It was 6:48am, and Dr. Wick’s spectacles were aglow with the sterile whiteness of fluorescent lights. Bow tie, beard, and bifocals in tortoiseshell – doing absolutely nothing to subvert the shrink stereotype.
I was tired. A building-wide fire alarm was a rude awakening, and my morning reflection was catastrophic – my eyes laced with grit, stress acne dotting my forehead. Morning caffeination was likewise a rough journey: the communal teabags kidnapped by a roommate, the last Mountain Dew pilfered by another, the Keurig bedridden with some electronic pathology. I was greeted at the front door with unsavory winds. My car was caked with thick blankets of ice. My legs swerved from under me in true slapstick fashion. Goddammit, why did I leave New York? Thankfully, the drive to the hospital was uneventful, and parking was plentiful. Benefits of being the early bird. After six attempts of knotting a paisley necktie using the reflection from a metal sculpture, I was presentable.
Still tired though. And decaffeinated. And completely unaware that I was going to be given real responsibility at 6:48am. Who expects responsibility on the first day of work? Especially in psychiatry, where you need some training before being tasked with a crazy?
“Joanne is a 53-year-old female. That’s all the information I’ll give you – it’s your job to fill in the blanks. You’ve got an hour before rounds start, so be prepared to present a full medical and psychiatric history by then.”
Some classic psychiatric silence, then a furrowed eyebrow tinged with some cocktail of pity, mischief, and compassion.
“Oh, and be careful. She made the last med student cry.”
With that, Dr. Wick knocked three times on the wooden door and threw me into the den.
Joanne looked up. I must have looked as unprepared as I felt – she studied me in the way one gazes at roadkill.
“Oof, you look terrible.” Ouch.
I shoved the internal deer out of the headlights, a skill honed for medical school interviews and first dates. Gay men, like sharks, have a sixth sense for smelling fear, and fear is not sexy.
“Happy Monday, Joanne. I’m here to obtain a medical and psychiatric history from you.”
“Well, it’s not incredibly interesting.”
“I doubt that.”
“That being said, I evidently made the last med student cry.”
“So I’ve been told.”
“Do I look like someone who makes med students cry?”
“Not especially.” An honest answer. She was in standard streetwear: a white t-shirt, denim jacket, khakis, and unremarkable sneakers. Smart, chic, and forgettable. No tears were clawing at my eyes.
“So then why do you look so scared?”
I needed to play my cards right, derail the aggression, built rapport. “This is my default face. I’m terrified at baseline.”
“What are you scared about?”
“Everything, I’m a med student. Anxiety is a prerequisite for the application.”
She was not prepared for such honesty so early in the morning, but she kept her cool. It was a test. “Do tell.”
The clincher. “Well, this morning I was wondering if white supremacists are allowed into heaven, so that’s terrifying.”
Utter, utter bemusement. A pointed pause. No response.
“Well on that note, can we begin?”
Scrutiny and reconsideration. Royal flush or go fish?
“Yeah, yeah. I’m here for my alcohol ‘problem.’ What else do you want to know?”
“Joanne is a fifty-three-year-old female hailing from New York comma New York comma with a past medical history significant for hypercholesterolemia and gallstones period she was visiting her daughter living in Minneapolis comma Minnesota comma when she was found unconscious in her daughter’s home period upon discovery by her daughter comma she was suspected to have consumed open quote dangerous amounts of alcohol close quote as reported by the emergency department comma and was promptly transported to the emergency room in Edina period she promptly underwent gastric suction…”
My mouth spat off more medicalese into the dictation software, my eyes unable to conceal my delight. How many witches did this company hire to create a microphone that acts as a scribe?
She was transported yesterday to the Mayo Clinic here in Rochester, Minnesota, where she continues to be monitored for residual symptoms of withdrawal and awaits placement at a rehabilitation center. Social work has been
canceled consulted for the latter and stated that Joanne will likely find placement within the next 2-3 days.
Then again, the proofreading was grueling.
She denies any previous history of depression, anxiety, hallucinations, or suicidal
ID Asian ideation. She reports that her drinking became excessive when she went through a divorce four years ago in 2014. She sighted cited additional financial stressors and a family history of addiction (both father and mother continue to drink alcohol regularly) as further motivation for her drinking. She used to drink wine regularly but has since transitioned to hard liquor like vodka and rum over the last year. She has been hospitalized once prior to this hospitalization for alcohol abuse, but she can’t he currently does not use services provided by Alcoholics Anonymous or other addiction organizations.
