| "Some people are going to tell you that a surgical career requires people who only have one-track minds," Dr. Benton says. "I'm here to tell you that it requires people of great sensitivity and a wide variety of strengths... only one of which is a one-track mind."
People around me laugh nervously. I'm sitting in the auditorium at the student union, surrounded by a couple dozen mostly first-years and a couple undergraduates, for Dr. Benton's surgical careers presentation. He's given this speech for a few years now, and when I went to it my first year of med school, that's how I became more sure than ever that this was the right choice for me. Also I remember how impressed I was when Dr. Benton remembered who I was right away when I went up to him after the lecture. I think that's when I decided to apply to the U of Chicago and not to some place I could have gotten in easier -- even though I really wanted to leave the area.
"Some of you have your minds made up, some don't. At this point I don't think I need to tell you that the more honest you are with yourself about your future direction, the better off you'll be," Dr. Benton continues. "The decisions never stop. Prepare yourself now. If you're a first-year, you need to decide now which concentrations you want to take for your second year. By this time of the school year when you're third-year, you'll have to think about meeting the application deadline for your sub-internship."
I don't belong here -- this talk isn't really aimed at third-years. So I'm sitting in the back, in the shadows. I don't know why I'm here really. Lately I've been thinking about that surgical sub-internship. I know Dr. Benton wants me to go for it, and I should. But then there's the internal medicine sub-i, and the pediatric. And the trauma sub-i...
"I see there's quite a few African American and Latino students in the audience," Dr. Benton goes on. "I want to start off by saying that all of you, in your own way, have had a challenge getting this far. You might have had financial challenges, or maybe not. Whatever your personal challenge, being a young person of color in med school takes a lot of mental energy from day to day, and sometimes you don't even realize how much. But that can make it harder for you to make decisions you need to make now, or to go that extra mile and maybe consider a surgical career."
Now the students sit up and look interested. None of the professors tells it like Dr. Benton does. He tells it like it is, doesn't sugar-coat it, and he says it in a way that makes even the white kids listen.
"How many people of color do you anticipate entering the surgical program here next year?" challenges a girl in the audience -- Peace Williamson; she's in my nephrology class. I'm watching her, mainly because she's very good looking, and then suddenly I realize that Dr. Benton has seen me. He looks surprised.
"We won't have exact numbers until the spring semester, but last year we had twelve new African American surgical interns starting their residencies, and I believe a slightly less number of Latinos," he answers her. "But we expect there's going to be a five to ten percent increase from last year."
He's looking right at me.
After the lecture, only a couple people stop up to talk. I go down too, and pretty soon it's just me and Dr. Benton. He guesses right away that I'm having trouble picking between sub-i's, and that that's why I came.
"You're only third-year. That's normal," Dr. Benton reassures me. "But you didn't have to come sit through this whole lecture -- you can always stop in upstairs if you need to talk about it."
"I think it's a pretty good lecture," I shrug. "I even saw a couple high school kids in the back."
"Yeah, we do afternoon programs for the kids from the charter schools," Dr. Benton says, "but the kids from the city find out about this somehow and just show up at night." He shakes his head. "To be honest," he sighs, "while I love to see them show up, most of them are just here because they're dreaming. Maybe one in fifty ever comes back. They're not doing school, and they haven't laid any groundwork, and... well, you don't like to have to tell them that it's probably too late for what they have in mind."
"But they could work hard and make it up," I say.
"Some can. Some," Dr. Benton says. "But in the end, all you can hope to do is reach the kids who aren't already in trouble, with more stable backgrounds who are committed already to hard work. Trouble is, they're all getting taken by the good engineering schools these days. And then, of course, when they do get into med school, it's hard to get them into an operating room."
Dr. Benton gets passionate talking about recruiting smart black kids for surgical careers. I know he didn't need to be lectured -- he always wanted to operate on people. He also doesn't believe in affirmative action -- he's told me before. He tells me again about how supportive his family was and how they managed to get him through school without breaking themselves. He had such a great family, I say.
"I was lucky," he says, "and so were you. City Tech is a great school and it's still got a fine college prep program, and it's even improved since I graduated." He knows I went to City Tech -- but only for one year, which he doesn't know. I went there after Momma and I moved. It's just never come up, that's all. I change the subject. "That was a tough question there about the numbers," I say.
"Numbers aren't everything." Dr. Benton picks up his briefcase and then gives me a friendly look. "So hey -- what's your question?"
Sometimes I think Dr. Benton can look right through me. "Well," I say, "it's... kind of a weird question."
"Shoot."
I speak carefully. "Well, I was wondering... in your experience... who do you think saves more lives -- the surgeon, or the trauma physician?"
