Chapter 5: November 2010

Adam sipped his water beneath the dark green umbrella as he fingered the metal loops expanding across the table that he sat at. The table and umbrella were just outside of the Camden Pub on Pratt Street, a block south of the University of Maryland Baltimore campus. The tables and chairs nearly occupied the entire sidewalk, but there were not very many people eating outside now. It was an unseasonably warm day at the end of autumn, but still most patrons were inside, where a monotonous pop beat blared. He took another look at his cell phone again to double-check that he had the correct time, and indeed it was seven minutes later than Hannah had agreed to meet here. He wondered if she had forgotten, was too busy with her work, or perhaps at the last minute she had been scared off. After all, he had been- and still was– a research subject in one of her experiments and it was possible that she’d realized it and was trying to avoid the awkwardness by fleeing the situation. He thought about going back inside– it was warmer than usual but still not particularly comfortable– but he reasoned that he ought to sit outside to make sure that he saw her. As he pondered it more he thought that she would likely come inside to look for him anyway. Still, he remained outside, hoping that if there was any doubt in her mind, he would decrease her chance of changing her mind at the last minute by seeing her approach on the street.

He drank two and a half glasses of water before he spotted her emerging from the parking garage down the street. Her long legs propelled her rather quickly down the sidewalk and every now and then a short gust of wind would blow her long blonde hair crossways. She crossed the street at a wide angle, cutting diagonally across the road just as two cars drove past. She noticed Adam and waved hello, then picked up her pace a little bit until she arrived at the umbrella.

“I’m sorry,” she said, panting for breath. Her cheeks were red and puffy; sweat was beading on her forehead. Still her, clean white blouse almost sparkled in the sunshine beneath her jacket and her jeans were just tight enough to reveal the shape of her legs. “I was in the middle of an experiment when I realized that I was late. I hope you haven’t been waiting!”

“Not at all,” said Adam hastily, although the past nine minutes had felt like a very long time to him. He decided that he did not want to play that up too much.

“Gosh, it’s hot out here. Do you want to move inside?”

“Sure.” Adam pushed his chair out and stood, then followed her into the pub. The warmth inside was refreshing and the aggravating foursquare pop beat had switched to something gentle and acoustic.

“How are you today?” asked the hostess at the front.

“Oh, fine,” said Hannah.

“Can we get a table in the back?” asked Adam.

“Sure, hon,” she replied. They followed her to the back of the pub, where few people sat and it was quieter. They settled into their chairs and picked up the menus that the hostess had handed them.

“How did you know about this place?” asked Hannah.

“I’m here a lot,” said Adam, rolling his eyes.

“Oh,” she murmured. “Sorry.”

Her eyes disappeared back into the appetizers.

“It’s alright,” he replied quickly, trying to recover from his last sentence. “I didn’t mean it the wrong way. It’s just that there are only four or five good restaurants within a block of the hospital, and when you’ve got to see the family doctor, the transplant surgeon, the gastroenterologist, and, when things aren’t going so good, the nephrologist…”

“Nephrologist? You have kidney problems?” She put the menu down.

“For a year or so, yeah, things weren’t looking good. But I bounced back.” He hesitated for a second. “I thought you would have known that.”

There was no accusation or harshness in his statement, just a flicker of surprise. Hannah shook her head.

“There’s a lot I don’t know about you. It’s really Solomon’s job to pick the patients, know their medical histories… my job is mostly lab stuff. It’s just recently that he’s had me come along with him for some of the follow-up visits.”

“Were you there when he put my cells back inside me?” asked Adam.

“No, I had class.” She appeared somewhat disappointed. “I wish I could have, though. I’ve only seen one of those surgeries.”

“Are you going to do them when you graduate?”

“Oh, gosh, I hate it when people ask me this…” murmured Hannah as she rubbed her temple.

“Oh, sorry!” exclaimed Adam. “I didn’t mean– well, I don’t know–”

“It’s okay!” she chirped. “No need for you to apologize. It’s a fair question, I just get asked about my future career twice a day, especially since things started blowing up with the study and all of that. I do really enjoy surgery. It’s just a different world. I had just started out thinking that I’d want to be an infectious disease specialist so I could work in Africa or maybe some kind of primary care doctor. Or a general surgeon. They’re building a hospital where I used to work in college and they could use another surgeon there… just not someone who transplants livers.”

“Don’t they need liver transplants in Africa, too?” Adam’s question was innocent, but he realized after it escaped his mouth that it sounded rather cheeky. He fumed quietly to himself at doing so poorly so far at making conversation.

Hannah chuckled anyway. “Of course they do. There’s just no… infrastructure. I could show up ready to transplant livers and inject Hepatolife all day long, but unless I had a whole transplant team behind me and the sort of facilities to do it… not to mention the drugs you have to take every day. I don’t even know what kind of trauma surgery or life support they have there– so many of our transplants here come from people who are in car accidents or get shot and then donate their organs. And the drugs. They’re immunosuppressive, they’re expensive… I’m sure you know all about what’s necessary.” Her voice drifted off as she got to her last sentence, as if she was trying to avoid the painful reality of Adam’s own need for a liver transplant.

“Oh yeah, I know,” said Adam. Then he smiled. “But it’s something I haven’t had to think about in a while.”

Hannah smiled back.

“So how do we sustain a system like that?” he asked.

Hannah laughed again. “That’s why I wish I had gone to public health school or studied policy… I don’t know how to do something like that. It takes a lot of government investment, that’s for sure, to pay for the doctors, nurses, medications, and all of that. The sort of stuff we’ve been working for in Maryland. The best it seems we can get in Africa is what happened with your dad’s company coming in and helping us build a hospital in exchange for letting us test out Verilife in clinical trials.”

“I’ve always been curious how that happened, to be honest,” said Adam. “He never explained much about it to me.”

