As the days grew shorter and the winter holidays approached, I increasingly found myself thinking of Benny. It usually happened in small moments—waiting for an elevator, making a selection at a vending machine—when I had a few seconds to process just how differently the passage of time was affecting us. Through sheer repetition, I was becoming a more competent doctor. Inserting the large IV successfully had earned me a well-timed boost of confidence, as well as a public commendation from Dave at the next intern report. And the young woman’s bladder had not been punctured; the fluid wasn’t urine but abdominal fluid, coming from around the muscles. After that I placed four more large IVs in quick succession. With each one I burned off a bit more of the cloud that had hovered over me in the fall. I grew better at making diagnoses, more comfortable using an ophthalmoscope, and more relaxed interacting with patients. I knew I was still under a microscope, but I was no longer subjected to one-on-one meetings about my mental health. I could just show up for work and do my job.
But the changing of the calendar brought nothing for Benny. There was no silver lining to his interminable stay in the hospital. He simply waited day after day after day for a heart that might not ever come. Some days he moved up on the wait list, on others he slid down. The pogo sticking was inevitable, and Benny said he was at peace with the process. But I wasn’t. There were many things to complain about in our healthcare system—the inefficiency, the barbaric hours, the waste—but his plight was gradually consuming my thoughts. Why were we doing this to him? It seemed like he was stuck in an absurdist play.
If there was one constant in our chaotic hospital, it was Benny. His name evoked one of a handful of mental images from the rotating cast of providers who cared for him: reading under fluorescent lighting, jotting in a journal, using lightweight silverware, being prodded and poked like a fledgling fire. Graciously allowing doctors, nurses, and medical students to interrupt whatever he was doing to check his vital signs, listen to his lungs, or peer into his mouth. I had often joked with Benny that while I felt like I lived in the hospital, he actually did. But by December the jokes had faded and we found ourselves talking mostly about faith and hope, formulating strategies for coping with an endless hospital stay, talking about how things might be different one day.
Our roads were diverging, and the metaphor I’d created for our simultaneous journey was breaking down. One evening in late December, when I wanted nothing more than to be home with my family, I took a break from my work and popped in to see a man whom I presumed felt the same way.
“Mr. Santos,” I said as I stepped into his room. Magazines and journal entries were once again scattered across his bed, and a pair of headphones was resting above a stack of CDs on his nightstand. We never dwelled on his writings, but I knew he was documenting his interminable hospital stay. I often thought of how his meticulous penmanship stood in such contrast to the presumably messy subject matter. Several medications were dripping into his arm through a large IV that was attached to a metal pole as he watched a Knicks game.
“Come in, come in,” he said, waving me toward the distressed leather chair in the corner of the room.
“What’s new?” I asked.
He muted the television and shook his head. “Nothing new. Nothing new with me, nothing new with the Knicks. You?”
“Same ol’ stuff,” I said, taking a seat. I stared out at the Hudson River, as I had so many times, wondering if it was going to freeze over. The river was nearly still, its dark water bleak and ominous, and I momentarily felt the urge to compare it to Benny’s predicament. “Almost halfway through the year,” I said. Benny wrinkled his brow, perhaps contemplating a mental calendar, before I added, “almost halfway through intern year.”
“Right! Congratulations. You’ll be running this place soon.”
We both smiled. “I hope not.”
Our eyes gradually drifted to the Knicks game, and I tried not to ask the question I always asked, but I couldn’t resist. “Anything going on with the wait list?”
“No news is bad news,” he said softly, like air being let out of a balloon.
We stared at the television impassively as I thought of something to say. I worried that my constant reminders of the wait list weren’t helpful. Just because I thought about it didn’t mean he needed to. Did forcing this kind man from Miami—a guy who’d spent most of his childhood on a beach—to talk about his limited, difficult life help him in any way? Probably not. I needed to change the subject.
“But I have faith,” he said. “I know God has a plan.”
He had said this many times before. Over time it had become clear to me just how deep Benny’s faith ran. It was, strangely, the biggest chasm between us. At first, it embarrassed me; then it angered me. How could he believe that this was all part of a master plan, that a supreme being was choosing to confine him to a hospital, waiting for a heart that might not ever come? Then I came to see that, our caregiving notwithstanding, his faith was the primary thing keeping him alive. His perpetual good nature, his resilience in the face of countless near-fatal setbacks—all was built on the foundation of his belief that God would take care of him. I had to admire the intensity of his belief, even if I couldn’t share it.
