Sex, Drugs, and Public Health

V. Bio – Chem

Sun, escaping the New York jungle of Central Park, shafted through the lab window and glinted off a Rube Goldberg cacophony of glass, test tubes, safety goggles, and Bunsen burners on my section of the bench. Valves protruded from the backsplash of the counter, all aimed at me like enemy machine guns. They were labeled:

“Gas; Water; Oxygen; Nitrogen; Unknown.”

From this, I despaired, I’m supposed to recreate the Krebs Cycle? Our livers had thirty thousand years to figure out how to do it and I get one week?

“How’s it going over there?” the small guy to my left asked, kind of friendly.

Some people are so quiet and innocuous, you don’t know they exist: wire rim glasses that made me unsure if he actually wore glasses, white shirt buttoned down, grey tie, tweed jacket beneath his lab coat. All pretty boring. Except his hair. Full, thick, and way past his ears, almost as far down as his sideburns.

“Oh, great,” I lilted. “Just fine. And you?”

“Yeah,” he smiled. “I’m lost, too.”

You know how back in High School you go for the obligatory photo for the yearbook and the photographer says, “Smile! No, I mean, Smile. Don’t grin. Don’t grimace. Try to smile.”
And we struggle as hard as we can to smile, but the photo still stinks? Then, some other people, they just do it, naturally even before they sit down so all the photographer has to say is, “That’s great.” And they’re done?
That’s how his smile was. So natural, it relaxed me just to look at it.

“I think we’re supposed to put this stuff in the Erlenmeyer flask, and retort it into there, aren’t we?”

He pointed at my Rube Goldberg and, I realized, he was right.

Huh? Why was he helping me?

“Ralph,” he introduced himself.

I introduced myself back and, naturally, comfortably, we became side-by-side lab partners in Biochemistry while everyone else sneered and cussed and faked their way through the afternoon, isolated from their neighbors by two distances: the physical one created from the limit of their elbow’s reach, and the emotional effect of saying, “Do your own experiment. I’m busy here.”

As I cook-booked my way thru each step in our chemical mimickery of the human body’s processes, the tune and words of “Love Potion Number Nine” came out of nowhere and cycled around my brain. I couldn’t dislodge it, so I commandeered it:

I got a big old fear of Physiology
The nasty old professor makes me shake and pee
I need something good to sneak into his wine
I’m gonna mix a flask of – – Love Potion Number Nine

When the lab was over, Ralph smiled, and dissolved back into the swirling background of Med School.

That night, in the cafeteria, I asked my roommate if he knew Ralph.

“Oh, the short kid with long hair,” he said as he straightened his tie in the glass of the cafeteria’s dispensing machine. “The one who wears tweed jackets?”

“Yeah. You got something against tweed jackets?”

“So… out of fashion.”

“So, what’s in? I asked, still struggling to become a New Yorker.

He turned to look at me, incredulous. “Polyester, of course.”

“Oh.” I made a mental note for my next shopping trip.

“But that Ralph,” he continued, “is weird. And not from here.”

“Not from here?” I sought clarification.

He dropped coins into the machine, “He’s from out west somewhere.”

“How far west?” I asked, self conscious that I, myself, had gone to school in Indiana.

“You know, somewhere,” he waved his hand as if chasing a fly, “the other side of the Hudson River. West.”

“Oh, yeah,” I mused, “out there with the Indians and cannibals, right?”

I expected either a guffaw or outrage at my sarcasm, but instead, he just took his coffee from the Horn and Hardart dispensing machine and said, “Yep. Out there.”

IV. Histology

Oh boy, Oh boy, Oh boy. I get to use my microscope!

We all flowed into Histology lab, wooden boxes swinging from our arms. Fumble, fidget, plug it in, twirl the knobs, bounce excitedly on our stools.

“It’s a Bausch & Lomb 742,” boasted Dolin, in response to someone’s question, but loudly enough for the whole lab. He buffed his already shining new bifocal microscope, exuding both pride in his possession and cockiness that it, alone, would snag him an “A” like some magical biopsy tool. Somehow, he managed to secrete all this enthusiasm from a face permanently fixed in a scowl. No one had seen a smile from him since day one in the auditorium.

“You vill brick your fingers and zee blut you vill smear on zee slide,” the Histology prof directed. “Zhen find zee corpuscles of all zees different types,” he pointed to the board. Erythrocytes, basophils, neutrophils, platelets, macrophages, blasts.

Wow. I hope I find all of them. Well, not the blasts. That would be weird. Diagnose your own leukemia. That would be a bummer.

