In the second week of my residency, I was allowed to hold a scalpel. A box came around in the lecture hall, the blades turned facedown into the cloth like victims. We passed them back from row to row while the chief of general surgery gave a talk on complications.
He had prepared a presentation and ordered the slides by likelihood of death. Most catastrophe was fundamentally mundane, he said. Did we know, for example, how many patients died after surgery because we accidentally stitched them back up with our own scalpels inside?
The answer was that no one knew. We could guess but we could never get the numbers. That was the catch, of course, how it was impossible to count what we did not remember.
The chief of general surgery told us that when it came to surgical complications, we were all thinking too hard. You think complications happen, he said, when you don’t know what to do. The truth is that you will know what to do. You’ll know the procedures so well you’ll think they’re a part of you. But the time will come when you fuck them up anyway.
The illustration for this slide was a clip art man with a smile but no nose. On top there was a clip art scalpel, and an arrow pointing into his clip art stomach.
Also, the chief of general surgery said. Even if the patient turns out all right in the end, the malpractice will set you back ninety-five-thousand dollars at least, and that’s not counting the lawyer.
▴ ▴ ▴
Later I wondered about these cases, how long it took the patients to notice. Whether this was the kind of thing you knew right away, fresh from the haze of anesthesia, or whether the realization grew more slowly, over days or years. Whether you could grow old this way, never suspecting—so that even after the scars grew dull there could be a blade lodged beside your liver, buried inside and then stitched over neatly within.
In pop psychology there is a myth about flashbulb memories. A truly exceptional event, the thinking goes, can sear the moments before and after into your recollection. Even years later the subjects in these studies will tell you where they were after their first child was born, or when their father died, or when John F. Kennedy was shot: down to the newsreels on their televisions, down to the colors of their shoes. The problem is that the memories are wrong. In these studies, researchers report that subjects do not even remember what they do not remember, left with the embroidered fabric of stories that sound like truths.
But in the weeks since I began searching for my younger sister, I have noticed a certain clarity in my memories of Rose. Sometimes I think I remember not only the day that she left but the whole of her more completely now, even the things I never knew. I was conscious in our youth of a spreading void between us, as if we stood on either side of a canyon furrowed by our seven-year divide. After she was gone, I was startled when I began to see her reflected in inconsequential things: a patient whose heartbeat I became convinced had the same tempo, a wig in the oncology gift store that was the same shade as her hair. Over time I have come almost to hate this—how in her absence, the world seems steeped more strongly in her presence.
▴ ▴ ▴
During a cadaver class in the early days of medical school, I saw a ribcage split and eased open for the first time. The air was thick and burnt with the smell of newly cut bone, and we stood around the table looking inward while the teaching surgeon paused for questions. We touched mostly on clinical things: how to reach in around a hernia, how to count the lobes of a liver, how to use a surgical stapler by squeezing the handles three times after lifting the safety, like firing quick shots from a gun. I don’t remember asking anything. My hand was very close to the cadaver’s open palm, and I kept looking at the wrinkles, how the skin had grown rippled and stiff as a worn-out glove. A real patient, the surgeon told us, would have come in on rolled towels. Instead our cadaver was arched awkwardly over a piece of wood, the abdomen thrust into the light—an expectant angle, as if craning backward before a somersault.
Someone asked about the age at death. Maybe sixty, said the surgeon, and then hesitated. It’s hard to tell with these patients, he told us, without checking the papers. She could have been much younger, the years layered on more thickly with disease.
▴ ▴ ▴
On Fridays, sometimes my parents call while I am still outside general surgery. The halls are lined with unused machines, and I take all their calls by the same empty bedside, leaned up on the rail and absently smoothing the sheets. Occasionally I have thought about changing my number, but in the end I always answer, our conversations leaden and awkward. Rebecca, they say, we went to church today, or we bought more tomatoes, or we cooked pasta and defrosted meatballs for dinner and deep-cleaned the carpet under the bed. That’s nice, I say sometimes, or really?, and then before the silence weighs too heavily, I hang up.
▴ ▴ ▴
As a child, the only doctor I ever met was the father of a girl in my elementary school, a radiologist who worked at New York Downtown. During a field trip there, he spoke to our class about lung cancer and pushed us around in wide-backed wheelchairs which he stole from a nearby waiting room and rolled out into the empty hall. On the subway back, the girl whispered to me that her father had treated the school librarian. I knew her, an old and gaunt-looking woman who had disappeared in the fall and returned that winter stretched gaunter. For months I wondered what other secrets this man took home every night. I grew up with her father as my secret idol. Even then, I dreamt of carrying that knowledge everywhere like a hidden glass ornament, shielding it from unseen cracks.
