‘Is that all?’ the patient asked anxiously. ‘You mean I have less than an hour to live?’
‘I didn’t say that, Mr Alder,’ Barney responded, as gently as he could. ‘But we may both die of old age if I don’t get some more details.’
Something in Barney’s manner (perhaps it was the ease with which he had pronounced ‘carcinoma’) convinced Adler of his young physician’s competence. ‘Okay, ask me.’
‘Now where exactly is your cancer, Mr Adler?’
The man thought for a moment and finally replied, ‘I don’t know, I’m not sure. Hell, you’re the doctor, you should be able to find it.’
Barney was beginning to get the picture.
‘Mr Adler, everything except skin cancer is invisible to the naked eye.’
‘Then take me to x-ray, for God’s sake. What are you waiting for?’
Barney picked up a piece of blank paper and tried to sound concerned. ‘I think that’s a good idea, Mr Adler. But first I’ll have to tell them what part of you to photograph. Do you hurt anywhere in particular?’
‘My heart, Doctor. I think I’ve got cancer of the heart. Is it curable?’
‘I can’t say till I’ve got more information,’ Barney answered. ‘If you could tell me what symptoms you have – and when they started.’
‘I’d say it began last Sunday.’ And then he noticed Barney’s pencil was still. ‘Aren’t you writing all this down?’
‘Don’t worry, Milton, just keep talking.’
‘Well, that’s it. I just told you, the pains started on Sunday.’
‘Did anything else happen over the weekend? I mean, was it otherwise uneventful?’
‘I don’t know what you mean. Isn’t terminal cancer enough?’ And once again he grew suspicious. ‘Are you sure you’re not a medical student?’
Barney ignored this question and asked one of his own. ‘You’re married, Milton? Is that right?’
But by now Alder was frantic. ‘You asked me that already for the goddamn forms. Now get me your superior or I’ll call my lawyer!’
For a split second neither man moved. And that second stretched into several minutes as patient and doctor sat silent in the little examination cubicle.
Then Barney asked very delicately, ‘What made you think of your lawyer, Milton?’
‘What do you mean?’ the patient retorted angrily.
‘You said you wanted to see another doctor. Why would you possibly need a lawyer for that?’
Adler was at a loss to answer but rose to his feet in protest.
‘Sit down, Milton,’ Barney ordered softly but firmly. The man complied like an obedient child.
Barney leaned his elbows on the table. ‘Now Milton, are you in some kind of trouble?’
‘No, absolutely not.’
‘Are you okay financially?’
‘Yes, yes.’ He waved dismissively. ‘Stop asking these stupid questions.’
Then Barney asked, ‘How about your marriage?’
‘What marriage?’ he suddenly exploded. ‘If I still had a marriage, why would I be calling my lawyer? She’s hired the biggest barracuda in New York. And my guy’s such a weakling he’ll probably even lose me visiting rights to the kids. Christ, I could die.’
He buried his head in his hands and began to weep.
After a moment Barney softly suggested, ‘You mean you want to die, isn’t that really what you’re saying, Milton?’
‘Yes, yes.’ He nodded, his hands still covering his face. ‘I love her and I love my kids. What do I have if they’re gone – just an empty goddamn apartment. You can’t imagine how terrible I feel.’
‘I think I can,’ Barney said sympathetically. ‘I’d say you feel as bad as a man who has cancer of the heart.’
It was Barney’s first successful psychiatric diagnosis – and his first failure.
Although he immediately prescribed medication to lift the patient’s mood, he felt that Adler was too close to seriously cracking up to let him go home.
He called the Psychiatric Ward and explained the situation. The chief resident there, a very tired guy called Barton, was annoyed. ‘Listen, kid, if we had to bug every depressed person that walked into E.R., we’d need Central Park to house them all. Besides, we’re packed up here. It’s strictly standing room only. Give him some Librium and send him home.’
‘But, Dr Barton,’ Barney remonstrated politely, ‘I think this man might try to kill himself.’
‘Well, that’s different,’ came the voice over the phone. ‘If he does try that, call back.’