So I swabbed my left index finger with the traditional alcohol, held it up before me, picked up the sharp little lancet in my right hand, took deadly aim, and jabbed.

I missed.

My index finger jerked back, away from the arrow-like lancet. I snickered at myself. Well, it’s just an issue of will power.

I planted my left elbow firmly on the counter, index finger pointing ceiling-ward. Its vulnerable, fleshy pad exposed to my focused pupils and to the poised lancet. I firmed the muscles in my left arm to hold it there and, before my left hand could suspect what I was doing, lunged with my right.

Missed again.

Boy, my left hand is fast. Maybe if I…

A hairy paw grabbed my left wrist, and pushed my hand down flat onto the counter.

“Now you vill get your blut. You see, zehr is no vhere for your fing-her to go.”

Ouch.

While my eyes were buried in the microscope, sorting through my drop of ten thousand or so red blood cells, looking frantically for a white one – ANY white one, just one white one, I heard my roommate’s voice.

“Forgot to tell you. This was in the mailbox this morning.”

I pulled my eyes out of the microscope sockets to find him holding a white envelope. The return address was my Draft Board. I almost puked on my microscope.

“Open it.”

“Naw,” I shook my head. “Think I’ll hide it behind the right kidney of my cadaver.”

“Why?”

“Cause we’re only gonna remove the left one. Don’t have to dissect them both. We’re gonna leave the right one in.”

“No, I mean…”

“I KNOW what you mean!” I said way too loudly.

I waited for everyone’s eyes to fall gradually back into their eyepieces again, then I mumbled, “If they’re yanking me out of Med School, I don’t want to know.”

“Open it. Not reading it won’t change what it says.”

“Blah-blah-blah… deferred until Medical training completed… blah, blah, blah.”

“That’s great,” my roommate smiled. “One less worry.”

“Yeah. Now all I have to worry about is Physiology, Anatomy, Physiology, Histology, Physiology, Bio-chemistry – ”

“Are ve vorking or are ve chitty-chatty?” the professor boomed pretty much toward us.

III. The Lion’s Den

“Here we go,” John said, taking an audibly deep breath. “Physiology lab.”

The specter of failing, as had the eight from last year, now known throughout the school, unimaginatively, as ‘The Eight’, hovered over all of us like a plastic shroud that someone could drop on us at will.

Groups of four were assigned to tables with anesthetized dogs who’d been unlucky enough to be strays, and we were ordered – ‘instructed’ was the term the Physiology Prof used, but with his history so well known, ‘ordered’ was how we took it – to do a dozen things we’d never done before, just to start the experiments.

“Who’s gonna insert the catheter?” I asked my group, figuring if I asked first, someone else would volunteer.

“You,” barked a kid named Marshall, his face stubbly with three days’ growth, his hair curly and disorganized, his tie stained and askew. He made me think of that Frank Zappa guy.

“Why me? I’ve never done this.”

“I’m attaching electrodes to this transducer. You think I know what I’m doing? Look confident. The Prof’s watching.”

The room descended into murmurs and busy looking clueless elbows moving decisively within white coats. There were, I later learned, three people in the room who had done this before and the lucky tables where they worked actually got real results to record.

“This is awful!” suddenly rang out.

All eyes shot, not to the source of the outburst, but to the Physiology Prof. He stood, clipboard in hand, white-coated, at a table near us, and didn’t flinch. Didn’t even look up. Just continued his instruction, getting ever nearer to finishing with that table and then arriving at ours.

As the murmuring took over again, I looked over at the student who had erupted. It was easy to find her. She was the tallest one in the room, and blonde – an irrelevant detail that all the guys had noted since day one.

“This poor animal!” she followed up, disrupting the murmuring again.

“Now that,” whispered Murphy to the other three of us, “is why women don’t belong in Med School.”

Something moved in our peripheral vision and all four of us dropped our eyes and hands to our sleeping dog, entangled in its net of wire and catheters.

“What is the arterial pressure?” the Professor asked us.

“Uh-h-h,” was the way I started.

“Ninety millimeters,” Zappa shot back, in a voice implying his annoyance at the professor’s intrusion.

“Hurry up with the venous catheter,” the Professor ordered. “We have to begin the infusion.”

He was about to move to the next table when Murphy opened up. “Did you hear that girl, Professor?” he chuckled. “Pretty annoying, huh?”

“Happens every year,” the Prof droned. “Women are different, which you should know Mr. Murphy since you’re married.”

