate.
It was when she’d be wanting to be kissed that you’d heighten her tension by leaving her to flip the record. Perhaps you’d return to the couch. But perhaps she’d follow you to the turntable and you’d kiss her, leading her to your bedroom…
I can say fairly certainly that Pedro the Lion doesn’t orchestrate their CD’s thusly.
I’m on top of Stockholm and we’re at the point in the evening beyond the kissing and small talk. Both of us concentrating on this moment. David Bazen begins slowly bleating, ‘Suddenly, I don’t love you at all… I don’t love you at all… I don’t love you at all…’
I stop and sit on the side of the bed, exhaling the words ‘Fuck me.’
‘What?’ Stockholm says, confused.
‘It was an expletive,’ I say, walking to the stereo to change the CD, ‘not a request.’
When I get back into bed, I start rubbing her back and we talk, listening to Nina Simone’s Pastel Blues. She tells me she’s going to Montgomery for the weekend.
‘Doesn’t your ex-boyfriend,’ I ask her, ‘live in Montgomery?’
‘Yeah,’ she says, ‘it’s no big deal. I’m just going to see my dog.’
I lift her hair and kiss the back of her neck, not understanding that this is the last night she’ll ever spend in my bed.
I met the ovarian cancer patient only once before and it was about two weeks ago. I met her oncologist in the elevator a few days later. I informed him that she had just come into my care.
‘I wouldn’t,’ he cautioned me, ‘waste too much energy developing a relationship with her. She won’t be around for long.’
I laughed, saying ‘ouch.’
She’s in my clinic exam room now, waiting to be seen. I go in the room and she’s still concerned about her blood pressure, which is not ideal, but not acutely high.
‘I noticed,’ I tell her, changing the subject, ‘that you were in the hospital this weekend.’
She nods.
‘What happened?’
‘I’s vomiting all weekend,’ she says. ‘I couldn’t keep nothing down.’
‘Did you get chemo on Friday?’
‘Yes sir,’ she says.
‘Were you vomiting before the chemo?’
‘No,’ she says.
‘You understand that the chemo isn’t going to cure you,’ I ask her again. ‘Just perhaps keep you around a bit longer or be more comfortable.’
‘Yes.’
‘Well,’ I say, taking a deep breath, ‘it appears the chemo isn’t making you more comfortable. In fact, it seems just the opposite is happening.’
She doesn’t say anything. I consider how to proceed. In the spring and fall sometimes people will take chemo to extend things a few weeks, to see someone graduate or make it through one more Christmas. When it happens in the winter or summer, sometimes people have some other short-term goal.
‘Is there some big event coming up for your family?’ I ask. ‘Someone pregnant or coming home from somewhere? Some particular thing you are hoping to see before you die?’
‘No,’ she says, a little surprised.
‘You understand,’ I say, perhaps too firmly, but wanting to make myself clear, ‘that you are going to die.’
Our eyes lock on each other. Neither of us says anything or moves. Like a child’s contest or a war negotiation, we’re waiting to see who blinks first.
‘Well, what do you want me to do?’ she says, harshly, ‘Cry?’
‘No. I want you to understand there’s nothing your cancer doctor or I can do to stop you from dying. I want to change the focus of your care from trying to extend your life by a few days or weeks to making your remaining time as comfortable as we can.’
She doesn’t say anything.
After a bit, I take my stethoscope and listen to her heart and lungs. I begin writing my note. After a bit, she begins talking.
‘I ain’t afraid of dying. I lived a good Christian life. I read my bible. I go to church. I don’t mess with no alcohol or smoke no cigarettes. I ain’t never gone out and messed about.’
She frames these as criteria for not fearing death, but there’s anger in her voice. They’re objections to her diagnosis. They are eminently logical.
There’s more silence.
‘Do you remember when I first met you, I said you seemed older than you were?’ she says.
‘Yes, ma’am. I remember.’
