It was a cliché: doctors’ exams escalating to full-blown sex, the murmured questions and soft touches that got more searching and finally obscene. I wanted to be the kind of woman who explored porn, but I wasn’t, really, so my notion of vast video shelves featuring white coats and stethoscopes swinging over infirm but rapturous pussies was unverified. I didn’t care to sound Gordon’s familiarity with the subject. Still, we had slept together for the first time six hours after I had auscultated and percussed his lung fields, and thus, for me, some sort of ur-porn idea lingered behind all our subsequent encounters.
No therapeutic alliances were abused: we were both medical students. The chief resident had told a roomful of us to pulm-exam one another, and sweet, upright Gordon had immediately pulled off his shirt so he’d be easier to percuss. It turned out he had tremendous shoulders, the divot between his traps and lats gouging his spine before sweeping down to a high, buttercream—I was, at that moment, extrapolating—ass. I typically came on to urbane, which is to say gristly, men. My most recent ex, Zane, was approximately ninety-eight percent cartilage.
“No consolidation, no effusions,” I said. “Wanna tap me?” Lightly, very lightly. Luckily Gordon was deaf to terrible puns, but he had been intrigued when I mentioned a biker-predominant bar a few miles outside town, and that evening we proceeded to get stinking drunk. Two rounds in, I had eaten a few of the hot wings he had ordered for me, too embarrassed or delirious to demur; two rounds later I confessed to vegetarianism and he got hoarse and snuffly—I hadn’t seen an actual tear, but the bar was dim—telling me he was sorry if he’d been a bully and a creep and that I should eat whatever I wanted, whenever I wanted it. I think it was bafflement that made me take his wrist and kiss it, and then it had just been one more round and two nearly-not-closed-out tabs before we were sloshing around my apartment. I assured him that despite my present tipsiness, my sober self would definitely be consenting to this just as heartily. He didn’t think this was funny. He got over it.
Now we worked on different rotation teams—me in GI, him in emergency— and had been seeing each other for over a month. It was epiphanic, dating someone just because he was good-looking. At night, the inner mantra that ran through my head when I was getting turned on was “what a happy little whore you are.” Neither of those words figures largely in my audible vocabulary. And, to be fair, he was good at other things—knew his way around a farmers’ market, cared about European soccer clubs, emailed obscure suggestions every week to the college radio’s garage-and-punk hour. I was seven years older, but that wouldn’t actually matter unless we went long-haul, which seemed about as likely as my becoming Surgeon General. And being old was my secret power. I’d given head, to coin a phrase, more times than most of my classmates had French-braided their hair.
One night Gordon was in my kitchen making chickpea tagine when I came home. His pretext: I had incidentally washed a few of his shirts and boxers while doing my own laundry, and he didn’t want me to feel forever slotted into traditional woman-chores. Also I never lock the door, so we had been spared a blushing conversation about keys. I sniffed from the doorway. The tomatoes were a little high in the mix, I thought, but then I hadn’t been cooked for in a while. Maybe this was how food smelled ten yards from the stove.
“Placed my first Foley cath today,” I said. “Did you know where the female urethra opens? I don’t think I was ever a hundred percent sure in, like, a visuospatial way. I’ve never watched myself pee.”
I pecked him and grabbed a sack of pita off the counter to arrange in a bowl in the dining room.
“Maybe they would be nice in, like, sixths?” he called out. I started tearing the pita into pie-like crumbling wedges and he brought me a knife and a cutting board. Then he was back to the kitchen. Lippy sound of fridge opening. Automatically I inventoried the fuzzy cheese-nubs, expired condiments, and three veggie wraps I’d stolen from pediatric grand rounds earlier in the week. He came back with stacks of Tupperware I didn’t know I had.
“So, here we’ve got some hummus, some cucumber salad, and a little pilafy thing.”
“How long did this take you?” I was not one for strenuous acts of charm. It felt wrong, too, to leave him unsupervised for hours among the artifacts of old-me: Zane’s abandoned paperbacks, a few shapeless sweaters we had kept because they fit—or didn’t not fit—us both.
“Sorry, it’s a little overboard, huh?” He looked hurt that I hadn’t led with a compliment.
“It’s amazing. I just don’t know how we’re going to eat all this, and have extensive sex in the wake of our food comas.”
He brought out the tagine and we dug in. The boy could cook. He laughed when I mimed taking a picture of it and furiously air-texting on my air-phone. As the sauce and two-buck chuck settled in heavy, though, I started to wonder whether an evening alone with a few Friday Night Lights reruns might actually be preferable to the next phase of the joie-de-vivre fest.
“You know who would really love this,” I said. He looked up. “Masha.” Masha was my friend in the French department, a PhD student who had turned up at the same fossils-divestment vigil I’d once attended when I was feeling particularly dirty about my week of unnecessary printouts and long drives to DSW to walk among hundreds of perfect shoes. I had stayed until the last tea lights burned down to sooty pogs just to meet the only other woman there who looked, as I did, like a poorly disguised cop arranging a drug sting in a freshman dorm: slightly thinning hair, figure-unflattering messenger bag, sack lunch crumpled in hand. Now we texted each other little updates and mock-jeremiads in the predawn, when I was walking to work and she was putting her George Sand dissertation to bed for the night.
“She lives on ramen and freezer pizza,” I went on. “She probably hasn’t seen a recognizable vegetable in weeks.”
“Uh . . . so?”
“Let’s just call and see if she wants to make herself a little plate while it’s still warm.” I knew he didn’t like this much, but he might attribute it to some automated generosity-reflex rather than a dodge.
He busied himself inspecting his shirt for streaks of parsley and flour. “If that’s what you want.”
