Hi, it’s Jeremy again, the DAK amputee/physician. My life has been pretty crazy lately, but I decided it was time to sit down and do an update.
I’m a second year resident right now in an internal medicine residency program. Now that the winter is over, things have settled down a lot. It was very crazy for a while in the hospital. December through February are probably the worst months to be a resident because the hospital is very busy and patients just seem to be sickest then. I was working on the general medicine inpatient wards then and we were getting the maximum number of patients every night. I was the only senior resident on the team and we had almost thirty patients on our service! Nobody gives me an easy time because I use a wheelchair, believe me.
I was lucky that I had two very good interns on my team. One of my interns was a guy named Tyler, who was going into radiology next year. The other was a girl named Mary, who was staying in internal medicine. I already knew Tyler and I knew he was a smart and efficient resident, so I wasn’t worried. I hadn’t met Mary before this rotation, since she was a resident at the local county hospital and was just rotating through our university hospital. The interns from the county hospital are sometimes a crapshoot, but she turned out to be good.
There’s still some awkwardness when I meet a new person on the team and they realize that I’m disabled. I had talked to Mary on the phone the night before our first day and I thought about saying, “Oh, by the way, I’m in a wheelchair,” just so it wouldn’t be a surprise to her the next day.
I met Mary and Tyler the first day in the resident lounge. I got there first and I was going through the patients’ labs and writing everything down. Even though we had a lot of patients, everyone was fortunately pretty stable.
When Mary arrived in the lounge, I recognized her from her “facebook” photo posted in the lounge, but it really didn’t do her justice. Mary is Indian and really really beautiful, even while wearing her scrubs. I think I probably gawked at her a little bit, just because she was so attractive. But right away I saw she had a big diamond ring on her finger, not that I would have had a shot with her anyway.
Mary had probably seen my picture on the wall too, which I guess looks like me, but I could tell she was squinting and trying to figure out if it was really me, even though I was wearing scrubs too. I decided to put her out of her discomfort. “Mary, right?” I said.
She nodded. “You’re Jeremy?”
“Yeah, have a seat.” She sat down on the couch and I wheeled over to her to go over her patients with her. She was slightly distracted and it was really really obvious that she was staring at my stumps, which were wrapped up in my scrub pants. Once again, this is something I’m used to, but that doesn’t mean it wasn’t very awkward. I would have hoped my fellow doctors could be more mature than that.
It turned out Mary was a pretty good intern. Considering our service was getting slammed, I felt like she was someone I could count on to do her share of the work and not need too much help. But January, the senior resident’s job is much easier because the interns actually know what they’re doing.
Because we were spending every fourth night in the hospital, I wound up spending a lot of time with Tyler and Mary. We had lunch together every day and dinner together on call nights, so we talked a lot. Mary was married, like I had figured. Her husband was a lawyer and worked pretty long hours too. “I’m not even sure he misses me,” she joked to us one time.
“I don’t think that’s possible,” Tyler said.
“Aw, that’s so sweet,” Mary said.
Tyler was always very affectionate with Mary and I was beginning to think he had a thing for her. He even said to me a few times, “Wow, Mary looks really hot today.” Mary seemed very affectionate and flirtatious in general, although she never was with me. Sometimes I felt a little left out when I was around the two of them, because I didn’t feel comfortable flirting with Mary like he did.
Even though it was very difficult, I had been making a big effort to put women out of my mind lately. I had a kind of bad break-up with my last girlfriend Liz, which I had been feeling bad about, but then something happened to make me feel exponentially worse.
It happened one night when I was at home, watching TV while my mom was making dinner in the other room. And yes, I do still live with my folks. My friend Michelle tells me every week that I need to move out, but I really don’t see the big deal. Her argument is that you can’t be thirty (yep, I just turned the big 3-0) and still living with your parents, plus it’s bad for relationships. She’s like, “Oh my god, Jeremy, do you want to wake up one day and realize you’re forty and still living with your folks???”
My argument is that I’m not in a relationship right now and there are plenty of thirty-year-olds who still live at home. My parents don’t interfere too much in my life except that my mom cooks for me, and it’s nice to not live alone. Also, my sister Lily and her family live really nearby so I get to see them all the time too. When I first lost my legs, I felt like I had to move out of my parents’ house, just to prove I could live on my own. But now that I have already proven myself, it’s not so bad living with my parents. I’ve been staying with them almost two years now and I don’t have any immediate plans to move out. They don’t mind me staying with them, except that my mom would like me to get married, of course.
