The Respiratory Intensive Care Unit of University of Michigan Hospital was on the top floor and the huge plate glass windows showed amazing views. Unfortunately, the patients, most of whom were in comas, wildly confused, or wracked with pain, were in no position to appreciate them. Maybe the nurses did. Somebody had put up a plaque on the wall with a tiny bottle of water from Lourdes, the shrine that is supposed to cure the hopeless. Hanging on a string next to the bottle was a little hammer and a sign that said “in case of emergency, break glass.”
My goal in life was to be a doctor who made a difference in peoples’ lives, so I decided to be an intensive care specialist. It was hard work, at that time we residents were working a shift of 18 hours in the unit, then 12 hours off to sleep and take care of any other needs in your life.
I was almost as out of it as my patients sometimes. The hospital provided an infinite supply of free coffee. The interns and resident thought it was a creative solution to getting rid of toxic waste left over from the incinerator. It was terrible, but loaded with caffeine and you couldn’t beat the price. On this particular morning, I was drinking a cup of this fine brew and watching the sun rise through the bleary eyes of one who had not slept. In an hour, the professors and fellows would arrive, bright eyed and bushy tailed, to listen to our tales of midnight desperation and the solutions we tried. They would nod wisely and the fellows would quote the latest articles, scoring points with the professors by showing how dumb we were.
My career as an intensivist was turning as sour as your stomach does after drinking that coffee.
So far my greatest save was a man I’ll call Wilbur. His wife had brought him in after she found him unconscious in a pool of vomit at the foot of the stairs. Wilbur had 6 cardiac arrests that night and we got him through every one of them, gradually getting his wildly fluctuating blood chemistry under control, simultaneously diagnosing and treating body lice and gout at the same time.
Wilbur lived to walk away, even wrote me a thank you note. Over the weeks of his hospitalization, I got to know his wife and learned what a typical day in their lives was like. She would wake up in the morning and go to work to make money to pay for Wilbur’s booze. He was frequently sleeping in a pool of vomit when she left. He would sleep it off in the day, but when he returned in the evening he would be drunk, beat her and drink until he fell asleep.
I referred them to a social worker, but they both seemed satisfied with this dysfunctional arrangement and returned to it after Wilbur was strong enough to leave the hospital. I, through staying up a countless nights and practicing the most subtle and desperate of my arts, put Wilbur back on the streets.
So there, I was in my white coat, standing in front of the coffee urn and enjoying the morning light as the sun rose outside the plate glass window. Morning light is so beautiful. Maybe it is intrinsically beautiful, but I have always had the theory that many really beautiful movies are shot in morning light –maybe to avoid interruption to outside scenes. For whatever reason, I even though my eyelids felt like sandpaper on my tired eyeballs and I was about to undergo the ritual humiliation of morning rounds, the soft light gave everything a clear and wondrous glow.
In this glow, I spotted my future, which was contained in a small white pamphlet somebody had left on the floor. The title was incredibly unpromising: “Morbidity and Mortality Weekly Report.” Not the sort of thing you’d pick up for airplane reading. But it was. The reports were amazing. Each was about a raging epidemic that was solved by intrepid medical detectives. I began to put two and two together. The people who did these investigations jumped into airplanes and dived into dangerous situations full of excitement. They save hundreds or even thousands of lives by getting a sewer fixed or banning cans of soup with botulism in them. Obviously they worked like dogs during the investigations, but I imagined that in between calls, they sat around somewhere, like firemen between fires, enjoying relatively normal lives and regaling each other with tales or arguing about the medical literature. In that moment, I knew I wanted to be a field epidemiologist.
Flipping the pamphlet over, I saw the name “Philip Brachman, Director, Bureau of Epidemiology,” and an address for “the Centers for Disease Control (CDC), Atlanta, Georgia. Unhesitatingly, I picked up the hospital phone and asked information for his number. They owed me the long distance call.
I was shocked when the great man himself picked up the phone. “Ice storm here,” he snapped, my secretary didn’t come in. “I’m practically the only one here. Bunch of wimps these people.”
Even though he was a curmudgeon, I was thrilled to have made it past his secretary to make my pitch to the big man. I told him I wanted to join the CDC as soon as possible.
“You idiot,” he shouted. “Don’t you know we closed admissions for the Epidemic Intelligence Service months ago?” Bad news. “We finished the interviews weeks ago too.” The fact that he continued to fulminate at me suggested a ray of hope. After all, why should this important man waste his time yelling at me if he was just going to blow me off? Clearly I would have to beg and beg I did.
Eventually, Dr. Brachman relented, but he set strict standards for me to show my worthiness. He would schedule 8 interviews for me, starting at 8 the next morning. I was to be in Atlanta then to take the interviews. This was a serious challenge. My shift ended at 6:00 PM and I was in Michigan. Even if I could get a plane, I wouldn’t be back in time for my next ICU shift. So I would have to convince somebody else to volunteer to take at least part of my next grueling shift. Fortunately, unlike most people in Ann Arbor, I am not a football fan, so I was able to trade an emergency room shift during a football game for the time I would be in Atlanta. Being in the emergency room in a college town during a football game is a breeze. Even people with massive heart attacks wait until the final score before coming in. So mostly we sat around waiting to see if there would be a car wreck, but there were few of those during the games. Afterwards, it was a different story, as the backed up mass of suffering humanity crested like a wave on the emergency rooms.
