Chapter 31

The last name on my list of patients for the morning is Matthew Stoughton. It doesn’t immediately ring a bell, but right off, I assume that he’s on the younger side based on his first name. There are exceptions, but old men are usually not named Matthew. They’re more likely to be named Robert, Richard, or Charles.

Given a patient’s first name, I can often guess their age within a decade. Especially with women, since female names tend to be trendier (although I haven’t gotten to see many female patients since I’ve been at the VA). For example, if you meet a woman named Dorothy, Helen, or Ruth, she is definitely older than the hills. You are never going to see a twenty-year-old woman named Mildred or Agnes. That just doesn’t happen.

Or if the woman’s name is Linda, Donna, or Nancy, she’s probably middle-aged. A woman named Jessica, Nicole, or Melissa is probably more likely to be around my age. And if you meet a girl named Sophia, Emma, or Isabella, she’s probably in Leah’s preschool. It’s harder with men, but you can bet a guy named Matthew, Justin, or Brandon will be an OEF/OIF vet, while a Frank or a Walter probably fought in the Korean War or even maybe World War II.

So when you give your kid a trendy name, beware. When you name your daughter Madison in 2010, remember that her name will be the Mildred of 2090.

When I glance through his chart, I discover I’m right about Matthew Stoughton. He’s thirty-three years old and no longer active duty, which is a good thing because at our last visit, I discovered that he was snorting coke. He didn’t come to me because he was snorting coke though. He came to me because he was having chest pain. Probably because he was snorting coke. I gave him a whole speech about it last time he was here.

Of course, Mr. Stoughton’s real problem is probably his PTSD. He’s had a hard time adjusting since he got home from Iraq, and he’s struggled with outbursts of anger and bad nightmares. Aside from the coke, he drinks and God knows what else. He’s enrolled in an outpatient support group for vets with PTSD but he rarely shows up for the groups—same deal with his one-on-one appointments. Every time I’ve seen him, he’s had dark circles under his haunted eyes.

But today he looks great. He flashes me a big smile when I pick him up in the waiting room. He’s even put back on a little weight, so that I can better identify the tattoos wrapping around his arms: dog tags, an American flag, and two rifles intertwined.

“How are you doing?” I ask him once we’re in the examining room.

“I’m good!” Mr. Stoughton’s eyes are bright. “My chest pain is gone!”

“That’s wonderful!” I exclaim. “Why do you think that is?”

“Probably because I quit snorting coke,” he says, like I’m an idiot.

“Right. That would do it.” I smile at him. “Did our visit motivate you?”

I’m hoping he’ll tell me that the talk I gave him at our last appointment was what turned his whole life around. But instead, he laughs. “Well, a little. But really, it was April.”

April—my age or younger. See how good I am at this game?

“Who’s April?”

“My girlfriend,” Mr. Stoughton says. “Let me tell you, she lays down the line . I mean, not literally, obviously—she won’t let me do coke at all.”

“Well, that’s great,” I say.

He nods. “Also, she’s got the two of us going to the gym every day. And she cooks every night—we’re on an all-Vegan, gluten-free diet.”

“Oh, that sounds…” Disgusting. “Wonderful. ”

“Also, I got rid of my motorcycle,” he says. “April got me a bicycle and I ride everywhere on it. It’s great exercise.”

“Wow.”

“We’re basically ridding our bodies entirely of toxins,” he explains. “Like, instead of coffee in the morning, we have a mixture of wheat grass, kale, broccoli, lemon juice, and green tea.”

“Oh.” I can’t even pretend to find that appetizing.

“Also,” he adds, “April threw out our television.”

I nearly gasp this time. It sounds too horrible for words. “That’s great.”

“Yeah,” he says, although he doesn’t sound as convinced this time. He thinks for a second, “Dr. McGill, do you ever call family members of patients?”

I nod. “Sometimes. Who would you like me to call, Mr. Stoughton?”

He takes a deep breath. “April. Maybe you could tell her that it’s okay for me to have a cheeseburger sometimes. And that it’s okay to have a cup of coffee.”

“I could do that,” I say, even though I’d rather lick the floor. This April sounds like a tough cookie.

“Also,” he says, “maybe you could tell her it’s okay for me to have some coke? I mean, just a tiny bit.”

I almost laugh. What kind of person asks their doctor to tell their girlfriend that it’s okay to snort coke? I must really seem like a pushover. “I don’t think April will go for that.”

“No,” he agrees. “Probably not.”

After I finish up with Matthew Stoughton, I go onto the computer and look up the record on Herman Katz. He’s still hospitalized, thanks to a bout of right lower lobe pneumonia. On top of everything else, his swallowing has been affected by the stroke and he’s been aspirating. I see a note from interventional radiology, who recently inserted a feeding tube into his belly. I close my eyes and remember Mr. Katz showing me his “I’m a little teapot” position to explain when he felt pain. A guy like that is not going to do well with a feeding tube.

And part of me still blames Ryan. Despite what he claimed. I scoured the operative report he dictated for any signs that something went amiss, but I’m not sure what I’d find there. Then while the incision was being closed with #3-0 Vicryl, my hand jerked wildly and caused a massive stroke.

“Dr. McGill!”

I look up and see Dr. Kirschstein at the door to the examining room. He’s hovering at the door to the examining room, wearing his white coat. His eyes are unreadable thanks to his eyebangs.

“Hi, Dr. Kirschstein,” I say.

