Epilogue

A few weeks later I found myself back in the CCU, standing in front of Carl Gladstone’s old hospital bed, doing my best Baio impression. I was now a second-year resident, and before me were four anxious, enthusiastic interns—a new pod—waiting for rounds to begin.

I had spent the final weeks of intern year dissecting my initial struggles and had come to the conclusion that early on, I simply hadn’t had the capacity to fully immerse myself in my patients’ realities. I was so busy trying to master the medicine—to listen for a murmur or a wheeze rather than a note of despair—that I’d missed out on crucial opportunities to intervene in my patients’ lives.

In my primary care clinic, I spent much of the year trying to ensure that my patients had all of the right medications—at times in excess of twenty different pills—and neglected to ask if this was ever too much. I failed to notice the wrinkled brow or the look of distress as I handed someone two dozen prescriptions to fill. But as the year wore on, I developed the ability to think outside the diagnosis, beyond the science of medicine to the art of medicine. I discovered that there is so much more to being a doctor than ordering tests and dispensing medications. And there is no way to teach that. It simply takes time and repetition.

There had been no ceremony to mark my transition from intern to supervising resident; I’d just shown up one day with a new assignment, a new list of patients, and a new group of exuberant, unwrinkled understudies. I wanted to see how far I could push them.

“Okay, Frank,” I said, pointing to a tall African-American man. “Twenty-four-year-old black girl is found unresponsive in her hospital bed. You’re first on the scene. Go.”

Frank squeezed his stethoscope before running his hands down his crisp new white coat. “Twenty-four, let’s see…twenty-four…and you said it’s a woman?”

“The clock is ticking, my friend. And you’re stalling.”

As my intern pondered the scenario, I turned to the group. “A wise man once said that when you arrive at an arrest, the first pulse you should take is your own.” They scribbled down the pithy statement, and I whipped my stethoscope around my neck. “Last year,” I went on with more than a hint of swagger, “my residents had a scoreboard. One column was for arrests, one for lives saved, and they actually had one for arrests called while pooping. I’m still waiting for—”

A voice from a speaker a few feet above my head screeched: ARREST STAT, SIX GARDEN SOUTH! ARREST STAT, SIX GARDEN SOUTH!

A rotating schedule had predetermined that today, the day before my thirty-hour CCU shift, was my day to run any cardiac arrest that occurred within the friendly confines of Columbia University Medical Center. It was a day I’d been thinking about for months. Years, really. This was the first arrest where I was going to run the show. Showtime. I dropped my scut list and broke out in a sprint.

“Good luck!” Frank howled as I crashed through the CCU doors. “No pooping!”

I’d rehearsed this moment in my mind hundreds of times. I’d thought about it over dinner with friends, on the subway, at bars, on airplanes, in my bed. This responsibility, more than any other part of being a doctor, was what I fixated on. The stakes simply couldn’t be higher.

I sprinted down the long hallway and up a flight of stairs, trying to stay calm. Or calmish.

ABC, ABC

Time slowed down as objects from intern year passed me in slow motion. To my left was Dave’s office, to my right the vending machine I’d abused after the initial feedback session. As I passed the elevator Dr. Chanel and I had taken in the aftermath of my needle stick, other physicians joined me in the all-out sprint to Six Garden South: Ashley, Lalitha, Mark, and Don. More followed behind them. It looked like a scene out of Pamplona, except we were the ones doing the chasing. When we arrived at the sixth floor, a nursing aide pointed down another hall and said, “Fourteen. Bed fourteen.”

As I entered the room full of people, Baio’s voice caromed into my head: You have to take command of the room.

“I’m Matt,” I said forcefully, “and I’m the arrest resident.” They were the words I’d said into a mirror hundreds of times, words that I hoped would establish my authority. A dozen heads turned in my direction, just as I had imagined, and I positioned myself at the foot of the bed. As I looked at the patient before me, an unconscious, middle-aged white woman, words were shouted in my direction.

“Ms. Cardiff, forty-seven-year-old with coronary artery disease…”

A stream of phrases continued at me like an additional stanza to Billy Joel’s “We Didn’t Start the Fire.”

“Hepatitis C in 1993.”

“Blood sugar 103…”

“Deep vein thrombosis in 2006.”

“Platelets 170.”

“No pulse.”

Those two words smacked me in the face. “Mark,” I said, addressing my colleague at the head of the bed, “do we have an airway?”

He held up an index finger and said, “Yes.”

“Is she breathing?” I asked, as calmly as possible.

He squeezed a bag of oxygen down into her throat and said, “Not on her own, but I got her.”

