A History of the Present Illness (11 page)

The day I met Joan, the surgeons suspected that she had a slow internal bleed, and they wanted to open her up to find out for sure. I explained to Joan that she needed a second IV for surgery and that I was going to numb up the spot before inserting the needle. When I reached for her arm, she pulled it away and tucked it between her legs. When I tried again, after at least a minute spent reassuring and cajoling her, she howled. And when I moved to her feet, still looking for a decent vein, she kicked me in the chest.

I told my attending that I thought it was time to move to Plan B.

“No, please, no!” she wailed as I tied her arms to the bed-rails with soft restraints. “No. No. Noooooooo!!” she screamed, louder still, as I pinned her head and torso and my attending held a mask of nitrous oxide over her filthy, scarred, and screaming face.

As soon as she was out, I put in the lines and we took her to the OR. I ran the whole case, the attending occasionally pointing at a dial or a drug but mostly telling me the story of his solo trip up Mount Whitney that weekend.

“You're ready, you know,” he said after we'd dropped Joan in the post-anesthesia care unit. “For internship, I mean. You don't need this rotation. You should drop it and go on an adventure. Do something wild and crazy while you can.”

I thanked him but didn't take his advice. Putting people to sleep so they could be painlessly cut open and made healthier was wild and crazy enough for me.

The Saturday before my medical school graduation was one of those perfect late-spring days in San Francisco when there's no hint of fog and the locals who usually complain about the cold complain about the heat instead. Althea and I decided to brave the lines at the dive restaurant on the pier at China Basin in exchange for the pleasure of sitting outside by the water and the seagulls, drinking beer and eating oversize burgers. She too would be staying in San Francisco, doing the Family and Community Medicine Residency at SF General. We joked about how great it would be the day I delivered a baby and handed it off to her for its first full physical.

We were well into our second beers and discussing all the weddings taking place in the two weeks between graduation and internship, when out of the blue Althea said, “Did you ever feel, you know, like you hated them?”

“Who?” I asked.

“Patients,” she answered into her glass. “The ones you were taking care of.” She leaned forward. “You know. All that whining and manipulation and wasted time. The way they made you look stupid and useless in front of your team when you were killing yourself just to keep going and learn and not hurt anyone.”

Just then our dessert arrived. “
Signorine,
” said the obviously Latino waiter, with a small bow and an exaggerated sweep of the arm not laden with other customers' dirty dinner plates.

“Cappuccino? Espresso? More beer?” he asked without waiting for our answer.

“Patients are sick,” I said. “Probably they can't help it.”

We'd been given a generous slice of tiramisu with three
and a half ladyfingers along the edge and a decorative spray of shaved chocolate across the plate.

“A work of art,” Althea said, pushing the plate toward me. “You eat. I don't deserve it.”

I eyed the cream bulging voluptuously between the thin layers of sponge, then moved the plate back to the center of the table. “Not all patients,” I said. “And not all the time.”

“No,” Althea agreed. “Not even most of them. So why do I keep thinking of the hard ones?”

A seagull landed on the railing beside our table, opening and closing his beak as if he wanted to join the conversation.

“You know what Dean Rosenthal would say.”

Together we intoned, “Focus on your strengths, and you are weak; focus on your weaknesses, and you get stronger.”

I looked out at the bay. Three middle-aged women glided past the pier in bright orange kayaks. Farther out, a windsurfer struggled to remain upright in the scant breeze. The water wasn't quite the blue green of the tropics, but it sparkled in the sunlight.

And I had at least four more years in San Francisco ahead of me.

Althea must have been having similar thoughts. “Mostly it's amazing, though, isn't it?” she said. “Medicine, I mean. Interesting, challenging, important—everything you'd want in a career. And we get to do it here.”

I nodded. “And it probably gets better once you're really a doctor.”

“You mean the week after next?”

We laughed and picked up our forks. The tiramisu was as good as it looked.

