Point of Balance
It all began with Jamaal Carter. If I hadn’t saved him, things might have been very different.
When the pager beeped I rubbed my eyes in anger. It had roused me and I had woken up in a foul mood. Of course, the surroundings didn’t help. The surgeons’ on-call room on the second floor reeked of sweat, feet and sex. Residents are always hornier than a two-peckered billy goat. I wouldn’t be at all surprised if a couple of them had been banging away in the top bunk while I snored.
I am a sound sleeper. Rachel always used to tease me and say it would take a crane to get me up. That simply doesn’t apply to the pager: the damned gizmo always succeeds in waking me up on the second beep.
That comes of being a resident for seven years. If you didn’t answer the pager the first time, the chief resident would tear you a new one. And if you couldn’t find a window in which to grab a bit of shut-eye during the thirty-six hours you were on call, then you didn’t last the distance, either. So we surgeons got into the knack of instantly falling asleep while we nurtured a Pavlovian response to the sound of a pager. I had been a staff doctor for four years now and my turns of duty had since been halved, but the conditioning remained.
I grappled under my pillow until I found the gadget. The number
342 flashed up on the LED screen, the Neurosurgery extension. I checked my watch and got really pissed. There were just twenty-three minutes left until the end of my shift, and the morning had been hectic, owing to a traffic accident that began in Dupont Circle and ended up on the operating table. I had spent three hours piecing back together a British cultural attaché’s skull. The guy hadn’t even been here two days and had found out the hard way that you exit a stateside roundabout the other way around, compared to London.
The nurses knew I was taking a nap, so if someone had paged me it had to be serious. I called 342, but it was busy, so I decided to hurry over and see what was the matter. I splashed some water on my face at the sink in the back but left the light off. Lately I had avoided mirrors like the plague.
I went out into the corridor. It was twenty to six and the sun was already setting behind the treetops in Rock Creek Park. The light shone through giant panes of glass, creating orangey oblongs across the floor. The year before I would have enjoyed the view, even as I ran to the elevator. But now I didn’t look up from the floor. The man I had turned into did not admire the scenery.
In the elevator I almost bumped into Jerry Gonzales, a male nurse on my team who was wheeling a gurney. I cracked a shy smile and greeted him with a nod. He was a stocky guy and had to move over to let me in. If there’s one thing two straight men hate, it’s bumping into each other in an elevator, especially when they haven’t showered for many an hour, which we hadn’t.
“Hey, Doc Evans, thanks for the book you lent me the other day. I have it in my locker. I’ll give it right back to you.”
“That’s okay, Jerry, you can keep it,” I said with a dismissive wave of my hand. “I don’t read much anymore.”
There was an awkward silence. Time was, we would have busted each other’s chops or swapped wisecracks. But that was before.
I could almost hear him bite back the words on the tip of his tongue. Good. I can’t stand sympathy.
“You got that gangbanger?” he said at last.
“That why they paged me?”
“They had a shootout down at Barry Farm. It’s been on the news for hours,” he said, pointing to his ear, which always had an earphone stuck in it. “Seven dead and a bunch of wounded. A turf war.”
“So why didn’t they take them to MedStar?”
Jerry shrugged his shoulders and stepped out of my way.
I came out of the elevator on the fourth floor, for the neurosurgery unit. St. Clement’s is a small, private and extremely expensive hospital. Even most people who live in Washington have never heard of it. Nestling on the south side of Rock Creek Park, near the Taft Bridge, it’s a very swanky place. Its client base lives in Kalorama, mainly foreigners and senior embassy officials—people with no health insurance whose governments grudgingly pony up for the humongous bills. The area is not at all accessible and you likely won’t have come across St. Clement’s, either, on your way through the neighborhood. You don’t find that massive Victorian redbrick building unless you really want to.
To my dismay, the hospital’s mission was not to support public service, either. The shareholders liked to keep costs low and revenues high. But fortunately, in common with all US hospitals, it was required by law to treat any emergency case that landed on its doorstep. This is how I crossed paths with Jamaal Carter.
He was in the middle of the corridor, outside the nurses’ station. A police officer and two paramedics were standing by, their uniforms dripping with blood. His bodily fluids had daubed dark, ominous stains on the reflective patches. The paramedics were shaken and spoke in hushed tones. Considering what they had to cope with in their line of work, some very bad shit must have been going down.
One of the emergency interns hovered next to the gurney, with a suitably earnest look on her face. She must have been new; I didn’t know her.
“Are you the neurosurgeon?” she asked when she saw me roll up.
“No, I’m the plumber, but they lent me this cute white coat so’s my overalls don’t get dirty.”
She looked all flustered, so I winked to let her know it was a joke. She tittered nervously. It’s always good to lighten up with the new kids. The residents usually treat them like some dog shit they’ve stepped in, so a scrap of humanity is manna from heaven.
She pointed to the kid on the gurney.
