Read an Excerpt
Chapter One
I just want to help people, I just want to help people, I just want to
help people. . . .
I crouch on the floor in an Emergency Department supply closet, wedged
in between boxes of adult diapers and pregnancy tests. The door swings
open, and a nurse pokes her head in.
“Are there any linens left in here?” she asks.
“I’m not sure.” I stare into my lap, letting my hair fall across my face
like a curtain. Hopefully she doesn’t notice my puffy eyes.
“Are you the intern that just stuck herself?”
“Yes.” I discreetly wipe my nose with the back of my hand. I try to
sound less panicked than I feel. “Yup, that was me. I just took the
needle out of the patient and accidentally stuck myself in the hand with
it. Like an idiot.” I attempt to laugh ironically, but it comes out
sounding more like a desperate whimper.
“Well, when you’re done doing whatever it is you’re doing, you need to
report to Employee Health. They’ll test you and give you medication.”
She peers down at me through her tiny bifocals. Her voice sympathetic,
she asks, “Have you ever had a needle stick before?”
My chest is so tight I can barely get the word out. “No.”
“Well, I’ve had four in my career, and it’s not that big a deal.”
“Really?” I’m buoyed by a surge of hope. “Did you—”
“Make sure to get yourself together before coming back out here. It’s
unprofessional to cry in front of the patients.” She closes the door
abruptly.
The motion-sensor light goes off, and I am left in near–pitch darkness.
I just want to help peo— Oh fuck everyone!
I spend probably fifteen minutes sitting in the dark supply closet, too
exhausted and depleted to move. I’ve been awake for over twenty-four
hours. During that time, I’ve peed twice, eaten once, and asked myself,
How did it come to this? eighteen times. I thought I’d be good at this.
Why am I not good at this? I reach into the pocket of my white coat for
my inhaler, and the lights flick back on. From the corner of my eye, I
see something tiny and brown scurry across the floor and dive behind a
box of gauze pads. I spring to my feet, and my head strikes the shelf
above me. Pain sears through the back of my skull. I yelp, and as my
hand flies up to my scalp to check for bleeding, I knock over a box,
causing a million little Band-Aids to come fluttering down all around
me like ticker tape, as if to say, Congratulations! You’re a
twenty-six-year-old loser hiding in a closet.
It wasn’t supposed to be like this. I graduated at the top of my
class—Alpha Omega Alpha honor society, in fact—from medical school. I
beat out hundreds of other applicants for a coveted internal medicine
residency spot at Philadelphia General Hospital. The Philadelphia
General, my first choice. I could have easily gone to the Cleveland
Clinic or Mass General or Mayo, but I chose to go where I knew the
training was rigorous and unmatched because I was certain, beyond a
doubt, that I could handle it, probably with one arm tied behind my back.
I can recite the name of every bone, muscle, and nerve in the adult
human body the way other people can recite song lyrics (and, just for
reference, there are 206 bones in the human body). I can diagram, from
memory, the biochemical pathway by which the liver converts squalene
into cholesterol. I can list the top twenty medications for hypertension
and the side effects of each, without using a mnemonic device. I’ve
studied. My God, have I studied. I’ve studied to the point of
self-imposed social isolation. To the point of obsession. I’ve prepared
for this for years, decades, my whole life. I wrote an essay in third
grade titled “Why Tendons Are Awesome!” that not only earned me an A,
but was prominently displayed for months on the classroom bulletin
board. I mean, I was meant for this.
I’ve been an intern for twenty-four hours, and that arm that’s tied
behind my back? I’m ready to rip it off this instant.
Sighing, I crouch down, pick up all the Band-Aids, and cram them back
into their box. Then I emerge from the closet sheepishly, expecting to
find at least one of the several ED nurses waiting for me, ready to
comfort me in that stern-but-understanding, maternal way of theirs.
The only person at the nurses’ station is a disinterested janitor on his
cell phone.
A balding man wearing large, square wire-rimmed glasses and an angry
expression barks at me from the hallway. “Excuse me! Miss, do you work
here?”
I nod, and he approaches. “My wife is still waiting for a bed.” He
indicates a woman in a hospital gown lying on a stretcher that’s been
pushed to one side of the bustling ED hallway. “When is she going to be
moved to her room?”
“I’m not sure . . . ,” I say, uncertain if I can help him but
desperately wanting to do something, anything, right. “Has she been
admitted?”
“Obviously, yes. She’s being admitted for observation for pneumonia. Her
name is Tally. Lenore Tally. Do you have any information on her?”
The name means nothing to me. “I’m sorry, she’s not one of my patients,
but I can try to find her nurse for you,” I offer. The few nurses in
sight look busy, drawing blood and taking vital signs. “It might take a
few minutes, but—”
The man throws up his hands in frustration. “None of you people have any
answers! Oh, for God’s sake, I’ll find her nurse myself!” He storms off,
and I can hear his voice echoing down the hall: “Excuse me? Do you work
here?”
My shoulders sag. So much for doing something right. At this point, it’s
clear: the gaping black hole of despair that has consumed my being can
be filled by only one thing. I need baked goods, and I need them stat. I
hurry to the vending machine in the ED waiting room, eat two and a half
bags of mini chocolate chip cookies while waiting for the elevator, and
find, to my great disappointment, that my mood is only marginally
brightened.