“It’s not fair” was all I could muster.
My tired eyes drifted down from Benny’s face to his light blue hospital gown, and as I zeroed in on his chest, the Bee Gees song “Stayin’ Alive” began playing in my head. What if Benny’s frail heart gave out? Would I be able to lunge into action? Would I be able to bring him back to life? Could I perform chest compressions so vigorously that his ribs might crack?
“What?” he asked. “What’s not fair?”
But my mind had already moved on. Our conversations were often like this—clumsy, uneven, awkward. Prolonged silence often followed an unanswered question. I routinely lost my train of thought in mid-sentence, remembering that there was something else I needed to do for a different patient on a different floor. There was a condition called ICU delirium—living in an intensive care unit can cause profound cognitive impairment—and I occasionally wondered if he had it. My sleep deprivation certainly didn’t help things. We were two delirious guys, just trying to hold a conversation.
“Medicine,” I said, feeling my voice tighten, “is the only place I can think of where everyone is miserable. Doctors are miserable, patients are miserable, support staff is—”
“I’m not miserable,” he said. He turned his head away from the television and locked eyes with me. “Really, I’m not.”
I knew he was telling the truth. But it still confounded me. When a patient yelled at me or an error was made, it was easier to think of something else—to think of Benny—and transfer the anger or disappointment in my own moment to the faceless system that had wronged him. But there was no one person to blame for his situation. Certainly not his doctors, who vigorously advocated for him at the weekly transplant meetings, not the nurses, not the organ donors, not even the administrators at the UNOS organ-sharing network, who had carefully crafted an algorithm to remove subjectivity from the allocation process. There was no one to blame, no one to silently curse. But that didn’t change the way I felt. He said he wasn’t miserable, but I felt that way for him.
“The whole thing is bullshit,” I said under my breath. I again wondered if I’d crossed the line between patient and friend. Technically he was no longer my patient; he was just another guy stuck in the hospital over the holidays. He was more than that, though, and we both knew it.
“Well, today I am miserable,” I said, looking at the clock. “I’m on hour seventeen of thirty. These shifts are insane.”
Still, I felt no urge to get up. Even though I was inching my way out from under the microscope, I had not yet totally recovered from Dre’s wordless departure. Calibrating my emotional investment in patients still filled me with anxiety. It was easier to live behind the wall, to stay detached, which was fine but for the lingering feeling that each time I withheld some piece of myself from my patients, I was doing them a disservice. I balanced the guilt with a rational explanation: I didn’t need to relate to my patients’ pain because it was all I could do to handle my own. But underneath the excuses my need to connect with patients still existed; it was a fundamental quality of the doctor I wanted to be. I suspected I was spending more time with Benny to compensate for the barricade I’d constructed for others.
“Don’t know how you guys do it,” he said. “I really don’t.”
“I’m gonna look like ass in the morning.”
Benny’s attention returned to the television, and I reflexively checked my pager. I felt awkward eliciting his sympathy. He didn’t need to hear how long I’d be in the hospital or how tired I’d be in the morning. With all that was going on around him, I doubted he ever got a decent night of sleep. But complaining had, for so many interns, become second nature. It may even have been part of the twelve-step process toward breaking. Enthusiastic intern becomes bitter intern becomes broken intern. “Some of it’s great,” I added, “but some of it is rough.”
Benny turned off the television, and I took this as a sign that I was allowed to vent. There was so much I wanted to say, so much of the quiet hellishness of an intern’s life that I wanted to describe. Why did Benny need to be the one to hear about it? Because my colleagues already knew what it was like and people outside the hospital would never understand. But Benny Santos, professional patient, was a man apart.
“Talk to me,” he said.
I took off my white coat as a symbolic gesture that I was now talking as a friend, not a physician. “So many things go into being a doctor,” I said, “connecting with patients, medical knowledge, performing procedures—and on any given day you can consider yourself a failure at one of them. Or all of them.” He nodded. “You can beat yourself up to the point that you’re ready to quit. But on the other hand…at any moment you can look around and say, ‘I’m better than that guy. I’m a better doctor than her.’ ”
“Huh.”
“So much of it is mental.”
“I can imagine.”
“I’m sure you can.”
“It’s like sports,” he said, pointing to his head. “All mental.”
