‘Come on, Laura, where’s your sense of adventure?’
‘I think I lost it after my first all-night surgery.’
‘Laura, darling, is it really worth all this?’
She saw the sadness in his eyes, knew the loneliness he felt, yet answered, ‘Yes, Palmer, it is to me.’
The phone rang.
Bennett Landsmann opened one eye while trying to keep the rest of his body asleep. It was 2 A.M. and he had just gone to bed after thirty straight hours in the E.R. But the ringing persisted relentlessly and finally with a sigh of defeat he picked up the receiver.
‘This is Dr Landsmann,’ he said gruffly.
‘This is Dr Livingston, but you can call me Barney.’
Bennett opened his other eye and sat up.
‘Hey, do you know it’s the middle of the night?’
‘No,’ Barney quipped. ‘But can you hum it?’
‘Are you high on something?’
‘Not unless you count Nescafé and chocolate bars. No, Landsmann, this is the first time I’ve sat down in what seems like a month. I must have interviewed several million patients and written up histories for every damn one of them. I’ve lost count of the cuts and lacerations I’ve sewn. I got so dazed that the chief resident actually told me to lie down.
‘Anyway, being a man of leisure for the next fifteen minutes, I thought I’d see how they were treating you up there at Yale. Were you actually sleeping, Landsmann?’
‘No, of course not. I was doing some extra research in my spare time. Trying to invent a cure for bullshit. Anyway, how’s your ass?’
‘Aching just like the rest of me. Well, how about you, old buddy? Are you at least doing any horizontal dancing in the sack?’
‘One or two nurses have looked favorably upon me. But there’s even a pecking order in that department, and senior residents get the best talent. Anyway, I’ll survive. What do you hear from Castellano?’
‘Nothing. I mean, what do you expect? She’s working as hard as we are. And whenever I do call, old Palmer claims she’s out. Half the time I’m convinced he’s giving me the straight-arm.’
The friends were exchanging Casualty Ward anecdotes – some of which were so grisly that only gallows humor made them tolerable – when Barney innocently touched a raw nerve.
‘So, in other words, outside of total fatigue and sexual deprivation, you’re happy in New Haven?’
There was a silence.
‘Hey, Landsmann, are you still there?’
Bennett hesitated. ‘Well … it’s kind of a long story.’
And he then recited a litany of ugly incidents.
When he finished, Barney said, ‘I can imagine how you feel.’
‘Can you really?’
‘I’d say your mood was pretty black.’
‘Right on, Livingston. And getting blacker all the time.’
28
Informed observers of the American scene predicted that 1963 would be remembered as the year of Black Awareness. That is until the events of November twenty-second. Now the hallmark of the year would be John F. Kennedy’s assassination.
Not only was the body politic in turmoil, but the human body also featured prominently in the news. It was the beginning of a new era.
All over the country there was news of successful replacement of diseased and dying organs. Dozens of people received the gift of life when the kidneys of another were transferred to them.
At the University of Mississippi, the first lung transplant was performed. In Houston, Dr Michael De Bakey used an artificial heart to maintain the circulation of the patient’s blood during heart surgery.
And when they lacked a human donor, the laboratories came to the rescue. Thanks to man-made corneas, some who were blind could see again.
But not all the medical news was good. For the American Hospital Association reported that the average daily cost per patient had more than doubled in five short years. From $18.35 to $36.83.
And before Jack, another Kennedy died that year. On August seventh, JFK’s second son, Patrick, was born five and a half weeks premature, weighing four pounds ten and a half ounces and suffering from RDS (respiratory distress syndrome). His lungs had not developed sufficiently. He could inflate them but could not retain any air.
Wrapped in a blue blanket and placed in a little plastic box, the infant was rushed from Hyannis Port to Boston Children’s Hospital, where the entire staff was mobilized in the fight to save him. The hospital had an apparatus unique in the world – a huge oxygen chamber thirty-one feet long and eight feet wide. Two specialists worked inside the machine in a desperate attempt to force oxygen into the baby’s system.
