We Were Present All Along by Jessica Weisberg

We ate Skittles so we’d be awake when our patients died. On a quiet night, we would lay on the floor of the lounge or on its itchy red couches pretending to be bad doctors, analyzing x-rays of decaying livers like they were Rorschach Tests. We were twenty-six or twenty-seven or twenty-eight, without hobbies and on no sleep. We admired residents who still managed to follow their favorite sports teams.

Those among us who didn’t care about sports spent our off-days eating, sleeping, and emailing about Georgina. She was older, thirty-six or thirty-seven, maybe. We emailed when her hair looked unwashed or when she wore her tight red jeans or when one of us caught her flattening her shirt as she came out of Dr. Graham’s office or when a patient — hand pressed against a wound, blood spurting from between his fingers— asked to be treated by her. The old people from the nearby projects would ask for her, too.  We exchanged emails with theories about the butterfly tattoo on her forearm, her newsy cap, the flowers she had painted onto her clogs, why her mood was so jarringly good, why she tied up her ponytail with a piece of rope.  We were certain she was depressed. She had been a musician, we thought, because once in class she had (idiotically) compared the intestine to a guitar, but she couldn’t have been an especially talented musician because she was in her mid-thirties — at least! — and had ended up at medical school. We wrote until she didn’t seem real anymore. We didn’t think much of it when we accused her of malpractice and prostitution and murder because the emails didn’t seem serious or at least not as serious as doctoring.

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            We were busiest in the late evening and on weekends. Most of our patients were drunk students or black guys their age who had just been shot. On Saturday nights, we’d wager with granola bars about whether there’d be more stomachs to pump or wounds to dress. It was usually the latter, except in late spring when the kids finished their finals and drank too much Stoly.

The bleeding boys would always ask for Georgina. “I hear she can heal,” we heard one of them tell a nurse.  There were fifty or more emails about what that might have meant — if she evangelized or sang or gave them blowjobs. When we didn’t have our own patients, we’d try to listen to what she was saying from behind the white curtain. She addressed everyone by their last name, as in Mr. Malek or Mr. Ortiz or Mr. Hicks. She had written an email asking that we all consider addressing our patients more respectfully. “When someone with a title as fancy as ‘Doctor’ refers to a patient by a first name, it creates this stark sense of hierarchy that I don’t think is healthy for our profession,” she wrote. No one responded to her, but we emailed about the email more than sixty-three times because how could she really be so naïve to think that when two people are in a room and just one of them has a scalpel that those two people could ever be the same.

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Georgina left dandelions on her cadaver’s chest and referred to it by name — Mr. David Wilson. He had been a science teacher and someone heard that she sent a letter to Mrs. David Wilson to say thank you and who-knows-what about the advancement of science. We knew she took figure-drawing classes at the art school and that she once complimented the woman who cleaned the bathroom on the length of her neck. During orientation, she had said that she wanted to become a doctor because she found the human body humbling and beautiful. We were surprised when the dean had replied, “It is beautiful. Isn’t it?”

There was nothing beautiful about the hospital, with its foam-board ceilings and scratched floors, the screeching wheels of gurney, the piercing beeps of a heart monitor. It was the ugliest place we’d ever seen. Hospitals aren’t as busy as they are on television. We spent a lot of our time drinking grainy coffee, watching sleeping people sleep, bored enough to soak in the ugliness. We had all been trying to be doctors since we were twelve. We had tried through high school and college and medical school. Being a doctor was different than trying to be a doctor. It left you with much less to talk about, much less to celebrate: A good day was when no one died. An okay day was when someone died but there was nothing we could do about it. Our job was hard, the population we worked with made it harder. Our only stories were hospital stories, which we could only tell each other.  

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We didn’t notice the deaths. The head doctor called everyone into the hospital on a Sunday afternoon and told us: Too many deaths.  There had been more deaths than anytime in the hospital’s modern history. More than when a particularly violent and ambitious gang-leader had been around, more than the 2004 flu season. There were no specific instructions.  We were doing badly and needed to do better.

Georgina raised her hand. “Is preventing death the only metric of whether we’re doing our job well?”

We tried not to look at each other.

“What would be a better metric, Georgina?”

“There are plenty, actually. Better use of the hospital by people in the neighborhood, decline of preventable illnesses, positive reviews from patients.”

“How can patients make reviews when they’re dead, Georgina?”