She stares at me now. I’m not sure what she wants me to say.
‘Alright then,’ she looks at the ground. She’s disgusted and finished with me and I’m not sure what I’m supposed to say, what she wants me to do.
I get up and through the closed door of the exam room, I hear her say ‘Damn Yankee.’
I sit down with a group of nurses in their break room. One of them is talking about a doctor that she finds attractive, but doesn’t know his name. The other nurses are trying to figure out who she’s talking about. When I join them they pretend they’re going to change the subject for a moment or two, but revert to the game of twenty questions quickly enough.
Eventually we figure out that she’s talking about Pasteur. The girls are in agreement that he’s pretty hot and, they claim, has a great ass.
‘Erik can hook you up,’ one of the nurses says. I chuckle, eating a peanut butter cookie. The nurse is—not unattractive but—not Pasteur’s type: she’s about twenty pounds past the technical definition of obese.
‘You don’t want to go out with Pasteur,’ I tell her.
‘Why not.’
‘He’s kind of a flake,’ I say, which is true enough.
‘So?’ one of the nurses says, ‘We’re not looking for a soul mate.’
‘We’re just looking,’ one of the other nurses says, ‘for a check-mate.’
The other nurses give a bit of a disgusted groan when she says this.
I laugh, saying ‘ouch.’
An half hour later, I’m walking through the ED and I see the ovarian cancer patient laying in one of their stretchers. The timing is so tight I know she went directly out of my office and into the ED. I shake my head and avoid eye contact.
I laugh, saying ‘ouch.’
The Marquee and I are eating Barbeque at KC’s and he’s telling me about the disaster of Merteuil’s night out. She and the Tech both got drunk early on. Her husband and the Tech’s girlfriend—who were not drunk—got bored and left early. Not only did Merteuil not spoil things with the Tech’s sideline hook-up girls, she and the Tech went home with one of them. It’s unclear to the Marquee whether or not they had a three-way.
‘You don’t suppose her husband’s sleeping with the Tech’s new girlfriend?’ I ask the Marquee, dipping my pulled pork sandwich in the sauce.
‘The way Merteuil tells it,’ the Marquee says, ‘hubby ain’t got no sex drive.’
‘Maybe just not with her,’ I say, ‘Maybe he’d become Keith Moon if he was with someone else.’
The Marquee doesn’t buy my argument. I dig into my baked beans.
‘Here comes your man,’ the Marquee says.
I look up and around and don’t see anyone. He nods at the television and I see they’re playing Columbo.
‘I love this guy,’ I say, grinning.
‘How’s Birmingham,’ the Marquee asks.
‘Haven’t heard anything,’ I say, shrugging and putting more of the sandwich in my mouth. ‘Saw him out the other night. He gave an upright, non-moving wave and then looked away. I guess that’s done.’
‘Too bad. He was cool,’ he says. ‘Stockholm?’
‘She’s going to stay in Montgomery with her ex-boyfriend,’ I say, chewing and half-laughing, ‘Make me an angel that flies to Montgomery.’
‘And dear Chicago?’ the Marquee asks, grabbing some of my fries.
‘I think the thing you said was true,’ I say, ‘I’m going to die alone and sad.’
‘There must be some mistake,’ the Marquee says, opening up his sandwich and examining its contents, ‘I didn’t order this with extra melodrama.’
‘You don’t like music, do you?’ I laugh, swigging back the rest of my beer. ‘Let’s go back to my place. I’ll play you some you might enjoy and we can drink bourbon.’
He belches and agrees.
This post has a soundtrack click here to hear it.
The HIV Gosling has continued to deteriorate. He’s now on a venturi mask at maximum oxygen concentration. The sound of the oxygen rushing into his mask makes it difficult to hear his weakened, whisper of a voice and he’s too short of breath to repeat himself.
