Short Stories -- Going Deeper

The voice came to him through a haze of sleep. “Got a cutter for you, Jake.” He
sat up slowly, flicked the light on, rubbed his eyes, and then peered at his watch. 4 a.m.
Damn. He had hoped to get at least a few hours sleep.

The intercom crackled again. “Jake?”

“Yeah, I’m coming.” He splashed some water on his face, laced up his Adidas,
stumbled out of the call room. He grabbed the chart at the nursing station and went
down the hall to the trauma room.

She was perched awkwardly on the gurney, holding a tea towel around her right
arm. Punk pink hair, eyebrow ring, jeans, beaded T-shirt, the jean jacket lying bloody on
the chair. “Hi, you’re Amanda Jacobs? I’m Dr. Jake Smith, the E.R. resident.
May I take a look at your arm?”

She slowly unwrapped the sodden towel. Three lacerations to the volar forearm,
half an inch through the subcutaneous tissue. Exacto blade or utility knife, most likely.
“Oops, that one looks like it is going to spurt. Can you put some pressure on it while I get
gloved up?” She nodded and reapplied the towel. He looked at her again, noticed she
was pale and a bit tremulous. “Are you feeling okay? A little sick? Would you like to lie
flat?” She shook her head. He ratcheted up the head of the stretcher so she could lean
against it. “Just rest your arm on the arm board there, that’s right.” He guided her through
the standard neurological exam for the hand. No nerve or tendon damage. Good. He
adjusted the operating light while he took a quick medical history. Healthy, no problems
with anesthetics, no allergies, tetanus shot two years ago.

“I’m going to infiltrate the skin a bit with lidocaine, clean this up and then stitch it. Stapling would be faster but you get a better cosmetic result with sutures, I
think. Is that okay?”

A nod. Maybe a little less disdainful.

He undid the tapes on the sterile suturing tray, peeled open packages of sutures and shook them onto the tray. He froze the wound, waited, cleaned it, applied a surgical
drape, gloved, sat down on the revolving stool and began the familiar ritual. She
watched with a concentrated frown, didn’t flinch. It took all of ten minutes.

He went over the usual wound care instructions, and then paused. “Amanda,
before you go, can we talk about why this happened?”

She shook her head, looked at the floor.

“Amanda, were you trying to kill yourself?”

“No.”

“Those are pretty deep lacerations and you have scars there already. Cutting may
start innocently enough as a release of tension, or an expression of inner pain, but it can
quickly become addictive….” He paused, realized he’d lapsed into lecture mode and lost
her. Her eyes were dull, she wasn’t listening. “Do you have someone you can talk to, a
counselor or psychologist?”

No response.

“How about staying overnight and speaking to the psychiatrist in the morning?”

“No!”

He sighed, leaned back on the revolving stool, took off his gloves. “Well, I’ll
give you some phone numbers of some people who can maybe help.” He rummaged on
the shelf, gave her a preprinted sheet the E.R. social worker had made up. “Can I call
someone to come and pick you up? Your parents? A friend? Boyfriend?”

A tear rolled down her cheek.

He zeroed in on boyfriend. “Did you two have a fight tonight?”

This time she nodded.

“You might feel better if you talk about it…”

No reply. What was he supposed to do with her? He was so tired. And he had a
presentation to give tomorrow. But hey, it’s not about you, it’s about her.

“Okay, let’s approach this from a different angle.” On the back of the chart he
drew a little stick girl sitting on a gurney with a big cloud over her head and a little stick
doctor with a question over his head. He drew a door, and outside the door, a stick
boyfriend. He printed underneath: “What would help?” He handed her one of his pens.

She hesitated, but finally took the pen and drew an X through the boyfriend. Next, she
drew a little square of paper in the doctor’s hand and a cab outside the door.

A cab home. Well, that could be arranged. He tapped the square. “What’s this?”

She printed ‘Morning after pill’.

Uh, oh, a new direction entirely. Girls didn’t usually cut themselves after consensual sex. He printed ‘Did he rape you? Date rape?’ She nodded, started to cry.

“Amanda, I’m terribly sorry this happened to you,” he said and paused. “Listen, you don’t have to report it, if you don’t want to, and you don’t need to have the whole rape kit done, but if you decide later to prosecute this--” he found himself stumbling, forced himself to be calm and professional, “this man, there’s a standard protocol for evidence that we have to follow now, and---”

“No!”

He looked directly at her for the first time. The tears were brimming over, her mascara was smudged, but she was still keeping herself under tight control. “No. I don’t
want all that done. And I’m not talking to anyone else about this. I’ll be fine.”

