A Life in Medicine Read online

  Helen fell into the rhythms of the Bronx. She met with Diana each morning and each evening. “The students,” said Diana, “are improving.”

  “They need to be taught to do good,” said Helen. “You are teaching them by example.” She surprised herself. She had avoided a moral vocabulary. These had been the words of distance between herself and her parents: duty, family, obligation.

  But Diana smiled and slicked back her hair. She had begun to wear it in a ponytail, too, a thick curly fall to complement Helen’s thin fair one.

  “Stick in the mud,” Michael Smith teased her. “Dr. van Horne, Jr.” He’d become friendly with the head of housekeeping, a middle-aged black man from Yonkers, and the two of them sat on the steps outside the emergency room talking football and joking, catcalling women as they walked by.

  Diana stopped in front of him. “You left a patient in the hall last night and went off without signing him out. When I just happened to come by, he was already going into diabetic coma.”

  Michael Smith paled. “I’m sorry,” he said.

  “Tell it to the patient,” said Diana, and left.

  “But is he okay?” called Smith. She didn’t answer.

  Everyone in the hospital knew and respected Helen now. “Good morning, doctor,” she was greeted by the man who ladled out the scrambled eggs. “Good evening,” by the woman mopping the women’s ward. Sometimes the Spanish workers slipped and called her “sister” when they stopped to thank her for taking care of a relative. Helen would glance at her own upright reflection in the glass doors, curious to see how she might be mistaken for a nun.

  She became convinced that this was how the people of the hospital saw her, as a nun, a medical missionary to the South Bronx. Bride of Christ, she taunted herself, standing in her room one night as the moonlight spread across the floor and crept up her ankles. Spinster Mother of City Hospital. How had this happened to her? That night she plaited her sheets into dreams: her nails became claws; her arms, wings of a nun’s habit; and she felt the spring air rustle her belly as she swooped on a creature, garbage rat, skittering city mouse, swallowing its body with one snap while its head lay severed and bleeding on the ground.

  Yes, she told herself, waking the next morning. The meaning of her years in Africa came to her suddenly as if in revelation. Apprenticeship. Learning to subjugate her will. She would dedicate herself to the patients and the students of City Hospital. Her face took on a pregnant glow, and she felt more content than she could remember in her life.

  Because the dean would not remove Michael Smith, Helen decided she would make him into a doctor. She gave most of the teaching duties to Diana, but she no longer avoided the boy. To Diana she said, “You must think of how you will fit your practice around your family, and how you will choose a job where your husband can find work too.” Diana smiled but said nothing. To Michael Smith, whom she caught leaving the hospital at five, with a blood sugar left unchecked, she said, “You must do whatever is necessary for the patients’ good, even if it means you don’t eat, don’t sleep, or don’t leave the hospital.”

  Smith flushed slightly, then looked over her left shoulder at a flurry of young nurses who were leaving, too, and said, “I’m going into radiology.”

  “Good,” said Helen. “You’ll make money. But first, you must pass your medicine rotation.” As she walked away, she felt his eyes on the sway of her hips. Students, she told herself, become infatuated with the power of their teachers. Later that night, sitting at the bedside of a dying man, a drug addict infected on a hole he had eroded in his heart, Helen felt herself strengthen and harden in conviction. None of the private hospitals taught the concept of service. It was here the boy would learn to be a doctor, and it was her responsibility to teach him.

  The third week of May began the wave of deaths. Death was of course a familiar presence at City Hospital, but like a wild tide, people began dying in unprecedented numbers. First, it was several cardiac failures on the men’s wards, then a medication allergy on the women’s ward, then one of the drug rehabilitation doctors fell out of a closet one morning, curled in the fetal position with a needle in his arm and stone-cold dead.

  Helen called a meeting of the hospital’s physicians. “I can’t find a pattern,” she said, “but I feel a connection, somewhere underneath.” She didn’t add, and I feel somehow responsible.

