3
BEING DOCTORS
‘He that sinneth before his Maker,
Let him fall into the hand of the Physician.’
ECCLESIASTICUS 38:15
26
In 1962 advances in medicine and automotive mechanics seemed to be moving in parallel lines. A new electric shock device could revive an apparently lifeless patient – the way an emergency jump-start revitalizes a dead car battery.
And in cases where the patient’s own heart failed, physicians were now able to replace the faulty valves with artificial ones – made from such substances as plastic, Dacron, and the like.
The only difference was that spare parts for a car come with a warranty and medical repairs do not.
Were such physicians imitating and perhaps arrogating the work of God? If so would they, like Prometheus, be punished?
Another event was interpreted by some as the visitation of divine wrath against the medical profession when a ‘harmless’ tranquilizer called Thalidomide that doctors had confidently given to pregnant women was found to cause grotesque birth defects.
And that was followed by the moral issue. If women, reassured by their physicians, had been innocently ingesting this hidden poison, were they not entitled to have their pregnancies terminated? Or did medical ethics force them to run the risk of giving birth to malformed children who would lead an impaired and painful life?
The new direction of medicine was affirmed by the bestowal of the Nobel Prize on James Watson and Francis Crick for the discovery of DNA, the stuff of life itself. Despite its daunting nomenclature, deoxyribonucleic acid had a surprisingly simple structure. Shaped like a double helix with, among other things, thiamine and sugar, DNA might ultimately enable scientists to bake ‘live’ gingerbread men. In other words, to create human beings in the laboratory.
Was this not the ultimate outrage to the Chief of Services in Heaven?
And while this brave new world beckoned on the horizon, humanity would more immediately be served by what would quickly become the most frequently prescribed drug of all time. The saver of souls and soother of psyches, the indispensable palliative for the Age of Anxiety, the miracle of medications: Valium.
The orchestra struck up ‘Here Comes the Bride.’ Laura took Barney’s arm, and all the guests remarked upon her beauty and on the handsomeness of her escort.
It was three days after graduation and the sun was shining through a clear blue sky. But there were some shadows upon what should have been a wholly bright occasion. For the loving relatives and friends were all too painfully aware of who was absent, since, by default, the duty had fallen to Barney to give the bride away.
As they slowly walked down the makeshift aisle created by the rented chairs arranged in the garden of the Talbots’ home, Barney wondered what Laura was feeling. She seemed tranquil, dignified, and calm, the loveliest of brides.
But was she happy?
In scarcely half a dozen measures of ‘The Wedding March’ they reached their destination: Reverend Lloyd, the Talbots’ local vicar, and, on his left, a triumphant Palmer and his Best Man, Tim – ‘the blond-bland Polo nut’ – as Barney thought of him. (How ill-at-ease he looked without his horse.)
When all were at their posts, the minister began.
‘Dearly Beloved, we are gathered here in the sight of God and in the face of this congregation to join together this Man and this Woman in Holy Matrimony.’
After emphasizing the sanctity of the occasion, he asked if anyone present could show just cause why Laura and Palmer should not be joined together. Barney – who believed he could – nonetheless resolved forever to keep his peace. When the reverend asked who giveth this woman, Barney indicated that he gaveth.
At this point, he relinquished Laura to the custody of Palmer, who duly promised to take her as his wedded wife. And she promised to ‘love, honor, and obey’ till death did them part.
The equestrian Best Man then handed over the ring, which Palmer placed on Laura’s finger, and after a few well-chosen platitudes from Reverend Lloyd, the couple kissed for the first time as man and wife.
Instantly, the strains of Mendelssohn’s immortal wedding theme announced that the time had come for all present to feed their faces and get completely smashed.
Uncertain what his role now was, Barney stood and watched the newlyweds disappear into a flurry of well-wishers.
‘Lovely couple, aren’t they?’ asked Reverend Lloyd.
‘Yeah,’ Barney replied, feeling a curious melancholy, ‘my brother Warren’s in there taking pictures.’
