“No.”
“Well. You should have asked. She’s not that crazy. She’ll tell you, if you ask.”
Another time, the resident said, “Go see Mr. Benson; he has a good story of duodenal ulcer.”
I went to see Mr. Benson, first stopping at the foot of his bed to read his chart. This was another trick. The bedside chart contained only nurses’ notes on fluid intake, things like that, but it could still be helpful. Also, it made you look professional if you came in and read the chart first.
“Ah, Mr. Benson, I see you’re in your second day of recovery from surgery.” Thinking that if he had had surgery for his ulcer, it must have been severe.
“Yes.”
“And putting out good urine, I see.”
“Yes.”
“How’re you feeling, any pain?”
“No.”
I thought, Just two days after surgery and no pain? “Well, you’re making an unusual recovery.”
“No.”
For the first time, I really looked at him. He was sitting in bed wearing a bathrobe, a small, precise, tense man of forty-one. He had the detached look that many postoperative patients have, when they turn their focus inward to heal. But it was different in his case, somehow.
“Well,” I said. “Tell me about your ulcer.”
Harry Benson spoke in a flat, depressed voice. He was an insurance adjuster from Rhode Island. He had lived with his mother all his life. She was sick and needed him to take care of her. He had never married, and had few friends outside work. He had had severe ulcer pains for the last five years. Sometimes he vomited blood. Sometimes a lot of blood. He had been in the hospital six different times for this pain and blood. He had had several transfusions for blood loss. He had had a barium swallow that showed the ulcer. The doctors told him last year that they would have to do surgery if the medication didn’t heal the ulcer. The bleeding continued, so he came back to the hospital and underwent surgery two days ago.
That was his story.
As the resident promised, it was a classic story, and after so much medical attention, Mr. Benson told it clearly. He even knew physicians’ jargon, like “barium swallow” for an upper-GI series.
But why was he so depressed?
“Well, given your history, you must be glad to have the operation over with.”
“No.”
“Why not?”
“They didn’t do anything.”
“What do you mean?”
“They opened me up, but they didn’t do anything. They didn’t do the operation.”
“Mr. Benson, I don’t think that’s right. They did an operation to remove part of the stomach.”
“No. They were going to do a partial resection, but they didn’t. They took one look and then closed me up again.”
And he burst into tears, holding his head in his hands.
“What have they told you?”
He shook his head.
“What do you think is wrong?”
He shook his head.
“You think you have cancer?”
He nodded, still sobbing.
“Mr. Benson, I don’t think you do.” He had no swollen glands, no history of weight loss, no pain in other parts of his body. And I was pretty sure they wouldn’t send a student to talk to somebody who had just found out he had inoperable cancer.
“Yes,” he insisted. “It’s carcinoma.”
He was so upset I felt I had to do something immediately. “Mr. Benson, I’m going to check on this right away.”
I went back to the nursing station. The resident was hanging around. I said, “You know Benson? Did they do a gastric resection?”
“No, they didn’t.”
“Why not?”
“When they opened him up, his blood pressure went to hell, and they decided they couldn’t go through with the procedure. They just closed him up as fast as they could.”
“Did anybody tell him that?”
“Sure. He knows.”
“Well, he thinks he has cancer.”
“Still? That’s what he thought yesterday.”
“Well, he still thinks it.”
“He’s been told specifically,” the resident said, “that he does not have cancer. I told him, the chief resident told him, his own doctor told him, and the attending surgeon told him. Everybody’s told him. Benson’s a weird guy, you know. Lives with his mother.”
I went back to Mr. Benson. I said I’d checked with the resident, and he did not have cancer.
“You don’t have to kid me,” he said.
“I’m not kidding you. Didn’t the chief resident and the other residents come to see you yesterday?”
“Yes.”
“And did they tell you you didn’t have cancer?”
“Yes. But I know. They won’t tell me to my face, but I know.”
“How do you know?” I said.
