Doing Harm (3 page)

“Dr. Collier, I’m sure he’d recite anything you’d like him to.”

“I bet he would.” Dr. Collier chuckles again. “Well, I’ll see what I can do.” His attention abruptly shifts to one of the other guests behind us, a senior doctor in the department. “Enjoy yourselves, you two.” Still smiling, he guides his wife by the elbow away from us and toward the other doctor.

“What were you doing back there?” I murmur in Sally’s ear as we walk the short distance from the foyer to the living room.

“Trying to help you.” She nonchalantly plucks a salmon-topped cracker from a passing tray and bites into it.

“I thought we agreed to do things my way. In the car.”

She swallows the salmon cracker and wipes the crumbs off her fingers with a cocktail napkin. “We never agreed on anything. You simply stopped talking. Remember? I saw an opportunity and took advantage of it. Did you see Dr. Collier’s reaction?”

“Yeah. He made fun of me.”

“But in a
good
way, Steve. I bet you he talks to you about a job next week.”

“I bet you he throws me out of his office.”

But she’s spotted one of the other resident’s wives, a friend of hers, and is moving away from me, smiling and waving. She’s already begun to work the room.

A catering girl walks up and offers me a bruschetta. I take it, shrug, and follow Sally into the crowd.

CHAPTER 2

Monday, July 13

It’s 6:45
A.M.
, and I’m sitting in the cafeteria of University Hospital, cradling a strong cup of coffee. The early-morning rush is under way. I watch idly as nurses and medical technicians, bleary-eyed and blank-faced, stumble into the cafeteria on their way to the 7:00
A.M.
change of shift. They grab coffees and juggle paper plates heaping with scrambled eggs and bacon and hash browns to take with them to their jobs upstairs on the patient wards. A few doctors also mill around, mostly other surgery residents wearing long white coats over hospital-issued scrubs—members of surgical teams who have finished their morning rounds and are tanking up before heading to the operating rooms for the rest of the day.

A boisterous group of surgery residents sits at a nearby table, huddled over their meals, swapping stories about patients. At one point, the table erupts into raucous laughter, and one of them accidentally spills coffee onto his white coat. Cursing, he grabs a napkin and starts wiping at the ugly brown spot spreading toward the embroidered University Hospital emblem stitched in bold maroon across the right breast: a caduceus with the words
PRIMUM NON NOCERE
printed underneath.

I idly finger the University Hospital logo on my own white coat.

University Hospital.

I love being a doctor; I especially love being a doctor
here.

Who wouldn’t? A sprawling, eclectic complex of sleek, modern high-rises interconnected with squat and sturdy nineteenth-century edifices located in the heart of Boston, University Hospital is the primary teaching hospital for uberprestigious University Medical School, and year after year is consistently ranked among the best hospitals in the world.

But the place means more to me than just a number on some magazine’s “Best Of” list. Much more. Not a day goes by when I don’t think about how special it is to be part of this place, or remember all of the years of soul-crushing academic labor it took for me to get here. Founded almost 250 years ago by the top doctors in colonial America, who themselves had been trained by the top doctors in Europe, University Hospital is steward of a grand tradition that stretches back generations: a mecca for cutting-edge medical innovation that’s reliably churned out, in equal measure, Nobel Prize winners, medical-school deans, and surgeons general. Only the best of the best are chosen to train here.

And I’m one of them.

It certainly wasn’t easy to get here.

I smile to myself and remember the very first speaker on my very first day of medical school: the dean. He was a burly cardiothoracic surgeon, a former Army Ranger stuffed into a three-piece suit, built like a tank and very imposing, especially to impressionable first-year med students. After making a few perfunctory welcoming comments, he walked out from behind the lectern, took off his suit jacket, carefully laid it over the back of a chair, and walked to the front of the podium. It was a slick move—folksy yet calculating, sparking an immediate sense of intimacy in a roomful of complete strangers. He then launched into an easygoing pep talk, full of earnest admonitions that your dad might have delivered over a mug of hot chocolate sitting at the kitchen table the night before you headed off to college.

He told us to relax; that we had made it; that our moms were already proud of us; that the competition was over; that it was time to stop trying to beat the grade curve and focus on becoming good doctors.

