Chapter 33

My Alyssa-related responsibilities on the day of her Grand Rounds the next week not only involve helping her set up her presentation, but I also have to pick her up at the Long Island Railroad, because she is coming in from Manhattan and doesn’t have a car. I am Dr. Jane McGill—maid for examining rooms, laundress of hospital gowns, and now chauffeur for Grand Rounds presenters.

Dr. Kirschstein forwards me Alyssa’s itinerary for the morning (only Alyssa would have an itinerary for a morning trip to Long Island) and advises me to show up “well before” the arrival time of Alyssa’s train. That doesn’t quite go to plan when Leah face-plants during the long, long journey from the garage door to the car, and I have to take her back into the house to wash and cover her wounds with Frozen Band-Aids. I end up driving like a madwoman to make it to the LIRR on time.

I beat out Alyssa’s train by mere seconds. I watch it pull into the station as I get that horrible feeling in my stomach that accompanies every interaction I have with this woman. I shift from foot to foot, clenching and unclenching my fists. I silently recite my mantra:

She has no power over you anymore. There’s no reason to be afraid of her.

Except it doesn’t work. Even if I live to a hundred, I will always be afraid of Alyssa Morgan.

My hands ball into permanent fists as I see Alyssa emerge from the train. Alyssa was several years older than me when she was my senior resident, and I estimate that by now, she’s at least in her mid-forties. But she doesn’t look a day older than she had been during that month when she made my life a living hell. Alyssa isn’t beautiful but she’s got a timeless appearance, with her high cheekbones and strong jaw. She always kept her hair swept up during residency, but now her straight brown locks fall just below shoulder-length, barely sweeping the edge of her gray suit-jacket.

Although I’ve seen Alyssa a handful of times since residency, this is the first time we’ve had to do more than smile and nod. I’m actually going to have to speak to her. And presumably, be pleasant. This is going to be a challenge.

Alyssa glides across the train platform. She regards me briefly, then strides right past me like I’m a homeless person she’s trying not to make eye contact with. She looks around the platform, maybe checking for someone holding up a big sign that says “DR. MORGAN,” or perhaps a stretch limousine waiting for her.

I clear my throat, but Alyssa doesn’t turn. Finally, I call out, “Alyssa!”

She turns and regards me with more curiosity. I’m genuinely baffled. She knows that someone is here to pick her up—why is she having so much trouble figuring this one out?

“I’m here to take you to the VA,” I tell her.

Alyssa’s face falls. “Oh.”

I don’t know what to say. Should I apologize?

No, I shouldn’t! I schlepped all the way over to the LIRR to pick her up. And I’m not even late, in spite of a major tripping incident this morning.

Alyssa finally holds out her hand to me. “I’m Dr. Morgan.”

I stare at her hand. I’m not entirely sure what to do. Should I pretend we’re just meeting each other for the first time, even though we worked together for two years? Finally, I say, “I know. It’s Jane. You remember me, right? Jane McGill.”

Alyssa’s eyes widen. “Oh! Jane… I didn’t realize. You look…”

I’m very glad she doesn’t finish that sentence. I genuinely don’t want to know how it ends.

I lead Alyssa to where I parked my car, and she looks nothing short of horrified by the sight of my Toyota Camry. I’m a VA internist—did she think I was going to be driving a Mercedes? Okay, the car does have a few scratches on it, including one really long scratch that runs across both the front and back doors on the right side. Also, there’s that big dent in the front fender. And the smaller dent in the back fender. But that’s just body damage—it’s fine on the inside and that’s what counts.

Unfortunately, Alyssa doesn’t look any more impressed when she opens the passenger side door. She plucks a French fry off the seat and holds it up accusingly.

“This was on your seat,” she says as she shakes it in my face.

So? I’ve got a four-year-old child. French fries happen—you can’t stop them. To be honest, I’m astonished she only found one of them. If she looked in the back, there are probably enough French fries to feed us for a week if we somehow got trapped in the car.

I take the French fry out of Alyssa’s hand and toss it out the window when she isn’t looking. Then I start up the car, intending to speed the entire way to the VA.

The lights are not on my side. Almost immediately, we miss a light that I know will result in us having to wait for a good minute. I glance at Alyssa, who is staring out the window miserably. I feel somehow compelled to make conversation. This is a time when I wish I were more like Ben, who never feels any obligation to talk in order to fill awkward silences .

“So,” I say brightly. “How are things?”

Alyssa sighs. “Fine.”

“And how is…” Crap, I can’t remember whether Alyssa had a son or a daughter. “How is your… child?”

Nice save, Jane.

“Fine,” she says, without offering any gender-specific cues.

“They must be getting older,” I comment. Since all human beings are getting older, it’s probably a safe assumption.

“Yes, it goes fast,” she says vaguely.

