Chapter 2: The Process of Forgetting
Welcome back to Only by the Grace of the Wind, a slightly surreal novel presented in twelve serial chapter instalments released every Monday morning.
Please don’t forget to like, comment, and share!
Feeling lost? You can get your bearings by visiting the Table of Contents
Overnight, I am visited by a memory disguised as a dream. My father and I are in the Danson’s grocery store picking up a lime for my mother, who is determined to make red curry without the aid of a mix. He is clear-sighted again, prescient and playful.
“Karina,” he says in a gentle baritone that drifts out from the rolling citrus mounds. “I’m getting old.”
“You’ve always been old,” I reply and hand him the hard little lime I’ve been palming. “You were what, fifty-two when you had me?”
A coy smile spreads across his lips. He squeezes the lime, its pitted yellow-green skin flexing ever so slightly in his grip. “Something like that.”
“The cool Boomers tell me age is just a number.”
“Maybe that’s true,” he says. “But the years are stacking up. It’s getting harder to ignore Captain Clock.”
“Is he a “captain” or a “cap’n?” I ask.
The old man’s eyebrows furrow in deep umber ridges. “Like Cap’n Crunch,” I explain. “He’s not a captain. He’s a cap’n.”
My father appears to find this joke more bemusing than amusing. “Captain Clock,” he repeats. “You know him, too, but you just don’t know it. But he’s always there, lurking, cracking his whip. He wants to disenchant, to lure us away from the ebb and flow of seasons and sunlight.”
We drift deeper into the produce stacks, where it seems the misters are working overtime. Fat globe eggplants and miniature zucchinis bob like buoys in their thick-lipped crispers, which are close to overflowing. The chard, I note with muted alarm, is cascading onto the floor.
“The clock is always tick, tick, ticking,” he continues. “Think about it. We work by the hour, for time is money. We accept the tyranny of punctuality, for timeliness is next to godliness. Even on vacation, for God’s sake, we agonize over our days of relative freedom, for lost time is never found again.”
He sniffs in a kind of laugh. “Is this all flowing?” he asks.
“The man’s got you by the minute hand,” I say. “Waste too many seconds, and Captain Clock orders an eternity of lashes.” I pantomime cracking a bullwhip, and a loud thwack rings in my ears.
“They want you to see the will of God in the face of Captain Clock,” he says. “Can you imagine?” He clucks and shrugs his shoulders, tenting his sweater and sending him momentarily aloft to float amid the metal coiling above. “They buy and sell it like everything else,” he calls down to me.
Like an errant feather, he flutters back down to where I stand, drifting to and fro along unseen currents. With practiced dexterity, he balances the little lime in the space between his first and second fingers. He rotates his hand, and two more appear.
“Is something on your mind, Dad?” I ask.
“Time,” he says. “I’m getting old, and sometimes, I worry it’s slipping away. I should never have retired.”
I feel a chill then, a frigid swell that creeps into hidden crevices. Perhaps it is the rising water lapping gently at our ankles, our thighs, our hips. I notice, perhaps for the first time, a lentigine, an age spot, on my father’s tanned pate. It pulses like a beacon, illuminating, as though for the first time, my father’s face, which takes on a wizened quality in the fluorescent grocery store glow. Those twinkling, mossy eyes, set delicately apart, are wrapped like dumplings in finely creased skin.
I notice I am treading water. Gone is the grocery store and its waterlogged fruit. We are now afloat in an endless expanse of what must be an ocean. Above us, the firmament dims with a congress of bruise-coloured clouds.
There, bobbing in the still water, I grasp my father’s hands, which are warm and soft. To my surprise, they are covered in a tapestry of intricate inky iconography, a concatenation of numbers strung together with double-headed arrows. Like a frog, I propel my body forward. I embrace my father in a seeking hug.
“You can have some of my time,” I say and root for his gaze, which is fixed somewhere in the distance. Its wistfulness evokes in me something like an ache, a regret. His visage is round and pallid now, like a moon on a clear night. His gnomon nose is slightly askew. Even in the palling sky, it casts a shadow that darkens his eyes.
“I’m proud of you,” he says and squeezes my hand for emphasis. Then he places a single lime, warm and a little too massaged, into my hand again.
“Beware the gobblers of time, Karina,” he says. “They’ll take it all from you if you let them.”
“It’s just a few years,” I say. “It will pass in a flash.”
“Oh, that’s true, too,” he murmurs. The water is rising now, and I close my eyes. The last thing I hear is his voice, sonorous even underwater. “But then again, it all passes in a flash.”
*****
My first day of clinical teaching unit (CTU) is also a 26-hour call shift, an eternity in day format. I arrive to the handover room fifteen minutes early, raw and sour and exhausted from yesterday’s melee. Perhaps it is the fate of a silver tongue to turn to acid. I remember my mother warning me that men cannot tolerate shame.
A cruel, mocking irony hangs like a cloud over the aftermath. These days, my father retains almost nothing, so I assume yesterday’s scene has already evanesced into the aether, like most of his new memories. For me, its very happening has coated my consciousness in an acrid, gummy lacquer, tinged with guilt, drip drip dripping over my remembrances like honey from a spoon.
I will not be able to see him again until later this week, but his routine is mechanized, and I am merely an adornment. The senior caravan will deposit him at the community centre’s glass entryway in a few hours and retrieve him at the end of his shift. In the interstices between these events, the moments that fill his unsupervised time alone in his house, a syncytium of habits, honed over decades, will imitate a life lived. Thoughts will pass through his awareness and dissipate like mist. When he sees me again, this Saturday, he will be surprised to see his full-moon caller. Like clockwork, I think. Captain clockwork.
The team’s clerk has beaten me, it appears. He is perhaps a decade younger, tall, smooth, a gym rat. His pressed button-down shirt strains against his confidence and he beams at me from beneath shaped eyebrows and a yesterday haircut. He is perched on a chair pulled out from the stained wooden table in the centre of the room, where, inexplicably, there is a half-eaten store-bought cake piled onto a tray. A trail of hardened electric-blue frosting hangs precariously from the table edge.
“I’m Jaden,” he proclaims, almost roars, with aggressive affability. “So you’re the resident?”
I offer a limp, effete hand, which he leans forward to promptly crush. “Ophtho,” he says.
“Autseau,” I repeat, putting my emphasis on the second syllable. “I have to hear last names twice.”
“No, I’m saying I’m an eye guy,” he replies and taps the outer edge of his manicured eyebrow. “Like ophthalmology. Eye or die.”
He purses his lips and thumps his chest with a closed fist.
“Gotta represent.” He nods at me a few times before pulling out his phone.
Eye or die. Whether he’s animated by braggadocio or Hemingway’s aficion, it’s quite the slogan. Or perhaps it’s a kind of medical student branding, a sing-it-from-the-rooftops covenant with the residency gods. Like all such aspirants, Jaden is on a pilgrimage to claim his golden ticket, a spot in a prestigious specialty program. Ophthalmology is the O in the vaunted ROAD to freedom, so he will have to ingratiate himself to the gatekeepers, whose fickleness is legendary. If vanity likes a mirror, though, Jaden’s good looks and zeal might charm his interlocutors, who are always on the lookout for an apt pupil.
