2. Stranger in the Mind – Chapter 2

Chapter 2.  October

October 1.

“Great to be off Night Float at last!” I say, as Karen and I load the weekly groceries into the trunk of our Chevy in the A&P parking lot.  The sudden downpour that kept us waiting in the store has puddled the asphalt.   

“It’ll be nice having you home, instead of losing you at nine-thirty every night,” replies Karen, as the last bag goes in. 

“We’ve been doing pretty well with our budget too,” she says, as we pull out of the lot into moderate, late Saturday afternoon traffic on Memorial Drive.   The blacktop is shiny-wet.    

I go through the gears on the column shift.  “This car’s sure a snail.  Yeah, we’ve been able to stay within the twenty bucks a week we allowed for groceries.  And that even let’s us get a little extra once in a while like the picnic stuff for tomorrow.”

“Well, the $140 that you make covers rent and one week’s groceries, and my $220 takes care of the rest,” says Karen, “And even lets us put something away regularly.  So we can afford a little splurging once in a while.”

“I’m really glad that you’re looking after the budget,” I say.  “If I do go into practice, maybe you can be the office manager if you decide not to continue teaching.”

“Why do you assume I’d want to manage your office instead of teach?”  she says  “I’m really enjoying myself and I can’t think of anything else I’d rather do.  Certainly not billing and collecting and filing records.”

 She a little hot?  “I didn’t mean to assume anything.  It was just a thought since you’re managing our money so well.  Don’t bring that up again.  Switch to something else.  Anyway, I’m looking forward to seeing some fall leaves tomorrow.”      

“It’s probably a little early for a lot of autumn color,” says Karen, “but up in New Hampshire the color change arrives before it does down here.  Probably even more so up by Mt. Manodnock.  So maybe we’ll be lucky.”

“Even if there isn’t that much color, it’ll still be great to get away from the city and stretch our legs.  I hope there aren’t a lot of people planning to climb tomorrow,” I reply.  “It won’t be like the Sierras, but it’s what we have available.”

“Do you still feel sleepy, or did that short nap after lunch get you caught up?” Karen asks.

“No, I’m okay.  I don’t need that much sleep.  Why?”

“I was thinking about a movie.  ‘Spartacus’ has been playing downtown a while and might not be there much longer.  Or would you rather see ‘Psycho’?  Want to go after dinner?”

“‘Spartacus’ sounds good to me,” I reply.  Definitely not ‘Psycho!’

“You don’t sound that enthusiastic,” observes Karen.

“No, it’s a great suggestion; you know I’ve said that I wanted to see it and we don’t need that early a start tomorrow.  Do you know when the show times are?  Otherwise we’ll need to pick up a paper.”  I make a right turn after the light changes to cross the Charles River by the Boston University Bridge.

“Oh, did you finish your letter to your mom?”  I ask.

“No.  I thought that I’d do that tomorrow night if we don’t get back too late and I’m not too tired.”

“I got off a quick one to my folks last night between patients.  We can mail them both on Monday.”


October 2.

I wake early, despite turning off the alarm last night.  Predawn grays the sky beyond the curtains.  The fluorescent green hands and numerals of the clock say 6:07.  Karen is asleep, her back to me, dark hair spread over her pillow.  I ease off the edge of the bed to use the bathroom, shutting the door to muffle the flush, but as I try to quietly slip back between the sheets, she turns towards me.

“What time is it?” she murmurs.

“Still too early, go back to sleep.”

Karen settles next to me as I lie on my back, and rests her head on my shoulder and chest, her left arm and leg across me, groin snugly warm against my left thigh. My lips rest against her smooth forehead and, nose in her hair, I inhale the faintly earthy scent of her scalp mixed with a trace of the Chanel No. 5 that she favors.  Her breath puffs softly against my chest.  In spite of our own “late show” after the movie last night, I feel a little surge of desire.  The sound of her gentle breathing becomes a soft snore.

Oh well.  Tonight maybe.  Wish I could fall asleep as easily.  Don’t need to leave till 9:00–plenty time.  Will it be windy and cold up there?  Jacket should be enough.  Last time up there was sophomore year with Jerry and his girl friend.  Sal up?  No sense waking him just because I am.  Why won’t he meet me—at least show me see what he looks like?  And no details about himself?  Maybe he’s ugly or old–afraid I’ll be repelled by appearance.  Maybe a public figure?  Someone I’d know from hospital or med school?   Sal really his name?  If he were someone I’d recognize, an alias would make sense.  Can’t even be sure about his sex, so maybe ‘he’ is assumption too.  Mental voice just like spoken voice?  Sal is so guarded.  If he exists at all.  Strange.  If he doesn’t, I’m spending lot of time wondering about a figment of my psychosis.  Figment of my psychosis.  Like that.  Wonder if Sal would be irritated or amused if I repeated that to him.

I wake to Karen’s kiss and cheery, “Good morning.  We’d better get up and get ready to go.  It’s 8:15.”


October 3.

My first full day back working in daylight, and I’m walking to lunch along the fifty yards or so of corridor between the pediatric building and the cafeteria with the other two residents from the Eighth floor.  We arrive at the double doors and push the right one open.

The room is packed.  The air heavy with the steamy smell of food and thick with voices.  The general roar accented by the clash of pans, the sharp clatter of dishes, and the clank of food trays.  The line stretches along the wall from the food serving area back to where we stand at the entrance.  House officers in their white jackets and pants, nurses wearing white uniform dresses and the distinctive caps of the hospitals where they trained, maintenance workers in gray or blue coveralls, staff and faculty in long white lab coats and ties, some puffing on pipes, post-doctoral fellows standing close by their mentors, the array of various hospital workers from lab techs to elevator operators, student nurses in their dark blue uniforms with white aprons, medical students, many in full whites, hoping, as we used to, to be mistaken for house officers and thus not be asked to pay. 

“What a line.  We should have either come earlier or later,” sighs Dave Siegal, the Eighth floor Senior Resident, as we survey the crowd.  “Bet you’re happy to be off nights, Bob.”

“It was a good rotation–the responsibility, being first up for things.  But a month is long enough,” I reply.  “I think that if I‘d had it later in the year, after I got more experience, I would have felt more comfortable about it.”

“Well, you did good with Toby White that night we were on together.  Remember, somebody always has to go first, and somebody last,” says Dave, “Luck of the draw.”  Then turning, “So, Allie.  On Eight the kids are smaller, have different problems, and they don’t talk as much.  Otherwise, it’s the same as on Five.”  He laughs at his own joke.  Allie is Alice Peterson, the other first year resident on the floor, originally from Howard University.  She’s just completed two months on Five, one of the two floors for older children and youth.  Seven and Eight are the infant and toddler floors, taking children three years of age and under.

“I’m thinking about going into I.D. (Infectious Disease) later, so I think that I’m going to enjoy my two months on Eight,” says Allie, “This ought to be the start of the winter infections.”

“Hmmm, maybe more like next month,” replies Dave, as we move at last into the serving area and pick up brown Bakelite trays, navy surplus stainless steel utensils stamped USN, and get our lunches–macaroni and cheese, canned peas and carrots, chopped iceberg lettuce salad, coffee, and chocolate ice cream for me. 

“There’s a place for us to sit,” says Allie pointing, “There–where Norman and his fellows are leaving.” 

