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Girls should never go into Emergency Medicine, said Anna's mother Kaye, the training programs are in the worst neighborhoods in the whole country.  So that was what I did, because I didn't want to do everything right.  Besides, I laughed at her inside myself because the doctors that drive in and out of the clinics and the hospitals never get hurt, she should know that by now.  It's the campesinos that live there who knife each other up on Friday night.  I lost track of Anna when we went to high school and she got sent to a private school with a dress code that made her look like a poster child for American Wholesomeness while I wore jeans to school every day of high school so I could carry a boot knife.  Anna's mother was a doctor and the sole reason I went to medical school, Doctors aren't necessarily all that smart, she said in her offhand way, waving a hand carelessly as if imparting great wisdom, which she was, but to a man they are the best students in the country.  It was a funny way to say it because she was a woman and I'm sure she would have been pleased to know a single sentence from her put me on a career path that was so improbable it was a negative number but I never told her.  For some reason, I wanted to deny her the satisfaction, like it gave me some kind of power over her.

When I tried it on for size, what she said about being a good student, and saw the way the teachers began treating me different, like they liked me, I enjoyed that because at the top of my To Do List was to get out of the house and away from my old man.  I'd heard him smack my mother around when he came home drunk, and wondered at the weirdness of the next morning when the damage often showed but mom was busy making breakfast and pretending nothing ever happened, even going out of her way to please him.  One night, he storms in the door knocking things over and he comes in my room and starts masturbating only I didn't even know what to call it back then, I just knew it was scaring the piss out of me, literally, and when he put a hand on my leg I opened my mouth and started screaming at the top of my lungs.  He went for my throat, but I was young and fast and he was slow and drunk and my mom did make an appearance, finally.  "She's just having a nightmare," my father said.  "Julia, you shouldn't disturb your father like that," my mother scolded, as if she thought he'd been asleep.  She walked out of my room first and he leered at me over his shoulder on the way out and from that time on, I knew I was on my own.  I was eight years old. 

  So, you can imagine that Anna's mother seemed powerful to me: it wasn't the status I envied, not the title, not the money, it was the power.  Getting a good education would give me poder.  Pretty soon, teachers started expecting good grades from me and sometimes I wondered if I'd earned enough of a reputation among the commovedor that they gave me A's even when I didn't turn in my best work.  Either that, or I was more critical of myself than my teachers were, I never knew which.   

I had no doubt when it came time to apply to med school, a bilingual female from somewhere nobody else came from. Harvard tucks away full ride scholarships for people like me, but I stayed close enough to home to feel like I could recognize myself.  I mean really, Harvard?  I didn't want to get to know the people I imagined going to school there, old money, my-family-came-over-on-the-Mayflower crowd.  I picked the County when we all had to list our choices for residency; only one program, which everybody thought was crazy or arrogant or self-destructive or some dumb thing but L.A. County's Emergency Department program came through for me like I knew they would because they needed me more than I needed them.   There is hardly a patient that walks through their doors who speaks English. 

I liked the work, shift work, people come in and out and most of them you never see again so you don't have to act like you care about how their kids are doing in school and crap like that.  I could enjoy taking care of them while they were there, I was still more one of them than one of the doctors and besides, they say interns are so low on the totem pole that they're actually beneath the ground but I didn't care, I was higher up than I'd ever been before and after I got into med school, my old man never touched me again. 

I remember when I first saw the Practice Bulletin on the Abuse Cycle.  There it was, in 10-font typeface; 1. An interlude of calm  2. Rising tension  3. Explosive behavior  4. Remorse and reconciliation.  You mean everybody knows about this?  I felt like hiding the paper but as time went by I heard so many stories about thugs who terrorize their wife and kids that it started to seem more normal and gradually I realized it helped me do my job.  Patients seemed to want to tell me about stuff they wouldn't tell anybody else.

One night, a nurse dragged me over to a curtained off room, like, we didn't always pull the curtains but this one was shut up tight and I walk in and there's a fat guy on a bariatric cart who was crossing the street in his I'm-too-fat-to-walk-mobile and a truck slams into him.  One lung is down and his other lung was so crowded by all his grasa that his O2 sats were in the 30's, the son of a bitch was dying right in front of our eyes.  They'd worked their way up to the senior resident for this one, there was blood on the floor and the fat guy is grey.  The senior says, "You wanna give it a try?" as if it were the most hopeless situation in the world and who was I to think I could do something he couldn't do and it occurred to me that my boot knife would come in handy getting through all that fat but instead I asked for an 11 blade on a long handle, not some wimpy 15, but an isosceles triangle with a point like a dagger and then I just kept shoving it in until it scraped against bone.  We had to improvise with a tongue depressor to keep the space open while I threaded the chest tube and I knew it was a good thing the senior was out of there in five months because he hated my guts after that but my reputation was made, as a lowly second-year;  good with the pissed off rejects and good with a knife.

