Man's 4th Best Hospital, page 31
I tried to hide my surprise. A coincidence or something more? “Oh?”
“Yeah. Angel—I’ve kept in touch with her and Runt—she told me that you guys were hiring, getting really swamped, and the Fat Man wanted gender parity. I’ve heard only good things—and who wouldn’t want to work with Fats?”
“Why, no one wouldn’t, darlin’,” I said in Quick’s accent. “No one wouldn’t a’tall.”
She laughed. As people age, their laughs never change. I loved that girlish trickle.
“I’m a nurse practioner now. Got my degree at Yale.”
“Wonderful! When do you start with us?”
“Monday, and—”
“Hi there, you lovebirds.” A familiar voice. “Quite nice to see you together again!”
“Angel?!”
“And my dear, lovable old Runt,” Angel said smoothly, with neither pause nor gesture.
The Runt paused and gestured, pointing to his raised finger. “That’s”—pointing to his heart—“me!” He was wide-eyed and smiling. Not wearing his bike helmet.
So now she’s fluent with both us and Runt? And now he’s paralyzed in gesture talk?
“Angel,” I said, “you look terrific! And your speech is literally gorgeous. Why?”
“I’m pregnant! Finally!”
“Wow! Congrats!” I looked at Runt, who tried to speak but stopped, gestured an affirmation, much like Angel had always done. They were ecstatic. I felt really happy for them and asked Molly if she’d like a drink and she said, “I don’t drink, remember?” and I said, “Still?” I retrieved my own bottle of George Dickel Sippin’ Whiskey from the bar and got another two beers for chasers. We chatted about how great it was that Angel’s soul sister, Molly, would start Monday.
She had come to the party with Angel and Runt, so I offered to drive her home. It was a great condo in the suburbs and, well, we kissed as we always had and I felt in it that wonderful sense that the woman was melting like her lips were melting soft into mine and as if no time had passed we went into the bedroom—no longer a “little girl” bedroom with fluffy toy bears and bunnies from those years ago but a, well, grown-up-licensed-nurse-practitioner bedroom all order and big-screen desktop that made me realize how far she’d come and how much older we’d gotten and we kissed some more on the bed and I unbuttoned her blouse and unhooked her bra and I was astonished at how Toni and Sue had maintained and as I reached up between her legs she caught her breath and said:
“Nope.”
“What? Why nope?”
“We have to talk.”
“Right now? Can’t it wait about fifteen—”
“Nope. Talk.”
“About what?”
“About what happened.”
“Oh. Okay.” I tried to catch my breath and focus, detumesce. “It was simple. You TURFED me. Left me for that idiot Howie Greenstein or whatever his last name was.”
“I married him.”
“Did you love him?”
“Somewhat.”
“He was dull as dirt.”
“After you, I needed dull. I loved his not being crazy, and, frankly, at the time I was kind of interested in cystic kidney disease—he was impressive on that. He had promise.”
“He was on prescription drugs—did you know that?” She seemed shocked. “On tranqs of all kinds, all year long.”
“So? He had promise. And you had . . .” She paused. “You had Berry.”
“Wait a sec. She and I were free to see other people.”
“Anyway, you were crazy, and I didn’t think you’d even live through the year.”
“Me too.”
“You had a big effect on me, Roy, but you were so bitter. I was getting bitter too. It’s one reason I ditched you. But there were two final reasons—in addition to your being crazy and bitter. One time, after one great night of sex, and it was great sex—I give you that.”
“Tonight?”
“I asked you, ‘If I get pregnant, will you marry me?’ You looked as if you’d been shot. And you said, ‘You’ve got an IUD,’ and I said, ‘Yeah, but it can still happen,’ and you without even thinking about it said no.” She was staring at me as if I’d committed a crime.
“Sorry. I guess I was really shocked by the idea of marriage, not to whom.”
“Maybe, but I heard it being about me.”
“What was the second reason?”
“Again, after great sex, I asked you a few questions about the other woman you were seeing. You were evasive. Finally, I asked, ‘What’s her name?’ Remember that?”