“Well,” explained Hannah, “When I first went over in high school, all we did was build a little schoolhouse and take some pictures hugging little children. I was pretty dissatisfied with that. Then in college I started studying anthropology, read on my own about the history of development, learned about the history of Africa– it just blew my mind how little I understood when I first went over and how disempowering it must have been to have a bunch of white teenagers build you a building.”

“No kidding,” said Adam. “When I was little every now and then I would see a bunch of white people in matching green t-shirts and wonder what it was all about. Now… the idea of a bunch of American teenagers coming to Africa just to help out with something that probably didn’t need them, just some money and time… it just feels weird to think about.”

“I had gone with some group that ships high schoolers all over the world to do little work projects and so I went back to them, determined that I would do something different as a team leader. I knew there were a lot of things that the community needed– after all, they were desperate enough to have someone else build something for them when they had plenty of able-bodied men hanging around. But I decided to ask them.”

“How’d you do that?”

“I raised my own funds to go back. And instead of doing anything for anyone, I just sat and listened. I talked to the community leaders, I talked to the women at the river, I even talked to a few local officials. I didn’t make them any promises and I didn’t tell them what we could do for them. It took a little while– they were experienced enough with the whole game to just ask for money or buildings or child sponsorship. But when I listened long enough, they told me all kinds of stuff that they felt like they really needed. They didn’t need a new dormitory built for the orphanage– they didn’t even really need an orphanage. Most of the kids in the orphanage had parents who had just given them up so that they could put their face on a card and get money for school.”

“Oh gosh.”

“Yeah. So what they really wanted was some kind of health care. The nearest hospital was three hours away, and people only went when they were really, really sick. So I went back home and I asked some some nurse friends, and they gave me some books about basic stuff you can do where there’s no doctor– oral rehydration solutions, basic maternity care, that kind of stuff. There were enough people I knew that had gone with me before that were interested in helping out, so we went back and did some educational seminars. The people loved it. I found out that there was supposed to be a health outpost nearby, but someone had embezzled the money. The community leaders went to governor to complain and they started paying a nurse to staff it. I raised more money and started an NGO called Africa Partnership to do community education in nearby villages.”

Adam loved watching how animated Hannah was becoming as she was telling her story. Her blue eyes grew wide as she emphasized each dramatic turn.

“Then when I started doing research during the school year with Dr. Bode, I found out that your father was from a nearby village– and he asked me about doing the phase I clinical trial there. It seemed a little weird at first, but when they offered to build a clinic, staff it with a doctor, and do all the legwork… then I went over their research protocol with a fine-tooth comb. Can never trust a big company with a lot of money trying to get someone out of poor people. Plus I had been helping with the animal studies, so I knew that Hepatolife had a low incidence of side effects already.”

“My dad sure does like to brag about that clinic. I think he wants to name a floor of the hospital after me or something.”

“Wow!” exclaimed Hannah. “Maybe I can get one, too.”

They shared a brief laugh at his father’s exuberance. Adam thought briefly about whether or not he would approve of their talking and joking while he was ostensibly supposed to be studying, but quickly shrugged off that thought in his mind. In his distracted thoughts, he was caught off guard by her next question.

“What was it like for you, growing up there?”

He realized that he had not thought much about Ghana lately; his father went there every now and then for various business reasons or occasionally to visit family, but he had always been too sick to go himself. He slouched down a little further in his chair.

“I, uh… I don’t remember too much. I mean, when I was real little we were in the village. I guess I was probably one of those barefoot little kids running around getting hugged by white teenagers, if they came out as far as we were. But we moved to Accra when I was pretty young. After that my life was a lot like people here, I guess.”

“Okay,” said Hannah. She leaned in to listen more. Adam was not sure what else to say.

“I guess you’re not going to ask me if I ate bugs or if I crapped in a hole outside when I lived in Africa,” he said with a small grin.

Hannah laughed. “Oh God, I hated it when people asked me that.”

“You too?”

She nodded.

“Yeah, there’s not so much to talk about growing up in Africa when you’ve lived in a fairly modern city. I’ve been here since I was 14.”

“What was that like?” asked Hannah.

“Uh…” Adam looked away. He felt his stomach twisting in a way that he wasn’t used to as he was subjected repeatedly to questions that he’d never pondered himself or had tried to forget about the answers to.

“I was wondering if you could help me with my biology. I think my dad will get mad if he finds out that we were here for an hour and I didn’t get any studying done.”

“Oh!” exclaimed Hannah. “Well, sure. I didn’t realize… you just wanted to study.” Adam could see that she looked more disappointed than surprised, although she was trying to camouflage it.

“Oh no, it’s not that…” said Adam. Again, he felt defeated by every word that came out of his mouth. “I didn’t mean… that I didn’t not want to be just with you. I mean, I have a tutor… that doesn’t make any sense. I don’t know what I’m saying.”

He threw up his hands half-heartedly. Hannah giggled a little, which he couldn’t help but smile at.

“It’s okay,” she said. “I can help you with your homework, if that’s what you really want. I did get a 38 on my MCAT.”

“Damn!” exclaimed Adam. “My dad wasn’t kidding about how smart you are.” In all of his half-hearted preparations for medical school, he had learned that 45 was a perfect score and 35 was very competitive. “He once had a really passionate conversation with someone from Towson about how shameful it was that they didn’t know what the average MCAT score of their students applying for med school was.”

“Your dad?”

“Yeah… I told him that you were going to help me study.”

“I see,” said Hannah with a raised eyebrow. “So was that excuse more for him or for you?”

“Oh gosh, you ask these questions… like you…. I dunno.” Hannah giggled again. He felt so embarrassed when she did that, but somehow instead of forcing him back down he felt like her laughter drew him out just a little each time. Yet every time he felt relaxed, he kept saying something that made him sound even more confused and awkward.

“We can cut right to the biology homework if you want,” offered Hannah. Adam could tell by the way that her lips still curved upward a bit that she was only half serious.