But without success. After a mere thirty-nine hours of life, the baby died.
(Ironically, only a year later, a new technique of treating RDS was perfected by doctors at Children’s Hospital in Louisville, Kentucky.)
By the end of 1963 the Harvard Medical School class that had received diplomas a year earlier had ostensibly completed all requirements to practice medicine in America. They were, most of them, between the ages of twenty-four and twenty-nine.
They were also, most of them, far from ready to practice, because the end of internship most often signals yet another beginning.
True specialization demands intensive concentration on a specific aspect of medicine. Like anesthesia or pharmacology. Or on one tissue, like skin or blood. Or one area, the chest or abdomen. Or one organ, the eye or heart. Or one physical technique, the art of surgery. Or even one mystery (though some insisted it was not a science), the workings of the mind: psychiatry.
Thus, Barney Livingston, M.D., having duly fulfilled the requirements of internship and wanting to become a psychoanalyst, needed to spend three years in psychiatric residency (and thereafter another optional twelve months).
And if he wished to be a full-fledged member of a psychiatric institute he had to have the insides of his own head probed by a senior analyst. This was intended to get himself in better touch with his unconscious, and thereby help his patients to get in better touch with theirs.
Thus, assuming that he did not stumble along the way, Barney might be free and clear of all the pedagogical requirements in another six or seven years. This would put him on his own at last in 1970, at the age of thirty-three. In other words, he’d just be starting when professionals in other fields (like little brother Warren, who would receive his Law degree that year) would have been off and running – not to mention earning a real living – for pretty close to a decade.
And this, always assuming he had fulfilled his military obligations somewhere along the way.
And Barney’s road was not the longest. Graduates aspiring to surgical careers, like Bennett (who had been invited to stay at Yale) and Crete (who had switched to Georgetown Hospital in Washington), had at least five years of postgraduate training to complete – one as an intern, two as assistant resident, one as first assistant, and, provided they had not collapsed or reached senility by then, a final year as chief resident. Of course, if they were going into a subspecialty, like pediatric surgery, there would be still further years of training.
Doctors are often accused of callousness, venality, and self-infatuation. But they remind us that they have sacrificed the springtime of their lives, completely lost the precious years between their twenties and their thirties acquiring skills to benefit their fellow men.
Furthermore, they have suffered deprivations. Most of them have not had more than a dozen real nights of sleep in all this time. Many have sacrificed their marriages and have lost the unique opportunity to see their children grow.
So when they argue that the world owes them some compensation – in the form of wealth, respect, and social status – their demands are not entirely without cause.
Also, as the grim statistics show, they often suffer worse than any patient. For no one can repair a broken marriage or restore the children damaged by their father’s ostensible neglect.
&nbs
p; Laura had been at the hospital when the Kennedy baby was rushed in. Although she had no direct contact with the case, she remained there in a kind of mass vigil with most of the staff.
She had been awake for more than forty-eight hours when White House Press Secretary Pierre Salinger, himself on the brink of tears, announced that ‘Patrick Bouvier Kennedy died at 4:04 A.M. this morning. The struggle of the baby boy to keep breathing has been too much for his heart.’
And she shared in the collective grief and sense of failure that pervaded every corridor.
When she heard one of the new interns say, ‘At least the Kennedys have two other kids, it’s not all that terrible,’ she turned on him.
‘What the hell kind of attitude is that? The point’s not what she has, but what she’s lost!’
The chastened intern retreated.
As a first-year resident in pediatrics, Laura had at least a few serious responsibilities.
For instance, when the time came for Kathleen and Mort Paley to bring their six-month-old in to have his lip repaired (the palate surgery would be done later), Laura stood right at the surgeon’s shoulder. She watched intently as Fedorko meticulously closed the ugly tear, concluding with nearmicroscopic nylon stitches to connect the outer skin. The disfugurement had all but disappeared.
