Testosterone

I wrote this one a long, long time ago in the medicine wards when I was only in my third year of medical school.  Years later I used excerpts from it in a talk I gave on sexual harrassment in the medical training . . .


Testosterone

Our school has immersion programs; Spanish Immersion for example, in which you get to spend a substantial amount of time in a foreign country to improve your understanding of another language as well as another culture.  Evidently, I have inadvertently signed up for the Testosterone Immersion program.

I am approaching the end of my rotation in internal medicine during which I was grouped with five guys.  That’s it, just little old me and five men.  I wish I were one of those girls that would bring out the fake gentleman – I’ve come to the conclusion that there are no real gentlemen – in all the guys.  You know, the type of woman that walks into the room, and all the guys stand up to offer her their chair, and then proceed to try to impress her by making clever remarks or finding ways to exhibit their masculinity, making themselves look like a bunch of monkeys in human clothing. I happen to be the opposite kind of girl.  I’m the type of girl that guys complement by allowing her into their males-only circle.  I actually once heard a guy say, “oh Shadow is not a woman, she’s one of us,” and then looked at me expecting expressions of gratitude, or perhaps waiting for me to prove my guy status by performing some sort of male ritual.  And so it is that for the past four weeks, I have been swimming in testosterone.

First, a little about my team.  Eddie is our senior resident, which means he’s been doing the doctor thing for over two years, and in less than another year he’ll be done.  He is of the rare species of doctor, Doctorus carious, who actually went to medical school because he wanted to take care of people. He is really funny and jokes around a lot, but never makes a joke about a patient.  I want to be like Eddie when I grow up – figuratively speaking, of course, as I’m quite a few years older than him already. 

Eddie gave us a little let-me-tell-you-how-it-works talk at the beginning of the rotation.  He believes in team work, which means we all have to stay at the hospital until every last one of us is done with their work.  It sounded like a good idea at the time.  But when I’m exhausted after fourteen hours of work, most of us are done and waiting for that last person, and Eddie is passing the time by pimping us about all the different ways a patient’s salt levels may rise, I find myself too distracted by my fantasy of shoving a couple of salt sticks up his nostrils to answer his questions correctly. 

We lost a patient once on our service with Eddie.  Lost - as opposed to found?  Lost; as in “I was walking up the stairs this morning and I found a patient on the corner of a step.  I picked him up and put him in my pocket, but he must have fallen out.  Because when I reached the top of the stairs, he was no longer in my pocket.  I lost the patient.” 

No?  I suppose more in the lines of “this patient came up to me and placed her life in my hands.  She told me it was very precious to her and asked me to take good care of it.  I did my best to hold on to it.  I gripped tight with all of my strength.  But it was like trying to hold on to water.  No matter how I squeezed my fingers together, how I cupped my hands, how gingerly I walked around making sure I wouldn’t trip, it just dripped through my fingers.  I lost my patient.” 

In medicine we learn many new words, but we also give new meaning to old words.  We lost a woman who was about my age on Eddie’s service.  Sure, she had made some mistakes in her life, in her lifestyle.  But to pay for them with her life?  Lost; as opposed to rescued; as opposed to saved. 

Every morning at rounds we had talked about her worsening condition, every morning we watched helplessly as she took a huge step towards death.  And yet I was shocked when it happened.  Patients usually don’t die in the medicine service; they die in the intensive care unit (ICU).  We cleverly sign them off to the ICU team and quickly forget about them before they have a chance to die.  That’s why it’s so rare to lose patients in medicine.  Eddie is unique in his habit of following the patients even after we sign them over to the ICU.  That’s how we felt her loss even though technically she was not in our service any more. 

Eddie was furious about her death.  Michael, the junior resident tried to pacify Eddie by reminding him that we can’t help them all.  Michael knows everything.  He is the type of doctor who spent his medical school years buried in books.  And he remembers, word for word, everything he had ever read.  He is brilliant.  It turns out however, that compassion is not taught in medical books, so he never had a chance to learn it.  I watched Eddie as he ripped Michael a new asshole for making such a cold statement.  As far as Eddie is concerned, no one in their thirties, regardless of who they are or how they live, should be allowed to die.  He is not in the business of losing patients.  You could say he’s a sore loser.  I am going to be like Eddie when I grow up.

