Cody bought Ann lunch in the cafeteria, since they missed the free food in the noon conference. As Ann waited on the long line to get her food, she could still hear Dr. Dergan’s words echoing in her head: You have a lot of learning to do.
“He probably thinks I’m the dumbest medical student ever,” Ann said. “He probably thinks it’s hilarious that I want to be a surgeon.”
“You’re being way too hard on yourself,” Cody insisted. “It was only your first day…”
Ann shook her head. She looked down at the pasta salad on her plate, but she didn’t feel hungry. She just wanted to go home, crawl under the covers, and never come out.
“I would take any advice he has about becoming a surgeon seriously,” Cody added. “He used to be a surgeon, you know.”
Even though he was in a wheelchair, somehow Ann could imagine Joel standing over a draped body, holding a scalpel in his hand. He seemed like that type. “I heard about that,” she said. “Why did he quit?”
Cody checked around to see if anyone important was in the vicinity. She leaned forward. “This is all rumor, of course. But what I heard is that he got into a bad car accident and he wasn’t able to operate anymore afterwards.”
“Why not? There are surgeons who are disabled, aren’t there?”
“Didn’t you notice when he was examining Mr. Jameson?” Cody said. “He’s a quadriplegic… he can’t move his fingers. You can’t be a surgeon if you can’t move your fingers.”
Ann had noticed that he was holding the stethoscope in his palm rather than between his fingers, but it hadn’t stood out in her mind. “He hides it really well.”
Cody nodded. “He can still do a lot, even without his fingers. I’ve seen him put in central lines before, faster than most of the residents. Of course, that’s like bread and butter in surgery. I’ve heard he was an amazing surgeon.”
Ann tried to imagine what that must have been like for him, to go through all those years of training, just to have it ruined in a split second by a car accident.
“Dr. Dergan doesn’t think much of medicine,” Cody went on. “Half the time, you can tell he doesn’t want to be here. I guess he’d rather be in the OR.”
“I don’t blame him…”
“But he is a great teacher,” Cody said. “And he’s incredibly brilliant, maybe the smartest attending in the hospital.” She smiled. “He’s sort of cute too, don’t you think so?”
Ann blushed. “Well, I guess…”
Cody laughed. “Sorry, it’s just that most of the attendings are old men. I don’t get out of the house much these days.” She leaned forward again and spoke in a confidential tone. “Dr. Dergan doesn’t date, apparently. I overhead the nurses discussing him. It drives them crazy that he won’t let them set him up.”
Ann was surprised at how interested she was in this information, especially considering how nervous she felt around Dr. Dergan. She placed his age around 33 or 34, which was fairly young for an attending in a university hospital. She had dated guys that age in the past, but she wasn’t about to confess to Cody how sexy she thought Dr. Dergan was. He was her attending, after all.
“Anyway, I’ll help you look good next time he pimps you like that,” Cody said. “I’ll tell you everything you need to know so next time you’ll look like a superstar.”
Ann felt grateful for Cody’s help, but she wondered if it would be enough to get Dr. Dergan’s seal of approval.
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“Is it just me or do the medical students get dumber every year?”
Joel Dergan posed the question of Dr. Clyde Buerger as he wheeled himself into the physician’s lounge. Clyde had been a renal attending at the university hospital for the past twenty years and he simply laughed at Joel’s comment.
“I think it’s just you, Joel,” Clyde said.
Joel wheeled himself over to the refrigerator and started shuffling through it for his lunch. He had been pleased when he first heard that the hospital had banned drug company sponsored lunches, but now he missed the gourmet food. He would have been willing to abandon his principles if it meant he didn’t have to eat a homemade turkey sandwich every single day. He was getting too old for miracle whip.
“I mean, is it too much to ask for a third year medical student to know how to do a simple abdominal exam?” Joel went on. “What do they teach them during the first two years anyway?”
“You know how it is,” Clyde said. “They barely get to lay their fingers on a patient till third year. Don’t be so hard on them.”
Clyde taught the pre-clinical students, so Joel expected the man knew what he was talking about, but it still infuriated him. When he was a student, Joel never would have come into a third year clerkship without the basic knowledge needed to work-up a patient. Now it seemed to be happening more and more frequently.
That was only one of the many things that bothered Joel about medicine. He hated the fact that all they did was talk about the patients ad nauseum, tweak their medicines a little bit, and then wait a week to see what happens. Nothing that got the adrenaline going like slicing through someone’s chest.
Of course, Joel was no longer capable of getting that same feeling he used to, ever since the nerves to his lower body were severed. He couldn’t feel or move anything from the inferior border of his nipples downward. His fingers were also paralyzed on both hands, except for his thumbs, which he could move with only moderate strength.