“Nah, that’s boring… and besides, you never answered my question about becoming a liver surgeon. Not to bring up a subject that’s awkward or re-ask a question you don’t like to answer.” He hoped that by making the joke on himself this time, he might be able to recover. It seemed to work, as she laughed yet again in that gentle way.

“Yeah, well… I really like the whole community development aspect, or maybe being an internist or infectious disease doctor where you get to do more cerebral stuff in the hospital all the time. You can make an even bigger impact if you think about population health, dealing with bigger problems like sanitation and vaccines and all that. But surgery, especially transplant… this kind of stuff is really exciting. I mean, you get to see people who were… y’know, wasting away– I hope you don’t find that offensive–”

Now it was his turn to laugh to ease the tension. “Nah, I sure felt like it. I don’t think I ever used those words, but I’d say they’re pretty accurate. Measuring my life out in how many shits the lactulose made me take to clear out the ammonia that was poisoning me…”

She resumed her thought with more vigor than she had left it. “–and you get to watch these people who were wasting away get better! They get up and they walk and go on dates with awkward girls who can’t stop bringing up uncomfortable subjects.”

Adam felt an odd sense of relief that she had felt the tension, named it, and shared her blame in it. He, of course, felt the need to respond with a little more self-deprecation, since that had seemed to work last time.

“Oh no, you’re not awkward. At least not compared to me!” he proffered.

“You don’t know me all that well,” said Hannah, grinning. “You’ll see, in time.”

The waitress came around again with two more waters in her hand.

“Have y’all decided what you want yet?”

Hannah and Adam looked at each other, then back at her.

“Uh… no,” stammered Adam.

“Just a few more minutes, please,” requested Hannah.

“Sure, kids,” replied Jen with a hint of addled sarcasm. She skipped away just as abruptly as she had come back. Hannah and Adam turned back to one another.

“I guess we should look at the menu before we get around to the biology textbook, huh?” quipped Adam.

“I guess so. Wanna split an appetizer?”

“Sure. Did you have something in mind?”

“How about oysters? Do you like oysters?”

“I do, actually… my dad doesn’t, though, so I’ve only had them once. We grew up near the river, but he was always more of a regular fish kinda guy more than shellfish.”

“I see. Have you ever picked crabs?”

“Uh… what do you mean, picked?” Adam was not sure what she meant, although he was pretty sure he’d heard the phrase before.

“You know, like you get a bushel of crabs and pick ‘em apart and eat them.”

“Like… Maryland crabcake?”

“No, silly. You’ve lived in Maryland for 6 years and you’ve never picked crabs?” Hannah seemed rather astonished as she said this, which Adam didn’t know how to interpret.

“Like I said, my dad doesn’t really do shellfish.”

“Okay. We are gonna have to pick crabs sometime. Maybe you can come down and we’ll do it at my parents’ house.”

“Oh, where’s that?”


“Which is…”

“South of the city. It is the burbs if ever there were burbs.”

“I see. I don’t get out much, in case you haven’t noticed.”

“I don’t mind,” said Hannah with a more mysterious smile. “It’s a relief, to be honest.”

“Oh?” Adam was intrigued.

“It’s just that a lot of the conversations I have with guys in my class are all about the one-upping. ‘So you’re doing research with liver regeneration? Well, I’m developing a cardiac revascularization device.’ ‘You started an NGO in Ghana? I led a program that screened 2,000 destitute women for breast cancer in East Baltimore.’ I mean, it’s mostly just a few jackasses. But everyone’s so competitive, all the way through.”

“Yeah, I… haven’t noticed that with some of the pre-meds.”

“Fortunately, most of the real assholes get weeded out in the med school interview. But some of them still slip through. And then they ask you out on a date and all they wanna talk about is how awesome they are and how they’re totally gonna match in orthopedic surgery or plastics.”

“What do you mean, match?”

“Well, throughout your fourth year of med school you interview for whichever residency you want to apply in– and then you rank the programs that you want to go to. The programs rank their favorite candidates. A computer somewhere then goes down the list and figures who goes where, and on Match Day you all open your envelopes and find out where you’re going to do your residency.”

“Wait, the computer figures it all out?” he asked incredulously.

“Yeah, it sounds really weird trying to explain it… but that’s how it works.”

“Sounds nerve-wracking.”

“Well… yeah. Especially for the super-competitive residencies where there aren’t a lot of slots, like orthopedic surgery or dermatology.”

“I guess transplant is pretty competitive, huh?”

“Well, actually transplant surgery is a fellowship… you do five years of general surgery residency, then you apply after that to do two more years of fellowship.”

“Whoa. That’s a long time to be in training. I knew it was long, but… so what about other residencies?”

“Some are shorter… like internal medicine, family medicine, pediatrics… those are all three years. Some specialities you do one broad-spectrum intern year, then three more years just in that specialty. That’s when you have to do two matches– one for your internship, one for your residency.”

“And internship is… different from residency?”

“Well, sort of. Gosh, now you’re asking all the confusing questions and putting me on the spot!” joked Hannah. “Internship is your first year of residency, and everyone says it’s the hardest. Sometimes it’s just a part of your residency program, like if you’re in general surgery or internal medicine or whatever. Sometimes it’s different, like if you want to be a radiologist you do one year of internal medicine and then three years of radiology.”

“Oh, okay. How about infectious disease? You said you were interested in that.”

“So that’s three years of internal medicine and then three years of infectious disease fellowship.”

“That also sounds like a lot.”

“Yeah, it is. But you get paid more.”

“Like, how much more?”

“Like… a primary care specialty that mostly does outpatient working full-time might earn $150,000 a year… one of the internal medicine specialties might make more like two-twenty or two-fifty. General surgeons start off in the one eighties and then just go up and up with the subspecialties. Solomon probably makes about four hundred a year.”

“Damn,” muttered Adam. “But he works his ass off.”

