A Week at Work

A Week at Work

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The last week of July in 2009 is the craziest week that Dr. Wu has had since she became a Rehab physician fifteen years ago.

Dr. Wu moved from the Midwest to the Northeast in early July, and thus far, her transition to the new hospital has been smooth. At the age of fifty, she is proud of her adaptability.

The oddness begins on Monday morning, around eight o’clock. When Dr. Wu walks to the Rehab ward to do her routine morning round (a morning round is a doctor’s daily visit of his or her patients typically early in a day), she sees a couple, the man in a light blue hospital gown and the woman beside him, walking toward her in the long corridor. They don’t look familiar to her. Perhaps a new patient from the weekend? Judging from their appearance, she presumes the woman is the wife of the patient. The man is almost bald, and the woman has gray curly hair. The patient pushes a walker and shuffles with stiff steps that hardly lift off the floor, like two mopping sticks. His back is slightly hunched over. The woman follows the man closely. She is not slim, nor obese. Although not wobbling, she doesn’t look strong or agile enough to catch the man in case he falls.

Dr. Wu walks fast with an easily identifiable heel-clicking rhythm that sounds like she is in a hurry. As she approaches the couple, she steps swiftly to the side, leaving ample space for the patient and his (presumed) wife. When they come to about ten feet apart, she suddenly hears the woman’s loud scold, “Why do you turn your head sideways like a broken Chinese toy?”

 “Broken Chinese toy?”  What a simile. Without slowing down, Dr. Wu turns her head slightly and glances at the man. She notices the patient’s head is bent to the right shoulder. Since he’s not her patient, the doctor doesn’t stop and passes them.

As a physician, Dr. Wu has developed a compulsive habit of making differential diagnosis of “abnormal” things or signs that she sees in people passing by—a twisted neck, strange involuntary movement, unusual gait pattern, muscle twitching, or “lumps.” She is good at telling if a lump is “good” or “bad.”

Yet, at this moment, the words “a broken Chinese toy” pesters her mind. Instead of making a differential diagnosis, she questions, “What? And why?” Did my Asian look evoke the woman’s imagination?

It’s not imagination. After all, for the last year or so, all major TV channels have spent chunks of time talking about poor quality Chinese products. Some TV anchors even stood on Fifth Avenue asking shoppers exiting Nordstrom and Macy’s if they had bought anything that was made in China and went to peoples’ homes looking for the furniture, home décor, cooking wares, or dining sets that were made in China.

Aren’t people tired of the same news every day? Regardless, she has enough of it, so much so, she stopped watching TV altogether. Naturally, for many people, turning on TV the first thing in the morning and last thing at night is an irreplaceable routine like breathing air, and the large black screen has become the pacemaker of their brainwaves.  How natural is it to come up with the simile of “broken Chinese toy” to describe anything that is bent or crooked? Media is a major source of neologism.

Since her move to the Northeast, Dr. Wu has encountered a new phenomenon. A lot of her patients ask her: “Where are you from?” “Where are you from originally?” “Where did you go to medical school?” “Are you Japanese?”

Looking around in her new workplace, she sees fewer black, brown or yellow people as she was accustomed to see in the Midwest. She presumes that’s because people are curious. She answers the questions without giving much thought to it.

After the morning round, Dr. Wu goes back to her office. This is the time when she thinks about her patients and makes plans for them: how well the patients are doing, who can go home soon, and which new patients are ready to be admitted to the Rehab unit.

Around 9:30 a.m., while the doctor makes her treatment plans and writes new orders in the computer, a male Asian physical therapist, Phil, knocks on her door.

Dr. Wu can tell it’s Phil from his soft, almost timid way of knocking.

“Come in.” Dr. Wu raises her voice. She presumes Phil is here to give her an update about his patient. When she sees him inside the office, she greets him, “Hi, Phil, good morning.”

Phil is a South Asian American of medium height, who is always impeccably groomed and dressed.

Dr. Wu likes him because he is a very reliable therapist and has good clinical judgement. He knows how to prioritize which patients to see first early in the day so that he can help the doctor decide who is ready to go home or who is ready to be transferred to the Rehab unit. An ideal team player on the rehab unit. People like Phil makes her transition to a new workplace easier and enjoyable.

Today, to the doctor’s surprise, Phil doesn’t speak. His face is as pink as a peach. His eyes are filled with tears.

“What happened to you?” Dr. Wu’s heart tightens. She remembers that Phil told her last week that he has a family member who is terminally ill and was put on hospice care. Maybe…? She suspects the worst.

Phil hesitates a moment, then replies, “Dr. Wu, my patient asked me if I’m Chinese.”

Dr. Wu’s mind goes blank.

Phil raises his chin and adds, “I told him I’m not.” The redness spreads to his neck.

Had she not heard Phil’s words, Dr. Wu would have almost forgotten that one of her new colleagues asked her last week, “Are you ashamed to be Chinese?” At that time, she was staggered by her colleague’s question, but she saw no malice in her demeanor. She is simply being candid and unhypocritical, she thought. In fact, Dr. Wu felt sympathy for her colleague. “No,” she replied, then she added, “thank you for asking.”

