The Agony Of Pregnancy Loss

This is going to be another heavy hitter, Dear Readers.  Please consider whether this is good for you to read before proceeding.  It contains graphic descriptions of a miscarriage, surgery, and references to abortion.

I’ve given myself away, but then this is not fiction.

My medical school had an agreement with a VA (Veterans Administration) hospital, where third- and fourth-year medical students could rotate through and get some up-close-and-personal experience being on the front lines.  Rather than standing on a stool (if you were short like me) holding retractors in the operating room, we were taught to actually operate.

And in the medical wing, we learned by doing, and by working closely with the attending physician.  This was much better than standing at the back of a crowd of students, interns, and residents on ward rounds in the private hospital.

I had lots of harrowing adventures at the VA.  I loved it.  Everything was edgy and often dicey.  The patients were high morbidity.  The doctors were all foreign medical graduates, some of whom were the best docs I’ve ever worked with, and some of whom…well, I sure wouldn’t want them working on me.  You just never knew, from day to day, what you would end up in the middle of.

I loved surgery.  Part of that was Dr. Duy, a brilliant Vietnamese surgeon who taught me how to tie one-handed knots down in a hole (in those days, gall bladder surgery was done through an open incision, and you were literally working in a hole up to your wrist).  He taught me how to amputate a gangrenous leg–we had to do that a lot because of the diabetic veterans who were “drinking men” and didn’t take care of themselves.  (That was one of the intake questions:  “Are you a drinking man?”  It was crucial to know, because if he was, if deprived of his alcohol he might go into DT’s and die on us.  For “drinking men,” part of the admission orders were two beers or two shots of rye whiskey per day, more if indicated.)

I dreaded operating with Dr. Chung, a Korean doc who didn’t speak much English and was a clumsy brute compared to Dr. Duy. He did a lot of abdominal surgeries looking for metastatic cancer.  In those days the way you did that was by opening somebody up from top to bottom, and taking biopsies from all the major organs, to send to Pathology.  Then you would stand around in the freezing OR, hugging yourself and jumping up and down until the frozen section came back.  After that you either did or did not take out more stuff, and finally you closed the abdomen and took an x-ray to make sure you hadn’t left anything in there.

My job was to close the abdomen.  There weren’t surgical staples back then, or any of a million conveniences we have now–just a bunch of different sizes of suture material, either dissolving or non-dissolving.

Dr. Chung would walk away, stripping off his gloves, and I knew that I was going to close.  It was no easy task for a small person, especially if the patient was large, pulling the wound together and tying the knots, with nobody to put their finger on it to keep it from slipping.  Yes, it was that simple.

Dr. Chung used to tell me to hurry up and just to make sure I did, he would tell the anesthesiologist to wake the patient up while I was still working!

The reason I’ve gone into all this is: One day I walked into the operating suite and smelled the distinctive odor of halothane gas.  That is what we used in those days as the anesthetic.  I’m sure some or even most of you have smelled that smell.  There is nothing like it.  It triggers my PTSD just thinking about it.

I walked into the OR and asked the scrub nurse, who was scurrying around setting up for the next case, what the deal was with the gas.

“Oh, the anesthesia machine is leaking,” she said in mid-scurry.  “We have a requisition in.”

Uh-oh.  That meant it might get fixed today, or next week, or next month…

So we operated with the doors open.  I tell you, we were all half-anesthetized.  I hope those patients did all right, because I don’t remember a thing.  I spent two weeks half-gassed to death, and then my rotation ended and I could breathe again.

But not the baby I was carrying.  I was married, and this was my first planned pregnancy.  I was 16 weeks along, and I loved the little flutter in my tummy with all my heart.

Then one day, at the end of my surgery rotation, the fluttering stopped.  The bleeding began.

I called my OB doc.  He put me on strict bed rest.  I was torn between being panicked at the prospect of losing my baby, and being panicked because my own OB rotation was supposed to start in a few days.  But the bleeding got heavier, and finally waves of pain had me curled into the fetal position, panting.  Then something warm and wet came out in a gush of blood.

I sat up and looked.  It was a little alien, wrapped in its delicate capsule.  All of it was there.  I could see the tiny limbs, and the beginnings of a face….I wrapped it up in plastic wrap and took it to my OB.  I don’t know what they did with it.

I can’t begin to describe the grief.  I think losing this pregnancy unleashed all the grieving I hadn’t been able to do for the abortion I had suffered 13 years before.  I was overcome, and could do nothing but sob for two weeks.  Then I picked myself up, put on my whites and went to my OB-GYN rotation.

I knocked gingerly on the attending’s office door.  She was the daughter of an OB with whom I had done a rotation as a 3rd year student, and we mutually hated each other.  The daughter was worse than her father.

“Yes, come in,” she said to my knock.  I entered.  She did not offer me a chair.  In fact, she did not even look up from her charting.

“I heard what happened.  It won’t affect your grade,” was all she said.  Then, awkwardly waiting for some other utterance, I perceived that there wasn’t going to be any, so I left her office.

