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…
The next day, most of the patients I introduced you to left my service. Some were transferred to other services—the pancreatic cancer guy went to surgery’s and the batshit-crazy drunk lady went to psych—some were discharged—the snakebite guy.
The HIV guy did, in fact, have AIDS and Pneumocystis carinii pneumonia. (For those that strive to be hip with their toxonomy, it has been renamed Pneumocystis jiroveci. No More PCP, now PJP, which does not taste great with a glass of milk with its crusts cut off.)
He had to stay in respiratory isolation for a few a while to ensure he didn’t have tuberculosis, but he started to show some improvement even in those first few days. His CD4 count, for those of you who know about such things, was 13. I won the bet of the five physicians in that pool—closest without going over—I guessed 11.
The emphysema lady, the lady for whom I wrote impossible admit orders, bears some mentioning.
After I left, the nurse saw my impossible orders and asked Dr. Pasteur, the ICU resident, to amend the orders so the patient could be moved out of the ED and into her hospital room. Trying to help the nurse out and, I guess, believing I had made an error, he changed my orders and the patient was sent upstairs.
‘I’m so amazed how much you have to know to be a doctor. You spend so much of your time teaching. I’d like to give you a day where you can sit back and relax.’
Around 5:30 am, she quit breathing.
A code blue was called. She was intubated and put on a ventilator. I arrived at 6 am as they were preparing the patient to be moved to the ICU. I looked at the patient and then at Dr. Pasteur.
‘Good call last night with her,’ he said to me, with a surprising amount of sincerity.
Now, I’m not a violent fellow. I’m not one to start—or even get into—fights. But hearing him acknowledge that I’d told him the patient was in no condition to go to the floor, that she would poop-out and quit breathing, that she would code if he didn’t intervene—and he did not intervene—was too much for me. I wanted to slam him against the wall. I wanted to grab the lapels of his white coat and twist them as I hissed into his face, mere inches from his nose, my spittle violating his cheeks and eyes that my call, that my judgment, my acumen was useless because of his impotence, his lack of insight, his writing orders on a patient who belonged to me.
But instead I’m just staring at him. I know he’s going to be publicly humiliated when the MICU attending reads my note from the previous night. I’m standing in silence for a full ten seconds, then ask, ‘who’s your attending this morning?’
I ask this, not because I don’t know who his attending is, because I do know. I ask him this because I want him to think about the intellectual tear down he’s about to receive. I want his nausea to begin now.
He tells me the name, closing his eyes and shaking his head, beginning to anticipate his berating.
‘You should probably,’ I tell him with faux compassion, ‘lube with K-Y now; he won’t spit when he tells you to grab your ankles.’
When I leave the hospital I check my messages.
Chicago’s called and confirmed our plans for Saturday. I’m deeply relieved to hear his message. To be honest, I spent a fair amount of the day fretting that he wasn’t going to call me at all.
Birmingham has also just called, leaving a message telling me I should meet him at the bar. So I drive to the bar and meet him.
We have a beer, have dinner in a Vietnamese dive nearby, and head back to my place. We dip into my Glenlivet 21. We’re both sitting on my couch, our knees touching, leaning forward to set down and pick up our glasses. I’m telling him about my clinic, explaining the way we performed certain tests.
That’s when he says something so perfect, so amazing, that had I been writing a script for him to read, I couldn’t have given myself a better gift. It starts like this:
‘I’m so amazed how much you have to know to be a doctor.’
Now this is below the belt, because much as I’ll deny it, if you fawn over my intellect, I’ll become a slobbering idiot for you. But then, he tops it with this:
‘You spend so much of your time teaching. I’d like to give you a day where you can sit back and relax.’ We live near a historical site and he majored in history, I knew this already. ‘Let’s spend the day there and let me show you some of the things I know about.’
Now, I’m not a fellow to talk about sporting wood or growing a chubby, but the combination of the fawning and the offering was too much for me. I set down my scotch and grab his collar, drawing him to me, kissing him.
Her hair combines the scents of a clean, subtle shampoo with the steak and mussels she’s been serving. It’s curiously exciting.
One thing I’ve never heard talked about, but that I have experienced a few times, is that when men—men who don’t usually have sex with other guys—do have sex with a guy, their amount of ejaculate is tremendous. I mean beach towel tremendous.
Now understand, I’m a doctor, I’m used to people exaggerating about fluids. Patients tell me they bled pints, that they vomited gallons, that they coughed up liters of phlegm. But there’s a difference here: They’re not used to seeing blood on the floor, vomiting, and sputum production. I’m familiar with typical ejaculate: personally, clinically (3-5 cubic centimeters), and via video and photographs.
The amount of ejaculate in this situation is undeniably atypical and enourmous. I can see the puzzlement in his face and in his voice when he says, ‘where did all this come from?’ while wiping his spunk off his chest, his shoulders, off his own face, off my pillows and headboard.
