It’s time for sex, drugs, and alcohol.
He quickly drops alcohol from his list of hedonistic pleasures: he’s a lightweight, and regarded through the distorted lens of a hangover his present life is even less attractive than when he’s clear-headed. The one exception is Monday night: he always wakes up on Tuesday morning without a hangover, no matter how wasted he gets. He experiments with drugs of all kinds. The worst that can happen is an accidental overdose, which — given his particular circumstances — is not an outcome that he fears. Addiction isn’t an issue in this universe: he wakes on Tuesday with no physical reminders of substance abuse or bar brawls or other bodily mishaps — and even if it was, he’s well beyond caring.
He screws everything on two legs and quite a few things on four. (If he were a ‘glass half full’ sort of person, he’d be grateful that he isn’t eternally stuck on a solitary Greek mountainside with goats as sole companions . . .) He starts off with Miss Overachiever — his scruples are forgotten in his quest for total oblivion — because she’s at hand, willing, and experienced. (“Greg, have you never stimulated a clitoris? This is how you do it!”) Once he has learned everything she can teach him, he moves on. When he’s through every girl he wants to screw (and the Dean’s wife too, for good measure), he tries out guys. And then threesomes. And foursomes. He also gives S/M and bondage a try, but deep down he’s vanilla. And sated. And bored.
He quits focusing on the carnal pleasures of life when he unexpectedly finds distraction of a different kind. At first it is just a diversion of the usual sort, i.e. a sexual one. She catches his attention in a supermarket, stretching up to reach items on the top shelf. She isn’t his type: short, plump, hair dyed blonde, about fifteen years older than he is. But when her blouse slips out of her jeans, exposing a smooth bronzed midriff, he is turned on. It hits him with such force that he is instantly determined to sleep with her.
A more confident man would accost her under pretense of needing advice on some grocery, a more chivalrous one wouldn’t need a ruse: he’d help her get down the tins of refried beans that wobble perilously over her head. Greg watches while about ten tins topple down on her, and then he follows her to her home, a somewhat dilapidated house in the suburbs. He’s good at trailing people by now, and he’s even better at sussing out their private lives. A peek at the nameplate on the door, a chat with a neighbor who is walking his dog, and he knows enough to sally forth and conquer.
“Hi,” he says when she opens her door. “My name’s Greg. I’m a med student.” (This impresses people, so he doesn’t bother to lie about it.) “I’ll be going to Haiti this summer to volunteer at a rural health clinic, so I need to learn Spanish.”
She gives him a condescending smile that he doesn’t like at all. “Haiti?” she queries. “They speak French there.”
Damn, but he needs to brush up on his Geography! “I mean Honduras. Always getting the names mixed up,” he says, praying that she doesn’t come from there. “I heard you give Spanish lessons.”
“Yeah, I do. How many do you want?”
“As many as possible. How about we start now?”
“As many as possible?” she asks with a kinder smile this time. “How many can you pay for?”
Money isn’t an issue. He can safely spend whatever he has, because it’s always back in his wallet come Tuesday. Whenever that doesn’t suffice, he nicks cash off someone else. Mark, for instance. Or someone in the library who is careless enough to leave their purse unattended. Or out of the cash register in the cafeteria when the cashier is distracted, which is the case on Thursday at 12:37 p.m. when her son’s school calls to tell her that the kid has been admitted to hospital after an injury in PE class. If he needs a big sum, say, for a motorcycle, he breaks into the Dean’s place and steals his wife’s jewelry. (He’d gotten caught a few times, until he figured out how to disable the burglar alarm, and the first pawnshop that he patronized ratted him out to the police, but those were minor glitches in an otherwise smooth plan.)
“Let’s start with five hours a day for the next five days,” he suggests, digging out his wallet. “I can pay for today’s lessons straightaway, and you’ll get the rest tomorrow.”
It takes longer to soften her than he anticipated; having to start from scratch every week doesn’t exactly help. By the time he manages to get into her panties, he can hold his own in rudimentary conversations about daily life. Before he tires of her, he can decipher medical texts and get decent patient histories. He tires of her before he tires of Spanish, so he continues the lessons (without the sex) until he can write comprehensible patient records and hold short talks on medical cases.
