Why is she so obsessed with my relationship with Sam? She mentioned it three different times on the previous evaluation form.
“I don’t have Asperger’s,” I repeat.
“Does the diagnosis bother you? Does it change anything?”
“Yes!” I fall back into my seat on the couch. “It changes everything. It means that I can’t change. People have shitty childhoods and they overcome it. You’re taking that from me. That’s what you’re doing right now. You’re stealing my excuse and giving me one that won’t ever go away. So yes, it bothers me!”
“I’m surprised.” She doesn’t appear even a little bit shaken by the fact that I just screamed at her. “I didn’t expect you, of all people, to buy into the social stigma of something like Asperger’s. Asperger’s is a very broad diagnosis. And to some extent all of us might be considered as having some of the characteristics described as part of the autism spectrum. Most people maintain a certain distance between themselves and others, because too much emotional empathy can make it debilitating to leave the house or hear stories of people suffering. And doctors, surgeons especially, are much closer to the autism spectrum than those in the field of sales and marketing, for example. I’m not diagnosing you with anything, Isabel. I’m not going to label you.”
Now I’m the one surprised. “You aren’t?”
She shakes her head. “I don’t believe it will make any difference in your life one way or another. All I want to do right now is ease your fears. I know you’re afraid of becoming like your mother, committing suicide. I thought if you knew what I believed to have been your mother’s true problem and the fact that she could have benefited from forcing herself into a normal college environment, you might be less afraid.”
I exhale and rest my head in my hands. “It’s a lot to absorb.”
“Why? Because I may have told you that you’re not normal? You’ve never been normal, Isabel. And what else are you afraid of most? That there’s some psychological disorder behind your lack of empathy with patients? Look at what happened with Marshall. You feel it now, don’t you? You see his illness and his life merging and the impact it has on him, right?”
“I do.”
“You can make those connections. In you, they’re fewer than in most people, but at the same time they’re stronger, and more valuable because of that.”
I’ve never been so confused and disoriented in my entire life. “So … why did you fail me the first time?”
“Because you were too young, your parents refused to address your issues and need for therapy—”
“Wait … I need therapy?”
“Yes,” she says firmly. “I’m recommending to Chief O’Reilly that he allow you to practice as a resident on an interim basis, assuming you continue to work at this hospital, where you have friends and family to support you, and assuming you agree to see me twice weekly until we mutually decide you don’t need any further therapeutic intervention.”
I sink back into the couch and stare up at the ceiling, thinking.
“Isabel? How do you feel about those terms?”
How do I feel? Light. Relieved. I lift my head from the back of the couch and look at her. “Okay. I feel okay about that deal.”
“It’s not a deal, it’s a solution.” And then she smiles. An actual smile. After scribbling a bit more on the pink evaluation sheet, she signs the bottom and hands it across the table to me. “Congratulations. You’ve just passed your intern exam.”
A couple of minutes later, I’m walking through the halls of the hospital, still shocked and not quite ready to process everything. I nearly plow into Justin and his fledgling interns. He stops when he sees me. “What are you doing here?”
I wave the pink sheet in my hand for him to see. “Apparently passing my intern exam.”
“Seriously?” He begins walking, and I walk beside him. The sound of eight feet shuffling behind us is odd but somehow comforting. Like maybe I won’t have to do this resident thing alone. It is a little scary now that I finally have the chance to think about being here rather than getting here.
“Seriously. But no Hopkins. For now.”
He snatches the chart of a post-op peds patient from outside the hospital room door. “They rejected you? I bet the program’s full. That’s probably why.”
I shrug but decide not to tell him that it’s because I have to stay here and go to therapy. “It’s fine. I can still learn plenty here.”
“Beats living in a college dorm and taking PE classes, right?” Justin says, being uncharacteristically nice. “God, I’m still traumatized from middle school and high school PE.”
