Third Degree (35 page)

“Do you know,” Dr. James challenges, “that physicians who show
genuine
empathy and even anger or frustration toward a patient’s condition have a patient cooperation rate that is nineteen percent higher than doctors who choose to remain impassive with their patients, even those who learn more than is required about their patients?”

“I haven’t read that one. What publication is that from?”

“Seventy-one percent of patients care more about an emotional connection with their doctor than they do about academic credentials or experience.”

I snort back a laugh. “Well, that’s stupid.”

“Stupid or not, obviously it’s human nature if there’s such a large majority showing that preference. Just as it’s human nature to feel guilty and responsible for deaths that, logically, you aren’t responsible for.”

Nice move, Dr. James. Well played. I thumb through another chart, not really reading anything. “I don’t think I’m ready for where me and Marshall were headed. Something’s missing. I’m off balance. Like I jumped too many steps … I went too fast. Not that I don’t want to be with him; it’s killing me not to. I just know that I’ll screw him up, and that sucks. It really sucks.”

“Okay,” she says, nodding. “That’s exactly what we need to be talking about. You’ve changed a lot recently, but there’s more change to be done and you have to take it in baby steps
or you’ll hit these emotional bottoms that will set you back.”

I drop my head into my hands for a moment, then look up at her, desperate, hopeful. “You have a plan? You think you can really help me?”

She gives me a tiny smile. “I do and I can.”

For the first time in maybe forever, I feel like I can hand over control. Not just that, but that I’m better off handing it over. I don’t have to shoulder all of this on my own. Which is what my whole life has felt like, if I’m being completely honest. I’ve always been the one who knew the most, who won all the arguments, and winning arguments means you have to own those choices.

A few tears leak from the corner of my eyes. I wipe them away quickly, but before leaving this office, I make sure to mumble a thank-you. I still feel raw, empty, and lonely, but at least I don’t feel crazy. She wouldn’t clear me to work if I was crazy. That’s a tiny bit of hope I can cling to like a lifeline.

I’m walking the halls again, not sure where I want to be. O’Reilly’s probably expecting me to pay him a visit at some point. To tell him I’ll work again. And I will.

But right now, my feet are leading me to the third floor. To Clay Culver’s room. I spot a woman lying on a cot in the room next door, sound asleep, and recognize his mom immediately. And there are at least eight teenagers in the third-floor waiting room, several of them engaged in a card game, like they’ve been hanging out for hours.

I review his chart and see that his vitals have declined since last Friday. He’s showing no brain activity. He can’t breathe on his own. But when I walk into his room, he looks the same as he did a few days ago. I take a deep breath, unable to shed the weight of all the articles I’ve read about this kid, all the clips from local news stations.

I busy myself untangling his IV line, not sure what I’m even doing in here, and then I start talking. “My mom thinks you’re going to wake up. She really believes that. But she’s a biology teacher. And I’m a licensed physician and I say you’re not going to wake up. Parents aren’t perfect. They can screw us up a lot. They can ignore things that are right under their noses. But that doesn’t mean they don’t care.

“Your mom hated that you were sick. She hated seeing you suffer, the idea that you’d have to live the rest of your life with this potentially deadly disease … but Justin’s right, she screwed up. Big-time. But maybe she was in denial, like you were. Maybe this mistake will make her fix five more just like it. Maybe this mistake is going to save us from world destruction in fifty years, like some kind of bizarre butterfly effect.” I grip the railing of the bed so hard my knuckles turn white. My face is completely wet with tears, and my nose is running. “I’m going to be a surgeon, just like I planned, and I’m gonna remember this. I’m gonna remember you lying in this bed, your brain completely fried from oxygen deprivation, and I’m going to envision
every patient I treat or operate on in their own diabetic coma, with their girlfriends and moms upset, and I’ll figure out how to make sure that doesn’t happen. So this sucks for you, but you’re going to have to be that person for me.”

I lift my shirt up to my face and wipe the tears away, then walk out of Clay Culver’s room and head for the chief’s office.