Then he overhears two students in the library talking German. It isn’t the first time he overhears them, but it’s the first time he considers learning the language. They’re med students too, from the year above his. He offers to help them with their assignment in return for German lessons. They are skeptical (every week anew), but by now a paltry essay is child’s play to him. What they don’t know is that he writes the same essay for them week after week while they have to teach him something new each lesson. He finds German tougher than Spanish, but after a while he gets the hang of it. Then he moves on to Chinese and Japanese and Hebrew and Russian. And he has always wanted to learn how to play the piano. (One day he even ‘buys’ a Steinway grand with the money that he nicks from the Dean, but the music store can’t deliver before Tuesday . . .)
“Where did you learn German?” one of the German students asks him about four months into their lessons — from his point of view. From the Germans’ perspective, it’s still the first week of instructions, but he obviously isn’t a newbie. He anticipated the question, so he has his answer ready.
“My dad was stationed in Germany. He was in the marine corps,” he says.
That much is true, but the implication that the entire family lived there is false. His dad, posted abroad for most of Greg’s childhood, had left his family in Lexington, an arrangement that worked to everyone’s satisfaction. The explanation is so neat that he uses it to justify his language skills for any and every language — and no one calls him on it, regardless of whether his father could have been stationed in the corresponding country or not. In fact, the tales of his extensive travels and the little stories that he fabricates to give them authenticity are so seductive that he almost believes them himself. Especially the ones that he doesn’t tell anyone, such as . . . an encounter with a Japanese buraku inspiring him to study medicine. That tale is much cooler than doing it to get his father’s goat.
He spends very little time in the library nowadays, but one day, checking out an obscure point in Russian grammar, he spots a frizzy-headed guy at one of the tables and the sight rings a bell.
“’Looks like scurvy, but isn’t scurvy’, wasn’t it?” he asks, confident that he knows the answer to the riddle now.
“Your patient,” Greg says impatiently. “The one who’s dying.”
“What about her?”
“Weren’t those her symptoms?”
Frizzy Head scowls. “What the fuck gave you that idea?”
Greg riffles through his memory. “You said . . .” Didn’t he?
“I don’t know you; never talked to you in my life!”
“Well, no, but you do have a patient who is dying,” Greg half asks, half states.
“Yeah, but she isn’t dying of scurvy, or anything that looks like it. She has fever episodes and myalgia, and her kidneys are shutting down.”
“Intermittent fever, pain, and proteinuria?” Greg echoes, wondering how his memory could deceive him so badly, even as his brain sifts through possible causes. “Malaria. Or yellow fever. Has she been to Argentina?”
“Tested for both and no, she hasn’t.”
“Other symptoms?” Greg asks, intrigued. “Prior medical conditions?”
Frizzy Head sighs, but recapitulates everything that he professes to remember.
“That can’t be all; something is missing,” Greg says, snagging Frizzy’s notes from under his fingers and leaning back to read them. Remembering his forays into obscure diseases he asks, “Has anyone in her family died of unknown or unnatural causes?”
“Your patient history sucks.”
“Gee, thanks! Why don’t you get a decent one, if you’re so good at it?”
Greg, rising, balls up Frizzy’s notes, and tosses them at him. “I will. Take me to your patient.”
“No way!” Frizzy straightens the crumpled notes, giving Greg a hostile stare. “I’m not helping some smartass student who wants to play at being doctor to harass my patient.”
Greg ignores the stare. “It could be Weil’s disease, scrub typhus, typhoid or paratyphoid fever, viral hepatitis, Henoch-Schoenlein purpura, adult Still’s, Blau syndrome — or ten other things. There’s no way of narrowing it down unless you get a decent patient history. If it’s something genetic, there’ll have been other cases in the family.”
Frizzy leans back and looks him up and down. “You’ve . . . heard of adult Still’s?”
“Hmm? Yes,” Greg says abstractedly, racking his brain for further diagnoses while pacing up and down in front of Frizzy. “It’s unlikely to be adult Still’s if there’s no rash. Has anyone noticed a rash?”
Coming to a decision, Frizzy rises and jerks his head at Greg in an unspoken invitation to follow him. He takes Greg to the second floor of the Medical Center, the university’s teaching hospital, where his patient occupies a room on a general ward.
Getting a decent patient history turns out to be slightly tricky: neither the patient, a young teacher named Eleanor, nor her family can distinguish between relevant information and trivia, between facts and gossip, between omitting unnecessary details and lying by omission. Nor do they take kindly to having their lies dismantled and their hypocrisies exposed; they complain to Frizzy’s boss, who promptly has Greg evicted from the premises. Frizzy — whose name is Arnold Linnebaker — gets a dressing down from his boss and refuses to give Greg the time of day afterwards.
