Two for the Price of One: Two Views

[Note: Another foray into prose/poetry]

Boundaries and Expectations

 

September 12, 1986

Partly cloudy skies.

Driving home alone, I could barely concentrate on the road.

My eyes welled up.

 

Will I be a good mother? Can I do this?

Minutes before,

what I suspected was confirmed.

This was planned, yet I was overwhelmed.

I took a deep breath,

focused on the road and the sky, made my way home.

 

Into our little brick house.

I rush to the phone to call Gary.

He is still on rounds at the VA.

I have him paged.

It takes many minutes, seemingly forever.

 

Hello, Lin?

I’m pregnant!

Wow! This is such great news!

When do you think you’ll be home?

The usual time.

You can’t get out early?

Linda, you know I can’t.

 

I sighed and exhaled, resigned to this reality.

Okay, we’ll talk later.

I was left to my thoughts.

 

Eight months crawl by.

I was not glowing with new life.

Queasy, tired, morning, noon and night.

Ear infection, bronchitis, heartburn

I didn’t enjoy sharing my body.

 

So many rules:

No caffeine, no alcohol, drink milk

I don’t like milk.

Vitamins the size of Pluto.

Alcohol was no loss, caffeine another story.

I’m responsible for this new life!

I don’t want to screw it up!

 

The due date kept changing.

First May 2, then May 11, finally May 16

That day comes and goes.

The longest gestation in history.

I am ready! Nature has its way, though.

 

May 20 Gary travels to Long Island to take part 4 of his medical boards.

My parents come up from Brooklyn to keep me company.

At 5 pm they leave me with friends and

head back home, Gary is on his way.

I feel some contractions: Braxton-Hicks or the real thing?

 

Gary gets home by 9pm.

My water sort of breaks after midnight.

We call the doctor.

He tells us to come to the hospital.

It is before dawn on Thursday morning.

We put the garbage cans by the curb before going to Albany Med.

 

27 hours, the last 7 hard labor,

an apt description.

First, no progress, then Pitocin – a brutal treatment.

Finally, I push!

Such a relief! My body is almost my own again.

 

4:39 am, Friday, May 22, I look at my baby.

Labor was hard on me, but she is perfectly formed.

She is part of me and yet, she might well be an alien.

We are one and we are separate.

I understand her; I feel her joy, her hunger, her frustration.

But I am clueless, she is a mystery.

 

I fall in love over those first few weeks.

Her wondrous eyes, sparking with light.

Her pink, smooth skin.

She emerges into herself.

Curious, demanding, loving.

 

30 years later and

it is all still true.

 

[Note: Gary’s remembrance of that same time]

September 12, 1986.  I was on rounds when I heard my name over the VA hospital intercom for the first (and only) time in my life.  The operator put me through. Linda tells me that we are going to be parents. You could have knocked me down with a feather.  I was elated and scared and excited.  She asked me if I could get home early that day.  But the patients cannot wait.  I work as fast and furiously as I can to get out early but 10PM is the best I can do.  I remember not being able to concentrate during rounds that day which is the one and only time that ever happened.

That VA rotation was in many ways horrible.  Perhaps it was also an experience in growing up.  The VA is an underfunded, second rate health care system and, in my mind, a poor excuse to offer people who fought for our country and now are down on their luck.  And, to be sure, if you are a veteran and have other health care available to you, you are not going to the VA.  So these are the guys who things have not gone well for after they came back home.

I was an intern along with two others on that rotation.  Claude Scialdone was another intern with me and he was amazing. I can’t remember who the third intern was but it was not someone who did all that much.  Worse than that, our resident who was supposed to guide and support us was an empty suit (perhaps an empty white coat is the better medical term?).  And the attending physician came by in the morning to round, as he was supposed to do, but did nothing else.  So Claude and I were basically two guys just out of med school trying to keep 40 very sick veterans alive with basically no help.

It was frightening and it was exhausting.  On a normal day, when I was not on call, I would get there before 7AM and get home anywhere from 8PM to midnight.  When I was on call I wouldn’t get home at all.

One particular patient still sticks in my mind.  He had been there since well before I started my 6 week rotation and he was often times confused, weak and kept running fevers.  I worked him up for sources of infection again and again.  I ordered chest x-rays to look for pneumonia, urine cultures and blood cultures but they repeatedly came back negative.  I asked my resident about the guy – I told him I was certain we were missing something.  There was something going on and we were failing to identify it.  The patient was treading water at best and sooner or later we were going to lose him.

