He then turned to his resident and said, ‘George, take the ball from here. If it checks out, we’ll get Moretti started on Dilantin.’
As Marks and his group of worshipers moved on to the next neurological enigma, he commented to Barney, ‘That was a tough one to call. You did a splendid job. Too bad you’re opting for psychiatry. You should become a real doctor.’
Pharmacology, though given relatively short shrift among the last of the preclinical courses, is in fact a discipline that can help determine the success or failure of a medical career.
It is not just that students learn about the composition of innumerable drugs, their actions, uses, and contraindications. For all this can be found in the various expensively bound reference books behind a doctor’s desk. Rather, it is the physician’s ability to write a really good prescription and thereby win hearts and influence minds.
No patient will feel comforted unless he receives some sort of prescription – that little document with cryptographic scrawl – that proves his physician really cares.
In Barney’s view, which he somewhat unwisely put to Morris Cohen, the professor, ‘It’s like a door prize, isn’t it? I mean, the patient sort of feels unloved if you don’t give him something tangible. A souvenir or sop.’
‘I beg your pardon, Livingston, you might display a little more respect for scientific research. Does polio vaccine or penicillin qualify as “soppish” to you?’
‘Please, sir,’ Barney said, quickly backtracking, ‘no disrespect intended. But isn’t it true that sometimes just an ordinary aspirin dressed up in fancy terminology can act as a placebo? I mean, a prescription can make a patient feel he’s starting to recover from the second he gets it in his hands. I think there’s literature that backs this up.’
‘Well,’ Cohen retorted in defense of his important discipline, ‘a good doctor should be able to determine if his patient’s ailment is psychosomatic in the first place.’
A voice inside Barney was shouting, Shut your mouth, you idiot – you need this course to get your damn degree. And so he shut his mouth.
Professor Cohen had already sensed that Barney had more to say. ‘Please, please,’ he coaxed sarcastically, ‘feel free to carry on the dialogue. Say whatever’s on your mind.’
‘Uh, well,’ said Barney, with exaggerated diffidence, ‘it’s just that psychophysiological symptoms still are symptoms that need treating.’
Then he swiftly put in a word for his sponsor. ‘As you’ve often put it, sir, there’s a “dosis for every diagnosis.”’
The guy looked like a cat who had just been stroked. ‘Well put, Livingston. Now we’re back on track,’ he purred. ‘All right, gentlemen, let’s take a look at those abbreviations.’
Cohen proceeded to explain why doctors still composed prescriptions in Latin abbreviations. ‘For centuries this was the universal language of medicine. Indeed, Latin had been the language of instruction, too.’
But Barney thought – and this time made sure not to say – You’re full of shit! We’re taught to write in Latin just to add to our mystique. The patient cannot translate q.i.d (quater in die) as ‘four times a day’ and p.c. (post cibum) as ‘after meals,’ and so he feels he’s in the hands of a great healer.
A doctor must be very careful never to employ a foreign phrase his patient might possibly understand. For instance, he will never write per rectum, but instead abbreviated it to ‘p.r.,’ when he prescribes a medicine to be shoved up the ass.
After that particular session, Bennett raced over to berate his friend.
‘What the hell is wrong with you? You pull that psychiatric bullshit with a pharmacologist and he’ll flunk you sure as “Lucky Strike Means Fine Tobacco.”’
‘Don’t sweat it, Landsmann. Didn’t I retreat with finesse?’
‘Not noticeably, Barn.’
‘Hey, listen, I held back. I didn’t mention that no fancy doctor on Park Avenue would write a readable prescription – or he’d lose his mystique.’
‘Livingston, I do believe you’re turning cynical.’
‘Hell, Landsmann, isn’t that what Med School is supposed to do to you?’
Laura could not get the children out of her mind.
Of all her clinical rotations, she felt the greatest involvement during Pediatrics. Perhaps it was a latent maternal instinct, but she regarded every patient she saw – whether gashed dangerously near the eye, racked with pneumonia, or horribly disfigured from an automobile crash (a chronic danger) – as her child, too.