Armed with his patient history, the Xerox copy of the patient file that he made secretly, and the lab report, Greg settles down in the library and gets cracking. He doesn’t care about Frizzy giving him the cold shoulder; in a few days Frizzy won’t remember his physiognomy and will be duly grateful for the solution to his problem. Then again, in a few days his copious notes and the illicit Xerox copy of the patient files will vanish, which means that he’ll have to return to the Medical Center to obtain them again — unless he commits them to memory. He opts for the latter course of action, because getting at the necessary information at the hospital cost him all of two days and he doesn’t feel like going through the entire hassle again.
He sneaks into the Medical Center on Monday night in order to obtain the latest lab report, only to be informed by a night nurse whom he has never seen before that Eleanor died during the course of the day.
“She died?” he mouths.
“Yes, her liver failed,” the nurse on duty says. “I’m so sorry. Was she a friend of yours?”
“No,” Greg says, turning away. “Just a patient. I’m, uh, doing a rotation in the department.”
Just a patient named Eleanor, with doting parents, a bitchy sister, a cheating boyfriend, two cats, and tons of get-well-soon cards, balloons, and teddy bears from her students. A thirty-three year old blonde, five foot four inches tall, with a slight lisp and a love for Charles Dickens and Latin beats. A loquacious young woman with a quirky sense of humor and blatant disregard for the truth.
“You win some, you lose some,” the night nurse says. “You get used to it — losing ‘em. It’s tough the first time, and the second time, and the third one.”
“And after that it’s a walk in the park, huh?”
“After that you know that the pain and the sense of failure don’t last.”
“They should,” he insists. “She’s dead!”
“Don’t shout, hon! If all that pain stayed put and increased every time a patient died, we wouldn’t be able to cope, would we? No one would benefit, least of all our patients.. . . . Throw a pity party by all means, but remember that it doesn’t help her at all.”
Good point: he can’t help Eleanor by drowning his sorrows in alcohol or drugs, but he can save her next week or the week after or . . .
He persuades the night nurse to pull the complete patient file with all the lab reports (“for study purposes”) and commits everything he now has to memory. Tuesday sees him in the library, jotting down everything he remembers and looking up various diseases, but avoiding Frizzy and all direct contact with Eleanor. He’d be quicker if he ran a few tests, but that would entail further contact with Eleanor and he’d rather not see her again until he’s sure he can save her. After ten days he has narrowed the cause of her demise down to three possible culprits. Nevertheless he waits until the following Tuesday to present his results to Frizzy, because he’ll need to see how Eleanor responds to treatment to decide which of the three it is, and even six days is cutting it tight should she not respond to his initial treatment.
“Familial Mediterranean Fever,” he declares, marching up to Frizzy on Tuesday morning.
Frizzy looks up from the textbook he’s studying. “What the fuck?”
“Your patient. She has Familial Mediterranean Fever — unless she was bitten by a copperhead snake. But given her sedentary lifestyle the snake bite is unlikely.”
“My patient most definitely does not have Familial Mediterranean Fever, whatever that may be. And he’s a he, not a she.”
“Thirty-three year old female, feverish episodes, myalgia, kidney failure. Name of Eleanor Giordano. Does that ring a bell?”
“No. You’ve gotten me mixed up with someone else. My patient is a fifty-five year old male with totally different symptoms. So leave me alone; go bother someone else. I haven’t got the time for stupid games.”
Greg eyes Frizzy suspiciously; as far as he can tell, Frizzy is absolutely serious. Besides, he has no reason to mess with Greg’s head: it’s not like Frizzy can remember meeting him before. Greg, for his part, has no evidence that Eleanor is Frizzy’s patient: the copies of her patient file ceased to exist two weeks ago.
“If Eleanor isn’t your patient, then whose patient is she?” Greg asks.
“Don’t know, don’t care.”
Since the question was rhetorical, Greg doesn’t take umbrage at Frizzy’s tone, but rushes off to the Medical Center, straight to Eleanor’s room . . . To what used to be Eleanor’s room. This week there’s no sign of Eleanor. A man of about fifty is occupying her bed. He’s sleeping, but the woman seated by his bedside raises enquiring eyebrows at Greg.
“I’m looking for Eleanor Giordano. This is her bed,” Greg says baldly.
The woman shrugs. “I’m afraid I don’t know who had this bed before Harry was admitted to the hospital. You’ll have to ask one of the nurses.”
“How long has he been here?” Greg asks, pointing at Harry with his thumb.
