Doctors (46 page)

And now she realized that however much she wanted to succeed, she wanted
that
, too.

Barney was proud to be operating with the First Team, though he knew the best he could hope for was to be called upon to hold a clamp.

At least he would be watching Thomas Aubrey (“the surgeon’s surgeon”) and anesthesiologist Conrad Nagy (“the best gas-passer in Christendom”) do their stuff.

Today’s procedure was a cholecystectomy. What would usually be the routine removal of a gallbladder was this time made a “little more interesting,” as Aubrey put it, “because our patient, Mr. Abrahamian—as you will have read in his notes—has had a complex childhood history that included rheumatic fever, and practically every allergy you can think of. We have to be alert for surprises.

“Dr. Nagy has administered atropine as a pre-op, induced anesthesia with sixty milligrams of methohexitone, and used salcuranium for good neuromuscular harmony. To keep the patient asleep he is using nitrous oxide and oxygen in a 70:30 ratio.

“So much for prologue, now we open the curtain.”

Holding the scalpel like a cellist’s bow, Aubrey made a Kocher incision, then beckoned to a nurse on his right and another on his left to come forward and hold the abdominal drains. Aubrey put his right hand into the wound to move the liver and thereby expose the gallbladder. He grasped the organ with a ring clamp and lifted it toward the surface.

His first assistant, Dr. Lipson, kept the opening wide with a broad-bladed Deever retractor. He then signaled to Barney to take a narrow-bladed retractor and place it under the costal margin—the bottom edge of the rib cage.

“Now, gentlemen,” Aubrey announced, “we have maximum exposure. A careful surgeon must take his time in inspecting the entire area he has exposed.”

He took them on a guided tour of the duct system and arterial supply before removing the gallbladder. Thereafter he led his intrepid explorers in a search for any possible bleeding points that he had not already tied. At this point he turned the show over to Dr. Lipson to close the wound while Aubrey continued to narrate.

“Please note that Dr. Lipson is carefully avoiding the capsule of the liver, since sutures passing through that organ would cause bleeding. When all is ready, we will insert the drain—”

Suddenly, the anesthesiologist broke the spell of placid pedagogy.

“Problems, Tom,” he said, an unmistakable edge of worry in his voice.

“What’s up?” the surgeon asked calmly.

“This guy’s sizzling. Blood pressure’s sky-high. Pulse is one-eighty.”

Dr. Aubrey quietly ordered, “Somebody get a rectal temperature.”

Barney stood mesmerized, as one of the nurses inserted a thermometer. He began to sweat, yet did not dare wipe his brow for fear of losing his concentration on the retractor he was holding. He glanced at Nagy. The anesthesiologist’s forehead was furrowed and his eyes broadcast anxiety. Aubrey’s attention remained riveted on the open wound as if dissociated from the panic all around him.

After what seemed an eternity, the nurse removed the thermometer.

“My God!” she gasped.

“Just read it, Helen,” Aubrey ordered in quiet clipped tones.

“It’s almost a hundred and eight, Doctor.”

“Shit,” Nagy cried out, “malignant hyperthermia. Let’s get some ice, stat.”

Barney heard footsteps racing toward the door. He felt that he, too, should be reacting to this emergency, but how? Frightened and confused, he turned to the chief surgeon.

“Should I help them get ice, Doctor?”

“Did I give you any orders, young man?” Aubrey snapped in his first display of emotion. “Just keep holding that retractor and stay out of the way.”

At this moment the anesthesiologist blurted, “Tom, the EKG is going crazy.”

Aubrey ripped off a glove and reached for the patient’s groin to feel for the femoral pulse. Barney could tell from the expression above his mask that he had found none.

“No heartbeat,” another voice called out.

“EKG flat,” Nagy announced. “He’s dead.”

There was a sudden flood of silence. No one
dared
speak until Dr. Aubrey decided on a course of action.

At last he ordered, “Dr. Nagy, continue aerating the lungs.”

The anesthesiologist nodded and obeyed.

Why the hell is he doing that? Barney wondered. This poor bastard’s dead.

The surgeon then tapped his assistant’s shoulder. Lipson understood and moved aside, ceding the task of suturing Mr. Abrahamian to the swift and dexterous hands of the chief surgeon.