Dr. Saul Norman runs the infectious disease research program in the Barton Labs, a Harvard service at the County, and he and his fellows provide consultations in infectious disease to the rest of the hospital.  Norman has an international reputation, directing a lab very active in research that produces a plethora of papers published in prestigious journals.  His fellows get good starts on their own academic careers since, by the time they finish their fellowships, they will all have published a number of papers co-authored with him.  Positions with him are highly sought, and very competitive.

“I wouldn’t mind landing a job with Norman when I finish my residency,” says Allie.

“I remember when we first came to the County as sophomores and I saw Norman sitting by himself in this cafeteria,” I say.  “I thought that he was an elevator operator or something.”

“How could you make a mistake like that?” asks Allie, taken aback.

“Well, I’d never seen him before, and look at him.  He’s not quite an achondroplastic dwarf; his arm proportions are longer; but his head is very large compared to the rest of him, with a prominent forehead, and his hair is sparse and white.  And he is certainly a near-dwarf in height, if not actually one.”

“What’s the medical definition of a dwarf?”  asks Dave.

Allie and I look at each other.

“OK, Bob, since you brought it up, find out and tell us at afternoon rounds.”

Damn.  Me and my big mouth.  Like I’m not going to be busy enough in clinic this afternoon.  Hope this isn’t a sign that Dave’s going to be a SOB as SR.

Between patients in the afternoon outpatient clinic I try to find the definition of dwarf.  It’s not in my pocket Harriet Lane Handbook and the pediatric textbooks are back in the office on Eight.  Luckily the last two patients are no-shows, and I have a chance to get back to the textbooks before rounds. 

The Nelson’s not here.  Okay, look in Holt.  Index–dwarf tapeworm–OK–dwarfism:  pituitary, short-limbed, thyroid.  But no general definition.  Under short stature?—hmm—-two and a half standard deviations less than norm for age.  Is that what Dave’s looking for?  Can Sal check him and see? * * * *

“Hello Robert.  Oh, I see what you want me to do.”

“Right Sal, what do you think?  Could you just check and see if that answer is what Dave is looking for?”

“You want me to frivolously probe his mind for your benefit?”

“You don’t have to sound so snotty like it’s devious or illegal.  I’m not asking you for the combination to a safe.”

“Bob.  That’s what an ethicist would call taking the first step onto a slippery slope.  Today, checking to see if an answer’s right; tomorrow, finding the answer to a question in an examination.  If your powers do become stronger, you are going to have to think through, as I did, which uses of telepathy are ethical and which are not.  Besides, you’ll always remember the answer if you have to do the work to find it.”

“Damn it, you’re lecturing like some prof.  Forget I asked you; I’m too tired to listen to this kind of crap.”

“I hope you’ll be less angry when you think about it a little.”

“Sal, get out of here.  Go!”

Pompous prick.  So damn self-righteous.  Screw it if he heard that.  Let’s see-—maybe in medical dictionary.  OK, here’s du, dw . . .

A short time later, we’re standing around Dave in the hall by the nurses’ station. “We don’t have that much time this afternoon to go though the patients,” he urges, “So let’s be efficient.  You JR’s give quick sketches of the progress or setbacks on each of your patients, so we can pick out whom we want to present to the Chief at Teaching Rounds.  Students, since you’re just starting with us today, listen for now.  You can always ask questions, of course.  By Wednesday I want each of you to have worked out with your JR which kids you’re going to follow.  Then you’ll be responsible for actively participating in their care and giving their presentations.  Be brief.  But give all the positives and pertinent negatives.” 

My thighs and calves feel tired and slightly sore from yesterday’s outing as we walk the ward.  Hope Karen doesn’t have to chase kids at recess.  We stop by the first crib, and Dave says, “OK, Allie, you got this kid with Staph pneumonia?  You’ve had time to review the chart.  Tell us about Kevin.” 

The small steel and glass partitioned space, painted a drab, generic hospital green like the walls, is just large enough to hold the well-used tan-colored steel crib, and the tall, bright green oxygen tank connected by tubing to the plastic tent enveloping the crib.  A battered, sturdy wooden chair, an IV pole, and a low, tan, crib-side steel cabinet complete the furnishings of the cubicle.  Through the beads of condensed mist on the inside of the tent, we see a pale, tired, six month old, his four limbs restrained by gauze strips tied to the crib frame.  The needle in his right foot, secured by a welter of small adhesive tape strips, connects to the glass IV bottle containing his antibiotics.  Oxygen bubbles softly through a water bottle to humidify it.  He lies on his back, dark hair damply plastered to his forehead, eyes shut, and breathing rapidly despite the oxygen. 

“Kevin is a six month old Caucasian male, admitted nine days ago, with a 104 temp, and a history of a preceding cold that got worse, with increasing fever, moist cough, vomiting, much decreased intake, and increasing listlessness for the two days prior to admission.  On exam, his chest was full of inspiratory rales, with decreased breath sounds at the bases.  Chest x-ray showed bilateral dense infiltrates, right-sided pleural fluid and pneumatocoeles.  Chest tap and blood cultures grew out Staph aureus.  He’s doing well on Erythro and Chloro.  Fever’s coming down, and the chest tube’s dry, not bubbling, and should be coming out tomorrow.”  Allie succinctly concludes her summary.

“Still needs O2, I guess.”

“Yes.  His respiratory rate goes up when we try to turn it down.”

“How long will you treat him?” asks one of the students.

“Four weeks if there are no complications,” replies Allie.

“So let’s give a brief progress report about him to the Chief,” instructs Dave. 

We move along through the ward, pausing by each crib cubicle to give our updates.  Allie and I, as the two JR’s, have pretty much split the twelve infants and toddlers on this floor which, with the Eighth floor, takes care of the kids up to thirty-six months of age.  We pause at one of my patients, a new admission today. 

“Bob, how’s. . .” Dave pauses to look closely at the name card on the crib, “Rachel been doing since coming in?”

“Rachel is an eleven month old Negro girl, born full term at this hospital to a nineteen-year old gravida two, para one mother, who was growing and developing normally and was in her usual state of excellent health, until . . . ”

“Brief Bob, just the pertinents,” Dave interrupts.

“Okay.  She began to have a low-grade temp, and vomited up to five times daily for the two days prior to admission, then had six large, non-bloody, liquid stools yesterday, and three more overnight till her admission from the ER this morning.  She hadn’t voided for eighteen hours. . . “  I conclude my summary after adding the physical exam findings, labs, and IV fluids.

“Good.  That was better.  Present her to the Chief,” says Dave, “OK, that’s it.  We’ve got the two kids we want to discuss this afternoon.”  He turns to the students, “That’s how to do the work-round presentations—-concise and to the point.  Of course when you present to our ward attendings or faculty, give them the full ‘medical student’ treatment, unless they tell you otherwise.”  He turns to leave.

One of the students looks down to the end of the row.  “Ah—-Dave?  We haven’t looked at this one,” he says.

“Oh that’s just Sally Rider, our hydrocephalic boarder,” says Dave.

“What’s a boarder?” asks the student.

The group walks over and stops.  Dave rests his left arm on the rail of the crib.  “Did your class go out to Lexington State Hospital last year during the physical diagnosis course?” he asks.  “Remember the room full of hydrocephalics with gigantic heads, and the rooms full of Down’s Syndrome kids?  Well, Rider’s been on the wait list to get into Lexington State for about a year; meanwhile she boards here.  She’s mute and probably blind.” 