“It’s like you have to trick yourself into thinking you should stick with it. And to be honest, I resent the fact that some of my buddies—the same ones who could never get into medical school—are making ungodly sums of money while Heather and I are hundreds of thousands of dollars in debt.”
Benny looked away, and I realized I’d said too much. I glanced down at my scut list, embarrassed that I was complaining to someone who had so much more to complain about. It felt good to vent, but then it didn’t.
“How is Heather?” he asked. “She good?”
“She’s great.” I didn’t mention that residency had also affected my personal life. Intimacy was something that now almost had to be planned. And when we discovered that we had a night off together, it was euphoric. Otherwise it was like being in a long-distance relationship with the person you live with. I stared at Benny, lost in his big, wet, brown eyes. I knew I was talking too much. “Tell me about the Knicks,” I said.
He didn’t tell me about the Knicks. Instead, he clasped his hands like he was about to pray. “You guys,” he said, “give me hope. Makes me feel like you’re invested in me. Invested in what happens.”
The comment caught me off guard. I tried to think of something significant to say. “Of course we are.”
Benny shifted positions in his chair. “I meant to ask, Matt, what happened with that test?”
My mind quickly scanned all of the daily tests, both literal and figurative, and drew a blank. “What test?”
“Few weeks ago I passed you in the lobby and you said you were having a test. Or getting the results of a test. A blood test.”
Oh, right. That test.
After I’d completed my ridiculously complex regimen of pills, a series of blood tests had been arranged to determine if I’d contracted hepatitis C or HIV. The intervening days—after the blood was collected and while the tests were being performed—had been some of the most nerve-racking of my life. I was unable to sleep, I was distracted on rounds, and if I thought too deeply about the possibility of living with HIV, I dry-heaved. I had bounded past Benny in the hospital’s lobby on my way to see Banderas to learn the results.
“Right,” I said. “I forgot we bumped into each other.”
I briefly closed my eyes and considered what I had told Benny and what I wanted to tell him. I knew so much about him, so much about his medical history and his personal history, so much about the contours of his skin and his allergies and the unique way his heart murmured, but he knew relatively little about me. I had mentioned the needle stick in passing but hadn’t told him about the HIV risk or the pills. It felt unfair to burden him with my issue when he was dealing with so much more. But maybe I should have. Isn’t that what genuine friendship is actually about?
On the morning Benny was referring to, I’d woken up at 4:15 and popped out of bed knowing that my test results would be available later that day. I’d yanked a dress shirt and tie out of my closet, imagining myself as a sickly young man, a doctor with a chronic illness in need of a new wardrobe, with smaller clothes that would fit my withered frame and long-sleeved T-shirts to hide the skin abscesses that were destined to appear on my arms. I’d skipped breakfast and braced for the worst.
I’d kept my head bowed on the subway to work, silently praying that things would turn out okay. In between prayers, I’d glanced around the train for Ali—the fraudulent spiritual adviser, my fraudulent spiritual adviser—but I wasn’t sure why. Perhaps I took comfort in familiarity; I liked the pretend powers I projected onto him. He was a sign of normalcy. At that point, I would’ve taken any sign that I’d be okay. If Ali was on the train, being weird, all would be right in the world.
During rounds, I had quietly counted the minutes until Employee Health opened and sprinted toward Banderas’s office the moment I could excuse myself. I had nearly knocked Benny over when I turned a corner and bumped into him in the lobby.
Sitting in Benny’s room on that cold night in December, I wanted to tell him about all of this, I wanted to tell him how I’d imagined Banderas rolling into work, checking his email, pulling up my test results, perhaps putting a hand to his face, wondering if he could break the bad news to me over the phone or if I needed to be told in person. I wanted to tell Benny that I could have checked the results on the computer myself but I was afraid to. I wanted to recount every moment in painstaking detail just as I’d lived it.
But when I looked into Benny’s eyes, I chose not to say any of this. A man who’d been on the receiving end of so much bad news in his life didn’t need a dramatic reenactment of my good news.
“Things worked out,” I said.
“Oh.” A smile emerged over his face. “Oh, that’s wonderful. I’m so relieved for you. Whatever it was.” He stood up to hug me, but the IV kept him tethered to the metal pole, so he waved me toward him. As I leaned in and extended my arms, as if on cue, my pager went off and I was summoned to the intensive care unit for an orientation session.