Dr. Benton seems taken by surprise. "Another numbers question," he says. Finally, he answers, "I really don't know. Never thought it was important to think about. Everyone works together, or is supposed to. No one gets all the glory, if that's what you're asking."
"No, I --" It's not coming out right. "I mean... who's more responsible if they make a mistake? On a patient?" I don't know how to word this. "Who makes the most difference?"
Dr. Benton considers, and then just shakes his head. "I don't have an answer for that one." He sort of cocks his head a little, like he's just figured out where this is all coming from. "Hey man," he asks, "how is that ER rotation going?"
"Fine," I tell him. I want to tell him that I think I've got things ironed out between me and Dr. Carter. Ever since I spoke up like that, things seem more normal. Dr. Carter personally gives me a work schedule every week now, and I'm never just stuck doing sutures any more. I think I handled it pretty good, taking charge like I did. Dr. Benton would approve, if I told him. But now I feel like I shouldn't mention anything more about it. It's late, and we've already talked too long.
Later, I'm in the nearly empty library, searching Medline aimlessly. I came to Dr. Benton's talk looking for answers I didn't get. I ought to be at home studying, but I don't feel like going home. I'm about to leave when I remember there was something else I wanted to find. I log in to the Trib archive on the Internet, just out of curiosity. I can't remember the name of the guy who fell in front of the El, so I try a bunch of different search terms -- "intern," "student," "killed," "died," "County General Hospital" and all that. Finally, I get a hit. Two, actually.
* * * "What have you found for us, Haleh?" Dr. Carter says, joining me and the other students and residents at the admit desk, and sounding way too energetic, like he's just drunk a whole pot of coffee. He's just started his shift, but I've been on since 7:00. He peers at the board.
"I've got a 70-year-old lady brought in from her nursing home with a rectal prolapse," Haleh offers sweetly. "No thanks," Dr. Carter says, grimacing. "Mohamed, you take that one. I'll take the lower back pain." No wonder Dr. Carter's so happy -- he's the attending and he never has to take any of the more distressing cases. This makes me happy too, because that means I won't have to treat them. I'm doing tag-team rounds with Dr. Carter these days more often than not. Sure enough, he motions for me to come along with him, and we go into Exam 3, where a white male in his mid-twenties is waiting on one of the beds. Dr. Carter examines his chart and asks him what's wrong.
"I just got done telling the nurse," the patient whimpers. "My back is killing me. I think it's my kidney -- it's a kidney stone."
Dr. Carter hands me the chart to hold, and I look at it while he hoists the patient into a sitting position and does an exam. "Watch me, William," he says. He demonstrates palpitation and percussion. The patient screams. "Sorry about that," Dr. Carter says. Haleh comes in. "Urine's negative, no blood or crystals," she reports. She casts a critical eye on the wailing patient. I look at the chart to see if I missed anything. Pulse 90, BP 120 over 70, respiration 20. "Dr. Carter?" I don't want to talk in front of the patient. Dr. Carter comes out into the hall with me, and I ask him if someone in that much pain shouldn't have a higher BP. "That's a good question," he says quietly in a singsong voice, raising his eyebrows and scanning the chart. When Haleh comes out, he orders a spiral CT. "Radiology's backed up. Want me to check the turkey file?" she asks.
"Go ahead, but send him up anyway." "Is he faking?" I whisper. Haleh snorts. "Honey, if you ain't on all fours on the bed, you don't have a stone, and you don't get the Vicodin." "Haleh," Dr. Carter admonishes her, writing the order. "Thirty IM of Toradol."
"Carter!" It's Abby, one of the nurses, shouting from down the hall. "We've got an impalement coming in. Right now."
"Wow, you don't see one of those every day," Dr. Carter says cheerfully. He zips across the hall to Trauma 2 and I follow him in as the paramedics bring in a bloody bundle. Unconscious, I hope -- it's a man with half a golf club sticking out of his collarbone. "Bad shot on the eighteenth fairway," Doris the paramedic explains, "got mad, slammed the club against a tree, it broke, and then he tripped and fell on it. Good luck!" She snatches her backboard and escapes.
"Oh God," Dr. Carter groans, no longer cheerful after he gets a good look. "No wonder they couldn't intubate him in the field. We might have to take this out down here."
Then the man wakes up and starts thrashing around and screaming his head off. "Push some Versed," Dr. Carter calls out calmly. I help Abby keep the man still, but then Dr. Carter swears a blue streak. The golf club has fallen out of the guy's neck, just like that, and blood is now spurting everywhere -- all over us, all over the floor. Dr. Carter calls for a clamp. "William, go get Malik. We're going to need some more help in here."
