Doctors

  Lack of dedication? Lack of energy? If asked directly he would have explained it as a lack of time. His eyes that once would barely glance at calendars were now affected by the movement of the hourglass. He now longed for the weekend. Since he had taken in a Puerto Rican fireball to share his practice, he had let the younger man take Saturdays and Sundays. Meanwhile Luis sat alone in his study, aimlessly skimming through the journals, with the television tuned to whatever football game was being played, as a kind of background music.

  And the glass by his side was never empty.

  Sunday had ceased to be a special day for Inez Castellano, but only because she now spent every day of the week in penitent prayer.

  The already burning zeal had lately intensified, thanks to the advent of Father Francisco Xavier, a charismatic refugee from Castro’s Cuba.

  ‘Thank God,’ she told Luis, ‘he came in time to save our souls.’

  ‘Not mine, querida,’ he had scoffed, ‘my soul’s well past saving. You can have Francisco Xavier verify it in his next chat with the Almighty.’

  But he was relieved – if not delighted – that although she talked of hellfire, she at least was talking. Better auto-da-fé than autism.

  Luis’s gentle mockeries had no effect upon Inez’s ardor. When not in church confessing or reciting Hail Marys, she would read her Spanish Bible.

  ‘Your mother’s studying to be a nun,’ Luis remarked, his little smile unable to belie the touch of irritation in his voice. Indeed, from what Laura saw, there was more truth to it than jest.

  Inez spent her time atoning for sin – her own, her family’s, the world’s. At first Luis had tried to go to church with her, to sit with her at prayer. But even when her earthly body was mere inches away, her soul was in another world. Their younger daughter was with God already. And his wife was clearly praying for the day that she would join her.

  Almost the moment the Castellanos and Livingstons finished Christmas dinner, Inez rose from the table and started to put on her coat and scarf. She could not be late for Vespers and Benediction.

  ‘Let me go with you,’ Estelle insisted.

  ‘No, no, please don’t feel obliged.’

  ‘Honestly, I’d enjoy it. The choir is always so beautiful – and I love the sound of Latin—’

  She did not add that hearing Latin always brought back memories of Harold, who – especially at this time of year – was very much a living presence in her psyche.

  ‘All right, Estelle, but let us hurry. Father would not be happy if we were late.’

  ‘My mother’s gone completely bananas,’ Laura declared to Barney as the two of them began to clear up the dishes from the dining room table.

  Warren had decamped for yet another ‘heavy date.’ Dr Castellano had already escaped to the sanctuary of his study.

  ‘Can’t Luis do anything about it?’

  ‘What do you want him to do, Barn – give her electric shock treatments?’

  ‘That’s not a joke, Laura.’

  ‘It wasn’t meant to be. I really think she’s heading for some sort of breakdown.’

  She fell silent for a moment, merely stacking plate upon plate. And then she blurted out, ‘What’s wrong with me, Barney? My own mother barely acknowledges my existence. My father’s a certifiable alcoholic. It hurts me so much I’m almost beginning to—’

  He understood the rest of her unspoken thought.

  ‘I can’t help it. I know I should be more understanding. I mean, professionally speaking.’

  ‘Yeah, there’s the bitch of it, Castellano. You can never be professional about your family. I mean, even if you become dean of the Med School, around here you’ll always be treated like an adolescent.’

  ‘I know,’ she acknowledged sadly. ‘And what’s worse, it makes me feel like an adolescent. To be honest, since I see you all the time up in Boston, there’s no real reason for me to come home any more.’

  The next morning Laura sat silent as Barney drove her along the Brooklyn-Queens Expressway to LaGuardia in the Castellanos’ venerable Studebaker.

  Finally he said, ‘Cheer up for chrissake, Castellano. In less than two hours you’ll be in Boston and – as the poet Milton put it so well – “emparadised” in your beloved’s arms. Why the hell aren’t you glowing?’

  For a moment, she did not reply. And then, just before the Grand Central Parkway exit to the airport, she said, already holding back the tears, ‘Look at me – two useless parents – one drunk on God, the other on C2H5OH.’

