by Robin Cook
“Is that what you’re scheduled for today?” asked Susan while she thought about how to respond to Berman’s offer. She knew that it was hardly professional by any stretch of the imagination. At the same time she was attracted to Berman.
“That’s right, a minuscule-ectomy, or something like that,” said Berman.
A knock at the door, followed by the rapid entry of Sarah Sterns before Susan could even respond, made Susan jump, and nervously she began to fuss with the stopcock on the I.V. Almost at the same time Susan realized how childish this action was, and it made her angry that the system could affect her to such a degree.
“Not another needle!” voiced Berman, dejected.
“Another needle. It’s your pre-op. Roll over, my friend,” said Miss Sterns. She crowded Susan in order to put her tray on the night table.
Berman glanced at Susan in a self-conscious way before rolling over on his right side. Miss Sterns bared Berman’s left buttock and grabbed a handful of flesh. The needle flashed into the muscle. It was over almost before it began.
“Don’t worry about the I.V. rate,” said Miss Sterns on her way to the door. “I’ll adjust it shortly.” She was gone.
“Well, I must be going,” said Susan quickly.
“Is it a date?” asked Berman, trying not to lean on his left buttock.
“Sean, I don’t know. I’m not sure how I feel about it; I mean professionally and all that.”
“Professionally?” Berman was genuinely surprised. “You must be being brainwashed.”
“Maybe I am,” said Susan. She looked at her watch, the door, and back at Berman. “All right,” said Susan finally, “we’ll get together. Meanwhile you have to get back to normal. I’ll live with being unprofessional but I don’t want to be accused of taking advantage of a cripple. I’ll stop in here before you go home. Do you have any idea how long you are going to be in the hospital?”
“My doctor said three days.”
“I’ll stop back before you go,” said Susan already on her way to the door.
At the door she had to give way to an orderly arriving with a gurney to transport Berman to the OR, to room No. 8, for his meniscectomy. Susan glanced back at Berman before turning down the corridor. She gave him the thumbs-up sign, which he returned with a smile. As she moved down toward the nurses’ station, Susan pondered over her mixed emotions. There was the warmth of meeting someone with whom she felt a rather immediate chemical attraction; at the same time there was the nagging reality of the unprofessionalism of it all. Susan couldn’t help but acknowledge that for her to be a doctor was going to be very difficult in every respect.
Monday
February 23
12:10 P.M.
Like a slalom skier Susan wove her way down the hospital corridor crowded with lunch carts filled with an assortment of colorless food. The reasonably pleasant aromas emanating from the evenly stacked trays reminded her that she hadn’t eaten that day: two pieces of toast on the run hardly constituted a meal.
The arrival of the lunch carts added to the appearance of utter chaos at the nurses’ station on Beard 5. It seemed to Susan that it was a wonder indeed that the right patient got the right drug, therapy, or meal. To Susan’s pleasant surprise, Sarah Sterns had a smile and a quick thank-you for Susan before pointing to the resting place for the I.V. tray. No one else even acknowledged Susan’s presence and she left. It took her about three seconds to decide to use the stairs rather than wait for the crowded elevator. After all, it was only three floors down to the ICU.
The stairs were made of metal with an embossed surface like beaten silver. The color had been orange but now had become something approaching a dirty tan except in the center of each step, which was worn shiny by multitudinous footsteps. The walls of the stairwell were made of cinder block, painted dark gray. But the paint was old and peeling. Some previous plumbing catastrophe or accident had provided a series of longitudinal stains that descended from above along the wall to the right. The stains reappeared each time. Susan rounded the platform and started down another flight. The only light in the stairwell came from a bare bulb at each floor landing. On the fourth floor the bulb had blown, and because of the relative darkness Susan had to proceed with caution, advancing her foot to find the first stair on the next flight down to three. The distances between the floors seemed remarkably long to Susan.