“Their families can. They can say if their loved one died peacefully and comfortably.”

“There’s a hospice ward for letting people die comfortably. That’s not our goal here.”

“I just think as doctors we have a lot of bad history to make up for. That it’s in the best interest of the profession to make people comfortable, to make sure they’re not confused.”

“That sounds great,” the dean said. “But just don’t let people die while you’re doing it.”

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The hospital recorded deaths by month and by cause. March: Four lung punctures, eight bullet wounds, seven heart attacks, ten infections. February: twelve infections, seven bullet wounds, three neck injuries. Like that. We agreed, over email, to reveal how many of our patients had died that year — it was the only way to find out what percentage had been Georgina’s. So we each emailed our number. Seven, fourteen, nine. The people who covered weekends had the most deaths. It wasn’t an easy number to calculate: There were patients we treated in the final hours or minutes of a shift who may or may not have made it. We didn’t want to check records; we wanted to do this quietly. We had thirty-six deaths between us. There were forty more to account for: blood loss, spinal injuries, heart failures. 

            There were other residents besides Georgina whose numbers we didn’t have. They probably had deaths, too.  But then, one of us brushed the curtain while Georgina had a hand over her patient’s mouth — he was young, black, and bleeding. It had happened quickly, but it happened. One of us saw it. Maybe he had asked her to die and she had listened. Maybe he had said something that made her angry. Maybe he was a Republican. Then, one of us watched her remove an I.V. from the arm of someone who needed it. We walked past while she massaged a young guy’s legs, and one time we swore we heard her humming “The Circle Game” as she was washing her hands, like death was something to celebrate.

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None of us wanted to go to her potluck, but we felt we had to. She lived a ways from campus, a decision she explained with a sense of ethical superiority. We didn’t dare ask if the neighborhood was safe, because then she would launch into a lecture about assumptions, racism, and cops and we didn’t have the energy to talk about those kinds of things in the middle of a shift.

            She lived on the third floor. Her walls were painted orange and the music wasn’t in English. A young child tugged at her skirt.

            “Thanks for coming,” she said, reaching for a hug. “Yes, this one’s mine.” She ruffled the child’s hair. “His name is Grant.”

            We shook Grant’s hand. He sucked on the neckline of his tie-dyed shirt. “I didn’t know you were a mom.”

            “Yep. Don’t know who the dad is, in case you were wondering and afraid to ask. My mom lives nearby and he stays with her while I’m at the hospital.”

            “That’s great you have help.”

            “Oh god,.” She poured Grant a cup of orange juice. “It would be impossible otherwise. School is definitely not made for working moms. It’s made for stand-up kids, like you all.”

            We didn’t know what to say to that, so we didn’t say much and we placed our pasta salad, corn salad, and grapefruit juice on the dining room table with the rest of the dishes. There were people we didn’t recognize — people who weren’t from medical school. They wore bright-colored pants and some of them had children. They knew Georgina from “around.” They talked about the local government.

            “Have you heard about this?” Georgina looked at us. “The university might be changing the public school into a charter school, make it more suitable for professors’ kids.”

            “Sucks,” said a woman with a red bandana around her head.

            “I’m sorry, but can you explain why that’s such a bad thing?”

            “What it means is that the children of these rich professors are going to be taking up slots in our community school and we’re going to have to ship our kids halfway across town to find a school that’s half as good. That’s time. That’s gas. That’s money,” Georgina said.

            We nodded.

            “And just like, philosophically, does the university have to own this entire area? They just get to decide how we should educate our kids? There’s no discussion, no feedback, no town hall. Just ordering the rest of the community around,” Georgina took a bite of eggs and spoke as she chewed. “That’s not how any real change happens. I know I say this all the time in class, but healing should be collaborative! Not so top down.”

            “Preach!” The woman in the red bandana said.

            Georgina laughed. “Sorry, I get worked up about this. But it drives me nuts how little they have us rely on intuition, you know? Before there was medicine that was the skill people relied on to heal other people. They listened. They asked questions. Now, we want all our doctors to be these perfect A-students who are too sleep deprived to think for themselves. It’s like they’re preparing to hand off our jobs to robots.”

            She was calling us robots to our faces. We had come across her type in high school and college. People who were mad at the things we were good at — school, the SATs, MCATs. Maybe we weren’t as freethinking as Georgina and the woman in the red bandana. Maybe we were more beholden to the ideas and values in which we were raised. But at least we were too busy saving other people’s lives to critique our own.