We shower off. I change the sheets and throw the pile of towels in the wash. I’m not sure how to deal with the headboard—Pledge? Murphy Oil Soap?—so I just use a fifth towel and warm water. I lay down next to him, throwing my arm across his chest and gently thumbing his ear as we talk and drift into sleep.
In Monday’s post, I mentioned that I won a bet among five physicians for guessing a patient’s CD4 count. It occurred to me that I should say a word about it, but thought it was off-topic and, to be honest, wasn’t sure if anyone would think it needed explanation. Apparently, it did.
Here’s the deal: physicians bet about everything. CD4 counts are perhaps our more benign wagers. Before a biopsy is back, we put our chips on adeno versus squamous carcinoma. We play our cards on whether someone is having acute coronary syndrome or indigestion. We lay odds on someone having a pulmonary embolism versus being a hysterical whiner.
When physicians make such bets, it’s not idle gamesmanship; physician bets are about testing clinical acumen.
I listen to someone’s chest and bet with my interns about the specifics we’ll see on chest x-ray. When they lose, I have them go back and listen again. Sometimes, my intern will win and I’ll go of my own accord—and dishonor—and listen again.
I even place bets with myself. I look at a jaundiced patient’s eyes and estimate their bilirubin. I’ll look at the pink under a tongue and guess a patient’s hemoglobin. I’m at the point now where I am trying to estimate combined hemoglobin and bilirubin. When they both hit seven, white people turn a most curious shade of chiffon.
So why bet? Why enter pools? Labs aren’t always available. At my hospital, CD4 counts are only run on weekday mornings. That’s assuming we have an HIV diagnosis established, which takes three or four days. As a patient’s CD4 count changes, the antibiotics I choose change. The bugs that cause their illness change. The way they will respond to treatment changes. By wagering, we’re keeping tally of our ability to assess a patient’s needs.
More importantly, lab errors occur. By predicting what the lab values should be, I’m able to spot errors. When other physicians have been ready to transfuse a patient, I’ve had blood counts repeated and found the severity of the anemia was a lab error. I can think of eight patients who I’ve spared the risks of a blood transfusion in the past four months—to say nothing of the blood that was saved for a patient who actually needed it.
If things continued the trajectory of the previous eight days, I’d be named Surgeon General or develop a successful cancer vaccine within eight months.Betting is an effective way for physicians to keep us improving ourselves. I lost a bet to a surgeon this weekend, blaming his mismanagement of a patient’s IV fluids for an electrolyte abnormality. I wrote a consult telling him to change the fluids to fix the problem. Turned out, I was wrong. We later discovered that the patient was secreting inappropriate antidiuretic hormone. I’m not likely to make the same mistake again.
Physicians are, all day, betting. Betting on your diagnosis, gambling that their intervention will make you well. While our wagers make a game of our very serious job, they remind us that something is on the line.
Different attendings have different wager amounts. The standing bet for one oncologist is always a Can of Diet Pepsi. A certain intensive care physician always bets One Shiny Penny. These physicians are so good that they almost never lose, but I’ve never seen a can or coin change hands.
When physicians are constantly testing their acumen, they get so good that they can start setting up the treatment right along with ordering the diagnostic studies. Their patients start getting better that much faster—or, when appropriate, are made comfortable that much sooner. Since its Wednesday, I won’t mind the cheese of saying that it’s their patients who are the winners.
And if you’re gonna play the game, boy, you gotta learn to play it right.
The decision on whom will be chosen for chief resident has been looming over those of us nominated for several weeks now. It’s been all but promised to one resident. When I was asked to interview, I did it more for the experience than with any real expectation for the job.
So when I’m chosen and offered the contract to stay on for an additional year as chief resident, being an attending physician and responsible for the residents and our conferences, I’m a bit nonplussed, but pleased and honored.
I go out for a celebration dinner with Dr. Pasteur, whose ass is still smarting from the tongue lashing he received two days previously. We have Daiginjo Saki with our sushi and forgive each other. I forgive him for nearly killing my patient. He forgives me for ensuring that he was held responsible for it.
The Marquis shows up and we pour him the remains of our bottle.
It’s Thursday night and they want to head to Square One, a nearby bar in the basement of a Thai restaurant. I leave them there and head over to Stockholm’s restaurant. When I walk in, she sees me and her face lights up. When I see that, mine does also. She pours me a glass of the Trimbach ‘Cuvee Frederic Emile’ Alsace Riesling and I tell her the news.
She takes a break and we head through the kitchen into the back alley. She smokes while I drink my wine and kiss her neck. I love the way white wine cools my tongue and makes her neck feel warm. Her hair combines the scents of a clean, subtle shampoo with the steak and mussels she’s been serving. It’s curiously exciting.
