Confessions of a Medical Student
Callaghan and I stood together that first day, waiting in our new white lab coats. To tell you the truth I felt like leaving right then and there—in the centre of anatomy were tables covered with linen shrouds. Underneath the shrouds were white mounds. Padre Moran in his robes marched to the front of the room flanked by Dean Witt and the anatomy prof. Behind them were lecturers, the anatomy fellow, and Tim, the assistant with a gimp foot. Dean Witt, the tallest in the troupe stepped forward in his dark suit, stretched to his full height and asked for quiet…
“Let us bow our heads,” Padre Moran said. Seventy novice medical students formed around the metal stables with cadavers.
May we pray for those who were God’s children though their souls have departed; their bodies remain today, for they have been bequeathed to science. Let us remember they have been given to you in good trust in the name of medicine and learning…
I looked up to hear a sob. Callaghan was crying. He wiped tears from his face. Padre Moran asked for silence. We recited the Lord’s Prayer. Callaghan sobbed softly. We were ordered to unveil our body. I took a breath and unrolled the white shroud from cadaver # 166. A man lay stiff on the table, his skin darkened, thick, tight about his joints so his knees and elbows seemed unnaturally polished and large. His skin flaked in places and had the colour of rust. His feet were wrapped neatly in plastic bags tied over his ankles; his hands were similarly wrapped. The head, which we could see through the translucent plastic, revealed a face and shut eyes that appeared smoky, the jaw and brown sunken, the flesh ridged from lying on one side. The features were indistinct, smudged. My stomach twisted. “I don’t think I can do this.”
Short Stories by Ronald Ruskin
Neurology and Psychiatry
June 1, 2004
American Journal of Psychiatry June 2004, Vol. 161, No. 6, pp. 964 - 966
Mrs. Fields is wheeled into the auditorium. She stares at the ceiling. Dr. Nigel Browne, silver-haired, 6’3”, the neurology chief in his long white coat takes his Queen’s Square hammer in his right hand, smiles, and speaks to the patient. We are 70 medical students perched at wood desks that rise from the medical auditorium. Dr. Browne has studied neurology at Oxford and psychiatry at the Maudsley Hospital in London. He has an eagle’s face on a giraffe’s body. He sees and knows everything.
“Mrs. Fields,” Dr. Browne says, “thank you for coming. What is your problem?”
“Doctor, I am unsteady on my feet.”
“There.” Like a maestro, Dr. Browne raises his hands to us; we are his orchestra. “We have the presenting complaint.” He directs his hammer, asking the patient to walk. The patient lurches and almost falls. The chief resident catches her as she loses balance.
Dr. Browne writes on the blackboard “Astasia-abasia.” He pivots to face us. “Who knows about astasia-abasia?”
In July, my first month as a psychiatric resident at Hotel Dieu Hospital, I am called to the emergency department Sunday at 9 p.m. to see a gaunt woman pacing the crowded waiting room. Her children, a boy, 6, and a girl, 4, sit in obedient stillness. The casualty officer notes, “Patient medically stable but has religious concerns. Refer to Psychiatry.” I introduce myself and lead the woman to an examining room with a female attendant. Two sunken gray eyes pierce mine with a chilling stare. “What is the matter?” I ask.
The woman is silent. Her lips quiver; her eyes flee mine. I read her chart, her scant history. Her daughter, sitting outside the examining room, asks to join us. Moments later, her son enters. Five of us crowd the tiny room. In the children’s eyes I see confusion. The woman adjusts the crucifix around her neck; her fingers tremble.
“What is wrong?” I ask.
“Mama will not eat. She’s—,” the boy begins, but the mother puts a finger to her lips.
“I want to see Sister Marie,” she demands.
Sister Marie oversees the emergency department, a petite woman with soft brown eyes in a white habit. I know Sister Marie from rounds yet hesitate to call her. A nurse assures me that Hotel Dieu Hospital, founded by a French order, considers it a duty to respond to religious requests.
“I must speak to Sister Marie,” the woman pleads. I dial the sisters’ residence. I have no clear history or mental status; the woman refuses to talk. She seems more unsettled. On the telephone, Sister Marie agrees to come. Soon we are six in the tiny room.
“Yes, my dear,” Sister Marie says. “What troubles you?” The woman’s gray eyes turn to slits. I am unprepared for what comes next.
“The Devil is in me. He is in the room,” the woman hisses. “I am possessed.”
In my second year of medical school I worked as a night orderly at Sunset Lodge. I lifted old men from wheelchairs to toilets. I dressed bedsores and stumps; changed sheets, pajamas, and catheters. Some men weighed over two hundred pounds. Many had had strokes. Lowering them to their bath, I had to check that the water was not too warm and make sure the men did not slip from my arms.
At bedtime we talked. Friends and family had moved away, or had died, or didn’t come. I was curious about old age; I wanted to understand their life. My favorite patient was Robert. He spoke in a brogue and hobbled with a cane. He was a hundred years old.
“What’s a young lad like you doing in this place?”
“I’m studying to be a doctor.”
“You should be in kindergarten.”
“I’m twenty-three. I am working to pay my tuition.”
“Find a cure for insomnia,” he shuffled to bed. “I haven’t slept for 30 years.”
