Робин Кук - The Year of the Intern

The memory of my first pelvic floated across my consciousness. It had been during a second-year medical-school course in physical diagnosis. I had had no preconceptions, which was fortunate, because my patient was quite a hefty lady. She was a clinic patient in for a regular checkup. At first I didn’t think my arm was long enough to reach the uterus, and the guy after me claimed he lost his watch — although he found it later in the bag where we threw the gloves. At the time, we had not yet been through obstetrics or gynecology, and reaching into the lady was strangely unsettling. But after a hundred or so, a pelvic examination is a routine like any other. The only problem is finding the cervix — which might seem absurd, because it’s always there. But when there’s a lot of blood and dots, the job can be hard, particularly if the patient is uncooperative. Moreover, you don’t want to hurt the patient by fumbling around. So it pays to take a few minutes extra and do a good job. But not before lunch.

“How long had you been pregnant?” I suddenly asked the girl from New York.

“What?” She was sputtering again, in obvious surprise. Since it was important for me to know, I let the question hang in silence. “Six weeks,” she said finally.

“And was it a doctor or someone else?”

“A doctor in New York,” came the resigned answer.

“Well, we’ll do what we can for you,” I said, and she nodded in relief.

Leaving the room, I told the nurse to get her ready for a pelvic. In a matter of minutes the nurse reappeared to say that everything was ready, and when I walked back in the patient was draped and waiting nervously in the stirrups, with her skirt rumpled around her waist. As I prepared to insert the speculum, I couldn’t help recalling a night six weeks before when I had been waked up by a nurse saying that she couldn’t catheterize an elderly patient with a full bladder because she couldn’t find the right hole. I had gotten up and been halfway over to the hospital before the ridiculousness of the situation hit me. If the nurse couldn’t find it, how could I? But I did, after a while; it was just a matter of persistence.

It was the same with finding this cervix. Persistence. Surrounded by blood and clots, which I cleared away as best I could, the cervix suddenly popped into view. The orifice was closed, and no new blood appeared when I dabbed it with a sponge stick. I pushed down on the abdomen, to the girl’s great discomfort, and got nothing. Then I noticed a small tear, bleeding very slowly, on the posterior aspect of the cervix. Almost surely that was the problem. I cauterized it with silver nitrate, called a gynecologist, explained things, and walked over to lunch with a unique feeling of accomplishment. Miraculously, I was still hungry.

Lunch was a rapid affair; fifteen minutes of stuffing down two sandwiches and a pint of milk amid careless banter of surfing, surgery, and sex. Nothing serious — there wasn’t time for it. I made some tentative plans with Hastings to go surfing late the following afternoon about four-thirty. Carno was eating at a distant table; except for seeing each other at the hospital, we rarely got together any more. I also talked with Jan Stevens for a few minutes. I hadn’t seen much of her lately, although during July and August, early in my internship, we had had quite a spree, culminating in an unusual weekend trip to Kauai.

The first day, Saturday, had been great. We stocked the car with beer, cold cuts, and cheese, and drove to the big Kauai canyon. On the way, the road rose and fell among the clouds, moving us in and out of quick rain squalls as the sugar-cane fields rolled by on either side. The canyon was even more expansive and spectacular than we had expected. I found a lookout for us, and Jan turned the groceries into sandwiches. I asked her not to talk — a necessary precaution, because as our relationship had developed so had her desire to communicate. The view was wonderful, what with rainfall, waterfalls, and rainbows sparkling in the corners of the steep valleys that branched off from the main canyon. I was totally at peace.

By late afternoon we had driven to the end of the road on the northern shore, right at the beginning of the Napali coast. In a secluded grove of evergreen trees, I put up our borrowed pup tent, and as the sun prepared to set among the puffy little clouds along the horizon, we swam naked in the still waters within the protective reef. It didn’t matter that there were campers in full view at the other end of the beach — although I wondered why they were so near the water, rather than where we were, on higher ground among the pines.

Somewhat self-consciously we ran up to the car. I pulled on a pair of white jeans and Jan wriggled into a nylon windbreaker. Even another meal of cold cuts and beer couldn’t destroy the atmosphere. Night descended rapidly, with the sound of breaking surf on the reef mingling with the soft whisper of the breeze through the evergreen trees above us. The night creatures began their eerie symphony, increasing in intensity until they dominated even the sound of the surf. The western sky was just a smudge of red. Jan looked beautiful in the half-light, and the idea of her in nothing but that nylon windbreaker seemed fantastically sexy. In fact, I was delirious with the sensuality of the moment.

Naked once again, we returned to the beach. As we slid into the water the full Hawaiian moon floated over a ridge of trees; the scene was so perfect it seemed unreal. I couldn’t stand it a second more. Holding hands, we ran back to the tent and fell together on the blankets. I wanted to devour her, to capture the moment in my mind.

Slowly and reluctantly, from the depths of this wet embrace, I became aware of the whine of mosquitoes. In our desire to make love, we tried to ignore them at first, but they began to bite as well as whine. No passion could have resisted that onslaught. In dreadful seconds the whole sensual atmosphere disintegrated, ending with Jan’s departure to the shelter of our Volkswagen. Still shaking with desire, I resolved to stick it out in the tent rather than sleep crammed into a car built for midgets. I rolled up in one of the blankets so that just my nose and mouth were vulnerable. Even so, the mosquitoes bit me so relentlessly that my face began to swell, and finally I surrendered, trudging back to the car accompanied by a swarm of mosquitoes who seemed as unfulfilled as I was.

I knocked on the window, and Jan sat up, wide-eyed, opening the door with relief when she recognized me. I stumbled in wearily and told her to go back to sleep. After smashing the mosquitoes that had come in with me, I somehow fell asleep myself, under the steering wheel, in a contorted ball. In about two hours I awoke sweating. The temperature and humidity had risen to Turkish-bath levels; the moisture was so thick it had condensed on all the windows. Opening a side window, I felt a cool rush of air and about fifty mosquitoes come into the car. That was that. I started the engine, told Jan to relax, and drove out to the main road and back toward Lihue, until I found an elevated spot with a good wind, where I managed to doze until the sun came up. My breakfast was bread and cheese mixed with ants and sand and washed down with warm beer, all eaten off the hood of the car. Then I woke Jan up and we drove back to town.

Somehow Jan and I had drifted apart after that. Not that I blamed her for the weekend. It was more because she began heckling me a lot, especially after we started sleeping together, wanting to know if I loved her, and why not, and what was I thinking about. I loved her sometimes, in a way that was hard to explain; as for what I was thinking, most of the time we were together my mind just drifted. Anyway, I couldn’t cope with her questions. It had simply become convenient to let the whole thing slide back into casual friendship. But it was nice seeing her in the cafeteria. She was still a great-looking girl.