Her head, with sparse, wispy blond hair and prominent blue scalp veins, is approaching the size of a large pumpkin, triangular face way too small for her swollen skull.  Her eyes gaze downward, eye whites showing in broad arcs above her pupils, scanning constantly back and forth, unfocused.  Her wizened body is the size of a six-year old’s, all white skin stretched over bony, twisted limbs, forgotten by her brain.  Diapered and lying on her back.

“Our social worker doesn’t know why it’s taking so long,” I add.  “Apparently she was cared for at home until her mother got some progressive, downhill-type illness, and she was brought here because there wasn’t anyone else to take her.  She’s really about 16–maybe older–but you sure can’t tell that by her size.  She’s up here with the infants because her care is essentially the same, and physically she’s not much larger.  Poor gork.  The County gets dumped on all the time.”

We turn away and leave together for the elevator.  Dave didn’t ask about dwarfs.  Won’t remind him.

“You lucked out,” whispers Allie, “Dave forgot to ask you to define dwarf.”

“I had a chance to look it up.  I was ready.”

“So tell him.”

“Yeah, right.”


October 5.

Dave talks to Sam and Chris, the medical students, after our afternoon work rounds, giving them final instructions before their first formal presentations to the Chief at 4:00 PM.

“Just remember to discuss your cases in the same order that you do your write-ups.  Dr. Wasserman won’t expect you to be letter perfect at this stage of your rotation and you’ll be able to refer to your notes if you need to check anything.  That’s something that he doesn’t like the residents to do when they’re presenting since they ought to know their patients cold.  And your JRs will be there to back you up if you get stuck.  Any questions?  No?  Okay, you two will go first, and Allie will present her case last.  Let’s head on down.” 

We buzz for the elevator to the basement. The outer door opens, and Peg O’Hare, the diminutive, fifty year-old operator, slides open the inner, accordion door with a cheery, “Good afternoon doctors.  Going down to your conference?”  Her left eye looks straight at us, right eye aims off to the side; red-dyed hair frizzy.  She could be a leprechaun.

“Right, Peg,” says Dave, and we follow him in.

The elevator stops with a jerk.  Father Joseph Salerno is waiting to get on, as we exit.  He makes eye contact and smiles as he always does.  Father Joe is in his forties, of medium height, wearing steel-rimmed bifocals, and is starting to put on weight.  His short beard shows more patches of white than does the brown hair on his head.

“Hi, Father Joe, going up to see Toby White?” I greet him,  “I heard he should be about ready for discharge.”

”There may be a slight delay, he replies.  “His mother called today to say that he had a little fever this morning, and asked me to see him again.” 

Sal sure straightened me out yesterday about Toby.  Asked me whether I was more bothered by Toby’s residual brain damage because I felt sorry for Toby, or because my ego was hurt since I couldn’t keep it from happening.  Trouble is, I hesitated before answering.

The conference room is tucked away in the back left corner of the basement. It is a plain, boxy room without pictures.  Windows are set high up on the two exterior walls just below the ceiling, at ground level in window wells.  The walls were painted hospital green, but have been fading for years.  Well worn, blue linoleum tiles cover the floor.  A small table and a chair stand in front of the blackboard on the long windowless wall.  The door to the hallway is to the right of the blackboard.  Two rows of chairs form a broad “U” along the three other walls.  Old wooden student chairs with writing arms are randomly mixed in with armless metal chairs. 

Vinny, our chief resident sits behind the table, back to the blackboard, and will conduct the conference.  By custom, Stan Wasserman, chief of pediatrics at “The County,” the occupant of the Richard and Sylvia Krassner Chair of Pediatrics at Suffolk University Medical School (SUMS), sits in the middle of the front row to the left of the blackboard, with the rest of faculty around him.  The faculty all wear long white lab coats; the men with buttoned-down shirts, traditional ties, and gray flannel or khaki pants—-undoubtedly from Brooks Brothers, Rogers Peet, or the COOP–under their coats; the one woman, Frances Foreman, wears a conservative dark blue dress under hers.

Stanley Wasserman is a somewhat heavy-set, fortyish man, about 5’ 10” in height, with dark brown, slightly wavy hair, accented by flecks of gray, clean shaven but with a perpetual hint of “five o’clock shadow,” horn-rimmed glasses, and an easy but somewhat serious smile.  His voice is a surprisingly youthful tenor, contrasting with his body build and appearance.  Most of us were drawn to his training program because he was known to possess not only an encyclopedic command of pediatrics, but also a good-humored, humane, and skillful approach to conveying that knowledge.  He is definitely Stan the Man to his residents. 

Those who are presenting cases sit in the front row and look at Dr. Wasserman as they speak.  He and Vinny are already seated and joking, puffing on their pipes, as they wait for the house staff and students to file in. 

Sam, Chris, and Allie, as presenters, take their seats in the front row.  I sit behind them with Dave, next to Wilson Wee, the SR on Six, predictably nicknamed “Wee Willy,” even though he is a well-built, 6 foot tall Chinese from Hawaii who went to Dartmouth and was on the swim team, until he over-trained and hurt his shoulder.  He was a year ahead of me at SUMS.  Not many from the Far West out East here–three in his class–two in mine.  Guess it’s all perspective.  For Westerners, Baahston’s the Far East.  Far West is pretty geocentric.  East Coast.  Elitist. 

“Hi Wil–how many kids are your guys going to present today?”  I use his “formal” nickname. 

“Just two.”  Wilson unzips his black leather tobacco pouch, stuffs his pipe, flicks a chrome Zippo, and lights up in a cloud of fragrant, gray smoke that I breath in and recognize.

Borkum Riff?  Used to smoke that.  Funny.  Surgeons at County smoke cigarettes like T.J., their boss.  Pediatricians seem to go more for pipes like the Chief.  Thinkers or pretenders.  Cynical.  However. I get out a box of matches, my own plastic tobacco pouch, unroll it, and start to fill my down-curved, briar pipe with my “custom” blend.  Cowboy matches and “custom” blends. More posing. I strike the wooden match over my thumbnail and draw the flame into the tobacco, puffing out smoke.

“And we’ve got three.  Maybe we’ll have short rounds which would be OK with me after the busy week we’ve had.  Unless the other floors have a lot to present.”

“Hear ye, hear ye, let’s get this show on the road,” Vinny announces, “Let’s start at the top.  What have you got for us from Eight?”

I lean forward and prompt my student, “Sam, that’s your cue.”

Sam, sitting straight upright, face stiff, with the patient’s aluminum chart binder in front of him, begins, “The patient is a two-year old male, admitted last night because of inspiratory stridor and respiratory distress of four hours duration.  His present illness began yesterday morning when . . .”  Sam does a good job, needing only a few reminders to present just the positives in the patient’s past, family, and social histories.  He handles the questions about the details of his presentation pretty well, not getting flustered, and does only a minimum amount of looking up in the chart.  Dr. Wasserman stops Sam just before he gives the admitting diagnosis and treatments. 

“Before we find out what the admitting house staff thought and did, let’s do a differential diagnosis of what might be going on here,” Dr. Wasserman says. 

Vinny stands up by the blackboard and picks up a piece of chalk.  He turns to the group, “Give me some ideas.  In any order of probability–well?”

“Epiglottitis,” says one of the students.

Vinny scratches the word onto the blackboard, then turns to look at us expectantly, jiggling the piece of chalk in his right hand.

“Good,” says Dr. Wasserman, “looks like someone’s been reading.  And what bacteria?”