My resident responded by asking me if any of the cultures had grown anything and the answer was no.  He then explained that this means he’s fine.  He wasn’t fine.  He wasn’t close to fine and I knew that in my marrow, but I was out of ideas and had no help.

At that time, the VA closely controlled the use of the newer, broad spectrum antibiotics.  If you ordered any of them, you automatically got an infectious disease consult.  Normally that might not seem like a problem, but in the Albany VA at that time, it meant you got Dr. Aldonna Baltsch on your floor. Dr. Baltsch was as feared as any doctor I have ever known.  She was a phenomenal, dedicated, passionate physician but she was also a perfectionist with a temper.  She would come in and yell at you for all the errors she determined you were making.  I think she just wanted to make us better doctors but perhaps didn’t exactly know how to go about doing it.  In any case, nobody ever wanted to see Dr. Baltsch around.

For that reason, nobody ever called for an infectious disease consult.  And the interns and residents became experts at using combinations of older antibiotics to avoid the newer ones that came with a dreaded visit from Dr. Baltsch.  But in this moment, I realized I feared the prospect of failing and losing this patient more than I feared Dr. Baltsch.

So I ordered a new wave, broad spectrum, expensive antibiotic when my resident wasn’t looking.  I did so because I knew that, while it would bring the holy wrath of Dr. Baltsch, it would also bring her expertise.  She came up and was really, really angry.  It was as if Mount Vesuvius was going to erupt and the lava would scorch us all.  However, as it turned out, her anger was entirely directed at my resident.  She never even spoke to me – which was fine with me.

And she ordered exactly the same tests I had ordered.  But this time, after they yet again came back negative, she ordered an LP (spinal tap).  That came back negative too but she told the lab to hold onto the spinal fluid sample longer for viral cultures and they eventually came back positive for Varicella (the virus that causes Chicken Pox).  Turned out he had Varicella encephalitis, an infection of his brain caused by that virus.  This is still the only case of Varicella encephalitis I have ever seen.

He was placed on antiviral antibiotics.  His fevers ceased after a few days and he finally started to get better.  Dr. Baltsch called for a special meeting of everyone in the entire department of medicine basically to humiliate my resident.  It looked like vultures picking at a carcass as the entire faculty went after the guy.  I almost felt sorry for him.

That rotation eventually gave way to others, some nearly as hard and some not quite as tough.

But fall turned to winter and winter to spring and then I took my boards exam on Long Island.  Knowing Linda was past her due date and could go into labor at any minute, I rushed through the exam.  It was the only time in my life that I was the first person out of the room on such an exam.  That night, Linda had spontaneous rupture of membranes (her water broke).  We took out the garbage and drove reasonably calmly to Albany Medical Center where she gave birth after 27 long hours of labor.

She was an amazing trooper.  No anesthesia.  One single dose of one pain killer.  Hour after hour.  I spent much of the time with her but also left to do rounds and see patients during parts of the process.  At the end, on May 22^nd, Leah emerged, perfect, beautiful, alert and brilliant.  A miracle in our lives who has been such a great joy ever since.

Leah was a force of nature.  It is hard to explain how even in those earliest days she had a spirit and a liveliness and a curiosity.  I felt like she saw and understood the world around her in ways that most babies could not and her smile melted my heart.  Life had taken on new meaning and I fell in love with her.

Still I was torn.  I could not devote less time to my patients than what I felt I needed to.  And yet I wanted to be home; to be with Leah; to help Linda who was in some ways almost a single parent. She was exhausted and I was exhausted.  And I could not do all I wished I could do.  I could not do all Linda needed me to do.

Having already completed all of the hardest rotations in May of 1987, my last rotation of internship was scheduled to be an easy one in a community hospital very near our house.  It was going to be perfect.  I would be working a short walk from our house, the hours would be reasonable.  A long, hard winter was about to give way to a beautiful spring and hours with Leah and Linda.  It didn’t work out that way.  On the day Leah was born, an intern quit the program and the department of medicine met to determine who should cover that intern’s rotation. They decided I should cover it.  I was back in the VA hospital.