“Patient’s granddaughter says patient slept thru night”
By the end of the week, I had received another message,
“Patient’s granddaughter says patient no longer hallucinating and UPS delivery man no longer conspiring to break into the home.”
I really am going to need some dress shirts and ties for Sunday mass, I thought and I said a silent prayer of thanks right then and there.
After that, things got busy for a while. I saw my first case of shingles, my first patient with Lyme disease, my first case of Bell’s palsy and so many other firsts. It was like I opened my brain every morning, crammed it full of new material all day and could barely shut it down for sleep for a few precious hours every evening.
It turned out that I would soon have a diversion from all that intensity. One afternoon there was a small envelope on my desk and inside was a hand-written invitation.
RETIREMENT WITH STRINGS ATTACHED PLAYERS
INVITES YOU TO A CONCERT FEATURING SELECTIONS FROM VIVALDI’S
The Four Seasons
I had a feeling that I already knew who the performers were going to be and where the concert was going to be held. I just hoped that a certain young violinist would be in the audience.
Chapter 21
I arrived at the Weinkopf house on a warm early autumn Saturday afternoon. There were a surprising number of other cars already parked on the cul-de-sac in front of the house and other concert-goers headed around to the backyard. There, I saw rows of folding chairs, a few tables with bottles of soda and plates of cookies and about 30-40 very friendly looking people of various ages milling about and looking like they all knew one another. At that moment, a middle-aged nicely-dressed couple stepped toward me and extended their hands.
“You must be Dr. Vega,” the gentleman of the pair said, “Jill has told us a lot about you and your special way with older patients. I am Martin Weinkopf and this is my wife, Annette.”
“It is such a pleasure to meet you, Dr. Vega,” his wife greeted me, “Thank you so much for what you’ve done for Norman.”
“Mr. and Mrs. Weinkopf, I am very honored to meet both of you but please call me Carlos. I won’t even officially be a doctor until next spring.”
“Carlos it is, then, but hurry up or you’ll miss the beginning of the concert.”
I looked around and saw Jillian conferring with her grandfather as he prepared to play. Their conversation was animated and intense. I wondered if that was what Greco and I looked like when we were discussing a patient with a challenging disease. It was at that moment that she glanced up, saw me and smiled warmly. She started to walk towards me but was stopped by someone who needed to ask her a question. She looked a bit frustrated.
“Can we talk after the concert?” She called out to me.
I nodded quickly and enthusiastically.
We sat down in a hushed silence as four elderly men with their instruments walked towards their places in the front. And then disaster struck. One white-haired violinist tripped and pitched forward landing on his outstretched hand. I jumped up and ran over to him to assess the damage. The codger was holding his swollen wrist against his chest and moaning.
“Sir, I am a medical student, may I have a look?” I asked.
“You can look, but can you fix?” he replied with growing trepidation.
Unfortunately, there was already significant swelling and point tenderness over the wrist bone on the thumb side of his wrist. While there was no gross deformity and no obvious nerve or blood vessel damage, he would not be performing at this concert.
I looked up to see a trio of very concerned but also very disappointed musicians.
“Will Charlie be okay?” asked Norman Weinkopf.
“He’ll be okay,” I reassured him, “but he needs to go to the emergency room for an xray and a splint. And he won’t be playing this afternoon. I’m really sorry.”
“Won’t be playing?” he echoed, “but everyone is here to listen to the concert!”
Charlie had heard enough. “We are NOT going to cancel the concert. There must be a way. Wait a minute…where’s Jillian?”
“Hey Uncle Charlie,” Jillian said from the back of the crowd of concerned onlookers, “What do you need?”
“I need you to take my place in the concert”.
“Uncle Charlie, that is not happening.”
“Jillian, please. Norm and the rest of us haven’t performed for an audience in years. Who knows when we’ll get another chance. You’re a conservatory violinist and you know this music as well as we do. Why not give it a shot and play with your old Grandpa?”
Jillian got up and stormed off. She returned with three items which I later learned were not all standard stringed quartet equipment. She had a violin, sheet music for The Four Seasons by Antonio Vivaldi and an ice bag.
“Uncle Charlie,” she gestured to the ice bag, “put this on your wrist and elevate it above your heart. We’re going to play Vivaldi like he’s never been played before and then YOU are going to the emergency room, is that clear?”
“Yes ma’am”, said a chastened but happy old geezer.
Chapter 22
After the lilting strains of Vivaldi had long faded away and most of the guests had started to make the short walk back towards their cars, I finally got the nerve to approach Jilllian. She had been busily playing hostess in addition to being an unexpected featured performer so I wondered if she would be pretty tired by now.
“Can I help you put away the chairs and tables?” I offered.
“Oh sure, thanks for offering,” she smiled warmly and gestured with a hand to where things were being stacked up.
“I just wanted to say that I’m really sorry your Uncle Charlie got hurt, but I’m not sorry I got to hear you play. I know I’m no music expert, but I thought you were just amazing.”
Jillian actually laughed. “Charlie has wanted my grandfather and me to play together for years. He probably planned the whole trip and fall thing just as a set-up to get his wish.” She continued, “As for the nice compliment, in the music business, you take a good review wherever you can get one, so thank you, kind sir…” her eyes danced with another dazzling smile and then she bowed formally.