Anyway, I was home watching football on TV and my brother-in-law Ryan (my sister’s husband) came over with my nephew Duncan. I was sort of half-lying down on the couch, because it’s honestly really hard to sit in my wheelchair all day. Considering I have full sensation, it can get very uncomfortable to sit all day, no matter how much I shift my weight, so most of the time when I get home, I want to get out of the chair right away. It worked out because Duncan wanted to play in my chair while Ryan and I watched TV. I let him because I’m a pushover uncle.
Ryan and I were shooting the shit while we watched. I’ve become a lot closer to Ryan in the last two years while I’ve been living at home to the point where I think I’m closer to him than I am to my own brother. Anyway, we were just talking and all of sudden Ryan said out of nowhere: “By the way, Jeremy, your mother wanted me to tell you that Liz got engaged to that guy she was seeing.”
I was completely shocked. They had only started dating very recently and I knew they were serious, but I hadn’t realized it was that serious. It was strange that my mother would put Ryan up to telling me, although I guess she knew we were good friends and it would be easier to hear it from him, considering I’d probably find out eventually.
“Are you okay, Jer?” he asked me.
I said I was okay, but I honestly didn’t feel okay. I felt awful. I think Ryan noticed this. “Why don’t you try going to that Catholic singles thing? I bet you’ll meet someone there.” (I’m sure my mom told him to say this too.)
My original argument for not wanting to go is that I’m not a practicing Catholic and I didn’t think I’d meet women there that I’d get along with. But the more I thought about it, the more I was starting to feel like I didn’t want to meet any kind of women. Every relationship I’ve had in the last six years has had a really large ratio of pain to enjoyment. I was sick of it. “I don’t think I want to meet anyone,” I told Ryan.
“You mean you want to wait a while?”
“No, I mean, I think I want to just stay single.” It’s funny because when I said it, I actually sort of felt a weight lift off my shoulders, like I could finally stop worrying about how I was going to find a girlfriend.
“You don’t mean that,” said Ryan. I assured him that I did. “So what are you going to do? Never go out on a date again? Come on.”
The more I thought about it, the more the idea appealed to me. I guess I had always been worried about being lonely, but the thing was, I wasn’t lonely. At all. I had my parents, I had Lily and Ryan and my nieces and nephews nearby, and I had my work. I actually had a really full life. It sort of irritated me that society made me feel like I had to find a relationship and get married eventually. My life was really good the way it was. I didn’t need a wife and kids. If I could live this way for the next ten to twenty years, there was nothing wrong with that.
I know you’re thinking, what about sex? I have to confess that my sex drive has been really really low since my accident, compared to what it was before. That’s not to say that I don’t have any interest in sex, because I do, but it isn’t the same as it was before. I don’t think about it much at all and I masturbate only rarely. I don’t know if it’s physiological, like from nerve damage or whatever, or psychological, but sex just isn’t that important to me anymore. Not that I want to go through the rest of my life without ever having sex, but believe it or not, the thought about not having it for long periods of time doesn’t bother me that much anymore.
Anyway, about two weeks into my rotation, one of the residents was having an informal engagement party and invited all of us. Usually I hate engagement parties because it just reminds me of my ex and my lack of a relationship, but I wasn’t going to let that bother me anymore. My parents were both surprised and thrilled that I was going out to a party. I think my mom was secretly hoping I’d meet someone. She still wasn’t buying my story about deciding that I want to stay single.
Anyway, I kind of hate getting ready for a party, but I tried not to think about what to wear too much. I think in the past, I’ve tried to take the focus away from my stumps, but now that I wasn’t considering the idea of meeting someone, I just wore some pants from work and they looked fine, I think.
The unfortunate problem was that my left stump was hurting me a lot. No phantom leg pain or anything, but the stump just hurt a lot when I touched it. I had been noticing it for a couple of days and it didn’t seem like it was getting worse, but it wasn’t getting better either. I didn’t have any fever, which was good. I had my mom take a look at it, because I can’t see it that well and she said it seemed a little bit red on the bottom. Or more red than usual, because my stumps always are kind of red. I don’t know the reason, but my stumps healed very badly and are just always prone to infection, which is why I can’t wear prosthetics. I made a doctor’s appointment to get it looked at; even though I could have had someone at the hospital write me for some antibiotics, I’ve gotten very sick with these infections in the past and I thought it was better to just go to my regular doctor.
I put on some antibiotic ointment from the hospital and wrapped my left stump up in a stocking. It didn’t feel too painful, so I figured I could survive the night like this. The stocking didn’t seem to show through my pants.
I got to the party when it was already pretty crowded. I knew most of the people there from the hospital and everyone welcomed me. A few people were surprised I showed up because I never come to parties. I’m probably one of the less social residents in the hospital.
