By 10:00 AM, the caffeine buzz has worn off, replaced by the crushing reality of American healthcare.
I am standing at the nurses' station, pretending to update a chart but actually online shopping for a new watch, when I hear it.
The sound of Dr. Lucas Silva losing his mind.
He is on the phone at the end of the counter, gripping the receiver so hard his knuckles are white.
"I understand the policy," he is saying, his voice tight. "I am looking at the policy. I am also looking at a seventy-year-old woman who has a mass on her pancreas that we cannot identify without the contrast MRI... No, an ultrasound is not sufficient... Because I said so... I am the Chief Resident... Hello? Hello!"
He slams the phone down. He puts his head in his hands.
"Trouble in paradise?" I ask, sliding over.
He looks up. If glares could kill, I would be a smudge on the linoleum.
"Insurance," he spits the word out like a curse. "Mrs. Gable. Bed 8. She needs a specific MRI sequence to rule out a tumor. Her insurance—'BudgetCare Plus', which is neither budget-friendly nor caring—denied it. They want us to do a 'wait and see' approach."
"Wait and see?" I repeat. "Wait and see if she dies?"
"Essentially," Silva runs a hand through his hair, making it even more chaotic. "I have to file an appeal. It takes forty-eight hours. We don't have forty-eight hours. Her enzymes are spiking."
"So just do the scan," I say.
Silva laughs. It’s a hollow, bitter sound. "Oh, right. I forgot. You’re a York. You think things justhappenbecause you want them to. If I order that scan without approval, the hospital eats the cost. Five thousand dollars. And then Administration eatsme."
He stands up, grabbing Mrs. Gable’s chart.
"I have to go tell a sweet old lady that we’re going to 'monitor her condition' because some actuary in New Jersey decided she isn't profitable enough."
He stalks off toward Bed 8.
I watch him go. I look at the phone he just slammed down.
I look at the computer screen in front of me.
I hate this place. I hate the smell. I hate the shoes. But mostly, I hate the fact that Lucas Silva—who is annoying, rigid, and has terrible taste in footwear—looks so defeated. It ruins his face. He has a very symmetrical face. It should be smiling, or at least yelling at me.
I sigh. I straighten my scrub top.
"Time to mingle," I whisper.
Mrs. Gable is delightful.
She is a tiny bird of a woman with white hair and a hand-knitted shawl. When I walk into her room, she is doing a crossword puzzle.
"Seven down," she mutters. "Five letters. 'A sharp pain'."
"Grief," I suggest, stepping inside. "Or maybe 'Agony'. Though that's five letters too."
She looks up and beams. "Dr. York! The handsome one. Don't tell Dr. Silva I said that, he looks like he carries the weight of the world, poor dear."
"He does," I agree, checking her vitals monitor. "He needs a hobby. Or a Valium. How are you feeling, Mrs. Gable?"
"Oh, fine, dear. Just a little tummy ache." She reaches into her purse and pulls out a strawberry hard candy. "Would you like a sweet?"
I look at the candy. It is covered in lint.
"I would love one," I say, taking it and slipping it into my pocket.