  Barney did not return to Brooklyn, either. Instead he drove back across the Triborough Bridge, then over the George Washington and onto the Jersey Turnpike to begin his long journey toward Pittsburgh, Pennsylvania, where, the following morning, Hank Dwyer and Cheryl De Sanctis would be consecrated man and wife.

  The nuptial Mass was celebrated in St Anthony’s Parish Church, in the center of America’s industrial heartland. The relatives on both sides of the chapel seemed to be either miners or steelworkers.

  The reception in the local Knights of Columbus hall featured such diverse delicacies as mozzarella in carozza, lasagne verde, not to mention turkey, ham, and Irish stew for Hank’s relatives. The three-foot-tall wedding cake had the traditional figurines of bride and groom but with a sophisticated difference. For the tiny replica of Hank was also dressed in white, as suited a future doctor, with a miniature marzipan stethoscope around its neck.

  But perhaps the most delicious items were the bridesmaids – Cheryl’s sister and three friends – all as voluptuous as the bride herself. And Barney’s endocrine system suddenly reminded him that he had been celibate since the previous summer.

  He therefore decided to try his charm on the prettiest of them, who had the evocative name of Gloria Cellini.

  ‘Any relation to Benvenuto?’ he asked, attempting to see if flattery would get him anywhere.

  ‘Yes,’ she answered, ‘he’s one of my Chicago cousins.’

  Barney was bewitched and bedazzled by her deep brown eyes, the ivory teeth, and the cleft between the two Italian marble spheres that lay below. For a moment he thought he would make medical history and become the first man to die of unrequited lust.

  The five-piece orchestra began playing ‘Fly Me to the Moon.’ Barney was already there.

  ‘Are you a doctor, too?’ she asked.

  ‘If it will impress you, Gloria, yes. If not, I’ll be a lawyer, Indian chief, or whatever you like.’

  She giggled. ‘You’re funny.’

  ‘Would you like to dance?’

  ‘Swell,’ she replied, and offering him her hand, led him to the bustling dance floor.

  Fill my heart with song and let me sing forevermore.

  You are all I long for, all I worship and adore.

  In other words …

  Two dances later Barney spied Hank heading for the john. He mumbled something to Gloria about having to check on one of his patients and please not to dance with anybody else until he came back.

  Hank was the only other person in the men’s room, grooming his hair with greaseless, stainless Vitalis. In the mirror he saw Barney enter and greeted him ecstatically.

  ‘Hey, Livingston. What do you think? I’m actually married!’

  ‘Yeah, Hank, you were great up there. Say, do you know Gloria – ?’

  ‘Cellini? Good-looking, isn’t she?’

  ‘That’s an understatement. But Hank, I’m new to Pittsburgh. I don’t know the customs – the ethos, if you know what I mean.’

  ‘No, frankly I don’t know what the hell you’re talking about.’

  ‘What I want to know is, can I get that girl to bed?’

  ‘Sure,’ Hank said, smiling cherubically. ‘It’s easy.’

  ‘Easy? Jesus, what do I have to do?’

  Hank finished coiffing, popped comb into breast pocket, and on his way out remarked casually, ‘Just marry her.’

  Barney had a cold and hungry ride back to Brooklyn.

  On New Year’
s Eve Palmer Talbot was struck by lightning.

  At the Hunt Club dance the admiration of the Boston aristocracy for his tall and stunning sweetheart was palpable. He could feel their approving glances as he whirled her about the dance floor to the mellow strings of the Lester Lanin Orchestra. Even he had never seen Laura so beautiful, or, he confessed to himself, so pensive.

  This was such an important event on the Boston social calendar that his older sister Lavinia had flown in from England with her husband, Viscount Robert Aldgate, and their infant son, the Hon. Tarquin Aldgate (who had puked his noble three o’clock feed all over an ever-smiling BOAC chief stewardess).

  Conviviality was rampant as the witching hour neared. At five to twelve all glasses were filled with Dom Perignon and Lord Aldgate was asked to propose the toast.

  ‘To Mother and Father, good health and happiness. To Lavinia and Tarquin – er – happiness and good health. To Palmer and Laura – um – health, happiness, and – um – marriage.’

