I shook off my terror and continued. “Chest CT in the ER last night demonstrated a pleural effusion as well as a collection in the liver. A dedicated CT of his abdomen and pelvis was pursued to further evaluate this finding, which revealed his hepatic abscess.”

“Yes, now it’s making more sense,” Dr. Jaiswal stated. “Sounds like there was no diagnosis apart from fever of unknown or at least unclear etiology and some nonspecific small pleural effusion found on a chest X-ray as the PCP worked up the patient. Due to Mr. Frame’s worsening clinical status on antibiotics, his physician appropriately referred him to the ER for advanced evaluation and treatment that could not be offered in an outpatient setting. Upon arrival to the ER, they completed a series of CAT scans that revealed Mr. Frame’s final diagnosis of hepatic abscess. In keeping with the guidelines for the management of this type of hepatic abscess, it will require drainage in addition to antibiotics to ensure proper treatment,” she said, giving me a curt nod signaling that because I obviously lacked the proper medical deductive reasoning, she would make the patient presentation herself.

Then, turning to the patient, she said, “Nice to meet you, Mr. Frame. We will be speaking with interventional radiology today to coordinate the drainage of your infection. Of course, there is more testing we will need to do as well while we continue your treatment. There will be many more people by to see you—providers from the departments of radiology, infectious disease, gastroenterology, and, of course, the general internal medicine team.” She smiled at Mr. Frame the way a person who has everything under her control would, as if to say that nothing could go wrong because a benevolent captain was in command of this ship.

She turned back to me. “Thank you, Dr. Harper. You can go home to rest up for tonight. Make sure to read about how to take a history, the workup of fever of unknown origin, as well as the presentation, evaluation, and treatment of hepatic abscess. Ideally, these are things you would do before rounds. Thank you again. I’m sure we all learned a great deal from your presentation.”

“Yes, of course, Dr. Jaiswal.”

With that, she pivoted on her kitten heels and walked out of the room. One by one, the interns followed, a trail of white coats shuffling behind trying to keep up. One intern tripped on the feet of the one in front of her.

I slinked out of the room, wishing desperately that I could vaporize. That morning, I went home and napped away the day.

I never forgot that encounter. For the entire intern year, I made sure to ask too many questions of my patients. After all, it was the clinician’s job to get the history. Sure, the patient had to answer questions honestly in order for this to work, but I was the detective, so I needed to know what I was looking for and where to look for it. To the best of my ability, I not only read about the topics I didn’t understand, I also read around them. I reviewed the history in my head and practiced my assessment and plan, making sure the reasoning led to a logical conclusion. And if I felt that I didn’t have all the information from a patient, I went back as many times as required to make sure I got it. Each case was a story, and the story had to make sense.

That was the last time I was unprepared for Dr. Jaiswal’s rounds. What’s important was that in that very long year, she helped me become a better doctor because I saw the good in her, in the value she placed on meticulous preparation and critical thinking. The other parts, the parts that were derogatory and cruel? I made up my mind to ignore. All of it, the rough and the smooth, was crucial for my development as a doctor. I later realized that even with its excruciating challenges, this intern year prepared me best for the transition from my former life to my life after residency and my divorce.

* * *

—

“Doctor Michele Harper.”

My residency program director had called my name, breaking my trance. My final graduation.

I don’t remember what I wore to the ceremony, or who spoke, but I vividly remember how eternally grateful I was for the power to compose myself in the seven seconds it took me to stand and walk to the podium. I claimed my diploma and took the obligatory photos before dissolving into tears. I knew how to compartmentalize—my family dysfunction and my stint in medical school had given me a lot of practice. I didn’t have time to grieve for my marriage or for the future my ex-husband and I would never share. I had to pack, move, unpack, coordinate a divorce and the sale of our co-op, and start a new job in a new city, alone. I hadn’t even considered the new life part. Thank goodness for that convenient oversight. If I had stopped to consider that for even one moment, I don’t know how I would have gotten into the Ford Explorer Dan and I shared—it would be returned to him, as it had been a gift from his family—to make the drive to Philly.

I don’t remember much else about my residency graduation because I was striving so hard to let go of that future and struggling to understand that another was already under way. I’d signed a lease for an apartment in one of the upscale buildings in Center City, within walking distance of the hospital where I was to work. The doormen called you by name and asked how your day was going. The elevators ascended silently at warp speed. My thirty-fifth-floor unit was absolutely tranquil, and I had floor-to-ceiling windows that let in waterfalls of light. I hoped these fancy things might fill the void inside me currently inhabited by pain.

For my first night there, I had an air mattress, six boxes of clothing, two boxes of kitchenware, and my computer. I possessed little else materially. The one item I had taken from our co-op in the South Bronx was a large mirror. I asked Dan to send two items that had been gifts to us: a woven basket from Kenya and a framed photograph of a woman standing at a bus stop in front of the Shepard Fairey Barack Obama HOPE poster. He agreed, but I knew he wouldn’t send them, and I couldn’t muster the energy to mount any significant protest. They would be just two more parts of a past I had lost.

On one of my first days in the new apartment, I sat for hours on the living room carpet staring out the windows. I could see the signs and fa?ades of neighboring businesses, many of which were owned by my new employer. Unfortunately, the neon sign announcing “Andrew Johnson Hospital” was the biggest during the day and shone brightest during the night. It wasn’t reassuring then, and as it turned out, that wouldn’t change. Still, I could just make out a corner of the Schuylkill River snaking along the horizon, which offered a calming contrast to the cityscape.

The particulate matter of memory, heavy and unrefined, filled the room. I inhaled it, letting it abrade the back of my throat and sting my eyes. I lifted my chin into peak June sunlight. Closing my eyes, I leaned into the gold, orange, and red behind my eyelids. I was drawn to it, like a plant. I felt my skin baking. I felt the crackle of the heat, but I didn’t flinch: I was finally feeling something. I didn’t know what existed beyond the window, beyond the door to my apartment. I didn’t know myself in this place. I didn’t know what I would be. I fancied that all things happened for a reason, so there had to be a reason I had been stripped to my core and was sitting here on a warm carpet, in the blazing reflected light of an unknown city. In a couple of days, I would unpack these boxes, don crisp green scrubs, and go to work. Sometime soon, I’d figure out the rest, but now, I just had to be broken. There wasn’t energy for much else.

A cloud breezed by, offering a moment’s respite from the heat. Thank the goddess for those windows. For the light. For the silence. Thank the goddess for the view from thirty-five stories up: I didn’t yet recognize anything I saw from that height, but it offered a critical distance, a life-saving perspective.

THREE

    Baby Doe: Born Perfect

Night shifts are always inconvenient and much like hangovers: The older you get, the harder they are to recover from. For some, they are a badge of honor; those types sprint them like marathons, race after race, year after year, with the stamina of a long-distance runner. The nocturnists, the hospital-based physicians who are scheduled to work the night shift exclusively, are the strong and brave among us. The goddess forever blesses them because they allow the rest of us to dwell largely in the light.