"Librium, 25 mg. size," he answered, a little confused. Evidently I had interrupted him.
"Fine," I said. "I'll give you a supply, but I recommend that you contact your doctor tonight or tomorrow. Meanwhile, I'll prescribe an injection of Librium to give you an immediate effect."
Before he could say anything else, I rose quickly from the bed, opened the door, and stepped out into the fluorescence and bustle of the ER. Mechanically, I wrote a prescription for "Librium 25 mg., sig: T tab P.O., QID, disp. 10 tabs," my mind going back over the absurdity of patient becoming therapist. That in itself seemed an almost schizophrenic delusion. A nurse tried to give me another chart, but I waved it away. I told another nurse to give the patient in the psych room 50 mg. of Librium intramuscularly. I was only half aware of the activity around me. Then, before leaving, I just had to go back and look in on that schizophrenic once more, to make sure he wasn't a hallucination. I opened the door. He was there, all right, staring out at me.
I closed the door and started down the long passageway to my room. It was all too true — all the things I had thought about myself in those seconds after he said Karen's name. I was a cold, detached son of a bitch and getting more so. Everything I thought about confirmed it. My initial relationship with Carno, for instance; it had just disappeared in a disguise of inconvenience. In fact, I had been too selfish and lazy to keep it going. Surfing was probably the biggest cop-out of all, especially since I apparently was using it to cover and relieve my progressively isolated life. And Karen herself — a vacant and meaningless relationship if ever there was one. Feelings I had vaguely noticed, the emptiness and undirected yearning — I had sought vainly to repress them by encounters with Karen and Joyce, even Jan. Much of this became horribly clear to me as I sat in the chair in my dark room, searching for answers.
I hadn't always been like this. Not in college, where friends had come easily and stayed. And the lonely yearning so much a part of me now? Perhaps a little during the first year of college, but not after that. Medical school had come next. Had the seeds of change been planted there? Yes, after all, it was during medical school that friends had drifted away, and attitudes and practices with women had changed, out of necessity, driven as I was by hard economics and limited time. But not until internship had the seeds of change germinated. Now I was sexually and socially little more than a cruiser, except that I operated in a hospital rather than the real world. How different it had all turned out. The phone rang, but I ignored it. Taking off my whites, I put on some wheat-colored jeans and a black turtleneck.
Why had this happened to me? Was it only the schedule? Or that combined with the fear and anger always inside me? Was it basically my self-disgust at not speaking up when I believed the system was rotten, at letting myself be carried along nevertheless, holding it all in? Was my brain so warped by exhaustion it was no longer logical? I didn't know. The more I thought, the more confused and depressed I became. Confused about causes, not effects. In perspective, the effects were clear: I had become a real bastard.
Suddenly, I thought of Nancy Shepard, of how I had pushed her out of my mind, rejected her questions and accusations. That night we argued, she had been trying to tell me what I had just learned from my therapist — my therapist, the schizophrenic. What a triangle, I thought: a double-dealing nurse, a barely compensated schizophrenic, and a screwed-up intern. Nancy Shepard had called me an unbelievable egotist, a selfish blob working toward a point at which love would be impossible. And she had been right. What did it matter that there was more to it; that it was not innate in my personality, but developed; that I had been encouraged, day in and day out, to avoid genuine emotional involvement because to do so was the only natural defense I could conjure up to deal with the anger, hostility, and exhaustion? What did it matter that an intern's routine was senseless monotony, or that the medical system was designed to use and harass him? To a Nancy Shepard — to anyone — the end personality result was all that mattered. She had brushed me lightly with some truth, and I had kicked her out of my life for her pains.
Lying down on the bed, I wondered what to do now. For the moment, sleep. How many bridges did I still have standing? And Karen? I didn't know. Maybe I'd see her, maybe not. I hoped I wouldn't, but I knew I probably would.
Day 365
The appendix lay to one side in a steel dish, where I had put it a moment earlier before turning back to the operating table. The surgeon was finishing sewing up the stump where the appendix had been. Our concentration was so intense that neither of us saw the hand until it crept into the operative field and began groping aimlessly around, palpating the fleshy, moist intestines. The hand was ungloved — most definitely out of place in our previously sterile operative field. It seemed to be a foreign thing from the twilight zone beneath the surgical drapes. The surgeon and I looked up at each other in alarm, and then at Straus, the newly arrived intern, but Straus couldn't take his eyes off the hand. The next few seconds whirled in mental confusion as the three of us strove to connect the intruder with one of the operating team. Just as I dropped my needle and thread and was reaching to pull the hand away from the incision, the surgeon figured it out. "For Christ's sake, George, the guy's got his hand in his belly!"
Awakened from his reverie, George, the anesthesiologist, poked his nose over the ether screen and commented, "Well, I'll be damned," in a noncommittal sort of way, before dropping back on his stool. With a deftness that belied his apparent torpor, he injected a potent muscle-paralyzing drug, succinylcholine, into the IV tubing. Only then did the patient's hand relax and fall back onto the surgical drapes.
"When you said you'd keep the patient light, I never thought I'd be wrestling with him," said the surgeon.
Instead of answering, George eased off on the succinylcholine IV with his right hand while his left opened the tank of nitrous oxide a few more turns. After several forceful compressions of the ventilation bag, to speed the nitrous oxide into the patient's lungs, George looked up to join the fray.
"You know, George, this epidural anesthesia of yours is good fun. Puts the challenge back in surgery. In fact, this case is exactly like a sixteenth-century appendectomy."
"Oh, I don't know," George retorted. "Back then the patients not only attacked with their hands; they kicked, too. Have you noticed how quiet his feet have been? We're making a lot of progress in anesthesia."
As such sallies went, this was a pretty heavy barrage, and the surgeon decided not to return fire. Instead, he directed his attention toward salvaging what he could of the operative field. While he kept a precautionary hold on the patient's troublesome hand, I covered the incision with a sterile towel soaked in saline. Straus and the scrub nurse and I were still sterile, as the OR terminology put it.