“Beta strep?” ventures the student hesitantly.

“Need to read more,” says Vinny, “What would be the most likely bug?  Let’s have one of the other students answer.”

“Hemophilus influenzae,” says another student more confidently.

“Correct.  Type b.  And why is it important to think of that first, even if you feel that another diagnosis is more likely?” asks Dr. Wasserman.

When none of the students responds, Lou Sharp, one of the JR’s on Seven says, “Because it’s the most serious problem, and can rapidly cause death.”

“Absolutely,” says Dr. Wasserman, “ You must think of the things that can kill the child and that require rapid intervention, and rule them out first.  And ruling out does not necessarily mean doing a lot of tests or studies.  Many times observation, the history, and the exam will give you the most important clues as to what’s going on.”

“OK,” prompts Vinny, “That’s one possibility.  Let’s have some others.”

“Wait, before you go on–one other point for the students and interns,” interrupts Dr. Scott, “Under no circumstances should you ever attempt to visualize the epiglottis in the ER or outpatient clinic if you suspect epiglottitis.  Doing so could precipitate a disastrous, acute, total obstruction of the airway.  As soon as you suspect the diagnosis, be fully prepared to secure the airway.”  Dr. Virgil Delmonte Scott dresses with a flair, and speaks like the scion of Virginia planters he is rumored to be.  However, the house staff refers to him—-never to his face of course—-as “Ol’ VD”—-a nickname that he detests.   

“Virgil, you always seem to have the last word, but your point is well taken,” says Stan Wasserman, with a chuckle.

Chief’s Rounds end at 6:20 PM, after the last case is presented and discussed.

There’s a large crowd waiting for the elevator, now operated by a thin, young man who must be new.  We finally get back to the Eighth Floor, and pick up our coats and book bags from the office.  The students are pleased that they got through their presentations intact and Allie and I tell them that they did well.    

  Both Allie and I are off tonight, with the Eighth and Seventh Floors covered by Lou Sharp.  We walk together down the long corridor to the front of the hospital, recapping the day, say goodnight, then separate to go to our cars.  Wonder what’s for dinner.  Starved.  OK Sal, time for our afternoon chat  * * * *

“Hello Robert, I’ve been waiting for you.  How was your day?”

“Hi Sal, I appreciate your asking.  You could have just taken a look and seen how it was, but you’ve been respecting my privacy by limiting your depth of contact.  Why don’t you go ahead and see for yourself tonight.”

“I’m happy that you’re feeling more and more at ease with me.  Even a week ago, you wouldn’t have felt comfortable enough to say what you just did.  Do you realize that you’ve gotten better at layering your thoughts so that I don’t see as deeply when I enter your mind as I did when we first met?  But you still occasionally have lingering doubts about my reality, don’t you?  Well, Edgar Allan Poe wrote that ‘All that we see or seem–is but a dream within a dream.’”

“Dream or not, talking to you beats listening to the Top Forty,” I reply, with a smile.

“Extraordinary how potent cheap music is.”

“That sounds like a quote too.  Who said that?”

“I believe it was Noel Coward.”

“What is this crap, Sal?  Noel Coward, Poe?  You trying to sound like a professor, or are you one?”

“I have access to some of the best minds in Boston.  Without paying a cent of tuition, I can listen in on a professor lecturing on Homer at Harvard, a futurist in his study at MIT, a sociologist at Boston University, a Jesuit at Boston College–anytime.  And I do have my favorite minds that I visit regularly.”

“So are you saying that you’re self-educated?”  I ask.  Very interesting.  This prove he’s real?  I don’t know those quotes.  They’ve got to come from outside of me.  Unless I absorbed them some place and stored them subconsciously?

“Did I say that?”  asks Sal.  “Have you forgotten what your professors told you about always listening to the patient and not trying to read too much into what they say?”

“Well, okay.  But my folks would have loved it if I could have done that before they paid out all that education money for eight years.  Dad’s put in a lot of hours and miles repairing farm equipment, and mom had to take a job when my brother and I went off to college.”

“You don’t get a diploma to hang on the wall, doing it my way.  Professional schools like to see those Latin words printed out, with a date of graduation and all the seals and signatures at the bottom.  It’s not about knowledge and thinking, but certification.”

A little cynical, though probably true.  Who are you, Sal?

October 8.

“It’ll be different, going to a party with teachers rather than physicians,” I say to Karen as we drive over the Charles River to Cambridge and turn left on Memorial Drive.  “I hope I can keep all the names straight.”

“Now you know how I felt at that first resident get-together at Dr. Wasserman’s,” she replies, “But this will be a much smaller party than that one.  It’s just the kindergarten, first, and second grade teachers and there’re just two of us per grade.  There should be three other men there too.” 

“It would have been nice if you could have gotten a school closer to where we live so you wouldn’t have to take the subway and make transfers every day.  It’s a long commute for you, and it’ll get harder in the winter,” I say, “Maybe we can switch off sometimes and you take the car and I’ll take the subway.”

“I’m happy that I was offered any position at all, coming in with no seniority.  I didn’t want to substitute teach again like I did last year.  The staff was very welcoming at Peabody.  It’s a good thing that I got my Masters at B. U. during your senior year in medical school.”

“And I’m just grateful that your cousin George told you to look me up when you got to Boston.  I owe him one for getting us together.”

“Yes, and I have to smile when I think of how he characterized you as being somewhat shy and serious in college.  You proposed four months after we met.”

“You inspired me.  And lucky for me, you accepted.  Anyway, tonight should be fun with a potluck, unless everybody brings the same thing.  Let’s see how creative teachers can be in the kitchen.  Anyone teaching home ec?”  I ask.

“There’s no home ec in elementary school,” Karen says, “But you’ll probably still eat much better with teachers cooking than if you doctors held a potluck.”

“Yeah, even though I worked in the dining room all through college, I sure didn’t learn how to cook.  I’ve got to laugh now, thinking how I invited you over to the apartment and fed you canned corned beef hash cooked up with frozen peas and seasoned with catsup and Tabasco, over Uncle Ben’s Rice.  Guess it wouldn’t count as haute cuisine.”

“Actually, I found it rather tasty,” says Karen.

“Thanks for being kind.  It was that bottle of “Paisano” we drank with it that made all the difference.  Nothing like a quality dollar-quarter wine to class up a meal.  By the way, where we’re going is off Bay State, right?”

“Yes.  Take a right at Boylston and go through the Square then get back on Bay State.  Then I’ll tell you where to turn when we get closer.  Remember our hostess tonight is Maggie Smith, my co-first grade teacher; you’ve heard me talk about her.  We get along well.  Her husband, whom I haven’t met, is Tom.  Maggie is so lucky–they live on Walker St. which is just a short ways from school.”

“What’s Tom do?” 

“Maggie said that he’s an assistant prof at Harvard, I think in social relations, but I’m not sure of that.”

“I’m sorry that we can’t stay too late tonight since I’m on duty in the morning.  Hate to run out on your friends right after meeting them.  You think leaving around 10:30 would be OK?”

“I’m sure they’ll understand.  In fact I mentioned that possibility to Maggie yesterday.”

October 10.

Monday evening, driving home.  The western sky is a darkening sooty orange. Fighting drowsiness, I crank the front windows down so that the fall cold blows on my face.

“Sal, talk to me and keep me awake. I had a bunch of admissions to Seven and Eight on Sunday, didn’t get much sleep, and then a busy day today.  Had to struggle to stay awake in Dr. Wasserman’s conference.”

