Internal Medicine: A Doctor's Stories (26 page)

“Oh, me?” I felt embarrassed again. “I’m fine.”

“Good,” he said, and then: “Would you mind?” He stooped below the counter, and from the leftmost bin brought out another film jacket. Slipping two sheets into the box beside the one that held Scatliff’s KUB, he thumbed the switch and the images flickered into light and shadow.

It was Carrie B again. I stepped back, struggling with annoyance. Why was he dredging this up? Below the annoyance I could feel a wave of anxiety surging back and forth.

“I think I get it,” he said, as much to the films as to me.

I was beginning to feel the fatigue of the night. I could not see any connection between these two sets of films, and feared another discourse on God’s mystery. I had enough craziness on my hands already.

“I think I know what she was trying to say,” Joe said.

“What?” I said. It was an expression of irritation more than a question.

He gestured at Carrie B’s films, its darkness hedged about by bright spines. “There’s nothing there, either,” he said.

I had an impulse to say something snide, but it died before I could find words for it. For a moment I wondered if I was going to vomit again.

“It’s a . . . a crying out. An appeal.” He was speaking more to the films than to me by now, his revelation leading him in pursuit. “She put those needles in looking for some response—not from us, from herself. Because she’s empty inside, too. See?” He waved again at the films, but now he had turned his face toward me, his eyes alight in the glow of the view box, his hair a wild crest. He really did look mad.

“At least when she sticks needles into that”—he waved again without turning—“it responds. She feels
something
.”

I think the expression on my face must have told him I wasn’t following.

“The body,” he explained. “It’s important.
You
must know that.”

I wasn’t sure if he was addressing me as an internist, or as someone who had recently splashed the contents of his guts on the floor of the Gero unit.

“We think it’s about the mind, you know. All of this”—he waved his hand in the air—“we think it’s about personalities and psychology. But all that’s secondary. It all . . . depends. On this.” And here he turned again to the films on the wall: dark and unrevealing Mr. Scatliff, bright and mystifying Carrie B.

“It’s the body that’s the problem. But what makes us call
them
crazy is that they try to solve the problem: They feed it garbage. They feed it pain. The rest of us just suffer it, like the beasts of the field.”

All I could think to say was, “Isn’t that where we come in?” but it sounded lame as I said it.

Joe laughed. “I think we’re part of the problem.”

I could only stare.

“We’re not solving anything. Not the way they do. Those things they do, they
mean
something. What does all our medicine
mean
?”

I realized I had no idea what he was talking about. I was tired, and didn’t care. The air in the room had something in it I didn’t want to acknowledge.

Joe dispelled it with a sudden laugh, a shrug. He turned back to the view box and pulled the films, jacketed them. “I do go on sometimes,” he said. And then, turning, “Are you okay?”

I pretended he was speaking about my stomach, which felt empty, and told him I was.

T
HE TRAFFIC ON
I
-40
was heavy despite the lateness of the hour. I drove in the right-hand lane, too tired to join the rapid weaving of the faster lanes, pinned behind a panel van driving stolidly at sixty. I felt the trip stretching out, its duration rendered uncomfortable by my thoughts. The image of Carrie B’s X-rays floated ghostly over the road ahead, the bright streaks in it seeming to crack open the darkness: something struggling to break through the shadows. I was tired of thinking about her, but the image persisted, distracting me from the road ahead. I shook myself upright, gripped the wheel tighter, tried to dispel the illusion of something hovering over the pavement, but as I did the discomfort I had been feeling, which I had thought at first was simply fatigue, and impatience over the slow pace of the van ahead, solidified, forming a solid knot in my gut.

I remembered, with a fleeting, visceral burst of shame, how I had vomited on the Gero unit. I had never done this before, I thought, not on any of the rotations of my residency or medical school, where I had witnessed things far worse than Mr. Scatliff retching up the contents of a garbage can.

What had gotten into me? The knot in my stomach would not relax: it tightened, rather, and began to burn. I began to feel as if I couldn’t catch my breath. In a moment, I told myself, I would begin to feel sharp spines between my ribs.

What was the matter with me? The image of those films, the impossible sharpness intruding where there should have been only curves and soft shadows, flashed before me again. I tried to shake it away, but it persisted, and with it the pain in my belly seemed to sharpen.

I was starting to feel something more, as well, I realized: something like fear. Was I having a panic attack? Without realizing it, I had started to slow down: the rear of the panel van was receding ahead of me; lights were glaring in the rearview mirror. I bore down on the accelerator and reluctantly, as if it, too, were laboring under some inward malaise, the car responded, the speed creeping up again to sixty, sixty-two, and the panel van drew nearer, its dull white silhouette almost blocking out the ghost of Carrie B.

