Embarrassment upon Humiliation upon Mortification in My Intern Year

by Christine Benton Criswell

As I turned and stacked my papers into an ever tidier pile, ready for my presentation, I peered out into the audience and saw Dr. Peña’s sapphire eyes looking back at me through his round, dark-rimmed glasses. He was, as always, wearing his starched white lab coat, buttoned up and so bright that it practically glowed under the conference room’s fluorescent lights. His hair, flecked with white at the temples, was perfectly styled and gleamed every time he moved his head. He smiled a professional-looking smile at me, and I smiled back, holding his gaze long enough to try, once again—but without success—to define in my mind the shape of his face, the hue of his lips, the texture of his skin, to etch it all into my memory. But alas: he was, to me, an elusive entity, like the whiff of a flower that floats through the air, so refined and beautiful that he lay beyond my ability to capture him with words or concrete thoughts.

This was Morning Report, and, as one of the Team Medicine interns, I was, for the first time, presenting a case to the rest of the residency program. My fellow interns were huddled together in the back of the room, standing with their eyes closed, their heads nodding, their shoulders slumped. The more senior residents were seated in folding chairs a little closer to the podium, tapping on their Palm Pilots and talking in booming voices. And seated around the oval, mahogany conference table in large, leather chairs were the Internal Medicine and subspecialty attending physicians. All but one of them were occupied with something other than my presentation: preparing their coffees, nibbling on breakfast pastries, reviewing journal articles. Only Dr. Peña was focused on me, his pen primed to take notes.

I began. I was unsteady at first. But as I relayed my patient’s history, physical exam findings, and laboratory results, my voice grew louder and more solid. I remembered to say everything I had planned to say, and I said it just the way I’d rehearsed, with the proper tone, a good rhythm, inflection at all the right spots.

The patient I was discussing was a woman with advanced liver disease, so severe that the organ was no longer effective at clearing toxins from her blood. I explained how these toxins had built up and were affecting her brain, causing confusion and other neurologic problems, a condition called hepatic encephalopathy.

At the end of my presentation, I looked out into the room and enjoyed a moment of silence. Several of the attending physicians—including Dr. Peña—then began to ask me questions: What is the name of the hepatic encephalopathy grading criteria? Which neurotoxin is most associated with this ailment? How does this neurotoxin work at the cellular level? Having prepared for weeks, I was able to field these questions with ease.

Morning Report ended shortly after that, and as I prepared to leave, I saw Dr. Peña standing by the door. I steadied my breathing, prepared my mind for the conversation, then approached him and said hello.

He complimented me on the depth of my research, my presentation skills, and the way I handled the questions. I said nothing at first, instead concentrating on his soft Colombian accent, its staccato rhythm, musicality, precise articulation. I tried my best to memorize it, as if one could memorize something as abstract as the color of a dialect, the feel of a cadence on your skin, the taste of an intonation. Finally, I answered him.

“Thank you so much, Dr. Peña. I’m so glad you liked it. I did work hard on it.”

He said nothing, and I began to puzzle over what to do next. Suddenly, he lifted both of his hands in front of him to the level of his ears, palms facing me, and began twitching them forward and back. I thought this was odd but of course did not let on.

So I did, I think, what any person my age would have done in that circumstance. I reached out and gave him a double high-five.

I retrieved my hands and waited for what I was sure would be an enthusiastic response. But Dr. Peña just stood there, his hands in the air as before, twitching them back and forth. His facial expression did not change.

“Asterixis, Christine. This is the hand tremor people with hepatic encephalopathy get.”

Of course it was. And I’d just double high-fived the most distinguished, most sophisticated doctor in the hospital. I immediately shifted my focus from his face to his hands. I studied the branching pattern of his palmar creases, the fleshy and wrinkled thenar web space, the interphalangeal articulations until my vision blurred. At some point, he bid me well and walked away. My mind was so paralyzed that I’m not sure I managed to say goodbye.

Many times over for the next two weeks, I thought about the moment our hands made contact. I kept replaying it in my mind, longing to go back in time, somehow erase the act from my memory, and his. I tried to avoid Dr. Peña. Fortunately, this wasn’t too difficult, as I had just started on my elective Surgery rotation and was interacting with faculty from the Surgery department rather than those from Internal Medicine.

While on this rotation, I was required to “take call” every third night. On the second night, a severe ice storm struck the area. I was up with admissions, so I was unaware of the weather until my upper level resident contacted me early the next morning. He told me that he and the other members of our team would be unable to drive in, given the treacherous road conditions, and that I—the first-year intern—would have to round on all of the patients by myself.

