“I’m not done. Your grandmother. She was diagnosed with cancer in her fifties, just a few years after she started teaching. And you know what she did?”
“What, Dad?” I asked quietly.
“She kept on teaching. She got that double mastectomy, and all that chemotherapy, and all that radiation, and she fought cancer for twenty years straight. She did not stop teaching. She woke up one morning and all her toenails had fallen out, and you know what she did?”
“What’s that, Dad?”
“She put on her socks and her sandals and she went to work. So that’s what you’re going to do, kiddo. I know you. These are the people you come from, and this is who you are.”
One should not count on a working-class father to soft pedal grief. He knew how much I was hurting, because he’d been through it, too. But he didn’t stop expecting the greatest effort from me.
I did not drop out. I did not stop going to class. And even though for a long time I wondered if I had failed Frank by not walking the desert of grief for long enough in his honor, I have never forgotten my father’s words. These are the people you come from. This is who you are.
FRANK’S FUNERAL WAS held the next weekend in his hometown. I drove over with our friend Michael, and there was snow on the mountain passes. We pulled up to the VFW in Michael’s dark car, and found the funeral gathering in the fluorescent-lit meeting room, where photos of Frank were clustered at the front and the walls were decorated with the usual VFW regalia: war memorabilia, a poster board with community announcements, another with the twelve tenets of Alcoholics Anonymous. The crowd was varied: a few premeds, a group of devastated young men from Eugene, and then Frank’s family. Several stepdads were there, in jeans and button-downs. Frank’s mom wore a long black dress, and his beloved grandmother, who had been the rock of stability in his youth, held a calm face.
“You’re Rachel,” she said, when I introduced myself. “He loved you.”
“You’re Ma,” I said. “He loved you so much. I’m sorry.”
“It’s an awful thing,” she said.
I felt awkward about my own calm face, as others were weeping around me. “I’m sorry, I don’t cry as much,” I said. “I’ve been crying a lot at home.”
“Don’t worry, honey,” she said. “People show their grief in different ways.” And so, not for the last time, a person who was suffering more than I could know reached out to comfort me.
The funeral had been unexpected and hastily arranged, of course, but everyone did their best. Frank’s mother had put together a heartbreaking slide show to begin the ceremony: baby pictures of Frank and childhood pictures, with two of Frank’s favorite songs—one by Sarah McLachlan and one by Antony and the Johnsons. There was Frank graduating from high school, then college. There was Frank with the long blond curls he cut in order to look like a good premedical student. And there was the Frank I knew, twenty-six years old and alive, laughing broadly in his periodic-table-of-the-elements T-shirt.
The preacher who spoke did not know Frank, and he said as much, but he finished the ceremony by saying that Frank’s mother wanted to add a message. The message was this: “I want everyone to know that Frank did not mean to leave us.”
When I spoke with Frank’s mom afterward, it became clear what her message meant: she knew that some antidepressants could increase the risk of suicide, and she wanted to sue the doctor who had prescribed them for Frank. “What do you think?” she asked me.
“I don’t know,” I said. “I guess I just don’t know.”
She was trying to make sense of the death, and I would see many people try to do the same at the various memorials I attended in Frank’s name over the next week. Some said that he had killed himself because he was gay, and he was pushed into conformity by the premedical curriculum. Some blamed it on depression. Some quietly blamed his family; some blamed homophobic society. I never could make much sense of it myself. In my grief I refused all explanations, as if putting labels on Frank’s life or his death would do violence to the complicated and beautiful person he was.
I did feel guilty, though. If my mind grasped at any easy explanation, it was, This was your fault. You should’ve known. When he told you about the depression, when you joked about killing someone with caffeine. Those were messages, and you should have understood.
If I had called him that Sunday night, maybe he wouldn’t have made an impulsive decision. If I had loved Frank better, or shared the online exams from my MCAT prep course with him. My mind could twist any detail into a knot of blame.
Gradually, though, I healed. Healing meant accepting that Frank’s death was not my fault. Maybe he had tried to reach out to me, and maybe I had missed it. Just as I was involved in his life—that Tupperware of fish at his bedside table, my phone number on the bottom of the note—I had been involved in his death. I was involved because we were truly friends, and we loved each other.
