We are now the old-timers, newly promoted second year residents, sitting together, feeling secure, in the back row of the basement conference room. We look over the newly arrived residents and interns in the front row. They are excitedly introducing themselves to each other, looking about the room, probably wondering, as we did a year ago, whether or not they have chosen the right place to train. Dr. Wasserman and the faculty are in their usual places on the left side of the room. Dave Siegal is sitting in the chief resident’s chair today for the first time.
“Okay, everyone, let’s start the meeting,” says Dave, calling us to order. “For the new house staff, I’m Dave Siegal, your chief resident, and this, as you know, is Dr. Stanley Wasserman, our chairman, who has some words of welcome.”
“We start a new academic year today,” says Dr. Wasserman. “I’d like to warmly welcome the new house staff. The faculty and I, Dave and the senior residents, will do everything that we can to make your stay at the County worthwhile. You’ll notice I didn’t promise an easy or pleasant tenure, because the work will be hard but I believe, rewarding. To the returning senior residents, I’ll repeat what I said last week. Thank you for a very good year of hard work as JR’s and interns. Now it is your turn, as the Senior Residents, to use your knowledge and experience, to support and coach the junior house staff and to welcome the newly arrived SR’s. At this time I’d like to introduce the members of the department.” He introduces each of the faculty, without the usual kidding around. Then, he turns the meeting back over to Dave.
“Before I hand out the schedules and talk about the nitty-gritty details of the rotations,” says Dave, “let’s go around the room and introduce ourselves. Why don’t we have the SR’s go first?” We stand one by one and state our names and our assignments, as the new house staff looks us over. Then it’s their turn to rise and feel our scrutiny as they give their names and backgrounds.
At the end of orientation, I find my new JR’s, Marcello Pasco, from the University of the Philippines and Kathy Neal, from Tufts. We crowd into the lift, along with the other teams who are also talking excitedly.
“I’m small and don’t take up much room, so don’t you be crushing me or you won’t get to your floors,” warns Peg O’Hare, as she reaches out to shut the elevator door. “First stop is Five.”
We are the last off on Eight.
The new training year is one week old. The JR’s, the two fourth year students, Miss Kennedy, the head nurse on Eight, and I are talking over nursing concerns, something that I’ve initiated as a part of work rounds.
Miss Kennedy starts, “We can’t keep an IV in Kim Martin, that nine month old with dehydration. Now that he’s better, he wiggles out of all restraints.”
“And Jack Reardon, the 14 month old is back again with another fracture, this time his femur. His parents seem loving enough with him, but the staff doesn’t think that their story of how he keeps tripping and falling is enough to account for his fractures. Could he have some form of brittle bone disease?”
“Oh, and Sally Rider is a real problem with those pressure sores on her head. We keep trying to turn her head from side to side, but her head is so big and heavy that she doesn’t move it spontaneously, so now she’s got them on both sides.”
Now I’m responsible for all problems. Could Sal peek into minds of Reardons? No! Big ethical no-no. Wonder if he might be somewhere around hospital? Seems to be an edge of worry–something–in his thoughts. Like I’m now able to feel some emotions. He on staff?
Marcello says, “Back home, my professor said that when they recover enough from dehydration to kick out of their restraints, they’re well enough to eat, and she used to advise thin, rice soup.”
“But here we can calibrate their electrolyte requirements and get IV’s easily, so it’s a different story,” I say. “We can rest the gut a little longer before challenging it with food.”
“Do we know for sure that giving something soupy as Dr. Pasco suggested, say chicken soup with rice or crackers would make the diarrhea worse?” asks Harry, one of the two students. “They must have a lot more experience with gastroenteritis in a place like the Philippines than we have here.”
“I’m sure that they do. But what may seem to work there, may not necessarily be the best thing to do. Just the best under the circumstances,” I reply, smug in my Western science. “The principle of resting the gut is pretty much universally accepted.”
“If this IV comes out, can we try an NG tube with an oral electrolyte solution to see if that’ll work?” asks Kathy.