Every ward in Children’s Hospital held scenes that often moved her to tears. There were the terminally ill with diseases like cystic fibrosis, hemophilia, thalassemia, muscular dystrophy, and worse. Some of their lives would be measured in days, perhaps months – at best a few years. But all were incurable.
At first she felt drawn to a life in the laboratory, which she would dedicate to the quest for cures for these child-killers. But then she realized what she wanted was to be with the children, if only to make their deaths a little easier.
But the battle was not always one-sided. There was the joy of having a pediatrician detect near-invisible diseases like galactosemia – potentially fatal but simple to cure if discovered in time.
But Laura’s most profound feelings were reserved for the premature babies, born twelve to fourteen weeks early and unable to breathe for themselves. They were so light and fragile (some less than two pounds) that they would actually turn blue if merely touched by a physician’s stethoscope.
These tiny incubator patients fought pathetically for every breath, and the battle to save them might take days, even weeks. And, at that, they were lucky to rescue one out of four.
Barney might say it was her lingering guilt over Isobel’s death, but she didn’t give a damn about the reason. She only knew that what she wanted to do with her life was save babies.
So she applied for an internship at Children’s Hospital. And was accepted.
‘Laura, open up!’
‘Go away, I just got off duty and I’ve gotta sleep.’
The knocking grew louder and more persistent.
‘Please, I have to talk to you,’ a frantic female voice called.
‘Oh, shit,’ Laura grumbled to herself. She sat up in bed, threw off the covers, and went to the door. ‘Sometimes I wish I had an unlisted room number.’
She opened it to find Grete, in tears.
‘What’s wrong, Andersen?’ she muttered.
‘Laura, I’ve been rejected by every single Harvard hospital. I feel like killing myself.’
Laura made Grete come in, sit down – and calm down. First she let her get the crying out of her system. Then she tried to bolster her spirits by appealing to her ego.
‘Look at it this way, it’s Harvard’s loss, not yours. I mean you’ve been accepted at dozens of places – and they don’t have a monopoly on good surgeons here. Pick a place where they want you.’
‘Well, I’ve got offers from Johns Hopkins and Georgetown. So I guess I’ll be spending the next few years somewhere in the vicinity of our nation’s capital.’ And then she added, with a smile, ‘Maybe I’ll even get to date President Kennedy.’
‘Sure,’ Laura replied, ‘JFK would work a bombshell like you into his heavy schedule …’
She giggled. Grete was herself again. The Queen of Innuendo.
Bennett Landsmann was also refused a surgical internship by the three Boston hospitals to which he applied.
It surely wasn’t something he lacked. After all, he was a Harvard summa, a Rhodes scholar, and had outstanding grades in his clinical rotations. As Barney once again explained, ‘I tell you, Landsmann, it’s just too much melanin – black’s not beautiful in surgery.’
‘You want the truth, Barn? I deluded myself into believing I was different. Somebody had to be the Jackie Robinson of surgery, and I thought I would be the guy. Anyway, it hurts like hell.’
Barney grabbed his friend. ‘Fuck ’em, Bennett. Fuck ’em all.
You’ve been accepted in a million places. Go to Philadelphia, Chicago, Baltimore – you’re gonna be such a great cutter they’ll be on their hands and knees asking you back as full professor.’
Bennett looked at him. ‘You’re a real mensch, Livingston.’
‘I’m flattered, Landsmann. And, if it means anything, I think you’re one.’
‘Ah yes, Dr Livingston,’ Bennett replied with a less broad smile than usual, ‘but I’m a black mensch.’
The cases of Grete and Bennett were exceptional. For the most part the M.D.’s of 1962 would be going to internships at the hospitals of their first choice.
Even Lance Mortimer, the lowest on the totem pole, was accepted by Mount Hebron in Los Angeles.