“Oh, he does,” said Hannah. “Even with all the research and admin stuff he does, he still operates a lot, rounds in the hospital, teaches lectures… he’s nonstop.”

Jen appeared again. “Have you decided?” She seemed slightly more exasperated at this point.

“Oh, yes,” said Hannah. “We’ll share the oysters as an appetizer and I’ll have the quesadilla. Can I switch my side to the steamed veggies?”

“I’ll, uh, have the bleu cheese burger,” said Adam.

“Alright, and anything else to drink?”

“Water’s fine for me,” said Hannah.

“I’ll have a Coke.”

“Alright, comin’ right up!” Again, she disappeared. Adam had forgotten how hungry he was and sort of wished that he had ordered a little faster. But while Hannah was ordering, he had figured out his next clever line and was eager to try it.

“Okay, I’ll turn the question on you: what was it like growing up in, uh, If-Ever-There-Were-Burbs-This-Is-Them Columbia?”

Hannah seemed confused by his phrasing at first, then laughed again. “Well, here we go learning about how awkward I am. From what you’re telling me, it wasn’t that different from growing up in deepest, darkest Africa!”

Adam appreciated the return fire. “Running water, ambitious parental figure, and three square meals a day. Same for the upper-middle class around the world.”

“Yeah, my parents wanted a lot for me… but they also knew that I’d throw off any expectation they put on me. I did all the stuff that white girls in the suburbs do… piano lessons and gymnastics when I was younger, field hockey and the aforementioned work trips when I was older. I didn’t really think much about medicine until the second trip to Ghana. Then I got some fire in my belly with all the classes down at College Park– learning about history, the way that systemic injustices still play out today, the disparities in health care delivery to minority communities in America and to the poor abroad– and I just wanted to help people. There was always this strong sense that because I grew up in privilege, I owed something back to a lot of people and had to make a difference in the lives of those people if my life was gonna matter.”

“Mm,” said Adam emphatically. “Clearly you are better at coming up with tough answers on the fly than me! But we still haven’t gotten around to the awkward part yet.”

“Well, I see what you’re eager to learn about,” joshed Hannah with another mysterious-looking smile, the sort that Adam was not used to seeing directed at him. He took a moment to study it as she paused before launching into her explanation. Her lips were just slightly upturned with a shift to the right, almost as if she was delighting in a secret, but somehow the secret was in or around him. It gave him a little shiver.

“Well, I guess with all this social justice passion and wanting to get into med school and doing research with Dr. Bode… I was kinda different from a lot of other people. I went through a vegan phase– thank God it was short– but I didn’t have any problem telling someone at the cafeteria where their meat came from. I mean, now it’s trendy to be all fair trade, but freshman year in college it certainly wasn’t. Or the whole thing with this health reform campaign. It’s only ten other students or so who are into it– no one else in my class seems very interested in learning about how people get their health care in this city. ”

“But you seem to like being different.”

Hannah’s face turned from her excitable expression to a more pensive look. “Yeah, I guess you’re right. I do. In a world like suburban Maryland where everyone’s a unique little snowflake, when you have a cause and a passion to set you apart– well, it’s certainly makes you feel a lot more meaningful than just getting married and having kids or going into dermatology so you can make a ton of money and go home at 5 every day.”

Their plates appeared in front of them, along with eight oysters in a tin full of ice carefully arranged in a circle around a small bowl of cocktail sauce. Both entrees were steaming; Hannah’s quesadilla still had cheese bubbling out of the sides and Adam’s burger was dripping with warm tallow onto the plate and staining his fries.

“You’re not gonna judge me for eating this delicious burger, are you?”

“Oh, God, no,” exclaimed Hannah. “Like I said, the self-righteous vegan phase was short. I realized that no one can live up to all these causes. And living a perfectly socially conscious life is downright boring, especially when your only friends are self-righteous vegans. Plus when I went back to Ghana I came to appreciate what’s it like to eat a cow that you saw drop out of its mother.”

“It certainly tastes better than McDonald’s,” opined Adam. “My father can’t stand the meat here compared to back home.”

“And you have to be patient with people who have never been exposed to these kinds of things. Especially poor people, who so many times are just still complicit with the system that oppresses them because they’ve been taught to stand in line and serve it. I mean, right here in Baltimore there are people who are working a job, maybe two but still can’t afford decent health insurance. So they go to the ER whenever they have a problem and they get some expensive tests and some medicines to go home with but they’ve still got the same problems and can’t afford half of what gets prescribed. Or they have insurance, but they have crappy insurance and nothing they need is covered. The ER gets paid, the doctor gets paid, but nothing changes for the better.”

“I guess I’d never really thought of it that way,” said Adam. He took a large bite of his burger and wiped his mouth on the sleeve of his t-shirt. “But, I mean, sometimes when I think about it– okay, not that much– but when I do, how it compares back home where people don’t have anything. At least here poor people have something.”

“Well, yeah,” admitted Hannah, “But there’s still so much suffering and dying unnecessarily here. It’s worse in Africa, sure, but while I’m stuck here in Baltimore for med school I have to make a difference here while I can.”

“So what exactly are you doing about that?”

“Well, I’ve been meeting with some people in West Baltimore… there’s a bill they’re trying to pass to make healthcare in Maryland free for all citizens. Paid for by the state government! They will probably have to raise taxes to do it, but I think in the end we might save a little money when people get primary care and don’t abuse the ER or end up on the street because they have to pay a bunch of medical bills. They handed me the job of trying to organize community support in West Baltimore– get a bunch of people to a rally in a month, signing petitions, that sort of thing. It’s sort of like what I was doing in Ghana, but it’s a little more intimidating when I walk in and don’t have quite the same power here that I did there.”

“I guess the white skin goes a little further over there,” observed Adam. “Can’t say I ever understood that, either.”

“Again, it’s the systems of power…. You should really take a sociology class. I think you’d love it.”