“Dr. Wasserman must be used to residents nodding off on him,” says Sal.  “At least you’re only on duty every third night this year.  By the way, how’d the party on Saturday with Karen’s other teachers go?”

“Teachers sure do a lot of shop-talk when they socialize.  I thought only doctors did that.  But it was really interesting to see Karen in her milieu rather than mine.  I think it’d be fun to watch her teach.  Wonder if they’d let me visit her classroom?  That would probably make her nervous, though.”

“Were there other husbands there?” asks Sal.

“Spouses.  One teacher was a man, teaches second grade; his wife was there, but she’s a high school librarian so she’s sort of a member of the club.”

“Isn’t that unusual, a man teaching early elementary school?”

“I asked Karen that, because I was surprised too.  She said that it was, but she says Frank really seems to enjoy it and the kids relate to him very well.”

“Did you get to talk to him much?”

“Yeah.  He was interesting.  I finally got up the courage to ask him why he went into second grade teaching.  He laughed.  I guess he gets asked that a lot.  He said that he was always interested in teaching and, after thinking about it, decided that he could make the biggest impact by teaching in the lower grades.  A very conscious choice.  Frank’s an idealistic and thoughtful guy.”

“Did you go into pediatrics for similar reasons?”

“No, not really.  At least not for reasons as well articulated as Frank’s.”

“What about the other husbands?”

“Oh–Tom–Maggie’s husband.  He was something else.  I don’t think I came on very strongly about being a doctor, but he seemed to really have a chip on his shoulder about that, and took pains to let me know that he didn’t have a high opinion of doctors.  He went on and on about how physicians are mostly motivated by money, practice medicine by rote, and have no interest in science.  He said that even those who are in academic medicine are really pseudo-intellectuals who are over-paid in relation to the true, scholarly faculty.  That was after he asked me what I was planning to do after the County, and I said that I was thinking about a fellowship and then research and teaching.  What a schmuck.  I wonder if he’s as opinionated and prejudiced in the classroom?  Or, come to think of it, maybe it’s because I told him that I thought Nixon had clearly won the second debate.  Maybe the wrong thing to say to a Harvard prof.”

“That seemed to get your juices flowing.  Fully awake now?  Did you tell Karen about him?”

“Not really.  Karen likes Maggie a lot so I didn’t want to risk throwing cold water on their friendship.  I just said that Tom holds some strong opinions.”

“Very tactfully put,” says Sal.

“The other husband, Ben, was fine.  He sells insurance and seemed as puzzled as I about Tom’s attitude.  Well, here we are, home–and I’m lucky tonight–there’s a car just pulling out.  Want to keep talking till I get on the elevator?”  I quickly back into the space.  “But I don’t know what I’ll do if Karen wants to have Maggie and Tom over for dinner.  I mean it’s going to be tough to keep up the chitchat.  Maybe I’ll stick to something safe—-like, say, politics.”

“I think you’re on the right track.  It would only be for an evening, and if he makes enough of a fool of himself, you won’t need to say anything to Karen.  It’ll be obvious to her.”

October 12.

On Mondays, Wednesdays, and Fridays, immediately following morning work rounds, we have attending rounds for an hour, with two practicing pediatricians who are members of the clinical faculty.  Attending rounds are intended to give house staff exposure to private practice, since the full time faculty less little experience with that.  Most of the attending physicians have either graduated from SUMS, the County, or both.  Bernard Siegal, Dave’s older brother, a pediatric dermatologist in Chestnut Hill, and Dorothy Kerkorian, a general pediatrician in Cambridge, are our ward attendings this month.  Being an unpaid attending gives the clinical faculty a chance to fulfill their Hippocratic oath by teaching their craft to apprentices and provides a degree of prestige within the professional community.  They also have an opportunity to counteract the cynical folklore, held by many residents and students, that “LMD’s,” or Local Medical Doctors, are rather dull-witted with knowledge that is out of date.  Not that we encounter very many LMD’s practicing in the South Side to form an experience-based opinion. 

This morning there aren’t that many patients on the ward to discuss, and none with puzzling rashes, so we ask our attendings to give us their take on private practice.

“Do you have any time to read?” asks Chris, one of the students.

“It’s true,” says Dr. Kerkorian, who has been in practice for four years after leaving the County. “That as practicing pediatricians you may have even less time to read than you did as residents.  But you read in a more focused fashion.  You read about the problems that you see in your practice.  Remember that today’s house officer will be tomorrow’s LMD.  Just because someone has graduated from training does not mean that he or she has suddenly become more stupid, less curious, or less idealistic than she was a short time before.” 

Defensive?  Well, after three years, none of the residents you trained with are around to remember you.  You become just one of “them,” another LMD.  Dense until proven otherwise.  It’ll happen to all of us.

“It’s also important to avoid seeing so many patients that you cannot do a decent job and end up running an assembly line,” says Dr. Siegal.

“Tell them what happened to you when you tried to cut back on your practice,” Dave says to his brother with a broad grin.

“Well, it’s an interesting commentary on human nature,” says Bernard with a chuckle.  “Last year, I decided that my practice was becoming too large, and yet I didn’t want to tell the doctors who were referring me patients to stop.  After all, I might need their referrals in the future.  So I increased my fees thinking that that would put a damper on new patients.  But instead, my practice continued to grow.  I guess the patients decided that if I could charge more than anyone else, I must be the best around.  Maybe they’re right.”

“Too many patients and high fees certainly isn’t a problem that I have,” says Dr. Kerkorian.  “It’s different in general pediatrics, which is not a referral practice like dermatology.  It may not seem as glamorous or as exciting as doing research, but after only four years in practice, I know the joy of watching kids grow and change over time.  And I know that I’m helping in the process by providing their parents with information, advice, and support.  And preventive care.  It’s a very different perspective from what you get in the hospital with acutely ill patients.  Our training is oriented to be ninety-five percent hospital-based and yet private practice is exactly the opposite.  There’s a real disconnect there.  It took me a while to realize that not every baby with a high fever might have meningitis.”

“And of course,” says Bernard Siegal, “For me it’s one hundred percent office work, except when I’m doing attending rounds.”

“So Dr. Siegal, how did you cut back on your practice?”  I ask.

“I haven’t figured that out yet.  For new patients, my appointment wait is now out to four weeks.  But they’re willing to wait.  And willing to pay,” he says with a smile.

“If we don’t have any more patients, I guess we’re done early today.  We’ll see you on Friday,” says Dr. Kerkorian.  “Remember to watch Kennedy-Nixon Debate Number Three tomorrow night, if you can.  It’ll be important.  Nixon seemed to hold his own much better in their second debate.”

October 15.

It’s another Saturday on call, but since the winter illness season doesn’t usually start till next month, maybe it’ll be an easy one.  

“Hey,” says Lou Sharp over lunch, “I’m off today, but I’ve got nothing planned till tonight.  If it’s quiet this afternoon, you want to hit some balls on the court behind the nurses’ dorm?” 

“Sure, ” I reply, “but I haven’t swung a racket since July.  You got some fresh balls?”

“They’re always fresh.”

“As long as they’re fuzzy.”

“Hah, hah.  Lame.”

  “Sorry to hear that you’re hurt.  Page me at 2:00,” I say, “and if I’m not tied up, we’ll do it.”

