I nodded.
“So you are aware of the degree to which she in fact causes the unfortunate events of her life. And the likelihood that she will continue to cause them in the future.”
I nodded, and realized. She had seduced me after all.
The chief of service spread his hands. “Well, then. It’s hard. But that’s the way it is.”
She was cheerful, waiting for me in the conference room.
“Did you have the meeting?”
“Yes.”
“And what did they say about me?” She was as eager as a child.
“The chief resident will be talking to you.”
“You tell me now.”
“Karen, why didn’t you tell me about the drug overdose?”
“What drug overdose?”
“The one last year, when you were at college.”
“It wasn’t any big deal.”
“I think it was.”
“I figured you already knew about it. I thought when you called the college they told you about it.”
“No,” I said, “I didn’t call.”
“Anyway,” she said, shrugging it off, “what did they say about me in the meeting?”
“Well,” I said, “they think you need further therapy. They think it’s very important that you get it.”
“Will you be giving me my therapy?”
“No. I’m afraid my six weeks are up. I’m going on to another rotation starting Monday.”
“You are?” She seemed shocked.
“Yes. Remember? I told you last week.”
“I don’t remember.”
“Yes.”
“Well, will I at least see you again?”
“Probably not. I don’t think so.”
“So this is it?” Tears welled in her eyes.
“Yes.”
“Really?”
“Yes.”
She stood up and looked at me with her steady eyes. The tears, if they had ever been there, were gone. “Okay, goodbye,” she said, and marched straight past me, out of the room, and slammed the door.
I never saw her again. I never heard what happened to her. I never tried to find out.
A Day at the BLI
Five teaching hospitals surrounded the Harvard Medical School, but in the eyes of the students, the least interesting was then the Boston Lying In Hospital. Over the years the other hospitals had decided not to do obstetrics, so all deliveries were now done at the BLI: a whole hospital full of babies being born.
Most of my fellow students were unexcited by obstetrics, but I was fascinated at the prospect of seeing a delivery, and even doing one or two.
On my first day at the BLI, I stepped into a world that reminded me of nothing so much as Dante’s Inferno. Room after room filled with women, all twisting and writhing in rubber-sheeted beds like oversized baby bassinets, all shrieking at the top of their lungs in the most hideous agony. I was appalled. It was like something from the nineteenth century. From the eighteenth century.
“Yeah, well, these women are all on scope,” the resident said. “They all insist on it. They come in the door and, the very first thing, they go, Give me the shot. So we scope ’em.”
Scopolamine, famed in World War II movies as truth serum, was a soporific drug. But, as the resident explained, it wasn’t a painkiller at all.
“That’s why they’re screaming so much. Scope’s not a painkiller.”
“Then what’s the point?”
“The point is, it’s an amnesiac. They’re having the pain, but they won’t remember any of it when it’s over.”
And a good thing, I thought, watching them twist and scream and shriek. Many of them had to be tied down to the bed with restraining straps.
“You gotta watch how you tie ’em down, because you don’t want ’em waking up with bruises on their wrists. But if you don’t tie ’em down, they’ll bang around and hurt themselves, pull out their IVs, all sorts of stuff.”
I felt embarrassed for these women. Many were wealthy and elegant: carefully applied makeup, coiffed hair, manicured nails. Now they were tied down to a rubber hamper and they were swearing and screaming, utterly out of control. I felt like an intruder, seeing something I should not see.
“Why do you do this?” I asked.
“They insist on it. You tell ’em this is what happens, you show ’em, even—they go, I don’t care, give me the shot.”
I kept looking at the nurses, trying to see how they felt about it. They were women, too. But the nurses were blank-faced, neutral. As far as they were concerned, this was how it was.
“Isn’t there another way?”
“Oh sure,” the resident said.
Down the hall were more rooms. No rubber bassinets here, just ordinary hospital beds with women panting and groaning, with the occasional cry of pain. Most of the beds had IV lines hanging from them.