But even as I tried to take command of myself, the sense of impending doom rising in my gut grew stronger, beginning to take on the unmistakable edge of fear. My pulse was accelerating. I was starting to sweat.

What was the problem? I had seen an old man vomit garbage. I had seen a woman with needles in her chest. And this had me on the verge of panic? I wasn’t supposed to be scared by this kind of thing: the vicissitudes of the body hadn’t
frightened
me since the first week of medical school.

It had never occurred to me before that nerve was so essential to being a doctor. What if I had lost it?

This question only added, of course, to the unidentifiable sensation still surging up in me, which I was beginning to think was the opening salvo of a psychotic break. Had I picked up something in the hospital? Some psychiatric contagion?

Unwillingly, but helpless to do anything else, I let the car drift onto the shoulder and slow down. Beside me the traffic continued to flow on, louder now as the larger vehicles passed. My hands still gripped the wheel. If I let go, I knew they would be shaking. Sweat was pouring down my face.

I tried to concentrate. What was wrong? The pain in my belly would not let me think.

And then, as the pain grew, it twisted appallingly into something that I recognized, finally, for what it was. I was about to vomit again. Right now.

I threw open the door, registering in a fleeting moment the possibility that a passing car might shear it off, and in the next moment that I didn’t care as yet another burning flood burst out of me, splattering the concrete. A semi roared by, rocking the car, and I vomited again, and again, all coherent thought lost for the moment in the free fall of nausea.

The vomiting stopped, finally, leaving me bent over the sill, the seat belt still restraining me. I let it pull me back upright, putting my hands back on the wheel to steady everything, and took a deep breath.

And with that breath, to my surprise, returned not the panic and helplessness, but some access of rationality I had not expected.

The pain in my belly was gone. I felt lightened, not only of the mass of hot iron that had filled me a minute before, but of the dread that had grown out of it. Both were gone, both dispelled together, as if I had vomited up the fear as well.

For a moment I had an urge to look at the puddle on the pavement to see if there was anything there to explain this change, but the urge was ridiculous and I resisted. Because what was rapidly becoming clear to me, in what I was starting to understand would only be a brief respite, was that despite the relief of having vomited, I was still sick. I could feel the nausea returning, but with it came as well the welcome certainty that I was in the throes of a gastroenteritis, undoubtedly brought on by the stone-cold sausage pizza I had consumed so greedily two hours before. The presentation was classic.

As the nausea swelled again, the clarity of mind that had come to me with its cessation began to waver, filling with another surge that for a moment I almost mistook, again, for fear. And in that moment, finally, I understood what Scatliff’s urgent gaze had been trying to convey, the meaning in those painful shafts of light scratched over Carrie B’s chest films.

Joe had been right, but he had missed something as well. Scatliff’s helpless gorging on what no one else could stomach, Carrie B’s attempt to pin her own internal mystery: there was no special insight there, just another iteration of the problem. A problem, I finally realized, Joe shared, the F-Max nurse shared, I shared. Every patient in that hospital, and every staffer. Every patient and every doctor I had ever known.

It
is
the body that makes us crazy: our inability to interpret our corporeality, the inscrutable messages it bathes us in with every passing moment. For the patients, it wasn’t their insistence on interpreting, on trying to decode those messages, that made them mad. We are no different in this. The only thing that separates them from us, I realized, is the solutions we arrive at. Sticking needles in yourself is just crazy. But do the treatments I prescribe really make a difference? Not if the problem is mind living in a body. There is no solving that.

Our bodies: inscrutable because unmeaning. They remain the essential mystery we keep trying to solve, although sanity tells us the attempt can only end in dissolution, mind and body both.

And as for spirit? Where was spirit in all of this? Or was that only another symptom, just one more fantasy conceived by consciousness out of flesh? Just then, beside the roadway, I couldn’t say. Perhaps Joe could. I set the thought aside and gingerly, hoping the quivering in my guts had gone as far as it would go, I looked back over my shoulder and put the car in gear.

T
HIS IS A STORY
I
HEARD A FEW YEARS AGO
,
FROM A
doctor who claimed he’d heard it from someone who was there when it was told originally. The story as I heard it raises doubts, however, as to when any original version might have been told. As to the truth of it, whatever there might have been originally, I doubt there was any left in the version that finally reached me. But as a story, the kind doctors might tell among themselves in the night when no one else is listening, it bears repeating at least one more time.

T
HE PHYSICIAN’S LOUNGE WAS
not usually occupied at two a.m., but on this night an ice storm had begun as darkness set in; most of the on-call doctors in town had come in early and stayed. We staked out places on the sofas and chairs as we arrived, holding them jealously as the room filled. One of us—Benson, anesthesia—had arrived late, and now lay curled up in one corner of the floor, snorting intermittently. The room was lit by a single lamp, which left the far corners in shadow.