Two weeks after his injury, Joel had attempted to hold a pencil in his hand and it went clattering to the floor immediately. It didn’t take any kind of genius to figure out what would happen if he tried to hold a scalpel. Nobody would bring him a scalpel to test his theory because they knew he’d go straight for his wrists.
Joel could have wound up on the street corner, begging for change, but he had his residency director to thank for not letting him give up on himself. The director talked Joel into applying for a medicine residency after he finished rehab. Joel had always looked at medicine as the lowest of the low, but he supposed it was better than being on welfare or being a psychiatrist.
It was difficult to adjust to life with a disability. Joel had always pushed himself to the extremes of his physical capacity, but he realized how much more limited he was now in that regard. He hated having to wait for elevators all the time rather than just sprinting up and down the stairs. He hated the look of surprise and distrust on the patients’ faces when he introduced himself as the doctor. He hated having to stick to a schedule of catheterizing his bladder every four hours. He got sick much more often these days and had already been hospitalized several times for urinary tract infections in the past six years. When he woke up in the morning feeling feverish, he knew this was something he couldn’t afford to ignore anymore, since a simple infection could potentially send him into septic shock. He just couldn’t push himself the way he used to.
His hands were another limitation he had to work past. He had gotten a lot better with his hands, to the point where most of his patients and colleagues didn’t even realize he had anything wrong with him. He had initially been told that he would never be able to function without braces on his hands, but he had trained himself to be able to write and feed himself without any aids, although it took a lot of practice and he knew his handwriting was nearly illegible to everyone but himself. Performing any kind of surgery was completely out of the question.
In rehab, the doctors had tried to point out how fortunate he was. A lot of quads can’t even wheel their own chairs, Joel. Look how much you can still do. Joel knew he should have been grateful for what he still had, but he couldn’t help but think of what he could have had if not for that damn car crash.
And that included Kyra.
Joel pushed thoughts of Kyra out of his mind as he placed his turkey sandwich and bottled water in his lap and wheeled himself back to his office to eat his lunch. He had seen a lot of quads become overweight diabetics due to their poor ability to burn calories, so Joel made an effort to watch what he ate. Back when he was a surgery resident, he had a washboard stomach without even trying… now he had a substantial gut for the first time in his life and he knew that no diet was going to make up for the lack of muscles in his trunk. Joel had never thought much about his own appearance before his injury, but now he looked down at his flabby belly and atrophied legs and hated what he saw. It wasn’t the sort of body that any woman could possibly get turned on by.
What bothered him most was the way his fingers looked. His own doctor claimed it wasn’t very noticeable, but Joel hated the way his fingers had become stiff and curled and the obvious atrophy in his entire hand. Every time he looked down at his useless fingers, it was a reminder of the career he had to give up.
As Joel took a bite of his sandwich, he thought about the new medical student on their team: Ann Lowell. He knew he had a reputation for being hard on the students, but that girl looked completely terrified of him. It was a bit of an ego boost to know that he could inspire that kind of fear.
He had no intention of going easy on her just because she had shed a few tears. If she was serious about wanting to be a surgeon, she had to be able to stand up to grilling. What he did today was nothing compared to what she’d face in the future. Surgery attendings were the worst when it came to “pimping” residents and students.
Joel wondered if Ann had what it took to be a surgeon. He liked that she answered without hesitation when he asked her the question… she was dedicated, that was for sure. But surgery material? Not really. No, definitely not. He couldn’t help but compare her to Kyra Manning, one of the best female surgery residents he had known. Kyra had her moments when she faltered, but in general, she was tough, confident, smart as a whip, and extremely beautiful. Ann was none of those things.
Well, he amended, she is pretty attractive. Ann had an unusual combination of black hair contrasting with pale skin and blue eyes that made her looks appear very exotic, unlike Kyra, the all-American girl. Kyra had been far more beautiful, but there was something strangely appealing about Ann.
Joel shook his head at how inappropriate and pointless it was to be thinking about a med student this way. He hadn’t been out on so much as a date since it had ended badly between him and Kyra, and he supposed being alone that long was taking its toll.
Why don’t you try to get a girlfriend or something? Joel asked himself that question a lot. When he was younger, he seemed to just fall into relationships. Now it was harder. Most women his age were married or engaged, and the few single women just didn’t approach him anymore. Women rarely flirted with him since he’d been in the chair. He had a few opportunities to date when nurses or friends offered to set him up with someone, but he kept imagining the disappointed look on his prospective date’s face when she saw him.
