Chapter 9. May
“Okay, honey, that must be Peter buzzing. I’ll see you late Friday night right after the meeting ends. Anyway, I’ll phone after we check in at Atlantic City.”
“Please don’t forget to call me. Peter drives like a maniac and it’s night, and I’ll be worried until you get in.” Karen comes to my arms and gives me a farewell kiss to last the next three days at the meeting.
Peter Norris is waiting at the curb, standing beside his red Sunbeam Alpine. I squeeze my battered suitcase into his trunk, and he pulls out into the glow of the late afternoon. How much of a maniac can you be in one of these? Sporty looking, but on the turnpike? Snail.
“I hope this is worth it, Peter. On call two straight nights so that we can spend six hours driving down to New Jersey. Tell me when you want me to take the wheel.”
“We get to hear what’s new and hot in peds, before publication. And our guys who were down there first now have to cover for us. Have you used a floor shift before?”
In my imagination we flash past our fellow residents somewhere along the Connecticut Turnpike, as they head back towards Boston in the moonless night, headlights glaring momentarily into each other’s eyes. A bit before 1:00 AM, we cross the causeway into Atlantic City, and look for the motel where most of us are staying. The meeting is at the Traymore Hotel, right on the Boardwalk, but the rates are lower at the Atlantic Breeze Motel, three blocks away, which is where Carol, the departmental secretary, booked us.
I use the payphone in the lobby, suitcase at my feet. “Hi Karen. I hope I didn’t wake you, but we just got in.”
“How could I sleep without knowing that you arrived safely? Any problems on the way down?”
“None. The meetings start at 9:00, and Dr. Wasserman is moderating an afternoon session. So it’ll be a full day. And he’s taking the residents out for dinner tomorrow night.”
“Well, I hope you learn a lot. Enjoy the seafood, but be careful not to eat raw oysters. The Globe had an article today about hepatitis from contaminated shellfish in New Jersey.”
The main ballroom of the Traymore Hotel is crowded by the time Peter and I walk over after eating breakfast at a small café a block from our motel. The princes of pediatric academia have gathered for their annual bazaar. Here, they and their trainees display their brightest wares, fresh from laboratories and hospital wards, in the form of fifteen minute “papers,” for others to weigh and evaluate, with questions and comments following each talk. Some presentations are “bought” by the attendees with favorable supporting questions and statements. More skeptical comments and harder probing challenge the value of others. A young, hopeful acolyte can launch a career in research and academics with a tour de force presentation and a brilliant defense of his or her paper, during the comment period.
We find separate seats along the side wall, and survey the audience. Only a few from County. Stan Wasserman up front, puffing pipe, chatting with friends. Hope he’s not really looking for chairmanship somewhere else. Rumored. Looks relaxed. Not many women. Lots of pipes and tweeds.
The Society president opens the meeting with his address, and then sits at the table beside the podium to introduce each speaker and keep them on schedule. Actually gongs them when they run overtime! By noon, nine papers have been presented, applauded, discussed, and, in some cases, eviscerated. It is clear that some academic fiefdoms are accorded more respect than others.
There is a welcome break for lunch and coffee, and I run into Peter, Joan, and Wil in the lobby, and we decide to walk along the Boardwalk and find a restaurant less crowded than the ones in the Traymore.
“The Boardwalk is really made of boards.”
“Amazing, Bob, considering its name,” says Joan.
“Look, there’s a salt water taffy shop. Maybe I’ll get some to take home to Karen.”
“Hope she’s got good fillings,” says Peter.
The Atlantic Ocean is dark and uninviting even in May, leaden surf breaking onto gray sand. The wind off the water has a penetrating chill that makes me appreciate my Harris Tweed jacket and it speeds the cadence of our feet.
Ten minutes of brisk walking past shops and stands—-some open, some closed. Past other hotels and piers, extending out into the water including one advertising “The World Famous Diving Horse.” The billboard shows a horse plunging off an impossibly high tower into a tiny vat of water. The convention crowd thins out and we settle on a seafood restaurant that doesn’t have a line outside. No raw oysters or clams or we’ll be getting gastrointestinal things.