My morning was nightmarish. By noon, though, the roads had improved and my teammates made it to the hospital. Given my post-call status, I should have been able to go home. But I had considerable leftover work to do, work I was not supposed to leave for my teammates. By the time I’d finished it, I’d been awake for thirty-six hours.

I was about to collect my things when I overheard the front desk clerk say something about the roads becoming bad again. Although I was desperate to get home, I thought it would be unwise to try to drive, considering the area’s steep hills and the fact that I was so sleep-deprived.

So I headed straight for the resident overnight call rooms and claimed one as my own. I wasn’t supposed to do this—the call rooms were only for the residents working the night shift, not off-duty residents who were too tired to drive home. But considering the circumstances, I felt justified in my action. The bed was threadbare, with a flat pillow and a single, thin sheet that only came up to my mid-chest, but I fell almost instantly into a deep sleep.

I woke at four thirty a.m. to the screeching of my pager alarm. I got out of bed and headed to the scrubs station at the end of the corridor to get clean clothes before taking my shower.

It was a long walk. Our hospital was one of the largest buildings in the country, right up there with the Pentagon, and each passageway seemed to go for miles. I walked through several vast departments but never once encountered a patient, a nurse, a doctor—not even a janitor. Everything was quiet, empty, at this hour. The only sound was my own footsteps.

Once at my destination, I discovered with surprise that only one pair of scrubs remained. I looked for a label indicating the size but there wasn’t one. I didn’t know if they’d fit, but I was out of options. I grabbed them and hurried back to the call room.

There, I showered, dried myself off, and pulled the scrubs shirt over my head. It was too big, at least by a couple of sizes. And the shirt had a deep V-neck, which would have been too revealing for work. I looked at my reflection for a few minutes, wondering what I was going to do. Then, in a flash of inspiration, I decided to try on the shirt backward. It was uncomfortable, with the high collar pressing up against my throat, but it would do.

I put on the scrub pants. They were also too big, but I rolled up the cuffs several times, and luckily, they stayed in place. I reached for the waist drawstrings. To my dismay, one of them had retracted back into the paints. I grabbed the available one, which was dangling some distance from the waste, and yanked at it, praying that I wouldn’t pull it out. I did not, but this maneuver caused the pants to cinch way up on my left side and gape open on my right. I reached around to the right side, feeling for the retracted drawstring, hoping I could pin it down through the fabric and somehow guide it out. I found it bunched up under the waistband, but I could not get enough of a grasp on it to pull it out.

By now, about ten minutes had elapsed. I was running out of time to get ready. I had no choice but to wear the scrubs as they were and hope no one noticed.

The room, which was spartan in every other way, was equipped with a high-power hair dryer. I plugged it in, and in no time, my hair was dry. It was only after this that I remembered that my post-dryer hair routine required the use of a heated hair curler to tame wayward bangs. There was a small mirror in the bathroom, and I took a peek. My bangs were sticking straight up to the ceiling.

I tried patting them down, to no use. I tried spitting into my hands and rubbing the saliva into my bangs, but all this did was mat the hair together. I was close to paging our team’s resident and telling him I was too sick to come to the hospital, when I remembered that one of the nurses kept a can of hairspray in a drawer at the front nursing station.

I opened the call room door and looked both ways. Then I darted out, one hand clutching the baggy side of my scrub pants and the other holding down my vertical bangs. I walked as fast as I could, but it was an awkward way of moving, so my progress was slow.

I reached the nursing station and found the hairspray. I would have liked to use it right then and there, but I needed a mirror and there was none to be found. So, I decided to take the hairspray back to the call room. I had a decision to make: Which hand would I release to hold the can? I opted for the hand currently holding down my bangs so I could keep a grip on the pants.

As I began the trek back to the call room, I got the uncanny sense that someone was approaching from behind. I turned, and there, appearing debonair as usual, was Dr. Peña. He looked right at me.

“Christine, how are you this morning?” His eyes flitted from my bangs to my scrub pants, but he spoke naturally and smiled his usual, easy-going smile. I met his gaze briefly, then quickly looked away, locking my eyes onto an emergency crash cart down the hall.

 “I’m fine. Thank you.” My voice was shaky and quiet.

He continued in his customary, congenial manner. “Are those surgeons treating you well? I hear it’s a difficult rotation for the interns.”

A drop of sweat rolled down my back. My shoulder muscles tensed. I looked up and tried to smile, but my mouth was too stiff to move. Articulating anything was out of the question.