Right away, I made myself a very dilute rum and coke. I had already promised myself (and my parents) that I wasn’t going to drink much tonight, since I was driving, but I know that once I start drinking, I tend to just keep going. But I really needed at least one drink to loosen up a little bit. Plus I figured it would ease the dull throbbing in my left stump.
I found my intern Mary sitting on a couch next to Tyler. He had his arm around her and she didn’t look uncomfortable with it at all. It made me uncomfortable though. “Jeremy! I’m so happy you made it!” she said.
“I can’t stay long,” I said, already planning my escape.
“Rum and coke?” she asked me, pointing to my drink.
I confirmed that it was and she took it from me and had a sip. The familiarity of the gesture was kind of sweet. “Wow, this has almost no rum in it. I thought you were Irish.”
Ha ha. I really don’t think it’s funny when people make jokes like that, but I didn’t let it bother me. “I’m driving,” I explained to her.
“Do you want me to get you a drink?” Tyler asked her. He had taken his hand from around her shoulders and put it on her knee. I was surprised at how much nerve he had, considering she was married.
“Sure,” she said. “I’ll have what Jeremy is having, but with a lot more rum.” She laughed. “Isn’t it weird to be hanging out outside of the hospital?”
“I guess so…”
“I love your shirt,” Mary said. “Green is a good color for redheads. You look really cute.”
I didn’t know what to say to that, so I just blushed. I felt like she was patronizing me. Plus I’m not really a redhead, but for some reason a lot of people think I am.
“I was going to bring my friend Pauline,” she said. “She’s really nice. You would have liked her.”
“Thanks, but I’m not really interested in…” I stopped myself.
Mary looked curious. “In what?”
“In dating anyone right now.”
“Oh,” said Mary. “Why not?”
“I’m just not.” The conversation was making me a little uncomfortable, so I was grateful when Tyler came back with drinks. The rum and coke that he had brought for Mary looked like it was almost entirely rum and I wondered if he was trying to get her drunk. Probably.
Mary actually wound up getting very drunk that night. I managed to stay fairly sober, surprise surprise. I could see Tyler was eating it up, getting very affectionate with her. At one point, they were almost kissing. By the time the party was winding down, Mary was so trashed that she could barely even stand up.
“Can you give me a ride?” she asked me, giggling, and she sat down on my lap. I immediately grabbed my wheels to keep from losing my balance. This would have been pretty awkward to begin with, but the fact that my stump still sort of hurt made it much worse. I was glad when she got up again right away, especially because even though the situation was so weird, I was afraid that having Mary’s body on my lap for too long would give me an erection, which would have been mortifying.
I was actually fairly concerned about her. “Do you want me to drive you home?” I asked her.
“No, I can take her,” Tyler said, appearing out of nowhere.
I gave him a look and said, “Come on…” She’s married!
He shrugged and helped her put on her coat and they left together. Of course, I have no way of knowing if they hooked up or anything like that. I wouldn’t have been that surprised, considering how drunk Mary was and how much Tyler liked her.
I made it to a doctor the next day and I had to go through the usual argument with the nurse so that she’d let me stay in my chair rather than getting up on the examining table. This is absolutely the only nurse who wants me to do that. Anyway, I just took my pants off so that my stumps were exposed through the ends of my boxers. It was weird sitting there like that in the room and I was hoping the wrong person wouldn’t walk in.
The doctor came in and bent down to take a look at my stumps. I actually winced with pain when he started fingering my left stump. “This looks pretty bad, Jeremy,” he said, clucking his tongue. “Definitely infected.”
I was pissed off because I really do make an effort to keep my stumps in good shape and I don’t know why this keeps happening to me. I guess all the crazy hours lower my resistance. He gave me antibiotics and said that I should try not to put too much clothing on top of it, but that was impossible since I had to work and I wasn’t going to wheel around with my stump exposed.
The day after, we were on call again. We got slammed with lots of sick patients as usual. The sickest one belonged to Mary. It was a demented 80 year old woman who was septic, which had sent her into atrial fibrillation, which was sending her into pulmonary edema. The worst of it was that her family wanted her be full code. I tried to talk them out of it and explain that someone in her condition probably wasn’t going to survive a code blue and it was just wrong to pound on her chest for nothing. But you can’t argue with some of these families.
Some people try to use the fact that I’m an amputee as a reason that I should advocate patients being full code. I don’t understand that at all. Just because I was in a trauma and the doctors saved my life, it doesn’t mean I think we should do things that are futile. Yes, I was intubated and I survived it, but I was 23 years old and completely healthy otherwise. If I were 80 years old and demented, I don’t think I’d want someone to put a tube down my throat. It’s cruel.