In the rehabilitation and Extended Care Building of the San Francisco Veterans Affairs Medical Center, where some people came and went but most came and stayed, Rodney Brown, a.k.a. A-Rod, nudged the Bible off the edge of his bed. It hit the floor with a slam, and across the room, K.C.'s eyes opened, scanned, then rolled up, and he said, “Shit, man, not again. What the fuck time is it anyway?”

Rodney ignored K.C. and turned on his call light by slapping his left arm against the pressure-sensitive pad beside him on the bed. And then he waited, something he was getting good at, not that he had much choice, though at least he was better off than Danny Stockton, who had taken one in the head, or Pablo Villela, who lived two floors up on the ward where you didn't have to do anything for yourself, not even eat, not even breathe.

He listened for footsteps. Sometimes he could tell which girl was coming by the way her shoes touched down on the linoleum: Esther did a tap-shush, Celeste made a squeak-sigh-squeak, and big Grace—full of self-importance—sounded as
solid and steady as a man. With Rita, his favorite, there was only the nearly inaudible brush of one nylon thigh against the other.

Unfortunately, Rodney's nose also worked well—too well—and now it was telling him that someone somewhere not far enough away was crapping himself. He hoped it was K.C. and not himself, since the hall was completely quiet, meaning it was still the night shift, the staff sacked out in an empty bed or in the med room or wherever the hell else they hid when you needed them most.

Hallway light bled through gaps above and beneath the door, then diffused across the room. It was just bright enough that Rodney could see K.C.'s open eyes trained on that place where—for a few months—there'd been a
before
photo: K.C. standing on the two legs God gave him outside the projects up on Cashmere and La Salle, his arms around the woman who'd visited daily until the afternoon she hadn't pulled up the tan vinyl chair, but stood to one side of K.C.'s bed and announced that she loved him, but she was too young for all this, that she needed a life, a real life like the one she'd always dreamed of, that she wished him well and he'd always be in her prayers, and, finally, that she really, really hoped they could be friends forever, no matter what.

Footsteps sounded in the corridor. Rodney listened, then smiled. It was Grace for sure, and he was about to advise K.C. to turn his head and catch some of the eye candy as big Gracey bowed and reached for the Bible on the floor, when pain exploded in his right foot like the sudden, excruciating burn of a lighter held to his toes.

“Oh fuck!” he yelled, though the pain faded as quickly as it had appeared, replaced by a smolder with a throbbing behind it.

K.C. asked if he was okay, but Rodney didn't answer. He was concentrating, relaxing into a hurt so familiar it was almost as if he could smell the strange German pizza a nurse named Eva used to sneak him at the hospital in Landstuhl in those last, best days before they transported him back stateside. “You are lucky,” she had whispered, placing tiny rounds of sausage and melted cheese on his tongue and jerking her chin at the other beds. Her breath, warm and sharp from cigarettes and coffee, had traveled into his ear and down his torso, landing between his hips, where it blossomed into a problem he could no longer solve.

Rodney shook that memory away by conjuring the image of his mother when she finally arrived at his foreign bedside. She had changed planes four times to get from San Francisco to him—her first air travel in nearly a half century of life, a trip for which she'd been given the cheapest ticket instead of the most direct route, a trip she'd made without hesitation even though he'd signed up against her wishes, even though he'd fucked up again, ending just as she'd feared he would.

He had watched her scan the ward, skipping the white boys but slowing down at the brown ones, as if the desert sun might have lightened his color. If he could have shouted out while her eyes lingered on the black bodies covered in bandages, he would have. Finally, she saw him. Her lips parted and her eyes closed. Then she crossed the room, and it seemed for a second that she might climb over the plastic side rail and into the bed beside him. Instead, she leaned way over and kissed his forehead, then moved to stroke his arm. But before her fingers made contact, she'd done a visual sweep of his body, then stopped short, her hand trembling above his chest like those crazy birds after the bombing of Fallujah, unsure where—or whether—to touch down.

