The View from the Vue (5 page)

“Call him,” I said. “Tell him to come to the hospital right away, and I’ll talk to him.” I shuddered at the thought of having to explain a dying James St. Peter to a physically healthy version.

About half an hour later there was a pounding on the locked door. The nurse went to open it. In raced a gigantic, muscular man about two and a half times the size of my patient. Now I really shuddered. I looked around, but there were no other doors on the ward. I was stuck. I figured I’d better get it over with, so I introduced myself to the weeping man and explained why I had called him here. After a few minutes of talking to him, I realized that he was sound—not only of body, but of mind as well. Furthermore, he was very upset about his brother, and begged to be allowed to see him before he died; so we went together into James’s room.

William leaned over the bed and called, “Hey, buddy, it’s me—William—hey, look up at me.” But James was going to spend his last moments with his private friends, and he didn’t even cast his brother a glance.

William and I walked away from the bed. He seemed a bit more composed now, and drew a sigh. “I’ve been figuring something like this was gonna happen for a while,” he said. “I want to thank you for taking care of him and trying to help.”

The speech was made with tremendous sincerity and dignity. In reply, I stuttered a little, and finally managed to say, “Thank you, Mr. St. Peter.”

The man turned and looked down at me in bewilderment. “No, no,” he said. “You’ve got it wrong. My brother is St. Peter.”

Now I was bewildered. “But…aren’t you both St. Peter? He’s James St. Peter, and you’re Will—”

“Oh, I see,” he interrupted. “No, he’s not James St. Peter. His name is St. Peter James. I’m William James. You’ve got it backwards.” He smiled tolerantly at me.

I flushed and pawed at the floor with my right toes.

“Matter of fact,” continued William James, “his name is really Allen St. Peter James. But he always went by his middle name.” Then he paused a moment and added, “You people here seem kind of mixed up.”

In retrospect, I think Mr. James was right. But it should be kept in mind that the Bellevue Psychiatric Pavilion was not a place where wealthy neurotics came to stretch out on a couch at fifty dollars a half hour. The clientele were genuine end-of-the-roaders, and they descended in hordes on an understaffed, underequipped hospital whose primary asset was the grittiness of its personnel. If this staff did, indeed, become a little mixed up now and again, it was both understandable and forgivable.

Understaffing was a perpetual major problem at The Vue. It’s true that there was never a shortage of interns and residents, but there never was enough of anyone else. The house staff might have been persuaded to work at The Vue because of the tremendous educational potential, but this hardly constituted an inducement to nurses, aides, orderlies, elevator operators, messengers, or laundry workers. To them, The Vue was just a big filthy, depressing place, where the pay was lousy, the hours long, and where it was easily possible to contract a dreadful disease without even having gotten any pleasure out of it.

A large proportion of the ancillary help were dedicated people. They had to be. A nurse might come in to work on the midnight-to-eight shift and find herself responsible for covering anywhere from four to eight wards. She’d barely have time to finish passing out one round of medication before it was time to repeat the whole process. And as for playing the Nightingale bit, she just had to forget that ambition. On the night shift at The Vue, there was no time to comfort the sick or reassure the dying. It was a victory simply to keep the Spartan inhabitants properly medicated in the hope that perhaps some of them might get better.

There were also none of the pleasant little services that private hospitals provide to make the lives of interns and residents more bearable. Smiling young women did not come around each morning and draw the bloods for testing; unshaved interns did. Interns also, personally, performed blood counts. When they had finished doing that, they filled out X-ray requests, and hand-delivered them to the X-ray department. And when X-ray called for Mr. Jackson to come down for his barium enema, an intern would wheel him down, lift him onto the table, wait while the procedure was being done, lift him off, and take him back upstairs. By that time, the electrocardiograph machine might have run out of paper, and someone would have to hotfoot it over to Central Supply for some more. Guess who was the messenger?

True, there were some volunteers at The Vue, and they did some very nice things, like passing out books and toys to the clientele, or helping a paralyzed stroke victim do his exercises so he might regain some function in a limp arm or leg. Whatever human touch was offered at that place was due in large measure to the volunteers. But after he’s been up all night, what does an intern care for the human touch? All he wants is a slave or a magician to make the scut work vanish.