Prior to this hospitalization, she reported having a verbal
alteration alteration Jesus Christ alteration altercation with her daughter, which led her to start drinking in the basement of her daughter’s home. She then open quo “blacked out” and woke up in the hospital. Currently, she reports jitteriness essentials and chills, but is not experiencing severe symptoms of withdrawal.
I rattled off more details of variable relevance – electrolyte levels, family history of breast cancer, negative sexual history (“Men never cease to disappoint.”). My note told a cohesive narrative, one that was sterile and clean and professional. It certainly did not sound like Joanne.
After all, there was no place in the note to record her moments of feminist hellfire, when she was nearly incandescent with political heat. Or how she cherished her beagle almost as much as her daughter. Each of her sentences was delivered with a whipcrack, a genuinely pleasant affect intertwined with the harsh content of her words. She sparred in conversations with nimble jabs that were impossible to grasp fully before she threw another. She painted grand canvases of mythical creatures. She owned a punching bag. She slept naked. She always won.
I had never been more grateful for the drag queens in New York who roasted me in front of hostile homosexuals. Over two years in Hell’s Kitchen, I sharpened my wit against their lipsticked whetstones. I grew a tough skin and a cheeky smile, equipped with fangs that I could comfortably bare for the first time in medical school. Finally, in this hospital filled with vanilla Midwesterners, I was a sparring partner who could keep up.
“Do you ever think about things outside of medicine?”
“Medicine and being criminally gay are my only two defining qualities.”
A sincere chuckle. “Well, do you ever think about how much of paleontology is a lie?”
“What do you have against fossils?”
“Do you realize that this country dumps millions of dollars for scientists who essentially play jigsaw with dinosaur bones? How do you approximate the sinew and muscles without seeing the animal in action?”
“But I feel like that’s the point. You figure out how dinosaurs worked so you can use that information to help today’s society.”
“Yeah, but that guesswork is still a long shot in the first place. Paleontologists literally made up the triceratops and the brontosaurus, and now we’re feeding those lies to our children.” She took a conspiratorial breath, her blazing gaze torching my self-confidence. My pursuit of a counter was futile. She always won. I had to pivot.
“Do you think about aliens?”
“Ooo, we’re going the X-files route, are we?”
I rebutted by whistling the Illuminati motif.
“But yes, I do. An unhealthy amount.”
“If they came down to earth, do they disprove the Bible?” Sometimes, I had to remind myself that I was not the patient.
“What do you mean?” A question without any fluster. Over two days, she had grown comfortable with my rhetoric twists. She did not have to buy time.
“If life forms more advanced than humans visit our planet, does that not throw the entire basis of Christianity out the window? Man would likely not be God’s sole chosen people, would they?”
“Likely not,” she conceded. But there was a lilt at the end – she was calculating the perfect response. “But what if those aliens are actually the beasts in that crazy section of Revelation?”
“I feel like that part of the Bible was written in a drug dream.”
“Hey, Scripture is Scripture.”
We could not keep the charade of solemnity any longer, verbally pirouetting around each other with no desire for the other to fall. Our laughter escaped us and saturated the room, embracing us tightly with its volume before draining beneath the doorframe. In the ensuing quiet, our conversation deescalated from a heated boil to a comfortable simmer.
“I’m not gonna lie, I can’t wait to get out of here.”
“Hey, I’m not that bad of company, am I?”
“Oh honey, you’re the best part of this entire damned hospital.”
“I’m flattered.” I was. And surprised – she really said that.
“Joanne is our 53-year-old female with a negative past medical history who is hospitalized here for her alcohol addiction. This morning, her insurance was accepted by the Banyan Treatment Center in Wilmington, Massachusetts, for a voluntary two-week rehabilitation. Having been accepted to the Center, she is now preparing for discharge this afternoon. Her daughter will pick her up around 3pm, and a flight to Massachusetts has been booked. Over the past week, she showed minimal symptoms of withdrawal, and she has attended multiple AA meetings and patient education sessions. Last night, she reported ‘absolute confidence’ in her ability to stop drinking permanently.” I glanced at her face, and she nodded in the affirmative.