“How did you know that?” he reared back.

Shut up, Murph, I said to myself.

“Shut up, Murph,” Zappa shushed from the corner of his mouth.

“You think I don’t read your files?” the Prof raised his eyebrows. “All of them?” He fixed Murphy’s eyes. “Loyola College,” he turned to Zappa, “N.Y.U.,” he looked at me, “Notre Dame,” he finished with John, “Columbia. I expect good work from this table.”

Finally he swiveled to move on, and the three of us began to turn on Murphy. But the Prof stopped and turned his head back to us. “Oh, and Holly over there? She who annoyed you with her outburst?”

We all hung in the silent moment.

“Harvard.”

When the Prof was out of earshot, John beat Zappa to the punch.

“Nice work, Murphy. What were you trying to do? Kiss a little professorial butt?”

“Are we almost done?” Murphy slumped. “I need a drink.”

And I suddenly had a bad vision of the future for our red-headed, freckled faced, sad-eyed Irishman.

“So Marshall,” I asked, my pen poised over our lab notes. “What was the arterial pressure again?”

“I don’t know,” he snapped. “Make something up. Like I did.”

And a sense of dread, like some onrushing cloud of radiation, began to engulf me. If I don’t get drafted out of Med School, the Physiology Prof will flunk me out. My whole life will be fried to a useless crisp because here, I have no Fallout Shelter to run to.

So I dove into what should have been an exhilarating exploration of the world’s Second Oldest Profession, but was, because of this thing hanging over me, a blur of classes, labs, and library hours. I always avoided the Dean’s office, constantly fearing a call or note from the little bald man, transmitting a lethal pain as does the vagus nerve, when it conducts to the brain, news of the death of your mutilated heart.

In the evenings, I read my day’s notes, outlined them, re-read them, then underlined the important parts (that is, every line). I sunk into sleep when my eyelid muscles no longer had the endurance to remain open.

In sleep, dreams were intertwined with nightmares. I see my father, shaving at the mirror. He turns to me.

His eyes say, in my silent dream, what I always believe I’d heard years before: “you need to watch over your mother for a few days. I have to go into the hospital for a little test.”

Even in sleep, I feel my gut spasm at the words “a little test.”

Behind the swirling curtains of another dream, I stand at my father’s bedside in a room of white walls, white sheets, white food on a white tray served by an albino nurse.

“I’m fine,” my father smiles at me. “I’ll be home tomorrow. They’re taking real good care of me here.”

I was dedicated, from that day, to being a performer of such miracles for others. A restorer of indestructible and indespensible fathers, when their bodies betray them.

But hovering above each dream scene was the dark gossamer threat of my Draft Board Damocles, my Report for Active Duty date one day closer.

I awoke, all my muscles sore from the constant tension, to face another day, already hopelessly behind in my studying.

II. Our Body

The classical moment in a new Med Student’s life is when he (or she – more on that later) is introduced to his cadaver. My father had told me about how my grandfather acquired his. With a shovel, apparently. At midnight. With a couple of other new Med Students watching for the police while he and his lab partner dug as fast as they could.

In New York in the late 1960’s it was much more civilized. Those who had donated their bodies to science before their demise hung, in a chilled room, suspended with ice tongs by their ear holes. The school’s technician removed them, placed them on tables, and covered them with plastic sheets. Then he leaned into a corner of the lab to watch as new students slowly pulled back the sheet with all the bravery they could fake smeared across their faces.

“There’s something wrong with his skin,” I blurted.

“Her skin,” one of my dissecting partners corrected.

“No breasts,” I corrected him.

“Mastectomies,” he pointed to the dual scars with his steel dissecting probe.

“It’s the chemical that preserves them,” Tom, our not-a-hair-out-of-place Ivy League third partner said. “It turns the skin brownish.”

“Maybe it’s natural,” our fourth partner offered. “Like she’s maybe Puerto Rican or Jamaican or something. Anyone know her name?”

“We aren’t told their real names,” Mr. Professor-of-Medicine-to-be with perfect hair pontificated. “So we’ll have to name her ourselves.”

“Let’s not,” I suggested. “Wow. Look at all the scars on her abdomen. Hope the surgeon left enough parts for us to find.”

And my chest swelled with a familiar sadness as a vision of JFK, his brain all scrambled within a shattered skull, replaced our cadaver for a moment. Another father lost.

