Doctors (51 page)

“I’ve heard it’s pretty high,” Barney murmured.

“Nine—
nine
times higher than the general population. You’ve chosen a very dangerous specialty, my friend.”

Barney knew doctors could not save every patient. That was a fact with which he was prepared to come to terms. Hadn’t a mugging victim he was treating just died on the table while an I.V. dripped blood into him?

But now at once he realized what the difference was. A knife is swift: life’s blood pours swiftly from the body. A psychiatrist may be dealing with a similar phenomenon, but in
slow motion.
His job should not be sewing up the wound as much as trying to deflect the knife.

“Hey, when do you get off?” the psychiatric resident inquired.

“Half an hour ago,” Barney replied.

“I leave as soon as Sarah Field comes in, which should be any second now. Want to grab a little breakfast?”

“No, thanks,” said Barney, still in shock. “I just want to sleep. I want to crawl into bed and block out all of this.” He turned and started off.

“Don’t count on it,” Barton called after him. “Most interns can’t distinguish between sleeping pain and waking pain. It’s
all
one fucking nightmare.”

“Thanks,” Barney responded, “you’ve been a real help.”

S
eth Lazarus had been the bonus baby of the graduating physicians.

Even Peter Wyman conceded this, although he might have claimed that unofficial honor for himself, had not Harvard made him a preemptive offer. Professor Pfeifer wanted him around, since Peter had become indispensable for his
own
research. As Peter saw it, Mike (they were on first name terms now, of course) wanted to “ride on the comet’s tail.” Thus Peter had applied only to hospitals within walking distance of the Biochem lab. He was, naturally, accepted by all.

His mentor had seen to it that Peter’s meager intern’s salary was supplemented by funds from the National Institutes of Health.

Thus for Peter nothing changed, except that the stationery he had printed now read: Peter Wyman, M.D., Ph.D.

Seth had established a record unprecedented in Harvard’s history: he had received A-pluses in every one of his clinical courses. Hospitals had wooed him the way the colleges courted prize high school quarterbacks. Moreover, because of his multifaceted talent, he had been offered special rotations in whatever discipline he felt he wanted for his specialty.

Think of the prestige of Surgery, said half-a-dozen chiefs of service. You’ve got virtuoso hands. You cut like Jascha Heifetz plays the fiddle—with finesse, dexterity, and absolute precision. You could be another Harvey Cushing.

Needless to say, Seth was deeply flattered by the comparison to Harvard’s legendary neurosurgeon and physiologist.

But he declined with thanks.

As he confessed to Judy, he did not want to consecrate his life to treating human beings who were passive and unconscious.
He even reasoned that this was a possible explanation of the clause in the Hippocratic Oath which prohibited “cutting for the stone.”

For almost the same reasons, he turned down an invitation from his old boss, Tom Matthews, to join the Path team full-time. Matthews all but guaranteed Seth would succeed him as department chief. But Seth had viewed Pathology merely as a means to an end—the way to recognize what made a human body die. In that department patients reached the doctors far too late.

No, if surgery was too much like the work of plumbers, or carpenters, Path was archaeology. It is no consolation to a widow to find her husband’s cause of death. But think what happiness you’d bring a wife if you could decipher all her husband’s symptoms. Then if you had time and expertise enough you could possibly save his life.

So Seth chose a middle course: Internal Medicine, where astute diagnosis might even spare the patient the necessity of surgery. So what if internists were sneered at by surgeons as mere “fleas”?

Despite the blandishments of San Francisco, Houston, and Miami—not to mention Boston and New York—he wanted to go home to Chicago. He felt a special tie to his old hospital. His heart was there. His future wife was there.

Unfortunately, he had not reckoned with the fact that Mom and Dad were also there.

For in the time since Howie died, his mother had undergone a metamorphosis. Although she visited the cemetery as regularly as she had the nursing home, she now began to obsess about her other son.

Seth in his naïveté made a strategic human error. He and Judy had decided that the following June, when his internship concluded, would be the ideal time to marry. They both agreed not to tell their parents. So when he returned to Chicago right after graduation he had chosen the path of least resistance and lived at home.