“I’m Karina,” I say. “Family medicine.”
He looks up from his phone, and I can see he has only obliquely heard me. He squints, then sniffs with understanding.
“We’ll both be clueless, then,” he says with a smirk.
“Clueless” is an incendiary word in medicine. It is usually lobbed as a salvo behind one’s back, a cruel tar-and-feathering that never quite washes off. I don’t believe anyone has ever accused me of cluelessness, a moustache-hair from outright incompetence, the perception of which marks the clinician with a Scarlet I. So them’s not just fightin’ words. Them’s something much more insidious, even from a medical student. There is subtext here, tinged with gendered scorn, but I know better than to give voice to what lurks in the betwixt and between.
With his gleaming white smile and easy charisma, he would come out smelling like a rose, and I would appear a prematurely gray hysteric who cows vulnerable medical students.
Woe betide she who becomes what she hates.
“We’ll be fine,” I reply curtly. Rather than join him at the table, I take a seat at the lone computer station in the corner of the room.
“Yeah, I’m not too worried,” he says blithely and turns back to his phone. “My apps are in. It’s just a waiting game now.”
The rest of the team trickles in slowly, and I greet them in turn. The trapezoidal desk at which I sit is an industrial relic wedged against a wall peppered with scuffs and dings. Foam spills from the ergonomic wrist pads in tufts, and it appears a crew of determined vandals has stripped the desk of its rubber bumpers. Beneath the chipped formica is a particleboard collage gouged with crude carvings. Hallway footsteps wobble the ramshackle keyboard on its two remaining plastic feet. The keys are caked in what appears to be an amalgam of doughnut glaze and dandruff.
I make a mental note to chart elsewhere.
The attending is the last to arrive. He is a slight, bespectacled man at the end of middle age. His angular face is flinty and weathered, and his deep-set grey eyes lazily survey the room from beneath caterpillar-thick brows.
“I am Dr. Pavel Pitomec,” he says, the words sticking slightly against his darting tongue. “Who printed the list? Hmm? Anyone has printed the list?”
A harried, bleary-eyed young woman in crumpled scrubs sweeps into the room with her head bowed.
“Sorry I’m late, Dr. Pitomec,” she says. “The printer was jammed.”
He nods with a sour expression puckering his drum-tight face and leans back while she distributes the stapled packets. “You were on-call resident?” He pats down his wispy hair, which an unseen, clanky vent has mussed.
“Yes,” she says. “I’m Marissa.”
“You were Team Gold with Dr. Dhaliwal?”
“That’s right.” She nods at us with a wry, tired smile. “I always seem to end my blocks on call.”
Dr. Pitomec draws a pen from his pocket and twirls it artlessly in his fingers. “Sandya—Dr. Dhaliwal—told me some about these patients on ward, but this new team knows nothing. You can fill in gaps.”
Marissa balks for a moment. Her eyes flit across the page in apparent dread. She doesn’t know all these patients, I intuit. During the last block, she cared for only a quarter, or maybe a third, of the list. Her colleagues managed the rest.
“Uh, OK, Dr. Pitomec. I’ll give it a shot.” She pauses for a moment to scan the first patient’s brief summary. “Ms. A. Horchuk is a 72-year-old woman who was admitted a few days ago with an acute exacerbation of her longstanding COPD.”
She begins to cough and puts a hand delicately to her throat.
“And?” Pitomec barks over her fit.
Marissa hurriedly takes a swig of water from her water bottle. “She’s a 40-pack-year smoker and was on 5 litres of baseline home oxygen,” she rasps, then, with a heroic effort, manages to expectorate whatever had gone down the wrong way. “On admission, she required upwards of 13 litres.”
“And her course in hospital?”
“Well, she wasn’t my patient, Dr. Pitomec, but I know she was receiving antibiotics and steroids, per the protocol. We’d have to look to see how many days she has left.”
“How much oxygen now?” Dr. Pitomec almost shouts this last question.
“I don’t know,” the resident sighs. “It was a busy night.”
Pitomec laughs without humour. “Busy night,” he echoes. “But now is morning.”
Marissa fingers the pages of her creased, hangdog list with a tired franticness. “I could quickly check the EMR,” she says.
He snaps his fingers in a petulant display. “No, leave,” he says. “Time is wasted enough. We will do the work. Go home.”
Aghast, the resident opens her mouth to speak, but Dr. Pitomec preempts her with a shake of his head. “This is rounding time, and clock is ticking.”
Marissa’s voice breaks stridently. “But the new patients—”
“Senior gave me handover for new patients in emerg this morning,” he says. “There is no need for echo.”
The outgoing on-call resident wrings her trembling hands. Then she rises and slings her backpack over her shoulder. “OK,” she says, lagging for just a moment to gauge the gravity of Pitomec’s decree. He gestures impatiently toward the door, so she scurries into the hallway without another word. The swish of her scrub bottoms fades as she flees.
When Pitomec speaks again, I discover I have been holding my breath.
“So,” he says. “That was waste of time.” He folds his patient list lengthwise and places it in front of himself. “OK, listen. We are Team Gold. I am Dr. Pitomec. We have three residents and one medical student. The list is joint project. Most staff, they like to run list in morning and at end of day. This is stupidness. I run list in early morning and at ten. Then we spend rest of day fixing patient problems. Any questions?”
Across from him, a ruddy-faced, cheery young woman in a hijab smiles broadly and gives the room an arcing wave. “I’m Ru’aa,” she says. “IM junior. Nice to work with you, Dr. Pitomec. I don’t think we’ve met before. So, do you want us to call you with patient issues or go straight to Lydia?” She gestures toward the stone-faced woman beside her.
Pitomec chirps in disapproval. “I am responsible for patients. End of story. If something is wrong, I will know. You will call.” He pauses to belch quietly into his closed mouth. “Senior can help, but I do not like surprises. Understand?”
Ru’aa nods and scribbles a few notes in a pocket-sized notebook.
“OK, let’s get going,” Pitomec continues. “Introduction. Tell me your name and program.” He flicks his hand and gaze toward me. “You?”
I pull myself erect in my chair. “I’m Karina,” I say, doing my best to project my thin voice, which is somewhat hoarse from yesterday’s event. “Final-year family medicine resident.”
“Here?”
“Yes,” I reply. I expect a follow-up question, but instead, Pitomec just eyes me cooly. Nervously, I pet the flyaways hovering, as they always do, in a halo around my bun.
“Uh huh,” he says, scraping his tongue against his front teeth. “And you?”
He points to Lydia, the ostensible senior. She has an impassive, overly scrubbed face and high-cut sandy bangs. Her thin lips part to speak, but the corners remain fixed in place, as though bound by an adhesive. “I’m Lydia, the senior,” she says in an alto hum. “Hopefully sub-specializing in rheumatology.” She wags two pairs of crossed fingers in a Nixonian wave. “Wish me luck for the match.”
Pitomec motions for her to wrap up her introduction. “Anyway,” she continues, “I know CTU is daunting, so don’t think twice about coming to me with questions. If I don’t know, we’ll figure it out together.”
