Intern (25 page)

I was flailing in a quagmire of my own making, and yet the quagmire was the only place I could imagine being. The constant cogitation was exhausting and seemingly preordained. Perhaps this was the way it had to be; perhaps the way my life had unfolded depended on who I really was, deep inside, not the part that could be changed or molded or beaten out like a pellet of ore. A lyric kept going through my head:
You may find yourself in a beautiful house, with a beautiful wife/And you may ask yourself—Well . . . How did I get here?

In a flash, I thought of Lisa. I wondered how she was doing. At one time, I had ruminated over her illness, too. I had been racked with doubts before. I remembered discussing her with my father, crouched uncomfortably on the living room carpet, the snow packed outside, the house unbearably lonely, crying the both of us, me for my losses, he for me, and perhaps for his losses, too. But that had been a very different problem than the one I was now facing. As a good friend had once remarked, “Some problems are divine.”

I felt the urge to cry, but I told myself to wait until a more appropriate time. I cleared my throat, tightened up my face, anything to keep
myself from sobbing, but the tears came anyway, hot and quick, salting my face. Images were shooting in from the fringes of my memory. I had seen them before, perhaps in my childhood, perhaps in a movie. I was six years old again, running across the road into oncoming traffic, only to be whisked up into my father's arms. He was forcing me to eat an overripe banana on the way to the school bus stop, dragging me along in my starched public-school uniform. I was back in middle school, preparing to defend my title in the Math Field Day competition. After the competition, in the school parking lot near the petting farm with the one goat and a few chickens, my father took one long disappointed look at my fourth-place certificate and ordered my mother to kiss it.

I don't feel like being bold. I just want to be solemn and brooding. Being courageous takes too much effort. What's the point? When the going gets tough, the smart get out! That's what the preacher used to say on the steps of Sproul Hall. Get out, get out. I can't get out!

At one time, I had been so optimistic about my future, and so had my parents. I had invested it with so much hope, comfort, profundity—and here it was, and I had become a doctor, and it was all so muted and colorless. Everything was gray, in tone and shade. What would happen if I broke myself down again and rebuilt? I was afraid that all that would remain would be fragments of shell and dust. Everything else would evaporate.

O Wind,
If winter comes, can Spring be far behind?

—
SHELLEY, “ODE TO THE WEST WIND
”

 

W
hen I was a boy, I used to ponder the following question: Should a person stop doing something if there is a chance that thing could lead to disaster? For example, would I stop driving altogether if I knew that at some point in my life I was destined to crash into a brick wall? Would I consign myself to a life of immobility (especially true in Southern California) to avoid such a calamity? During the winter of my internship, I often asked myself this question in relation to medicine: Should I go on? Though I was still working in the hospital, I was just barely functioning. And I wasn't sure that disaster did not lie ahead.

In December, with the pain in my neck starting to subside, I was sent back to Memorial—to substitute for an intern who had just returned from a leave of absence for major depression. Even though she was back on the wards, the chief residents thought it best that she perform her Memorial service in the spring, so I ended up spending New Year's Eve once again on call on the leukemia ward.

That night, I saw Kayvan Patel for the last time. A middle-aged man, he had been diagnosed with acute lymphocytic leukemia two
years earlier. At first his disease responded to chemotherapy and he went into remission. But the cancer returned and eventually proved resistant to all treatments. He knew he was going to die. But first, he wanted to spend a little more time with his two sons, eight and eleven, to impart lessons they could carry with them when he was gone.

He could not escape the hospital, though. The leukemia had ravaged his immune system, so every time he got a new fever—which happened every few weeks—he would be hospitalized and placed in virtual isolation. His sons were discouraged from visiting him because they were going to school and posed an infectious risk. He was given antibiotics—antibacterial, antiviral, antifungal—for weeks at a time, often becoming violently nauseated and short of breath during his daily infusions. With each passing day his frustration and sadness grew as he realized the fever was consuming the precious little time he had left.