He remembered back when he was a young surgery resident, the way he used to size women up, and daydream about what they might be like in bed. He very rarely had those kinds of thoughts anymore. He got the feeling that most women thought of him as asexual and he had started to think of himself that way too. He felt very self-conscious about his body, about relying on a wheelchair, and about his ability to perform sexually. There were too many reasons to avoid women entirely. It would be easier to live his life as a bachelor.
Joel sighed and started in on his stack of paperwork. He hated medicine.
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Ann read up on the differential diagnosis of a GI bleed that night in an effort to impress Dr. Dergan. She dug through her large stack of textbooks, making notes and outlining information that she guessed he might ask her about. She even brought her dinner back to her bedroom to continue studying as she ate. She made notes on not only the differential diagnosis of an upper GI bleed, but also how to work it up, and how to treat it. By the end of the night, Ann’s eyes were red and tired.
Dr. Dergan might have been tough, but she believed that she could impress him if she made the effort. She was nothing if not a hard worker and it was important to prove to him that she was surgeon material. She wasn’t going to let him intimidate her like he did yesterday. She refused to be “the dumb med student.”
Ann wasn’t used to waking up very early in the morning and she felt exhausted when she dragged herself to the hospital at 6:30AM. She found Cody, who looked like surprisingly bright-eyed. Despite her sleepiness, Ann tried to pay attention as Cody taught her how to pre-round on the patients. She showed Ann how to collect vital signs and read the chart to find out what had happened the night before. Cody was so unbelievably nice… Ann wished everyone on the team could be like her. “You know more than you let on,” Cody reassured her. “Just try not to let Dr. Dergan shake your confidence.”
As good as she felt when she was talking to Cody, all her confidence flew out the window when Dr. Dergan rolled up for rounds in the morning fifteen minutes late. Ann’s stomach filled with butterflies and her palms immediately became drenched with sweat.
Dr. Dergan wasn’t smiling when he approached them. His hair was slightly damp as were his shoulders. His pants were wet enough to cling to his thin legs. He was wearing leather gloves on his hands, which he pulled off with some effort. “It’s raining,” he muttered. He ran his hand through his damp brown hair. “The elevator smells like wet dog.”
She tried to smile at him cheerfully, “Hi, Dr. Dergan.”
“Hello, Ann,” he replied. He seemed slightly perplexed by her chipper attitude. “I’m glad somebody seems happy to be here.”
Ann tried to sound eager. “I have that presentation ready for you.”
Dr. Dergan gave a disinterested nod and waved over a hassled looking Sheldon. “All right, let’s round, people. We’re already running late.”
Some of the other attendings treated rounds like an Olympic event, running up and down stairs half a dozen stairs, hurrying from room to room. Ann suspected that Dr. Dergan wished he could do that, but his wheelchair limited him in using this method of torturing students and residents. Instead, he would force everyone to stand in front of each room for what felt like an excruciatingly long period of time, as he grilled the resident presenting the patient. Ann’s feet were burning and her ankles were sore before they finished off the first floor of patients. She wished that she could ask for a break from standing, but she knew that wouldn’t be met with approval.
After almost an hour straight on her feet, Ann felt like she was going to collapse. When they went into a patient’s room, she surreptitiously slid into a chair as Dr. Dergan spoke to the patient. The relief in her lower extremities was heavenly.
As soon as they got out of the room, Dr. Dergan looked up at her. “Don’t ever sit down in the patient’s room,” he said.
“What?” She thought he hadn’t even noticed that she was sitting.
“Medical students don’t sit,” he said. “Ever.”
Ann’s face flushed. She felt some of her anger at Dr. Dergan returning as he wheeled forward toward the next patient’s room. Cody noticed Ann’s expression and patted her on the shoulder in a sympathetic gesture. “One of the hardest things about third year of med school is getting used to standing all the time.”
“I just needed a second off my feet,” Ann murmured. “It’s not like I was taking a nap. He’s lucky… he gets to sit through all of rounds.”
“Believe me, I’m sure he’d rather be standing,” Cody said. “He used to be a surgeon, remember? Those guys stand for hours and hours without a break. Whatever else you say about Dr. Dergan, you can’t question his endurance.”
Ann knew Cody was right. She noticed Dr. Dergan shifting his weight in his wheelchair several times and she wondered how comfortable it was for him to be sitting in that chair all day. At least she had the option of sitting or standing.
Ann’s patient was on that floor, so she knew Dr. Dergan was going to start asking her questions very soon. She was looking forward to showing off all the work she had done last night, but most of all, she just wanted to get it over with. She was dismayed to see that there was another team stopped in front of her patient’s room and knew this meant there was going to be a larger audience.