I back out and turn to go, but I run into someone. It's the kidney stone guy, standing there half dressed. He's not supposed to be in here. "My back is killing me," he moans desperately. "I need something for the pain. Nobody gave me anything that works."
I try to tell him that he'll have to wait outside, but he isn't listening to me. "I said I need something!" he screams in my face. Then he grabs my wrist, hard. I manage to break free, but he follows me. I catch just the slightest glimpse of something short and silver in his hand. Then there's a gasp -- Abby, the nurse -- and he piles into me, shoving me against the table with the intubation kit on it. Suddenly someone grabs me from behind with strong arms and quickly shoves me to the floor. It's Dr. Carter. He's now standing between me and the kidney stone patient, who's sweating and confused and looks about to throw up. Dr. Carter's arm is outstretched, his hand reaching out, shaking. But right when I think we're both going to die, Malik and three security guys show up, and they grab the guy. The silver thing falls out of his hand onto the floor. He doesn't resist.
"Abby, you got the clamp?" Dr. Carter asks, looking back at the patient on the table. "William, you okay? You all right, William?"
Malik picks up the silver thing. "Oh man," he laughs. "Look at this. It's a church key, man!" He waves it in front of Kidney Guy's nose derisively. "Yeah, you a real badass. Come back when you're serious, dude. Heh heh."
I just sit there on the floor, dazed, watching as Malik, Abby and Dr. Carter resume working on the golfer while Security hauls the other patient away. My lab coat's covered with the blood that was on the floor. So is Dr. Carter's. By the time I get up on my wobbly legs, they've got him stabilized, and Abby and Malik are taking him up the OR. It's just me and Dr. Carter and a lot of blood. He lets out a big, unsteady sigh. "You okay?" he asks me again. "I think I just got the wind knocked out of me," I tell him. "Are you okay?" "Yeah, I think so." He looks down at his bloodstained lab coat. "But I think we need to take a short break."
We stagger down the hall to the men's room, and on the way Dr. Carter picks up a stack of scrubs from a supply cart. Man, I always wondered why there seemed to be such an endless supply of those things around. Now I think I'm getting an idea. In the men's room, I take off my bloody coat and realize it's ruined. There's also blood on my cheek somehow, so I go to wash it off. Dr. Carter takes his coat off too, but he just stands there at the sink for a second, then slumps down to lean on it, covering his eyes with his hand. "Oh," he finally sighs, sounding exhausted. I see his shirt is also sprayed with blood from the gusher artery. He unbuttons the shirt and throws it into the trash. When he stops to unfolds one of the scrub tops, I can see he's got a couple of big scars on his back. They look like fight scars, but I'm sure they're not. He doesn't seem self-conscious at all, or even aware that I'm looking, but I don't want to stare. I look down quickly.
"Are you all right?" Dr. Carter asks me again as he pulls on the scrub top. "That guy knocked you down pretty hard."
"Actually, I think you did that," I say. "Thanks."
Dr. Carter shrugs, and smiles. He tells me that sometimes you do caught up get violent incidents working in a city ER. "I was hoping that was one ER experience you weren't going to get while you were here."
"Do I get extra credit for fighting drug-seeking bad guys?" I ask him.
He laughs. "No, I'm afraid not."
It hits me that, in the space of five minutes, I went from trying to save some poor guy's life, to getting nearly killed by a crazy junkie, to having the first decent talk with Dr. Carter that I think I've had. My head is spinning. "William," Dr. Carter says suddenly, "there's something wrong with you."
What does he mean by that? Then I follow his look and see there's a smudge of blood on my shirt front. "Oh," I say. Dr. Carter produces a second scrub top from the stack he brought with him, and tosses it to me. "Actually, that's okay," I tell him, putting it down. "I'd rather not."
"You don't want to change?" He sounds surprised. "You know, med students are allowed to wear scrubs. I won't mark you down for it."
I chuckle, a little too hard. "No, that's all right, Dr. Carter, it's not even really a big spot. I think if I get a new lab coat, though, it ought to cover that right up, for now." I see that Dr. Carter isn't quite with me, so I tell him that I think it's important to look good. "You know, in front of the patients," I add quickly. "So professional," Dr. Carter comments.
I start to feel self-conscious, but his tone is not mocking or joking. "Benton must love you," he says.
He looks sad. I shrug as best I can and keep my eyes down on the sink as I finish up washing my hands. When I look up, Dr. Carter seems like he's a million miles away. Then he just says we'd better get going. But he waits for me as we're going out, and he gives me an awkward little pat on the arm before we go back to work. NEXT: THE CONCLUSION |