“Why do I need one when I’ve got you?” he asked with a smirk. He watched her mouth scramble to find a retort, but launched into his next question before she could respond. “Are you still doing stuff in Ghana?”

“Yeah, technically I’m still on the very small board of directors for the NGO… I’m actually going back in a few weeks after the conference and the rally to check up on things and see how the hospital construction is going. That nurse I told you about earlier– Afua is her name– is the one who’s really running things day-to-day. It’s great when you can empower local leaders to really take charge.”

“Africans doing great things for Africa, my dad always says. Of course, he usually says it a bit more enthusiastically than I did.”

“I like that! I’ll have to tell Afua next time I see her.”

“If she works with my dad, she’s probably already heard it.”

Hannah held the quesadilla in her hand, as if she was pondering it. Adam watched her hesitate and again her face took on a thoughtful look, as if she was deep in concentration.

“So, uh, would you like to come with me when I go back?”

“To Ghana, you mean?” Adam knew what she meant by ‘go back’ but was still trying to process the weight of her invitation.

“Yeah. I think you’d like to see it.”

“I mean, my dad would freak out, being away from the medical center. If something happened…”

“I think it’ll be okay, really. The drug is working. You’re better! It’s almost in your home village, really– at least that’s what your dad says, I don’t know if he’s making it up or what.”

“He’s probably exaggerating a little bit.” He paused. “I mean, I would love to go with you, I’m sure I’ll learn a lot. Is it even okay?”

“What do you mean, okay?”

“Like… for a guy to go with a girl to another country.”

Hannah smiled. “We both do things our own way, remember?” She bit into the quesadilla.

Adam nodded gently, smiling back. “I guess we do.”

A beeping sound emerged from below the table. She pushed away, pulling a small timer from her belt. “I need to get back to the lab– I’m not just saying that, I really do have stuff on a timer and all that. But if you really want to get around to that biology homework, we could always do this again on Saturday.”

“I’ve got practice then,” said Adam. “For track.”

“You run track?”

“I do.” He practiced his own version of the seductive smile, which felt contorted and bizarre to him. But clearly Hannah recognized, for she replied with her own.

“What events?”

“Sprints and shot put.”

“Hmm!” she remarked. He was not sure what she meant by that, but could detect her eyes moving over his arms. He was about to speak again when she started up.

“Well, I’d say that you should buy stock in Hepatolife… but I guess that’s a little redundant, huh?” she said.

“It pays my college tuition,” said Adam with a shrug. Hannah pulled a bill from her purse and laid it on the table. “Whenever I get around to tutoring you, you can pay.”

“Looks like it might be a while,” quipped Adam.

And with that, she leaned in quickly to hug him. First the scent of her perfume mingled with dry sweat from her earlier rush to meet him caught his nose, quickly overcome by the sensation of her clean, straight hair brushing his face. Moments later, he realized that her chest was pushing into his in a way that he had not experienced before. As soon as he realized what was happening and felt his body reacting to it, the front door was already swinging closed behind her.




Gainers leaned himself against a light pole and stared off into the distance, down the street. His eyes moved lazily from his black plastic watch to the hill as Fulton Avenue met North Avenue; the street divided by a trash-strewn median was empty of traffic and every pair of headlights that he saw held the possibility of being the bus he was waiting for. He’d just barely missed the 6:44AM bus when he ran back inside Jessi’s house to take the medication he had forgotten about at breakfast, but he might still be able to show up at work on time if the next one came in soon. On the corner opposite him lay an old friend, asleep in the tall grass with only his ragged shoes attached to pale brown legs sticking out from the foliage. Gainers winced inwardly as he remembered briefly the nights that he had slept there himself; passed out among the cigarette butts, empty bottles, and discarded chicken bones.

His memory was interrupted by the approach of the square black-and-white MTA bus bearing a soft yellow #1 on its electronic sign. He stepped up as the door hesitantly folded open and fumbled in his pocket for an assortment of quarters and dimes, gently placing them in the coin slot one-by-one with his left hand while his right held on to the railing. Each coin slid into the machine with a satisfying plunk and when he had managed to fit a full $1.60 into the machine he shuffled towards the back and took a seat.

He stared out the window at the red-brown rowhouses rushing past, interrupted by street corners sparsely populated with other folks waiting for the bus and the occasional dealer who wanted to get an early start to his busy day. As they crossed Route 40 along a bridge above an empty highway canyon, Gainers could see the red-orange sun just start to spread out above the Baltimore skyline. The concrete canyon below the bridge gently sloped downward as it ran into the city and spilled out into the narrow streets to the east, while a few of the taller hospitals– Mercy, Johns Hopkins, and University of Maryland– could be seen, as could some of the financial buildings further downtown. There was a gentle haze in the air, shimmering as the temperature began to rise from the deep overnight chill and the sun began to illuminate the concrete-and-glass landscape.

The bus continued to shudder beneath as it lurched forward in the morning haze. Gainers fiddled with the the keys in his pocket as he looked out the window, rubbing the warm metal back and forth between his fingers. As they came to a stop at a red light, he observed two men in grimy brown clothing holding up cardboard signs and wandering through the traffic, taking a coin or two from stopped cars. Behind the tinted glass and from the height of his seat, he felt very distant from the street. He shook his head as he thought about where that money would be going and again felt his own sense of guilt for the years that he had spent holding up a sign that said “HUNGRY PLEASE HELP GOD BLESS” when all he had filled his stomach with was vodka. As the light turned, they meandered back to the corner, where two boys had dragged a cooler and were scrawling their own cardboard sign announcing bottled water for a dollar.

