The Patient Unexpected

Joel Bradley, Grand Prize Winner 2009 Gerald F. Berlin Creative Writing Award

Joel Bradley, Grand Prize Winner 2009 Gerald F. Berlin Creative Writing Award

by Joel Bradley, SOM ’12

Grand Prize Winner 2009 Gerald F. Berlin Creative Writing Award

I

He felt himself relax – he had thought he might not be admitted. He heard his breath for a moment beneath the erratic symphony of beeping monitors, which piled up and faded away as he was wheeled past inpatient rooms, hospital beds and treatment areas. The long corridor walls gave him the feeling of falling slowly down a funnel, the walls, floor and ceiling angling into one another in a long symmetrical sweep. It reminded him of the awkward arrogance of early studies in perspective, only the clothes were different, the people etched to scale. He recognized that for others those thinning dimensions constituted a vague, foreign dread – but for him they were a return home, and again he was surprised to feel that way about a place he had never been.

He exchanged pleasantries with the nurse wheeling him past the wards, but was careful not to seem more pleasant than he should, given his condition. The aimless chatter was a welcome cloak for his gaze, which flickered aside to whispered conversations over charts and monitors, human shapes under white sheets and faded pajamas, waiting room magazines, families. He wondered if Jeffrey Murphy, R.N. (plastic badge swinging rhythmically from a blue clip at his waist) could detect how grateful his patient was for another chance to take part in this vast human library: wanting to be there, but with the delicious luxury of not needing to be.

They stopped at a long, high desk, with four oblique rectangles of computer monitors peeking over the top. Jeffrey laid a thin file on the counter and waited. The concert of electronic sounds settled in now, washing over the place. Phones, beepers, radios and the arrhythmic cacophony of beeping, blinking vaudeville monitors played steadily, their variations perceptible only to those who listened because they had to. There was a whole, but no one seemed aware of it – all were simply individual players and sections, warming up in rooms backstage with no conductor.

“Okay, who’d you bring us this time?” the nurse behind the counter said brightly, addressing both of them at once, perm, forehead, brows and eyes breaking the plane of the desk, then re-submerging. Her tone carried the customary theatrical annoyance, a familiar artifact of hospital staff everywhere, like a dusty and ungainly vase that manages to be charming not because it is elegant, but because it is ordinary: expected.

“Robert C. Matthews – for undiagnosed heart palpitations, acute abdominal pain. First visit here. ER. Insurance is Blue Cross – photocopy in the back.”

“Always one step ahead darling” she approved, genuinely grateful to avoid the paperwork. “Room 8 it is, Mr. Matthews. I do sure hope you enjoy your stay with us,” she drawled, smiling sympathetically, standing now, affecting an over-polite hotel receptionist. He noticed how tired she looked.

Matthews smiled the way he knew he should – appreciatively, but with a taut, languorous note of someone made anxious by the continuous surprise of severe pain. As the wheels beneath him groaned away on the tiled synthetic floor, he smiled inwardly.

Jeff flung the curtain of the tidy, dull cubicle wide on its runners and spun the stretcher into place, beside the bed. No: Matthews assured him that he was fine moving there himself, but compromised by accepting a proffered hand as he negotiated the uneven gap.

A moment later Matthews was at last partially alone while Jeffrey strode over to discuss his chart with one of the circulating nurses at a row of computers along the opposite wall. He could hear their murmuring and a few words, but not enough to tell what was being said. He had long ago gotten over being anxious under such circumstances, perhaps because he took refuge in knowing that the actual reasons for his being there didn’t really matter: only the need, which justified it.

Briefly Matthews wondered – as he often did – if it should frighten him how much he wanted to be here, how need had materialized from want: how desperate he had become. But he recognized no fear in the way he felt. For hours, the intoxicating wash of relief that had followed him in the revolving door of the ER had been seducing his doubts, beckoning with the familiar resignation that he was not quite ready to call addiction. He did not think of it as sickness, but as a stumble, a committed hiatus – only it kept getting longer, and with time, less explicable to friends and family. They thought he was on some kind of extended sabbatical. In a sense, he was.