He waited for me to speak, questions in his eyes. Then he said, “Ah, I see. They are working you so hard you are afraid to tell me. Don’t worry. It won’t last forever, I promise. Get some rest soon.” He walked past me, and, catching my breath, I watched him glide down the hallway until he turned and disappeared from sight.

Two weeks later, I started my second Internal Medicine rotation. I’d been assigned to Dr. Cunningham’s team, and for this, I was grateful. I was not yet ready to come face to face again with Dr. Peña.

One of the patients on our rounds was a sixty-three-year-old man with lung cancer. He’d developed excess fluid around his right lung, making it difficult for him to breathe, so our team came up with a plan to drain the fluid by placing a tube (known as a chest tube) into his thoracic cavity. Dr. Cunningham had performed many chest tube placements over the course of his career, so we were all looking forward to watching his technique.

Before the procedure, the resident, my co-interns, and I gathered at the patient’s bedside to obtain his consent. As the resident explained the potential risks and benefits of chest tube insertion, I looked around for Dr. Cunningham. We were in the ICU, where the patient bays were open to the central part of the room, so I had a clear view of everything. There were dozens of people milling about: nurses in their bright-colored scrubs, charting, distributing medications, silencing incessant machine alarms; doctors with stethoscopes slung across their necks, talking in serious tones to their reverential trainees; phlebotomists poking their needles into increasingly difficult-to-find veins; radiology techs maneuvering their bulky, portable x-ray machines from bed to bed. I even saw a chaplain approach a small family, moving in that kind, heavyhearted way clergypersons do when death is imminent.

But Dr. Cunningham was nowhere to be seen.

I was about to turn my attention back to the resident when I spotted Dr. Peña walking into the room. I swiveled around and dashed over to the corner of the patient’s bed, where I did my best to hide behind his tall but skinny IV pole. It wasn’t much of a hiding place, of course, so I bent down and pretended to tie my shoes. I could see Dr. Peña’s shoes, his unmistakable wingtip Oxfords, and I tracked them as they made their way in our direction. Eventually, they stopped right in front of us.

The resident and interns greeted him. He did the same and explained that Dr. Cunningham had the flu and had asked him to perform the chest tube insertion. The resident updated Dr. Peña on the patient’s condition, then asked, “Where’s Christine? She needs to be here.”

They began to look around, and almost immediately, my co-intern spotted me. “Christine! What are you doing on the floor?”

I slowly rose, trying my best to avoid coming into contact with Dr. Peña’s line of sight. He was, however—just like everyone else—looking directly at me. I grew faint. I began to stagger. And then, I collided with the IV pole and nearly fell backward. There were several cries of concern, and the resident even leapt forward to come to my aid. Somehow, I managed to calm myself enough to lie and tell them that I was fine, that I had just gotten a bit lightheaded after standing up. Thankfully, as far as I could tell, they believed me and moved on to the task at hand.

Dr. Peña, the residents, and the other interns walked over to the sink and “scrubbed in” for the procedure, after which they had to be very cautious about what they touched. If they came into contact with anything that wasn’t sterile, they would have to stop everything, “break scrub,” which entails removing all of the now contaminated clothing, and go through the entire sterilization process again. It’s a big hassle, so, for each procedure, the resident appointed one of us to be the “unsterile” intern, available to do such tasks as handling paperwork, picking up instruments that accidentally drop to the floor, answering pages. It was my turn. As usual, they had taken off their pagers and placed them on a countertop to give me ready access to them in case one happened to go off.

The resident and my co-interns cleaned and draped the patient. A scrubbed-in nurse organized the procedure instruments. Dr. Peña palpated the patient’s chest, feeling for the best place to insert the tube. Once he was satisfied, he drew a circle around the spot using a sterilized marker, picked up the syringe containing local anesthetic, and injected the site. The patient hardly flinched. Dr. Peña picked up the scalpel, pressed it to the skin, and slowly pulled his hand back, making a neat incision. The room grew silent.

I began to recover from my embarrassment. No one was looking at me anymore. I’d become invisible, blending into the patient’s room like a piece of furniture. I closed my eyes and took several deep breaths. I felt the tension release from my body.

And then suddenly, a loud, shrill, beeping sound fractured my tranquility. It was a pager alert, turned up to top volume. I rushed over to the pager counter to find it and silence it. As I was making my way there, though, Dr. Peña said, without a trace of hesitation or shame, “It’s mine. I forgot to put it on the counter. Christine, will you please get it? It’s attached to my belt—at my right waist.”

I froze. It was an impossible task. The pager kept going off, over and over, each note louder than the last. After I could delay no longer, I approached him. I tried to visualize the pager on his belt and all of the steps I would need to take to remove it. I’d have to act calm and nonchalant. No chit-chat whatsoever.