So, I like this life, staying aloof from the residents and going home alone.  It feels safe.  Every once in awhile I look up an old boyfriend just to get laid.  I always went for the reserves, nobody new, and it feels so good to have someone's hands on me, that's it almost more than the sex.  My guys act all hurt, like you only come around when you want something from me.   I don't stick around long afterward, either, and nobody ever comes to my place.  I make sure no one from my old life even knows where I live.

Emergency Departments are the Keepers of the Legends.  In a place like L.A. County the stories are fantastic, and none of them can be verified.  It doesn't matter, we all believe them, anyway.  There's the bullet-in-the-head Hall of Fame, always trotted out for the interns.  These are people walking around with a 9 mm round too close to a critical structure to go after it, you'd be surprised how common it is.  But the favorite, told in whispers, is about the old Department head, a real asshole.  He hardly ever showed his face where people were doing the actual work but one night he decides to come down and inspect the troops and keels over with a fucking heart attack right in his own E.D.!  Nobody wants to touch him, man.  Finally, somebody puts him on a cart and then somebody else calls cards and the cardiology fellow shows up and it's this skinny, white broad with black hair cut off right below her earlobes wearing pearls and heels and a red suit and she starts screaming bloody murder over how nobody is doing anything for this guy.   She's yelling orders into the air, where's the senior resident? She wants to know and when she finds out who the guy on the cart is it looks like she's going to have a heart attack right along with him.   She finally gets leads on him and gets him down to radiology and that was the last we saw of him.  Everybody knew he lived, but his chairmanship days were over. 

  So, one of the favorite hospital policies to ignore is the rule about not leaving the campus in scrubs.  Really, the campus?  That sounds a lot more like brick buildings covered in ivy than permanently stinking tile covered emporiums where you can often hear screaming from the lobby.   It seems like it's not fair because a lot of us hardly own any clothes by the time we're juniors, we're in the hospital all the time anyway, nobody knows what day it is, we sleep in scrubs, work in scrubs, get laid in scrubs and for some reason we have to change clothes to walk outside?  So I'm in full battle dress one day in Target, an isolation gown on backwards for a jacket, flowing out behind me like a bridal train, when I run into Anna's mother, with no Anna.  She shrieks my name and stares at me and the full reality is evident: she knows nobody but a doctor would break the rule so flamboyantly that there are still 18-gauge needles in both of my pockets.  Julia, you're all grown up, she says and she's all quiet now, like we're in a church or something, and you're a doctor.   I can see her coming for me, arms wide open so I back away and say I'm all dirty and I wouldn't want her to catch a mega-resistant bug from the places I've been lately, ha-ha, but she won't give up, she takes my hands like a consolation prize and looks at my nubby nails and one thumb still has a little bit of somebody else's blood on it from pushing in an IV and she starts crying right there in the card aisle and I'm trying to figure out the quickest way out of there except I can't just bolt, so I say, what's Anna up to these days? And then it's like I'm right back at work, she's in a residential treatment facility and then she tells me that she's divorced, because, get this, Mike was very abusive and I think was that why we were friends?  We both had dickheads for fathers but neither of us ever talked about it?

I was still trying not to get sucked in but she's pouring out her heart right in the middle of the birthday card aisle where we're surrounded by glaring exclamations that read Somebody's Four Years Old! and I think, this is intolerable, so I say let's go sit down for a minute and then we're sitting next to the popcorn machine which somehow seems really silly, like, we should be inside some important looking building for all this to take place but she's talking away like she doesn't even know where she is or care who hears and there isn't anything I can do but listen.  She says she knew Anna was using drugs and that was what made her father so crazy they finally had to get away from him, file a restraining order, carry permit, the whole nine yards and she would have hired private security but she was too broke and Anna blames herself for her parents' break-up, original thought there, meanwhile her addiction goes from bad to worse and one night her mom sits up in bed with this sick feeling and goes to check on her and she's passed out on the floor and not breathing.  Kaye starts giving her CPR and she's crying and trying to figure out how to get to the phone while still doing CPR but she can't reach the phone and finally she decides she'll have to make a run for her purse which she does and dumps everything out on the floor next to her unconscious daughter and dials 911 and that's it, doesn't say a word because she's right back doing CPR except she manages to scream Help in between a couple of breaths and she's like going crazy afraid her daughter is going to die or maybe she's already dead and she's screaming Help! every so often and the cops tag the phone and the TRO and bust down the door and race upstairs, weapons drawn.  Then she told me the only nice thing I have ever heard about L.A. cops:  one of them took over CPR.  It may not look like it on TV, but solo CPR is exhausting and true to form as the professional she still was, she'd cracked a couple of her daughter's ribs but she kept her heart beating. 

