Chapter Twelve Nomi #2
The old man nods, still grasping for his cane where it lies on the floor, his tremors evident with the difficulty he’s having. With a short exhale, I lean over, grab the cane, and return it to him.
“Thank you,” he says stiffly.
“You’re here for a wellness visit today?
” My words are short and clipped but professional, which is honestly impressive considering the amount of fury seething beneath my skin.
I know she spouted off all those purported medical benefits at the city council meeting, but I didn’t realize Nomi was actually dispensing medical advice along with all her dime bags and eight balls and bong hits.
I cannot believe Dr. Srinivasan condones this.
“Yes, I see Dr. Appa for check-ins between my neurologist visits.” Mr. Gutierrez tries to sit higher in his seat, but his left leg wriggles involuntarily beneath him, making him slide back down each time. The skin stretches tight over his knuckles as he grips the arms of his chair in a struggle.
“This movement,” I indicate his wriggling leg, “this is dyskinesia from the levodopa usage?”
“That’s right,” Mr. Gutierrez grits out.
“How long have you been taking levodopa?”
“Eight years.”
I nod tightly. Dyskinesia often develops after a few years of levodopa usage, but for it to be this pronounced is concerning.
Parkinson’s patients don’t usually come into the ER for emergencies related to the actual disease—it’s the secondary impacts that get them.
Falls, primarily. Complications from pneumonia and asphyxiation when they can no longer swallow.
I’m familiar with the disease, how you treat those secondary emergencies requires a basic understanding of the patient’s underlying etiology, but I’ve never been involved in the treatment of the disease itself.
It’s an incredibly complex, debilitating condition, and not something you can solve by smoking a big, fat blunt.
Again, anger roils through me at Nomi’s interference in this man’s life. “How long have you been using marijuana, sir?”
“Excuse me?”
“Reefer. Ganja. Weed.” I spin around on the stool to face him. “Cannabis,” I say, making a face at Nomi’s preferred term and its sanitized version of the truth.
Mr. Gutierrez leans back, both hands on his cane, and regards me coolly. “I don’t like your tone, Doctor.”
“Well, I cannot assess how your medications are functioning without understanding how your… marijuana habit may be impeding them,” I manage through my flexed jaw.
His brows form a single dark thundercloud. “I don’t have a marijuana habit. I use it when the dyskinesia gets so bad I cannot walk, or when my back clenches so tightly, my spine feels as though it will snap in half. It loosens and calms the misfiring muscles.”
“And did you use marijuana before your Parkinson’s developed?” I press, feeling my face pulse with heat. “Have you considered that it may be worsening your overall condition?”
“You know nothing about my condition. I will not sit here and listen to some hot shot doctor insinuating that I somehow brought this on myself!” Mr. Gutierrez huffs furiously as he struggles to his feet.
“Nomi told me to reschedule this appointment until I could see Dr. Appa, but did I listen?” He shakes his head. “She was right about you.”
“Oh yeah?” My head jerks up as Mr. Gutierrez shuffles out of the room, unable to keep my calm any longer. “And what did your drug dealer say about me?”
Mr. Gutierrez pauses in the doorframe, eyeing me with disgust.
“That you’re the worst kind of doctor there is.”
Surprisingly, the day devolved from there.
The bad feelings brought on by Mr. Gutierrez’s appointment stewed in a furious, rolling boil all afternoon that bubbled up every time one of Dr. Srinivasan’s patients tried me.
The number of people that (1) stormed out of the clinic today, (2) cried, and (3) placed very convincing hexes on me are all greater than zero.
When I finally finish the last appointment, I exhale, feeling the fury leave my body, utterly spent.
Four hours of appointments—that’s all it took to bring me to my knees.
I slump into the office and lay my head on the desk.
The door swings open, banging into the wall so hard I nearly fall out of the chair. Dr. Srinivasan looms in the doorframe, which is impressive considering he’s only five foot six. Without a word, he stomps over to the It’s been ___ days since I’ve received a complaint about Julian sign.
What’s he going to write? He’s never been able to change it from zero. But then he takes it off the wall and throws it down in a shocking display of emotion. For as long as I’ve known Dr. Srinivasan, he has been a bastion of calm professionalism, if a little snarky at times.
Not now.
His skin heats to a deep crimson as he struggles to form the words. “Julian,” he finally utters, “you’re fired. Get out.”
My eyes bulge as I jump up from the chair. “Dr. Srinivasan, no! Please—I had a bad day, I’m sorry!”
“It’s not working out. You haven’t learned anything I’ve tried to teach you about treating patients with compassion, and after your behavior with Mr. Gutierrez today…
” Dr. Srinivasan trails off, shaking his head.
