8. Stranger in the Mind-Chapter 8

Chapter 8.  April

April 2.

It’s a rainy Sunday afternoon, and we cancel our beach plans to drive up to Plum Island.  We have a light lunch of clam chowder and French bread, then lie on the bed to read the Sunday papers.  But the papers are soon scattered on the floor, along with our clothes.

Now Karen holds her body above me, arms extended.  I hear her breathing through parted lips as she moves on me.  Her face turned up, eyes closed, fine sweat glistens on her flushed forehead and cheeks, and her long brown hair moves loosely to and fro.  I delight in touching the supple curves of her body, the smoothness of her skin; feeling her movements.

“Oh, you’re as hard as a stick,” she gasps.  Then, “I’m so close.”

At her words, I feel myself start to gather, deep in the pelvis,  “Me too.  Oh hurry,”  and then I too am swept along into the long rising wave of our swelling orgasm and ….

“Hello, Bob,” says Sal, “Oh!….”

“Get out!”  We crest as our bodies mill out our union.  The wave breaks.  Karen shudders.  I hear her long, low, drawn-out moan, echoing my own exclamation as I lift up from the mattress, fitting so tightly together. 

The reverberations fade away and Karen sags onto me, lying along my body, breathing rapidly.  I slowly become aware again as I catch my breath, feeling her warm weight.

“Damn you, Sal, are you still here?”

“I’m so sorry.  I’ll go.”

Damn that Sal!  It’s ridiculous intruding.  A ménage à trois,  This is all such an absurd and unlikely a thought  that I have to chuckle.

“I didn’t think it was funny,” Karen murmurs softly into my chest.

“No, I’m happy because you make it so very wonderful.”

“Oh, it was,” sighs Karen, “but I must be getting heavy; I’d better get off you.” 

“No, please stay a while.  I love feeling your weight on me.”  I hug her tightly, and bury my nose in her hair, inhaling deeply and whispering, “Karen, I love you so much.”

“Bob, you know I love you too.  It was so good this time.”

After a long while, as I’m getting drowsy, she stirs and asks, “Do you have the towel?”  She rolls off and onto her side.  “Let’s take a shower,” she says, as she sits up on the edge of our bed.  “It’s nice not having to use that messy diaphragm and gel during the week after my period.”

“Mmmm,” I agree, sitting up too and nuzzling the warm, smooth place where her neck and shoulder meet, tasting her slightly salty skin, inhaling her scent.  “You go first.”

April 4.

It’s late afternoon in the nursery.  I’m coming off a busy call last night, and my tank is running dry.  Carly, the SR for the nursery, Peter, the other JR, and I are making work rounds.  The small premie in her Isolette looks like she may make it.  But she can’t tolerate oral feedings just yet because of her rapid breathing.

“She’s still losing weight,” I say.  “We’ve got to do something till she can take enough by feeding tube.”

“Well, let’s clyse her,” says Carly.  “She needs fluids and some calories to tide her over.”

“How do we do that?”

“You never learned that as a student?  It’s really simple.  I’ll show you, then you can do it on her and anyone else who might need it while you’re on this rotation.”

Carly draws up a mixture of one-quarter normal saline and ten percent D/W in a fifty cc syringe, adds half a vial of hylouronidase, mixes it with the fluid in the syringe, then slowly injects it between the baby’s shoulder blades just under the skin, raising a gigantic wheal on the very small baby’s back.  She finishes by pressing a small cotton wad moistened with flexible colloidin against the needle site, to seal in the fluid until it can be absorbed.  The deep indentation left by her finger gradually fills in as we watch. 

“Dr. Usher in Montreal is treating premies with hyaline membrane disease with IV’s,” Peter says.

“Would you like to try getting an IV into this baby?” asks Carly.  “And I hear Usher’s on call day and night, so he personally does it all.”

“No, my hands aren’t that good.”

“You’re not the only one,” says Carly.  “That’s why you need to learn how to do clysis.  The hylouronidase really speeds the uptake of the injected fluid.  And you can repeat as often as needed.  Now do either of you have anything else to do before Chief’s Rounds?”

“No,” says Peter.

“I just have to do three heel sticks as follow ups on this noon’s bilis (bilirubin),” I say, “But the babies don’t look like they’re getting more yellow.”

“Remember, you can’t trust your eyes.  Especially with dark skinned babies.  Quantify by checking the bilis.”