“Inventive. Sure, give it a try,” I say. “Let me know what kind of solution you want to use. Remind me to show you a paper where they did just that in Peru. But then again, that was in Peru. You have to be careful about the amount of salt you give because it can cause hypernatremia. Still, it would be a shame to do a cutdown when he’ll probably be off IV’s by tomorrow.”
“Kathy, could you talk with the Reardons again about how their baby fell. You’re right, Miss Kennedy, two fractures in 3 months seems a bit much. He’s an active child, though–remember those bruises on him when he was admitted?”
“And Poor Rider. I don’t understand why she hasn’t gotten into Lexington State yet. She’ll probably still be here when I leave. I know you’re doing the best that you can with the sores. Just hope that they don’t turn into really deep ulcers.”
“What about a plastic surgery consult regarding the sores?” asks Marcello.
“Good thought. Put in the consult request and talk with them in person when they get here. Maybe they’ll have something to offer.”
The plastic surgeons do come by later in the afternoon, but they don’t have anything new to add.
Maybe Sal can help with Rider. If he could check out the collective wisdom of Boston’s neurosurgeons and dermatologists.
During the after-work drive home, the summer heat has shortened the fuses of Boston’s drivers even more than usual. Nice to be able to get away from this–have a calm conversation with Sal while we inch along. Not tempted to blow horn and trade insults. Oh oh—guy in Plymouth gave guy in Chevy the finger– now he’s getting out. I’m stuck.
“So what do you think, Sal? Could you scout around and see if there is any possible way to heal those head ulcers or to relieve the pressure on them so that they have a chance to heal?”
“I’ll let you know what I come up with tomorrow.”
“Thanks, I’d appreciate that, and so would poor Rider, that is, if she could think or could feel pain.”
“What makes you so sure she can’t?”
“How can she? She’s got a bag of water for a brain.”
Glad those guys just yelled at each other—no punches or cops would be here and we’d be here forever. Everybody’s blowing their horns—and it’s too hot to roll up the windows.
At the end of morning work rounds, I talk to the students and my two JR’s about what we’ll need to do on Monday. Then, having decided on the cases that Kathy and Marcello will present to the department, we head down to Saturday Chief’s Rounds. The summer has been quiet up till now and rounds have ended early.
This is just as well, since it gives the new residents a chance to get used to the setting and the system, and we SR’s a chance to become more accustomed to our new supervisory roles, one step removed from the direct patient care that we were intent on giving just a week ago.
With Karen on summer break, it’s also been nice to get off early and take advantage of the long afternoons created by daylight savings. Especially since the Boston Arts Festival is taking place during these first two weeks of July.
“I wonder what Karen has planned for today?” I say to Sal on the way home. “She said that she wanted to take in some of the Arts Festival, and there are events all over the city,”
“I’m sorry, Bob, could you repeat what you just said.”
“It wasn’t anything important. Just about maybe looking in on some of the Arts Festival.”
“Are you enjoying the perks of being an SR and being on only every fourth night?” Sal asks.
“Yes, but what is really nice is only being on every fourth weekend, even though we have to cover both Saturday and Sunday the weekend that we work. Since I worked the first weekend, I’m not scheduled again until the twenty-ninth and thirtieth. That’s really great during the summer.”
“By the way, are you interested in hearing what I found about bed sores?” asks Sal.
“Of course. Did you learn anything that will help Rider?”
“I really didn’t think that there would be, but thanks for searching,” I say. “Maybe I’ll ask one of the students to look through the Index Medicus just to be sure that we haven’t missed something.”
“That’s a good idea.”
“Yeah. Well, to switch to something more enjoyable, have you taken in any of the Arts Festival? Would you care to join Karen and me today if we do one or more of the programs?”
“Not today. And I’ll say goodbye now, since you’re almost home.”
“Okay. Talk with you tomorrow Sal.”
A little abrupt? In a hurry? Glad he has other interests. Was beginning to wonder.