“Okay, okay. Just the morning after pill and some antibiotics,” he said hurriedly,
wondering if he was doing the right thing. He remembered being eighteen, his first
girlfriend, their first sexual experience, how scared she’d been, they’d both been,
afterwards when her period was late—even though they’d used protection. But that sex
wasn’t forced; they had both been ready, or thought they were. He couldn’t imagine
forcing anyone. This was not right. He cut short his reverie with a start, saw Amanda
looking at him expectantly. “You wait right here, I’ll go get the pills for you.” She
nodded and he went out to get a pack of each. He paused awkwardly at the door. What to
say, what to say? “Amanda, not all guys behave this badly, okay?” She gulped and
nodded.

………………………………………………………………

Four months later she was back in the same emerg; he remembered the pink hair
before he saw her name on the chart. Overdose. Two hundred Extra Strength Tylenol—
how had she choked them all down? She was alternately moaning, vomiting, and
thrashing; they couldn’t get the charcoal into her, she kept puking it up. Two large
bore I.V.s running, normal saline, she sported gauze and tape where she’d ripped the first
two lines out. Were the levels back? Yes. Two sets. He plotted them. She’d need
N-acetylcysteine for sure. And she was probably going to stay nauseated all night with
those levels, unfortunately.

“Hi, Amanda, we’ve met before; I’m Dr. Jake Smith.” A frightened glance at him
and then she bent her head and heaved into the basin propped in her lap. He stepped back
involuntarily. “Amanda, did you take anything else besides the Tylenol? Any other pills?
Any street drugs?” She straightened up, saliva dripping from her lower lip, shook her
head, bent over the basin, dry-heaved again. “Amanda, I’m sorry you’re so sick, we’re
going to give you the antidote for the Tylenol and you’ll be staying in the hospital.” She
nodded, shut her eyes, and lay back wearily. “Okay, I’ll talk to you in a few hours, you
try to get some rest.” Psych consult, please, oh, please. Why do they all want to kill
themselves? It’s the worst part of my job.

………………………………………

Four days later, getting off an afternoon shift, he went up to see her on the psych
ward. He’d done a rotation there the year before, not the nicest place. She was in the
day room, playing solitaire. No one else was around.

“Hi, Amanda. I’m Dr. Smith. From E.R, remember?”

She glanced up, shuffled her feet in the paper slippers.

“I came by to see how you were doing.” Actually they’d asked him to come. She hadn’t spoken to anyone since that night. Selective mutism. He sat down.

“Are you getting some help here?”

“Yeah, they’re okay, I guess.”

That had been easy! But don’t blow it here. “That’s good.”

Silence.

“Do you want to talk about anything?”

“Do I have to?”

“I guess not.”

He imagined he saw a smirk. He sat, hands in his lap, trying to recall his psychiatric training, trying to convey that he didn’t mind whatever she did. There was a lengthy silence, then she shook her hair out of her eyes, straightened up and seemed to come to a decision.

“Are you going to write it in the chart?”

“Not if you don’t want me to.”

She nodded slowly. “They’re always trying to make me talk so they can write in my chart. They sit there with their bright smiles and their clipboards—like vultures. Medical students, nurses, psychiatrists, all trying to coax me to talk.” She mimed writing on a clipboard. “‘Why’d you take the overdose, Amanda? You’ll feel better if you talk about it.’ All day: ‘Why, why, why?’ Like I’m a case of something gruesome to be presented.”

He hadn’t thought of it that way before. It was a hospital rule that complete
histories had to be on the chart in 24 hours or less. No one ever thought to tell medical
students what to do if the patient wouldn’t “cooperate”. Just get the history. Somehow
the patient’s feelings were secondary in the rush to get all the work done.

“Yeah, I can see why you might not be comfortable telling them everything. It’s
pretty painful stuff.” He shifted in his chair. “You don’t have to tell me anything if you
don’t want to. But if you do, I’ll keep it confidential.”

“No, I might as well tell you. They’re not going to let me out of here otherwise, are they?” She looked at him appraisingly.

“Maybe not for awhile.”

“Okay.” She sighed. “Let’s see. Same boyfriend. I went back to him.”

“Oh,” he said, trying to be neutral.

“I feel so stupid,” she said and stopped.

“Because….” he said, wanting to encourage her.

“My friends all told me he was bad, they told me not to go back to him, but – you
know what it’s like to be in love – I didn’t believe them – I thought he was wonderful,”
her voice softened, “--I was sure they were wrong.” Her face fell. “Except that they
weren’t. He’d been cheating on me the whole time! When I found out, I confronted him.
And you know what he did? He laughed in my face.” She paused to let the words sink in.

“That must have hurt a lot,” he said carefully.