“Now, here, these women get an epidural, a slow spinal drip, for pain. And they maybe get a little Demerol, and they just work with the pain.”
It seemed much better here, much more human.
“Yeah. Whatever,” the resident said.
There were more rooms down the hall.
“Down there,” the resident said, “is where we have the girls from the Home.”
“The Home?”
“The unwed mothers,” he said, and named the home where they came from.
We walked down there.
“You gotta keep an eye on the nurses here,” he said. “If you’re not careful, they won’t give the girls anything for pain at all. Sometimes they let ’em get all the way to the delivery room with nothing at all. Sort of punishment for their sins.”
I expressed disbelief. I was back in Dante’s hell.
“Yeah, well, it’s Boston,” the resident said.
We went into this room. It was incredibly tranquil. Four or five teenage girls, panting and breathing and counting contractions. Only one nurse to attend them, and she was out of the room a lot. Some of the girls were having a great deal of pain, and they looked frightened, to be alone, experiencing this pain. I stayed in the room with them.
One girl, named Debbie, was red-haired and pretty. She was glad for some company and told me all about the Home, and the nuns who ran it. Debbie wasn’t Catholic, but her family had been angry when she got pregnant. They had taken her to the Home five months earlier. They hadn’t come to see her since. A few friends from school came to visit, though not many. Her sister wrote letters, but said her father wouldn’t let anyone from the family visit Debbie until it was over.
Debbie said the nuns were okay if you didn’t pay any attention to their lectures about sin. She said the Home was okay. Most of the girls were fifteen or sixteen. They all worried about missing school. Debbie would have to do her sophomore year over.
Debbie had read a lot of books about childbirth, and she told me how the baby developed in the uterus, how at first it was like a pinhead but then a couple of months later there was a beating heart and everything. She told me about breaking water and about contractions and how you had to breathe with the pain; she and the other girls had practiced the breathing. She knew they weren’t going to give her painkillers. She had heard that. The nuns had told her.
From time to time as we talked, she would stop to go through the contractions. She asked to hold my hand during the contractions, and she would squeeze it hard. Then she would let go, until the next time.
Debbie explained that the girls talked a lot about keeping their babies, that most of them wanted to keep them, but a lot of the girls wouldn’t be fit mothers in Debbie’s opinion. She herself wanted to keep her baby, but she knew she couldn’t, because her father would never allow it, and anyway she had to go back to school.
“Can I have your hand again?”
Another set of contractions. She looked at the wall clock. She told me they were only three minutes apart. It wouldn’t be too long now, she said.
I talked to some of the other g
irls in the room. They were all the same, all right there with the pains, paying attention, going through it. Most of them said they didn’t want to see the baby after it was born: they were afraid that it would be too hard if they saw the baby. They were experiencing intense physical pain, and they were talking about intense emotional pain, but they were all right with it. They all had a calmness and a dignity.
* * *
Meanwhile, back in the high-class rooms, the private patients, the respectable married women, were strapped down in rubber beds, swearing like sailors, screaming their heads off.
It didn’t make any sense to me. The people who were being punished were having the best experience. The people who were being indulged were having the worst experience.
I saw my first delivery. It was, on the one hand, just like what I expected. And, on the other hand, to see the little head appear, and then the little body, immediately transported you to some other reality. It wasn’t a medical procedure; it was a miracle. I walked around in a daze. I saw several more deliveries. I couldn’t get used to the feeling. I was floating.
I went back to the room with the girls from the Home. It was still peaceful; the girls still panting, alone. Debbie was gone. I checked the other rooms; I couldn’t find her.
I found the resident scrubbing outside a delivery room.
“Say, did that girl from the Home deliver?”
“What girl?”
“Debbie.”
“Don’t know her.”
“Sure you do. Cute girl, red hair. Debbie.”
“I never look at the faces,” the resident said.
