The View from the Vue (32 page)

The screams of the women and of the students were getting to me. “Christ Almighty, will you tell me what’s wrong with them?” I roared. “Aren’t they labeled or something?”

“Yes,” said the controlled voice. “They’re labeled, all right. One is labeled ‘Mommy’ and the other is labeled, ‘Baby.’”

I quietly read the fellow the names and numbers of the patients. Then I went looking for Oscar Goldberg. Fortunately, he had finished up and had gone home to bed. By the time I saw him, the story had already become funny.

After three weeks of this stuff, the students rotated and our new batch arrived. After the first day with the new group, my wife met me at the door. “Do you feel better?” she asked soothingly. “I told you the three weeks would pass.”

I slumped into a chair. “Lord,” I growled. “What a strait-laced bunch of sourpusses these guys are. They don’t do anything funny at all. I thought the day would never pass.”

My wife rolled her eyes up in her head and sighed deeply. Then, we sat down to supper.

The history of medical internship is a saga of privation and suffering.

Until recent years, internship was looked upon as no more than the fifth year of medical education, a time of apprenticeship when the graduate would receive the opportunity to test and refine his new skills under the supervision of experienced physicians. As implied by the name given him, the intern lived in a room on the hospital grounds so that he could be summoned at any hour to meet the needs of his professional charges. Most hospitals, recognizing the basic human requirement for a little R and R, gave each intern one night off duty per week. This largesse did not extend to salaries, though. Since when did people get paid for receiving a valuable education? Only because it was necessary to keep them alive, moving, and relatively odorless, interns were provided free room, board, and laundry services during their year of indenture.

It was primarily the postwar trend toward earlier marriage that altered this general state of affairs. Previously, a married intern had been an unheard-of commodity, but as more and more young medical graduates began to hear the Siren’s Song, the age-old foundations began to tremble. Newlyweds established residence in close proximity to the hospitals and let it be known in no uncertain terms that one-night-per-week visits to the love nest were definitely insufficient. Hospital administrators sighed and hired larger numbers of interns, so that an every-other-night work schedule could be established.

That was a start. What came after was truly revolutionary. When those wives found out how their husbands were spending their time, all hell broke loose. “What kind of a game is this?” screeched one intern’s mate after another. “Here we live in this cruddy, rat-infested dump, while I work my ass off nursing (or teaching, or sales-clerking), and you don’t bring home a plugged nickel.”

The interns would blink their bloodshot eyes. “But, dear,” they’d answer, “I’m in training.”

“Training my ass. What the hell do you think would happen if Bellevue had no interns? Who’d take care of the patients? They’d have to close up.”

“Well, I…”

“Never mind, ‘well I.’ Tomorrow you get yourself down to the administrator and tell him you want some money for all that work you do.”

In time, the intern staffs got together and paid administration a visit. They suggested it might be nice if they were to receive a wage. The administrators met this idea with a predictable lack of enthusiasm, but the interns reminded them that, after all, they had wives too, and couldn’t some little thing be worked out? Eventually the guilt-ridden administrators sat down to work out the details.

By 1963, when I came onto the intern scene, it was pretty well agreed that interns performed a useful and necessary function while they were in the process of obtaining their postgraduate educations. Virtually all hospitals were paying a salary. In some cases, this didn’t amount to much. For example, Yale-New Haven doled out $25 a month to their interns. At The Vue, things were considerably better. My salary was $3,200 a year, but an $800 annual “living-out allowance” brought my earnings to a cool $4,000. In combination with Myra’s salary as a schoolteacher, this permitted us to rent an apartment where we had a fighting chance against the cockroaches and to eat in such a manner as to avoid coming down with vitamin- and protein-deficiency diseases. Our attending physicians told us how fortunate we were, and how they had
really
had it tough. These comments were guaranteed to earn an older staff man an excessively polite “yes, sir,” while more than one junior faculty member was quietly but firmly told to blow it out his ass.