‘Are you married?’ asked the vicar.
‘Uh, no, sir.’
‘Well then, doctor,’ Reverend Lloyd said heartily, ‘with any luck, you may be next!’
It was about this time that Bennett Landsmann began to suffer an identity crisis.
Though he was no stranger to racial prejudice from the total segregation back in Millersburg to the less overt (and therefore more insidious) social ostracism in Cleveland, he had always been able to roll with the blows. And now he had naively thought that his status as a Harvard M.D. would make people look up rather than down at him.
But he was mistaken. For he was quick to realize that his fellow citizens still saw only the black skin beneath the white jacket.
Living in New Haven for his surgical internship – and hopefully residency – in the prestigious Yale-New Haven Hospital, his eyes were opened and his mind perplexed.
The hospital was not just near the city’s ghetto, it was at its very epicenter. And although he himself lived – and parked the new Jaguar with M.D. plates, which Herschel had given him – in a modern air-conditioned apartment building across the parkway near the Old Campus, he spent almost every hour of his day encountering the anger of New Haven blacks.
The university and its nearly all-snow-white students were the rich and privileged; the blacks were the demeaned, neglected, consigned to poverty. The road built off Route 95 between the college and the ghetto was considered a Machiavellian ploy on the part of Yale – a sort of highway-moat to keep the riffraff out and leave the patricians in their tranquil citadel.
Not that the hospital was segregated. Both blacks and whites garbed in medical regalia were visible in equal number. The only difference was that the surgeons who performed the operations were white and the team that mopped the blood up later were descendants of the slaves that Lincoln freed.
Bennett tried to keep his equilibrium and his sense of humor. But he was lost – caught in no-man’s-land between two separate and distinct societies. And he did not feel at home in either. Worse, neither was claiming him as their own.
A day did not go by without some sort of disquieting reminder of his ‘otherness.’
Once, while working in the E.R., he admitted a black family who had just sustained minor injuries in a car accident. The wife, who had been hurt the least, was merely in a state of shock. A shot of demerol seemed appropriate. To save time Ben decided to take his own prescription to the drug dispensary.
The pharmacist looked at the paper and then stared at him.
‘Doctor Landsmann, eh?’ he asked. ‘He must be new.’
‘I beg your pardon?’ Bennett said politely.
‘Boy, you should know the rules. We’re not allowed to give this kind of stuff to orderlies – only to a doctor or his nurse. You tell that lazy Landsmann he’d better come himself.’
‘I’m Doctor Landsmann,’ Bennett answered, hoping that his voice sounded calm and dignified. For he was too embarrassed to be angry and too wounded to be hostile.
Their glances met.
‘Oh, gee, I’m sorry, doctor,’ the pharmacist said deferentially. ‘I didn’t know – I mean, most of the staff –’
‘I understand,’ said Bennett softly. ‘Just make up the prescription. I’ve got a patient in distress.’
‘Of course. Of course.’ The druggist turned and brought the demerol with uncanny speed.
The following S
aturday evening a territorial war between Italian and black gangs produced nearly a dozen casualties, including one young black shot in the chest by a zip gun.
Bennett was assigned the gunshot victim. He and a nurse swiftly wheeled the young man into the first Trauma room on the corridor. As she scurried off to prepare a hypodermic, Bennett took a closer look at the bullet wound. But when he reached to cut open the patient’s shirt, he gasped with difficulty, ‘Hey, shit! Don’t touch me, man, I want a doctor.’
‘I am a doctor,’ Bennett said as soothingly as possible.
‘Don’t jive me – there’s no nigger doctors in this place. Get me The Man himself.’
Bennett was on the verge of protesting that he did in fact qualify for the distinction when Herb Glass, a fellow intern, entered to ask advice about the multiple knife wounds he was treating.
As Bennet turned to have a sotto voce dialogue with Herb, his own patient screamed, ‘There, there – I want that guy. My fuckin’ chest is gonna kill me. Tell that doctor I need help.’
Bennett quietly explained the situation.
