Third Degree (34 page)

A wave of pain and nausea hit me. “He’s not going to wake up.”

“Maybe statistically the chances aren’t great.” She stands and reaches for the knobless door. “But kids are very resilient.”

“The only reason he’s still allowed to lie there with a machine breathing for him is because he’s a kid and not a wrinkly eighty-five-year-old.”

Mom stands in the doorway, her eyes sweeping over the room one more time. “You can keep yourself in here if you want, but the door stays open. And your father and I both agreed that regardless of whether you accept O’Reilly’s residency position, you will attend your appointments with Dr. James if you want to live in this house.”

That’s about the biggest dose of discipline I’ve ever been handed from my parents, and
I’m nineteen years old. “I thought you were selling this house.”

“The offers haven’t been great,” she says. “The real estate agent thinks that holding off until spring might bring in more money.”

It feels like there’s something more behind the decision to hold off than the offers; I can hear the partial lie in my mom’s tone. I’m dying to ask her if handing this place over is as devastating to her as it is to me. But I let her walk away and head to work, where she gets to spend all day with lots of normal teenagers who do normal things like take high school biology when they’re sixteen instead of being in medical school.

The whole morning, I continue my analysis of patient charts, printing so many pages I have to leave my room to hunt down a new ink cartridge. I make binders with dozens of tabs and sort and highlight, trying to distract myself from thinking about how many texts Kelsey has probably sent me between last night and today—do they start out nice and then get angrier the longer I ignore them? And about what class Marshall is in right now, whether or not boot camp met outside. And what kind of indoor fitness does Sergeant Holloway include in his curriculum? He seems like the type to force us outside in freezing weather and then call us a bunch of girls for complaining. And then I’m thinking about Marshall and how the cold weather increases his joint pain and stiffness …

“Been looking for this?”

I jump and scream at the same time, then sigh with relief when I glance up and see Justin standing in the doorway of my bedroom, holding a pink piece of paper. I pick up the remote beside me and click a button to turn off the music I’d been blaring from my iPod dock.

“Jesus Christ, you scared the hell out of me.” I rub my chest and lean back against the bed, waiting for the adrenaline to settle down. “Did you break into my house?”

He shrugs. “I watched you punch in the garage code once.”

I scowl in disgust, thinking about the handful of times I brought him home with me when my parents were gone and what transpired during those hours.

“You didn’t answer my text or the doorbell.” He wanders around my room, glancing at my project spread across the floor. “What are you doing at home? O’Reilly gave you a job.… I know he hasn’t told you in person yet, but it’s implied. Meaning you show up. You work.”

“I’m reviewing charts from all the patients I’ve diagnosed with chronic or terminal illness over the last year and sorting them by dates of most recent follow-up.” I hold up a clipboard with a chart attached. “Thirty-seven patients, and you know what the average time has been since they were last seen?”

He shrugs again, not even taking the clipboard from my hands.

“Twenty-nine days,” I answer despite his lack of interest. “Twenty-nine days. Do we know anything about their mental state right now? No. Eighty-nine percent of terminal patients
experience depression, forty-seven percent engage is reckless behavior—”

“Look at this.” Justin picks up an article from yesterday’s paper and reads. “ ‘Two weeks ago, Clay Culver sat beside his girlfriend in the bleachers at a high school basketball game, eating nachos and rooting for his best friend. Today, doctors aren’t sure if he’ll ever wake up again. His mom, Ellen, and younger sister, Bella, have been by his side for the last five days, and both say they’re not giving up hope that Clay will wake up.’ ”

I press my palms over my eyes. “His mom is a single mother, did you know that? And he has a little sister and a girlfriend, did you know that? Maddie is his girlfriend’s name. She was on the news last night. She’s on the swim team and she got all her teammates to help collect money for Clay and his mom. I mean, they need it. His mom hasn’t been able to work.”

Justin sighs and sits down beside me, leaning his back against my bed. “What’s your point, Jenkins?”

I drop my hands and stare at him. “We didn’t know any of those things about him. What kind of doctors are we?”

“Not psychiatrists or therapists. We took a complete family history. His parents’ marital status, his dating life, and his siblings were of no concern to us.”

That’s something I would have said … 
before
. Before Marshall. I shake my head in protest. “Don’t you feel responsible? Don’t you feel guilty? We’re the ones that delivered the diagnosis. We’re the ones that saw him first in the ER.”

“I feel disappointed. I feel sad. But guilty? No,” Justin says. “You’re right. We told the family that the kid’s diabetic. We provided education on his disease and referred him to an endocrinologist.”

“It wasn’t enough. We should have followed up.” I swallow the lump in my throat I’ve been fighting for days now, my voice wavering. “We should have kept him in the hospital until he was mentally ready to handle his diagnosis.”

“What happened to your logical reasoning skills? I don’t even know you anymore.” Justin stares at me, half in wonder and half in disgust. “First of all, we were interns, Isabel. Our attending physicians hold all the responsibility. Second, that’s not even true, because really his mom is responsible for this. I don’t care if she’s all by herself and has fifty babies—it was her job to make sure he took his insulin, checked his blood sugar. Even if she was scared shitless when we came in that room to tell her the bad news, it was her job to stay calm, to let her kid throw a dozen things around the room and then tell him he’s going to be okay. If he was my kid, I would have locked him in his room, held him down, and given him the shots myself if it meant he would live.” He releases an angry breath. “That was her fucking job and
she
screwed it up. Not us.”

