Open Times

Writing a presentation for third-year med students, something that will inspire some and scare off those who should be saved before they’re too far in debt, is a real pain.

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Blake reaches in his pocket and fingers a blue rubber band, the thick sort with resistance. He can already see the expectant faces, hopeful faces waiting for answers to impossible questions. How do you cope with stress? Do you ever lose control? He spreads his fingers.

It’s early, just before he needs to make rounds, and he attempts a few guiding notes, some lyrical words. He browses through online databases looking for quotes that aren’t completely misguided. He writes.

My scalpel is a telephone, a way of communicating with another human being. No. My blade is a paintbrush. It’s a light, a tiny flashlight. No. My work is to navigate the map of the human body, to reveal stories that are buried beneath the skin. No.

Blake circles the words map and buried before noticing a couple standing a few feet away. Public displays of affection are tolerable some days. Not today. Today, purple clouds are closing in around them, the only three in the park so early in the morning, settled near the basketball courts. He crosses out paintbrush because the line seems too pretentious and shifts on the hard bench as thunder rolls above. The storm charges forward.

Blake closes his notebook — those precious few words contained. Writing a presentation for third-year med students, something that will inspire some and scare off those who should be saved before they’re too far in debt, is a real pain. He never imagined he’d ever have to return to the horrendous lecture halls he’d barely survived.

The couple kisses with sloppy tongues, showing off their youth, as the rain begins. With less than two hours before he needs to deliver his speech, Blake nestles the notebook in his bag and makes his way to his new, custom-built BMW 230i convertible. It’s the kind of car a younger version of himself could never imagine owning. It’s a car he can barely imagine himself owning now. Every time he walks toward it, there is the feeling that he’s won something, game-show style, and he can’t help but swagger.

His stomach revs with the engine. His machine glides through the storm. It pauses in front of Scarlet Café, which is closed, and then Blue Coffee, which is also closed. Blake is an OSU grad, hardly a Michigan fan, but the service at Blue is better.

He idles for a few minutes, peering in the windows to make out a scrawny guy, who he thinks manages the place, refilling straws. Blake wonders if he has time to wait. It’s an 8-minute drive to work, and his first appointment is in 15. He could get there in 7, but he’s cutting it close as it is, waiting for inspiration to come.

No café is open until 5:30 a.m., even though this is the med center, a part of town populated by doctors who are crepuscular animals known for their staggering caffeine dependence.

With no immediate access to decent coffee, he moves a block down and stops at the gas station, jogs toward the small shop without umbrella, and watches, disdainfully, as the off-brand coffee percolates. “One minute,” the gas station attendant says with a smile. Blake has one minute. Not much more.

He hovers around a warming oven filled with donuts, watches the icing dripping from thin metal racks, and eyes the rows of lottery tickets across the aisle. There is a cluster of women, three of them, buying scratch-offs, scratching them with quarters, then buying more or cashing in for a few bucks. They look related, these three. They look as though they inhabit a different planet, all loud pastels against a backdrop of gray.

Blake watches one of the three, a middle-aged woman in ripped jeans with a touch of jaundice, lift her arms like a superhero. She squeals, “Forty dollars, forty dollars, ya’ll!” Her friends check the ticket, recheck their own tickets, and congratulate her without any apparent sincerity. The woman turns to Blake. “You! You’re my lucky charm. I won right when you passed. Bless you. Bless you. Can I buy your coffee? Will you walk by again, just like that while I scratch this last one?”

“No worries,” he says, smiling but not moving.

“I see. Well, can you stand there awhile, while I scratch off a few more?”

The coffee is ready. Blake can make out the grounds floating on the top of murky liquid. He glances at his smartwatch. “One more, then I have to go.” There is a short bottle of liquid next to him that promises a cornucopia of vitamins, along with a healthy dose of caffeine. It appears to be marketed as a panacea, with so many promises listed on the label that there is no room for readable text. He places it, along with a pack of gum fortified with Vitamin B2, on the counter.

“You a doctor?” the youngest of the women asks as he unrolls a few dollars from his money clip to pay. Her ball cap is bejeweled and spells out U.S.A.

“Have a good day, ladies,” he says, leaving them to tease out the mystery. His phone vibrates. He rushes out without getting his change, hearing another yelp of joy as he walks out and wondering what kind of jackpot was achieved.

Blake’s machine is efficient on wet roads, far more so than the Jeep he used to drive when he was still paying off loans. The tires do their work, angling and gripping and getting him to the dozen-decker parking lot without so much as a slip or skid. He takes one of the first reserved spots. Glancing in the rearview, he sees the gray in his beard. He downs the syrupy contents of the small bottle and scrambles to open the driver’s side door in enough time to spit it out. He jogs toward his office to collect his thoughts, his mouth watering around the acerbic remnants of the toxic energy drink.

The hospital café isn’t open till 8 a.m., and he has only a few minutes to sign in. He must check on two patients, then deliver his speech. The idea hits him that there should be drones delivering quality coffee to doctors at the press of a button, and he jots this note down. 5:30 a.m. exactly, and as he strides down the linoleum halls, he calls Blue Coffee, requesting a special delivery. He’ll order coffee for the whole floor so it doesn’t look so self-indulgent. He assures he’ll tip well.

As he waits, he finds a French press and searches his office for some leftover grounds. Nothing. Ani, one of his favorite baristas and usually the cashier at Blue Coffee, says she’ll check with her boss but will try to make it happen.

“So long as you can get me that coffee before 7 a.m. I have a speech to deliver,” he explains, angling the phone on his shoulder as he checks the break room, only to find some instant coffee — hardly enough for a cup.