  The next day staphylococcus broke out in the neonatal nursery, crops of pustules erupted on even the heartiest of infants. Helen stood outside the plate glass of the babies’ ward and watched the nurses wrap a tiny corpse, folding the blanket around the child, a flannel shroud. Why, she asked herself, because even Africa had not prepared her for the speed and the sweep of these deaths. Overcome, she paced the streets outside the hospital, walking blindly past the rubble, the garbage, and the deserted streets, in the long twilights of the late spring.

  But the final straw was Henry, the chief of maintenance, who sat, sighed, and fell over one day at dinner. It was Michael Smith who leapt on his chest and screamed, “Help,” because he’d been sitting with Henry, once again playing poker when he should have been drawing the evening bloods on the men’s ward. They all came, residents, students, Helen, Diana. They ran a code in the cafeteria just as they would have in the emergency room: hooked up the EKG machine, pumped the chest, breathed in the slack mouth, started several large-bore IVs, and called to each other pulse, medication, paddles, step back, shock. But it was different, thought Helen, as she pierced the skin over his clavicle for a central line and glanced at his waxy face. It was Henry. She slipped and hit the artery. A geyser of blood sprayed her, Michael Smith, and the girl who was ventilating with the ambu-bag. When she got the vein, on the third try, she pushed it forward, but his blood clotted even as she pushed it in. “What the hell,” she shouted, and there was a pause because they realized, inescapably, after fifteen minutes of flopping his flaccid blue arms, cracking his posthumous ribs, and watching the cardiogram read off an unremittingly straight line, that they were working on a dead man.

  “Enough,” said Helen. “Get a clean sheet. Wipe up this blood. Get these people out of here.”

  Michael Smith stood behind her, shaking and weeping, staring at Henry’s still face. “His wife,” he said, “his children.”

  “I’m sorry,” said Helen.

  The narrow hall that led to her room seemed longer than usual and peculiarly dry. She licked her lips, but her tongue stuck to the faint moisture on the roof of her mouth. She thought of calling Henry’s wife, getting back to the wards, a memorial service, but the image of a corpse she had once found intruded. It was out in the bush at the end of the dry season, a young boy mauled by a lion so that one arm lay at an unnatural angle, connected only by a tendon that had hardened into rawhide. She stood at her door, looking straight ahead at the eroded slats.

  The student, Michael Smith, came up behind her quietly. “Please,” he said, touching her arm. She turned slowly and noticed that he was taller than she, how young he was, that his cheeks and nose were freckled with blood, and that he was still weeping.

  “What do you want?” she asked him gently, but he just stared at her, moving his hand along her arm. “No,” she said, seeing her pale face reflected in his eyes. He reached around her with his other arm and opened the door, pressing against her so she could feel the heat of his body radiating into her own. “Smith,” she started, as he bent to kiss her neck. She felt revolted by her wave of desire, sick, like she might vomit. “Go away,” she said, “now, before I have to report you to the dean.” But when he looked up, his eyes wide and unfocused like a sleepwalker’s, she pulled him to her breast and slowly licked the sweat that beaded across his face. “I’m sorry,” she whispered. Afterwards, as he lay across her, naked and exhausted, she murmured it again, tracing his lips, “I’m sorry.”

  “I love you,” Smith said, rolling over and going back to sleep, curling defenselessly. Helen stared at him, then got up and showered, letting the water run
for hours down her face, between her legs. Then she chose her whitest blouse and went out onto the wards.

  “Look,” she said to the men’s ward secretary. “Has the ward been repainted?”

  “No,” said the woman.

  “But,” Helen said in the nursery, “the babies are all so plump and healthy.”

  “Yes,” said the practical nurse who was bathing a new arrival.

  Helen walked a long path through the hospital. The women’s ward had a new but familiar smell: dust soaked into earth, the beginning of the rainy season.

  When she found Diana, she was going over cardiograms with Michael Smith in the emergency room.

  “I called Henry’s wife,” said Diana.

  “Yes,” said Helen, taking the cardiogram from her. “What’s wrong with this patient?”

