Shelly Is Doing Great

Chapter 1: The Best Appendix in the Building

Erin McCabe had been dying of a ruptured appendix since eight-fifteen that morning, and by ten-forty she was starving.

This was her fourth death of the day. She lay on her left side on the exam table in Room Four, knees pulled up to her chest, right hand pressed flat over the spot just inside her hip bone. She took short, shallow breaths through her teeth. Her forehead was damp because she had splashed it in the bathroom between encounters. Her face was the color of cold oatmeal because she had not slept, which was not technically part of the role, but it helped.

The student across from her was named Brandon. He had a brand-new white coat with the fold lines still pressed into it from the packaging, and he wore his stethoscope draped around his neck like a scarf his grandmother had knitted and he felt obligated to wear.

"Okay," Brandon said. "So. On a scale. Of one to ten. How would you rate. Your pain."

He said it in five separate pieces, like he was reading it off cue cards.

"Nine," Erin gasped.

"Nine," Brandon repeated, and typed it into his tablet. Then he stared at the number for a while, as though it might change if he gave it enough time. "Would you say it's more of a nine, or more of a high eight?"

Erin let out a groan. It started low in her stomach and climbed slowly up toward the ceiling tiles, and it was, she knew, the best groan in the building. Second-year medical students had been known to step backward from it.

Brandon stepped backward from it.

"A nine," he said quickly. "Nine is great. Not great. Nine is noted."

The Northcoast College of Medicine's Clinical Skills Center had once been a Babies R Us. It sat in a strip of office parks in Independence, a few miles south of Cleveland, between a dental billing company and a place that sold commercial ice machines. On sunny days you could still see the faded outline of the old sign on the brick, including the backward R, and the cartoon giraffe that had once stood beside it. Nobody had been able to fully scrub off the giraffe. It loomed over the parking lot like a ghost who had died happy.

Inside, where the cribs and car seats had been, the college had built twelve exam rooms out of drywall. Each room had a sink, a padded table, a rolling stool, a blood pressure cuff mounted on the wall, and a framed print of a sailboat that nobody had ever looked at directly. Each room also had a large mirror that was not a mirror. Behind the glass, in a long dark hallway, faculty sat in front of monitors and ate granola bars and watched the students try. A camera in the corner of every ceiling recorded it all for later, so that the students could watch themselves fail in high definition.

The floor of the main hallway still had faint aisle numbers painted on it. Room Four was in what used to be Aisle Nine, Feeding and Nursing. Erin found this funnier than anyone else did.

She was a standardized patient, which meant she was paid twenty-two dollars an hour to be sick for strangers. She had answered a Craigslist ad four years earlier. It had said, Are you an actor? Are you comfortable being touched by nervous people? At the time she had a theater degree from Kent State, two seasons of community theater behind her, and three years of selling phone cases at a mall kiosk. The answer to both questions had been yes.

Since then she had developed the best appendix at Northcoast. She also had excellent migraines, a convincing pulmonary embolism, and a chest-pain-that-turns-out-to-be-a-panic-attack that the faculty requested by name. The panic attack was popular because Erin did not have to work very hard at it.

Brandon washed his hands, which was good. He warmed the stethoscope on his palm, which was very good. Then he pressed down on her lower right abdomen with two stiff fingers and let go fast, and Erin screamed, and Brandon leaned toward her belly and said, "Sorry. I'm so sorry," directly to her stomach, as though her stomach were the one who had been wronged.

When the buzzer sounded at the end of the twenty minutes, Brandon thanked her for her time and told her that someone would be in to see her soon. Then he left, and Erin uncurled, sat up, and drank half a bottle of water in one go.

This was the part she liked best.

After every encounter, the standardized patient stepped into the hallway and filled out a checklist on a tablet clipped to the wall. The checklist was long and very specific. Did the student introduce himself or herself by name and role? Did the student use the patient's preferred name? Did the student wash his or her hands before the physical exam? Did the student ask about the onset, location, duration, character, and severity of the pain? Did the student explain the next steps in plain language?

Yes, yes, yes, mostly, and no.

At the very bottom of the form was a box labeled Additional Comments.

The Additional Comments box was Erin's only reliable joy.