By leaning out over the metal banister Susan could see down into the subbasement and up to where the spiraling stairs became lost in collapsing perspective. Susan felt slightly ill at ease in the stairwell. The decaying darkness of the walls seemed to move in on her, awakening some atavistic fear. Perhaps it reminded her of a recurrent dream she used to have as a child. Although she had not had the dream for a long time, she remembered it well. It did not concern a stairwell but the overall effect was similar. The dream involved moving through a tunnel of twisted shapes which would progressively impede her progress. She never made it to the end of the tunnel in her dream despite the fact that the goal seemed very important.
In spite of the mildly disquieting atmosphere in the stairwell, Susan descended slowly, step by step. Her deliberate footsteps rang out with a dull metallic echo. She was alone. There were no people and it gave her a few uninterrupted moments to think. For a short period of time the immediacy of the hospital receded from Susan’s consciousness.
The encounter with Berman became more complicated in her mind. The lack of professionalism was diluted because, in reality, Berman was not Susan’s patient. She had been called simply to provide a peripheral service. The fact that Berman was a patient was important only in facilitating their chance meeting. But Susan wasn’t sure if she were just rationalizing. Rounding the landing on the third floor, she paused at the head of the next flight.
She had reacted to Berman as a woman. For a constellation of inexplicable reasons, Berman had appealed to her in a basic, natural, even chemical way. To an extent that was encouraging and reassuring. There was no doubt in Susan’s mind that she had begun to think of herself in a sexless sort of way over the first two years of medical school. She had used the word neuter in talking with Berman but only because she had been forced on the spur of the moment to find a term for it. Obviously she was female; she felt female and her monthly menstrual flow emphasized its reality. But was she a woman?
Susan started down the next flight of stairs. For the first time events had forced her to intellectualize a tendency which had been developing for several years. She wondered if Carpin had been called instead of her and if Berman had been some equally attractive female, would Carpin have responded as a male? Susan stopped again, considering this hypothetical situation.
From her experience she decided that there was a very good possibility that Carpin would have performed in an equivalent fashion.
Susan recommenced descending the stairs, very slowly now. But if it were true that a male would respond in a way similar to hers, why was it so different for her? Why did she dwell on it?
It was more than the debatable question of medical ethics. Berman had made Susan feel like a woman. All at once it came to Susan. The biggest difference between herself and Carpin was that Susan had an extra obstacle. She knew that both of them wanted to become doctors; to act like doctors, think like doctors, to be taken for doctors. But for Susan there was an additional step. Susan wanted also to become a woman; to feel like a woman, to be taken for and respected as a woman. When she had entered medicine, she knew it was a male-dominated career choice. That had been one of the challenges. Susan had never imagined that medicine would make it difficult for her to achieve fulfillment in a social sense. Academically she could compete; she was reasonably sure of that. The next step was going to be harder, an uncharted course. And Carpin? Well, for him the social part was easy. He was a male in a recognized male role. Being in medicine only supported his image of himself as a man. Carpin only had to worry about convincing himself he was a doctor; Susan had to convince herself that she was a do
ctor and a woman.
Arriving on the second floor, Susan was greeted by a sign which stated in bold letters: “Operating Room Area: Unauthorized Entry Forbidden.” But the sign wasn’t necessary. To Susan’s momentary consternation, the door was locked! Her overly active imagination suddenly had all the doors from the stairwell locked, and she thought of herself caught within a vertical prison. It was a fleeting thought, totally irrational. “Wheeler, you’re too much,” she said aloud for her own benefit and encouragement. She quickly descended to the first floor. The door opened easily and Susan joined the surging mob on the main floor.
She took the elevator and returned to the ICU entrance. It took a bit of fortitude to begin to open the door. Once she started, it took strength. The ICU door was massive and very heavy.