“Hmm . . . Yeah, I do, yeah. There was something about that—”
“You said, ‘Berry.’ And in the way you said it, I knew that you really loved her.” She nodded. “I was in a crucial place in my therapy, and my therapist said I was replaying my Electra complex.”
Shit. My love life crunched by a jerk psychoanalyst. “You didn’t go to Runt, did you?”
“Nope.” We stared at each other, grown-ups now. “I did fall in love with you, Roy, but you were too angry for me. And when the book came out, I got really angry at you.”
“For including you?”
“For not using my real name! You used Angel’s real name. She told everybody, ‘How can he do that to me?!’ but was proud of it. Why didn’t you use mine?”
“Out of respect, not wanting to hurt your feelings.”
“Oh, so you felt guilty, and were mollifying me?!”
“Molly-fying Molly! Tell you what. In the new novel I will.” She smiled. Touching her inner thigh, the most incredibly smooth skin anywhere, I said, “I’m not angry anymore.”
“But you’re married. It’s over. I’m incredibly into you—really, um, wet—oops, I shouldn’t’ve told you that—but you’re with her now, and—”
“I was with her at the end of the House year, but it didn’t matter then, remember?” She shook her head. “That night, both of us on call at Four North, you getting off shift. I said, ‘Come sleep with me in Kirstein,’ and you said, ‘It’s illegal’ and I said, ‘It’s illicit,’ and—hey—it was amazing! When you sat on me in the bottom bunk and grabbed the box spring of the top bunk, you said, ‘This is like making love on a night train across Europe!’”
“Oh my God, I forgot all about that. Oh, God, that was so good.”
I bent toward her and, caressing her nipples, kissed her, and she responded. I slipped my palm farther up the smoothness of her thigh, and she pushed it away and said, “Nope.”
“Yes!”
“Nope.”
Feeling like an abuser might feel, I sobered up enough to stop, soften, talk for a while, go. Feet feeling way far away from body and sounding loud on the chill brick street as I searched endlessly for where the hell my car had gone, I stumbled to one knee, ripping a hole in my pants. Kneeling there, I took a few breaths and, as if in prayer to the God of Big Things, looked up and whispered, “Thanks.”
20
Money.
Like sharks scenting blood, the bills started to circle and bite.
Fear of going broke for me is a bad fear, like fear of getting sick or dead or worse—stroked out. Every month I had to come up with an extra 6,000 dollars just to stay even. In April, I was going to get killed with quarterly bills and taxes, almost 30,000 dollars.
Now, with a family and a big mortgage, I was scared shitless.
All of us at the FMC were close to hitting an upper limit of patients. Why? Our reputation of being human had gotten around; the cash crisis in BUDDIES and the revved-up turnover because of TOSS; and all the new patients abandoned by their docs who’d joined Ruby Red Rose Carpet Concierge at the Kissy-Saud. It was a huge stress that had us all racing around, cutting things short, seeing patients outside our comfort zones, missing lunches, getting irritated with one another.
Fearful, frantic for cash, I found work on night shifts in Emergency wards all up and down the coast, deep into the dire suburbs, and even all the way into Massachusetts.
My shifts were seven at night to seven in the morning. The pay was great—1,200 dollars a shift. I took as much work as I could. Luckily in my training at the Chinle clinic, I’d handled bad disease, drunken brawls, gunshots, knifings, car crashes, and obstetrics emergencies. I could handle just about anything that came through the EW doors. Exept car crashes and multiple gunplay—stuff that, if I got advance call from the ambulance barreling toward me, I could page the on-call surgeon about, stabilize the blood and the guts and the heart and the brain as best I could—shoving things here and there, tying off bleeders, in some sense of redeemed bodily order. I loved more than anything the arrival of a surgeon. I would assist when he or she came in.
On my first moonlighting night, a one-year-old who’d fallen and had a laceration beneath the eyebrow was brought in by his mom. I had a hard time at first—maybe because, in that baby, I could see Spring.