He was wearing cologne—a light, earthy woods fragrance. I closed my eyes and inhaled deeply. I could have remained like that indefinitely, imagining us walking through a pine forest, the crisp air on my cheeks, broad columns of sunlight piercing through the tree branches, his warm hand in mine—

But then he cleared his throat, and, with a jolt, I came back to reality.

The pager continued to sound. All eyes now were on me. I inched closer, just behind him and to the left. I said a quick prayer. Focusing on the gap between his gown and his body, I reached forward, slid in my arm, and aimed my now shaking hand toward his beltline. My primary goal, other than finding the pager, was to avoid touching any part of his body.

I began to “explore.” I extended my fingers and moved them around, waiting for the solid form of a pager to materialize under them. It did not. I was forced to increase their range. I stretched my fingers out as far as they’d go and started sweeping them in wide arcs: forward, backward, left, right. And then my hand brushed up against his stiff belt. I followed it forward and, finally, I found the still-beeping pager.

Now I had to remove it. It was in a case attached to his belt with a spring-loaded clip. I grasped the clip, squeezed, and pulled. But it did not budge. I repositioned my fingers and attempted the maneuver a second time. Again, it clung to his pants. I tried again, and again, and again. Over and over, I pulled at the pager, all the while becoming increasingly aware of the rising tension in the room as the minutes ticked on and the beeping continued. 

Bless his soul, Dr. Peña said nothing throughout all of this, though I could hear the nurses in the room whispering and snickering.

I said to myself, I am going to remove this pager even if it kills me. I switched off my emotions, silenced the executive part of my brain, and, in an act of desperation, shoved my fingers under his waistband in an attempt to remove the pager from a different angle.

He may have flinched, may have even said something to me, but, by then, all of my senses were numb. I grabbed at the pager case and yanked, screaming at it in my mind to come loose.

But the wretched thing still did not.

I was on the verge of collapse when an idea struck me. Why not try sliding the pager out of its case instead of attempting to remove the entire contraption, case and all?

I reinserted my fingers, wriggled them around a bit to achieve optimal positioning, and, with infinite ease, slipped the pager out from its case and into my hand.

Clutching it to my chest as if it were a baby bird fallen from its nest, I retreated to the remotest telephone in the ICU. I went through the motions of returning the missed call, then spent the next ten minutes or so regaining a solid footing on my fragmented emotional state.

When I regained my composure, I walked back to the patient’s bay, deposited Dr. Peña’s pager on the counter with the others, and watched as he finished the procedure. At one point, he looked up, made eye contact with me, and, without a trace of reproach in his expression, mouthed the words, “Thank you.”

Dr. Cunningham returned to work the following day. One afternoon, after I finished my morning responsibilities, I stopped by the computer lab to do some research on a condition affecting one of my patients. I was engrossed in reading when I heard someone from the hallway call out my name.

“Christine, how’s it going?” It was my former teammate Alex in the doorway, beaming. Alex was one of my favorite people in the residency program. He always provided levity when I needed it most.

But he was not alone. Behind him was the entire Internal Medicine C team: interns David, Carrie, and Leigh Anne; upper-level resident Jack; and, of course, attending physician, the one and only: Dr. Peña.

My face began to flush. I looked away, but it was too late. He’d seen me.

Without warning, Alex blurted out, “Hey, Christine, what’s wrong with your skin? It’s so red!”

Everyone turned their heads toward me. Some of them craned their necks, some of them leaned to the right or the left, some stood on their toes. Alex’s eyes were wide and full of alarm, as though he’d never encountered someone my shade of crimson before.

In that moment, every thought in my brain vaporized except for one: I must, at all costs, avoid Dr. Peña’s gaze. He was standing such that he’d be in my peripheral vision if I looked directly at Alex. So I rotated my head as far to the left as it would go and fixed my eyes on what turned out to be Leigh Anne’s earlobe.

I stared at that small, nicely-shaped ear for several seconds, trying to think of what to say. Using every ounce of creativity I could find, I managed to craft a story about having a rare dermatologic condition, something I was sure none of them had ever heard of before, something that hadn’t even been written up yet, and—please do not worry, I am under the care of a highly skilled physician.

I held my breath. Alex and Dr. Peña said some things I couldn’t process, and there was, I think, some quiet tittering. And then they walked on down the hall, and I began to breathe again. Feeling suddenly tired, I lowered my head to the computer desk.