  “Thirty-year-old man with chest pain,” began Diana, glancing over at Helen. Michael Smith was looking over Helen’s shoulder at the strip of paper. Diana frowned. “Came in this morning,” she went on. Michael ran his hand slowly up Helen’s thigh. Diana stopped and stared at Helen, at her grey hair, at her grooved cheeks. Helen examined the cardiogram as though nothing had happened.

  Diana cleared her throat, her face mottled scarlet. “I understand, Dr. van Horne,” she said, “that you’ve told Mr. Smith he will pass his medicine rotation ?”

  Helen didn’t answer for a moment. “Will you take a fellowship next year?” she asked. “Of course, it is easier to adjust around a husband and children if you work in the emergency room.”

  “I left my husband,” said Diana. “I wanted to be like you.”

  Helen looked down again at the cardiogram, but her hand began to shake. After a few minutes she said, “And do you think Mr. Smith should pass?”

  “No,” said Diana.

  “Then fail him,” said Helen.

  “Christ,” said Smith to Helen, “that’s unfair.” When she didn’t answer, he looked wounded for a moment, then slammed out of the cubicle.

  Diana stared at Helen, embarrassed. “He’ll go to the dean,” she started.

  “Yes,” said Helen, “he would be right to do that.” She folded the cardiogram carefully back into the chart. She thought of Henry’s dead body lying on the gurney waiting for his wife. His lips had turned a particular shade of blue, like the dusky sapplure of Lake Tanganyika at the last moment before the fall of night. It was the most beautiful color she had ever seen.

  Helen sat on the bed in her room. “I regret to inform you,” she wrote to the dean. She stopped and got up, staring at her face in the mirror, overcome with self-disgust. She seemed to herself grotesque, an old woman, a sexual vampire. “Is there ever any justification,” she wrote on the wall beside the mirror, “for a teacher—” And yet, the deaths had stopped. She started again, “If A is a middle-aged woman, and B is a young male student, and insects grow, must grow in the rotted womb of fallen trees,” but she lost interest and turned to the window. Cars honked and revved their engines, beasts of the Serengeti growled and spoke to her. She walked to the window and threw it open, as far as it would go. “It’s the rainy season,” she shouted to them, “order up the antibiotics, sow the crops.” She saw them crowded on the expressway, antelope, giraffe, lions, surrounded by fields of ripened corn. “Yes,” she whispered, because she felt at home. She heard the cry of the ambulances, the voices swelling from the emergency room, the beat of the hospital as it trembled with its load of humanity, and for her children, the patients and the students, she obeyed. She spread her arms Daedalus, Icarus, straight at the hot sun of the South Bronx, and hesitated.

  Helen climbed down from the windowsill and sat at her desk. “The men,” she said firmly, to herself, “do it all the time.” She listened for a moment, for a rebuttal. Then she pulled on a white coat, to cover herself, and went out onto the wards.

  Hart Crane

  EPISODE OF HANDS

  The act of treating another human being, of holding another’s hand, becomes an act of supplication and healing in this eloquent expression of what can lie unexpressed between doctor and patient and the power of the most basic of human responses.

  HART CRANE, born in 1899, published his first poem as a seventeen-year-old boy. His first book, White Buildings, was published a decade later. His masterpiece The Bridge was published in 1930. Hart Crane committed suicide in 1932 at the age of thirty-three.

  The unexpected interest made him flush.

  Suddenly he seemed to forget the pain,—

  Consented,—and held out

  One finger from the others.

  The gash was bleeding, and a shaft of sun

  That glittered in and out among the wheels,

  Fell lightly, warmly, down into the wound.

  And as the fingers of the factory owner’s son,

  That knew a grip for books and tennis

  As well as one for iron and leather,—

  As his taut, spare fingers wound the gauze

  Around the thick bed of the wound,

  His own hands seemed to him

  Like wings of butterflies

  Flickering in sunlight over summer fields.

  The knots and notches—many in the wide

  Deep hand that lay in his,—seemed beautiful.

  They were like the marks of wild ponies’ play,—

  Bunches of new green breaking a hard turf.

  And factory sounds and factory thoughts

  Were banished from him by that larger, quieter hand

  That lay in his with the sun upon it.