What’s mind boggling is that both Phil and Dr. Wu are American citizens. But what’s the meaning of being a citizen? What is the value of an American citizenship? Why do people have to distinguish Chinese American versus other Asian Americans?

Now facing Phil, what can Dr. Wu say? She says simply, “No, you’re not Chinese.”

Phil doesn’t say a word. He walks away abruptly, sniffling.

Phil’s silent retreat makes Dr. Wu wonder if her affirmation makes him feel better or worse. Is it only being mistaken as a Chinese that makes him feel shameful, or his Asian face that he cannot escape?

Just a few months ago, when Dr. Wu returned from her annual trip to China, at the international airport, she was stopped by a female customs officer in a gray-blue uniform. The first and only greeting that she got from her was: “Do you have counterfeits?” There again, her face trumped her blue U.S. passport.

Over the past two decades, Dr. Wu has kept a famous quote by Mark Twain in her purse on a piece of laminated paper that says, “Keep away from people who try to belittle your ambitions. Small people always do that.” She touched the piece of paper in her purse, then she answered “no” to the woman officer and has forgotten about this incidence until today.

The doctor knows she is two decades older than Phil. She wonders if sharing Mark Twain’s quote with Phil would help him. Then she decides Phil will learn by himself with time. He’s a smart young man.

People learn with time. That was how she learned to be tough twenty years ago when she began her residency training. She recalls vividly, during her first week of residency training,  a senior resident, Dr. Singh, told the new comers, “Human beings are like eggs, the more you boil, the harder they get.”

Eggs? What a strange simile, she thought.

Soon, Dr. Singh was proven to be right. At the beginning of her second year of residency training, Dr. Wu became pregnant. When she told the chief resident about the news, instead of a word of “congratulations,” all she got was an F word and a stare that said what a mess you’ve caused me. She worked until her baby was born and was given a two-week-long maternity leave.

She survived. Dr. Singh was right. Human beings are not only like eggs, they are tougher than eggs and can become insensitive to hot water or even hot oil.  What bothers Phil no longer bothers Dr. Wu. Phil will get there, she tells herself.

Besides Mark Twain’s quote and Dr. Singh’s words of survival, Dr. Wu received another new, perhaps even odd “wisdom,” recently. Her friend gave her a beautiful Chinese flower vase as a housewarming gift.

“Flower vase in Chinese is Hua Ping. The sound of Ping is the same as the word harmony and peace. So, keeping a flower vase at home is good Feng Shui,” the friend explained with an air of seriousness.

“Oh,” Dr. Wu nodded politely. She knows nothing about Feng Shui. Twenty years ago, she would never believe it and dismissed it as a joke. It made no sense to her. Now, as she gets older, she is ready to embrace it. She has her theory: Feng Shui is nothing but a mindset. Perhaps one can call it “positive energy”? It reminds lazy people like herself to relax. No need to sweat with yoga or to spend time in praying or meditating. Just jeter un coup d’oeil at the vase. Voila, tout est bien. She places the vase in her living room near the door so that whenever she enters or leaves the house, she can see it.

But when she travels, it would still be useful to keep Mark Twain’s quote in her purse. One can’t carry a flower vase around all the time. She chuckles at her own wit.

The week before, in the middle of July, the doctor heard some news on the radio on her way to work. “The renowned Harvard scholar, Professor Gates, was arrested at the front door of his own home,” simply because he is Black. She is not surprised. Nowadays, names such as Blacks, Jews, Mexicans, and Chinese, are used as insults by certain people who are either ignorant or have specific purposes.

Dr. Wu wonders if Professor Gates carries some kind of quote like that of Mark Twain’s or if he believes in Feng Shui?

Of course not. Professor Gates is a tough guy, and he won’t be belittled by small people.

What a Monday morning. Fortunately, the rest of day is peaceful.  No one even asks where she is from. Maybe Feng Shui finally worked? Or God has a daily quota for the number of “insults” one person receives each day.

On Tuesday morning, Dr. Wu gets up at her usual time around 5:30 a.m. After her morning routines and a cup of Taster’s Choice instant coffee, she drives to the hospital. She arrives at work before 7 a.m. and starts her day by reviewing patients’ previous night medical record updates and lab results. She usually does her morning round at 8.

Around 7:30, her pager vibrates. She looks at the message. It’s the unit nurse, Michelle. Dr. Wu picks up the phone and dials the number that Michelle left for her. Before the first dial tone ends, Michelle answers.

Dr. Wu says, “Good morning, this is Dr. Wu. I’m answering my pager.”

Michelle replies, “Hi, Dr. Wu. This is Michelle. Mr. Laurent’s family is here and they want to talk to you.”