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The professors  started shadowing us. They stood in the corner like gargoyles as we pumped stomachs, took blood pressure, stitched stitches.  They were wasting their time. We tried to be patient; we wanted to trust the process. We discussed sending an anonymous tip from a new email address. We wrote a draft. “We would like to recommend that the university focus its investigation on resident Georgina Quinn. We have observed her unorthodox medical practices firsthand and fear that she is putting patients in danger and damaging our reputation in the community.” We couldn’t decide which examples to include. The time one of us watched her suffocate a patient. The time she removed an I.V. But maybe, one of the newer residents wrote, she was checking the patient’s breath or replacing a needle. “Let them see it for themselves. This will work itself out.” Josh was one of the residents who still watched sports. We hated waiting, hated watching our professors waste their time, hated being watched like we were third-years again.

“What the hell did you just say?” Professor Knight had grabbed Georgina by the wrist and pulled her into the hallway. A few of us watched from the lounge’s cracked door.

“I don’t see why she can’t watch. It’s her brother. It’s no big deal. It doesn’t distract me.”

“That’s just not how we do things. You must know that. Don’t play dumb.”

“I think I’m more accountable to my patient when a member of his family is watching. I think it takes the doctor off a pedestal.”

“That’s a lovely idea, Georgina. It makes a nice story. But you should have gone to school to be a biomedical ethicist. We’re doctors, not philosophers.  I hear the stuff you’re telling these people and it’s just completely inappropriate. It’s too political. That’s not your job.”

“But, health is context! We should be talking about the larger structures making them unhealthy. They should know it’s not all their fault.”

“And that’s not your job,” Professor Knight said. He wasn’t angry. He was finished. “Let me know if you don’t understand that.

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We didn’t have as much to email about after Georgina left. We wrote about our grossest patients and the weddings we had to miss because of our crazy schedules. One of us had to serve as a witness for a sex offence trial and describe the defendant’s penis. That was funny. For a while, we would try to guess where Georgina and Grant were living — Costa Rica was the most common answer. That was where angry Americans started new lives, learned to dance with fire and make pots.

We eventually heard that she had moved to Portland, Maine to resume her residency at an osteopathic school. One of the professors at the nursing school said that this had been Georgina’s plan all along; her mom had some connection to Maine. There was no goodbye party. She didn’t even send out a group email. We thought this was telling. Things between Georgina and the school had ended badly.

The dean scheduled another meeting. We assumed it was an update about the deaths. We lined up to listen. The Dean talked about how the new construction would wipe out half the parking lot and how we might want to allow ourselves ten extra minutes to get to work. We looked for each other across the hallway and rolled our eyes, as if to say, “We’ll email about this later.”

“I also wanted to follow up on our last meeting. The numbers weren’t as alarming as we originally thought. We didn’t account for that fact that many more of our patients had been coming from lower-income backgrounds. We were just looking at the numbers and the numbers don’t say everything, as Georgina would tell you if she was still here.” He chuckled in a bemused way.  “But we were glad to have the opportunity to observe you all and to appreciate how hard you’re working. But we noticed quite a lot of small, but significant oversights you made.  We saw people forgetting to wash their hands, forgetting to ask questions about family background. Small things that make a world of difference. We know you’re overworked and tired. We’re all human. We all get distracted. But try to be more present while you’re on shift.” He looked at us. “We’ve also been forwarded some unfortunate emails sent amongst a number of you. I don’t want to summarize them here because their content is just too”— he shook his head —“unfortunate. What I saw in those emails were a bunch of scared children unable to recognize the weight of their own responsibility.”

 We wondered who leaked it. Josh was too disinterested, had too many hobbies. Holly, perhaps: She had seemed most impressed by the potluck. We wanted to email our guesses, but it wasn’t safe. The lounge wasn’t safe either. The dean didn’t remember what it’s like to be a resident. We needed an outlet, a well where we could pour our frustrations, a way to stay sane. 

© Jessica Weisberg, 2014

Jessica Weisberg is journalist and fiction writer. Her articles have appeared in The New Yorker, The New York Times, The Guardian, Elle, and many other publications. She's a story editor at Page 1, a film and television production company, and is working on a novel and a short story collection.

We Were Present All Along was read by Michaela Morton on 1st October 2014