Dr. Wick’s eyebrows danced amusedly. “Absolute confidence?”
“The most absolute,” she interjected. A proud nod. She was ready to go.
Absolute confidence. Of course. She was a businesswoman armed with an MBA and an Etsy. She was a badass art consultant with an embarrassing ex-husband. Not only could he not satisfy her sexually, but he also tried the same unsatisfactory maneuvers with other women. Joanne’s divorce was one of the quickest cases her lawyer had ever seen. She moved to a studio apartment where she lived alone, independent of domestic nonsense.
When her business started to struggle, she began pouring herself a glass of chilled chardonnay before bed to take the edge off. This became a ritual: just the one glass at first, savored after kicking off her business flats and resting her feet on an art deco ottoman. Soon it was two glasses. Then a bottle. Then back down to one glass because that was when she stopped counting. When her wine nights became too frequent and expensive, she switched to hard liquor. When people saw the bottles in her recycling bin, she lied. Weekly cocktail parties. A mixology course. Book clubs.
Shortly after that, she corkscrewed out of control. She began sipping her liquor neat – ice became a cumbersome luxury. Her body ballooned outwards, so she ate fewer meals. She lost her balance multiple times, tearing the ottoman, a canvas, and the wallpaper she never liked in the first place. She tried every trendy hangover cure before settling on the unsettling mixture of coffee and Monster Energy. Joanne concealed her drinking well until one day when her daughter heard a thud in the basement. She raced downstairs to find her mother fourteen shots in, unconscious, and nearly apneic. The semblance of life she crafted had cracked. She was found out. Ashamed.
But Joanne was not the type of woman who let life assault her. She spent hours making calls to find the right sponsor for her. After hanging up on five women, Joanne found her perfect sage. She pored over textbooks discussing the neuroscience of addiction. She painted her addiction on a canvas, a beautiful anemone tinged with purple hues. She paid her dues.
She was going to get better.
After submitting Joanne’s discharge orders, I helped pack her toiletries and she said goodbye to the ward for the last time. The rest was a blur.
When we got into the elevator: “Oh honey, such a shame you’re in medicine.”
As the doors closed: “Doctors can’t be trusted. They have too much power.”
Three flights down: “You’ll see when you become one.”
The doors opened, revealing her family on the other side. “You’ll probably be just like them,” she said. She walked away with a victorious swagger, leaving me alone with Otis’ somber jazz. She always won, but it somehow felt like everyone lost.
Dr. Wick was stirring a Victorian teacup with a teaspoon. The weekly feedback session. Critiques sandwiched between praises. This week, however, Dr. Wick had only positive things to say: excellent patient rapport, accurate diagnoses, splendid ability to keep the differential appropriately broad and narrow, snazzy tie. The positivity began to drone on and on. I smiled and nodded, attempting to conceal how empty I felt. Though the feedback was the most insightful I had ever received, my patience was frayed. His cadence shifted towards goodbye, as did mine. I was ready to go home. I needed to get out of there.
Instead of a farewell, Dr. Wick said, “I noticed you’ve been oddly distant from both the patients and staff this week. Is something wrong?”
A week had elapsed, a week since Joanne lifted her petite daughter in a tight vice, her dog cartwheeling on the pavement with excitement. Her laugh rippled through the air, her smile uneven with relief. They hurriedly rushed into the car with fresh discharge papers nearly flying away. She looked back one last time and sent me the wink of a confidant before family whisked her away to the MSP airport.
One week later, she still held my thoughts captive. She was unquestionably my favorite patient, so why was she the one who did not get better? What had I done wrong? How could I make sure that other patients did not feel the same way? The futility of medicine washed over me as I described my distress to Dr. Wick, vacillating in intensity from sorrowful soliloquy to hoarse harangue.
Throughout the monologue, Dr. Wick folded and unfolded his hands as if they were an origami swan. He sipped his tea with unspoken eloquence. After my final words sliced the air, he let the silence sit.
“It’s not our job to make miracles happen.”
With that pithiness, he shrugged her off like an unfastened cloak, clearing out the headspace soon to be occupied by a Michael or Judy or Sam.
