Doctors (62 page)

I
t was an awesome moment to be thrust into the world. Yet in the years 1967–68 most of the doctors who were graduated from Med School a half-decade earlier would at last be freed from supervision and out on their own, honored with the crown of omniscience, but cursed with the awareness of their limitations and fallibility.

It was a time of such confusion that military leaders were pronouncing on the value of life and physicians were redefining the moment of death. Moral schizophrenia was epidemic.

General Westmoreland told the press that Orientals, like those his troops were trying to kill in Vietnam, held human life to be less important than did those in the more enlightened West.

Blacks ran riot in the cities, incurring the white man’s wrath. Yet, paradoxically, when some of these same men put on khaki uniforms and machine-gunned the Vietcong, white generals pinned medals on their chests.

This contradiction, this schizophrenic attitude toward violence,
was epitomized by Cassius Clay (as white men called him) or Muhammad Ali (as his brothers and a handful of the liberal left referred to him). The great warrior stood on the steps of the induction center and declared that he would not employ the talents God had given him for mayhem to square off against the Vietnamese. He who had willingly leapt into the ring to make opponents “dive in five” or “hit the floor in number four” refused to join in the destruction of a people who could not even afford the price of boxing gloves.

Ali was diagnosed as mentally incompetent for Army duty. (“I said I was the greatest—not the smartest.”) The times they were a-changing.

Meanwhile doctors now were asking, “What is death?” In other words, when could they remove the organs of a man deceased to use them as replacements for defective parts of men diseased?

In a country so close to the South Pole that it was sometimes lit by the aurora australis, Dr. Christiaan Barnard was waiting for a death to be declared so he could graft the corpse’s heart into another’s body.

At Groote Schuur Hospital near Capetown, surgeons added one more dimension to the debate on whose life was of more importance. Dr. Barnard’s third patient, a white Capetown dentist, was rescued from death by the gift of a “colored” man’s heart. How would the sages of apartheid now classify this patient? Which part of the bus, which toilet, and indeed which township would be home for Philip Blaiberg, Barnard’s most successful—and most controversia—patient?

Still there was a good prognosis for the world. Transference of the heart from one chest to another stole the headlines in 1967, yet in that self-same year in a quiet laboratory in Cleveland, Ohio, Dr. Robert White removed the entire brain from a monkey’s skull and transferred it into another’s.

The prospects defied credulity.

There is no graduation day in psychoanalysis, for in a sense it never ends. Indeed, the most significant part of the therapy begins only when the patient rises phoenixlike from the ashes of his inhibitions, stands vertical, and walks out into the labyrinth of daily life, his psyche now a compass that will—hopefully—lead him to the right decisions.

It was with ambivalence—pride and relief alternating with
sadness and apprehension—that Barney faced his final session with Dr. Baumann.

Though his analysis officially was at an end, he was still aware that he would always carry with him unresolved emotions.

Indeed, throughout his inward odyssey from memory to memory, Barney had discovered that Harold’s illness and his early death had robbed him of the father he had so desperately needed. And there was no changing that.

Dr. Baumann’s help had also taught him how to understand what he was doing—r at least
why
he was doing it. He could look forward to the greatest gift analysis can give—the rare ability to act as an adult.

That was the good part. But there was still a precinct that remained off-limite—a character in the drama of his life who seemed to appear in almost every scene, but whose function never was explored. And Dr. Baumann knew full well that Laura Castellano was hardly a “walk-on.”

His patient had so vividly described this girl, not merely her virtues, but also her troubled psyche, that Baumann often found himself wondering what she was really like. Yet he knew that he had failed to help the young psychiatrist disclose exactly what this mythic figure meant to him.

With merely minutes left and Barney free-associating about entering his thirtieth year, he remarked, “Well, Castellano’s turning thirty, too. I feel so guilty being optimistic when I know that she’s so damn miserable.”

Fritz intervened.

“About Laura—”

Barney interrupted.

“I suppose you’re thinking I’ve been holding out on you and that I maybe harbor—I don’t know—romantic feelings about Laura. But I don’t.”

