Authors: Erich Segal
Despite all her hospital experience, Judy could not suppress a shudder.
“Hello, Howie,” Seth said gently.
The boy did not even turn to look at him.
“Can he hear?” Judy asked as calmly as she could.
“I think he can—sort of—but he doesn’t understand words.”
There was silence, except for the gurgling sound emanating from Howie.
“Why is he so thin?” Judy asked. “I mean, even if he can’t swallow, why don’t they give him an I.V. or something?”
“No, it’s deliberate,” Seth explained, trying to keep a rein on his emotions and speak with clinical objectivity. “They have to keep his weight down so two nurses can lift him when they have to do … all sorts of stuff, like change the bedding, shaving him—”
“And the diaper? …”
“He’s twenty-five years old, but he still needs one.” Seth shook his head. “And it’s been like this for over twenty years. My folks have really struggled to be able to keep him in a private nursing home. In a state facility he’d probably be dead by now—which would maybe be a blessing.”
The room grew silent again, except for Howie’s noises. They stood there for several minutes more, Seth looking at his older brother with an expression that she could not decipher. Finally, he said, “It’s been good to see you, Howie—take care of yourself.”
During the drive back they were both silent. He wondering what she was thinking. She groping to understand why he wanted her to know.
Finally, she asked, “Are you afraid this is something hereditary?”
He shook his head. “It isn’t. He was in a car accident when he was four. Thrown against the metal dashboard.”
She paused to assimilate this information. “Where were you at the time?”
“Safely cushioned—in my mother’s womb.”
“Oh,” she said. A simple monosyllable conveying that she now understood. “So you feel guilty?”
There was a moment’s pause, after which he said very quietly, “Yes. It’s crazy, but I can’t help it. I have this irrational guilt because I’m out functioning in the real world and he’s stuck in that room forever. And my parents seem to reinforce it by the way they treat me. Do you know, there have actually been times when I wished I could have changed places with Howie.” He buried his head in his hands in a futile attempt to crush the image from his mind.
Still averting his gaze, he continued, “And do you know the most ironic part? The guy’s stronger than me. I mean, I had asthma as a kid, but goddamn Howie’s got the constitution of an ox. He’ll outlive me.”
“I’d hardly say he was living now. Is he in any pain?”
“That’s a mystery, really,” Seth replied. “The doctors have convinced my parents he can’t feel a thing. But I don’t see how they can be so sure, since he’s got no way of
telling
us. And I just can’t bear that place’s rigid notion of humanity. I mean, he had pneumonia two years ago when tetracycline had barely come on the market. Why do they
have
to go to all that trouble to get hold of the newest wonder drug merely to prolong the guy’s … existence?”
“It’s wrong,” Judy agreed. “And, just between us, that sort of thing goes on in my own ward all the time. There we
know
the cancer patients are in pain. But still the doctors keep on trying this new drug and that new drug. They use the patients for human guinea pigs.”
“So I guess you’ve seen cases like Howie before, huh?”
She hesitated for a moment and then replied with pained candor, “No. I’ve never seen anything as bad—because it doesn’t look like there’ll be an end to it.”
Seth nodded sadly, wondering if he dared confide in her the secret that was burning in his mind.
That someday he would put an end to Howie’s suffering.
T
he students going off for Christmas vacation in 1959 had no notion that they would be returning to a year of great significance for them. They knew only that they would be paroled from laboratory drudgery.
They could not know that 1960 was to be the year of sit-ins in the South to force desegregation; that Chubby Checker’s “Twist” would capture the whole nation; and that Israel would capture Adolf Eichmann.
That it would also turn out to be the year in which Professor Theodore Maiman perfected the first light amplification by simulated emission of radiation, otherwise known as LASER.
That November would see the election of young John Fitzgerald Kennedy.
And perhaps most important for their immediate lives, the first birth control pills would go on sale.
The course was Physical Diagnosis, its purpose to instruct the student—who heretofore had worked only with cadavers, test tubes, and a pinioned dog—in how to deal with patients.
