Travels (5 page)

“Gee,” I said.

“Will you help me, Doc?”

“Sure,” I said. “What’s the problem?”

“Take my shoes off for me.”

He nodded toward the foot of the bed, where his feet stuck up under the sheets. I wondered why he was wearing shoes in bed, but he was so big and fierce, it didn’t seem worth asking.

“No problem,” I said.

He released my arm, and I walked to the foot of the bed. I lifted up the sheet.

I saw two large, bare feet. Ten toes—or actually nine, because one big toe was missing. There was just a dark stump.

I looked back at the man’s face. He was watching me carefully, glowering. “Go ahead,” he said.

“What did you want me to do again?” I asked.

“Take off my shoes.”

“Are you wearing shoes?”

“You can see ’em right in front of you!” he shouted angrily.

I pulled the sheet back, so he could see his own bare feet. But he just nodded. “Well, go ahead!”

“You mean these shoes here?” I pointed to his bare feet.

“Yeah. The shoes on my feet. What are you, blind?”

“No,” I said. “Tell me, what kind of shoes are these?”

“Just take ’em off!”

He seemed so volatile. I had no idea what was wrong with him, or how to proceed. I decided I would go along with him.

I pantomimed taking his shoes off.

“
Jesus!
” he shouted, groaning.

“What’s the matter?”

“Don’t you know
nothing?
Unlace ’em first!”

“Oh. Sorry.” I pretended to unlace the shoes. “Better?”

“Yeah. Jesus.”

I pretended to remove the first shoe, and then the second. He sighed, and wiggled his toes.

“Oh, that’s better. Thanks a lot, Doc.”

“Don’t mention it.” I was eager to get away. I started off to the nursing station.

“Hey! Not so fast.” He grabbed me again. “Where do you think you’re going?”

“To the nursing station.”

“With
my
shoes?”

“Sorry.”

“Sorry, hell! I wasn’t born yesterday. You leave ’em right here!”

“Okay. There, is that okay?”

“Gotta watch you guys every minute.” Then his expression abruptly changed. He looked down at the sheets. He became panicky, frightened.

“Hey, Doc. Can you help me?”

“What is it now?”

“Just get that spider off the sheet, okay? Both them spiders. You see ’em there.”

“Have you been seeing spiders?”

“Oh yeah, lots of ’em. Especially last night—they’re all over the walls.”

He was an alcoholic in the midst of the DTs. I said, “I gotta go to the nursing station.”

He grabbed my arm again, and he pulled his face close to mine. “
I’m not touching those spiders any more!
”

“Good idea,” I said. “I’ll be back later.”

He released me. I went to the nursing station. There were some nurses and a pinched-faced man of thirty-one who was incredibly turned out, sharp creases in his trousers and jacket, pressed tie, immaculate haircut. He glanced at his watch. “Dr. Crichton? Or should I say,
Mr
. Crichton? I’m Donald Rogers, the visiting chief resident in neurology, and you’re late. When I say I want you here at six, I mean six and not six-oh-three. Is that understood, mister?”

“Yes sir,” I said.

That was how my rotation in neurology began.

It never got better.

Clinical neurology is basically a diagnostic specialty, since relatively few severe neurological disorders can be treated. The clinical neuro ward at the Boston City reflected that depressing state of affairs; in essence, cases were admitted simply so the young doctors could see them. The thirty-seven patients on the floor all had different diseases. The staff never admitted a patient to the floor if there was already one with the same disease. It wasn’t a hospital ward—it was a museum. Most people referred to it as the Squash Court, or the Gourd Ward.

But we pretended it was a normal hospital floor with treatable patients. We did all the regular hospital things. We made rounds, we drew bloods, we ordered consults and diagnostic tests. We carried out the charade with great precision, even though there was little we could do for anybody.

Besides myself as the sole medical student, there was an intern named Bill Levine from New York, a first-year resident named Tom Perkins, and Dr. Rogers, the visiting chief resident. He was a Southerner from Duke who did everything by the book. Rogers was always immaculately turned out; his “presentation,” as he called it, was awe-inspiring. One day Levine, who loathed Rogers, asked him about his ties.