The analyst did not reply.

“I mean, I’ve been completely honest with you, Doctor. I don’t deny that once or twice through all the years we’ve known each other I’ve had—call it sexua—thoughts about her.”

There was a silence.

“Are you sure you aren’t camouflaging something?” Baumann asked directly.

“Sure I’m sure. But with due respect, sir, it’s a new world. Nowadays it’s possible for men and women to be just good friends.”

“It has always been possible,” Baumann replied. “I just wonder if you are certain it’s that way with you and Laura.”

“It’s how she feels about me, I’m sure about that.”

“And you?”

“I don’t know. I really, honest-to-God don’t know.”

“Well perhaps this is something you might work on in the future.”

Though he had not yet completed the two supervised analyses necessary to be admitted to the Institute, Barney was nonetheless Board-certified to practice general psychiatry, and could now see private patients outside the hospital in an office of his own.

Through the widening contacts he had made among older colleagues, he learned that one of the Senior Fellows, Brice Wiseman, had just lost to the Army the young psychiatrist with whom he’d shared an office.

Barney found himself in turmoil. He sat down in his newly purchased Eames chair, closed his eyes, and tried to look within himself to find out what was bothering him.

Was it perhaps the fact that Brice Wiseman’s office was on the East Side of New York, close enough to Park Avenue for all the connotations of privilege emanating from that legendary street? Yes, that was part of it.

And then there were the furnishings. His predecessor had collected exotic art and artifacts and had made his office a sort of poor man’s museum.

Ah, but isn’t that the point? No poor man would be likely ever to be treated in such regal splendor, he told himself. If I’d needed help when I was just a kid in Brooklyn, would I have had the chance to see the well-intentioned Dr. Livingston in his offices between the avenues of Madison and Park? Then he thought immediately, in his own defense, that he was also seeing troubled people at the hospital for nothing. He pondered longer, trying to plumb the deeper reasons for his discontent.

And, finally, he knew.

It was not the address, the fancy decor, or the pictures. It was the
price.
For at the bedrock of his qualms he found what was disturbing him: he had to put a value on
himself.

On the surface it seemed ridiculous that he had never thought of this before. But then up to now all he had ever wanted as reward was a good night’s sleep. The hospital paid him a salary—if
you could call it that. And his writing brought a little extra. That at least was work he could somehow quantify.

But how could he assess himself—his brain? And if the people a psychiatrist sees are already in such distress, how could he impose yet one more burden on them? True, Freud believed financial sacrifice was part of the incentive for successful treatment. But not
everything
the Master said was right. For after all, when he psychoanalyzed himself, he clearly didn’t send himself a bill.

Barney found himself recalling childhood incidents. Like overhearing Luis Castellano talking to the mother of a child whose broken arm he’d just set.

(“How much do I owe you, Doctor?” she had said.

“Is five dollars too much for you?” he had asked.

“No, no,” she had said hesitantly. “But is it okay if I pay you some now and some later?”

And Luis had reassured her, “Fifty cents a week will do. But I’m not in any hurry. We can talk about it when I take the
niño
’s cast off.”)

But then Luis did not have to pay a hefty office rental or half the salary of a receptionist.

Yet does a doctor really need these trappings?

“I know how you feel,” Brice said the next day. “But even if you were Rockefeller and had all the goodwill in the world, you’d have to charge. It makes the patients take you seriously. It’s documented in the literature—not just by Freud, but Ferenczi and plenty of others. Of course, you’ll make exceptions where there’s indigence involved. But, otherwise, if I were you I’d peg my fee at somewhere between twenty and thirty bucks a session.”

But Barney’s conscience was still not assuaged. “In ancient Babylonia a doctor only got paid when he had cured his patient.”

Wiseman laughed. “Hammurabi made that rule back in 1800
B.C.
Nowadays I think the AMA would tend to look upon that as a bit outmoded.”

And then he once again addressed the point: “You’re providing a service, Barney. See yourself, if you will, as a taxi driver transporting a patient from sickness to health. The meter has to run, doesn’t it?”

