I took a look behind the curtain, and came upon a man and a woman desperately pulling a large brown dog onto the examining table. At the same time, a couple of determined-looking nurses were doing their best to push him off. The dog was not making a sound, his four legs sticking straight up in the air, only taking an occasional shallow breath. No question he was in a coma. I took a quick history, and found out that Fido, a three-year-old chocolate Labrador, had fallen down a whole flight of stairs an hour before, and landed on his head. A few minutes later, he became unresponsive. In a panic, his owners, carrying the dog between them, flagged down a cab and asked the driver to take them to the Animal Medical Center. The driver must not have heard the first part. He took them to the Schultz ER instead. I talked the nurses into leaving the dog on the table, so I could examine him. One of his pupils was much larger than the other. That, together with the coma, meant he had a fast-growing blood clot pressing on his brain. It was too late to do a CT scan to confirm what I was thinking. In the time it would take to schedule and perform, he was sure to be dead. I quickly sent to the OR for the instrument pack used for neurosurgical emergencies. A few minutes later, I was drilling a hole on the side of the head where the clot was likely to be. A spray of blood came pouring out, and the dog’s breathing improved almost at once. A half hour later, he opened his eyes. He was coming out of the coma.
I’ve seen some grateful patients’ relatives in my time, when things turned out the way everybody hoped. The patient better, smiles all around. The family throwing their arms around you, kissing your hands. On the other hand, if the results are bad, you don’t know what to do first. Run to the bathroom, or make sure your malpractice insurance is up to date. The owners of this dog were different. As soon as he began to wake up, they both began to sob. Fido was licking everybody he could get his paws on, and his owners couldn’t stop hugging and kissing him. It was obvious we had to get the dog out of the ER ASAP. The shit was sure to hit the fan, sooner rather than later. Lucky it was a holiday weekend. If not, one of those chickenshit hospital administrators – they don’t know from beans what makes medicine tick – would already have been nosing around, having conniptions about how you can’t take care of dogs in a people Emergency Room, etc., etc. It ended up with the owners, Teitelbaum is their name, taking my patient home after I’d arranged for a couple of off-duty neurosurgical ICU nurses to keep an eye on him. An oxygen tank and a heart monitor were delivered within the hour to one of the old Georgian mansions up on Murray Hill where Fido and his folks lived. In the end, the dog got the best postop care – animal or human – of anybody in the metropolitan area that holiday weekend. Which, as everybody knows, is the worst time to get sick, since the fledglings are just out of medical school and are – without exception – wet behind the ears.
Within a day, Fido was back to normal. Jumping up and down, pissing all over the oxygen tank. He must have thought it was that rarest of objects, an indoor fire hydrant. By the time I took out his stitches a few days later, it was time to say goodbye. That’s when Arnold and Marie – which by this time they insisted I call them – invited me for a farewell drink. They’d done their homework. They’d already looked into the best way they could show their appreciation “for bringing our Fido back to us.” With that in mind, they’d had a talk about me with The Chief. They’d found him “charming.” Which suggested to me he smelled their hundred million bucks – the amount Arnold had gotten from the sale of his electronics business – as soon as they came in the door. The upshot? They were endowing the Fido Teitelbaum Professorship of Neurosurgery. Meaning they were going to donate a few million, which would be invested, so the income could pay the salary of a professor and the cost of his research. Plus a nice chunk for the Department. And the first Fido Teitelbaum Professor? Who else but me? The only catch being I had to turn forty-five before it was official. That’s what The Chief told them were the rules of the Department. News to me. He then suggested himself for the job (though he already held two other endowed professorships) if they were in a hurry, since he already fit the age requirements. They wouldn’t hear of it, since it was me, and no one else, who’d saved the life of their Fido. They were putting up the money now, but it was to be held in escrow, with the interest going to the Department until I came of age.
CHAPTER SIX
THE CHIEF
February 1984
The conference rooms at the Schultz are all inside, like the cheaper staterooms on a cruise ship. No windows, no sunlight. Like in Las Vegas, where it’s always a guess if it’s day or night. Besides, in these closed spaces, there’s no fresh air, winter or summer. What you get instead is cold, recycled wind. Pollution, hospital style. Your lungs getting a whiff of what everybody else just coughed up or belched out.