▴ ▴ ▴
In late September Mount Sinai hosts a seminar on the psychology of lie detection. Another resident tells me that the guest lecturer is famous for developing a method to read off truths from the smallest gestures of faces. During the seminar we learn that there is a taxonomy of facial expressions, that this man has categorized every motion from the flex of an eyebrow to the narrowing corners of lips. For hours he clicks frame by frame through videos of liars—an interview with Nixon, a recording of a woman taking a suicide questionnaire and answering no, no, no, though we are told that after leaving the ward she went up the street to throw herself off of a bridge. The presentation reminds me of the heady first days of my anatomy classes, when I would walk across the medical school campus and imagine the rest of the world peeled and exposed before me. I felt a thrill, early on, when I looked into the mirror, the sense of a bloodless dissection. In the evenings when I was too exhausted for books, I quizzed myself on my reflection, thinking tensed zygomaticus major, contracted risorius, strain slightly in the orbicularis oculi, knowing these things were nameable and countable, how we had defined the terms and angles of a smile.
During a break in the seminar, I practice reading off expressions with the boy sitting next to me. When we begin he tells me his name is Daniel. Hi, I say, and then scrutinize his open expression for some indication of a false identity, but I find none, and he shows me his name badge to be sure.
Though it turns out that we are both terrible liars and terrible at spotting them—I tell Daniel that I am deathly afraid of heights, which is true, but he claims that my nose twitched once as I spoke. When it is my turn he says that as a child he had gotten lost in a department store for an hour. He was eight years old, he tells me, and he had hidden under a rack in the men’s coat section, trying to pick out his mother by her shoes. This sounds so pathetic that I tell him I believe that it really happened, but he laughs and says it isn’t true, not all of it, because he had actually been in the children’s section by the jeans instead of the dress coats in men’s. That’s not really a lie, I tell him, but he insists that it is.
“You should have seen something,” says Daniel. “Like maybe when I said dress coats, you should have noticed if I blinked.”
This is the point of the presentation, we agree—that somewhere on our faces, even the littlest deceptions are laid involuntarily bare.
That evening I am taking the elevator up from the basement when a nurse wheels in an entire surgical bed. Sorry, she says, and then rolls the bed in more tightly until I am pinned up against the wall. Up close it is an enormous thing, bulky and padded. Once the doors close I feel like a trapped animal.
In my youth I slept for years in a thin-framed steel bunk bed that was nothing like this one—stripped down, no safeties, not even rails. I shared the bed with my sister and slept in the lower bunk even through college; we kept the same places at Thanksgiving and Christmas when I returned home on breaks. The day our father assembled the bed, he let me choose a bunk first. The top, I said, but we had covered our ceiling with glow-in-the-dark stars, and that night I grew terrified in that lovely claustrophobia, how I seemed too near to the sky.
Once she switched to the upper bunk, Rose complained about the ambient light. There was always something outside, she said—police, streetlights, neighboring cars. Eventually our mother installed specially made curtains over the windows, heavy enough that I could pull them down during the day and wash the whole room into dark.
Neither of us slept easily; I could hear our awakeness in the cadence of our breaths. On one of these nights, after we had lain without speaking for hours, Rose announced suddenly that she no longer believed in a God. I dreamt later that things would have been different if I had answered, if I had reached up to find her hand. Instead I lay very still and unspeaking, the night stretching senselessly through the darkness. I never told my parents what she had said, not even later. I thought of my friend with the radiologist father, how easily he had locked what he knew behind waiting room doors. I did that, then, in that anxious silence, lifted what I had been told into a dusted-off place in my consciousness and held it there for what I imagined might be an eternity.
▴ ▴ ▴
It was my mother who begged me not to enter medical school, terrified of the profession and the woman she feared I would become. She did not often mention her childhood, but on the winter break before I graduated from college, she recounted a series of eye infections from her grade school years. Her parents mistrusted the size and intentions of hospitals, but gave in after a month to consult a family doctor. She could still remember his expression when he shined in the light—like he thought he could look through to her soul.
That summer I ran down our printer compiling stacks of applications. Often when I was in the other room, I knew that she circled them nervously, running her thumb over the piles. She claimed to worry only that I would be consumed, pulled at all hours into the hospital away from the waiting world, but I always suspected that her distrust ran deeper.
“They look at you differently,” she said once, when I pressed her. “Like a thing, thinking they know how you work.”
