There Has to Be a Catch
By Marc Egnal
“There has to be a catch.”
My roommate, Abioye, and I were scrolling through places where we could intern. We had both finished four years at Einstein College of Medicine, living in a tiny walkup in Brooklyn, and were facing impossible burdens of debt. Here’s what med school is like: elation at scoring high on your MCAT along with a near perfect undergraduate GPA, joy at being one of the few to gain admission to a prestigious school, four years of grueling work, and then graduation and total depression, realizing it would be decades before you can pay off all you owe. In both our cases, that was over $200,000.
Medical internships are not the promised land—only a step along the way. Typically, you’re paid about $60,000 a year (which doesn’t leave much after living expenses), and you’re asked to work impossibly long shifts—often 18 to 24 hours at a time. Those hours may sound crazy—and they are. It’s a rite of passage every doctor endures.
So, we were startled and excited when we saw the posting from Missoula Foothills Medical Center. The salary, $70,000, was just a touch above average. But the perk was a singular one. The listing read: “Stay with us for a year, and we’ll pay 25 percent of your medical debt.”
Abi and I plunged into Wikipedia to see what western Montana had to offer. Missoula was hardly a desolate place, home to a notorious party school, the U of M. Trout streams and hiking trails abounded. That appealed to me; I came from a small town in upstate New York. Abi, born in Lagos and a big city kid, wasn’t quite so enthused. But the inducement was hard to ignore. Neither of us was tied down by any romantic entanglements that might hinder a move to the hinterland. So, we applied, hoping we wouldn’t be pushed aside by a mad stampede from other similarly burdened med students.
“There has to be a catch,” Abi repeated. We didn’t know it at the time, but he was right.
We applied to several other places, if with less enthusiasm. We hoped we could stay together; we had become best friends during our four years at Einstein. Abioye Ogundipe was a “gentle giant” well over six feet in height. He was an old-fashioned idealist in an era when too many of our classmates were cynical or narrowly self-interested. His goal was to work for Médicins Sans Frontières, preferably in a poor African country. He was a cheerful person, fun to be around, but when hassled, watch out.
Only a week later (a remarkably quick response), Missoula Foothills invited us both to join their team. We’d be interning in the ER.
Missoula, often called by locals “Zootown” (you’d get that, if you heard how Missoula was pronounced), had definite pluses. Rents were astoundingly low. We leased a townhouse for less than the cost of our cramped quarters in Brooklyn. Public transit was surprisingly good—it was a college town—but we decided to shell out for a used F-150.
The local paper, the Missoula Daily Sentinel, provided a valuable window into town life. What Abi and I greatly enjoyed was the back page, entitled “Rumors and Sightings.” Reports of alien craft were a constant. So were stories about various monsters, often accompanied by artist’s renditions. The Flathead and Blackfeet reservations were not far away, and many of the strange creatures that purportedly slaughtered cattle and sheep leaped from the pages of indigenous lore. These fiends included Wendigos and Teihihans, both evil, human-like demons. Abi and I viewed it all with amusement, with Abi noting that it reminded him of Nigerian folklore. But locals (excluding the college kids who lived in their own bubble) took it seriously.
After a weekend settling in, we went to our scheduled meeting at the Emergency Room. Madeleine Rourke, who headed the ER, met us with a smile, a clipboard of paperwork, and told us not to be shocked by anything we saw. But we were.
Here was the layout for the ER. You entered a foyer, where the triage nurse had her station. Next came a large anteroom. Standing against the wall were three heavily armed Montana State troopers. Some show of force was no surprise. Abi and I had trained in Brooklyn and the Bronx, where every ER has an armed officer. Especially at night, many of the injured came from drunken brawls and needed restraining as well as healing. But that job required only a single officer, generally with a sidearm—not three soldiers cradling automatic weapons. Still more unsettling, the walls of the anteroom were riddled with bullet holes, hastily plastered over.
Madeleine tried to reassure us. “Think of Foothills as a frontier hospital in the Wild West,” she said. “That’s why we’re so generous to interns. The violence that happens in the western reaches ends up on our doorstep. Foothills is actually a safer place to work than Missoula General. They housed the vast majority of serious Covid cases. Several doctors and nurses died there during the pandemic. That didn’t happen here.”
Abi and I were silent, processing what we were hearing and seeing. Madeline continued: “If you’re in the main part of the ER, where patients wait and are treated, you’re always safe. If for some reason, you’re here with me, and I ask you to leave, do so immediately, with no questions. I’ve been at Foothills over twenty years, and I can assess risk in a way you may not be able to do.”
Our shift started that day, and like interns in that time-honored tradition, would continue for twenty-two hours. “So, that’s the catch,” Abi said to me as we got into our scrubs. I wasn’t sure we had yet seen the full picture.