Lou grew up in Chestnut Hill, and was taught tennis on clay courts at his parents’ country club, whereas I learned to play on the public hard courts of San Sebastian.  I was on my high school team, but when I came east it took me a while to adjust to the Har-Tru courts at Harvard, and I never really felt comfortable on them.  A big, flat, first serve just didn’t work as well as it did on hard courts.

I check with the floors at 1:45, and there’s nothing doing, and I tell them and the operator where I’ll be after 2:00.  I find Lou in the HOB lounge watching TV, sprawled out in one of the overstuffed leather armchairs that fill the large room.

“All quiet so far, Lou, still feel like playing?” 

We go up to change, then walk across the parking lot to the southern ER entrance to the hospital, dash across East Walden St., and walk behind the four-story student nurses’ dormitory.  No one else is using the court, and Lou pops open a can of balls. 

“Didn’t you used to play in college?” asks Lou.

“Second doubles, so I wasn’t exactly burning up the court.  How about you?”

“Second singles my sophomore year at Middlebury, but when the lab load got too heavy my junior year, I dropped off the team.”

“Pretty sharp, Sharp, second singles as a sophomore.  Your coach must have been pretty disappointed when you quit.”

The court is asphalt, and has not been maintained.  The surface has a scattering of cracks, with tufts of browning weeds protruding, and the net is fraying.  We begin to rally, my semi-Western forehand and sliced backhand to Lou’s well-schooled Eastern forehand and backhand drives.  The air is cool, but the sun warms our skin, and though we’re both out of practice, it feels good to be trading strokes and running each other.  The sound of the ball echoes crisply off the brick dorm wall and soon there are a few kibitzers and laughing hecklers looking out the windows. 

“It’s Saturday.  Don’t you girls have anything better to do?” calls out Lou.  “Did all of you get grounded?” 

I recognize one smiling face, “Hey Juliet, finally got caught, huh?”

We’re into our first set, 4-3, when the courtside phone rings.  “It’s probably mine,” I say, and walk over to pick it up. 

“That was your floor,” I say to Lou.  “Need to restart an IV on Larry Kelso.  But I think it can wait a while.  The next dose of antibiotics isn’t due for two hours, and the nurse said that he’s been drinking and peeing.  That okay with you?”

“Sure.  It’s love-fifteen,” calls out Lou, as he prepares to serve again.

“Love-fifteen?  How ‘bout just serving up some plain love?” one blond girl says with a giggle.

“You can come over to the HOB when you’re off detention and see about that,” Lou replies, as he walks back to the fence to retrieve the ball that I returned well over the baseline.  “Fifteen-all.” 

October 17.

“Good night, honey” says Karen and gives me a quick kiss before turning off the light.

“Ah, don’t you feel like making love?” I ask again, and I place my hand on the smooth inside of her right thigh and squeeze it gently.

“No, I told you that I had a long day.  I’m tired.  And besides, I’m probably going to have my period soon.”

“All the more reason to make love now.  We won’t be able to for almost a week.  Come on–I dreamed about loving you all day,” I plead.

“Oh Bob, why must you insist?”

“Besides, I’m at the hospital again tomorrow night, so I won’t be home till Wednesday.”

“Can’t you wait?”

“You’ll probably have your period by then.  You just don’t know how strong a man’s sex drive is.  It can almost be painful.  Please?”

“Oh, all right, if you must,” she says with a sigh, “Otherwise you’ll probably keep me up all night, tossing around.”

“Thank you,” I say gratefully, “Let me help you take your gown off.”

“No, leave it on, just lift up my skirt.  I changed the sheets this morning, so be careful.”

I reach under her gown for her body.

“That’s ok,” she says, “just help me with the diaphragm.”

She does not respond as she usually does and I have my release alone.  Tonight she wants no after-play and quickly falls asleep.

October 18.

It’s been quiet, and now I’m in my tiny room in the HOB, after signing out to the Night Float.  Hope it stays quiet.  Lately Sal has stayed up late to talk when I’m on call.  Unless I get tied up.  See how things were with him today, not that he lets me know much about himself.  So Sal * * * *

“Good evening, Robert.  I was hoping you’d call.  How was your day?” 

Always touch of formality–he older?  “Oh–so, so.  And how was yours?  Not that you ever give me any particulars.”

“I’m fine and wide awake.  But you seem to be bothered by something nagging at you tonight.   Anything you want to discuss?  I don’t want to seem nosy if you don’t.”

“You sure can pick up on my emotions.  But, you’re right.  I guess I wasn’t too thoughtful with Karen last night when she was tired.  You can take a deeper look in my mind and see what happened.  I don’t feel like discussing the details.”

  Sal is silent for a moment, then speaks, “Bob, no wonder you have something on your mind.  You feel guilty and a little ashamed of yourself because you badgered Karen last night till she gave in.”

“Yeah.  Not a great way to treat the one I love.  But I had such an urgent need for her yesterday–it was so very disappointing to get home and find that she didn’t feel like making love.  I guess I acted like a dog.”

“A dog?  From what I know about dogs, most of them show a lot more caring to the ones they love.  Maybe more a pig.”

“Yeah.  You’re right.  I was a greedy, self-centered pig.”

  “Bob, you don’t get off that easily.  You think that if I agree that you acted badly, then everything will be all right, because you’ll have confessed, been scolded, and then you’ll be off the hook.”

“No, that’s not it at all,” I protest.  “You make it sound so childish and selfish.”

Sal says nothing.   

“Sal, are you still there?  Say something.”

“Bob, I don’t need to say anything when you’ve already said it.  Now do you plan to make things right with Karen?  She trusts you to be honest with her and not play games.  I know that you love her.”

“Sal–so help me out.   What do you think I should do.”

“You’re not a child.  When I read you just now–along with finding out that you bullied Karen and then felt guilty over it–I also saw that you already know what to do.  Just open your mind now and let the thoughts rise up to a conscious level.”

I close my eyes, breathe slowly and deeply, as Sal had previously instructed me; the thoughts slowly come.

Karen, I love you, yet I acted selfishly and took advantage of you.  I backed you into a situation where you had to give in to me or feel guilty for not doing so.  Please forgive me.  I promise that I’ll try hard not to do that again.  But I am a man, with faults, so I could fail again.  If I do, please know that it’s not because I don’t truly love and respect you but that I am weak.  Tell me when I seem to be losing it.

“That’s good for starters,” says Sal, “Tell her that tomorrow, first thing.  The longer something festers, the deeper it burrows, and the more of a scar is left.”

“That’s quite a medical metaphor, Sal.  I’ll do it as soon as possible.  I already feel better now that I spilled my guts to you.  I know what I need to do.  And I guess some flowers wouldn’t hurt either.  Say, do you think that you could take a peek into Karen’s mind and tell me how she’d react if I said that to her?”

“Sorry Bob.  I hope you’ll understand, but that would be an ethical no-no for me.”

“Yeah, I kind of thought that it might be.  Good night, Sal, no hard feelings.  Thank you very much.  I really mean it.”

“You’re welcome.  Good night Robert, I hope you get some sleep tonight.”

Must be how a Catholic feels after confession.  Except Sal didn’t absolve me but made me confront and deal with it.  Probably that’s what priests do when parishioners come for advice.  He did say, “confessed.”  Could he be a priest–or a shrink?

October 19.