Then, she said something I’ll never forget.
“If I play for a living, it will mean going from audition to performance to review and back again. You know, you got a pretty good review yourself from my family in the role of ‘retired musician’s doctor’. In fact, in the business, we’d say you pretty much ‘killed’ that audition.”
“Now, it’s my turn to say thank you, kind lady”, I bowed in an exaggerated parody of formality.
She almost giggled at that one. “Are you too busy at this time for another try-out, Dr. Vega?”
“Is there someone else in your family who needs a physician in training?”
“Well, there might be,” she winked, “but she isn’t sick. Are you up for some more Italian ice?”
I tried to contain the enormous grin spreading across my face, “How about dinner instead?”
“I’ll get my bag”.
Chapter 23
We chose a casual restaurant in the center of town with a small outdoor patio garden bordered with geraniums overlooking the sidewalk and its happy cargo of shoppers and passers-by. I frankly couldn’t believe my good fortune.
After some small talk and some fried mozzarella sticks, she decided to answer the obvious question without me having to ask it.
“You’re probably wondering why I’m here with you if I already have a boyfriend and you’re not my type”.
“The thought had crossed my mind.” But I was so deliriously happy that I was willing to dismiss it in a heartbeat just to be here with you.
She continued, “Well, that day in the parking lot, I was telling the truth for the most part. At the time, I was seeing someone, but it was about over. I don’t see him anymore. The fib I told was about you not being my type. The truth is, I could f
eel something between us the minute you walked into the exam room but I couldn’t let that get in the way of my goal which was to make sure my grandfather got what he needed. I hope you won’t hold that against me too much.”
You could be an axe murderer and I wouldn’t hold it against you.
“I can understand that your grandfather would be your top priority at that moment,” I admitted, “and I don’t hold it against you at all.”
“His memory is still pretty terrible, you know. What the medicine has mostly done is allow him to sleep and to help him feel less paranoid. He doesn’t see things that aren’t there and he just feels a lot more at peace. But believe me, we are all very grateful for that.”
I felt a little uncomfortable with all the adulation and I wanted to get to know her better so I said,
“Now that my head is so swelled it won’t fit through the door of the restaurant, can we please talk about you?”
“Well, you met my parents. My dad is a pharmacist and my mother is an accountant. I have two older sisters who have disgustingly practical careers in business and are married and have moved out west. I have always been the dreamer in the house. I discovered music early and have been in love with it ever since. At the conservatory the first day they said to us, ‘look to your right and look to your left and realize that two out of three of you are going to be music teachers someday so don’t think that just because you were admitted here you’re automatically going to make it as a performer.’ I heard that and became all the more determined that I would play music for a living—with a major symphony if possible.”
We finished our dinner and strolled down the main street of the town. I realized that I had been consumed with learning medicine for so long that I had almost forgotten what it felt like to be really content. We turned the corner to look at some brightly colored Victorian homes when I felt her hand slip into mine. It just felt so natural to be walking like that—like we’d done it a hundred times before. And yet there was a rising feeling of excitement in my chest.
It wasn’t long before we arrived back in front of her house. I barely had time to look down at her when she was suddenly in my arms kissing me.
“So how did my audition go?” I asked, suddenly a little breathless.
Her eyes flashed brightly and she pulled me down towards her again. “You’ve definitely earned a call-back, Dr. Vega. My people will be in touch.”
Chapter 24
As I drove back to Dr. Greco’s office the next day, I couldn’t have been more confused about my future. I had no idea what medical specialty I would choose to study. I had been offered a great practice in a beautiful town—but might have to decline. And to make matters worse I had finally found someone who might be truly special—but both of us were headed in different directions in less than two weeks.
So I did what any red-blooded American male would do in a similar situation. I hit the denial button. I absolutely put off any decision-making whatsoever. I worked long hours with Dr. Greco soaking up every morsel of medical wisdom he could give me. Then I spent every spare moment with Jillian like there was no tomorrow. For all I knew, for the two of us, there might not be.
The last day of my rotation was a Friday and Dr. Greco called me to his office.
“Dr. Vega, you’ve done all you can here and I’ve taught you about everything I can convey in the time we’ve been given. A little birdie told me you’ve got some non-medical unfinished business to take care of before you leave our little town. Why, don’t we shake hands and part now so you can do that? You already know what your evaluation for this rotation will look like. Congratulations and good luck in whatever direction your career takes you.”
I wasn’t sure what to say.
“Dr. Greco,” I finally replied, “I want to thank you so much for everything. This has been far more than a medical rotation. It sounds like a cliché to say so, but it has truly been a life-changing experience. Whatever happens, I will never forget you, Sir.”
And at that moment, we actually embraced. I don’t think either of us expected that.
I drove over to Jillian’s house where she was packing for her last year at the conservatory. Up until then, it was like an unspoken agreement that we hadn’t discussed the future. Now, we had no choice.
She ran over immediately to give me a hug but her eyes glistened with tears she was trying not to show.