Another junior resident in our team is Daryl.  He is short and stubby, very direct in his conversations, and can make anyone laugh despite themselves.  He himself never laughs or even smiles.  I remember distinctively meeting him and NOT thinking that he was handsome or attractive.  But it seems to me that every time he leaves our team room to go and talk to one of the nurses, he returns with a phone number.  There must be something in his wit that completely compensates for what he is lacking in his height.  He also reads a lot and knows everything, but even though he tries to paint a tough-guy picture of himself, it is a delight to watch him with patients and see that he cares about them, more than he’d ever be willing to admit.  Watching Eddie and Daryl together is like attending a two man stand up comedy act.  We just sit back and enjoy the show.

I’ve been working with Eddie, Michael, Daryl, and two other male students during this service.  It took less than four weeks to make a guy out of me.  Now I find myself scratching my crotch and belching in public, finding a connection to sex in all subjects of conversation, and every other word that comes out of my mouth is a profanity.  No, let me rephrase that last part:  Every other fucking word that comes out of my fucking mouth is a fucking profanity.  Not to mention the couple of times that I caught myself checking out the nice hooters on the nurses. 

It’s been quite a learning experience!  I’ve learned that nurses can be referred to by the size of their breasts.  Because heaven forbid we should actually try to learn their names.  For example, we have the-flat-chested-nurse taking care of bed eight, or the-nurse-with-the-nice-pair-of-jugs-on-her taking care of bed three.  One might ask about the possibility of two nurses with similar sized breasts.  How would we differentiate them?  There is no need for despair – or for the learning of names.  A secondary measure of identifying nurses is by the size of their ass.  So Ms. nice-jugs-and-round-ass can easily be differentiated from Ms. nice-jugs-but-flat-ass.  I don’t claim to be a saint in all of this myself.  I won’t deny that there’s a male nurse on our floor that turns my blood into hot lava every time he passes by.  But I simply hide it better.  You would never catch me referring to him as the-nurse-with-the-big-dick, or the-well-hung-nurse.  No, I didn’t learn his name either, but I just appropriately refer to him as the-male-nurse. I’m just grateful that they are rare a species, male nurses, otherwise I would have to find secondary measures of identifying them too. 

In defense of the nurses, I must mention that they never try to learn any of our names either.  They have a simpler strategy of identifying us; they just lump us all together – men and women, doctors and students – into one entity named “The Doctor”, or just “Doctor” for short.  On the elevator, you hear them say “which floor Doctor?” or in the hallways, “good morning Doctor.”  In the wards you hear someone ask “Who ordered this for patient B?”, and the answer is always “The Doctor.”  Apparently the individual whose name is The Doctor is known to everyone and does not need further identification.  Although I admit, I have not been initiated into the circles of nurses, so I couldn’t possibly know what other measures are used by them to identify individual doctors.  As I don’t think I’ll ever have the privilege of being admitted into the nurses’ secret society, I’m just going to have to be content with my honorary membership in the testosterone clan.

I was not very passive to these comments regarding women in the beginning of the rotation.  Let’s not forget that I have a little suppressed feminist living somewhere inside me.  So at first I tried to point out these insults to feminine identity by opening my eyes wide and gaping at the guy who had just made an offensive comment.  The gaping eye trick didn’t work.  I had forgotten that men were blind to any form of body language used by women, unless it comes in the form of an invitation to have sex, in which case it is promptly recognized and acted upon.  