I stayed that way for a long time, contemplating with a shudder what Dr. Peña must now think of me. Thoughts of leaving crossed my mind: for the day, for the month, for the year, maybe, considering not just Dr. Peña but also the suffering inherent in internship itself, for the rest of the my life. I even cried a little. But eventually, that kernel of resilience that had always resided within me, that had up to now been buried under layer upon layer of sleeplessness, self-doubt, and humiliation, began to grow, softening my thoughts’ edges until I was able to pull myself up from the desk. Internship was not going to last forever, I reminded myself, and, besides, I already had my schedule—I would not be working with Dr. Peña again.

I had a few minutes before our afternoon conference, so I checked my email, hoping a message from a friend might take my thoughts off things. But instead, near the top of the list, was an email from our program director with a subject line reading, “Important: Schedule Change.” I opened it, to find the following:

Dear doctor. Please note that you have been reassigned from Team A to Team B for your April Internal Medicine rotation. Your team will consist of—

I shut my eyes and said a quick prayer: Please don’t let it be Dr. Peña’s team. Please, please, please. Please don’t let it be.

I took a deep breath, opened my eyes, and scanned the list of names: interns Joe, Kathy, and Evan; resident James; and then, there it was, in bold letters: attending physician Dr. Peña. Once again, my head fell to the desk.

Still, I resolved to persevere. On our first day working together, I woke up early so I’d have plenty of time to get ready. I made sure my clothes were ironed, my shoes polished, my sweater free of stray hairs. I left for the hospital two hours before rounds started in order to read through every page of the patients’ charts and perform comprehensive exams. I took notes and even practiced what I would say when the team arrived.

Finally, it was time to round. Dr. Peña led us through the halls, saying a warm hello to everyone we happened to come upon. The hospital was more cheerful than usual that day, as the nurses had decorated their stations for Valentine’s Day. Garlands of red and pink hearts, plush Cupids with their bows and arrows, and candy dishes brimming with chocolates adorned each unit. We visited the ICU first, checking Ms. X’s ventilator settings and oxygen and carbon dioxide levels. We went to Mr. Y’s room and asked him how his abdominal pain was today. Then it was time to check on Ms. Z, a young woman with Hodgkin’s lymphoma.

I somehow ended up walking directly behind Dr. Peña as we approached Ms. Z’s room. He knocked on her door, paused for a moment, and walked in. I followed, trying to keep a good distance between us, but the crowd behind me pushed me right up next to him.

He was almost to the patient when it happened. I didn’t see what caused it—maybe a loose shoelace or one of Ms. Z’s belongings on the floor—but Dr. Peña tripped on something, and his normally graceful body began to hurtle through the air like a bolder launched from a catapult. His hands were in his pockets at the time. He tried to pull them out, but they must have gotten stuck, for he came crashing down, unbraced, onto Ms. Z’s chest.

Her eyes flew open. We residents gasped. Dr. Peña let out a loud, prolonged groaning noise that filled the room.

After what seemed an eternity, Dr. Peña lifted his head and made eye contact with Ms. Z. Her eyes were wild, her neck craned, her arms poised to shove him off of her. He jumped from the bed as if it were a hot stove and stammered an apology, then turned and looked at us with a sheepish expression. There was, I noticed, a slight change in the coloration of his face—the birth of a blush—and his eyes began to drift around the room, roaming from face to face. They eventually landed on mine. For a moment, he just looked at me blankly. Then there was the slightest smile, a subtle crinkling of the eyes, and, in some way I cannot explain, I knew with certainty what he was thinking. We are one, you and I: imperfect, clumsy doctors, inevitably making fools of ourselves from time to time, and would you please be so kind as to overlook this in me as I did for you?

I wanted to run to him with open arms. I wanted to embrace him. I wanted to once and for all declare my love. But of course I restrained myself. I held his gaze, smiled back at him with conviction, and mouthed the words, It’s okay.

And then he began to laugh. He laughed and laughed, and soon we were all—with the exception of Ms. Z (who remained scowling)—laughing.

The room seemed suddenly brighter and more colorful. I felt a buoyancy in my spirit that I hadn’t felt since before internship. As Dr. Peña turned his attention back to Ms. Z, I pulled back my shoulders, straightened my back, and breathed a sigh of relief. Given everything, I thought, there’s little hope of my ever winning Dr. Peña’s heart. But at least we are, without a doubt, now even.

BIO

Christine Benton Criswell is a writer and physician in San Antonio, Texas. Her work is featured in several journals, including Jimson Weed, The Headlight Review, and New Pop Lit. In her spare time, she enjoys reading, practicing tai chi, and watching K-dramas.