Clinical Judgment

[Plucky samba-inflected music begins to play.]

[Narrator, a man with a deep voice, begins to speak] The day I was fired I—I remember leaving the hospital. And on my way out, I saw my assisting nurse in the hallway. I thought she was going to stop but she just slowed down a bit, and she said, “Thanks for all the crackers!” She kept going. Excuse me? I thought it was very strange… even for her.

[Music continues.]

It was just this silly little thing.

So Ellen—my assisting nurse, that’s her name, Ellen. The cafeteria had this curried lentil soup on the menu… I think it was Tuesdays and Thursdays.

Curried lentil.

Obviously that wouldn’t be my first choice [laughs]. When something is called “curried,” usually it tastes like it was curried against its will, if you know what I mean? [laughs]

Anyway, Ellen would order it every time. She loved that stuff. And then once I remember she was complaining that you know, the soup is good and everything but she likes to crumble saltine crackers into it, and it only comes with one packet. You can’t buy them. They’re not on the computer system, or whatever. She asked once and they had to call the manager. [laughs]

So then I decided to start getting the lentil soup too, just to give her my crackers. Everything tasted the same anyway. Maybe some people found it kind of strange, but it made her happy, and I don’t like to think about it like, oh you’re my assistant. Every one of my assistants is like a friend to me. It’s better that way.

So anyway, she started waiting for me to come with the crackers, in the break room, before eating her soup. Then one day I come into the break room on a lentil soup day and she’s like eating salad… Cobb salad. And I just thought, okay, she’s taking a break from the soup and a few days after that, I was fired.

I don’t know, maybe it’s nothing.

But it seems a little like… what if she knew the whole time? I—I don’t know, I just keep thinking about it. [Laughs uncomfortably.]

It’s okay. I’m happier now. Long story. Now should we order?

Yeah, okay.

[Wooden chair moving, light rustling of clothing, ambient sounds of a quiet, airy restaurant come up as music recedes into the background.]

[Footsteps approaching on a concrete floor.]

[Server] Hey folks. How we doing tonight?

[Narrator] Yeah. Good… we’re good.

[Server] Have you folks dined with us before?

[Narrator] No.

[Server] Ok, well welcome. So we have the regular menu, here [sound of flipping a folded sheet of light cardstock] and then there’s a set seasonal menu, which is always rotating, and that is here. [Sheet flipping again.]

[Narrator] Okay, so what is the set menu?

[Server] Well, for the appetizer there’s a chanterelle mushroom bisque. And then for the main we have a half cornish hen with fennel and plum… and then for dessert we have a nice tarte tatin—

[Narrator] Is it good?

[Server, laughs] Uh yeah, I think so.

[Narrator, to listener] What do you think?

[A pause, ambient restaurant sounds.]

[Narrator, to server] Okay then we’ll take it.

[Server] Ok, sounds good. [Cardstock being picked up and refolded.] I’ll be out shortly.

[Narrator] Thanks.

[Narrator, to listener] Want some water?

[Water pouring into a glass, then a cap screwing on, and the bottle being set down.]

[Narrator] You know, you just have to accept what the universe gives you. If they want to get rid of you... they’ll find a way.

[Glass set down on table.]

[Narrator] I think at some point the administration—the nurse manager—saw me as a liability because of what happened with the previous nurse, Mel. She… she was Indigenous… Cree. Quite young, nice person. She was really good with patients… you could tell they really felt comfortable with her. But she didn’t look… you know um… you couldn’t really tell she was Indigenous. So... staff would say things to her that they would never say if they knew.

[Listener’s chair creaks slightly.]

[Narrator] So Mel told me she was thinking of leaving, I don’t know… it really bugged me. She was just gonna walk away without saying anything. So I convinced her, lodge a formal complaint, you know… but they didn’t like that. [Light scoff.] Gave her bad shifts, or they would schedule her with one surgeon, no one wanted to work with the guy… so she ended up leaving anyway. I went to the nurse manager and I said, “I’m noticing a trend here. Seems like the white staff lasts a lot longer.” Then she looks at me and she says, “Excuse me, are you saying I’m a bigot?” So I just left it at that. I mean what else is there to say, right?

[High heels approaching.]

[Narrator] Oh, looks like our soup…

[A wine glass being struck lightly.]

[Narrator] No—nevermind. False alarm.

[High heels retreating.]

[Narrator] Um, but maybe they could bring us some bread… Anyway, after that they just started making things just hard enough that you couldn’t complain about it—just really subtle.