One night I dreamed that my brother and I were driving together through the darkness in the pickup truck that we shared in college. We arrived at the lake in Montgomery, and my brother slowly navigated the truck into the shallow water. The headlights played out over the water in the darkness, and my brother nodded silently to me. I pulled the door handle, and stepped out into the water. I leaned over and began searching through the water with my hands. I knew I was looking for a body, but I didn’t know if I would find my own body, or Frank’s. Finally I found him, thin and dripping and dead, and I lifted him gently from the water and placed him in the back of the truck. I got back in beside my brother, and we drove away.
CHAPTER 4
I INTERVIEWED FOR MEDICAL SCHOOL ALL OVER THE COUNTRY, but nothing out of Texas felt quite right.
At NYU, for example, all the medical students live in a tower directly above the medical school. “We elevator commute!” my tour guide announced jocularly. When I asked if any of the students refrained from living in the tower directly above the medical school, he scratched his head for a minute and said, “Well, there is one girl who lives in Brooklyn. But nobody really hangs out with her much. I think she has kids or something?”
The radiologist who interviewed me there also mentioned the tower. “Oh,” she said. “That’s exactly how you have to do it. You must,” she said. “You must live in the tower directly above the medical school.”
When I asked her if, as a radiologist, she missed interacting with patients, she said simply, “No.”
I got wait-listed.
At another fancy school, I asked a student panel what percentage of graduates go into primary care.
“Oh, don’t worry,” a student answered solemnly. “If you come to school here, you don’t have to go into primary care.”
Afterward, another student—a woman—came up and grabbed my wrist. “Hey,” she whispered.
“Um, hey,” I said.
“Listen, I’m going into general pediatrics,” she whispered.
“Okay,” I whispered.
“I just wanted you to know,” she whispered.
“Why are we whispering?” I whispered.
“I guess some people feel like it’s a waste of my education,” she said. “Like, if you go here, you should become a specialist.”
After one particularly devastating interview in New York City, I called my friend Jonathan, in Chicago. All day I had been thinking of Frank: how much he would’ve loved to be in my place, touring the hospital in a brand-new suit. I felt the weight of going on, and going to medical school, without him. At that time I felt that he deserved it more, and that I had not mourned him enough. I had returned to classes too soon after his death.
Jonathan spoke slowly, his voice crackling over to me from Chicago. “If we mourned fully any one loss,” he said, “that would take a whole lifetime.”
He paused. “But other things happen.”
ONE PLACE THAT DID FEEL RIGHT was the University of Texas Medical Branch (UTMB) on Galveston Island. On Galveston, I had a built-in group of friends wh
o I knew through my friend Margaret, who was an MD/PhD student there. They all lived in a yellow Victorian house halfway between the medical school and the beach. After every test, my friend Katie would bicycle down to the water and throw herself in. Then she would bicycle home, rinse the sand from her feet with a garden hose, step inside, and fix herself a gin and tonic. That seemed, to me, like a livable life.
Margaret, Katie, and their friend Emily were all student directors at the St. Vincent’s Student-Run Free Clinic, where eventually I would meet Mr. Rose. St. Vincent’s—the clinic—is a medical clinic staffed by volunteer students and physicians from UTMB. The free clinic operates in collaboration with St. Vincent’s House—the House—which is a historically black community center and an Episcopal mission house. The House is a hub of crucial services for working-class and poor Galvestonians. It has a school where people can get a GED or learn English, a food pantry, a chapel, and a preschool. The House’s second story holds eight exam rooms, which are shared by a nurse-managed day clinic and the student-run free clinic. The student-run clinic operates every Tuesday and Thursday evening, as well as Saturday during the day. The House provides the space, a paid receptionist, and office needs such as printers and Internet access. UTMB supports the clinic by paying for blood tests and Pap smears to be run, and the rest is paid for by grants (including some grants from UTMB), donations, and volunteer labor. The main annual fund-raiser is a talent show.
