Chapter One I just want to help people, I just want to help people, I just want to help people. . . . I crouch on the floor in an Emergency Department supply closet, wedged in between boxes of adult diapers and pregnancy tests. The door swings open, and a nurse pokes her head in. "Are there any linens left in here?" she asks. "I'm not sure." I stare into my lap, letting my hair fall across my face like a curtain. Hopefully she doesn't notice my puffy eyes. "Are you the intern that just stuck herself?" "Yes." I discreetly wipe my nose with the back of my hand. I try to sound less panicked than I feel. "Yup, that was me. I just took the needle out of the patient and accidentally stuck myself in the hand with it. Like an idiot." I attempt to laugh ironically, but it comes out sounding more like a desperate whimper. "Well, when you're done doing whatever it is you're doing, you need to report to Employee Health. They'll test you and give you medication." She peers down at me through her tiny bifocals. Her voice sympathetic, she asks, "Have you ever had a needle stick before?" My chest is so tight I can barely get the word out. "No." "Well, I've had four in my career, and it's not that big a deal." "Really?" I'm buoyed by a surge of hope. "Did you--" "Make sure to get yourself together before coming back out here. It's unprofessional to cry in front of the patients." She closes the door abruptly. The motion-sensor light goes off, and I am left in near-pitch darkness. I just want to help peo-- Oh fuck everyone! I spend probably fifteen minutes sitting in the dark supply closet, too exhausted and depleted to move. I've been awake for over twenty-four hours. During that time, I've peed twice, eaten once, and asked myself, How did it come to this? eighteen times. I thought I'd be good at this. Why am I not good at this? I reach into the pocket of my white coat for my inhaler, and the lights flick back on. From the corner of my eye, I see something tiny and brown scurry across the floor and dive behind a box of gauze pads. I spring to my feet, and my head strikes the shelf above me. Pain sears through the back of my skull. I yelp, and as my hand flies up to my scalp to check for bleeding, I knock over a box, causing a million little Band-Aids to come fluttering down all around me like ticker tape, as if to say, Congratulations! You're a twenty-six-year-old loser hiding in a closet. It wasn't supposed to be like this. I graduated at the top of my class--Alpha Omega Alpha honor society, in fact--from medical school. I beat out hundreds of other applicants for a coveted internal medicine residency spot at Philadelphia General Hospital. The Philadelphia General, my first choice. I could have easily gone to the Cleveland Clinic or Mass General or Mayo, but I chose to go where I knew the training was rigorous and unmatched because I was certain, beyond a doubt, that I could handle it, probably with one arm tied behind my back. I can recite the name of every bone, muscle, and nerve in the adult human body the way other people can recite song lyrics (and, just for reference, there are 206 bones in the human body). I can diagram, from memory, the biochemical pathway by which the liver converts squalene into cholesterol. I can list the top twenty medications for hypertension and the side effects of each, without using a mnemonic device. I've studied. My God, have I studied. I've studied to the point of self-imposed social isolation. To the point of obsession. I've prepared for this for years, decades, my whole life. I wrote an essay in third grade titled "Why Tendons Are Awesome!" that not only earned me an A, but was prominently displayed for months on the classroom bulletin board. I mean, I was meant for this. I've been an intern for twenty-four hours, and that arm that's tied behind my back? I'm ready to rip it off this instant. Sighing, I crouch down, pick up all the Band-Aids, and cram them back into their box. Then I emerge from the closet sheepishly, expecting to find at least one of the several ED nurses waiting for me, ready to comfort me in that stern-but-understanding, maternal way of theirs. The only person at the nurses' station is a disinterested janitor on his cell phone. A balding man wearing large, square wire-rimmed glasses and an angry expression barks at me from the hallway. "Excuse me! Miss, do you work here?" I nod, and he approaches. "My wife is still waiting for a bed." He indicates a woman in a hospital gown lying on a stretcher that's been pushed to one side of the bustling ED hallway. "When is she going to be moved to her room?" "I'm not sure . . . ," I say, uncertain if I can help him but desperately wanting to do something, anything, right. "Has she been admitted?" "Obviously, yes. She's being admitted for observation for pneumonia. Her name is Tally. Lenore Tally. Do you have any information on her?" The name means nothing to me. "I'm sorry, she's not one of my patients, but I can try to find her nurse for you," I offer. The few nurses in sight look busy, drawing blood and taking vital signs. "It might take a few minutes, but--" The man throws up his hands in frustration. "None of you people have any answers! Oh, for God's sake, I'll find her nurse myself!" He storms off, and I can hear his voice echoing down the hall: "Excuse me? Do you work here?" My shoulders sag. So much for doing something right. At this point, it's clear: the gaping black hole of despair that has consumed my being can be filled by only one thing. I need baked goods, and I need them stat. I hurry to the vending machine in the ED waiting room, eat two and a half bags of mini chocolate chip cookies while waiting for the elevator, and find, to my great disappointment, that my mood is only marginally brightened. It had never occurred to me--until the moment I drew the needle out of my patient's vein, popped off the test tube full of his blood, crossed my hands to reach for the gauze pad, and jabbed the end of the needle