Walking the Fine Line: A Medical School Memoir

Chapter 1: Peaches and Patients

Here’s Chapter 1 of my memoir about medical school in the 1980’s that I’m publishing in serial format. To make sure you don’t miss the next installment, become a subscriber.

May, 1985

In Rockland County, New York, a loud crash echoed from the basement of my parents' house.

"Hey, what's going on down there?" my mother yelled.

"I'm looking for clues," I answered.

"Clues to what?"

"Clues to what happened to me over these past four years. I know they're in here somewhere," I explained, as I continued to overturn box after box that my father had neatly arranged, containing the remnants of eight years of college and medical school. Of course, the boxes weren't labeled. I am the overcompensating sloppy type, not the obsessive neatnik.

I didn't know exactly what I was looking for, as one by one, I leafed through hundreds of syllabi, lecture notes, transcribed lecture notes, and condensations of each, for all of my medical school courses. Maybe I could find some little doodle or daydream in the margin, a response from the sleight of my hand that was not programmed from the lecturer's voice. I wasn't too successful at finding such things, but I was more than a little amazed that I had cumulatively digested all those axioms, words, formulas, principles, and descriptions, though they rang only a faint bell when now perused. I could have been learning to fly a plane, or becoming an accomplished musician or artist with all that time and energy, I thought. Now all I was left with was a lot of boxes.

The search continued, and I was losing my patience—I started throwing things. I realized that, for the most part, I would be left with my own present free associations, dreams, and memories to untangle and rewire my neurons, to find that occasional meatball smothered in spaghetti. Up to this point, such spontaneous flashes of insight had been mere flickering afterimages that would occasionally seduce my mind's eye, a strobe light with such a large time interval between flashes that the images could never coalesce. One day in the Hamptons, the surf slithered through my thoughts as I drew freely in a sketchbook, but, before I knew it, words had filled up several of the 11x17 inch pages: not coherent thoughts, but hand hieroglyphics—nascent, undifferentiated wisps that seemed to represent a gravitational convergence of energy, as if part of some cosmic prelude.

Several weeks later, I was in my car, driving fifty-five, staying alive, and listening to a band named "'Til Tuesday" tell me to "hush-hush" and "keep it down" because "voices carry." I gazed out the window, letting my thoughts wander, and suddenly, I was besieged. Oh no, it was happening. The floodgates of my mind were opening, the reducing valve bypassed—and not when I was ready, no. I had been trying to write for months, and every time I sat down at the typewriter, it was like pulling teeth, and feeble ones at that, from the mouth upstairs. Total incoherency—it was getting frustrating.

But then, like now, all of a sudden, without warning, thoughts would start to flow—it could get very uncomfortable at times, like now, when I was on the Palisades Parkway in upstate New York, tape-recorder-less, pen-less, and paperless. I reached into the back seat, hoping I could find something to receive my transmission, but all I came up with was an old banana peel. "Shit," I thought. Maybe I can scrawl some words with my fingernail onto the inside of the banana peel, it's still a little moist. Foiled again, Junior, you forgot, you bite your nails down to the bone.

The waves of ideas were coming faster, and I was having trouble concentrating on the road. Worse, it had started to rain, and my wipers were blurring my view even more. It seemed to happen a lot lately when I was leaving the Psychiatric Hospital where I was doing a drug trial—weird choice of words, these doctors. Anyway, I guess all that "primary process" thinking going on in there with all those schizophrenics starts my own brain juice to get freshly squeezed, and since I was always teetering unsteadily on that line in the first place, it wasn't that hard to tip me over the edge.

So, here I was, literally being electrocuted by all the voltage up there, with no fuse, no capacitor, and no way to short-circuit my racing thoughts. If I could hold on just a little bit longer, I'd make it to my folks' house, where I was heading, and get myself a fix on some good platen or at the worst, a pen.

In the meantime, I would have to amuse myself. I reached into my fruit bag—I always stopped at this fruit stand when I left the hospital, right before I got onto the highway—and grabbed another peach. I usually bought an entire basket of peaches, both because I like peaches, and because I'm a person of excess. When given the chance, I'll always go for the most, the largest, the longest. Someone could have easily trailed me home by just following the trail of peach pits on Route 17. I had usually eaten a dozen by the time I hit the George Washington Bridge, and then the rest would usually rot in the refrigerator.

