Fiction by Dr. Kevin Dautremont

I wanted to be just like Yakov.

Yakov was cool. He was also impervious to the slings and arrows of outrageous fortune, or at least to the scalpels and barbs of General Surgery. Of course, it helped that he had served on a submarine in the Russian navy. And that he had slipped out across the suddenly porous border during Yeltsin’s presidency. It probably didn’t hurt that he had spent a year and a half driving taxi while he learned English and waited for a residency position to open up.

He was a fourth year resident and I was in my first. He should have been chief resident but Cudworth hated him. Dr. Simon Cudworth. Professor of General Surgery. Rigid. Demanding. Sarcastic. Mean. Had he been born Spanish and about five hundred years earlier he’d have made a great Inquisitor. Instead, he made do with tormenting residents and sacrificing the occasional medical student. All the residents and most of the attendings were afraid of him. All that is except Yakov.

Once Cudworth smacked a fifty dollar bill into Yakov’s hand and told him to get a haircut forthwith. The Russian waited until Cudworth had walked away before turning to the rest of us. He snapped the bill in front of our faces and grinned. “Pizza tonight, comrades.” Yakov loved the spotlight. He was a fine surgeon and an excellent clinician who presented his cases with panache and flair. My greatest hope was that Cudworth would forget my name and I could fade off into the background. It wasn’t meant to be.

Somehow the fates had conspired to stick me on Cudworth’s rotation. While the other residents could slouch around in scrubs, I would have to stay in shirt and tie. While they could lounge at the back of the lecture hall during rounds and catch a few moments of sleep, I would have to stay alert and upright in the front row. While they could rush through admission physical exam before moving on to other pursuits, like eating, I would have to be thorough and complete. Dr. Cudworth had made that very clear on the first day. He had looked me in the eye and said, “There are only two reasons not to do a digital rectal exam. If the patient lacks the lower end of his bowel, or if the physician lacks fingers. You do have fingers, don’t you?”

It was near the end of my time in purgatory. I had been called to the ward to do yet another admission and arrived bleary eyed and yawning. The nurse shook her head sadly. “How long have you been awake for?”

“I don’t know. What day is it?”

The patient was an elderly man, calm and understanding as I fumbled my way through the examination, my eyelids continually drifting downward. I struggled along until I reached the final indignity, Time to explore the hidden secrets of the rectum. I bent over the patient and began. Something was wrong. I screwed my eyes shut in concentration while a loud exclamation escaped my lips, “What on earth?”

Yakov stuck his head through the exam room door. “Is problem?”

“I don’t know. I’ve never felt anything like this before.”

Yakov stepped into the room and looked at me. Then down at the patient. He turned and shouted through the open door. “Nurse, come please. Bring scissors.”

The patient’s head snapped up. “Is something the matter?”

Gently pushing the man’s head back down, Yakov moved to stand beside me. “For you,” he said to the patient, “Is no worry.” He looked me in the eye. “For you, not so much.”

I followed his gaze. Stretching downward from my neck, into and out of the nether regions of patient’s large intestine, was something long, and blue, and striped.

Yakov patted my shoulder. “That, my friend, is your tie.”