The instructor, Professor Derek Shaw, wore his stethoscope like a High Priest’s breastplate and had a manner as starched as his white coat. He began by describing the proper procedure of doing a “work-up” on a new patient—the ROS, or Review of Systems. He pointed out that in disease, more than in any other area, the past is truly prologue—the childhood illness father to the man’s disease.
He warned them not to overlook any area of physiological activity—no system, vessel, gland, or organ. And he gave the fledgling examiners a very important piece of advice: “Most patients will be unaware of the medical terms for such functions as urination, defecation, and sexual intercourse. Thus you may have some difficulty making them understand your questions if you pose them in a strictly scientific manner—if you get
my point. It may even be necessary to employ more vulgar terms.”
Yes, Professor Shaw, the class all thought as one, we know the words you mean.
So after we check respirations and determine if there are any heart and vascular anomalies, prior problems with the stomach, kidneys, glands, nervous system, psychic history, we’ll ask them if they’re having any problems with pissing, or screwing.
It was finally time for hands on.
“Remember,” Shaw intoned, “in medical investigation there is no technology, be it fluoroscope, x-ray—or even microscope—that will ever make the human senses obsolete. The fundamental instruments of diagnosis always will be eyes and ears and nose—some bacteria smell—and hands. And remember that the moment you touch your patient you give the impression that you already have begun to heal him.
“The body is a symphony of sounds which, if harmonious, play a lively melody and, if discordant, indicate that somewhere in the body’s orchestra an instrument is playing out of tune.
“Thus our first exercise in diagnosis is the act of auscultation, learning to differentiate between the variety of sounds that are distinguishable only to the well-tuned ear.
“A
bruit
heard above a major artery indicates a vessel narrowing or partial obstruction. And in the thorax, which we might call the pulmonary Carnegie Hall, with the ribs providing the superb acoustics, the oboe-like bleating known as
egophony
will tell us of efflusions in the membranes that surround the lungs.
Rales
emitted by the wind section can be designated ‘tinkling,’ ‘whistling,’ ‘piping,’ or ‘low-pitched.’ In any register they are an overture to bronchial dysfunction. Then the tympanic resonance—a low-pitched drumlike sound when we percuss a patient’s chest with our fingertips—reveals the presence of a fluid or infection in the cavity beneath.
“And then, of course, there is the
souffle
—a murmur of the heart that, as it wanders up and down the scale, gives the suggestion that a valve is damaged.”
Shaw did not continue his musical metaphors when he went on to the palpation of the four quadrants of the abdomen.
It was the professor’s logical notion that the most likely bodies on which to begin examination would be one another’s.
But there was instant rebellion. Not from the women, however. They were four and divided neatly into two sets of alternating
doctors and patients. And then—for propriety’s sake—they were taken to an adjoining room where they could perform the exercise without providing titillation to the masculine majority.
For understandable reasons, at first the men were loath to touch—and be touched—by their fellow classmates. Injecting one another had been one thing. Though painful, it had been merely skin deep. But bodily examination was quite another.
Who the hell would want Peter Wyman groping for his prostate, or manipulating his scrotum?
Professor Shaw was used to mass resistance, but never on such a scale.
It began as a sort of bronchial murmur, quickly escalating into spasmodic gasps of “No way. Nobody’s finger’s going up my ass.” And—yes, quite audibly—“Fuck you, Shaw.” But when, out of the corner of his eye, the professor noticed a few students beginning to slip out the rear exit, it became evident that he had a full-fledged mutiny on his hands.
Rather than give the entire class an immediate flunk, he declared new parameters for the initial session.
“Now, obviously, we can’t do everything in a single class,” he announced, hoping they would not hear capitulation in his voice, “so I think we should limit this first meeting to getting acquainted with heart sounds. The bruit, the murmur, the thrill, and fibrillation.”
And to be certain of regaining their goodwill, he offered an enticing inducement for future sessions.
“Since these can sometimes literally mean life or death,” he began with deadpan face, “no course of this nature can overlook the correct teaching of a thorough vaginal examination. Naturally, for this procedure we will have to invite some patients of a more … experienced nature. But for the moment let us listen to our hearts and learn their music.”
The room hushed as fifty-eight stethoscopes lifted to study fifty-eight chests.