No one at our table gasped or puked; all the day’s entertainment was three tables over. Next to the table where four women, their books open, were already identifying anatomic points on their cadaver. Over at the table where the college football player and three other guys had yuked it up loudly, obnoxiously, before they pulled back the plastic sheet. Three of them were now staring at the body of the football player. Three guys in white coats at a Medical School, looking down at their passed-out acquaintance, unsure what to do. We sure had a lot to learn.

I.       The Auditorium

“Look to your left,” the little man said to us from behind the podium. Twin snakes wound their way up the front of the podium toward him.

“Look to your right,” he continued his command.

All 128 of us swiveled our heads obediently, even though we knew what his third line would be.  It was legendary and we’d all heard it many times.  He would say: “One of the three of you will not graduate and become a doctor.”

The real message, of course, which neither the Dean at the podium nor any of us in this Med School auditorium would say aloud was: work harder than you’ve ever worked before.  Sacrifice sleep for study. Sacrifice your social lives.  Sacrifice your marriages. Give your fellow students wrong answers.  Fear the professors and their grade giving.  Learn not just the human body, but the entire medical library.  And be able to regurgitate it in its entirety, on command.

But he was cute about it, this Dean.  After all, he had heard the famous saying, too.  He changed the third line:

“All three of you should graduate and become physicians…”

It should have been a relief, but he wasn’t finished.

“…as long as you work harder than you’ve ever worked before, and learn everything we have to teach you.”

He smiled beneath his bald little head, above the brass snakes entwining the brass staff of Caduceus on the podium, and awaited our applause.  He heard only silence.  Our hands were frozen in terror.  The underlying message, after all, had not changed.

We congregated outside the auditorium, as soon as we’d been released.

“Hi, I’m John.”

I responded to the stranger with my name. 

John added with a toothy smile, “believe me, I’m going to make it to graduation.”

I felt a powerful urge to be honest, but instead I just added, “Yep.  Me too. I’m gonna be an Internist. Like Kildare.”

We almost had a moment of optimism there, the two of us.  Then a tall guy with an intensity burning to the verge of homicidal maniac leaned into our conversation.

“You two don’t know what you’re talking about.”

“And you do?” chirped John.

“Yeah,” he pinned us to the wall with his eyes.  “I do.  I was here last year.  Right here.  First year student and – ”

“Well,” I interrupted him, “You’re here this year too, so you made it just fine.”

“Think so?” he hissed.  “I’m not a second year student.  I‘m a first year student.  Again.  Along with eight others.  They flunked us in Physiology Lab and we’re repeating.” He bore in deeper with his eyes.  “You only get one repeat.  The sword of Guillotine – Dr. Guillotine – is hanging over our necks.  Yours, too.”

“Damocles,” I corrected him because it made me feel better somehow.  “Sword of Damocles.”

“Well,” chirped John with a broad smile.  “Good luck this year.  We’ll see you in the study hall.”

The tall guy slunk away, into the milling group.

It was autumn in New York.  Beyond the dark paneled walls of the century-old Med School, trees were bursting into yellow and red and orange across the Avenue in Central Park.

“Come on,” John offered, “Let’s take a walk before classes start.  Exercise is good.”

“Thanks, but I have to do some business in the Dean’s office.  Catch you after lunch.”

When the Dean’s secretary said, “You may go in now,” I laid a letter on his desk for him, then sat in the chair, trembling as he read it.

“Hum-m,” he murmured as he read it.  “Looks like you’ve been drafted.  This is an order to report for Active Duty.”

“In ten days! They told me I’d be deferred,” I tried to say without wailing.  “Told me the physical this summer was ‘just a formality’.  Promised me they wouldn’t draft me.  They knew I was accepted into Med School.”

“Okay.  Okay.  Calm down.  I’ll write them a letter.”

 “I don’t mind going some day, but I’m worth more to them as a doctor.  If they pull me out now, I don’t know if I’ll ever get back to Med School.”

“I’ll take care of it,” he smiled beneath his little bald head. “You’ll get your deferment back.  I’ve got four other letters to write.”

”Four others?  Same issue?”

“Yep.”

“They tried to draft four other guys out of Med School?”

“Yep.”

“But if I’d gotten a ‘Report for Active Duty’ date just a week earlier, before school began, I’d have been gone.”

“Yep.”

“They lied to me!”

“Calm down.  They have quotas to fill. You’ve got other things to worry about now.  Study hard.”

So I left it to him. Not because I was overflowing with confidence in him, but because I knew I couldn’t do anything to change that letter which hung, Damocles-like, just inches above my entire future.

                                                                                              ( to be continued)