“Frankly, Julian, I’m disgusted. Embarrassed.
And more than anything, disappointed. You have so much potential—you’re bright and hardworking, with excellent training.
But you’re not cut out for this type of care.
You’ll have to finish your probation somewhere else. ”
Pressure builds up behind my eyes, stinging my sinuses. “Nowhere else will have me!”
“Well, now we know why, don’t we?” Dr. Srinivasan frowns at the sign on the floor and leans over to pick it up.
He grabs the cloth and wipes off the marker’ed message.
“I’m sorry, Julian. Not to you, but to my patients, whom I’ve allowed you to hurt.
I’m sorry to your mother, who is a deeply kind woman, and whom I wished to help with this favor.
But I cannot give you access to my patients any longer. ”
“I’m a good doctor,” I assert, louder than I mean to. “I save lives!”
“When you have your way, yes,” Dr. Srinivasan agrees.
“You thrive in emergencies with a top-down approach. You assess the damage. You make all the decisions. No one’s in any state to argue with your judgment.
But that’s not how it works anywhere else, Julian.
Here, you have to collaborate with your patients to find the solutions together.
You have to put your ego aside and listen to someone else because your voice isn’t the only one that matters.
And that, I’m afraid, you’re incapable of doing. ”
My stomach bottoms out. “I need this job, Dr. Srinivasan. If you fire me after six weeks, there’s no way Philly Gen will take me back. My entire career’s at stake. What can I do to change your mind?”
Dr. Srinivasan huffs humorlessly. “Become a different person?”
“Okay. I’ll do it.”
“Julian, be serious. There’s no way to come back from how you acted today. How you’ve been acting this entire time.”
“I’ll apologize to Mr. Gutierrez, to anybody you want. I’ll count to ten before I say anything. I’ll—I’ll go to therapy!”
“Will you study? Will you learn—”
I laugh, a burst of giddy relief at the tiny glimmer of hope. “—yes! I’ll learn anything! I’ll study so hard—”
“About cannabis, Julian? About its medical benefits? How it’s used to treat different conditions, including Parkinson’s?”
The words die on my lips. “I—but sir, it’s—”
“See? You cannot do this job. You refuse to expand your narrow worldview, which is unacceptable.”
I swallow, my heart thudding in my chest as I try, desperately, to sound reasonable. “But I believe cannabis use is unethical, sir.”
“A significant portion of the medical community disagrees with you. Isn’t it worth educating yourself before you take such a harsh, unyielding position on a complex subject?”
“I—I suppose so, but—”
Dr. Srinivasan strides over to the desk and reclaims the chair. “Though I absolutely shouldn’t allow you to stay one more minute under my employ, I’m willing to consider it if you honor my conditions. All of them.”
My face goes slack with relief. “I—thank you, sir! Anything!”
“First, you won’t see any patients until you complete my conditions to my satisfaction.”
“Okay.”
“Second, I won’t write you the recommendation letter you need at the end of this probation unless I see real growth in you as a doctor. I won’t lie to protect your incompetence. Do you understand?”
Everything above my collar flushes with shame. “Of course, sir.”
“Third, you will learn everything there is to know about both medicinal and recreational cannabis with an open mind.”
The thought makes my stomach recoil. After watching Dad waste away in our garage, stoned until the very end, I already know what cannabis does to a person.
A family. A future. Add that to what I’ve seen in the ER—car accidents from driving under the influence, psychotic episodes from overuse, and yes, lots of foreign objects in butts—and my mind’s made up.
But I also know this condition is non-negotiable.
Dr. Srinivasan obviously believes in cannabis’s value—he uses it himself.
“I will read every medical study there is, sir.”
“Not enough,” Dr. Srinivasan counters. “You need to witness firsthand how cannabis helps people in their daily lives. I want you to shadow Nomi Wyeth and learn everything she’s willing to teach you. She’s an expert of great knowledge.”
The hope blooming in my chest gets chopped down like a weed. “Uh, sir. That’s impossible.”
“Make it possible.”
“You see, Nomi…” I pause, searching for the right words, but my brain supplies exactly none of them.
Is so pretty, it makes my chest hurt.
Kissed me and blew my world apart.
Makes me feel like I’m… I’m more and less, all at once.
“Hates you, I know,” Dr. Srinivasan supplies succinctly, and I wince, my heart spiraling in my chest.
Yes. Those are the right words.
“She’ll never let me shadow her, sir. Not after I filed that zoning complaint.”
“Interesting predicament.” Dr. Srinivasan’s eyebrows rise as he dryly regards me. “Whatever will you do.”