At 2:00, we loyally attend the start of the Gastroenterology Section meeting, being moderated by Dr. Wasserman. After the second paper, I slip away to the Infectious Disease Section. The afternoon offers multiple, simultaneous, topic-based meetings, and some planning is necessary beforehand, to decide which paper being given at what time in which room, to listen to. A buffet of ideas. The corridors are filled with attendees, some striding purposefully towards their next session. Others standing off to one side and chatting.
We meet Dr. Wasserman in the lobby of the Traymore at 6:00, decide on a restaurant, and contend for taxis in front of the hotel. Our turn comes, and off we go, four to a cab. At the restaurant, Dr. Wasserman tells us of his own taxi ride in from the small city airport. “I said to the cabby, ‘You must do well, with all the conventions.’ And he said, ‘You got that right. You should have been here last week with the steelworkers. The whores were in from New York and Philly and this place was really jumping—-but then they all went back.’ ‘Why?’ I asked. ‘Oh, this week there’s a bunch of baby doctors in. By the way, what’s your line of work?’ And I’m ashamed to say that I answered, ‘Office equipment.’”
I enjoy my blintzes, and afterwards three of us walk off dinner, the mile or so, back to the motel.
I call Karen. “Hi Karen. I heard a lot of new stuff today—-it was really exciting to be able to see and hear people that I’ve only read, present their latest work in person. How was your day?”
“It was all right. Nothing exciting at school. You’re back from dinner with Dr. Wasserman already? Where’s Peter?”
“He ran into some classmates from Montreal this afternoon, and they were meeting after dinner. Peter asked if I wanted to go along, but I thought I’d catch up on my sleep. Anyway, we’ll probably be starting back tomorrow afternoon, before the last paper, at about 4:00-4:30.”
“Where will you eat dinner?”
“We’ll pull off the road somewhere to take a break and eat.”
“Well, be sure to drive carefully. I’ll wait up for you. By the way, I still haven’t had my period.”
“Oh. Are you worried?” Oh, oh–she couldn’t really be pregnant? Been careful. “After all, it’s not quite three weeks and sometimes you’re irregular.”
“But I’ve never been this late. Suppose I am pregnant? We weren’t planning to have a baby this soon.”
God, are we ready? “We’ll just start our family one or two years earlier, that’s all.” Positive. Stay positive. “Our parents will be surprised and thrilled. Especially your mom, since you’re her only chance for a grandchild.”
“Would you be happy too? Come home to me tomorrow, Bob. Please drive carefully.”
“Of course I would be, sweetheart. Now I have maybe two reasons to come home. I can’t wait to see you.” Want to hold you now, Karen. Hope we can handle if that’s so. “Good night, I’ll see you tomorrow night. I love you.” Holy shit.
I don’t sleep well; just too keyed up after that possible revelation from Karen. However, we still have a full day of talks ahead of us before we head home, so Peter and I are up by seven, dressed and out for breakfast by 7:45. We review the scientific program over eggs and coffee, and decide on what we want to hear, then walk to the Traymore. As I listen, fighting sleep. I try to envision myself as one of the bright, earnest, well-prepared young researchers presenting their papers. Maybe, in a few years after my military obligation is served, I’ll be up there too. The information pours out in a relentless torrent, and by four, I feel close to brain-overload. Time to go home. We meet back at the motel, load the Alpine, and leave Atlantic City for the turnpike. It’s close to midnight by the time we pull up to my apartment house.
“Thanks for the ride, Peter. We’re all square on the gas and the tolls, right? See you at rounds in the morning.”
“Good night Bob, take care.”
I put my bag down, and just get my key in the lock when Karen opens the door. “Welcome home, darling.” And she comes into my arms for a long one.