The woman grimaces. “Three weeks now? And before that we were . . .”
But Greg doesn’t stop to listen to the sad tale of Harry’s medical travails. He looks in on every room on the ward. Then he checks the floor above and the one below. Finally he goes to the nurses’ desk on the second floor, the one he is sure Eleanor’s room is on. “Do you have an Eleanor Giordano on this ward?”
“Giordano? No, I’m sorry. I’m afraid I can’t access admissions records from here. If you go down to the lobby, the admissions desk is through the glass door on the right. They can tell you where to find Ms. Giordano.”
“I’m not family. I’m a med student. I’m doing a rotation here and I’m supposed to check on Giordano.”
The nurse looks him up and down. “A student? We have no record —“
“Dr. Linnebaker is my supervisor,” Greg improvises.
“Oh, okay. He isn’t here. He has the night shift. Didn’t he tell you?”
That explains why Frizzy can afford to hang out in the library all day. “He did. He’s in the library researching the case. He sent me over to check out the patient file.”
The ‘library’ part of the story evidently sounds convincing, because the nurse sits down and pulls out the filing cabinet. “I’m sorry, but we have no one of that name on the ward. I’ve tried ‘G’ and ‘J’. Are you sure you got the name right?”
Greg scratches his chin. This time two weeks ago, Eleanor had been ensconced in the bed in Room 208. He’s sure of that. This week, ‘Harry’ has supplanted her for no apparent reason. That’s a major anomaly in Greg’s confined little world. So far, even minor changes in his surroundings were precipitated by his own actions; never ever has any deviation from the norm cropped up all by itself.
What does it mean?
“Nurse? . . . Nurse! Please! Something is wrong. Harry — he isn’t breathing anymore!” It’s the woman from Room 208.
The nurse looks up, but Greg doesn’t wait for her to react. He sprints to Eleanor’s room where Harry has indeed stopped breathing. His heart has also stopped beating.
“Need a crash cart here,” Greg yells as he positions his hands to start CPR.
He’s learned how to do CPR — on a living, breathing fellow student. Now that it’s the real thing, it’s anyone’s guess whether he’s doing it correctly. Is he pressing hard enough? He ups the pressure; if Harry dies, he won’t appreciate any effort to keep his ribs intact. One hundred compressions per minute: is he too fast or too slow? Thirty compressions, clear airway, two rescue breaths, he chants to himself. It seems like forever before the crash cart arrives and releases Greg from his labors. Breathing heavily, he steps aside and watches them shock Harry’s heart back into action.
“What’s wrong with him?” Harry’s partner wails. “We’ve been here for three weeks and he’s just getting worse. Where’s Dr. Linnebaker? I want to talk to Dr Linnebaker!”
Not quite looking her in the eyes the nurse says, “He has other commitments, but he’ll come as soon as he can.”
“Other commitments? My husband is dying and Dr. Linnebaker has other —”
Greg interrupts her. “He’s in the library,” he says. The nurse positively glares at him.
“The library?” Harry’s wife echoes dangerously. She’s just short of an apoplexy. “What’s he doing there?”
“Researching your husband’s symptoms instead of sitting here and twiddling his thumbs while your husband dies. Now go and sit with him; he needs you, and Linnebaker won’t be back any the sooner if you keep everyone from doing their jobs.” He makes a shooing motion with his hands.
“Did you have to mention the library?” the nurse complains once Harry’s wife is out of earshot. “Patients expect their doctors to be there for them around the clock. It’s unreasonable, but there it is. I’d better page him, I guess.”
Greg realizes that he doesn’t have much time. “Give me the patient file.”
When the nurse hesitates, he gives her his most charming smile. “Look, I must have gotten the cases Dr. Linnebaker talked about mixed up, but if I don’t know about old Harry here by the time he turns up, he’ll bite my head off.”
Armed with the patient file he settles down in a corner. He figures he has about half an hour before Frizzy reaches the Medical Center. Harry’s symptoms are not specific: difficulties in swallowing, followed by slurred speech, sleep disturbance, and finally incidents of memory loss. The brain scans show no sign of a blood clot or a tumor.
He jots down notes on a pad that he nicks from the nurses’ desk, and when his half hour is up, he returns the patient file to the ward before heading out to the library. Frizzy will doubtless find out that an unknown person invoked his authority in order to access patient data, but there’s no way that Frizzy will be able to identify Greg as the culprit. He’s safe as long as he stays away from the Medical Center.
