Friday, April 29, 2005

8:22 PM

PG-13 for language

Well, I’m sure you are all relieved to hear that I’ve successfully renewed my ACLS credential. So once again: for intubating manikins, I am your go-to guy.

After class I came back up to the office. Chase and Foreman were surprised – and probably a little disappointed – to see me, until I sent them home on time. After they left, I ate my cold Reuben from the caf, took a Vicodin, and sat down to finish the task I’ve been putting off for so long: Cameron’s file. I hate working late, but I hate being nagged by Cuddy even more, and, most of all, I hate being nagged by the sight of this folder on my desk.

I finish Cameron’s final evaluation and turn that night she came over into an exit interview. Stated reason for leaving: none given. I’m not going to put down that stuff about “dealing with things.” I don’t understand it myself and it gives me a sick feeling every time I try to understand it, every time I think of her standing there in my apartment, her hand stretched out…. No, that’s all I’m going to write. If Human Resources doesn’t like it, that’s too damn bad.

I click the print icon, look down to make sure there’s paper in the printer, and watch the print window pop up. The printer whirrs and spits out the first page. I lean back in my chair and fish in my pocket for a lollipop, fidgeting with the wrapper….

Grape or cherry? I couldn’t decide.

I was standing in the hospital gift shop. I’d come for an afternoon candy fix. It had been such a shitty day. It was late April, in my second year of residency; it had been pouring down rain all week; it felt warm and clammy everywhere, even inside the hospital. Even my clothes felt slightly damp.

The damp was annoying, but in a strangely comforting way: it made it easier to just give in to the hate. I’d been on Ogilvie’s service for about a month now, and I was hating it. And since work was my life, that meant I was pretty much just hating life.

For one thing, we were on General Medicine, which meant we took a lot of whatever the clinics and ER spewed out. Lots of pneumonia and flu; dehydration from various disgusting microbes; chest pain, back pain, dizziness, “nerves”… and, of course, diabetes. Everybody had diabetes. And everybody had a story, usually a false one. “I’m feeling faint.” “The pills don’t work.” “I threw my back out sneezing in the elevator.”

That was aggravating enough – didn’t matter if you threw your back out sneezing in the elevator or having fun with a hooker, wasn’t going to change the treatment (except for the VD screen.) Why did they think I cared?

Ogilvie, though…. This was my third rotation with him, and it was the worst one yet. I was doing my best to follow Dr Ball’s advice, trying harder than I’d ever tried before, and all I was getting for it was crap. If I offered my opinion, I was in trouble. If I kept my mouth shut, I was in trouble. Morning rounds were a test of endurance, every day, as Ogilvie sipped his coffee and leaned on the chart rack. “So what’s your opinion, Dr House? What do you mean, you don’t have an opinion? Of course you have an opinion.”

And as we trudged down the hall, the med students would look uneasy, and the other residents would give me sidelong looks. I wasn’t sure which ones were worse: the looks of triumph (yeah, take that, he got you good, House) or of commiseration (yeah, he’s a jerk, pity we can’t stick up for you or anything like that.)

Only three more weeks to go, and then we’d switch rotations and I’d get to do it all over again, no doubt with a new layer of calumny in my file, courtesy of Ogilvie.

I sighed. One of the worst parts of this rotation was that it was harder than ever to leave work behind. Whether it was going home for the night or stealing twenty minutes for a candy break, it didn’t matter; work came along with me, I could never get my mind to put it aside for a while.

Which made it difficult to concentrate on other matters. Such as Tootsie Pops. I realized I was still standing in the gift shop, staring at the box on the shelf. Grape or cherry?

The gift shop lady was giving me a curious look. Great. Already decompensating and it was only Monday. I chose cherry and started moving on to the chocolates: another overwhelming choice….

“Dr House?”

I started a little and swung around. It was Dr Ball.

“It’s good to see you,” he said. “How are you doing?”

“I’m doing… I’m doing fine. And, uh, and you?”

“Very well, thank you. And you’re doing… fine?” He raised his eyebrows and peered at me over his eyeglasses.

“Yeah,” I said lamely. He headed over to the register; I grabbed my candy and a Coke and followed him over.

He put his Tab on the counter. “’Doing fine.’ Well, I’m glad to hear that.” He handed his bill to the gift shop lady and turned back to me. “Do you have a minute? Let’s walk and talk.” He thanked the lady as she gave him his change, and took a step back towards the door. I plunked my stuff on the counter. The gift shop lady nodded towards Dr Ball; he nodded towards the door, and at last I realized he’d paid for my snack.