Beside her, Jaden is drumming his fingers softly and almost quivering with anticipation. “Hey, everyone,” he bellows jocularly when it is his turn. “Jaden. Med student. As I was telling the family resident, I’m an eye guy.”
He leans forward, barely able to contain his schtick. “Eye guy,” he repeats. “I’m an ophtho gunner.”
Pitomec guffaws once. “Eye guy,” he muses. “Pretty clever. You have applied?”
Jaden beams triumphantly. “All in,” he says.
“Ah, well, good luck, then.” Pitomec glances at his watch. “OK, Team Gold. Let’s divide list.”
Together we comb through the list of patients currently admitted to the four internal medicine wards in the hospital and the emergency department overflow cots. From the short course-in-hospital summaries, we glean enough information to appropriately delegate responsibility for our team’s charges. I am assigned seven patients, whom I will visit shortly on my tour around the hospital.
Before we leave, Dr. Pitomec addresses us once more. “I mean what I am saying about keeping me in loop. It will be very bad for you if I am unhappy.” He scowls and scans our faces with his flinty gaze. “Who is on call tonight?”
I raise my hand. “It’s me, Dr. Pitomec.”
In my periphery, Jaden stirs. “Hey, me, too,” he says.
Dr. Pitomec rises and fingers a Blackberry and stylus out of the breast pocket of his white coat. He wags it peremptorily.
“I am giving you my number. Do not text. It is a waste of time. Call me. I will answer.”
We dutifully tap the digits into our phones. Pitomec, I write in the contact section. Jaden slides into my line of sight, looming like a linebacker over my chair.
“Hey, Karina,” he says, and I am buffeted by a bouquet of man scents, a mixture of cinnamon gum and rosewood cologne. “Do you have QuidNunc?”
I peer up into his broad, smooth, boyish face. “Look up KareBear,” I instruct. “Capital K and B.” Without a trace of irony, he tells me his handle is JTrain2020.
“Like 20/20 vision,” he says.
We agree to keep in touch throughout the day. I also trade QuidNunc info with the other residents. To keep us linked, Ru’aa creates a QuidNunc chat kluster, Team Gold Rox Our Sox.
“Don’t forget, we’re a team,” she says. “No one has to shoulder any load they can’t handle, OK? Reach out if you need anything.”
From the doorway, Lydia concurs with a nod. “This will be a good block,” she reassures us. “Tough, but good.”
Without even a grunt of pardon, Pitomec stalks past the rangy senior resident and out into the hallway. She cranes her long, sinewy neck out the doorway for a moment before stepping back into the room with a look of amused exasperation.
“Don’t worry about him,” she says. “His bark is worse than his bite.” She pauses, as though considering her own advice anew. “Don’t fake it, though. If you don’t know, ask. No hero shit.”
We assent in a dissonant chorus and bustle out of the room. Gingerly, I fold each page of my list lengthwise, leaving a blank column beside the patient names, between which I draw flimsy arrows.
I venture out into the noisy hospital corridor, teeming with surly nurses piloting mobile computer stations. This morning, I will have to see seven patients in an hour-and-a-half, which equates to a little less than thirteen minutes for each of my new charges. My stomach lurches, but there is no time for angst.
Near the main nursing desk, I spot a sign for the chart room, where I know I will find a bank of computers. They’re clean enough, so I don’t reach for the spare nitrile gloves I keep wadded in my back pocket.
With clumsy fingers stiff in the overcooled hospital air, I log into the electronic medical record software. It has become customary for me to call IT at the beginning of each new rotation to activate my login, which, in a regress of bad luck, somehow deactivates in the brief interims between blocks. But to my pleasant surprise, it appears I am finally in the system. Perhaps things are looking up.
For each of my as yet unknown patients, I assess and transcribe their vital sign trends and recent bloodwork and imaging. The ward’s paper charts are organized according to room number and filed along the back wall of the nursing station. I flip through the small reams of doctor scrawl to flesh out each of my patients’ courses in hospital, glancing at the nursing and other allied health notes, taking stock of who requires occupational therapy, physical therapy, speech and language pathology, and the assistance of social work.
In a shorthand honed over years in the salt mines, I construct an almost pictographic representation of each of my patients:
With these bits of data floating in the hospital jello of my working memory, I make my circuit. From the vitals and bloodwork, I learn that all my patients are more or less stable. Though indisputably sick, they are, for now at least, grumbling along. There is no time for a proper assessment during this morning blitz, but I am sure to greet the patients in turn and introduce myself.
“I’m Dr. Bergson,” I say with a smile. “But you can call me Karina.”
Like an inspector on an assembly line, I lay eyes, as we say, on each of my patients. Quickly, I cover the standard litany of questions. Are they eating and sleeping? Any changes to bladder or bowel? Do they have pain? Are they short of breath? Who and where are they, and why are they here?
With my seafoam-green stethoscope in hand, I perform a micro-physical exam, auscultating hearts and lungs, squeezing swollen legs, and pushing my fingers into abdomens scaphoid and protuberant alike. Mine is an elderly cohort comprising the usual suspects: chronic disease, organ dysfunction, sepsis, dementia, and failure to thrive.
I assign monikers to each of them, a mnemonic I’ve learned to keep them straight. “Grandma Nutt” is a plump woman in her 70s with a bone infection caused by uncontrolled diabetes. “Shaq” is a man nearly two metres in height, whose feet hang limply off the foot of the hospital bed. I make a skull-and-crossbones doodle beneath the name of a woman with clostridium difficile colitis. C. Diff, as we call it, imparts an odour to its sufferers’ waste that defies description. The pictogram serves as a warning to breathe through my mouth as I approach her vicinity.
On my way back to the handover room, I order follow-up bloodwork and x-rays and double-check my patients’ medications. Then, seeing that I’m actually a few minutes early, I head downstairs to the Ground Down Cafe to grab a cup of strong coffee. I pull out my phone and text Rhiannon, who is beginning her second day on the anesthesiology service here in the hospital.
Karina [09:53:47]: Hey, Rhi. First day of CTU. 26-hour call with an ophtho gunner clerk. Wish me luck.
Coffee in hand and patient list in my scrub shirt breast pocket, I slowly jog the stairs up to the fourth floor handover room. On the table, beside the stale store-bought cake, is now a box of doughnut holes and a cardboard jug of coffee, next to which someone has propped a notecard that reads 4 Nurses Only in stern block letters. I take a seat at the table and wait for the rest of the team, which files in as a cluster at exactly ten o’clock.
We greet each other cordially.
“How’d it go?” Lydia asks the group.
We all mumble something to the effect of, “yeah, good, busy.”
“Anyone not finish rounding?” Ru’aa asks. She leans forward to make eye contact with me and Jaden, and I can sense in her solicitousness something more serious.
“I have one left,” says Jaden.
Lydia nods and purses her lips. “Don’t worry about it,” she says. “We’ll have a look after.”
Ru’aa turns to me with eyebrows raised, but before she can pose her question, Dr. Pitomec sweeps in with his eyes glued to his Blackberry. With him is a young, slim woman wearing a stylish blue skirt and a white, ruffled blouse. She is carrying a laptop, which she artlessly pecks at as she approaches the table.