I was met by a nurse in scrubs, who said “Come with me.”  I followed her into a room where a woman was lying on a table, her feet up in stirrups, a stainless steel bucket on the floor between her legs, and what looked like a large suction hose…..

“Go ahead, sit down,” commanded a senior student.  “You’re going to do this one.”  I looked from the apparatus at the bottom of the table to the ashen face of the Hispanic woman at the top…

“Is this what I think it is?” I whispered.  The senior student nodded.  I threw up in the bucket and ran out.  I ran all the way home and collapsed on the bed, hysterical.  My husband came home and found me that way.  It was the only time I ever saw him in a fury.  I know that he went to the dean, because on another occasion when I was stuck holding retractors for the OB father and daughter combo (I had to repeat OB after that episode), they skewered me about my husband going to the dean.

All these years later, I just can’t, in my wildest nightmares, imagine expecting a woman who had just lost a wanted pregnancy, to go on abortion detail.  I know there are many things more cruel than that in this world, but for me, at that moment, I would rather have suffered a horrible death than to perform an abortion.

All the while I was thinking of that woman.  I found out her history, why she was there to get an abortion: she was a Mexican migrant worker, she already had six children, and her husband had threatened to punch her in the stomach if she didn’t abort, because six children was enough for him.  Birth control pills were beyond her reach financially, and her husband refused to use condoms.  So it was she who bore the consequences.

I firmly believe in a woman’s right to control over her own body.  If that includes abortion, who am I to judge?  When Rebecca, who was childless at the time, said “Give me children or I will die!”  Isaac replied, “Am I instead of G-d, that I can give life?  Go and pray!”  I too feel that way:  Am I instead of G-d, who gives life and brings death?  I am just a mortal human, trying to feel my way as best I can.

As it says in Ethics of the Fathers (a Jewish text), “Judge not, lest you also be judged.”

Breaking the Silence of Stigma: In Memory of Kaitlyn

Kaitlyn, Rohonda's daughter

In Memory of my daughter, Kaitlyn Nicole Elkin

On April 11, 2013, I got the most dreaded call that any parent could ever get, a call from the police in the town where my 23 year old daughter Kaitlyn was starting her 3rd year of medical school at Wake Forest School of Medicine.  He said he had to talk with me about my daughter and that I had to go there to be told what he had to say.  I begged this man to tell me then, as I would have a 3 and a half hour drive to Winston-Salem.   My initial split second thought was, “Kaitlyn is in trouble!  She’s never been in trouble in her life,” then my thoughts turned to other things and the blood left my body as he told me what happened. He said that she was deceased.  I envisioned her getting into an auto accident and when I asked him what had happened, he said that she had taken her own life.  My world and everything I’ve ever known came crashing to an end at that moment.

How could this have happened?  My daughter seemed to be the most together person I have ever known in my life.  Graduated valedictorian from Whiteville High School, graduated summa cum laude from Campbell university in 2 and a half years and got accepted to medical school where she could pursue her lifelong dream of being a doctor and she was doing extremely well in it.  She had friends; she had just taken a Step One medical board exam that she felt she did well on.  She was an artist, a writer, avid runner, she had common sense and was wise well beyond her years.  She was excelling and seemed to have the world in her grasp.

I had just seen Kaitlyn the weekend before as she had come home for a few days for Easter.  We had a wonderful mother/daughter day and we went shopping, out to eat and the movies.  We had a wonderful time and she seemed totally happy.  How could this have happened?

She wrote my husband and I a two page suicide note, (as well as letters to some of her friends and her sister Stephanie.)  In this letter she stated that she had been sad all of her life and had worked very hard all her life to hide it and protect us from it.  She said that she knew she would have been a successful doctor, wife and mother, but that she was exhausted from the weight of the sadness she has had all her life, could not go on, and this is what made sense to her.  She stated that I might wonder why she had not sought help and that she did not know why herself.

She was a high achiever, but we never put any pressure on her to succeed because she set these high goals for herself.

The reason I am writing this letter is to tell all parents, friends, or spouses, that no matter how happy someone seems to be, there may be a devastating depression within that they are hiding.  Parents, ask your children from time to time, “how are you really doing” and make them talk about their feelings.  As you do this, I hope that they are forthcoming with you, my daughter was not and we had a very good and close relationship.

I’m devastated by her loss, lost in a sea of “what could have been”, the wonderful life that she could have continued to have had.  But I celebrate her life, thanking God that I had the honor of having this beautiful being in my life for 23 years.  But I wish I had more.

If this letter helps at least one person to come forward with their depression, or a loved one to ask about it and have that child open up to them, then it is worth it.

Rest in peace my beautiful daughter, the peace that I thought you already had.  And as I’ve always told you, I love you bigger than the universe.