“Let me look at you.” I hold her at arm’s length. “Nope, you haven’t changed since I‘ve been gone; you look as good as ever, maybe better.” And I kiss her again.
“Come in and shut the door.”
“Are you feeling OK?” I ask. “You shouldn’t have stayed up waiting.”
“Was it a hard drive?” she asks, “ Are you tired? Do you want something to eat?”
“No, no, and no. It was fun, but I’m so happy to be back with you. Do you think you’re really pregnant?”
“I don’t know, but I am late. Are you worried?”
“Not worried. Just surprised in a happy way, mommy-to-be.” I hug her gently for a long moment.
“Well, of course I’m still not sure,” she says with a pleased smile. “Why don’t you wash off the road dust, then come to bed.”
I turn off the shower, and pull back the shower curtain to find Karen holding out a towel for me, dressed in her wedding night negligee.
“Room service,” she says. “I hope the motel didn’t offer this.”
“Glad to see this little old dress can still get a rise out of you,” she growls with her best Mae West imitation.
I step out of the tub, past the towel, and pull her close.
“Hey, you’re getting it all wet.”
“It’ll dry out over the chair.”
“At least dry yourself first.”
Later, spent and drowsy, Karen asks again, “You sure you’ll really be happy if I’m pregnant?”
“Silly woman, of course I’ll be happy. Are you worried?”
“No. But I’m so glad you’re home.”
“Me too. Home to both of you.”
“Please hold me.”
We drift off to sleep on our sides. My chest and abdomen fit around the curve of her back and I breathe in her warmness.
“It’s good to have you back,” says Sal. “I missed our talks.”
“I feel the same way. Thank God we didn’t have teaching rounds this morning since Dr. Wasserman won’t be back from New York till Monday. It would have been tough to stay awake.”
“So, you might be a father?”
“Yeah. And I thought we were being careful too. Well sometimes the nicest things come as surprises.”
“Still, don’t you feel a little anxiety about it?”
“Oh, of course. But I’d probably feel that way even if we had planned the pregnancy. I mean becoming a parent is a huge responsibility.”
“You’re a pediatrician, and Karen’s a first-grade teacher,” says Sal. “You’re both used to being around little children, so you’ve got some advantages that other new parents don’t have.”
“Very true, but it’s different when they’re your own. You can be more dispassionate and objective about someone else’s kids.”
“How do you think Karen feels?”
“I guess she must feel like I do.”
“Do you think that she’s been looking for reassurance from you?”
“Why? Well, wait a minute. Now that you mention it, she has asked me a number of times how I really felt about her being pregnant.”
“Maybe she was checking you out because she’s a little ambivalent herself?”
“Yeah. That’s certainly possible. She was planning to teach for a few years before we started a family. That’s going to be screwed up. I mean if she is pregnant and has our baby, I can just continue as we’d planned. But when she becomes a mother, then everything changes for her. Poor Karen. I should have realized that.”
“What will you do?”
“Do you think that she’d feel better if I let her know that I realize how this upsets her plans and how unfair it must seem to her to bear the whole burden of changing career plans?”
“Feeling that you’re understood by the one you love is always comforting.”
“Thanks for the suggestions.”
That night after our showers, as we get ready for bed, I broach the subject of her possible pregnancy. “I’ll check Monday about an obstetrician, if you’d like me to. Maybe we should think about confirming things? It’d also be okay to wait a little longer too, if you want to.”
“But aren’t you anxious to find out?”
“Of course I am. I’m just trying to do what you want.”
“Well why don’t you ask about someone. I could go any time in the late afternoon, after school, although Tuesday is my early day. Maybe someone whose office isn’t too far from here?”
“Okay. Look honey, I know that you were hoping to teach for at least a couple of years before we had any children. I know how much you enjoy teaching and how good you are at it. This could change things a lot.”
“Well, it can’t be helped now. Things do happen unexpectedly, and then we just have to cope.”
Cope? Not 100% thrilled. Wouldn’t be either, if it were my career.
“I know I’d feel upset if I had to put my career on hold. Are you?”