Right.

This to 120 hypercompetitive, anal-retentive, type A overachievers who had spent the last several years single-mindedly decimating any and all obstacles to gain the coveted seats they were now sitting in.

Who was he kidding? Half of the class was already taking notes. And who could blame us? We’d been competing against one another academically since practically before we could crawl. We were the ones who had survived the premed Darwinian free-for-all in college. We were the ones who had beaten the academic bell curve, who had successfully slipped into that thin sliver of grade Nirvana to the far right of the hump. That’s a tough mentality to shake off. And one, I’m not ashamed to admit, I never have. It’s what got me here.

Luis, the junior resident I’m currently working with, slouches into the seat across from me with a tray of food and grunts good morning, running his hand across his bald head, over his bloodshot eyes, and down his olive-colored face toward the rough, salt-and-pepper stubble dotting his chin. It’s a striking, if not particularly handsome, face—thin and long, almost gaunt, and all sharp angles, with thick cords of muscle extending from his chin down his neck. He was on call working in the hospital for most of the weekend, and this morning he’s been in the hospital since well before 6:00
A.M.
, checking on our patients.

I sip my coffee, considering my breakfast companion as he scratches some notes on a piece of paper he’s laid out on the table in front of him. Luis Martínez is a few years behind me in our training program, but this is the first time I’ve worked with him closely on a daily basis. His smoothly shaved head, by the looks of it a defiant stand against a markedly receding hairline, looks good on him; the prominent rise of his naked skull somehow makes him appear more commanding and belies the lower rung on the professional food chain he currently occupies in University Hospital. Even now, clearly exhausted, with another full day of work looming ahead of him, his squared shoulders and prominent jawlines betray not a hint of weakness or capitulation. He oozes self-confidence and radiates unassailable authority, even around me, and even though I’m his direct supervisor. But not in a bad way. He’s not arrogant, or egotistical. Just self-assured. It doesn’t bother me.

As a junior resident, Luis’s job is to handle the myriad practical issues involved in taking care of hospitalized patients: medication orders, nursing questions, diet changes, initial assessment of problems, discharge paperwork—all of the minute-to-minute, hour-to-hour details and minutiae that constantly arise when patients are staying in the hospital. It’s essential stuff. But it’s also a lot of grunt work. In medical parlance, we refer to it as scut, and to the interns and junior residents who take care of it as scut monkeys. Surgeons hate scut. But scut pretty much sucks no matter what kind of medicine you practice.

I don’t have to do scut anymore. I did my time in the trenches, when I was a junior resident like Luis. Now my job is to oversee Luis, teach him what I know, and pretty much make sure he doesn’t do anything stupid. I’ve worked with him for only about a week now. He seems like an okay guy. Taciturn and gruff, he runs a tight ship and, for the most part, keeps his thoughts to himself. We don’t talk very much beyond work-type stuff. He’s older than I am, several years at least. I heard he did some time in the military before he went to med school. Beyond that, I realize, I really don’t know anything about him—where he’s originally from, or where he went to school. I make a mental note to find out more.

But he definitely gets the job done, and gets it done well. Quite well. I don’t worry about his doing anything stupid with the patients. He’s also unfailingly polite and attentive to my directions; although I suspect that he secretly considers himself to be a much better doctor than I am, despite my greater experience. But that’s no big deal. Supreme self-confidence isn’t necessarily an unusual, or even unhealthy, attitude to have in medicine. A lot of doctors, at all levels of training and in all specialties, think they’re better than the next guy. It gives you the confidence you need to get up in the morning and go to work. Besides, in the end, the most important thing is that Luis always follows the chain of command and does exactly what I tell him to do.

Most weekday mornings, Luis and I meet here in the cafeteria to discuss our patients and plan their treatments for the day. This morning, as with every morning, I listen attentively over my coffee, interjecting now and then with questions, suggestions, or instructions on how to best take care of the patients. Most mornings, once he finishes going down his list of patients, I’ll usually give Luis some more work to do, then retreat to the operating room to enjoy myself.