Rhonda Sellers Elkins

Clarkton, NC

The Road Less Traveled: Daily Prompt

The day’s mail dumped through the slot in the steel door of my nineteenth-floor apartment on the corner of 47th and Lake Park.  South Side Chicago, bad neighborhood, but somehow this award-winning architectural wonder had been built there, and because of its location in the slums, it had been designated as HUD housing (Housing and Urban Development), which meant that a starving premedical student like me could manage the rent.  OK, sometimes I had to hock something, or take on an extra shift cocktail-waitressing at the glitzy downtown disco where I made my tuition money, but somehow I always got the rent money together in time.

I picked up the mail and flipped through it nervously.  I had applied to five medical schools, and the acceptance (optimist) letters, or rejection (pessimist) letters, were beginning to come in.  I knew where I wanted to go, and I knew where I could afford to go; and those were not necessarily the same places.  But I had not applied anywhere I would not be happy to be, so it all boiled down to finances.

There it was.  A catch in my throat: I couldn’t get my breath.  A thin envelope meant rejection; a fat one meant acceptance, because it was full of forms to fill out and return.  Here it was: a fat envelope from the University of Illinois, one of my top choices, and affordable, as it was a state school.  I ripped open the envelope and read breathlessly:

“Dear Ms. So-And-So:

We are pleased to inform you that you have been accepted into the University of Illinois College of Medicine…..”

My eyes skimmed the letter.  At the very bottom, as if by an afterthought, I read:

“Due to your excellent academic performance and related experience, we are pleased to offer you a full scholarship.”

I nearly fainted.  My heart pounded as if it wanted to leap out of my chest.

There was a knock at the door.  I grimaced.  Who could this possibly be, interrupting my moment of orgasmic bliss?  I stomped over to the door irritably.

“Who is it?”

Giggles in the hall.

“It’s us!  Let us in!”  It was the Bosom Buddies.

The Bosom Buddies were an all-woman old-time string band from East Lansing, Michigan, an easy train ride from Chicago.  I was one of the two banjo players in the group, and we played fairly regularly.  We played for square dances and Moose Lodge spaghetti dinners and old-time festivals and dinners-on-the-grounds, and we always had a blast.  But what were they doing at my door unannounced?

“We had to come see you, and tell you the news,” said Susie the fiddler breathlessly.  “We had to come in person, so you couldn’t say no.”

Uh-oh.  Sweat started rolling down my ribcage.  What the hell could be so important that they had to take the train down from East Lansing, taking a chance that I might or might not be home?  And not say no?

“Prairie Home Companion has asked us to be their house band!” Susie squealed.

“Wow, that’s fantastic!” I hugged them all.  “Congratulations!”

But why the fuck were they standing on my doorstep telling me this news?

“And,” panted Susie, “Mary (their regular banjo player) went and ran off with Sally (her lover), and formed a duo, and now we don’t have a banjo player, so we want you to join us and come out to Minneapolis!  Will you come?”

My life flashed before my eyes.

This was more than I could have imagined in my wildest dreams.  To be the banjoist in the house band on Prairie Home Companion, the famous National Public Radio show hosted by Garrison Keeler!  Fame and fortune!  Respectability!  Getting to actually play the banjo for a living, instead of just for fun and a few bucks here and there!  Not only that, playing with the Buddies, my favorite people in the whole world!

Then I looked at what was in my hand.  The fat envelope.  My acceptance letter to medical school, and a full-ride scholarship.  I sat down on the floor and cried.

Four women sat down with me, hugging me and asking what was wrong.  I cried harder.  How could I possibly make a decision like this?  Each of these things was the fulfillment of a dream of many years.  I knew I was one of the top old-time banjoists in the country.  And I knew I was destined to be a physician.  Healing was in my bones.  And so was old-time music.

I remembered my manners and invited them in.  They had brought their instruments, so I got out the banjo and a fifth of whiskey and we had a few tunes and got all likkered up, and then I broke the news.  I couldn’t go with them.  My path in life lead elsewhere.  We all cried.

They left, crestfallen, and I spent the rest of the night bawling.  I didn’t know whether I had made the right decision or not.  It just kept bouncing back and forth in my head, and my heart felt like it was being physically torn apart.

The Buddies didn’t find another woman banjo player who was up to their standards, so they didn’t take the job in Minneapolis.  Guy’s All-Star Shoe Band became the Prairie Home Companion house band, and they do a real good job of it, but they’re not the Buddies.

We all went in different directions after that.  A couple of the girls joined other bands.  Susie hitchhiked across the Sahara desert and got a ride with an Irishman on a motorcycle, and they got married and moved to Ireland.

I went on to medical school, and then graduate school in Anthropology, and then a residency in Pediatrics.  I don’t regret my decision, but every now and then I look back to the road less traveled by and think: what would have happened if……

Blog For Mental Health 2013!