“You needn’t try to be a psychiatrist. I’m all right with being pregnant-—if in fact I am.”
“I’m only trying to let you know that I realize you could feel ambivalent, and that it’s okay.”
“Don’t patronize me. I’m all right.”
“I’m sorry if it sounded that way to you. I just want you to know that I understand how you feel.”
“No, you can’t understand how I feel. Men always say that they know how a woman feels, but they really don’t. We’re the ones who always have to change and adapt. We’re the ones who always are expected to ‘put up with.’ We’re the ones who have to carry the baby and then give birth. All that stuff about things getting more equal? That’s a bunch of BS!”
“Guess things aren’t really fair.”
“No, they’re not.”
“Guess we should have been more careful about using the diaphragm each time we made love,” I say. She doesn’t reply.
We go to our own sides of the bed, lie down, and I turn off the light. After long, silent, uncomfortable minutes in the dark, I turn towards her. “Karen?”
“I don’t want us to go to bed feeling like this. Come, let me just hold you. I won’t try to make love.” She turns over and moves into my arms. I rub her back and, after a time, her muscles relax.
“I didn’t mean to get upset, Bob. I didn’t even realize that I felt like that.”
“You needed to get your feelings out. I’m glad you didn’t just bottle them up and become resentful.”
“You’re trying to be a shrink again,” she says, sounding a little more playful.
I give her a tender hug.
“Don’t blame yourself,” she says. “I enjoy making love without the diaphragm too. After all, I could have insisted on using it. And don’t get me wrong, I am excited and happy about the possibility of being a mother, previous plans or not.”
“I am too. Sleep well, honey.”
“And you’d better too. You’re on duty tomorrow.”
Sal was right. Glad Karen and I got this out. Better now than later. Be nice if we could talk mind to mind like with Sal. Clearer, quicker. But that’s impossible.
“Hi honey. How was your day with the brats?” I say as I come into our apartment. I walk into the kitchen and kiss her.
“It was fine, and I know that you’re joking, but please don’t call them brats.”
“It’s just that I really believe that the words we use have an influence over how we feel and act. And as a teacher, I don’t ever want to get to the point of being resentful of my students.”
“I . . . okay.” Caught myself. Was going to say ‘I understand.’ Don’t go there again. She still pissed?
“Oh, and did you get a chance to check about a doctor for me?”
“Yes. I asked one of the OB residents, who was in my class, whom he would use for his wife. And he suggested one of our professors that I’d kind of thought about too, Dr. Karlsberg. He’s somewhat fatherly and a gentleman as well. Thoughtful too. And his office is fairly close to us.”
“Does he only deliver at the County?”
“No, he’s also on staff at the Memorial and the Lying In.”
“That’s good. Did you call to set up an appointment for me?”
“No, I didn’t yet. I didn’t know whether you’d want me to check on other OBs.”
“He sounds fine. I can call him tomorrow myself, after I check my schedule at work. You said he’s fatherly. How old is he anyway? I don’t want someone who’s ancient.”
“Probably early fifties.”
“Okay. That sounds like a good age. Thanks for checking. Did you have a hard night, on-call?”
“No. Things are kind of quiet in May. I got more than six hours of sleep, though I did have to go to the floor once to check Mary Anne. She’s the leukemic girl, I was involved with, remember? She got readmitted during the day.”
“Oh no. Is her leukemia coming back?”
“No, I don’t think so, although she’ll be getting a bone marrow tomorrow to see. Her white blood cells got low from her treatment, and she has a pneumonia again.”
I get home a little early, wonder where Karen is, then remember that she’s seeing Dr. Karlsberg today to get the results of her tests. Guess I must still be ambivalent, since I‘m not sure I’d be disappointed if they were negative. Must be pregnant though; been nauseated every morning. Wonder if she’d feel disappointed if the test is negative. Hope we’re both ready for parenthood. Hope we’ve got enough saved up to carry us till I finish residency.
