A Life in Medicine

by Robert Coles

  WALT WHITMAN (1819–1892) published at least six editions of Leaves of Grass between 1855 and 1891.

  1

  An old man bending I come among new faces,

  Years looking backward resuming in answer to children,

  Come tell us old man, as from young men and maidens that love me,

  (Arous’d and angry, I’d thought to bear the alarum, and urge relentless war,

  But soon my fingers fail’d me, my face droop’d and I resign’d myself,

  To sit by the wounded and soothe them, or silently watch the dead;)

  Years hence of these scenes, of these furious passions, these chances,

  Of unsurpass’d heroes, (was one side so brave? the other was equally brave;)

  Now be witness again, paint the mightiest armies of earth,

  Of those armies so rapid so wondrous what saw you to tell us?

  What stays with you latest and deepest? of curious panics,

  Of hard-fought engagements or sieges tremendous what deepest remains?

  2

  O maidens and young men I love and that love me,

  What you ask of my days those the strangest and sudden your talking

  recalls,

  Soldier alert I arrive after a long march cover’d with sweat and dust,

  In the nick of time I come, plunge in the fight, loudly shout in the rush of

  successful charge,

  Enter the captur’d works—yet lo, like a swift-running river they fade,

  Pass and are gone they fade—I dwell not on soldiers’ perils or soldier’s

  joys,

  (Both I remember well—many the hardships, few the joys, yet I was

  content.)

  But in silence, in dreams’ projections,

  While the world of gain and appearance and mirth goes on,

  So soon what is over forgotten, and waves wash the imprints off the sand,

  With hinged knees returning I enter the doors, (while for you up there,

  Whoever you are, follow without noise and be of strong heart.)

  Bearing the bandages, water and sponge,

  Straight and swift to my wounded I go,

  Where they lie on the ground after the battle brought in,

  Where their priceless blood reddens the grass the ground,

  Or to the rows of the hospital tent, or under the roof’d hospital,

  To the long rows of cots up and down each side I return,

  To each and all one after another I draw near, not one do I miss,

  An attendant follows holding a tray, he carries a refuse pail,

  Soon to be fill’d with clotted rags and blood, emptied, and fill’d again.

  I onward go, I stop,

  With hinged knees and steady hand to dress wounds,

  I am firm with each, the pangs are sharp yet unavoidable,

  One turns to me his appealing eyes—poor boy! I never knew you,

  Yet I think I could not refuse this moment to die for you, if that would

  save you.

  3

  On, on I go, (open doors of time! open hospital doors!)

  The crush’d head I dress, (poor crazed hand tear not the bandage away,)

  The neck of the cavalry-man with the bullet through and through I

  examine,

  Hard the breathing rattles, quite glazed already the eye, yet life struggles

  hard,

  (Come sweet death! be persuaded O beautiful death!

  In mercy come quickly.)

  From the stump of the arm, the amputated hand,

  I undo the clotted lint, remove the slough, wash off the matter and blood,

  Back on his pillow the soldier bends with curv’d neck and side-falling head,

  His eyes are closed, his face is pale, he dares not look on the bloody stump,

  And has not yet look’d on it.

  I dress a wound in the side, deep, deep,

  But a day or two more, for see the frame all wasted and sinking,

  And the yellow-blue countenance see.

  I dress the perforated shoulder, the foot with the bullet-wound,

  Cleanse the one with a gnawing and putrid gangrene, so sickening, so

  offensive,

  While the attendant stands behind aside me holding the tray and pail.

  I am faithful, I do not give out,

  The fractur’d thigh, the knee, the wound in the abdomen,

  These and more I dress with impassive hand, (yet deep in my breast a fire,

  a burning flame.)

  4

  Thus in silence in dreams’ projections,

  Returning, resuming, I thread my way through the hospitals,

  The hurt and wounded I pacify with soothing hand,

  I sit by the restless all the dark night, some are so young,

  Some suffer so much, I recall the experience sweet and sad,

  (Many a soldier’s loving arms about this neck have cross’d and rested,

  Many a soldier’s kiss dwells on these bearded lips.)

