There were no cars behind me. Why should there be? It was 0430 and I was at the stop sign on Wyatt St. six blocks south of Children’s. All I needed to do was turn right, like I had every other morning the past seven weeks. I saw the headlights half-a mile further south on Wyatt, a solitary feature, approaching from the dark, the distance between the matching orbs and their bouncing over the railroad tracks I knew were there running east and west belied a large, heavy vehicle with a stiff suspension; probably a delivery truck at this time of the morning. I was invisible in the winter’s pre-dawn dark of a moonless sky, having missed the setting minutes before, the southern Hell’s crater being the first to slip behind the Horizon.
“You’ll never be a good surgeon, Rob. You don’t work hard enough. You don’t follow through…” He sat across from me in the hospital cafeteria. Most of the staff tried to have dinner at home, but not the Dick. His wife worked the evening shift so there was nothing for him to be home for half the days of the week, and the other days of the week we worked through dinner. I imagined him arriving home around seven-thirty or eight to a plastic covered plate on the stove, his wife well into the broadcast TV shows, I remembered him talking about the Thornbirds. If he got home at eight, I got home at ten because he always left me a list of tasks to do; lines to remove, tubes to pull, things to look up like the staging of nephroblastoma and five-year survival numbers.
His name was Randy Richards, MD. He insisted on all his residents calling him Rand, which we did; but we all thought of him as the Dick. I think he laid his hand on me once, but I don’t honestly remember, but I do know that he pushed Baolin against the wall. I supposed it didn’t occur to him, because I outweighed him by at least thirty pounds, mostly lean body mass. He was still plenty big, relative to most people, just over six feet, and rectangular in build with a thick brow, pronounced mid-facial features and a diminutive jaw, Cro magnon-like, if not Neanderthal, I thought, which was only reinforced by the fine black hair creeping up from the collar of his scrubs to establish continuity with the hairline of his scalp, the sort of a neck that must have been a quandary for his barber, driving the poor bastard into a frenzy every time he whipped out his razor to do the neck, afraid of a beating if he went to far, or didn’t go far enough.
“…like the pediatric hernia repair we did this morning, when I asked what pre-operative medication Jimmy needed. You had no idea. Those are important details you need to elicit from the patient. Do you even remember the med?”
“Desmopressin.” The five-year-old had von Willebrand’s disease, the most common type, Type I. It was an outpatient case and I had fifteen minutes in the pre-op holding area before the Dick arrived, and I spent half the time playing with Jimmy to keep his trembling lower lip from erupting into full-throated cries.
“What type of von Willebrand’s did he have?”
“Type I, 60-80%, usually asymptomatic.”
“What was the dose?”
“5mg.” Thank God I remembered.
“How many milligrams per kilogram?”
“Ahh,” Quick math…Jimmy was about 30lbs. I’d guess, divided by 2.2, goes into 5000…
The Dick interrupted my mental calculator, “0.3 micrograms per kilogram,” he said, rolling his eyes as he drained the 2nd of his 3 cartons of 1% low-fat milk lined up on the front right edge of his tray. “That’s what I mean,” he said, lifting his hands in a shrug like delivering a benediction. “We even talked about it.”
“Sorry, Rand, I’ll try harder.” I didn’t know what else to say. I was exhausted and the end to my day was still several hours distant.
“I honestly don’t know if you can, Rob. You have less than two weeks left on this rotation and I feel that I’ve done all I can for you and it’s like you never fail to disappoint. You’re a third year resident, you should be further along.” He picks up his third milk carton and carefully tears open the proximal cardboard seam facing him, folds back the wings and teases out the center portion to create the spout without fraying the thin waxy cardboard edges joined by the adhesive, all while managing to maintain eye contact. He’s a great one for eye contact, and earnestness.
We’ve had talks before in a similar vein, but he seemed particularly intent and severe tonight. I knew he thought I was a shitty resident, but then why did he let me operate on his patients. I just figured it was part of his treatment, like basic training. The other pediatric surgery staff wasn’t nearly so malignant; sadly, she was not my assigned preceptor. What did he want from me?
“What can I do Dr. Richards?” I don’t touch my tray. I’m not hungry. “I feel like I’m working as hard as I can. I’m here before five and don’t get home until ten most evenings,” I say, but I know that it sounds weak and whiny to him; hell, to me; and I’m sorry I said it as soon as it’s out of my mouth.
“Rand, please,” he says, tightly, then slips a forkful of meatloaf dunked in ketchup into his mouth. He looks at me with this frown, chewing slowly. He swallows, and then his forehead smooths like he’s crossed a mental bridge of sorts. He continues, “I don’t care how much time you spend here, Rob. What I care about is what you get done. I care what you learn. I care that you do not miss the details that the lack of awareness thereof can kill patients…so spare me the sob story of how much time you spend here. We all did it; I did it. Goddamnit. You think every other day is bad. Try every fucking day on for size, for two years straight. I would go three to five days in a row before making it home for a few hours. I guess what I’m saying is that you asked for this. This is what we do. This is what you do; and if you don’t want to do it, for Christ sake, just say so.” His voice, low, tense, urgent, enveloped me in a cloak of shame. I cast a furtive glance over the Dick’s shoulder.
I imagined I could see the Dick’s temporalis muscle’s literally swelling with blood, but there was no mistaking the tumescence of the masseters at the angle of the jaw when he saw my gaze shift, forgetting about the eye-contact thing. “I’m talking to you, Rob, Goddammit. Can you give please give me the courtesy of your attention?”
“Sorry,” I say again, or is it the first time. I can’t even remember.
“Being a surgeon, Rob, is never easy. It never was, and it never will be. You just gotta wanna.” His eyes slip from my face, as though he’s suddenly aware of the reality that we’re not alone in his office, or some other quiet corner of the hospital.
It’s too late. It’s no secret now. The entire cafeteria is watching, and the Dick’s facial tension eases in what I take to be satisfaction. I know my eyes are bright. I think there might be a tear. I hope not. I wonder if he does this with all his residents. I don’t think so.
“And, by the way, sorry’s not good enough, Rob.” He tips back the milk carton, wipes the milk from his upper lip, “You still have a week left, but if you don’t demonstrate some progress, I can’t in good conscience recommend you,” he says with no diminishment of tone. From the corner of my eye I see people looking away.
The lights pass through the cone of light from a street light. It is a truck, a semi with a fifty-three foot trailer. I think of my kids sleeping, only the oldest stirring with my morning kiss goodbye. My wife will be getting up in thirty minutes to get the kids ready for school and daycare. Three years of a hundred –and-twenty-hour work weeks, and I’m not going to make it. Living in a shitty neighborhood with gang graffiti on the STOP sign on our corner and loud cars at night. My wife working full-time with our youngest two in daycare and the oldest being bused to a school on the other side of town. For the first time in my life, my hardest, and my best, but I’m not even sure about that anymore, isn’t good enough. I’m ashamed. I had stopped wearing my seat-belt two weeks into the rotation because I didn’t see the point, figuring that if God wanted me that bad, He could have me. Now, I just wanted him to take me.
The truck’s two blocks away now. I’m scared. My foot on the brake is trembling. I don’t know what to do. I’m tired. I feel the approaching rumble of mass. I hear the rattling growl of a diesel engine rapidly approaching…