There are little pockets the wind never gets to. My first impression as I walk into the weekly neurosurgical conference: a familiar aroma that hits you in waves. The first one seeming to vaporize out of the walls. That’s what a long-sealed burial chamber must smell like; insistent but not overpowering, the sharpness gone out of it. Generations of trainees leaving us a sepulchral hello.
Where the second wave comes from – it reminds you of onion soup, but hits the nose like a punch – is obvious. The gamy odor of slept-in scrub suits released by last night’s on-call group. Clipboards held to their defenseless chests like shields; heads lolling like some Lubyanka guest after an all-nighter. Sitting close by, but worlds apart: the Chief Resident, magnificent in his spotless white coat set off by the blue and gold Princeton tie. The Judenrat appointed to keep the perspiring aspirants running and panting after the mechanical rabbit.
Da Nang Bill O’Foaleolain, The Chief, is presiding. Lab coat over scrubs; dog tags gilded like a baby’s first shoes, glinting in the yellowish light coming out of the fluorescents overhead. OR cap worn at a rakish angle. No Major’s oak leaves pinned to it? Must have left the insignia at home by mistake. Shiny combat boots complete the ensemble. Two years in the Army, three months in Vietnam. Ten years out, he’s still playing soldier. And it’s not just the getup he wears. How about some of the stuff he writes? “Neurosurgery: A Military Metaphor,” for starters. Published in that right-wing rag, Annals of Patriotic Medicine, a few years ago. After that, it only gets worse.
He’s a classic case of cardio-cerebral disjunction. A fancy way of saying his heart’s still out there in the glory days of Da Nang, but the rest of him stays planted in his duplex penthouse on Sutton Place. His reentry into civilian life smooth; no crash landing for this Vietnam vet.
Good to know he’s not perfect. Of all things, it’s his name that’s a problem. Wouldn’t be in Ireland, where having lots of vowels is nothing special. Even here it’s not a big deal, considering almost everybody goes by the unisex pseudonym of “Hi” or “Hey” anyway. But on early morning neurosurgical rounds, you can’t blame a patient for wanting to address his doctor by his real name, not that moronic diminutive “Doc.” That’s where O’Foaleolain can be a real handicap. A lot of patients needed emergency testing right after rounds – slurring of speech, involuntary movements of the muscles of the face. A stroke overnight? A worsening of the tumor? You’d think The Chief would have changed his name, made things easier for everybody. But no, only Jews and transsexuals do that. You leave for vacation as Marvin, come back as Mary-Ellen. Or, everybody knows you as Yossi Farfelmacher, all of a sudden you’re James Fenton.
I’m in charge of neurosurgical training at the County. That’s like being a lifeguard. Just another pretty face when nobody is drowning, but if one of our fledglings is about to knock a patient off by doing too much or too little, I’m your man. Most of the time, I get them out of trouble. But if I can’t, it’s our collective ass; the fledglings’ and mine. Coliseum time at the weekly conference. Chief snarling. The smell of blood in the air.
Not that I operate much anymore. I lost my taste for it a while ago. Finding out what the brain has on its mind was beginning to make more sense to me than cutting
heads open for a living. A short time before Eva’s death, I’d put the final touches on my research project. I was about to do a house-to-house census of the brain, searching for spaces reserved for genius. Beethoven, Babe Ruth, Duke Ellington: did they get to skip the preliminaries because they were born with the right wiring for the limelight? The spaces I was about to explore are called “special centers.” They’re the UFOs of brain research. Meaning they may not even exist. And even if they do, talking the brain into unlocking its own secrets is about as easy as getting to interview the little guy with the antenna growing out of the top of his head.