“Being able to get micro-bili’s is a Godsend,” I say.  “In my rotating internship, the lab could only run regular bilis on venous blood and we had do jugulars and femorals when the kids didn’t have any other veins left to try.”

“Yeah, you don’t want to go to the femoral repeatedly if you don’t have to,” says Carly.  “You’re too close to the hip joint.  And I remember the story that the Chief told of the newborn who had a cardiac arrest while getting a jugular done.”

After conference, I contact Sal from the car. * * * *  “Come in Sal.”

“Hello Robert.” 

He sound a little sheepish?  Hard to tell with just a voice.  But he didn’t contact me yesterday.  “How’re you doing, Sal?”

“About Sunday.  I am really sorry about intruding.  I feel terribly embarrassed.  Please forgive me.”

He is sheepish.  “Oh, Sal, there’s nothing to forgive.  I’m not mad.  In fact, if anything, it’s sort of funny now.  If you’d been peeping through the windows, that would have been another matter.”

“But it was worse.  Being in your minds and feeling your emotions.  I had no idea it could be like that.”

“Yeah, probably.  But it was an accident, so you’re forgiven, if that’ll make you feel better.”

“Thank you Robert.  I don’t want to jeopardize our friendship.”

“Sal, it’s okay.  Forget it.  But what did you mean when you just said, ‘I had no idea it could be like that?’  Are you a virgin?”

“Lately, I’ve lived more of a life of the mind.”

“And that means?” I ask.

“Just what I said.”

“Even when you say that you’re sorry, you’re not going to tell me more?”

“Afraid not.”

“Damn you Sal, you’re so frustrating at times!  Maybe I shouldn’t accept your apology and just let you stew awhile in your guilt.”

April 11.

“Looks like Baby Boy Towne will need a repeat exchange transfusion,” says Carly, after calling the lab.  Towne’s bilirubin rebounded after the first exchange, as is often the case, but it has not leveled-off; instead, steadily rising to 22.    

“Bob, you did him yesterday, so you’ve done two this year, haven’t you?” Carly continues.  “And Peter, you’ve had a couple this year also.  I’m sure that both of you will have more chances before you complete this rotation.  So Bob, why don’t you supervise Joyce, our student.  I’ll be close by to back you up if you need me, but I think you can do it.  There’s nothing like teaching someone else to really cement information and skills.”

See one, do one, teach one–the old training triad.  “That’s fine with me.  Okay, Joyce?”

“Oh yes,” says Joyce with enthusiasm.  Joyce is a fourth year student taking an elective in the nursery.  She is short and stocky, with pale blond hair in bangs, and wears dental braces that make her look younger.  She plans to go into pediatrics. 

“Let’s order the blood, then go to talk to his mother,” I say.  “After that we’ll discuss the why’s and how’s of exchange transfusions.  You don’t know how lucky you are to have this opportunity as a student.”

We return from the ward, get coffee, then sit at the chart stand, to go over Baby Towne’s history and lab work.  I ask Joyce to discuss ABO blood group incompatibilities, and her answers tell me that she has a good understanding of the subject.  Then I go over what we will be doing, drawing diagrams, before we move to the converted walk-in hall closet and start setting up with the nurse, waiting for the call that the blood is ready.

“I’ll glove up too, just in case,” I say, “but you’ll be doing everything unless I see that you’re having problems.  Otherwise, you tell me when you need an extra pair of hands.”

After donning gloves and opening the sterile pack, we prep the abdomen widely around the cord, then drape the baby, leaving just a little yellow abdominal skin showing around the cord.  “Okay, you have your catheter and syringe with saline hooked up, and the cord secure,” I say.  “Now cut across the cord but not flush to the skin.   Next identify the umbilical vein.  The two arteries are paired, small, and stick out-—see them?” 

“Yes, here they are.  So this other has got to be the vein,” says Joyce.


Carly pops her head through the door opening.  “How’s it going?”

“Great,” says Joyce, confidently threading the thin red rubber catheter into the vein.

April 14.

“Hello Robert,” says Sal, “Congratulations.  I guess you and Karen are celebrating tonight.”

“Yes, it’s hard to believe that we’ve been married for two years.  It seems like just yesterday.  We’ll be dining at the Hotel Somerset.  A lot quieter than Durgin-Park, though less fun.”

