and survived the Bataan Death March. They might have made it through the barbarous treatment of the Japanese, but they might not make it past the emergency room on a night when Barry Krakauer was the admitting resident. Or he would argue that the patient needed to be admitted to orthopedics or general surgery. Once he turned to me that first month, when we were admitted a COPD patient who was fighting to stay off the ventilator, “Covington, when a patient comes in the emergency room, they’ve got to show me that they really need to be in the hospital.”
On rounds, during that first month on the ward while Barry was my resident, he always seemed to see trouble coming before I did, and the minute he saw smoke on the horizon, he’d subtly stand out of the way. Once I didn’t know the blood count of a patient who had a bleeding ulcer after we transfused him. Barry took a step away from me as Mark Armstrong, our attending physician, asked me that very question. Things had been so fast and crazy, I hadn’t the time to obtain in the lab. Barry burst in. “It was 30.5%,” he replied, making me look both stupid and inept. I hated him for it, nursing my feelings close to my heart, adding that much more contempt that I had for the man. That hatred for the man is tattooed to my soul.
During that long first year, my feeling toward Krakauer I found were shared by many of the other residents. Krakauer’s sense of self-entitlement that grated most on his fellow house staff members. Neither did his narcissism nor his manipulative ways endear Krakauer to his fellow house staff members. There was more than a trace laxness and fecklessness in the way that Krakauer conducted his professional life. If Barry could slough an admission off upon another resident, he never hesitated to do it. None this was lost on the rest of the residents of the internal medicine department. None of it was lost on the residents in other specialists when Barry dumped a patient on them. He was not liked.
Picturing himself as a ladies man, with his hair of long black curls, a nose like a Russian wolfhound, his thin lips, and his lean frame he appeared to me like Long John Silver, readying to pirate a ship in calm water. Not every pirate sails the seas. But the women did seem to chase him, something of stupefying surprise to me, though in time, most of them recognized him for the sleaze he was. One modus operandi he used was to provide a shoulder to cry on when some nurse or resident had just been dumped by their boyfriend. During my internship year, there was an especially beautiful second year resident. She had moved to Albuquerque for her residency in internal medicine with her boyfriend, a well-known journalist, in tow. Coming off call one evening when she was still an intern, she found all her belongings strewn out on boxes on the cement patio in front of the main door of their house. That was the first and only notice that their relationships was over. Who was there but Barry when she needed a shoulder to cry on. And healing for Bruce was total only when it was in the Biblical Sense too. Every time I saw him after that, I could hear the soulful warbling of Marvin Gaye singing “Sexual Healing.” Proud of the fact, Krakauer circulated the story within the residency group. Chagrined, she regretted her intimacy with Krakauer for the rest of her residency. No longer would she even say “hello” to Barry in the hallways. Whereas Krakauer thought he was just ministering to the sick and needy in his satyric ministrations, he couldn’t understand the animosity that many of the women in the medical center held for him. Who could blame her?
As Krakauer was a third year resident when I was an intern, it was good to know that it was his final year in the program and I wouldn’t have to deal with him anymore when the year was up. But Barry surprised me. He surprised all of us. Instead of Barry disappearing, receding from our life like a conscientious butler – something that was too much to hope for – he became ever more entangled in it. Rather than going off and doing a fellowship, or going into private practice, he talked himself into a job in the emergency room first at the Albuquerque VA Hospital and then, finally, at the UNM Medical Center. He was living proof of the Peter Principle. There was a certain irony to it: where he had argued so much in the past with other ER attendings whether a patient had to be admitted, he was now admitting patients to the various services of the two hospitals. “I believe I have to have a good reason not to admit a patient to the hospital when they come in the emergency room. They’ve got to prove to me that they can go home.” The first time he pulled that one on me when I was an admitting resident, I reminded him of what he had said when I was an intern and he was the admitting resident. He denied making the statement. But the other residents remembered. Not a few of them called him on it when he tried to admit someone who truly didn’t need it. While he worked in the emergency room, he invariably wore surgical scrubs, the V-necked tops amply showing off his chest hair and his gold necklaces, with a white lab coat and his Littmann Cardiac Stethoscope draped around his neck. But he was still a fuck-up. One night when I was on call, he beeped me to admit a Navajo grandmother. Like many of her tribe, she was diabetic and hypertensive. Unfortunately, she spoke no English. But her daughter, who was with her, did speak English. She had shigellosis, having diarrhea for the last three or four days. Krakauer seemed to be proud of himself for finding the bacteria under a microscope. He had shown the slide on the microscope in the lab to the medical students who were in the emergency room that night and the ER residents. What he didn’t do, though, was take a thorough history. What was bothering her worse than the diarrhea was the chest pain she’d developed yesterday. To Krakauer’s chagrin, the EKG revealed tombstones across the precordial leads, evidence that she’d had a heart attack. Her cardiac enzymes almost reached a thousand. What would Sir William Osler have to say. I worried for the citizens of Albuquerque the nights he was in the emergency room. Barry circumvented some of my worries: contacting the resident on call for any speciality, he essentially shifted the responsibility to their shoulders. This infuriated me as much as anything. It proved how spineless he truly was.
During the second two years of my residency, I went out of my way to avoid Barry Krakauer. I dreaded the nights I was on call when Krakauer was in the emergency room. While the other emergency room attendings pulled their weight, Barry always seem to be more interested in any new nurses or residents he wanted to know better, or, in the winter, how the skiing was on Sandia Crest or in Santa Fe, a long hour away. When he I was down in the emergency room admitting a patient, he had not adequately worked up, I watched as Barry orchestrated the patient flow in the emergency room. As they wheeled one inebriated patient in asleep on a gurney, Barry said to me, “It looks like he’s going to need to come in, too.”
“Work him up, Barry. Then give me a call.”
That was Barry. The winds had changed. Those were, as my religious mother would say, “Saint Jude” nights, when one just have to pray for deliverance. When I saw on my calendar that I was due to be on with Barry in the ER, I’d just groan. And I’d slip the medallion of St. Jude she’d given me in my pack. Those nights, one of Barry’s girlfriends would drop him off at the emergency room entrance. He’d already be in his surgical scrubs. I’d go to bed early the nights before I knew that I’d be paired with him. Once Barry came on, I knew he’d repeatedly call me about patients who didn’t really need to come into the hospital; when they came into the hospital, he’d never have their story really together. Unlike the maxim he had given me when I was his intern: “He never had his ducks in a row.” Not infrequently, he’d never have done the appropriate work-up of their condition, nor would he have begun any basic treatment for it. Barry Krakauer, Talk show host and emergency room attending. Frankly, had I been Barry Krakauer I would’ve been embarrassed had my internal medicine skills as Barry’s had, to the point where they were at best tenuous when he had a medicine patient in the emergency room. He got to the point where he’d call one of the internal medicine residents down to the ER to interpret an EKGs that eluded his comprehension. Barry, having gone through the same medicine residency, was even more qualified to read them since he had become board certified in internal medicine. That was the way Barry got by: making someone else do his work. Things there were even busier than they were at the VA, and I dreaded to see his number come up on my beeper whenever I was on call as a second and third year resident. I never forgave him for the was he always made someone else take the blame for one of his misadventures.
Finally, on a godforsaken early spring night that brought rain and wind, thunder and lightning, towards the end of my