Barney watched in growing disbelief. Why the hell is he sewing so carefully—sewing at all, actually? They’re only going to reopen the guy for a postmortem.

By now Barney had removed the retractor and was merely a helpless and confused bystander as oxygen continued to inflate the dead man’s lungs.

Aubrey tied a locking half-stitch, which squared the last knot. “All right,” he said quietly, “take him to the recovery room. I’ll be there in a few moments.”

As the late Mr. Abrahamian was wheeled off, Aubrey turned and strode coolly back to what must have been the star’s dressing room.

Lipson re-entered from post-op and saw Barney rooted to the ground. “What’s up?” he asked.

“I don’t understand what I just saw,” he answered.

“Which part?”

“The guy was dead and they still—”

“Oh that,” Lipson answered. “How much surgery have you been in on?”

“This is the first week of my rotation,” Barney replied, and then demanded, “Now will you please explain to me why the hell you pumped air into a guy who’s so dead he had no pulse or heartbeat?”

“Calm out, amigo,” said the young doctor, “you’ve just learned why no patient ever dies on Dr. Aubrey’s operating table. Thanks to the balloon work of Aubrey’s gas-passer, Mr. Abrahamian will be pronounced dead
after
the operation by somebody in the recovery room.”

“You mean just for Aubrey’s ego?” Barney replied with astonishment.

“No,” Lipson protested, “Tom’s a bigger man than that. But you can’t imagine how much paperwork he’s saved—even though I usually do it for him. All the damn certificates, hospital papers, insurance forms—that bureaucratic crap takes hours. Now it’ll be a job for the boys in post-op. So you’ve learned something today, eh, amigo?”

“Yeah,” said Barney, “I’ve learned that I don’t want to be a surgeon.”

Just before their fourth and final year, Second Lieutenant Palmer Talbot flew into Boston from California—military rate—on United Airlines. A week later he could have winged home without a plane, so inebriated was he by the heady wine of Laura’s newly affectionate behavior.

For her part, Laura was delighted at having a Stage Door Johnny outside the operating theater—a man whose qualities she respected, who treated her like something other than a sexual brass ring on the medical carousel.

Palmer had determined to make his Army years an educational experience. He had been accepted by the Army Language School in Monterey and had begun the study of Chinese. It would mean a commitment to the military for an additional year. But it had seemed worth it, especially when Laura had been so cold and indifferent to him.

Now he had a Laura who preferred sitting by a fire in the
living room of his Beacon Street house and talking about everything—as long as it was nothing to do with medicine.

She told herself she had forgotten how well read he was, what a good listener—and how loving. There was no one in the world, she convinced herself, who cared for her as much as Palmer Talbot. What a fool she had been to risk losing him in the smug confidence that she was yet to meet “Mr. Right.” For she had now decided that it could never be “
Dr.
Right.”

She tried not to burden him with the deep hurt she still felt at the disintegration of her family. The separation had become all the more definitive when earlier in 1961—in January to be exact—the United States government completely severed diplomatic ties with the Castro government. And then the Bay of Pigs invasion, launched by exiled Cubans from Miami intent on “liberating” their homeland, reduced relations between the two countries from absolutely nothing to overt hostility.

“Now I couldn’t see Luis even if I wanted to,” Laura commented wryly.

“Well, actually you
could
,” Palmer offered. “It’s still possible to go to Mexico and fly over from there.”

Laura looked at him and tried to sound resolute when she pronounced, “I’ve no desire to visit Cuba, Fidel, or my father.”

“Haven’t you had any contact at all since he left?”

“A few crummy letters. I didn’t even bother to answer them. I mean, the guy’s more than
un poco loco
to be a revolutionary at his age. He claims his greatest aim in life is for me to join him in Cuba and be a doctor there.”

Palmer shook his head. “I read somewhere about men doing outlandish things at his age—sort of menopausal madness. Even if you wanted to, I wouldn’t let you follow him.”

“Don’t worry, there’s no risk of that. Or of my joining my mother in her religious retreat.”

“How is she, by the way?”