I waited all morning for the routine stuff to end. The morbidity and mortality report, meaning who we made worse and who died on our watch. Statistics. You read them like a batting average, except the lower the percentage, the better you’re doing. Also, funding issues and complimentary letters about what a wonderful department we are. What came next were the updates on research done by the faculty. These usually gave me the willies. Reminded me of my abortive hitch in the Boy Scouts. Troop 166 used to meet every week in a temple in Fort Lee. At least once every session, we were supposed to jump up on a rope and climb it all the way to the ceiling. The first time, my palms were already sweaty. For good reason; I’m a terrible klutz. As expected, my hands promptly slid off the rope. I fell on my ass. Not only once, but three times in a row. After that, I stayed on the ground, my face as red as my palms, while the rest of the troop scampered up there in their brown uniforms. To me they looked more like Hitler Youth, the higher they climbed. After that, I hid out in one of the stalls in the men’s room, as soon as my early warning system – a big-time cramp in the stomach – notified me that jungle gym was ready to start. Thirty years on, I was still getting ready to hide out in the toilet whenever it came time to report on my suicide project.
By this time, I’d long ago put Beethoven and the Bambino on the back burner. Ever since I understood that Eva might not have planned to kill herself, I’d started hunting for some special area that can trigger suicide on its own. Located in some dull suburb of the brain, one of those nondescript places you realize was a bomb factory only after the neighborhood blows up. I had no proof; it was just a remote hunch. But how often can you tell the same story without proof? Time after time, I sat there in my own logorrhea; the smell of defeat keeping everybody far away from me. But that day, I couldn’t wait to spill the beans. Not all the beans – just enough to make people sit up and listen.
Akbar Kurastami, known to all as Persian Pete, had the floor. Black hair slicked back, merging at the neck with grey curls rising like seaweed from the back of his collar. Tight-fitting, doublebreasted pinstripe suit, dark grey silk shirt and a tie with lots of pink in it. With that outfit, he could have done it all. Sell anything from underage girls to over-the-hill washing machines. As usual, he was going on and on about his pet subject, the post cingulate cortex. A part of the brain that’s a lunar landscape, off the tourist route of even such adventurous travelers as cancers and ready-to-pop blood vessels. Persian Pete is the world expert on this area, and he’s convinced there is oil under that particular desert. Male mice have a penis which is half as long as their entire bodies. So he removed the post cingulate cortex from a bunch of mice – post mortem – and mashed up what he got out. When you’re doing experiments with mice, to get an erection going, you have to use an electrical probe. For them to get a spontaneous hard-on, they need to be in the company of their female counterparts, back in the communal cage. So he injected the solution he’d made from the post cingulate cortexes, hoping to make the live mice rise and shine. Nothing doing. He then tried different dosages, also different liquids for the solutions. Still, nothing doing.
You’d think that would put an end to the project. Wrong! In research, not knowing is as good as knowing, maybe even better. You can make a whole career out of coming up with progress reports about your lack of progress. He kept beating the subject to death in that crooning voice. The accent a cocktail of French, plus a light hint of American, with occasional weekends in Cairo thrown in. I just wished he’d shut up.
Besides, I had some scores to settle with him. Whenever he could, he tried to make mincemeat of my project. “Max, this just doesn’t make sense,” “Max, you can’t be serious.” That’s what I really needed, to be made a laughing stock in front of the Department. While his research was more “serious”… trying to give mice a hard on?
And then there was the matter of Rosie, The Chief’s red-headed secretary. She was one of those women who send out a prologue before they walk into a room, and an epilogue as they’re leaving. One long-ago Christmas, I asked her to be my date at the party the Department throws every year. As soon as I mentioned it, she put on this wistful puss. Eyes a little moist, her face getting pink. No “sorry,” no thanks for the invitation. Came right out with it. “Akbar (what’s this with calling a senior surgeon by his first name?) and I have plans for the evening.” I could right away see that kissing under the mistletoe was not going to be at the very top of their agenda. I was plenty pissed off at Pete after that turndown. You’re entitled to ask why, but I don’t have a good answer for that. The truth is, there was no reason for him to know about my invitation to Rosie. But it was still his fault because he was always standing in my way. Women after him, never after me. The OR nurses falling over each other to scrub with him, long discussions with the prettiest of our girl students in his office, door closed. I was on real short rations then – I hadn’t met my student social workers yet, who promptly pulled me out of these particular doldrums – while he had a glut on his hands. It wouldn’t have killed him to be more generous, share the wealth. Instead, he kept all the goodies to himself.