The doctor knows Mr. Laurent well. He is seventy years old. A month ago, he was found to have two masses, one in the lung and the other in the brain. The lung mass was removed and confirmed to be malignant two weeks ago. The brain mass is biopsied, but he has to wait for the pathology result. In the meantime, Mr. Laurent has been on the rehab unit. He has recovered somewhat physically but is not strong enough to go home with his wife, who is also in her seventies. As of yesterday, the family agreed to go to a nursing facility of their choice near their home, and Mr. Laurent could continue more rehab while waiting for the brain biopsy result. In this way, his wife can visit him during the day and go home in the evenings. Who doesn’t want to sleep in his or her own bed, especially at her age? Transportation to the nursing facility is set at 10 a.m. this morning.

“His family?” she asks, thinking perhaps Mr. Laurent has changed his mind.

“The brother-in-law is here. He’s a lawyer,” Michelle whispers.

“Okay,” she says, not knowing what being a lawyer has to do with her patient.

Hearing the doctor’s usual calm tone, Michelle adds, “He’s mad.”

“I’m coming. Give me five minutes.”

Mr. Laurent has been medically stable, and his discharge plan was set yesterday with the help of Alice, the social worker. Dr. Wu has not received a pager about the patient’s medical condition. So, she doesn’t think that Mr. Laurent has had any turn of events since yesterday. To make sure she doesn’t miss anything, she opens his electronic medical record and sees a note from the Oncology team. She notices the time of the note was at about eight o’clock last evening. Apparently, the brain biopsy result came back yesterday afternoon, which confirmed the brain mass is also malignant. Ah, the family had hoped the brain mass would be benign. The doctor’s heart sinks. She can see why the brother-in-law is “mad.”

What’s worse is that the note says the hospital pathology lab can’t tell what kind of cancer it is. So, the patient has to wait longer for further testing. The oncology team informed the family about the biopsy result and its implication: If the lung and brain cancers are the same, it means the lung tumor has metastasized and the prognosis would be worse.

Oh, God, please let the two masses be different, she prays silently.

Dr. Wu has not met the brother-in-law before. She figures the brother-in-law is here to lend support to his sister and Mr. Laurent, who have been facing agonizing waits for the last few weeks. It is like waiting for a verdict. She signs out the medical record and looks at the clock on the wall. Now, it’s ten minutes to eight. She goes to the unit to meet the family, pondering what to say.

Mr. Laurent is in room 116, which is on the right side of the U-shaped unit. When Dr. Wu arrives at the door and turns to the right to face the room, she sees Mr. Laurent lying in the bed. His face is as white as a sheet of paper and his eyes are closed. A light blue blanket covers his body. Did he sleep at all last night? He must be exhausted. The sight of the patient makes her heart ache.

The doctor enters the room. She sees on the opposite side of the bed a man sitting by the dresser that is against the wall. Before she can open her mouth to greet them, the man jumps up as if he were ejected from his chair. He is tall, at least 6”2’, broad-shouldered, and has gray hair at the side of his temples. He wears a white T-shirt and belted khaki pants. With his left hand on his hip, his right index finger pointing at the doctor, he shouts at Dr. Wu, “How dare you!”

Dr. Wu still has her mind on Mrs. Laurent. She glances at the wife quickly. Mrs. Laurent stands by her husband’s bedside. Her eyes are red as if she is on the verge of crying. Dark circles are under her eyes. She doesn’t say a word. The doctor gives the wife a nod that says I got the news too, then she turns to the brother-in-law.

The lawyer continues to shout loudly as if Dr. Wu was deaf. “My brother-in-law has cancer in his lung and in his brain. How dare you send him to a nursing home.” His voice thunders, echoing in the hallway. His hand trembles.

At this moment, before Dr. Wu replies, Alice, the social worker, a thirty five-year old blonde woman, walks in. Alice had arrived early today to make sure the discharge goes smoothly. After a few minutes on the unit, Alice has heard an earful of what’s going on with Mr. Laurent, his biopsy result and his brother-in-law’s arrival. Then the noise from Mr. Laurent’s room draws her in.

Once inside, Alice sees this tall, crimson-faced man stand in front of Dr. Wu, towering over her. The doctor, a slim, pale-faced Asian person, has nothing but a pair of ultrathin glasses guarding her from this angry man, who seems to be ready to punch her.

Dr. Wu nods at Alice as if nothing is unusual. She says to the brother-in-law calmly, “I’m very sorry to hear the news. I understand your feelings. We didn’t know that the pathology result had come back yesterday when we made the decision to send Mr. Laurent to the nursing home. Since the results are back, we can change our plan if you’d prefer. According to his oncologist’s note, we still have to wait for another result to see the precise diagnosis. As you know, that result will determine the course of his treatment.”

The words “change the plan” prompts Alice to give Dr. Wu a stare signaling not to promise too much.

The lawyer fumes on. “I don’t care about your plan. My brother-in-law is NOT going to that nursing home!” He waves his right hand in the air as if to say he, the attorney, is the one who makes the decision.