“You like these ties?” Rogers asked, in a soft Southern accent.

“Well, I was wondering how you managed to keep them so smooth and unwrinkled, Don.”

“My wife does that. She irons them.”

“Does she?”

“Yes. She gets up with me at five in the morning, and after I have dressed and tied my tie, she irons it for me. While I am wearing it. She does that.”

“No kidding,” Levine said.

“Yes, she’s okay,” Rogers said. “Only once she scorched my shirt, and then I had to get dressed all over again. But she’s never done
that
again.”

“No, I’ll bet,” Levine said.

“No. She learned her lesson that time,” Rogers said, chuckling.

Rogers was a bit of a sadist. He kept a series of straight pins in the lapel of his jacket, near the buttonhole. On rounds he liked to stick these pins into the patients, “to check their responses.” There was a kind of insane pretense in all this. None of the patients were getting any better. None of them were changing at all, from day to day or week to week, except for the two who had inoperable brain tumors. They were slowly dying. But no one else was changing at all. The patients were indigent, extremely ill patients who were shuttled from one state institution to another. As we made rounds each morning, there wasn’t really that much to discuss. But Rogers stuck pins into them anyway.

Levine had to spend only a month of his internship rotation on the ward. Levine was a heavyset, smiling guy of twenty-five who was almost bald. A warmhearted soul, he despised Rogers and the ward. He expressed his distaste by lighting a joint every morning before rounds.

I didn’t find out about this until the second day. I passed by the men’s room, smelled the smoke, and went inside. “Bill, what’re you doing?”

“Having a toke,” he said, sucking in his breath. He passed the joint to Perkins, the resident, who took a long drag, then held it out to me.

I pushed it away. “Are you kidding? What are you doing?” It was six-thirty in the morning.

“Hey. Suit yourself.”

“You mean you guys are
stoned on rounds?
”

“Why not? Nobody can tell.”

“Sure they can.”

“You couldn’t tell, yesterday. And you think Pinhead can tell?” Pinhead was what Levine called Rogers.

“Hey, relax,” Levine said, taking a deep drag. “Nobody cares. Half the nurses are loaded, too. Come on. This is great stuff. You know where we get it? Bennie.”

“Bennie?”

“Bennie. You know, in the elevator.”

It was the medical student’s job to draw bloods from the patients daily. Every morning I would show up at 6:00 a.m. and go to the nursing station, and the night resident would read off the list of bloods to be drawn for
the day. So many red tops from Mr. Roberti, a red and a blue from Mr. Jackson, a pink and a blue from Mrs. Harrelson, and so on. I had to draw about twenty tubes of blood in half an hour, to be ready for morning rounds at six-thirty.

The only trouble was, this was my first clinical rotation and I hadn’t ever really drawn blood before. And I tended to pass out at the sight of blood.

In practice, I’d go to my first patient, put on the tourniquet, get the vein to puff up, and try to get the needle in without passing out. Then, when the blood gushed, I’d stick on the vacutainer tubes and get the required number of tubes, breathing deeply. By this time I would be very dizzy. I would quickly finish up, pull out the needle, slap a cotton ball on the elbow, dash to the nearest window, throw it open, and hang my head out in the January air while the patients yelled and shouted at me about the cold.

When I felt okay again, I’d go on to the next patient.

I couldn’t do twenty patients in half an hour. I was lucky to do three patients in half an hour.

Fortunately, I got help. The first day, I went up to a huge black man named Steve Jackson. He could tell I was nervous.

“Hey, man, what’re you doing?”

“Drawing blood, Mr. Jackson.”

“You know what you’re doing, man?”

“Sure, I know what I’m doing.”

“Then how come your hands are shaking?”

“Oh, that … I don’t know.”

“You ever draw blood before?”

“Sure, no problem.”

“ ’Cause I don’t want nobody fucking with my veins, man.” And with that, he snatched the needle out of my hands. “What you want, man?” he said to me.

“Some blood.”

“I mean, what? What tubes?”