After the failure of facial expressions, I tried to make intellectual comments that would suggest the language used was offensive to women.  In this case I was laughed at and made to admit reluctantly that I was indeed one of the guys and not really offended by these comments – which in all truth I really wasn’t offended, but was just trying to do the politically correct thing.  I knew these guys well enough to know that they were all good, harmless guys, perfectly capable of working with women and respecting them as peers.  After all, they worked well with me as their equal. I understood their desire to come across as strong macho men when put together in a group like ours.  This pattern of behavior is analyzed in TV specials on Animal Planet where a group of male baboons are put together and then observed for the actions that establishes one of them as the prominent male in the pack.  I guess these guys were each trying to establish themselves as the prominent male in our pack.  Our very own Animal Planet special! 

My attempts at curbing these comments were finally put to rest one day when in response to the above-described method of identifying nurses I protested by asking Daryl “How can you guys say these things about women?  Don’t you have sisters, or mothers?”  Poor Daryl started to say “Yes, I have a mother,” but then he was interrupted by Eddie, saying with a very thoughtful and serious face “That’s quite a coincidence really, because I have also had Daryl’s mother.”  After this conversation, since I spent five minutes laughing at Eddie’s response with water spewing out my mouth and nose, I decided to just go with the flow and let the conversations take their natural course.  Who knows, if I spend another year or two with these guys, I might even grow a penis.

DRE - Part 2

Part of checking in on a patient every morning, is reading the nurse's report to get the vital signs, and also to see if the nurse has left any notes.  One day the nurse had noted that she had seen some blood in Mr. Sanchez's diaper.  I was a month away from finishing all of my non-psychiatric rotations.  Somehow I had hoped that I'd make it through this month without having to do any DREs.  Naturally, when I saw the note, I thought "oh no, here we go again."

I decided to check with my senior resident first before I ran and stuck my finger up some one's bottom.  He reassured me that some sort of a test was done on the patient's rectum a couple of days before, and it must just be some irritation from that.  I was relieved; until I saw the note again the next day; and then again the day after that.  Reluctantly my senior consented  to my doing a rectal exam on the patient.  In the hospital, if there isn't an obvious problem, you don't want to go looking for one, so I understood his reluctance.

I was worried; how was I going to talk the grumpiest patient in the whole hospital to consent to a rectal exam?  In all honesty, I was hoping he'd refuse it anyway.  It turned out that he was quite compliant with me, probably because I had been nice to him, and he had eased up with me.  I found myself repeatedly telling him that he doesn't have to consent to it if he doesn't want to, but he told me to go ahead.

There are moments in one's life that always stay vivid in one's memory.  I remember with distinction how I was looking up at the rail on the curtains as I was closing them to give Mr. Sanchez some privacy, and at the same time bitterly thinking to myself "how may fucking asses do I have to stick my finger in before I can be a psychiatrist!"  I took my anger out on the curtains, and by the time I turned back to my patient, I was the same compassionate doctor I had been before.

I told him to get on his side.  I looked at the poor man's bottom that was now all sagging skin, showing evidence of some long gone muscle mass and fat.  I approached the skin gently and began moving the two sides apart.  To my utter horror, the second I put the slightest pressure on his bottom, a large amount of blood squirted out of his rectum!

By this time in my training, I knew enough about bed-side manners to know that it's never good for a patient if the doctor, in the middle of the physical exam jumps three feet back screaming "OH MY GOD THIS CAN'T BE GOOD!"  Unfortunately, I was already half way through the air in my three foot jump before I remembered this fact, but just in time to stifle out the scream.

My brain immediately kicked into overdrive.  This kind of bleeding, over at least three days, couldn't be compatible with  life, or at best the patient should have been comatose; yet miraculously I had just spoken to the patient.  I stole a look at him to make sure, and yes, he was very much still alive.  Furthermore, he was alert enough to converse with me and give consent for the exam.  I came to the absurd conclusion that I must have seen it wrong, since I could not explain the situation in any other way.

I decided to check him again, hoping with all my might that I had made a terrible mistake.  Maybe I was just tired and was hallucinating.  I approached him as one would approach a dead lion, fearing at any moment for the lion to spring up and attack.  This time I was even more gentle, but alas, the moment I put any pressure on his bottom, more blood shot out.  No way I was doing a DRE on this guy!  I couldn't even get near the rectum, and the little strip I had with me that verifies presence of blood in fecal matter now looked downright ridiculous.