  Susan Onthank Mates

  THE GOOD DOCTOR

  Helen van Horne is the essence of what it means to be a good doctor and a doctor who is good. Chairperson of Medicine at City Hospital in the Bronx, she is on the ward at 5 A.M. and at 11 P.M., helping and overseeing everywhere, dedicating herself to patients and students alike.

  What unfolds in this story, then, is all the more shocking—and instructive—as readers are asked to ponder how such a good doctor could go so terribly awry. Susan Onthank Mates’s complex, disturbing story offers a rich exploration of basic human need, lofty altruism, and the double standard that lies just beneath the surface within the patriarchal culture of medicine.

  SUSAN ONTHANK MATES, a former concert violinist, is now a practicing physician and writer living in Barrington, Rhode Island. “The Good Doctor” was the winner of the 1994 John Simmons Short Fiction Award.

  Some years ago, during a winter that drove even the thieves and addicts indoors, Helen van Horne arrived to run the medicine department at City Hospital. Born in Wisconsin and just returned from Africa, she expected to feel at home in the South Bronx.

  “Why,” she asked Diana, as they rounded on the men’s ward after a meeting of the community board, “do they hate me, so soon?”

  “You look very clean,” said Diana kindly. “Your blouses are always white.” She didn’t add, you are so pale, your blue eyes so light they seem a disfigurement. Diana Figueroa was the medical chief resident for the year.

  “Are you married?” asked Helen, noticing the gold band on Diana’s smooth brown finger.

  “Yes,” said Diana, and Helen imagined a home, two children, and a swing set. When Helen chose medical school, the act implied spinsterhood. Aware of her attractiveness, she tried but found herself unable to offer the standard plea for forgiveness: my patients, my students will be my children. Instead, she swept behind the patients who disapproved, the wedded college classmates, the condescending but lecherous professors, in the dust of her flight to Africa.

  “What does your husband do?” she asked Diana.

  “He said he wanted to be a lawyer.” Diana finished writing in a chart, signed her name, and handed it to Helen.

  “Oh,” said Helen. “I suppose one of you might have to work part time.” She tried to imagine herself, when she was a young doctor, coming home at eight or nine in the evening, on her day off call, to talk to a child instead of throwing herself into bed.

  “One of us does work part time,” said Diana. “When he works at all.” She laughed. “Men,” she said.

  Helen began reading the chart. “I suppose that’s fine, then,” she said. She countersigned Diana’s note, which was incisive and succinct. I will help this chief resident, she thought. She is smart, like I was, and young enough to be my daughter. It pleased Helen to think of a daughter, married and a doctor.

  In Tanzania, Helen ran a dispensary, single-handed, far into the bush. She operated by automobil
e headlight, diagnosed by her senses alone, tended the roses next to her well, and learned the language of solitude. “A good summer,” she wrote to her sisters. “Not too much malaria, I’ve got the women to allow tetanus vaccination, now if only the generator doesn’t break down again.” She had two brief love affairs, otherwise the years passed from grassy summer to muddy winter to grassy summer like figures of a dance.

  She slipped into relationship with the Masai and the earth: she cleaned the clinic each sunrise, ordered seasonal supplies with the solstice, and stopped numbering days entirely. She menstruated on the full moon, and the villagers came when they came, appearing unexpectedly on the horizon, carrying their sick in hammocks slung horizontally between tall men. After fifteen years, Helen described Tanzanian mountain fever in a clear and intelligent communication to the British journal Lancet, and because the virus was isolated from her specimens, and because it was interesting in its mode of replication and transmission, Helen’s name became known.