I had one. I’m not certain whether she was slave or magician, but she got the job done. She was my wife, Myra, and she had to be the greatest volunteer in the history of The Vue. We once figured out that if the City of New York had paid her for the work she did, Gotham would have faced bankruptcy several years sooner.

Myra’s unofficial career began one night during the autumn of my internship year. She had come to join me for dinner at the doctor’s dining room, the gourmet establishment in the Bellevue basement where free meals were served to all house physicians. Since house physicians wore white jackets with the emblem, CITY OF NEW YORK, DEP’T OF HOSPITALS on the sleeve, interns’ wives simply put on their husbands’ extra jackets and walked in past Miz Matthews, the gigantic assistant dietician who used to station herself at the doorway to prevent any medical students or other ringers from cadging dinners.

It was a slow night. The weather hadn’t yet turned cold enough to trigger epidemics of pneumonia and chilblains on the Bowery. We had finished up the ward work before supper, and at the moment there was nothing to do. So we sat and talked over second helpings of dessert, savoring the luxury of indolence far more than the food.

After a while I realized that the day’s laboratory reports must have arrived back on the ward. It was the intern’s job not only to review them, but to paste the slips into the charts as well. When I mentioned the lab slips, Myra picked up her pocketbook and made ready to leave.

“Wait a minute,” I said. “There’s nothing going on. Why don’t you come up to the ward and keep me company while I do the slips?”

Myra looked uncertain.

“There’s no problem,” I continued. “No one’s going to bother you, but if it makes you feel better, just leave the white coat on. You’ll look like a med student.”

Myra thought for a moment. “Okay,” she said. “Guess it’s better than sitting around the apartment.”

We went upstairs. I checked through the pile of reports and then began to paste them into their owners’ charts. Myra watched for a few minutes and then quickly grabbed half the pile of slips that were left. I looked up.

“No reason for me to just twiddle my thumbs,” she said. “I don’t think it takes any special training to stick these things into the charts.”

We finished the lab slips in half the time it usually took me to do them alone, and a wonderful idea began to germinate in my cerebrum. “Come on,” I said. “Let’s go up to the lab and I’ll show you how to do an admission blood-workup.”

Myra protested that she couldn’t possibly do that.

“Sure you can,” I said. “They’re the exact same tests that you learned in the human biology course you took in college. I’ll just have to brush you up a little.”

The lab was always an ungodly mess, and we had no trouble finding the remains of a tube of blood that some intern had left lying around earlier that day. Myra watched me perform a hemoglobin concentration, a hematocrit, and a white-cell count and differential examination.

“They really are just the same,” she mused.

“I told you. Here. You try it.” She did, and I checked her out. She was right on target. My joy knew no bounds.

By the time we returned to the ward, my little idea was ready to bear fruit. In our absence, a new patient had been wheeled up for me. The slip from the Admitting Office read, “ASHD, early CHF.” This meant “arteriosclerotic heart disease, with early congestive heart failure.” The patient attached to the note was a gentle, little, seventy-year-old man from the Lower East Side, and his swollen legs, pulsating neck veins, and rapid respirations all attested to his cardiac decompensation. I grabbed a needle and a syringe, and drew a blood sample from him.

Myra read my intentions accurately. She held out her hand and I gave her the tube of blood. She recoiled slightly. “It’s…it’s still warm,” she said, her tone reflecting considerable dubiety and more than a passing wave of nausea.

“Hot from the vein,” I said. “Now, you can do the blood tests while I take his history and examine him.”

Myra gripped the tube more firmly. “All right, foxy husband,” she said with a grin. “It’s still better than sitting around the apartment while you’re here.”

“For me that goes double,” I replied. She started off toward the lab as I wheeled the wheezing patient into the examining room and went to work.

