2023 Short Story & Essay Contest: Second Place, Adult Short Story Contest
As my wife will tell you, I am a meticulous professional, and have much to commend me in that area. My working life is spent inquiring after my patients’ health, writing prescriptions for laxatives, and reading about new ways to remove earwax. I wear starched shirts and bowties to the delight of my many elderly patients who see in me the doctor of their youth.
My office staff greets me with courteous deference, though I have caught them glancing at each other knowingly. For this secret signaling there are multiple interpretations but no diagnosis. Maybe it’s because of the polka dots on my bowtie. Maybe it’s the oil of cloves I use to shine my pate. They don’t understand that my elderly patients love the powerful scent—it reminds them of a time when their sense of smell was still strong and alive. Sometimes leaning forward to listen with my stethoscope, I sense a frail hand gliding across the glistening surface of my baldness.
I go through my daily routine. Never do I fail to listen to my patients’ hearts and lungs while Mabel tells me how her garden is doing. She asks for a few extra doses of lisinopril, the medicine I have prescribed for her blood pressure. Her tomatoes ripen overnight on a mixture of horse manure and 10 milligrams, she claims without blushing. Surprisingly, Mabel’s blood pressure is better than usual, which suggests that gardening is an arterial relaxant.
Henry, meanwhile, arrives in suspenders, a network of broken capillaries carving tiny paths down his nose. I lean in with my ophthalmoscope. I can smell the Camels he’s been smoking. His fingers are yellow as sand and waxy as tallow. He talks about Vietnam. My own father served, as Henry knows by now. I owe the Vietnam War a great deal, though for reasons unrelated to Agent Orange. Apparently, I have a debt to a diminutive, wistfully smiling, pixie-faced woman with a lotus in her hair. My personal history is not particularly on Henry’s radar, of course, though he visits my office on a regular basis. He comes to tell me about his tiny urinations waking him up in the wee hours of the night. “I just don’t get the bang for the buck, like I used to, doc,” and I quite agree with him that in terms of bodily functions, his words accurately capture the experience of the gerontological crowd.
My day goes on. Esther with the hard lump in her rectum, Gerald with the rotting toes, Lily with the flaky scalp. The electronic medical record is to patient care what left-swiping on Tinder is to love. Not that I know this firsthand, but I have a lonely nephew who talks to me sometimes about his longings. In any case, scribbling my notes used to be easy in the days when we had paper charts. All we had to do was write: Subjective: Can’t pee. Objective: Enlarged prostate. Assessment: Prostatic hyperplasia. Plan: Terazosin 2 mg. Ahhh, what a relief! Nowadays, the computer refuses to close the case unless I’ve checked off a hundred boxes, torn out the last strands of my failing hairline and justified my billing codes. It is what it is.
Three days a month, I show up at the hospital and lead the residents on rounds. I do this on a volunteer basis, to lubricate my creaking brain, lest I end up being my own patient in my impending decrepitude. The residents wear soiled white coats like they’ve thrown them on immediately after getting out of bed and rushed to the hospital without putting a comb to their hair. In short, there is something rank about them I prefer not to describe any further. The United States Army should take over and straighten them out.
Let me be clear: Though I find their hygiene off-putting, their unbrushed teeth are nothing to me. My relationship with the three-resident weekend rounding posse is fleeting. After I’ve fulfilled my obligations with the team over the course of my assigned shifts, I send the trainees on their way. The next month, it’s a different crew. In name only, of course. After a decade or two of this routine, everyone looks the same. The men especially, I don’t know why.
So naturally, I was surprised when after rounds, a lady doctor burst into my office. I can’t say she was in tears. In fact, I am glad not to be so obliged. If there’s anything that makes me uneasy, it’s weeping females. My marriage has much improved since my wife reached menopause. She insists this condition celebrates the end of tears due to the “pause” on “men,” an etymology I strenuously oppose, linguistically speaking, but metaphorically accept. The truth is, as couples age, they begin to look more and more alike until you can only tell Francis from Frances by the toupee he wears.
But I digress. Back to the woman who appeared in my office without knocking: While not exactly in tears, she certainly had a dusky look. “I need you to sign this,” she says. “Please.” The next thing I know she’s flinging some sort of petition across my desk. Just to clarify—this is not my desk. Three days a month do not warrant a private office; however, Dr. Henderson lets me use his, though he has never explicitly invited me to help myself to the silver-wrapped anal suppositories he keeps in the second side drawer.
