Chapter 1: March 2010

Hannah began to ask, “Dr. Bode, should I start…” but let it trail off as she heard the doctor’s pager go off from his belt. Before she could even close her mouth, his hands had opened the pager, closed it back up, and then reached for the nearest phone. He punched in the number and then turned his head back to address her.

“I’m sorry, Hannah, but this is one of the inpatient nurses calling. They wouldn’t call unless there was a serious problem.” He reached into his pocket and pulled out a stack of index cards, flipping through them in rapid succession as the phone rang. “Yes, Nicole? Yeah, it’s me. What’s going on?” Hannah watched his face carefully, trying as she often did to interpret what was happening by listening to his words and reading his expressions. Things always happened around her, life-and-death decisions made in a few rapid words or in long discussions filled with the flip-flip-flip of index cards. His smooth, soft chin gave way to more defined, angular features, as though you could look twice and see at once a jovial, compassionate teacher and again a fierce, irascible surgeon. Dr. Bode walked over to the nearest computer and kept the phone to his ear as he typed in a set of passwords.

A grayscale image appeared on the screen. Hannah immediately recognized the familiar shapes of an abdominal CT—liver, kidneys, stomach, and intestines appeared and disappeared as Dr. Bode scrolled quickly through the series of images. Each slice was a simple two-dimensional image cutting a horizontal plane through the belly, captured one at a time and pieced together into a compelling story from ribs to pelvis.  Besides the basic anatomy, she had no idea what she was looking at—yet Dr. Bode continued to nod as he listened on the phone and kept scrolling up and back. He magnified one portion, changed the contrast on the screen, changed back, scrolled some more.

“Fucking resident,” he muttered. “Why didn’t they call me?”

Hannah kept waiting for what he was so concerned about to become apparent to her, but she could barely tell where the particular image he was focused on was taken in the patient’s body, much less the significance of the tiny blurs and areas of dark and light. She was trying to keep up with his scrolling, but kept getting lost, trying to compare what she saw on the screen with the images in her mind of what the inside of an abdomen ought to look like. She’d been studying it for years—books, videos, even dissecting a human body the first year of medical school. But she was still far away from being able to just look at a picture and immediately tell that something was wrong, at least not in the way that Dr. Bode was so ably doing. For now, she was an observer trying to absorb whatever energy or knowledge or experience she could from what was happening in front of her.

“Call him back and tell him that I will meet him at the OR shortly.”

He hung up and turned effortlessly, moving out of his chair and almost into Hannah before she realized what was happening. However, she also moved out of his way before she realized what was happening, re-enacting the common dance that emerged quite frequently when a more important doctor moved in a direction currently occupied by less important people.

“Let’s go,” he said, rather superfluously.

“Is there a problem on the floor?”

He stopped and turned back to face Hannah.

“One day you’ll graduate from medical school. And you’ll be a surgical resident. And one day a nurse will call you and tell you that something is wrong. And you’ll go see the patient. And you’ll get an abdominal CT scan. And on that day you will not just trust what a radiologist tells you.”

He turned back towards the door and once again moved swiftly towards it as Hannah was beginning to nod in the affirmative. Hannah wondered briefly if this was a waste of energy as she was fairly certain that he knew he’d been heard.

“What happened?” asked Hannah.

“Do you remember Mr. Goodson? We talked about him at length today on rounds.”

“He was the one who came in with abdominal pain and fever, right? The alcoholic schizoaffective who kept saying that demons implanted HIV in his stomach?” Hannah tried to remember as many details as possible from earlier in the day when all of the patients had been discussed with the whole team—medical students, surgical residents, and Dr. Bode, the attending surgeon.

“That’d be him. He’s peritoneal now.”

A few seconds of silence.

“You don’t know what that means, do you?” asked Dr. Bode. His tone shifted slightly, and Hannah felt no shame despite his prior harshness.

“I don’t.” Hannah shook her head.

“What the hell do you learn in class all day long?” he asked, immediately reverting to his earlier tone.

“I dunno,” Hannah said in a defensive tone. “Something about cultural competency. I have a long list of rare genetic syndromes I need to memorize for next week’s test.”

“Well, what it means is that there’s irritation inside of his abdomen.”

“Aren’t there lots of things that can irritate your abdomen? Inflammation is a pretty common part of diseases in the belly, like in Crohn’s or celiac disease…” asked Hannah, not sure what Dr. Bode was talking about.

“Well, of course,” he remarked curtly. He kept a rather rapid pace, and Hannah struggled to keep up as his long legs propelled them down long hallways as they walked from his lab to the hospital connected by a bridge over the street below. “But most irritation stays inside whatever is infected or inflamed—the gallbladder, the stomach, the intestine. When something ruptures, though, you’ll usually know it—the abdomen gets rigid, swollen, tight. It’s because the lining of your abdominal cavity doesn’t like to deal with the stuff that you’ve swallowed and all the bacteria in your gut.”

“Oh,” chirped Hannah.

“We call it a surgical abdomen. Because the only way to fix it is to operate.”

“I’ve heard that term before,” she said. “But I wasn’t sure what it meant.”

“Well, now you know! Go and tell your classmates before they get on my service next year.”

“Of course!” exclaimed Hannah, who was actually kind of glad to have some sort of special knowledge that her classmates didn’t have about the clinical years to come. Every day they struggled to absorb more and more information about the human body and she had long nurtured a suspicion that what they covered did not always correlate with what they would see in the hospital when they moved from their first two preclinical years to the last two clinical years. “So why is our patient peritoneal?”

“That’s a good question,” said Dr. Bode. “We’re going to find out very soon when we cut him open. If the pathologist doesn’t beat us there.” He chuckled.

Perhaps it was the speed at which they were walking or the number of confusing turns they had already taken, but Hannah didn’t get the joke and just kept walking as she tried to figure it out.

“Huh?” she murmured finally.

“Oh, you know. Pathology. They do autopsies.”

“Ohhhh,” she said. “That’s next week.”

