Just Like Someone Without Mental Illness Only More So (12 page)

There are a million lives going by at a million miles an hour, and all I could take in was the briefest narrative account of how they came to be in the hospital. There was the passion and energy of a twenty-year-old girl, holding down a job and taking care of her seven-year-old brother who was going to die of a horrible rare cancer; a thirty-two-year-old grandmother whose sixteen-year-old daughter had just had a baby; the father who wanted us to operate on his daughter’s inoperable brain-stem tumor and put it in his head instead of hers … I didn’t have time to give any of these stories anything like the attention they deserved. I wrote orders and discharge plans and tucked people in for the night.

My first clinical rotation was obstetrics. My first patient was in labor, and what she said to me after I introduced myself was “Cut me. Take out the baby.”

“You’re making good progress,” I assured her, and she had a beautiful baby about ten minutes later. This doctoring stuff wasn’t so hard.

I watched other doctors like a hawk. I worked very hard at learning how to examine babies and children. I still carry in my brain high-resolution images of how the doctors I admired listened to hearts and felt bellies. I kept accounts of what worked and what didn’t, when I was right and when I was wrong. Everybody who loved medicine wanted it to be better than it
was, and that meant wanting to be a better doctor than you were.

Even most so-called accidents could be studied like diseases with various risk factors: teen gun violence required a gun, a grudge, alcohol, and impoverished future prospects. Take away the preconditions and the harm stops. Figure out what goes wrong and fix it. Goodness emanated from Harvard and a few other centers of excellence and spread in a centripetal manner, pushing back the darkness. Good doctors went out and displaced not-quite-so-good doctors. Better medicines and surgical procedures displaced older ones. Medical science and care from World War II till the time when I entered medical school was one success following another, a nonstop steady climb. There was no reason to believe it couldn’t go on forever.

A surgeon in charge of my surgery rotation said that he knew who I was but that he was going to treat me as if I was normal. I sincerely thanked him and told him I would try to act that way.

Like other things we do to protect patients from our germs, hand washing and wearing gloves and masks, scrubs and surgical gowns were adopted originally to protect doctors and nurses from the diseases of the people they were taking care of.

Scrubs were not made to be worn outside of the OR, where they were always covered by sterile gowns, but as soon as the first absentminded surgeon went out of the OR in scrubs, fashion history was made.

Scrubs have no pleats. Except for the patch pocket over the left breast, suitable for holding three-by-five index cards, they
are exactly like cutout clothes for paper dolls. When they started using scrubs in the OR they were white, but blood on white looks too much like what it is and bright white under OR lighting was not restful. Now they are slightly rumpled, gray, blue, green, or, more recently, pink. They started using pink in the OR under the mistaken assumption that doctors wouldn’t want to be seen in pink scrubs in the cafeteria or elsewhere. Very shortly after the introduction of “OR only” pink scrubs, pink scrubs were everywhere, including neighborhood basketball courts.

If everyone wore surgical scrubs instead of regular clothing, we could save trillions of dollars. There is no other way to fully clothe a person for less than ten dollars.

Doctors on call or stepping out of the OR are so important they don’t have time to put on a shirt and tie. Exhausted, unshaven, and wearing scrubs, I was more credible than with a freshly shaven face, pressed shirt, and tie. There was an intrinsic seriousness to what we were doing that made wearing scrubs okay.

Back in Hollywood Hospital, there were no scrubs. The doctors were very well dressed, and the patients were in pajamas. The doctor in charge of the whole place wore baby-blue alligator shoes, drove a light blue ’59 Cadillac convertible, and wore what I was sure was the button to end the world as a tie clip.

I wanted to be a good diagnostician. There was a way of touching people that created trust and gave relief from the day-to-day way people treated one another. I was watching and learning from masters. The doctor’s job was to shut up long enough to let the patient be the most important person in the room,
because she was. There was an unforced and absolutely real respect for people just because they were people. And we, as doctors, were their servants. For all the things that felt wrong, that felt right.

If you weren’t an idealist, why would you go to medical school?

During my core rotation most of our patients were eighty-five or older with overwhelming, intractable problems, which we ignored while looking for things around the edges to adjust. If there was something that we believed in, that helped us keep our spirits up, it was the
salvageable patient
.

When one of my fellow students presented a demented ninety-six-year-old patient who went into heart failure because she ate tuna fish, I couldn’t help wondering aloud what exactly the point was. Our junior resident told us that the point was for us to learn physiology from fragile patients so we would be ready and up to the task of saving a salvageable patient when one came along.

Richard was a very polite, fastidious twenty-nine-year-old heroin addict who was nervous about letting anyone except himself draw blood because they might mess up the few good veins he had left. I watched his technique closely. Learning how to draw blood and do other procedures was high on my list of interests. He tapped the needle against the skin and tried to bounce it into the vein. He thought he was better at it than he really was.

Every morning the whole team watched as the resident listened to the heart and lungs of each of our patients. Usually he said nothing because there was nothing to say. One morning
while examining Richard he stopped and had each of us listen to a spot he had located on the patient’s back.

“Those are rales and rhonchi,” he stated flatly. “Richard is coming down with pneumonia.”

He had one of us write orders for a chest X-ray and massive doses of IV ampicillin. Four hours later Richard was short of breath, running a 105-degree fever, sick as a dog. The chest X-ray hadn’t been done and the antibiotics hadn’t been given. The one time we had a physical finding that might have made a difference on the closest thing we had to a salvageable patient, the damn orders were written but never taken off. Our resident was closer to tears than mad. Richard did well. If he had been eighty-five, he probably would have died.

My father asked me what I was learning from all this. I told him that needing a doctor was a bad sign.

It continues to amaze me how easily doctors can walk away from their mistakes. A patient would be sent to the ICU with horrendous complications and zero prognosis, and the surgeons who botched the case could be toweling off in the locker room and chatting about how to bill for the various procedures involved and the upcoming Pats game.

The month before I finished medical school one of my sisters had a psychotic break right after she quit drinking. I went down to New York and was a model of tough-minded efficiency, hiring an
ambulance and getting her transferred to a better hospital and better care after it was carefully explained to me why such a thing was not possible. That evening I had two Heinekens, a dozen oysters, a big steak, a double of Jack Daniel’s, and called it a day. A job well done. The best proof I had that I didn’t have a problem with alcohol was that I drank at least a little every day for many years and didn’t have any trouble.