The bus turned down Martin Luther King Boulevard, with the monolithic brick buildings of  University of Maryland Baltimore rising on the left and the thick trees lining the narrow, curving walkway on the right. Over the driver’s shoulder and out the enormous square windows he saw the football stadium and baseball stadium as the road rose into a highway. They turned and rolled down Baltimore Street, passing the Veterans’ Administration hospital on the left where many of Gainers’ old friends had gone and complained that they felt suicidal and wanted to quit drinking for a few warm meals and a place to stay on the 6th floor inpatient psychiatry units. They passed below a glass bridge connecting the VA hospital to the staid red brick of the University of Maryland Hospital, towering over them on the right.

They came to a stop, the next street up, at a large open square with a small garden in the center and people milling about. A few of his compatriots exited the bus and started walking north towards Lexington Market, where Gainers imagined that they would likely spend the day panhandling or selling to save up enough to bring back to a corner or liquor store back on the West Side. They passed men and women in white coats walking from one side of the square to the other, carrying large coffees and leather bags surely full of important papers. Gainers began to daydream about what it would be like to be one of those doctors, spending his day doing important things and going back and forth to work in a nice car to a comfortable house out in the county. He reminded himself that nobody’s life was perfect, but he wondered if he would feel better and struggle less if he had those things or if he would still shiver inside every time he passed one of the thousand liquor stores along his way. He found himself surprised by this thought emerging from his brain. He had been having more like it since he had been forced by Jessi to take his medication more regularly.

The bus eventually stopped again in the shadow of an enormous bank and he slowly rose and hobbled to the back, where he stepped down the dirty metal stairs and pulled open the folding glass door. He left behind the hisses and groans of the vehicle as he walked down the street and over to his office, where he picked up a well-worn plastic broom and dustpan set, firmly gripping their gray handles as he strode out into the warm morning.

He first wandered down along the Inner Harbor past the tall pentagonal World Trade Center building, sweeping up every piece of trash that he found and occasionally stopping to make conversation with one of his fellow Harbor Partners. They were all dressed in forest green polo shirts emblazoned with the bright yellow “Harbor Partnership” logo; their pants and shoes had been black on the first day but had quickly worn down to a dusty gray within a few hours of working. They puttered along the dark brick pavilion that encircled the harbor, talking and joking as they were passed by an ever-growing crowd of people walking through.

The sun was rising even more in the pale blue sky and as it did the air grew warmer, as it had been the last few days. Gainers felt his collar stick to him with sweat and figured that he should probably find himself some water soon. Getting accustomed to drinking water was something that had taken some getting used to; he had previously remained well-hydrated between a six-pack of National Bohemian and a fifth of Rikaloff a day. Now, however, he had to drink water, which meant remembering to drink water before he became so sick that he had to be revived with cold water poured over his face as had happened at the end of August. He turned northward and walked past the two-story brick-and-glass edifice that sat at the harbor’s edge full of trendy restaurants and gift shops to the intersection of Pratt and Calvert streets. There, two young boys were sitting on a large cooler waving 20oz bottles in their hands and walking in between parked cars when the light turned red, taking advantage of the warmer weather on this weekend day.

“Cold water one dollar! Coke, Mountain Dew, whatever you want! One dollar!” they each shouted in turn, to no one in particular. Gainers had not thought to speculate on their age but their heads barely met the rearview mirrors on most of the cars. Perched on a drab gray concrete planter nearby was a skinny teenager with a wad of bills in his hand and cheap headphones dangling off his ears, blaring indistinct beats loud enough to be heard over the din of traffic. His feet rested comfortably on the cooler as he disinterestedly thumbed at his smartphone.

“Lemme get a water,” said Gainers.

“One dollar,” replied the young entrepreneur. Gainers reached into his back pocket and fished out a messy ball of crumpled bills, smoothing them out as he looked through for a single dollar. When he found it, he stuck it straight out only to have it snatched away from one of the younger kids, who had returned from wandering the street when the light turned green. Immediately it was replaced in his hand by a small off-brand plastic water bottle that was almost as sweaty and warm as he was.

“Thank you kindly,” said Gainers with a smile.

“Ain’t no thing,” said the teenager.

“You’re welcome!” exclaimed the boy.

Gainers turned back towards the Harbor, the brown-blue water shimmering in the noon sunlight. To his left rose the old smokestacks bearing the obnoxious Hard Rock Cafe sign and neon-rimmed guitar almost the size of one of the stacks. Directly ahead was the pyramidal glass dome of the Baltimore Aquarium, which Gainers had wandered inside for the first time last week after saving up a week’s worth of paychecks. He had been cleaning up behind hordes of schoolkids and tourists who waited in long lines early in the morning to get in for months and before that he had panhandled just outside the exit for years.  He had never had a particularly strong interest in marine biology himself, but he was rather curious about what it was that made anyone pay $26.50 to look at some damn fish when you could get a lake trout sandwich with fries and a soda for $5.75 a few blocks north.

His curiosity had finally gotten the best of him last week, though, and inside the aquarium, though, he immediately forgot about the cost and found himself amazed that he had never been here himself. A group of rowdy first-graders dressed in smart white polo shirts and khaki pants or skirts rushed past him in the very first room, where bright blue glass columns filled with water that bubbled every few seconds fascinated him for fifteen minutes. He watched the bubbles dance up the columns in the darkened room for a while, then walked into the main hall of the aquarium. A pool the size of half a football field sat in the center of the hall, filled with rays and other fish that Gainers couldn’t distinguish gliding through the water. He gripped the railing over the pool and watched in awe as the light reflected off the water and danced on his face. The smooth, graceful movements of the rays below intrigued him; he wondered aloud to no one in particular what it would be like to fly through the water like that.

Escalators crisscrossed above the pool to take patrons to the next several levels of the aquarium. As Gainers moved up the escalator he found himself more in awe of the pool as his view of it got wider and wider. He was so transfixed that he tripped getting off the escalator, but then when he looked up and found himself on the second level his mind immediately turned to the line of glass tanks here.