No way I was ever going to forget what he did to me.
When my turn came, The Chief didn’t even bother to call me up to the lectern. He just looked in my direction, and, using that special tone he could pull out in an instant for giving patients bad news (feeling your pain but oh, ever so glad I’m not you), asked: “You got anything new, Max?”
I didn’t answer right away. He was just going to go on to the next speaker when I got up and walked to the front of the room, dropping my slides off with the projectionist along the way.
CHAPTER SEVEN
THE ME
May 1983
The New York City Medical Examiner’s Office, the ME, has its own blue brick building in the no-man’s land between the County and the Schultz. That’s where the business of death is transacted – the lobby filled with funeral directors milling around the secretary in charge of dispensing death certificates, waiting to get their particular show on the road ASAP. A couple of years ago, I started going up to the autopsy rooms to schmooze about suicides with the staff. I told them what I was looking for; an abnormal spot in the brain that in some way made people knock themselves off. They were polite, but I could tell they were pretty dubious about what I was getting at. Still, they began calling me whenever a suicide was brought in for autopsy. I’d look at the brain with the pathologist while he was dissecting it. We never found anything out of the way. Ditto with looking under the microscope, even with special stains to check for abnormal cells or blood vessels. Some of the brains we examined belonged to people whose stories were similar to Eva’s. No depression, fine until the last moment, but they still ended up hanging themselves or slitting their throats. Over time, I began thinking of them as the “amateurs.” Nothing like those regular customers of psychiatric clinics, “suicide risks” they’re called, the long-time depressives and schizophrenics. Those are the “professionals.” They know what they’re doing. So far, no way of telling one group from another. I’d have to dig deeper.
Around that time, one of the first MRI’s in the city was installed at the Schultz. For me it was a godsend. I found out pretty quick how good the technology is at finding tiny tumors or weak blood vessels in remote parts of the brain, the kind of out-of-the-way conditions a C-T scan – or even the microscope – misse
s sometimes. Much in demand, the MRI was in use from early morning until late at night. But I had a Trojan horse on the MRI service: Murray, one of our old trainees, who’d washed out of the program because his hands kept shaking whenever he scrubbed with The Chief. Pissed Da Nang Bill off. According to him, when you’re working on the brain, there’s no room for distraction. You’re feeling anxious, your bladder’s about to bust, an itch in your balls – forget about it. So now, Murray was a happy voyeur, a radiologist, looking instead of doing. Hands so steady I’d let him carry a bucket of nitroglycerine for me anytime. When I explained to him what I was looking for, he offered to keep the MRI lit for me after hours. That’s how I found myself walking into the sub-basement of the Schultz some evenings, carrying a canvas bag with Domino’s Pizza plastered all over it. What it actually contained was the newly removed brain of a suicide, which I’d borrowed from the Assistant Medical Examiner who had just done the autopsy. It would have been everybody’s ass if what we were doing had leaked out. But who’s going to be suspicious of a guy who’s innocently bringing over a pizza to share with his old friend Murray at the end of a long day?
It’s a lot easier to do an MRI on a brain that’s separated from its owner. Pacemakers, credit cards, watches, the stuff that makes the magnet go haywire – no problem. Same goes for the panic some patients get into when they find themselves locked into that tight metal cylinder. First they fidget; then they start yelling, begging to be let out. It takes a lot longer to do the job that way. But with the brain on its own; out of the pizza bag in a jiffy, onto the spot where the head usually rests. Then the twenty-minute bombardment (no kidding, it sounds like a war in there) by the magnetic waves. At the end, you have the most intimate snapshots of the brain you could hope for.
The first two brains I brought over showed nothing special on the MRI. Afterwards, I checked the histories of their late owners. Ten attempted suicides between them, plus volumes of notes to show for their many visits to mental hygiene clinics. People get to put their heads inside one of these psychiatric laundromats for fifteen minutes every couple of weeks, courtesy of New York City. They’re supposed to do a wash and dry of your brain. Clean out whatever is bothering you. Psychoanalysis? The exact opposite. Look for help in that direction, you get to splash around in your own dirt. As long and as often as the insurance company or your father can afford it.
Max Page 3