  Palmer beamed as the six Baccarat glasses clinked across the table and, glancing knowingly at Laura, commented, ‘I’ll drink to that.’

  Laura unexpectedly remarked, ‘And so will I.’

  Palmer was so elated that he could not mention it till the next afternoon, and then only when he was dropping Laura off at Med School.

  ‘Laura, did you mean what you said last night?’

  She looked up at him and replied, ‘Maybe.’

  No sooner had she regained the safety of the Vanderbilt fortress than Laura thought to herself, I said it but I’m not really sure I meant it. So why the hell did I say it?

  15

  ‘I’ve got cancer,’ Lance Mortimer announced.

  ‘What?’

  ‘I’ve got more cancer than anybody else in this whole school!’

  It look Barney several seconds to realize that Lance was talking about pathology slides of other people’s carcinomas.

  ‘That’s great, Lance,’ Barney replied. ‘And I assume, as usual, you’ve got dupes to share with your friends.’

  ‘Absolutely, and that goes for syphilis and gonorrhea, too. This is going to be a terrific semester!’

  All during the fall term the students had complained about the ‘irrelevance’ of the curriculum: the dead bodies in anatomy, the lifeless memorization of chemical structures, the total absence of anything remotely related to disease.

  The new semester would remedy all this, although it would not go so far as to confront them with an actual live patient.

  ‘Pathology, from the Greek pathos, meaning suffering, is the morbid side of histology. Last term you studied microscopic slices of healthy tissues. This course will examine those same tissues when diseased. In other words, pathology is to histology what rotting wood is to mahogany, or, more benignly, what pickles are to cucumbers and yogurt is to milk.’

  Thus spake Brendan Boyd, professor of Pathology, renowned as the most dynamic lecturer in the school, a man described by one student as ‘really making death come alive.’

  ‘After all,’ he explained, putting his subject into historical perspective, ‘the Egyptians were practicing this science nearly four thousand years ago, and we have their records describing various traumata, tumors, and infections. In this respect, Hippocrates was really a Johnny-come-lately and can receive credit only for creating an orderly method for systematizing diseases. The great Galen, personal physician to the Roman emperor Marcus Aurelius, recognized the presence of pus in urine as a sign of internal inflammation in the bladder and kidneys, and discovered the causes of various malignant growths.

  ‘We pathologists have rightly earned a reputation for near-infallibility. For, though our other colleagues in the wards can sometimes miss a diagnosis, a postmortem can invariably find the answer. In other words, we may not be able to cure you, but at least we can tell you why you died.’

  The students laughed appreciatively.

  ‘I told you,’ Lance whispered to Barney, ‘he’s really cool.’

  ‘I’d call it pretty morbid humor.’

  ‘Well, after all, he’s a pathologist.’

  ‘In the early days of medicine,’ Boyd continued, ‘diseases were thought to be caused by evil spirits, and as such were invisible to the eye. By the end of the eighteenth century, however, Van Leeuwenhoek’s innovations on the microscope came into use and these spirits were seen to have shape, size, and movement and came variously to be called “bacteria,” curiously derived from the Greco-Roman word for walking stick; “viruses,” from the Latin for poison; “fungi,” from the Greek for sponge or the Latin for mushroom, take your pick; or, generically, simply “microbes.”

  ‘Among the first modern shining knights to slay these invisible dragons with their equally invisible swords was Louis Pasteur, whose many victories include vaccines to control anthrax in cattle, prevent rabies in humans, not to mention the process for sterilizing milk. The French – whose proclivities for alcohol have raised cirrhosis of the liver to a high art – were astounded by Pasteur’s discovery that the fermentation that created wine and beer was actually caused by benign microscopic yeast cells. From this we see that germs can sometimes serve mankind.

  ‘In any case, the battle lines were drawn. Microbes were the enemy – resourceful, insidious, unrelenting, and capable of countless disguises. Medical scientists were the good guys, riding steeds as white as leukocytes, their microscopic eyes scouring that seemingly invisible world for signs of the foe. It would take a Homer – or at least the Oxford Companion to Medicine – to do adequate justice to the many heroes in this never-ending battle.