The streetlights are already on when I cross Franklin Ave. and open the door to the small, ground level flower shop at the corner of Franklin and Salem.  The dark, oiled, wooden floor planks creak as I step on them.  I smile at the 11-year old with Down Syndrome sitting on a stool just inside the door, the son of the shop owner.  He is slowly and carefully clipping the tips from long-stemmed pink carnations before placing them into a florist’s bucket with fresh water.  I’ve seen him playing on the sidewalk outside the shop ever since I lived on Salem St. as a student.

“Hello Brian.”

“Ey ya,” comes his guttural reply.  He looks up, happy that I know his name. 

“Evening Mrs. Malloy,” I say to his mother behind the counter.  How gutsy for this family to keep Brian at home, instead of sending him to an institution.  So many parents were told to do in the past.  Bizarre–rooms at Lexington State full of children and teens with Down Syndrome that we saw as med students. “I need some roses.”

“A special occasion?  Or do you need to make something right with the lady?” asks Mrs. Malloy with a smile.

Jeez–everyone a mind reader these days?  “Ah, yeah.  What do those long stem reds go for?” 

“Usually they’re seventy-five cents, but I know you boys don’t get paid much, so I’ll let you have them for sixty cents each.”

“Thanks, I sure appreciate that.  Here’s two dollars.”  I lay the rumpled bills on the counter, then dig through my pants pockets and come up with a dollar in change.  “And here’s another buck to make it five roses.”

“Oh doctor, a lady likes either one, six, or a dozen roses.  Tell you what, you’ve heard of a baker’s dozen?  Well, I’ll let you have a florist’s half-dozen.  With a bit of greens.”

“You’re more than kind.  Thank you very much.”

“You know, you’ve always said hello to Brian when you pass.  So many others, even doctors and nurses, seem to shy away from him.  He’s really a very loving child.”

“Children with his condition often have a very pleasant, friendly nature.”

“We know he has mongolism; it’s all right to use that word with us.”  She wraps the roses and a sprig of fern in a cone of green florist’s paper and hands it to me with a smile.

“You’re very brave, Mrs. Malloy.  And thank you very much.  Good night, Brian.”

“Goo nigh, doc.”

October 20.

I make the connection to Sal after turning the corner into Bay State, heading home after work.  It’s dark earlier now, the street lights glow yellow; the wind is brisk and picks up paper scraps and brown leaves from the sidewalks and gutters and swirls them into the street between and under the cars.  The air holds a definite nip after the sun goes down; the heater works with an earnest purr and some heat begins to flow out of the vents.

“Hi Sal.” 

“How did it go with Karen last night?” asks Sal, getting right to the point.

“Well, thanks to our conversation the night before, good.  I think she was really surprised when I apologized right away after getting home.  She probably thought that I hadn’t considered how she might feel, once I satisfied my needs.”

“And how did that make you feel?”

“Well, that got me to thinking.  If she was surprised that I might feel badly about how I behaved, then she couldn’t have very high expectations of me.  That was painful.”

“And had you coerced her before?”

“Well, yeah.  But only once.  And never physically.”

“Only once?  And psychologically like this time?”

“Yeah.  Well.  Maybe twice.”

“Maybe twice.  And, in the past, did you ever say anything to her about being sorry afterwards?”

“Probably not.”

“So why should you be surprised?  You never gave her cause to think that you would ever be aware of the way she felt.  And you weren’t sorry enough that you stopped doing it.  She can’t read your mind.”

“Good God, Sal, you don’t let me get away with a thing, do you?”

“Would you rather have me to say, ‘oh good little piggy’ and tell you that everything you do is great?”

“No, no.  Of course not.  It’s just that it’ll take me some time to get used to having my–ah–conscience speak to me so freely.  I’ve always thought of myself as a pretty decent person, and yet you made me face up to acting badly with Karen.  It’s tough to see myself as I really am, not as I’d like myself to be.”

“Before you can make changes, you need to face yourself honestly—at least if you really to want to change or grow.”

“Yeah.  Maybe I’ll grow up one of these days

“Don’t be too hard on yourself.  Changing a habit like smoking or drinking is tough enough; changing a part of your nature is even harder.”

October 21.

I’ve finished my presentation to the Chief; the questions from residents, students and faculty answered; the discussion over.  I’ll be on call for Seven and Eight tonight, after rounds.  Puffing on my pipe, I listen to the other cases and discussions, jotting down the occasional pearl in the pocket loose-leaf notebook that all of us carry for that purpose. How many false pearls, cast before us true swine?  Old cliché.  Ol’ VD, purveyor of glass beads to swine.   And Bob the pig—oink, oink—gimme, gimme.

The patient from Five is a case of possible endocarditis (infected heart valve), in a ten-year old girl with a prior attack of rheumatic fever that left her with a scarred mitral valve.  She’d recently been to a dentist without getting the recommended penicillin prophylaxis beforehand, given to prevent bacteria that are seeded into the blood stream during dental manipulation from infecting the damaged valve.  Now she’s had fever for nine days, with possibly a change in her heart murmur.  Saul Norman and his infectious disease fellows are here to discuss her.  I look at him, sitting across the room, his feet just barely reaching the floor, his lab coat shortened considerably. 

If I decide to try for an infectious disease fellowship after military service, it wouldn’t be bad to come back to Norman-—if I could get in.  Maybe Stan the Man would put in a word for me with Saul.  Hmmm, Saul–Sal, could it be?  Should I try to contact Sal and see if Norman reacts?  Would Sal get ticked at me? Give it a try.  Why not? * * * *  

“Hello Robert, you’re quite early today.”

“Hi Sal, I was starting to daydream, so I thought I might as well talk to you as nod off.”  I look carefully at Dr. Norman all the while.

No pause in Norman’s speech.  No sign of surprise or recognition.  Either he’s not Sal or he’s really good at covering up.  Didn’t really expect it would be easy to trick him.

“It’s important to draw a sufficient number of blood cultures,” Dr. Norman is saying, “You do not need to wait for a fever spike in order to obtain a culture, as was once believed.  Just get as many samples as possible, at different times and from different sites, to maximize your chances of getting a positive culture.  That’s because you want to start antibiotics on suspicion of endocarditis rather than holding off for two or three days, waiting for culture results, allowing further damage to occur.  The worst situation would be to suspect endocarditis and start treatment, but recover no bacteria.  You might then be locked into a prolonged course of antibiotics, totally blindfolded.  Can anyone tell me the minimum number of blood cultures recommended?  One, two, ten?”

“Why don’t you concentrate on learning your craft rather than playing detective?” asks Sal.  It’s always hard for me to tell about his emotions, but there seems to be a hint of amusement in his thought.  “I’ll talk to you tonight as usual, if you don’t get tied up with an admission or a problem on the floors.”

“OK, Sal.  You’re not mad are you?” I ask.

“No.  But do you really think that I can’t walk and chew gum at the same time, Bob?  Talk with you later.”

What’s that supposed to mean?  Guess he’s making a little joke because of what I tried.  On other hand, sometimes the best place to hide something is in plain view.  Norman just smile to himself?

After rounds I walk over to the cafeteria to get dinner out of the way.  It’s much less busy and more muted at night than at noon, since everyone who doesn’t have to be at the hospital is grateful to be eating elsewhere.  The diners sit a few to each long table and there’s the soft murmur of conversations.  The Friday night fare is baked cod, boiled potatoes, and canned beets.  Dessert is canned peaches or ice cream.  I opt for both–vanilla ice cream on peaches. Peach Melba.  Mom taught me that.  Well OK.  No raspberry sauce.  For purists it’s just canned peaches and ice cream.  Cheapo.  Melba sounds classier.  But no classy dinners.  Baked cod and fried cod and poached cod and codfish sticks and codfish stew, Friday after Friday.  Boston, home of the cod and the scrod, or is it scrod and cod?  There’s Wil by himself. 