A team of anesthesiologists arrived a moment later and inserted a breathing tube into her trachea. “Lalitha,” I said, “does she have a pulse?”

My pod mate mashed down on the woman’s groin. “No.”

“Don,” I said, “please start chest compressions.” Don had already started chest compressions.

“Too many people,” a nurse announced and shooed several medical students away.

I took a long breath and said to the nurse beside me, “Please give one round of epinephrine and one round of atropine.” The medications were at my side a moment later and inside the woman’s pale, thin arm a second after that. I watched as Don continued to crack ribs, paced to the beat of the Bee Gees, as defibrillator pads were slapped on the woman’s chest and back.

The unconscious patient was exceedingly thin, like a skeleton wrapped in a tiny layer of flesh. Perhaps she had a chronic illness—cancer, tuberculosis, or cirrhosis—that robbed her of excess muscle and fat. But there was no time to think about that. I knew all eyes were fixed on me. Someone handed me the woman’s morning lab results. All normal. “Do we have central access?” I asked.

“Almost,” Lalitha said, brandishing a large needle toward the woman’s groin. “Okay,” she said, “got it.”

“Epi and atropine are in,” the nurse said.

I looked at the cardiac monitor. “Please hold compressions,” I said, “and check for a pulse.”

As Lalitha felt the groin for a femoral pulse, we waited. And waited. Eyes slowly turned to me.

“I see a blip!” a voice near the door shouted. “We got a pulse!”

Lalitha looked at me and shook her head. No pulse.

“Definitely a pulse on the monitor!” said another.

They were making the same mistake I’d made a year earlier in the CCU. A blip on a monitor was not the same thing as a pulse. In fact, the two could be entirely unrelated, but that was a subtle point not always appreciated by physicians-in-training. “No,” I said firmly. “We do not have a pulse. Resume chest compressions.”

There were faint whispers in the periphery—students and residents discussing my decision—as the team went back to work. More epinephrine was infused into the woman as a new intern named Claire tried in vain to acquire arterial blood from the patient’s wrist, so we would know how acidic the lifeless body had become. She readjusted the needle time and again, trying to find the tiny artery, as beads of sweat formed on her forehead. Claire knew everyone in the room was now looking at her, watching her fail over and over.

She stepped back from the body, closed her eyes, and took a deep breath. I’ve been there, I wanted to say, just stick with it. Claire’s freshly pressed green scrubs now had a small, rapidly expanding sweat stain under each armpit. A moment later, she was edged out of the way by Mark, who took the needle from her and immediately hit the artery. The syringe quickly filled up with blood, and he sent it off to the lab seconds later as the sweaty intern looked on, crestfallen.

I scanned the patient’s chart for possible clues. Why had this woman suddenly lost her pulse? Nothing jumped out at me. And I didn’t have time to give the chart a close read. I felt the glare of the room, knowing that they were waiting for me to make a decision, relying on me to figure out what to do. I felt the urge to say something, to dole out more instructions, but there was nothing to say. We were following protocol and it just wasn’t working.

“Please hold compressions,” I said a minute later, “and feel for a pulse.” The room fell silent as Lalitha explored the woman’s groin. Several minutes had elapsed since we had begun the resuscitation, and as with a missing child, hope diminished with every passing moment. I gritted my teeth as I awaited Lalitha’s call. Two dozen people watched me watch her.

Please have a fucking pulse, please.

I imagined saying the words “Does anyone object to stopping the resuscitation?” as I waited. What if someone objected, would I have to listen? Did it have to be unanimous? I’d never seen someone object. This would certainly be an unfortunate time to be confronted with that—

“We have a pulse,” Lalitha said softly, “we definitely have a pulse.”

“We have a pulse,” I repeated. Did everyone hear that? We have a pulse! “We need a blood pressure,” I said calmly, as Don strapped the blue cuff around the woman’s arm. “We need a pressure,” I said again.

“One ten over sixty,” Don said. “Yesssss!”

“We have a bed in the ICU,” a voice behind me whispered. It was Ashley. “They’re ready. Let’s move her.”

“Let’s move her,” I said loudly, “ICU. Now. Lalitha, keep a hand on that pulse. Let me know if you lose it.”

She nodded. The crowd parted, and we wheeled the patient in the direction of the ICU. As we emerged from the room, I saw Baio, standing in a corner watching the events. He winked at me. At least I think he winked at me.