“All right, Ann,” Dr. Dergan said. He crossed his arms against his chest and leaned back in his wheelchair. “Let’s hear the differential for an upper GI bleed.”
She couldn’t help but notice that the hallway had become very quiet. The other team was obviously listening in. She took a deep breath, calling to mind what she remembered from the textbooks. “So, um, it could be peptic ulcer disease, or um… gastritis, or esophageal varices, or—”
“What’s the cause of esophageal varices?” Dr. Dergan interrupted her.
“What?” Ann said.
“I’m asking, what’s the pathophysiology behind esophageal varices?” Dr. Dergan asked.
Ann stared at him. “What do you mean?” She felt her face turning red.
Dr. Dergan rolled his eyes. “Ann, I thought you said you were prepared. Come on, this is a really simple question.”
“But you asked me for the differential…”
“Look, you’ve got to be prepared for follow-up questions,” he said. He shifted in his wheelchair, but he kept his brown eyes pinned on her. “Whenever an attending asks you to present on a topic, you have to be prepared to answer any tangential questions. You have to read my mind and know what I’m going to ask you.”
Ann nodded, knowing it would be pointless to describe the depth she had gone into for this presentation. She simply hadn’t anticipated this particular question.
As if things couldn’t get any worse, to her horror, Dr. Dergan turned to the medical student on the adjacent team. “Do you know the pathophysiology of esophageal varices?”
The medical student’s name was Kyle and he was one of the smarter kids in her class. He replied instantly: “It happens when blood is diverted from the portal vein due to portal hypertension, which is often caused by liver cirrhosis.”
“Correct, excellent,” Dr. Dergan said. He looked back at Ann. “See, that was a medical student level question. You should have known that one.”
“But…”
“When you’re in the operating room,” he went on, “and you don’t know the answer to a basic question like that, they’ll throw you out of the OR and tell you to come back when you’re prepared.”
For the second time in as many days, Ann felt tears rising in her eyes. No, I’m not going to cry in front of him again.
To her dismay, he noticed her reaction. “Ann, you can’t break down over every little thing,” he said. “I’m not being that hard on you. I’m really not.”
“I’m not…”
Dr. Dergan sighed and rubbed his still damp knee. “Okay, Ann. Go get yourself together and then you can rejoin the team. We’re going to the seventh floor.”
“I’m together,” Ann said, sticking her trembling chin out resolutely. “Really.”
“I’m serious,” Dr. Dergan said. “Don’t argue with me. Get yourself composed and you’ll join up with us again later.”
I hate you, Ann thought. I can’t stand another month like this.
As she marched to the bathroom to wash her face off, she realized that she might crack if she spent the rest of the month with Dr. Dergan. It wasn’t so much his questions that she couldn’t take, but rather the way he insulted her when she got the questions wrong. Every time she couldn’t come up with an answer, she felt like the world was coming to an end. She couldn’t live this way.
Ann heard a knock on the bathroom door and then Cody’s heart-shaped face timidly peeking through. “Are you okay?”
Ann wiped her eyes. “I’m okay. What are you doing here? Aren’t we still rounding?”
“Dr. Dergan wanted me to go check on you,” she said.
Strange how Dr. Dergan could rip her apart like that, then appear to show some concern for her. “I feel like such an idiot,” Ann said. “What did he say about me after I left?”
“Nothing.” Cody blinked innocently. “I swear, we just continued rounding. He didn’t say a word about you until he asked me to find you. I mean, so you didn’t know one question? Big deal.”
“He hates me. He thinks I’m dumb.”
“That’s not true,” Cody insisted. “Dr. Dergan’s just got this… way of doing things. You just have to get used to him. He gave me a hard time at first too.”
Ann found that hard to believe. Dr. Dergan quizzed Cody a lot, but she almost always knew the right answer to his questions and he was clearly very impressed with her. Cody was a smart girl and she knew how to manage patients. She wasn’t a bumbling idiot like Ann was.
“I don’t think I can stand another month with Dr. Dergan,” Ann admitted. “I need someone who I’m not terrified will yell at me.” She took a deep breath and glanced at her reflection in the mirror. “I think I’m going to ask if I can switch to a different team.”
“Ann, no!” Cody cried. She took Ann’s hand in her own in a comforting gesture. “Please don’t leave. I think you’ll really learn a lot on our team.”
“Look at me,” Ann sighed. “Do I look like I’m learning a lot? I’m miserable.”
Cody shook her head. “You can’t give up after two bad days, Ann. I hate to say it, but that’s not what a surgeon would do.”
Ann knew that Cody was right, but she was too miserable to care. She couldn’t stand another day with Dr. Dergan.