“Well then, what is our job?” I asked, in a tone slightly more steely than I had intended.
A teaching moment. I braced myself for the medical aphorisms, leaving her behind as a blip in the conversation. Medicine is not necessarily about healing, but rather, equipping patients with tools. Physicians owe service and compassion, not investment, outside of the clinic. Patient opinions do not reflect your care. Compartmentalization. Compassion. Closeness. Coldness.
Instead, he caught the cloak, and with the wisdom that only simplicity can bring:
“It is not your job to be her friend.”
Four years later, I was nestled in my favorite gayborhood again, but this time as a resident. Wiser? Probably. Smarter? Ummm. More tired? Jesus fucking Christ.
A global pandemic kept the hospital beyond capacity and my time outside of it stale. Patients were on edge. They complained about their roommates, their nurses, how loud the fire alarm was, how I pressed on their stomach too hard, how I didn’t press for long enough. For some, new symptoms miraculously manifested on planned discharge dates. Others simply walked out of the hospital when we weren’t looking, disconnecting themselves from the sole interventions that kept their lungs open.
It was 11am on a brisk Tuesday when I decided I needed ice cream. The 28-hour shift I just finished was brutal. Seven new patients, two of whom were in so much pain that they couldn’t speak. I was running on fumes. Two hours of sleep and a bag of hot Cheetos were my only sustenance overnight, and my body was furious with my decision to be a doctor.
But no one died overnight, and that warranted a damn celebration. So, still dressed in my scrubs of questionable cleanliness, I waltzed into my favorite bodega with the town’s best ice cream sandwiches. I deserved to treat myself. As I headed towards the freezer in the back, I heard a familiar whipcrack.
“You know, I read about broccoli rabe recently – they’re cruciferous.”
I rounded the corner searching for its source. New York was such a big city. It couldn’t be…
I saw her next to the dry pasta. Joanne had just grabbed the last ice cream sandwich. She hadn’t noticed me, so I doubled back just far enough to be out of her sight. I recalled the seventeen progress notes I wrote about her, each one describing a woman who developed more insight with each passing day. As I peeked around the corner, my brain unintentionally started to write the mental status exam of the woman I was seeing.
Appearance: Woman dressed in a bright red cardigan and fitted jeans, appears to be in her late 40s/early 50s. Frizzy hair underneath a winter hat. Wearing mask appropriately over nose and mouth.
Behavior: Calm, cooperative, noted to be chatting on the phone
Speech: Fast rate, appropriate in volume. Loud laughter.
Mood/Affect: Bright, cheery
Memory: Discussing her grocery list over the phone without need for list
Attention: Able to attend to conversation and pick out groceries appropriately
Insight: Unable to fully assess
Judgment: Unable to fully assess
I continued to eavesdrop, feigning intense focus on the sodium content of soy sauce.
“Oh, I’m finally buying that sausage today. I called Harry, and you were right! He designed the logo. It was inspired by that nudist he was hooking up with.”
“Acrylic has been so expensive recently – I blame it on the Sudanese.”
“Carrot stew? Absolutely disgusting. She needs to be stopped. I will sneak into her house and destroy the carrots, or I’ll just burn the house down.”
“Cow’s milk? I am a bovine queen.”
“Lisa, stop saying I should try Trader Joe’s pasta. Why are you obsessed with Trader Joe’s?”
Only she could take a mundane grocery list and imbue it with such vitality. She took a packet of penne, surveyed it quietly, and then put it back. “Lisa, I don’t trust your taste in pasta. You use that green-top parmesan cheese. A disgrace. I’m not even Italian.”
Her basket looked heavy, but she held it easily in one hand. Broccoli rabe, sausage, some jars of spices, coconut milk, corn, strawberries, Cheeto Puffs, an ice cream sandwich. Below them all sat three bottles of chardonnay, clinking against one another whenever she pivoted. After paying the cashier, she turned the corner with a flourish out of my sight. She never noticed the sad resident staring at the Kikkoman bottles for far too long.
There was nothing to buy, so I headed towards the exit. I glanced back once to survey the store and see if I could catch her one last time. No sign of her. The fluorescent lights felt hot, in spite of the fresh blanket of snow outside. I nodded to the cashier and walked out.
God damn it, Joanne. You made your last med student cry.