Twenty blocks east of St. Vincent’s is the main UTMB campus, a large complex of buildings dedicated to research, education, and patient care. There are lecture halls and small-group rooms for the schools of medicine, nursing, and allied health professions, as well as for the Graduate School of Biological Sciences. There are massive laboratory buildings including the Galveston National Lab, a biosafety level-four facility that houses research on measles, Ebola, anthrax, and other highly infectious diseases. There is a hospital complex composed of four separate hospitals linked together. The main hospital is John Sealy, but there is also Rebecca Sealy, the nearby Shriners Burns Hospital, a children’s hospital, and Hospital Galveston. Hospital Galveston is a maximum-security prison hospital where UTMB providers treat prisoners from across the state. Hospital Galveston is right on campus, linked to John Sealy Hospital by a sky bridge.
Galveston had the Institute for the Medical Humanities, where I could do a PhD that would bring together my interests in medicine and the arts. Galveston had a historic seawall built in 1901, an aquarium with a baby hammerhead shark, and a dive bar called the Poop Deck. And, for much of the last century, UTMB had been a flagship charity hospital serving poor and uninsured patients from across the state. The students I met at UTMB were mission oriented: they were proud to be part of a hospital with a long history of caring for the poor.
UTMB had already begun to cut back on charity care by the time I was applying. But there was no way to know, then, the full scope of what would happen. On September 13, 2008, just a week before my UTMB interview, I opened up my computer to find that Galveston was underwater.
TO UNDERSTAND GALVESTON you have to understand hurricanes. Barrier islands protect the mainland from these storms. When hurricanes hit, barrier islands like Galveston take the brunt of the storm’s destructive force.
One hurricane, the Great Storm of 1900, had already changed the character of the island forever. Before the Great Storm, Galveston was the main port for the Southwestern United States. The Southern Pacific Railroad begins there, and the town boomed in the nineteenth century as cotton, wheat, and tobacco flowed through the port. Immigrants came, too: Galveston was the Ellis Island of the South. It was also a slave port until the federal order for emancipation arrived in Texas in 1865.* The party in the streets of Galveston on June 19, 1865, gave rise to the Juneteenth holiday celebrating the emancipation of American slaves. After emancipation, black civic leaders in Galveston established the state’s first black high school and black public library. Statesman and former slave Norris Wright Cuney led black dockworkers to unionize and to campaign successfully for fair pay.
Today, many Galvestonians are nostalgic for the 1890s, when our city was progressive and rich—a temperate barrier island of towering stone churches and cobbled streets, home of the state’s first medical school. On September 8, 1900, that Galveston was utterly destroyed.
The Great Storm of 1900 killed six thousand people and wrecked nearly every structure on the island. The bridges to the mainland were knocked out, and the city was out of communication for days afterward, while newspapers around the world shared news of the storm. So many dead bodies were left in the wreckage that Galveston men were forced at bayonet-point to gather the bodies and load them onto barges for burial at sea. The men were given whiskey to help them cope with the awful stench. But the barge-loads of dumped bodies were carried back to the island on the waves, and finally, Galvestonians torched them in massive funeral pyres.
Reports from those who witnessed the Great Storm were surreal: One doctor wrote of coming across the corpse of a woman with “a half-born babe” protruding from her. Another described orgies in the streets of the devastated city—likely a tall tale. Cholera swept through. “The story of Galveston’s tragedy,” resident Ida Parker Austin wrote, “can never be written.”
The story of Galveston itself could have ended then. But 1900 was a time of progress in America, and Texans were a hardy lot. Like their descendants who would respond to the Great Depression of the 1930s with a massive public works investment, Galvestonians responded to the Great Storm by rebuilding—and building better. The U.S. Army Corps of Engineers was brought in to construct a seawall on the ocean-facing south side of Galveston. This eighteen-foot-high seawall would protect the island from the battering waves of any future hurricane, but it meant that the grade of the entire island would have to be raised. And so Galvestonians spent six years walking from house to house on wooden catwalks, while remaining structures were winched up from the earth, and silt from the bay was pumped in to form new, higher ground under the island. Today, the island still slopes gradually down from eighteen feet above sea level at the seawall, to just above sea level at Broadway, then to the level of the bay on the north side of the island.