“I wish I was like you.” I tucked him in. “It’s impossible. Everybody sleeps.”
“Sit with me tonight, laddie,” Robert smiled. “My wee eyes stay open.”
“You dream you’re awake,” I said.
“The trouble is, no one listens,” he said. “I stopped sleeping after Mary died.”
Robert fought in the Boer War and had seen Queen Victoria in Canada. With silver hair, milky blue eyes, and sunspots on trembling hands, he appeared frail yet cheerful, longing to tell his stories. Evenings he sat in the solarium, following sunlight as it faded below the lake. “Promise to watch me tonight,” Robert smiled. “My eyes never close. I’ll tell you when I was young soldier in Africa and saw the lions. You promise?”
After I cleaned my men and put them to bed, I curled up in a chair, trying to catch a wink. Regularly a man fell from bed, a diabetic slipped into coma, a patient grew agitated. I rarely slept. The night before my morning pathology lab, I vowed to sit at Robert’s bed. But a female patient wandered off. We searched wards, basement, and grounds. By morning we found her by the lake, sitting in a chair, staring at the sunrise.
“I’m sorry, Robert—” I sat on his bed and held his sun-spotted hand.
“Next time, we will talk,” Robert’s milky blue eyes watered. “Promise me?”
“Yes—but I must go now. I have Dr. Klein’s Pathology lab—I am already late.”
The following week, Robert was waiting. He told me of his travels at nineteen from Scotland to Europe by steamer and was about to talk about Africa, when I was called to 3-West, the psych ward—their orderly was absent. All night I watched the patients, a few restless souls. Two men had to be secured to their beds and one had diarrhea and needed to be washed. When I returned to Robert his eyes were wide open.
“You ran away again,” he said. “I was going tell you about the lions.”
“Please,” I said, envious of his quests. “Tell me about Africa. I’ve a few minutes.”
“Africa is a big place,” his eyes stilled. “Why not stay, laddie?”
“I must go to Pathology—Dr. Klein takes attendance. Next week, I will be here.”
“Does Dr. Klein tell stories? Will you remember to come? I have many stories.”
“Yes, I promise.” Exhausted, I found a chair and shut my eyes until my shift ended at seven. I peddled home and slept heavily before Frank, my lab-mate called from the hospital “Ruskin! Are you dead? You’ve been late for two Pathology labs.”
I parked my bike outside the hospital and rushed to the pathology lab. I was sleepy and twenty minutes late. Students flocked around Dr. Klein—he took attendance at the start of each lab. If I stood on my toes I saw he held a large bottle with a specimen inside. Everyone stared at the bottle, their eyes rapt—I had no idea what he had said.
“The autopsy is done respectfully. The internist or surgeon may err in diagnoses, yet the pathologist approaches post-mortem with humility,” Klein’s lips seemed cast in a melancholy smile. “We are ignorant but Death schools us in life’s mystery.” Dr. Klein spoke in short precise sentences. “Follow me. Remember, single file. Understood?”
“Yes,” everyone said.
Klein passed me. I leaned to stare at the bottle and half-asleep brushed against him. His eagle eyes scanned my ID. He looked up. “Ruskin? You came late?”
“I didn’t mark you present last week,” he said. “You know the attendance rule.”
“Three late notices and we see the Dean. This won’t happen again sir, I promise.”
“Why is that?” Dr. Klein asked. “Have you been indisposed?”
“No sir. I work as a night orderly at Sunset Lodge.”
“Indeed.” Klein’s face darkened. “Ruskin, follow me.” We entered a somber hospital tunnel. Klein held the specimen bottle. “I worked as an orderly one summer--for tuition.” He led me to the auditorium, patting my shoulder, but I was uneasy around the Pathology Chief. Klein chaired the clinical-pathological conference. A case was discussed weekly, the internist spoke first, the surgeon next—the pathologist last, showing post-mortem findings. Klein stepped on stage, beckoning me to join. “Come here, Ruskin.” I looked up, surrounded by faces in a coliseum, waiting for the lions to spring.
Klein pointed to the specimen. Students stared down at me with piteous grins.
“Ruskin, you want to be a pathologist?”
“I don’t know exactly, sir.”
“Excellent, that you know you don’t know,” Klein said. “What am I holding?”
“It looks like a human organ, sir. But I can’t be sure.”
I heard coughing, muffled laughter. I looked for an exit door; they were all shut.
“Excellent,” Klein said. “Which human organ might this be?”
“It might be—a kidney.” Frank shook his head. He stared away.
“Is this kidney-shaped?” Klein’s eyes twinkled.
“Not exactly, sir.”
“Not exactly?” he quizzed. “Then, if it is not a kidney, what is it?”
The specimen was chestnut color. “It seems, perhaps, a human heart, sir.”
“Excellent,” Dr. Klein said. “Why did this person die, Ruskin?” I held the bottle to the light. I turned it right, left. I shook my head. Klein asked me to sit. I was mortified yet my ordeal was not yet over. Klein toured us through the new pathology labs. He led us to a room that looked like a kitchen. It was in the basement, white-tiled and spotless. “Ruskin?” Dr. Klein said. “What is this room?”
“I am not sure, sir,” I shuddered.