Doing Harm (4 page)

She reaches our table and introduces herself to me. My need to assert surgeonlike authority in front of a med student overcomes my urge to do the gentlemanly thing, so I remain seated as I size her up. She’s tall—very tall, almost as tall as I, and at six-one, I’m no slouch—with a long, svelte frame. Her hair flows down her back in thick, straight waves before gliding to a graceful stop just past her shoulders. She has eyes the color of dark chocolate and sharp features that abruptly soften around her cheeks and the edges of her slightly upturned nose. I have to admit that Luis was right: She’s pretty. Not beautiful, like a model; her body is a little too thick, her features just a little too asymmetrical.

But she’s definitely good-looking—attractive in an intelligent, down-to-earth, approachable kind of way. And, as she leans over the table to shake my hand, I can’t help but notice that Luis’s description of her physical attributes was right on the money. Now I truly understand why Luis warned me—I might be happily married, but I’m not dead, and I labor to keep my eyes from lingering over the utilitarian, but provocative, dip of her scrub top.

There’s something else about her that stands out almost immediately. Something that’s harder for me to put my finger on. Something elusive. A …
stillness.
A calm and magnetic self-composure that underlies everything she does and says. It’s in the way she moves confidently toward me, locking her eyes onto mine and shaking my hand, her attitude and motions utterly devoid of uncertainty—like Luis, but less commanding. It’s also in her voice, which is light and amiable and soothing, like a radio DJ’s.

As she shakes my hand, her face breaks into a radiant smile, the lines extending across her smooth features, like ripples from a pebble tossed into the middle of a deep, placid pool. Her grin is broad and eager and completely natural, lacking any trace of self-consciousness, almost like the smiles of my daughters. Her hand is soft, her movements fluid and controlled.

“Nice to meet you, GG,” I say. “I understand you might be interested in going into urologic surgery.”

“Actually, Dr. Mitchell, I’ve already pretty much decided that it’s for me,” she says. “What you guys do for a living is terrific. Kidney surgery, prostate surgery—I think that stuff’s awesome. This is my subinternship, so I’ll be with you guys for the next six weeks.” During their last two years of medical school, University med students spend two-to-four-week blocks with various departments in University Hospital to earn credit toward graduation. Subinterns are advanced students interested in taking on more advanced tasks.

“Great. I just hope Luis and I don’t end up making you change your mind.”

“I don’t think so, Dr. Mitchell,” she responds seriously. “I’ve heard great things about you. And Dr. Martínez. I’m really excited to be working with both of you.”

Luis and I exchange a look.

Is she bullshitting us already?

And even if she is, do I care?

I decide to take the compliment at face value. For now. “Well, thanks. And please call me Steve. I’m just a resident—I don’t deserve any respect.”

She chuckles appreciatively. Luis smiles thinly.

“Okay, Steve. Seriously, though,” GG says earnestly, “just let me know if there’s anything I can do for you guys. I really want to help out as much as possible.”

“Be careful what you wish for. We’re going to take you up on that.”

“That’s what I’m here for.”

She unclips a well-worn, black leather case from her hip, and holds up a sleek smartphone.

“Really, just tell me what I can do for you, and I’ll put it right in my extra brain here. I can put anything you want me to do in my daily schedule right now. I’ll be printing out some spreadsheets once I get home tonight to help get everything organized. Nothing too fancy—just Excel.”

Luis and I exchange another glance.
Is she for real?
But I have to admit that GG’s eagerness is infectious. Normally, I might brush off someone like her as an annoying kiss-ass med student, but instead I smile. “That’s okay, GG. Luis and I will talk to you about that later. We don’t have a lot of time right now. I have to go to the OR.”

Undaunted, she immediately snaps the phone back in place on her hip, like returning a gun to a holster. “No problem, Dr. Mitch … er, Steve.”

“Luis’s going to take care of you this morning, get you all settled in, and assign you some stuff to do. In general, we’ll pretty much expect you to function at the level of an intern: help in surgery cases, gather lab results, do some scut. Oh, and you’ll be going to the resident’s outpatient clinic every Tuesday morning to see patients with Luis. Okay?” I stand up without waiting for an answer.

“Great!” she exclaims.

“Oh, hey. Steve?” Luis asks.