Dr. Wu says sympathetically, “We don’t know when the pathology result will come back. Mr. Laurent is not ready to go home yet. So, he has to wait, and in the meantime, get more therapy. It was the family’s choice to be closer to home. If you don’t want him to go to that particular facility, we don’t have to send him there. Do you have a place in mind where you prefer him to go?” She scans the room to see if Mrs. Laurent has her own thought.

Alice’s face tightens. Her blue eyes narrow. The doctor doesn’t know what she is talking about, she scolds her without speaking. Where do they prefer? You think it’s easy for me to find a bed anywhere they prefer? Facing the lawyer, she crosses her arms on her chest, with a “no nonsense” demeanor, and she says firmly, “Let me tell you, if he goes to another place that has no contract with our hospital, the insurance won’t pay for the travel. I warn you ahead of time. It’s $4000 dollars for a one-way trip.”

“Urn!” the lawyer snorts. “Four thousand dollars? You think I care about four thousand? Don’t use this to scare me. My brother-in-law will NOT go to a nursing home!” His body shakes.

At this point, Alice has had enough with the lawyer. Who does he think he is? An attorney? He is nothing but a redneck. Had the doctor been a blonde, he probably wouldn’t dare to act this way.

The doctor knows Alice well and suspects she doesn’t like the lawyer’s attitude. But she understands that the family is still in shock about yesterday’s result. It’s natural that they are frustrated. In front of the patient and his family, the doctor refrains from saying anything that might add fuel to the fire.

Dr. Wu continues to speak to the brother-in-law in a calm voice. “It’s okay if you want to change your mind. Let me know if you decide to go to a different place.”

The doctor’s composed demeanor gives the brother-in-law an impression that she is in control of the situation. He cools down and asks, “When will he know the result of the brain biopsy?”

“I’m not sure. I have never had a case like this when the biopsy result doesn’t come within a few days. But if you would like, let’s go to my office, and we can call the lab together.”

The family members agree. They follow the doctor to her office, leaving Mr. Laurent in his bed. This will give the patient time to rest, Dr. Wu thinks. She feels sorry about the loud conversation in the patient’s room. She asks a nurse to close the door before they leave the unit.

 

Dr. Wu’s office is one floor below the rehab unit, next to Alice’s. Before Dr. Wu enters her office, she asks Alice to hold the discharge.

Alice says okay, while rolling her eyes.

Dr. Wu notices her eye-rolling and doesn’t say anything. She knows Alice is not happy about the situation and pushback by the brother-in-law, but she has always obeyed her orders in the past.

Back in her office, Dr. Wu sits behind her desk. Mrs. Laurent and her brother each sit in an armchair facing her. The doctor turns on the speakerphone and dials the operator’s number.

After a couple of transfers, she calls the doctor who has worked on Mr. Laurent’s case in the lab. “Hi, Dr. Chan, thank you very much for answering my call. This is Dr. Wu. Mr. Laurent is my patient on rehab. Are you familiar with his brain biopsy result?” She then gives the pathologist the patient’s Social Security number and adds, “The patient’s family is with me here. We’re on the speakerphone. The family received the brain biopsy result last night. They know that both the lung and brain masses are malignant. Now, they are waiting for the final diagnosis of the brain biopsy. As you can imagine, they are devastated.”

The pathologist replies, “I understand.”

“The family would like to know when they can get the final brain biopsy result so that they can plan the next step.”

The pathologist explains that Mr. Laurent’s brain biopsy is a rare case. Although they know it’s a cancer, their laboratory doesn’t have the proper tools to determine the type of cancer. Therefore, the sample has to be sent to the National Pathology Center in Washington for further investigation. “That’s the best place to make a diagnosis. They have two hundred pathologists there, just to work on difficult cases like this one. It’s hard to tell how long it’ll take because it depends on how many tests they’ll have to run. If one test can’t tell, then they’ll do another test, or another one. Each test may take several days to see a result.”

“I see. I had no idea,” Dr. Wu says. She glances at Mrs. Laurent and her brother, who listen attentively. Now, they know. It’s not as simple as they thought.

“Do you have the national lab’s phone number?” Dr. Wu asks.

 The pathologist asks, “You want to call the national lab?”

“Yes. I’d like to try.”

“Hold on.” After a couple of minutes, the pathologist reads a number, and Dr. Wu writes it on a piece of paper. Then, she reads it back to verify.

“Good luck,” the pathologist says.

“Thank you very much,” Dr. Wu says and hangs up.

Dr. Wu dials the national lab number. Again, she is transferred from lab to lab a few times and finally reaches the correct pathologist.

Dr. Wu feels hopeful. She introduces herself and the family one more time, then explains the situation. “As you can see, the family is devastated. They would like to know when they can get a final result back or how long they’ll have to wait.”

“I understand. Unfortunately, nobody can tell. It’s a very rare case. We’ve done one immunologic staining test so far, but we might need to run several tests before we’ll know for sure. As you know, these tests are expensive and time-consuming. And we have to make sure not to waste sample tissues. I’m very sorry I can’t tell you exactly when we’ll have a result.” The pathologist sounds apologetic.