I had never been able to escape that tremendous guilt of throwing food out, you know, when others are starving, but, as I said, I am a person of excess, and this seemed to take precedence. Don't get me wrong, I would usually finish whatever great quantity of food that I would buy or order, because I had a voracious appetite—my mantra is, "Eating Makes Me Hungry." I don’t get full, I just get tired of eating. And, in this case, there were these huge baskets of extra-large peaches—two superlatives—and I just had to have one.

I dribbled peach juice on my tie. I didn't care. I was used to dribbling stuff on myself. I just wished I had remembered to bring my portable tape recorder with me, which I had started to do just for circumstances like this. It didn't surprise me that I forgot it. It never surprised me when I forgot things anymore. And since I couldn't remember whether or not it had always been that way, I couldn't put my finger on the reasons why it might be happening. Too much marijuana in college? Getting older? Man, I was only twenty-six. Or, maybe it was just that things were getting more complicated, more things to keep track of these days. I dunno.

But, this year was even more rough, because I was sort of "taking it off," and to celebrate all the free time I would have, I had started to take jazz guitar lessons, started to write a book, religiously maintained my weight-lifting and running, and had gotten a new girlfriend. And, oh yeah, I was doing research full-time.

Leisure is a dangerous thing. I was starting to get the feeling that maybe I didn't want to have free time. That might be why I went to medical school in the first place. But, I didn't want to think about that now. Right now, I wanted to figure out a way to remember to bring my guitar, gym shorts, socks and tee—don't forget the sneakers—on the way to the hospital, when I was going to stop and work out on the way back, before heading to my guitar lesson. Plus, pick up that letter off my desk that I wanted to mail. I had put my wallet on top of it so I wouldn't forget it on the way out, but I had forgotten my wallet. What about my glasses, where the hell were they?

I had left in such a rush because I was late, that I had forgotten them, too. I had driven halfway up the street, but realized it was raining and I have trouble driving in the rain without my glasses, so I had turned around to go back and get them. Better late than dead. And while I'm there, I figured I'd pick up my umbrella, which I had also forgotten. Better late and dry than dead and wet.

My little tricks sometimes worked, like trying to put everything I would need for a given day in a backpack the night before I would leave. But, invariably, I would get to the hospital, be forced to park a ways from the place, and decide not to lug the whole backpack in. I would grab what I needed from inside it, go into the hospital, and then realize I had put something, like my beeper, in one of the small zippered compartments that I hadn't bothered to open in my haste to get into the hospital. What's more, it would have started to rain, and I would have also left the umbrella in the car. And so things would go.

Maybe I was getting Alzheimer's Disease or something. Maybe it was from trying to memorize too much all these years. Now there was no storage space left up there for immediate memory. To make matters worse, I didn't have random access to the rest of the information up there that was cluttering everything up. It felt as if I was constantly in a fog, always two or three steps behind myself, who was two or three steps behind everyone else. I recalled that line from comedian Stephen Wright, who said, "You know that feeling when you lean back too far on the back two legs of your chair and almost fall over, and catch yourself at the last minute? That's how I feel—all the time." It hadn’t always been that way. At least I don't think it had.

I did still possess some vague recollections, though disparate parts of a montage that I walked around in.   But, I still tried to look back, as I had finally made it inside the front door, and somehow there was a typewriter with paper beside it, waiting for me.

I tried to think back but it was hard, because it seemed as if there were a thousand doors slamming at once, trying to hide the path from where. I had come; the mind works in strange, maybe not so strange ways that way, somehow trying to protect you from feelings and realizations possibly better off buried in some graveyard of lost hope.     

But inside I knew, maybe not specifically—yet—but I knew that I had undergone a tremendous change during the past few years…and I could also feel a resistance building inside me, continuing even as I began to write, unfolding and rising from below, Banzai-pipeline style, a creature-feature rearing an ugly head from the depths and ready to swallow again what I presumptuously was going to attempt to regurgitate.

It was difficult to try to remember how I had felt before the respective years of medical school, before I knew all the names and terms, the drugs and diseases, the way it "really was" in the hospital. It seemed as if it always was this way, that this point of view was one that I had always had, but I knew that this illusion was simply part of an entire rationalization scheme concocted by my unconscious to deal with what had passed—and they didn't have to teach you that.