One day, he decided he had had enough. The months of hospitalizations and the endless, mysterious fevers had taken their toll on his mind as much as his body. When he told his doctors that he wanted to go home, they discouraged him, telling him he could rapidly succumb to an infection, but he would not be dissuaded. On New Year's Eve, shortly before midnight, he called me into the small room that had become his home. Lying on sheets wet with perspiration, his face dark and flushed, he spoke to me with a resoluteness I had not seen in the three weeks I had known him. “They say I will die if I leave the hospital,” he whispered. “I will take that chance because here I am already dead.”

Not long ago, his words could have described my feelings, too. It had been a bleak autumn. Trying to make it through each day was like pedaling a bicycle up a steep hill, straining to keep my balance as my calves burned with heat and pain. The constant pressure to perform, to satisfy the expectations of my family, my colleagues, and myself, was too much to bear, and eventually I cracked. And once I cracked, the crisis of confidence became self-sustaining, as I began to flagellate myself over my state of mind. Why wasn't I stronger? Why couldn't I handle
the stress? Why me? Why now? The lower I felt, the worse it got, as my mood seemed to feed on itself. But fortunately, even in the midst of this crisis, I knew that my dark mood was pathological. I had enough insight to know that I was clinically depressed.

Because I was miserable, I succeeded at making the people close to me miserable, too. A nugget of anger was always wedged deep in my brain, ready to explode at the slightest provocation. At times I lashed out at Sonia, dumping my frustrations on her even though we were supposed to be in the prime of our courtship, a honeymoon phase. Post-call, I'd snap if I didn't get enough sleep. One afternoon, exhausted after a difficult night on call, stress ulcers stinging the inside of my mouth, I told Sonia I wasn't going to be able to make it to a social function at her parents' house that evening.

“My parents had it a lot worse than us,” she said, clearly annoyed by the change of plans. “Those were the days of the giants. My father used to be on call every night. You and I have it comparatively—”

“Stop it!” I roared, rage surging through me, momentarily clearing my mind of its cobwebs. I always hated it when Sonia compared me to her father. I was having a hard enough time in medicine without being reminded of how he had succeeded.

“Why are you yelling?” Sonia shouted.

“I don't want to hear about your father or your family! I have my own way.”

Before long we were angrily circling each other in the foyer. We were in our volcanic phase, and in the volcanic phase, you didn't know where the lava would flow.

“Have you no concept of what I'm going through?” I barked.

“You act like you're the only one!” Sonia said. “I've got my own stuff to deal with.”

“You don't know the pressure I'm under!”

“Don't dump it on me,” Sonia retorted. “It isn't fair.”

“You see how I'm working. Why don't you understand—”

“I understand, but honey, you need help. You're depressed. Remember how things were last summer—?”

“Stop it, just stop! I can't deal with this right now.” And with that I stormed out of the apartment.

As was typical in those days, Sonia called me a few minutes later, and we quickly made up. That was the nature of our fights during internship: explosive eruptions rapidly followed by amends and calm. After a long nap, I apologized for my outburst, and we went to her parents'. But I still felt like a razor precariously balanced on its edge.

IN JANUARY
, I rotated back to the outpatient clinic at New York Hospital. After what I had been through the past couple of months, I was glad for an easy rotation, and it was good to see some of my regular patients. Perry Richardson showed up for his normal psychotherapy session. A lumbering black man with a flirtatious manner, he had fallen on hard times after being laid off as a sales representative at a pharmaceutical company, losing his apartment and his boyfriend, even living for a while in a homeless shelter on Ninety-sixth Street. But he had started taking night classes in graphic design and was planning on starting a glossy-brochures business. Jimmie Washington came in, too, still loudly announcing in the waiting room that she was a busy obstetrician. She had a few surprises for me, like the stroke she had suffered in 1984. “Did I know about that?” I asked. “You would if you'd been listening,” she admonished. “Okay, so tell me about the stroke,” I said. “It was after my brain surgery,” she replied. Brain surgery! I didn't know what she was talking about. It turned out that she had had a brain aneurysm resection fifteen years earlier, which I thought probably explained her eccentric personality.