I strapped him down to a “papoose” board to keep him from squirming and, taking the smallest suture needle, started toward the eye. The baby was screaming louder than any other baby in human history, face red, and with superbaby strength he wrenched his head away. The mother screamed, the nurse shouted at her to “please go away,” and as the nurse held the head, I made a second approach. The sharp tip of the needle wavered above that eye and I said to myself, Whatever you do, Basch, do not stick this needle in that eye, and my years in the House and Chinle clicked in so my hand was robot steady, and three quick sutures later, it was done.
I checked the baby out with a helpful acronym to assess facial health I had learned at the BMS: TEON. Two Eyes One Nose.
It was a strange world. I was totally in charge, the only doctor in the EW, and often the only doc in the hospital.
A few of these hospitals were enclaves of the rich, with espresso machines and nice clean sheets on the on-call bed, and not all that busy—valid emergencies of articulate people accompanied by worried family members.
But most others were in severely neglected cities of the poor with, at best, wounded, dented vending machines dispensing sugar-soaked soda and pancreas-testing Ring Dings and Korn Kurls. Often there was no on-call room to sleep in. Once I slept in an operating room on a hard upholstered gynecology table, feet up in the stirrups. That night, I never slept more than ten minutes at a time, because the EW had the city’s only night doctor for poor people, with really badass chronic diseases of multiple organ systems in fierce acute decay: alcohol, drugs, and the resultant guns, knives, cleavers, and even, once, a ritual Nepalese ice ax. As opposed to the surburbans, the poor often came in alone, or with police. I was their only care. Often after a shift, I was ashamed that I hadn’t been all that nice.
Most wrenching are gunshots known as “talk and dies.” Especially the young. One moment they’ll be talking to you clearly as you assess the bullet’s damage, and then they die.
After one particularly gruesome gun death, I asked the on-call trauma surgeon who had tried and failed to save the kid, “How do you keep on doing this?” And she said, “The day you don’t cry is the day you should quit.”
And yet I was startled to find, in the midst of the carnage and suffering, moments of goodness, if not grace. At one of the worst inner-city emergency wards that was the only chance for the poor to get care, but so understaffed that nonemergency patients had to wait at least two hours to see a doctor, many patients when they finally saw me were really angry. It was understandable. I can’t say I handled these interactions well. But I noticed that the head night nurse never lost her cool or even showed a sharp edge. Terry Malick was about 40, thin, and fit, with strawberry red hair and blue eyes that were vigilant but not hardened. She had worked there for decades. I was amazed at how, in the chaos, she was calm, steady, even kind. When I left, totally frazzled, I asked her how she kept working in a place like this, often on night shift, with such, well, what Berry called “equipoise.”
“I wouldn’t work anywhere else,” Terry said. “Yeah, it’s a bitch, mostly. But we’re a real team—lifers, many of us girls. Sometimes a person, when they’re finally seen, starts off by giving you the finger and a ‘Fuck you!’ But then, if you take care of them, when they leave, they give you a hug.”
I hated the exhaustion. Caffeine, nicotine, and alcohol couldn’t cut it. If the day before I’d been at the FMC, then up late on Ward 34 or with Spring and Berry or at a party (though I soon cut out all social life), and then worked the next full day, then drove an hour to an EW and didn’t sleep on that shift? I’d be totally wiped out on my dawn drive to the morning check-in. After one of these long, sleepless stretches, driving back from the boondocks, trying to keep my eyes open as they repeatedly closed, the radio on full blast, the window open to freezing, I suddenly heard not rock and roll but scratching, grinding sounds and opened my eyes to see I was moving fast toward a row of bushes and then trees and whirled the steering wheel left and fishtailed back onto the shoulder of the road and stopped.
Drenched with sweat. Trying to breathe.
On adrenaline, I drove to my ten-hour shift at the FMC and, that night, Ward 34.
* * *
One evening during my crazed do-or-die, take-care-of-your-family moneymaking, I was at home in a wired-up, exhausted-down state—with an assiduous titration of caffeine and bourbon. I sat at dinner with Berry and Spring and, under the table, Cinny, he hoping against hope, Just this one time, God of Dogs, make an exception and slip me some table scraps!—and Olive the Destroyer, gnawing her steel cage. It was a birthday celebration with old friends, the Robbs. Christine I’d known at Oxford, a Pulitzer Prize–winning journalist at the city paper who’d introduced us to the Register Star investigative team.
