The Precarious Nature of Being

Chapter 1

Patrick James Coady was a man with a distinctive cleft chin and an impossible smile. I met him in the summer of 1995, back when he was just finishing his intern year and was rotating on our ICU medical wards at County Hospital.

“Jim”, as he was called then, was always keen to say hello to me with a few positive words or a quick smile as we rotated on our internal medicine shifts. I was his senior resident, and being two years ahead of him I had earned the distinction of supervising the intern physicians while they did most of the work. Despite the fact that I could have easily wandered over to the call room while he handled all the orders and phone calls from the nursing staff, I found myself always sticking around the unit to watch him work on the nights we overlapped.

“Hey Rosie, how you doing? Room 321?” Jim shuffled through a handful of papers as he listened to the other end of the receiver. “Oh yeah, the gentleman with urosepsis-“ A pause. “A Fib? OK. Yeah. Let’s give the 50mg of metoprolol again and call me back if it doesn’t stop. Thanks Rosie.” He hung up the receiver and adjusted the buttons on his beeper to delete the page. He caught me staring at him and smiled. “Love Rosie, she’s so smart. Love working her.”

I nodded silently, imagining that she must feel the same.

When the nights were slow, I liked to take Jim out of the hospital and walk around the parking lot through the desert areas that surrounded the medical campus. We were close enough in reach to respond to an urgent pager request but far enough away to feel like we were taking a break.

With the night sky above and the smell of creosote around us, a certain amount of vulnerability was possible. I had taken an interest in him and I wanted to mentor him. He had the aspect of a young man who was partially lost, halfway in search of something meaningful and the other part of him being pulled in some kind of rebel direction.

“Where do you think you wanna go after you graduate the program?” I asked, breaking our silence.

He looked at me again and smiled the second time that night. “Good question, Mark.”

We walked a few steps in tandem.

“Wish I knew.”

He didn’t speak again.

“ I think you’d be great at teaching”, I suggested.

Jim shrugged.

“You have a lot of positive energy and I think if you channeled that you could really propel others in that same direction.”

“I’m not so interested in the medicine, Mark, you know? I know it’s important. It just isn’t as interesting to me as I hoped it would be.”

I could relate to that thought. Sometimes the magical part of medicine was hidden by the endless charting, constant phone calls, and the sheer amount of work that would drive almost sane human beings to want to leave the field.

“What else would you rather do?” I asked somewhat jealous of the question. With the amount of student loans that I had, I didn’t even have the privilege to consider the option of doing something outside of medicine. Where else could a twenty something year-old make enough to pay back the $200,000 that they owed?

“I think I want to heal people in another way. Like a priest.”

“What?” I exclaimed, suddenly, somewhat embarrassed of my harsh reaction, but also not able to feign my surprise.

“Yeah.”

I could tell I had scared him and his idea off. I set my hand gently on his back.

“Sorry, it’s just not something I’ve heard before. Doesn’t make it wrong. How would you even go about doing that?”

His facial expression changed.

“I’ve talked to the priest where I go to church in my neighborhood. He thinks it could all work out fine. What with the doctorate we get in medicine…he really doesn’t think that I need to go through all their schooling again. Just do a year or two in one of the Episcopal seminaries and probably be good to go.”

“You’re leaving us?”

“Not sure. Maybe. I think so.”

“You can’t.” I wanted to tell him it was because I couldn’t imagine being friends with a priest, but that felt like the wrong sentence in that moment. He looked up and down my face. “You’re such a good doctor,” I volunteered instead.

He nodded. “ I like parts of it too.”

We finished the walk in silence that evening, until his pager went off again and we made our way back to the call room.

The next morning after we finished giving the patient sign out to the day team, I pulled him aside.

“ I know you’re probably itching to get home, but why don’t we grab breakfast. At least let me take you to coffee. I feel like we have an unfinished discussion.”

Jim smiled broadly.

“That would be great.”

We jumped into my car and I snaked up one of the main roads in town and headed over to the diner down the street, one of the only places open at 6:30 AM and a fixture for the hospital staff in our New Mexico small town.

We motioned to Amy, one of the regular waitresses, and asked her to bring over two specials and two coffees.

“ You want your coffee, the usual way, Mark?” Amy asked.

“Always.”

“ I’ll take mine black,” Jim added.