Maybe I was just being too cryptic about the whole thing.

But when I tried to sift it out objectively, I could point to facts that were reflective of the change, and I hoped that they would be keys to unlocking the greater truth.

Because I felt it was important to find it out, since I was sure everyone went through it similarly, and there must by some explanation for the reality of it all, the reality of medicine, which by the end of third year I had had come to dread, though I had entered school just a short time ago, thinking that doctors were gods and medicine could cure people.

So I glanced backwards, and would see brief shooting images of patients gone by, of faces, of names, of personalities I had touched and their pain I had tasted--relentless  shadows in my rear view mirror--and I felt the sadness within me grow like the swelling of a formerly peaceful ocean, and for once it sort of felt good.  Or rather, I knew that it was better then the illusion of a tranquil sea which wanted to maintain itself.   But I was in control if I really made the effort, though I could only drift in and out of specific feelings, crossing back and forth over a line that separated tears from laughter--and nervous laughter at that--but in its "oppositeness" seemed to convey an essence about what had happened to a lot of the feelings. 

And images began to immediately swirl around in my head of the most recent rotation I had had, one in the neurological intensive care unit, on rounds in the morning with plastic smiles plastered on everyone's faces, the attending physicians, residents, nurses and students as one of the residents recounted the recent "progress" of one of the several brain-dead, quadriplegic patients occupying the unit.   Looking down, I could see his sternum stained black-and-blue from the repeated knuckle-rubbing which attempted to elicit his remaining reflexes--he was barely a brainstem, a computer without a terminal.  Yes, the line apparently divided opposites, but was really more of a selective blanket, keeping the truth warm enough to make you cry every once in a while but thick enough to hide the light. But I must steer back towards them, as once again I had drifted into safer waters.

It seemed as if all the patients who were making visits in my mind had either died while I knew them or, inevitably, shortly after I had left:   the intravenous drug abuser from whom treatment was so mercilessly withheld; the helpless, elderly Hispanic man who had had a prior stroke and came in literally drowning in a pool of liquid death, a tenacious mucous that could not be swallowed or expectorated; the friendly, elderly woman who succumbed to bleeding esophageal varices on the night before she was scheduled to go home; the strong Greek man who came in because of a nagging cough, who on a CAT scan was shown to have a lung tumor the size of a grapefruit.

The images persisted:   the white-haired, African-American man who was admitted to the hospital weighing less than his temperature, which was 89 degrees Fahrenheit.   He had been to Hell's Gate and back, arresting on the night of his admission, with a blood glucose of twenty-four (normal 80 to 120).  I tapped on his chest when I initially examined him ("percussing"), and the sound reverberated as the dull, hollow thump of a brittle, bony cage, with the barest hint of skin over it, and the subtlest suggestion of life beneath it.   I remember wondering how he could be alive.  I recall his persistent answer to the question, "How are you doing today?'', regardless of whether it was after he bled out four units of blood from hemorrhagic gastritis, or after he underwent respiratory decompensation requiring transfer to the intensive care unit, intubation (having a tube put down his windpipe so that he could be hooked up to a respirator), and his being "tuned back up" for the fourth or fifth time, before being returned to the floor.

"P-p-p-p-p-pretty good," he would stutter in a soft, unassuming voice that was humorous in its pleasantry.  On the night he had that upper gastrointestinal tract bleed, I put a naso-gastric tube through his nose down into his stomach, and rinsed out the blood with saline, siphoning out syringeful after syringeful of bloody fluid--I felt like a servant filling water buckets from the well.

During a typical episode of respiratory failure, his breathing would become labored, his mental status would worsen, and I would quickly give him 100% oxygen by mask, only to watch his respiratory status deteriorate.   Eventually, his words would become slurred and unintelligible, his head would rock back, his eyes would roll back, and we would rush him to the intensive care unit, where I would later visit him.

His arms and legs were so swollen with extravascular fluid, due to the low protein content of his blood, that they looked like water balloons and felt like an over-ripe peach--only the indentations made by my fingers would eventually disappear.  He was malnourished,  and had an "exfoliative dermatitis" (i.e., his skin was peeling off), the dermatologists said.      None of the physicians on his case, which included hematologists, dermatologists,  general internists, and gastroenterologists,  ever figured out what was wrong with him•..

The list of patients could go on and on.   But for now, I would have to look back farther.