“I heard them talking, when they thought I wasn’t listening.”
“And they said you have cancer?”
“Yes.”
“What did they say?”
“They said I had nodes.”
“What kind of nodes?”
“Aerial nodes.”
There was no such thing as aerial nodes. “Aerial nodes?”
“That’s what they called them.”
I went back to the resident.
“I told you he was weird,” the resident said. “Nobody ever said anything about nodes to him, believe me. I can’t imagine how he—wait a minute.” He turned to the nurses. “Who’s in the bed next to Benson?”
“Mr. Levine, post-cholecystectomy.”
“But he’s new today. Who was in that bed yesterday?”
“Jeez, yesterday …”
Nobody could remember who had been in the bed the day before. But the resident was insistent; records were pulled and checked; it took another half-hour, and still more talks with Benson, before the story finally became clear.
On the day after his operation, Mr. Benson, worried that no surgery had been performed, had feigned sleep while the residents made rounds. He had listened to what they said, and he heard them discussing the patient in the next bed, who had a cardiac arrhythmia involving the sino-atrial nodes of the heart. But Mr. Benson thought they were talking about him, and his “aerial nodes.” And he had been in enough hospitals to know that nodes meant cancer.
And that was why he was so sure he was dying.
Everybody went back and talked to him. And he finally understood that he did not have cancer, after all. He was very much relieved.
Everybody went away. I was alone with him. He beckoned to me. “Hey, listen, thanks,” he said, and he gave me twenty dollars in cash.
“Really, that’s not necessary,” I said.
“No, no. Give it to that guy Eddie in room four,” he said. And he explained that Eddie was a bookie, and he was placing bets for everybody on the floor.
“Put it on Fresh Air in the sixth,” he said.
That was the first sign that Mr. Benson was on the road to recovery.
“Go see Mr. Carey in room six; he has a good story for glomerulonephritis,” the resident said. My elation at being told the diagnosis was immediately tempered: “In fact, the guy’s probably going to die.”
Mr. Carey was a young man of twenty-four, sitting up in bed, playing solitaire. He seemed healthy and cheerful. In fact, he was so friendly I wondered why nobody ever seemed to go into his room.
Mr. Carey worked as a gardener on an estate outside Boston. His story was that he had had a bad sore throat a few months before; he had seen a doctor and had been given pills for a strep throat, but he hadn’t taken the pills for more than a few days. Some time later he noticed swelling in his body and he felt weak. He later learned he had some disease of his kidneys. Now he had to be dialyzed on kidney machines twice a week. The doctors had said something about a kidney transplant, but he wasn’t sure. Meanwhile, he waited.
That was what he was doing no
w, waiting.
He was my age. I talked to him with a growing sense of shock. In those days, kidney dialysis was still exotic treatment, and kidney transplantation more exotic still. The statistics were not encouraging. If the transplant worked at all, the average survival was three to five years.
I was talking to a doomed man.
I didn’t know what to say. For a while we talked about the Celtics, about Bill Russell. He seemed happy to discuss sports, glad to have me there. But all I wanted to do was run from the room. I felt panicky. I felt I was suffocating. What could I do here? I was a medical student faced with somebody who was going to die, just as surely as the basketball season would end in a few weeks. It was inevitable. It didn’t seem like there was anything I could say.
Meanwhile, he seemed so pleased to talk to me. I wondered how much he knew. Why was he so calm? Didn’t he know his situation? He must know. He must be aware that he might not walk out of this hospital again. Why was he so calm?
Just talking away, sports. Baseball season. Spring training.
Eventually I couldn’t stand it. I had to leave. I had to get out of that room. I said, “Well, I’m sure you’ll be up and around in no time.”
He looked disappointed.
“What I mean is,” I said, “you’re definitely on the mend, you’ll probably be out of here in a week or so.”
He looked very disappointed. I was saying the wrong things. But what should I be saying? I had no idea.