“Hi Wil, like some company?”  Wilson is chewing but nods his head yes and motions towards the bench.  “You going out tonight?” 

He swallows before speaking.  “Yeah, with Ken Dill.  He’s a medicine resident.  Got no dates, so we thought we’d head over to Cambridge later.  Joan Baez is singing at a coffee shop near the Lampoon Building.”

“She any good?”

“Oh yeah.  You ought to take Karen to hear her.  What a clear, pure voice,” Wilson says.  “It’s a cheap night out, but they’ll probably raise prices after she puts out her first LP.  Doesn’t hurt that she looks great too.”

“Well then, she’d better have some bodyguards tonight, what with all your wild men down from Hanover for tomorrow’s game.  How’s that go?  ‘Dartmouth’s in town again, run girls run; down from the hills we come, fun girls fun.’”

“I’m surprised an effete Harvard man knows that song.  Must be penile envy.  But this wild man couldn’t line up a woman for the weekend,” sighs Wil, before taking another bite of fish.

“That’s because they all heard that you’re Wee, Wilson.”  Wil gives me the finger since his mouth is full.

“Couldn’t resist.  You going to the game?  Karen and I‘ll probably go.  If you’ve got no date, come with us.  We can stop by the apartment for lunch after morning rounds, then drive over or take the subway.  Parking will be a bitch.  And you can even pretend you’re couth and sit on the Harvard side.”

“Thanks.  A home lunch plus company and a ride would be great, but I’ll sit with the Big Green savages if you don’t mind. Probably run into some guys I know.  Just can’t get used to being around drunks who think they’re sophisticated.  We can meet after the game and I’ll listen to you crying about Harvard getting smashed.  Anything happening on the floors?”   

“Not that I know of, but I’ll swing through Seven and Eight after leaving here, and then I’ll probably hang out in the office and read, or dictate discharge summaries, until the Float arrives,” I reply.  “Then, if it stays quiet, I’ll go up to the lounge and watch the end of the fourth debate.”

“You’re a glutton for punishment,” says Wil.  “There’s nothing more they can say tonight that they haven’t all ready said in the first three.”

“I guess.  But I still don’t know how I’m going to vote.  Karen is sold on Kennedy, but I’m not so sure.”

October 25.

The last glow of twilight has faded and I feel the night chill stiffening my cheeks as I exit the hospital after rounds and cross Franklin Ave. to the corner of Cooper Square to pick up some apples at Mangione’s before driving home.  I did a lot of convenience shopping at that small grocery and sundries store when I was a medical student, living then only a block away.  I glance at the familiar name in gold letters on the window, S. and A. Mangione, as I enter. 

“Hi Antonio,” I say. 

“Hey, doc,” he replies from behind the produce.  “Don’t see you as much as we used to, now that you’re a real doctor.”

“Well, I’m married and living over on Beacon now.  I shop where the wife wants to go.”

“Yeah?  Well, come in once in a while to say hello.  Don’t forget us.”

“I couldn’t ever forget you guys.  And anyway, here I am tonight.  Where’s your brother?” 

“Oh, Salvatore?  He went home early.  Wasn’t feeling so good.”

I sort through the Macintoshes, picking four.  Salvatore.  Could it be?  Nah—Came here during four years of school.  Not one contact.  So couldn’t be him.

“Tell him I said hello,” I say as I pay for the apples.  “And that I hope he feels better.” 

“Yeah, I’ll do that.  And don’t forget to come back and see us.”

I pull on wool gloves and turn up my collar against the damp chill before opening the door. Walking to the car, I think * * * * “Hi Sal.”

“Hello Robert.  It’s getting colder, eh.”

Why beat around the bush?  “Look Sal, let’s get right to the point.  I’m pretty sure you’re not, but I’ve got to ask.  You’re not Salvatore Mangione, are you?”

“That’s an interesting thought.  Would I confirm it if I were?”

“I don’t think you are, but I want to be sure.”

“Well, you struck out on Friday, and you probably struck out again tonight.  But this isn’t baseball,” says Sal, “you can strike out as many times as you like and you’re still at bat.”

I unlock the car.  “You’re not angry with me for trying?”

“No, Robert.  I think it’s quite natural to be curious about whom I might be.”

“But you still won’t tell me or give me any hints?”  I think I detect a tinge of amusement in his reply, but I’m not very good at picking up his emotions.

“No—-not at this time.” 

October 29.

It’s a drizzly but warmer morning and I’ve driven in for Saturday rounds.  The fallen leaves lie yellow, orange, red, and gray-brown, sodden and unswept, moldering in the gutters, and tramped into wet leaf pulp on the uneven brick sidewalks.  Salem St. where, as a medical student, I shared an apartment for two years with Jerry Jacobs–now in OB at Bellevue-is parked full.  I circle Cooper Square, which is directly opposite the Administration building.  Funny Boston names.  Cooper Square is really an elongated oval.  Not a right angle in the place.  The narrow park in the middle of the ‘square’ has a central asphalt walkway with black iron benches running its length and mature elm trees, branches now bare of leaves, around its perimeter.  The four-story sooty-brick walk-ups crowding around the Square have been mostly converted into rooming houses and apartments, many occupied by medical students at Suffolk University Medical School (SUMS for short) and nurses and hospital workers.

On my second circle I luck into a nose-in parking space fronting the small “County Pharmacy.”  I put up my black umbrella, lock the car, and cross Franklin Ave., passing Aesculapius on his pedestal, the lower quarter of his bronze staff burnished bright by four decades of medical students rubbing it for good luck, take the steps two at a time, close the umbrella while hurrying past the front information desk and stride down the long corridor towards pediatrics.  We’ll have brief work rounds before Chief’s Rounds at 9:00.  The elevator arrives and, as Peg opens the door, Joan comes rushing up in a wet, blue trench coat, shaking out a clear plastic rain bonnet, and we both get on. 

“Good morning Bob,” says Joan, looking me up and down and smiling.  “Are you Bing Crosby or Clem, the farmer today?”

“What?” I reply, startled.

“Wellll, You’re looking just a bit informal aren’t you, wearing that cardigan?  Is that California-style?  Sweaters?”  The door opens on her floor and she exits, trailing a laugh. 

Damn.  Gone before I could think of a reply.  Some New Englanders.  So stuffy and narrow-minded.  Got a buttoned-down shirt and a tie under my sweater, after all.

“She really nailed you with that one,” cackles Peg.  “Me, I like Bing.  Now if you could only croon “Galway Bay” like he does, I’d give you a big, fat kiss.”

Whoa-—glad I’m no singer.

On rounds, we go through the floor quickly.  Not that much has changed from yesterday afternoon.  Allie’s on.  She knows my patients.  Chris is on too.  Had a month on the ward.  A sharp student.  Thinking about peds residency.

The Chief is away for the week and “Ol VD”-—Dr. Virgil Delmont Scott-—holds forth at Chief’s Rounds, playing his role as assistant department chair with gusto.  Dr. Scott has aspirations to be a chair too, somewhere, but the references that he liberally cites to buttress his statements are sometimes difficult to find when we residents and students try to look them up.