“You mean will she drop a lung?” I shook my head. “It’s a miracle she hasn’t already.”
“Why do you suppose she’s flinching like that?”
I stared at him.
“Do you think they’re touching the pleura? Something like that?”
“How the hell should I know?” I repeated. “She just scares the daylights out of me.” I turned on down the hall. “Come on. I’m sending her out.”
I left it to Joe to complete the paperwork involved in the transfer. While he was working, I waited nervously for EMS.
THE THREE FIGURES OF the EMTs filled her room. I watched over their shoulders as they gently helped her stand and guided her to the gurney in the hallway. They placed her on it and began to strap her in.
“Not tight,” she said. And then that uncanny giggle erupted out of her, her eyes glazing over with an inward look I could not interpret, could not even look at without disordering my thoughts.
When I looked back at her I found her gaze upon me again.
“Thank you, Doctor,” she said, her expression almost prim, then catching at another inward expression of surprise as they swooped her up and away.
When I got back to the workroom, Joe was standing expectantly, pager in his hand.
“It’s Gero again.”
“DOC?” THE NURSE SAID. “It’s Mr. Scatliff. He’s vomiting and can’t seem to bring it up.”
I sighed. Another set of films I hadn’t seen yet.
We could hear the retching all the way down the hall. There was a small crowd gathered around a bench; it parted as we approached.
Mr. Scatliff’s wasted form curled over a trash can. He was clutching his gown to his chest with one hand; the other waved in the air, making a series of fluid gestures that seemed unrelated to anything else that was going on. I watched it, fascinated by its apparently independent movements. Was he gesturing to us? Conducting some internal music? The retching rose to a crescendo, and suddenly a flood of incomprehensible objects erupted from his mouth and rattled in the can.
And just as suddenly I felt, with a mixture of cold fear and uncomprehending surprise, a wave of nausea rising in me, and before I knew it I had vomited, too, right on the floor, splashing my feet and those around me.
I looked up, embarrassed. The entire crowd had turned to look at me, each expression a different mask of surprise.
But the face I found most startling was Mr. Scatliff’s. He had turned from his retching to look at me, and for a moment, as his free hand wavered toward me, I imagined I caught a glimpse of something intelligent in his eyes. Whatever it was, at that moment I didn’t want to know about it, and turned away as another gush of fire erupted through my chest.
AFTER AN INTERMINABLE PERIOD marked in my memory by scattered flashes—Joe’s face, a mixture of concern for me and for his pager, which kept going off; the amusement on the faces of the staff; beyond them the frieze of patients caught in attitudes of surprise, incomprehension, or intense concentration on any number of objects in the area, including me; and the interminable business of cleaning up the mess I had made—I followed Joe the long distance of the hallway toward the locked doors at its end.
Radiology was dark again, Reggie by now gone home for the night; the room flickered into light as Joe palmed the switches. He stooped to the bins below the counter, and I heard the stiff film jackets falling back into their bins with a hollow knock as Joe lifted each in turn.
“Roberson, Rush, Rutledge,” he muttered. “Sandler, Saknussem, Scarne. Scatliff.” He stood, grunting, snapped a pair of view boxes on, and slipped the films under their clips.
A crown of ribs, translucent with age, floated above dim clouds of bowel; a few dark pools of gas, a scatter of phleboliths, the spine a gnarled tree, but no foreign body. Nothing disrupted the ordinary shadows of an old man’s belly. I let out a sigh. Joe stepped back from the view box and ran a hand through his hair.
“I don’t see anything,” I said.
He nodded.
“That’s good,” I said.
He gave me a sidelong glance. There was something in his expression I couldn’t read.
“How are you feeling?” he asked quietly.
“Oh, me?” I felt embarrassed again. “I’m fine.”
“Good,” he said, and then: “Would you mind?” He stooped below the counter, and from the leftmost bin brought out another film jacket. Slipping two sheets into the box beside the one that held Scatliff’s KUB, he thumbed the switch and the images flickered into light and shadow.