He sets the chart back in place, obviously satisfied with the report, and we shuffle on toward the next door, which he passes up. But after reading the patient name on the chart next to the door, I freeze in place, reaching for Justin and tugging the sleeve of his lab coat. “Look.”
“That’s Laprosky’s patient. He’s not surgical.”
I tap my finger beside the name: Culver, Clay. “Look!”
“Clay Culver,” Justin says finally, his face reflecting the shock I’m most likely wearing. “Late-onset adolescent type one diabetes.”
Both of us reach for the chart at the same time, but I get it in my hands first. Already my heart is pumping at the speed of a racehorse’s, my stomach twisting. I flip the binder open, and Justin leans in to read with me. He waves a hand behind him, not looking up, and says, “Go! Rounds. Now. Report back to me in fifteen minutes.”
The fledglings scurry away.
“Oh, God,” I say, after reading the most recent update. I feel nauseous and dizzy all at once. “Oh my God.”
Justin closes the binder and rests it back in place. “It sucks, but it happens, you know?”
Justin and I don’t do this stuff. We don’t do feelings, or anything like feelings, with each other. So, of course, he takes off toward his next post-op patient. My chest tightens with panic, and I take a tentative step inside the room. Clay Culver is lying flat on his back, his light blond hair splayed out across the pillow, a breathing tube coming out of his mouth, a blood pressure cuff around his arm, other tubes and wires everywhere.
I flash back to the pissed-off fifteen-year-old, aggressively throwing objects around the room and shoving nurses out of his personal space.
And just like that, the lightness I’d felt in Dr. James’s office is gone. I can’t think. I can’t breathe. I drop my pink sheet of paper and run from that room as fast as possible. I keep running, down two flights of stairs, down another hallway, toward the ER doors, which will lead me to the outside stairs and the elevated train. I can’t wait to get on the “L.”
“Isabel!” I hear Dad shout, but I keep going. I can’t breathe. I need air. “Isabel!”
He jumps in front of me, taking hold of my shoulders. “What happened? What’s wrong?”
I didn’t even feel myself begin crying, but tears are streaking down my face. I try to take a breath but can’t. I lean over, resting my hands on my knees. “I can’t … he’s in a coma. He’s in a coma and I …”
“Who’s in a coma?” Dad asks, with such urgency in his voice that I panic even more. He leads me over to a chair in the waiting room and forces me to sit down. “Who is in a coma, honey?”
“Clay Culver,” I manage to say, wiping away more tears. “I never called him Clay Culver. I knew his name and I never called him by his name.”
I can feel Dad’s confusion, but he’s a doctor so he’s focused on the fact that I’m hyperventilating, and he’s ignoring the looming questions. As my breathing grows more and more ragged, his panicked voice becomes more distant and little black sparkles dance in front of my eyes. I’ve never fainted in my entire life. Not once. But I know it’s about to happen and there’s nothing I can do to stop it.
Lucky for me, my dad also recognizes the early signs and catches me before my head hits the tile floor in the waiting room.
I wake up in an ER bed, my sweater lyi
ng on a chair beside me. The panic is gone. My limbs are like Jell-O and numb. Everything is numb.
Don’t feel it. Don’t let yourself feel it. You’ll die if you feel like that again. You’ll suffocate to death. The words play over and over inside my head. I’m nearly positive they’ve been playing for whatever length of time I’ve been unconscious.
The curtain around my little ER bed flies open, and Dad and Marshall stand in front of me, looking all kinds of worried. They’re feeling. Don’t give in to it. Don’t let the feelings pull you under.
“Good, you’re awake,” Dad says at the same time Marshall practically falls over with relief and says, “Thank God. What happened? Did you forget to eat? Low blood sugar?”
The mention of blood sugar brings Clay Culver back to my thoughts, and the stab is so painful I have to close my eyes and force in a shaky breath. Don’t feel it. Don’t feel it. I open my eyes again and shake my head before swinging my legs off the end of the bed. “I’m fine.” I turn to Marshall. “Can you please take me home?”