I recognized this woman now as one of my three weekend residents: She was the one with the overlapping cobblestone teeth and the belladonna eyes. In fact, she had approached me two days prior, at the start of our weekend together, requesting to work at my clinic next month, in order to fulfill the requirement for an outpatient rotation with a geriatrician. She had for some reason concluded a priori that I was the best man for the job. Perhaps she expected from me the wisdom of Methuselah, though in modern matters, I am sure she had me pegged as a dinosaur.
“It’s a leave of absence request.”
“Certainly,” I said, reaching for Dr. Henderson’s commemorative desk pen.
Can a face fall? It’s the first time I recall seeing such a vivid exemplar of this phenomenon. Apparently, she had been expecting something more from me. Her cheeks, her mouth, her whole physiognomy slackened a centimeter.
I have always been under the impression that if a person makes a decision, and hands you a piece of paper to sign off on that decision, nothing else needs to be said. However, I remembered a moment of reckoning when my wife, a few years into our marriage, announced her desire for termination. The effect on me was anything but transactional, in spite of her professional phrasing. Her words pierced me to the core. I had no desire to sign any of the forms she had at the time presented me with, and told her as much, in an appropriately crestfallen manner. From that moment on, Robert Louis Stevenson’s definition of marriage as “one long conversation checkered by disputes” kicked into gear. I learned to accommodate my wife’s needs, which I carefully wrote down in a notebook. Even with this punctilious effort, it took us years to acclimatize.
But back to the young doctor with the scintillating eyes of Murano. Lessons learned. “Is something wrong?” I asked.
Her chin wobbled, but she straightened herself, still clutching the paperwork. I noticed her hands were raw and red, like those of washerwomen of yore, nails clipped short. “Things have come up,” she said, wiping a sniffle with the back of her hand. “I have a family emergency.”
I had during this time remained sitting, hunched at my desk. There should have been no doubt about which one of us was the petitioner. “Won’t you have a seat?” I gestured.
“Then you’ll sign?” she asked, without taking me up on my invitation.
“Of course, I’ll sign.” I glanced at the papers she shoved under my nose. Temporary leave request, the form said, under which someone had typed in my clinic’s address and the dates of this resident’s upcoming rotation. Her name, the sheet generously reminded me, was Isabel Furness. I signed next to the X. “Here you go,” at which moment our eyes met. “I’m sorry,” I said. “I was looking forward to having you in my clinic.”
This in fact was true, generically speaking. I enjoy mentoring learners in my office, having discovered early on that if you keep repeating three clinical points forward and backward a number of times, my trainees will retain them forever. The hard part is finding sufficiently innovative ways to say the same thing over and over again. Poetry, it is not.
The young woman—Isabel, or did she call herself Izzy?—Dr. Izzy grabbed the signed papers out from under me. Behind the puddles that seemed to be forming in her eyes, a violet sunset shimmered. Gray clouds curved over the irises. She turned abruptly toward the door. From behind, in her white coat and sneakers, no one would have guessed she was anybody in particular. But of course, I knew better. Or should I say, my wife did, by osmosis, having succeeded over the years in passing her insights on to me.
I finished entering my notes into the computer. I could have dictated them, but who knows if someone looking for a lawsuit was listening. You can’t be too careful in a hospital. Fortunately, I have never been sued. That is because I apply fastidiously the aforementioned rule of threes to complex situations. A patient with chest pain who appears to be having a heart attack, for example, could instead be having a pulmonary embolus (One); or (Two), pericarditis; or (Three), an aortic aneurysm. Three things, all of which can kill if you miss them. This stodgy habit has prevented me from ever jumping to conclusions, and in consequence, I believe, from making mistakes.
I glanced at the institutional wall clock. Overall, I’d wrapped up this monthly weekend stint rather pleasantly. There had been the nice surprise of Mrs. Wilson, one of my clinic patients who had mistaken her hand sanitizer for gin. It is hard to tell Mrs. Wilson’s dementia from acute methanol poisoning, but as I am happy to report, we were able to discharge her back to her shifty-eyed caregivers after admitting her overnight to the floor for observation.
