Thursday, September 28, 2006

10:43 AM

This backstory post alludes to people and events in earlier entries, most importantly:

a favor for Dr Ball
while I looked around....
it's the springtime of my life

Thanks to Namaste for the beta.

PG-13 for language

I blink as I look around. It's sunny, a splendid early fall day, a bright sun in a perfect blue sky. The trees are picking up their first glints of color. And I have the perfect view. I'm alone, on the roof of the hospital.

It's like I'm in a dream. To be precise, it's like I'm in a dream at the exquisite moment when I've realized I'm dreaming and that it's a very pleasant dream and I'd like to keep dreaming it, right before it all dissolves into wakefulness.

Once I would have been putting the finishing touch on the moment by enjoying a smoke or a cup of coffee, or even Stacey's company. But I've had to give up those pleasures, addictive as they are. Stacey's gone. Smoking's out; I could bring a cigar, I guess, but that takes too much planning. Coffee's still an option, but not for the roof; I can't carry the cup up that last flight of stairs. I need both hands for the cane and the banister.

How long has it been since I've been up here? My rehab after the ketamine treatment didn't include jaunts to the roof, and I didn't come up here when I first came back to work. And now... well, there's a meeting going on downstairs, sponsored by the Committee for Graduate Medical Education. And since I have fellows, I'm supposed to be at that meeting. But G-Med is too cheap to buy doughnuts, so what did they expect? Especially when it's such a nice day outside?

I could have just gone out to the balcony, but my leg's feeling a bit better this afternoon. So even though I'm not pretend-hiding from anyone today, I decided to come back up to the roof while I still -- while it was still relatively easy. I don't know how much longer I'll be able to do this on impulse the way I used to.

I lean against the low wall. The trees start to rustle as the breeze picks up the first of the falling leaves....

Eileen looked down at her score, considering. “Maybe we could get together sometime. I don’t know when; I don’t have my calendar with me,” she hastily added.

“I’m waiting on some stuff myself," I said. "I could call you.”

I'd told Eileen the truth when I said that. The "stuff" I was waiting on was the results of my fellowship applications -- invitations to interview -- and, indirectly, the results of everyone else's applications, to see what my work schedule would look like after it was bent, folded, spindled, and mutilated to accomodate everyone else's interviews.

It was still a little early for those invitations to be rolling in, so I wasn't thinking about them when I headed back to work the Monday after I went bowling with Eileen. When Hirsch gave me a couple of weird, knowing looks during morning rounds, I figured it was because he knew I was In For It somehow about some thing. But what? It was well past my birthday, so I was safe about that. I couldn't recall having done anything in the last day or two that would land me in trouble. Maybe he'd gotten a peek at the next rotation schedule, and knew I'd soon be inflicted on one of his friends -- or one of his enemies. Or maybe one of my enemies.

It was a busy day: lots of flu and pneumonia, and plenty of E.R. and clinic admits as all the people who thought they were well enough to go to work found out the hard way that they weren't. Soon afternoon rounds were upon us, and as I half-listened to my first-year make it through report, I realized that Hirsch was still giving me the funny look -- and now so was Barras, the other third-year; and even some second-year from another service who'd shown up for cross-coverage.

It was annoying, especially since I was still smarting a little from the disaster with Eileen, so as report ended and people started gathering their papers I discreetly shot a rubber band across the table into Barras's sternum. He looked up.

"What's up?" I demanded.

"Haven't you checked your mail, House?" he asked.

"What? How -- " I started, and fell silent with the rest of the room as Hirsch stood up. Barras smiled broadly.

Hirsch looked around the crowded conference room. "Well, before we move on here, I have some great news. It looks like some of you have already heard it, but now I can say it officially: the nominations for Chief Resident have been announced. Congratulations to our own Dr Barras --" he held up a hand to hold the applause -- "and Dr House!"

The applause started as Hirsch pompously shook Barras's hand, then mine. Some more people stuck their hands out at me; I shook them, mechanically, trying to position myself so no moron tried to slap me on the back. I glanced across the conference room to Barras. He was getting the same treatment and didn't seem to mind it at all. Maybe it was because for him, the congratulations were sincere.

He looked up at me and grinned; I forced a kind of smile and nodded back. As the room emptied, he came around the table and slapped me on the arm. "Congratulations!"

"Thanks. You too."

He was still grinning. "Doesn't seem real, does it?" He chuckled at the expression on my face. "Well, maybe it does to you; I always figured you'd be nominated." He stared around the room as if he were so bewildered with joy that he couldn't figure out what to do next. Call somebody, probably; either that or make coffee.