‘Fuck him,’ Herb whispered indignantly. ‘He should feel lucky he’s got a doctor with hands like yours.’
But Bennett’s self-respect had been so bruised that he persuaded Herb to switch patients.
Without another word, he walked across the hall to begin suturing the stab wounds of a patient he hoped would either be more tolerant or – better still – unconscious.
‘For Heaven’s sake, can’t you try and see sense!’
Henry Dwyer, M.D. (as Hank now felt he should be called in view of his new status), was trying to reason with Cheryl, as she was nursing their fourth child, Rose Marie. It was barely dawn and he had just come back from a grueling thirty-six-hour shift on the wards of Boston Memorial.
‘Hank, will you please stop bellowing – you’ll wake the kids.’
‘What do I care? They never let me sleep after I slave my guts out just to put bread in their mouths.’
‘Hank, they’re only little children. How do you expect me to explain to them what an intern is?’
‘That’s your problem, Cheryl. You’re the mother. In my house Dad was always treated like a king.’
‘Oh, pardon me, Your Majesty. Do I take it you were born toilet-trained?’
‘That’s beside the point. You’re dodging the important issue.’
‘Honey, it is not an issue. The Catholic church explicitly forbids birth control. Or have you completely lost your faith?’
‘Look, don’t try hitting me with that lapsed priest business. I don’t feel guilty anymore. Besides, if you want to throw the Good Book at me, how about Saint Paul, I Corinthians: “It is better to marry than to burn”?’
‘What on earth is your point, Hank?’ So emphatic was her gesture of exasperation that her breast pulled out of Rose Marie’s young mouth.
Hank was nearing the end of his rope. How could a sexy – or at least a once-sexy – woman like Cheryl not understand that men in their prime needed regular intercourse, even if certain prudish, straitlaced Catholic girls thought it was slightly dirty?
He squatted down beside her, his quadriceps femoris aching from his climbs up and down the hospital stairs. ‘Honey, I burn. I give that damn hospital my heart and soul, but there’s one special part of me I save especially for you. Now am I being clear enough?’
Little Rose Marie let out a wail. Hank frowned as if she meant it as a reprimand to him. Cheryl put the baby’s tiny head back to her breast.
‘Hank, I understand that you have needs, but you’re a doctor. Don’t you realize that a woman who’s just given birth—’
‘I deliver babies day and night, so don’t tell me about so-called “postpartum” depression. That’s just your excuse for keeping me away.’
‘Come on, that isn’t fair. I didn’t say I was depressed. I’m just tired. I’ll get my old enthusiasm back again.’
‘Oh sure, and then get pregnant right away.’
‘Not while I’m nursing.’
‘It’s an old wives’ tale that a nursing woman can’t get pregnant. I was simply implying that four kids is plenty for any struggling doctor’s family.’
‘But, Hank, the struggling’s almost over. Once you’re set up we won’t have any problems. And besides, you know my parents want to help us now.’
‘I have my pride,’ he countered sanctimoniously. ‘I don’t take handouts from my in-laws. All I want is respect. Every husband needs respect.’
‘I do, honey. You know I worship you.’
‘Then why don’t you respect my needs?’
Cheryl was crying, the tears spilling down her cheek onto her breast and moistening her baby’s brow.
‘Hank, I’ll do the best I can. Tonight – when everyone’s asleep—’
‘Fat chance,’ he sneered sarcastically. ‘Someone’s always crying for attention.’
She was desperate to placate him. ‘And we’ll practice … some control.’ She could not bring herself to say the actual word ‘contraception.’
Hank smiled triumphantly. ‘Good, that’s my girl. I’ve read the literature and and they’ve refined the Pill to—’
‘I didn’t say the Pill,’ she interrupted hesitantly. ‘Catholic families can only use the rhythm method.’
‘The rhythm method?’ he exploded. ‘You can dare to say that, when what’s sucking at your breast this very minute was conceived that way? Besides, that’s just a lame excuse to keep things down to once or twice a month.’