Amy ran behind the counter and pulled out two mugs, filling one high with coffee and the other two-thirds way. She walked them over to the bar and set them down as another waiter came over to ask her something. A few minutes later, she was back.

Jim thanked her and leaned back, exhaling.

“I feel really good that I told you, Mark.”

I raised my eyebrows, allowing the bitter liquid to hit my lips.

“About the priesthood. I’ve been thinking about it this last year and just this week I scheduled a meeting with Dr. Gomez to discuss what it would look like to not come back next year.”

I drank the coffee quicker this time and was thankful to see Amy bringing back two plates piled high with French toast to interrupt my thoughts.

“Enjoy!” She exclaimed, as she set the heavy platters down on our table, like an artist delivering her craft to the museum.

I dug into the food and took a bite, chewing it slowly, thinking. Did Jim know about me?

I cut out another bite from the toast. He may.
Swallowing, I drowned the sweetness with coffee and set my mug carefully down on the table, as careful as I hoped my words might sound placed in a sentence to respond to him.

“We’re going to really miss you if you leave. You know, Rosie, especially!” I looked up at his face to see if I could encourage him to change his mind. “I’ve always thought she’s got a thing for you!”

Jim laughed, twirling his fork on his plate a few times, and then setting it down.

“Yeah, she’s great. She really is. You’re all great.”

He hadn’t touched his food.

“You ever close your eyes Mark, in silence, and really try to listen to yourself? You ever think, who am I?” He gestured to his chest, and pointed all of his fingertips to his sternum. “Outside of the noise. I had an Uncle once, he told me, anytime I hear the chatter of the world, and feel lost, just go inward.” His fingers hit his chest again. “Go inward. All this year, I’ve see so many people die. And then we go on doing our paperwork. I’m not cut out for it. I can’t talk to people as fast as I need to get the rounds done on time. The patients tell me about the illness that brought them in and I want to ask them their whole life story. So, I’ve been going inward. And that’s when I hear it. That I want to take care of people, but not this way.”

He looked away, and his eyes met with Amy who had been watching him. He smiled and gave her a big thumbs up, and started cutting out his first bite from the toast.

My own stomach began to feel a bit nauseated as I realized that he was moving further away from me. How could I tell him that he was one of my only friends, my only male friend?

How to say how much I needed him and how I was worried that this new path would take him away from me? I wasn’t sure if any of my attending physicians had told him. I had told Dr. Gomez, our program director on the first day I interviewed for the job.

“Before we get started”, she had asked me then, “is there anything you think that we should know about you that’s not on your application?”

There was something the way she had asked the question, the look in her eye that was an invitation, that made me feel impossibly close to her in that moment. I hadn’t been able to tell nearly anyone along my residency interview trail, but somehow she had crafted her words so carefully that it made me feel like I could tell her anything in just a few seconds.

“I’m transgender,” I told her, shaking between the words, hoping to have her respect still and also knowing that I may have lost it in that instant. “I transitioned from female to male a few years ago. I think you should know that.”

She looked at me, intensely. She didn’t look away; it was the thing I respected the most about her. I knew it was a product of that intense medical training, the one that taught you to do things you might not otherwise do. I recognized it later, in the way that I would meet with patients who had bugs crawling out of their wheelchairs, and you couldn’t look away because then they would see that you didn’t consider them human.

“This is great.” She repeated it again, and I wasn’t sure if it was to convince herself or me of it this time. “This is great.” She jumped into the rest of her questions and didn’t bat an eye.

When I got a phone call a few days later, she let me know that she was thrilled to personally accept me into the program, and that if I had any logistical issues with my paperwork along the way, to call her immediately.

Jim sat across from me, both of us sitting in silence, and him still innocently making his way through the toast.

“There’s nothing wrong with it now, just because it’s not what I would choose. I’m sorry. It’s just hard for me to understand.” I felt my face go hot and paused my sentences with another drink of my coffee.

“All the priests I’ve know are so standoffish, so closed-minded. If you’re half as different from them, well, then…” I searched for words of support and fell upon the only ones that made sense in that moment. “This is great.”
Jim’s face immediately changed. “Maybe you’ll even get my to go to church again, but I can’t promise you that entirely yet.”

We both grinned. I sighed, relieved, only hoping that he wouldn’t change too much if he did decide to go away.