Since none of us adults had time to cook, we’d gone crazy with a serious load of takeout from Tienja Dong Garden—specializing in heavy, greasy, salty Chinese. As we sat talking, all of a sudden I felt a sense of dread—something was badly wrong in my body, in the region of the heart. I put my finger on my radial pulse. It was fast, wildly irregular. The dread turned to impending doom. The clammy sweat of terror.
My father’s heart attack. I’m gonna die. Wait. Be a doc. Assess.
Abnormal pulses can be regular or irregular. If irregular, a lot of them can be regularly irregular. There is really only one that is irregularly irregular, and this was it. Atrial fibrillation. Diaphoresis—the clammy sweat of terror. Leading to an MI?
“Um,” I said, “Berry?”
“What’s wrong?”
Not wanting Spring to hear, I said, “C’mon. Let’s talk.”
In the hallway, I said, “I’m in atrial fibrillation. We’d better go to Emergency.”
“Oh my God, is it serious?”
“Dunno. That’s why we’re going. Don’t tell Spring why or where. Ask Bill and Chris if they can stay with her for a while.”
Nothing like this had happened to me before, and Berry was as scared as I. On the way in to the Robert Grossman Hospital, named after the only creative dean ever at the BMS, I called my local doc and pal from the House year, Bob Press. He said he’d get a cardiologist to come in.
Luckily, the EW wasn’t busy. But after my vitals were taken, I sat with Berry, waiting. And waiting. Thinking clot, and then stroke, and then gomerhood.
But I had learned that if I—or any of my family—go to a doctor, it’s helpful to say I’m a doctor, and when they ask what kind, I tell them and then ask, “Have you heard of the novel The House of God?” Almost always they perk up and say, “Oh yeah, it’s my favorite book!” “Well, I wrote it.” Their responses range from “Really?” to, with a suspicious look, “No, you didn’t.” I did. “No, you didn’t—you can’t have—that was written by Shem, and you’re Basch.” I say it’s a pen name, and offer a card with both names. And then the word spreads throughout the EW, and we all get a lot of attention. Docs and nurses crowd the room, want to chat, almost always telling me where they were when they’d read my novel.
I play this card shamelessly. It got us of the family Basch good care. And it worked that night.
The EKG and the monitor showed atrial fibrillation. Bob Press arrived, with the cardiologist, a kind-looking, bearded, shy guy named Steve Abramson. They stayed, supervising the attempts with meds to convert me to NSR—Normal Sinus Rhythm. I watched as if from a distance, focused on the sound from the heart monitor. Wild jazz riffs of the randomly random:
Beep . . . beepbeepbeep . . . beepeebeep. . . . . . . beep . . . bbbbeeeeeeep! . . . b . . . eee . . . BEEEEP!
I tried to calm down, and performed all the ways to stimulate the vagus nerve. Nothing worked. I feared death or having to go through cardioversion—the docs putting me under and shocking the heart, stopping it. And then waiting—hoping!—it will decide to start up again on its own, and reset into NSR. Press chatted for a while and left.
After three hours, nothing. My heart was drunkenly rumbling along at 150 like a ganja-high steel band. Was I imagining a tightness in my throat? Angina, the sign of coronary insufficiency, maybe heading toward an MI? Being a patient, I suddenly felt the whole package of dealing with doctors, waiting, hoping, fearing, left alone on a gurney. Being a doctor, I felt bad that mostly, lately, with patients I had not been terribly nice.
At eleven, change of shift, Dr. Abramson said, “Your signs are stable. I don’t want to cardiovert you—how ’bout we TURF you upstairs, under the care of the resident on call for the night?”
The thought of being at the mercy of the resident upstairs shocked me, and I felt something go BANG!
Normal Sinus Rhythm. Beep . . . Beep . . . Beep . . . etc.
The cardiologist and I looked at the screen. It lasted.
“Thanks, Steve, but I’m out of here.”
“Wait. You need some meds. The one thing you do not want is a clot and a stroke and winding up locked into paralysis and silence. And you should do a twenty-four-hour heart monitor, echocardiagram, and—”