I called her, then pulled Gordon onto the couch for a bit of directionless nuzzling. Masha lived in one of the cinderblock “cottages” on my street that dominated Southern university real estate. She arrived a few minutes later with Klaus, her blue heeler. Klaus sat with us on the couch and chewed a few flashcards while we watched Masha eat.
“So what’s happening when you’re not saving lives?” she asked Gordon.
“I guess the rest of the time I’m reading textbooks on how to save additional lives.”
“And for fun?”
“Journal articles, main focus: life-saving. No, actually Ultimate season is starting up again, grad student league. We’ve got a tournament in Baltimore next weekend, so we’re practicing whenever a few of us have the same day off.”
“That can’t be often.”
“No, we’re terrible.” He shrugged. “We do have awesome uniforms our captain’s mom donated. Sort of Star Trek Lego Man.”
“Ugh. Do you remember back when Legos weren’t so gendered and narrativized?”
“Not really, no.”
“They used to be so open-ended. The story could just be about building things. Or not even building. Shaping things.”
“Sorry I missed out,” he said with the faintest bow of the head. He could have been a court page telling Queen Elizabeth her seventy-year-old boobs were still like unto pearls of the Orient. “Are you doing something more, uh, open-ended, then?”
“I’m writing this thing about Eric Rohmer movies. Like, how people manage to make decisions when there’s no deadline and no consequences? Solution pending, since I have no deadline or consequences until someone likes my pitch.”
“And for fun?”
“Yeah, that’s the fun stuff. That and fighting back against the summer negroni craze. I’m thinking about an app that will tell people that they’re in a store that sells Campari so they have the option of boycotting that store.”
“Isn’t that all liquor stores?”
“For now, yes. Once the movement gets going, no.”
Gordon gave me a look that said joking or stupid? that I pretended not to see, burying my head in the shallows below his collarbone.
“Aw, sleepy girl. Tuck yourself in and I’ll start on dishes.”
“No, no. I need to do at least half of those. Let’s meet up for a run in the morning and then we can clean up together.” I made a very slightly exaggerated yawn. “You need a night alone?” I could see him mastering testiness. He was going to be an excellent doctor. I gave a wet apologetic “errrrmm” in his shoulder.
“Thanks for letting me crash, guys,” said Masha. “Gordon, you’re a swell cook. Who knew?”
Gordon kissed me hard on the front steps and told me to be a good girl. “Within reason,” I replied. In my floppy Ikea bed I got my full night’s sleep and my gooey-hearted tv drama fix. By the next day I was back to my new baseline self and Gordon and I did business in, most notably, an armpit and a utility closet. I wanted to make an Arm & Hammer joke when we finished but couldn’t quite work it out. Around dusk we took a break, and I walked past Klaus and Masha on their neighborhood loop.
“So things are good with Viking man-child?” she asked.
She cocked her head. “I’ve seen garden gnomes more enthused.”
“I’m excited! Excited in the moment. It gets a little harder to reconstruct after.”
“Fine.” She tugged Klaus and started trotting up the hill again. “Don’t be a pregnant stranger!” she called over her shoulder.
I was joining the on-call resident the following day, so I wore my dingiest, sk8r-grl scrubs, pockets stuffed with nuts, apple chips, and a topped-up iPod. Probably I could have packed a joint and a cheese plate—many of the attendings were only minimally aware of students’ existence, trying to finish rounds as quickly as possible and get back to their swim clubs or Sunday New York Times. One of the hepatologists had a nine-year-old girl in a softball uniform trailing behind her, watching cartoons on an iPad and crashing into med carts and oxygen tanks. When rounds were over I holed up in the resident workroom for chart notes.
I stared at my half-finished note for T Sprague, 63yM. A lot of cirrhosis cases were the same story: patient gets delirious from toxins unprocessed by the liver, you coax the bowels into shitting more toxins, patient gets a little better and goes home. Or lungs get boggy from fluid that can’t flow through the liver, you coax the kidneys to pee it out, patient gets a little better, home. No feats of daring, no hairpin turns. Just steady as she goes, until a transplant came or it didn’t. Every day I was more and more tempted to make up my physical exam notes, since in all likelihood the patient was faring about the same as the day before, maybe five or ten percent better if he was a fighter.
When I was little I wanted to be a priest, being Catholic and slightly more rule-oriented at the time than most of my squirming pewmates. I liked the idea of laying my oil-or water-dipped hands on rows of foreheads and bestowing a runny streak of my own soul on congregants. Jesus’ soul too, of course, but since he was in all of us, I could just hand out bits of me and it would come to the same thing, right? Naturally I’d cap it with a few short paragraphs of rousing oratory, which I would have fun writing on one of the beautiful old rectory typewriters that smelled of toast crumbling under the keys. A pope or two came and went and didn’t exactly jump on the lady-priest idea, which was just as well since I had hit my teens, discovered Anne Sexton and Liz Phair, and wanted to write long, disgusting lyrical ballads about fucking and poorly-dosed drugs. So priesthood was tabled through my teens and twenties, until I got downsized at Teen Wall Street Journal (kidding, but it was almost that bad) and a college roommate-turned-pediatrician suggested I try one of those post-baccalaureate programs that turns former corporate lawyers and consultants to—finally!—productive members of society as doctors, nurses, and social workers. In medical school you would lay your magic hands on new acolytes and the healing would begin. Washed in the blood of the lab.
Which is to say, I was on call the entire day anyway, and there was no reason not to check in personally on Mr. Sprague and his cirrhosis unless I had truly recidivated. I’d be the good little shepherdess today.