“His BP’s one hundred over sixty, pulse rate’s eighty-nine. He’s stable, but there’s a very nasty T-Five–level gunshot wound.”
I leaned over him. The gangbanger lay facedown. He wore sagging pants and a blue Washington Wizards jacket. Somebody had cut it open with scissors to treat a light injury to his right arm, which was covered in tattoos. The other arm was handcuffed to the gurney.
Most of the jacket’s back was missing. Right where the team’s emblem should have been, someone had ripped out a wide expanse of cloth. In its place was an exit wound, which was seeping blood. The bullet had lodged against his spine, between the shoulder blades. His readings were stable, his life was not in danger, but the injury could well have damaged his nervous system.
The gangbanger groaned a little and I crouched to look at his face. He had delicate features and was doped up. I brushed his cheek to attract his attention.
“Dude, what’s your name?”
I had to repeat the question several times before I could get him to answer me.
“Jamaal. Jamaal Carter.”
“Hey, Jamaal, we can fix you up, but you need to work with me, okay? Can you wiggle your toes there for me?”
I took off his big-ticket Nike shoes, which would have been shiny white before the shootout but were now a dirty crimson. His toes would not move. I dug a pen tip into the middle of the sole of one of his feet.
“Can you feel that?”
He shook his head, very scared. If that kid had turned sixteen, then I was a monkey’s uncle. Greenhorns in gangs were getting greener.
Jerk, jerk, jerk, I thought to myself.
“What’s this kid doing here?” I yelled at the senior nurse, who had just put down the phone and walked out of the station to come my way. She was wringing her hands.
“They’ve rerouted him to us from George Washington. They’re up to their necks and MedStar is, too. Dr.—”
“I don’t mean that. I mean why the hell isn’t he in surgery? We have to remove that bullet right now,” I said, pushing the gurney.
She stood in front of me, blocking my way. I didn’t bother trying to shove. It wasn’t worth my while tussling with the senior nurse, above all one who outweighed me by sixty pounds. When she sat behind the counter, she gave the impression she was wearing it.
“I’m sorry to have paged you, Dr. Evans, but I’ve spoken to the medical director and she hasn’t approved the operation.”
“What are you talking about, Margo? Dr. Wong is at a congress in Alabama!”
“I called to see if there had been any developments since I paged you,” she said with a guilty look, and shook her head. “When she heard about the gang . . . about the patient, she said he should be stabilized in keeping with the law. Now we’re waiting for some public hospital to okay a referral so we can reroute him there.”
I took a deep breath and ground my teeth. It was all very well for the medical director to rattle off orders from the seclusion of her suite in a five-star hotel. But out there in the real world was a kid who would be foisted onto an overburdened public hospital, where he’d be lucky to get treatment from an overworked resident and would face a high-risk operation with little chance of success. If they booted that kid out of St. Clement’s, it was dollars to doughnuts he’d never walk again.
“Okay, Margo. I’ll call Dr. Wong,” I said as I reached for my cell phone. “You got anything to tell me?” I asked the paramedics while I waited for the call to go through.
“The slug ricocheted off a wall before it hit him; that’s why he’s still alive,” one of them said, shaking his head. “If only it had gone
a couple of inches to the right, we’d be talking about a graze here, but . . .”
But his hard luck is now our hard luck, I thought.
I raised a finger and drew away from the paramedics. My boss had picked up the call.
“Don’t even think about it, Evans.”
“How are the martinis going down, boss?”
“You are not to operate.”
“Stephanie, he’s just a kid and he needs help.”
“Help which will cost ninety thousand bucks that no one can pay us back.”
“Boss . . .”
“Evans, we’re already way over our pro bono budget for the year—mainly because of you—and it’s only October. I’m sorry, but the answer’s no.”
“He’ll be paralyzed,” was all I could find to say. As if she didn’t know.
“He should have thought of that before he joined a gang.”
Let nobody get on Medical Director Wong’s case for those words. True, she’s a heartless bitch, but she’s also an outstanding surgeon. Her duty was to look out for the hospital’s interests, which is precisely what she was doing. And as for her prejudices against gangbangers, well, we doctors are like that.
We make tough decisions based on the facts and the resources at our disposal. So there’s just one kidney available? We give it to the youngest patient, even though he’s a few places back on the waiting list. You smoke two packs a day despite those great big warning labels they come with? Well, don’t expect us to shed any tears if you come to us with lung cancer. You drink like a fish? When you show us your cirrhosis, we’ll probably crack jokes about pâté. Behind your back, of course.
Am I that way, too?
Good question, and one with no easy answer.
I’m not a fiend, I’m a human being the same as you. It so happens I spend so much time seeing bad things happen to good people for no reason that if something bad does happen to somebody for some apparent reason, then I put the blame on them. It’s the human brain’s instinct for self-preservation. I do my best and try not to take it personally. The Bible thumpers and politically correct will say that’s inhumane, but believe me, that’s how we provide the best possible service.