“Well,” said Dr. Bode. “I certainly can’t hold you not getting it against you. I shouldn’t hold any of it against you, really. I try not to—you are here to learn, after all. And our friends on the other side of the bridge are really the most responsible for teaching you about medicine, so deficiencies in your knowledge are not really your fault, since you all work as hard as you do..”

“I do kinda feel like what I see when I spend the afternoon with you and what I hear in the classroom are different,” Hannah remarked, testing her prior theory. They had reached the second floor surgical suite and were standing in front of a large shelf filled with surgical caps and masks.

“Well, they are,” said Dr. Bode curtly. “As you will soon see.”

Both quickly donned bouffant caps and tied their masks on, adjusting the large plastic shield extending from the upper part of the mask so as not to fog it up. Hannah was still getting soused to this process; she remembered well her first experience in the operating room with Dr. Bode when the shield got caught in her cap and her breath immediately blocked her vision as soon as she was scrubbed in and not able to touch her face again. She was trying to think through all the steps again as she rushed behind Dr. Bode, who flung open the door to the operating room with only the slightest hesitation to make sure that no one was behind it at the time.

The two other doctors in the cool, bright room who were hastily grabbing supplies from the large metal cabinets along the wall, turned their heads as he entered the room. Through their own plastic shields they briefly made eye contact with Dr. Bode. The taller South Asian doctor simply narrowed his brow with a look of cynical exasperation, while his pale-skinned colleague just looked away, then back to Dr. Bode, and then away again.

“I’m sorry, Dr. Bode,” mumbled the doctor. She then threw her hands halfway up in a gesture that seemed to deny responsibility while crying out that events beyond her control had brought them all this situation.

“So what happened here?” he demanded in a booming voice. Hannah immediately recognized from his tone that he asked not because he didn’t know the answer but because he viewed whatever had happened as a teaching opportunity for everyone. She had watched it happen enough times to know what was coming next: whenever Dr. Bode was the attending doctor, everyone else on the team was going to learn. This had begun this morning at 7am, when she arrived with Dr. Bode to the team room where everyone met: medical students who had spent the morning speedily recording all of the overnight vital signs for every patient the team followed, residents who spent the morning speedily examining every patient that the team followed, and the occasional visitor such as herself who tried to keep up. Each patient’s story was quickly described– a tale that might have spanned weeks condensed to a few short pieces of medical jargon with only the most lurid details indulged– and then just as quickly the day’s plan was briefly discussed and they moved on to the next patient.

Hannah looked over at the table and saw a black man laying on the table, entirely naked with his legs awkwardly splayed upwards as if he were about to give birth, with an overweight nurse trying to maneuver a thin catheter into his penis. Meanwhile, at his head, two anesthesiologists were taping a tube that they had just slid down his throat to his face and attaching the tube to an impressive machine full of gases that, to her, might as well have been magic because she hadn’t learned about them yet in class. His belly was grossly swollen and appeared tight, perhaps as if the demon the patient had been so sure of actually had implanted an embryo in there and it had decided to hatch and claw its way out. There were two large, circular discs suspended from the ceiling with six lights each, all focused in on that belly, just waiting for the invader to pop out into the spotlight.

“If he wasn’t so swollen, I could get this in,” complained the nurse with exasperation. “What’s going on with him, anyway?”

“I was wondering the same thing.” Dr. Bode spoke authoritatively, well aware that in the flurry of activity they had not answered his first question.

“You go scrub,” ordered the taller doctor, nodding to his companion. Hannah heard the door swing shut before she could realize what was happening.

Both remaining doctors began furiously scrubbing the patient’s abdomen with plastic sticks full of iodine. Starting in the circle and working outward, they painted a bullseye in brown liquid over his stomach, sterilizing his skin before they cut him open. Dr. Bode spoke first.

“What were you even doing there, Vinny?”

“The hell if I know. Looking for trouble.”

Both men chuckled.

“Actually, there was a patient next door that I had operated on yesterday and I was just trying to be a nice guy and find out what happened to him. The nurse grabbed me and said that she was worried because the resident wasn’t calling her back and the patient was looking very bad.”

His eyes moved down, gesturing towards the patient’s rather uncomfortable-looking abdomen.

“Again, just trying to be a nice guy. So I went in. I figured it couldn’t be too bad.”

“Clearly that’s what our esteemed colleague Dr. Janvier thought when she didn’t call the nurse back after being paged twice,” said Dr. Bode.

“Yeah, well, clearly,” replied the other doctor. Hannah was trying to remember if she had seen him before. In a blue cap and mask, the only way she could tell the difference between people was their height, voice, and eyes. He continued on.

“So his belly is distended and his pressure is 80 over 35. He’s hot as a whorehouse in New Orleans. The nurse doesn’t know how long it’s been, she hadn’t checked on him for a few hours. I call the OR and her charge nurse starts to call you. I wouldn’t be too hard on the resident. She only got paged 5 minutes before I happen to wander into this clusterfuck.”

“That’s not why I’m mad. Shit like this can happen. But it shouldn’t have.”

“Oh really?” Dr. Patel clearly sounded intrigued.

“Yeah. This patient had a CT scan done six hours ago. We ordered it right after rounds. There was fat stranding all along the right abdominal wall. Radiologist missed it. I doubt Sarah looked at the scan.”

“Oh.”

Hannah was trying to process the significance of this conversation, but she couldn’t remember what fat stranding was, but clearly it was an important but not easily obvious thing that could be seen on a CT scan. She decided to ask, speaking up for the first time since they had entered the OR.

“What’s fat stranding?”

“Oh!” exclaimed Dr. Bode. “Vinny, meet Hannah. She’s a second-year med student who’s been helping with my research and shadowing a little bit. We were over in the lab together when I got the call. Hannah, this is Dr. Devinder Patel, one of the general surgeons.”

“Hi, Dr. Patel,” said Hannah cautiously.

“Hello, Hannah,” replied Dr. Patel, his eyes brightening. “You don’t know how lucky you are to be attached to Solomon. Things are looking up for him.”

Dr. Bode’s eyes softened and he chuckled. “I’m lucky to have Hannah. She’s done a hell of a job with the research. She started working with me in undergrad and we’d be nowhere if she hadn’t been running samples for me for years. There were a couple of places where we had hit a wall and she figured out how to move it along. She’s coauthor on the paper that’s coming out next month.”