“Oh, we’ve spoken on the phone a few times. She claims she’s happier than she’s ever been since she ‘found her calling’—as she so piously put it. I think she expects me to visit her, but I’m in no mood to see a mother who would rather be a ‘sister.’ ”

He touched her on the shoulder. “I know what you must be going through.”

“I don’t think you possibly can. You know, with both my parents going loony, I’m kind of scared I’ll flip out, too.”

Palmer smiled. “How about flipping out over me?”

“I think I already have,” she replied, and put her arms around him.

There was now a good chance that the Army would send him back to Boston. Sponsored by the NDEA (National Defense Education Act), he could do his final year of service taking advanced courses in Far Eastern languages at a “recognized college or university.” Since the army “recognized” Harvard, he had come to discuss their program with its director, Simon Rybarchyk.

And to find out how things stood with Laura.

The night before he had to leave, as they were lying in each other’s arms by the fire, he said, “Look, Laura, I’d really like to come back East and study. But I can’t settle for what Shakespeare called ‘living in the suburbs of your affection.’ I know you’re not ready to get married. So I’m willing to play it any way you want, as long as we can be together—and I mean
live
together.”

Laura looked at him for a moment and then said, “Palmer, the girl who didn’t believe in marriage isn’t here anymore. Actually, I think ‘Laura Talbot’ sounds very pretty.”

“I don’t believe I’m hearing this. Are you actually telling me you’re willing to become Doctor Laura Talbot?”

“No,” she said, smiling playfully, “I’ll be Mrs. Talbot but
Doctor
Castellano.”

“You’re actually going to marry that schmuck?”

“I thought you liked Palmer,” she protested.

“Listen, I like Elvis but that doesn’t mean you should marry
him.
You’re only doing this because you suddenly imagine you’re all alone, and Palmer is the path of least resistance.”

“Barney, he loves me.”

“I know, Laura, I don’t question that for a minute. What I do question is whether, deep down, you honestly love him.”

T
here is a time of supreme crisis in the life of every fourth-year medical student.

As he is completing the last few “elective” rotations, doing a little more Surgery or Internal Medicine if he intends to be a cutter or a flea, he suddenly looks at the calendar and notices that in June
of that same year
he will be officially granted the title of M.D.

At that moment of acutely painful awareness, he realizes that he is not remotely prepared to become a doctor. Shit, he says to himself (or “Gosh,” if he is Seth Lazarus), people are going to think I know what I’m doing. They’re going to expect me to recognize what’s wrong with them—and cure it. How am I going to deal with that?

Now, retrospectively, the days of tedious scutwork seem like Paradise Lost. How infinitely better to be schlepping up and down the stairs and holding clamps while others operate. The worst he might come home with nightly is a pair of aching feet. But his conscience never aches.

Doing scutwork, he takes everything—but the responsibility. He is not yet obliged to be infallible.

Some who pass this crisis have the honest self-awareness that they always will be students; they will never have learned enough. But such candor cannot protect them from their patients’ pain. And ultimately, be it ten or twenty years, the strain becomes too much for some of them whose hearts break metaphorically—and even physically.

And they become members of that species known as the “impaired physician,” a euphemism for a doctor with a damaged soul.

The other—far more common—way by which the fledgling healer copes with this apocalyptic moment is
denial.
He deludes himself that taking the Hippocratic Oath is tantamount to baptism. That with the diploma come superhuman powers that—like microbes—are invisible except to the initiate observer.

The syllogism runs along the lines of Descartes’s “I think, therefore I am.” But in medicine the formula is, “I have a Degree, therefore I am a Doctor.”

Those who can successfully perform this satisfying self-hypnosis will win friends, awards, promotions, and—with perseverance—even a Mercedes SLC.

It was time for Barney to decide upon a specialty.

As had been his practice since his earliest memories, he held an inner dialogue with himself. Question: What makes you happy, Livingston? Answer: Making other people happy.

Well, that doesn’t help much—to do that you could play Santa Claus in a department store. Can you clarify these thoughts?

Yes, upon reflection I can translate my ambition—to treat unhappy people and make them see the joy in life.

The more he searched himself, the more he found the evidence that he was cut out for psychiatry. First and foremost, troubled people had been turning to him for as long as he could remember.