Just Like Someone Without Mental Illness Only More So (11 page)

“You’re Kurt Vonnegut’s son? I heard that you had hung yourself in a barn in New Jersey.”

“No. Actually I’m in med school.”

My mother glossed over the chaos we had come from. “You all turned out so well.”

To me it looked like one close call after another and like the woman had been just plain lucky. She could just as easily have a child or two in prison or not getting better from their various disorders and maybe having me hang myself in New Jersey rather than go to medical school.

In general people don’t wish the children of famous people well. It’s somehow fitting or instructive that we screw up or come to tragic ends. It helped me a lot that I didn’t grow up the son of a famous man. It was like watching from afar when the money hit. I’ll always remember my father as the world’s worst car salesman who couldn’t get a job teaching English at Cape Cod Community College.

At Harvard, the courses were pass-fail, but I wanted to get as much right on the tests as possible. I wanted there to be a margin of safety. There were a few of us who would race to see who could finish the tests first. I won more than once. Doing well seemed well within my power.

I loved that
we
had accumulated and organized so much information. I was standing on the shoulders of giants and was possibly the flower of Western civilization. Self-will was running riot, but it was for a really good cause.

Sooner or later in medical school you end up across the table from a senior surgeon with a pair of scissors in your hand. The surgeon ties and holds the suture and says, “Cut.”

You cut. He says, “Too long.”

You cut the next one a little shorter.

“Too short,” he says.

And so forth.

After thirty or forty cuts that are all too long or too short, you ask him if he wants the next one too long or too short, and that’s how you pass the test.

I practiced surgical knots until I could do them in the dark. Learning anatomy, microbiology, pathology, pathophysiology, pharmacology, et cetera, was like being on vacation. It was interesting in its own right and I was in love with being able to do it. The questions on the tests had right answers, and because I had read what I was supposed to read and studied what I was supposed to have studied, I knew what they were.

My publisher gave me a copy of Scott Turow’s
One L
, an excellent account of his first year at Harvard Law School, but I either wasn’t interested in writing anymore just then or couldn’t get an angle on medical school that made me want to write about it. If I really loved writing all that much, I wouldn’t have gone to medical school. Maybe it wasn’t so good for a guy like me to spend too much time alone with a typewriter.

It amazed me how angry some of my teachers and much of the psychiatric profession was that I had been treated with megavitamin therapy. There were two instances in large lectures where I was all but mentioned by name as promoting quackery. I felt like I had been kicked in the chest by a horse and would have
thrown up except it would have drawn attention. I was just a guy still in his twenties glad to no longer be in and out of psychosis. I didn’t think the vitamins had much to do with my recovery, and I did nothing to promote vitamin therapy. It just happened to be what they were doing at the hospital I was hauled off to.

The megavitamin docs and their critics all seemed like self-absorbed babies whose interest in helping patients was outweighed by the joys of self-righteous vehemence. Their primary interest was in yelling at one another.

A pox on both their houses. Where are the adults when you need them?

Gradually and carefully I’d stopped taking most of the vitamins. It didn’t seem to make any difference. So when I discovered my own enlarged thyroid in anatomy class and the doctors at Harvard’s Health Services suggested I stop taking the lithium, I didn’t think much about it. It was increasingly clear that there wasn’t really much wrong with me anyway. I had been started on lithium by one of the “vitamin doctors.” He didn’t change my diagnosis but said, “You’re the kind of schizophrenic who gets better on lithium.” This was all pre–
DSM III
, the modern way to slice and dice mental illness. The only thing I really had come to believe in, more than any specific therapy, was the medical model itself, which got rid of shame, blame, and other hurtful voodoo. That was worth doing.

The basic science and the preclinical courses were easy. I was looking forward to learning how to use a stethoscope and those cool little lights and how to draw blood. We practiced on one another and ourselves until we were ready to be unleashed on the world.

After a year and a half of amphitheater/classroom learning, we put on white coats and learned medicine by pretending to be doctors with people who really were patients with the whole show being overseen by people who really were doctors in real hospitals.

If you’re not sure what to say to a patient or the patient pauses for a while in his story, what you say is, “That must be hard for you.”

I remember staring and watching carefully as our Introduction to Clinical Medicine instructor easily took a patient’s hand and gently stroked his arm. I wanted to be able to do that. I was moving from a world where I couldn’t touch people I didn’t know to one where I could.

It was an advantage for me, over most of my classmates, to know that I was in medical school, at least partly, to save my own life.

We knew some things in amazing detail, right down to the microscopic and molecular level, like how cholera kills people. And over the years cholera has killed a ton of people; there were accounts of cholera epidemics where dehydrated corpses were stacked like cordwood. And now, because we understood it, we could prevent it and/or treat it. All those people who would have died from cholera and been stacked like cordwood got to do something else, like maybe have a son or daughter who went to Harvard Medical School.

There were no stains whatsoever on my coat, which was so white it glowed. I was an HMS II—Harvard Medical student, second year—doing Introduction to Clinical Medicine hoping I might stumble into doing something right or good or at least not humiliate myself too badly.

“Excuse me, but I’m one of the new HMS IIs, and the monitor and the guy next to the nursing station right back there both look really bad.”

“Thank you,” the nurse said kindly as she walked me back to the room. She looked briefly at the monitor and pulled the door closed.

The patient had had a heart attack at home and his family had gotten the heart going again but hadn’t done the breathing part of CPR, so his brain had been deprived of oxygen too long for there to be any hope of recovery. We were just watching him till he died, which was what he was in the process of doing. The nurse told me that the family came in every evening and that this would be a relief to them.

The breathing stopped after a few gasps. The monitor showed a flat line. The nurse unclipped his leads, looked at the clock, and noted on his chart the official time of death. We sat there quietly for a bit. Then we both had lots we had to do. I had gotten to be thirty years old without being in the same room when someone died.

Unless you like being unpopular, never mention that saving a life is a “for now” sort of thing.

Most of the patients I learned from as a medical student and then as an intern and resident would never be admitted to a
hospital today because they are
not sick enough
. Because inpatient stays cost insurance companies money and insurers control the vast majority of a hospital’s income, the push to get a patient home starts as soon as the patient hits the door. Leukemia, heart attacks, major infections, et cetera, have all become outpatient diseases. If you’re not sick enough to be in an ICU, you can probably be treated as an outpatient. As soon as you’re out of the ICU, you’re discharged to rehab or chronic care. Medical students, interns, and residents don’t get to know their patients or see how things turn out; much of what they do any given day is transfer and move people around. It’s all about placement.

My first patient in internal medicine was a cheerful seventy-five-year-old Italian. He was admitted for something else, but because he drank a quart of wine a day, I put him on Librium to prevent the DTs like the resident told me to. We turned our only bright spot on the ward into an unresponsive, openmouthed-snoring, bedridden lump. “Well, at least he didn’t seize,” said the resident.

Being six years older than most of my fellow students had some advantages. After being up all night I looked more like an attending. I was the only one in my class to have a baby at home. During some clinical rotations you were supposed to sleep over at the hospital. Ninety-nine times out of a hundred there wasn’t anything for us to do, so I sometimes went home, where I had real responsibilities, to sleep in my own bed and get up with my own fussy baby. I told them to call me if they needed me.

With the exception of one or two people who were there to please their parents, everyone at medical school was there because they wanted to be and had worked hard to get there. We
all expected to do important things. We all expected to be part of something like what medicine had accomplished between 1950 and 1975. We expected medical care to transform society. The idea that we would ever be told what we could and couldn’t do by insurance companies would have seemed far-fetched and bizarre.