“So cheer up, I’m sure they’ll be arranging for you to leave any day now. I’ve got to go now. Rounds, you know.”
He looked at me with open contempt. “Sure. Fine.”
I fled, closing the door behind me, blocking out the view of this man my own age who was close to death.
I went back to the resident. “What’re you supposed to say to someone like that?”
“That’s a tough one,” the resident said.
“Does he know?”
“Yeah, sure.”
“So what do you say?”
“I never know what to say myself. It’s a bitch, isn’t it?”
In retrospect, it seems inconceivable to me that in four years of medical education, nobody ever talked to us, formally or informally, about dying patients. Arguably the most important item on any medical curriculum, death was never even mentioned at the Harvard Medical School. There was no consideration given to how we might feel around a dying person—the panic, the fear, the sense of our own failure, the uncomfortable reminder of the limits of our art. There was no consideration of what a dying patient went through, what such a patient might need or want. None of this was ever discussed. We were left to learn about death on our own.
When I think back, I imagine the horrible isolation that young man must have felt, sitting day after day in a room that nobody wanted to enter. Finally some poor medical student comes in, and this young man has a brief chance to talk to another human being, and he’s delighted. He would like to talk about what is really going on in his life. He’s worried about what will happen to him. He wants to talk—because, unlike me, he can’t avoid the realities. I can run from the room, but he can’t. He is stuck with the fact of his impending death.
But instead of talking about it, instead of having the strength to stay with him, I merely mumbled platitudes and fled. It was no wonder he finally regarded me with contempt. I wasn’t much of a doctor: I was far more worried about myself than about him, but he was the one who was dying.
I was still pretending that I was somehow different—that he wasn’t like me—that it would never happen to me.
The Gourd Ward
Four o’clock in the morning, and I am stumbling around in the closet of my apartment in the darkness, trying to find everything I am supposed to bring, my stethoscope and my doctor’s bag and my notebook and everything else, because finally the day has come when I am no longer working part-time in the hospitals, pretending to be a doctor. My clinical rotations begin today. From now on I will work every day and every other night in the hospital. I am tremendously excited and nervous and I keep dropping things in my closet. At last I have everything but I can’t find my car keys. It is 5:00 a.m. I am going to be late for my first clinical rotation—neurology at the Boston City Hospital.
The old brick buildings of the Boston City looked more like a prison than anything else. I found the parking lot, and made my way through the basement corridors to the correct building.
I said “Good morning” to the elevator operator.
“Hiya, Doc,” the operator said in a deep voice. His name tag read Bennie, and he was acromegalic, six and a half feet tall and easily three hundred pounds, with long arms, thick fingers, and a long nose and chin.
“I’m going to Neuro,” I said.
Bennie grunted and closed the rattling cage door. The ancient elevator started up.
“Nice weather,” I said.
Bennie grunted again.
“Worked here long?”
“Since I was a patient.”
“That’s nice.”
“Did a operation on me.”
“I see.”
“In my head.”
“Uh-huh.”
“Your floor, Doc,” Bennie said, opening the cage door. I went onto the floor.
The first view of the neurology ward was startling. There were patients sitting in chairs, writhing in snake-like movements known as choreoathetoid. There were patients strapped in chairs, staring forward into space, drooling. There were patients lying in beds, groaning from time to time. Distant screams of pain. It was like something from the eighteenth century. From Bedlam.
I was going to spend the next six weeks here. I headed for the nurses’ station to report in. I passed a large man sitting up in bed, with the sheets pulled to his chin.
“Hey, Doc.”
“Good morning,” I said.
“Hey, Doc, can you help me?” Just to make sure I did, he gripped my arm powerfully. He was a very large man; he had hands like slabs of meat. Beneath a grizzled crew cut, his face was scarred. He looked dangerous. He glared at me.
“Nobody’s helping me around this joint,” he said.
“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.
Travels Page 3