Dr. Wu’s heart sinks. This could be weeks. She thanks the pathologist and hangs up.

Feeling helpless, she turns to the family. “I’m sorry. It looks like we have no choice but to wait. What do you want to do?”

The brother-in-law is undeterred and says defiantly, “I still don’t want him to go to a nursing home. He needs medical care. His primary care doctor can admit him to the private hospital near their home.”

“You think so? In this case, I respect your choice. I’ll ask the social worker to cancel the nursing home bed,” Dr. Wu says.

The lawyer nods. Mrs. Laurent doesn’t say a word, looking at her brother.

Dr. Wu sees no objection from the wife, so she stands up and says, “Excuse me for a minute.” She walks to Alice’s office.

Alice is sitting at her desk. When the doctor appears at her door, she raises her head and looks at the doctor inquiringly.  Dr. Wu says, “Alice, please cancel the nursing home bed. The family doesn’t want to go there. They want him to go to his primary care doctor’s hospital near their home.”

“Are you sure? If I cancel it, he’ll not have a bed. I hope they won’t change their mind. I’ve seen enough of this kind of cases. I can tell you, nobody holds a bed for a patient nowadays.”

Dr. Wu says confidently, “Alice, cancel the bed. The family does not want to go to a nursing home.”

Alice shrugs her shoulders and gives the doctor a reluctant “okay” gesture.

Dr. Wu returns to her office. By this time, Mrs. Laurent and her brother have made up their mind. They give the doctor Mr. Laurent’s primary care provider’s (PCP) phone number and demand a doctor-to-doctor communication.

Dr. Wu dials the PCP’s number. The hospital operator tells them that she will page the PCP. Dr. Wu leaves her phone number and hangs up to wait. She is comfortable with the family’s suggestion and suspects the family knows the PCP well. Otherwise, they wouldn’t ask for an admission to his hospital in such an impromptu fashion.

After about ten minutes, the PCP calls back. Dr. Wu explains about Mr. Laurent’s situation and the family’s desire that Mr. Laurent is transferred to the PCP’s hospital and under his care while waiting for the biopsy result.

“Hmm, I understand their situation. I’m very sorry to hear this. But it looks like Mr. Laurent doesn’t have a medical need to be in a hospital. He’s medically stable, right? Does he need IV fluid or IV antibiotics?”

“No, he needs more therapy, at lower intensity. He’s still weak and can’t go home yet.”

“Again, I’m sorry. I don’t have a medical reason to admit him. It’s an oncology condition. Perhaps, his private oncologist can get him into an oncology unit?” the PCP proposes.

Dr. Wu turns to the family. “Does he have an oncologist near your home?”

“Yes,” Mrs. Laurent replies. She quickly opens her purse and pulls out a bunch of cards.

“Okay. We’ll try. Thank you very much.” Dr. Wu hangs up the phone, still hoping they are one step closer.

Mrs. Laurent finds the right business card and hands it to Dr. Wu.

The doctor dials the number. It’s the operator again. They have to wait for the doctor to return the pager. This time, the wait seems longer. Dr. Wu excuses herself and checks on her other patients in the electronic medical record while she waits.

“Go ahead. Don’t worry about us,” Mrs. Laurent says.

Then the phone rings after about ten minutes. Dr. Wu answers and introduces herself and Mr. Laurent’s family on the speakerphone. She explains Mr. Laurent’s situation and says, “The family would like Mr. Laurent to be admitted to your hospital since this is an oncology condition.”

“I’m sorry. I can’t admit a patient who is waiting for a test result. I can only admit someone who has a confirmed diagnosis and a treatment plan,” the oncologist replies.

They all hear his answer. No need to explain. Dr. Wu, like the family, is disheartened.

It’s almost 11 a.m. The family must make up their mind. They are visibly exhausted and look like deflated balloons. They probably didn’t sleep last night.

Dr. Wu feels bad. After more than two hours of phone calls, they’re back to square zero. She asks the family again, “What do you want to do? Do you want him to go to the same nursing facility?”

Mrs. Laurent and her brother-in-law look at each other. They know that they don’t want to stay here. It’s too far away from home. So, they both nod an okay.

With their agreement, Dr. Wu stands up and says, “Let me talk to the social worker to see if he still has a bed.”

The doctor goes to Alice’s office and says, “Alice, the family now agrees to go to the same nursing home. We don’t have much time. I’ll explain to you later. Can you call the nursing home to see if they still have the bed?”

“I kneeew it,” Alice says. She pauses for a moment, then takes pity on the doctor. “Tell you the truth, I didn’t cancel it.” She winks triumphantly.

“You didn’t? How did you know?”

“I told you. I’ve seen many cases like these.”

 “I’m sorry for the trouble,” Dr. Wu says.

Alice has the nursing home manager’s phone number on a Sticky Note on her desk. She reads it and dials. It is the answering machine. She leaves a message. “Hi, Ms. Norton, it’s Alice again. Just to let you know that Mr. Laurent will be on his way in two hours. Now it’s about 11 a.m.”