I wipe away the tears that spilled down my cheeks, grateful that Justin doesn’t seem to be
acknowledging them. “I don’t know what’s wrong with me. I can’t see any of these things, I can’t feel their effects, and then suddenly I’m feeling them all at once. I want to send this long report to O’Reilly recommending follow-ups on all the patients I may have diagnosed and left in despair. Why am I like this? Why—”

I stop talking because I know if I continue, a sob will escape, followed by another, and the silent tears and runny nose in Justin’s presence are bad enough. An uncomfortable silence falls between us until he finally clears his throat and says, “Why aren’t we friends? You’d think with the very small percentage of people that have IQs as high as ours, we’d have some kind of companionship, some kind of desire to bond together, as minorities often do.”

“You’re not as smart as me.” I wipe my nose on my sleeve and force myself to admit the real truth out loud. “And you’re different. People like you. You know how to connect, how to interact. How to be at their level.”

“Exactly,” he says with a nod. “I went to regular school until I was fifteen. Did you know that?”

I shake my head. I guess I only really knew how old Justin was when he started med school. But then again, he did mention middle school and high school PE the other day.

“I’ve read tons of books on gifted kids, and you know what happens to almost all highly gifted children when you leave them in an educational environment with their same-age peers?”

“They get beat up? Teased? They piss teachers off?” I suggest, remembering vividly my one week of kindergarten.

“Well, yeah, that does happen. But after having enough time to adapt, those kids—kids like us—mimic the behaviors of their peers and teachers. And we’re quick learners, so we catch on, sometimes in as little as a month or two. When you think about it, it’s no different from a kid who speaks a different language at home. Switching back and forth becomes instinctive. By the time I got to middle school, I knew exactly what I could talk about with each person I interacted with. I knew their intellectual level, I knew their interests.” He glances at me. “You never got to do that. And I think that was a mistake.”

“Probably.” I lean my head back and study the ceiling. “Is this conversation weirding you out as much as it is me? Because I like us fighting and competing much better, I think.”

Justin sighs with relief. “Thank God we agree. I had to muster up some niceness to get what I want from you.”

I laugh despite my grim mood. “I knew it. Okay, let’s hear it. Why are you really here?”

“I want you to work with me,” he says. “I told Dr. James I’d come and extricate you from your rock-bottom mental state and cart you in for emergency therapy and hopefully get O’Reilly to put you on the schedule. You and me, we push each other. It works. It really works, and you know it.”

He stands up and reaches a hand out to help me up, but I pull my knees to my chest and press my face against my jeans, groaning loudly in frustration. “I don’t know … I don’t know what I want to do anymore. It’s all screwed up. I can’t separate the logical from the emotional. I can’t make a good decision.”

“That’s what therapy is for.” He sticks his hand closer, trying to coerce me off this bedroom floor. “After my dad died, I went to therapy for a while. It’s not a big deal. Maybe it helps and maybe it doesn’t, but regardless, people are more concerned with those who need it and aren’t getting it.”

Finally I place my hand in his, letting him pull me up to my feet. But I can’t let the thirty-seven patients go. I’m not ready to release myself from that responsibility. I end up gathering all the charts and tossing them into a box to bring along. Before we leave my room, Justin spots the shattered phone on my desk and scoops up the pieces. “Bet you fifty bucks I can fix this.”

My stomach twists just thinking about the messages that have accumulated in the last forty-eight hours, but I force the thought from my head and say, “Make it a hundred.”

@IsabelJenkinsMD:
Myth—Asperger’s is an emotional disorder. Fact—it’s a neurological and genetic disorder.

“All right, number twenty-three.” I yank a bright yellow binder from the bottom of a pile on the coffee table in the office of Dr. Winifred James, Ph.D. “Harold Stineman, age forty-two. I diagnosed him with chronic pancreatitis last February. I didn’t record in his chart whether he had any children. But I searched the system and there are two males, ages seven and nine, who share an insurance policy number but not the same household address. So I figure he must be split from the children’s mother. He was seen three months ago in the clinic with typical symptoms of his disease. When given two choices of medication to treat pain and nausea, he replied by saying he didn’t care which one. That’s in the chart. The resident who treated him documented that. The apathy regarding his own medical treatment could be a sign of depression, right?” I look up at Dr. James expectantly.

“It’s possible.” She’s seated in her armchair again, like the other day, but her feet are resting on the corner of the coffee table today. “Isabel, you’ve been taking me through patient charts for almost two hours now.…”

My face heats up and I begin the process of stacking the charts. “Oh, right. You probably have appointments this afternoon. Of course you have appointments.”

“The receptionist has already rescheduled all my afternoon patients today,” she says. “I have all day to listen to whatever it is you’d like to talk about. I’m just a bit confused about how all of these connect, why it’s so important to you, and what this has to do with you pushing Marshall away and not being able to face retrieving your things from school.”

I drop the binder onto the table and relax back into the couch. My back and neck are stiff, and I hadn’t even realized it until just now. “I need to make sure I haven’t screwed up with all these people like I did with Clay Culver.”

“And what does this have to do with pushing Marshall away?”

“That’s what started this whole mess of confusion and going from one extreme to another. I’m not sure I’m capable of finding a middle ground. When I got close to Marshall, everyone else sort of turned into him—I kept thinking about how they were just a version of Marshall, and …” I breathe slowly, counting to ten, and then exhaling just as slowly before speaking again. “I need to make sure these former patients are truly doing well, fix any damage I’ve done, and then make sure that I take a more holistic approach to patient treatment—without forming an attachment. There are all kinds of books and articles that I’ve completely ignored before, but they give dozens of methods for informing patients of a diagnosis in a manner that is emotionally healthy. Like, did you know if you compare a complicated surgery to the operation of a common household item, people are forty-nine percent more likely to feel at ease?”