Barney returned to the examination room, handed Adler two black and green capsules, and a paper cup of water.
‘Take one of these now, Milt, and the other tomorrow after breakfast. This ought to calm you down and let you sleep. But I want to see you back here first thing in the morning, okay?’
The patient nodded obediently and swallowed a capsule.
Barney walked his patient to the entrance and flagged him a cab.
Adler did appear the next morning. On the front page of the Daily Mirror. He had jumped fourteen stories from what the reporter called ‘his lavish East Side penthouse’. When interviewed, his grieving wife, who had been in the country for the weekend with their children, sobbed, ‘I should have known. Poor Milton was feeling so depressed. I should have known.’
Trying to steal a few precious winks of sleep, Dr Ivan Barton was dozing at a desk in the nurses’ station, his bearded chin cradled in his hands, when he was awakened by what sounded like a sledgehammer a few inches from his ears. He looked up with a start and saw an unfamiliar figure in a soiled white coat.
‘Are you Barton?’ growled an unkempt young doctor.
Having been up for the last thirty-six hours, the Psychiatric resident was slightly disoriented. He replied fuzzily, ‘Can I help you?’
Barney pushed a copy of the Mirror at him. ‘Take a look at this,’ he fumed. ‘This is the guy you refused to “bug” last night because you didn’t take me seriously.’
‘Hey, hey, slow down, old buddy,’ the slightly older doctor responded, gaining control of his faculties and (so he thought) his clinical technique. ‘You must be really new here.’
‘What the hell’s the difference? Maybe if you’d taken the trouble to interview Adler last night, you’d have seen what I saw. The guy was desperate.’
‘C’mon, kid, you weren’t that sure yourself or you’d have leaned on me a little harder. Am I right?’
‘No,’ Barney bellowed, and immediately thought to himself, It probably is my fault. I’m responsible for that poor bastard’s death.
‘Do you want to talk about it?’ Barton asked solicitously.
Barney shook his head and sat down. ‘I’m sorry if I flew off the handle. This is the first time I—’
‘Lost a patient?’ Barton finished his thought.
Barney nodded. ‘It’s terrible. If only I’d been on the ball, I’d have saved the poor guy’s life.’ He then looked up and asked, ‘Have you ever lost a patient?’
‘Yes,’ Barton confessed, ‘and if it’s any consolation, it actually gets worse each time you do.’
‘You mean you’ve lost a lot of patients?’ Barney asked in shocked surprise.
‘Listen, kid, it’s a statistical fact that med students “kill” an average of three patients before they qualify. And nobody keeps track after that.’
Barney shook his head in anguish. ‘I don’t think I can ever go through this again.’
‘Then don’t be a psychiatrist,’ Barton advised sincerely. ‘Take up something safe like dermatology.’ He paused. ‘Just like an orthopedic surgeon needs physical strength, a shrink needs a lot of inner resilience. The sad fact is the world is crawling with unhappy people – and that even includes psychiatrists. In fact, do you know our own suicide rate?’
‘I’ve heard it’s pretty high,’ Barney murmured.
‘Nine – nine times higher than the general population. You’ve chosen a ver
y dangerous specialty, my friend.’
Barney knew doctors could not save every patient. That was a fact with which he was prepared to come to terms. Hadn’t a mugging victim he was treating just died on the table while an I.V. dripped blood into him?
But now at once he realized what the difference was. A knife is swift; life’s blood pours swiftly from the body. A psychiatrist may be dealing with a similar phenomenon, but in slow motion. His job should not be sewing up the wound as much as trying to deflect the knife.
‘Hey, when do you get off?’ the psychiatric resident inquired.
‘Half an hour ago.’ Barney replied.
‘I leave as soon as Sarah Field comes in, which should be any second now. Want to grab a little breakfast?’
‘No, thanks,’ said Barney, still in shock. ‘I just want to sleep. I want to crawl into bed and block out all of this.’ He turned and started off.
‘Don’t count on it,’ Barton called after him. ‘Most interns can’t distinguish between sleeping pain and waking pain. It’s all one fucking nightmare.’