After parking, I run across Beacon, enter our building, and walk up the stairs to our apartment. Karen is waiting for me and I can tell that she has something planned.
“Hi, how are you feeling?”
“Don’t I get a kiss first?”
“Oh, of course. Come here.”
Karen then continues, “I’m glad that you’re home early. If you don’t need to rest, I have lunch prepared, and I thought that we could picnic along the upper Charles adjacent to the stadium, where I read that the Festival has an exhibit of paintings and photographs set up in tents.
“I thought that you might want to do something. Guess you’re not feeling tired. That sounds good to me. Isn’t there also a concert tonight?”
“Yes. The Pops is playing on the Esplanade. We can go to that too, along with half of Boston and Cambridge. Then ‘Jazz on the Common’ is Tuesday night,” but that’s the night after you take call, so we’ll see how you’re feeling.”
“I’m home,” I call out as I shut the apartment door. “How did your appointment with Dr. Karlsberg go?”
“I’m in here,” says Karen from the kitchen. “He said everything was fine with the baby.” We kiss. “You’re home early.”
“Yeah, there isn’t much going on, so rounds were brief again.”
“I got a letter from Mom today,” says Karen. “She has her ticket, and she sent her arrival date. She’ll be getting in on Saturday, August 5, in the afternoon.”
“Did she say how long she’ll be able to stay?”
“Till the twenty-sixth. Three weeks. In my last letter to her I said that we’d agreed that she could stay a month if she wanted to, but she doesn’t have that much vacation time.”
“You did tell her that she’d be sleeping in the living room?”
“Yes. That’s fine with her. I’m so happy that she’ll be with us for three weeks. You’re sure you don’t mind that she’ll be here during your entire vacation?”
“Of course not. I don’t know your mother very well, since we just met briefly at our wedding so this will be a chance for the two of us to get better acquainted.”
“I really do hope that you like each other,” says Karen. “You’re the two most important people in my life.”
“Baby will make three.”
“Yes, and baby makes three,” Karen replies. “Dinner will still be a while in the oven. Why don’t we go sit where it’s cooler?” We walk to the living room after I get a bottle of Carling’s from the refrigerator and settle on the couch. Karen continues, “I phoned Maggie today, to confirm that we could borrow her folding bed, and she said it was okay, so we’ll need to drive over and pick it up someday. I hope that it’ll fit in the trunk.”
“Do we need to do anything else to get ready for Mother’s visit?”
“If I think of something, I’ll let you know.”
“It looks like you’ve got Charlie progressing nicely,” I say to Kathy on morning work rounds. “Let’s get a repeat set of ‘lytes on him this morning,”
“Do we really need one? They were normal yesterday,” she says with a frown. “He’s been drinking and peeing well and isn’t vomiting anymore. His IV can probably come out today.”
“That’s why we want to check ‘lytes before pulling it.”
“Well, I think that it’s superfluous, since he’s been improving and they were okay yesterday,” says Kathy with a shrug, “But you’re in charge.”
“Anything else about him before we move on?”
She shakes her head no, and we continue on to one of Marcello’s patients, stopping beside the crib as he updates us.
“Okay, Marcello,” I ask when he finishes, “What do you want to do next?”
“I’d like to get an upper GI series, since the stool is positive for occult blood.”
“Why not a barium enema first?”
“Well, I thought that if the upper GI is negative, I would follow up with that.”
“I think that I’d reverse the order,” I say. “Statistically, you’re more likely to pick up something in the colon as the culprit.”
“Yes, but if it’s negative, doesn’t doing the barium enema first interfere with getting an immediate upper GI series?”
“Why don’t we go with the most likely causes and order a barium enema first.”
“Well, okay. But I still think that his symptoms are more in keeping with an upper GI site.”
“Guess we’ll see if you’re right or I am after the studies come back.”
Later that evening, I talk to Sal as I drive home. “I was a little afraid at the start of the year that I would have trouble being the coach and not the direct care giver, but I think that I’m making the transition.”