Although – as he confided to Barney – his father, screenwriter Terence Mortimer, had to get none other than John Wayne to phone the chairman of the board and threaten to lead a battalion of cavalry against the hospital if they didn’t accept ‘my buddy Terry’s boy.’
25
Their anointing as full-fledged doctors took place in June of 1962 at a ceremony in the Medical School Quadrangle. The podium erected in front of Building A was surrounded by a semicircle of spectators on wooden chairs.
On this hot and humid afternoon in the presence of the medical pantheon that had been their teachers, and of the parents whose dreams many of them would be fulfilling, they were to receive their diplomas. And, most importantly, they would be initiated into the sacred priesthood of the healing arts by pronouncing the Hippocratic Oath.
Estelle and Warren were both there, Warren’s camera recording the historic occasion for posterity.
But who was present to observe Laura’s consecration? The elder Talbots and her fiancé, of course, but none of them could really qualify as ‘family’ quite yet. There was no one from Lincoln Place. Laura had specifically told her mother by telephone not to attend.
‘But why, querida?’
‘May I refer you to the story of The Little Red Hen? You didn’t help me bake the bread. So I don’t want you to come and eat it.’
She had acted from hurt but ended by feeling guilty.
Just before the ritual began, as Laura was adjusting her cap and gown, two Catholic priests approached her. One was young and cherub-cheeked, perhaps a novice, the other elderly and, as his darkened glasses seemed to indicate, blind.
‘Señorita Castellano?’ asked the younger man.
‘Yes?’
‘Miss Castellano, this is Father Juan Diaz-Pelayo.’
Before she could respond, the old man started to address her in the pure Castilian of her mother tongue.
‘I have come to bless you,’ he announced, his voice quavering with age. ‘I was with your honored father in the Civil War – there were not many of us from the Church. And I had the misfortune to fall into – shall we say “unfriendly” company. Your father saved my life. I am sure he and your mother will have pride from you this day.’
His palsied hands then made the sign of the Cross, as he said: Benedicat te omnipotens Deus, Pater et Filius et Spiritus Sanctus.
‘Amen,’ added the cherub.
They vanished as quickly as they had appeared. Who had sent them? Her cloistered mother? Her father, somehow passing on the message through some secret network all the way from Cuba?
Barney had seen the encounter from afar and was at her side the moment the apparitions evanesced.
‘Are you okay, Castellano?’ he asked. ‘You look a little pale.’
‘To tell the truth, I feel like there was LSD in this morning’s coffee. These two characters came to bless me.’ She shook her head in disbelief. ‘I wouldn’t be surprised if the next thing that arrives is a chariot of fire. Don’t let them take me off, huh?’
‘I’ll keep my eye out. Stay loose, Castellano.’
The Dwyer family was represented by Hank’s and Cheryl’s parents. Each grandma held a twin; the little boy sat on his mother’s lap. They were ecstatic at the prospect of this ‘coronation’ of a simple kid from Pittsburgh.
Out of curiosity, some of the graduates-to-be surveyed the alabaster crowd to see if they could catch a glimpse of Bennett’s parents. But there was not a single black among them.
Barney had had dinner with Bennett and the Landsmanns at Maître Jaques the previous night. Their affection for one another seemed to him stronger than any he had seen among ‘real parents’ and their children.
But in fact there was a modest crowd of blacks waiting to raise a hearty cheer when Bennett strode onto the podium to get a handshake and a diploma from the dean. Of course, they were not seated in the sacred semicircle, but rather at the windows of the other buildings. The school’s custodial staff – janitors and cleaning ladies – were acutely aware that there were only two soul brothers (and no sisters) in the entire school.
The ritual began with the usual congratulatory and self-congratulatory speeches, followed by the presentation of various awards.
Professor Georges de la Forêt, a Nobel Prize winner for his work in molecular biology, emerged from his laboratory only once a year – for this ceremony. He came before the congregation to announce the winner of the John Winthrop Prize for the most original work in medical research by a member of the graduating class.