Unwittingly Wiseman had hit on a metaphor that corresponded to a genuine experience in Barney’s life. He had been a hackie.

He broke into an impish smile. “The only difference is we don’t take any tips. Right, Brice?”

Wiseman grinned and said, “Only if it’s on a stock or on a horse.”

By the spring of 167 there were nearly half a million U.S. troops in Vietnam, few of them understanding what exactly it was they were fighting for. Meanwhile, all across the United States there were at least as many protesters marching against their country’s involvement in Southeast Asia. General Lewis B. Hershey, the director of conscription, let it be known that men who had been given a student deferment from service to complete their education would forfeit that privilege if discovered participating in an antiwar demonstration.

A great many doctors had their military obligations to fill and would have to make a moral decision if asked to serve in Vietnam. By now large colonies of young Americans who had been conscripted were turning into self-made refugees and fleeing the country. Canada and Sweden suddenly became the centers of the draft evaders.

But there were other ways of keeping out of uniform. A doctor’s note declaring a young man unfit for service, for example. Since certification of mental instability was probably the most effective draft deterrent, Barney found himself under extreme pressure.

For what kind of doctor would he be if he declared a well man sick? He and Laura discussed it endlessly in their after-midnight “consultations.”

“Thank God the only boys I deal with are just a few days old,” she commented, “so I don’t have to worry about this sort of thing.”

“Don’t be so sure, Castellano. The way things are going, this war may be still on when they grow up.”

“Anyway, you’re in the hot seat
now.
How’re you going to deal with it?”

“I’m gonna declare that General Westmoreland’s insane and the whole war is lunacy.”

“I agree with you,” she said, “I’ve already marched my feet off. And I sympathize with the bind you’re in. I mean, nowhere in the Hippocratic Oath is it written that a doctor can lie to keep his patients out of battle. There’s no moral precedent.”

“There
is
,” Barney countered. “The Nuremberg Trials proved that morality transcended nationality. And don’t forget, if
these guys just sit here and set fire to their draft cards, they’ll be thrown into jail. Now isn’t
that
immoral? Besides, doctors are supposed to save lives. And whoever I declare unfit won’t go out there and kill people.”

“Gosh, Barn, you’re really taking a big risk. I admire you. What are you gonna say is wrong with them?”

“I’ll say anything I think is appropriate—foot-fetishism … schizophrenia, homicidal tendencies.”

“Oh, they’d just
love
a guy with homicidal tendencies.”

“Speaking of murderers,” Barney interrupted, “how’s that sonovabitch husband of yours?”

“He’s doing something in Washington.”

“That wasn’t my question. How are you two getting on?”

“Oh, I don’t know,” she answered. “Let’s just say it’s on hold. Anyway, he’s flying in tonight.”

“Don’t you think he’s bounced you like a yo-yo long enough? That’s pretty self-destructive, Castellano. Why don’t you give him some sort of ultimatum?”

“Look, Barn, I’ve already extended a cordial invitation to divorce. He didn’t accept. He says he likes things the way they are. Frankly, as far as I’m concerned, I’m too tired to care.”

Laura was so involved in this conversation that she did not notice the door opening. Or Palmer entering the room.

“To be frank, I’m probably to blame for his screwing around. I mean, maybe his affairs have just been to get back at me for my ‘liberated’ policy before we got married.”

“Christ, Castellano, you’ve got a unique talent for always making yourself the guilty party.”

At which point Laura screamed.

“Hey—what the hell’s going on?” Barney asked.

She turned and was relieved to see it was Palmer who had playfully nipped her on the neck. As he kept his arm around her waist, she reassured Barney.

“It’s my wayward husband trying to be Dracula. I think I’d better go now.”

“Okay, Castellano, only work up the courage to have him put up or shut up.”

She hung up.

Suddenly Palmer was undoing the buttons of her blouse, murmuring in a tone she had not heard for years, “I’ve really missed you, Laura.”

Thirty minutes later as they were sitting before the fire, Laura kissed him and remarked, “That has to rank as the greatest
conversion since Saint Paul went catatonic on the road to Damascus.”