Other patients had the usual diabetic emergencies; a case of rhabdomyolysis; cellulitis of the leg; unexplained jaundice; diverticulitis requiring a blood transfusion. The residents knew what to do, and needed my help only with a puzzling case of prefrontal seizures. There was just one unexplained anomaly, I realized, as I reviewed our patient Mrs. Espinosa’s chest CT.
But wait. I turned back to the computer and scrolled through the patient roster. I discovered it now–the true cause of Dr. Izzy’s distress.
As I left Henderson’s office, resting my briefcase for a moment on the floor to make sure the door was locked properly, I took the opportunity to adjust my collar and cuffs in preparation for this upcoming piece of unfinished business. Eventually, I found Dr. Izzy at the nurses’ station on the third floor. Locating her hadn’t been easy. She had wedged herself in a corner nook next to the ice machine, where she sat poring over her laptop.
To say she was shocked to see me was an understatement. You’d think I’d arrived to dismiss her from the residency, even though such an action would be redundant to her leave of absence request. Besides, I am no ogre, though I lean a little to the left when I walk, due to a collapsed disk at L4. I have gentle brown eyes, I am told. I am also soft-spoken, which makes up for the narrow range of my facial expressions. Believe me, one learns a lot about oneself over the years.
“I..er…just checking on the patients before I sign off. Dr. Henderson will be taking over tomorrow as usual.”
“Anyone in particular?” With a sullen kick, she sent a stool rolling in my direction, which I took as an invitation to sit down. I obliged—a little awkwardly, I admit. To my utmost discomfort, the dark curtain of her gaze seemed to conceal a mocking undertone.
I was beginning to question my mission, so in order to preempt failure, I blurted out: “You ordered a chest CT on Mrs. Espinosa. Just as a reminder, it was Mrs. Greely who was supposed to have the CT.”
Dr. Izzy seemed to take this in incrementally. “We fixed that,” she said at the end of her lengthy ingestion. Abruptly swiveling her stool, she began madly clicking on the computer as if she could outrace her embarrassment, if indeed she felt any. She angled the screen towards me. “Turns out Mrs. Greely had heart failure. Just like we suspected,” she said, showing me the radiologist’s timely report.
“Good, because as you know, Mrs. Greely’s symptoms being somewhat atypical, raised concern for a more serious diagnosis,” I answered, my expression no doubt acquiring that thin-lipped look my wife always complains about.
Now that we had this clarified, I became aware of Dr. Izzy’s disheveled and tired appearance. She looked for a moment more defeated than the oldest of my patients. Though contrary to assumption, gerontology features a surprisingly feisty clientele.
Perhaps I was overreacting. The residents had already been treating Mrs. Greely for possible heart failure as a precaution. No one had suffered from the delay in sorting out her condition. So. I added in a conciliatory tone: “I know mixing up who-gets-which-tests is an easy mistake to make over a long weekend. You shouldn’t take it so seriously.”
As I was thinking how to further reassure Dr. Izzy, I heard one of the nurses around the corner in the nurses’ station saying: “That Dr. Fettucini, do you think he’s on the spectrum or something? He talks like a robot.”
Never mind that my name is Todicheeni. I knew who they were talking about.
The moment I heard the nurse’s voice, I backed out of the alcove to show myself. There were two of them—one of them facing me and who now, catching my eye, tried with a warning expression to alert her fellow nurse as to my presence behind her. Apparently, the speaker didn’t get the hint. “And every time he tells you to do something, he repeats it three times. Like he’s casting a spell or something.”
Dr. Izzy shot me a questioning glance from her swivel chair. Then seeing me stand there like a stump, she jumped to her feet and very nearly pushed me aside.
“I never learned more from an attending than from Dr. Todicheeni,” she announced passionately. By this time the second nurse had realized I had been standing behind her. Her face turned a hospital green.
“Maybe everyone should mind their own business, because you—” Here, Dr. Izzy pointed at the nurse. “Because none of us are perfect. I’ve seen patients leaning on their call lights over and over and nobody comes, and it’s me who has to go and find their nurse for them.”
With that, she stopped speaking, while the three of them formed a splendid frozen tableau, led by Dr. Izzy as the very image of righteous anger conquering ignominy. Then Dr. Izzy turned and strode back into the alcove, with me following humbly behind her.
I cleared my throat. I suppose I might have been wrong about my three-pronged teaching style. I remembered now a friend who had gifted my wife a three-ingredient cookbook, aimed at simplifying recipes for the busy housewife. I have to admit that the dishes those recipes produced were execrable.