Although judging his training to be first class, no intern at the The Vue could bring himself to feel totally grateful for his lot in life. His day began at about 7:30
A.M.
, and when it ended at all, it was 6:30 or 7:00
P.M
. Sometimes the day did not end: it simply continued through the night until the next evening. Although an occasional blessed ward assignment was associated with an every-third-night rotation, for the greater part of the year the intern was on call every other night. The fact that this worked out to about sixty cents per hour for treating the sickest folks this side of Cook County did little to raise our spirits.

The long hours did even less for our educations than for our morale. One psychologist after another has determined that after someone has been awake for twenty-four consecutive hours, he’s only slightly more capable of learning something than he is of taking off from the roof of The Vue and soaring gracefully over the canyons of lower Manhattan. Sleeplessness thoroughly wipes out the ability to concentrate and greatly impairs the power of recall. In addition, by about the thirtieth hour out of the sack, you generally find yourself not particularly caring whether anyone lives or dies—including, and sometimes especially, yourself.

So it was that I came down to mid-February of my internship year in a sorry condition. It had been a hard winter in New York, with much cold weather and appreciable quantities of the white stuff that causes poets to burst forth with paeans. The Bowery citizens were being admitted in flocks. For the past four months, the only thing around The Vue that had been fuller than the wards were my nights. Under the best of circumstances, it was not customary to be able to snatch more than two or three hours of sleep during a night on call, but at that point it seemed like it had been weeks since my on-call bed and I had renewed our acquaintance. It seemed like weeks because it had been weeks.

An insidious thing began to happen to me. After their nights off, interns do not exactly leap from their beds, pound their chests, and do twenty deep-knee bends. But they do manage to get up, feeling more or less ready for the upcoming thirty-six big ones. Only in retrospect did I realize that I was losing my resilience. Where I formerly had managed to get out of bed five minutes after the alarm went off, it became ten minutes, and then fifteen. It stayed at fifteen minutes only because, at that point, my wife would apply her icy feet to my back and push. Then I’d stagger into the bathroom, feeling as though I would throw up any minute, and when I’d look in the mirror to shave, I’d have to operate among and between a field of little black dancing dots.

By the time I came home from work, I’d be utterly wiped out. I’d go into the bedroom to change out of my white uniform before supper, and more often than not, my wife would come in a few minutes later to find me lying on the bed on my back, my bare legs hanging over the edge. This happened because I’d sit on the bed to take off my pants and simply fall over backward, sound asleep. One evening she discovered me with my right leg up in the air, flexed at both the knee and the ankle, my hands arrested in the process of taking off the sock. Why I was doing that, we haven’t figured out to this day.

Once aroused and having eaten supper, I suffered through bouts of the greatest ambivalence I’ve ever experienced. I had to decide whether I should go directly to bed and recoup as much of my loss as possible. Or should I keep myself awake, by self-torture if necessary, just to enjoy the unalloyed pleasure of knowing I was off duty? Worst of all were the free weekend days. I could easily have slept till four in the afternoon on every one of them, but it seemed absolutely criminal not to be awake and ecstatic every possible moment I wasn’t at The Vue. So I’d set the alarm for around noon, thereby splitting the difference, and causing me to feel generally dissatisfied with myself.

Other peculiar things occurred. I’d leave the apartment to go to work and suddenly find myself inside The Vue without being able to recall the process of having gotten there. I didn’t think much of it at the time. We all have episodes of that sort of automatic behavior, and they’re perfectly normal. While driving a car along a freeway, we may suddenly realize that we’re ten miles nearer our destination, but can’t recall any of the intervening scenery. We’ve been concentrating on some thought or another to the exclusion of all else, using subconscious mechanisms to steer the car. But again, in retrospect, I realize that I never had the foggiest notion as to what concepts had been temporarily possessing my mind with such ferocity as to shut out all the magnificent sights between Stuyvesant Town and The Vue.

I began to forget other things as well, and got into the habit, which I haven’t shaken to this day, of writing myself notes and lists. Less acute problems went into my shirt pocket, while must-do-nows were clipped to my tie bar. Only in this way could I remember that it was Mrs. Gonzalez who needed the penicillin and Mrs. Goldberg who required the enema, and not the other way around.