Matthews put the thought aside and felt himself relax. He noticed the way the curtain hung in long, even folds. He drank in the aseptic smell of his stiff pillow, the papery character of the pressed, loosely-tucked sheets. He began to hear the smaller hummings of machine-motors beneath the beeping, heard the footfalls coming at different paces and angles, the hushed voices blending beneath those of actors on a nearby television turned a little too loud.

II

Dr. Jen Magovern was striding through the same wards the same morning with the peculiar levity of someone who had just come to the much-doubted end of years of perceived inadequacy. She was nearing the end of her final year as a resident in Portland, and was already in the process of interviewing in different parts of the Northeast, where she had grown up and wished to return. The third anniversary of a nearly faultless marriage was nearing, and she was almost ready to let herself feel happy without restraint or worry about her capacity to weather the arduous sacrifices of a life in medicine.

Only during these past few months in the hospital had she stopped bracing for the blow of rebukes and corrections from superiors that had been the wind and wrack of her education. She felt comfortable, confident: at last settled into the rhythms of a personality she could sustain without contrivance. She knew the protocols, the procedures, who to ask for what, and when to ask it. She had worked hard to avoid the petty failings that come of long hours and little sleep, and had earned the respect (or tolerance) of the staff. She had been waiting a long time, and it still felt dreamlike, almost too weightless to be believed.

Though just back from a day off, she knew most of the patients already: Jane, Steven, Gail, Alessandra, Solomon – patients who were now people to her beyond the charts that grew thicker with each day, taking on new tree-rings, new scars. It often surprised Magovern how quickly she could feel close to these lives, whose histories she had come to know so recently and at such feverish pace, under the pressure of illness, the fear of pain, the awful opacity of the unknown and unanswerable. It often felt like those minutes were years.

Parting the manila biographies now, she scanned the new lab values and lists of vital signs, which were the latest chapter of physiologies she had grown used to wrapping in their human blanket. “The stories of physiology are also the stories of people,” she recited to herself – something an old mentor had told her many years before.

Meanwhile Magovern wrote quickly in the hieroglyphics of acronyms and abbreviations, adding to the intimate tales she already had the privilege to know: work and home life, a childhood illness, the family history, important allergies, broken bones. She had become acrobatic at multitasking – thinking and doing all at once. Afterward she signed her name with the same sharp, resolute authority: a flourish that at last carried the feeling of solidity. It was in those small assertions that Magovern had found her proof, an evidence that announces itself not by grand motions, but in the smallest of details. Two new admissions today: a person suffering a third-degree electrical burn; another with undiagnosed heart palpitations, presenting with acute abdominal pain. She practiced their names, her rule to cover over the fact that she had never been gifted at remembering them. Magovern tripped over the second on her first pass through, misreading it. “Name: Robert Matthews. Age: 48,” she corrected. She chuckled, recognizing in the address and occupation – “Oregon”; “Journalist” – the idle voyage of sentimentality she had taken.

Of course, it wasn’t exactly an exotic name, and moments ago she had recalled some of his memorable words. Dr. Matthews had been an advisor to her during the arduous initial years of medical school. He was a person of rare poise and reflection in the hectic sphere of medicine, involved in uncountable things, but always capable of prioritizing a conversation in front of the elevators or on the way down one of the long hallways, even when his direction was opposite your own. Matthews was one of the few physicians who paid more attention to people than to his pager, which seemed to spend more time vibrating than in silence.

Magovern smiled openly at the thought: the last months had been so infernally busy that she had scarcely thought of him directly. That is, she hardly made it through a day without recalling his words, which had carried her through the darker episodes of her early disenchantments with medicine. He had been among her interviewers at the gray, indifferent gates of medical school, entering her life at a time when she was being won over by the doubt and pessimism endemic to the application process. She had felt remarkably at ease talking with Matthews – there was something redemptive in his manner, something that made her forget about apologizing for what she couldn’t say, didn’t know, or hadn’t yet done. He helped her unearth insights she hadn’t been aware she possessed, forcing her to abandon the fabricated offerings she had polished again and again, as though they were treasures.