I am proud and humbled to have been pledged by Ruby Tuesday of A Canvas of the Minds as a Mental Health Blogger for 2013.  It’s not an award, but a commitment to keep on blogging with the aim of erasing stigma and creating community among those of us who live with mental illness.  Our Mental Health Blogger community is a place where people living with mental illness as well as their families and loved ones can come together in mutual acceptance and support.  It’s awesome!  So here’s the pledge:

I pledge my commitment to the Blog For Mental Health 2013 Project.  I will blog about mental health topics not only for myself, but for others.  By displaying this badge, I show my pride, dedication, and acceptance for mental health.  I use this to promote mental health education in the struggle to erase stigma.

Here is where I’m supposed to write a short summary of my own journey with mental illness.  Where to begin?  I’ve had issues all of my life with PTSD and dissociation.  Likewise, I cannot remember a time when I was not depressed.  I ran away from home, permanently, when I was 16 and only by the grace of G-d did not die or end up trafficked to Mexico, although there were some close calls.  I didn’t know I had a mental illness till I was in college and desperate to make money.  There was an ad in the student newspaper: take drugs and get paid!  No, really, it was a study that the Psychiatry part of the medical school was doing.  So I went and applied, and had to take a whole day’s worth of psychological testing before they would give me the drugs.  Some guy called me the next day and said, “You have to go to Student Mental Health right now!  Your testing shows you are Severely Depressed.”  Humph.  I didn’t feel any different than I always felt, but if I had to go to Student Mental Health in order to get my drugs, that’s the way it was.  I went.  There was a nice lady behind the desk in a cozy room.  She smiled beneficently and asked, “Why are you depressed?”  “I’m not depressed,” I said. “Then why are you here?” she asked.  “The Psych Drug Study made me come,” I said.  She shuffled through my slim chart and said, “Your testing shows you are severely depressed.”  She looked up at me with that saintly smile and said, “You get good grades.  You have a good job.  You’re good looking.  So why are you depressed?”  I stood up, thanked the lady, and walked out.

The next time I got an inkling that I might be depressed came when I was in medical school, married, with a baby who never slept.  I adored him, and many years later I still adore him, but the fact is, he never slept through the night until he was five.  So at that time I think he was maybe ten months old, and I had not slept since he was born.  I was in the middle of my Cardiology clinical rotation.  Everyone had gone to lunch, but as usual I had no appetite and was uninterested in hanging out with people, so I was sitting in a study carrel reading EKGs.  My Cardiology attending came over and said, “Aren’t you going to go get some lunch?”  And I said, “No thanks, I’m not hungry,” avoiding eye contact by studying the EKG.  “Look at me,” he said, and I did, mechanically.  “You’re depressed,” he said.  “I want you to go home and get some help.  You need to see a psychiatrist.  Please call me tomorrow and tell me what you have done about this.”  And head hanging, I went home.  My ex-husband came home and said, “What are you doing home so early?” since I usually stayed late studying.  “I’m depressed,” I said.  He turned on his heel and walked out.  “Let me know when you’re better,” he said on his way out the door.  I called somebody at the medical school whom I trusted, and told him the situation.  Five minutes later I got a call from a psychiatrist, who gently demanded that my (ex) husband accompany me to an appointment on the following day.  He did.  The shrink explained to him that I was physically incapable of doing what I was doing, taking care of our son all night and being a medical student all day (and sometimes all night too).  He explained how to give the baby a bottle.

He also gave me my first psych drug, imipramine, which not only knocked me completely out, but gave me a horrible itchy rash from head to toe.  Then he gave me antihistamines for the rash.  I dimly remember lying on the cool hardwood floor wishing I was dead but having no control over my body and therefore being unable to act on it, which was good.  After I got over that, he gave me some other drug, which allowed me to make it through med school in one piece.

Then I got to my residency in Pediatrics, where the standard work week was 120 hours.  More sleep deprivation.  And still with the non-sleeping child, who, bless his heart, sleeps like a baby now that he’s in his 20’s.  And then there was the husband who needed attention too.  So I went to a shrink and got Wellbutrin, which is very good for some people, but me it tipped over into hypomania.  Only nobody in the medical world in which I lived seemed to know about Depression and Mania and those kinds of nervous system brain sorts of things.  They only knew about Show Up For Work And Keep Your Mouth Shut.  I had this private joke: if one of us residents died, they wouldn’t give us time off to go to our own funeral.

As it happened, three of us residents DID die, and another one got taken out of service for accidentally giving someone the wrong medicine, which caused their death; so instead of every third night call, we had every other night, and sometimes “every every” night, which meant we didn’t get to go home much.  I really don’t know how the program directors thought that flesh and blood human beings could tolerate that for three years and not kill themselves or die in car accidents falling asleep on the way home, both of which things did happen in our little corner of Hell.

Anyway.  Fast forward from the late 1980’s-early 1990’s when all this shit was going down, to Y2K.  That’s right, the nearly infamous Year 2000.  Well, it WAS infamous for me, because a whole conflagration of disasters hit me that knocked my pins right out from under me and I ended up in the hospital.  And I became disabled, just like I am now.  The only good thing was that some shrink finally noticed that I’m bipolar, and put me on Lithium.  But by then my medical practice was in ruins, my family life in tatters, my finances non-existent, and worst of all, I had lost my identity.