He had never put much thought into how many different kinds of fish there could be, nor all the different spaces that they lived in. He’d never been to any body of water besides the stale reservoir at Druid Hill Park and, of course, the polluted Inner Harbor. Now, with each habitat carefully exposed by the glass panes, he, found himself more interested in the marshes, ponds, and oceanside tide pools than he had ever been before. He wished that his reading was a little better, as he frequently encountered words on the backlit information cards that he was completely unfamiliar with.

He was delighted to watch various amphibious creatures swim back and forth, and in front of one particular exhibit displaying catfish and a small crocodile he noticed a little girl peering inside on her tiptoes. They were both fixated on the small turtle that was paddling furiously inside of the tank, to what aim he couldn’t determine.

“Look at him go!” exclaimed the girl.

“Yes,” he replied, “He sure is kicking.”

As he watched her stare through the window at the animals, each one fully enjoying this afternoon as they did every other one, he couldn’t help but compare himself to the girl with her wide-eyed wonder.

“Is this your first time to the aquarium?” he asked.

“Yeah. I couldn’t go with my class last year because I was sick, but now I can go. And wow it’s so beautiful!”

He smiled. “It’s my first time, too.”

He watched her eyes dance with fascination and joy from creature to creature and wondered what difference this day might make in her life. He wasn’t quite sure where she was from, or even if she was from the city. She wore cornrows giving way to bright red barettes that touched the white shirt of her uniform, suggesting that she went to one of the city public schools. He couldn’t remember ever encountering anything so interesting when he was in elementary school. He thought but uncharacteristically didn’t say out loud that perhaps if he’d had such a wonderful encounter when he was a young boy, perhaps things would have been different. For now, though, he was content that his life had changed. He smiled as he imagined that the turtle kicking furiously in the clear water to get from one log to the next could have just as easily been carrying a broom and dustpan and sweeping up debris along the way.

He slid his water bottle in his dustpan after he finished drinking and walked another two blocks east to find the one recycling container in the whole harbor. Just as he carefully dropped the plastic bottle in the bin, he heard a short scream from behind.

As he turned his head, all he could see was a blur of a human form crouching down; above it was a woman’s face contorted with surprise and grief. A light brown leather string dangled from her hand. Gainers later prided himself on being able to ascertain the situation quickly, perhaps, he thought, because in his younger days he had been fairly skilled at cutting, snatching, and running as the young man moving toward him. He prided himself even more for not giving in to his inclination to look away as he had done time and time again whenever something terrible happened before him.

Instead, he reached out his dustpan by its handle and planted it firmly on the ground. The purse snatcher, either anticipating Gainer’s move or reacting quickly enough to it, began to move left, away from the path of the outstretched dustpan. However, he failed to anticipate Gainer’s counter, which was to grip his broom firmly with his other hand and swing wildly out. The extended broom connected with the thief’s abdomen rather forcefully, sitting snugly below the leather purse, which he kept clutching even as he tumbled forward and fell facefirst into the concrete.Gainers then brought up the dustpan and gave the thief a satisfying thwack on the back, doing no real physical harm but rather emphasizing his victory in outwitting him.

By this point the woman’s screams had attracted a security officer wearing the same color scheme and logo as Gainers, only with more badges and less dirt. When the young man lifted his bloodied face from the ground, he scrambled upwards but only bumped into Gainer’s protuberant abdomen, bouncing off the ever-present fluid and scurrying backwards into the hands of the officer. Gainers smiled as the purse was returned to its owner, who took her own swing at the thief with it.

She turned to Gainers and shook his sweaty hand. She was an attractive middle-aged woman in a gray pantsuit, and though her afro had been ruffled by the event she was quickly composing herself. Gainers thought to himself that he might have asked her for change at some point in the distant past but couldn’t remember for sure.

“Thank you so much!” she gushed.

“Aw, it was nothin’,” replied Gainers with a smile.

She hugged him rather spontaneously, and he let himself enjoy the sweet smell of whatever was in her hair. While he was still reveling in the ecstasy of his own good deed and the scent of this woman, she quickly rushed off, just as busy as she had been before Gainers had stopped the thief. He kept smiling as he walked back towards the harbor.

As he waited for the light to turn so that he could walk across the five unidirectional lanes of traffic, he looked again at his watch and noted that he had just an hour before his psychiatrist appointment. He figured that he had enough time to work along the shops on the other side of the Hard Rock Cafe before he got back on the bus, and so he did. He passed his coworker again, who was carefully waiting for the seagulls to clean up behind a group of excited schoolkids veering away from a hot dog stand and towards their waiting bus.

“Awful good day to be here, ain’t it?” called his friend.

“Yessir it is!” replied Gainers.




Solomon sighed as he relaxed into his plane seat. He wondered if it would have been worth it to get a different flight with first class and extra legroom; just as quickly he realized that at this stage in the flight there was little point in thinking about it all. He tried unsuccessfully to tuck his legs either under his own seat or above his laptop bag under the seat in front of him before finally awkwardly crossing them so that his knees invaded Hannah’s space in the seat next to him.

“I hate flying,” he mumbled.

“Not surprising,” Hannah replied. She angled her legs to the left to make a little more room for him to relax, but mostly it just made her more uncomfortable.  “At least you have the window.”

“You can have it if you want. I’d prefer the aisle myself.”

“Fine with me,” said Hannah. She got out of her seat, almost bumping into the one person in the single seat across the aisle from them. Solomon then followed her out into the aisle and she took his seat next to the window, staring aimlessly out the window at the flashing lights on the wing against the blue-back dusk as Solomon once again did his slow dance with his feet to try to make them not stick out too awkwardly.

“Good job on the presentation, by the way. Best student presentation I’ve seen.”

“Thanks,” said Hannah. She seemed not to have noticed the gravity with which he had tried to speak, as she was very absorbed in trying to send off a text message before the plane took off.

“I’m not just saying that because it’s my data. Not many students present at this conference. Not even residents. It’s mostly fellows and attendings. People with M.D.-Ph.D.’s.”