  And as the bandage knot was tightened

  The two men smiled into each other’s eyes.

  Shusaku Endo

  from DEEP RIVER

  This excerpt tells the story of Kiguchi’s World War II military comrade, Tsukada. As Kiguchi looks out the windows of the plane bearing him toward India many years later, he recalls the terrible wartime events he and Tsukada endured in Burma—past events now at the heart of Tsukada’s present-day illness. As Kiguchi remembers the hospital doctors’ efforts on Tsukada’s behalf, he concludes that neither the attending physician “nor any of the doctors in the psychotherapy ward of [the] hospital could comprehend Tsukada’s suffering.” Endo’s novel shows that continued care “for dying patients even when the disease-specific therapy is no longer available or desired” may be an instructive irony, both medical and moral.

  SHUSAKU ENDO is considered one of Japan’s greatest contemporary writers, known for his searing examinations of moral and religious issues. Besides Deep River, he is best known for his novel Silence and his biographical meditation titled A Life of Jesus.

  That evening Tsukada passed a bloody stool. With blood appearing, it was now clear that he was hemorrhaging from somewhere in his esophagus or stomach.

  He was given an endoscope examination several days later. Tsukada’s wife telephoned Kiguchi with the disheartening results. “They . . . they don’t know where the hemorrhaging is coming from. The doctors are at a loss.”

  The bleeding, though intermittent, continued. Kiguchi felt as though his own demands for a confession from Tsukada had been the cause, and he found as many free moments from work as he could to visit the hospital.

  Often the foreign volunteer Gaston would be sitting at Tsukada’s bedside.

  “Mr. Tsukada, tell me about rock,” Gaston gleefully announced one day.

  “About rock?”

  “Mr. Tsukada go to river and look for rock. Rock shaped like Fujisan.”

  “I told him about landscape rocks. Although I don’t suppose there’s any way a foreigner can understand something as cultured as landscape rocks.”

  Kiguchi was relieved at Tsukada’s answer, for he seemed not to feel uneasy about his own condition. In any case, at some point in time Tsukada and this horse-faced foreigner had become fast friends.

  “But there’s one thing about this young fellow I really can’t stand.” Tsukada harangued Gaston in his typically haughty tone. “He says he honestly beli
eves there’s a God.”

  “Yes.”

  “Where is he, then? If he’s there, show him to me.”

  “Ye-es. Inside Mr. Tsukada.”

  “In my heart, you mean?”

  “Ye-es.”

  “I don’t get it. How can anybody today claim anything so foolish? Why, we’ve got rockets flying to the moon!”

  Gaston shrugged his shoulders and smiled. He seemed to have realized, from the kind of food he was delivering on the trays, that Tsukada’s condition was not good. His meals, which had been moving toward normal food for a time, had changed back to a liquid diet again. Kiguchi sensed that Gaston, mocked and made a fool of as he was, brought a meager sort of comfort to the patients. About the degree of comfort afforded by the wan winter sun trickling through the clouds. Still, each day Gaston brought temporary diversion to the many suffering patients here. At this hospital, he performed the role of the Pierrot in a circus.

  Tsukada finally stopped hemorrhaging, and the worried faces around him relaxed. Kiguchi confided only a portion of Tsukada’s confession to the doctor in charge. He did not mention Minamikawa’s name, and hinted only vaguely that Tsukada had eaten the flesh of an enemy soldier.

  “I see. So you were in Burma with Mr. Tsukada, were you? It must have been terrible. I was just a child evacuated to the provinces at the time, but even in Japan we had a shortage of food.”

  “That doesn’t even begin to compare with what we went through!” Kiguchi retorted with unintentional anger. He had heard from family members, and experienced them himself after repatriation, of the desperate shortages of food in Japan, but these bore no comparison to those of the Japanese soldiers who had wandered along the Highway of Death like sleepwalkers, drenched by the rain. Their starvation, after they had eaten tree bark and insects dug from the ground, after they had eaten everything, was of a totally different realm from those who received a ration, however paltry, of rice.