I thought of a day when she had taken Rose and me to a museum with a traveling exhibit on automatons, the entrance crowded with mechanical pianos pressing their own keys over and over, as if played by an unseen hand. We wandered the exhibit together until Rose shifted away, already bored, and then I walked up and down the aisles alone. In one room there was a music box the size of the refrigerator. The curator asked if I wanted to look under the lid.
I had seen the inside of watches before—once my father shattered his Canal Street knockoff and I holed up with it in my room for hours, using a tiny screwdriver to unfurl the coiled springs—but when the man opened the music box, it took my breath away. Inside there were hundreds of gears the size of thumbnails. I stood, watching them whirr. In that moment that machine grew beautiful to me, and somehow infinitely more ordinary; there were no ghosts within.
When I turned away from the music box, I found my sister gone and my mother interrogating a security guard in a barely suppressed panic, asking if they had seen a little girl about—and she swept her hands past her hips—that tall. After nearly an hour of searching, we found her on the rooftop balcony, dangling her legs through the rails and squinting at the passersby moving small on the sidewalk below.
▴ ▴ ▴
This is how I will always remember Rose, her youth wreathed in tiny defiances. Even in elementary school she had wanted out, though back then I never pinpointed how, or where, or what she wanted out from. I recognized only that she craved the thrill of escape, always watching through subway doors and car windows and racing to the far corners of each block when my mother’s back was turned. Her friends gave up on hiding games, but as the years rolled on, my sister carried that instinct within her, always springing up from conversations and schoolwork, from dinners, from the embrace of the boyfriend she brought home to parade before our parents and then discarded without ever once kissing, after three shackled days.
▴ ▴ ▴
In the wards there is a protocol for everything, and our lives are ceaselessly ordered. By October, in the few unwritten hours of the day, we do everything deliberately backward, eat cereal for lunch and occasionally for dinner, cannot remember the order in which to take on and off clothes that are not our lab coat and scrubs. Residency breeds a claustrophobic incestuousness, and we do this in the wrong order too—fuck first and then ask for dinner, knowing already that this will never happen, that we are always too tired and have no time during the day. We do it, we laugh in the morning, because as the hours unfold, time ceases to matter. We do it because there are beds everywhere, because the sheets carry the provocative scent of sterility, because we are young and our best years are before us and it is four a.m. and these are hours when anything goes.
This is how it is with the resident who comes behind me in the consulting room when I am scrolling unseeingly through Facebook, too exhausted to click any of the links. Beneath the unblinking lights I remember him slowly: Daniel, from the psychology seminar on faces. Twice we have stayed up together studying for in-training exams, but in this scrubbed twilight zone we explore each other differently, our bodies as familiar as textbooks. All the things that I have memorized—beneath my hands the trapezius muscle, the teres minor and teres major, I mouth these Latin names like little prayers as I trace my fingertips above each of his vertebrae, counting to twenty-four, counting bones. Though maybe this is only a story that I misremember. On the autoclaved sheets we forget all the terms within minutes and move our palms over nameless flesh, nameless muscle, each curve blurring into the next.
In the shuddering intimacy afterward, he rolls over to examine my face and asks me to lie to him so he can practice the taxonomy of expression. Sure, I say, and he thinks for a while and asks me to tell him about the last guy that I dated.
“There was one,” I say, “Jeff, in medical school, but at the end of the summer I walked in on him making out with a neurology third-year in one of the public bathrooms.”
“Who even does that?” says Daniel, and I say, “He was a bastard, I guess,” and I laugh.
He considers that for a moment, and then asks if I have any siblings.
“No,” I say, too quickly.
“I saw it,” he says, and then he grins, triumphant. “Right when you said that. The corners of your mouth, before you straightened them out—I saw that tiny frown.”
Though I have lain on these sheets many times, it is only then that I first feel truly exposed, scared at the way he has dissected the twitching of muscle down into these secret things.
“Okay,” I say. “I do have a sister. But she’s gone now. Not dead. She sort of—ran away.”
“How old is she?” he asks.
Often in examinations I have forgotten vital facts—once I could not remember the difference between systolic and diastolic, and another time I left the room of a dying woman, too scared to re-ask her age. Outside I flipped through the charts. She was ninety-five. I had never touched the body of a woman so old.
“She’s eighteen,” I tell Daniel. “Her birthday was last month.”
“What’s she doing now?”
“I don’t know,” I say. We roll over on the green-sheeted cot, and even then he searches my face for the giveaway trace of deception.
“I’m sorry,” he says, after a silence.