The light changes and I jam my foot into the gas pedal. Alyssa grabs onto the dashboard and flashes me a dirty look. I don’t care at this point. She’s given me so many dirty looks over the years, I can’t even distinguish them from her regular looks. I’m not even certain she has regular looks.

When we get to the VA, I lead Alyssa to the lecture hall where she’ll be teaching us all about hospice care. She hands over the flash drive containing her PowerPoint presentation, and naturally, everything goes wrong. I can’t seem to lower the screen onto which we project the computer image. Then when I sort that out, the image won’t appear on the screen. It would be so much more helpful if they got someone with actual AV knowledge to do this .

Alyssa watches me in silence interjected with tiny sighs. As people start to filter into the auditorium, she says, “I thought they were sending someone who knew how to use this equipment.”

“I do know,” I say through clenched teeth, despite the fact that I clearly don’t.

“Haven’t you been doing this for a year?” she says. “Why are you having so much difficulty?”

You know what I’d really like to do? I’d like to surreptitiously insert “I’m a bitch” into one of Alyssa’s slides. That would be awesome. But I feel like all the evidence would point to me as the culprit.

Alyssa sighs extra loudly, and I lift my eyes to glare at her. Honestly, I’ve had enough. She’s not the boss of me anymore. We don’t even work together. I don’t have to take her bullshit anymore. I finally spoke up to Barbara, and now she’s become… well, not a good employee, but much less awful. I’m going to stand up to Dr. Alyssa Morgan once and for all!

“You know what, Alyssa?” I say.

She raises her eyebrows at me. That’s when I notice that there are purple circles under her ice-blue eyes. I notice the multiple strands of gray threaded into her brown hair that she hasn’t bothered to dye. I wonder what Alyssa’s life is like right now. Maybe she spent her morning consoling a kid who face-planted in the garage. Maybe worse. I have no idea .

“You need to give me another minute,” I finally mumble. “I’ll figure it out.”

Somehow I say the right magic spell and the image from the computer suddenly appears on the overhead screen. I’m so relieved, I nearly cry.

“That’s fine,” Alyssa says to me, because saying “thank you” would be far too challenging for her.

The last thing I want to do right now is listen to Alyssa lecture for an hour, but I grab a bagel from the back of the auditorium and sit down in the last row. I don’t have any patients scheduled for this morning and I’m already here. Might as well listen to Alyssa’s talk.

“Hello, everyone,” Alyssa says. “Today I’ll be speaking to you about Overcoming the Risk of Suicide in the Hospice Population.”

Well, this is sure to be depressing.

“It may seem counter-intuitive to treat suicidal behavior in a patient who is already terminal,” Alyssa begins. “But part of the goal of good hospice and palliative care is to make those final days more comfortable for your patient. You might wonder why patients who are going to die soon anyway would try to kill themselves, but you’ll soon see that there are a plethora of reasons why a hospice patient might become suicidal.”

For example, if Dr. Alyssa Morgan became their hospice physician .

“For example,” Alyssa says. “They may worry about becoming a burden on their family and friends. Or they may see their strength and abilities deteriorating.”

Somehow, something that Alyssa is saying tugs at the back of my head. The bagel I managed to take one bite of churns in my belly.

“Let’s start with some statistics,” says Alyssa. “Suicide is the tenth leading cause of death in this country. By age, there is a bimodal distribution, with a peak over age seventy-five, but the largest peak in the forties. Women are more likely to attempt suicide, but males are far more likely to be successful.”

A man in his forties who is deteriorating.

“The most common means of committing suicide is by firearms,” she says. “Of course, pills are most commonly used in attempts, but firearms are the most successful by far.”

A man in his forties who is deteriorating and owns a gun.

“So let’s talk about risk factors,” Alyssa continues as she flips to the next slide. “The emotions that contribute to suicidal behavior are hopelessness and helplessness . The patient feels hopeless because he’s in a situation, such as terminal illness, where there is quite literally no hope. And he feels helpless because there’s nothing he can do about this situation. Suicide gives the patient what they feel is an escape from a hopeless situation. And it gives them control in a situation in which they feel helpless.”

Control . What every surgeon is obsessed with.

“It’s a common myth that most people commit suicide without warning,” she says. “Most people who are suicidal communicate many warning signs to the people around them, even if these signs aren’t always picked up. They may even communicate having a plan…”

I’ve got a gun locked away in my desk drawer at home.

“Although after they make the decision,” she continues, “interestingly, their mood can lighten because they feel that they are finally escaping from their problems.”

I close my eyes and remember the way Ryan smiled and winked at me when he had just been stripped of his surgical privileges.

Oh my God.

I sit up straight in my seat, knocking over the cup of coffee that I took but haven’t been drinking. A few people turn to stare at me, but I don’t care. Something has just occurred to me. Something horrible. Something I probably should have realized last week, but I ignored all the warning signs.

Ryan is going to try to kill himself.

And I’m the only person who knows it.