“Dr. McGill,” he says. “I’d like to share a word with you. ”

“Sure.”

“We’re having a guest speaker next week at Grand Rounds,” Dr. Kirschstein tells me. “So she’ll require extra assistance on your part.”

“Of course,” I say. In my head, I’m wondering how I can shaft this grand rounds responsibility onto someone else in the near future. “Who’s the speaker?”

Dr. Kirschstein beams at me. “She’s an expert on hospice care. And with our aging veteran population, I think this is an incredibly important point of interest.”

“Yeah, that’s true.” Hospice is an incredibly underutilized service, in my opinion. Many elderly people spend more on healthcare in their last six months of life than in the entire rest of their life. And for what? To die in a hospital? I want to die at home. Surrounded by people who love me. Possibly while eating an ice cream sundae. “Who is the speaker?”

“Her name is Dr. Alyssa Morgan.” Dr. Kirschstein raises his eyebangs at the look of absolute horror on my face. “Oh, do you know her?”

_____

Dr. Alyssa Morgan.

I could write a novel about that woman.

Alyssa was my senior resident during the first month of my intern year of residency. That meant she was in charge of training and supervising me during the very first month that I was a physician. Instead, she nearly made me quit. Over and over.

Okay, to be fair, I wasn’t the most knowledgeable intern on the face of the planet. But no matter how much I studied, there was no way I could automatically know that ordering an echocardiogram at County Hospital inexplicably required two forms instead of one. There was no way I could round on ten patients in sixty seconds. There was no way I could have every lab ever ordered on a patient over their lifetime at my fingertips while presenting a patient.

But that was just the tip of the iceberg of what Alyssa expected of me. Her favorite phrase was, “How could you not know that by now?” She used it on my second day.

By the end of my month with Alyssa, I hated her with every fiber of my being. I hated my life, and the only thing that kept me going was the sexy surgery resident who used to make visits to my dorm room. Then I moved on to a new rotation and had a new senior resident named Lily who was… lovely. Inexplicably lovely. If I didn’t know a lab value when I was presenting a patient to Lily, she would say, “Don’t worry! We’ll look it up together.” Then we’d skip off to the computer together. Lily covered a patient of mine once so that I could have an extra day off. She even bought me lunch on two separate occasions!

It was something of a vindication to discover that there were plenty of other interns who didn’t like Alyssa, but nobody hated her quite as vehemently as I did. But that’s okay—every intern seemed to have an Alyssa of their own. My best friend during residency Nina had it out with her senior resident right in the middle of the ICU when the resident repeatedly undermined her and badmouthed her to their attending physician.

When I became a senior resident, I remembered the way Alyssa was and tried to be the opposite, even when my interns turned out to be grossly incompetent. No matter how much they baffled me with their stupidity, whenever they did anything right, I would reward them with an enthusiastic, “Good job!” The truth was, I didn’t have it in me to treat an intern the way Alyssa did. It’s probably the same reason my daughter didn’t get potty-trained until she was nearly four years old.

After Alyssa finished her residency, she impossibly did a fellowship in hospice and palliative medicine. Of all the fields I imagined Alyssa doing, hospice would have been my last choice. It seems like by definition, hospice medicine calls for a physician who is remarkably kind and caring—everything Alyssa was not. Unless it was one of those things where after dealing with Alyssa, you’re just kind of glad to die. That was probably it.

I’ve run into Alyssa a handful of times since then. You’d think after all this time, my memories of her would have faded—and they have. I don’t stay up at night thinking about all the things I wish I had said to her. But on the rare occasions that I run into her, I sort of want to punch her in the face. And by “sort of,” I mean “desperately.”

So when Dr. Kirschstein tells me that I have to show her how to use our AV equipment or just even be within arm’s length of her, I want to throw up. I’m not even joking. I feel this instant, dizzying nausea that takes me a few seconds to recover from.

“Alyssa and I were in residency together,” I explain to him.

“Is that so?” Dr. Kirschstein smiles in amusement. “You are certainly quite well-connected, Dr. McGill! It seems like you know everyone. Next you’ll be telling me that you know Benedict Cumberbatch.”

Benedict Cumberbatch? That’s such an odd choice of someone a well-connected person might know. Why didn’t he say, “Next you’ll be telling me that you know the President”? Or even, “Next you’ll be telling me that you know Kevin Bacon.” Why Benedict Cumberbatch ?

“Well,” Dr. Kirschstein says, “I expect you’ll make Dr. Morgan feel at home here at the VA. She’s a quite well-respected physician.”

Is she? Damn. I was hoping she’d been discredited and disgraced.

After Dr. Kirschstein leaves, my fingers start itching to send Ryan a text message. He’s the only one around who truly knows how much I hated Alyssa. Ben has heard the stories, but he wasn’t there when it happened, so he doesn’t really know . Of course, Ryan could match Alyssa shot for shot with being cruel to his residents. But Ryan was actually trying to make his interns cry—Alyssa just did it because it was her personality. Now that I think of it, I’m not sure which was worse.

Before I can stop myself, I retrieve my phone from my purse and shoot a text message to Ryan: Alyssa Morgan is giving grand rounds at the VA next week!

I must have caught him between surgeries, because he responds after only a few seconds: The devil returns.

I smile. That’s the great thing about Ryan. Even though he barely had any interaction with Alyssa during residency, he still remembers her on my behalf. I write back: Maybe she’s nice now.

Maybe. Just don’t strangle her to death. You’ll be the first suspect.