“Thanks,” I said, and followed him out.

The lobby was crowded, noisy and wet. Unruffled, Dr Ball slipped through the jostling mob into a quiet, little-used corridor.

He paused, opened his Tab and took a sip, and strolled down the hall. I had to work to slow my pace to match his.

“How’s Dr Ogilvie’s service treating you?” he asked.

I opened my own drink. “Well enough,” I muttered.

“Well enough? Your standards must not be very high, then. You look… fatigued.”

“I thought looking fatigued was part of the job requirement,” I snarled.

Dr Ball lifted his eyebrows.

“Sorry. I… it’s been a long call....”

His eyebrows went up even further. “Have they already changed the current schedule since it went up this morning?” he asked. “I don’t remember seeing your name on the list; perhaps I need to refresh my memory. Or my copy of the list.”

Had I really just tried to lie to Dr Ball? I really was tired and stupid.

“I had to take an extra call this weekend,” I mumbled.

He gave me a long look. “It’s hard to catch up on sleep sometimes,” he observed, mildly.

He took another sip of his Tab. “How are your spirits?”

I didn’t – couldn’t – say anything. The question just staggered me, I didn’t understand why.

Dr Ball gave me another long look and stopped in front of a window. He walked over and gazed out at the heavy rain spattering the pavement and soggy flowers. “We always hear about sound mind, sound body,” he mused. “But I wonder – do we hear enough about the need for a sound spirit?

“I believe we ignore the needs of our spirits at our peril. If we neglect our spirits, we become… downcast, or worse: we become numb, stunted. We become animals – worse than animals. It’s possible to be an intelligent, successful… animal, and that is a great tragedy.

“We live in ugly times, Dr House. It’s difficult enough to care for one’s spirit. And then when you’re working so hard, putting your mind and your body to the test every day… It’s all too easy to neglect caring for the mind and the body, and unfortunately it’s even easier to neglect caring for the spirit.

“It seems to me that we do best when we choose our recreation thoughtfully, when we take care to address the needs of the spirit as well as the body and mind. It’s easy to slump in a chair and watch TV – it’s there, it doesn’t take any planning, it relaxes body and mind – but does it edify the spirit? Once again, age quod agis. If you’re going to work, work. If you’re going to play, play. And put as much thought into your play as you do into your work.

“That concert’s on Thursday, you know.”


He turned from the window. “You remember, that spring concert over at the University. The choral concert, the one our mutual acquaintance, Miss Abney, told us about.”

“Oh, yeah…. Already?” The pale green flyer was still on my kitchen table, buried under a pile of other papers.

We started back off to the elevator. “Already, indeed. Yes, the concert is this very Thursday. Remind me, Dr House; you’re not on call on Thursday, are you?”

“No, I’m not. But I’m in clinic.”

“Ah, but clinic ends at six. The concert’s at eight. Perhaps Mrs Ball and I will see you there. They’re serving cookies, you know.”

I chuckled. “I’ll do my best.”

“Excellent. I think it would do you good,” he said. He pushed the elevator button. “I suppose I would be do better to care for my body by taking the stairs. But give me a little time; I’m sure I can come up with a good rationalization by the time I reach the fifth floor. Where are you headed, Dr House? Back to the clinic, I suppose?”

I nodded wearily.

“Well, have a good evening, and remember Thursday. I hope to see you then.”

“Okay.” The elevator doors opened and Dr Ball stepped in. “Thanks, Dr Ball.” He smiled and nodded as the doors closed.

I started trudging back to the clinic, mulling over the concert as I went. Would I go? I was so tired lately, but if I stayed home I certainly wouldn’t be in bed any earlier. I had no connection to the University besides being at the hospital, no connection to the music department besides Eileen Abney -- and she was just a kid. A kid dating a bigger kid I’d worked with for a while, weeks ago. A kid I’d met exactly twice.

But the concert was open to the public, the price was right – I could get in for free, though I’d probably spring the five bucks for the ticket. It would be a nice change of pace. There would be cookies. And if I didn’t go, I would hear about it from Dr Ball.

I paused as I reached the clinic. I finished my Coke, threw out the can, and plunged in, leaving thoughts of concerts and madrigals behind.

Thursday afternoon found me in the clinic, checking my watch – and my temper, as best I could. It was the last Thursday in April, and Ogilvie was on a tear about charting. I knew there was going to be a meeting tomorrow afternoon, I knew he was going to be talking about charting, and I knew that I was guaranteed a public tongue-lashing if my charts weren’t done.