Her last note sent by e-mail several months back had gone unanswered, which was certainly unusual, but not unheard of – his schedule had always been borderline heroic, and more likely than not, sleepless. Speaking of which, her pager was buzzing.

III

Twenty minutes later, she entered, and stopped. They looked at one another in silence, not knowing for how long. He didn’t attempt to deny the unmistakable: something about seeing her made him let immediately go.

“I’m not really sick,” Matthews said.

His words shook as he said them: pale and fragile.

“That doesn’t matter,” Magovern said, after a pause she wanted to be full of many things she couldn’t yet say. “I’m glad you’ve come. Wait.” He heard her say his well-worn words, and nodded as if to release her from the gravity of the room.

She returned moments later and pulled a blue plastic chair in from the wall to sit facing him, close, listening. After he began, she said nothing; his words rolled on, pained but careful, articulate. Matthews spoke of the endless marching burden of the ill, and how the fatigue had seeped into him: the insidious pain of not being able to do enough, wanting to do everything. When a small car crash sent him to the hospital with a mild concussion, everything collapsed – a sudden leave of absence, a marriage that faltered then failed, and shortly afterward, the first feigned hospitalization. There followed a second, a third: a simple task with his knowledge of medications and idiopathic ailments.

Changing only his first name to maintain some stubborn formality of his former self, he had since moved from place to place, inventing rainbows of anguish to hide behind. The hospitals reminded him vividly of what he had left, reanimating the pain and dependence, the fear, the argument for why he had needed to care for the vulnerable, while helping him forget how vulnerable he had become. It was the wonder without the weight, and he had grown to need it.

Too weak to care for others, the unruly beauty of healing was the only thing that remained to him – only it was never quite his, and it left him unmoored, an unquenched specter floating in and unable to return to life. Watching had become his only treatment. Without it, only the work of his past remained, and by now he knew well that memory alone was not enough. He had thought that seeing would restore him, and it had not.

She had materialized at a time when his comfort with convalescence had begun to unsettle him – needling him with a kind of insidious unease that comes when temporary oddities begin to feel warm and usual, threatening permanence.

Magovern threw off a rare, startling flash of what he had been – a spark that cast into momentary relief the jagged map of his long descent into illness. He hadn’t ever come to these corridors seeking treatment: only to lie beside the illnesses that he believed would heal him. Now he found himself marooned, isolated far from that familiar shore by a current that had swept in low and deep, without noise, to leave him stranded. Finally Matthews knew to call that sickness.

After everything had been said, Magovern got up to leave, sensing the fatigue caused by the exquisite labor of confession. Slowly, she removed her white coat and folded it, placing her stethoscope on top and setting it on the table beside his bed. “For when you’re ready” she said, and walked out, leaving the chair in its place by the bedside. It was late already – she had been drawn deeply into his strange tale of tragedy and lost herself. She shuddered, feeling helpless and blank, wondering if she should have said more, done something differently.

It went on like this for days. Each morning she greeted him, gathered her coat and stethoscope and went off on rounds. At the end of each day, she placed her stethoscope carefully on top of the folded white coat that bore her name in blue cursive letters, setting it near his bed. For when you are ready.

Otherwise they said very little, addressing only the particularities of his treatment, a charming charade neither ever admitted taking pleasure in. They both waited.

On the ninth morning, Magovern was paged on her way in: Matthews was gone. The bed in room 8 had been made by the time she arrived, and the nurse confirmed that he had checked himself out that night, denying further treatment, saying only that he was feeling “well enough to get better on his own.” Returning to his room, Magovern stood looking again at where the stethoscope had disappeared from the surface of the folded coat, leaving an impression behind in the bright cloth.