Doctors (53 page)

“I’m up for the last part,” Laura said, smiling wearily, “but couldn’t we do it a little closer to home, like in our own bed?”

“Come on, Laura, where’s your sense of adventure?”

“I think I lost it after my first all-night surgery.”

“Laura, darling, is it really worth all this?”

She saw the sadness in his eyes, knew the loneliness he felt, yet answered, “Yes, Palmer, it is to me.”

The phone rang.

Bennett Landsmann opened one eye while trying to keep the rest of his body asleep. It was 2
A.M.
and he had just gone to bed after thirty straight hours in the E.R. But the ringing persisted relentlessly and finally with a sigh of defeat he picked up the receiver.

“This is Dr. Landsmann,” he said gruffly.

“This is Dr. Livingston, but you can call me Barney.”

Bennett opened his other eye and sat up.

“Hey, do you know it’s the middle of the night?”

“No,” Barney quipped. “But can you hum it?”

“Are you high on something?”

“Not unless you count Nescafé and chocolate bars. No, Landsmann, this is the first time I’ve sat down in what seems like a month. I must have interviewed several million patients and written up histories for every damn one of them. I’ve lost count of the cuts and lacerations I’ve sewn. I got so dazed that the chief resident actually told me to lie down.

“Anyway, being a man of leisure for the next fifteen minutes, I thought I’d see how they were treating you up there at Yale. Were you actually
sleeping
, Landsmann?”

“No, of course not. I was doing some extra research in my spare time. Trying to invent a cure for bullshit. Anyway, how’s your ass?”

“Aching just like the rest of me. Well, how about you, old buddy? Are you at least doing any horizontal dancing in the sack?”

“One or two nurses have looked favorably upon me. But there’s even a pecking order in that department, and senior residents get the best talent. Anyway, I’ll survive. What do you hear from Castellano?”

“Nothing. I mean, what do you expect? She’s working as hard as we are. And whenever I do call, old Palmer claims she’s out. Half the time I’m convinced he’s giving me the straight-arm.”

The friends were exchanging Casualty Ward anecdotes—some of which were so grisly that only gallows humor made them tolerable—when Barney innocently touched a raw nerve.

“So, in other words, outside of total fatigue and sexual deprivation, you’re happy in New Haven?”

There was a silence.

“Hey, Landsmann, are you still there?”

Bennett hesitated. “Well … it’s kind of a long story.”

And he then recited a litany of ugly incidents.

When he finished, Barney said, “I can imagine how you feel.”

“Can you really?”

“I’d say your mood was pretty black.”

“Right on, Livingston. And getting blacker all the time.”

I
nformed observers of the American scene predicted that 1963 would be remembered as the year of Black Awareness. That is, until the events of November twenty-second. Now the hallmark of the year would be John F. Kennedy’s assassination.

Not only was the body politic in turmoil, but the human body also featured prominently in the news. It was the beginning of a new era.

All over the country there was news of successful replacement of diseased and dying organs. Dozens of people received the gift of life when the kidneys of another were transferred to them.

At the University of Mississippi, the first lung transplant was performed. In Houston, Dr. Michael De Bakey used an artificial heart to maintain the circulation of the patient’s blood during heart surgery.

And when they lacked a human donor, the laboratories came to the rescue. Thanks to man-made corneas, some who were blind could see again.

But not all the medical news was good. For the American Hospital Association reported that the average daily cost per patient had more than doubled in five short years. From $18.35 to $36.83.

And before Jack, another Kennedy died that year. On August seventh, JFK’s second son, Patrick, was born five and a half weeks premature, weighing four pounds ten and a half ounces and suffering from RDS (respiratory distress syndrome). His lungs had not developed sufficiently. He could inflate them but could not retain any air.

Wrapped in a blue blanket and placed in a little plastic box, the infant was rushed from Hyannis Port to Boston Children’s Hospital, where the entire staff was mobilized in the fight to save him. The hospital had an apparatus unique in the world—a huge oxygen chamber thirty-one feet long and eight feet wide. Two
specialists worked inside the machine in a desperate attempt to force oxygen into the baby’s system.

But without success. After a mere thirty-nine hours of life, the baby died.

(Ironically, only a year later, a new technique of treating RDS was perfected by doctors at Children’s Hospital in Louisville, Kentucky.)

By the end of 1963 the Harvard Medical School class that had received diplomas a year earlier had ostensibly completed all requirements to practice medicine in America. They were, most of them, between the ages of twenty-four and twenty-nine.

They were also, most of them, far from ready to practice, because the end of internship most often signals yet another beginning.

True specialization demands intensive concentration on a specific aspect of medicine. Like anesthesia or pharmacology. Or on one tissue, like skin or blood. Or one area, the chest or abdomen. Or one organ, the eye or heart. Or one physical technique, the art of surgery. Or even one mystery (though some insisted it was not a science), the workings of the mind: psychiatry.

Thus, Barney Livingston, M.D., having duly fulfilled the requirements of internship and wanting to become a psychoanalyst, needed to spend three years in psychiatric residency (and thereafter another optional twelve months).

And if he wished to be a full-fledged member of a psychiatric institute he had to have the insides of his own head probed by a senior analyst. This was intended to get himself in better touch with his unconscious, and thereby help his patients to get in better touch with theirs.