It was Carrie B again. I stepped back, struggling with annoyance. Why was he dredging this up? Below the annoyance I could feel a wave of anxiety surging back and forth.
“I think I get it,” he said, as much to the films as to me.
I was beginning to feel the fatigue of the night. I could not see any connection between these two sets of films, and feared another discourse on God’s mystery. I had enough craziness on my hands already.
“I think I know what she was trying to say,” Joe said.
“What?” I said. It was an expression of irritation more than a question.
He gestured at Carrie B’s films, its darkness hedged about by bright spines. “There’s nothing there, either,” he said.
I had an impulse to say something snide, but it died before I could find words for it. For a moment I wondered if I was going to vomit again.
“It’s a . . . a crying out. An appeal.” He was speaking more to the films than to me by now, his revelation leading him in pursuit. “She put those needles in looking for some response—not from us, from herself. Because she’s empty inside, too. See?” He waved again at the films, but now he had turned his face toward me, his eyes alight in the glow of the view box, his hair a wild crest. He really did look mad.
“At least when she sticks needles into that”—he waved again without turning—“it responds. She feels something.”
I think the expression on my face must have told him I wasn’t following.
“The body,” he explained. “It’s important. You must know that.”
I wasn’t sure if he was addressing me as an internist, or as someone who had recently splashed the contents of his guts on the floor of the Gero unit.
“We think it’s about the mind, you know. All of this”—he waved his hand in the air—“we think it’s about personalities and psychology. But all that’s secondary. It all . . . depends. On this.” And here he turned again to the films on the wall: dark and unrevealing Mr. Scatliff, bright and mystifying Carrie B.
“It’s the body that’s the problem. But what makes us call them crazy is that they try to solve the problem: They feed it garbage. They feed it pain. The rest of us just suffer it, like the beasts of the field.”
All I could think to say was, “Isn’t that where we come in?” but it sounded lame as I said it.
Joe laughed. “I think we’re part of the problem.”
I could only stare.
“We’re not solving anything. Not the way they do. Those things they do, they mean something. What does all our medicine mean?”
I realized I had no idea what he was talking about. I was tired, and didn’t care. The air in the room had something in it I didn’t want to acknowledge.
Joe dispelled it with a sudden laugh, a shrug. He turned back to the view box and pulled the films, jacketed them. “I do go on sometimes,” he said. And then, turning, “Are you okay?”
I pretended he was speaking about my stomach, which felt empty, and told him I was.
THE TRAFFIC ON I-40 was heavy despite the lateness of the hour. I drove in the right-hand lane, too tired to join the rapid weaving of the faster lanes, pinned behind a panel van driving stolidly at sixty. I felt the trip stretching out, its duration rendered uncomfortable by my thoughts. The image of Carrie B’s X-rays floated ghostly over the road ahead, the bright streaks in it seeming to crack open the darkness: something struggling to break through the shadows. I was tired
of thinking about her, but the image persisted, distracting me from the road ahead. I shook myself upright, gripped the wheel tighter, tried to dispel the illusion of something hovering over the pavement, but as I did the discomfort I had been feeling, which I had thought at first was simply fatigue, and impatience over the slow pace of the van ahead, solidified, forming a solid knot in my gut.
I remembered, with a fleeting, visceral burst of shame, how I had vomited on the Gero unit. I had never done this before, I thought, not on any of the rotations of my residency or medical school, where I had witnessed things far worse than Mr. Scatliff retching up the contents of a garbage can.
What had gotten into me? The knot in my stomach would not relax: it tightened, rather, and began to burn. I began to feel as if I couldn’t catch my breath. In a moment, I told myself, I would begin to feel sharp spines between my ribs.
What was the matter with me? The image of those films, the impossible sharpness intruding where there should have been only curves and soft shadows, flashed before me again. I tried to shake it away, but it persisted, and with it the pain in my belly seemed to sharpen.