I found my senior resident and told him.  By the look of horror on my face, he could tell it was serious and he told me to page the Gastrointestinal (GI) team right away.  I paged them, but the disadvantage of talking to a guy on the phone was that he was not getting the gravity of the situation.  He told me someone was using his scope (an instrument to look into the rectum), and he'll be up as soon as the scope is ready for use.  I told him there was no way he could scope the patient, I pleaded with him to just go and take a look, but he refused to go without his scope.

Approximately two hours later I ran into the GI guy in the hallway, he had just come out of examining my patient, and frankly, he looked a bit pale.  He told me he could not scope the patient.  This was a great "I told you so" moment for me, but given the fact that I hadn't even believed my own eyes at the first sight, I let it go, and instead just gave him a blank stare which clearly asked "now what?"

After that, it seemed like every single department in  the hospital was consulted on Mr. Sanchez.  Turned out he had a rare reaction to one of the medications we had given him, and he was bleeding out of his guts.  He was too sick for any kind of surgery, so the only thing we could do for him was to put him on "bowel rest," meaning no food or water by mouth, and hope he'd get better on his own.  Poor Mr. Sanchez, he'd lost everything, and now he'd lost the simple privilege to eat and drink.

The days went by and miraculously his body healed itself.  His bleeding stopped.  He looked more and more healthy every day.  At some point, we began trials of feeding him and he tolerated well.  Every day I would visit him in the same sing-song, teasing, joking way, and now he was smiling at me openly.  In a couple of weeks, he went from being one step away from the grave, to being healthy enough for us to discharge him to a skilled nursing facility (SNF).

One day about a week after he was gone, I ran into one of the surgery interns that was involved in his care.  She asked me what had happened to Mr. Sanchez, and I told her with pride about his recovery and the discharge.  She responded with

"I knew it! He was too old and too sick to die."

I had gone to medical school with this intern and had always envied the elegance with which she could express herself.  The irony of her statement was understandable.  We had lost so many young and vibrant patients who came in for something as simple as a stomach ache and left in a coffin, that her statement made perfect sense.

I spent that morning contemplating what she had said, and simultaneously basking in the glory of medicine for our ability to have saved such a sick patient.  The glory didn't last long.  On the very same day, while we were doing our table rounds, which is when the entire group meets with the attending physician and we review every patient with the attending before actually going out as a group and seeing everyone, a nurse walked in.  The nurse asked my attending when he was going to sign Mr. Sanchez's death certificate.

I was so distraught I screamed.  My attending explained to me that Mr. Sanchez  had died of unknown reasons on his third day at the SNF.  The doctor at the SNF was refusing to sign his death certificate, and that was why they were asking my attending to do it.  I was furious.  I was also certain that he would refuse to sign the death certificate.  My attending gently explained to me that Mr. Sanchez had no one in his life.  Not a single person had come to the hospital to visit him, none had come to claim his body, and now no one was going to sign his death certificate.  My attending told me signing that paper was the least he could do for the human being who was once our patient.  To this day, I have the utmost respect for that attending.

What had made Mr. Sanchez hold on to dear life through all those days, only to give up on it at the SNF will be a mystery to me.  I took his loss personally and it was some time before I was able to accept it.  Ironically, the one DRE that stands out most in my memory, is the one that I actually never performed!

DRE - Part 1

Digital Rectal Exam; a fancy name for the act of sticking your index finger - preferably gloved - as far up a patient's rectum as it goes and feeling your way around in there.  It serves three purposes.  First, in men, it allows you to check the prostate and make sure it feels all nice and smooth, indicating it's healthy.  Second, it allows you to check for any polyps or masses that may be lurking there.  Last, but not least, it is a way of checking to see if there is blood in the stool.  Once you take your "digit" out, it is covered with fecal material that you spread on a strip which changes color in the presence of blood; obviously, you're hoping for no color change as you do this. 