  ‘Shall we sing of Sir Joseph Lister, the Englishman inspired by Pasteur; who came to realize what today is obvious to all, that operating rooms should be germ-free. His great achievement is immortalized far less grandly than Pasteur’s in that product familiar to all suffering from breath not fit for kissing – Listerine.

  ‘And no song of antisepsis can forget Miss Florence Nightingale, who almost single-handedly caused armies and civilians to comport themselves in sanitary fashion.

  ‘Then there is Ehrlich of the magic bullet aimed at syphilis. Ask not for whom Nobel tolled – it tolled for him in 1908.’

  At this, he lowered his voice and modulated his style. ‘And let us hope it tolls for someone in this room. Just as my own generation saw the conquest of polio by Jonas Salk, perhaps one of you will eliminate a scourge of mankind.’

  This was the credo at HMS. This is what they had been chosen to do.

  It is a common – if crude – metaphor that becoming a doctor involves going through a great deal of shit. But the second-term freshmen soon discovered that their professional initiation would literally require going through human excrement. What is more, it would be their own.

  Bacteriology introduces the student to the infinite variety of micro-organisms everywhere in his body, most notably in feces and saliva. Indeed, the professor warned them, even if they brushed their teeth with Colgate ten times a day, they would each have close to a hundred billion bacteria frolicking in their mouths.

  The first laboratory assignment was to carry out a bacteriological analysis of feces. They were divided into pairs of lab partners, one of whom’s first duty was to supply the specimen.

  To be totally democratic the laboratory pairs were chosen in alphabetical order. Barney confidently expected to be doing this unpleasant task with his good friend Bennett, since he assumed that ‘Landsmann, Bennett’ and ‘Livingston, Barney’ would be contiguous on the class roster. He had momentarily forgotten that ‘Lazarus, Seth’ came between them.

  In fact, Seth was known to Barney only by sight. Skinny, stoop-shouldered, bespectacled, with unkempt flaxen hair, he always sat in the front row at every lecture and filled page after page with frantic scribbling – but would never raise his hand or ask a question either during or after class.

  When they met across the lab table, Barney found Seth to be even shorter and slighter than he had thought. In fact, hi
s physique was distinctly reminiscent of the famous Charles Atlas ads in the comic books of his youth: Seth could have posed for one of the ‘98-pound weaklings’ into whose face the bully on the beach was always kicking sand.

  Seth diffidently offered to provide the specimen. And – should Barney feel at all squeamish – make the slides as well.

  ‘No, no, no,’ Barney replied as swiftly as possible, lest he be tempted. ‘I’ll do half the slides and you do the others, Seth.’

  His diminutive partner nodded and they set to work. In a matter of minutes all queasiness had disappeared, especially since the stains they were applying transmuted the fecal matter into new substances. Barney applied the swab on the Thayer-Martin medium to see if it would grow the causative organism of one of the nastier venereal diseases, and then went on to prep slides that would reveal intestinal enterococci both friendly and insidious.

  For most of the afternoon the two worked in silence.

  By five o’clock they had completed their slides and filled the various petri dishes for future reference and effluvience (for the lab assistant had warned them that as the cultures grow, ‘some of them develop an odor that even makes me sick’)

  As they were attempting to scrub away the residue of their labors, Seth remarked, ‘You know, there are more germs in our mouths than there are stars in the entire universe. Isn’t that fantastic?’

  ‘Only if we don’t have to memorize all their names,’ said Barney, half in jest.

  But from the first reading assignment it seemed as if they did.

  They had to absorb such arcana as which gram-negative rods are common to the gut, and which gram-positive cocci would be likely to be found in sputum. Which bacteria grow in clusters, which in filaments, which show individual patterns on the agar, which swarm over the dish, and which bacteria required anaerobic conditions.

  There was no way of getting around it, Barney told himself, for they knew in advance what their final exam would be – a mystery slide that would have to be identified. God, what a colossal waste of time this was going to be. Did anyone – even Bruce the assistant – actually store this stuff in his head after taking the course? It would be like learning the Manhattan phone book by heart while being fully aware that Telephone Information worked twenty-four hours a day.