In mid-May, second- and third-year residents and a smattering of faculty gathered to celebrate the end of the academic year. It was a boozy affair, a chance to send off the graduating residents, roast the chief residents (I sent in more than a few suggestions), and thank our professors. We also doled out awards. Some were serious—Most Likely to Win the Nobel Prize, Best in a Cardiac Arrest—and some were lighthearted—Best Looking in Scrubs and Cutest Couple. As dinner was served and drinks mixed, faces of finalists, whom we’d all voted for, flashed on a large screen. It was an outrageously fun night and one of the few times we collectively socialized. It was perhaps the only time that we saw one another in cocktail attire and certainly the only time we might have caught the Badass doing a shot.

It was the end of my second year of residency, and seated at my table were Lalitha, Meghan, Ariel, Ashley, Heather, and Mark. “Can I refresh anyone’s cocktail?” I asked the group.

I was decked out in the only suit I owned—the one I’d worn to my medical school and residency interviews—and the same one I’d pulled out of the closet a month earlier for my infectious disease fellowship interviews. I had briefly toyed with the idea of becoming a critical care doctor, responsible for running an intensive care unit, but I kept coming back to those moments on the ninth floor of the hospital, with Dre and Dr. Chanel and the needle stick. I’d had a glimpse of the world of HIV medicine, a small insight into what these men and women were dealing with, and I wanted more. I also wanted to understand why bacteria and fungi were ravaging Benny’s body, attacking his lungs, his liver, and his sinuses. “Drinks?” I asked again.

“The table politely declines,” Ariel said, taking a gulp of Chardonnay.

It was a thrill to see my pod mates in makeup and cocktail dresses, and I was starting to get a bit tipsy; for once, we looked like the ones who belonged in Us Weekly. They were the reason I had survived the slog of residency, but I wouldn’t fully understand that until I’d left them and had to practice on my own, as an attending at a different hospital in a different part of Manhattan.

In addition to being slightly drunk, I experienced a touch of melancholy as I looked around the ornate, wainscoted room. There were so many people who I never got to work with, never got to know. They all seemed so much happier right now, outside of the hospital. Glancing around, I realized that I had never met Dr. Sothscott after that fateful phone call in the CCU so many months ago. Was it possible I’d misheard his name? I never did find it in the hospital directory. Had it been someone using a pseudonym so he could freely blast me? I scanned the crowd and stopped at Mark, who was buoyantly wagging his index finger at me.

“Belieeeeve,” he sang to our table, “when I say…I…want it that way!”

I was staring down at my dark and stormy, contemplating the need to use the restroom, when Heather grabbed my elbow and smiled.

“I’m fine,” I said.

She pointed at the screen and nudged me; my face had just appeared as one of the five finalists for Best in a Cardiac Arrest.

A wave of pride washed over me. I had worked hard to demonstrate that I could calmly command a chaotic room, to not only appear calm but actually feel that way. To squelch the oh-shit-this-is-happening sensation when an arrest was called and act like bringing someone back to life was a routine part of my day. But knowing other doctors had voted on this was particularly special. “It’s an honor,” I said, to no one in particular, “just to be nominated.” The words were intended to sound like a joke, but I meant them.

Meghan stuck her index finger in her mouth and pretended to gag. When Baio’s face flashed on the screen as one of the other finalists, I looked over at him, but he was in mid-conversation with a pair of Lithuanian eyebrows. And next to them was Banderas. Was Banderas wearing a blouse?

A chief resident read out our names and then narrowed the group down to a final two: Baio and me. I looked over again, but he still wasn’t paying attention to the ceremony. How was he not paying attention to this? I was anxious and excited, probably more nervous now than during an actual cardiac arrest. I was also weirded out. How was my name mentioned in the same breath as Baio’s? “What will America decide?” I said, sotto voce, as I picked at my entrée. “It’s like the People’s Choice Awards.”

“Best in a cardiac arrest,” the chief resident announced, “is Matt McCarthy.”

Of all the things that could’ve crossed my mind in that moment, my first thought was of uncooked spaghetti—the sensation I’d experienced when I first performed CPR on that ninety-five-year-old woman in the CCU on my first night on call. It was inconceivable that the physicians at Columbia thought I deserved this over Baio, the man who’d shown me how to do CPR. The guy who’d taught me just about everything I knew. He was the best doctor I’d ever worked with, someone who seemingly knew how to handle any situation. If I had a medical question, I’d turn to him. If someone dropped dead in this room, I’d want him leading the resuscitation.

Heather gave me a kiss on the cheek and whispered, “Congratulations,” as Lalitha, Meghan, and Ariel gave me high fives.