“You told me this already. I think you were trying to scare me into working harder on it already.” She looked up from her phone.

“Oh, that reminds me. Rita called me when we were in the terminal and I missed it. I’ll have to call her back.”

“Oh?” Hannah’s voice was pert.

“Oh what?”


“What about her?”

“Why would she be calling you?”

“I don’t know,” lied Solomon.

“Did she help with the paper at all?”

“She found a couple of sorry souls who were willing to try anything to fix their livers.”

“Like Adam.”

“Yes, like Adam.”

“I was thinking about it the other day. You took a big risk on him, giving him a treatment. He’s the only one in the study with autoimmune hepatitis. All the others got cirrhosis from drinking, but his disease was still ongoing.”

“It was a risk I was willing to take,” said Solomon, looking straight ahead. “And it paid off pretty well, I think. Certainly more than I ever expected or even led Kofi on to believe.”

“What do you mean by that?”

“When Kofi came to me four years ago, he had already burned through a couple of other experimental protocols and Adam’s liver was still dying. He’d been on the top of the transplant list for years but he tested positive for so many antibodies that no liver was a safe match. Kofi’s savvy enough that his company trusted him with way more funding than I probably should have gotten considering how crazy my idea was and how little data I had so far. I told him what I thought I could do, but I warned him that for a kid as sick as Adam was, there was little hope that anything would work. I hoped he would get a transplant in the meantime so I didn’t have to deal with it, but it was always an unspoken agreement that Adam would be the first person to get Hepatolife.”


“Yeah, he moved some mountains for me.”

“Hmmm. So… Rita?” Hannah was eager to return the conversation to its original subject.

“How do you know Rita, anyway?”

“She was my clinical preceptor first year.”

“Oh, really?”

“Yeah, we all had one afternoon a week in the hospital with an attending to learn how to take a history. She was really fun to work with, and when I told her that I had worked with you in undergrad we talked about it some. Plus, she’s Adam primary care doctor.”

“You seem to be bringing up Adam a lot more lately,” observed Solomon dryly.

Hannah blushed slightly. “You still haven’t answered my question about Rita.”

“I did,” he stated plainly. “She did not help with the paper. I don’t know why she called, and now we’re about to take off so it wouldn’t do either of us any good for me to call her back now. Happy?”

He cocked his head down slightly, as if to try to assert his authority over her just enough to end the conversation. “Now, is something happening with Adam that’s going to fuck up my research protocol?”

“Jeez, relax,” said Hannah. “We’re just talking. That’s all. Mostly I help him with his homework and studying”

“I hope you’re not trying to bill for patient contact or anything.”

Hannah laughed. “We could wring the insurance companies dry that way, for sure! You know he’s still kind of getting adjusted to his new life. When you spend most of high school in and out of the hospital, it’s hard to find friends.”

“I guess so,” said Solomon. “So you’re not going to do anything that would get my protocol in trouble?”

“Of course not!” exclaimed Hannah. “Wouldn’t dream of it.”

Her phone beeped again, and immediately she pulled it from her pocket.

“My, someone has a lot of homework on a Saturday night,” observed Solomon as he pulled a medical journal from his bag and started flipping through it. “Better hurry up before the plane takes off.”

Hannah blushed. “Um, what would exactly mess up your protocol?”

“Anything that might possibly influence the outcomes we’re studying.”

“Such as…?”

“Such as any suggestion that he participated or continues to participate in the study because of undue or inappropriate influence on your part.”

“I don’t think you have to worry about that. He takes Hepatolife every day because he’s convinced that it’s keeping him alive.”

“Well, then, I guess we don’t have much to worry about.”

“Glad to hear it,” said Hannah, her thumbs moving furiously. Solomon almost didn’t hear the next thing she said.

“Does liver function have anything to do with muscle development?”

“Hmm?” replied Solomon. “Liver function? Well, estrogens are conjugated in the liver before they are renally excreted. So if someone’s liver is not functioning well, they’ll have excess estrogen. That’s why every man in my clinic has tits.”

“Okay,” said Hannah. “So if you didn’t have a good liver before and now you do, your balance of estrogen and testosterone would be improved…”

Solomon picked up where Hannah’s sentence began to trail off. “I presume that you are referring to the bulking up of our mutual friend?”

“Bulking up? Uh… yes. I guess.” Hannah blushed again and turned back to her phone.

Hannah smiled. “He just seems like a very kind person.”

“He probably is,” opined Solomon. “There are thousands of poor lost souls in Baltimore if you ever wanted to test that hypothesis.”

Hannah laughed. “He’s still finding his way. Do you want to come with us to Ghana next week?”

Solomon chuckled. “I’ve got surgeries scheduled. I can’t just drop everything to run off to Africa like you students! I like that you’re doing this whole research year thing, but just because you don’t have a test every 3 weeks like you used to doesn’t mean that you can just up and leave all the time.”

“You gave me permission to go, y’know.”

“I did. And because you did such a good job at the conference, I’m not going to rescind it.”

“You could give yourself permission to go, too.”

Solomon snorted. “Not this time.”

“Next time?”

“Sure,” mumbled Solomon, rolling his eyes. “I’d love to see the state-of-the-art operating theater they build in the bush. Kofi tells me they even have running water and electricity.”

“Oh, stop it already. You should be interested in the place that was so important to your research.”

“You sound like Kofi.”

“Well, Kofi respects his roots and goes out of his way to make sure that everyone involved in the whole process is thanked and congratulated.”

“Good! That saves me the trouble of writing 600 thank-you notes in a language that doesn’t have a typewriter.’

Hannah giggled, but quickly suppressed it and rolled her eyes. She opened her mouth to speak, but then her phone beeped again and she turned back to it. She shook her head, which Solomon noticed out of the corner of his eye as he opened another journal to read.

Chapter 6 was released on February 7, 2015.

Go to the discussion page.

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


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