We were soon too busy to reflect on the eccentricities of Foothills. Abi and I worked three twenty-two-hour shifts each week, getting by on pots of coffee and stimulants, which proved readily available. Practicing alongside Marianne proved a valuable experience. She could immediately distinguish between benign chest pains and an incipient heart attack or between swollen glands and a growth that demanded a biopsy. I even delivered a newborn with her guidance. The hospital had two OB/GYNs on staff, but they didn’t get to the ER in time.
About twice a month, the steel doors that separated the anteroom from the rest of the ER (and the entrance foyer) came crashing down, and we could hear the muffled sound of gunfire. Abi and I wondered about it. No one answered our questions, simply noting the “dangerous folk” who turned up at the hospital.
But then that Thursday in September came. Abi and I were both near the front door, giving feedback to the triage nurse. A patient had been unceremoniously dumped outside the entrance to the ER. He was morbidly obese, and two orderlies struggled to slide him onto the lowered gurney. The pneumatics groaned, elevating him. The two orderlies pushed him into the anteroom and then fled. The man was struggling to breathe, and his chest was heaving.
Marianne grabbed us. “Come with me,” she ordered. “Now!” She grabbed us by our wrists and pulled us into a small chamber off the anteroom. A steel door came down as soon as we entered.
“Marianne, what are we doing?” Abi asked. “That man needs our attention.” I agreed. Standard procedure would be to clear the breathing passages, apply oxygen, and check his vitals. Once he was stabilized, you investigate further.
“Can we at least see what’s happening?” I asked. There were two screens above the door.
“They’re not working,” she replied. It was clear she was lying. She did not want us to see what was going on in the anteroom. We could hear gunshots.
“That was wrong, very wrong,” Abi said. “I won’t let that happen again.”
“You don’t understand the dangers that people who come in here present,” Marianne responded. After about fifteen minutes, the door lifted. The body had been removed and the floor mopped.
Abi and I were both shaken and considered quitting. But the incentive to stay and receive that bonus was immense. And I felt I was becoming a better doctor.
Our second direct encounter with the violence of the anteroom came in January. Because of a snowstorm, the ER was short-staffed. Abi and I had been ordered to go to the front door, now frosted from the bitter cold, and help bring in a patient who had been left there. That seemed to be an unfortunate practice at Foothill—whoever brought these distressed individuals to the hospital didn’t want to be involved.
The woman lying on the ground presented much as that man had in September. She was extraordinarily obese and was breathing heavily, with her chest slowly rising and falling. Marianne, Abi, and I moved her onto a gurney, and pushed her into the anteroom. As before, Marianne, with great urgency, ordered us into the small chamber. Her grip was strong on our arms, but this time Abi tore himself away. What he planned to do, I wasn’t sure. There was no medical equipment in the anteroom. Marianne screamed at him, but he shook his head “No.”
The three soldiers seemed immobilized, seemingly afraid to go near the gurney. Marianne pushed me into the chamber, and the steel door came down as before. This time, she turned on the screens. “I want you to see this,” she said.
What I saw I can never unsee. Abi put on his stethoscope and began to check the woman’s breathing. Then the woman’s belly distorted, stretched impossibly, and a homunculus burst out. The creature looked like the Teihihans depicted in the Daily Sentinel. It was a small man with razor-sharp teeth, and claws where hands might be. It grabbed Abi and, as strong as he was, he couldn’t pull it off. It bit through his neck, and when it was clear he was gone, the soldiers opened fire. Their bullets made short work of the creature.
I let out with a string of words I never use in polite company. Then I grabbed Marianne and shook her. “What have you done?” I shouted. “You’ve killed my best friend. Why didn’t you warn us, explain any of this to us?”
“Would you have believed me if I told you about these demons?” she responded. “Maybe that was a mistake, a serious one. We are trying to keep these beasts a secret and the story contained.”
I was beyond angry. “You should tell Washington, or the army, or the FBI,” I said.
“We could,” she replied. “Missoula would become a ghost town, tens of thousands of lives disrupted. The army would launch another vendetta against Native Americans, and certainly we’ve sinned against them enough. Right now, we are keeping it in check. Everyone knows to bring cases of ‘possession’ here.”
I broke down in sobs, and she put her arms around me. “I hope you stay to finish your internship,” she said. “I will understand if you leave, but if you tell anyone about what you witnessed, we’ll say it’s your fantasy. If you stay, I promise we’ll do better than that 25 percent.”
I had nightmares that would stay with me for the rest of my life. For three years after I left Missoula, I struggled with PTSD. But treatments for that disorder have vastly improved. I’m not sure what my psychiatrist thought of the “hallucinations” I shared with her, but she helped me immensely. I finally finished my medical training and got a job in an ER in Rochester, not far from where I grew up. My finances were now in great shape, thanks in large part to being debt-free. The one year at Foothills had made all the difference in my bank account.
I also married and had two daughters. When the girls were five and seven, all of us traveled to Lagos to visit Abioye’s family. I had stayed in touch with them, and they welcomed us with singular hospitality. The Ogundipes did not believe the story about the “hunting accident.” But then, neither did I.