Like, we’d all be ready to go in the operating room and the nurse manager would come in and say, “Oh we need this for an emergency.” So we had to vacate. Then we’d be sitting there for over an hour… no one would come . Could have been just thirty minutes in and out, but no. Course you can’t prove that’s intentional. It’s just uh… some women… some of them had to take an overnight bus, or take a sick day. Or they were keeping it a secret... and then when they got to the hospital, we wouldn’t be able to take them. A lot of the time, we’d—we’d just… never see them again.

[Pause. Narrator inhales deeply.]

[Narrator] I thought if I just nicely explained to the nurse manager how important these procedures are… now I can be confrontational, but in this situation, I wasn’t being confrontational at all. She just went totally ballistic. Couldn’t handle the criticism, I think. I don’t know.

[Water pours into a glass.]

[Narrator] In Japan, if you come up with a system that works better, they give you a raise. Over here, they give you the finger [laughs bitterly]. I mean, what’s the point of legal abortion, if people have to carry to term because of scheduling issues? Right? It’s not really about losing my job, you know. I—I mean, I’d been thinking of retiring, I dunno, three years ago. It’s the way they did it. It was like in a TV show where all the women are high fiving because they got rid of the bad man. Except, you know... I’m the bad man! [Laughs.]

[Soft footsteps approaching.]

[Narrator] Oh, I think that’s our soup. Is that soup?

[Server] Uh, yeah… it is…

[Narrator] Smells great.

[Server] I’ll just move this, if that’s ok—

[Narrator] Yeah, sure, sure. Yeah.

[Bowls and various cutlery are set down carefully at different parts of the table.]

[Server] Okay, enjoy.

[Rustling, stirring soup, tinkling noises, a tentative slurp.]

[Narrator exhales deeply.]

[Narrator] How is it, too hot? What’s a chanterelle anyway, do you know? I was gonna ask but I thought you knew so I didn’t want to be embarrassing. I was thinking, better not be pork… Is it pork?

[Music in the restaurant background shifts to a more upbeat tune with a mysterious vibe. Sound of narrator blowing and sipping soup.]

[Narrator] Hmm… still don’t know. We’re allowed to eat pork if we don’t know… It’s like a loophole. [Laughs.]

[Narrator takes another sip, makes a noise as though he’s still trying to figure out the flavour. Saxophone comes into the background music.]

[Narrator] Thing is, it was just a technicality, something the other doctors do all the time. Nothing ever happens to them. I mean, what do you expect from a Christian hospital, right? That’s what healthcare’s like around here, behind the scenes. So that’s why I went to India— what was it… uh… wow, that was ten years ago now… you don’t want to hear about all this stuff, do you?

[Restaurant ambience, someone sniffs.]

[Narrator] I mean, I was just fed up with Canada. The way I was treated here. [Close sound of spoon running across bowl.] So I got a job as the administrator of a small village hospital in western India. It was through an NGO.

[Narrator sips soup.]

[Narrator] There were no paved roads, they had these huge divots and when monsoon season came, you know, you’d be up to your waist in muddy water. Could take like 40 minutes to walk one kilometer. Thing is though, I was happy there. People were so grateful… we were supposed to teach the women about natal health. You know, talk to them about nutrition, about avoiding some kinds of hard labour, things like that. But, after a while, I saw that things were… not really changing. No matter what I told them, they would still come in with low folic acid and anemia…

[Narrator] So this one time we were on a field visit to a government hospital in a slightly bigger town… you know close by. There was this burn unit. It was this big open room with like uh... you know 20 beds. No AC. One overhead fan moving so slowly that you could barely tell it was on. And there was a woman in one of the beds. She was just like… suffering like crazy. Her face… you could barely… It was hard to see even that it was a face. She couldn’t really talk, so we had to talk through this guy who was with her. We didn’t know who he was. Maybe seemed like her brother or something. No other visitors. A man on the hospital staff told me...and said that they saw this a lot. A woman gets dropped off at the hospital. Someone in the family says the primus stove exploded —[sound of phone vibrating on the table]

Oh, ah sorry. Usually I don’t keep my phone on but I told my daughter to call if she needed...can just… just… can I just quickly? Okay—thanks. Just… just a minute I promise.

[Sound of narrator moving chair away from table and walking about ten feet away. Phone continues to vibrate and background music gets louder.]