into the back of my hand--that I might be putting myself at risk by spending my days and nights tending to sick people. Well, then again, that's not true. It had occurred to me, but before it became an actual possibility, the idea of contracting a potentially lethal disease from a patient had a noble, romantic, Victorian sort of feel to it: the selfless, waistcoated doctor carrying a leather satchel and a jar full of leeches, sacrificing herself at the bedside of her patient--that sort of thing. I know the chances of actually getting sick are extremely slim, especially if I take prophylactic antiviral medication, but I worry nonetheless. I worry with a fervor that I both recognize as irrational and embrace as inevitable. Worry out of proportion with reality is kind of my thing. "Is this your first needle stick?" The nurse at the tiny Employee Health office next to the hospital pharmacy--her name tag identifies her as "Rhonda"--looks irked and preoccupied. When I walked in a moment ago, she was engaged in a heated phone conversation with someone named Hank about getting his lazy ass off the couch and maybe, for once in his worthless life, cleaning up the cat's vomit. It was quite a few minutes of this sort of thing before she turned around and realized I was sitting right in front of her desk, awkwardly trying to decide whether to wait for her to notice me or just interrupt her. When she hung up the phone, it was with one eye fixed suspiciously on me. "Can I help you?" I told her what had happened and, in doing so, triggered another bout of panicky tears. Rhonda kindly, if impatiently, handed me a box of Kleenex. Then she proceeded to fish out from a filing cabinet no less than eight different questionnaires, each of which she now seems determined to methodically complete in its entirety. "No. This is my first needle stick," I answer, twisting the damp Kleenex around my fingers. "Do you have any risk factors for HIV or hepatitis C?" Rhonda asks. "No." "Have you ever been tested for either?" "No." "Are you currently sexually active?" "Nope." "When was the last time you were sexually active without barrier protection?" "Um . . . never." "As in you've never had unprotected intercourse?" "As in . . . I've never had intercourse." Rhonda pauses, her pen hovering above the paper. "It's cultural," I add quickly. "I'm Indian. Premarital sex is frowned upon. Like, a lot. You've seen Bend It Like Beckham, right?" "That's . . . fine," Rhonda says, scratching one raised eyebrow. I sigh inwardly. Whatever, Rhonda. She asks me for my medical history (None, except a mild case of asthma), list of allergies (None, except cats), and social history (Do I smoke? No. Drink? No. Do I use illicit drugs? Obviously not.). Then she asks me to put my arm on her desk, ties a tourniquet around my biceps, and draws four vials of blood. As she tapes a wad of gauze over my skin, she says, "You'll need to come in for another blood test in six weeks and again in three months." She hands me a slip of paper. "And this is for the antiviral tablets. Pick them up at the pharmacy next door. You'll take them three times a day for the next six weeks." I look at the prescription. "Lamivudine? A nucleoside reverse transcriptase inhibitor?" I say, aghast. Rhonda stares at me. "That's the protocol." "But the potential side effects of this are nausea, diarrhea, abdominal pain, headaches, pancreatitis, and liver failure." She regards me skeptically. "If you say so." "Isn't there anything else I could take instead?" I plead. "I'm an intern. I can't afford to have headaches and go into liver failure. I have patients to round on. I have a lot to do." "That's the protocol." She enunciates each word in a way that indicates that she has fulfilled the duties laid out in her job description and, therefore, our interaction must come to an immediate close. I turn toward the door. "You don't think didanosine or even efavirenz would be a better--" Rhonda puts her phone to her ear. "Have a nice day, Doctor!" I'm sitting at one of a cluster of long tables near a picture window. A curt little sign in a metal stand nearby reads: Reserved for PGH Doctors and Staff. It's early, a half-moon still visible in the dawn sky, and the only other patron in the cafeteria dining room is an elderly man connected to an oxygen tank that he carries in a cloth duffel bag. He shuffles in my direction, notices the sign, then shuffles away. A plastic tray appears across the table from me, and a slender young man with round glasses says, "Hi. Stuart Ness, Harvard Med." He begins to vigorously dissect a grapefruit. "Yes, I remember. We met at orientation." Where you introduced yourself as Stuart Ness from Harvard Med. Twice. "Being on call is great!" he enthuses without prompting. "I admitted eleven patients, started fourteen IV lines, and still had time to watch a movie. I'm not even tired. I think I'll go for a run when our shift is over." I wonder if it's possible that I'm so fatigued I'm hallucinating this entire interaction with this gratingly peppy Harry Potter look-alike. "That's dynamite," I say. "I'm so psyched to finally be here. I can't wait to meet Dr. Portnoy. The man, the legend, am I right?" "Yup." "And the Dr. V. Did you hear that we get to work with him? Like, actually round with him and everything?" His eyes gleam. "So awesome!" "It's pretty awesome." I manage a thin smile. "What was your name again?" "Norah Kapadia." "Hey, any relation to Dr. Kapadia, the head of Pediatrics at UPenn? The one that came up with the Kapadia criteria for Kawasaki disease? I mean, I don't know how common a last name of Kapadia is, but--" I blow a puff of air through my pursed lips. I've lost track of how many times I've answered this question over the years, but it always comes from someone eager to show off that they're well-versed in rare pediatric disorders. "That's my father." Excerpted from The White Coat Diaries by Madi Sinha All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
