Робин Кук - The Year of the Intern

With all my medical books packed, I didn’t have anything to read to put me to sleep. Then I remembered the drug-firm throwaway I’d crammed into my suitcase. I pulled it out and settled back into the cool white pillow. Appropriately enough, it was titled The Anatomy of Sleep. Flipping to the back of the book, I learned it was a hard sell for a sleeping pill. I cracked open the volume haphazardly and began reading. With so much on my mind, I managed to finish a whole page before my eyes began to droop.

The harsh ring of the phone came at me even before I had a chance to start a decent dream. In customary panic, I snatched up the receiver as if my life depended on it. By the time the operator connected me to the nurse who had paged me, I was well oriented as to time, place, and person.

“Dr. Peters, this is Nurse Cranston of F-2. Sorry to wake you, but Mrs. Kimble has fallen out of bed. Would you come over and check her, please?”

The luminous radium dial of my alarm clock told me I’d been asleep for about an hour.

“Miss Cranston, we have a new intern tonight. Name’s Straus. How about giving him a call on this problem?”

“The operator already tried,” she said. “But Dr. Straus is scrubbed in surgery.”

“Piss.”

“What did you say, Doctor?”

“Is the patient all right?” I was stalling.

“Yes, she seems to be. Are you coming, Doctor?”

I growled something implying the affirmative and hung up. Clearly, I hadn’t graduated from internship yet. Until I actually hauled my body out of range, there would always be one more patient to fall out of bed. Lying there thinking about it was a mistake. I drifted back to sleep.

When the phone rang again, I responded with the usual panic, wondering how long I’d been asleep. The operator enlightened me — twenty minutes, she said — and canny as she was, saved me the effort of making an excuse by suggesting I might have fallen back to sleep. After all, it happened to everyone, even on emergencies. If I didn’t put my feet out on the cold floor immediately, my chances of getting up fell precipitously. For a while, my trick had been to place the phone several yards from the bed, out of reach, so that I had to climb out of the warm nest just to answer it. However, with so many laxative calls that I could handle while horizontal, I eventually abolished that ploy and returned the phone next to the bed.

After the second call, I hauled myself out straightaway and dressed rapidly. With luck, I could be back in bed in twenty minutes. My record was still seventeen.

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.