“Oh, hi, guys,” she says without looking up. “Arghh, really? Uhhhh.” Her nostrils flare in annoyance and she flings up one hand. “These computers are so frickin’ slow!”
She continues to hunt and peck for a moment more. “I’m Madison, by the way. Hospital pharmacist and apparently solver of all problems formulary.” She glances up at Pitomec, who is fiddling with his Blackberry. “You can start,” she whispers. “I’ll catch up.”
He wedges the phone into his white coat pocket and sneezes into the crook of his arm. “Pravda,” he mutters. “OK, Gold Team. Who has printed list?”
From somewhere out of sight, Ru’aa pulls out a stack of packets, each stapled diagonally across the upper left corner. Like a poker dealer, she passes them out.
“No funny business,” Pitomec says. “Start from top and work down.”
One by one, we run through the patients. Pitomec barks orders at each of us in turn.
Crackly lungs? “Get bloodwork, and don’t forget CRP.”
New onset delirium in an aged patient? “Get urine and abdo x-ray. If it is not bladder infection and belly is soft, then double laxative.”
Homeless man to be discharged on oxygen? The shelter won’t take him? “Discharge to street. Hospital is not hotel.”
When it is my turn to speak, I quickly marshal the building blocks of my presentation into a loose narrative.
“OK,” I begin. “I have a pleasant 66-year-old woman with a long history of severe chronic kidney disease on hemodialysis. She also has diabetes, which is badly controlled. She came in yesterday morning with a diabetic ulcer on her left calf. The family doctor had trialled doxycycline due to a history of MRSA, with nil effect. Her pain was unbearable, so her husband brought her to hospital, where she was admitted for further management. Here, we’ve switched to IV antibiotics, vanco, but cultures are still pending. Pain is controlled with regular long-acting hydromorphone, and she’s not using her PRNs, which is good. I took a look at the ulcer, and it’s not weeping or purulent.”
Pitomec starts to drum his fingers on the table. “Doctor,” he says. “Are you writing novel?”
My cheeks flush and I stumble over my words. “Sorry,” I say. “So for plan, we’ll await culture and continue to treat empirically.”
“You have missed boat,” says Pitomec. I look up from my list and note, with a frisson of dread, that his lips are pursed.
“What else would you suggest?” I ask.
“So let’s use our brains,” he continues. “You have told us this woman has ulcer that does not look like infection. It is not responding to antibiotic. Her pain is requiring regular narcotic.” His face contorts into a grotesque portrait of confusion. “Tell me, doctor, do you know what are you treating?”
I scan my colleagues’ faces for a hint as to what I have missed. They stare back at me blankly.
“I’m treating an ulcer secondary to uncontrolled type-2 diabetes,” I say.
Pitomec scoffs. “On non-dependent surface?”
In moments like these, my thoughts curdle and quiver, and I stammer. “I thought—“
“No, you didn’t,” Pitomec snaps. He turns to the team. “The answer is staring in our faces.”
Ru’aa holds up a pencil. She offers an ingratiating smile and shrugs her shoulders. “We could go through VITAMIN C and narrow down our differentials.”
“For clerk, maybe,” Pitomec says, and gestures stiffly at Jaden. “Are you clerk?” he asks me, his bloodshot, grey eyes peeled wide above purple lids.
The invective gums my neural machinery. I cannot summon any words, even in meek self-defence. Like a rainbird sprinkler, I oscillate my gaze from face to face. Ru’aa nods in my direction, encouraging. Lydia taps her flank with a surreptitious finger. Jaden, it appears, is looking past me. His fingers are steepled and eyes squinted.
Dr. Pitomec, in a particularly sneering display, appeals to the clerk, whose muscular arms flex at the invocation of his name.
“Maybe you know, clerk Jaden” he says. He wags his finger peremptorily at the internal medicine residents. “Don’t say one word.”
“The lesion?” Jaden says. He rocks side to side in pensive deliberation. “Well, she has CKD, right? Her kidneys are crap. And she has diabetes.” He turns to me, his broad, handsome face alight with curiosity. “What’s her creatinine?”
I hurriedly glance at my notes. “It’s 400,” I say. “And an eGFR of 10. Both are normal for her. She’s goes to dialysis Monday, Wednesday, and Friday.”
Jaden spreads his hands and appeals to Pitomec, who is almost trembling with barely-contained rage. “Is it calciphylaxis?”
Pitomec rattles the table in a crescendoing open-palmed drumbeat. “Yes!” he cries. “It is obvious! Woman on dialysis with wound that does not respond to antibiotic.” His lips twist into a parodic expression of scorn. “You did not even think of this,” he says to me.
My heart is pounding in my ears and I am tempted to run out of the room. Instead, I straighten my neck and try to affect a posture of calm receptiveness. “So what would you like me to do?” I ask Pitomec. “I haven’t come across calciphylaxis before.”
“Get some knowledge,” he replies venomously. “And then biopsy to confirm diagnosis.”
After an agonizing, pregnant moment, he smooths his white coat and runs his fingers through his wispy hair. “Who is next?” he says.
We continue making our way through the list, pausing for Pitomec to deliver his management diktats from on high. Every now and then, Madison, the pharmacist, interjects to clarify a medication decision or suggest an alternative in animated upspeak.
Benumbed and vaguely queasy, I present on my remaining patients, submitting, with the deference of a seasoned doormat, to Pitomec’s constant interruptions and bullying doubts.
“Are you sure, doctor?” he repeats with a disgusting little smirk playing on his thin, bloodless lips.
With each of his jibes, dipped in poison, Pitomec catches my gaze. His round wireframes are crooked, and under the fluorescent hospital lights, I can see that his cheeks are gnarled in pocked, waxy whorls. I cannot bring myself to look at the others, whose pity, or maybe disdain, laps at me like scalding water.
After what seems like a thousand years, our mid-morning rounds conclude. Pitomec and Madison leave together, muttering quietly to each other. Rudely, he shushes her with a raised finger.
“Team Gold,” he says from the doorway. “We will meet once more at four o’clock. Do not forget to eat some lunch food.” He swivels his attention obviously to me, and I glower at him askance. “If you are unsure, if you do not know, if you have question, you will call me,” he says. “I do not like surprises.”
He and Madison trundle into the hallway. Maybe it is my imagination, but a sotto voce “waste of time” seems to linger in the air of the handover room.
“Jesus, that was rough,” says Lydia. She pats my shoulder. “Don’t take it too hard, Karina. Calciphylaxis wasn’t my first thought either. Want to debrief over lunch? We can meet in the caf.”
I shake my head. “I’ll meet you down there,” I say. “Just need to catch my breath.”
“Yo, hold up,” calls Jaden from across the table. “I’ll come.” He jogs out the door like a basketball player making his way onto the court for a big game. Even from down the long corridor, his booming voice is so resounding that it sounds like he’s still in the room with us. “I mean, rheumatology? Isn’t that mad boring?”
Ru’aa situates herself so she’s sitting across from me at the table, where I am hunched over, back damp with stress sweat.
“Hey,” she says. “It’s OK.”
In her round, bright face, rimmed by the edges of her teal hijab, I see genuine concern and care. “Is it?”