“Really!” exclaimed Dr. Patel. “Well, then, it is even more of a pleasure to meet you, Hannah. Solomon has only the best things to say about his staff.”

Hannah gave a demure smile beneath her mask, and started to stammer something about how much she had learned from Dr. Bode when the door to the OR burst open again and Sarah emerged from the outside hallway, pushing the door open with her butt as she held her arms up in the air to keep them clean. They were dripping wet from her thorough scrub outside. She walked over to the scrub tech, who all this time had been carefully laying out surgical instruments on a long table just adjacent to the table where the patient was lying.

“I’ll scrub,” offered Dr. Bode. “You can leave if you want.”

“Nah, this looks like it’ll be fun. Plus, this is really more of my case,” said Dr. Patel.

“If you insist,” said Dr. Bode, clearly smiling beneath his mask. “I’ll let Dr. Janvier open.” They both stepped away from the table and Dr. Patel headed for the door.

“Go scrub,” Dr. Bode ordered Hannah. She went ahead.and followed Dr. Patel outside to the perioperative area. It was a long, wide hallway with large OR doors marked by big numbers along each wall. In the center of the hallway, tall shelves full of sterile-wrapped instruments and metal containers alternated with long sinks, each one equipped with foot pedals and large boxes full of individually wrapped sterile scrub brushes. Hannah watched as Dr. Patel turned on the water with a foot pedal beneath the sink, rinsing his hands and forearms and then taking a small sponge soaked in iodine from a silver package and thoroughly scrubbing each finger, then his hands, and then down to his elbows. Hannah tried to watch each step and clumsily imitate it. She had only done this once before, and tried to scrub mercilessly to get her hands as clean as possible. However, in her eagerness she touched the faucet with an outstretched finger and immediately remembered that she had contaminated herself and would have to start over.

“Relax,” admonished Dr. Patel in a gentle voice. She jumped, having forgotten that he was right beside her.

“Yeah, right, um… okay!” she replied quickly.

“It happens to everyone. Take your time.” He let his words stretch out to emphasize his point. “This is gonna be a long surgery.”

“Oh?” said Hannah, realizing as she looked at a clock on the wall that half an hour had already passed since Dr. Bode had first gotten the call that set events into motion. The excitement and fear was still intoxicating; she felt as though her heart was not going to slow down for a while.

After she finished scrubbing for two minutes, she rinsed again and then followed Dr. Patel into the OR, being careful not to touch anything and to keep her hands in front of her so as to maintain their cleanliness. As peculiar as the rituals of sterile technique were, they seemed to work– mostly– and so she maintained them as best an acolyte could. She approached the scrub tech, who was helping Dr. Patel get dressed. He then turned to her and first handed her a towel, which she used to dry her hands and her forearms. She carefully tossed the towel away, stepping into a green gown that he held up. She extended her right hand, followed by her left, into gloves that he held, popping her fingers into them with ease. She did it again with a second pair and held up a tag attached to her gown. The tech took it and she quickly spun around, pulling the back of the gown around her. Quickly taking the string that the tag was attached to, she tied her gown in the front and finally turned towards the table. There was already a sheet draped over the patient and Sarah was carefully cutting through his skin with a scalpel. Hannah stood facing the patient’s right just about thigh-level, with Dr. Bode just to her right, holding one end of the newly created incision and calling for various stainless steel devices to help hold skin and muscle back. Dr. Patel and Sarah stood opposite Hannah and Dr. Bode.

“So what’s the story? Diverticulitis? How come he’s on your service and not mine?” asked Dr. Patel.

“Well yes, it was diverticulitis. With a twist. Schizoaffective disorder, liver failure, hepatitis C. Thinks the devil implanted something in his belly,” explained Sarah, opening her mouth for the first time since Hannah and Dr. Bode had come into the OR.

“Well, if that’s the case then you’ve got two papers in the New England Journal in the bag!” exclaimed Dr. Patel.

Everyone laughed.

“Gainers is a patient under my research protocol that Hannah’s been working on with me since she was a student and I was a fresh-out-of-fellowship attending,” said Dr. Bode. “Anyway, we biopsied his liver last week for his treatment, so at first we weren’t sure if this was an issue that I would be responsible for or not. So he probably could have gone to the general surgery service, but last night I felt like he’d be better served on transplant.”

“I see,” said Dr. Patel.

Sarah jumped back in. “The admitting intern didn’t take that very well. Bitched to me for 15 minutes about why gen surg shouldn’t have turfed it to us.”

“Well, that is what interns tend to do,” remarked Dr. Bode. “But they become senior residents eventually and they can pretty much do surgeries like this with a little help from us..”

“Thank God,” said Sarah with exasperation.

Dr. Bode turned to the OR nurse who was peeking over his shoulder. “Karen, can we get some anastomosis materials up? I think we’re going to need them.”

“Sure!” came the cheerful reply. She quickly turned and walked out the back door of the OR.

Hannah continued to watch as Sarah cut through individual layers of tissue and muscle, pulling and tearing in a quick but thorough fashion. Hannah had only scrubbed in on a few surgeries before and still found the whole process of opening someone up fascinating. Her friends– even some of her fellow medical students– had never completely understood her fascination, and at times she caught herself forgetting that this was a living, breathing human being.

“Well, unless Hannah wants to take this ball of pus back to the lab and analyze it for demonic spirits, it looks like you just have one paper,” said Sarah with a hint of joviality but mostly cynicism as she pulled back on one edge of her incision to reveal a large outpouching of bowel that was cherry-red and gently throbbing. Hannah gazed in awe at the moist intestines gathered in a seemingly random bundle inside of Mr. Goodson’s abdomen, somehow migrating their way from the stomach in the upper right corner to the beginning of the colon in the lower left. Standing where she was, Hannah had an excellent view of this swollen, infected pouch the size of a baseball. She was so fascinated that she didn’t hear Dr. Bode ask her a question.

“Tell me, Hannah, about diverticula. We can make this educational for everyone!”