I was starting to feel something more, as well, I realized: something like fear. Was I having a panic attack? Without realizing it, I had started to slow down: the rear of the panel van was receding ahead of me; lights were glaring in the rearview mirror. I bore down on the accelerator and reluctantly, as if it, too, were laboring under some inward malaise, the car responded, the speed creeping up again to sixty, sixty-two, and the panel van drew nearer, its dull white silhouette almost blocking out the ghost of Carrie B.
But even as I tried to take command of myself, the sense of impending doom rising in my gut grew stronger, beginning to take on the unmistakable edge of fear. My pulse was accelerating. I was starting to sweat.
What was the problem? I had seen an old man vomit garbage. I had seen a woman with needles in her chest. And this had me on the verge of panic? I wasn’t supposed to be scared by this kind of thing: the vicissitudes of the body hadn’t frightened me since the first week of medical school.
It had never occurred to me before that nerve was so essential to being a doctor. What if I had lost it?
This question only added, of course, to the unidentifiable sensation still surging up in me, which I was beginning to think was the opening salvo of a psychotic break. Had I picked up something in the hospital? Some psychiatric contagion?
Unwillingly, but helpless to do anything else, I let the car drift onto the shoulder and slow down. Beside me the traffic continued to flow on, louder now as the larger vehicles passed. My hands still gripped the wheel. If I let go, I knew they would be shaking. Sweat was pouring down my face.
I tried to concentrate. What was wrong? The pain in my belly would not let me think.
And then, as the pain grew, it twisted appallingly into something that I recognized, finally, for what it was. I was about to vomit again. Right now.
I threw open the door, registering in a fleeting moment the possibility that a passing car might shear it off, and in the next moment that I didn’t care as yet another burning flood burst out of me, splattering the concrete. A semi roared by, rocking the car, and I vomited again, and again, all coherent thought lost for the moment in the free fall of nausea.
The vomiting stopped, finally, leaving me bent over the sill, the seat belt still restraining me. I let it pull me back upright, putting my hands back on the wheel to steady everything, and took a deep breath.
And with that breath, to my surprise, returned not the panic and helplessness, but some access of rationality I had not expected.
The pain in my belly was gone. I felt lightened, not only of the mass of hot iron that had filled me a minute before, but of the dread that had grown out of it. Both were gone, both dispelled together, as if I had vomited up the fear as well.
For a moment I had an urge to look at the puddle on the pavement to see if there was anything there to explain this change, but the urge was ridiculous and I resisted. Because what was rapidly becoming clear to me, in what I was starting to understand would only be a brief respite, was that despite the relief of having vomited, I was still sick. I could feel the nausea returning, but with it came as well the welcome certainty that I was in the throes of a gastroenteritis, undoubtedly brought on by the stone-cold sausage pizza I had consumed so greedily two hours before. The presentation was classic.
As the nausea swelled again, the clarity of mind that had come to me with its cessation began to waver, filling with another surge that for a moment I almost mistook, again, for fear. And in that moment, finally, I understood what Scatliff’s urgent gaze had been trying to convey, the meaning in those painful shafts of light scratched over Carrie B’s chest films.
Joe had been right, but he had missed something as well. Scatliff’s helpless gorging on what no one else could stomach, Carrie B’s attempt to pin her own internal mystery: there was no special insight there, just another iteration of the problem. A problem, I finally realized, Joe shared, the F-Max nurse shared, I shared. Every patient in that hospital, and every staffer. Every patient and every doctor I had ever known.
It is the body that makes us crazy: our inability to interpret our corporeality, the inscrutable messages it bathes us in with every passing moment. For the patients, it wasn’t their insistence on interpreting, on trying to decode those messages, that made them mad. We are no different in this. The only thing that separates them from us, I realized, is the solutions we arrive at. Sticking needles in yourself is just crazy. But do the treatments I prescribe really make a difference? Not if the problem is mind living in a body. There is no solving that.