And then he stopped. He realized that he’d gone too far. Cheryl was now weeping uncontrollably, bending over Rose Marie as if to shield her from her father’s anger.
He knelt down again and murmured, ‘Hey I’m sorry, hon. But you try going without sleep for two straight days and maybe you’ll know how incredibly strung out I feel. I’m really sorry.’
‘Oh, Hank, I love you. Please don’t let us fight like this again.’
Father, mother, child remained entwined for several minutes, rocking back and forth.
And Cheryl was assuaged. ‘Do you want breakfast, hon? I’ll make you some French toast as soon as Rose Marie’s asleep.’
‘That’s okay, I had some garbage at the hospital. Interns are like goats – we’ll eat anything.’
He rose and started for the bedroom as a second thought occurred to him.
Interns share another trait with goats: we’re always horny.
On Saturday nights Bellevue Hospital’s emergency room is like a MASH unit. To Barney, who’d been assigned thirty-six hours there, it seemed as if a world war was being waged on the streets of Manhattan.
Paradoxically, the knife and gunshot wounds were the easiest to deal with. By the end of the first few weeks he had sewn up so many miles (or so it seemed) of lacerated tissue that he found himself thinking of Luis Castellano’s description of the Spanish Civil War: ‘I was more a seamstress than a doctor.’
Gradually Barney was learning to suture skin in a semi-comatose state so he could at least rest his mind while dealing with the battered victims of urban violence.
There was never a chance of getting any actual shut-eye since, at least from Barney’s standpoint, New York lived up to its reputation as ‘the city that never sleeps.’
He tried to console himself by recalling that he had been forewarned about the rigors of internship.
But why, he asked himself, as thousands had before him, why do we have these inhumanly long shifts?
Surely no airline would ever let a pilot fly for half as long as Barney worked. How come interns were subject to such punishment?
Ironically, doctors – the very people who knew physiology best – seemed to ignore the fact that human beings cannot function normally when tired. That the interns were being driven to the edge of collapse.
He had had the temerity to ask a senior member of the staff the logic of allowing young physicians to punish their bodies in a way that would be deemed pathological in their pa
tients.
The distinguished elder statesman merely replied, ‘That’s the way we did it – and we survived.’
‘No, no, no, sir,’ Barney argued back somnolently, ‘even if you ignore our state of health, what about the unlucky patient who is seen by a doctor who can barely stay awake? Is it in his best interests that he be treated by a zombie? Tired people make mistakes.’
The doctor looked at Barney scornfully. ‘Livingston, this is part of your education and you know what they say: If you don’t like the heat, get out of the kitchen.’
And so Barney soldiered on, although he felt his blood was turning slowly into coffee and his brain to soggy white bread – with a slice of cheese on top. There was one consolation: He was too tired to be worried that he knew so little, too exhausted to realize that if he ever lost his trusty Merck Manual, he would have no idea what he was confronting or what to do about it.
One relatively quiet weekday night a man announced to the nurse at the admissions desk that he was ‘dying from cancer.’ But when asked to be more specific he replied, ‘I can only tell it to a doctor.’
The nurse assigned the case to Barney.
He took the man into one of the examination rooms, sat him down, brought a cup of coffee for each of them, sat across the table and asked for the usual information – name, occupation, and most importantly for the hospital, what health insurance.
The patient turned out to be one Milton Adler, an accountant aged thirty-five – who had Blue Cross and Blue Shield.
‘Fine,’ said Barney, putting down his pencil and trying not to choke on the fumes of the strong cigarette the man kept puffing. ‘Would you like some sugar in your coffee?’
The man grew agitated. ‘Jesus, what the hell kind of a doctor are you? I’m sitting here dying and you ask me whether I want sugar in my coffee. Did they saddle me with some student? I mean, haven’t you got a superior I can speak to?’
‘Mr Adler,’ Barney answered firmly, ‘I am a qualified doctor. I know all about carcinomas, neoplasms, and any oncological pathology you might have. And frankly, based on my experience, I think you’ve still got enough time to talk to me for fifteen minutes.’