Besides myself as the sole medical student, there was an intern named Bill Levine from New York, a first-year resident named Tom Perkins, and Dr. Rogers, the visiting chief resident. He was a Southerner from Duke who did everything by the book. Rogers was always immaculately turned out; his “presentation,” as he called it, was awe-inspiring. One day Levine, who loathed Rogers, asked him about his ties.
“You like these ties?” Rogers asked, in a soft Southern accent.
“Well, I was wondering how you managed to keep them so smooth and unwrinkled, Don.”
“My wife does that. She irons them.”
“Does she?”
“Yes. She gets up with me at five in the morning, and after I have dressed and tied my tie, she irons it for me. While I am wearing it. She does that.”
“No kidding,” Levine said.
“Yes, she’s okay,” Rogers said. “Only once she scorched my shirt, and then I had to get dressed all over again. But she’s never done that again.”
“No, I’ll bet,” Levine said.
“No. She learned her lesson that time,” Rogers said, chuckling.
Rogers was a bit of a sadist. He kept a series of straight pins in the lapel of his jacket, near the buttonhole. On rounds he liked to stick these pins into the patients, “to check their responses.” There was a kind of insane pretense in all this. None of the patients were getting any better. None of them were changing at all, from day to day or week to week, except for the two who had inoperable brain tumors. They were slowly dying. But no one else was changing at all. The patients were indigent, extremely ill patients who were shuttled from one state institution to another. As we made rounds each morning, there wasn’t really that much to discuss. But Rogers stuck pins into them anyway.
Levine had to spend only a month of his internship rotation on the ward. Levine was a heavyset, smiling guy of twenty-five who was almost bald. A warmhearted soul, he despised Rogers and the ward. He expressed his distaste by lighting a joint every morning before rounds.
I didn’t find out about this until the second day. I passed by the men’s room, smelled the smoke, and went inside. “Bill, what’re you doing?”
“Having a toke,” he said, sucking in his breath. He passed the joint to Perkins, the resident, who took a long drag, then held it out to me.
I pushed it away. “Are you kidding? What are you doing?” It was six-thirty in the morning.
“Hey. Suit yourself.”
“You mean you guys are stoned on rounds?”
“Why not? Nobody can tell.”
“Sure they can.”
“You couldn’t tell, yesterday. And you think Pinhead can tell?” Pinhead was what Levine called Rogers.
“Hey, relax,” Levine said, taking a deep drag. “Nobody cares. Half the nurses are loaded, too. Come on. This is great stuff. You know where we get it? Bennie.”
“Bennie?”
“Bennie. You know, in the elevator.”
It was the medical student’s job to draw bloods from the patients daily. Every morning I would show up at 6:00 a.m. and go to the nursing station, and the night resident would read off the list of bloods to be drawn for the day. So many red tops from Mr. Roberti, a red and a blue from Mr. Jackson, a pink and a blue from Mrs. Harrelson, and so on. I had to draw about twenty tubes of blood in half an hour, to be ready for morning rounds at six-thirty.
The only trouble was, this was my first clinical rotation and I hadn’t ever really drawn blood before. And I tended to pass out at the sight of blood.
In practice, I’d go to my first patient, put on the tourniquet, get the vein to puff up, and try to get the needle in without passing out. Then, when the blood gushed, I’d stick on the vacutainer tubes and get the required number of tubes, breathing deeply. By this time I would be very dizzy. I would quickly finish up, pull out the needle, slap a cotton ball on the elbow, dash to the nearest window, throw it open, and hang my head out in the January air while the patients yelled and shouted at me about the cold.
When I felt okay again, I’d go on to the next patient.
I couldn’t do twenty patients in half an hour. I was lucky to do three patients in half an hour.
Fortunately, I got help. The first day, I went up to a huge black man named Steve Jackson. He could tell I was nervous.
“Hey, man, what’re you doing?”
“Drawing blood, Mr. Jackson.”
“You know what you’re doing, man?”
“Sure, I know what I’m doing.”
“Then how come your hands are shaking?”
“Oh, that … I don’t know.”
“You ever draw blood before?”
“Sure, no problem.”
“ ’Cause I don’t want nobody fucking with my veins, man.” And with that, he snatched the needle out of my hands. “What you want, man?” he said to me.
“Some blood.”
“I mean, what? What tubes?”
“Oh. Red top and a blue top.”
“Gimme the tubes, come back later, you got it.”
And he put the tourniquet in his teeth, tied off his arm, and proceeded to draw the blood from himself. Now I understood: Jackson was an addict and didn’t want anybody poking around in his veins. So from then on, every morning I’d just drop the stuff off at his bed. “Yellow and a blue top today, Steve.”
“You got it, Mike.”
And I’d go on to the next patient.
The patient alongside Steve was unconscious most of the time. Steve watched me fumble to get the blood, and I guess it offended his sense of finesse. So he said he’d draw blood from himself and from Hennessey, too.
