Dear Dolores
by Rachel Kowalsky
Dear Dr. Kaye,
Just a friendly reminder to complete your E.R. provider note in the electronic medical record for the attached patients.
Thank you,
Dolores
Dear Dolores,
Apologies. There so many clicks and dropdowns! I’m spinning my wheels.
Sincerely,
Dr. Kaye
Dear Dr. Kaye,
Can you finish by Tuesday?
Dear Dolores,
I’m tangled in the template for URI’s. “Patient denies fever” feels wrong. I don’t want to click it. Happy Wednesday.
Dear Dr. Kaye,
Happy Wednesday. Making you aware, at 14 days I escalate to Admin.
Dear Dolores,
“Patient” leaves my patient nameless, and “denies” sounds like a trial. So, I’ve been free texting: “Felix doesn’t have a fever.” But the text box is glitchy. The seconds add up, become minutes, 14 days. It’s exhausting, Dolores, but necessary; each word reverberates so loudly.
Dear Dr. Kaye,
Admin gave you 3 more days.
Dear Dolores,
Great! For the girl who stopped eating, should I click “Appetite change”? I checked the box, then realized I’m not sure about her appetite. She could be voracious. Un-checked it. Her appetite, appetites, are unknowable, locked in her tiny frame. Isn’t that the problem? The chief complaint?
Dear Dolores,
What is a chief complaint? A complaint is a whine or grumble. Unwanted, uninvited. But we’ve sent the invitation. We’ve hung a shingle that says “Let us help” and “Tell us what happened, what changed today, brought you across weather and traffic and all life’s entanglements to see us.” Dolores, I have to change “chief complaint” to “chief concern” in every chart. Retrospectively. Yeah, I’m going backwards.
Dear Dr. Kaye,
I suggest moving forwards in time, not back. Back is not productive. Back doesn’t help anyone.
Dear Dolores,
It had to be done. But I’m on to the next patient: Underage, assaulted at a bar. Did she “accept” a drink? Or was she “given” a drink? You see the difference. When her friend took off with the guitarist, were they “separated,” or did her friend “leave” her? Should I include how she met the guy? It was a swiping app. Anyone over 40 will judge, anyone under will exhale sharply: could’ve been me. I’ll leave it out.
Dear Dr. Kaye,
Maybe worry less about the story?
Dear Dolores,
The story matters! I walk around it like a house. Where are the lights and the doors? How do I map the rooms? Is there a truth to reveal, or just what I see, believe, decide? Did she then “run away,” or “go missing”? Day 17.
Dear Dr. Kaye,
Sign and send!
Dear Dolores,
Representation is an ethical task. I write and click and click and write, and the story takes shape in its boxes. Do you know Metamorphoses? In Book One, after the deluge, the world is remade and fleshed in mud. Some mud becomes human and some becomes monster. I must not flesh the monster.
Dear Dr. Kaye,
It’s true. Also, at 3 weeks I have to notify your Chair. If we can’t bill, we can’t keep the doors open. Then we can’t care for anyone.
Dear Dolores,
The mud is our words, Dolores! Which words we choose, and where we place them. Consider the Russian boy with the languid eyes who skipped school to drink White Claw. School called it truancy and the police brought him in. I was his doctor. “Where were you?” I asked, my job to establish that he was safe while truant, not abducted, abused or run over. He told me he’d laid down beneath a tree in Central Park to contemplate the icicles on its boughs and the sun that angled through its limbs. “Weren’t you cold?” I asked, thinking of pernio or frostbite. But he said, “No, I wasn’t cold, I was happy.” And then he looked at me. Me! and said, “Do you know what I mean?” I wasn’t sure how much to include. I wrote “Absent from school. Visited Central Park. Did not feel cold.”
Dear Dolores,
Who are you, and what do you feel when you read my notes? Are you still thinking about the girl who was assaulted by the guy from the app? Her crappy, useless friend who took off with the guitarist? Did you stop reading when you got to that one, pick up your phone, call someone you love?
Dear Dr. Kaye,
I’m a former court stenographer, now living midtown near a diner with the best souvlaki. I review 80 charts a day. And make no mistake: I have cried, Doctor Kaye. I have cried to see writ large the pain of the people in the city I love. I count my blessings. With respect, you are not the only one who’s read the Romans. “I’m human, so any human interest is my concern.” That’s Terence. Also, I had to email your Chair.
Dear Dolores,
I understand. Tell him 3 weeks isn’t enough. Tell him we’re conversing with each other, and with history (the history of our patients’ lives), and with Ovid and Terence. Such things can’t be rushed.
Dear Dr. Kaye,
How much time is enough?
Dear Dolores,
I don’t know, because the story never ends. Sometimes as I type, I realize I should have said something else, done something differently. Was I too quick to CT scan? Too slow to intubate? Regret comes, fast as water. I look things up and call my friends. Sometimes I call the patient and ask: “What happened next?”
Dear Dr. Kaye,
Everyone does the best they can.
Dear Dolores,
You’re right, it’s never perfect. Even if we wrote down every moment from the start of creation, that first flash and bang, we’d be missing information. Like, who lit the match? What did it sound like?
Dear Dr. Kaye,
It’s my last day in billing and coding. I’m retiring! Of all the doctors I was ever assigned, you were the worst. And the best. May you find joy in your work. May you name every patient, only click what’s true, choose your words. May you walk those houses and find where the lights are. Never, ever flesh the monster. Talk back to history. And Dr. Kaye, take your time. Such things cannot be rushed.
Rachel Kowalsky is a Guatemalan American writer and pediatric emergency physician in New York City, as well as a four-time Pushcart Prize nominee. Her stories and essays appear in The Missouri Review, Variant Literature, Atticus Review, Booth, The Intima, and elsewhere. You can find her published work at rachelkowalskymd.com.
Hear more about this work on -ette’s companion podcast, pod-ette.