The Stethoscope and Pen

Fiction by Dr. Kevin Dautremont

In his “Divine Comedy”, Dante struggles through the Nine Circles of Hell before passing through Purgatorio to reach Paridiso. I’m not sure how many circles I’ve made it through but I did finally get a taste of paradise. Dr. Cudworth was off to a five day surgical conference in Europe and could only take one resident with him. It wasn’t me.

Some might have cursed being overlooked for an all expense paid trip to Germany. Stately hotel rooms. Exquisite dining at Michelin rated restaurants. Leisurely cruises down the Rhine. Instead, I could look forward to sleeping in the on-call room, eating stale hospital food, and running from the OR to the ER. It was going to be fantastic. For ten wonderful days I would no longer be the albatross hanging around Dr. Cudworth’s neck. I’d be someone else’s responsibility. Yakov’s.

On the first day, Yakov pulled me aside after morning rounds. “Come, we have coffee.” We sauntered down the hallway and I started to turn toward the staff cafeteria. The coffee there was usually abysmal but it was cheap. Yakov grabbed my arm and directed me instead to the front of the hospital. I cringed. This could only mean one thing. Starbucks.

Don’t get me wrong. Like all surgical residents I lust after Starbucks coffee the way Romeo pined for Juliet or Tristan kinda liked Isolde. The problem is one Grande Bold and my coffee budget for the week is shot. I shuffled after Yakov and sheepishly ordered a Short. He shook his head with intense vigour. “No, the big one,” he said, pointing at a Venti container, “And two those.” A pair of blueberry scones were added to the tray.

“But—” I pulled a five dollar bill from my pocket. It was all I had.

“Is no problem. I pay. It is, how you say, my train.”

“You mean your treat?”

“Whatever. Sit. Eat.” He smiled and poked me in the ribs. “My babushka would say you are too skinny.”

The scone was superb and jolt of caffeine was just what my brain needed. I took a large gulp and leaned forward. “I still don’t get it. Why are you being so nice to me?”

Yakov’s smile broadened. “I watch you. You smart and you care. You make good doctor. Not just here.” He leaned forward to tap me on the forehead. “But here too.” He pointed at my chest. He popped the last piece of scone into his mouth and rose from his chair. “Now come. Bring coffee and we solve your other problem.”

I scurried after him. “What do you mean? What problem?”

“You like other residents. No money. That mean bad coffee and not enough food. We try fix that.”

Circumcision is an orphaned procedure. It’s not covered by government insurance or by most of the private plans. The Pediatricians won’t do it and most family docs don’t want to. That leaves the Urologists. Their waiting list is about six months long and they charge the parents over $300. That leaves a gap in its availability to those who want it. Nature may abhor a vacuum but Yakov saw it as an opportunity.

Administration knew what was going on and while they did not openly approve it, they weren’t prepared to condemn it either. There were still enough parents wanting it done for religious or personal reasons and Admin decided to turn a blind eye and let things go on as they had for a few thousand years. Yakov had worked out the deal. He’d use an empty procedure room with the help of an off duty nurse. The hospital would not bill the parents and Yakov and the nurse would divide the hundred dollars he would charge. Everyone was happy.

Maybe too happy. Yakov was getting too busy to handle all the requests he was getting. His plan was to teach me to do circumcisions and off load some of his cases to me. He would keep the parents happy and I would earn some money.

We entered the treatment room where everything was waiting. Including Yakov’s ancient CD player. I had long known that Yakov always had to have background music when he operated. Even so I had to close my eyes and groan when he hit the play button. Keith Hampshire’s ‘The First Cut is the Deepest’.  “You’re kidding, right?” I asked Yakov.

He smirked and sang along, “Baby, I know.”

Everything else went well. The infant made it through with minimal fuss and much less pain than I’d expected. In a few minutes he was bundled up and being carried out into the waiting arms of his parents. The grateful father smiled and pressed a handful of twenties on to Yakov. The senior resident looked at the bills and shook his head. Something was wrong. The father had given him too many twenties; six instead of five.

Yakov’s grin stretched even wider as he peeled off one of the bills and handed it back to the man. “Thanks,” he said, “But I never keep tip.”

Fiction by Dr. Kevin Dautremont

I used to think Cudworth hated me. Not anymore. Hate is an emotion and I’m pretty sure Cudworth is incapable of any emotions. Sorry, that’s Doctor Cudworth to people like you and worms like me. Of course, I’m not really a worm—I’m lower than that. I’m a first year surgery resident. In the mind of Dr. Simon Cudworth, the only things lower are hard core heroin addicts, carriers of the bubonic plague, and medical students.

If it wasn’t for the medical students I think I might expire from despair. At least they look up to me. To them I am special—a real doctor, and a surgeon to boot. I even take the time to learn their names. In return they respect and admire me. At least I hope so.

It certainly seems that no one else does. The attendings ignore me. The nurses shake their heads and cluck their tongues whenever I pass by. And the senior residents all wish that I would just go away. Like I might steal some of their precious OR time or something. Not much encouragement there. Except of course from Yacov.

One time Dr. Cudworth had scraped the bottom of the barrel low enough to consent to have me as an OR assist. Second assistant, of course. That meant I got to stand in an awkward position holding retractors until my arms went numb while Dr. Cudworth and Yakov explored the unknown reaches of the patient’s inner being. For most of the procedure the only words Dr. Cudworth said to me were, “More retraction.”

Finally near the end of the procedure he deigned to actually teach me something. Jabbing at something with a pair of forceps, he looked at me. “What is this structure?”

“I don’t know. I can’t see it.”

“Well, more retraction. Lean forward and take a look.”

I obeyed. “That’s the superior pancreatic duodenal artery.” Dr. Cudworth grunted and looked away. I was right.

He looked at me again. “I’m going to start to close now. You can cut.”

Bonus. I would actually get to do something even if it was only cutting sutures. I was involved in the case. Shifting the retractor to my left hand I took the scissor from the nurse and snipped the first suture.

“Too long,” Dr. Cudworth snapped.

I moved the scissors down a millimeter on the next one.

“Too short.”

Up half a millimeter.

“I need someone who knows how long to cut sutures. Give the scissors back to the nurse. And more traction!” Dr. Cudworth finished one more suture and then slapped the needle driver into Yakov’s hand. “You can finish. I have a meeting.”

Yakov waited until Dr. Cudworth had scrubbed out and then turned to me. He held out the suture. “You need learn to cut the suture. I teach.”

“What? You want me to close?”

“How else I show you how cut sutures?”

The rest of the surgery went smoothly and as we stepped from the OR, I turned to Yakov. “Why’d you do that? Dr. Cudworth might be upset.” Yakov just waved a hand in the air. He wasn’t worried. “Still, why? Why are you looking out for me?”

He turned and looked me in the eye. “You remind me of Petrov.”

“Petrov? Was he a doctor back in Russia?”

“No.”

“A colleague? A friend? Family?”

“No, he was a dog.”

A dog? I stepped back and stared at him. “Was he at least a good dog?”

Yakov’s face broke into a wide grin. “No. But I like him.”

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.”