Louise Aronson, MD, MFA
Division of Geriatrics, UCSF, San Francisco, CA, USA.
J Gen Intern Med 22(12):1781
© Society of General Internal Medicine 2007
ometimes she spoke his name and he didn’t look up.
Then she said doctor and he turned to her, smiling.
The change in him was quick: a sudden loss of the
subjunctive, regular episodes of adjectival incontinence, the
excision of dependent clauses from his vocabulary. At first, he
called his work the opposite of fun. He told her residency was
war, each work night a battle. He said decisions were orders,
admissions were hits, teachers were generals, and interns were
grunts. I can’t believe it, he said, they train us to take care of
problems, not people.
Post-call, he explained, he wore rumpled day-old polyester
pajamas while his teachers stood before him, freshly washed
and fully clothed. Teaching was pimping, he said, and told her
about the general with the big rock and bigger rack. After that,
when he said pimping, she imagined breathy questions in the
hushed dusk of a patient’s room, tongue-moistened rose-blush
lips discharging facts along colorless corridors, a teacher’s
hands caressing the long, pressed sleeves of her lab coat, a
ring like the ring she wanted from him shining from her fourth
left finger like a polished gold star.
As the months passed, too tired for true talk, he said
instead: we got hammered. He said instead: we got hurt, we
got slammed, we got killed. By we, he meant himself and his
team, not himself and his patients; he meant himself and the
other grunts, not himself and her. He called work scut, and
then told her scut took care of patients. Patients were civilians,
he added, so she would understand that patients were
sometimes enemies, but also the raisons d’êtres for his
sacrifices, and hers.
To have a language is an expression she often thought of as
he spoke. Also—his words this time—a necessary violence,
words which reminded her of every war story ever told.
For nearly a year, he thought she wasn’t listening. He
thought his work alone bore the sounds, gestures, and marks
of meaning. So when at last she said she’d had enough, he felt
ambushed. Enough, he repeated, as if unfamiliar with the
word, and she knew then that she’d have to use his language,
not hers, to explain: We’re circling the drain, she said. We’re
going down fast, we’re cooked, we’re finished, we’re toast. My
we meaning you and me.
Received June 21, 2007
Accepted July 11, 2007
Published online October 9, 2007