There’s the rapid tap of her spike heels in the hallway, and I open the door. She has a wide happy smile, and comes right to my arms. “Are you ready to be a daddy?” she asks after we kiss, and gives me another hug, her cheek against my shoulder.
Sure hope so. “Wow, then it came back positive. That’s terrific, honey. We should go out and celebrate tonight.”
“Let’s stay home,” says Karen. “It seems more appropriate. After all, we’re starting our family.”
We sit on the couch after dinner, my left arm around her, her head on my shoulder, feet on the trunk that serves as our coffee table, feeling very close, watching TV for a while, before going to bed early.
“Guess I can throw away the diaphragm,” says Karen.
Karen comes back from the bathroom after retching. She is unsmiling and looks slightly pale and sweaty. I get off the floor where the Sunday paper is spread out, and go to her, but she waves me off.
“Maybe you should call Dr. Karlsberg tomorrow,” I say. “There’s stuff available that will help with the nausea and vomiting.”
“I’d rather not take any medicine if I really don’t have to. Just let me sit here for a while without moving.” She sits on the couch.
“I’m really sorry about the morning sickness,” I say. “Rest, and I’ll fix us breakfast. What do you feel like eating?”
“Oh, no thanks,” says Karen, “No food for me. Just get something for yourself, and when I feel better, I’ll get my own. I don’t even feel like talking right now.”
“How about just a cup of tea with honey?”
“Yes, that might help settle my stomach. Thank you.”
“Let’s scratch our trip to Concord,” I say. “When you feel better this afternoon, we can take a shorter drive over to Fresh Pond, and walk around the reservoir. The air will do you good. Maybe even have a Chinese dinner at Joyce Chen’s.”
“Sorry, but right now I can’t even think about food. Let me sit for a while and I’ll feel better.”
“Sure. Can I get you anything else besides the tea?”
“Please. I just don’t want to talk right now.”
“So Karen phoned her mom Sunday afternoon, and told her that she was pregnant.”
“And what was her reaction?” asks Sal. “Was her mother surprised?”
“Sure was, and excited. Karen’s an only child. So she’s her mom’s only chance to be a grandmother. One thing for sure, now her mother’s definitely going to come to visit us this summer. But it’s not like those jokes about mother-in-laws–we get along. Or at least we got along at the wedding.”
“Do your folks know?”
“After Karen talked to her mom, she called them. They were pretty excited too, although they already have a granddaughter from my brother Tom and his wife. Guess parents can never have too many grandchildren.”
“When is Karen’s mother thinking about visiting?”
“August. Which will be perfect because Karen should be over her morning sickness by then, and I had already asked for an August vacation in anticipation of her possible visit, when Karen and I talked about it back during the winter.”
“What about your parents?”
“It’d be pretty expensive for both of them to come. Maybe Mom will come when our baby is born. I wish that I wasn’t on call so much right now. Karen can use a hand in the morning. Maybe if she drives and I catch the streetcar, she won’t have to start out so early.”
“I’m sure that would make it easier for her.”
“Yeah, I’ll start doing that.”
“What did Dr. Karlsberg say about your morning sickness? You did call him, didn’t you?” I ask, as I set the table for dinner.
“He said I could have something for it, but that he’d leave that decision up to me. I’d rather not take anything unless it becomes worse.”
“I hate to see you so miserable each morning.”
“I do feel better by noon. And as you can see, my appetite is fine by dinnertime. I think I can get by without medicine.”
“Well, then maybe we’ll still be able to drive to Maine and Canada in a couple of weeks as we planned. That is, if you’re feeling better by then.”
“We’ll see. Maybe something less ambitious if I’m still not a hundred percent. It seems odd that you went all year without a real vacation, and then you’ll have one in June and another in August,” says Karen. “Couldn’t they have been spaced out better?”