I’ve discussed life support with him and the Geese several times. Part of the problem with pneumocystis is how friable it makes the lungs. A ventilator will likely rip his lungs open, collapsing them. I explain that if we put him on the ventilator, it’s extremely unlikely that he’ll ever be taken off of it.
I also explain that it’s probably the only chance he has at living much past tomorrow. I tell them he’s dying and recommend we try to make him comfortable during the process.
Neither the Geese nor the Gosling are willing to make a decision. They want to make the decision tomorrow.
‘What if he needs it tonight?’ I ask.
‘We’ve got family coming in tomorrow, keep him off of it tonight,’ the Goose, Sheri, says.
My forehead aches when she says this.
I close my eyes and run the Next of Kin algorithm again to ensure that she’ll be the decision maker when he cannot make his own. But I’ve run it twice already and know she’s the next of kin. Though the Gosling originally mentioned his ex-boyfriend, that guy never showed up and the Gosling began deferring to Sheri.
‘Well, putting him on life support isn’t something I’m going to do willy-nilly,’ I say. ‘I’m not going to do it unless I think he’s going to die without it.’
‘Don’t let it come to that,’ she says.
I look at the Gosling, looking even gaunter than when he first arrived. His hair’s greasy from his constant bouts with sweating and then chilling down. He’ll go apneic briefly, then breathe rapidly for a bit, the rate slowing, slowing, then apneic for a moment, then repeat the cycle.
‘I don’t know that I can prevent it,’ I say.
Something changes in her at that moment. For the first time since I’ve known her, her face weakens. For the first time since I have known her, she reaches out and touches me, taking my hand with both of hers. She says one word.
‘Please.’
I’m filled with revulsion. She hates me. Her effort to appeal to me to save her brother repulses me. My only power is to ease or prolong her brother’s agony.
‘I’ll do what I can,’ I say and extricate my hand from hers and myself from the room.
I’m overnight in the hospital that night and quite busy with new patients. I try to nap at 10pm, but get only fifteen minutes before a diabetic crackwhore comes into the ED in ketoacidosis. She does this once or twice per month. The ED doc makes the running joke about trying to figure out how to combine insulin with cocaine to keep her healthy.
I’m writing her admission orders around 11pm, when I get a call from the Gosling’s nurse. His breathing seems to be worsening. I order an ABG and some stat Nebulizer treatments.
On my way back to the MICU, I swing by his room. He’s confused, can’t even get a single word out, but maintains eye contact with me. Clinically, he’s worsening, but his ABG’s no worse than earlier in the day. I adjust him to enhance the anatomy of efficient breathing. I feel nauseous and uneasy. I should either be intubating him or giving him opiates.
In the MICU a patient with a subdural bleed has started seizing and is in status epilepticus. The MICU nurse and I work together to break the seizure. When he comes out of it, the nurse and I get him to the CT scanner to see if the bleed has significantly worsened.
It’s nearly 2am when I get a chance to break for a midnight snack—onion rings. I get another call from the Gosling’s nurse. She tells me he’s become agitated and confused and has been pulling the oxygen mask off his face. She’s spending all of her time in his room reapplying the mask.
I go up and examine him, putting the mask back on him. His O2 sat is in the high 80’s with the oxygen mask. Without it, it quickly drops to a level incompatible with life. His arms are weakly flailing, trying to remove the mask. His eyes are panicked and locked on me.
‘You need this,’ I tell him, in a soft, reassuring voice. ‘Don’t take it off. It’s keeping you alive.’
His hands continue to reach up toward the mask. I hold his hands by the bed to prevent this.
Should I make the confession now? Can you already see what’s going on, despite my lack of details? Is it obvious to everyone but me?
‘Get the restraints.’ I say to the nurse. She gets the restraints and ties his arms to the side of the bed. His oxygen sat’s stay in the upper 80’s now with the mask safely in place. He’s so exhausted himself in the struggle that he’s asleep now.