“Huh?” murmured Hannah, clearly paying attention but not to what he said.

Dr. Bode chuckled. “What are diverticula, where do they come from, and what happened to Mr. Goodson’s?”

“Um, well…” Hannah began think furiously, knowing that she was being tested in front of two other people who clearly knew the answer. She believed that they were silently waiting for her to respond with flawless grace and easily start spouting off facts about whatever clinical entity was lying before them. However, as often happened in medical school, Hannah was simply dumbfounded. To compensate, she started muttering something about infected intestines resulting in fever and swelling in a barely audible tone so as to possibly give the impression that she knew what was happening without going into too much detail.

Dr. Bode cut her off. “Didn’t you just study GI?”

“Well, we did, but we didn’t really talk about diverticulo. Diver– I dunno.”

Dr. Bode sighed with disappointment and shook his head. “Karen!” he exclaimed.

“Yes, sir?” asked Karen, who was unpacking more peculiar-looking devices from an armload of white boxes.

“Can you please put Dr. Kicnaraw in a headlock and bring him and his ridiculous false hair to the OR for me so I can personally berate him for his failure as an associate dean and head of the pathophysiology course here at the University of Fucking Maryland School of  Fucking Medicine?”

For the first time since Hannah had been in the OR, she heard a voice behind the curtain at the head of the bed where the anesthesiologists were working. “I’d like to work at the School of Fucking Medicine. I feel like Fucking Medicine is an under-represented specialty overall. It probably needs more research funding. We have Internal Medicine, Sports Medicine, Functional Medicine, Family Medicine… but fucking each other and our patients over is a glorious and long-standing tradition that ought to be recognized and supported.” The giggles from around the table eased the tension that had been quite overwhelming to Hannah just a few moments ago. She let herself laugh along with everyone else at the expense of her professor, accompanied by just the slightest twinge of guilt.

“Would you still want to work at the School of Fucking Medicine if Gordon Kicnaraw was in charge of all the second-year med student courses?” asked Dr. Patel.

“Are you kidding?” asked the anesthesiologist, now peeking his head over the curtain. “Gordy knows more about fucking than anyone else! He’s fucked every department chair over so many times we could make him his own brand of soap with that ridiculous toupee on the package. I’ve listened to his anesthesia lectures, and they are chock-full of cutting-edge research… from the 80’s. If he was in charge of teaching Fucking Medicine, all the first years would learn to fuck so fast that– oh, that is a big abscess,” he remarked, cutting himself off to admire the pathophysiology unfolding before him for a few educational moments. This immediately redirected the conversation back to the diverticulum, and Hannah remembered that she couldn’t recall anything she learned about the subject.

“I think there were a few slides about it in one of our lectures,” she said.

Dr. Bode groaned. “Diverticula are incredibly common, and diverticulitis is also common. But your probably spent about 2 minutes learning about it in favor of some long-winded discussion about drugs for Crohn’s disease.”

“Um… yeah, in fact!” Hannah was starting to feel more freedom to speak her mind, which was always difficult when she recognized that she was the least-informed person in the room. Even the scrub tech who was handing instruments to the surgeons as they worked knew more about diverticula. “Dr. Kicnaraw said it was important.” She lowered her voice and announced, “the toupee has spoken.”

Everyone at the table exploded with laughter.

“Okay, for that one, you’re off the hook for not knowing anything,” said Dr. Bode. “But for God’s sake, before you become a third year learn something about diverticula. It’s just when a little bit of the bowel wall that’s not as strong as the rest and bulges out. Sometimes they just get infected. Like poor Mr. Goodson here. How does he look, Sarah?”

“Surprisingly… not bad,” she answered. “For someone with fat stranding on his CT all up and down the abdominal wall, he’s looking alright. He must have had a microperforation, because I certainly don’t see anything too obvious here. And the infection doesn’t even extend the whole circumference of the bowel.”

“No kidding.” Dr. Bode took a careful look at the infected mass himself, carefully running his fingers over either side and then moving intestines around. He was mostly letting Sarah work and watching the entire time. For someone who was rather angry at his resident earlier, Hannah thought he was rather laid-back about how he supervised her work.

“He’s a survivor,” said Dr. Patel.

“Oh, he is.” Dr. Bode’s voice picked up its usual authoritative tone. “You don’t get to be 45 years old drinking a pint of vodka a day without some moxie. God damn. If only he was a doctor. A man that dedicated and… resourceful could have found a cure for diabetes by now.”

Dr. Patel laughed. “I don’t know how you do it, Sol, but you always see things a little different.”

“You just have to keep your eyes on the prize, Devinder.” Dr. Bode’s eyes darted from Dr. Patel back to Hannah. “Eyes on the prize.”

Hannah felt her hand move without her control and let out a small gasp before she realized that Dr. Bode had simply grabbed it and was moving it towards the open abdomen that Sarah was still working in.

“Speaking of which… Hannah, feel this liver.”

Hannah reached a little farther, carefully avoiding the now-deflated ball of pus that Sarah had drained with a suction and was now cutting out with a scalpel. She reached under the upper right portion of the skin flap and encountered a firm, nodular surface.

“Oh wow. That’s his liver?” she asked.

“Yes,” answered Dr. Bode.

“It’s hard,” she observed.

“Thaaaat would be the pint of vodka a day,” said Dr. Patel.

“Wow,” she remarked. She had felt other livers before in anatomy, and they were generally soft and smooth. She tried to recall as much of her knowledge of the human liver as she could, anticipating that she would be asked another question shortly.

“Were you going to do anything with the liver while we’ve got him opened up?” asked Sarah. “Because I’m not even going to have to anastomose anything. He’s a lucky one.” She had at this point removed all the dead tissue and was sewing the now-open tube of intestine together make a slightly narrower but still patent section.

“Unfortunately, no,” said Dr. Bode. “When we biopsied his liver last week, we got everything that we needed. Hannah was just going to test his cells today when we got called. And I wouldn’t put anything back inside while he was actively infected anyway.”

“Okay,” said Sarah. “But if you give him an ugly scar after I sew him up nice today, I’m gonna kill you.”