The Paleys were ecstatic. Three days later, as Kathleen was putting on the baby’s coat and hat, Mort commented to Laura, ‘It’s worked out just the way you promised, Dr Castellano. We’re extremely grateful – all three of us.’
As they shook hands, Laura thought, Words like that are what make most of us go into medicine.
But Laura was sleepwalking by the time she returned home after her twenty-four-hour rotation. One of the few neurons still working in her brain reminded her body that it needed some food in order to perform the basic functions of life.
She opened the Frigidaire, pulled out two yogurts, and sat silently at the kitchen table force-feeding herself, too tired to read even the newspaper lying nearby. She reached for a small pile of letters – bills, mostly – and aimlessly leafed through them. There was nothing worth staying awake for except one embossed ‘Georgetown Medical Center, Washington, D.C.’ She picked up a knife and opened the envelope with surgical precision.
Dear Laura,
Great news. Yesterday I actually got to make an incision on my own. Okay, so it was only a routine appendectomy. But the patient was an 18-year-old cheerleader-type whose greatest anxiety was whether she’d be able to wear a bikini again. Anyway I’d been practicing my technique (mostly on peaches and oranges) so when the Chief suddenly turned and handed me the knife and told me to go for it I was truly ready.
I took the scalpel, pronated my hand, went for it and made a really neat (I thought) transverse incision. And then he let me keep going until I had incised the peritoneum. I felt so high – I had finally been initiated.
I seem to be making progress in my therapy, too. Andy says that at one time or another almost every medical student has to seek psychiatric help. And he told me about a study made by the Markle Foundation a few years ago, and I went to the library and looked it up. Would you believe that out of 219,000 doctors in this country, only a lousy 11,000 are women?
And what really shocked me was that the divorce rate for female doctors is five times higher than for men – and God knows they’re not doing so well. Even a super guy like Andy is stuck with a pretty unsympathetic creature for a wife.
I’m due on in about three minutes and I’ve been writing this naked as a jaybird – so I’d better hurry and get dressed.
Please write and let me know how you are.
Love,
Grete
Laura smiled. Same old Andersen, always goes back to her body. I wonder when her shrink will get around to working on that?
And then it struck her. ‘Andy’? Does she call her psychiatrist by his first name? And how the hell does she know about his marriage? Is that something they would discuss in a therapy session? But she was too tired to give it any more thought.
She removed her shoes in the living room and walked on tiptoe up the stairs. The bedroom lights were still on. The bed was empty.
And unslept-in.
Laura sensed that she should have been upset. But she was so exhausted that even the disappearance of her husband could not overcome the beckoning of Morpheus.
It was only at eight o’clock the next morning that she was able to grasp the fact that Palmer had vanished. No note. No explanation. No nothing.
Her imagination ran the gamut of possibilities. Maybe he was in an accident. Maybe mugged and taken unconscious to a nearby hospital.
She thought of calling his parents but did not want to alarm them.
After making herself a cup of coffee, she studied the bulletin board in the kitchen where they had each put their individual time schedules.
Her eye fell upon the previous day’s agenda. Palmer had taken a seminar on ‘Anglo-Chinese Diplomatic History’ that night – 7 till 9 p.m. She had made up her mind to call the professor to find out if Palmer had been there the previous night, when the object of her inquiry suddenly appeared.
‘Good morning, Laura,’ he said cheerfully.
‘Palmer, you had me worried to death.’
‘Really? I’m glad to know you care.’
She knew the remark was intended to provoke a fight, so she let it pass.
‘Where the hell have you been all night?’
‘With friends,’ he answered, the better to annoy her.
‘That’s it? That’s your entire explanation?’
‘Have I ever asked you for a detailed account of your activities outside the house? You just tell you’ve been at the hospital and that’s the end of if.’
‘You had a seminar last night.’