Mary did a great job stabilizing her and we got her heartrate down to the 80s and her oxygen saturation was much improved. By about three AM, we felt that she was stable enough to hit the call rooms and try to get some sleep.
My stump was still throbbing a little, even with the antibiotics on board. I rolled up my scrub pants and tried to look at it to see if it looked improved at all. I couldn’t tell. In any case, I kept the pants rolled up, thinking I’d cool it off while I had the chance. I always keep the lights on when I go to sleep so that I’ll be able to read my pager when it inevitably goes off.
I think an hour had passed when I heard knocking at the door. Before I had a chance to say anything, the door opened and Mary was standing there. I was groggy but I noticed that her eyes flew open. That’s when I realized that my stump was lying exposed on top of the blanket. I can only imagine how much it must have grossed her out to see that. I quickly covered it up.
“I’m sorry,” she said quickly.
“It’s okay, it’s okay,” I said.
“I just—”
“It’s okay,” I said again. I wanted to try to forget this had happened. “What’s going on?”
“Mrs. Goulani’s blood pressure is in the low 70’s,” she said.
“Shit,” I said. I rubbed my eyes and tried to get my bearings. “How are her sats?”
“In the mid nineties,” Mary said.
“Pulse?”
“About a hundred.”
“Okay…” I rubbed my eyes. “Go over there and give her a small normal saline bolus. Like 250 cc’s. But watch her carefully… we don’t want to overload her lungs.”
Mary went running while I climbed into my chair. I still felt embarrassed about how she had seen my stump, but I was too worried about Mrs. Goulani to think about it much. I wheeled down toward the step-down unit, cursing the fact that I had to wait for the elevators.
When I got there, I saw right away that Mrs. Goulani’s blood pressure had dropped to the sixties. She was going into septic shock. I noticed that her oxygen saturation was dropping too. Mary was standing over the patient, looking ready to start chest compressions at any minute. “What do you want to do, Dr. Andrews?” the nurse asked me.
“Mary, can you call the ICU?” I said to her. She looked grateful to be given a task to do outside of the room. I turned to the nurse. “We need to start pressors on this woman right now. Let’s get some dopamine on board through her peripheral line. How much are we allowed to give without sending her to the ICU?”
“Maximum of five.”
“That’s it?” I rubbed my eyes again. This woman was in big trouble. I kept my eye on her oxygen level, which was still lower than I would have liked. I had a gut feeling that she was going to need to be intubated that night.
The ICU resident, Dave, arrived at the scene, looking very stressed out. At that point, we had started Mrs. Goulani on dopamine and she was still very hypotensive. “This patient needs to go to the ICU,” I said.
“We have no beds,” Dave said flatly.
I said, “Well, she’s going to die tonight if you don’t take her.” That sounded a little melodramatic, but it was absolutely true.
Dave looked over at the patient and flipped through her chart, “Jeremy, why is this woman full code? What the fuck?”
“I tried to talk her family into making her DNR, but they didn’t want it.”
I was getting more and more worried that we were going to have to call a code on this woman in the next fifteen minutes. Dave was still flipping through the chart, muttering that this was ridiculous. In a way, he was right, but it wasn’t up to us to decide that. “See here, Jeremy,” Dave said, pointing in her chart. “At her last hospitalization, she was DNR and the family said they didn’t want escalation of care.”
“Her family said they changed their mind though,” Mary spoke up.
“I’m not taking her to the ICU,” Dave said. “There are no beds. This woman shouldn’t be full code.”
I looked over and saw that Mrs. Goulani’s pressure was not improving at all on the dopamine. She was definitely going to die if we didn’t move her to the ICU and put in a central line ASAP. “Dave,” I hissed, “the family told me in no uncertain terms that this is what they wanted. You’re going to be in a shitload of trouble in the morning if you let her die over here. There must be someone you can bump out of the ICU to make room for her.”
I knew there had to be a way to make room in the ICU and Dave knew it too. I could see him thinking about the consequences of letting this woman die over here and I guess he decided he needed to move her. He looked like he wanted to kill me.
There was a huge weight off my shoulders when they moved Mrs. Goulani. I knew she was going to be well taken care of in the ICU and more importantly, she was off my service. I wheeled back to the call room, with Mary following close behind. “That was great,” she said when we were in the elevator. “You saved her life.”
I said, “Whatever that’s worth.”
“What do you mean?” she asked.
“Dave’s right, this woman shouldn’t be full code,” I said. “It’s ridiculous. This was her time and she would have been better off if we just let her go.”
Mary looked shocked. “You mean that?”