Marshall blinks, then comes to life again. “Yeah … yeah, okay. Of course.”
I hop off the bed and wriggle out of the grip Marshall has around my shoulders. Don’t feel it. Don’t let him in.
“Honey,” Dad says before I have a chance to get away. He knows. He knows who Clay Culver is. “You did nothing wrong. He skipped insulin doses, drank alcohol, took Ecstasy. You did nothing wrong.”
I inhale and turn around to face my dad. “I killed him. I told him he was fine. I told him he wasn’t dying, but he was dying! People die from diabetes. That’s what I should have said. It was my job to consider psychological state in his diagnosis. I killed him.” Stop it. Stop feeling. Stop.
Dad’s face twists with several different emotions, and finally he looks over my shoulder, addressing Marshall. “I’ll take her home. You can go. I probably shouldn’t have told you what happened.”
“Dad, I’m fine. Marshall is taking me home. To Mom’s house.” I turn and head for the doors, hoping Marshall will follow me.
He does. But when he tries to wrap an arm around my shoulders, the ice around me begins to chip and I start to panic all over again. I step sideways out of his reach and keep my eyes forward. He sighs but gives me the space I need. He’s driving an old Dodge Caravan that he most likely borrowed from his mother. I climb into the passenger seat and use every bit of my mental power to concentrate on one thought: Don’t feel it. Don’t let yourself feel it. You’ll die if you feel like that again. You’ll suffocate to death, again and again, ignoring everything Marshall says to me during the nearly twenty-five-minute ride.
Instead of taking me to my house, he pulls up to a red-brick house about half the size of mine. He puts the van in park but leaves the ignition running. “This is where I live. It’s about three minutes from you. Isn’t that crazy? All this time we’ve lived so close and we had to go to school two hours away from here to meet.”
I swallow the lump forming in my throat and turn my gaze to the windshield again. “Marshall, I really would like to go home. Please.”
“Yeah, sure,” he says, nodding and putting the minivan back into drive. When he pulls up to my house—the FOR SALE sign still resting in the yard—he not only shifts to park but pulls the keys out of the ignition.
I wrap my fingers around his keys and guide them back to where they had been. “I don’t want you to come in.”
He sucks in a breath, hiding the hurt on his face. “Izzy … just let me walk you inside. Maybe—”
“No.” I shake my head furiously. “Please. Just go.”
He reaches over me and I think he’s about to open the door to let me out, but instead he covers the handle with his palm. And I’m forced to inhale his scent, to think about how he makes me feel …
Don’t feel it. Don’t feel anything.
“I asked you to go away and leave me alone before, too,” he says, his voice low and right next to my ear. “Imagine if you had listened. You don’t need to be alone; you need someone to be here for you. And I’m willing to do that. All you have to do is let me.”
“This is different,” I say.
“No, it’s not.”
Marshall lifts his hand from the door handle and touches my cheek. My hands start to shake, fear and pain engulfing me. I’m drowning in it. I can’t do this anymore. I can’t let him inside me like this. I jerk away from his touch and squeeze my hands into tiny fists.
“This is your fault,” I snap. “You did this to me! You made me say that I wanted more with you … and … and I don’t. That’s the last thing I need.”
My heart is slamming again my chest. It’s such a relief to throw these emotions at something. At someone. I don’t want them anymore.
Marshall’s expression shifts from shocked to hard.
“You don’t,” he repeats, his voice cold and distant. “What do you want, then?”
I squeeze my eyes shut, desperate to feel that rush of relief again. “I want to be a fucking surgeon. And to not have to worry about you all the time. You made me feel like this! You made me feel sorry for you!”
Silence falls between us, my last words vibrating through the confines of this vehicle. I suck in a breath, guilt bubbling up like bile in my throat. “I’m sorry … Marshall, I didn’t meant that—”
“No.” He shakes his head, staring out the windshield, his knuckles now white from gripping the steering wheel. “You’re right. I don’t need this, either. I don’t need to spend my time with someone who’s clearly fucked up enough to get off on other people’s diseases.”