In Sprague’s dimmed room, a nurse was waving a bar code scanner over his IV bags. She turned and gave me a tiny, tight wave that told me not to wake him if I didn’t have to. He was slumped into the angle of his inclined bed and his skin had the weird dewy varnish of the hospital’s no-water-needed bathing towelettes. I checked the lines in his arms, the tube draining fluid between his ribs, and the Foley draining urine to a bag at the foot of his bed. Nothing inflamed, no pus around the punctured skin or the lines themselves.
Patients with truly tanking livers develop cadaveric breath that can make the entire room intolerable. As I leaned over Mr. Sprague, though, his sleeping gasps smelled only of the half-devoured package of Starbursts on his plastic tray. The gaudy candies were spilled over a paperback of Coetzee’s Slow Man. Sprague, a reader, maybe a self-deprecator. Those ridiculous kiddie sweets.
It’s a fact that on the aggregate, patients who are rich, or white, or have advanced degrees, all get slightly more attention in hospitals than the rest, and maybe for some doctors it’s because those patients look and act a little more like their bosses or spouses, or maybe it’s the sweet reimbursements of Cadillac insurance. As for me, I knew—and loathed myself for it—that I would probably always be a better doctor to patients who seemed smart in the narrow way I knew how to recognize and salute. A book in the room, a certain wryness injected into the ritual of the medical interview, maybe a stylish tchotchke on the windowsill to mock the supposedly soothing dollhouse pastels of the hospital, any of these snared me. I would keep a close eye on this guy.
And may there be—well, I know there are—many more doctors smitten by coweyed farmers and the tough semi-literates who wear their hearts on tattoo sleeves. And may I not be damned until God himself has given medical training a whirl.
Mr. Sprague flinched in his sleep when I slipped the cold stethoscope bell under the V-neck of his gown. You were supposed to repeat the phrase “ape to man, ape to man” as you listened to four spots on the chest, reminding yourself which heart chamber you grazed above: aortic, pulmonic, tricuspid, mitral. The four chambers knocked back at me, a whoosh between knocks signaling that one valve was unable to shut, wheezing on its hinge like an old door’s swollen wood. Hardy ape to fairly helpless man.
At home the image of Mr. Sprague, by now filled out to include an apartment lined with built-in shelves, called up the shades of all my old friends asleep under New York skies. Taylor the paralegal/food blogger, Ian the comedian. Mishy and Jon, math tutor racketeers. Timor mortis conturbat me. Most indelibly, catastrophic Zane, of the corncob teeth and the smallish but persistent Jack Russell of a cock. I had met Zane before enrolling in the postbac, during a year of graveyard-shift magazine blogging when I wrote breezy ephemera for people to read on their phones the next morning. I got third-string personalities to listen to James Taylor and Taylor Swift albums back to back and compose automatic-writing compare/ contrast prose poems. I told people which shoe they would be, if reincarnated as such, based on how they handled credit card debt and how they cooked their eggs. I took pride in my Gumby-like powers to stretch and stoop, if nothing else. When a launch party threw me in drinking proximity to a few kindred hustlers who were starting a Flaubert book club, though, I signed on in haste, hoping a few prodigal IQ points might come humbly home.
At meetings in crammed living rooms, Zane had my same malformed impulse control: we leapt and crawled over other commentaries, cutting people off, interrupting each other with phrases that butted and jagged in a spiny pile. We stayed out together afterward to continue bickering, and soon we were dating and happily exiled from book club. Even his black moods and days of utter disappearance lent charm to my routine of filing deadlines and, later, postbac exams in chemistry and statistics.
We decided to go for it as real common-law whatnots—not the “m” word, but something a little more current. We were a team. Zane came to visit one weekend a month during my first year of med school, then quit his fact-checking job to move South and live hangdog with me while “writing” a “book,” i.e. reading Pitchfork and New York Magazine and devising fantasy sports rosters.
Best ideas don’t happen on schedule. Maybe if I had let him futz around another couple months, chapters, like mudpuppies, would have begun wriggling out from the morass of his laptop. But he was slowly taking on the contours of a cardboard box left outside: drooped and lumping each rain, then firming up again, but a little less functional each comeback. Finally there were shit-and mold-streaks permanently frescoed in the bowl of the toilet, glass bottles and microwave popcorn-bags amassing in the bedroom, and, when I peeked at his desk from time to time, hundreds of unread emails and a word count frozen in place. After a couple hints and a particularly unsubtle incident involving a human-shield move between him and a Pabst 6-pack, he moved to the other end of town for a brief effort at détente, then left entirely.
Masha had kept in touch with him but counseled me to direct my romantic attentions elsewhere, loaning me a little purple book her mom gave her on “love languages.” It argued that there were lots of great mates out there: some of them would love you by changing the oil in your car; some by taking wistful black-and-white photos of you whenever you looked natural and beautiful, which for them would be most days; some by paying your loans or letting you occasionally fuck their friends. On nostalgic days, though, I only wanted to hear his language, complaining about the sorry state of the arts in small-town America, which was loving because it assumed I knew exactly how he felt. His language, telling me to skip my hospital shift because he needed my body that morning. Anyone who wanted me enough to throw sick people under the bus was definitely speaking from the language of love. Whatever Gordon’s language, he was always the first out of bed.
I was too proud to ask Masha about Zane directly, but I set about keeping tabs on him in what I assume are the usual ways: I made an OKCupid profile posing as an editorial assistant in Brooklyn, then waited to see whether he would ever pop up as a suggested match for skinny, Borges-loving “Claudia.” I bookmarked his Facebook page, but not much happened there unless he was forced into field of view by a wedding reception. By now, six months broken up, my lap around the internet was smoothed into mindless habit, the way I automatically stole pens from restaurant check-holders and nudged at zits in the bathroom mirror. I had hoped to draw his attention by publishing my incisive poems in some of the thinkier magazines, but no editor was buying my Marcia-Angell-with-linebreaks shtick, and some of my submissions were getting rejected the same day I sent them in, making me suspect that all the good periodicals were staffed by my former lab partners and lacrosse teammates. Fuck the haters, maybe, but sometimes I get the hunch that the haters have all the cool stuff on lock.