After mumbling a few unintelligible remarks in what was variously construed as French, English, or Esperanto, he squinted at a small scrap of paper and announced, ‘Ze winner zis year—’
Then he departed from his prepared text to offer a personal opinion, ‘and in my view perhaps ze most original mind to come here since myself.’ He then called upon Peter Wyman.
The triumphant winner rose from his seat to acknowledge the thunderous ovation of the crowd.
But there was none.
There was polite applause from the parents’ section and from his classmates a few scattered boos. And by the time Peter had mounted the podium and shaken Professor de la Forêt’s hand, the idea of expressing their collective opinion had so inspired the class that their chorus of deprecation seemed to resonate to the heavens.
By contrast, Seth Lazarus – honored as the highest-ranking student – was greeted with cheers more appropriate to a football stadium.
Nat and Rosie were sitting with Judy Gordon in the third row. Though proud, Rosie chastised herself, How can I be happy when my little boy is dead? At the same time, her husband inwardly rejoiced, Thank God I have one brilliant son alive.
Suddenly, as if activated by some celestial switch, decorum returned and the audience hushed.
Dean Holmes, looking more than ever like a high priest in his crimson robes, bade the students rise and repeat after him the sacred physician’s Credo – the Hippocratic Oath.
‘I swear by Apollo the physician …’
‘I swear by Apollo the physician …’
‘To hold my teacher in this art equal to my own parents …’
‘To hold my teacher in this art equal to my own parents …’
‘To consider his family as my own brothers and to teach them this art … without payment …’
Even as he repeated these last words, Barney reflected on the irony that most of his fellow students were not exactly going to do missionary work.
‘I will use my best judgment to help the sick and do no harm …’
Bennett Landsmann could not keep from thinking: The Nazi doctors also took this oath. How then could they have done what they did to Hannah?
‘I will not give fatal drugs to anyone – even if I am asked. Nor will I suggest any such thing …’
Seth Lazarus moved his lips, but did not say the words. For this was something he could not swear to.
‘I will not give a woman any medication to cause abortion …’
Laura Castellano was startled to find herself thinking of that time – so long ago – when she and Barney actively sought out a doctor who would not honor this tenet of the Oath.
‘I will be chaste and religious in my life and in my practice …’
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Hank Dwyer, already sweltering, began to sweat still more profusely. Will this be like the priestly vows I couldn’t take? Am I, even here, being tested by the temptations of the flesh?
I will not use the knife, not even to remove the stones within …’
Most of the future surgeons among them wondered at this injunction. Yet they were aware that for many centuries cutting human flesh was considered a menial procedure, often done by barbers. There was apparently little distinction between cutting hair and amputating legs.
But then again perhaps there was a reason for this interdiction. A religious one: the body was a sacred temple. Do not enter. Do not trespass.
‘I will not abuse my authority to indulge in sexual contact …’
Sitting on the podium with his distinguished colleagues, the surgeon who had made the pass at Grete Andersen tried not to hear this stern commandment of the vows he’d taken long ago.
At last the Oath concluded:
‘I will never divulge the secrets of my patients, regarding them as holy …’
‘I will never divulge the secrets of my patients, regarding them as holy …’
And then Dean Holmes announced, ‘You are now physicians. Go out and do honor to your profession.’
There is no experience in the world to match it. One might argue that it rivaled the taking of a marriage vow – or Holy Orders – yet for the one there was the institution of divorce and for the other the possibility of renouncing the commitment.
But the Hippocratic Oath could never be abjured.
That afternoon they’d made an irreversible commitment to serve humanity and give healing comfort to the suffering.
Furthermore, unlike the vows made in matrimony and religion, theirs was made not to God, but to man. If renouncing God would bring perdition, they would know it only in another world. But should they fail to serve Mankind, they’d know in this one.
And so they sallied forth to do battle with disease and death. And one another.