Quite useful it is, the DRE.  I despised doing it.  I've always been about establishing rapport with a patient and helping them feel comfortable, so they would feel at ease while talking to me.  Somehow the rapport changes once you've stuck your finger up someone's ass.  The DRE is, however, a right of passage for everyone who is on the journey to call themselves a doctor.  We had a classmate named Taylor McArthy whose team somehow convinced him to do two DRE exams on the same patient within a matter of hours on the same day.  I don't think that was fair to the patient, but for the rest of med school, Taylor was known to us all as Taylor Double Rectal McArthy.

Obviously, this is an exam that we performed quite often and I have lost count of all the rectums that my fingers have met, but there is one that stands out above all else, and remains etched in my memory.  This was the case of Mr. Sanchez.

Mr. Sanchez was what we refer to in our professional language as "a train wreck."  He was in his early 60's but looked more like he was in his late 90's.  He was skin and bones, and there was something wrong with every organ in his body, except for his gastro-intestinal system.  He had been a long time heroin user, and the fact that he wasn't getting any heroin in the hospital made him quite nasty and grumpy. 

During residency we switched or 'rotated' departments every month.  In each rotation, we would be assigned to a group with one senior resident (2nd year or above), two or three interns (1st year residents), and two or three medical students.  The patients which belonged to the group prior to us would all be transferred under our care.

I inherited Mr. Sanchez when I started one of my internal medicine rotations during my internship year.  I was warned that he was going to be a tough case.  Usually we covered patients with medical students, who helped out, but this one was too complicated to assign to a medical student, so I had him all to myself.

I'm a big believer in involving the family in the patient's care.  It was not easy for me to find any of his family members.  He had some contacts listed, and I called them all; sisters, brothers, cousins, aunts and uncles.  None of then wanted anything to have to do with him.  His long history of drug abuse had alienated him from his entire family.  They explained to me that they were at the end of their ropes, and at this point were hoping he would die so his suffering would end.  I didn't judge the family.  I can only imagine how hard it must be to deal with a loved one's addiction.

I did feel sorry for Mr. Sanchez.  He didn't have a friend in the world, and the nurses and all the other doctors hated him because he was so grumpy and yelled at everyone (when he could muster up the energy).  I made it a point to be nice to him.  Every morning when I visited him I was super cheerful and joked around with him. He would try to be his grumpy self with me, but a couple of times I got a smile out of him.  When I did, I would call him out on it and tell him he's not as mean as he tries to make himself out to be.  He would yell and tell me to get out of his room, and I would skip out laughing and telling him I saw him smile.  In a few days he opened up more to me.  Now I'm not saying I performed any miracles, it's just that he didn't yell at me, actually complied with my physical exam every morning, and answered my questions, his smiles became more frequent too.

Christmas

‘twas the night before Christmas, and all through the house, not a creature was stirring. That is, except for me.  I lay on my bed as tears rolled down the sides of my face.  This was a quiet kind of crying.  Not the kind that craves a shoulder, or could be soothed by friends, or should be kissed away.  I was not particularly feeling sad, or lonely.  There was no self pity in these tears.  The pillow that had on so many occasions dutifully collected my tears of grief, on this night before Christmas, was fulfilling its duties for another reason altogether.  On this night, the tears were for the sake of old man Hansen.

Old men are not all the same, but they mainly come in one of three different flavors.  The first flavor, thankfully the rarest, is the all-bitter type.  These are the men that yell at you on the subway for speaking on your cell phone, or corner you in a library and harass you for not sitting properly at the table.  These men must have lived a long life full of disappointments and loss, are angry, and have vowed to make everyone they run into pay for it.  Naturally, these men live to be about five thousand years old to maximize the time they can torment others.  They are beyond reach. 