Thus, assuming that he did not stumble along the way, Barney might be free and clear of all the pedagogical requirements in another six or seven years. This would put him on his own at last in 1970, at the age of thirty-three. In other words, he’d just be
starting
when professionals in other fields (like little brother Warren, who would receive his Law degree that year) would have been off and running—not to mention earning a real living—for pretty close to a decade.

And this, always assuming he had fulfilled his military obligations somewhere along the way.

And Barney’s road was not the longest. Graduates aspiring to surgical careers, like Bennett (who had been invited to stay at Yale) and Grete (who had switched to Georgetown Hospital in
Washington), had at least five years of postgraduate training to complete—one as an intern, two as assistant resident, one as first assistant, and, provided they had not collapsed or reached senility by then, a final year as chief resident. Of course, if they were going into a
sub
specialty, like pediatric surgery, there would be still further years of training.

Doctors are often accused of callousness, venality, and self-infatuation. But they remind us that they have sacrificed the springtime of their lives, completely lost the precious years between their twenties and their thirties acquiring skills to benefit their fellow men.

Furthermore, they have suffered deprivations. Most of them have not had more than a dozen real nights of sleep in all this time. Many have sacrificed their marriages and have lost the unique opportunity to see their children grow.

So when they argue that the world owes them some compensation—in the form of wealth, respect, and social status—their demands are not entirely without cause.

Also, as the grim statistics show, they often suffer worse than any patient. For no one can repair a broken marriage or restore the children damaged by their father’s ostensible neglect.

Laura had been at the hospital when the Kennedy baby was rushed in. Although she had no direct contact with the case, she remained there in a kind of mass vigil with most of the staff.

She had been awake for more than forty-eight hours when White House Press Secretary Pierre Salinger, himself on the brink of tears, announced that “Patrick Bouvier Kennedy died at 4:04
A.M.
this morning. The struggle of the baby boy to keep breathing has been too much for his heart.”

And she shared in the collective grief and sense of failure that pervaded every corridor.

When she heard one of the new interns say, “At least the Kennedys have two other kids, it’s not all that terrible,” she turned on him.

“What the hell kind of attitude is that? The point’s not what she has, but what she’s
lost
!”

The chastened intern retreated.

As a first-year resident in pediatrics, Laura had at least a few serious responsibilities.

For instance, when the time came for Kathleen and Mort Paley to bring their six-month-old in to have his lip repaired (the
palate surgery would be done later), Laura stood right at the surgeon’s shoulder. She watched intently as Fedorko meticulously closed the ugly tear, concluding with near-microscopic nylon stitches to connect the outer skin. The disfigurement had all but disappeared.

The Paleys were ecstatic. Three days later, as Kathleen was putting on the baby’s coat and hat, Mort commented to Laura, “It’s worked out just the way you promised, Dr. Castellano. We’re extremely grateful—all three of us.”

As they shook hands, Laura thought, Words like that are what make most of us go into medicine.

But Laura was sleepwalking by the time she returned home after her twenty-four-hour rotation. One of the few neurons still working in her brain reminded her body that it needed some food in order to perform the basic functions of life.

She opened the Frigidaire, pulled out two yogurts, and sat silently at the kitchen table force-feeding herself, too tired to read even the newspaper lying nearby. She reached for a small pile of letters—bills, mostly—and aimlessly leafed through them. There was nothing worth staying awake for except one embossed “Georgetown Medical Center, Washington, D.C.” She picked up a knife and opened the envelope with surgical precision.

Laura smiled. Same old Andersen, always goes back to her body. I wonder when her shrink will get around to working on that?

And then it struck her. “Andy”? Does she call her psychiatrist by his first name? And how the hell does she know about his marriage? Is that something they would discuss in a therapy session? But she was too tired to give it any more thought.

She removed her shoes in the living room and walked on tiptoe up the stairs. The bedroom lights were still on. The bed was empty.

And unslept-in.

Laura sensed that she should have been upset. But she was so exhausted that even the disappearance of her husband could not overcome the beckoning of Morpheus.

It was only at eight o’clock the next morning that she was able to grasp the fact that Palmer had vanished. No note. No explanation. No nothing.

Her imagination ran the gamut of possibilities. Maybe he was in an accident. Maybe mugged and taken unconscious to a nearby hospital.

She thought of calling his parents but did not want to alarm them.

After making herself a cup of coffee, she studied the bulletin board in the kitchen where they had each put their individual time schedules.

Her eye fell upon the previous day’s agenda. Palmer had taken a seminar on “Anglo-Chinese Diplomatic History” that night—7 till 9
P.M.
She had made up her mind to call the
professor to find out if Palmer had been there the previous night, when the object of her inquiry suddenly appeared.

“Good morning, Laura,” he said cheerfully.

“Palmer, you had me worried to death.”

“Really? I’m glad to know you care.”

She knew the remark was intended to provoke a fight, so she let it pass.

“Where the hell have you been all night?”

“With friends,” he answered, the better to annoy her.

“That’s it? That’s your entire explanation?”

“Have I ever asked
you
for a detailed account of your activities outside the house? You just tell me you’ve been at the hospital and that’s the end of it.”

“You had a seminar last night.”