“Thank you very much, Alice,” Dr. Wu says, nodding a couple of times.

“All set.” Alice waves a no big deal gesture. She knows the doctor too well, bullheaded, but well meaning. She cautions her in a lower voice, “Dr. Wu, don’t let people step on your toes next time.”

“Alice, they’re just frustrated and want the best for their loved one.”

“I know. But still, you should maintain your dignity,” Alice warns.

Actually, these hours of frantic phone calls are not a waste of time. The patient’s family has a better understanding of the situation. Although fruitless, they feel that they’ve done their best.

Before the family leaves Dr. Wu’s office, Mrs. Laurent hugs the doctor to say goodbye. Tears run down her cheeks. She can hardly speak a word. Her brother squeezes the doctor’s hand so hard that it hurts. He manages to say, “Thank you very much.”

“You’re very welcome and best of luck,” Dr. Wu replies.

The family leaves her office and hurries back to the unit. Dr. Wu puts in a discharge order.

As soon as the family leaves, Alice comes in without knocking. “You look tired,” she says, looking at the doctor.

“I’m okay.” Still feeling the pain in her right hand from the lawyer’s handshake, she rubs it with her left one. Then she asks, “Do you need anything, Alice?”

“May I take some of your time? I know you’re busy since you’ve spent so much time with the Laurent’s.”

“No problem. Go ahead,” Dr. Wu says.

“You’re new here. I want to make it clear. First of all, you know, you doctors don’t know anything about business. You’re not the only one. But some of you listen, others don’t.” She rolls her eyes and continues, “And worst of all, some don’t even care.”

“Business? It’s true. I’m not trained for that,” the doctor admits.

“Empathy is empathy. But empathy isn’t reality. People can’t always do what they prefer, but what they can or are allowed,” Alice says matter-of-factly.

The doctor listens.

“You don’t have to agree with me. I didn’t make the rules. The insurance companies did. Plus, hospital and nursing facilities’ beds are limited. Patients must go to the appropriate level of the care they need. In Mr. Laurent’s case, a nursing facility is the most appropriate for him.”

“You have a point. Hospital is not the best place if a patient doesn’t have a medical need. Especially, someone like Mr. Laurent, who is immunocompromised and can get a worse type of infection in the hospital.”

“I’m glad you finally agree with me,” Alice smiles.

“I’ve certainly learned a lot about the business aspect of medicine today. It’s a good lesson for me.”

“And I have another thing that I want to talk to you. No offence,” Alice makes a stop sign with her hand, then adds, “it’s your Asian face. In my opinion, the brother-in-law was full of it. I’m sure he wouldn’t act like this if you were white.”

The doctor shrugs.

“You don’t look like you’re convinced. I know these people. I want to say that you have to learn to defend yourself, stand your ground, so to speak.”

“I would if I thought he’s wrong. But I didn’t. I thought he was overwhelmed by the sad news.”

“I know you have empathy toward them. But you must have a limit. In my opinion, this guy has too much ego. He thinks he’s an attorney, a white attorney. And you… to be honest, you don’t have enough ego. Ego is not always bad. To me, one has to have ego, or you can call it dignity.”

Dr. Wu smiles. “You’re right. I don’t have too much ego. My mind doesn’t work that way. Somehow, I think about others more than I think about myself.”

“I know that. That’s why you’re a good doctor. But it doesn’t mean that you should let people take advantage of you.”

“Hmm, I’ll try. I don’t know if I can change. I’m not a three-year-old.”

“Anyway, I’ve said what I wanted to say. I had to tell you this, or else I won’t be able to sleep tonight.”

“Thank you for being honest with me. I really appreciate it.”

“Okay, you look very tired. I’ll leave you alone.” Alice waves her hand to say goodbye and pulls the door closed.

The doctor feels exhausted. She still has a whole day of work ahead, and yet she works until evening, then she goes home. All she does is take out a microwaveable dinner box lying on the top of the pile from the freezer. Without caring which one it is, she heats it and wolfs it down. Then she goes to bed and sleeps like a log.

The next day, Dr. Wu gets up, feeling fresh. She does her routine, then leaves her house. Halfway to the office, she realizes that she has forgotten to look at the flower vase. Well, perhaps just thinking about it would grant me a peaceful day ahead as well. She needs a peaceful one.

On Wednesday mornings, Dr. Wu has outpatient clinic at a separate campus. The hospital has a shuttle for patients and staff to move between the campuses. It is a thirty-minute drive each way and runs on the hour.

At noontime, Dr. Wu is done with her morning clinic. So far so good. Nothing unusual has happened until now. The doctor takes the shuttle back to the inpatient campus. When she gets on the bus, she sees three patients, all men, sitting on the right side of the bus, one in each row near the front. The left side is empty. She takes a seat on the left side, one row behind the driver’s seat. A few minutes later, Bobby, the bus driver, arrives. He is a chubby guy in his sixties. Typically, he walks onto the bus close to the departure time after riders are settled. He glances at his watch and starts the engine without a word.