“It’s hard, isn’t it, not diving in and making all the patient care decisions.”
“Of course the JR’s do need supervision. After all, this is only their first month at County.”
“When you were a JR, your SR’s cut you a lot of slack, didn’t they?” asks Sal. “Wasn’t that one of the appeals of coming here? That you were given a lot of responsibility during the first year?”
“Oh sure. But they also supervised us so that we didn’t hurt anyone.”
“Well, just try to keep that in mind.”
“Why? Do you think that I’m being too directive with my JR’s? I talk over case management with them and let them express their opinions.”
“It’s not so much what I think as what Marcello and Kathy think.”
“So what do they think?”
“Why don’t you ask them?”
“Tom and Harry,” I say to the medical students at the end of morning rounds, “You have your assignments. Do you feel confident enough now about doing the lab work we discussed on rounds without Kathy and Marcello there?” They say yes, and leave to carry out their tasks.
“Kathy, Marcello, could we talk in the office before you go off? We have a little extra time this morning.” We walk out of the ward and past Miss Kennedy’s desk in the hallway, and enter the small resident office.
“What’s up, Bob?” Kathy asks.
“It’s two and a half weeks into the year, and I wanted to check with you and see how you thought things were going.”
Marcello and Kathy look at each other.
“Why don’t you go first,” Kathy says to Marcello.
“I’m learning a lot about how things work in America,” says Marcello. “You have a lot more stuff to work with here than in my country.”
“Yeah. And this is a county hospital. You should see the resources available at a private hospital,” I say with a smile. “But I was wondering more about the teaching and supervision.”
“Oh, Dr. Wasserman is as good as his reputation.”
“How about right here, on the Eighth Floor? How do you feel about this rotation?”
“Oh—it’s all right,” says Marcello.
Not exactly a ringing affirmation. Stop beating around the bush. Just ask the question.
“I guess what I’m trying to get at is your feelings about how I’m doing as your SR.”
There is another pause while they look at each other again.
“Well, to be honest,” says Kathy slowly. “You did want an honest answer, didn’t you?”
I nod yes. Here it comes.
She continues, “I kind of feel like I’m being treated like I’m still a fourth year student. We’re not getting enough freedom to make management decisions about our own patients. You’re even telling us what diets to use, and what tests you want done, instead of letting us decide those things. Shouldn’t your role be more to supervise what we do and to keep us out of trouble and to teach us out of your experience? At first it was all right, since we were just starting, but now that the month is more than half over, and we know our way around. We don’t need as much hand holding.”
“Marcello, is that the way you feel too?” I ask. Et Tu, Marcello? Sal did try to warn me.
“Well, somewhat. I did have a pediatric residency in my country before coming to the U.S., so I do have some practical experience.”
Probably seen really exotic, serious stuff. Things we only read about.
I take a deep breath. “Thank you for giving me an honest answer,” I say. “It wasn’t what I wanted to hear, but I needed to know your feelings. I guess that it was harder for me to switch gears from being a JR to a SR than I thought.” I see Marcello and Kathy nodding their heads.
“Yeah. Okay. It looks like I need to pull myself back and give you more slack. If at any time you think that I’m becoming overly-directive again, please remind me of our conversation today. After all, we still have another month and a half to work together.”
“I’m glad that you brought it up too,” says Kathy. “Marcello and I were wondering how to talk to you about it. Next year, we’ll have to remember to not do the same thing when we’re SR’s. But we really do think that you’re doing a good job of sharing pearls with us, and working with the students. And we like you personally.”
Well, one positive. Nothing like being bad example. One way to make a point: “Don’t do as I do.” Even if unintentional. How did Sal know how Marcello and Kathy felt? Couldn’t have been coincidence. Just happened to tune in to them out of all the people in the city? He hang around our minds here at County?
I’m on call tonight, but things are quiet after eight, so that I have a chance to call Sal.