The CT of the subdural patient is relatively unchanged. I call the neurosurgeon and we review the scan together. My intern pages me with questions about a hypertensive patient and I tell him what meds to order. The Orthopods call me and ask me to do a pre-op evaluation on a hip fracture that they want to take to the OR in the morning.
At 4am I look in on the Gosling. He’s rapid panting like a big dog in the summer’s heat. His eyes are wide open, but not focused on anything. His hands are straining against the restraints, trying to reach his mask. This continues throughout the night.
At 7am, my intern, the bumbling one, shows up.
‘It looks like he’s trying to take the oxygen off,’ he says.
I explain that when patients are delirious they try to remove all the medically invasive tubes from themselves. I explain that it’s a predictable pattern.
‘But he’s not going for the IV’s or the Foley,’ he says, his voice politely lilting to suggest a question. But it isn’t a question. It’s obvious. The Gosling’s staring directly at me.
Nausea rolls over me and my stomach and bowels tighten into stone.
I call the Geese into the hospital. When they arrive, we talk at the bedside.
‘He wants the oxygen off. I need to make him comfortable. Now.’ I tell them. Sheri looks at the Gosling. She’s not crying, but clearly only because of extreme effort. She nods and goes to her brother.
I go to the nursing station and begin writing orders for a fentanyl drip. While I’m talking to the nurse, one of the Geese comes up to me.
‘He’s changed his mind,’ she says, ‘we told him his aunt and uncle are driving down this weekend, so he wants to stay on the oxygen for two more days.’
I close my eyes and rub my forehead.
Another of the Geese comes out of the room and looks at me expectantly.
I walk into the room.
‘Just the oxygen,’ Sheri says, crying and holding his hand, ‘not the ventilator or intubation.’
‘You think’ I ask, genuinely, ‘that he can make decisions right now and he wants to stay on oxygen for two more days?’
‘Yes,’ Sheri says.
The Gosling is panting into the mask, his head’s turned to the right and he’s looking down. He’s developed a patchy beard since he’s been in the hospital. His hands are still tied at his sides.
‘Well, then,’ I say, ‘I can untie his hands and he won’t remove the mask.’
Sheri looks at me and then at the restraints. Neither one of us say anything, waiting to see who will call the other’s bluff.
I walk over to his side, release the Velcro and unfasten the clip of the restraint off his right hand. He raises it and pulls the oxygen mask off his face and over his head with clear purpose.
‘No, Bobby,’ one of the geese says, crying, ‘don’t.’
He drops the oxygen mask off the bed and his hand falls to his side. I release his other hand. I walk behind the bed and turn off the oxygen valve. Without the oxygen rushing through the tubing, the room becomes quiet and funereal.
I come out from behind the bed and look at the Gosling, surrounded by the Geese. He’s staring at me.
He lifts his hand and slowly—ever so tenderly—raises his middle finger directly at me. He holds it—firmly in the air—for nearly five seconds, his eyes locked on mine as I stare at the finger. Sheri sees what he’s doing and closes her hands over his.
I take a deep breath and turn to leave the room. One of the Geese is in the doorway. As I walk past her, she mutters one word, ‘murderer.’
I’ve returned home and am searching through CD’s that I don’t play much. I see Leonard Cohen, Me’Shell NdegéOcello, Neil Young, and The Jody Grind. I pull out covers with images of the Union Jack, half-manikins, and 1960’s pin-up boys. I pop in Suicidal Tendencies and start it up while thumbing through other discs.
I reach underneath my bed, pulling out shoeboxes, small bags, and stacks of papers. Wisps of dust—too large to be called wisps, really—waft out and cling to my scrubs. Post-call mornings residents usually suffer from the triad of halitosis, narcosis, and priapism. Today, mine is marked by rhinorrhea, nausea, and palpitations.
The boxes I’m opening only have shoes in them. The bags have screws, electrical wires and used paint brushes. I begin going through the papers, but they’re just old undergraduate essays.