Rodney blinked and dragged his left wrist across his eyes; the pain was better now, no more than an ember. He looked down the bed at the bump that was his feet, a short, sloped ridge that might have been anyone's feet or even part of the bed itself, and there was no movement down there, but that didn't matter, because this time he knew he felt something.

“Grace!” he shouted, wondering where she'd gone.

He slapped the call light again, slapped it and slapped it. “Yo,” he said to K.C. “Help me, man,” but K.C. only grunted and pulled his pillow over his head.

Twenty minutes later—long enough for Rodney to be certain it was all coming back: the toe, the foot, the leg, everything—he heard the solid, steady steps again.

“Hey,” he called. “Gracey, please,” and the door opened.

The person in the doorway wasn't Grace or any of the other girls, but a guy Rodney had never seen before, a guy who would have been a total waste of his time earlier, since he would never, ever watch some Joe bend no matter how hard up he was. In fact, he decided, he wouldn't even mention the fallen Bible to the guy, he'd just call again later, hoping for Esther with her small, soft fingers, or Rita with her high-riding ass. But the guy could help him with something more important than a quickie thrill, more important—at least for this one moment—than even the good book itself, and so he said, “My right foot, man! I feel it!”

The aide nodded and pulled back the covers, and together they stared at the long white space on the sheet next to Rodney's mangled and scarred left leg. Rodney closed his eyes and waved the aide away.

Every morning, he somehow forgot. Every morning he woke up and recognized the hospital bed and the colorless walls he shared with K.C., and he remembered he was damaged,
but he forgot precisely how or why, and for a while—seconds at least, but sometimes much, much longer—he imagined that it wasn't really so bad, and that he might have a normal life with a job and a family and the ability to wipe his own ass. He imagined that what was left of him was worth saving.

1. She was born in the Ahmedabad district of Bombay province, India, in 1947, two weeks after partition, thirteen days after independence, the second of six children of a petty bureaucrat and a housewife with repressed artistic ambitions that seeped out in silent tears and storms of uncontrolled hilarity.

2. By age ten, her hair reached below her buttocks. She never cut it.

3. She did well in school and hoped to go to college. Her father said no.

4. At seventeen, she had her first bout of depression. Or so we assume. All we really know is that she stayed in bed for a year, and neither the local healers nor the specialists her father took her to see in Bombay offered a plausible diagnosis or effective treatment.

5. During that year, she read all of Jane Austen, the Brontë sisters, George Eliot, Thomas Hardy, and D. H. Lawrence. Twice.

6. To everyone's surprise, she married well, the youngest
son from a good family, a doctor with a growing practice in Springfield, Illinois, an aloofness reminiscent of Mr. Darcy, and a skin condition that sometimes stained his shirt and trousers. The year was 1967. They were the only Gujarati in central Illinois.

7. Her husband worked long hours and expected her to manage everything else. He didn't love her, and she knew it.

8. She had one son, then five miscarriages. After the first four, she took root on their living room couch. Her husband prescribed antidepressants, which she flushed down the toilet. “Life's disappointments,” she explained to her boy, “one cannot be treating with pills.” Of that time, her son recalls a heavyset woman hired by his father to keep house; pale, bland foods; and relatively happy afternoons spent combing the tangles from his mother's hair as she began to recover.

9. After the fifth miscarriage, she moved into the guest room and enrolled in classes at the university. Three years later, she graduated with honors and a double major in English literature and business administration.

10. That summer, her husband announced that he was relocating to Kentucky with his nurse, who, though neither especially young nor particularly pretty, was five months pregnant with his child and belonged to a pink-skinned but surprisingly open-minded extended family outside Louisville.

11. After her husband's departure, she spent a week in the hammock on the screened back porch, in what turned out to be her last such sojourn. Her son shopped and cooked and cleaned until one afternoon he returned from the store to find his mother trying on business suits. Before that day, he'd never seen her in anything but a sari.

12. For the next twelve years, she worked at the university from which she'd graduated, first as the administrative assistant to the chairman of the English Department, then as the dean's special assistant, and, finally, as the registrar of the College of Arts and Sciences.