“It has to be,” she says. “And look on the bright side—just 6 months of training left, right? Then you’ll never have to do any of this ever again.”
I let my head loll side to side, considering this prospect. “Tell me it’s worth it.”
Her smile fades at this entreaty. “That’s for you to decide,” she says softly.
In my self-pity, I have exposed a gauche kind of vulnerability. Realizing my mistake, I backpedal and offer a more decorous performance. “I’ll be fine,” I say. “Just have to put my head down and grind. It’s just medicine, right?”
She brightens again. “Resident sisters need to stick up for each other,” she says cheerily. “Shall we eat, finally? I’m starving.”
“Thanks, though, Ru’aa,” I say and clasp her hand. It is an abject bit of pandering, but I do not want to lose her sympathy.
She squeezes my fingers and rises. “We’re all in this together, right?”
We leave to join the others in the cafeteria, a vast expanse of high-top tables flanked on all sides by anachronistic vending machines that serve everything from coffee to stir-fried noodles. There is a kitchen in the back that is actually pretty good, but I’ve brought yet another almond butter and jam sandwich, which has compacted and folded in my backpack. I check my phone in between soggy, sticky bites chased down with lukewarm water from my plastic bottle. My heart sinks just a little at Rhiannon’s radio silence, but I know she’s on service with the prodigal Schumacher, whose hair plugs are probably blowing like streamers in the breeze as his golf cart whizzes across a verdant uptown golf course.
I send another dispatch from the abyss.
Karina [12:11:58]: Pitomec’s a fucking asshole
Lunch ends en route to the ward, with a final bite of sandwich sticking tenaciously in the hollow of my cheek. We return to the wards to tie up loose ends and write our progress notes. The afternoon passes in frenetic bursts of activity punctuated by QuidNunc chimes.
Team Gold Rox Our Sox
Lydia [13:22:44]: You guys good??
Ru’aa [13:23: 21]: Kickin butt and taking names!
Jaden [13:25:06]: yo whos free to check my orders? Im on oncology.
Lydia [13:31: 34]: Omw
Ru’aa [13:32: 01]: I can do it, Lydia. Let me know!!
Lydia [13:33: 41]: Already here, Ru
Ru’aa [13:34: 16]: kk
I am pleased to encounter no resistance from nursing as I try to coordinate a quick discharge for one of my heart failure patients, who is now back to her dismal baseline. The charge nurse, an uncommonly warm, matronly woman in her early sixties, waits patiently while I scramble to fill out the medication reconciliation form. My poor patient is on nearly twenty home medications, many of which we’ve adjusted during her time in hospital.
“You’re OK, dear,” the nurse says. “You just take your time.”
If only I could. My task pile is growing of its own accord, threatening to bury me. Ru’aa, who seems to be everywhere at once, texts me with a command from Captain Clock.
Ru’aa [15:44:02]: Patient RC’s wife is in his room. Do you have time to give her an update? She says she has to leave at 4 pm. Thanks and sorry!!
For just a moment, I break out in an arm-swinging trot. Then I come to my senses and slow my pace. The hospital floor swells and contracts under my bright pink crocs. Now is not a good time, I remind myself. Handover is in fifteen minutes, and I still have one last progress note to add to a swollen paper chart. I can reach out to the patient’s wife tonight, if there’s a lull during call.
My pendulous pockets are too full, so I dig my hands into my scrubs and rearrange the uncapped pens, which are digging into my thighs. Then I make my way to the report room.
This is medicine. The thought is an itchy incantation, a mantra repeated more in disbelief than declaration. My father’s time gobbler is a chimera, a tangle of tentacles seemingly without a head. But time per se is not its favourite food. It prefers vitality, which it wrings from its victims in a daily tithe of lifeblood. This we measure in increments of time. Otherwise, we would have no grammar to describe what has happened to us in the strange, liminal space between giving and taking.
There are Pitomecs on every service, petty tyrants whose cartoonish cruelty is the stuff of legend, but never kindling for revolution. My experience is by no means unusual, and in the atomized, cutthroat milieu of medical training, I will have to steel myself against what I know will be an onslaught. Alone and exhausted. As a clerk, I would staunch my tears with musty call room pillows that crinkled in my grip. Now, I give in to internal monologues, galvanized by righteous resident indignation that echoes in my interior amphitheater.
When we speak of the “culture” of medicine, we are usually describing the facade of a grand edifice that looms in every crevice of clinical life. For the resident, “culture” determines the extent of subordination, exploitation, humiliation, and intimidation to which she will be subjected during the course of her training. Every area of medicine is stratified in a top-down dominance hierarchy, but it is culture, often fiercely insular, that dictates whether, say, a resident working from sunrise to sunrise will eat her lunch perched on the toilet seat for fear of being labeled as lazy. It is culture that quails residents before surgeons who throw scalpels and blame absences on “lady problems.” Culture sustains a normative expectation of 80-hour weeks. It safeguards bullies, narcissists, and sadists and disclaims responsibility for their malfeasance. Culture knows what to do with loose lips.
The cognitive dissonance can be overwhelming. We are told that only the worthy are called to medicine, so we sacralize our suffering, wear the white coat like a hairshirt, and affect the piety of country priests. Never forget the privilege of service, they say. It is an honour to heal. And yet, one wonders about a vocational creed that fetishizes suffering and compulsive self-abnegation. The most pious of us genuflect before the martyrs who came before, Anglo titans whose pithy pronouncements fill PowerPoint slides in an endless procession of platitudes. We are, by and large, strivers and climbers, so it is no surprise that so many of my colleagues accept their indenture as something akin to a rite of passage. Some even compete with one another in bizarre bouts of oneupmanship to determine who is the most self-sacrificing. Like the Aztecs, who offered a beating human heart as oblation to the gods, resident docs since time immemorial have gifted their souls to Hippocrates for a chance at redemption.
Beneath this zealotry is dense, cynical material rooting. The hospital is a microcosm of capitalist production. Without the endless cut-rate toil of residents, healthcare’s foundation would crumble. In the hospital ecosystem, a rotating battalion of trainee proles is conscripted to care for patients under the supervision of staff physicians. On these rotations, residents provide “service” in the form of countless hours of underpaid clinical labour. Twice a week, they work twenty-six-hour “call” shifts during which the supervising physician collects a lucrative stipend, often from the comfort of their own homes, while their residents admit new patients, monitor the wards, and forfeit a night’s sleep for “learning.” The research literature is unequivocal about the perils of sleeplessness, especially for workers bearing high cognitive loads, but the brutal elegance of the current system is indisputable. Only robots, who would require no sleep at all, could run a hospital more efficiently.
Even within medicine’s cloister, it is rare that someone makes a moral argument against the obvious savagery of a 26-hour shift, which is expressly prohibited by international legal injunctions and domestic charters barring slavery. Culture, and tradition, demand we pay our dues. Neoliberal logic absolves our supervisors of profiteering, vindicates the system’s ritualized exploitation. As budgets sag and populations grey, the healthcare system is straining against the bounds of possibility. The courts and guild associations have ruled categorically against damming the river of cheap resident labour. No matter what happens, it seems, Medicine must eat its young, otherwise it would starve.
