The thought of Jan back in my room kept me going. At times like this, when the medical tensions were beginning to evaporate, all I could think about was escaping the loneliness, being near someone alive and healthy, talking to her and loving her. A few times in medical school a girl had waited in my room while I went off to do something. That had always made it nice to come back. But too often she would just grunt a little in her sleep as I slid in beside her.
That "something" my medical-school peers and I found ourselves doing at odd hours of the morning was almost always a lab routine. The need for blood counts and Bence-Jones protein analyses seemed to occur to the residents primarily after midnight. So hundreds of times we had ended up spending the wee hours in what you might call the bowels of the medical ship, counting tiny blood cells, which grew even tinier with the passage of time. Meanwhile, the resident on the bridge was steering the patient through, frequently complaining about the slowness of his blood counters in the hold. The truth about blood counts is that if you've done one you've pretty much done them all. The point of diminishing returns on the learning curve is reached quickly, particularly at 3:00 a.m., when your mind tends to dwell on getting back to your room and, perhaps, to the young lady.
In one twenty-four-hour period I had done twenty-seven blood counts, a personal record, though by no means a hospital record. My last few, in the small hours, were, of course, no better than half-educated guesses. Thus it went in the big leagues, where you were trained for a cost of $4,000 a year, to be a lab technician. All of us had worked up fantastic scenarios wherein we threw the urine in the resident's face and told him to jam the bottle up his ass, or we went on a sit-down strike in the cafeteria. None of these scenes existed outside our imaginations, because, to tell the truth, we were quite intimidated. As the professors never tired of pointing out, others were standing in line to wear our little white coats. What, in fact, happened was that late at night, when you felt pissed off and exploited, you cut a comer here and there and invented a plausible result. But this happened infrequently, and only late a night.
But worst of all was later, not having anyone to listen. The whole world seemed asleep and quite indifferent to your conviction that medical education was shitty and irrelevant. So you hurried back to your room, to the sleepy girl, grateful, finally, for her warm body.
Quite a few students got married at the beginning of medical school. I suppose they were not so lonely, having the omni-present warm body. And the first two years were fine — courses during the day and hitting the books at night. They probably had a ball. But it was different when the blood counts came those last two years, and all the other Mickey Mouse in the middle of the night. Gradually, I think, some just gave up trying to communicate the frustration. The warm body wasn't enough. In any case, a lot of them weren't married any more when we finally got that piece of paper saying we were Doctors of Medicine. Actually, we had been champion blood counters, Doctors of Concept and Laboratory Trivia. Not one of us had known what dose of isuprel would save a life.
When I opened my door, I couldn't decide whether to make a lot of noise or be quiet. The kinder instincts won, and as the light from the hall flooded in I quickly rolled around the door and shut it. I took off my shoes. The room was perfectly silent, and so dark after the fluorescent lighting in the hall that I couldn't have moved around without knowing the position of the furniture. Some furniture! Of course, the hospital bed I slept on did have interesting characteristics. It could be cranked up into such a comfortable position for reading textbooks that I never managed to get through more than one or two paragraphs before falling asleep.
The rest of the furniture included an easy chair as hard as stone, a bookcase, and a desk designed for a small child. If I put both elbows on it, there was no room for the book, especially one of those five-pound, thirty-five-dollar jobs so popular with today's medical publishers. As I moved about in the dark, the only potentially serious obstacle was the surfboard I had hung from the ceiling. Gradually, as my sight adjusted, I could see the outline of the window and the bed, and I put my hand down on the covers, running it back and forth, faster each time, until I was sure she had left. Sitting on the edge of the bed, I rationalized that I was exhausted anyway, and she probably wouldn't have wanted to talk. It was past two, and I was exhausted; I really was.
The phone rang three more times before morning. The first two weren't important enough for me to go, just nurses with questions about some order and about a patient who wanted a laxative. On the matter of laxatives, I have made a small independent study. The study proves conclusively that five out of six nurses are ten times more likely to ask for a laxative order between midnight and 6:00 a.m. than at any other time of the day. As for the reasons, they are difficult to figure out, hinging perhaps on a Freudian interpretation of the nursing profession's anal hang-ups. In any case, I felt it was a near-criminal act to wake me up for a laxative order.
Each time the phone rang, I'd sit bolt upright as a shot of adrenaline whizzed through my veins. By the time I got the phone to my ear, my heart was pounding. Even if I didn't have to leave my room, it would take me about thirty minutes after each call before I calmed down enough to fall back to sleep. On an earlier evening, answering from a dead sleep, all I could hear was distant mumbling. "Speak louder," I had shouted, closing my eyes tightly and concentrating, barely able to make out the remote words. They had been telling me that I was speaking into the wrong end of the telephone.
The third call was at the opposite end of the spectrum from my fear of not knowing what to do. I could handle it for sure; so could a four-year-old child. Mrs. So-and-So had "fallen" out of bed. Patients don't usually hurt themselves falling out of bed — they're too loose, and, besides, the nurses know what to do. None of that mattered to the hospital administration. As long as they "fell" out of bed, the intern had to go say hello, no matter what time it was.
So I got up feeling — how to explain it? — well, if s not nausea, although you feel sick to your stomach, and if s not a high fever, though your forehead would fry an egg. The best nomenclature is a description. You feel just as you might expect to feel at being startled awake at 4:00 a.m. after about two hours' sleep during which you were awakened each time you sank off — having finally lain down after working for almost twenty hours, emotionally exhausted, physically, too — to hold the hand of someone who "fell" out of bed unhurt. Actually, most of them just sank to the floor on the way to the bathroom. But regardless of how they got there, even if they were twenty feet from the bed, the nurses always called it a fall, and up you went, in the observance of an absurd legality.
This formalism is even more absurd when one realizes that a hospital is otherwise dependent upon these same nurses to determine a patient's physical state and to call the doctor if need be. But for some inexplicable reason they cannot be depended upon to see if a patient has hurt himself sinking to the floor. Yet if s more, more than something useless and arbitrary you must do. About half your time since third-year medical school has been spent in pursuit of the useless and the arbitrary, which are justified by the diaphanous explanation that they are a necessary part of being a medical student or intern and becoming a doctor. Bullshit. This sort of thing is simply hazing and harassment, a kind of initiation rite into the American Medical Association. The system works, too; God, how it works! Behold the medical profession, molded to perfection, brainwashed, narrowly programmed, right wing in its politics, and fully dedicated to the pursuit of money.