During my next long on-call day, I set about trying to crack the Sprague case. As a student on clerkship, you got a special pat on the head for discovering something important about a patient that your residents had failed to find—an old note about a forgotten drug allergy, a bit of family history that helped explain the patient’s current crisis. Unfortunately, such unearthings demanded a stop-and-frisk approach: you needed an inordinate number of charts and an inquisitorial relish to have any chance of finding juicy evidence.
I was going to try the opposite tack: if I focused completely on Sprague, I’d see something my harried superiors hadn’t. I began to scroll. It’s an odd feature of HIPAA confidentiality law that you are barred from seeking out anything about a patient not your own, including whether the person has ever been to the hospital at all. As soon as a patient belongs to you or your team, however, nothing in their record is too tangential or mortifying to forbid your scrutiny. I browsed his history of nail fungus, his migraines and the light-show auras that preceded them. Nothing we didn’t already know about his drinking problem, though, or any reason to suspect he might have had a virus or a genetic disease compounding the self-inflicted damage. Still, I couldn’t stop looking. He seemed to keep worrying about his prostate but kept deferring a PSA test. He was on his wife’s insurance plan and then he wasn’t. He phoned a nurse three times in May and then never again. At this point I was just being a creep—a legal creep—but I couldn’t quite close the window. Finally it was time for afternoon case conference and I logged off unsatisfied. I saw two new texts from Masha—“done because we are too menny. ugh.” and then three hours later, “no dead kiddos. but srsly shitty day. talk soon?” I typed “soon as I can, sorry” and jogged off to conference. The tabloidy grime of chart-trawling sat like a film on my hands.
Gordon and I crossed in the stairwell. By chance we had picked nearly identical baggy, androgynous green-gray scrubs. Together we looked like defectors from the decadent West to somebody else’s cultural revolution. People who, after a brief period of sanctioned carousing, had hit that mid-dictatorship slump. Selfless labor, greaseless foods, pregnancy-oriented sex.
“What’s likeable about me?” I asked, resolving in that instant to break things off if he said something about shared ideals.
“You’re a pretty good dancer. You’re smart. Brain so big you can see it from the front.” He kissed me.
“My fat brain, huh?” I was swaying against the banister in relief. He knew me at least a little, then.
“What’s eating you?”
“Sorry, I had a momentary hallucination that you wanted a really upstanding person or something. And I’m not sure I can be that.”
He squinched his eyebrows. “Just stand up as much as you usually do. The way you are is fine.”
“Sorry. Case report now. Nap à deux post-call?”
Stepping into the conference room, I realized I hadn’t asked how his day was. He had looked possibly tired, a pursed, hypoglycemic turn to the mouth. It’s so hard to be a subject and an object, or an I and a thou, or whatever it was we were supposed to dynamically, jointly be. In college one of my professors had a picture of Martin Buber taped to his office door, with the caption “authentic encounters here.” Guess where I never went. Now I wrote “AND HOW ARE YOU?” in balloon letters on the top of the case report handout and mentally practiced delivering it at the next opportunity.
At six it was time for sign-out, when the residents going home presented their patient roster to the on-call team, who would be responsible for the entire service until the night float residents came to relieve them at ten. Depending on the temperament of the residents they were paired with, students all over the hospital were discreetly packing their things and slipping down stairwells and elevators, or else hovering a step behind their residents like dogs who’ve heard “tennis ball” but haven’t spotted it yet. A resident named Ned and his gawky intern pulled up chairs alongside me and my resident Trish. Ned’s student stood at heel, discreetly scrolling around on his phone.
“Fire away,” Trish said.
“Okay,” said Ned, handing a printout to Trish and completely ignoring my best suicidally-obedient-footsoldier face, “first up, James Cantrell, 55 year old African American gentleman, past history hypertension, diabetes, reflux, status post triple-A repair six months ago, now day 2 for duodenal ulcer, biopsy this morning showed—big surprise!—H. pylori. He’s on protonix, amox, clarithromycin, plus sliding scale insulin. Watch that urine output. Watch that chem. He’s cranky as hell. Talk to the wife if you have to talk to anyone—very chill, used to be a nurse. Next.”
On he went through eight more names. Most residents signing off would have printed an extra copy so that the on-call student could follow along, too, but Ned was an aspiring cardiologist who had let it be known on my first day that he did not give half a fuck about the “poop service” or the “booze cruise” wing of liver-disease patients. He was a scrupulous doctor, though, and if my gallbladder exploded tomorrow I’d probably prefer his ministrations over those of Johanna, Trish’s meek, inaudible intern who seemed to reverse the digits of every test result she reported but who prayed for each patient on the service before every meal. Ned had no interest in teaching or helping anyone who couldn’t read an EKG properly, and despite my flailing efforts, all EKGs continued to look like more or less random variations on that Joy Division album cover.
Ned was speeding up now, dropping all but the first syllable in almost every word so that I was falling behind, losing the story while I stopped to pick up phrases like “DVT proph sub-Q unfrac hep TID” and restore them to linguistic solidity. I was puzzling over a particularly gnomic locution when a prickle on my skin told me Ned had stopped talking several moments ago. I refocused and did a quick body scan to assess whether I might have just farted or scratched my crotch or made a miserable face. None of the relevant muscles felt recently used.
“Why no intern?” said Ned.
“Oh, Johanna’s holding some people’s hands in room 49 while they talk about the benefits of paracentesis for the third time. It’s the best use of everybody’s time, trust me.”