Rosie, who had barely noticed when he’d stayed past dinnertime to study in the high school library, now fretted if he was not at the dinner table every night. Although he’d always telephone her from the hospital to let her know, more and more she viewed his absence as filial disloyalty.

Moreover, as this new obsession grew, she would not fall asleep until her son returned. Sometimes it was even
after
Johnny
Carson. And while some movie from the Stone Age flickered on the TV screen, she’d still ignore Nat’s pleas to shut it off and let him sleep in peace.

“Not on your life,” she’d answer sternly and would stay awake to hear Seth’s footsteps climbing toward his room.

One night when
The Late, Late Show
featured a classic from the silent days, she provided sound track by engaging Nat in dialogue.

“What do you think he does at this hour?” she asked.

At first her husband did not answer, for he had found a way of sleeping with a pillow over both his ears. Rosie had to shout again: “What do you think he’s doing, Nat?”

That was the very minute Seth entered and began tiptoeing upstairs. And so, unwittingly, he overheard a kind of verbal primal scene between two senior citizens. His father said, “For God’s sake, Rosie, the boy’s almost twenty-five.”

“And what if she traps him? Girls are known to do that. Everything is hunky-dory, or should I say hanky-panky, and Poof!—suddenly she’s pregnant.”

“Good,” said Nat. “Then you’ll be a grandma that much sooner.”

Seth remained on the stairs, spellbound by the conversation.

“Judy isn’t good enough,” said Rosie wistfully, “he could do better.”

Nat raised himself onto his elbows and retorted, “She’s a sweetie and they love each other. What do you expect, for heaven’s sake, Princess Grace?”

“I expect better.”

“Hey, listen, Rosie. Seth’s a lovely boy. He’s got a good head on his shoulders. But Prince Rainier he’s not. This girl makes him happy. What more can you ask?”

During the pregnant pause that ensued, Seth told himself to get upstairs and out of earshot. But his thoughts could not activate the appropriate motor areas in his brain.

And then he heard his mother say in a lugubrious voice, “I don’t want to lose him, Nat. It’s bad enough I lost Howie. I don’t want to lose my other child.”

“Who’s talking about losing? The boy’s in perfect health. He’s simply going to take a wife.”

“Take her where, Nat? That’s the point. I won’t allow my Seth to marry her. And that’s my final word.”

To which her husband answered, “I sincerely hope so, Rosie. Goodnight.”

*    *    *

The following Saturday, Seth Lazarus and Judy Gordon drove to Evanston and in the sight of God and in the face of a congregation—consisting of Daniel Carroll, Justice of the Peace, his wife, and a second witness (who cost five dollars) but not, alas, of their parents—were united in Holy Matrimony.

Those whom God hath joined let no mother-in-law put asunder.

It was Laura’s first experience with a disfigured baby.

Twelve hours earlier Mrs. Kathleen Paley had given birth to a seven-pound baby boy. The attending pediatrician, Dr. Paul Fedorko, had brought along his favorite intern so that Dr. Castellano could observe how to handle a newborn in the initial moments of its life.

The young mother had been in a state of panic when she arrived at the hospital. Her obstetrician, Dr. Jack Lesley, concluding that it would be easier on his patient and on himself if she were heavily sedated, administered a hundred milligrams of Nembutal to put her out and then “scoped” her—in other words, gave her a hundred milliliters of scopolamine—to
keep
her out.

Laura was astonished—it seemed enough medication to keep an elephant asleep for a couple of days. Mrs. Paley had been all but decorticated; it was as if the outer layer of her brain had been shut off. To Laura it seemed miraculous that the woman was still breathing.

It had been a breech delivery, which Lesley had handled expertly, but which served to delay discovery of the impairment till the very last minute.

The mother slept unaware of the shock awaiting her.

For her otherwise perfect little boy had been born with a partial cleft palate—the tissues in the area of the mouth and nose had not fused. In addition, the infant had a harelip that made him look as if a dog had bitten him and torn his mouth.

Fedorko had warned Laura to prepare herself for this possibility, since Kathleen’s family had a history of these malformations.

Laura had seen pictures of babies with cleft palates in textbooks but, although she tried to remain clinically detached, she shivered at the sight.