“Yeah.” I look at my watch, my mind already in the operating room.

“I forgot to mention it to you earlier—my ERIN account is all screwed up. It blew up on me during morning rounds, and now I’m locked out of the system. Can I borrow your account this morning until the IT people can fix it?”

“Sure, man,” I say absently. ERIN is University Hospital’s electronic medical records system. All of our medical orders and records, including medication prescriptions, are done on the computer. Without his ERIN account, Luis is helpless: He won’t be able to order medications for our patients, and GG can’t help him since medical students aren’t allowed to order medications because they’re not doctors yet. Without Luis ordering medications for our patients this morning, the wheels might come off our carefully tuned bus, and I might end up looking bad in the eyes of my bosses. I can’t have that. So I quickly jot down my account name and password on his spreadsheet.

“Thanks, Steve. The IT people said they should have it fixed by noon today.”

I glance at GG. She smiles broadly and opens her mouth as if she’s about to say something.

“See you, guys.” I turn and walk away before she has a chance.

*   *   *

Our first patient of the day, Mr. Bernard, is a carpenter from coastal Maine. He’s having his bladder removed because of cancer. I find him in the pre-op area, a large room with high ceilings next to the operating suites, where surgery patients sit in small cubicles on gurneys, waiting to undergo final evaluations before being wheeled into the OR. Doctors and nurses buzz around their patients, going through final checklists.

Mr. Bernard is already dressed in his standard-issue hospital gown. With all the amazing medical advances that have occurred since I started medical school—face transplants and HIV wonder drugs and complex surgeries performed with robots through incisions no bigger than keyholes—I’ve often wondered why somebody hasn’t gotten around to designing a better hospital gown.

Really. They’re the same everywhere I go. Flimsy and drafty and cold, sporting a hopelessly complex assortment of strings for tying it in place and characterized by the one reviled feature that remains the universal bane of all patients: a long open slit down the middle of the back running from neck to knees, corresponding to the vertical line at the exact center of the buttocks.

So there Mr. Bernard quietly sits, on a gurney in one of the cubicles with his butt crack hanging out the back of his gown, behind a thin plastic curtain that looks and feels exactly like a shower curtain at a roadside motel and is meant to afford some modicum of privacy here in Grand Central to people waiting patiently for their surgeries. Mr. Bernard is muscular and wiry, with a thick mop of dark hair flecked with gray, and squints a lot after the pre-op nurses take his wire-rimmed glasses for safekeeping. Like rings on a tree stump, his face is etched with the deep lines of many summers spent working outdoors.

We shake hands. His palm is sweaty and slick, and after I withdraw mine I have to resist the urge to wipe it off on my white coat. He’s not married and, unlike most of the other patients currently in the pre-op area who are surrounded by family members, is alone (“My girlfriend will be here later.” He shrugs without further explanation). We talk about the risks of the operation. I give him the usual reassurances: that this is a routine operation; that our safety record is excellent; that bad things almost never happen.

I like him instantly. He’s amiable, sharp, and witty. He’s also very precise and asks a lot of surprisingly insightful questions for a carpenter. He seems satisfied with my responses. He signs the remaining paperwork, including the consent form that gives us permission to perform the operation, without even looking at what’s written on the paper.

“I trust you,” he says simply. “After all, according to
U.S. News and World Report,
you guys are one of the best.”

Once the anesthesia resident and I are done running through our routine preoperative checklist, we wheel Mr. Bernard into the operating room. We help him move off the gurney and onto the operating table. During this process, his gown accidentally slips off because of some ill-tied strings, and before the nurses or myself can react, he’s naked from the waist down.

“Whoops. Sorry, everyone.” He laughs nervously. “Not much room for modesty around here, is there?”

“No, Mr. Bernard, I’m afraid there’s not. No problem. Let me help you out there.” I take a blanket out of a steel warmer tucked in a corner of the room. The blanket radiates a pleasant heat that reminds me of fresh laundry taken out of a dryer.

I bring the blanket over to Mr. Bernard, and, as I lay it across his abdomen, I’m startled to glimpse the words “DO NOT REMOVE” written in large, block letters in black ink on the shaft of his penis, running from up to down like a crossword puzzle.