I’ve wandered around some more since then, and although I’ve just been declared permanently and totally disabled by a Federal Social Security judge (and that feels pretty rough), I’m writing more than I ever have.  I’m blogging, and have become part of this wonderful community that is centered around A Canvas of The Minds.  I’m FINALLY writing my book, having used NaNoWriMo for the past two years to give me the kick-start I’ve needed to get two of the volumes well into progress.  I’m slowly redefining myself, and even though I still have attacks of  “the mentals,” I’m bumping along, and that’s OK.

Oh all right, that was not short.  I am Incapable Of Writing Anything Short.

Now comes the part where I am supposed to pledge five other Mental Health Bloggers.  OMG.  How am I supposed to choose????  I’ll just start, and when I get to five I’ll stop.  Maybe.

PAZ, of Melancholically Manic Mouse

Lunch, of Lunch Sketch

Nicolas, of Puncture Repair Kit

bpshielsy at The Pipolar Place

survivor55 at Bipolar and Breastless

I hereby pledge to remember to let all of the above know I’ve pledged them.

Lastly:  I am supposed to remember not to forget to link back to Canvas, so here it is.  I think I’ve linked back to Canvas about six times in this post, but I’m feeling kind of wacky today so if I’ve messed up in some of this stuff I hope everyone will forgive me.  And feel free to let me know!

Love to everybody and sending good juju for staying healthy this winter, and looking forward to another wonderful year of Mental Health blogging together!

Soul Survivor

The Psychiatrist and the Lightbulb

The husband and wife sat stiffly, as far apart on the stiff divan as the laws of physics would allow. The intervening silence froze the air.

“Well?” the cordial voice of the psychiatrist punched through the waiting silence, and it shattered and fell tinkling to the office floor. The man glared at him malevolently. The woman raised her eyebrows and nodded to the psychiatrist knowingly, while making a barely perceptible motion with her chin in her husband’s direction.

“I SAW that, Gladys!” the man accused angrily, rising slightly from the couch and shifting to face his wife. Gladys sat up primly, pursed her lips and folded her hands, gazing straight ahead beneath hooded eyes, her blue permanent curls trembling slightly.

“Now,” said the psychiatrist soothingly, “why don’t we start at the beginning?” And as there was no offer of a beginning, he took the more direct approach and asked the man:

“What brings us in here, today?”

“What brings US in here today,” snarled the husband, “is my WIFE! If you want to know why we’re here, ask HER, since she knows so much.” And he shut his mouth with a snap that could be heard all across the office.

Even I heard it, and I was just a second year medical student. This was my first time observing a psychiatric office visit, and it was turning out to be much more interesting than I had expected.

The psychiatrist sighed and tried again.

“Well, Mrs. Jones, why did you accompany your husband here today?”

“Thank you, Dr. Smedley. As you know, I had to lie to get him here, and he’s awful mad about that.” Mr. Jones snorted like a bull. “You can say THAT again. That’s the last time I fall for THAT line of__”

“Mr. Jones,” purred Dr. Smedley, “Your wife is only concerned for your well being.” Mr. Jones fell into a seething silence and glared at the doctor from behind thick black-rimmed glasses that made his eyes look twice as big as they actually were.

“Now, Mrs. Jones, if you would like to tell us all here what you told me on the telephone, I think that might be a good way to begin.”

“Well,” began Mrs. Jones uncertainly, darting anxious glances in the direction of her husband, who seemed to be occupying himself by entraining a psychic death-ray in her general direction, “It all began a few months ago when Gerald here started talking to the light bulbs.”

“I wasn’t talking to the lightbulbs, you little idiot, I was talking to the ALIENS who use the lightbulbs as an instrument of communication!” Gerald exploded, spraying saliva all over everything in his immediate vicinity. I had instinctively jumped back, but Dr. Smedley was wiping his eyeglasses with his pocket handkerchief.

Mrs. Jones simply nodded, shrugged her shoulders a bit and raised her palm as if to say, you see? This is what I’m talking about. Dr. Smedley frowned, scribbling furiously on his steno pad.

“Mr. Jones, may I call you Gerald? Thank you. Gerald, how long have you had this delusion that aliens are communicating with you through the light bulbs?”

“Delusion? DELUSION? What kind of an idiot do you think I am? Better yet, what kind of an idiot are YOU? HAH! YOU’RE the kind that they would NEVER speak to, so of course you don’t know. Of course you think it’s a delusion, because you’re a petty, ignorant little pissant that aliens wouldn’t waste their precious time on. And their time IS precious, too.”

Gerald climbed up and stood on the arm of the divan, directly beneath the ceiling light fixture, and cocked his head to bring his ear closer to the bulb. He closed his eyes and listened, nodding his head vigorously from time to time. His wife wept silently at the other end of the divan.

Here I got a little excited, hoping that he would go on and tell us more about the lives of aliens and their experience of time, but my hopes were dashed.