This morning is no different. After he finishes his report, I tick off the list of tasks—the scut—I want him to complete on each of the patients. Increase Mr. Kellogg’s IV fluids; he’s dehydrated. Switch Mrs. Cardoza to oral pain medications. Have physical therapy work with Mr. James; he’s been a slug since his surgery and won’t get out of bed. Order a CT scan for Mr. Richards; he’s been having persistent fevers and belly pain the last few days, and I’m worried he might have an abscess lurking somewhere in his abdomen. Complete the discharge paperwork for Ms. Tang.

With each of my directives, Luis nods and writes something on his sheet of paper.

“We have a med student starting with us on service this morning,” he says when we’re done, leaning back in his chair and rubbing his palm over the top of his head, like he’s polishing a doorknob. “She rounded with me earlier. She’s at a student orientation or something right now, but she’s going to meet up with us here in a few minutes.”

“How is she?”

“Smart. Definitely knows her way around the hospital.”

“Oh yeah?” I ask, marginally interested. Med students are usually pretty clueless. And therefore useless. “What’s her name?”

“Gigi. G-I-G-I. Gigi Maxwell. People say her first name should be more like, ‘GG.’ As in the letters G-G. Short for ‘Golden Girl.’ Because she’s such a terrific student. The word on the street is that she’s been knocking it out of the park on her other clinical rotations. Hard worker, great attitude, whip smart.”

GG.
“Nice break for you. I’m sure she can help you out with some of your scut.”

“Yeah. Look.” He glances around and then leans toward me over the table. “You’re married, right, Steve?” he asks, sotto voce. I can barely hear him over the din around us. I nod, curious as to where he’s going with this. “Good. Let me warn you up front anyway.” He lowers his voice even further, so that I have to scoot forward to make him out. “She’s also pretty cute. With a good-sized rack on her. It’s hard not to notice. A bunch of the surgery residents have been trying their best to get in her pants.”

“Is she letting them?”

“No. That’s my point. Exactly the opposite. She filed a formal complaint against Connors last month for putting his hand on her ass in the OR.”

“Connors.” I guffaw. “The guy’s a douche bag. Thinks with his prick. He’s banged half the nurses in the hospital.”

“Right.” Luis leans back and drapes his elbows on the back of the chair. “I for one am interested in keeping my job. Thought you would be, too. Wanted you to know the situation.”

“Thanks, Luis.” I’m grateful for the heads-up. It’s not like I’m going to be hitting on her or anything, attractive or not, but sexual harassment has been a pretty sensitive topic around here for a while, ever since a drunken neurosurgery professor groped a few female residents half his age at an out-of-town conference a few months ago. Surgery has always been a male-dominated field; and its men’s locker-room sensibilities have proven remarkably resistant to twenty-first-century notions of gender equality. Especially at a traditional place like University.

Anyway, after the neurosurgeon-groping thing blew up in a very public, embarrassing, and litigious way, every surgeon in the hospital—residents and professors alike, male
and
female—has had to suffer through sensitivity training lectures and weekly e-mail blasts reminding us of the importance of
maintaining a nonhostile work environment.
In the current climate, saying the wrong thing about, doing the wrong thing to, or acting the wrong way in front of a female medical student, especially one under your direct supervision, can get you into serious trouble. Connors, the surgery resident Luis is referring to, apparently hadn’t gotten the message.

I point to my wedding band and unsuccessfully attempt to stifle a yawn. “I’m good. But thanks, man. Just try to keep her out of my way, okay?”

“Sure.” He tips his chin in a direction over my shoulder. “Here she comes now.”

I spin around in my seat and follow his line of sight to the cafeteria entrance, where a tall girl with dark brown hair, wearing the standard-issue short white coat of a medical student, is surveying the room uncertainly. Luis catches her attention and waves her over.

You can usually spot the med students from about a mile away: Their short white coats and deer-in-the-headlights gazes make them stand out like sore thumbs. But as GG weaves through the human traffic of cafeteria rush hour, I can tell right away that she’s different. She’s wearing crisp green surgical scrubs under her short white coat. The purposefulness of each stride matches the intense expression on her face. This is a woman, it seems, who knows exactly where she’s going and how she’s going to get there.