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Prose Spring 2021

Clinical Aphorisms

by Angie Lee

Ding. The doors slide open.

“Going down?” A physician points to the ground and lifts his pointed eyebrows.

Olivia nods and he gets on.

Olivia is on her 52nd consecutive ride down to the first floor of Langley Porter. She has been on the elevator for, more or less, the entire afternoon. She hovers her finger over the close-door button when another physician, a younger one with too much mousse in his hair, dashes toward the elevator, outstretching his arm to wave it in front of the sensor.

If the sensor weren’t functional, Olivia thinks, the elevator doors would slam shut, amputating the moussed physician’s arm. Inside the small space would be herself, Dr. Pointy Eyebrows, and Dr. Mousse’s right arm — dripping blood, dangling nerves, and all. The arm, then, would teeter on the elevator floor, rolling around a bit before finding a stable position from which to ooze its remnants. Perhaps the fingers would twitch, once or twice.

The phantom limb is the false psychological sensation that a missing appendage is still attached.

Olivia learned this in her freshman year psychology seminar, the one she’d had to fill out an application to take, as it was such a popular class. Rumor had it that you got to dissect a real human brain as a part of the curriculum. In her application Olivia had written a story about how her interest in psychology stemmed from having a great aunt who had multiple personality disorder, how Olivia would be the one to sit next to her at Christmas dinners because no one else wanted to, just in case she inhabited one of her aggressive personality states like the angry cop or the violent schoolteacher. The story was completely made up — really Olivia just could not believe that her small state university had the proper resources for cranial preservation, and she wanted to verify that fact for herself — but it got her into the class, and the rumor ended up being true. On an average Tuesday night in the middle of the term, a TA brought into the classroom a brain, which was a shade between pink and yellow, on a tray which looked like one of those black plastic serving platters used by fast food chains in mall food courts. It reeked of formaldehyde and something similar to fish flakes. “Here’s the corpus callosum,” the TA said, lifting the brain off its tray with gloved hands. “That’s the bundle of nerve fibers that connects the left and right hemispheres of your brain.” The organ looked much drier than Olivia had imagined it would be. It was wonderfully grotesque. She wondered which part of it dictated her appetite, or lack thereof — which section warned angrily against the consumption of nutrients that were crucial to her body’s health. The next week she switched her major from English to Psychology.

The brain serves as commandant of the human nervous system. Each hemisphere is responsible for different tasks. The right hemisphere houses facial recognition.

Dr. Pointy Eyebrows and Dr. Mousse exchange a look indicating they know each other. Here we go, thinks Olivia. The elevator begins to descend, the red number above the doors decreasing every few seconds.

“How is our Mister Christian Dior?” Dr. Pointy Eyebrows inquires.

Dr. Mousse rolls his eyes. “Oh, you know, still thinks he’s Jesus,” he sighs.

The elevator is hot and smells like paint. Olivia becomes one with its back left corner, resting both arms on the thin ledges that outline the walls of the space around her. Wherever she goes, she likes blending in, feeling small and undetectable.

“It’s like his wife wants him to be a lunatic,” Dr. Mousse continues. “So that she can continue collecting those designer handbags with his approval.”

One check for ‘derogatory comments about patients or their families’ and another for ‘a violation of patient confidentiality.’ Olivia frowns. She has yet to come across a physician who doesn’t break one of the rules she keeps track of. The elevator experiment has not refuted but raised her level of skepticism towards the institution.

The ride stops on the second floor, welcoming a pretty nurse with red hair. The doctors grow quiet. Dr. Mousse backs further into the enclosed space, making room. He gets so close to Olivia that she can sniff the gel which sticks firmly to his head. The redheaded nurse smiles at both physicians, then averts her eyes. Watch your step, Olivia thinks as she enters, there could have lain the puddle of Dr. Mousse’s blood, his amputated arm.

Dr. Mousse has a rear view of the redheaded nurse. A nurse’s uniform is typically not flattering. It is designed for simplicity, with minimal places for contaminants to burrow. It is designed for comfort, for easy laundering, and for cheap replacements. It is not designed to fit perfectly to individual body types or to highlight one’s noteworthy physical features.

A nurse who attracts attention while in scrubs is a well-shaped nurse.