“That’s just the breaks,” I say. “I wish that I could have had a choice too, but with all of the residents to schedule, Dr. Wasserman’s secretary Carol just had to arbitrarily spread us out evenly throughout the year. At least, when we were discussing the possibility of a visit by your mom back in February, I was able to talk to Carol about giving me August off, although if I could have foreseen the baby, I would have asked for sometime in January instead. Think of what a waste it would have been if I’d been assigned vacation during your school year.”
“I guess so. I should be able to travel as long as we don’t try for a really early start each day. It’s been a long school year and I’m ready for a break. Let’s do some preliminary mapping for the trip after dinner.”
“Tell me about this patient you that want me to see,” says Dr. Foreman, after lunch. We sit in the office on the Sixth Floor.
“Portia Jones is a twelve year old girl who was just admitted. She presented late this morning in clinic with a three-day history of migratory polyarthritis involving her left ankle and both knees. Also had fever over that time. And she’s also become increasingly fatigued with decreasing activity tolerance. She was hospitalized at the General two years ago for her first episode of rheumatic fever, and was placed on monthly shots of Bicillin upon discharge, but after eight months, did not return for follow up.”
“Did they try to contact her when she didn’t return?” asks Dr. Foreman with a frown. Dr. Frances Foreman is in perhaps her mid-thirties, tall and athletic, an attractive blond with a no-nonsense manner about her. She is our staff pediatric cardiologist, hired two years ago after completing her fellowship.
“Portia and her mother said no, but I phoned the rheumatic fever clinic at the General, and they said their records showed that they had called the home, but the phone had been disconnected. Then they sent out a social worker, but the family had moved.”
“I did my training at the General,” says Dr. Foreman, “so I’m sure that they tried to locate her. Please go on.”
I finish giving the history.
“And there’s absolutely no hint of a sore throat or even a URI before the onset of her fever and arthritis?” asks Dr. Foreman.
“Well, that can certainly happen. About one-third of rheumatic fever relapses have no symptoms suggesting a preceding strep infection. That’s why continuous penicillin prophylaxis is so critical. With each relapse, the heart can become more damaged. We’ll need to see if the lab work gives us serologic evidence of a recent strep infection. Her history certainly suggests the presence of congestive heart failure as well. What did you find on examination?”
After I describe the positive physical findings, we go to the ward to examine Portia, who is sitting with the head of her bed cranked up. She has oxygen running through nasal prongs. I introduce Dr. Foreman, and Portia answers her questions with short, breathy sentences. Then Dr. Foreman examines her, checking her joints, carefully listening to her heart, checking her neck and abdomen, and listening to her lungs. She thanks Portia and we return to the office.
“I agree,” says Dr. Foreman. “She certainly fulfills the Jones Criteria for the diagnosis. And she does have active carditis and congestive heart failure as you indicated.”
“I’d like to start her on prednisone and Digoxin,” I say.
“What about aspirin?” asks Dr. Foreman.
“I read that with carditis, it’s better to start with prednisone alone and introduce aspirin as the prednisone is being tapered off, although there’s still debate about how and when to use them.”
“There’s no evidence that prednisone produces a better long-term outcome than aspirin in patients with carditis, and aspirin is certainly the drug of choice in patients without carditis. That said, most people would still use prednisone in patients who are in frank failure like Portia. Now, what dose of Digoxin are you going to use? Remember that patients with rheumatic carditis and failure can be exquisitely sensitive to digitalis. And you have to be very careful about giving it in split doses, right?”
Guess I deserved that. She remembers my goof on Eight. “Yes. I plan to give the digitalizing dose in thirds every twelve hours.”
“You needn’t be that cautious. I think you could give half the dose first, then a quarter every twelve hours. But you do need to check the heart rate and get an EKG before each dose.”
“Since she’s in failure, how about a diuretic?” I ask.
“That’s an excellent thought. I was just about to bring it up. Let’s go over the question of whether or not she needs penicillin, and then we can talk about the doses for all her meds.”
The discussion continues till all questions of management have been covered; then I proceed to write the orders. When I’m done, Dr. Foreman reads them carefully.