Third Degree (32 page)

A short while later, I’m lying in his arms, both of us sweaty and sleepy, the noise in the hall outside coming and going in spurts, beds rolling by creating a soothing rhythm.

I find that perfect spot in the crook of Marshall’s neck and gently rest my lips against his skin. “I want Johns Hopkins, but I want this, too. I’m not ready to give it up,” I admit despite my protesting conscious mind.

“What?” Marshall says. “Sex in on-call rooms?”

I laugh and allow my eyes to flutter shut. “Yes, but more specifically with you. And this. Right now. You get me, you know?”

He smooths my hair down and his hands drift slowly over my naked body. “We don’t have to think about that stuff right now. Just let yourself be happy with all the recent accomplishments and leave it at that, okay?”

“Maybe I could ask O’Reilly for a position here. I love this hospital.” The idea is out before I even let myself analyze it, but I know it’s something I want to explore.

“Izzy …” His tone is careful and guarded. He’s probably approaching this in the same manner I approach giving him medical advice. We can’t make decisions for each other. “Giving up your goals is not something I’d ever want you to do for me. Or for anyone else.”

“I wanted Johns Hopkins because it’s the best, because my dad went through that program. But lately I’m caring less and less about what he wants and more about what I want. And I want to be a surgeon and I want this.” I snuggle against him again, squeezing him tighter.

“But it would mean giving up your dreams of peddling prescription drugs at the university,” Marshall says in his most serious tone. “You have so much potential in that area. It would be a shame to see that go to waste.”

I laugh really hard. “I have no clue where that came from.”

“It was like a cloud formed around you suddenly. I thought you were going to claw that lady’s eyes out. I positioned myself for a fight. I would have totally had your back, by the way.”

I lift my head and kiss him on the mouth. “You are a very brave soul, Marshall Collins. I can throw you in front of any challenge and you’re ready.”

“For you.” He tucks my hair behind my ears. “For you, I’m ready.”

Chapter 25

@IsabelJenkinsMD:
80% of your brain is water.

“Let’s talk about Dr. Martin’s patient, the one he asked you for a consult on.” Dr. Winifred James, Ph.D., only allows her eyes to drop to the evaluation form resting on her lap for half a second before resuming efforts to point her X-ray vision at my brain. “Specifically, how did you feel when you finally pinned down a diagnosis?”

I stare at the frilly pink wallpaper. It’s too pretty in here. She’s trying too hard to make people feel at ease. I’ve been answering her questions for fifty-six minutes now, but it only took me thirty seconds to hate this office all over again. I’m 100 percent more nervous than I was the first time she tested me, mostly because I hadn’t even considered not passing, but after O’Reilly’s silent message yesterday, I’ve calmed down a bit. I think he’ll force her to pass me unless she truly believes that I’m a psychopath, and if that’s true, I’ll support being flunked. So my angle today is honesty. Just honesty.

“I felt relieved.”

One eyebrow quirks up. “Relieved? To diagnose a child with both cancer and a heart condition?”

“Yes.” I nod, convincing myself. “Don’t you think other people felt relieved, too? It sounds like the CDC did. I bet O’Reilly celebrated the fact that he didn’t have to quarantine the place or deal with his own staff being exposed to some kind of rare infectious disease.”

“Anything else?” she prompts. “It’s normal to have more than one feeling in a given situation. Sometimes conflicting feelings …”

“Heavy.” I glance out the window, watching the traffic zip by. “I felt heavy. Sometimes you want an answer so bad you don’t realize how that answer might affect you. And the fact that once you have it, there’s no hope of a different outcome.”

“Interesting.” She scribbles on the paper in her lap, and finally I have a few seconds to shake out my nervous hands. “What about Marshall?” she goes on. “Tell me about his illness and how that affects your relationship.”

“I guess that technically, his illness is the reason our relationship even happened,” I say, knowing that’s mostly true.

“How so?”

I try my best to explain the details of our fall break together and what we both revealed to
each other. “I think we both thought that no one could possibly accept the bad stuff, but I’m okay with that part of him and he seems to be okay with that part of me.”