[Narrator] Hi sweetheart, are you okay? Yeah. Yeah, uh-huh. Well, did he say anything about what happened at rehearsal?

[Server comes to the table, speaks over the narrator.]

[Server] Oh, I’ve got your cornish hen here… do you umm—I’ll just put it right here, okay?

[Clinking of cutlery being picked up, and heavier plates being placed on the table.]

[Server] And… just let me know if there’s anything else you need, okay?

[Narrator, in background] Oh, okay. [Light ruffling of foil at the table.] Well, if you don’t want to stay there I’ll come pick you up right now. Okay, are you sure? Call me if you change your mind… okay no problem, I’ll see you at home in a couple of hours, okay? Okay, bye. Bye.

[Narrator’s footsteps approaching.]

[Narrator] Whoa, is this the hen? [Chair pulls up to the table.] They just bring it out right now? I’m sorry I made you wait, I... I hope it’s not cold. My daughter’s taking an acting course… too much drama [laughs awkwardly]. So, are we supposed to cut this thing ourselves here? Want to go ahead? Okay, you… you go ahead.

[Sounds of slicing tender meat with a fork and knife.]

[Narrator] Thank you.

[Meat cutting sounds continue.]

[Narrator, with food in his mouth] Anyways, what was I saying? Oh yeah the thing about the primus stove. It was like a fixed excuse. Everyone knows those things don’t just explode. They’re made of brass, they’re very reliable. Just doesn’t happen. But everyone decided not to question it. [Sound of a utensil on a plate in front of you.] So people couldn’t afford antibiotics. The women would just lie there in pain. Mostly, they were there to die. That woman, whose face, you know… she died. Yeah… [sigh]

[More distant sound of a utensil spearing food on a plate.]

[Narrator] Actually went to her village to find out what happened with her. This woman told me it was been going on for a while. The mother-in-law and son were trying to extract money from the woman’s family. It was actually pretty widespread. You make life so difficult and painful for your daughter-in-law that when her parents hear about it, they give you money to stop. [More sounds of fork spearing food on plate just in front of you.] But over time the abuse… the woman would get habituated, the husband and the in-laws would make things worse for her. And sometimes… this is how it would end. The neighbour… she was kind of surprised I even came out there.

[Restaurant ambience with more scrape of fork on plate.]

[Narrator] I mean, I felt totally used . The NGO I was working for, they knew it really wasn’t about education or Vitamin C or whatever. But as long as the aid money was flowing in, you know. So I came back… came back to Canada. I made an effort to read more books by women and I realized that… the way that women are… what their lives are… oh that was happening here too, in a way. You know even, uh, how men make jokes on Facebook saying that women are dumb and they only like to spend money? I actually read this article the other day, about how women are like managers in the home. Like, now they’re working full time and still they’re doing most of the housework. It was interesting, I… I should send it to you.

[More utensils on plate as the jazzy song winds down on a long, final note.]

[Narrator] Anyway, so that’s when I started focusing more on women’s health. In fact, there was this conference about rural medicine and abortion. How even though it’s legal here, there’s people behind the scenes making sure it’s really hard to get one. Seemed like an area where you could really make a difference.

[Lightly ominous piano music begins.]

[Narrator] But, at that time, my relationship with my ex-wife was going downhill. Oof, that’s a whole other story… I… I don’t know, we just couldn’t get along. There was this whole, uh—

[Server] Hey folks—how are things? How’s the bird?

[Narrator] It’s—It’s delicious, thank you. Um, actually, do you have any bread… to mop up this sauce here?

[Server] Uhh, sure… we have a traditional double fermented rye that we make in-house…

[Narrator] Mm-hm.

[Server] Would you like me to bring an order of that?

[Narrator] Does it come sliced?

[Server] It does… it comes in about 4 or 5 slices.

[Narrator] Okay, great. Thanks.

[Server] Okay.

[Ominous piano music continues for a couple of bars, with the sound of shorter, more terse fork strokes on a plate.]

[Narrator] The thing is, people don’t realize how much of medicine is just about intuition. When you perform abortions...after a while you start to see patterns. Like, usually the woman comes into the consultation room by herself, but sometimes she’ll ask if her partner can come in too. But we only let them in when the woman specifically asks.

[Music shifts to a more irregular, roving melody.]

[Narrator] Sometimes the partner makes a big scene in the waiting room... we have to call security and all that, but that’s… kind of like a rare case. Most of the time you have to pick up on these little hints that something’s just not right.