On New Year’s Day 1901, the Galveston Daily News ran a story covering the damage from the Great Storm and the construction and repair that was already well under way. The headline read, GALVESTON WAS NOT BORN TO DIE!
Galveston survived, but it never again was the promising major city it had been. The live oaks on the island were replanted by the Women’s Public Health Association and, for a century, the seawall worked.
It didn’t work for everybody, however. When Galveston was forcibly segregated, the seawall defined the geography of segregation. Black families were restricted to the low-lying north side of the island, beyond where the grade had been raised. The north side would be home to African American neighborhoods throughout the twentieth century, as black communities took root there.
Other hurricanes came and went after 1900, leaving the south side intact. The north side of the island, including the downtown and the port area, flooded again in 1915 and then again with Hurricane Carla in 1961. The Galvestonians of the north side rebuilt.
Then came Hurricane Rita. In 2005, three weeks after Hurricane Katrina devastated New Orleans, Galvestonians went through a tedious and costly evacuation—including the first-ever total evacuation of John Sealy Hospital—for Rita. Hundreds of UTMB patients were evacuated by helicopter or ambulance. Katrina and the ghastly events at storm-bound Memorial Medical Center in New Orleans were certainly on the minds of the UTMB officials who opted for a total evacuation for Rita.† The 2005 evacuation cost UTMB $25 million, and that loss coincided with a $50 million cut to the university’s budget from the state legislature. This coincidence of budget cuts and a costly evacuation is one early root of the troubles that would lead UTMB to abandon its historical mission as a charity care hospital.
With most everyone from Galvest
on, Houston, and the surrounding towns suddenly on the roads, the evacuation for Hurricane Rita was the largest single mass movement of Americans since the Dust Bowl. But Rita turned. It hit a less populated area of the coast at the Louisiana border, sparing Galveston and Houston. More Gulf Coast residents died from heat and exhaustion during the massive evacuation than were killed by Hurricane Rita itself.
Then in 2008, the year I was applying to medical school, came Hurricane Ike.
ON THE MORNING OF SEPTEMBER 11, 2008, Hurricane Ike made a sharp turn toward Galveston Island. The National Weather Service report at 4:19 p.m. read:
LIFE-THREATENING INUNDATION LIKELY!
ALL NEIGHBORHOODS . . . AND POSSIBLY ENTIRE COASTAL COMMUNITIES . . . WILL BE INUNDATED DURING THE PERIOD OF PEAK STORM TIDE. PERSONS NOT HEEDING EVACUATION ORDERS IN SINGLE-FAMILY ONE- OR TWO-STORY HOMES WILL FACE CERTAIN DEATH. MANY RESIDENCES OF AVERAGE CONSTRUCTION DIRECTLY ON THE COAST WILL BE DESTROYED. WIDESPREAD AND DEVASTATING PERSONAL PROPERTY DAMAGE IS LIKELY ELSEWHERE. VEHICLES LEFT BEHIND WILL LIKELY BE SWEPT AWAY. NUMEROUS ROADS WILL BE SWAMPED . . . SOME MAY BE WASHED AWAY BY THE WATER. ENTIRE FLOOD PRONE COASTAL COMMUNITIES WILL BE CUT OFF. WATER LEVELS MAY EXCEED NINE FEET FOR MORE THAN A MILE INLAND . . .
ACROSS THE ISLAND and in the little towns around it, St. Vincent’s patients—and nearly everyone else—scrambled to evacuate. Vanessa, a patient in her fifties who lived just off the island, figured that she and her husband Jimmy would escape the worst of it. She was grateful that she didn’t have her kids or grandkids with her when the hurricane came. It meant that all she had to deal with was herself, Jimmy, and the animals.
The animals included a battered Chihuahua that Vanessa had nursed back to health, a sad-faced pit bull she found abandoned by the highway, and a formerly abused macaw that would greet Jimmy every evening when he came home from work at the refinery. There were two baby squirrels she found near death after their mother was run over on the highway, a rabbit, and more dogs.
No Apparent Distress Page 4