Olivia will become such a well-shaped nurse, in a few years’ time. Her curves will attract the attention of her male patients and hospital colleagues, and that of a few females, too. By then Olivia will have recovered from her anorexia. Upon completing her treatment at Langley Porter, she will return to college and finish her degree in Psychology. The degree will be of no use at first. After graduation, Olivia will turn to her mother for advice on what she should do next. Her mother will say, with the practiced ambivalence she often exhibits, that Olivia should do what she likes. Olivia will then think about what she likes — and the first thing she will think of is coffee (even on her most stubborn days, when she refused food, she would accept coffee). Though she knows this is likely not what her mother meant by her advice, Olivia will get a part-time job as a barista at Blue Bottle Coffee, where a customer will return, day in and day out, and order a caffe latte despite being lactose intolerant. This is because that customer will be interested in Olivia and find her quite beautiful, and a caffe latte takes longer to prepare than a black coffee. While she meticulously designs an elm leaf within the milk foam the customer will ask her questions about her day, at first shy and careful, and then as anticipated routine. That customer will eventually become Olivia’s husband. While working at the coffee shop Olivia will also attend night school, where she will learn the skills necessary to become a registered nurse. She will take the NCLEX and fail. She will take it again and pass. She will celebrate by eating forkfuls of cheesecake from the local bakery that offers only seasonal flavors. The seasonal flavor, then, will be maple pecan. A month later she will get hired as a nurse in a pediatric psychiatry ward in Oakland. Whenever she works with a teen patient struggling with anorexia, she will think of how it has come full circle, her life. She will remember the little elevator experiment she conducted during her days in Langley Porter, when her arms were so thin and her heart so cold. She will not once breach a patient’s confidentiality.

Semantic memory processes ideas and concepts that are not drawn from personal experience. Retrospective memory recalls people, words, and events encountered or experienced in the past.

Dr. Mousse grins a little.

Ding. First floor.

The medical personnel exit, the doctors following after Nurse Redhead. A dejected man pauses in front of the door, waiting for Olivia to get off.

“Oh, I’m going up,” Olivia says.

The man shrugs ever so slightly and steps onto the elevator. From up close, Olivia can see the wrinkles on his face. He has many — on his forehead, surrounding his lips, pinching the corners of his eyes — though he cannot be older than twenty-five. He stares at the buttons to the different floors. None of them are pressed. After a moment he presses the button for the fourth floor. Then, he does something that Olivia has not seen anyone do yet: he turns, arms straight at his side, and faces the back of the elevator. The two are now face to face — Olivia staring at him, him staring at the ground. The elevator lurches upwards.

On the second floor, the doors reveal another physician, waiting. It’s a woman this time, one who wears big round glasses. She notices Backwards Dejected Man and scratches her nose. Olivia wonders what Dr. Big Round Glasses will do next. She gets on the platform and moves to the right, leaning her back against the side wall.

Facing sideways. How diplomatic, Olivia thinks.

Dr. Big Round Glasses smiles at Olivia and puts her hands in the pockets of her white doctor’s jacket. On the third floor, another female physician boards, one that recognizes Dr. Big Round Glasses. Even when prompted by this new physician, Dr. Big Round Glasses doesn’t break any rules.

“Are you thinking fluoxetine or fluvoxamine for Phillips?” asks the new physician.

“Mmmm,” says Dr. Big Round Glasses. “Why don’t we discuss this later?”
Olivia is filled with a feeling that resides between the realms of pride and relief. Finally, someone who is trustworthy.

On cue with the ding of the fourth floor, Backwards Dejected Man turns around. Upon exiting, he holds the elevator doors open, potentially sacrificing his arm for the doctors and Olivia. The doctors thank him and disembark.

“Oh, I’m going down,” Olivia says.

Backwards Dejected Man looks at her for a long moment before going about his day.

It’s a rare occasion for an elevator to make a straight shot from the top floor to the ground floor of the building. This next ride, however, is smooth sailing. No stops, no participants in Olivia’s study. She begins to feel lonely.

Loneliness is perceived isolation.

Before dissecting the human brain, and before going to college, Olivia lived at home with her parents, whose presence tended to make her feel more alone. When Olivia was aged fifteen months, her sister, who was just a year older, died of congenital heart disease. Olivia was never affected by the tragedy; her parents never recovered from it. They raised Olivia from a steady distance, as if afraid of becoming too attached. On the first day of first grade Olivia packed her own boxed lunch — a ham and cheese sandwich with an apple on the side. Her upbringing had instilled in her an independence that was concerning more than impressive for her age. She was always provided for but never coddled. It was as if her parents had exhausted all of their coddling capacity on their firstborn, and they knew from experience that the overprotection of a child had no benefit in the end. And then once in a while, usually on a birthday, or the anniversary of her sister’s death, her mother would drink a bit too much wine and pour out her affection for Olivia all at once. Through tears, she would ask Olivia if she knew how loved she was, how much mama loved her. She would ask Olivia until she answered in the affirmative, again and again, though the truth was that Olivia wasn’t so sure. In such moments Olivia’s father was usually seated in the periphery and silent, sipping on a drink of his own. Olivia found solace in friends, but they, too, came and went. On days that she struggled to find someone to sit with at lunchtime, she avoided the meal altogether, heading instead to the school library where she immersed herself in other, better worlds.