[Slow, careful footsteps of a person in heeled shoes passes by.]

[Narrator] So okay. This woman comes in with her partner. Maybe boyfriend, maybe husband, I don’t know. She was very shy. They were in a… what could I call it… a biracial relationship. She looked like—Indian, I think. And he was white. Do people still say biracial or is that like what, what… oh okay. Anyway, we called her up for the consultation and he just got up with her and started walking in. So I asked her, “Is that okay with you?” and she nodded, but… it’s not that I didn’t believe her, it’s just...somehow the guy seemed a little um… off? [Laughs.] Usually we tell people what’s involved in the procedure and then we ask if they have any questions, and if they’ve made a decision about it either way, you know. And if they haven’t, that’s fine. But when I asked her directly...

[Server] Some rye here for ya.

[Narrator] Great, great, great, great. Thanks. Thanks.

[Server] Aaaaand let me just get this stuff out of the way for you.

[Gathering and piling of dishes.]

[Narrator] Yeah, no problem, no problem. Thanks. [Beat.] Oh uh, can—[sound indicating frustration]. He’ll be back. Ya so… when I asked her this, he says [mocking tone], “We don’t know yet.” In this way like it was almost aggressive. Like he was challenging me to ask another question. And then he says [mocking tone again], “We gotta pick up the kids now.” And then they just left. So we get out the patient’s chart, it has their phone number on it. I thought, you know, maybe if I call her she’ll be able to speak a little more openly. She didn’t tick the little box, but sometimes they miss it on the form, so… in any case—I just called her the next evening.

Yeah, I know, but… the thing is, I do counselling with patients all the time...and anyway no one picked up the phone. I just left a message, that’s it. But it was general, you know something like uh… “Oh, just following up from the hospital, please give us a call.” Something like that. The thing is, sometimes you have a hunch and you just have to follow it. Yes, technically it was against the guidelines, they’re just guidelines. It’s almost eight years that I’ve been doing this. Anyway, I mentioned the call to my assisting nurse, Ellen—you remember Ellen? And she told the nurse manager and they both ran right to the hospital admin. They said, “Whoa, what… what if her boyfriend picked up. Then what?” That’s when all the conspiracy theories really started flowing… “What if he thought she was colluding with you, what if he retaliated…?” These same people who were totally okay with sending women home because of scheduling problems said that I was putting women in danger. Gimme a break. You don’t get to call them bigots and just walk away… nooo-ho-ho no . They want the ones who keep their heads down .

[Restaurant ambience and a jaunty, somewhat disjointed melody plays.]

[Narrator] At one point I looked at Ellen and she was just sitting there like we were strangers. Like I hadn’t written her son a recommendation letter. And the way they asked me about the patient’s file and whether I had copies, it was like they thought I was going to start stalking her or something… [scoffs].

[Melody continues.]

[Narrator] But you know, I did see her again. The, you know, the woman that I called. Just a couple of weeks ago at the grocery store. She was working at the uh… the checkout. I was in the line right next to hers and I actually noticed her before she noticed me, so I tried to just look straight ahead. But then I looked over and she saw me. And she looked upset. Anyway, I just acknowledged her quickly and I got the hell out of that store. I didn’t want her to feel uncomfortable, you know? I don’t know. Maybe I shouldn’t have called. It’s just uh… I know it’s stupid … but if I had retired there would have been like some article in the paper… saying, you know, all… about all the good things I did and… I mean, every doctor gets complaints sometimes… someone didn’t like the way you said something. Or someone had complications from the procedure—an infection, or a perforated uterus. That one doesn’t happen too often, but it does happen, there’s a probability. Before , I would remind myself, well I’m—I’m within the range for probability, you know even the best doctors get complaints. The happy patients never leave reviews! [Laughs uncomfortably]... and it’s true. So after all this, I started going through the reviews, one by one by one—they go back years… like in, someone in 2003 saying that I hurt them doing an abdominal exam and I’ll spend hours trying to remember who it was… you know, going through every single abdominal exam that I ever did and just trying to remember how many of them sighed in a way that sounded more than just uh… uncomfortable.

[Music shifts to reflect a more urgent tone.]

[Narrator] And it’s crazy, I know. It’s just like I’m watching a medical drama in my head… it’s the same scene over and over and over again. Like… what if I’m the bad man?

[Song concludes with a long trilling sound and soft symbols.]

[Narrator] Then what?

[Restaurant ambience slowly fades away.]

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