Робин Кук - The Year of the Intern

But the laughter from that story had long since drifted away. We labored now inside Mrs. Takura, and the muscles in my hands and arms were numb from maintaining tension on the retractors in that awkward position hour after hour. As lunch-rime approached and receded, my stomach growled in protest, a counterpoint to the itch on my nose. My bladder was so full I didn’t dare lean against the operating table. Time crept on. I seldom saw into the wound, although I could tell what was happening from the surgeon’s comments. Fastidiously the vessels were sewn together — a side-to-side anastomosis — and the final suture was placed and run down with tired fingers. When I was at last relieved of the retractors, I couldn’t even open my fists; they stayed clenched until I bent the fingers back one by one and soaked them in warm water.

Although it was almost four o’clock, we were not through. We still had to close. Like all the others, I was tired, hungry, and uncomfortable in every way. Suture after suture, wire, silk, wire, slowly working up the long incision, starting from the bottom and working with rapid ties, the gaping portion very slowly but progressively drawing closed until the last fascial suture. Placed. Then the skin. By the time we snapped off our gloves at the finish it was past five — the beginning of my glorious night off.

I urinated, wrote all the postoperative orders, changed my clothes, and had some dinner, in that order. As I walked across to the dining room, I felt as if I’d been run over by a herd of wild elephants in heat. I was exhausted and, much worse, deeply frustrated. I had been assisting in surgery for nine straight hours. Eight of them had been the most important hours of Mrs. Takura’s life; yet I felt no sense of accomplishment. I had simply endured, and I was probably the one person they could have done without. Sure, they needed the retraction, but a catatonic schizophrenic would have sufficed. Interns are eager to work hard, even to sacrifice — above all, to be useful and to display their special talents — in order to learn. I felt none of these satisfactions, only an empty bitterness and exhaustion.

After supper, even though I was not on call, the usual ward work was still to be done, and I moved perfunctorily through a series of dressings, drains, and sutures. I rewrote IV orders, looked over laboratory reports, and did a history, physical, and preoperative preparation on one new patient, a hernia. Roso’s hiccups had started again as he came out of his hibernation with the Sparine. Anything I wanted to ignore I did so by leaning on my tiredness, rationalizing. I avoided even looking into Marsha Potts’s room.

Sleep was impossible, though I had been without it for most of twenty-four hours. Besides, I wanted to go somewhere away from the hospital, to talk with somebody. My confused and angry thoughts were rocketing around in my head too much for me to deal with alone. Carno couldn’t be located anyplace; probably he was with his Japanese girl friend. But Jan, thank God, was there and available. She wanted to go for a drive, perhaps a swim. She wanted to do anything I wanted to do.

We drove eastward, moving toward the silvery violet of the evening. The road took us up over the Pali to the windward side of the island, gradually climbing and opening out the view of the colors from the setting sun on the expanding panorama of ocean behind us. The scene had a poetry that kept us silent until we were through the tunnel and out in the shadow again, in Kailua. There we found a beach where we were alone. My head gradually cleared of hostile thoughts, and the prison of the day, with its creeping clock and stiff fingers, seemed far away as I floated in the shallow water, letting the small exhausted waves rock me with their surge. Later we lay on a blanket and watched the stars come out.

Wanting to hear Jan talk, I asked her questions about herself, her family, her likes and dislikes, her favorite books. All at once I wanted to know all about her, and to hear her tell it in her small, soft voice. She grew weary of this after a time and asked me about my day.

“I spent all day in surgery.”

“You did?”

“Nine hours.”

“Wow, that’s wonderful! What did you do?”

“Nothing.”

“Nothing?”

“Well, practically nothing. I mean I was the retractor, holding back the wound edge and the liver so that the real doctors could operate.”

“You’re silly,” she said. “That was important and you know it.”

“Yes, it was important. But the problem is that anybody could have done it, anybody at all.”

“I don’t believe it.”

“Yeah, I know you don’t believe it. Neither does anybody else. No one thinks that anybody but an intern can take an intern’s place. But let me tell you, in that operating room, no one could have done the nurse’s job except another nurse, ditto the anesthesiologist and the surgeon. But me? Anybody! The guy off the street. Anybody at all.”

“But you have to learn.”

“You hit the problem on the head. The intern is frozen in one spot, eternally retracting. They call it learning — that’s the rationalization — but if s a hoax. You learn enough about retracting after one day. You don’t need a year. There’s so much to learn, but why at this snail’s pace? You feel so damn exploited! They ought to hire people to retract, and put the intern over there tying knots and watching the surgeon work.”

“Can you tie good knots already?” she asked.

That stopped me. I could remember telling her that I wasn’t very good with knots, but still, her comment seemed discouragingly off the mark. It indicated that I wasn’t getting through to her and it was useless to try. Even so, I felt better, almost as if my own thoughts had focused. I told her no, I couldn’t tie very good knots, but I’d probably learn if they gave me the job.

She was getting to me again, turning me on. We ended up running through the shallow water. She was so beautiful, so full of life, I wanted to yell with joy. We kissed and held each other close, rolled up in the blanket. I was wild for her, and knew that we were going to make love, and that she wanted to as much as I did. But she felt obliged to talk some more first, and tell me some personal things about herself. For instance, that she had made love to only one other boy, but that he had tricked her because it turned out that he hadn’t really loved her. This went on for five minutes or so, slowly turning me off again, and I decided that making love was probably a bad idea, after all. She couldn’t believe this, and wanted to know why. The real reason, my inner frustration, would not have satisfied her. Instead, I told her that I loved the sheen in her hair and her sense of life but I didn’t know if I loved her yet. That pleased her so much she almost made me change my mind again. Driving back to the hospital, I got her to sing “Where Have All the Flowers Gone?” over and over again, and I felt at peace.

“You think you didn’t do anything today, but you did,” she said, suddenly turning toward me.

“What was that?” I asked.

“Well, you saved Mrs. Takura’s life. I mean, you helped, even if you thought that you should have been doing something else.”

I had to admit her point, a very nice point, which I had almost forgotten. For Mrs. Takura I would stand holding a retractor for weeks.

Back at the hospital I jumped into my whites and dashed over to the ICU to see how she was doing. Her bed was empty. I looked at the nurse, questioning, holding back the thought.

“She’s dead. She died about an hour ago.”

“She’s what? Mrs. Takura?”

“She’s dead. She died about an hour ago.”

As I stumbled back to my room, my thoughts piled up, tumbling over into tears, draining me of every thought except that the day had been a horrid abortion, unredeemed even by the act of love. In bed, I fell into a troubled sleep.