To placate the rabble, medicine’s totalizing culture manufactures its own propaganda. Mealy-mouthed administrators and academics traffic in bad faith and bullshit. “You should be grateful for each and every call shift. All those learning opportunities are priceless,” said my residency director during our program orientation. “And besides, it used to be worse. My mom, who’s a retired doctor, once had to live in the hospital for nine days straight!”
Ah, the bad old days.
If sanctimony and cant don’t do the trick, though, Medicine the Edifice can draw on a uniquely persuasive form of coercion to discipline subversive residents. From the residency program’s perspective, incorrigible troublemakers might be flirting with a red flag, academic remediation, possibly dismissal from the program. But the real cost would not be administrative. Overt resistance exposes learners to the culture’s most powerful weapon: ostracism. Should a trainee do anything to repel the keepers of guild knowledge, she would risk systematic exclusion from teaching. Especially in the hands-on specialties, where mentorship and structured repetition are crucial for the development of craft, if clinical teachers decide to withhold expertise or opportunity, the downstream effects would be catastrophic. All it would take is the disinterest of a few vindictive, or just apathetic, supervisors to flush years of hard work and hundreds of thousands of dollars down the drain.
All down the drain.
My inner monologue is interrupted by a jolting current of vibration that itches my outer thigh through the thin scrub bottoms. I glance at my phone.
Rhi L [15:50:22]: O that guy. huge dick running like a dog talk later.
I reply quickly.
Karina [15:51:16]: I figured. Off to call.
For the last time today, I head back to the handover room for afternoon wrap-up. Since I am the resident on call, I will have to care for Gold Team’s patients on the ward overnight while also fielding consults in the emergency department.
I am the last to arrive. Jaden raises his eyebrows at me in greeting. A toothpick dangles from Pitomec’s lips, and it bobs as he speaks.
“No problems?” he asks.
We shake our heads.
“Good. I do not like surprises.”
He gestures at me with a spindly finger. “You.” With an awkward flick of his wrist, he sends Team Gold’s battered black pager in an opaque plastic case skittering across the table. I clip it onto the elastic band of my scrub bottoms, which are cinched below my ribcage to prevent dragging.
“Senior comes at six,” he says. “Eat while there is still time.”
He stands abruptly and buttons up his white coat before whisking out of the room. Jaden and I confer with Lydia and Ru’aa, who offer lighthearted caveats about a few of their patients, including an elderly man with a known seizure disorder who is showing signs of delirium. They wave at us on their way out.
“May your pager be silent,” calls Ru’aa.
I stuff my heavily marked list in the back pocket of my scrubs.
“You’ve been on call before?” I ask Jaden.
He is already on his phone doing God knows what. “Yeah, man,” he says. “So how do you want to run this.”
“It’s up to you,” I say. “I can manage the ward if you like, and you can do the first few consults in emerg. Or, if you’d prefer to watch the ward, I could field consults.”
“Yeah, let’s do that,” he says.
“You want to manage the ward?”
“I hate IM consults.”
It’s all the same to me, so I hand him the pager, which he clips to the med student lanyard swaying from his thick neck.
“If you need anything, text me.”
He smirks. “Waste of time.”
I laugh. “Not bad,” I say. “And hey, even if things get crazy, don’t forget to eat.”
“Word.”
“You know where the call rooms are?”
“Yeah, I did peds here, too. Basement. For CTU, it’s room, like, 1128.”
“Perfect. OK, that’s all I’ve got,” I say. I heft my backpack over my shoulder.
“OK, peace.”
We leave the handover room together, but part ways in the corridor. Compulsively, I check my phone. No new messages. More an act of self-soothing than gesture at real communication, I send Rhiannon one more note.
Karina [17:21:14]: Call is starting. Visit if you want. No pressure, though
In the residents’ lounge, I reheat a glass container filled to the brim with tofu and quinoa. My personal rule on call is anything goes, but I don’t feel like the caf’s famous Hungry Farmer’s Breakfast with vegan chorizo for dinner, though it is delicious and available until 11 p.m. There are other residents in the dining area, across from the bank of microwaves, but they don’t acknowledge me, so I scramble onto a stool at an empty table.
When I was on low-risk obstetrics earlier in the year, I shared overnight call with a family doctor who, for whatever reason, took a liking to me. Throughout the evening, we chatted in between deliveries. She was close to my age, and I think she felt a kinship with me. In the wee hours of the morning, while we waited, saggy-lidded and mush-brained, for the nurse to page us, she offered a poignant observation. “You know what I remember most acutely about residency, Karina? It was the loneliness,” she said. “We’re usually alone while working. Happy to have you as company tonight.”
My call comrade will be Jaden, the ophtho gunner clerk bro who effortlessly showed me up earlier. I don’t begrudge him that, of course, and his guess, lucky or not, will likely endear him to Pitomec. In the lulls between consults and ward issues, I will have to read up on calciphylaxis, which is undoubtedly a clinical zebra. With my luck, Pitomec will pimp me on it in the morning, when I am dozy and uncaffeinated. I shiver with the anticipation of impending humiliation.
This week will be bracing, I know, an exercise in self-reliance. My only hope, in the end, is that Pitomec will do right by me in my formal evaluation. Sometimes, ward bullying is merely a form of hazing, and the reward for good composure is a passing evaluation. But that’s not always the case. More than a few of my family medicine resident colleagues have failed CTU, and our program has vowed to investigate recent allegations of anti-family medicine bias in the department of internal medicine.
To my surprise, the first consult of the night comes directly from emerg. Usually, the senior internal medicine resident calls me to provide context and guidance. She or he is responsible for fielding and screening consults from other services, which are sometimes inappropriate. Overnight especially, burned-out and pushy staff and residents are wont to “turf” patients to internal medicine, which they treat as a medical miscellany.
“Hello? This is Karina.”
The voice that greets me is gravelly and boyish, with a drawling surfer cadence. “Hey, buddy. Dr. Wee from emerg. Talked to the senior, Radovan, and he said I could just call you directly. Got a minute?”
I fumble for the list in my back pocket. “Hi, Dr. Wee. Yes, that’s great. One sec, I’m just grabbing something to write on.”
“No worries, buddy. Having a good night so far?”
“Just finished dinner,” I reply. “You?”
“Nice, nice. Yeah, it’s going, you know.”
“OK, I’m ready.”
Like every ER doc with whom I’ve interacted, he gives me a concise, almost conversational summary. “OK, buddy. It’s pretty cut and dry, I think. 38-year-old obese woman, pretty healthy, right, just a little pot smoking on the daily. Anyway, she came in with a pretty bad belly ache. Ran some blood. A little bit of leukocytosis, the white blood cells are prepping for a fight. Ordered a CT, and it looks like she’s got a raging appendicitis.”
“You ran this by the senior?” I ask.
He pauses for a moment. “Well, not the whole story. Told him about the bellyache, right, and he was busy with another patient, so he said to just pass the story on to you.”
“This sounds like a gen surg case,” I say. “She needs to go to the OR.”
“Yeah, yeah—I agree, buddy,” he says, almost coos. “But they’re a bit tied up right now, and you know, we’re getting kind of full—“
A strident, tinny voice pipes into the room from the overhead intercom. “Code Blue, fourth floor, internal medicine,” it blares. “Code blue, fourth floor, internal medicine.”