▴ ▴ ▴
When Rose turned ten, my uncle gave her a book for her birthday. Inside there were instructions on how to draw fifty different animals, each one enumerated into a collection of shapes. She flipped through it once, and we did not touch the book again for months. Eventually I was the one who lifted it down from the shelf. This is not my best or most vivid memory of Rose, though I have clung to it anyway. We are sprawled on our living room floor with pencils and paper, our drawings meticulous and terrible, copying animals made of ovals. After a while we grew bored and left for lunch. I do not remember if we finished the sketches. But I come back to this, now, how we lay by each other then sketching lions for an hour.
▴ ▴ ▴
It was humid, the night I told our parents, the air damp and feverish with August heat. I would split my life into halves around this moment, the time before I came home and the endless days since. In those restless last weeks before residency, I called home in a panic of acute loneliness. It was one a.m., but my mother picked up, and I confessed that I could not bear my own apartment, the sudden emptiness of Jeff newly gone. Back at home I spent most evenings wandering in and out of the kitchen, thinking of surgery and sleep. On this night I went out for a walk—to clear my mind, I told my mother, though outside the world seemed too swollen with summer. Someone needs to give New York an ibuprofen, one of my classmates had said at graduation. Reduce the inflammation, take this city down a notch.
Three days earlier Jeff had called to apologize. For nearly four minutes I watched my phone ring before shutting it off. In the voicemail, which I kept despite myself and listened to twice the first night before sleeping, he sounded husky. I imagined him calling amid a surge of sudden regret, dialing my number, maybe, from somebody else’s bed. I’m sorry, he said several times, always in that same muted, unparseable tone.
Rose had gone out to a movie with her new friend Christina. In those weeks, she always seemed to be leaving, out visiting Christina or other high school friends. Even when we were younger, I had always felt Rose slipping from me, but that summer I became acutely conscious of a spreading distance, the way she seemed to be growing too quickly into someone I had never known. In our single phone call at the start of the summer, she had handed the phone back to my father. I mentioned this to my parents—her constant goneness—but they pointed out that, unlike other daughters, she always came back home.
When I saw her, I was passing the doorway of a 7-Eleven. I remember walking and thinking about the case study of a man who had woken up one morning convinced that his leg did not belong to him, that a foreign limb had been slipped in somehow beside him while he slept. She stood with Christina in the shadowed alley beside the convenience store, their lips only just touching, bodies angled together and cradled awkwardly in the night.
In childhood when Rose was too young to speak, I had once stood beside her while she slept, taking the measure of her hair and her palms, wondering where I would look to know her completely. I thought of Jeff, how in so few days I could now count up a spiraling ledger of secreted selves. For a while I stood at the corner, watching Rose part and unpart Christina’s hair, their hands hesitant and searching around each other’s waists. Then I walked back home.
“I’m going back to my apartment,” I announced to my parents when I returned. My father looked up from the dining table, and then my mother shook the suds from her hands and came over, asking whether something was wrong, whether it was the residency, whether it was Jeff, so that I thought suddenly of crying.
“You just got back,” said my mother. “We set all the blankets on the couch, and I was going to make a casserole tomorrow.”
“I know,” I said, “but I’m going now. I want to sleep in my own apartment. I want to sleep in my own bed.”
“You’re never here,” my mother said, voice lifting. “You never tell us anything more than a day in advance. You never come home from the hospital, we never see you, and one day you won’t even know who we are.”
“You don’t know,” I said, “a thing about anyone. You threw out my old textbooks, and now even Rose has Christina, and don’t even pretend that you knew.”
▴ ▴ ▴
In the nights that followed, often before sleeping, I would remember how in those first seconds I thought bitterly not of undoing what I had said, pulling back and swallowing my own words, but simply felt—watching their faces swept blank with surprise—a sour reassurance. There was a comfort in knowing that Rose was uniformly opaque, that there had been no slices of her that only they knew. When I fled the apartment, my mother was already keening. Later I suspected that before Rose returned, they were already praying for her, the way we had done for my grandmother in the minutes after she died.
▴ ▴ ▴
I have never learned how Rose left. Whether she walked out in the morning, whether my parents beat her out with a broomstick, whether they gathered all of her things into a box and left it on the doorstep before she returned. I told myself later that she had run away voluntarily, that Rose had read the truth off their faces the next day and that there had been no tears. I would come to think that it had been a sterile procedure, as if cauterized—minimally invasive, nothing ripped, everything burned.
A family friend told me Rose was gone two days later, and then I called my parents in a panic. The cell reception was terrible in the hospital basement and I could barely hear myself above the static, but I asked whether I should put up posters, paper the city with flyers covered in a colored photo of her face and a reward.
“Did you call the police?” I said. “Do you have any idea where Rose is?”
