The fluorescent lights in the hall, the elevator doors, the stars in the sky — in fact, the whole trip over to Ward F escaped record in my brain. I functioned as an aware creature only when I found myself face to face with Mrs. Kimble.
"How are you, Mrs. Kimble?" I asked, trying to judge her age by the meager light of the lamp on the night table. I guessed about fifty-five. She was neat and tidy, and gave the impression of being a particularly meticulous individual. Her hair was drawn back in a tight bun that had streaks of gray.
"I feel terrible, Doctor, just terrible," she said.
"Where did you hurt yourself? Did you hit your head when you fell?"
"Heavens, no. I didn't hurt myself at all. I didn't even fall, really. I sat down."
"You didn't fall out of bed?"
"No, not at all. I came back from the bathroom, and I was squatting down right there." She pointed to the floor by my feet. "I was trying to get my notebook out of my night table when I lost my balance."
"Well, now try to get some sleep, Mrs. Kimble."
"Doctor?"
"Yes?" I looked back over my shoulder, having already turned toward the door.
"Could you please give me something for my bowels? I haven't had a decent movement in five days. Here, let me show you."
With great effort, she reached over and pulled out the night-table drawer, withdrawing a four-inch black notebook. She had to reach so far for the book that I was sure she would topple over, after all. I moved closer to the bed and held my arms under her extended torso.
"Look here, Doctor." She opened the notebook and ran her finger down a neatly written list of days. Each day was followed by a graphic and complete description of her bowel activity — form, color, and effort expended. Abruptly her finger halted at one of the days.
"There, five days ago was the last normal movement I had. Even that wasn't completely normal, because it wasn't brown. It was olive-green, and only this big around." She held up her left hand, with the thumb and index finger defining a circle about a half inch in diameter.
What could I say to her that would indicate competence and concern, and, most important, would extricate me immediately? I looked from the notebook to her face, groping for a reply and finding none. I passed the buck.
"I'm sure your private doctor would know far better than I what would be best for you, Mrs. Kimble. Just try to get some sleep for now."
Back at the nurses' station, I wrote something in her chart about the alleged fall; an entry in the chart was required after all such "falls." Then I set out on my return journey to my waiting bed.
"Well, Straus," I ruminated. "What would that little episode be worth under your new system? Professional pleasure, bull!"
My faith in airplanes is not unlimited. In fact, I don't truly believe- in the aeronautical principle. But I had to admit that the Pratt and Whitney engines sounded sturdy and reliable. I could hear them smoothly whining as they did their thing, and the huge, ungainly hulk of the 747 lifted off the ground, leaving Hawaii and my internship behind. I had a window seat on the left side of the aircraft, next to a middle-aged couple dressed in matching flower-print Hawaiian shirts. My carry-on luggage had been a bit of a problem — where to put it all — and I sat now holding my piece of coral, which was not designed by nature to fit neatly into a modern public conveyance.
The final good-byes had been rather subdued, after all. At the airport, Jan had "leied" me four times, as Hawaiian terminology puts it. Two of the leis were made of pekaki, and their delicate aroma floated in the air around me. There had been no more talk of Jan and me and the future. We would write.
I had mixed emotions about leaving Hawaii, but no ambivalence about the termination of my internship. Already, though, I was noticing a curious tendency in myself to remember and magnify the high spots, the fun of the year, and to forget the hassle and the hurt that actually had been dominant at the time. The body has a short memory.
As the plane banked to the left, I looked out the window at the island of Oahu for the last time. Its beauty was undeniable. Rugged ribbed mountains jutted toward the sky, covered by velvetlike vegetation and surrounded by a shining dark blue sea. By pressing my nose against the glass, I could see straight down to where the waves were breaking on the outer reef of Waikiki, forming long ripples of white foam. I would miss those.
I thought of Straus just starting his internship, with the whole year ahead of him. Right now, he was having one of the experiences I had had. Life was repeating itself. Straus and Hercules — that would be quite a confrontation. I imagined that the sharp edges of Straus's idealism would round off soon enough, after four or five cholecystectomies with Hercules.
Like a big bird in slow motion, the plane rolled back to a level position on its path toward California. The only evidence that we were moving was an almost imperceptible vibration. The island was gone now, replaced by an indistinct horizon where the broad expanse of ocean merged with the sky. I thought of Mrs. Takura, the baby born in the VW, Roso, and then Straus again. I didn't agree with everything Straus had said, but he had made me realize how little I knew, how little I cared about the system, except, of course, when it affected me directly. Imagine the AMA trying to block my federal low-interest loan for medical school! Impulsively, I rolled slightly to my right, clutching the coral, and extracted my wallet from my pocket. Settling back into the seat, I sorted through my cards and licenses until I came to it. "The physician whose name and signature appear on this card is a member in good standing of the American Medical Association." The words were impressive. They suggested an allegiance with a powerful institution. I had worked for five long years, and now I was there.
Just then I felt the first jolt, and then another one, sharper, more forceful, as the sign flashed on. "Ladies and gentlemen, please fasten your seat belts. We are expecting some local turbulence," the stewardess droned reassuringly.
I sat there next to the couple in the flowered shirts, holding my piece of coral and folding the AMA card nervously back and forth, back and forth, until the ragged fold parted and the card tore in half.
The Last Word
Dr. Peters has made the troubled journey from medical student through internship to the point at which society will recognize him as a full-fledged doctor. He can apply for, and undoubtedly receive, a license to practice medicine and surgery in any state of the Union. That will signal his readiness to be entrusted with all the responsibilities a medical license confers.
Thanks to his rigorous training, it can be assumed that he is ready academically. But is Dr. Peters equipped psychologically to practice medicine as a modern humane society has a right to expect?
"Old-line" doctors will be satisfied that he is. To the greater number of them, his personality aberrations are merely assurance that the "hazing" he got during his internship initiated him into the fraternity. Internship was rugged for them, and it should be just as rugged for the next generation. Toughen them up — these youngsters are too soft. Does such logic suggest that the older men may possibly be suffering from the same psychological problems as Dr. Peters, and for the same reasons? And what happens to the patient during these juvenile exercises?
The physician's traditional — indeed, antique — lofty standing on the world's scale of social values and, in the United States, the current awe of technological achievement have led to an attitude of increased veneration for the medical practitioner. As a direct corollary of this worship of all things medical, it has become unthinkable to question the medical profession's control over the education of the embryonic physician. Medical schools and medical training programs have been relatively free to do as they please. No one asks why.