Chapter 27

Izzy,

I’ve sent too many texts to count and since you haven’t replied, I’m trying email instead. I’m sorry for everything I said over Thanksgiving break. I don’t think you’re warped or twisted. I don’t think you’re anything but amazing. I was scared and hurt and angry and I needed to hurt you back and that was wrong. No matter what happens between us, I need you to know that I was wrong. I understand if you don’t want to reply, but I do hope you read this and that you believe me.

Happy New Year,

Marsh

P.S. My final grade in Anatomy was a B-.

P.P.S. I still miss you.

“Clay Culver’s funeral was this morning, correct?”

I nod to Dr. James from my seat on the window ledge in her office. “Who has a funeral on New Year’s Eve?”

“I doubt the family had any other plans for the holiday,” she says wryly. “How was it?”

I shrug. “Weird. Kind of idealistic and melodramatic. I’ve never been to a funeral before, so I guess I don’t have anything to compare it to. But personally, I don’t get why people put themselves through it.”

“Routine and closure,” she recites, and then, like always, she shifts subjects on me so abruptly I can hardly keep up. “You’re training three interns now. Are you enjoying that?”

“They talk about me.” I bring my knees up to my chest, hugging them. “The resident they were with before was nearly thirty. I’ve walked up behind them in the break room and overheard all kinds of things, like how their new resident can’t buy alcohol and how I was probably still in a training bra when they went to college.”

“Those are all true statements.”

“I guess.”

“But you wanted something different from the experience?” she suggests. “You had expectations?”

My eyes drift from the traffic below to Dr. James. “Yeah, I did. I kind of hoped it would
be more of a peer relationship. They’re basically me a year ago, right? I know what it feels like to have that honeymoon excitement coupled with the complete terror of screwing up and pissing off an attending or resident.”

“Sometimes we don’t form bonds with people like us. Sometimes those bonds come about from unexpected sources.”

I lean my cheek against the ice-cold window, feeling the weight of how true that statement is. My mind drifts to the email I read this morning. The email I still haven’t replied to. “I could talk to him, you know?”

“Marshall?” she guesses. Damn therapist powers.

“Yeah, and even before things got—”

“Romantic?” Instead of leaving long, gaping silences between her questions and my answers, like she does most of the time, she’s finishing my sentences. This only seems to happen whenever we discuss Marshall.

“After I’d known him for only a week, I explained my need for answers, and he got it. He really got it. He wasn’t just pretending to understand me. And then we really worked hard for the next step, and now it seems like it was all for nothing.”

“Every relationship serves an important purpose even if it doesn’t last forever,” she says, “Even your relationships with your college professor and with Dr. Martin, though failed and unhealthy. Because of those, you knew what you
didn’t
want when you were with Marshall. And you knew why.”

We’ve talked a
ton
about Sam and Justin over the past few weeks. Next to Marshall, these are her favorite topics. I’m not sure at what point in the therapeutic process we’ll begin talking about actual patients. Well, besides Clay Culver. He’s up there among the top five most-discussed topics during Izzy Jenkins’s therapy sessions.

“I guess that’s true, but why am I not happy?” I ask.

“Because whether you were romantically involved or not, Marshall was your friend. And no offense to you, but I don’t think you’ve had many of those in your life.” She scribbles something on a blank sheet of paper on top of the folder in her lap. “So what I’m really trying to say is that you’re not happy because you miss him.”

“He sent me an email this morning,” I admit, though before the session began I had told myself not to mention this.

She glances up from her paper, eyebrows lifted. “And did you reply?”

My lungs deflate. “No.”

She scribbles something else on her paper. “But you miss him.”

My chest tightens, and I rub it with the heel of my hand. “I miss him.”

There, I said it.

Dr. James hands me the paper she’s just written on. I glance at the sentence she wrote:

Assignment: Reopen the line of communication with Marshall
.