That month, I made my first house call. In truth, it wasn't entirely my idea. The patient, Roberto Gonzalez, had prostate cancer that had spread to the bones. He had been coming to see me with his wife at least once a month throughout the fall and winter, but he had missed his last couple of clinic appointments. One afternoon I got a call from his visiting nurse. I had never spoken with her before. (Admittedly, I
had even been a bit lax about filling out the home-care order forms that were periodically put into my mailbox.) “He's getting sicker,” the nurse told me. “He would love to see you.”

“How can we get him into the office?” I asked sincerely. (Did she want me to fill out another transportation form?)

“You could pay him a visit,” she suggested delicately. It hadn't even occurred to me. At no time during my education had I seen or heard of a doctor making a house call.

I went to see him one evening after work. His block in Spanish Harlem had the characteristic mix of pawnshops, check-cashing stores, and dilapidated storefronts painted with colorful murals. Children were jumping rope on the sidewalk in front of the building, while old men passed the time on a nearby stoop. Standing in my white coat, I rang the door buzzer. A teenage girl popped her head out of a fourth-floor window. “Dr. Jauhar is here!” she cried.

Inside, I ascended the cracking limestone staircase. It was a steep climb; no wonder he had been unable to come see me. At the top of the stairs, I was greeted by a shawl-covered woman in her sixties. She clasped my hand. “Thank you, Doctor,” she said. “Thank you for coming.”

The apartment was well kept and filled with Catholic adornments and the fragrance of potpourri. I followed his wife to his room. Mr. Gonzalez was lying in bed, wearing a diaper, his crumpled body barely making an impression on the crisp sheets. His lips and eyes were coated with crust, and his face was sunken. A plate of rice and beans was sitting on the bureau, untouched. “Dr. Jauhar is here,” his wife said. “He has come to see you.” He extended his hand weakly, and I held it. I asked him how he was feeling. “A little better,” he whispered. “But I'm sick of going in the bed. I'm sick of being a child.”

Instinctively, I reached for my stethoscope, but then I realized I had left it at the clinic. In fact, I had brought nothing with me: no penlight, no blood pressure cuff, no prescription pad, nothing. I looked up at his wife's smiling face, wondering if she noticed.

Without my tools, I couldn't follow my usual procedures, so I just sat at his bedside, stroking his hand. Afterward, in the kitchen, I sat with his wife and had a cup of tea. I asked her how she was holding up. “He wants me to wait on him hand and foot,” she said with a mixture of resentment and resignation.

“It takes a lot of love,” I said, not knowing how to respond.

“I don't know if I love him so much anymore,” she replied matter-of-factly. “Now it's more like I just take care of him.”

She took a sip from her cup. “He's jealous that I'm up on my feet and he isn't,” she said. “The other day I wanted to buy face cream, but I couldn't go because he wouldn't let me. When the grandkids come over, he says, ‘They came to see me.' ” She shrugged, like it was not in her nature to deny him such a small victory. “You know what he said to me the other day? He said, ‘When I die, the spirit is going to come take you, too.' ”

I nodded silently.

“That's not love,” she said. “That's egoísta. You know what that means?” I could guess. “It's everything for yourself.”

That night, while riding home on the bus, I felt curiously at peace. The trip uptown had filled me with a very different feeling than the ward medicine I had been practicing for months. Even though I hadn't prescribed any medicine or assisted them in any tangible way, I had learned so much about the Gonzalezes during my brief visit. House calls are a vanishing practice, but for me they were the sort of thing I had once looked forward to doing when I became a doctor.

Mr. Gonzalez died at home a couple of months later. It was two years before I made another house call. What I remember most about that first one was how impotent I felt. Outside the familiar terrain of the clinic, with no equipment or physician backup or formal training to speak of, I didn't know what to do. Later, when I mentioned the house call to a senior physician, he scolded me for having created a liability risk for the hospital by taking on this task without supervision. Overall, the experience seemed to have been a wash. So I was surprised when, two years later, I received a letter from Mrs. Gonzalez. “I just
wanted to thank you again for coming to see my husband when he was ill,” she wrote. “My family and I will never forget what you did.” My small, reluctant act of kindness had made a lasting impression.