“Hello Robert. I’m glad that you’re having a quiet on-call. Gives us a chance to talk. What’s up?”
“You were right about my JRs’ feeling that I was being controlling. We had a frank talk about that this morning.”
“I’m glad that I could be helpful,” says Sal.
“How come you just happened to tune into their minds? It seems to be too big a coincidence. You’re around here somewhere, aren’t you?”
“Robert, you know that I consider you to be a good friend, and I know that you feel the same way about me. What friend wouldn’t help? I knew that you were concerned about whether or not you were doing a good job as Senior Resident. And I decided to help you by checking the minds of your JR’s and students. That’s all. They weren’t hard to find. By the way, Tom and Harry think that you’re a veritable fount of pediatric knowledge.”
“Thanks. But how does doing that square with all the platitudes you’ve been spouting about ethical telepathic behavior? Tell me that.”
“I did not harm them in any way by going into their thoughts, nor did I personally profit from what I did. Instead, I helped to improve the relationship between the three of you. And helped you to become a more effective SR.”
“How did you know that I wouldn’t fly into a rage and really try to screw Kathy and Marcello after what they told me?”
“Because I know you now. I know that you’re basically a decent, well-meaning person. And you wouldn’t do that.”
“And you’re not physically around the County?”
“I’ll neither confirm nor deny that. As I told you before, there will come a time, but that time is not now. Enjoy what we have. It’s not necessary to analyze or understand everything. For example, I have no idea how telepathy works or why only a few of us are gifted with it. And yet you and I found each other through its use. And we’ve become friends. There’s no harm and no selfish gain.”
The phone rings and it’s the ER resident saying that there’s a possible admission to evaluate.
“Look, I’ve got to go. I hope you don’t resent my curiosity and doubt. I appreciate what you’ve done for me. But it’s natural to wonder.”
“No Bob. I know you think that I’m too secretive. Be patient. There really is a good reason. I value you as a friend. Good night.”
At nine o’clock I’m in the nursery talking with the JR on duty, when I hear my page. One of the ER Junior Residents wants me to evaluate a patient. It’s a busy Friday night as I walk into the ER, and the overflow benches in the hallway are fully occupied.
Inside, all six exam tables and cribs are in use, and the two JR’s, Phil Wright and Linda Nikolas, look harried. The nurses are flying about.
“Glad you’re here,” says Phil. “The kid in three has a stiff neck and a fever. We’re so backed up that I didn’t tap him but called you right after I examined him. He may have aseptic meningitis, since he doesn’t look that sick, but we just don’t know.”
“Okay, let me take look at him and then I’ll take care of the tap if it’s needed.”
I walk over and introduce myself to his mother. “Hi, I’m Dr. Morton, one of the Senior Residents on call.” I look at the chart, then say, “And I’m here to take a look at Marvin, Janet.”
Marvin’s mother Janet Smith, is a young, heavy-set Black woman with a worried frown, carrying her one-year-old on her shoulder. “We calls him JR for Junior. What’s wrong with him, doc? The other doctor said that he may need to be admitted and said something about a spinal tap. Said you’d be down to decide.”
“Yes. That’s what Dr. Wright told me too. I’d like to ask you some questions, then examine him. Then I’ll have a better idea about whether or not that’ll be necessary.” I run my hand across his scalp first. Warm. But fontanel closed. No clue there. Marvin begins to cry. Sounds normal-—not high pitched. I ask some quick questions.
“You want me to lay him down?” She asks when I finish my history taking.
“Not just yet. Please continue to carry him just like that. I’m going to listen to his chest, then look at his ears. Later on I’ll need him to lie down.”
His chest sounds clear with good breath sounds, as I listen to him inhale between cries. Then I look at his ears. His cries increase when he feels the otoscope touch him, but his mother holds his head steady, and I get a good look at first one ear, then the other. They’re fine. I go on with the exam, saving the evaluation of his neck for last. It is stiff, but he doesn’t look that sick. No rash. Did have some vomiting. Probably viral. But still needs a tap.