Now and again, however, a patient turns up who has a peculiar effect on you. They smell strongly of an aftershave that reminds you of your adoptive father, talk with a lilt, have a certain mannerism, or frightened little eyes, as Jamaal did.
And all those bulwarks you have striven to think of as indestructible are breached as easily as tissue paper. And you do what you never ought to.
You get involved.
“Stephanie, please . . . What do you want me to do?”
“I’ll tell you what. You sit out the eleven minutes until your day is done and go straight home. Then someone else will have to deal with it.”
There was something in her voice, something odd I didn’t get the gist of. I squeezed the bridge of my nose hard, trying to get to the bottom of it.
Then I saw what my boss had insinuated. As the top-ranking surgeon on site, for the next eleven minutes the legal liability for the boy’s fate was mine. All mine.
“Dr. Wong, I have to run. The patient’s condition has deteriorated. I fear for his life. I must operate to remove the bullet.”
“I’m sorry to hear that, Evans,” she said curtly as she hung up.
I barked a few terse commands and the paramedics leaped aside. The nurses whisked the patient into surgery. I still needed an anesthesiologist, but there wasn’t a single one in that hospital who could say no to me.
Not after what happened to Rachel.
After I scrubbed up for the operation, I made one last call.
“Svetlana, we have a situation. I won’t be home for dinner.”
“Very good, Dr. Evans,” she answered in her mechanical Slavic tones. “I’ll put your daughter to bed. Do you want me to tell her?”
I had promised to read Julia a bedtime story that night. A promise I had broken more often than I cared to remember.
I sighed. “No, go get her.”
I heard Svetlana call for my daughter, trying to make herself heard above the din from the TV.
“Hi, Daddy! Will you be home soon? There’s chicken for dinner!”
“Hi, honey. I can’t make it. This boy’s in a bad way, and only Daddy can help him, see?”
The ensuing silence was fraught with all the guilt a seven-year-old girl can make you feel. Cold, clammy and unpleasant.
“What’s on TV?” I asked to try to cheer her up.
“SpongeBob SquarePants. It’s the one where Plankton says he doesn’t want to steal the Krabby Patty formula anymore and opens a toy store.”
“And Mr. Krabs won’t stop till he talks him into stealing it again. I love that one.”
“Mommy liked it, too.”
I took a few seconds to answer. There was a lump in my throat and I didn’t want her to notice.
“I’ll tuck you in as soon as I’m back. But now I need you to be good, for the team’s sake.”
Julia sighed, to make it clear she wasn’t buying this one.
“Will you kiss me good night? Even if I’m asleep?”
“I promise,” I said. Then I invoked our battle cry, the one Rachel had made up. “Team Evans?”
“Yay team,” she replied, but with little conviction.
“I love you, Julia,” was the last thing I said to her before I went into surgery.
She hung up. No comment.
It was eleven thirty at night. I was staggering across the parking lot and dog tired after a long operation when my cell phone rang again. It was my boss.
“How’d it go?”
Her speech was slurred and I could tell the minibar tab would be hefty. Dr. Wong probably wouldn’t expense it to the hospital but cover it herself, in cash. All of us surgeons drink, and the older we get, the more we drink. It helps you sleep and stops your hands from shaking. But what we never, ever do is own up to it in public. Unless you’ve got nothing to lose, that is, as with me now.
“Well, there’s one gangbanger who’ll be back prowling the Anacostia streets in three to five years’ time. Or less with good behavior,” I said, fishing in my pockets for my car keys.
“I’ll have to notify the board. There have been complaints about your lavish use of resources, Evans. I hope your forthcoming report can justify the decision to operate.”
Exhausted as I was, I got that in one.
“Don’t you worry, boss. The report will be word-perfect,” I said, my words laden with sarcasm. “It’ll be the Victor Hugo of medical literature. I won’t give them any excuse to fire me.”
“If you pull off Friday’s op, you’ll be untouchable. Forever. You can be med director in any hospital you care to name,” she said enviously.
I was thankful she didn’t mention the other eventuality. That would be equally clear-cut.
“Come off it. It’ll be to the credit of the whole neurosurgery unit.”
She chuckled again, a bit too loudly. She was officially drunk.
“I have two ex-husbands who used to lie better than you, Evans. Now, you go home and rest up. Tomorrow you have an appointment with the Patient.”
“No worries, boss. I can handle it.”
“How old are you, Evans? Thirty-six?”
“Boy, at this rate, you won’t see forty.”
I hung up and turned the ignition key. The Lexus’s familiar roar boomed under the hood, and I smiled for the first time that day. The first time in many days, actually. Before the week was out, things would finally begin to look positive for us, which they hadn’t done since Rachel died. I would have a better job and get a life. Quality time with Julia.
Untouchable. I liked that.
Inside an hour, I would find out how wrong I could be.