“Carlos, you know we barely know each other, so it’s not like I have some claim on you. You have more rotations, a residency to complete and then a medical practice to begin. And who knows where I’ll catch on with a symphony? So I’ll understand if you…”
I was not going to let her finish the speech, “Jillian, sometimes it doesn’t take a long time to figure out that someone might be ‘the one’. You’re right, I don’t know for sure if you are the person I’m going to spend forever with, but I certainly know that right now, I can’t think about anyone else but you. We have something here. I know I don’t want to lose you. I’m willing to work to keep you in my life, even if there is some time and distance involved. Does that make any sense at all?”
She threw her arms around my neck and gave up trying to keep the tears from flowing down her face, “Damn it Carlos Vega, here I am trying to let you go gracefully and you insist on making it completely impossible!”
“Not this time, Jillian Weinkopf, you’re going to have to work a lot harder than that to get rid of me.”
Chapter 25
So there I was, back at my Midcentral State U apartment playing poker as my friends and I took a quick breather between rotations. We were the same players, playing the same nickel ante, quarter maximum bet games, still wondering where life would take us.
“Let me get this straight,” began Courtney the future joint replacement specialist, “it took you six weeks to make your move on this babe and after a fourteen day whirlwind courtship, you’re hoping to hold onto her while she plays the violin among the rich-boy society types in Philly and you disappear during your shock trauma sub-internship at Metro Health?”
“Show us the picture again,” Tyler said.
Gomey was not optimistic as he examined the photo on my phone, “In my village, you would need to offer three elephants and two Land Rovers to her father, and still you would need to keep bidding.”
“Thanks for the votes of confidence, everybody”, I said, exasperated, “Why does everyone think you have to have spend years with someone before you know they could be ‘the one’?”
“We’re not betting against you, Vega,” Courtney said in a much softer tone, “We just don’t want to see you hurt. You know what a shock trauma sub-I is like. You go in there and you don’t come out until it’s over. Jillian isn’t going to see you. Are you going to be able to get through that for six weeks?”
I let that question hang in the air.
Tyler hated long silences so he waded in with another question, “So did Dr. Fossil offer you his practice with a complimentary lifetime permit to hold little old ladies’ hands?”
“You’re not going to believe this, but he actually did,” and I told them about how different the whole experience was than I expected it to be.
“Well, Vega,” said Courtney, “then you’d better start winning at the poker table, ‘cause you sure aren’t getting rich from the hand-holding concession. I’m dealing. The game is Night Baseball, do you all remember the rules?”
Chapter 26
The rules at the Metro Health Shock Trauma Sub-internship say that the fourth year medical student who participates must follow the same schedule as the regular interns including sleeping overnight at the hospital every third night and being available for the same grueling schedule. I was to be supervised by a junior resident who was also overseeing actual interns (those who were in their first year of training after medical school).
I wanted the full shock trauma experience—stabilization in the emergency department, surgical procedures in the operating room and experience in
the surgical ICU with managing everything from machine-assisted breathing to unstable blood pressure to post-operative infections to kidney, heart and liver failure as well as what happens in the special situations when the brain and spinal cord are injured. I also wanted to see the reconstructive side of things and work with burn trauma.
Furthermore, I had heard that surgery training programs could be pretty physically and psychologically brutal. Even with less ridiculous working hours than in years past and with the advent of a much larger female contingent, surgery training continued to have the reputation for being like a football training camp. Lots of yelling and humiliation and extra laps if you didn’t perform as expected. I wanted to see what it was like close up and if I had what it took to endure it and hopefully thrive.
My junior resident introduced herself as Althea Johnson. She shook my hand firmly and immediately showed me around. She didn’t seem to beat or starve the interns and that seemed like a good sign. In fact, she spent a lot of time making sure they knew the inside track to impressing the senior residents and attending physicians.
We got through the orientation stuff and right away got called to the Trauma ED (emergency department) for a new case: an unfortunate motor vehicle accident victim who was not wearing a seatbelt. They let me just watch the first time. I marveled at how quickly each part of the team took care of a specific aspect of the case. Neck stabilized and fractures ruled out with imaging. Airway assessed and breathing tube was quickly passed into the patient’s windpipe. Two large diameter intravenous lines were started. Arrangements were made for CT scans or xrays of other injured parts. Blood was drawn for testing and to prepare for possible transfusion. I knew that in a very short time I would be participating with all of these teams and hopefully one day learning to manage one.
I felt the familiar adrenaline surge of the emergency room and the special sensation in my brain as it prepared to go into overdrive for fast decision-making. This was the situation I felt I had prepared for over the past few years. I had read a lot of articles and rehearsed many scenarios in preparation for this specific rotation. Now it was time to put my textbook knowledge into action.
Chapter 27
The next day I arrived in time for morning report and my first official day as part of Trauma Team Three. Team Three was headed up by a senior resident named Royce Cunningham. I saw Royce’s bio in the catalog and it was impressive. Harvard Medical School, Alpha Omega Alpha honorary medical fraternity, all-world everywhere he went. I think he invented his own molecule in third grade that cured cancer and baldness and just missed a Nobel Prize. He wasted no time in getting things started.