“Fine, whatever. Last, but definitely not least sick, Zach Holliday, 29 year old white male in the ED with what sure as shit looks like vodka-induced acute on chronic pancreatitis. Frequent flyer; same damn thing happened a month ago. We slapped some fluids, a banana bag, Ativan, and some Dilaudid on him and now he’ll just have to ride it out. Should have a floor bed in an hour. Obviously gotta watch vitals like a hawk, keep those fluids pumping. Let us know if you step up the Dilaudid, and I implore you not to tell this dude that we would ever think about writing him a script for oxy on discharge, because he’ll be bugging me about it every ten minutes this week.”
Ned’s aggrieved-football-coach shtick was buzzing somewhere just peripheral to my attention; I had derailed at the name “Zach Holliday,” which sounded so much like that of my own dearly estranged problem-collector, Zane Hadley. The age was a couple years off, but some marginally scarier version of himself could easily have soused his way to pancreatitis or worse.
Ned, intern, and duteous student trooped off after signout. Trish turned to me with a yawning stretch, a few unpackaged Goldfish falling out of her breast pocket. The background to her entire armory—phone, iPad, even the face of a cheesy analog watch she wore, laser-printed from the bowels of some developing nation—was a chubby baby in the arms of her dopey-looking husband. Late in the day, when Trish’s color started to wear, the laser baby struck me as vampiric.
“So look,” she said, “I’m not going to actually make you stay for the whole shift, especially since you can’t sign scripts or write orders. But how ‘bout this: take five and feed yourself, then read some chart updates on our roster, bring me three smart questions, and then maybe we’ll visit a few rooms together and I’ll get you out of here by nine. Deal?”
At that point, I could have asked for a copy of our newly expanded patient roster. I also could have used a quick dip in the cafeteria grease-pot, as I was many hours post-liftoff from lunch and was reaching the phase of evening when dirty hospital linens began bearing uncanny aromatic resemblance to tempeh or shiitake. Instead I sat down to a resident workroom computer and logged on to the records. One of the seats was normally taken by the daytime attending and faced out toward the others, desktop glowing blue into a windowless corner. I clicked the “Find Patient” tab and entered Zane’s name. Incredibly, five Zane Hadleys popped up instantly, and I had to think a moment about his birth year and a middle name— Dylan—I wasn’t sure I’d ever known. Getting a jump on the new guys. Starting with Mr. Pancreatitis. Wait, not him? Could’ve sworn—I had the snuck-upon script ready, knowing it wouldn’t quite hold together, knowing no one on the service gave a shit what I was reading on the computer at 6:40 on a Thursday, as long as I wasn’t shedding viruses all over the hard drive or actively deleting other people’s chart notes. The problem was those HIPAA audits you heard about. Among other problems.
Twenty or so different “Patient Encounters” from hospital or clinic visits populated a neat column on the left of the screen. The most recent was dated two months after we had broken up in July of the previous year. It was labeled EMERG and in the next column that showed the initial snippet of note, “CC: burns L arm/ wrist. 30y Cauc.” Below that were multiple encounters in blue to indicate Student Health Clinic, which Zane had the use of after we’d acquired a gleeful flurry of partner benefits for everything from health insurance to movie rentals. I held my breath and clicked
one. It rebuffed me with a pop-up “Some notes confidential (Psych).” I braced for the click of a trap door, for a dealer in clear visor and armbands to roll up my sleeve of phoney aces, for a chorus of sticky-fisted children to shriek at the razors I’d slipped in their apples.
Of course nothing happened. You just couldn’t read psychiatry notes without a psych password, and you were gently scooted down to the next readable note. This bumped me to the bottom of the Patient Encounters column, when Zane had shown up to the clinic for the first time for a flu shot. I bounced back to the emergency note. Adult male comes to the ED with second-degree burns to palmar aspect of left forearm and wrist. Patient a “poor historian,” that is, unwilling or unable to explain his charred arm. Normal vital signs. Alert and oriented.
The doorknob clicked as someone held it on the hallway side, finishing a conversation or deciding whether to share space with the oddball nontrad student. My hands jabbed at the keyboard faster than I could govern them. Johanna walked in and stood at my elbow.
“Oh. Looking up drugs?” Somehow I had taken myself to an online pharmacology handbook.
“You mean happiness.” She drained a shade wanner and pivoted to another computer. I relish the fact that interns are barred from writing student evaluations.
I double and triple-checked that I had completely logged out of the charts, then fled to the supply closet, a bad-milk roil churning my gut. I couldn’t tell which upset me more, the pain Zane had experienced without my knowing, or the prospect of being kicked out of medicine any time between now and the end of the electronic medical record system, which would come in the late century when the water and fuel wars began, but not soon enough. Not even knowing how to triage my distress made everything worse. What had he done? I gave in for a minute to lurid scenes that I knew stank of ridiculous melodrama even as they pantomimed before me: Zane holding a lighter to his arm and calling my name. Zane resolving to take too many pills, but thanks to one of those funky genetic mutations that make people go weird on benzos instead of just comatose, somnambulates his way to the stove or cigarettes or light fixtures. Zane on a motorcycle, helmetless, hoping for the worst, but instead skidding on gravel, and as he topples and flails, the muffler grills his wrist.
So this was the fruit of our détente month, when I thought he had been engaged in more conventional forms of sulking. It shocked me that nothing and no one had tipped me off to something, well, medical going on. I needed a posse of tactless, vigilant friends. All of mine believed a little too firmly in the privacy of passions. Maybe I needed Republicans. Hell, maybe I was a Republican.