“Both of you should feel good about yourselves.  You started your marriage with much more stress than most newly-weds, and survived the transition to being a couple.”

“We’re still adjusting,” I say.  “Karen gave me a lot more support, helping me make it through the every-other-night calls as an intern, than I’ve given her.  If she really knew how tough it was going to be, I wonder if she would have gone ahead with our marriage.”

“Have you asked her?  And did you realize yourself how strenuous and consuming it would be?”

“She’s always said that she would do it again when I’ve asked, but I still wonder.  I’m not sure that I would have, if I’d been in her shoes.  And no, I thought I knew that it would be hard, but I really didn’t realize how hard–not until I actually started working.”

“I’ll talk with you again tomorrow,” says Sal, as I back into a parking space off Beacon St.  “Have a lovely evening together.”

I climb the stairs to the second floor, cross the small hall to our apartment, and open the door. “Happy second anniversary,” Karen says, as she greets me at the door with a kiss.  “What time is our reservation for dinner?”

“Eight,” I reply.  “There’s time for a bath.  I want to wash off the County’s germs.”

The valet at the Somerset seems to turn his nose up at the dent in our car, as I hand him the keys.

We look around after we’re seated, at the dining room’s familiar layered drapes, mirrors, the crystal candelabras on the walls, and the large crystal chandeliers above our heads.

“Do you remember the first time we came here?”  I ask.

“How could I forget?  I called you after getting settled in Boston, as George suggested, and you took me out to eat Chinese food and see a movie.  Then you called me back and asked if I wanted to go out for dinner again.  When we came here, I remember you said, ‘This is just so that you don’t think that I’m always a cheapskate.’”

“And you said, ‘I try not to judge a person by first impressions.’  And I thought to myself, ‘She did think I was a cheapskate.’”

“So why didn’t you bring me here on our first date?”  Karen asks slyly.

“Well, because I didn’t know if we’d hit it off.”

“You mean you didn’t want to waste money on me if I turned out to be a dog,” she laughs.

The waiter, in standard black tuxedo and black bow tie, brings the bread, recites the daily specials, and takes our drink orders.

“The prices have gone up,” Karen says.  “The roast beef dinner is $5.00 now instead of  $4.50.  That’ll buy a lot of dog food.”

“Spoken like the wife of a cheapskate.  You’re a quick learner.  But that includes the salad or soup, beverage, and dessert, while at Durgin-Park, everything is ala carte.”

“And noisier.  This is much nicer.  Our place for special times.”

The wine comes and we toast each other.  When the waiter brings our salad and soup, he asks if we’re celebrating an occasion.

“Our second anniversary,” says Karen with a note of pride.

“Well, congratulations,” he says.  “Thank you for celebrating with us at the Hotel Somerset.  I’ll upgrade your desserts.”   And he does.

I feel so good that I even tip the snooty valet a buck-fifty when we leave.

April 17.

At the end of Rounds, Vinnie calls out to stop us from leaving, “Will the House Staff please stick around a little longer.  The students are free to go.  This doesn’t concern them.”  There’s a scraping of chairs as the faculty and students get up and leave the room.  The residents shift around in their seats, looking at each other.

“Wonder what this is all about,” I say to Joan.  “Did someone screw up and now we’re going to catch hell?”

“Vinny wouldn’t blast anyone in public unless it was a collective foul-up,” says Peter, who’s sitting on my other side.

“Just a couple of things,” says Vinny.  “First, we need to decide how to divide up the Spring Meetings (The annual national pediatric research meetings) during the week of May second to fifth.  Half us can go the first part of the week and half the second. And second I need two JR’s and one SR to volunteer to cover Wednesday night, the travel day for the two groups.  I know this means that if you volunteer, you’ll miss the meeting, but next year, the two JR’s will get to go the whole week, and the SR will get Thursday and Friday off as extra vacation days, as well as Saturday and Sunday.  Don’t everyone stampede me.”

“Why don’t we just draw lots like we did last year?”  suggests Mark.

“Any other suggestions,” asks Vinny, “Or does that sound fair to everyone?”

There’s a murmur of general assent.   

“Before we draw though, we should probably first have the three volunteers, to get them out of the draw.”

With only a little coaxing, Vinny gets his volunteers and, after preparing an equal number of slips with either a ‘one’ or a ‘two,’ we proceed with pulling them out of a box.