“Oh. Red top and a blue top.”

“Gimme the tubes, come back later, you got it.”

And he put the tourniquet in his teeth, tied off his arm, and proceeded to draw the blood from himself. Now I understood: Jackson was an addict and didn’t want anybody poking around in his veins. So from then on, every morning I’d just drop the stuff off at his bed. “Yellow and a blue top today, Steve.”

“You got it, Mike.”

And I’d go on to the next patient.

The patient alongside Steve was unconscious most of the time. Steve watched me fumble to get the blood, and I guess it offended his sense of finesse. So he said he’d draw blood from himself and from Hennessey, too.

The nurses took pity on me, and they helped out and drew a couple of tubes for me. And Levine, if he had been on call the night before, would draw a couple of tubes for me. And as the days passed, I didn’t have to hang my head out the window quite so long each time. So, with everybody’s help, I was eventually able to get the job finished by the start of rounds.

“Nice to see you on time for once,
Mr
. Crichton. Seems you make a major production out of drawing a little blood.”

I started to hate Rogers, too.

In this way, the weeks dragged on—the medical student passing out whenever he drew blood, the residents stoned on rounds, and Rogers sticking pins in everybody while we looked away. And always the patients drooling and writhing in the corners, the alcoholics brushing off invisible ants and spiders. It was a kind of loony nightmare, and it took its toll.

Finally the house staff had a party one night, and everybody got drunk on lab alcohol. Around midnight, we decided it would be amusing to draw bloods on ourselves, and send them in for liver-function tests. We used patient names, and sent them off.

The next morning, the nurses were puzzled. “I don’t get it. Mr. Hennessey has sky-high LFTs. So does Mr. Jackson. And their blood alcohols—this can’t be right. Who ordered these tests, anyway? It’s not in the books.”

“Oh,
those
tests,” Levine said, very pink-eyed. “I remember. I’ll take those.” And he passed the slips around to us. It turned out we all had evidence of acute liver damage. And we certainly had roaring hangovers.

“Ready for rounds?” Rogers said briskly. He was greeted with a chorus of groans. “Come, come, we’re already four minutes late.” We started off.

Rogers was in an unusually cheerful mood. He stuck lots of pins into people. Finally he came to Mrs. Lewis. In the ward, Mrs. Lewis’s bed was always curtained off, because this elderly woman was semicomatose and incontinent, and from time to time she threw her excrement in spastic movements. There was always a slight feeling of danger when we went up to Mrs. Lewis’s bed. And this morning, with hangovers, we weren’t looking forward to it.

But her bed was clean, and there was no smell. Mrs. Lewis seemed to be sleeping.

“She seems to be sleeping,” Rogers said. “Let’s just see how responsive she is today.” And he stuck a pin in her.

The poor comatose woman winced.

“Hmmm, there seems to be a little response,” Rogers said. He put his pins back in his lapel and pressed his thumb over the bony ridge just below Mrs. Lewis’s eyebrow. He pressed hard.

“This is a classic way to elicit a pain response,” he explained.

Mrs. Lewis twisted her body in pain, and her hand went beneath her buttocks. And quickly she slapped a handful of her own feces all over Rogers’s shirt and pressed tie. Then she collapsed back on the bed.

“Dear,” Rogers said, turning white.

“That’s a shame,” Levine said, biting his lip.

“She obviously doesn’t know what she’s doing,” Perkins said, shaking his head.

“Mr. Crichton, see that she’s cleaned up. I’m going to try and change. But I don’t have a change of clothes at the hospital. I may have to go home.”

“Yes sir,” I said.

So I helped clean up Mrs. Lewis, and I blessed her. And not long after that, I rotated off the neurology service, and went on to psychiatry, where I hoped things would be better.

The Girl Who Seduced Everybody
 

Three medical students at a time were assigned a psychiatry rotation on the wards of the Massachusetts General Hospital. It was a communal-living ward: fifteen psychiatric patients slept and ate in a dormitory setting for six weeks. After six weeks, the staff made a diagnosis and recommended further therapy for each patient.