The bus makes rattling sounds on the narrow roads because of the potholes. Dr. Wu checks the messages on her cell phone and her pager. Nothing. She turns and glances at the three patients on the bus. One patient dozes off. Two others look out the window. Nobody talks. One of the patients, skinny and pale, reminds her of Mr. Laurent. That makes her wonder how long does Mr. Laurent have to wait again? Days? Or weeks? What if the tumor has spread? Perhaps he needs another surgery or chemo?

It’s her habit of thinking about her patients all the time. This tendency is why she can’t be an oncologist. She would worry constantly about them and wouldn’t be able to sleep.

Then she thinks about Alice. She saved my day yesterday. She is amazed how well she and Alice have worked together. Their personalities are the opposite: like water versus fire. Yet, there is a kind of trust between them. She particularly likes her wit, resourcefulness, and “clairvoyance.”  She appreciates her conversation with Alice yesterday. Alice is young, but she is wise. But maybe, only maybe, if she could be a bit more patient, Dr. Wu ponders. The way she talked to the patient’s family was kind of too harsh. The more she thinks, the more she feels that she should talk to Alice about it.

Before she realizes it, the bus is at the entrance to the main campus. When it makes a left turn without warning, Dr. Wu feels a jolt. Suddenly, the driver’s side of the bus is lifted up onto the curb.

Dr. Wu is thrown flat to the floor, face down, one foot away from the doorsteps. She is dazed but strangely doesn’t feel pain. After a moment, she can feel the continued jerky motion of the bus. She knows that she is alive.

The bus bumps on and finally comes to a stop at the front entrance of the main building. Bobby opens the door without a word. He looks at the opposite side as if he doesn’t notice the doctor is on the floor.

Dr. Wu struggles to her knees. She finds her glasses hanging on her face, with one end of the broken frame wire stuck into her skin, just a half centimeter from her right eye.

The three patients on the right side seem to be fine. They are silent. Maybe they are in shock or too weak to say anything?

Dr. Wu stands up and gets off the bus. Slightly shaking, she holds her glasses with one hand so that the wire won’t pull on her skin and walks to the emergency room (ER) on the ground floor. In the ER, a young doctor asks her what happened. She explains to him. The doctor looks at her face and says, “This is dangerous. It’s close to your eye.”

Dr. Wu feels numb and still doesn’t know what happened.

Carefully, the ER doctor pulls the wire out of her face. “It’s only a small scratch,” he observes. “It doesn’t seem to need stitches. Just ice it when you go back to your office. Perhaps you’ll have a small scar, but I think it’ll heal quickly,” he says.

Dr. Wu thanks him and leaves the ER. She walks back toward her office. She doesn’t feel much pain. But without her glasses because of the broken frame wire, she walks more carefully. She feels like walking on clouds, a bit dizzy. She can see only shadows in front of her. Ah, this is how people with poor vision feel like, she thinks, trying to adjust her balance.

Since she can’t read anything on the computer, she decides to talk to Alice. When she arrives at Alice’s office, she knocks on the door.

Alice is sitting at her desk, typing on her computer. Without turning her head, she says, “Come in, Dr. Wu.” She recognizes the sound of the doctor’s step by heart. When she is done typing the last few words, she raises her head. Right away, she notices the small laceration on the right side of her face, so she asks, “What happened to you? Did you trip? You walk too fast.” She stands up swiftly, pulls a chair close to her desk, and says, “Sit down.”

“No. I didn’t trip. The bus went on the curb at the entrance and that threw me to the ground,” the doctor says, then adds, “it’s not a big deal, just an accident.” She wants to get to her topic.

“An accident? Oh my God! How? How many people are hurt?”

The doctor can’t see Alice’s face clearly, but she can imagine her eyeballs are popping out. “Don’t worry, only me. Patients are okay,” she replies.

“Only you? Tell me again how did it happen?” Alice leans forward.

“Well, it’s simple. I was the only one who sits on the left side one row behind the driver. There were only three other patients on the bus, and they sat on the right side.

"I see. Do you know who was the driver? Bobby or Joe? If you don’t know their names, is it the chubby one or the skinny one?”

“I know his name. It’s Bobby,” the doctor says.

“I'm going to tell the director. He’ll tell his boss."

"It’s an accident. If you tell the director and his boss, he'll be in trouble."

"You're hurt. You worry about if he's in trouble?" Alice raises her voice.

"It's an accident. Everyone makes mistakes"

"It's not an accident. He's been driving for twenty years. Twenty years! On the same road. He could have driven this road with his eyes closed. How can it be an accident? He did it on purpose."

"Why? I don’t know him and he doesn't know me."

Alice shakes her head and says, "It’s your face.”

The doctor can’t believe it. I’ve been in the U.S. for more than twenty years, have never had an incidence like this one. She says doubtfully, “My Asian face?”