Dr. Bode laughed. “I’ll try to do a better job than my resident. I would hope that’s what they pay me for.”

Dr. Patel looked at him incredulously. “So you’re going to regenerate this liver?”

Dr. Bode nodded and again smiled in such a way that could easily be seen despite the mask.

“Christ, I should read those department e-mails more often.”

“Maybe you should,” said Dr. Bode. “We’ve been keeping things quiet for the last year or so, after we finished the last round of animal testing. We would all hate to get all built up about something and then something goes wrong and it’s a big flop.”

“Happens all the time,” led in Dr. Patel. “I remember when that new diabetes drug came out…”

“This story again?” asked Dr. Bode.

“They should have handed out a new set of pants to every internist who watched their presentation. Everyone was on it, because the numbers were almost too good to believe. No other drug had been so effective. And then it turns out it not only consistently lowers your blood sugar, it also builds up in your pancreas. I must have placed a drain a week in someone’s pancreas because they came in with these necrotic pseudocysts.”

“I remember,” said Sarah. “Those were bad days.”

“You just told me my worst nightmare,” said Dr. Bode. “Although I at least have the advantage of working with patients who are already going to die.”

“Yeah, how are you doing that? The IRB must have put you through the wringer.”

Dr. Bode chuckled. “Did they ever. Hannah knows almost more about it than me– she wrote a lot of those proposals.”

“No shit,” remarked Dr. Patel. “And she’s a second year?”

Hannah nodded vigorously.

“I gotta talk to whoever sends you students,” said Dr. Patel. “I swear the students they send me are getting lazier and lazier. Last week one of them wanted to scrub out at 4:30 in the afternoon to go to a friend’s birthday party.”

“You’re kidding.” Hannah felt angry and almost guilty about the behavior of one of her own colleague, even though it wasn’t her who did it at all. “Who was it?”

“I don’t remember,” replied Dr. Patel. “It was a third year. I don’t remember his name.”

“Oh,” mumbled Hannah.

“Sometimes I understand. If you’re on your surgery rotation and you’ve been there for 6 weeks and you have your heart set on endocrinology, it’s not like you’re learning anything watching a second-year resident mucking around in the abdomen looking for a clue while you hold a retractor in the same position for four hours. Which is what was happening. It’s just that he thought it was a totally reasonable request.”

“What did you do?” asked Dr. Bode.

“I let him go home. I was so mad I couldn’t stand to be in the same room with him.”

“Did you write him up?”

“No, he came in the next morning and apologized. He knew he fucked up. But still. I just… I’m still blown away. Maybe internal medicine puts up with that sort of shit all the time.”

Hannah’s eyes were caught by the sight of Sarah gently lifting a large block of tissue– abscess included– out of the abdomen.

“Things are changing,” said Dr. Bode. “It’s not like when we trained.”

“And that’s what our attendings said when we trained,” said Dr. Patel. “But these work hour restrictions, caps, all that. It just doesn’t make sense to me. Residents are working longer, but they’re not getting any better. Last week one of them was asked to drain an abscess– just doing a favor for a medical inpatient– and he asked for an ultrasound of the thing without even looking at the patient. When you don’t work as much, you don’t get as much experience.”

Sarah took an large curved needle clamped inside of her needle driver and started plunging it into the patient’s muscle while Dr. Patel used another instrument to hold back the skin so that she could easily see. Her hands moved so quickly to dive, turn, pull, and then do it again with his fingers dancing around her workspace that Hannah could hardly follow what was happening

“It certainly doesn’t make me feel any more rested to just work 80 hours a week,” said Sarah. Hannah gulped. She had put in her share of long weeks, for sure, studying every day in medical school. And her friends who were third and fourth year medical students had some pretty grueling times when they showed up at 5:30AM and didn’t get home until 7PM. But they usually had some breaks and lighter rotations. Thinking about doing that every day for years as a resident, after she graduated from school intimidated her.

“Doesn’t help patient care either,” said Dr. Patel. “I hate getting a call in the middle of the night from a resident telling me that a patient is crashing and I ask a few simple questions. They say, ‘I’m the cross-cover resident for the night, I didn’t admit this patient.’ It’s their job to know the patients, but when they have to cover three services all night I can hardly blame them.”

Dr. Bode made an affirmatory “mmmm.”. He turned back to Hannah. “We should get back to the lab. Sarah can handle finishing up everything here.”

Hannah could see that Sarah was already sewing muscles back together, layer by layer reconstructing the abdominal wall that she had just effortlessly violated. Before long, Mr. Goodson would only have a long scar running from his navel to his sternum to remember this incident by.

“Okay,” she said. She followed Dr. Bode’s leading in removing gloves, then gown and heading for the OR door. When he reached the door, he stopped and turned.

“Sarah, I…”

His words came out quickly as if he had a long thought prepared and had it interrupted by some other event. Sarah looked up from her work, and again the face mask and shield were simply inadequate to hide her look of defiance mixed with fear. Hannah could instantly tell that she knew she had been caught red-handed but was still willing to exhaust every excuse to defend herself..

Solomon spoke first. “I’m sorry for being as harsh as I was earlier.”

“I should have looked at that scan myself, Dr. Bode. You were absolutely right.”

‘I’ll call the radiologist,” he said.

“Thank you,” she said.

And with that, he pushed open the heavy metal door and walked out with Hannah into the perioperative area.

 

***

 

Adam dragged a chair to face himself, then plopped down and lifted his legs gingerly to prop them up. He leaned back in his own chair and stared at the door to his professor’s office. Another student was indistinctly visible through the small window of obscured glass, making animated gestures as his voice occasionally rose loud enough to be heard through the wooden door.

“But that part of the question wasn’t clear!” he said, his gesticulating limbs flailing behind the glass. The professor responded with a low and calm tone, but Adam could not make out the content of his words. He rolled his eyes and decided to pull out his textbook to study, as he realized that this might take a long time.

He reached down to his backpack and unzipped it, carefully pulling his plastic bag full of medications out to reach his books. He chose the thinnest volume– Things Fall Apart by Chinua Achebe– but then thought that his professor might better appreciate it if he walked out to see him reading his textbook for this class. He heaved his large Genetics book onto his lap, gritting his teeth as a wave of discomfort shot through his distended abdomen.