‘Thanks,’ Barney responded, ‘you’ve been a real help.’
27
Seth Lazarus had been the bonus baby of the graduating physicians.
Even Peter Wyman conceded this, although he might have claimed that unofficial honor for himself, had not Harvard made him a preemptive offer. Professor Pfeifer wanted him around, since Peter had become indispensable for his own research. As Peter saw it, Mike (they were on first name terms now, of course) wanted to ‘ride on the comet’s tail.’ Thus Peter had applied only to hospitals within walking distance of the Biochem Lab. He was, naturally, accepted by all.
His mentor had seen to it that Peter’s meager intern’s salary was supplemented by funds from the National Institutes of Health.
Thus for Peter nothing changed, except that the stationery he had printed now read: Peter Wyman, M.D., Ph.D.
Seth had established a record unprecedented in Harvard’s history: he had received A-pluses in every one of his clinical courses. Hospitals had wooed him the way the colleges courted prize high school quarterbacks. Moreover, because of his multifaceted talent, he had been offered special rotations in whatever discipline he felt he wanted for his specialty.
Think of the prestige of Surgery, said half-a-dozen chiefs of service. You’ve got virtuoso hands. You cut like Jascha Heifetz plays the fiddle – with finesse, dexterity, and absolute precision. You could be another Harvey Cushing.
Needless to say, Seth was deeply flattered by the comparison to Harvard’s legendary neurosurgeon and physiologist.
But he declined with thanks.
As he confessed to Judy, he did not want to consecrate his life to treating human beings who were passive and unconscious. He even reasoned that this was a possible explanation of the clause in the Hippocratic Oath which prohibited ‘cutting for the stone.’
For almost the same reasons, he turned down an invitation from his old boss, Tom Matthews, to join the Path team fulltime. Matthews all but guaranteed Seth would succeed him as department chief. But Seth had viewed Pathology merely as a means to an end – the way to recognize what made a human body die. In that department patients reached the doctors far too late.
No, if surgery was too much like the work of plumbers, or carpenters, Path was archaeology. It is no consolation to a widow to find her husband’s cause of death. But think what happiness you’d bring a wife if you could decipher all her husband’s symptoms. Then if you had time and expertise enough you could possibly save his life.
So Seth chose a middle course: Internal Medicine, where astute diagnosis might even spare the patient the necessity of surgery. So what if internists were sneered at by surgeons as mere ‘fleas’?
Despite the blandishments of San Francisco, Houston, and Miami – not to mention Boston and New York – he wanted to go home to Chicago. He felt a special tie to his old hospital. His heart was there. His future wife was there.
Unfortunately, he had not reckoned with the fact that Mom and Dad were also there.
For in the time since Howie died, his mother had undergone a metamorphosis. Although she visited the cemetery as regularly as she had the nursing home, she now began to obsess about her other son.
Seth in his naïveté made a strategic human error. He and Judy had decided that the following June, when his internship concluded, would be the ideal time to marry. They both agreed not to tell their parents. So when he returned to Chicago right after graduation he had chosen the path of least resistance and lived at home.
Rosie, who had barely noticed when he’d stayed past dinnertime to study in the high school library, now fretted if he was not at the dinner table every night. Although he’d always telephone her from the hospital to let her know, more and more she viewed his absence as filial disloyalty.
Moreover, as this new obsession grew, she would not fall asleep until her son returned. Sometimes it was even after Johnny Carson. And while some movie from the Stone Age flickered on the TV screen, she’d still ignore Nat’s pleas to shut it off and let him sleep in peace.
‘Not on your life,’ she’d answer sternly and would stay awake to hear Seth’s footsteps climbing toward his room.
One night when The Late, Late Show featured a classic from the silent days, she provided sound track by engaging Nat in dialogue.
‘What do you think he does at this hour?’ she asked.
At first her husband did not answer, for he had found a way of sleeping with a pillow over both his ears. Rosie had to shout again: ‘What do you think he’s doing, Nat?’