I move to the living room and begin pulling books from the shelves. Ionesco, Beckett and Sheppard fall to the floor as I search behind their group. I thumb briefly through Miller. I see Ellis, but don’t pick him up. I move down and flip through the pages of Amis and Camus, letting loose sheets and notes fall out. I’m remembering bits and pieces from them. Sketches of ideas are scribbled on the backs of receipts for coffee and beer, airplane tickets, and grocery lists. (‘When did I need phosphorus-free detergent and a pizza stone?’ I wonder, before moving on.)
I remove the cushions from the couch and check the crevices. A dollar forty-seven in loose change and two pens. I search again. My hand singles in on a small box—my fingers feeling its openable rim—and I grow excited. I try to grasp around it, but it’s deep. I use my other hand to force open the springs so I can reach further inside. I tease out a corner, clasp onto it and try to pull it from the couch, but it falls from my grasp and deeper inside. I can no longer touch it. I’m sweating and the dust from under the bed has caused some lachrymosis.
I’m inturrupted by a knock on the door. Looking out the window, I see Merteuil standing on my back porch. She sees me and lifts her hands, dangling a six-pack in one hand and a McDonald’s bag in the other, saying ‘Ready for some beer and McMuffins?’
I open the door for her and walk into the living room, turning on the television. Merteuil steps over the CD’s, books, and videotape strewn around the room.
‘What the fuck happened in here?’ she asks, returning some of the cushions to the couch. I grab a beer and sort though some of the stuff on the floor. I tell her about the Gosling’s death.
‘Fuck me,’ she says when I’ve finished. It’s an expletive, not a request. There’s a moment before she says, ‘You know what your problem is?’
‘Christ,’ I say, biting into a McMuffin and flipping channels. ‘If I say yes will that stop you from telling me? You’re a surgeon, not a psychiatrist.’
I hold the channel on The Mary Tyler Moore Show.
‘You really pissed Pasteur off the other night, Erik.’ she says. ‘He’s supposed to be your friend. Have you noticed you get along with strangers: Nurses, clerks, techs, even docs from other specialties?’
‘Are you trying,’ I ask her, ‘to do the routine where you talk a lot of obvious shit to get my guard down?’
She doesn’t say anything for a while.
‘When I die,’ Betty White—as Sue Ann Nevins—is saying. ‘I want to be cremated and have my ashes thrown on Robert Redford.’
I laugh and Merteuil looks from the screen to me
‘You love her, don’t you?’ she says.
‘Stockholm?’ I say, shrugging, ‘sure.’
‘I mean Sue Ann.’ she says. She knows my drunken confessions; she knows the answer to this question. I’m trying to ignore her. I finish my second beer and grab a third.
‘If you want to shame someone, Erik, shame yourself. You love her,’ she says, motioning to Sue Ann, ‘but you’re the complete opposite. Let’s face it, you aren’t half the badass you think you are.’
I change the channel: Columbo.
‘Your lucky day,’ Merteuil says, ‘two heroes in two minutes time.’
‘If you think,’ I say, ‘that’s why I like her, you’ve missed the point.’
‘No, I haven’t. I get the whole Columbo thing,’ she says, then leans in and practically whispers, ‘but you’re the opposite of what you want to be.’
I grunt.
‘Patients,’ I say, ‘want shamans and gods.’
‘Just one thing I can’t quite figure out,’ Columbo says, turning around, after talking to the suspect.
We watch the rest of the show in silence.
‘You’re a pretty smart cookie,’ Merteuil says, standing up to leave as the credits start. She kisses my forehead, saying, ‘you’ll figure it out.’
I blink at her for a moment. She grabs her keys and walks out. I sit on the couch for a while, looking at the mess I’ve made—books, papers, and cushions still on the floor—before going to sleep.
A few weeks later I’ll get the shit beat out of me. A few days after that, I stop shaving my upper lip.