‘What time,’ I ask her, ‘do you get off?’
‘Soon,’ she says, pulling her neck away from me, still holding my hand.
‘Can you come to my house,’ I ask, ‘and play?’
‘Yes, I can,’ she says. ‘do you have any fun toys?’
‘Oh yes,’ I say, ‘I do. I do have toys.’
What toys, you ask? Lets just say that membership has its privledges.
Friday afternoon Chicago calls and leaves a message saying his sister has come into town and he has to cancel for tomorrow.
When I get to the bar that night, it’s pretty empty—or rather, completely empty except for a drag queen, a bartender, and the local coke dealer playing darts in the back. I order a Budweiser and make small talk with the drag queen.
‘Sure is coming down out there,’ I say, watching the rain.
‘It sure is,’ she says. ‘You can tell its spring because it’s raining so hard.’
I pause, then say, ‘but, it’s not spring: It’s the middle of July.’
‘Then why the hell’s it raining so hard?’ she says, pursing her lips, flipping her hair up, and turning away from me.
I didn’t, but I could have, think about how there was almost exactly a month until my birthday. I could have, but didn’t, think about what that month would hold for me. I could have also wondered what the next eight months would hold for me. If things continued the trajectory of the previous eight days, I’d be named Surgeon General or develop a successful cancer vaccine. I could have wondered that, but I didn’t.
It certainly didn’t occur to me at the time that in November I would start a story that was set into motion by the events of this week, that I would spend two months documenting a single day, and that by mid-February I would still be explaining what transpired the week of July 17th, 2005.
I was simply enjoying the summer. Enjoying the company of these people. Even enjoying the rain shower.
I wait until the rain lets up and then leave the bar alone, the wind blowing the remnants of the shower on my face and tee, its wetness darkening small circles of cloth on my chest and sleeve. I get in my car and listen to John Vanderslice’s Time Travel is Lonely, as I drive into the night, on my way back home.
There’s one more thing we need to discuss before I tell you about Saturday: I have, for most of my life, avoided the gym.
When I was seventeen, my mother warned me, ‘you’re very beautiful for a boy, be careful: people will try to use you for that beauty.’ While I liked the idea of being used for my beauty, her warning imbued me with enough concern to eschew enhancing my physical beauty and enough arrogance to believe such eschewal was in my best interests.
Around the same time, I heard Katherine Hepburn say that she didn’t like to watch her movies because, she said, ‘it’s like watching myself rot.’ At that point, I made the decision to put off working out until I was older, so that as I aged, some aspects of my physical form would be improving, even as age took its toll.
I came up with a game plan: I would begin aerobic exercise in my mid-thirties for its cardiovascular benefits, as well as its fat reduction. Thirty minutes per day, four or more days a week. Strength training would begin in my mid-fifties; the resistance would increase tensile strength of bones and prevent fractures, as well as improve my musculature.
But recently several new studies have suggested that the bulk of calcium deposition occurs during our mid-thirties. This meant that strength training should begin concomitantly with the aerobic exercise.
So in mid-March, I joined a gym and began working out a half hour a day, four to five days per week. I had no idea what I was doing and ended up injuring myself so badly I hobbled around on a cane for about three days.
Things I don’t remember: how all the broken glass ended up in the bathroom and what happened to the light fixture above my bed.
After that, I got a trainer who tells me what to do in a safe manner and allows me to think about other things while I work out.
As my body began to change, some things were difficult to get used to. I normally sleep on the softness of my arm, but it was now lumpy and hard. At first I used the Stairmaster too much and when I turned around I was knocking things over with my over-developed ass. To take care of that problem, I switched to what my friend refers to as ‘the fancy prancer’ but what my trainer calls the elliptical machine.
I wasn’t quite used to the increased strength and stamina either, but it turned out to be rather useful, as you will soon find out.
This is a lot of verbiage when a simple photo montage will do, so here you are. Or, rather, here I am.
A technical note:
This post has a soundtrack click here to hear it.
It augments the writing, so if it didn't work, try this link instead.
Saturday morning, I work my first shift moonlighting. It’s mildly exciting to work for six hours and make a week’s salary.
I meet Stockholm for lunch over a bottle of Shafer Pinot Gris and she decides to come to my house for a bit.
‘You want to listen to “Afternoon Delight”?’ I ask, trying to pick out the music. When I was seven and listening to this song, I thought it was going to be something like Turkish Delight and desperately wanted some.
‘Do you have “Summer Lovin’”?’ she asks, looking over my shoulder, wrapping her arms around me. I know she means ‘Summer Nights’ from the Grease Soundtrack, but I don’t correct her. I grab Carol King’s Tapestry and put it in the player.