‘Indeed I did.’
‘And?’
And that’s the end of it.’
‘You don’t expect me to believe that the discussion was so stimulating it lasted all night.’
Palmer grinned. ‘Laura, darling, that’s the sort of report I’m always getting from you. Your lovely green handwriting says you’re due off duty at eleven and then you appear at dawn, and just toss off some line about having an emergency. What if I told you that we had a little crisis – the appendix of Professor Fairbank’s book fell out and we used heroic efforts to suture it together.’
‘If that’s supposed to be a joke, I’m not laughing.’
‘Laura, I’ve not been laughing since the second week of your residency. I am by nature a gregarious person. Of course, you’re the person I’d most like to be around but you seem to be in scarce supply. Therefore, when some of the lads in the seminar suggested we go out for a few beers, I joined them.’
‘Didn’t you even try to call?’
‘Yes, darling I did, I tried you every half hour from eleven-thirty onward. There was no answer at the house and the hospital switchboard couldn’t locate you. Finally I just gave up and accepted a fellow student’s invitation to sleep on the couch.’
‘You’re very vague about this student’s gender, Palmer.’
‘Do I ask you about your fellow doctors’ gender?’
‘Cut this sophistry, goddammit,’ she exploded. ‘You know my job requires me to be on duty all night long. It’s not the same thing.’
‘Excuse me, but from my standpoint it is. Did you enjoy your solitary sleep last night?’
‘Of course not, I was—’
‘You were feeling what I feel almost every night,’ he interrupted.
‘Come off it, Palmer, don’t tell me you didn’t know how residents and interns live – if you can call it living. Do you think I actually enjoy being so dizzy from lack of sleep that I can barely see straight? I’m not some kind of masochist.’
‘That’s two of us,’ he countered. ‘You don’t enjoy your night shifts in the hospital and I don’t either.’ He paused, then added, ‘My classmates are all married, having kids – and having fun.
Meanwhile, for all intents and purposes I’m living like a hermit. In a nutshell, Laura, I will not go on this way.’
They stood there like two people on opposite banks of an ever-widening river.
At last she spoke. Her voice was weary. ‘Obviously I won’t give up the hospital.’
‘Obviously.’
‘So what do you propose as an alternative?’
‘Well, I think if we want to stay together, we’ll have to decide on some sort of compromise, some modus vivendi.’
‘On the contrary, Palmer. I think you’ve already made the decision for both of us.’ She took a breath and then asked, ‘So where exactly were you last night?’
He answered, with no apparent emotion, ‘Getting laid.’
‘Incurable’ is almost a taboo word in the medical vocabulary. Though most doctors can pronounce the word ‘terminal,’ they seem allergic to the special connotation of ‘incurable.’ It somehow seems to reflect pejoratively upon them. It’s also dangerous. Relatives of the unfortunate patient might have the temerity to ask, ‘Why can’t you cure him, Doctor?’
In ancient days the poor unfortunates who contracted leprosy were exiled, isolated from the rest of all humanity – and not only for their awful aspect or the terror of contamination, but also because society prefers to hide mistakes that simply will not disappear.
Leprosy can nowadays be cured quite easily with Dapsone. But it has its modern analogue in mental illness.
Though psychiatry is more compassionate in this regard. Its wards are carefully divided into ‘curables’ and ‘chronics’: those for whom the only therapy is a lethean medication like Thorazine, and others who might possibly be rescued from the dusky cavern of delusion.
Barney Livingston began his psychiatric residency that July of 1963 by being exposed to the psychotic (read ‘incurable’) section of Bellevue Hospital. Like every neophyte he had hopes of helping all the sick of soul. Thus when he pushed open the door of the Blenheim Ward, he did not see an overcrowded museum of waxwork figures. He did not see five dozen people, each of whom was living all alone inside a private world. Instead he looked on it in the manner Dante gazed upon the souls in purgatory, determined that he would help them leave.