A nurse strode into the supply closet and started plucking down the requisite bags and pads for an ostomy change. I scuttled out to the ward, fingering a new roll of gauze in my white coat pocket I hadn’t remembered taking. This year I’d begun lifting petty articles of first-aid, initially for the blisters brought on by new dress shoes but now perhaps out of some reptilian nesting impulse, stuffing my cabinets with packings and adhesives sufficient to rehabilitate a small guerrilla war. Surely one day a purpose would be made known to me.
Sprague’s room was bright on his side. A roommate was moored on the other end, hospital bed encircled in blue-and-pink curtains that glowed in slurpee tones when the tv ensconced within jumped from shot to shot.
“I’m not drinking this,” he said to me, holding up a plastic jug of dissolved lactulose, a laxative for cirrhotics that by repute tasted like sidewalk chalk fermented in Gatorade.
“So I see. Have you given it a try?” I asked, giving my best cahootsy smile.
“Only every day for the past week. Are you the new doctor?” he asked, looking at my white coat like I was a fringe fanatic who had decided to wear a tricorn hat for the day.
“I’ve been in a bunch of times but I guess you’ve been resting a lot. I’m a med student training with the GI team. I sort of liaise between the doctors and the patients to make sure you’re getting everything you need.” This was mostly true.
“This,” he shook the jug, “I do not need.” He sounded mildly encephalopathic, his gestures a little larger and faster than they needed to be.
“I see. I’ll talk to your doctors and see if maybe we can make some adjustments.”
He dug his elbows into the mattress to crane his head and shoulders higher and forward. Neck veins pulsed like heat waves off his damp face. “Do you know how anything works here? Anything?”
I gave a forced little chuckle. “Well, I guess that’s kind of the big question for us all, isn’t it.” This was decidedly not within the purview of his wit. I looked around for a life preserver. A few paperbacks were pushed against the far corner of his picture window.
“I saw you reading Coetzee the other day. I love all the books where Elizabeth Costello shows up.”
“Who?” Shit, I was pronouncing it wrong. I had always aimed for something that combined elements of “Goethe” and “Aaliyah,” but maybe it was one of those names that ought to be dodged, like the Scottish play or NWA.
“Oh, well, I saw Slow Man in your pile of books.”
“The crap my sister left. About being sick or something. You know what’s the thing I least want to hear about?”
“Sure, I get that.”
“Bet you do. Could you find me a nurse?”
Trish’s mothering radar must have told her that I was not a baby to be fucked with that night. She patted my arm and sent me home with a printed packet of “supplementary reading” for my idle moments. I knew she’d never bring it up again: one of the journal articles cut off after the third page. Another had its abstract in English while the rest was in German. Labor and computers were diminishing us all.
I drove home, drafted and deleted several emails to Zane—discarded subject lines “halloo,” “know you don’t want to read, but,” and “ouch?!”—then gave up and walked to Masha’s. Klaus met me at the screen door and skittered in place while I listened to Masha’s weight creak up from the couch. She came to the porch with a blanket pulled childishly over her shoulders and a pair of frumpy purple acrylic socks jacked up her ankles. She held open the door for me and Klaus butted my crotch, backing up and snuffling as I pressed into the room.
“It’s a lady,” Masha reproved him.
“Well, ish. I think I broke the gentlewomen’s agreement pretty hard today.”
I drew a deep breath. “I think I saw some medical information I wasn’t supposed to know about Zane.” I paused. “I think I looked it up.”
“Not good.” She thought a moment. “Who else did you look up? Me? Your residents?”
“His was the only one. But maybe it needed to happen.” I explained what I’d glimpsed in the chart and how it felt like a message in a bottle, the castaway just as marooned and bananas whether the note was found now or five years from now. Masha made looseleaf tea on the stovetop and didn’t look up from her work or say anything. Finally she turned to me.
“So you think the burn thing was some kind of—gesture. Death wish or something.”
“Just one theory.”
“More probable than, say, the possibility that he was making stir-fry and the oil caught fire? Or that he was ironing and lost focus? Or fiddling with one of the two hundred other house and car things that make heat?”
“I’m just saying, I know he was really upset about breaking up.”
“Oh my God. You are making yourself the star of this. Can’t it just be that a guy got hurt, and went to the doctor—not you, an actual fucking doctor—and now he’s better, and leading a perfectly full life that happens not to include you?”
“But I wonder, could I have helped, and should I be helping somehow now?”
“Nope. Didn’t, shouldn’t.”
I slung my bag over my shoulder. “Okee doke. I need to go think some more.
Thanks for your input.” Where the hell had I gotten input? A workplace-environment seminar?
She stared at me. “I texted you first.”
I drew a blank.
“I soft-failed my orals. They won’t actually put it in my record if I do better in January, but I’m basically on parole until then.”
“Shit, that’s awful. I am so, so sorry.” I hugged her. She didn’t hug back. “Look,” I said, “I don’t want to make your whole thing just feel like the epilogue to my litany of worries. You deserve your own time to vent.” She cocked an eyebrow at me and I started to feel like a dick of the worst kind, but there was nothing to do but go on. “Let’s split off for now and then lay into those assholes in your department over a bottle of wine. Maybe tomorrow. I’ll bring the arsenal.”
“Yeah, we’ll see.” She stepped back from me and her voice flattened. She would be less pissed the sooner I got out of sight, I decided. If I wasn’t in the mood to connect with others, it would be way worse to fake it. Right? Right.
Gordon knocked on my door an hour later, still in scrubs and backpack.
“Nap à deux?” he said, turning down the hall to my bedroom and sitting on the bed.
“Wait, those are gross. Off.” I gestured at the germ-teeming scrubs.
He grabbed my hands and put them on the waistband of his pants, which I yanked down. He pulled his shirt inside-out and off in one motion.