It had never occurred to me—until the moment I drew the needle out of
my patient’s vein, popped off the test tube full of his blood, crossed
my hands to reach for the gauze pad, and jabbed the end of the needle
into the back of my hand—that I might be putting myself at risk by
spending my days and nights tending to sick people. Well, then again,
that’s not true. It had occurred to me, but before it became an actual
possibility, the idea of contracting a potentially lethal disease from a
patient had a noble, romantic, Victorian sort of feel to it: the
selfless, waistcoated doctor carrying a leather satchel and a jar full
of leeches, sacrificing herself at the bedside of her patient—that sort
of thing.
I know the chances of actually getting sick are extremely slim,
especially if I take prophylactic antiviral medication, but I worry
nonetheless. I worry with a fervor that I both recognize as irrational
and embrace as inevitable. Worry out of proportion with reality is kind
of my thing.
“Is this your first needle stick?” The nurse at the tiny Employee Health
office next to the hospital pharmacy—her name tag identifies her as
“Rhonda”—looks irked and preoccupied. When I walked in a moment ago,
she was engaged in a heated phone conversation with someone named Hank
about getting his lazy ass off the couch and maybe, for once in his
worthless life, cleaning up the cat’s vomit. It was quite a few minutes
of this sort of thing before she turned around and realized I was
sitting right in front of her desk, awkwardly trying to decide whether
to wait for her to notice me or just interrupt her. When she hung up the
phone, it was with one eye fixed suspiciously on me. “Can I help you?”
I told her what had happened and, in doing so, triggered another bout of
panicky tears. Rhonda kindly, if impatiently, handed me a box of
Kleenex. Then she proceeded to fish out from a filing cabinet no less
than eight different questionnaires, each of which she now seems
determined to methodically complete in its entirety.
“No. This is my first needle stick,” I answer, twisting the damp Kleenex
around my fingers.
“Do you have any risk factors for HIV or hepatitis C?” Rhonda asks.
“No.”
“Have you ever been tested for either?”
“No.”
“Are you currently sexually active?”
“Nope.”
“When was the last time you were sexually active without barrier
'protect'on?”
“Um . . . never.”
“As in you’ve never had u'protect'd intercourse?”
“As in . . . I’ve never had intercourse.”
Rhonda pauses, her pen hovering above the paper.
“It’s cultural,” I add quickly. “I’m Indian. Premarital sex is frowned
upon. Like, a lot. You’ve seen Bend It Like Beckham, right?”
“That’s . . . fine,” Rhonda says, scratching one raised eyebrow.
I sigh inwardly. Whatever, Rhonda.
She asks me for my medical history (None, except a mild case of asthma),
list of allergies (None, except cats), and social history (Do I smoke?
No. Drink? No. Do I use illicit drugs? Obviously not.). Then she asks me
to put my arm on her desk, ties a tourniquet around my biceps, and draws
four vials of blood.
As she tapes a wad of gauze over my skin, she says, “You’ll need to come
in for another blood test in six weeks and again in three months.” She
hands me a slip of paper. “And this is for the antiviral tablets. Pick
them up at the pharmacy next door. You’ll take them three times a day
for the next six weeks.”
I look at the prescription. “Lamivudine? A nucleoside reverse
transcriptase inhibitor?” I say, aghast.
Rhonda stares at me. “That’s the protocol.”
“But the potential side effects of this are nausea, diarrhea, abdominal
pain, headaches, pancreatitis, and liver failure.”
She regards me skeptically. “If you say so.”
“Isn’t there anything else I could take instead?” I plead. “I’m an
intern. I can’t afford to have headaches and go into liver failure. I
have patients to round on. I have a lot to do.”
“That’s the protocol.” She enunciates each word in a way that indicates
that she has fulfilled the duties laid out in her job description and,
therefore, our interaction must come to an immediate close.
I turn toward the door. “You don’t think didanosine or even efavirenz
would be a better—”
Rhonda puts her phone to her ear. “Have a nice day, Doctor!”
I’m sitting at one of a cluster of long tables near a picture window. A
curt little sign in a metal stand nearby reads: Reserved for PGH Doctors
and Staff. It’s early, a half-moon still visible in the dawn sky, and
the only other patron in the cafeteria dining room is an elderly man
connected to an oxygen tank that he carries in a cloth duffel bag. He
shuffles in my direction, notices the sign, then shuffles away. A
plastic tray appears across the table from me, and a slender young man
with round glasses says, “Hi. Stuart Ness, Harvard Med.” He begins to
vigorously dissect a grapefruit.
“Yes, I remember. We met at orientation.” Where you introduced yourself
as Stuart Ness from Harvard Med. Twice.
“Being on call is great!” he enthuses without prompting. “I admitted
eleven patients, started fourteen IV lines, and still had time to watch
a movie. I’m not even tired. I think I’ll go for a run when our shift is
over.”
I wonder if it’s possible that I’m so fatigued I’m hallucinating this
entire interaction with this gratingly peppy Harry Potter look-alike.
“That’s dynamite,” I say.
“I’m so psyched to finally be here. I can’t wait to meet Dr. Portnoy.
The man, the legend, am I right?”
“Yup.”
“And the Dr. V. Did you hear that we get to work with him? Like,
actually round with him and everything?” His eyes gleam. “So awesome!”
“It’s pretty awesome.” I manage a thin smile.
“What was your name again?”
“Norah Kapadia.”
“Hey, any relation to Dr. Kapadia, the head of Pediatrics at UPenn? The
one that came up with the Kapadia criteria for Kawasaki disease? I mean,
I don’t know how common a last name of Kapadia is, but—”
I blow a puff of air through my pursed lips. I’ve lost track of how many
times I’ve answered this question over the years, but it always comes
from someone eager to show off that they’re well-versed in rare
pediatric disorders. “That’s my father.”