“I got a two,” says Peter, “what about you?”

“Two.  Are you planning to drive down?”


“Could I catch a ride with you,” I ask, “And split the expenses and driving?  I’d like to leave my car for Karen to use.”

“Sure, as long as you pack light.  I’ve got a small trunk.”

“I’ll leave the tux at home.”

April 23.

Karen spreads out a blanket on the grass under a crab apple tree, and I lay out the pickles, potato salad, and fried chicken from the wicker basket.  We’re a little late for the cherry blossoms, which are past their prime and now petal the ground like soft pink snow.

The sun has us in short sleeves, and the warmth feels wonderful after gray March with all its wind and rain.  The daffodils are fading, but the tulips stand proudly erect, red, yellow, and white.  On the hill across from where we sit, three children are rolling over and over down the grassy slope, laughing.  A trip to the Arnold Arboretum is part of our rite of spring.

After the chicken and potato salad, we have peanut butter cookies, and coffee out of the thermos.  Karen puts the dishes away in the basket, and we stretch out, head by head, on the blanket, holding hands and looking up, through the thin tree canopy, at white clouds slowly sailing past overhead, on their sea of blue sky, squinting against the brightness.

“This is so nice,” sighs Karen contentedly.  “What a perfect day.  This sense of life just springing out of the earth after winter is something we don’t feel so keenly back in California.”

“Yes.  It’s spring and we’re in the springtime of our lives and marriage.  May we have a long growing season, bright with blossoms.”

“Why that’s poetic, Bob.  And you told me you were hesitant to take lit courses in college.”

“That wouldn’t even qualify as greeting card verse,” I reply.  “Are you in any hurry to walk around and look at the rest of the garden?”

“No, I feel so comfortable and happy right now.  Let’s just lie here a while.  We’ve got all afternoon.”

I feel myself getting drowsy, then just before I fade into sleep, Karen says, “You know, I haven’t started my period yet.”

That gets me fully awake.  “You’re not terribly late, are you?  You’ve been a little irregular before.  How late are you?”

“Four or five days.”

“Then it’s probably nothing.  But since you woke me, how about giving me a kiss?”  I reach for her.

“Now cut that out.  Wait till we get home at least.  Maybe we should get up and see the rest of the arboretum now.  You certainly don’t need any more rest if you’re feeling this lively.”

April 26.

I’m having lunch with Wil in the cafeteria.

“Well, my Air Force orders came today,” says Wil with satisfaction.  “Wiesbaden.”

“Congratulations.  Isn’t that in Germany, and your first choice?”

“Yep.  Since I’m in for three years, it might as well be overseas.  I don’t know when I’ll have the chance to travel otherwise.  I put in for Japan too, but Europe is really where I wanted to go.”

“When do you report?”  I ask.

“Right after June thirtieth, for orientation in Alabama.  Guess we need to be taught military procedures and protocol like saluting and discipline and get uniforms.  Then I ship out.”

“I hear that Mark is going to a Public Health Service hospital on an Indian Reservation in Arizona,” I say.  “How are he and Juliet doing since she had the termination?  They still together?”

“Yeah, from what I hear.  At least for now.”

Peter comes up to join us, carrying his tray. “No one sitting here?” 

“Just you, Peter.”

He sits and says, “Well, you’re a short timer now, Wil.  Where are you going next year?”

“Air Force in Germany.  Yeah, the group is splitting up,” says Wil.  “You guys will be taking over as SR’s in July, with a new group of JR’s to whip into shape.  We taught you all we know, so you’ll be ready.”

“You want to hoist a few brews after Rounds to celebrate?” I ask.  “Maybe some of the others would like to go too.”

“Sure, where?”

“How about the Melody Lounge on Bay State?”

“Too early for the jazz,” says Wil, “unless we stay till nine.”

“I can’t stay that late.  Karen will be expecting me.”

“Man, that girl’s got you well-trained,” says Wil.  “Nah, shouldn’t have said that.  If I were married to her, I’d want to get home early too.  You lucked out with Karen, Bob.  She’s way too classy a lassie for you.”

“For someone known as ‘Wee Willie,’ I wouldn’t talk.”

“I’ve got no problem with staying late,” says Peter.   

“That’s three of us.  Let’s see who else might be interested in going,” I say.  “Ask around.  I’ll talk with you guys at Rounds.  I’ve got to get to clinic.”