“I’m afraid that I agree with Dr. Wright,” I say. “JR does have some of the symptoms of meningitis. Now there are two types of meningitis. One is due to a germ that needs to be treated with antibiotics in the hospital, the other is caused by a virus that does not need treatment and may not need to be admitted at all, or at most only for a day or two.”
“Oh my God. What kind do you think he has?”
“More likely viral, the less serious kind, but the only way we can be sure is to do a spinal tap and run lab tests.”
After I explain what will be involved, she says, “I got to get his father. Can you watch him a minute?”
While she’s gone, I call out to one of the nurses scurrying by, “Jackie. Page Dr. Pasco and ask him to come right down, please. He’ll need to do a tap on this kid.”
Janet returns with a stern-faced young man in a white tee shirt, blue jeans. “This is Marvin Willis, Senior, JR’s father,” she says.
I extend my hand, which is ignored. “So what’s wrong with my son?” He asks unsmiling, thick arms crossed over his well-muscled chest.
I explain what we think is wrong with Marvin and what needs to be done.
“You want to stick this needle into my son’s back because you don’t know what he’s got? Can’t you find out some other way?”
“That’s the only way to be sure whether or not he has meningitis and whether or not he’s going to need antibiotics. And even then, the tests may not be definite, so he may need to be admitted for a couple of days for observation until the cultures come back.”
“So why not just do that and not stick him with the needle?”
I re-explain. But JR’s’s father becomes more irritated. “If you do this-here tap, how long’s it going to take to find out?”
“The tests will be done right away except for the culture which will take twenty-four to forty eight hours. But it’ll probably only be an hour after the tap to get the first results.”
Marvin Willis explodes. “God damn it! This place sucks! We had to wait two hours to get him checked and now you tell me he’s got something real serious and it’ll take another hour to find out. If we wasn’t Black you wouldn’t treat us like this. Damn Ofays.”
“Being Black doesn’t have anything to do with it,” I say, trying to sound calm. “We’re just doing the best that we can for everyone who comes in here.” Should I reach out to him. Better not. Might take a swing.
“Marvin. . . “ begins Janet.
“Woman, don’t you be starting on me too.”
“What’s happening here?” Allie, who’s down here for another patient, puts her head through the curtain, then walks through. “Stay cool, Brother.”
“What are you, a nurse?” says Marvin.
“I’m a doctor here. Dr. Morton and I, we work together. Can I help?”
“We been waiting so long, and now this . . . now Charlie here says we got to wait some more to we find out if my boy’s got something really bad. If he was that sick why didn’t he get seen sooner?”
“Doc Morton may be White, but he won’t jive you. I’d trust him with my own kid. I realize I it’s so hard to wait when you’re so worried, but we’re just trying to do our job for everyone the same way. Let me take you two outside, while doc here takes care of your boy, okay?”
“Yeah. Okay, Sister. I mean doctor. But if anything happens to my son, I’ll be around,” he says turning to stare at me.”
Allie puts a hand on each of their shoulders and gives me a smile as she guides them out through the curtain. I mouth a silent ‘thank you.’ Marcello comes through the curtain a short time later, followed by Jackie carrying a lumbar puncture kit.
“I was outside, but thought there were enough people in here, so I waited,” says Marcello, looking a little sheepish.
“Well, let’s get going,” I say, after taking a deep breath.
Fortunately the CSF shows an increased number of lymphocytes, consistent with viral meningitis, and, after saving an extra tube of fluid for the research project of one of Saul Norman’s fellow’s, Marcello and I return to the ER to share the good news with Junior’s parents.
Later I catch up with Allie in the cafeteria. “Thanks for bailing me out. That guy looked ready to take a swing at me.”
“I managed to stay with them, while my JR took care of our admit. He cooled down. The mother was pretty reasonable.”
“Since when do you have a kid for me to take care of?”
“Oh you know, that was just a little white lie,” Allie laughs.