“Gerald. Please sit down. Now, I am about to demonstrate something about the nature of light bulbs, and I hope that after I show you this, you will be able to understand that light bulbs do nothing more than convert electricity into light. They are not capable of transmitting sound or any other kind of means of communication.” Dr. Smedley opened his desk drawer and produced a light bulb and a hammer.

Gerald’s eyes grew large with fear. “No. Doc, please. Please don’t do it. Those are very important. They contain essential classified secret emissions.” Dr. Smedley wrapped the bulb carefully in a tea towel. “No, Doc, you don’t understand. Once you bust those things, it’s all over. All is lost. You can’t go back—” CRUNCH! With a satisfied smile, Dr. Smedley carefully unwrapped the tea towel to reveal the shards of the light bulb, its now naked element quivering in shame.

“Do you see now, Gerald? This is nothing more than a piece of tungsten metal attached to a special piece of glass. No one could possibly use this as a communication device, even if there WERE aliens,” he said kindly.

“Gladys, get up. We’re going. This man is dangerously insane.” Gerald collected his wife and hustled her out the door. She kept her eyes down, this time, no longer seeking the eyes of Dr. Smedley. He had discredited himself a little, I think.

“Well now, what did you think of THAT for your first outpatient psychiatry case?” Dr. Smedley turned his high beams on me.

“Well,” I began carefully, “personally, I really wanted to hear more about the aliens in the lightbulbs. Like, what did they say to him, and how often did he talk to them, that sort of thing.”

“Ms. L_,” Dr. Smedley glared at me. “Aliens do NOT talk to people through light bulbs!”

I knew I was pushing it but I had to advance my case. “Dr. Smedley, isn’t it true that each person experiences reality in his own unique way?”

He nodded, “Of course.”

“In that case, is it not possible that this man’s reality happens to be that aliens communicate with him through the lightbulbs? I mean, whether or not this is the objective truth, it’s still his reality, right? So who are we to argue with him about what is real or not real for HIM?”

As I delivered my speech, I observed Dr. Smedley becoming redder and redder in the face, but somehow I could not stop myself. All of the outrage that had been building pressure during the absurd and degrading occurrences of the interview with the Joneses came pouring out all at once. I felt suddenly, triumphantly, at peace.

But oh, no! What’s this? Dr. Smedley climbing upon his desk–where just five minutes before Gerald had stood upon the divan—and Dr. Smedley is jabbing his forefinger at me, for emphasis, and shouting “WE—ARE—THE–AGENTS–OF–REALITY!” Over and over, again and again. WE. ARE. THE. AGENTS. OF. REALITY!

Aghast, I backed slowly out of the room and closed the door, never to return. Just like Gerald and Gladys Jones.

THE END

Postscript~with very little poetic license, this is a true chronicle of the first day of my psychiatry rotation in medical school, in 1983.  Proving, once again, that truth IS stranger than fiction.

 

ⓒ 2012 Laura P. Schulman, all rights reserved. All reproduction without express written permission of the author is prohibited.

 

Labels and Identities, Part Three (and then some)

I loved medical school so much that I was never even aware of the fact of “being a medical student.” I was too busy being it it, doing it, loving it, being in love with it.

Nevertheless, I had a sense of solidity that I had never experienced before. With my dual degree program came huge financial commitments, and great opportunities. I applied for and got many kinds of grants and fellowships, some as large as $10,000 and some as small as $300. They all added up, and each one was a feather in my cap.

There were jobs, too. The first years were a patchwork of lab jobs, hospital grunt work, general go-fer gigs for the administration. Then I settled into my niche of tutoring and educational program development. I helped design and implement a model of teaching medical communication skills to new doctors, and a testing tool to evaluate its effectiveness. Faced with an embarrassingly inadequate human sexuality module in our med school, I complained, and was given the green light to develop the ideal one. Med school was “heaven on a stick,” to borrow a phrase.

My marriage surpassed any expectations I could have had, if I was the type to have expectations, and I’m not. I could never have imagined the satisfaction that bloomed from the cultivation of cooperation and intimacy between two people in love with each other and with their respective and mutual work, for we shared certain teaching and administrative duties in the school. We were a team. We were even asked to write an article for the medical school journal on the art of cooperation and compromise.

I got pregnant during the fourth year of my six year program. It was not overtly planned. But since we were using the Cooperative Method of Fertility Awareness Family Planning (another of my hats, since I was a certified teacher and taught in the Student Gynecology Clinic) which required both partners to be clearly aware of where the woman is in her fertility cycle, we KNEW I was fertile and the predictable outcome did in fact result. It took us both a few minutes to get used to the idea, and then we were elated.

I was in the midst of a long subinternship in surgery at that time. A subinternship is just like an internship, except you don’t get paid. You work the same long hours, take the same night call, have the same responsibilities as an intern. Our med school supplied students to a chronically understaffed VA hospital, and there were many excellent subinternship opportunities there. It really was a great thing to do as a student in surgery. At the private hospitals, the best a medical student could hope to do in surgery was stand on a stool at the back of a crowd hoping to get a look at the surgeon working. If you were really lucky, you might get a turn holding retractors, which meant you could actually see the operation in progress.