She typed: Student was polite and washed his hands, which puts him ahead of roughly half the people I've met. However, when asked to rate my pain, I gave a clear number, and he tried to negotiate me down like he was buying my used car. When he caused me severe pain during the exam, he apologized to my stomach and not to me. My stomach and I are a team. Please speak to both of us. Finally, he told me someone would be in to see me soon, but did not say who, or why, or that I need emergency surgery, which I do. I left the room believing I might be seen by a janitor.

She read it over, fixed a comma, and hit submit. Somewhere in a database, Brandon's future had become a tiny bit better, whether he liked it or not.

She had three more appendixes before lunch.

Erin lived in the left half of a half-double in Lakewood, on a street lined with other half-doubles, each one slightly more tired than the one before. Her half had two bedrooms, one of which was full of boxes she had moved from her last apartment and never opened. It had a front porch with a broken swing and a kitchen with a stove that only lit on the third try.

It also had a radiator.

The radiator was in the living room, under the front window, and it banged. It banged in January, which made sense, and it banged in August, which did not. Her landlord, Mr. Szymanski, said it was just the pipes settling. The pipes had apparently been settling since 1952. Some nights the banging came in long, angry rounds, like someone trapped inside the wall was pounding to be let out. Erin had started saying, "I know, buddy," when it happened. She was aware that this was not a good sign.

She got home at a quarter to six that evening and then, as she did most evenings, sat in her car in front of the house for a while.

She did not plan to do this. It just happened. She would turn off the engine and look at the porch, with its broken swing and the dead geranium she had bought in May, and she would think, I'll go in in a minute. Then she would check her phone. Then she would listen to the end of a song, and then the beginning of another song. Then a neighbor would walk past with a dog and she would pretend to be looking for something in her purse. Tonight it was forty minutes before she made it inside, which was about average.

She did not know exactly why she did it. Going inside meant being home, and being home meant being alone with the radiator and the boxes and herself, and in the car she could still be someone on the way to somewhere.

Dinner was a bag of shredded Mexican-blend cheese, eaten standing at the counter, by the handful. She had a system. She ate it straight from the bag, then folded the top over and secured it with a chip clip so that it would be ready the next night. She thought of it as meal prep.

She watched two episodes of a show about people renovating farmhouses and fell asleep on the couch with the cheese bag on her stomach.

At seven minutes after two in the morning, her phone rang.

She knew who it was before she looked. Nobody else called her at two in the morning. Nobody else called her at all, really, except dentists' offices and a robot who wanted to talk about her car's extended warranty.

"Hi, Mom."

"Were you asleep?" said Janice McCabe.

"It's two in the morning."

"I know what time it is, Erin. I own a clock." There was a pause, and the sound of ice rattling in an empty glass. Her mother drank white zinfandel out of a five-liter box that she kept in the refrigerator door, and she put ice in it, which Erin had once pointed out was technically watering it down, and Janice had said, That's the point, I'm being responsible. "I just wanted to tell you something."

"Okay."

"Your father is on Facebook with a jet ski."

Erin closed her eyes. "Okay."

"A jet ski, Erin. He's sixty-four. He's standing next to it in a life vest, and she's standing next to him in a life vest, and they both have the same sunglasses. Matching sunglasses. Like a couple of state troopers."

"Why are you looking at his Facebook?"

"I'm not looking at it. It came up."

"It doesn't come up, Mom. You blocked him. I watched you block him."

"I unblocked him to see if he was dead."

The radiator chose this moment to bang three times.

"What was that?" her mother said.

"The radiator."

"In August?"

"The pipes are settling."

"Your whole life is settling," said Janice, and then, before Erin could decide whether to be hurt, "Anyway. I'm out of wine. I'm going to bed. Love you."

She hung up.

Erin lay in the dark with the phone on her chest and the cheese bag sliding slowly off her stomach onto the floor. She thought about her father, standing beside a jet ski in a life vest with a woman named Tammy who sold above-ground pools. She thought about the twelve encounters on tomorrow's schedule. She thought about Brandon, and how at least Brandon had washed his hands.

Then she got up, picked up the cheese, clipped it shut, and went to bed. She had to be dying again by eight-fifteen.