She stares at me long enough to make me squirm. “I didn’t realize that you were aware of your family history. Of your birth mother’s mental health problems.”

Oh, right. That’s because I hacked into the hospital system and looked at your report. Shit
. I clear my throat, giving away the potential lie in that action alone. “I … um … overheard my parents talking recently. I haven’t told them I know yet.”

“Are you afraid that you might become like your mother? That you might inherit mental illness from her?”

“Are you afraid of that?” I ask. “Is that why I failed the first time?”

She turns around, plucks a sheet of paper off her desk, and sets it on the coffee table in front of me. “Are you familiar with the term
twice exceptional
?”

“Someone with both extreme strengths and areas of significant disability,” I reply automatically.

“And I know you know what Asperger’s syndrome is,” she goes on.

“You think my birth mother had Asperger’s syndrome?” I blurt out, unable to help myself.

“You tell me,” she says, leaning back in her chair, ignoring the page in front of her. “You’re phenomenal at diagnostics, Isabel. What are the symptoms?”

“I don’t diagnose psychological disorders,” I say.

“But you know them, correct?”

“Correct.” I sigh. “Symptoms for which stage of life?”

She lifts both eyebrows this time, possibly impressed. “Adolescence.”

“Disinterest in following social norms or conventional thinking, inability to read body language at times, lack of empathy—though it can be much less present as adolescents move into adulthood—anxiety, depression …”

“Do you know the name of the publication that provided you with that information?” she asks. I nod. “How long ago was the article written?”

“Three years, five months, and eighteen days.”

She leans forward and taps the paper on the coffee table. “Now, look at the date on this form, admitting your birth mother into a hospital for treatment of her depression … that was nearly forty years ago.”

“The depression was a symptom of undiagnosed Asperger’s,” I mumble to myself before looking up at Dr. James. She’s studying me in a different way than earlier, like she’s anticipating a new reaction from me. Suddenly I get it. My heart sinks to the pit of my stomach, and I’m already shaking my head. “No … I don’t have Asperger’s. This isn’t forty years ago. Someone
would have told me. Someone would have diagnosed me. Do you know how many tests I’ve had, all relating to my freakish brain? Hundreds.”

I stand up like I’m about to leave, but I know I can’t. So I pace back and forth in the space between the couch and coffee table in this too-pink office.

“You lived in eight different foster homes the first five years of your life, Isabel. You were an unusually and highly gifted child who not only didn’t fit in with peers but also didn’t fit in with the families you lived with. How could you fit in? They didn’t understand why a three-year-old could read at the level of a high schooler. By the time of your adoption, you’d experienced so much rejection and also had the intellectual capability to take that rejection personally. Behaviors like defensiveness and a lack of proper relationships and connections were to be expected. Even things like being taken advantage of by an older man in a position of authority makes sense as one of the long-term effects of your early childhood.”

Why is she so obsessed with my relationship with Sam?
She mentioned it three different times on the previous evaluation form.

“I don’t have Asperger’s,” I repeat.

“Does the diagnosis bother you? Does it change anything?”

“Yes!” I fall back into my seat on the couch. “It changes everything. It means that I can’t change. People have shitty childhoods and they overcome it. You’re taking that from me. That’s what you’re doing right now. You’re stealing my excuse and giving me one that won’t ever go away. So yes, it bothers me!”

“I’m surprised.” She doesn’t appear even a little bit shaken by the fact that I just screamed at her. “I didn’t expect you, of all people, to buy into the social stigma of something like Asperger’s. Asperger’s is a very broad diagnosis. And to some extent all of us might be considered as having some of the characteristics described as part of the autism spectrum. Most people maintain a certain distance between themselves and others, because too much emotional empathy can make it debilitating to leave the house or hear stories of people suffering. And doctors, surgeons especially, are much closer to the autism spectrum than those in the field of sales and marketing, for example. I’m not diagnosing you with anything, Isabel. I’m not going to label you.”

Now I’m the one surprised. “You aren’t?”