“Uh, Mr. Bernard?” I say. “Don’t take this the wrong way, but is that what I think it is written on your, you know…”

“Yeah.” He chuckles with a sly grin. “It is. I’m glad you noticed it before you put me to sleep. I wanted to see your reaction.”

“Can’t say I’ve seen that one before, Mr. Bernard,” I say, laughing. I relay the joke to the rest of the operating team, who laugh appreciatively.

“Just wanted to make sure you people were all awake this morning.” He chuckles again.

He lifts his head from the pillow and peers keenly at me over the top of the warming blanket as I adjust his feet on the operating table.

“Hey, Dr. Mitchell. What’s your first name, anyway?”

“Um … Steven. Steve.”

“Steve.” He repeats my name as if testing the way it sounds coming out of his mouth. “So, you said you’re a resident?”

“Yes.”

“A resident. And that’s like, what … a doctor in training, right?”

“Yes.”

“Well, Steve, did you get enough sleep last night? I read in
Parade
magazine once that most resident doctors are sleep-deprived and that doctors make more mistakes when they’re sleep-deprived. I hope you got enough sleep last night. I need you firing on all cylinders, you know?”

He seems like a good guy, what with the DO NOT REMOVE penis joke and all; so even though I’ve gotten a full night’s sleep, and am actually feeling pretty energized this morning, I decide, perhaps a little recklessly, to play with his mind a bit.

“Well, Mr. Bernard, it’s not so much that I was up all last night and didn’t get any sleep that’s bothering me. I just wish I hadn’t drunk all that cough syrup this morning.” It’s a line from an old movie.

Mr. Bernard frowns, intently studying my masked face, apparently trying to decide whether I’m serious or not. I immediately regret saying it. What had seemed to me an exceedingly clever joke doesn’t seem so exceedingly clever anymore.

After a moment, Mr. Bernard decides I’m joking … I think. He laughs … sort of. It sounds more like a grunt.

Dr. Andrews walks into the room. “Good morning, Steve. How are you today?”

“I’m good, Bill, thanks,” I say, relieved by the distraction. “We’re ready to go when you are.”

“Great.” He leans over and whispers in my ear, “Which patient is this?”

I turn my head toward him and whisper back, “Mr. Bernard. Young guy. High-grade urothelial carcinoma, likely T3. Metastatic evaluation negative. Completed neoadjuvant chemo. History of hypertension but otherwise healthy. He’s a carpenter.”

He nods and walks up to Mr. Bernard’s head. “Mr. Bernard, how are you today?”

“Hi there, Doc,” Mr. Bernard slurs. The benzodiazepine tranquilizer the anesthesia resident has given him is beginning to drag him under. I take comfort in knowing that he probably won’t remember the cough-syrup remark. Prospective amnesia, it’s called, a common side effect of benzodiazepines.

“Ready to get this done?”

“Get what done?”

“Your surgery. We’re going to remove your bladder this morning.”

“Why?”

“Because you have bladder cancer.”

“Ohh, yeah. Right. Sounds like … good … cough syrup…” His voice trails off into a snore.

“Did he sign the operative consent form?” Andrews asks me, one eyebrow arching above the other over the straight blue line of his surgical mask.

“Of course.”

“Good.” The raised eyebrow drops back in position next to its brother. “I just need to use the little boy’s room. You okay to start?”

“Sure, Bill.”

As the door swings shut behind him, the anesthesia resident says, “I didn’t expect the benzos to put him out like that. Usual antibiotics? You guys like to give one gram of Cefotetan for these cases, right?”

“Yeah. Cefotetan. Usual poison.”

“No problem.”

The anesthesia resident’s attending appears shortly thereafter and, once they’ve put Mr. Bernard all the way under and secured a breathing tube down his throat, I go out to the scrub sink to wash, then return to the room and, with the help of the scrub nurse, put on my sterile gown and gloves. The scrub nurse and I trade small talk about our weekends as the two of us set up the sterile field and place a catheter in Mr. Bernard’s bladder.

“Knife, please,” I say after we’re ready. I hold my right hand out behind me, looking not at her but at Mr. Bernard’s abdomen. She passes me the scalpel with practiced ease. I close my fingers around the metal handle, still warm from the steam sterilizer, savoring the feel of it in my hand, experiencing the anticipatory thrill that always jolts my brain immediately before I cut the skin.