But since I did not know how to communicate my realization to Dr. Izzy, which would have sounded like a useless apology, I simply resumed where we had left off. “As I was saying, a small mistake such as ordering a CT on the wrong patient is nothing to lose sleep over. It does not amount to anything drastic.” I hesitated, and then added pointedly, “It certainly does not warrant taking a leave of absence.”
She stared at me with the incredulity of an earthling encountering a Martian who, for all his formidable alien appearance, was carrying a cluster of octopus-shaped animal balloons.
“I am taking a leave of absence because my husband just ditched me,” she burst out. “I’ve got a kid. He’s only 2 years old. And our nanny…well, why go into it. You get the picture.”
All this information sounded like a non sequitur, but I gathered she was giving me the actual reason for her leave of absence. “I am very sorry, I didn’t realize,” I said, chagrined at my own formality, not to mention having falsely assumed that the “family emergency” she had announced earlier was code for her lapse in professional performance. But once I had made this admission, it didn’t seem so difficult for me to go on and say, “I have been a bit of a buffoon.”
Dr. Izzy’s shoulders dropped an inch or two. “That’s fair,” she said.
We had both settled on our respective seats in the alcove. “Shall we get on with it?” I suggested after a bit, in an effort to break our hapless truce. “Shall we now look at Mrs. Espinosa’s CT? There is something I wanted to show you.” Like me, Dr. Izzy seemed to welcome the break from my awkwardness, which in the manner of many of my personal interactions, had become hers as well.
“You mean Mrs. Greely’s, right?” she asked. “Remember, Espinosa’s was the one I ordered by mistake.”
“Indeed,” I responded. “But for now, our task lies with the latter.”
Dr. Izzy tossed me a skeptical glance before obediently turning to pull up Mrs. Espinosa’s radiology file on her computer. The two of us studied the black and white wedges in front of us. “The radiologist read it as normal,” she finally said, running through the written report.
“But is it?”
She toggled back to the images. “No!” she exclaimed after a minute, echoing the animated cry of Archimedes. “Look! There are two tiny filling defects in the pulmonary arteries.” She pointed to the right lower lobe of the lung.
“What’s causing the obstruction, do you think?”
Frowning, she ventured her guess. “Pulmonary embolism, maybe?”
“You just saved Mrs. Espinosa’s life,” I solemnly proclaimed.
Dr. Izzy answered with a modest shrug. But credit must be given where credit is due. “You did,” I insisted. “Think, the radiologist missed it! And now,” I said, rising from my stool, “I am sure you know what to do next.” I was for a moment painfully tempted to mention the three prongs of Virchow’s Triad. Unfortunately, the nurse had dampened my enthusiasm for such teachings, so I remained silent.
“Of course I do.” She stood up too. “Anti-coagulate and work her up. Could be recent surgery. Maybe cancer. Or…” She counted three fingers. “Let’s see: vascular stasis, hypercoagulability, and….” She lowered her voice the way spies might sharing a shibboleth in the night. “Vascular trauma.” Then she smiled. I hadn’t known she could smile.
I beamed back at her so much so that I had to take her hand and shake it vigorously. “Please reconsider your leave of absence.”
As I followed her out of the nurse’s station towards the elevator, the nurses turned their backs discreetly. I pressed the elevator’s “down” button. Dr. Izzy, who was going to the fifth floor to tend to Mrs. Espinosa’s embolism, pressed “up.” Symmetry aside, I didn’t want to part like this, heading in opposite directions. “You’re welcome to rotate in my office any time,” I reminded her. The elevator door opened. It would have been too clumsy at this juncture to talk about how my wife and I never had any children and so forth. Or offer our babysitting services on short notice. But maybe one day, there would be time for that. I hoped so.
I headed home on foot, since we live only half a mile from the hospital. I was feeling very chipper. Virchow’s triad, I chuckled fondly, as though communing with an old friend. But for some reason my thoughts veered to my wife. Something about today’s encounters had thrust her person directly in my line of vision. Her insistence on truth. The light in her eyes. Her clever asides. The way she had slowly let me back into her life. Admittedly, those were four things, not three. I wasn’t about to let that bother me. I’ve been told certain feelings can’t be accounted for. There are situations where the parts never add up to the whole.