  On the day she received the letter from City Hospital, Helen folded it carefully into her skirt pocket, slung the rusted clinic shotgun on her back, and took the long path over the ridge. When she had first set up, the missionary nuns who preceded her said to always take the jeep. Lions, they warned earnestly, shaking their heads. Elephants. Rhinoceros.

  Helen sat on a rock and watched a pair of gazelles leaping across the bleached grass on the other side of the ridge. In the distance, a giraffe swayed against the trees. I live in a Garden of Eden, she thought, why would I ever want to leave? She looked down the way she had come, to the tin roof of her clinic. It was such an insignificant mark on the land, so easily removed. She traced the varicosities on her leg and felt suddenly afraid.

  And so Diana became the guide of her return, pointing out the snow that bent the branches of the blue spruce whose roots cracked through the concrete of the long-abandoned formal entry to City Hospital. “I grew up on Willis Avenue,” Diana told her as they sat in the cafeteria.

  “I grew up on a farm near Madison,” Helen replied, “but my parents are dead. There’s no one who knows me there now.”

  They sat for a moment, surveying the crowd of people, the yellowed linoleum, and the sturdy wooden tables. “Three types of students rotate here: do-gooders, voyeurs, and dropouts sent by the dean,” said Diana. She nodded down the table and Helen saw an extraordinary beautiful young man with smooth, almost hairless golden skin, laughing and tossing his head. Like the African sun, thought Helen. Like sex.

  “Mike Smith,” said Diana. “A real goof-off. Kicked out everywhere else, the patients complained.” Helen looked down at her lunch, conscious of her gray hair and how long it had been since she’d worked with men. She stared at the boiled tongue and sauerkraut.

  “You’ll get used to it,” said Diana. “Some of the cooks are Puerto Rican, some are from the South.”

  Helen took a bite of the meat. “I’ll write a letter to the dean,” she said, “about that boy. These patients deserve consideration, too. A failing student should be failed.”

  “It won’t,” said Diana, “do any good.”

  Helen studied Diana’s smooth face, her soft black eyebrows, and her neatly organized list of patients dipped to the board next to her lunch. “I hope you have enough time with your husband,” said Helen. “I hope you decide to have children, soon, before you get too old.”

  In the afternoon of the day she came, Helen carried her two suitcases up to the staff quarters and sat on the narrow bed. There was a single bureau in the room, battered but solid oak, standing at a slight tilt on the warped linoleum. In the top drawer she found a tourniquet, a pen, index cards, and several unused needles. She picked them out carefully and dropped them into the garbage, then lined the drawer with paper towels from the sink. Folding her skirts into the bottom drawer, she found a package of condoms tucked into the back right corner.

  The window stuck several times before it finally creaked all the way up. Car horns, salsa music from the local bar, sirens, the sooty yearnings of urban life blasted into the room. Helen wrapped her arms around herself and stood, considering. She looked across at the decaying curve of the expressway, traffic crowded like wildebeest during mating season in the Serengeti. Then, turning back to the task of unpacking, she noticed faint fingernail scratches, hieroglyphics of passion, etched on the green wall at the head of the bed.

  Over the next few months, Dr. Helen van Horne took charge of the department. She reviewed charts, observed procedures, met everyone including housekeepers and orderlies. “What disinfectant do you use?” she asked. “Why is this man waiting so long at X-ray?” She was on the wards at five in the morning and eleven at night, her faded hair pulled into a ponytail, starting an intravenous at a cardiac arrest, checking the diabetics’ drawers for candy. Sometimes, standing in front of a washbasin, or sitting at a deserted nursing station at the change of shift, she would suddenly find herself watching the papery skin on the backs of her hands. What do I have to show for the years? she asked herself, but then a young woman gasping from rheumatic heart disease, or an old man bent with cancerous metastases passed by her, and she told herself: it doesn’t matter. And she got back to work.

  “What are they doing?” she asked Diana as they passed a window looking toward the inner courtyard of the hospital. Michael Smith, the contours of his back glistening in the heat, kicked a ball toward some other students, boys and girls, who were encouraging several small children to kick it back.