Susan stepped once again into the nether world of the ICU interior. One of the nurses looked up from the desk but then went back to an EKG tracing in front of her. As Susan scanned the room, she was again struck by the purely mechanical appearance, the lack of human voices, even the lack of movement save for the fluorescent blips tracing their incessant patterns. And there was Nancy Greenly, as immobile as a statue, a casualty of medicine, a victim of technology. Susan wondered about her life, her loves. Everything was gone, all because of a simple menstrual irregularity, a routine D&C.
Susan forced her eyes away from Nancy Greenly and ascertained that her group had since departed from the ICU, presumably for Grand Rounds. At the same instant Susan acknowledged to herself her acute discomfort about being in the ICU. The psychological and technical complexity of the room caused any residual euphoria from the I.V. episode to vanish. Her imagination forced her to ponder the situation if something suddenly went wrong with one of the patients while she was standing there. What if someone expected her to make some life-death decision to go along with her white coat and her impotent stethoscope in her pocket?
Controlling the urge to succumb to a minor panic, Susan tugged at the inertia of the door and escaped into the corridor. Retracing her steps to the elevator, Susan mused about the difference between fact and fancy, between reality and mythology, between what it really was like being a medical student and what people thought it was like.
Remembering Bellows’s comment about Grand Rounds on 10, Susan pushed the tenth-floor button and allowed herself to be compressed toward the rear of the elevator. It was a miserable trip. The car was a potpourri of human beings with every conceivable affliction, and it stopped at every floor. The air was heavy and hot, particularly since one rude passenger was smoking despite the sign plainly forbidding it. The occupants did not look at each other; they stared blankly at the light progressing from number to number, as did Susan, wishing the doors would open and close more quickly.
Impetuously she pushed her way to the front of the elevator at the ninth floor. At 10, she broke from the crowded cubicle with relief.
The atmosphere changed immediately. The tenth floor was carpeted and the walls shone with an even luster of newly applied semigloss paint. Gilded frames set off portraits of former Memorial greats in their sartorial academic splendor. Chippendale tables topped with a variety of lamps were interspersed between comfortable chairs along the length of the corridor. Neat piles of New Yorker magazines were arranged at rational intervals.
A large sign opposite the elevator directed Susan to the conference room. As she walked down the corridor she could see into the offices. These were the private offices for some of the more established doctors at the Memorial. A few patients were scattered along the corridor, reading and waiting. They all looked up as Susan passed. Their faces were uniformly expressionless.
At the end of the corridor Susan passed the office of the Chief of Surgery, Dr. H. Stark. The door was ajar, and inside Susan caught a glimpse of two secretaries typing furiously. Just beyond Stark’s office and on the other side of the corridor was a second stairwell. At the very end of the corridor, over two swinging mahogany doors an illuminated sign proclaimed: “Conference in Progress.”
Susan entered the conference room, letting the doors close quietly behind her. It took a few moments for her eyes to adjust to the darkness, since the room lights were out. The focal point of light at the end of the room was the projected image of a Kodachrome of a human lung. Susan could just make out the outline of a man with a pointer describing the details of the photograph.
From the gloom in the foreground Susan began to discern the rows of seats and their occupants. The room was about thirty feet wide and some fifty feet long. There was a gentle downward slope of the floor to the podium, which was raised by two steps. The projection equipment was professionally hidden from view. The projected beam of light, however, was visible throughout its entire path due to the swirls of cigarette and pipe smoke. Even in the darkness Susan could tell that the conference room was new, well designed, and sumptuously appointed.
The next color slide was a microscopic section, and it provided relatively more light in the room. Susan was able to pick out the back of Niles’s head with its prominent lump. He was sitting in an aisle seat. She walked down to the proper row and tapped Niles on the shoulder. Susan could see that they had saved a seat for her. She had to squeeze past Niles and Fairweather before she could sit down. It was next to Bellows.
“Did you do a laparotomy or start an I.V.?” whispered Bellows sarcastically, leaning toward Susan. “You were gone over a half-hour.”
“It was an interesting patient,” said Susan, bracing for another lecture on punctuality.