I’d been staying late every night this week to catch up, and I only had a few more left to do. After clinic I’d head upstairs to medical records, work for a while, and then go straight to the concert.

And now it was 5:50. I dropped my last chart in the basket and rubbed my hands. But before I could make even the smallest noise of triumph, the triage nurse handed me another chart.

“Oh, come on!” I whined. “Five-fifty! Patient checking out! I’m done!”

She shrugged. “We close at six. This guy came in before six. Everyone else is busy. Should be easy. Room five.”

Room five contained a guy in his sixties sitting on the exam table and squabbling with his wife about the need to be there: “I told you, Jean, it’s just a cough!”

She looked up from her seat against the wall. She looked sad. “I’m sorry if we’re wasting your time, Doctor, it’s just -- he’s had this cough for days, and he won’t take time off work, and…”

“And so you brought him in after work to the walk-in clinic. Well, that’s why we’re here, I guess. I’m Dr House.” I looked at his vitals – he was a little warm.

I did a quick exam. As he took off his shirt, I looked over at the clock. 5:55. Definitely my last patient of the day. Then a sandwich at the caf, off to sign charts, and….

I turned back to the patient. As I did, the wife caught my eye again. She was looking even more miserable.

“She’s been nagging at me all afternoon about this,” grumbled the patient. “I keep telling her, it’s nothing, and – “

“Take a deep breath,” I interrupted. I auscultated his back and his chest.

“Cough keeping you up at night?” I asked.

“No,” said the patient. “Yes,” said the wife. He glared at her.

“Your wife was right to make you come,” I said, stuffing my stethoscope back in my pocket. “You have bronchitis, and I think you’re working on a side of pneumonia.” I pulled out my prescription pad. “Stay home from work tomorrow. Get plenty of rest and drink plenty of water. I’m writing for a cough suppressant so you can get some sleep, an inhaler to help the wheezing, and an antibiotic for whatever you’re trying to grow in there. You can put your shirt on now, we’re done. Call if you have any trouble. You should see an improvement in a couple of days.”

He got a hesitant look on his face. Oh, no, here it comes, I thought – double-dipping on the clinic visit....

“My wife – her indigestion – “

“Don’t bother the doctor,” she said irritably. “The clinic’s closed now, and we need to get to the pharmacy.” She stood to leave. I looked closely – had she swayed a little?

“We can ask a nurse to call in the scrips for you,” I said. “Mrs…”

“Prochaska,” supplied the patient.

“Mrs Prochaska, are you feeling all right?”

“I just stood up a little quickly, that’s all,” she said.

She didn’t look good. The patient slid off the table and I guided the wife over. I pulled over the pulse ox, clipped it on her finger, and frowned when I saw the results.

“What’s wrong?” said the patient – the original one.

“Help her get her blouse off,” I grunted. “I’ll be right back.”

I stuck my head out into the hall and yelled for a nurse. “EKG, nitro, Maalox, crash cart. I think I’ve got an MI in here.”

A few minutes later, I was staring at the EKG. Sure enough, she was having a heart attack. I gave a few orders to get her started and headed out to the desk to call for a bed.

Suddenly the nurse was calling me back in the room -- her heart rhythm was deteriorating. We called the code a couple of minutes later.

We started a couple of drips, finally got her stabilized, and got her upstairs to the coronary care unit. I gave report to the CCU fellow. As I finished, he got up and crossed the room. I was rubbing my face with my hands when he sat back down.

He shoved a cup of coffee at me. “Good save,” he said. “Tell me, why are the MI patients coming in through the clinic and the ER is filled with little old people coming for their weekly enemas?”

I shrugged. “Why are they coming in with only ten minutes to spare, and on their husband’s dime?”

“You thought you were out the door, and then… she crumped.” The fellow grinned sympathetically. “Bet that sucked.”

“Yeah… yeah, it did.” I stretched and looked up at the clock. It was 7:50. “Oh, shit!”

He glanced up at the clock. “Oh, did you have plans?”

I clambered up from the chair. “I sure did. I…” I had to chart. I had to. I sighed in disgust. “I gotta go. Thanks.”

I wandered out of the CCU, avoiding Mrs What’s-her-name’s room. The concert was at eight – no way was I going to get there on time. And I still hadn’t charted. I hadn’t even eaten.

I had to go chart. I started towards Medical Records when I remembered that all my stuff was still down in the clinic. I sighed, turned back, and headed off.

I banged on the door of the clinic and finally got a housekeeper to let me in. My jacket was gone. Great. I stomped out and stood in front of the clinic, trying to figure out what to do next.


I looked up. It was the guard at the desk.

