Just Like Someone Without Mental Illness Only More So (10 page)

Earnest young man

(Vonnegut family photo)

What we hope to get out of taking care of patients is a glimpse of a transcendent moment.

I believed that I was a bright enough, hardworking, idealistic kid who was good at math and science, who, if it hadn’t been for Vietnam and the sixties and mental illness … if I hadn’t been called upon to save too tough a world at too tender an age … maybe I should have been a doctor.

It was not reasonable for a twenty-eight-year-old with a 1.8 undergraduate math and science grade-point average, recently off heavy meds, to think he might be able to go to medical school, but there’s something about manic depression that, if you’re lucky, gives you a contagious optimism. I believed I should be a doctor, and people who met me back then, especially if they were interviewing me, came to think so too. Sooner or later a medical school had to admit someone six years off the
beaten track, with three psychotic breaks and a 1.8 undergraduate math and science GPA. Maybe I’d be the guy.

By the time I actually applied to medical school, I had put together two and a half years of straight A’s at UMass Boston and had published a few articles in
Harper’s
and
The Village Voice
. And I was working on a book that I thought was going well. Attitude was creating reality.

When I applied to medical school, no one asked me if I thought I was going to go crazy again. It was a more polite time. The questions I was asked were vague enough that I could have gotten out of talking about mental illness altogether, but how and why I came to be applying to medical school at the advanced age of twenty-eight didn’t make much sense without it. My grades at Swarthmore weren’t very good; my MCAT scores were good, but a ton of applicants had good MCAT scores. My only real distinction and accomplishment was having published a few articles, and they were about mental illness. “Why I Want to Bite R. D. Laing” was a seminal piece of work. Without being mentally ill, I was just another overaged, mediocre applicant. I had to project some strength that would make up for the fact that I’d have six years’ less time to take care of patients than most applicants.

Somehow, some way, the insightful, providentially wise admissions committee of the day offered me a place in the Harvard Medical School class of ’79. I was three years off of Thorazine. It had been almost four years exactly since I was hospitalized. Getting into medical school tied up my having been mentally ill with a big red bow.

Harvard Medical School is five white-marble buildings surrounding a quadrangle of grass and walks. When the building in the Back Bay down near Mass General became too small, Harvard sent a delegation with plans to talk with Cornelius Vanderbilt, who looked the plans over and reportedly wrote out a $13 million check on the spot, saying, “Good meeting you, gentlemen. I believe that should cover it.” So they named the dorm, which is also built out of white marble, after him. Vanderbilt Hall.

Seen from Longwood Avenue, Building A looks a lot like the Parthenon. There aren’t any other buildings in the neighborhood that look like the Parthenon. There’s a tree off to the side that was grown from a cutting from the tree on the island of Kos under which Hippocrates taught his students. Hippocrates gave us the famous oath that contains the admonition “First, do no harm.”

The quadrangle was built in 1906. There were no antibiotics then. Surgery had to be very quick and was as likely to kill you as cure you. Keeping germs out of the surgical field was a novel idea. There were 155 medical schools in the United States, most of which were run for profit by one or two doctors, like trade schools. There were no admission requirements. If your family could pay, you could be a doctor. Doctors were taught and trained without being exposed to patients or science. The chances of any given patient being helped by any given doctor
were slim. Most were peddling snake oil of one sort or another. The Flexner report, published in 1910, sought to improve medical care by making sure medical schools had reasonable admission requirements and were associated with universities and that medical education stressed the scientific method and empirical observation of patients. One of the things that stressing science and empiricism did was to democratize medical care and make innovation possible. In European medicine, medical students didn’t have any exposure to patients; things were done a certain way because they had always been done that way, and all the various committees and academies and practice guidelines said they should be done that way. So the forces of innovation won, and American medicine became the best in the world, and all that white marble was trying to get us to be the best we could be.

After you’ve promised to “do no harm” and to honestly do your best to ascertain what is true, the rest is just details.

Science was the only way we could avoid fooling ourselves about what helped and what didn’t. Doctors were supposed to act like battlefield medics, identifying and addressing pain, suffering, and disability. I believed that once you had a medical school education, especially a Harvard Medical School education, doing
good
was just a matter of showing up.

I liked all the white marble, but it can be hard to live with. The five buildings facing the quad appear to be not quite part of this world. They have wings that stretch and branch out into labs and foundations and institutes and hospitals and on and on into the so-called
real world
, but it’s all connected to the white-marble hole.

My Harvard Medical School advisor had a recurring nightmare.
He’d wake up in a cold sweat saying to himself, “This really is the best place.”

There was and always will be a million miles between what my classmates and I wanted to do and what we would end up doing. We at Harvard and Harvard’s teaching hospitals were the light and the way. All you had to do was ask us. It has always amazed me how much quackery and bad medicine goes on. The temptation of being worshipped and pushing snake oil and making a ton of money at it turns out to be more than most people can withstand.

After being rejected by fourteen publishers, my book
The Eden Express
was published the same year I started medical school. My favorite rejection comment was “This book is good but with your last name it would have to be better.”

I took the paperback advance and bought a substantial serious adult-type Victorian house a ten-minute walk from the medical school. When a classmate came over for something, he said that it was the kind of house we weren’t supposed to have until we were older.

“I am older,” I pointed out. Right before getting the book published and right after getting into medical school, I got married.

The book ended up doing well enough to pay most of my way through medical school—no
Slaughterhouse-Five
, but not bad for a beginner.

Harvard took some flack for admitting me, which probably had something to do with why I shut up and didn’t write much for thirty years. There were letters from outraged alumni who knew deserving applicants. With so many earnest wholesome
applicants, why was Harvard out dredging for bottom-feeders like me?

My mother, my cousins, and my sisters weren’t doing so great. We had eating disorders, co-dependency, outstanding warrants, drug and alcohol problems, dating and employment problems, and other “issues.” At least now number one son was married and had a fixed-up Victorian house where everyone could have Thanksgiving and Christmas dinner. What chip on what shoulder? Maybe a man with a compass, a machete, and a strong right arm could lead his people out of the wilderness. If I, as a sick person, had been dragging a dozen or more people down, maybe as a healthy one I could lift up that many or more.

I saw myself as somewhat of a placement problem, and getting into medical school was a huge help. Later, when I was interviewing applicants to HMS and they all had such high aspirations, I wondered if less might not be more. Maybe one of them might say, “I’m just looking for an interesting way to hang out and stay out of trouble.” Something like that.

A child ready to learn how to read represents an enormous amount of luck, work, time, and patience. Imagine the astounding luck and work involved in making a medical school applicant. Doctors are like baby oysters on a very deep reef of forefathers and mothers and aunts and uncles hundreds of feet deep with a million important details buried beyond recall. What I asked myself about applicants was whether talking to them made me more or less lonely.

Zachary, my first son, was born when I was two years into medical school. First son had first son so there could be an orderly succession, like the House of Windsor.

Having a famous parent is a leg up to nowhere. It made sense to people that Kurt Vonnegut’s son would have mental health problems. It made sense that I would not do well.