The nurses took pity on me, and they helped out and drew a couple of tubes for me. And Levine, if he had been on call the night before, would draw a couple of tubes for me. And as the days passed, I didn’t have to hang my head out the window quite so long each time. So, with everybody’s help, I was eventually able to get the job finished by the start of rounds.
“Nice to see you on time for once, Mr. Crichton. Seems you make a major production out of drawing a little blood.”
I started to hate Rogers, too.
In this way, the weeks dragged on—the medical student passing out whenever he drew blood, the residents stoned on rounds, and Rogers sticking pins in everybody while we looked away. And always the patients drooling and writhing in the corners, the alcoholics brushing off invisible ants and spiders. It was a kind of loony nightmare, and it took its toll.
Finally the house staff had a party one night, and everybody got drunk on lab alcohol. Around midnight, we decided it would be amusing to draw bloods on ourselves, and send them in for liver-function tests. We used patient names, and sent them off.
The next morning, the nurses were puzzled. “I don’t get it. Mr. Hennessey has sky-high LFTs. So does Mr. Jackson. And their blood alcohols—this can’t be right. Who ordered these tests, anyway? It’s not in the books.”
“Oh, those tests,” Levine said, very pink-eyed. “I remember. I’ll take those.” And he passed the slips around to us. It turned out we all had evidence of acute liver damage. And we certainly had roaring hangovers.
“Ready for rounds?” Rogers said briskly. He was greeted with a chorus of groans. “Come, come, we’re already four minutes late.” We started off.
Rogers was in an unusually cheerful mood. He stuck lots of pins into people. Finally he came to Mrs. Lewis. In the ward, Mrs. Lewis’s bed was always curtained off, because this elderly woman was semicomatose and incontinent, and from time to time she threw her excrement in spastic movements. There was always a slight feeling of danger when we went up to Mrs. Lewis’s bed. And this morning, with hangovers, we weren’t looking forward to it.
But her bed was clean, and there was no smell. Mrs. Lewis seemed to be sleeping.
“She seems to be sleeping,” Rogers said. “Let’s just see how responsive she is today.” And he stuck a pin in her.
The poor comatose woman winced.
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“Hmmm, there seems to be a little response,” Rogers said. He put his pins back in his lapel and pressed his thumb over the bony ridge just below Mrs. Lewis’s eyebrow. He pressed hard.
“This is a classic way to elicit a pain response,” he explained.
Mrs. Lewis twisted her body in pain, and her hand went beneath her buttocks. And quickly she slapped a handful of her own feces all over Rogers’s shirt and pressed tie. Then she collapsed back on the bed.
“Dear,” Rogers said, turning white.
“That’s a shame,” Levine said, biting his lip.
“She obviously doesn’t know what she’s doing,” Perkins said, shaking his head.
“Mr. Crichton, see that she’s cleaned up. I’m going to try and change. But I don’t have a change of clothes at the hospital. I may have to go home.”
“Yes sir,” I said.
So I helped clean up Mrs. Lewis, and I blessed her. And not long after that, I rotated off the neurology service, and went on to psychiatry, where I hoped things would be better.
The Girl Who Seduced Everybody
Three medical students at a time were assigned a psychiatry rotation on the wards of the Massachusetts General Hospital. It was a communal-living ward: fifteen psychiatric patients slept and ate in a dormitory setting for six weeks. After six weeks, the staff made a diagnosis and recommended further therapy for each patient.
The resident explained the whole procedure. As students, we would each be assigned one patient to interview over six weeks. We would then make a report to the staff, and participate in the diagnosis. Other physicians would be interviewing the patients, too, but we would see them more often than anyone else, and our responsibilities were therefore to be taken seriously.
When we arrived on the floor, the patients were in the midst of a communal meeting. The resident couldn’t interrupt the meeting, but we stood outside the room while he pointed out our patients. Ellen’s patient was a heavyset woman in her fifties who wore garish clothes and makeup. This woman had had an affair with a doctor who gave her amphetamines, and she was now severely depressed. Bob was assigned a thin, scholarly-looking man of fifty who had been in Dachau and who now imagined cardiac problems. I was assigned a tall, strikingly beautiful girl of twenty with short blond hair and a miniskirt. She sat in a rocking chair, her long legs curled under her, looking very calm and composed. She looked like a college student.
“What’s her problem?” I said.
“Karen,” he said, “has successfully seduced every man she has ever met.”
During the psychiatry rotation, you saw your patient three times a week. You also saw a training analyst twice a week, to discuss your case and your feelings about it.
Robert Geller was my training analyst. Dr. Geller was a middle-aged man who had a beard and favored bright striped shirts. His manner was very quick and direct.
Dr. Geller asked me what I hoped to get out of my psychiatry rotation, and I said that I was very interested in psychiatry, that it was something I thought I might end up doing. He said that was fine. He seemed a neutral, balanced person.
“So, do you know anything about your patient?”
Yes, I did. I explained I hadn’t had a chance to talk to her yet, that I had only just seen her in the room, a twenty-year-old girl, sitting in the rocking chair.
“And?”
She seemed nice. Pretty. She certainly didn’t seem like a psychiatric case.
“Then what’s she doing there?”