I grew to despise the Boston Lying In Hospital. I stopped showing up for my duty hours.
Of course, childbirth has changed greatly since then. You let a husband in the delivery room and he won’t permit his wife to be tied down screaming like an animal, even if the doctors and nurses see nothing wrong with it. And the negative consequences of delivering narcotized babies have come to be more clearly acknowledged. Natural childbirth was a rarity in Boston in the late 1960s. The few doctors who did it were considered outlandish kooks. Now natural childbirth is quite unexceptional. In fact, except for the recent enthusiasm for cesarean sections, childbirth practices represent one of the areas where medicine has changed for the better. And the Boston Lying In Hospital has long since been torn down.
Lousy on Admission
Emily was a sixty-six-year-old woman who lived alone in a small apartment. On a routine visit by a social worker, she was found lying unconscious on the floor, and was rushed to the hospital.
In the emergency ward, she was noted to be semicomatose for unknown reasons. Her clothes were filthy and unkempt. She was also infested with lice. She was cleaned up, deloused, and admitted to the medical floor.
When I first saw her, Emily was a tall, gray-haired, sharp-featured woman, sleepy and unresponsive. If you tried to wake her, she would grunt and push you away. Nobody knew what was wrong with her, how long she had been lying on the floor of her apartment, or why she was stuporous, but lab tests showed her chemistries were severely unbalanced.
My resident, Tim, reviewed her chart. “Lousy on admission,” he sniffed. “Obviously a lot of neglect here, probably some senility. God knows how long she was lying on the floor.”
Emily was given intravenous feedings to correct her body chemistries, but she did not awaken. Meanwhile, nobody was able to find out anything more about her. Apparently she lived alone in a small apartment in an unfashionable part of town. Apparently she had no friends, no living family. No one came to visit her. She was an isolated, neglected old woman, obviously unable to care for herself. She was in our hands.
And we were not able to determine why she was unresponsive. She appeared to be in a deep sleep, but we couldn’t tell why.
Abruptly, on the third day, Emily awoke. She looked around at all of us.
“Oh shit,” she said.
Her language further distanced her from the resident staff. An old lady who swore: she was obviously senile. We questioned her. What was her name?
“You think I don’t know? Scram, Daddy-oh.”
Did she know where she was?
“Don’t be ridiculous.”
Did she know what day it was?
“Do you?”
Did she know who the President was?
“Franklin Delano Roosevelt,” she said, and cackled.
A psychiatric consultation was requested. The psychiatrist found Emily to demonstrate “bizarre ideation, strange flow of ideas, and hostile affect.” Noting that she had been lousy on admission, he suggested that she might be in the early stages of senile dementia.
We still had no idea why she had been comatose, and we ran more and more tests on her. In the meantime, she seemed to sleep less, to be more generally alert. But she remained distinctly odd: you never knew how she would greet you when you walked in the room.
One day it was “Ah, Dottore, how are you today?” in a corny Italian accent. “What news from the Rialto?”
One day it was “All quiet on the Western Front?” and her irritating cackle.
One day it was “Going to stick me full of needles again today? The human guinea pig, huh? You think I don’t know what you’re doing, Daddy-oh?”
She hated Tim, and the feeling was mutual. But for some reason she liked me. “Ah, the gigantic cherub, cómo está usted? Pablo should paint you, dearie.”
I talked to her. I was able to confirm that she had no living family, that she had never married, that she had lived alone for many years. I asked her the usual questions you asked old people, like whether she had any hobbies. She would snort contemptuously at the very idea. “Hobbies? Hobbies? I’m not an idiot.”
“Well, then, how do you spend your time, Emily?”
“None of your fucking business, Dottore.”
She puzzled me. She was evasive, but there was a strange strength to her, a kind of imperiousness. I speculated she might be a rich old Boston lady fallen on hard times, and now embarrassed by her condition. I speculated she might be foreign-born. She seemed to know a lot about artists and literature and music, making all sorts of references to Pablo and Ezra and Thelonius and Miles.