White lie?–irony or figure of speech?
“Yeah. And what’s Ofay?”
“Well…just another way of saying ‘Whitey.”
I catch up with Kathy just before we leave the ward for Chief’s Rounds. “Kathy wait a minute. I’ve been meaning to ask you, how do you feel about patient management since we had that talk last week?”
“I think that you’re trying hard to let us take the lead. Thanks.”
“Do you feel that I’m still adequately backing you up?”
“Oh yes. I don’t get the feeling that you’ve gone too far in the opposite direction of not giving any supervision,” says Kathy. “I know Marcello feels the same way.”
“That’s good to know. Anyway, I‘ll ask him too. Let’s get the elevator.”
After conference, I catch up to Marcello who’s headed for the cafeteria. “Hey Marcello, got a minute? Let me talk with you while you eat. I’ll get a cup of coffee while you get dinner.”
He confirms what Kathy said and, feeling better, I say good night to him, wishing him a calm ‘on-call,’ and head out for my car. I guess I could have asked Sal to check on them, but I feel better doing it myself, openly. I call up Sal to tell him about how things are going as I unlock the car.
The concrete, asphalt, and bricks of the city have absorbed the sun’s energy all through the day, and at six-thirty, with the sun still high in the western sky, they exhale their stored heat into the still air. I drive along Bay State with all the windows rolled down and my jacket off, tie loosened and shirtsleeves rolled up, but I still sweat.
“Hot enough for you, Sal?”
“July and August in the city are terrible. That’s why the Cape and the Maine coast are so popular.”
“Well, maybe we’ll get a chance to sample them when I go on vacation in three weeks, but even then, with Karen’s mother here, we’ll probably stay at home and just take day trips. Karen is counting the days till she gets here.”
“Everything ready for her visit?”
“Karen and her mother are very close, aren’t they?”
“Yes,” I say. “Karen is an only child, and she lived at home until coming to Boston for grad school.”
“And then she met you and you were married six months later. Not much time for her mother to adjust to losing her baby.”
“Karen told me something interesting recently. Apparently her father and mother divorced when she was two, and he moved out of state. She never saw him again. Her mother told Karen that her father had died, not that they were divorced. Of course, that was only a partial lie since her mother learned that he was in fact killed in 1947. But she never told Karen the full story until 1949 when she was twelve years old.”
“Karen must have been stunned,” says Sal.
“She was. She was very upset that her mother would lie to her for so long. Since then, she’s accepted her mother’s explanation that because divorce held such a stigma then, she wanted to spare Karen until she was old enough to understand and handle the fact that her father had never made an attempt to contact her.”
“Rejection. I can see how that might bother a child. Her mother never considered remarriage?”
“Did her mother try to dissuade her from marrying you?”
“I guess she did try to have her delay the wedding until we both ‘were sure we were right for each other,’ but Karen told her that we were sure. Karen suggested that I write to her mother and ask for her approval of our marriage, and I think that helped ease her doubts a little. I mean that I was being that old-fashioned.”
“What would have happened if she hadn’t given her permission?”
“I asked for her approval, not her permission. We would have gotten married anyway,” I reply. “Probably she realized that, since Karen has a mind of her own. But it’s better that she did give us her approval.”
“Well, I hope that you’ll get along when she comes to visit, and that she won’t still see you as a rival.”
“She’s had two years to get used to the idea of Karen being married to me. After her own painful experience, I would think that she’d really want Karen’s marriage to succeed. And now that Karen’s pregnant, the prospect of becoming a grandmother should hopefully be exciting to her.”
“Just remember that her husband abandoned her and Karen not that long after Karen was born. She may view the pregnancy as a danger period for your marriage. Even Karen may have a subconscious concern about it.”
“Good point. The possibility never occurred to me. Did you get it from Karen’s mind, or did you think of it yourself?”
“No. The thought came to me as you were telling me the story.”
“I’ll try to be sensitive to that possibility with both of them.”