What is it about making love on a summer’s afternoon that seems the pinnacle of romance? Is it some collective game we play, pretending ourselves back in Eden? I see the reflection of our naked bodies outlined by the summer foliage of the window in the protective glass of a sketch of the Duomo and Santa Spirito in Florence. I barely recognize myself. I have a hard time turning away from the reflection.
When I roll her on top of me, I’m surprised at my strength. This, I think, was the first time that I noticed a tangible difference in my abilities since I started going to the gym. I seem to hold her high in the room and I’m grateful I don’t have a ceiling fan above my bed. Afterwards, we’re both shining with sweat, but I’m not breathless.
‘Cool,’ I remember thinking. She begins to get dressed, a bit late for work. I kiss her goodbye and head back to bed to take a nap.
When I wake up, I check my messages. Chicago’s called to say that he wants to meet me late in the evening, and Birmingham called saying he went fishing and wants to join me for a couple of beers in the early evening.
I throw a couple eggs, a cup of milk, and a fist full of strawberries into the blender and drink it while watching Bad Lieutenant and then go back to sleep.
When I wake up, the night is cloudless and bright. I walk to the bar under the stars. I look up at the milky way and think about A Zed and Two Naughts and how many billions of years of astronomical arrangement and millions of years of biological evolution has been undertaken, all so I could experience this day, this evening’s walk.
‘It’s all been leading up to this,’ I say out loud, into the night.
I get to the bar and see Birmingham with his friends. When he sees me he shouts, ‘hey there, buddy!’
I laugh and join them. He throws his arm around my shoulder in such a way that no one thinks about it but me. They pour me a beer and everyone is shouting and having fun with mock bravado. Around nine, a few of his friends head home to help put their kids to bed. Birmingham takes this opportunity to drive me home.
I’m walking to the fridge to get us some beer when he jabs me in the side. I grab his wrist and spin, twisting his arm slightly. I still have hold of his wrist when I see his smiling face. I relax my grasp.
‘You want,’ I say, smiling, letting go, and taking a step back, hands open and at my sides, ‘ some of this?’
We take it outside, take off our shirts and begin wrestling in the backyard. He easily has twenty pounds on me, but I hold my own.
‘You’re pretty wily,’ he says, after I escape from a hold.
‘I grew up in Iowa,’ I say, ‘you’re not going to pin me unless I let you.’
He attempts again, and tries to roll my face onto the ground.
‘Not the face!’ I shout. Thinking of the difficulty of explaining a black eye at work.
‘Will you let me?’ he whispers, not relaxing his grip, and we head inside. We’re both filthy, mud on our skin and leaves in our hair, and we jump into the shower together.
By 11:30 Birmingham has returned to his friends at the bar and I head to the bar where I met Chicago. Chicago’s already there and our faces light up when we see each other. We drink shots to ourselves and talk about music we love.
By 2 am, we are lit and laughing and allowing our hands to rest on each other’s shoulders or touching each other’s knees for emphasis as we tell stories. We make the short trip back to my home safely and things get a little foggy.
Things that I remember: him looking over my wall of CD’s and grabbing Joe Jackson’s Body and Soul, my pouring Myers rum into the leftover limeade from Monday. Things I don’t remember: how all that broken glass ended up in the bathroom and what happened to the light fixture above my bed.
At some point before dawn, we were both in my backyard in our boxer shorts, him smoking, me telling some ridiculous story. When we went back in, I remember standing behind him and thumbing his waistband and bringing his shorts down. I took hold of his neck and pulled his back into my chest and held his ear to my mouth. I was drunk and was trying not to breathe hard, but I knew that I was. When I reached around his waist and pulled it closer to me, he—also breathless—said the words that formed the pinnacle of my summer, perhaps the pinnacle of a man’s life:
‘I feel like I could listen to you talk forever,’ he said, ‘plus,’ he added, importantly, ‘you know how to fuck.’
In the morning, my alarm clock starts playing Berlioz’s Rêveries, I wake and quickly prepare for work, leaving him in my bed.
Can you feel it then? Is it palpable? This is me on top of the world: falling in love with people who are falling in love with me. Excelling at my job and being recognized for it. Living a dream in all its glory.
You can hear the ratcheting as I rise and rise up and up and up. You’re there with me, aren’t you?
Looking out, seeing the ground fall away as you rise higher and higher, at first feeling ten feet tall, then you’re in the branches, then over the trees and seeing more distant buildings, then over the rooftops, and you’re looking out—out over everything and taking in the horizon. The very earth feels beneath you. Maybe its sunset and you’re seeing all the oranges and purples in the sky. It’s beautiful.
That’s when the sound of the ratcheting curiously changes. You can feel yourself disengage from the chain, and you feel a premonition somewhere near your umbilicus. It’s then that you realize you are at the pinnicle of a rollercoaster, and it’s a long, long way down…