Since Thanksgiving she’s given me many one-sentence assignments:
Express a personal story to a patient that relates to the patient’s fear or diagnosis
. Or
Have lunch with a colleague and discuss anything but medicine. Tell your parents one of your fears and how you wished they’d helped you with it
. I’m expecting to see something like
Join the circus
any day now. Actually, I expected her to ask me to confront my parents about what I read in my mother’s medical history—a confession I recently made to Dr. James after she assured me of full confidentiality during our sessions. But so far, that topic has stayed out of my parental conversations.

“It isn’t fair to Marshall if I just show up at his house and declare my love.”

“Do you love him?” She’s now scooted to the edge of her chair.
God, her job must be boring
.

I roll my eyes, trying to brush it off casually. How am I supposed to know if I love him or not? I’ve never loved anyone in that way before.

“Okay, forget that question. Forget love or a relationship. You need closure, and so does he, most likely.”

“You said open the lines, not close them,” I point out.

But she might be right. Based on Marshall’s email, it does seem like that’s what he needs. And that idea makes my chest ache even more. Maybe I’ve been denying myself closure because I subconsciously want to deny that we’re over.

Dr. James shrugs. “You might only be opening them for a short time, but it’s still important. And I’m not saying you have to prepare a speech and PowerPoint presentation. I’m saying to take one tiny step. Something. Maybe he needed your friendship as much as you need his.”

“I don’t know.” Contacting him feels wrong and complicated. Not to mention the fact that his family has probably made dartboards with my picture on them, and if any of his family members have Marshall’s aim, my face is probably covered with holes. They just want him to be happy, and so do I. I was as wrong as Marshall, probably more so, for projecting my anger and fears on him. The last thing I want to do is open those wounds again and cause him more problems.

“A text,” she suggests. “Send him a text that says,
Can we talk?
That’s all. Nothing about a future relationship implied in that. Just
Can we talk?
”

I take a breath and glance at the clock. “I have rounds with my interns in five minutes.”

“Izzy … it’s an assignment, and I expect it done by the next time we meet, understood?”

“I’ll think about it.” I’m sure I’ll obsess over it like I’ve been obsessing over that email
and the idea of replying to it, but that doesn’t mean I’ll go through with it. Everything else she’s made me do thus far has been way easier than this.

But all I can think about, as I exit her office and head out into the hall to find my fledglings, is Thanksgiving night. Before everything got all fucked up. Marshall came over to my house while Mom was out shopping the early Black Friday sales with one of her work friends. We were trying to be good, and we even sat in the living room watching a movie—I mean, we’d already gotten completely naked in the on-call room earlier that day.

My eyes kept fluttering and I worked hard to keep them open during the movie. I was exhausted from being up early and cooking at the hospital all day. Marshall eventually turned the volume down on the TV and stretched us both out across the couch.

“You can close your eyes,” he whispered, pulling me against his chest. “I don’t mind.”

My nose rested against his sweater, allowing me to inhale all the familiar Marshall smells with each breath I took. “See, this is the problem with on-call rooms,” I mumbled sleepily. “You don’t get this part.”

He tightened his arms around me and pressed his lips against my temple. “Yeah, I like this part.”

We were both asleep by the time my mom got home a little after midnight, but I woke up after hearing the floors creak beneath her feet while she attempted to sneak past us. I lifted my head and then stared at Marshall, wanting nothing more than to fall back asleep with him.

His eyes opened and he leaned in, kissing me and then kissing me again until I was breathless and hot and feeling safer than I’d ever felt in my entire life. “I could do this all night,” Marshall whispered, nibbling on the end of my ear.

My hand slid under the back of his T-shirt and sweater. “Even with all these clothes between us?”

“Yes, even with our clothes on.” He tangled our limbs together and then our tongues, and I could actually feel his patience in that kiss, feel that he wasn’t planning to go anywhere, that holding me could be enough.

Thinking about that now hurts so much. I mean, I loved being with him right then, but I hadn’t realized how special that moment was. How much it represented the kind of person Marshall Collins really is, and how we’d both been brave and exposed ourselves to each other with our clothes on—which is much scarier than getting naked, I’ve learned. Do we still have that bravery, or has it gone to waste?