He peered over the open book to his ankles, barely visible below where his jeans ended. They were still swollen and his dark brown skin took on a shiny hue where it had distended from the edema, though they looked better now that they’d had a few minutes up on the chair. He wished that he had worn his stockings today and he wondered if he should take an extra dose of diuretic, though he decided against it when he realized that this meeting with his professor could take a long time. He didn’t want the drug to kick in halfway through, forcing him to get up and empty his bladder.

He looked down at the book and the door opened. A student that he vaguely recognized from class stormed past, muttering indistinctly and looking upset. He slowed down only to walk around the chair that Adam now realized was in the middle of the hallway, but he was gone before Adam could react. Adam slowly placed his textbook back into his backpack and eased his legs off the chair.

His teacher came to the office doorway, placing a hand on the frame. “Sorry to make you wait, Adam. Someone else thought they had priority, and we quickly… lost track of time.”

“No problem,” said Adam, dragging his backpack across the floor to the office instead of placing it on his shoulders. He took a seat in a soft, comfortable chair that he feared he might have some difficulty getting out of, then rested his skinny arms on the armrests. The office was lit by a single lamp that gave a yellow glow across the oversize stuffed bacteria dangling from the lampshade.

“So, Adam, you wanted to talk to me?”

Adam nodded. “Yes, Professor Witherspoon. I, uh, won’t be able to make it to your class next week because I have a doctor’s appointment.”

The professor, a man with a graying goatee flanked by sagging jowls, smiled. “Oh, Adam, you didn’t have to meet with me for that. An email would suffice.”

“Oh, my father insisted that I come to see you. And, well, there’s a couple of other things I’ll have to miss.”

Professor Witherspoon’s eyes narrowed. “Other things?”

“Well, I have another appointment– a procedure– scheduled for the following week during the lab. We already looked it up in the lab manual, I can probably do the steps with the Thursday lab section and I don’t think it’ll affect my experiment. And then I have a surgery scheduled just after the third exam, so that’s gonna be a little bit trickier because I don’t really know how long my recovery period will be or how long I’ll have to stay in the hospital. But I can still probably keep up with my classwork.”

“Hmmm. Well, have you asked your surgeon how long it usually takes people to recover from this procedure?”

Adam chuckled. “Well, he doesn’t exactly know.”

“He doesn’t do very many of them?” The professor raised his rather bushy eyebrows.

“He hasn’t done any.”

The surprise on Professor Witherspoon’s face was apparent. “Uh, Adam, who is this…?”

“Dr. Bode. He’s doing an experimental protocol at the University of Maryland.”

“I see.”

“And I know it’s, uh, probably not the best thing to undertake this kind of thing while I’m in the middle of the semester.”

“Uh-huh.”

Adam placed one hand on his belly, which bobbed gently. “I guess you’re probably curious about what’s going on. Most biology professors are.”

“Some of the other professors have alluded to your medical issues, but I’ve tried not to pry. Your work so far in class has been satisfactory, so I haven’t bothered to inquire further.”

“I guess you heard about the time I vomited blood all over Dr. Raimi?”

Professor Witherspoon nodded. “We… worked very hard to keep the discussion of that incident limited to the people who needed to know about it.”

“Thanks.” Adam looked down again at his feet, which were starting to feel a bit more uncomfortable.

“So… do you anticipate being able to keep up with your classwork during your recovery, or do we need to get student life involved so you can take a break or put a hold on your grades or–”

“Well, my father is very confident that the treatment will work, so I don’t think so.”

“Okay. So you… just wanted to warn me in case it didn’t work out?”

“My father just said it was really important that we talked face-to-face.”

“Well, I have to give him credit for not fooling around with an incomprehensible email or voicemail, which is usually how these sorts of things usually end up starting.”

“He’ll be happy to know that he was right.”

Professor Witherspoon nodded. “Well, then, if you don’t have any other questions I guess I’ll consider myself… aware in case I don’t see you in class.”

“Thanks,” Adam said, reaching around for his back and lifting it to his lap. “See you on Friday!”

 

***

 

Hannah slowly walked up the three marble steps and paused in front of the wrought-iron security door. She looked up cautiously and admired the well-worn brick facade of the three-story rowhouse, the only one on this side of the street with intact windows. All of the others were either boarded up or simply open with a few shards of broken glass hanging like stalactites from their frames. Some of them were brick and others were gently shaped sandstone, narrowly squeezed side-by-side in a pattern that repeated block after block all over the city. The street itself was littered with trash on either side and a few cars were parked haphazardly along the curb, some of which also had some broken windows. Spring had not yet quite arrived and the trees on the far end of the block were only starting to bud; the lot that they sat in had one well-worn diagonal path and tall, dry brown grass otherwise.

She saw a young man with his hands in his pockets slumped against the light pole, constantly looking from side-to-side. He had yelled “Sweet Dreams!” to her as she had driven by just a few minutes ago, which she had not comprehended until just now when he did it again to another car driving by slowly. That car had come to a stop and they had briefly exchanged words and shook hands, at which another young man had appeared from around the corner and handed something to a passenger in the backseat of the car. After a few brief moments, the car then sped away and the other young man disappeared from out of sight.

Hannah opened a small piece of paper that she had in her pocket and re-checked the address. She then cautiously knocked on the door three times and waited, constantly looking around herself to make sure that no one else was approaching. One of her medical school classmates had recently been held at knifepoint walking from class to his house only three blocks away– and that was a mile from here, in a much nicer part of town.

After 30 seconds, Hannah knocked again, this time with slightly more urgency. She heard someone stirring inside and she was glad that she would finally have the door opened to her. However, it was at least another minute before she heard the sound of keys jiggling around. It went on and on until she heard a male voice shout from inside.

“Jessi, how the hell you open this damn door?”