“Ladies,” I said, trying to hide my slight embarrassment, “if any of you would like an advanced tutorial on the art of cardiac resuscitation, we can arrange private lessons. You’ll find that my rates are competitive with—”

“Oh, barf,” Lalitha said. “Please stop. No acceptance speech.”

“Shut it down,” Heather said.

Maybe I’d grown; maybe I was better than Baio. The learning curve was steep, and perhaps I’d just barely nudged past him. I looked around the room to relish the moment, to catch the cheers of encouragement from my colleagues. Dr. Petrak gave me a thumbs-up, and Mark was whistling wildly through his fingers. I smiled, kissed Heather, and gave Mark a fist pound. Taking another long sip of the dark and stormy—a sip that was bound to nudge me from tipsy to intoxicated—I felt someone come up behind me, squeeze my neck, and whisper, “You’re welcome.”

A year later, as I was on the verge of graduating from Columbia’s residency training program it happened. Standing in a conference room—the same room where Dave had demonstrated the proper way to perform phlebotomy after my needle stick—I felt my pager vibrate. Before me was a gifted young medical student named Christopher, and I was again channeling Baio. I had completely shed the paranoid urgency and trepidation of intern year and was now dressed casually—khakis and a button-down—because I was on a research elective and Petrak had asked me to spend my spare moments teaching medical students. “Forty-seven-year-old woman is found unresponsive,” I said, recalling the first arrest I’d run on my own. “Go.”

“Okay, okay,” Christopher said, twirling his curly dark hair. “Okay, what else?”

“That’s it.”

Staring at this young man, I thought of all of the experiences that lay before him: the arrests, the tears, the grief, the joy, the rapture. The strange enchantments of medicine. I also couldn’t help but reminisce on all that I had seen and done in my three years at Columbia. Remarkably, I used the reply-all button only once during residency, after our besotted awards dinner, when I wrote, “Heather is pregnant. Just kidding,” and shared a link to a Vampire Weekend song called “I Think Ur A Contra.”

My pager buzzed again. I halted the role-playing with Christopher and glanced down at the four words on my pager’s tiny screen: HE GOT THE HEART.

“Holy fuck,” I said. “Let’s go.” I grabbed Christopher by the shirt-sleeve and tugged him out of the room with me. “Holy shit, c’mon!”

Sprinting down a flight of stairs to the cardiothoracic intensive care unit, Christopher must’ve thought we were on our way to an actual cardiac arrest. I nearly trampled an Orthodox Jewish couple and quickly started scanning the beds in the unit. No, nope, not him, not him, nope, no, no, YES!

The page wasn’t tagged, meaning I had no idea who’d sent it, but scores of doctors knew that I was close with Benny and that I’d want to know if anything happened to him, good or bad. I sidled up to the team of surgeons and anesthesiologists standing in front of his room. Benny was attached to a ventilator and had a dozen tubes going into his arms, like I’d seen him so many times before. As we approached, a surgical intern was presenting his case to a team of transplant doctors, “…year-old man postoperative day zero status postcardiac transplantation. Currently sedated and stable on—”

“Do you guys know this patient’s story?” I asked, butting into their horseshoe to address the medical team. “Do you know anything about this guy Benny Santos?”

Like Darby Masterson, I just wanted someone to know. Anyone. The young physicians stared at me blankly, blinking quickly, before consulting their scut lists. But there was nothing on their papers to indicate how special Benny was. To them, he was probably just another transplant patient. My eyes were met with blank stares. We stood in silence until I let out a celebratory yelp. “He got the fucking heart!”

One of the surgeons wrinkled his brow. “Are you from social work?”

I slipped on a gown and gloves and prepared to enter Benny’s room. “No,” I said, fighting back a smile. “I’m not from social work.”

“Respiratory therapist?” another asked.

Without the scrubs or white coat, I didn’t quite look like a doctor. I was just some enthusiastic, slightly unhinged guy in loafers who didn’t mind interrupting their rounds. I nodded at Benny and said, “I’ve known this guy a long time.” I was about to elaborate, about to provide an anecdote that offered a glimpse into the life of this remarkable man, but I caught myself. How could I possibly explain what Benny had been through or what that struggle meant to me? I turned away from the team of doctors and took a few steps closer to him—his body once again attached to a ventilator, but this time, finally, with a new heart—and I smiled. The stories could wait. “Take good care of this guy,” I said softly. “I’m not his doctor anymore. Now…just a friend.”

I picked up a remote control sitting on the nightstand next to Benny’s bed, turned on the television, and started flipping through the channels until I found Judge Judy.