Alice rolls her eyes again although the doctor can’t see her face. “In case you don’t know, this isn’t the Midwest. It’s the East Coast.”

The doctor doesn’t’ get it. Her mind is on her agenda. She says, “Don’t worry about it, Alice. I want to talk to you about Mr. Laurent’s family.”

“What about them? He’s gone.” Alice raises her eyebrows. Suddenly, she opens her eyes wider and asks, “He’s not coming back? Have they called you?”

“No. You think too fast. What I want to say is that you know how devastated they were yesterday. Just imagine hearing the news about a second cancer in the brain in addition to the lung cancer. Plus, they still had to wait to know the type of the brain tumor it is. I would have gone mad myself.”

“You? Gone mad?” Alice rolls her eyes. Then she sighs, “I know. I know. Tell you the truth. I didn’t feel good afterward. I shouldn’t have yelled at him. But a nursing home bed isn’t easy to get nowadays. Plus, when I saw the way he acted, I just couldn’t stand it.”

“I know, Alice. Thank you for standing by me. I appreciate it. But patients are patients. We should always put them first,” Dr. Wu says softly, yet with firmness in her tone.

“I’ll try next time. I promise,” Alice nods. She gives the doctor a sincere wink.

“Thanks.” The doctor smiles. She knows deep inside Alice is a compassionate person.

Two weeks later, when Dr. Wu takes the bus again on Wednesday, the bus is full, so she sits in the last row. After a minute, she sees Bobby arrive. For the first time since she has used the shuttle, Bobby announces loudly, “Does everyone have their seatbelt on?”

Dr. Wu buckles up. When she looks at the rearview mirror, she sees Bobby staring at her. His gaze is unpleasant. She suspects that Alice has told his boss about the accident. Now, he is in trouble.

Fortunately, bad luck doesn’t persist. It’s just that week. Perhaps the flower vase worked or the doctor has become even less sensitive.

A few days prior to Thanksgiving that year, Dr. Wu receives a tiny thank you card. She feels odd. Nobody has sent her a Thanksgiving card to her work address before. She reads the sender’s name. It’s from The Laurent family.

A greeting from the Laurent’s family?

It would have been several months since Mr. Laurent’s discharge, and Dr. Wu still thinks about him every now and then. Is he getting better? What’s the final diagnosis? How are they doing?

Dr. Wu is eager to know what the card says. It has to be good news, or else why would they send me a card?

She uses scissors to cut open the envelop careful not to damage the content inside. She takes out a small ivory-colored card. She opens it and sees that the handwriting is neat and clear. She reads: Dear Dr. Wu, I just want to express my and my family’s gratitude for your compassion and support when my husband, Mr. Laurent, was under your care.  I also want to let you know that my husband passed away peacefully two weeks ago. I’m doing okay. I wish you and yours a wonderful holiday season. Signed with Mrs. Laurent’s name.

Tears blur her eyes.

At this moment, Alice walks into Dr. Wu’s office. Seeing the doctor’s tearing eyes, she asks sharply, “What happened? Did someone hurt you?” Alice holds the word “again” back. She shakes her head as if to say why are you so weak?

The doctor can’t speak. She hands the card to Alice.

Alice reads it. Her eyes well too. “That’s very considerate of her to let you know,” she says and nods.

“Yes.” The doctor nods too.

“I guess ‘her family’ means her brother, the lawyer, appreciated your help.”

“People have feelings. They can tell if we have tried our best.”

“You did. You certainly did.”

“I only did what I was supposed to do. Plus, Alice, you helped too. Without you, they would have been stuck here much longer.”

“You’re right,” Alice says, blinking a few times. “They seem to be a close family. It is comforting to know that they’ve done their best for Mr. Laurent and he died with his family near him.”

“Yes.” Dr. Wu nods.

“Are you going to reply?” Alice asks.

“Yes, I will.”

“Do you mind telling her that I send my condolence too?”

The doctor looks at Alice’s face and says agreeably, “I’m sure Mrs. Laurent and her family will appreciate that.”

 After work, she goes to the Walgreens store near her home and buys a greeting card. She writes on the computer knowing her handwriting is not legible. “Dear Mrs. Laurent, I am very sorry to hear the loss of your husband. Please accept my deepest sympathy. I would like to thank you for your kindness and thoughtfulness for letting me know, especially at a difficult time such as this one. Sincerely yours.” In the next line, she adds, “P. S. I don’t know if you remember our social worker, Alice, who helped arrange Mr. Laurent’s discharge when he was leaving the hospital. I shared your card with her. Alice sends her condolence to you and your family as well.”

After writing the card, she prints the letter, Dr. Wu signs her name, and folds it in the envelope along with the card. She seals the envelope and mails the card the first thing the following day.

About the Author

Quin Yen

Quin Yen (pen name) resides in California. She enjoys reading, writing and hiking. Her stories have been published in the Brilliant Flash Fiction, The Write Launch (multiple), Humans of the World, Route 7 Review (online), and her photographs have been published in The Northgate Living and Memoir Magazine (upcoming).