The second flavor is most favored in old movies.  These are the bitter-sweet men.  You know the story-line; lonely man, snaps at everyone and everything in sight, and walks around with the map of Los Angeles engraved in the form of frowns on his forehead.  Then by some odd chance this man runs into a cute little girl with curly blond hair, and due to some crazy circumstances they must live together in a place isolated from the rest of the world.  After two hours of  boring you to death, the man finally smiles and gives the child a nice hug while tears of joy stream down both of their faces.  These men are more common, and beneath their bitter exterior, there is really someone sweet, and reachable.

The third and commonest old-man flavor is all sweetness.  These are men who have lived a long life, have faced disappointments and grief, but also have loved and been loved.  They have reached old age with a positive attitude, have learned to take life’s ups and downs in good stride, always talk sweetly to children and have a kind smile on their faces.  They always seem to have good stories to tell, and if you keep your heart open, they can reach you. 

Mr. Hansen was all sweetness.

He was in his late sixties or early seventies, altogether too young to die.  He was admitted to our inpatient medicine service in July, transferred from another hospital.  At the other hospital he had been treated for something I forget, but something benign, like a broken toe.  However, as they had run some routine studies on him, they had found tumors everywhere.  Further studies had indicated advanced and highly spread cancer in its late stages.  Of course all they had told him was that he had some “masses” in his body and was being transferred to us for evaluation.  Poor thing, he was brought in by an ambulance, but ended up waiting on the gurney for many hours since we did not have a bed ready for him.  When we finally found him a bed, as soon as he was placed in it, the ceiling above him started collapsing.  We rolled his bed out just as big chunks of ceiling were falling onto where he had been a few seconds before.  I ended up taking his history out in the hallway while we waited for the maintenance men to fix the ceiling.  Despite all of this, he was far from angry and talked with me in high spirits.  He turned out to be a veteran of world war II, a father of three, and grandfather of many.  You’d be amazed at how much you can learn about a person if you just pull up a chair, sit next to them, and listen.

At some point in our conversation he built up enough courage to ask me about these “masses.”  No one had told him what they were.  He had his suspicions, but even as he feared the worst, he was still hopeful for the best.  I thought about pretending not to know anything and deferring his questions to the doctors, but I could tell that he really wanted to know, and was frustrated with everyone bouncing his questions off to someone else.  So I told him.  I held his hand and said that things did not look good.  That the studies had shown these “masses” were all cancer which had spread all over his body.   As I told him all this, I could see all of his hope seeping out of him, and the sweet smiling face of only a few minutes ago was replaced by a sad, terrified face.  He was silent for some time, and then the first words out of his mouth were “How Long –  How long do I have?”  For which I had no answer.

The hospital in which Mr. Hansen was staying is no ordinary hospital.  It is the type of hospital where you – the doctor or medical student – would place your orders in the state-of-the-art computer program.  Pick any order as an example; make it simple, say a blood draw.  You place your order into this geniously designed piece of software knowing that you’ll have to make twelve phone calls, meet five different executives, and get down on your knees and beg seven times before the blood is drawn.  Then comes the challenging part; making sure that the blood actually makes it to the lab before the end of the century (21^st century to be precise).  The job of a medical student working in such a hospital is wrought with peril. 

To add to the excitement, the floor on which our team room was located had a very special head nurse.  One of the routine daily duties of this nurse was to pop into our room at any hour and make life miserable for us.  She did not discriminate between the residents and the students and derived much pleasure from yelling at the whole lot of us.  Some mornings I could tell she had just flown into her office through the window, since in her eagerness to start her day by ruining ours, she would forget to stash away her broomstick and pointed hat and would run into our room still fully clothed as the wicked witch she was, waving her broomstick in the air and cackling as she worked up a storm!  Sometimes when I was the only unfortunate one in the room during her attack, I would wait until her storm was over, and then have a good cry after she was gone.  At other times, when the whole team was there, we would wait for her to leave and then laugh at her craziness.  Although we did stifle our laughs to make sure that her little spy gnomes hiding in our drawers would not report our bad behavior to her.  During our service there a couple of the medical students on our floor “dropped out” of the medical school altogether.  Or at least that’s the explanation the administration gave us.  I think that’s just a cover up story though.  The more logical explanation would be that the head nurse ate them.  She must have been made head nurse as a strategy to keep her away from patients, for the safety of the patients of course.  Once she had a field day with me over something I’d done for Mr. Hansen.