She shakes her head. “I don’t believe it will make any difference in your life one way or another. All I want to do right now is ease your fears. I know you’re afraid of becoming like your mother, committing suicide. I thought if you knew what I believed to have been your mother’s true problem and the fact that she could have benefited from forcing herself into a normal college environment, you might be less afraid.”

I exhale and rest my head in my hands. “It’s a lot to absorb.”

“Why? Because I may have told you that you’re not normal? You’ve never been normal, Isabel. And what else are you afraid of most? That there’s some psychological disorder behind your lack of empathy with patients? Look at what happened with Marshall. You feel it now, don’t you? You see his illness and his life merging and the impact it has on him, right?”

“I do.”

“You can make those connections. In you, they’re fewer than in most people, but at the same time they’re stronger, and more valuable because of that.”

I’ve never been so confused and disoriented in my entire life. “So … why did you fail me the first time?”

“Because you were too young, your parents refused to address your issues and need for therapy—”

“Wait … I need therapy?”

“Yes,” she says firmly. “I’m recommending to Chief O’Reilly that he allow you to practice as a resident on an interim basis, assuming you continue to work at this hospital, where you have friends and family to support you, and assuming you agree to see me twice weekly until we mutually decide you don’t need any further therapeutic intervention.”

I sink back into the couch and stare up at the ceiling, thinking.

“Isabel? How do you feel about those terms?”

How do I feel? Light. Relieved. I lift my head from the back of the couch and look at her. “Okay. I feel okay about that deal.”

“It’s not a deal, it’s a solution.” And then she smiles. An actual smile. After scribbling a bit more on the pink evaluation sheet, she signs the bottom and hands it across the table to me. “Congratulations. You’ve just passed your intern exam.”

A couple of minutes later, I’m walking through the halls of the hospital, still shocked and not quite ready to process everything. I nearly plow into Justin and his fledgling interns. He stops when he sees me. “What are you doing here?”

I wave the pink sheet in my hand for him to see. “Apparently passing my intern exam.”

“Seriously?” He begins walking, and I walk beside him. The sound of eight feet shuffling behind us is odd but somehow comforting. Like maybe I won’t have to do this resident thing alone. It
is
a little scary now that I finally have the chance to think about being here rather than getting here.

“Seriously. But no Hopkins. For now.”

He snatches the chart of a post-op peds patient from outside the hospital room door. “They rejected you? I bet the program’s full. That’s probably why.”

I shrug but decide not to tell him that it’s because I have to stay here and go to therapy. “It’s fine. I can still learn plenty here.”

“Beats living in a college dorm and taking PE classes, right?” Justin says, being uncharacteristically nice. “God, I’m still traumatized from middle school and high school PE.”

He sets the chart back in place, obviously satisfied with the report, and we shuffle on toward the next door, which he passes up. But after reading the patient name on the chart next to the door, I freeze in place, reaching for Justin and tugging the sleeve of his lab coat. “Look.”

“That’s Laprosky’s patient. He’s not surgical.”

I tap my finger beside the name:
Culver, Clay
. “Look!”

“Clay Culver,” Justin says finally, his face reflecting the shock I’m most likely wearing. “Late-onset adolescent type one diabetes.”

Both of us reach for the chart at the same time, but I get it in my hands first. Already my heart is pumping at the speed of a racehorse’s, my stomach twisting. I flip the binder open, and Justin leans in to read with me. He waves a hand behind him, not looking up, and says, “Go! Rounds. Now. Report back to me in fifteen minutes.”

The fledglings scurry away.

“Oh, God,” I say, after reading the most recent update. I feel nauseous and dizzy all at once. “Oh my God.”

Justin closes the binder and rests it back in place. “It sucks, but it happens, you know?”

Justin and I don’t do this stuff. We don’t do feelings, or anything like feelings, with each other. So, of course, he takes off toward his next post-op patient. My chest tightens with panic, and I take a tentative step inside the room. Clay Culver is lying flat on his back, his light blond hair splayed out across the pillow, a breathing tube coming out of his mouth, a blood pressure cuff around his arm, other tubes and wires everywhere.

I flash back to the pissed-off fifteen-year-old, aggressively throwing objects around the room and shoving nurses out of his personal space.