Safe he may be, but by Monday evening he’s no nearer to a diagnosis than he was on Tuesday morning. (Oh yeah, and he’s been expelled for not attending the endocrinology exam, but that isn’t exactly news.) Maybe Frizzy has a diagnosis by now.
Greg goes to the nearest pay phone and calls Harry’s ward. “Hello, my name is Luke Nelson. My uncle Harry Nelson is on your ward, I believe. I’m calling to find out how he’s doing.”
“I’m very sorry, Mr. Nelson, but your uncle passed this afternoon.”
“He’s dead,” Greg says dully.
“Yes, I’m afraid so. My sincere condolences.”
“What did he die of?”
“I couldn’t say. You’ll have to contact his attending for details.”
That’s the second of Frizzy’s patients dead. But maybe this week was a one-off and next week Eleanor (or Harry) will reappear in Room 208.
Tuesday morning he slaps Mick Jagger into silence and heads straight to the Medical Center without showering or eating breakfast. (Mark’s eyes bulge out of his head as Greg streaks past him towards the door.)
A child is lying in the bed in Room 208, a boy of about twelve.
As he watches the boy leaf through a sports magazine, Greg can feel his heart dive into his lower intestines. Both Eleanor and Harry are irretrievably lost, and if his hunch is correct, this boy will also be worm fodder by Monday evening.
One patient per week — that’s how many people have died ever since he’s gotten stuck in Exam Hell. (He has no idea how long he’s been in The Rut, because he has no way of keeping count, but he figures that it’s been a hundred weeks at the very least.) And unless he can work out a way to save Frizzy’s patients within seven days, that count will rise. The boy in front of him will be the third one he knows, but even if he shuns the Medical Center henceforth, he’ll know that someone there is dying — dying because he can’t figure out what’s wrong with them.
He’d thought it couldn’t get worse than the brain-rotting boredom of endless repetition. How often has he wished for the tiniest of aberrations, for a slight deviation from the norm? Well, now he has gotten what he wished for, with a vengeance. If boredom was purgatory, then this is hell! And the only way to make it bearable is to stop these people from dying, because unlike him, once they are dead they stay dead.
He needs to become quicker at diagnosing Frizzy’s patients. He has to find cause and cure within a week.
Step 1 comprises gaining the nurses’ confidence.
He returns to his apartment to get his lab coat — in the following weeks he never leaves the apartment without it — and then approaches the nurses’ desk.
“Hey, I’m the med student who has been assigned to Dr. Linnebaker. He asked me to report here today at 10 a.m. and read through his patient files before he returns.”
His cover story works wonders; Greg withdraws to the conference room with a pile of files, of which he ignores all but one. Armed with the file of one Leroy Miller he returns to Room 208 to interview the boy and his father.
Once he has as much information as he needs, he proceeds to Step 2: Working with Frizzy, not against him.
He steps up to Frizzy’s table in the library, slaps his notes down in front of him and says, “Twelve-year-old male with weakness of the extremities and the neck, swallowing difficulties, and respiratory issues.”
“What the fuck!” Frizzy exclaims, looking anything but pleased.
“Your patient. He’ll be dead by the end of the week unless we figure out what’s killing him.”
Frizzy tosses his head in a quick negating gesture. “He isn’t dying. He’s showing neurological symptoms, but he’s far from —“
“You don’t know that.”
“And you do? Who are you, anyway?”
“Name’s Greg. I know because I’ve seen cases like that before.” He hasn’t, but the white lie is necessary. He’ll tell a few more if they serve to find a diagnosis. “You’re running out of time.” He knows that for sure. Leroy’s sell-by date is a mere six days away.
Since Frizzy still seems unconvinced, Greg ventures an educated guess. “His neurological symptoms will spread to vital organs, and then he’ll crash.”
At that moment Frizzy’s pager goes off. He stares at it, then at Greg in disbelief. “How’d you know?”
Greg shrugs. “I’m that good.”
By the time Greg and Frizzy reach the Medical Center, Leroy is in respiratory distress. He develops a pulmonary infection that kills him on Monday afternoon.