“It did.” she said, and shook her head as if to clear the memory. “I couldn’t
believe that this guy--that I thought I loved -- would be so cruel! That he felt nothing for
me. That he’d used me. And I’d gone back to him. How stupid could I be? I felt so
awful, I just wanted to die. Right then and there. And you know the rest…”

“I’m sorry.”

“Go on, tell me he’s a jerk. Tell me I should hate him, right?”

“Don’t you?”

“No, strangely enough, I hate myself. Why is that? Why is it easier to hate myself than hate him?”

“I’m not sure. Maybe, if you’re busy hating yourself, you don’t have to deal
with the hurt underneath, the relationship not being as wonderful as you’d thought. Many people blame themselves initially. Maybe it’s a way that allows them to feel they could control the situation if it were to happen again—by doing or not doing certain things…. ”

“Maybe.”

“Well, that’s one reason, there might be others. The thing about counseling is that
it lets you stand back and look at it and look at why you’re having trouble letting go of
the relationship.”

“It’s pretty stupid to go back to a guy who rapes you; I don’t need counseling to figure that out,” she said flatly. Oh, minefield here. She was waiting to see what he’d
say, how he’d judge her.

He took his time, chose his words carefully. “Maybe it’s hard to stop loving
someone, even when he rapes you.”

She started to cry.

He went and got the Kleenex off the T.V. stand and handed it to her. He found a wastepaper basket by the door and brought it over as well so she could throw the used Kleenex away. Eventually she calmed down and started talking again. A lot
of things to sort through. He sat with her for awhile and talked some but didn’t try to
convince her about anything. At least the process had started.

Eventually, he had to go. He shook her hand and wished her well and he saw the three scars on her arm, livid red. She drew her sleeve down hurriedly.

…………………

It was eight months later and he was stationed at U.B.C. for the summer. Definitely a less brutal rotation; someone even covered so he could have lunch. And he needed lunch today; it had been a crummy morning with the ruptured aortic aneurysm right at the start of hand-over rounds and then the cardiac arrest they couldn’t resuscitate. He was beginning to question if he was really in the right profession. If he had stayed in Engineering, he would have been finished by now, in Edmonton, with a job, with Sally. Not in Vancouver, hearing third hand last month about Sally’s engagement to his ex-roommate Bruce.

He crossed the street to get a bagel and coffee. In the coffee shop he saw someone familiar: jet black hair now, but ends still sporting some pink. Should he acknowledge her? Would she be embarrassed? Apparently not, for when she turned and saw him in the lineup, she smiled warmly.

“Hi, remember me? Amanda Jacobs? You’re Dr. Smith, right? I guess I never said thank you for stitching me up that first night.” What a transformation! Bright, lively, confident.

“That’s okay. How are things going now?” he said.

“Much, much better.” she said.

“That’s good to hear.”

“I ditched the boyfriend for good. And I got counseling. I went to that doctor you
said had helped your friend. She was really good!”

“Great, I’m glad you liked her.” They moved forward in the line and he saw her
arm. The three scars were still faintly red, but there weren’t any new ones. “Are you in
school here?”

“Zoology. Summer elective. How about you?”

“Three month rotation here.”

“Better than V.G.H., hey?”

“Well, quieter. Nice for the summer.”

He paid for his lunch and followed her to the service counter to add sugar and
cream to his coffee. She stood there uncertainly, stirring her coffee. He smiled, and
waited. Finally, she said: “Can we sit down and talk for a few minutes? Are you in a
rush?”

He shook his head and gestured to a table in the corner. They sat down.
She played with her coffee some more and then looked him straight in the eye.
“The thing is, I’ve been to E.R.s before. They don’t like cutters.” She waited for
his reaction.

He nodded, it was true.

“But you were different. You treated me with respect. You asked why I cut. And you came and saw me after the overdose. I felt like such a loser back then. But you didn’t treat me like one.”

“You’re not a loser, Amanda.”

“Well, thank you, I agree with you now, but I didn’t then. But it made me think.
And so I talked to the psychiatrist that day. And she said that I was judging myself much
too harshly. That from anyone else’s perspective, from your perspective, I wasn’t a
loser, I was just a girl who fell for a guy and got hurt—and went back to him and got hurt
again—but finally learned her lesson. Not a reason to kill myself. She said that she
agreed with what you said the first night, too—most guys aren’t like him. I was just
unlucky the first time and I should try again. It made me realize that you were right,
maybe there was hope.”

“So you went for counseling….” he said.

She smiled. “Yes. And it helped a lot. And I stopped cutting too when I figured out there are better ways of expressing myself. And so I thought, when I saw you today in the lineup, that I should tell you that. That what you did helped me a lot. So, thank you!”

“Thank you for coming to tell me.”

There are moments where you’d like to say more, but you know you shouldn’t. He opened the door for her, and stood outside in the summer heat, watching her go.