That was the very minute Seth entered and began tiptoeing upstairs. And so, unwittingly, he overheard a kind of verbal primal scene between two senior citizens. His father said, ‘For God’s sake, Rosie, the boy’s almost twenty-five.’
‘And what if she traps him? Girls are known to do that. Everything is hunky-dory, or should I say hanky-panky, and Poof! – suddenly she’s pregnant.’
‘Good,’ said Nat. ‘Then you’ll be a grandma that much sooner.’
Seth remained on the stairs, spellbound by the conversation.
‘Judy isn’t good enough,’ said Rosie wistfully, ‘he could do better.’
Nat raised himself onto his elbows and retorted, ‘She’s a sweetie and they love each other. What do you expect, for heaven’s sake, Princess Grace?’
‘I expect better.’
‘Hey, listen, Rosie. Seth’s a lovely boy. He’s got a good head on his shoulders. But Prince Rainier he’s not. This girl makes him happy. What more can you ask?’
During the pregnant pause that ensued, Seth told himself to get upstairs and out of earshot. But his thoughts could not activate the appropriate motor areas in his brain.
And then he heard his mother say in a lugubrious voice, ‘I don’t want to lose him, Nat. It’s bad enough I lost Howie. I don’t want to lose my other child.’
‘Who’s talking about losing? The boy’s in perfect health. He’s simply going to take a wife.’
‘Take her where, Nat? That’s the point. I won’t allow my Seth to marry her. And that’s my final word.’
To which her husband answered, ‘I sincerely hope so, Rosie. Goodnight.’
The following Saturday, Seth Lazarus and Judy Gordon drove to Evanston and in the sight of God and in the face of a congregation – consisting of Daniel Carroll, Justice of the Peace, his wife, and a second witness (who cost five dollars) but not, alas, of their parents – were united in Holy Matrimony.
Those whom God hath joined let no mother-in-law put asunder.
It was Laura’s first experience with a disfigured baby.
Twelve hours earlier Mrs Kathleen Paley had given birth to a seven-pound baby boy. The attending pediatrician, Dr Paul Fedorko, had brought along his favorite intern so that Dr Castellano could observe how to handle a newborn in the initial moments of its life.
The young mother had been in a state of panic when she arrived at the hospital. Her
obstetrician, Dr Jack Lesley, concluding that it would be easier on his patient and on himself if she were heavily sedated, administered a hundred milligrams of Nembutal to put her out and then ‘scoped’ her – in other words, gave her a hundred milliliters of scopolamine – to keep her out.
Laura was astonished – it seemed enough medication to keep an elephant asleep for a couple of days. Mrs Paley had been all but decorticated; it was as if the outer layer of her brain had been shut off. To Laura it seemed miraculous that the woman was still breathing.
It had been a breech delivery, which Lesley had handled expertly, but which served to delay discovery of the impairment till the very last minute.
The mother slept unaware of the shock awaiting her.
For her otherwise perfect little boy had been born with a partial cleft palate – the tissues in the area of the mouth and nose had not fused. In addition, the infant had a harelip that made him look as if a dog had bitten him and torn his mouth.
Fedorko had warned Laura to prepare herself for this possibility, since Kathleen’s family had a history of these malformations.
Laura had seen pictures of babies with cleft palates in textbooks but, although she tried to remain clinically detached, she shivered at the sight.
Dr Lesley signaled the pediatricians to take the infant away. Laura and Fedorko wrapped the baby in blankets and the nurses rushed him out on a small isolette to Intensive Care. Meanwhile the mother was wheeled to her room where, because of the sedation, she would remain unconscious for at least half a day. This would give Lesley and his team enough time to steel themselves before confronting the parents.
Laura learned an important lesson that day. When a doctor had good news to tell a patient, he presents it on his own. He is like an opera star; he stands center stage and sings an unaccompanied solo. By contrast, when all has not gone perfectly, a different tune is sung – more like an oratorio for as many voices as possible.
To put it more bluntly, in times of crisis doctors believe there is safety in numbers.
Laura was drafted for the team – comprising Lesley, his chief resident, and Fedorko, who was now the child’s official doctor. They reassembled twelve hours later outside Room 653.