The phone rang, making the decision for him. Barras snatched up the receiver. "Hello? Yeah! Thanks, man.... No, I had no idea.... Well, a little.... Komeda, Rosenthal, Tanner, and Coombs...."

So that's who nominated Barras. Not too shabby.

"....Yes he did. ...That's right." He looked up at me. My stomach dropped.

"It's Patel," Barras said. "He says congratulations."

"Thanks," I muttered.

"He says thanks," Barras reported. "....Sure!" He checked his watch. "Another hour or so?"

I decided it was time to escape before Barras felt obliged to include me in his plans. I slipped out of the conference room and headed as quickly as I could for the mailboxes.

As I threaded my way through the halls, I kept getting smiles and congratulations from the other residents and even some of the attendings. Finally I made it to the mailboxes. As usual, my box was stuffed full -- I usually only checked it a couple of times a week -- but I immediately knew that the envelope on top of the stack was the one I'd come to find. It was heavy, cream-colored, with my name handwritten on the front and THE COMMITTEE FOR GRADUATE MEDICAL EDUCATION engraved on the back flap.

I tucked the rest of the mail under my arm as I opened the letter:

Dear Dr House:

The Committee for Graduate Medical Education is pleased to inform you that you have been nominated to serve a fourth year of residency in the position of Chief Resident.....

I stared at the letter.

I should have been happy to receive it. I should have been throwing the rest of my mail in the air and whooping for joy.

But I felt none. The nomination was pointless. Who did this to me, anyway?

You were nominated by faculty members Lewis L. Roderick, M.D., Neurology, and Patrick Jennings, M.D., Ph.D., Nephrology....

Damn it. They meant well, they meant it as a compliment but...

But even though it was a huge honor, I simply didn't want to be Chief Resident. It meant baby-sitting all the other residents, planning events, booking speakers, working on the schedules, mediating disputes, sitting in on disciplinary hearings -- all the administrative and supervisory crap I hated. And even if I wanted to be Chief Resident, there was no way in hell G-Med would ever offer me the position.

I could always just not apply, but... Roderick and Jennings were two of my most important references for my fellowship applications. What would they say if I blew off this compliment they'd paid me?

No, I'd have to go through with it. I'd have to go through the motions, apply and be interviewed, knowing the whole time that it was nothing but a big waste of time -- and knowing that everyone else knew it was a big waste of time. Great.

I took the rest of the mail out from under my arm. The next item was also from G-Med: the general announcement, including a complete list of all the nominees. I scanned the list, frowned, and checked the pocket of my lab coat. Satisfied, I stuck the letter in my other pocket, jammed the announcement back in my box with the rest of the mail, and went to go find someplace to think.

January wasn't the most pleasant time for a smoke on the roof, and when I got up there it was almost dark. So I did what all the other smokers did in the winter and set up in the vestibule at the top of the stairs, propping the door for ventilation and an escape route. Some thoughtful person had even dragged an old chair up there. I pulled the letter, a book of matches, and my single cigarette out of my pockets, and settled in to read and think. Maybe I could just "forget" to turn in the application....

A door slammed, down on the next landing. I sat up to listen. Two men's voices: one speaking, one laughing. I couldn't make out what they were saying because of the echoes, but their voices didn't sound like nurses or orderlies and weren't weary enough to belong to residents. Footsteps, climbing up the stairs, with the flat footfall of dress shoes.... Oh, shit. Attendings.

They were getting closer. I quietly stood up and slipped out onto the roof, gently closing the door behind me and leaving it open a crack, blocking it so it wouldn't close in the wind and lock me out. I stepped away from the door and around the corner of the vestibule, out of the wind. Hopefully they wouldn't be jerks and pull the door shut.

They didn't. Instead, one of them decided to be an even bigger jerk and open the door again. "Anyone out there?" he called.

"Oh, just leave it," one of them said from inside. "Come back in and close the damn door, it's cold out."

"Hang on," said the first guy. "Smell that? Someone's out here, let me just see...." His voice grew louder as he came around the side of the vestibule. "Well, look who's here!" It was Ogilvie.

"I was wondering who'd be out in this kind of weather. Partying it up with your friends?" He looked down at my smoke. "Give me one of those, will you?"

"Sorry. My last one." It was the truth; I never carried more than one for precisely this reason.

"Liar," he said. "Don't worry, I won't stay long. I've got enough sense to come in out of the cold. Of course, I've got someplace to go," he sneered. "So: nominated for Chief Resident! Bet you never thought you'd live to see the day, especially considering how you started off here."

I took another drag on my cigarette and stared straight ahead, refusing to take the bait.

"But you've made it all the way up to now without getting thrown out...."

"I've still got five months to go."

"...and you even managed to impress Jennings and Roderick enough for them to throw their nominations away on you. You've done well for yourself, House."