“You can think of a better one than that, I hope.”
“To tell the truth, it was a dressing change on Robert Redford’s circumcision.” Susan pretended to be absorbed in the projected slide for a few moments. Then she looked over at Bellows, who snickered and shook his head.
“You’re too much, I . . .”
Bellows was interrupted by becoming aware that the man on the podium was directing a question at him. All he heard was “ . . . you can enlighten us on that point, Dr. Bellows, can you not?”
“I’m sorry, Dr. Stark, but I did not hear the question,” said Belows, mildly flustered.
“Has she shown any signs of pneumonia?” repeated Stark. A large X-ray of a chest with the right side clouded silhouetted Stark’s thin figure on the podium. His features could not be seen.
A fellow resident sitting directly behind Bellows, leaned forward and whispered for Bellows’s benefit, “He’s talking about Greenly, you asshole.”
“Well,” coughed Bellows, rising to his feet. “She did have a low-grade temperature elevation yesterday. However, her chest is still clear to auscultation. A chest film two days ago was normal, but we have one pending for today. There has been some bacteria in her urine and we believe that cystitis rather than pneumonitis is the cause of the temperature elevation.”
“Is that the pronoun you intended to use, Dr. Bellows?” demanded Dr. Stark, as he walked over to the lectern, placing his hands on each side. Susan struggled to see the man; this was the infamous and famous Chief of Surgery. But his face was still lost in shadow.
“Pronoun, sir?” intoned Bellows rather meekly and with obvious confusion.
“Pronoun. Yes, pronoun. You do know what a pronoun is, don’t you, Dr. Bellows?”
There was a bit of scattered laughter.
“Yes, I think I do.”
“That’s better,” said Stark.
“What’s better?” persisted Bellows. As soon as he said it he wished that he hadn’t. More laughter.
“Your pronoun choice is better, Dr. Bellows. I’m getting rather tired of hearing we or some indeterminate third person singular. Part of your training as surgeons involves being able to deal with information, assimilate it, and then make a decision. When I ask a question of one of you residents, I want your opinion, not the group’s. It doesn’t mean that other people don’t contribute to the decision process but once you have made the decision, I want to hear I, not we or one.”
Stark w
alked a few steps from the lectern and leaned on the pointer. “Now then, back to the care of the comatose patient. I want to stress again that you must be fully vigilant with these patients, gentlemen. Although it can be frustrating because of the intense chronic care that is required and, perhaps, because of the grim ultimate prognosis, the rewards can be fabulous. The teaching aspect alone is priceless. Homeostasis is indeed extremely difficult to maintain over protracted periods of time when the brain . . .”
A red light on the side wall suddenly sprang to life, blinking frantically. All eyes in the conference room turned toward it. Silently a message flashed onto a TV screen below the red light: “Cardiac Arrest Intensive Care Unit Beard 2.”
“Shit,” muttered Bellows as he jumped up. Cartwright and Reid followed at his heels, and the three pushed their way to the aisle. Susan and the other four med students hesitated for a moment, looking at each other for encouragement. Then they followed en masse.
“As I was saying, homeostasis is difficult to maintain when the brain is damaged beyond repair. Next slide, please,” said Stark consulting his notes on the lectern, hardly paying heed to the group storming from the room.
Monday
February 23
12:16 P.M.
There was no doubt that Sean Berman was very nervous about being in the hospital, facing imminent surgery. He knew very little about medicine, and although he wished that he were better informed, he had not bothered to inquire intelligently about his problem and its treatment. He was frightened about medicine and disease. In fact he tended to equate the two rather than think of them as antagonists. Hence the thought of undergoing surgery offended his sensibility; there was no way for him to deal rationally with the idea that someone was going to cut his skin with a knife. The thought made his stomach sink and sweat appear on his forehead. So he tried not to think about it. In psychiatric terms this was called denial. He had been reasonably successful until he had come to the hospital the afternoon before his scheduled surgery.