  “Oh,” laughed Diana, “he’s too much, isn’t he?”

  “The children will pull out their IVs,” said Helen.

  Diana walked around to the door. “Mr. Smith,” she called, “the children will pull out their IVs.”

  “Anything you say Dr. Figueroa,” said the boy.

  “He played football for Harvard,” said Diana, apologetically, when she came back inside.

  “When you are a teacher,” said Helen, looking back to check on the children but involuntarily glancing at Michael Smith’s tight buttocks, “you must be careful about personal relationships. There is the issue of abuse of power.” She looked away quickly, and with humiliation.

  “Yes,” said Diana. “But,” she added, “the men do it all the time.”

  After that, Helen gave the teaching of the students over to Diana. She herself spent even more hours attending research meetings at the medical school and supervising the medical service. She set up studies and chaired meetings. She read textbooks of molecular biology. “We are beginning to see a new syndrome of infections in IV drug users,” she said in conference, and felt her power as the other doctors listened, because she was the Helen van Horne of Tanzanian mountain fever. She was senior and spoke with authority of microbial isolation and immune alterations. She submitted scholarly articles, and her roots spread into this identity, Chairman of Medicine at City Hospital. She stood taller, her walk grew firmer.

  Once, she brought Diana with her to the medical school, to listen to her lecture. Afterwards, the men in the audience, who were division chiefs but not department chairmen, spoke to her carefully and politely. The dean, who was the same age as Helen, came up to tease her about her theories, and Helen, who had, despite herself, imagined the touch of his hands and the feel of his skin, caught each barb and sent it back, leaning against the podium and laughing. But when she introduced Diana to him, he widened his stance. When Diana said how much she admired his research, he put his arm around her and introduced her to the other men, who, one after another, smiled with authority and watched her smooth brown cheeks.

  Helen threw herself into work. “Examine these patients and report to me,” she told the students. “Tell me if they are rude,” she told the patients, “tell me if you think they will make good doctors,” and the women always remarked on Michael Smith. Oh, they said, his hair, his eyes, his body. “He’s careless,” snapped Helen to Diana, “missed diagnoses, wrong medications.” But when the boy stood to be rebuked, Helen felt the speculation i
n his eyes. She tightened her lips. “If you don’t work, I will fail you, don’t think I won’t,” she told him. But he glanced at her breasts and her nipples hardened.

  “I don’t want to be any superdoctor,” he said, looking at her seriously. “I want to enjoy my life, you know what I mean?”

  She laughed, because she had felt that way, too, then walked away. You are a fifty-year-old woman, she told herself. You are inappropriate. You are disgusting.

  Later, on the wards, she rounded with Diana and set stern rules. “No more than six units of blood per bleeder,” Helen said, after she watched an intern run ten units into a cirrhotic.

  “But he’s a young man,” said Diana.

  “He’ll vomit up twice as much tomorrow,” said Helen. “We don’t have enough blood.” She felt a pleasure in teaching this resident, after all the years of solitude. The girl would be a good doctor, she thought, but she needed disappointment.

  “City Hospital,” read the dean’s reply, “has always been an albatross to the Medical School.” It was spring now, and Helen watched the cornflowers pushing up through the cobbled ramp leading to the ambulance bay. She wondered if the dean had ever seen an albatross. Wingspan as wide as a man’s arms, Daedalus, Icarus, she thought, and remembered the bird that followed them all the way from Dar es Salaam to Madagascar. Her lover was Indian, son of the supply ship’s owner, a merchant in Dar. “Look,” he said to her as they were making love. His gold neckchain lay fallen in a spray of sweat from his dark chest onto hers, looped around one pink nipple. “You belong to me,” he said. That was when her skin was smooth and firm, her hair a pale sheet of gold. She had wished, suddenly and just for a moment, that a child, his child, would seed and grow in her womb. A year later, he was gone.