“You Dr. House?”


“Wanda told me to hold this for you.” Wanda was the clinic desk clerk. He rummaged behind the desk and produced my jacket.


I stood in the hall and thought. I had my jacket. I was closer to my car than I was to Medical Records.

Screw it. I was going. I’d just come back and chart later.

By the time I got to the main campus, found a parking spot, and made my way back to the concert hall, it was past eight-thirty. An usher kid slipped me into a seat in the very back. She looked at me curiously; as I sat down, I realized I was still wearing my white coat. Great. She probably thought I was somebody’s grandpa.

It was warm, it was dark, the choir was singing, and all of a sudden I was jolted awake by the applause. A small group was forming on the stage. I looked at the program: the promised madrigals were coming.

As the harmonies unwound, I could feel my brain unwinding with them. My fingers started to tingle a little as my trapezius muscles started to relax.

The next group assembled. I looked at the stage, and double-checked the program: this was Eileen’s group. A few more madrigals, in French and English. I listened carefully and tried to pick out Eileen’s voice, though it was difficult sometimes with the tight, complex harmonies.

The choir re-formed to accompany a couple of soloists, and then the house lights were coming up for intermission. I stood up and saw Dr and Mrs Ball across the backs of the seats. It looked like Dr Ball was talking to someone -- it occurred to me that he might be talking to David Kopp. I shrugged off my white coat and slunk out in a hurry.

I was able to get back to my seat without being spotted, and just to be on the safe side, I moved further into a dark nook in the back row, away from the main aisle. I slouched down and hid behind the program.

The house lights came down and the choir filed on stage. They sang some pop and folk selections, and then rearranged themselves again. I looked down at the program. We were getting ready for the last section: all Rogers and Hart. I read ahead: Choir, small group, selected soloists… and there was Eileen’s name. She’d landed her solo.

The choir led off with “Blue Moon” The small group picked up with “I Could Write a Book,” and then came the soloists: “The Lady is a Tramp,” “You are Too Beautiful,” “I Wish I Were in Love Again…”

The key changed and Eileen stepped forward:

Men are not a new sensation;
I've done pretty well, I think.
But this half-pint imitation
Put me on the blink…

I'm wild again
Beguiled again
A simpering, whimpering child again
Bewitched, bothered and bewildered am I.…

A few more solos, a duet (“Give Her a Kiss”) and then the choir came back together again….

And the concert was over. The choir sang the alma mater; the applause started; the choir filed off stage.

The director stepped forward and started saying something about senior recognition and special encores by the seniors; I didn’t feel like staying for that and my charts were starting to weigh on my mind again. I gathered my things, crept toward the back door and slipped out.

There were tables set up in the lobby, and some of the choir members, still in their long dresses and black tie, were bringing out trays of cookies and bowls of punch. I was suddenly very conscious of my rumpled clothes and scruffy face. I hurried to a side door and slipped out into a long, half-lit hallway. I stopped for a moment to put on my jacket, gathered the rest of my stuff, and headed off to the exit at the other end.

I heard the door open behind me. “Dr House?”

I turned. Eileen was standing in the doorway.

Her face lit up. “I thought I saw you!” She stepped forward, closing the door behind her. “You really came?”

I looked at my shoes, looked up at her, and shrugged. “Yeah.”

“Wow. I… Thank you. Thank you for coming. I hope – did you like it?”

She seemed so surprised and grateful. I found myself smiling. “I did. I liked it very much. And congratulations on your solo -- you sounded terrific.”

She looked away for a moment as she started to blush. “Would you like to stay for the reception? We’re having cookies and punch….”

I shook my head. “No, I… I have to get back.”

“Back? This late?”

“Yeah, I have some stuff to finish up.” She looked aghast. “Nothing much,” I added.

“That’s good.” She hesitated for a moment, and quickly stepped forward. She stuck out her hand, offering me a little bundle wrapped in a paper napkin. “I hope you’ll have some cookies anyway?”

I took the bundle and peeked inside the napkin: three sugar cookies. My stomach growled.

I looked back up at Eileen. “Thanks.”

She smiled again. “Thanks again for coming. It was so nice of you to come.”

“It was a great concert.” I wrapped the cookies back up and started to turn towards the door. “Well, um… good night.”

“Good night, Dr House.”

I trudged down the hallway to the exit. I opened the door, but before I stepped out, I looked back over my shoulder. At the other end of the hall, I saw the door being quickly pulled shut. I sighed and stepped out into the night.