Our bodies: inscrutable because unmeaning. They remain the essential mystery we keep trying to solve, although sanity tells us the attempt can only end in dissolution, mind and body both.
And as for spirit? Where was spirit in all of this? Or was that only another symptom, just one more fantasy conceived by consciousness out of flesh? Just then, beside the roadway, I couldn’t say. Perhaps Joe could. I set the thought aside and gingerly, hoping the quivering in my guts had gone as far as it would go, I looked back over my shoulder and put the car in gear.
THE
GRAND
INQUISITOR
THIS IS A STORY I HEARD A FEW YEARS AGO, FROM A doctor who claimed he’d heard it from someone who was there when it was told originally. The story as I heard it raises doubts, however, as to when any original version might have been told. As to the truth of it, whatever there might have been originally, I doubt there was any left in the version that finally reached me. But as a story, the kind doctors might tell among themselves in the night when no one else is listening, it bears repeating at least one more time.
THE PHYSICIAN’S LOUNGE WAS not usually occupied at two a.m., but on this night an ice storm had begun as darkness set in; most of the on-call doctors in town had come in early and stayed. We staked out places on the sofas and chairs as we arrived, holding them jealously as the room filled. One of us—Benson, anesthesia—had arrived late, and now lay curled up in one corner of the floor, snorting intermittently. The room was lit by a single lamp, which left the far corners in shadow.
In the lounge chair next to the lamp sat Hawley, a pediatrician, and by far the oldest in the room. He had been long established in his practice when the rest of us began. Two of us had been his patients. A solo practitioner, he shared call with the two larger pediatric practices in town, which explained his presence that night, although some of us harbored a suspicion that he would have been here anyway: he was that kind of doctor, one of the old school that took its obligations more seriously than we do now, to the point of abandoning any life of his own. We were all a little in awe of him, a feeling tempered by the contempt younger doctors feel for the antiquated notions of the old.
We kept our distance from him, however, for another reason entirely. He was different. There was a tendency to produce outlandish statements bordering on a ki
nd of clinical mysticism which made everyone uncomfortable, partly because he seemed oblivious to their effect on the rest of us. Or perhaps he was aware, and simply didn’t give a damn. In any case, he gave every indication of thinking differently from the rest of us, and, given his seniority, and the primitive reverence his patients held him in, this difference made the rest of us nervous. No one had ever caught him in a mistake, or reading a journal.
He was also fond of telling us long, apparently pointless case histories, involving patients or practitioners who had departed this scene before most of us had been born. He offered these tales (for that was what they were, and whether based on actual cases or entirely fabricated was an open question) whether we wanted to hear them or not, and with a disregard for our obvious impatience that made the entire performance intolerable: maddening because so impervious, and so benign. It seemed mean to resent this in him, and yet we all did. Not that he noticed. In telling these stories he seemed to retreat into himself, so that his involuntary audience came to feel they had been ensnared in a novel kind of meditative practice, through which the old man sought some inner meaning that had not yet revealed itself—and clearly, as far as the exasperated auditor could tell, never would.
But what was perhaps most exasperating was that bland indifference: listening to old Hawley droning on and on, whether in the hospital coffee shop or at some random nursing station, one never got the feeling that the telling was motivated by some inner doubt or turmoil. There are cases that bother you, we all knew that, the ones that leave behind names and faces that pop out at you in the night. There’s always some residue of doubt. Not with Hawley. The cases he dredged up were gruesome enough, but in telling them he seemed the embodiment of clinical equanimity. He seemed to be rehearsing the case, not in search of absolution as the rest of us would, but for some other reason entirely. It seemed—and I think this was, ultimately, why none of us could stand him—that he was telling them for our benefit.
Internal Medicine: A Doctor's Stories Page 18