Hannah would have been amused if she wasn’t already so scared of being here. For her first year and a half of medical school, West Baltimore looked to her like a vast wilderness that could be seen from the upper-story windows of the hospital or her own rooftop deck, impenetrable and unsafe. Besides the robbery, she had also heard of a law student who had been carjacked and another medical student who had been simply assaulted for no apparent good reason by a gang of 14-year-olds. Somehow, she knew, patients came from here by bus, taxi, car, or foot to the enormous hospital downtown every day. However, she knew very few people who commuted in the other direction.

“Gainers, what are you doing up?” The woman’s voice inside was muffled, but still clearly harsh and accusatory.

“Jessi, there’s someone at the door!”

“What?”

“Come on down. I’m tryin’ to let ‘em in.”

“Gainers, what the hell are you thinkin’?” her voice was getting louder and closer. “First off, you are supposed to be restin’, and not gettin’ up every 5 minutes so you can answer the door! Lordy! You are gonna be the death of me. Second, you don’t know who it is? Maybe them knuckleheads down at the corner gonna come stick a gun in your face and come in. Did you look out the window first?”

“No, ma’am,” said the male voice.

“I don’t know what I’m gonna do with you.”

“Let me look.”

“Oh, no you don’t! You go back down and lay on that couch. You just had surgery last week!”

Hannah stepped back from the door so that she could be seen from the window just to the left of the door. The window was decorated with a few houseplants and a large, faded sign that read “Schmoke for Mayor.” She saw a face pop into the window and then disappear.

“I don’t know who that is. Maybe it’s one of them social workers from the hospital.”

She heard the keys jiggling again and then the door opened. Hannah saw a short, chubby black woman in jeans and a t-shirt that hung from her large shoulders. Her graying hair was neatly braided and her wide, brown eyes shone through a dense cloud of cigarette smoke. She balanced the cigarette in her hand between her lips, put another key into the security door, and opened it.

“Hi!” said Hannah, trying to overcome her nervousness with cheerfulness.

“And who might you be, young lady?” asked Jessi, who confidently put one hand on her hip and the other to her mouth as she pulled in on her cigarette.

“My name is Hannah Wells and I’m a medical student at the University of Maryland. I’m here because we’re part of the new campaign for universal healthcare in Maryland and-”

“You doing another survey? I done took one from one of yo’ colleagues last week,” she exclaimed in her raspy yet confident voice. Hannah felt her pulse racing more with every sentence. She was already out of her element and now clearly here was someone who was uninterested in her company. But she swallowed hard and pushed back.

“No, we’re looking for community advocates and organizers.”

“Oh, so you need my help?” asked Jessi rhetorically. “Awful nice to see someone say that instead of just showing up with a plan in place to fix my problems.”

“I’m sorry, I didn’t want to intrude. If you’re busy–”

“I am busy, but go ahead.”

“Well, we’re trying to really push for universal healthcare in Maryland, but there’s just not enough momentum.” Hannah was trying to remember everything that she’d heard at the Students for Healthcare Justice meeting last week where she signed up to help and get involved. When she left the meeting, she had felt energized and passionate. That continued into the volunteer meeting shortly thereafter where she had picked up her assignment. One of her classmates, Josh, was taking a whole year off school to do a health policy internship. He had held the room spellbound with his detailed presentation on health care access in Maryland, forcefully asserting the need for reform and the exciting challenge before them. All that was needed was awareness and momentum. The legislators would have to respond. People were suffering and dying because of poor access, and Hannah tried to stoke that flame in her own mind as she talked with this increasingly exasperated woman.

“So you need some momentum? Hon, I am a little old black woman who can’t even get my own damn brother to take his medicine, much less get some momentum going across the state. Momentum, huh?”

Hannah felt increasingly desperate and confused about what was happening. “Ida Carver said that you were a really important community organizer and that you would be the best person to talk to!”

Jessi’s face changed from suspicious to quizzical, with her eyes narrowing just a bit on Hannah.

“So Ida Carver sent you, huh?”

“Uh, you could say that,” said Hannah, not at all understanding Jessi’s expression and sudden change.

Jessi chuckled. “I ain’t seen Ida for a minute. She didn’t want to come herself, huh?”

“I don’t know… I mean, we were just going around the room dividing responsibilities and I volunteered for community advocacy and Ida said that you were the first person I should talk to. I tried to call you, but the line was disconnected.”

“Oh, that was just a few days this week because I paid my phone bill a little late,” explained Jessi. “The number works.”

“Well, good!” said Hannah, being a little too enthusiastic in the hopes that she might relieve some of the tension.

“Come inside,” ordered Jessi. “I do owe Ida an awful lot.”

Hannah stepped into the dark, smoky house and sat down on the enormous brown couch to the right of the door that Jessi gestured to. Between this couch and the other one just below the front window, nearly a quarter of the room was already consumed. Opposite the other couch was a very large flat screen television set up on a worn, plain table, loudly discussing the sexual proclivities of a young woman who apparently had not two but three potential fathers waiting backstage. Across the room from Hannah was an enormous bookshelf filled with an array of tchotchkes and a neatly ordered stack of books. Above the television was a framed triptych of high school senior photos, two girls in sparkling blue dresses and a boy in a black tuxedo. Each one smiled behind a soft filter beneath the words “Frederick Douglass High School.” On either side of the teenagers, photos of two preschool boys in various poses– hugging their mother, dressed up for church, rolling trucks in the grass– decorated the wall. The campaign sign in the window and the bookshelf on the other side blocked a lot of the light coming into the room, and the only other light came from a small lamp on the bookshelf. The smell of smoke, years and years of it absorbed into the carpet and couches was almost overpowering.

On the other couch lay a man about Jessi’s height but with a much larger belly; he was wearing shorts and a t-shirt that were respectively pulled down and riding up enough to reveal a clean white abdominal binder wrapped around his body. Hannah instantly recognized that abdomen and thought to herself that just a week ago, she had her gloved hand inside of it. He looked over at her and nodded hello, and she nodded back with a brief “hi,” trying to ascertain if she should say anything or not.

“Name’s Gainers. Gainers Goodson. How you be today?” he asked jovially.

“Just fine,” answered Hannah, nervously glancing back and forth between the television and the abdomen. “And yourself?”