A friend is a person with whom one shares a mutual bond of affection. Friendships can increase one’s sense of purpose and belonging.

Back on the first floor, Olivia is greeted by Nurse Redhead and one of her nurse friends. Back already? What a short break, Olivia thinks. Or had the ride with Backwards Dejected Man taken that long? Nurse Redhead doesn’t recognize Olivia. She presses ‘two’ with her left hand while covering a yawn with her right.

“Tired?” the friend asks.

“I worked 18 hours yesterday, went home, closed my eyes, and before I knew it, I was back here.” Nurse Redhead yawns again. “I don’t know how I’ll make it through the night in my right mind.” The two look at each other and smirk.

One check for ‘raises concern about ability to provide high-quality patient care.’

The friend claps Nurse Redhead on the shoulder, and they return to work on the second floor.

Olivia decides she has had enough. She regrets not having ended her study on a positive note, with Dr. Big Round Glasses. She finally hits a button and feels a tiny drop in her stomach as she ascends.

The sinking feeling in your stomach is caused by a change in force as experienced by your organs.

Years after she gets married, and months after she retires from her nursing position, Olivia will feel her stomach drop one last time, while she’s on a rollercoaster with her granddaughter at California’s Great America. It will not be a large rollercoaster (her granddaughter will only be six) but still Olivia will scream and shout and when the ride is over she will say “Meemaw is too old for this! Let’s take a break.” Her granddaughter, whose name will be Claire Olivia, will smile and shrug and ask for ice cream. They will sit together on a bench by a popsicle stand and Olivia will watch as Claire Olivia licks her strawberry-flavored treat in pure bliss. While trying to get the last bite off the mid-section of the popsicle stick, Claire Olivia will drop a piece of it onto the ground and threaten to cry. Under the hot sun, the frozen dessert will melt onto the cement pavement by their feet. The small red puddle will remind Olivia of the pool of blood she’d imagined on the elevator, that day in Langley Porter, when she’d gazed at everything with apprehension, a deliberate kind of cynicism. She will think of that phase of her life as her own phantom limb of sorts, a psyche from which she is detached but still feels connected to at times. She will wipe her granddaughter’s sticky mouth with a paper napkin and tell her it’s okay, Meemaw will get her another popsicle. When her granddaughter beams up at her, Olivia will think that she would like to stay on earth, for as long as she can, with Claire Olivia. Olivia will not leave the earth for another year, and when she does it will be peaceful, in her sleep and without pain. To her family it will seem sudden. “She was riding rollercoasters just last summer!” they will say with exasperated voices. They will pour coffee on the grass beside her tombstone and whisper for her to enjoy.

The socioemotional selectivity theory states that the concept of an end drives one to live in the present.

When exiting the elevator, Olivia steps over the imaginary puddle of Dr. Mousse’s blood. Just in case. The fourth floor seems much more spacious than she remembers. Lots of windows. Wide hallways.

“Where have you been?” her roommate asks once Olivia enters their room, which could be the definition of bland. She wonders if she will ever leave this strange and suffocating space.

Olivia sits down on her bed. Her legs dangle off the edge, her toes point towards her roommate.

“Did you know that in 1995, Dr. Jack D. Ubel at the University of Pennsylvania conducted an observational study of inappropriate comments made in a hospital elevator?” Olivia says.

“No.” The roommate begins to comb her hair.

“Did you know that in 14 percent of the elevator rides, a physician breached the confidentiality of a patient?”

“Have you been reading?”

“Did you know that here, it’s even higher than 14 percent?” Olivia says. “But there’s this one doctor, she has these big round-”

There is a knock on the door.

“How are you ladies? I’m filling in for Dr. Cao tonight.” A doctor steps into view and adjusts her glasses, looking down at a clipboard.

Olivia smiles widely.

“This is her,” she says, and sits up straighter in her bed. She prepares to listen and to learn, as she has been doing all day.

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