Lincoln’s Birthday was a holiday at The Vue and, to celebrate, we went to lunch at the Philippine Gardens. This was a little place a few blocks away where, for under three dollars two could stuff themselves to bursting with first-class Filipino cooking. I say we went there that day because Myra tells me we did. I have no recollection of the event. The meal was made memorable for my wife, she says, by my incessant yawning. She finally grew weary of studying my tonsillar beds and requested that I cover my mouth. Whereupon, eager to please, I suppose, I put my hand over my eyes, leaving my mouth unabashedly agape. My wife and the other couple we were with enjoyed a merry laugh over my little bit of silly behavior. At least I’m told they did.

At about this time, I came to the decision that sleep was more important than food, and so, every day when the other interns went down for lunch, I would forgo Miz Matthews’ delicacy of the day and hightail it for my room. There, I’d carefully set the clock radio for half an hour in the future, turn up the volume full blast, and proceed to savor thirty indescribably delicious minutes of sleep. The alarm always seemed to go off almost as soon as I had set it, and I’d drag myself to my feet by sheer power of will, drop past the cafeteria and belt down a couple of slices of bread or a candy bar, and head up to the ward for the afternoon’s work.

The whole thing came to ahead on a dismal Friday afternoon. The temperature was right around freezing and the remains of a recent New York snowfall lay on the curbs, gray and disgusting. I had had no sleep the night before and relief was still not in sight. Remember, we worked essentially every other night. The word “essentially” is important: in order to be able to get a full weekend off duty, we’d work Thursday, Thursday night, Friday, and Friday night. Then, at noon Saturday, we’d be gloriously free till Monday morning, while the other intern covered the ward. So another full twenty-four hours of sleeplessness lay before me. I was not pleased.

During rounds that morning, I had been unusually irritable. I peevishly questioned the necessity of every therapeutic maneuver suggested by Ellen Carlyle, our resident. The last bed we stopped at belonged at the time to Mrs. Greenspan, an eighty-some-year-old woman who had been brought to The Vue two weeks before, unconscious from a stroke. Unresponsive she had come, and unresponsive she remained, a most ominous prognosis. Ellen solicited suggestions regarding her care. I recommended that we notify her family not to let her insurance policy lapse and then arrange to let her incubate her bedsores in a nursing home. Ellen told me, a bit tartly, that she didn’t think I was very funny. I didn’t care.

I spent the rest of the morning working on the ward and, when lunchtime came, I made my customary scoot upstairs to my room, set the alarm, and let my eyelids snap shut. Just another twenty-four hours.…

I still don’t remember the alarm going off, and I have no recollection whatever of getting out of the bed. Neither is there a memory of walking down to the ward, but somehow or other I got there. I was sitting at the desk, with the patients’ order book open in front of me and my pen in my hand, when I was seized by overwhelming uncertainty. Several times I started to write my order, but I knew there was something peculiar about it. Then I began to feel generally confused, a very unpleasant sensation.

I looked around and saw Ellen standing across the room, in front of the doorway to the examining cubicle. Slowly I got up, carrying the order book, and walked over to her.

“Are you sure you want me to give that dextroamphetamine to Mrs. Greenspan?” I asked.

Now I was not the only confused person in the room. She put one hand on her hip and stared up at me. “Larry, what in the world are you talking about?” she said, with just the least bit of edginess in her voice.

Suddenly I felt completely exasperated. Here I was, working like hell, and people were playing games with me. “Come on,” I growled. “Quit crapping around. Not five minutes ago on rounds, you told me to give Greenspan a slug of Dex. But I just don’t think it’s a very good idea.”

Ellen looked even more confused. She held out her wrist. “We finished rounds at a quarter after ten this morning,” she said, very evenly.

I looked first at her watch and then at my own. They both said one-thirty.

My heart started to pound and my cheeks began to burn. “B—but…you…I know you said…” At that point, confusion totally overwhelmed me and words failed. I had an urge to run from the room.