The problem, Greg decides, isn’t that Frizzy and he aren’t working effectively. They deal well with each other (once Frizzy’s initial distrust is overcome) — maybe too well. They are like well-oiled machinery, their mental cogwheels interlocking without a hitch, Frizzy transforming Greg’s diagnostic torque into the motion of medical treatment. If medicine were motorcycle racing, they’d win the Grand Prix. But it seems that harmony doesn’t facilitate the diagnostic process. Greg doesn’t need someone who thinks in the same structures that he does; he requires friction, the stimulus of discordant ideas. He doesn’t want the blandness of steamed vegetables; he craves the variety of a good curry, with coriander, cumin, and turmeric vying with musky cloves and sweetish onions, while earthy lentils and solid potatoes provide structure.
No one regrets the need for Step 3 more than he does, but there’s no help for it: he’ll have to find suitable input sources for new ideas. Frizzy’s colleagues at the Medical Center are too busy with their own stuff and not exactly inclined to obey when a student whistles for them to come. So, the next Tuesday, after getting the patient file from the nurses Greg returns to the library and looks around.
Brash Frat Boy, the Mouse, and Overachiever aren’t stellar, but in sum they probably have an IQ of 400. With a bit of luck they’ll hit on an innovative idea or two. Greg marches up to the table where they are (still) preparing for the endocrinology paper and drops the newest patient file in their midst.
“Woman’s dying,” he says. “The attending is stumped. Care to share ideas?”
“We’re preparing for an exam,” Brash Boy says.
Greg rolls his hand expansively. “I know. Endocrinology, Rounceville’s course. He’s fixated on diabetes, hypothyroidism, and Graves’ disease. You can prepare for those later. I need your help now. Dying woman, remember?”
“What’s she dying of?” Overachiever — Lisa is her name, he recalls — asks, reaching for the file.
He sighs in mock exhaustion. “If I knew, I wouldn’t be asking you.”
Lisa rolls her eyes without looking up from the file. Brash Boy — he can’t remember his name, but it doesn’t matter — pushes back his chair. “I haven’t got the time for this. Come, girls, let’s go somewhere where we can learn in peace.”
“Wait!” Lisa says, holding up a hand commandingly. “This woman is really dying. Her liver values are plummeting.”
“’S what I said,” Greg says, pulling out a chair and straddling it. “Any ideas, anyone?”
They get kicked out of the library before the morning is over, not only because of their volubility, but also because Greg, finding notebook paper too small a format for brainstorming, writes down symptoms and possible causes on a big table with Lisa’s lipstick. So they traipse over to the Medical Center, where Greg finds an empty lecture hall with a blackboard — which is where they should have come from the start. (He stores the thought for the next week.) The Center has the added advantage of proximity to the patient: he can send Brash Blond, Mousey, and Overachiever to the ward if he needs more information from the patient or the medical staff.
They lose the patient, and the next three too, but Greg feels that he is getting closer to solving the problem. The format he now has pleases him: his three groupies take care of staff and patient enquiries, saving him a lot of time and bother. Besides, losing someone he knew every week, even if it was someone he’d only known for a few days, had taken its toll. He’d been increasingly frantic, pacing through the hospital and through his apartment (to Mark’s distress) and popping tranquilizers to keep anxiety levels in check, which in turn had slowed his thinking down. Now he can let the trio take care of all patient interaction.
His little team also provides valuable input — when they aren’t moaning about losing study time. Devin is good at sifting through reams of data in order to find symptoms or values that don’t fit, Tricia can combine seemingly random facts to form a viable hypothesis, and Lisa, while hopeless at medical stuff, charms or coerces medical staff and patients alike into parting with information or agreeing to medical tests and procedures. She has Frizzy eating out of her hand, which spares Greg no end of bother, and she’s also the one who stays when the other two give up for the night or return to their books.
Maybe they’ll get lucky sometime and save a life. He won’t be able to save all of them, but if he could save every third patient or so . . .
He can’t help feeling that all these people dying is karma flipping him the bird: You think you’ve settled down comfortably in Examination Week, Greg House, learning languages, playing the piano, screwing girls, and taking drugs? Every time you’ve made your peace with your lot, I’ll think of something new, something different, something even worse! I’ll change the game until you’re crawling on your knees begging for mercy, for oblivion, for utter annihilation!
Well, he isn’t going to crawl, ever. He’s going to stay standing, no matter what, and every life that he pulls out of the clutches of the demon deity that rules this cosmos will be a fart in its face!
“What if the boyfriend is telling the truth and the bruises were caused by Tessa stumbling and falling?” Lisa asks. It’s Friday, it’s close to midnight, and they’re running out of ideas. Furthermore, their patient is running out of time. Her kidneys have shut down and her liver is failing.
“He’s lying,” Greg states. They all do.