I remember a pause, and the jagged sound of their breathing. My father swallowed, and then asked whether I was excited to begin my residency and whether I had been cooking for myself lately, as if I had never spoken her name. I circled back to her again in the days that followed, each time more feebly, and eventually I gave up. Once, before I hung up, my father added almost as an afterthought that they had disassembled the bunk bed. If I ever visited again, he told me, I would need my own set of pillows to sleep comfortably on the couch.
▴ ▴ ▴
Come November, I begin to see the operating theater as a jungle of compulsion, all that cleansing and cutting and Jesus Christ, did you pass your hands through your uncovered hair? For a whole month while I am pulling knife blades across vessels and bone, I worry that I will never learn to steady my hands.
I am cauterizing a patient today—don’t bury the tip of the instrument, cautions the watching surgeon. Cut with the heat, not with force. The smoke curls unhurriedly within the abdomen, and first, I pray silently, first let me do no harm.
▴ ▴ ▴
I go to winter flu vaccination clinics, organized by a missionary group at the shelter on East Eighty-Sixth. After Rose’s disappearance, I attend these events selfishly. Good residents give back to the community, we are told, though I am the one searching. There are too many people and there is no sense in looking. Still, I go and I go. Before the thirtieth visit, the school holds a ceremony and we receive printed certificates for our dedication.
All week long it has been raining, the sky swathed in unbroken gray. We trample in wet and swearing, track dirt all over the linoleum entrance between the shelter check-in desk and the door. There is a prayer before the clinic, and we are standing around in the lobby during the pre-vaccination mass. “Sometimes you need the rain,” another resident tells me. “I get bored when there are too many beautiful days in a row.”
The shelter volunteers clear out a room, and we fill it with rows of collapsible tables and folding chairs, unpack cotton balls and sharps containers to the murmur of prayer from the room down the hall. When the mass concludes we take our places. I am assigned station five—“Injections,” a volunteer informs me, “not nasal spray”—and already we have fallen into the familiar tableau of authority, the first-year medical students adjusting their hospital badges too often, everywhere the throngs of premed students, always near at hand, always so eager to defer. Someone props open the door, and the shelter residents flood in to form haphazard lines. We have assigned the premed kids to sign in the patients. They mill about with their eyes down, as if we are gods. I want to reach out and shake them. It’s amazing, I think of saying, what can be hidden away under a white coat, how this must be the reason for shrouds in the morgue, to cover up any deadness within.
▴ ▴ ▴
What I remember most clearly from that first cadaver class, where we stared at the woman aged not by time but by illness, was how fully I had failed to prepare. There was a prep session beforehand that I had not attended, and so I walked into the classroom not realizing that the body would be headless and limbless, that it was cheaper to purchase only the torso for lecture, our professor bent at the start of the day over a shapeless trunk of covered flesh. I took my place at the table—in the presence of any part of a body, it seemed redundant to admit surprise. We watched two procedures on a screen, the camera burrowed in through incisions the size of bottle caps, and then the attending wheeled in a saw and told us he was going to crack the chest. Don’t worry, he reassured the front rows, the bodies were bloodless. Then we leaned in closer, our voices drowned by the whine of the saw as he lowered the blade.
This is what it means to be a cadaver, I told friends later—you are sliced and stitched and hollowed. I was conscious throughout the lab of a resonant emptiness, the way I felt, even as we reached in to hold the discolored organs, that there was nothing left inside.
▴ ▴ ▴
Sometimes at the flu clinic I hold my breath when I walk around corners. She’ll be there this time, I think. Or now, or maybe now.
Though perhaps I have simply gotten better at lying, even to myself. If she came, what would I say?
There are times, a professor said once during a lecture on palliative medicine, when there is simply nothing more to be done.
▴ ▴ ▴
Still, during ER rotations I linger on my breaks by the entrance, checking the sign-in sheets twice every hour and asking the attending to watch for a girl about age eighteen. I can only describe her as I remember her. The ragged cut of her hair, the eggshell curve of her chin. Every night I dream longingly of terrible things—that Rose will slip in the winter and shatter her elbow, that she will be struck by an unthinking cyclist, that she will wake up one day to uncontrolled bleeding and gasp for help. In these dreams, she is whisked to Mount Sinai and I stand by her mutely, examining the pale splintered places in her X-rays and stroking her arm. Against protocol, I am assigned as her surgeon. Beneath anesthesia, she lies unmoving beside me while I stitch her back together, weaving the needle into her skin. In these dreams, just before I wake, I am fixing the broken things between us with a scalpel and sutures, mending the only wounds I know how.