Mr. Hansen needed many studies and procedures done while he was with us.  I’m not exactly sure why since there really was not much we could do for him.  Maybe we did all those tests for our own sakes, just so we felt like we were doing something.  So that we wouldn’t feel so incompetent, so utterly impotent, in the face of death. For whatever reason, all these studies were ordered.  CAT scans, MRIs, X-rays, and any other imaging study that has been created in medicine to date.  As a general rule, studies ordered in this hospital were never actually carried out.  There was never anyone available to transport the patient to the location of the study at their given appointment time.  Later on in the service I learned to transport the patients myself, and to flip off anyone that tried to stop me.  But at that time I was still new and rather civilized, so the transportation of Mr. Hansen posed a real problem for me.

I devised a plan to overcome the hurdle of transportation by asking Mr. Hansen’s family members to take him, as I had met them all by that time and felt very comfortable with them, and they in return trusted me.  We planned everything with the family the day before.  The study was scheduled for eight in the morning, and a son was to come in at a half passed seven and take the patient down with the wheelchair I had left there the night before.  The way we schemed and plotted, all whispering and looking around, wary of listening ears, you’d think we were plotting an assassination! 

On the morning of the appointment I came in confident that my patient would receive the care that he needed with the help of his son.  Around 7:30 in the morning, as we were all working in our team room, we heard a loud screech and a sound of laughter that chilled us to the bone.  We could deduce from the sounds that the head nurse was about to claim a new sacrifice.  We waited in utter dread to find out who the intended victim was.  And she walked into our room, red in the face, breathing hard, poised for the kill. 

“Which one of you arranged the transportation of Mr. Hansen with his son?” she asked, as she scanned our horror-struck faces. 

I felt my heart sink down into my shoes, and I knew – I was on the menu as the fresh catch of the day.  She ripped me to pieces, and took her time in doing so.  She yelled and screamed, waved her arms in the air, insulted me and all my ancestors, and when she was all out of steam, she left the room and sent in her pupil witches-in-training to abuse me.  To this day, if I do a half-assed job at everything I do, it’s because she bit off the other half. 

What she had not planned on, however, was that this experience only brought me closer to Mr. Hansen and his family.  They were very concerned about the trouble they had gotten me into.  It turned out that the son had shown up in the morning, only to find the wheelchair I had left next to his father had disappeared, so he had to ask for one.  Instead of getting a wheelchair, he had received a full interrogation by the head nurse.  He had tried to cover for me, but she has her ways of making people talk.  He had finally cracked under her pressure and sold me out. 

Mr. Hansen was eventually transported for his study and many other ones, and I went with him to all of them.  During his stay, I spent time with him and his family, and made sure that his questions were answered and his needs were met.  He tried asking his famous “how long” question from all of the doctors, and never got a clear answer – there is no clear answer.  They told him that the tumor had started in his lungs and then spread to his brain, his liver, and his kidneys; that there was no hope of an operation.  That he didn’t have much time; maybe enough to get his affairs in order and say his good-byes.  They told him all this as his eight year old granddaughter was sitting next to his bed, staring at the floor and pretending to be invisible, in perfect compliance with the doctors who had pretended not to see her.  I repeatedly heard Mr. Hansen say to the doctors “Well, I’ll be happy if I make it ‘till Christmas.”

I had forgotten about Mr. Hansen.  So many different patients to see, exams to take, homework to do, assignments to finish, and hoops to jump through before you can call yourself a doctor.  But on the night before Christmas, as I lay in bed in those sleepless hours when I can no longer ignore all the emotions I had suppressed, I found myself wondering if Mr. Hansen had indeed made it ‘till Christmas.  That’s how I found my tears flowing into my pillow.  I was hoping he had made it, that’s all.