Dr. Lesley signaled the pediatricians to take the infant away. Laura and Fedorko wrapped the baby in blankets and the nurses rushed him out on a small isolette to Intensive Care. Meanwhile the mother was wheeled to her room where, because
of the sedation, she would remain unconscious for at least half a day. This would give Lesley and his team enough time to steel themselves before confronting the parents.

Laura learned an important lesson that day. When a doctor has good news to tell a patient, he presents it on his own. He is like an opera star; he stands center stage and sings an unaccompanied solo. By contrast, when all has
not
gone perfectly, a different tune is sung—more like an oratorio for as many voices as possible.

To put it more bluntly, in times of crisis doctors believe there is safety in numbers.

Laura was drafted for the team—comprising Lesley, his chief resident, and Fedorko, who was now the child’s official doctor. They reassembled twelve hours later outside Room 653.

“All set, Paul?” Lesley inquired.

Fedorko nodded. “I’ve got the book,” he said and turned to Laura. “Are
you
okay?”

“No, to be completely honest,” she replied. “I mean, I don’t know what I’m doing here in the first place.”

“Well, if you’re going into pediatrics, this is something you’ll have to learn. Also, frankly, these things are always easier if there’s a woman present,” Paul answered.

Shit, Laura thought, it’s my job to keep the mother from “acting like a woman”—in other words, getting hysterical. What am I supposed to say—I’ve been through it, too? Or is there some special cliché that’s appropriate for “just us girls”?

She turned to her preceptor. “What’s in the book, Paul?”

“You’ll see,” he said, and then smiled. “Don’t worry, Laura, this is one of those occasions when we can almost guarantee a happy ending.”

Lesley knocked.

A man’s voice bade them come in. They entered, their number making the little room seem crowded. Mort Paley was sitting by his wife’s pillow, holding her hand tightly. She was clearly still more or less comatose, but her husband leaped to his feet the instant the doctors entered.

“Hello, Mort,” the obstetrician said, deliberately using the first name to reinforce the effective parent-child relationship that always gives a doctor the upper hand. “Congratulations.”

“But there’s something wrong, I know,” Kathleen called out. “I mean, I’ve been asking every nurse on the ward and they just keep saying ‘Wait till Dr. Lesley comes.’ Something’s the matter—it’s on your faces. All your faces.”

The obstetrician began again, “Let me introduce my colleagues.”

Mort listened impatiently as Lesley presented each member of the team by name and function. It was more obvious than ever that they were not there to bring glad tidings.

Laura empathized with him. Why are they taking so damn long? she wondered. Can’t they just tell the truth and calm these poor people? Christ, they must think the baby’s dead.

“There’s a little problem,” said Lesley finally, without emotion.

“What? What’s wrong?” Mort demanded. “I mean is he sick or something?”

At this point Lesley ceded the floor to the pediatrician.

“Dr. Fedorko will explain. It’s really his department.”

Paul coughed and put on a show of confidence as he began.

“Now, Mort, I am sure you know that there’s a history of cleft palate on Kathleen’s maternal side—”

“Oh, no,” the father gasped. “You mean the kid is gonna look like Kathleen’s uncle? The guy is practically a freak. He can’t even talk normally.”

“What is it, Mort?” his wife asked. “Is our baby like Uncle Joe?”

He took her hand to comfort her as she began to moan. “No, no, please tell me it’s not true.”

“Mort and Kathleen,” the obstetrician interrupted, “this is 1962. We’ve got the know-how to correct this sort of deformity. Just let Dr. Fedorko show you what wonderful work pediatric surgeons do these days.”

Once again he called upon—or rather, it seemed to Laura, passed the buck to—his colleague.

“Look at these pictures,” Paul said soothingly, opening the photograph album.

“Oh, Christ.” Mort Paley cringed.

“But those are the ‘before’ pictures,” Fedorko insisted. “Look at those same children after they’ve been operated on. Aren’t they marvelous?”

Mort was not assuaged. He was still sick at the thought of what their baby looked like
now.

He stared at the doctors and entreated, “Please don’t show these to her now. Can’t you at least wait a day?”

“No, Mort,” Lesley answered categorically. “This is something the two of you have got to face so you can start to deal with it right away.”