“Now we’re clean.” His knees were scissored open on the bed and when he’d drawn me into the diamond of blanket between them, he clenched them into my hips so I was vised in place. We made out for a minute, then his hands wriggled under my shirt and plucked at nipples. I could tell by his focused silence that he was working hard at being a great lover—which he nearly always, effortlessly was—but the particular firm-not-crushing grip between his thumb and index finger was the same hold I’d use to lift a stinkbug with a square of toilet paper and carry it to a derelict corner of yard. Made me feel specimened, if not outright pestilent.
I cupped my hands over my breasts. “What if I said you had to wait?” It hadn’t come out as slow or husky as I’d wanted. More Miss Julie than Mila Kunis. “Whoa, what’s wrong?”
I wriggled out and pulled my shirt back over my breasts. “I just thought we could play a little game.”
“There’s a playing way to do this and then there’s actually having zero interest.
You act like you have zero interest.”
“I’m sorry, could you lend me a script I can work from?” I snapped.
He slid back from me a few inches. My God, I’d scared the pobrecito. “C’mon. Roll with it,” I said. For good measure I licked and bit his ear.
“Do you really need that shirt?” He was warming up again.
I patted nicely on the equivocating cock. “Supply mission.”
I straightened and made for the front room with its coatrack of jackets and scarves. I only had six or seven scarves to choose from but I made a production of it, knocking over boots and throwing noisy raincoats and sweatshirts onto the couch to dramatize the soundshow. I was trying the ply of a batik zebra-print scarf when I felt myself being watched. My eyes snapped to the window and saw a brown-haired woman my own age, staring at me from the apartment across the street. She was in a tight pencil skirt and had the kind of ruffly gauze blouse one could get away with at work if one wore a sweater or one’s boss were a predator. She had her hands on her hips in disapproval. Christ, was it that obvious what I was up to? Then, to my puzzlement, she squeezed her fists further into her waist as if juicing a lemon. She frowned harder. She turned her body ninety degrees and glared at me again, her eyes locked on mine though her face was in quarter profile. Here was the ghost of Tradition, of homecoming games and public libraries and tailored skirts pressed as fresh newspaper.
She spun a hundred-eighty degrees so now I only saw a sliver of her right face. Then I saw she was in a room much like mine, but brighter, and was using her window onto our dark street as a mirror. I was invisible. It made me lonely, and would you believe loneliness is the cheap generic for many a brand-name aphrodisiac. I balled the scarf in my hands and returned to Gordon splayed on the bed. Ten minutes later I came. And eighty minutes later. Two hours later I nested on the couch amidst the scarves and coats while Gordon slept his good, thick sleep. I still felt covered in prickles, a combatant creature acutely out of habitat, and didn’t want to lance innocent skin.
Friday afternoon I swung onto I-81 and left behind the suburban traffic for seven hours of blank farms and biblical billboards. In a blaze of texting I had swapped days off with other students so that I could bundle three in a row, an unheard-of break. I determined not to think until I could actually see Manhattan, and by that time Funkmaster Flex was throwing artillery around on Hot 97 and it was impossible to think anyway. I joined the sludge up Broadway and finally came to rest at the apartment of a classmate from my postbac, now doing medicine at Columbia. Amy was on night float in obstetrics and left me a key under the mat, with instructions for the wifi and the temperamental shower in case we never laid eyes on each other. I felt like I had been dragged to another altitude and spent the night conscious of my own too-deep breaths, which got more jerky the more I tried to wrangle them to order. When Amy came home at seven in the morning I feigned sleep, then was actually lulled to it by the slow, light sculling of her snore.
Awake a few hours later, I deployed phase one. I texted Zane that I was in the area for a wedding, and would he like to have coffee. I was shocked when he responded only a minute later. Sure but would have to be around 1. My heart flopped over at the un-fuss with which we’d begun almost-speaking again. If ease was the ultimate sign of affection, there was still a current there. He asked that we meet at a bagel place, apparently beneath his current apartment. Not exactly a bower of confessions, but what place was at one pm?
When I got to Bagel Heaven, Zane was sitting in a booth already. A few bites were missing from his egg-on-poppy sandwich. Dick move.
“Bon appétit,” I said. “Or am I too late for that?”
“I held off on coffee until you got here.”
“Great.” I walked to the counter and bought us two mediums.
“Let’s try this again,” I said, extending the paper cup to him. “It’s so incredible to see you.” And it was. His hair was strangely long at the nape and he wore a mostly-trimmed beard, though untouched scraggles and longer, lanky patches remained. From the neck up he looked like the spirit-animal of himself. I scrutinized his body but there wasn’t much to see: an oxford shirt, sleeves buttoned at the cuffs, hid the skin and its shapes. It was too warm for oxfords.
“So you’ve got a wedding.”
“Yeah, high school pals, junior-prom dresses in a Marriott warehouse, you know the drill.”
“Anyone I know?”
“Well, probably, dimly, right? I mean, you used to know the outer circles.” I said. “Annie?”
“Naw, Annie’s still on the market . . .”
I shook my head. I could feel warmth spreading my face. Zane gave me a long look.
“Must be tough to get away from the docs.”
“They’re very accommodating for weddings, christenings, and funerals. If I had begged time for a burlesque show it might have gone differently.”
He twisted his cup in circles, his eyes on the coffee banking along the inner walls.
“For a long time I’ve wanted to know how you are,” I said, putting my hand on his. He took both his hands and rummaged around in his hair, a tic that drove me nuts.
“Things are good. I’m doing this thing at NYU’s library that’s fine but not perfect, so I started looking around and now I’ve got this interview lined up for this afternoon. Sort of more content-creation.” He looked down at whatever invisible things had come out of his hair.
“So, writing on the internet? I think you used to use words like ‘writing on the internet’.” I smiled. The left corner of his mouth smiled.
“Can’t put one over on you.”