There’s a beep in my ear.
“Sorry, Dr. Wee,” I say. “I’m going to put you on hold. Just a moment.”
Flashing on the cellphone screen is the name Jaden Singh. With a swipe of my finger, I tip the animated handset off its anachronistic landline base.
“Jaden?”
He sounds panicked. “Shit, Karina. That’s our patient. Come up! Now!”
I switch to Dr. Wee. “That’s our patient having a code blue, Dr. Wee.”
“Oh, bummer,” he drawls. “I’ll try gen surg again. Good luck, buddy!”
I dart out of the residents’ lounge and bound up the two flights of stairs to the fourth floor. My crocs squeak on the stone floor, and from the panel of windows lining the corridor walkway, my reflection looks back at me, disheveled and elfin, grey curls fully liberated from the bun that once contained them.
A crowd has already gathered outside of one of the rooms.
“He’s a full resuscitate,” a voice shouts from inside.
I careen into the room, which is teeming with nurses and doctors hovering around a supine body stretched out on a hospital bed. One of the ICU docs, Dr. Obugolu, has taken control of the code. In her calm intensivist way, she commands the room with equanimity. She sees me enter and calls me by name.
“Dr. Bergson,” she says. “Everyone has already been assigned a role. Please stand to the side.”
I tuck myself into a corner, where I watch the scene unfold. Lying on the bed is a frail elderly man wearing a diaper. Looming above him, hulking, is Jaden, who has both his hands over the man’s sternum. His chest compressions are like pistons, and his smooth, boyish face is slick with sweat.
“Now wait,” says Dr. Obugolu.
Everyone backs away from the patient. Amid a tangle of telemetry stickers and wiring are two pads placed strategically on his chest, with cables that feed into a machine beside him.
“Everybody clear?” croaks a rugged older nurse.
The assembled reply in chorus. “Clear.”
Someone I can’t see defibrillates the patient, sending an electric current into his heart. The man’s cachectic body spasms. Dr. Obugolu peers at the ECG.
“He’s still in Vfib,” she says. “Continue compressions. Can someone draw up a mil of epi?”
Jaden places one hand flat on the patient’s chest and places the other on top, interlacing his fingers. He begins to pump again. The man’s ribcage bows under the pressure. With an audible snap, like a twig crunched underfoot on a forest walk, something breaks in the man’s chest. Jaden pauses for a moment with a look of horror spread across his face.
“Keep going,” says Dr. Obugolu. “Ribs will heal. If he makes it, he’ll thank you.”
Hesitantly, Jaden continues to pump. At the end of the round, he allows another young man to replace him. He looks around, bewildered, and nods once in my direction, shellshocked.
The code continues for some time, cycling among chest compressions, resuscitative medications, and defibrillations, but it is clear the man was dead on arrival. Eventually, his heart falls quiescent. The dreaded flat line snakes across the monitor. After a quick survey of the team, Dr. Obugolu opts to formally terminate the code blue.
Like sand from an hourglass, people and machines drip out of the room. Dr. Obugolu grips my elbow lightly.
“Do you know how to pronounce?” she asks.
I nod. “I’ve done it before, Dr. Obugolu.”
She glances up at my hair. “I like the curls,” she says. “It suits you.” She follows the last of the nurses into the hallway. One of the trio guffaws loudly.
“And he just said that to you? God, he’s so basic!”
Jaden hovers awkwardly beside me, twitching.
“You OK?” I ask. “We can debrief if you like.”
He peers down at me, doleful, almost childlike. “I’ll do the pronouncement paperwork,” I say. “Then we can go somewhere to chat.”
“I broke his ribs with my hands,” he says quietly. “I felt them crack, you know, give way, and his chest just, like, caved in. I could feel his spine at the end of my compressions, Karina.”
“He was a frail old man,” I say. “I know that’s cold comfort, but you did right by him. Those were perfect chest compressions, Jaden. See, all that time in the gym was good for something.”
The clerk shakes his head. “I was going to the beat of that Justin Timberlake song, Can’t Stop the Feeling.” He kicks at the speckled hospital floor. “So stupid.”
“Why don’t you take a break,” I say. “I can handle things.”
“Nah, I’m fine,” he says, and I can see in the way he rights himself, shakes off the micro-trauma with a sweep of the glossy black hair from his damp forehead, that he’s constructing his facade anew. “The nurse paged about this guy with focal neurological symptoms,” he says. “But when I went to see him, he just, like, wanted to chat. Chart says he had a stroke last year that left him with a 6th nerve palsy. It’s pretty crazy—his left eye won’t move laterally. I did a neuro, and he’s fine otherwise.”
“Do you need me to go see him?”
“Nah, he’s good,” Jaden says. “That’s standard neuro-ophth. Don’t worry, I’ll tell you if I need something.”
I eye him for a moment, then shrug. “OK, Jaden.” Like most of us, he lives behind a fortress, shielded from the darkness and sorrow. It would be cruel to poke at the masonry, so I leave him be.
“Actually, just one more quick thing,” he says. “There are a few orders for Tylenol and shit pending. Do you mind approving them?”
“No problem.”
He holds out his fist. “Daps.”
I feel like an old woman as I awkwardly bump fists with the clerk, who is several years my junior.
“Yeah, you got it, boss,” he says. “OK, peace.”
He strides out of the door, phone held low against his hip, and I glimpse on his screen a slow-motion video of a football tackle.
I step out of the room and onto one of the mobile computer stations idling by the door. I quickly click through the requests for Tylenol, nicotine replacement gum, and other miscellaneous orders that should have been put through during the day.
Then I return to the patient’s bedside, where he is lying supine, one arm bent ignominiously beside his sunken chest. His eyes are wide open. No one bothered to cover his wizened, nearly naked body. I tsk to myself as I draw a warm blanket from the heater in the hallway and stretch it over the emaciated figure. I gently close his eyes and complete the pronouncement checklist with as much dignity as I can supply, draping his exposed figure as though he were alive and shy, taking my time.
When I finish, I deliver the pronouncement document to the charge nurse, who tells me she can coordinate with the coroner.
On my way back to the resident lounge, I stop at a computer station to page the senior resident, who calls me almost immediately.
“Hey there, Karina. I hope you didn’t end up seeing the appy,” he says in a friendly tone. “That was not an appropriate consult.”
“Tell me about it,” I say.
“I’m Radovan, by the way,” he says. “And you have an actual appropriate consult in emerg. Want to meet me down in B to discuss?”
The night proceeds with back-to-back consults, two acute congestive heart failure decompensations, a bilateral kidney infection, and an unfortunate thirty-something man with end-stage cancer and a new bowel obstruction. With Radovan’s help, I admit these four patients onto the Gold Team, where my colleagues and I will care for them until they are discharged from hospital.
Time passes differently in the hospital. It is embodied, carnal, a confrontation with rhythms and instincts that leap, unslaked, from the abyss into awareness. Unmet hunger tears at you with an urgency that blurs vision and slows steps. Ignore it for long enough, though, and it recedes. Slowly, the sensorium sharpens, and you go on. Only an itch remains, a prickly disquiet that crawls along the skin and smoulders in apprehension, latent but incendiary. All it takes is the slightest spark, a whiff of burrito or a glimpse of a pancake, and the embers ignite into a conflagration. Then you must eat. There is no choice. Time slows. Thoughts thicken. Panic sets in. In those moments, only food can resurrect.