After the third hold song, Ani returns. “I got it approved,” she says. “I’ll be there in a jiff.”

From Room 8A, Blake and his patient watch the rain as they go down a series of follow-up questions. Mr. Heller explains that he is in a lot of pain and would kindly like some Xanax. Blake assures him that the pain is temporary, and that the incision appears fine. “It’s healing just fine,” he says, assuredly, then offers a smile-nod combo that he tends to offer when refusing Xanax. He tells Mr. Heller to watch the rain a moment. “How’s your breathing?” he asks. “Really pay attention.”

A fill-in nurse, someone named Trudy, concurs. Mr. Heller breathes. He breathes slower, watches the rain, and, finally, closes his eyes.

“No one else can do that,” the nurse whispers on their way out. Blake worries she’s right.

The thing about Blake is, he knows how to focus — no matter caffeine withdrawal or whatever else. But as soon as he’s out of 8A, he’s wondering where Ani is. He checks his watch. Only 7,034 steps. Did he give her clear enough instructions? Does she have the common sense to take one of the good, RESERVED spots in the lot as opposed to walking a damn block from the visitors’ area?

Patient No. 2 is not an easy one. Mrs. Sebastian Willow, who insists being referred to as such, is what lesser doctors refer to as a frequent flyer. This is her third carpal surgery, second wrist. Blake counts backwards from 100 as he suits up. He’s filling in for yet another new surgeon who didn’t sign up on his round.

The precision of an endoscopic surgery for carpal on a woman with the tiniest wrists he’s seen in his lifetime is not something he’d been looking forward to, but it is something he will execute with precision and grace. Five, four, three, two … one. He enters the room to meet with two assistants and his station set up to perfection. The tiny tools that were once fumbled and dropped with his clumsy, big hands, are now a part of him, an 11th finger or a mechanical extension. He cuts away the flesh and navigates around the thin line to avoid nerve damage. He feels the pressure release, subtle, or thinks he does, as he places tiny incisions. This woman will be back to texting in a few hours.
Ms. Sebastian Willow will be checked out as soon as her paperwork is complete, Blake explains. He provides her with aftercare instructions and tells her to stay off Facebook for a while.

“Instagram okay?”

The coffee should be here. Blake made good time. He has almost 20 minutes to spare before his presentation and, still with no idea what to say, he figures he could give an account of the very surgery he just completed. Perhaps he could frame an entire speech around a surgery. His head screams at him, somewhere along the forehead just above the eyebrows. It screams out in withdrawal.

Speed-walking to the front desk, Blake glances down at his watch to see 11,000 steps. Most people are just waking up. He asks if someone has been around to deliver coffee, and Anita, the receptionist with phenomenally big hair and watery eyes, says no.

Blake’s headache seems to be wrapping around his head, scarf-like, now. He rushes down the hall, toward the parking lot, wondering if he could make it back to the gas station in time to return for his speech. He recalls the anxiety attacks he used to have in front of groups, the terror of being unprepared. He imagines himself in the audience of students, bored and eager all at the same, waiting to be a doctor. He remembers the invincibility of promise, endless promise. He tells Anita to wish him luck.

“Sweetie,” she says, with a maternal sweetness. “You got this, whatever it is.”

He lets out a breathy laugh as Ani, resplendent Ani, arrives with a tray full off coffee and one single small cup that promises to hold a quad espresso just for him. He wants to tip her $100. He reaches out his arms in joy as though ready to hug her as she sets the tray down on the counter.

He pulls out a $50 and hands it to her, which he thinks will leave her $10 for the trip. She smiles and turns on a heel, waving goodbye and explaining that she wants to beat the storm on the way back.

“Thank you,” he calls out. He sees she drops something, the cash! And he calls out, gesturing quickly to get her attention before she is out of earshot. Just as she turns, his hand gestures down. The tiny cup, the glorious one, falls to the ground. The small plastic lid bounces off and lands beneath a chair. The golden-brown liquid turns to a small puddle near Blake’s feet.

As the puddle spreads, a woman in a wheelchair screams out in pain. There is an emergency laparoscopic call to action. Blake counts backwards from 100. He realizes he’s the only one on-call right now and will have to meet with the students late.

The life of a surgeon, he’ll say, is such that you cannot over-prepare. Now is the only time you’ll have. Take advantage of it. The things, the lifestyle, the fancy car you may be able to afford, are all simply ways to get you back to the core, this hospital, where you will live to save others from pain.

Blake stands in front of over 100 med students and recounts his morning. “I’ve hit 21,000 steps since 4 a.m., I’d really like a cup of coffee, and I’ve met with three patients, executing two surgeries, one of which was an emergency.” He goes on. He examines their eyes, pulling a small rubber band out of his pocket. “I count down from 100 whenever I need to find my center. I stretch this small rubber band with each count.”

Four students drop out that week. Blake receives a single note, which Anita delivers with a smile. “It has a gift card in it, I think!”

When Blake opens it, he is in his office. It’s a Friday, and he’s fully caffeinated. It is a thank-you note from a student who says she is third year. The small plastic card containing a mantra: “Go on,” and the handwritten note, resplendent in barely readable doctor scrawl, simply says, “I carry a rubber band now. I’m ready.”

“Sure are,” Blake says. He reaches in his pocket, stretches the band, and takes a breath. The clock, such an archaic and beautiful thing, ticks, and he thinks about how precise the gears must fit to balance time. He looks down at his smartwatch and sees 28,439 steps. He writes the number down in a small notebook before standing to stretch, walking slowly toward his perfect car. He heads home to a quiet apartment, where he will sit with a novel, pausing now and again to acknowledge the hope he feels for the world.

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