These references went right past Tim and the other residents. They just thought she was senile. In fact, Tim became increasingly annoyed with her. He ordered more and more tests on Emily.
We still didn’t know what was wrong with her. Emily had lots of minor problems—a slight hypothyroidism, a degree of anemia—but nothing that would explain her stuporous condition on arrival. A condition that was now gone. Yet Tim continued to order tests. Finally he said, “We have to deal with her anemia. I’m going to order a bone-marrow biopsy.”
Bone-marrow biopsies were painful. “Why?” I said.
“Just to complete the workup.”
“But her anemia is improving, and it’s probably iron-deficient,” I said. “There’s no evidence of any other problem. Why are you putting her through a biopsy?”
“I feel it’s required,” Tim said.
Actually, I didn’t like Tim. I’d had terrific luck in most of the residents I had been assigned to for my year of clinical work, but it was inevitable that sooner or later I’d be paired with someone I didn’t get along with.
Many things about Tim troubled me. He wasn’t well educated except in narrow scientific matters; he didn’t know sports, or politics, or popular culture, like current movies. So he didn’t understand what patients were telling him if they alluded to any of these things.
Either because of this or for another reason, Tim was sarcastic about the patients. He made nasty cracks about nearly everyone under his care. He also complained about the patients’ families, and the trouble they caused when they visited the hospital.
Finally, his physical manner was rough and harsh. He’d yank and pull at people in their beds, shoving them around, yelling at them, “No, no, not like that, just stay the way I had you!”
In ret
rospect, Tim was a frightened man trying to hide his own sense of inadequacy behind a façade of bullying sarcasm. But at the time I thought he was outrageous. All of the house staff had witnessed his behavior; more than once, glances were exchanged at the bedside. I felt Tim ought to be taken aside. I felt he needed psychiatric help. But nobody was doing anything about Tim, and it wasn’t my position to suggest that a member of the house staff needed a shrink. I was just a medical student, the lowest of the low. And at the end of three months, Tim was going to give me my grade.
But now Tim was planning to do a punch biopsy on Emily’s hipbone, a painful and, I believed, unnecessary procedure. I felt he wouldn’t dare to do it if Emily weren’t an old woman without friends or relatives, a woman no better than an alcoholic bum, a woman who had been lousy on admission.
“I’m doing it at one o’clock,” he said. “Want to assist?”
“No,” I said.
“I’ll let you do it, if you want.” A bribe.
“No,” I said.
“Why not?”
I’d already registered my protest, so all I said was “I have clinic follow-ups all afternoon.”
“Okay,” Tim said. “You missed your chance. I’ll get the nurse to help me.”
I still hoped he wouldn’t go through with it, but he did. The test was negative. Emily’s marrow was fine.
Still, they kept Emily in the hospital. She had been there two weeks now. There was an unspoken rule about old people, which was that you discharged them from the hospital as soon as possible. Emily had gained strength steadily during the first week, but now she was starting to decline, to drift into a vague passivity.
At rounds the next day, the house staff discussed further tests for Emily. More exotic blood chemistries. Another EEG. A series of brain X-rays, a pneumoencephalogram. These tests would take at least another week.
I was already feeling guilty about the bone-marrow biopsy. Now I felt I had no choice. I spoke up.
I said that, while Emily was clearly a strange person, her health now seemed basically good. There wasn’t any compelling reason to do further tests. If she was senile, as everyone thought, then these tests wouldn’t benefit her. There was no advantage to diagnosing an incurable disease. True, we had never found out what had put her in a coma, but we had been trying for two weeks and there was no reason to think we would succeed in a third week. Meanwhile, Emily was in noticeable decline. I argued we should discharge her, and do any further tests on an outpatient basis. And I suggested that if Emily had a family, they would now be pushing us to let her go, and that by keeping her around, we were open to a charge of exploiting her as learning material.