Tonight, I eat once more just before one, a saccharine energy bar in a bright pastel wrapper.
In its way, I suppose, hunger is easy. The famished resident is always just one granola bar from relief. Fatigue is more insidious. Like the tides, it ebbs and flows. The resident in motion is rarely sleepy, but a creeping lassitude descends upon her after dinner. She pines for repose, aches for a break, and sometimes it comes. Lying there on her stiff call room cot, she tries to mollify her fitful mind and its ineluctable spirals. The pillow crinkles under her restless head. And that bastard Captain Clock freezes time in place. The minutes push through sap until a brain-rattling call from emerg rouses the resident from her stupor. Time swells and pulsates then. If it is early morning, the sleepless resident experiences a renaissance. Fatigue wanes. An inebriant confidence takes over. She works with gusto. Time soars straight until the sun peeks over the horizon. If, however, the resident is permitted a few hours sleep during this rhapsody, a stony, groggy malaise permeates her whole being. She can scarcely think.
I suppose it is a bit of good luck that on this night, I do not sleep. Rhiannon, my comrade, sends a few messages at midnight, while I am performing a rectal exam on a young man with terminal cancer.
Rhi L [12:03:31]: Hey where r u Kept really late to help cover sick colleague Feel like im gonna faint
Rhi L [12:06:56]: Heading home Talk tomorrow May ur pager be silent
I reply at 3 a.m.
Karina [03:01:22]: Hope you get some rest. On the bright side, thunderstorms are expected this morning. May the golf course be flooded
I jog up to the fourth floor to check the wards, and I find Jaden standing, like a flamingo, on one leg, writing lazily in an open chart.
“How about some sleep?” I ask
He glances up at me without changing his posture. “I’ve gotten a little, boss. I’m good to go.”
I extend my hand. “Pager.”
The manicured eyebrows stand at full salute. “Yeah?”
“Pay it forward when you’re a resident,” I tell him.
He yanks the scuffed pager case off his lanyard and gestures to me with prayer hands. “You’re a hero,” he says. “Are you sure?”
I withdraw my hand quickly and hold it limply behind my back. “Clueless family resident?”
He squints at me for a moment and then rolls his eyes. “Nah, man. I was just joking. It was, like, banter. I’m an eye guy and you’re a family resident. It was like, hey, we’re fish out of water.”
“So?” I say.
“Really?” He jams his hands into the back of his scrubs and rocks on his heels. “We’re a good team, boss. I mean it.”
“And?” I press.
He lets out a honking laugh. “Look, I’d want you to be my family doc, OK?” he says. “How’s that?”
I snatch the pager from his hands and clip it to the elastic waist of my scrub bottoms. “Sleep tight, Jaden.”
The pager finally falls silent at 5 a.m. I lie down on the stiff little call cot, but can’t sleep. So I make my way to Ground Down just in time for the opening barista to arrive. She and I chat for a few minutes, and she gives me a free latte, which I nurse in a corner booth.
Handover sneaks up on me, as it always does, but I still arrive in the stuffy little room early. I have my backpack beside me, packed. Photocopies of my admission notes are stuffed unceremoniously in my scrub pocket. I pop a mint in my mouth to offset my morning potpourri.
Jaden joins me five minutes before rounds. Aside from a day of stubble, he looks exactly as he did the day before. His bespoke shirt seems to be pressed.
“All right, boss?”
“I’m alive,” I say. “How did you do that to your shirt? It’s flawless.”
He grins. “Steam,” he says. “And practice.”
Lydia and Ru’aa arrive with a minute or so to spare.
“How was call?” asks Lydia.
“All is well,” I reply.
Ru’aa pulls a chair noisily up to the table and plunks down. “Any sleep?”
I shake my head. “It was steady.”
Pitomec arrives last. He is wearing the same outfit as yesterday, and his white coat is rumpled. “Team Gold,” he mutters in greeting. With a protracted, breathy sigh, he seats himself at the head of the table, on which a tin of zucchini bread has joined the old birthday cake and stale doughnut holes. It appears that someone has torn a hunk from the loaf with her hands rather than find a knife. He eyes the smorgasbord with obvious revulsion.
“OK, it is morning,” he begins. “Radovan has given me full report on four new patients.”
“I can fill in the gaps,” I offer. “I admitted all of them.”
“Not necessary,” he says. “I trust Radovan. With him, there is never surprise.”
A wave of fatigue, or maybe dread, washes over me, and for an instant, I close my eyes. When I open them again, Pitomec is tapping his finger on the table and glaring at me.
“So, doctor,” he says. “Nurse tells me you did not speak with wife of Mr. Chen yesterday. She has been waiting for update, and there is no update.”
My heart sinks. In my scramble to manage the night’s events, I just plain forgot to call. Instinctively, I turn to Ru’aa, the messenger, who offers a tight-lipped smile chilled with gentle reproach.
“I can do it before I leave,” I say. “Sorry, Dr. Pitomec. I had meant to call, but the night was busier than I expected, and I just didn’t have a chance.”
Pitomec shakes his head forcefully at my cavil. “No, doctor,” he spits. “You missed your chance. Now, she is angry, and she will not speak to resident, says nurse.”
He leaves a gap for me to reply, but I don’t know what to say. “I’m sorry,” I mumble.
His lip curls under and he pockets his pen. “It was surprise to get such news this morning,” he says. “I do not like surprises.”
“I’ll do it before I leave,” I repeat. “We could set up a family meeting for tomorrow.”
Again, he refuses with a vigorous head shake. He snarls at me with naked scorn. “What can you tell me about calciphylaxis?”
I shake my head, utterly defeated.
“Go home,” he hisses. “Two days you have disappointed me. Go and sleep and think. Why am I disgrace? Should I be here?” He pauses for effect and fixes me with a slow, squinting sneer. “You will tell us tomorrow.”
I rise, droop-shouldered and debased, and heave up my backpack. My ears are abuzz with an ambient whir, which provides the only sound in the mute minute that follows Pitomec’s damnation. I look at no one as I leave, not even Jaden, who I suppose will have to wait a bit longer to be dismissed from his night of call.
The bus ride passes in an instant. My scrubs fall from my body and my bed opens up like a yawning maw. I shower with my eyes closed and wipe down my phone with rubbing alcohol. On the screen, flashing dully, is a message from Rhiannon.
Rhi L [08:55:06]: Morning sunshine Happy post call day. Sleep well. U are loved.
I smile in spite of myself as my eyelids begin to fall.
Karina [08:59:35]: :)
And without a moment’s reflection of Earth’s last rotation, my consciousness flickers and dims. Captain Clock, it appears, has gone on a lunch break. Before I give myself to sleep once more, I pull the window shade and don my eye mask.
Waste of time, I mumble to myself and cackle into the counterfeit darkness of a post-call morning.
***
Note: The illustrations accompanying this story were generated using AI technology