Now, I had a pretty good security system built around my heart that had worked well for me for years, but like everything else, things wear out and in that moment I was tired of keeping my guard up, feeling like I was on the run  all the time so I'm crying now, too, and I just let loose with this flood of tears that ordinarily would have caused far too much humiliation for me to ever walk back in that store and I just kept saying, I'm so sorry, I'm so sorry  and we're both looking for something to blow our noses on until jointly we decide to purchase Kleenex and then walk out of the store, together. 

  I finally let her hug me in the parking lot and it felt good, like the hands-on feeling I got from the neighborhood guys I occasionally gave the honor of fucking me and suddenly I was just questioning everything, like why am I doing this?  As if working until I hallucinate from sleep deprivation is an end in itself?  Why?  I had such a big problem with post-call hallucinations that I didn't even talk about it when the other residents joked about their own visual disturbances.  Twice, I'd had auditory hallucinations, which are not a well documented consequence of severe, acute sleep deprivation and I didn't know what was going on there but eventually I told Anna's mom about it and she wasn't too surprised, she said it meant I'd been under a lot of strain for a long time, Yeah, like my whole life, I thought and then I thought about Anna and her mom keeping up this secret in a nice house and wearing those damn uniforms and smiling all the time and it just made me want to go lay down and not get up.

  Everybody could see the change in me right away when I went back to work, like, I just don't really care and I told the senior resident I'd had some tragic news about a family member and should probably take some time off.  Anna's mom still had the house and said I could live there and she'd feed me for as long as I wanted to stay and maybe we could help each other and Anna, too.  So, I moved into Anna's bedroom and started visiting her so much they joked about me being an unpaid employee of the treatment center and I could see that Anna really was getting better and every single time I saw her she told me what a big help I was and I didn't believe it for a long time because I was wrecked, too, but then I saw that allowing Anna to see that was the very thing that was making her better, which is still something I don't understand although now I believe in this verdad, this mystery, two sick people can help make each other well and when she says I'm a big help I say You're a big help, too and one day we said this to each other in the chapel which is packed with junkies of every description and it just seemed so funny we start laughing until we cried and snorted and had to catch our breath and we ended up rolling and crawling around on the floor in hysterics and every time we looked at each other the hilarity started all over again and nobody took the slightest notice of us so I guess it's a good thing we were where we were.

  After three months without a word, one of the residents called to ask if I knew what my plans were and I said I'd call her back and that night the three of us sat around the kitchen table and talked it over, like a real family.  I kept looking at Anna's mom for a cue until she finally stood up, took my hands again, looked me in the eye and said, I will not be disappointed if you drop out and I realized I'd been waiting for her permission which surprised the hell out of me because I didn't think I asked for permission from anybody.  So, with fifteen months to go to Board Eligibility I gave it all up and the department chairman did his duty and called my cell phone to ask if I wanted to come in and talk it over, like he cared.  There were plenty of ambitious kids ready to make a mark in the world, or at least in his department.  I'd gotten scholarships for everything because I was such a brilliant underprivileged hermanito so I didn't have a ton of debt to work off like most of my companeros, most of them would graduate with 30-year notes.  For the first time in my life, I just felt so free, even though I had no idea what I was doing.  We talked about getting out of L.A. but none of us really wanted to leave the house where we'd been broken and then put back together again.  We all had the feeling that the world was our oyster.  

Trudy Sirany has practiced Ob/Gyn in Minnesota for the last 26 years.  She was born in Wisconsin, attended college in Michigan and is the only one of her collegiate group of friends (all of whom had long hair parted down the middle) to remain in the Midwest.  She resides on five acres in Blaine with her two teenage children, two very large dogs  (who bark but do not bite) and a small but ferocious cat, who once brought home a turkey.