“Okay, the boyfriend is abusive, but he knows where to hit so that it doesn’t show, and the bruises we can see were caused by falls, like he says,” Devin posits. “Then she has a neurological problem.”
Greg writes ‘neurological issues’ in the column with the patient’s symptoms. “Okay, we have a new symptom. Can we —?”
“Two new symptoms,” Tricia says. “The bruising could be a symptom too.”
Greg tips his head, considering her suggestions. “Not bad,” he concedes, turning to the blackboard to put ‘bruising’ underneath ‘neurological issues’. He throws the chalk up in the air and catches it a few times while he considers possible matches to the list of symptoms on the blackboard. “Lisa, go and check the patient’s eyes. The others can go home.”
“What am I checking for?” Lisa asks.
“You’re looking for golden-brown rings around the cornea, Kayser-Fleischer rings. They’re indicators for . . . ?” He wiggles his fingers, as though tickling a reply out them. They stare at him blankly. He sighs. “Wilson’s disease. Copper accumulates in the liver and other organs.”
Lisa trots off obediently, the other two pack up.
“You’re sure it’s Wilson’s?” Tricia asks, hesitating in the door.
“Yes,” he says. When she still doesn’t move, he makes a shooing motion with his hands. “If not, I know where to find you. At the hoedown tomorrow evening.”
She nods and leaves. Greg goes up to the ward and watches from outside the patient’s room while Lisa wakes the patient. The patient blinks and yawns, but doesn’t protest when Lisa bends over her and shines a flashlight into her eyes. A moment later Lisa straightens and looks round. Seeing him, she nods.
Greg goes to the nurses’ desk. “Call Dr. Linnebaker. We have a diagnosis.”
Lisa joins him there. “What happens now?” she asks.
“Chelation, and then zinc acetate to prevent future copper build-up. That’s if her liver recovers. If not, . . .” He shrugs.
“When will we know?”
Lisa arches an eyebrow. “That’s . . . a very precise estimate.”
Yes, well, so far none of his patients have survived longer than that. If this one dies, she’ll do so by Monday evening.
“Do you need to wait here?” she asks next.
He doesn’t watch over his patients once treatment starts. There’s nothing he can do for them from that point on, and so far, they’ve all died. That isn’t something he’s particularly keen to witness. “Why?”
“There’s a dance tomorrow evening —“
“A hoedown, over at Myer’s,” he interrupts her. “I know.”
He leaves her unspoken question unanswered, but come Saturday evening he downs a couple of beers and then goes to the hoedown.
Lisa greets him with tipsy enthusiasm. “I didn’t think you’d come.”
“I didn’t think so either,” he admits.
She drags him onto the dance floor, where he jiggles around uncomfortably. Finally she relents; they get beers and sit down on a bale of hay.
“Why did you do it?” she asks him.
“Risk your medical degree for the sake of a patient. You missed the endocrinology exam yesterday. You could get expelled.”
He hums noncommittally.
She stares at him incredulously. “Don’t you care?”
Not at the moment, he doesn’t. He’s never felt better: they’ve diagnosed the patient and with a bit of luck she’ll live.
“I did it, because . . . I can do it and no one else can,” he says, thinking it through. “If I don’t do it, people will die. Isn’t that why we’re studying medicine: so we can save people’s lives?”
She nods. He crushes his empty beer can, throws it aside, and rises. Lisa, rolling her eyes, picks up the can and tosses it into the trash.
“Are you leaving?” she asks.
“Yeah. I’ll see you around sometime,” he says. “Tuesday, probably.” Another week, another patient.
“Wait!” she calls, rummaging around in her purse. She takes out a pen and a scrap of paper — a bill, he later sees — and writes something down. “Here, my number. Call me if . . . you need help with a patient again.”
He pockets the paper, although he knows that he doesn’t need it. Come Tuesday she and the other two will be sitting in the library again, leafing through endocrinology textbooks.
He returns to the Medical Center, where the latest blood test tells him that the patient’s condition — maybe he can afford to start thinking of her as ‘Tessa’ — is improving. Her liver values are stabilizing. He can hardly believe it; deep down he’d been sure that despite the diagnosis her condition was too serious for her to recover.
He hangs around the Center until Monday, monitoring Tessa’s recovery. Monday morning he drops by the Dean’s office to get expelled. (When he doesn’t go there in person, the Dean’s secretary harasses Mark with telephone calls, and Greg is feeling so at one with the world that he’s prepared to spare Mark the bother.) Then he’s back at the hospital.