“Oh, y’know, just tryin’ to recover. I been laid up at University for a week. Die-ver-tick-you-lye-tis.” Clearly he had practiced saying this. “They done cut me open and pulled it out. But you know, I was so scared when I went in, coulda sworn there was an demon in there! At first, nobody believed me ‘coz I wasn’t taking my medicine. But then they go in and they tell me sure ‘nuff, there’s something in there! Wasn’t no hocus-pocus though. Just a- a- die-ver… y’know.”

Hannah nodded. “Mm-hmm.”

“And now!” he exclaimed. “My good sister here done took me back in out of the care and kindness of her heart.”

“I, uh, didn’t realize that you were related.”

Jessi reappeared from the kitchen with three glasses of water.

“You know the Bible says whatsoever you do unto the least of these, you have done it unto me,” said Jessi. Hannah was pondering the significance of that statement when Jessi jumped into her next one, handing out the glasses of water without blinking. “It also says that wine biteth like a serpent and stingeth like an adder.”

“And it ain’t kidding!” affirmed Gainers. “I’m done with this bullshit.”

“Watch your mouth in front of guests!” snapped Jessi. She sat down on the couch where Gainers feet were resting, so close to Hannah that their knees were nearly touching. Hannah’s eyes drifted back towards the teenagers in gauzy portraits, beaming down on all three of them as they sipped their water in the in the smoky living room.

“You lookin’ at my babies?” asked Jessi, her voice softer than it had been since Hannah had come in.

Hannah was startled. “Um, yes! The three on the wall?”

Jessi craned her neck around to look at the pictures. “That’s them. Two of ‘em are God’s angels, called up early. One’s still here to do his work. That’s her kids right next to her.”

“”Oh,” said Hannah, still trying to compose a response to the revelation that this woman had lost two children in the prime of life when Jessi’s voice resumed the direct, commanding tone it had previously conveyed to Hannah.

“So tell me how on earth Ida Carver thinks I can help you, or you help me, or whatever it is you zealots are planning.”

“Well, as you know, there’s–”

“I don’t know anything about your crazy plans. Let’s start there.”

“Uh, okay. Well, there’s a big grassroots campaign to get universal healthcare in Maryland. But we need community involvement.”

“How can it be a grassroots campaign if you need community involvement?” asked Jessi, and Hannah realized that she had never really thought about it until now. Nevertheless, she decided to take her loss and move on.

“Well, there are a lot of students and health care workers who are concerned. We all work with patients who slip through the cracks or they’re really trying but they just can’t get coverage because they make too much money or they have a preexisting condition and we just want to do something.”

“You just want to do something, huh?”

“Yeah!” exclaimed Hannah.

“And you need some black faces in your pictures, huh?”

“I didn’t say that,” said Hannah, finding herself increasingly defensive but also amused and intrigued by Jessi’s barrage of questions.

“I been there,” she said. “I got up there and I told my story into the cameras. I went door-to-door, I talked to reporters, I waved signs. I gave ‘em hell. Ooh, excuse my language.”

Hannah smiled a little at her remark, wondering just what sort of hell this woman could give.

“I even shook hands with the Governor once. He gave me a big sweaty handshake and thanked me for such a good job with my advocacy. And then he took a picture with me. And that was it. Twenty years later, I’m still sitting here in this house and there’s still dealers on the corner every single day.”

“What were you working on?”

“Health care reform.” Jessi smirked.

“Oh,” murmured Hannah quietly.

“The bill never passed. Outvoted in the Senate. But Ida never gave up, it seems. She was just waiting for her chance.”

“Well, she thinks she has it again. Twenty years is a long time,” Hannah said excitedly. “Things have changed! We can make a difference!”

“Of course they’ve changed, honey,” said Jessi. “When Obama got elected, it was an awful big deal around here. But things always go back to the way they were. Kids still having kids, kids still killin’ kids. No sense of responsibility around here, no one cleaning up after themselves.”

She sighed and looked away, then reached into her pocket for another cigarette. She held it carefully in her fingers, twirling it back and forth for a few minutes. Hannah watched in silence as she pondered the cigarette, flicking her lighter on and off at least six or seven times as she looked down, then up, and then at Hannah.

“Lord don’t give me a break any day.” There were a few more moments of silence, then she lit the cigarette and put it to her lips.

“I’ll do it.”

Hannah raised her eyebrows, now infected with Jessi’s suspicion. Jessi smiled.

“You need momentum? I’ll get you some momentum. You were brave enough to come out here clearly not knowing what you was getting yourself into.”

“You could tell?” asked Hannah.

“Are you kidding, girl? I was worried when I sat you down you was gonna wet my couch.”

“Oh, well, it was just that I, uh–”

“Were you worried about Javon down on the corner? He a businessman. No matter how hard I try to run him off, he always come back. He not gonna mess with you. Anything happen to you, he’d probably protect you. He don’t need attention or trouble on his corner.”

“Oh,” said Hannah. She was a little puzzled by Jessi’s familiarity with the drug dealer, but as she thought a little more she figured that Jessi would know these sorts of things. Perhaps that’s why Ida had said she would be so valuable.

“There’s a community meeting on April 2nd up at the Western District poh-leese station,” she explained, accenting her words in that peculiar Baltimore way that Hannah was still getting used to. “Tell Ida that if she’s not there I am gonna personally walk over to whatever fancy house she’s livin’ in and beat on her door until I get arrested for disorderly conduct. Like the good ol’ days. Tell her that if she’s not too good for Sandtown no more, she can come down here and see me herself.”

“I will,” said Hannah, already trying to spin Jessi’s words more diplomatically in her head and then thinking that clearly there was some kind of complicated code mixed in there that defied her suburban-raised translation.

Jessi eased herself up out of the couch and walked to the door. Hannah followed her there and turned back to face Jessi.

“Thanks.”

Jessi smiled. “You a good girl. I can see why Ida sent you here.”

“I still can’t,” admitted Hannah.

“You want something,” observed Jessi. “Keep it up.”

 

Click here to proceed Chapter 2, which was was released on October 1, 2014.

Go to the discussion page.

 

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Trousseau Syndrome by Matthew Loftus is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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