As a subintern at the VA, I worked one on one with each of two foreign doctors. Dr. Duy was a marvelously skilled Vietnamese surgeon, French trained, with nimble fingers and a gift for teaching. The first day, he taught me how to tie surgical knots one-handed with both my right and my left hand. I still use some of the skills he gave me, even though I haven’t done surgery in more than ten years.

The other surgeon was a North Korean. He was a coarse brute who caused unutterable pain and suffering. I don’t remember his name, thank G@d

My jobs included assisting the surgeon in the evaluation of the patient, preparing the operative site, and if it was an abdominal surgery, opening the abdomen and preparing the operative field. After the surgeon had finished in the abdomen, my job was to close the layers of the abdominal cavity and finally the skin. We had a grumpy old anesthetist: if he thought I was taking too long sewing the patient up, he would “lighten up” the anesthesia so that the patient would start to cough. The old bastard.

One morning I went into the operating room and found the doors propped open. “What’s this?” I asked the nurse. “Why are the doors propped open?”

“We’ve got a leak in the anesthesia machine,” she told me. “Until they get it fixed we’re gonna have to operate with the doors open.” Oh, I though, this way we’ll only be half as anesthetized as the patients.

I inhaled Halothane along with everyone else for the next four weeks. And then, one week after I finished that rotation and went on to the next one, I miscarried. I was ten weeks along.

I had no idea how attached I had grown to that little nubbin of life that was growing inside me. I absolutely fell apart. I couldn’t function. The clinical rotation I had just started was, of all things, Obstetrics and Gynecology. I couldn’t set foot on the ward for a week after the miscarriage. I just lay in the bed and cried.

The dean ran interference for me and spoke to the OB/GYN director, who was a woman. She was the daughter of the senior OB/GYN in that town, and had joined her father’s practice. She had a strong academic background, loved power, and used it freely.

When I finally got my feet back under me I made an appointment to speak with her, for I had already missed the whole first week of my eight week rotation. I knocked on her door.

“Come in,” she called. I entered the sleek wood office. She sat writing at an expansive desk. “I heard what happened,” she said, not bothering to raise her head and look at me. “It won’t affect your grade.”

I waited for whatever came next, but it never came, so I waited some more, not knowing what she expected of me.

“You can go now,” she said to her desk, still scribbling, “The nurse will give you your assignment.”

I wandered back out into the hall, feeling very unsure of myself, and was greeted by a large and cheerful nurse who ushered me down a hall and into a clean green room whose only features were a GYN exam table, an exam light, a wheeled stool, a kick bucket (the kind on wheels that you position with your feet, that’s why it’s called a “kick bucket”), and a room divider screen, with whatever was behind it.

Not too long afterwards, the door opened again and the same nurse brought in a gowned woman, and asked her to make herself comfortable on the table. The nurse positioned the woman and left her alone with me. There was an awkward silence, since we had not been introduced.

Five minutes later the door opened again, and this time it was Dr. S. and an entourage: an intern, a resident, and another medical student. Dr. S. began to talk to the woman on the table, and intermittently explaining a thing or two to the entourage. I felt like a ghost, since no one had acknowledged my existence since the nurse had put me in there to begin with.

Next thing I knew, objects were being retrieved from behind the room divider. A tray with sterilized instruments on it. And a machine that looked like….a vacuum. It was a vacuum. For performing abortions. My stomach contorted. I begged pardon, and stumbled from the room, under the searing glare of Dr. S……

Labels and Identity: Part Two

Medical school was a blast.  I kid you not, I have never had such fun since I was seven years old.

That was the time that my pet baby turtle died.  I have never once heard of a pet baby turtle that did not die young, but instead grew up to be an adult turtle giving rides to children in the zoo.  But I digress.

My baby turtle died, the kind that children are not allowed to have anymore because of Salmonella.  And I buried it in my mom’s flower bed behind the L-shaped brick house we rented, way far away from the road, down a dirt driveway half a mile long.

It wasn’t two or three days until I realized what a blunder I had made.  I had passed up a stellar opportunity to further my scientific education.  So I dug up Mr. Turtle and laid him out upon my little bed, took up my X-Act-O knife and began the postmortem by separating the plastron from the carapace.

Just as soon as I lifted the lid of the turtle’s front shell, some horrible stinking greenish black slime poured out directly on my bedspread.  I jumped back, gagging, fighting off waves of panic.  That has always been my motto, “Do Not Panic.”  It has served me well in many situations.

The hideous stench of the decomposed turtle innards drove me to quick action.  I snatched up the bedspread, turtle swathed within, and ran out the back door.  My chief concern of course was what my mother was going to do when she noticed that my bedspread was gone and that the house smelled like rotten turtle guts.