“Will it leave you enough time for writing other things?” “Yeah, probably. Maybe not right away.”
I launched in on a long, pointless exposition of the online “journal” I was required to keep throughout med school as part of my humanism accreditation. The deans could log in and browse my 500-word streams of consciousness, generally written the same day a new installment was due, and usually devolving into capsule reviews of movies I’d seen, the seasonal planters in the hospital atrium, and the various styles of dress shoe spotted on the wards. I was flubbing at semi-automatic rate, and my throat was making the prefatory jerks of crying, but there was no way to start over.
“Uhm,” he said.
“Are you sad?”
“No. Actually the main reason it seemed worthwhile to meet you today was to make sure you knew that. I’m really good.” I waited for the slip-in, the indirect assertion of dating status—Cara thinks I’m in a good place, too—but he was still, thank God, the kind of person who found that sort of thing feebleminded.
As soon as I had taken my last sip, Zane picked up our cups and carried them to the trash. Coffee was over. When he returned with a takeout box, I asked if I could use the bathroom in his apartment, as Bagel Heaven claimed not to have one. It looked crude, but I swear there was genuine tension in my bladder. He sighed and led me out and up a flight of narrow stairs that began a few steps from the storefront.
Once inside, I relieved myself, then stood up to examine the bathroom shelves. A small stack of anthology-type books above the toilet, a habit I’d made him stop— too germy. There was one of those geriatric seven-chambered pill dispensers, which I read as a private half-joke. I couldn’t tell the contents just by color and shape. A nursing student could have, maybe. A jam jar held a random collection of Q-tips and Q-tip-sized things. I took a small pair of hair-trimming scissors and came out. He was sitting on the couch, shoulder bag still slung across his chest. I perched on its arm.
“Hey, I really want you to do well today.”
“I don’t think it’s a big competition. This company apparently needs a ton of articles about education. I’m a warm body that can type.”
“Maybe you’ll meet people there who’ll fix you up with something more exciting.” I touched his face. “You missed parts.” I brought the trimming scissors to the gully under his lower lip where a few long hairs lurked.
“Jesus, stop.” He batted my hand away, screwing his eyes shut as though afraid the scissors would head there next.
“C’mon.” I moved in again. “Just this little kudzu patch here.”
“Get away.” He held his hands out in front of his face.
“You look like a recovering stroke patient with that beard.”
“Not your problem.”
I stood up. We were both breathing audibly. “I’ve got a couple more weddings and reunions and things coming up this winter in the city. Maybe we could do something a little less rushed next time.”
I started the drive home as soon as I got back to Amy’s neighborhood, even though I’d taken Sunday off too. The same interstate billboards asked me again, half their background Disney blue, the other half smelter-orange: Where are YOU headed?
Masha’s birthday fell a week later. An email from a girl in her department invited me to a house party in her honor. Gordon had gotten involved in some kind of multiplayer video game for ethical people and declined to join, citing something about “finding water for the colony.”
At one point in the hours of balefully well-curated music, I was pinned outside the kitchen by a law student who wanted my take on medical malpractice. It wasn’t clear whether he was for or against; I think I started yammering about the cocaine treatments of Bleuler and Freud. I overheard Masha on the other side of the doorway, complaining loudly about her favorite coffee shop being overrun by professional-school kids who thought they were hot shit because they dry-cleaned their clothes.
“Like, I get it, you’re coming into money, you need to know your robusta from your arabica. Just order a variety pack from Hammacher Schlemmer, ok?”
Lawboy leaned into me. “Wow, unhappy birthday girl.”
“Believe me, I’ve heard schlimmer.” I excused myself and made a drink from the litter of bottles next to Masha, grabbing my present from where I’d tucked it atop the fridge. Martin Buber Martin Buber I coached myself. I encounter thee.
“And how are you?” I asked. I handed her the narrow hardcover I’d brought. “I got you something in New York.” Admittedly I’d picked it up—a little first-person bagatelle about insomnia by a prominent film critic—right here in town, but it was surely available wherever interstate commerce and the college-educated got together.
“Gee thanks. It’s fun to read the books I should be writing.”
“Oh, there’s room for more. With the rise of Big Pharma, kids will want to know, what was insomnia?”
The tiny dining room attached to the kitchen was dominated by an oversized dog-door, the flap of which slammed every two minutes as the host’s pup strode in and out, looking for potential hot zones in the party.
“Dance with me,” I said. I took her hand and she dislodged it.
“Nah, I better check on the smokers, make sure they’re not burning Jill’s yard down.” She wove away through bobbing clusters of guests toward the front hall. I saw Gordon’s bearish frame bounding up the porch as she opened the door. He had changed his mind about the party, or the colony had died. It didn’t matter.
“Smoking! Bad! Party! Good! Verdict! Mixed!” he shouted, grinning. A few porch lurkers winced.
“Your focus group is here,” Masha called to me without turning.
And oh, he was perfect in that minute, a living star, a creature with lights and bells for hands and feet. His whole simple bouncing self spoke to me. And maybe I could be simple and bouncing too? So it was honest, just then, to take his chin and say, “All my love is for you.”
And a week later, when the provost’s office called me in to ask what the hell I was doing in the long-archived charts of the federally protected, I had accrued just enough convected radiance from Gordon’s sweet skin that everyone understood, immediately, the wild splendor of my innocence. It was in my face, a bill of health, a recommendation straight from the sun.
I got off with a warning.
Laura Kolbe’s poems appeared or are forthcoming in AGNI, The Awl, Colorado Review, Kenyon Review, and Yale Review, among others. Her essays appeared or are forthcoming in Poetry Foundation and Virginia Quarterly Review. She’s a physician in Boston.
“Poor Historian” originally appeared in Big Blue Whale (TLR Summer 2016)