“She’s doing fine,” Frizzy says. “Should be out of here in a week. You did well, Greg. Let me know if you’re looking for a rotation in gastroenterology.” He slaps Greg’s shoulder awkwardly.
He goes to a bar and gets drunk. Then he breaks into the piano store and plays their Steinway grand until the police arrive. On similar occasions he’d insulted the officers until even long-suffering Officer Trebbin voted in favor of a night in a cell at the precinct, but tonight he’s feeling so mellow that he plays the officers’ favorite songs, from Frank Sinatra to Danny Boy. In return the officers give him a ride back to his apartment, where he manages to reach his bed without puking all over the carpet.
The next morning he wakes up with a throbbing head and the Stones’ ‘I’m Free’ in his ears.
He sits up so suddenly that the sharp stab of pain in his cranium robs him of his vision. By the time he gets a good look at his alarm the song is over. It is, however, definitely 9 a.m. (9:02, to be exact.) He moves slowly, keeping a close eye on the alarm clock, although he isn’t quite sure what he wants the device to do or play. Would he feel better if it suddenly started playing ‘Satisfaction’?
The clank of a saucepan in the kitchen reassures him somewhat: his head and his radio may be going wild, but Mark is behaving predictably. Greg shuffles into the kitchen — his headache precludes a quick sprint to the Medical Center — and feels his way to his seat, eyes squeezed shut against the bright morning light. A moment later a plate is slid under his nose.
“Pancakes,” Mark says unnecessarily. “Think you can eat?”
Greg squints up at him. Solicitous enquiries haven’t been part of Mark’s Tuesday morning repertoire so far. He isn’t even singing — for which Greg is duly grateful, but in sum he’s perplexed.
Mark pours two mugs of coffee and sits down opposite Greg. Pushing Greg’s mug across the table, he asks, “What are you going to do now?”
“Nurse my hangover,” Greg mumbles, playing for time. What the fuck is up?
“Think you’ll find another med school that’ll take you?”
“I’m . . . expelled?” he asks tentatively.
“That’s what you told me when you returned at 3 a.m. making a racket that would have woken the dead.”
It’s Tuesday morning and he’s still expelled! That means it’s Tuesday, March 22. He’s free! If it weren’t for his pounding skull, he’d be bopping around the kitchen like a bouncy ball. As it is, he buries his face in his hands and cries like a baby.
Mark clears his throat awkwardly, coughs a few times, and finally says, “I’m sure you’ll find a school that’ll take you. Or maybe you could try something else. Medicine was never your —“
“Yes, it is!” Greg cuts him off. “I’m a doctor. I will be a doctor.”
Mark’s expression is skeptical. “Look, if you need any help — money or assistance writing applications — I’d be happy to . . .”
“I’m fine!” Greg says. “I’m free. I’m fucking free!”
He’s leaving Ann Arbor, that much is for sure, before nightfall. There’s no way he’s risking getting into another loop here; if that happens again, it had better be somewhere new. So he packs a few belongings into a small suitcase and takes the cash that Mark offers him, assuring him that as soon as he knows where he’ll settle down, he’ll send for his remaining belongings.
“You can keep my alarm clock,” he says in parting. He never ever wants to see that particular harbinger of despair again.
On his way to the Greyhound bus station, he takes a detour past the dorms on the university campus. Lisa’s face, still bloated with sleep, lights up when she sees him. Then she spots his suitcase and it falls again.
“Going on vacation?” she asks.
“Nope, leaving altogether,” he tells her. “I got expelled.”
She leans against the doorframe. “You’re an idiot. Brilliant, but an idiot. What’ll you do now?”
“No idea,” he admits. “I thought . . . I’d say goodbye.”
“Well, goodbye then, Greg House,” Lisa says, straightening.
He takes it as a dismissal and turns to go.
“Hey!” she calls. When he looks back at her over his shoulder she says, “You’re really good at . . . what you do. You’ll be a great doctor. Don’t give up!”
“I won’t.” She seems to be waiting for some sort of return compliment, so he says, “You really suck at it. Find something where you can push paper and boss people around, and you should be fine.”
She laughs disbelievingly. “I’m going to be a doctor and I’m going to be the best. You’ll come to me begging for a job.”
“Right!” he says sarcastically.
“And when you do, I’ll actually give you one. Good luck, Greg.”
At the bus station he buys a ticket for the first bus to depart without checking the destination. He sits in the back row, grinning manically. For the first time in his life he knows where he’s going.