I dumped the turtle remains back in the flower bed and dragged the bedspread into the garage where the old wringer washing machine stood.  There was a handy half gallon of chlorine bleach within reach, so I spread out the bedspread and emptied the contents of the bleach bottle onto the black slime place in the middle.  Then I wadded the whole thing up and stuffed it into the washing machine and went away from there.

From this it should be clear to anyone that I was destined to be a surgeon.

Anyway.  I loved medical school.  I did not encounter one single dead turtle there, but that was because I went to human medical school instead of veterinary medical school.  I often wonder why I didn’t think of that when filling out my application forms.  But that is water over the dam.

I was far, far too busy being a medical student to think about identity issues.  At first, there was a lot of course work, and a whole new system to learn.  The school I chose turned out to be what I later came to think of as “The Hippy Medical School,” because it was a center for innovation in medical education.  The Dean at that time was a Social Scientist and not even a physician.  The faculty were all top level experts in their fields, but they were also critical thinkers and often quite eccentric.  The most common word I heard during my six years there was:  Inquiry.

The immediate impact as far as I was concerned was that they honed in on my past as a traditional healer (no, I have not written anything about that yet, aside from the turtle), and proposed that I join the new phalanx of the Medical Scholars Program in Social Sciences.  The Medical Scholars Program means you do your four years of medical school, and then somehow or other you manage to do a full graduate program in some other discipline, with the aim of coming out of it with the letters MD, Ph.D after your name.  The accepted second discipline had traditionally been in “hard science,” like microbiology or biophysics, but since our Dean was a Social Scientist she was stumping to get the Social Sciences represented in there too, and I came along at just the right time.  So I became the first MSP student in Anthropology.

Somehow I convinced them to let me “just” go for a Master’s Degree in Anthropology instead of a Ph.D., for the same reason I didn’t become a surgeon:  I wanted to have a family.  Anthro Ph.D’s are known to drag on for seven, eight years on the average, and always involve one full year of fieldwork in some primitive place where one is quite likely to contract some dramatic tropical disease, excellent for bragging about at annual meetings but not so great if you have plans to reproduce someday, and I did.

One of the things that one does as a first year medical student is to dissect a human cadaver.  That is taken for granted;  it is a rite of passage.  Every medical school does it a little differently, but we all need to know what goes on underneath the outer carapace and plastron of the human body.

In our school, one cadaver was assigned to a pair of students, who then alternated dissecting and observing.  Through a series of happenstances, there ended up being an odd number of students and an extra cadaver, and she was assigned to me alone.  Yup, just she and I.  We were the outliers.

My poor cadaver!  I will never forget her.  She was an old, old lady.  She was curled up in the fetal position, and from the condition of her muscles and tendons, it looked like she had been that way for years.  I couldn’t help thinking of an old lady just like her that I had met years before, when I worked as an itinerant phlebotomist and was sent to a “convalescent hospital” to draw all of the patients’ blood there.  The poor little old lady looked up at me in terror from within her blue, blue eyes, her silky white hair combed neatly in a French twist on the back of her head.  She made little whimpering noises as I tried to straighten her arm out to draw her blood the normal way….but she had been curled up like a snail for so long, her muscles were all contracted and it could not be done.  So I drew the blood from her hand.

And there she was, or someone very like her, lying on my dissecting table, all crumpled up.  And I was supposed to be dissecting her armpit.  The armpit is a fascinating place.  It contains an electrical switchbox that operates the whole arm, including the hand.  So it’s essential to open it up and examine its contents.

But my lady was not able to cooperate in even the clumsy way the other cadavers did, and I was wondering how I would ever get the job done.  It didn’t help that I had come into the anatomy lab alone, late on a Saturday night, having no date.  Needing inspiration, I headed over to the lab’s radio to try to find a classical music station.  I have always found that classical music helps, as long as it is not Benjamin Britton.

Just as I arrived at the radio, I nearly collided with another ghoul in a white coat and plastic gloves.  “Oh, excuse me!  I was just looking for a classical station!”  we said, in unison.  And grinned sheepishly, realizing we were without question the two geekiest geeks on the planet, spending their solitary Saturday nights in the cadaver lab, looking for a classical music station.  Neither of us had noticed the other was there, even though we were just a few cadavers down from each other.  We found a good classical station.

“Oh, uh, well, since you’re here, could you help me with Madame Pretzel (I had named her) over here?  I can’t seem to access her axilla.”

“Mmmmm, why, I’d be delighted to!”  hummed the geek-boy, and he came over and helped me.

I though he must certainly be gay, because he was adorable, had good manners, and liked classical music.  But I took a risk and asked him out for coffee, and he eagerly accepted.  I found out he wasn’t the least bit gay, just highly cultured.  We got married.

By then I had accumulated so many Labels and Identities that I actually hyperventilated if I thought about them.  So I avoided thinking about them, and instead continued running three miles a day as I always had, and added two dance aerobics classes a day plus a weight training session three times a week, just to keep all the identities from running into each other and getting knocked down.