“Mary, come on. How long does this woman have? Would you want to spend the last few months of your life with a tube down your throat?”
We were almost at the call rooms and Mary stopped walking and sat down on some couches outside one of the rooms. I said, “What’s wrong?”
“I’m just surprised to hear you say that,” she said.
I knew what she was getting at before she said it. Just because I’m in a wheelchair, I’m supposed to be Mr. Compassion, but I’m not. I’m realistic, just like everyone else.
“Sorry,” I said, because I wasn’t sure what else to say.
Mary looked up at me. She looked tired and tousled, but still really beautiful. She said, “Can I ask what happened to… um…”
I was surprised she asked me that but it was late and we were both so tired, neither of us were thinking straight. “I was in a bad car accident.”
“A long time ago?”
“After my first year of med school.” I added, “And yes, I had a tube down my throat, so I know what’s it’s like and it wasn’t fun.”
“I’m sorry,” Mary said.
“Sorry for what?”
At that point, Mary did something unexpected and started to cry. I was so shocked by this, I didn’t know what to say. I patted her shoulder a little awkwardly.
“Please don’t be mad at me, Jeremy,” she said. “I’m sorry, I just… I feel like I screwed up with Mrs. Goulani and got her sent to the unit. And now I’m saying all this dumb stuff to you…”
“It’s okay, we’re both tired,” I said. “And you didn’t screw up. She was really sick when we got her.”
“And I feel like I never see Steven anymore,” she added, wiping her eyes. “Like an hour a day if I’m lucky. He doesn’t even bother to come home early if I have a day off.”
“Residency can be very hard on a relationship,” I said sympathetically.
I put my hand on her shoulder again to comfort her and I was again really surprised when she leaned forward and kissed me. I was so shocked that I almost pulled away. I thought she had done it by accident, as if that were possible. But then I felt her hand on the back of my neck, pulling me closer to her. First I was angry at myself because I had already promised myself I wasn’t going to get involved with any more women. But the truth was that I did have a tiny crush on Mary and her kissing me was really turning me on.
Then almost as abruptly as it had started, she pulled away. She wiped her mouth with the back of her hand. “I’m going to go to sleep now,” she said.
“Uh, okay,” I said.
I watched her walk away, trying to figure out what the hell had just happened, if I had just hallucinated it. Well, one thing I knew for sure was that I had a huge hard-on. I quickly wheeled myself into my call room and closed the door behind me, then transferred to the bed.
That night, I did something I had never done before, which is I masturbated in the call room. I imagined Mary on top of me and all over me, really really passionate. She was kissing me and running her hands all over me. In my fantasy, I didn’t feel self-conscious about my legs at all.
I pulled my pants down and grabbed my right stump while I started jerking off. I imagined Mary naked and straddling me, imagining the feel of her soft brown skin. My stumps were shaking like crazy and even the pain in my left one was completely gone. I’m sure if someone had walked in on me right then, it would have been quite the site.
I came really quickly and I did my best to be quiet. I doubt anyone heard me.
I lay in bed, covered in sweat and exhausted. I did my best to clean up with the limited resources in the call room. I was a little worried that the cleaning crew was going to figure out what had gone on in here.
I was almost hoping Mary would need to call me about a patient that night, but she never did. I didn’t see her again until the morning and neither of us said a word about our kiss last night. I almost started wondering if it had been some kind of dream, except I knew it wasn’t.
Around one o’clock, Mary found me in the resident lounge to tell me she was signing out and going home. “Is that okay?” she asked me.
“It’s fine,” I said, “but… um, do you want to talk?” We were alone in the lounge, so I wheeled toward her.
“What for?” Mary said, taking a step away from me.
I straightened up in my chair. I felt really uncomfortable all of a sudden. “You know, about last night.”
“Can we just forget about that?” she asked. “I mean, it was just a one second kiss. I don’t want you to get any ideas. I’m not really interested.”
At that moment, I was really furious at her. I felt like she had just punched me in the face. She was the one who kissed me and now she was treating me like I was some kind of pathetic stalker. I guess some pretty girls think that they can manipulate guys all they want. “Go home, Mary,” I finally said.
The last week of the rotation was somewhat awkward. Mary and I barely talked and I noticed she made an effort to avoid me when she could. I found out at the end of the rotation that she had slept with Tyler too and pulled the same shit with him. That actually made me feel a little better, because Tyler is a player and not the kind of guy who’s easily manipulated by women.
In general, the whole experience just strengthened my resolve. I wanted to stay single because I felt like every relationship I had was turning out badly, and Mary had just illustrated that point so well. So I’m pretty much done with women, at least for the time being.
To be continued....