I started on the first cookie as I walked to my car. Dr Ball had been right to make me go – that had been such a nice break, to get out of my apartment and hear some good music. It had been a good concert. The reception, though… should I have stayed? No, I needed to get back. And it would have been so awkward – all those kids, all those girls in their long dresses; drinking punch and eating cookies with Dr and Mrs Ball, and Eileen, and David Kopp.

I ate the second cookie in Medical Records as I slogged through my charts – counter-signing my telephone orders, my notes and summaries, dotting my i’s and crossing my t’s, madrigals singing in my head as I worked.

I finished every last one. At last I grabbed the last pile and carted them off to Betty, the evening clerk. “Thank you, Dr House, thank you,” she clucked. I watched her as she signed them in, one at a time, putting them on the cart. When she was done, she pushed the cart over to the shelves where they’d await the next doctor’s signatures. One by one, she started stuffing them onto an overflowing shelf. Finally she gave up and stuck them on a new shelf. When she’d finished, she used masking tape and a Sharpie to label the new overflow shelf: OGILVIE. I threw down her pen and got out of Medical Records as quickly as I could.

As I strode back out to my car, I tried to keep myself from fuming over Ogilvie’s nagging us about charting when he was so far behind himself; all it would do would get me too angry and frustrated to sleep. And for once it was easy; my head was full of music, my mind still in the concert hall.

I ate the third cookie in my car, after I’d had a smoke, before I pulled out of my parking spot. When I’d finished, I started to stick the wadded-up paper napkin back in my pocket, but instead I stared at it for a minute, thinking of the half-lit corridor, of the paper napkin when it was full of cookies, when it was in Eileen Abney’s hand as she offered it to me. Maybe I would stay next time.

Finally I stuck the napkin in my pocket, put the car in gear, and started for home.

I was at a stoplight a few blocks from my apartment when it occurred to me that there might not be a next time: if Eileen broke up with David Kopp over the summer, I would probably never see her again.

Suddenly I didn’t want to think about the concert any more.

I open my eyes and realize that the print job is finished, and probably has been finished for a while. I straighten the papers and reassemble Cameron’s file. It’s too late to run it by Human Resources tonight; I’ll have to do it Monday: my final farewell to Dr. Cameron.

I lock her file in my desk drawer, put the rest of my stuff away, and shut down the computer. I take a deep breath – I’m stiff from sitting all day -- and push myself to my feet. I pause in the doorway, looking back at the desk, before I finally turn out the lights and lock the door behind me.

You can hear a clip of Ella Fitzgerald singing “Bewitched, Bothered, and Bewildered” on My Funny Valentine: The Rodgers and Hart Songbook at


Blogger Sanlin said...

Good on ya, Doc. :-) Hey, if I ever need someone to call a code and summon a crash cart, yours will be the first name on my turning-blue-lips, Doc. ;-)

You know how you once told a clinic patient that your conversation would take twice as long if she repeated everything you said? I'm beginning to think a lot of life is set up that way. Example: Wilson gets sent packing by Vogler, packs up his office, gets reinstated and unpacks his office. What a lot of work, fuss and trouble to get back to where things were before (more or less, because nothing is ever quite as neat after a mess ;-) ). Now, Cameron leaves, you do the paperwork and close up her file... Well, I'm not the kind of person to spoil a good story by giving away the ending. That's where my observations about "the more things change, the more they stay the same" ends, for now. ;-)

On to madrigals... I'm having flashbacks from University about *your* flashbacks. LOL Not that I ever had a noxious, jealous jerk and patent hypocrite like Ogilvie breathing down my neck. My profs were all pretty cool, actually. But, feeling done under and needing a break? Yeah, I hear you, on that one.

It seems like Eileen always has a very sensible instinct to feed that raging sweet tooth of yours, Doc. How odd that Cameron should also possess miraculous sugar-divining/locating abilities. ;-) One of your unspoken talents seems to be attracting 'sweet young things,' so to speak. ;-)

Ahh... Dr. Ball. "It’s possible to be an intelligent, successful… animal, and that is a great tragedy." Have I mentioned, recently, how much I respect that guy? ;-) Having someone to watch your back is *good.* Having someone to feed your spirit and sustain your heart is *better.*

That was an excellent catch on Mrs. Prochaska. You always stay focused on the well-being of your patients, no matter what else is going on around you. That's a great--and lifesaving--quality. :-)

"Bewitched, bothered and bewildered..." Oh, haven't a lot of us been *there.* ;-)

Since I'm just full of pat phrases, today, the one I'll leave you with is: "It's not over till it's over."


May 02, 2005 9:25 PM  

Post a Comment

<< Home