By the time Myra returned, I had completed the history and the physical examination and had done an electrocardiogram to be as sure as I could that the episode of heart failure had not been triggered by a heart attack. Myra gave me the results of the lab work, and I entered them into the chart. Then, while I wrote up my conclusions, she left for X-ray with my charge, and returned with the views of his chest just as I was finishing up my notes. All I had to do was read the films and start the little man on therapy. My wife had saved me a good hour of scut work. An hour! More precious than platinum or petroleum to an intern! I had found El Dorado, and my euphoria was boundless.

Within days I was the envy of every other intern at The Vue. Sticking to her claim that it was better than sitting home alone, Myra would arrive around dinnertime on most of my nights on call. Miz Matthews soon was greeting her like one of the regulars, which, of course, was what she had become. After supper, we’d go up to the ward and take care of the lab slips and any necessary blood tests and urinalyses. New admissions now seemed like duck soup, and if nothing else was going on, I’d catch up on my chart reviews while Myra would give the nurse a hand by doing general aide’s work. She drew the line at emptying bedpans, though. That, she said, was not better than sitting home alone.

When I finished my internship year and moved into the first year of residency training in obstetrics, my unofficial associate came along with me. We rapidly discovered that obstetrics was not only more to my taste, it was also more to my wife’s taste. She delighted in the quick-paced excitement of the labor and delivery suite, where every blood count and every trip to X-ray was an emergency. Furthermore, she was able to acquire some new skills beyond doing lab work and running off to X-ray. Three delivery rooms were operating at full capacity, but with only one nurse, and occasionally an aide, to keep things going. Keeping things going involved setting out drapes and instruments, handing sutures and other necessary equipment to the doctors, weighing, footprinting, and wrapping up the newborn babies, and then cleaning the rooms for the next round of deliveries. Myra learned to do it all, and the nurses were as ecstatic as I was.

Not everyone shared our enthusiasm, however. One of the senior residents complained endlessly to me that it was not proper for my wife to be there. No, he did not mean to imply that she was interfering with my concentration; and, yes, he did have to admit, she seemed to be serving a useful function. But nonetheless, he just thought that a resident’s wife shouldn’t be in the hospital when her husband was on call.

“Suppose my wife were a doctor too?” I asked him one night in exasperation. “Would she have to take her residency in another hospital so we wouldn’t be on call together?”

“Of course not,” the senior resident answered with hesitation. “That would be different.” But just how it would be different he could never quite explain. So Myra kept coming to The Vue, and he kept bitching about it.

The matter was finally settled one night when one of our patients suffered a severe laceration at delivery. Blood poured from the woman’s vagina so that the floor beneath the table looked like the Red Sea. The senior resident and I worked frantically to suture the hemorrhaging gash while the only other available resident pumped fluid and blood into the patient’s arm.

“What’s her hematocrit?” shouted the senior resident.

“I don’t know,” the pumping resident called back. “I drew a tube for it, but I can’t leave off here long enough to run the thing.”

In one breath, the senior resident managed to take both the names of the Lord and Savior in vain. “Get a hold of somebody who can do that hematocrit,” he bellowed at no one in particular.

Without saying a word, Myra got up off the stool in the corner from where she had been watching the commotion. She took the tube of blood from the resident, and walked rapidly out of the delivery room. In a few minutes she was back.

“Hematocrit’s 31,” she said loudly.

“That’s a low blood count for someone who’s doing all this bleeding,” the senior resident yelled. “Pump in that blood faster.”

The other resident pumped faster, the senior resident and I sutured faster, and in a few minutes we achieved satisfactory hemostasis. The emergency was over.

I have to give the senior resident credit. As he peeled off his gloves he thanked Myra politely, and from that time on never failed to greet her warmly whenever he came up to labor and delivery and found her there. Myra had become one of the boys.

As such, she discovered even greater worlds to conquer. Blood counts were okay, and setting up rooms was fine, but nothing was really quite as fascinating as the deliveries themselves. Myra watched and listened, and before long was a fully qualified sidewalk midwife. She learned that there’s no great trick to doing a routine delivery. The mother actually pushes the baby out, and the major responsibility of the attendant is to control the process, guiding the child out slowly and smoothly so that neither the baby’s head nor the mother’s bottom is damaged by a precipitous delivery.