I didn't say anything, but I wondered how Ogilvie knew who nominated me. That information was confidential, so I hadn't thought it would hit the grapevine quite that quickly.

"But what about your pal Foghorn Leghorn?" Ogilvie asked maliciously. "He didn't come through for you? Oh, too bad. I bet he even gave you the talk."

I kept silent, but gave him a quick look, pretending not to understand.

"No? I'm surprised," he said. I made a mental note to get him in a poker game the minute residency was officially over. "Apparently, every so often he invites some resident over for a mint julep on the veranda and a long chat. It's usually one of his pets, but sometimes it's one of the problem children. If you weren't on his pet list, I thought for sure you'd be on his shit list.

"It makes sense that he wouldn't recruit you. There was a lot of controversy about whether or not even to admit you, and Ball was in the 'no' corner. So was I. But G-Med voted to let you in, and here you are."

I'd heard enough, so I walked across the roof to the low wall at the edge. But Ogilvie was persistent as pinworms. He followed me over and stood by my left elbow, looking out over the wall at the panorama of the college town.

"There it is," he said, "the whole world spread out before you. You're smart, you're just starting your career, you've got the world at your feet.... and there's still only two faculty members who can stand the thought of seeing your face for a fourth year. You've been nominated for Chief Resident, yet you know you haven't got a prayer of actually getting the offer.

"You're in a real pickle, aren't you? It's a waste of your time to apply; I think you know that, even as conceited as you are. G-Med will never offer you a slot.

"But you still have to do it. You're going to have to send in the papers and sit in that interview and pretend that you can't tell that they can't wait to get you out of there. If you don't, it's going to look terrible. You've got fellowship applications out, you've got to show that you take opportunities and you're striving for excellence and all that future-doctors-of-America crap. And most of all, you can't take the tiniest chance of ticking off the guys who nominated you, because they're also your references, and they're the only ones you've got. So you're going to have to go through with it."

"Thanks for caring enough to point all this out," I said sourly.

"Oh, I don't care one way or the other. I don't even care if you stay. As of July 1, I'm out of here. Anesthesia," he bragged. "Starting a fellowship downstairs. So do what you want, as long as you stay out of my PACU.

"I just saw you out here and wanted to congratulate you. Only you could be so screwed up that a CR nomination's a trap instead of an honor."

"Aren't your shoes getting wet?" I asked.

"Roof's been clear for days, but thanks for asking," he said.

The door opened. "Hey! Are you coming?"

"Yeah, hang on," Ogilvie shouted over his shoulder. He turned back to me. "Well, enjoy your nomination, House. Take as long as you like. Don't worry, I'll leave the door open."

He walked back across the roof and rapped on the door. As the door opened, I could hear his friend complaining: "Jesus, Stan, what took you so long?" To my relief, I didn't hear the door slam shut again; Ogilvie must have kept his promise and propped it open. I gave them another minute or two to clear out of there before I went back inside.

How long ago that was. And now I'm a department head with three fellows (of whom one was himself a Chief Resident, as he loves to remind us.) I even have my own conference room, with a coffee pot, plenty of chairs, and a carpet stained with my own blood.

The trees quiver, and another couple of dried leaves skitter across the top of the wall. I check my watch and decide I'd better get back before my leg stiffens up. I take my cane and head for the door, back down to my little kingdom.


Anonymous Armchair Elvis said...

Love this.

September 28, 2006 6:47 PM  
Anonymous Benj said...

Beautiful - love the parallel rooftops, the landscaping in this fic is pretty damn breathtaking at times and always so sublte. Love the 'Foreman' forerunners - wonderful stuff.



September 28, 2006 8:00 PM  
Anonymous Auditrix said...

Thanks, AE and Benj. :)

Sometimes it seems like the only scenes in this fic that don't take place on the roof are the scenes that take place at a dinner table.

September 29, 2006 9:08 AM  
Anonymous maineac said...

"As persistent as pinworms" made me laugh out loud.

I just love reading this 'blog' and the slowly unfolding backstory. It's like a life lived in reverse. It's really a unique piece of writing.

September 29, 2006 6:27 PM  
Anonymous Dr. Aylesman said...

Hey, House. Check THIS out. Remind you of anyone you know?

October 01, 2006 2:26 PM  
Anonymous Auditrix said...

So did it work for you, Dr Aylesman?

October 04, 2006 3:54 PM  
Anonymous Dr. Aylesman said...

Hey, I don't have a problem. I can stop being an asshole anytime I want to. I just don't want to.

And besides, I'm just a social asshole. It's not like it interferes with work or my marriage or anything.

October 06, 2006 10:22 AM  

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