Well, the resident told me that she had successfully seduced every man she had ever met.
“What did he mean by that?”
I hadn’t asked.
“Really? I would have asked,” Dr. Geller said.
I explained I just hadn’t thought to ask; I was trying to absorb everything, just seeing her and so on.
“And how do you feel about seeing her?”
“I don’t know,” I said.
“You don’t know?”
“No.”
“You said she was beautiful.…”
“Attractive, yes.”
“What did you think about having her as your patient?”
“I guess I wondered if I could handle her.”
“Handle her …”
This was a psychiatrist’s trick, repeating your last phrase to keep you talking.
“Yes,” I said. “I wondered if I would be able to handle her case.”
“Why shouldn’t you be able to handle her?”
“I don’t know.”
“Well, just say whatever comes to mind.”
This was another psychiatrist’s trick: I was immediately on my guard.
“Nothing comes to mind,” I said.
Dr. Geller gave me a funny look.
“Well,” he said, “are you afraid you won’t be bright enough to deal with her?”
“Oh no.”
“No problem there. With brightness.”
“No.”
“Are you afraid you don’t have enough knowledge to help her?”
“No …”
“Are you afraid you’re so busy you won’t be able to devote enough time to her?”
“No, no …”
“Then what?”
I shrugged. “I don’t know.”
There was a pause.
“Are you afraid you’re going to fuck her?”
I was profoundly shocked. The statement was so coarse and direct. I didn’t know how he could even imagine such a thing. My skull was ringing, as if I had been struck. I shook my head to clear it.
“Oh no, no, no, nothing like that.”
“You’re sure it’s not that?”
“Yes. Sure.”
“How do you know it’s not that?”
“Well, I mean, I’m married.”
“So?”
“And I’m a doctor.”
“A lot of doctors fuck their patients. Haven’t you heard?”
“I don’t believe in that,” I said.
“Why not?”
“I believe that when patients come to you, they are in a dependent state, they look up to a doctor, because they want help and they are frightened. And they deserve to be treated, and not have their dependencies exploited by the doctor. They deserve to get what they came for.”
I believed all this very strongly.
“Maybe she came to get fucked by her doctor.”
“Well,” I said.
“Maybe that’s what she needs to get better.”
I began to feel annoyed. I could see where this was heading. “Are you saying you think that I want to, uh, have sex with her?”
“I don’t know. You tell me.”
“No,” I said. “I don’t.”
“Then what are you worried about?”
“I’m not worried about anything.”
“You just told me you weren’t sure you could handle her.”
“Well, I meant … in general, I wasn’t sure.”
“Listen, it’s okay with me if you want to fuck her. Just don’t do it.”
“I won’t.”
“Good. How old are you?”
“Twenty-four.”
“How long have you been married?”
“Two years.”
“Happy?”
“Sure.”
“Sex life okay?”
“Sure. Great.”
“So you wouldn’t be tempted in the first place.”
“How do you mean?”
“I mean, since your marriage is happy and your sex life is good, you wouldn’t be tempted by this girl in the first place.”
“Well, I mean … No, of course not.”
“She’s pretty?”
“Yes.”
“Sexy?”
“I guess.”
“I bet she knows how to maneuver men.”
“Probably.”
“I bet she knows just what to say and do, to wrap men around her little finger.”
“Well, I’m sure I can
handle it,” I said.
“I’m glad to hear that,” Dr. Geller said. “Because that’s going to be your job.”
“How do you mean?”
“The only way this girl knows how to relate to men is sexually. She gets everything—friendship, warmth, comfort, reassurance—from the sexual act. That’s not a very good life strategy. She needs to learn there are other ways of relating to men, that she can get the warmth and approval she wants from a man without having sex with him. She’s probably never had that experience before. You will be her first experience.”
“Yes.”
“As long as you don’t end up fucking her.”
“No. I won’t.”
“I hope not. Good luck with her. Let me know how things go.”
My conversation with Dr. Geller struck me as helpful. Although he obviously had some fixed idea I wanted to have sex with this girl, that didn’t worry me in the least. I was quite confident that I wouldn’t. I knew that, in becoming a doctor, I was assuming special responsibilities. This was the first of them.
In fact, far from worrying about sexual temptation, I was eager to see Karen, and begin our work together. I went immediately back to the floor and introduced myself to her.
She was very tall. She came up to my shoulder when we stood side by side. She had a lean, athletic body, and clear green eyes that looked at me steadily. “You’re my doctor?”
“Yes,” I said. “I’m Dr. Crichton.”
“You’re very tall.” She moved closer, until her forehead touched my shoulder.
“Yes.”
“I like tall guys.”
“That’s good.” I stepped back a little. That seemed to amuse her.
“Are you really my doctor?”
“Yes. Why are you smiling?”
“You look too young to be a doctor. Are you sure you’re not just a medical student or something?”
“I’m your doctor, believe me.”
“What kind of a name is Crichton?”
“It’s Scottish.”
“I’m Scottish, too. What’s your first name?”
“Michael.”
“Is that what they call you? Michael or Mike?”