The ever-penitent Dwyer offered himself as a diagnostic lamb. He agreed to be Peter Wyman’s partner. And his virtue was rewarded. Though he was the pain in the collective class’s neck, Wyman nonetheless had great powers of observation.
“You’ve got tachycardia, Hank,” he said, after listening to his partner’s chest for what had seemed an inordinately long time.
“Come on, Pete,” Hank persisted. “I’m twenty-three years old and fit as a fiddle.”
“I’m sorry, Hank, I’ll stick by my diagnosis. And if you don’t want those kids of yours to be orphans, I think you’d better go to the Health Service. Although, frankly, I don’t think they’ll tell you any more than I can.”
“Okay then, Peter, save me the trip.”
“Well,” Wyman said, “the first thing I’d advise is that you quit smoking.”
“Aw, come on, I only have about half a pack a day. I’m under a lot of tension and it really helps. I mean, when you finish class you go back to a quiet little dorm room. I go home to a bedlam of screaming kids, dirty diapers, formulas, bottles—and a wife who’s always bitching that I’m not helping enough.”
“Look, Hank, there’s published proof that links smoking and vascular disease, but it’s your life, not mine. By the way, I also think you’re much too overweight.”
Hank Dwyer had a very long fuse. But he needed all of it to suppress his anger. “Would you like to know my appraisal of you, Wyman?”
“I’d be interested in hearing your speculation,” Peter allowed.
“I’d say that you had a heart of stone and a face to match.”
Hank then gathered his notebooks, stormed out of the classroom—and immediately lit a cigarette to calm his nerves.
During Christmas vacation Warren had accompanied his mother to Miami Beach to look at three or four apartments Aunt Ceil had designated as “real possibilities.”
They finally found one nearing completion in Carlton Towers. Indeed, Estelle’s actual apartment was still only air, as the twelfth floor was yet to be built. But they could imagine what a good ocean view it would have. And most important, in Warren’s sage estimation, it was a condominium.
“It’s the coming thing, Ma,” the lawyer-to-be assured her, “and it’s a sound investment.”
“But aren’t the payments a little high, Warren? I don’t dare live over my means.”
“No problem. I’ve worked everything out. With your pension you’ve got more than enough to live the life of Riley till I’m out earning big coin as a lawyer. And, sooner or later, old Barn’ll finish that endless course of his and become a very rich doctor. Besides—Carlton Towers has got that extra little guest
room so Barney or I can pop down for a weekend with our wives.”
Estelle smiled. “And may I ask whom you intend to marry?”
“Sure. A great girl—fantastically gorgeous—has an A.B. from Barnard, a law degree from Yale, and she cooks like Julia Child.”
“Wonderful. Have I met her?”
“No,” Warren stated, “and neither have I. But I won’t settle for anything less.”
“Look,” Estelle said with affectionate good humor, “the important thing is that you marry somebody you can talk to—who will be your friend. That was what your father and I had. You don’t need these mythical creatures with Einstein’s brain and Betty Grable’s legs.”
“Come on,” Warren chided disapprovingly, “isn’t Laura gorgeous and smart and nice—?”
Estelle nodded. “Yes, but sometimes I wonder if she—”
“If she what, Ma?”
“Well, unfortunately, I think that deep down she isn’t very happy.”
“Why?” Warren asked in genuine bewilderment.
“Maybe because she’s
too
beautiful and
too
smart and
too
nice.”
Even Laura did not have the strength to endure Christmas alone. Three hours earlier she had cheerfully waved goodbye to Barney and Suzie, who were setting out in one of Lance’s cars for a cabin in Vermont, where they were looking forward to being snowed in by a blizzard all week.
Sitting in the lonely cafeteria, trying to eat lukewarm turkey that tasted like the artificial plastic decorations that were hung desultorily here and there, she was driven to such a point of unhappiness that she decided to go home after all—even though her last Christmas there had been so catastrophic.
But when she trudged through the gray slush of Lincoln Place, she realized that her childhood landmarks had become completely foreign to her.
Even the Livingstons’ house sat with its empty windows looking down forlornly at the red and green
FOR SALE
sign in front of it. That was all their neighbors had to offer as a festive decoration.