Doctors (50 page)

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 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 semicomatose 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 patients.

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.”

“Is that all?” the patient asked anxiously. “You mean I have less than an hour to live?”

“I didn’t say that, Mr. Adler,” 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 Adler 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?”