That night, I was on a plane to Atlanta thinking back on the years of medical school that had led me to this. For me, there were two high points to medical school. One was the first day in the, aptly named, gross anatomy room. This was a huge room filled with embalmed dead bodies on tables. It was a gruesome and appalling sight the first time. I had started medical school at Wayne State University, which was in the decaying heart of Detroit. Our professors called it “the closed head wound capitol of the world,” and pointed out that the silver lining that we had our pick of the very best bodies from the ones arriving every day at the doors of the huge Wayne County Morgue. They proudly pointed out that we provided bodies for most nearby medical schools and that we were intimately involved the important new kidney transplant surgeries. Indeed, helicopters would often land on the medical school roof. We later learned they were taking kidneys and other organs out to other medical schools for transplantation, not bringing patients in to us. Anyway, the quality of the bodies—or cadavers, as they are called in medical circles—was of little interest to me as we walked towards the big swinging doors of the gross lab. It was just too much for me. I turned and walked firmly backwards, right into the waiting arms of Dr. Nicholas Miseres, head of the anatomy department. “In you go,” he said.
“I quit,” I said.
“No you don’t. Get in there, you can handle this.”
So I sheepishly turned back into the gross lab, as Dr. Miseres and his minions captured the faint of heart and headed us all into the big room. There we were formed into groups of four and each group was given a cadaver. We were to keep the cadaver’s face covered and start on the leg. This avoided a bit of the shock. The shock was that all four of us assigned to my cadaver wanted to be psychiatrists. This was bad news. Most groups had at least one budding surgeon, eager to dive in with knife and fork and elucidate the subtleties of anatomy. The only anatomy psychiatrists care about is between peoples’ ears, and this doesn’t do much good when the patient is on the couch telling you about their mother. So none of us was particularly eager to get on intimate terms with the grey legs, reeking of formalin. After a couple of sessions, two of my partners stopped even coming, so my best friend Herman and I had to do twice as much work to try to keep up with the teams of four.
In spite of doing twice as much dissecting as the other students, Herman and I flunked the test on the anatomy of the foot. Perversely, our absent partners, who had just looked at pictures in books, got A’s. Herman and I were horrified. Who wants to go to a doctor who flunked foot…or anything else for that matter? We made an appointment to see Dr. Miseres and see if there was anything we could do to redeem ourselves. When we sat before him we asked in penitent voices what we could do. “Well,” Dr. Miseres said, when something like this happens we Greeks buy a bottle of ouzo, sit down at the kitchen table, drink it and have a good cry.” Ouzo, licorice-flavored Greek liquor is delicious in small doses. Drinking a whole bottle would make anyone cry.
“What about the anatomy of the foot? How can we make up our deficiencies?”
Dr. Miseres looked each of us in the eyes, seemingly measuring these sad specimens of medical students. “Do you plan on becoming surgeons?” he asked, seeming to prepare himself for awful consequences if one of us actually made it to practice surgery on the innocent population.
“No sir,” we said. “We plan to go into psychiatry.”
He seemed to be barely able to hide his relief. “Then don’t worry. Nobody but surgeons cares about the anatomy of the foot, and even most of them probably forget it.”
“What about our grades?” we asked timorously.
“Don’t sweat it. This is a pass fail-program and I promise you there will be no more questions of the foot. But pay attention to the important stuff, because I will be asking about the heart, lungs, brain, that sort of thing. And don’t even think of going into surgery.”
Dr. Miseres was true to his word and both Herman and I eventually passed. Herman finished at Wayne State, which had a rich supply of crazy patients to learn about, much as it had a rich supply of organs and bodies. After two years I transferred to University of Michigan, where I was told that a student failed anatomy, which led him had attempted to commit suicide by shooting himself in the heart. He grievously injured himself, but missed his heart entirely, a hazard of not paying attention in anatomy class. Had he had the benefit of Dr. Miseres counseling, he would either have passed the course or his bullet would have hit the most important chamber of the heart, the left ventricle and he would have dropped stone dead to the floor.
Speaking of being shot in the heart, a friend and I got tickets to a Tina Turner concert, but we were only able to get the cheap seats in the back row. After a couple of songs, the rich, middle aged people sitting in the front row got up and left. We scooted down the dark aisles like speedy little rodents and slid into the plush of these choice seats. As Tina belted out each song, a gentle spray of saliva flew out of her mouth, arced gracefully and settled on the audience. We settled down to enjoy the music and the saliva in the darkness. I kept thinking “Tina Turner spat on me! I have Tina Turner’s cells all over me.” That was as close as Tina and I ever got to sharing body fluids. She doesn’t know what she missed.