I don’t want to feel anything, but these words—his words—feel like everything. My breaths are coming jagged and forced.
“It was going to happen anyway,” he adds. “Maybe it’s better that it’s right now.”
“Maybe,” I agree, but some part of me is screaming inside my head, Nooooo! “Bye, Marshall.”
I reach for the handle, fling open the door, and head up the walkway. My ears are on high alert, and I don’t hear him drive off right away. I don’t know how long he sits out in front of my house, though, because I close all the blinds, dig through my parents’ medicine cabinet, take three sleeping pills, and climb into my bed, pulling the covers over my head.
Before I fall asleep, I send Marshall a text. I need to shed my guilt. I just want to be a doctor, I write. I want to focus on work and not let all this other stuff in. It’s not really about you. I’m sorry I blamed you. I didn’t mean that.
Even though I want to stay numb, a few tears and a giant stab of pain hit me during the minutes it takes for the sleeping pills to kick in. If it weren’t for Marshall, Clay Culver’s forthcoming death wouldn’t affect me like this. I’d have a handle on myself. I’d be in control. Before I fainted, I’d never felt such a loss of control in my entire life.
And I might have lied to Marshall. I’m not even positive I can be a doctor anymore. Maybe it’s too hard. Maybe I need a lab full of rodents in my life instead of real people. Real people complicate things. Real people die. Real people can be killed by other people.
Chapter 26
@IsabelJenkinsMD: Ppl shed about 600,000 particles of skin per hour. Even our skin is destined to invade other people’s lives. It’s everywhere.
Monday morning at 6:00 a.m., my mom finally forces herself into my room by removing the doorknob. I think she had expected to find me passed out, dirty, and starving to death because her mouth begins to form words and then hangs open in silence when she sees me.
My room is immaculate. I’m immaculate. And fed. I have boxes of protein bars, a water bottle with a filter, a bathroom with a sink. I’m seated on the floor, fully dressed, my hair wet from the shower I just took, and pages and pages of printed medical history lie in neat stacks all around me. Stress for me equals cleaning and organization and projects—anything busy to keep me from thinking too much.
“It’s Monday,” she says, like this should mean something significant. “You
may have decided not to go back to school—at least I assume you’ve decided that, seeing as you haven’t left your room since Friday—but I’m sure Marshall is safely is his dorm, a full two hours away. You can come out now.”
“If I’d needed to leave the room, I would have.” I bend over and read a page in front of me, highlighting two sentences near the bottom. “And I didn’t intentionally want to drive him away. It’s just easier like this.”
At least that’s what I’m telling myself. Up until Saturday night, I kept reading the texts he sent me:
Izzy, I think you’re wrong. It isn’t easier this way. Not for me. I’m sure it isn’t for you. Please talk to me.
Then the one that caused the screen to blur in front of my eyes:
I miss you.
After reading that one, I felt so much. Too much. Everything. I threw my phone against the wall, sighing with relief when the message shattered to pieces. That way I couldn’t keep reading it over and over again until I jumped in my car and drove to his house. Unfortunately, I now know the whereabouts of Marshall’s residence, thanks to him.
“He’s a nice kid, Izzy,” Mom says. “He doesn’t deserve to be dropped like that.”
“First of all …” I keep my voice calm and steady, my hand continuing its work with the highlighter. “You knew Marshall for like five seconds when he was what? Fifteen? Sixteen? And second, he knows me. He knows that I care about him but that I suck at relationships. He knows that he didn’t do anything wrong. He knows that I have some shit to work out. We never made any promises to each other—not like marriage—so quit acting like you understand when clearly you don’t.”
Her mouth forms a thin line. “Fine.”
It almost sounds true when I sell it like that. I almost believe it myself. Not that he doesn’t know those things about me—he does—but my feelings are way more conflicted (as Dr. Winifred James, Ph.D., would say) than I make them out to be.