Because I Come from a Crazy Family

by Edward M. Hallowell

  George was an unforgettable character, demonstrating more energy, drive, and dedication to his work, and to helping others, than just about anyone else I’ve ever met. Both a surgeon and a Ph.D. in biochemistry, he did research into nutrition, particularly the nutritional care of the surgical patient, following in the footsteps of the great Franny Moore.

  His labs were at the old Boston City Hospital, near the Fifth Harvard Surgical Service, so I got to attend surgical grand rounds with some of the greats—John Mannick, George Clowes, Bill McDermott. George had a team of about a dozen: nurses, would-be doctors like me, surgical fellows from the UK or Europe, grad students, other docs doing research.

  George was a brilliant dynamo, nonstop action, nonstop ideas, nonstop demands. We were always preparing one grant proposal or another, tracking down one reference or another, running some errand or another, and trying to keep up with everything else he wanted us to do. We were always on red-alert.

  Looking back, I can see that George had both dyslexia and ADHD. Left-handed, like many of us with those conditions, when he couldn’t think of a word he simply substituted “thing.” So a sentence could go, “Ned, I want you to go up to the ward and take the, uh, thing …” Somehow I learned how to fill in the blanks.

  One of my jobs was to take the calipers Bruce Bistrian would give me, go to all the patients on the surgical ward, and measure their triceps skin-fold thickness as well as arm circumference. This scared the patients because many thought I was measuring them for their coffin! I had to explain to them in considerable detail that what I was doing had nothing to do with their demise, only their nutritional status. Once they understood, they were quite happy, even proud, to be measured.

  Then I had to record their weight and serum albumin level from the chart, gather up their twenty-four-hour urine and fecal collection, put those goodies into plastic bottles with preservatives, transport them across town, gather data from the previous day, enter it into the computer, run the program, and graph the results. I did this day after day.

  We had a hardworking, fun-loving team. We often went out drinking after work (not with George) and we came to really like each other. Then and there I got hooked on teamwork.

  I also became smitten with a nurse on the team named Julie.

  Before I knew it, we were together all the time. Julie was one of those rare people who are good to the core. But she was also playful, full of laughter, cute as could be, and very smart. With me she was a really good sport, putting up with my sometimes ridiculous, impulsive behavior. For example, late one wintry night we were driving down Mount Auburn Street in Cambridge when we passed an old man standing in a snowbank. I stopped the car.

  “Why are you stopping?” Julie asked.

  “That man back there, he looks stuck.” I backed up the car, put on my flashers, and got out. Sure enough, the man was stuck. Julie and I helped fish him out of the snowbank, only to find his right leg was amputated below the knee. His prosthesis was pretty grungy. When we asked him where he lived, he told us nowhere. He was homeless.

  I said we can’t just leave him here, and Julie said OK, let’s take him to a shelter, and I said can’t we take him home and clean him up, and she amazingly said OK, we could take him home. I think I’ve developed this habit of taking people in because Duckie and Uncle Jimmy took me in. In any case, it was not me but Julie who took on the lion’s share of the work when we got this fellow back to the apartment.

  He stank—no other way to put it—so badly that it was nauseating to be in the same room with him. Julie took him into the bathroom, drew a tub of hot water, took off his clothes, and helped him into the tub. I helped ease him into the bath as well, but Julie ran the show, knowing what she was doing far better than I did.

  The tub quickly filled with such slime that we had to drain it and fill it up again. We must have used a full cake of soap on the poor man, who was happy as a pig in poop, moaning with pleasure and smiling from ear to ear as he was bathed by this lovely nurse.

  By the time Julie finished washing him stem to stern, he actually pinked up, smelled like soap, and was clean. He spent the night on our couch.

  “Please do me a favor,” Julie said to me as we were falling asleep. “Don’t fish any more men out of snowbanks, OK?”

  We didn’t have a lot of money, but between her job as a nurse working for George and my stipend as a research assistant, we had enough money to have fun, and I could still send some to my mother. We loved going out to eat; in Cambridge and nearby, there were lots of cheap places to choose from. We also loved ball games, cheering on the Celtics and Bruins, and we loved movies.

  The research panned out well. Our data showed that the surgical patients at Boston City Hospital came into the hospital in better nutritional shape than when they were discharged. That was a dramatic finding, because declining nutritional status impairs recovery big time, especially wound healing.

  The paper was published in the Journal of the American Medical Association and became one of the most cited papers of the decade.

  George gave me various other unsavory jobs, like decapitating rats in a guillotine and “harvesting” their blood in a paper cup while they exsanguinated, taking the blood over to MIT, and entering the data into Prophet, the software system I was trained to use; weighing people at the obesity clinic he ran; editing and rewriting his incredibly bad prose; and writing editorials that were above my head but nonetheless gave me good experience. All these jobs contributed to the cause, George’s mission: improving the nutritional care of the surgical patient and raising awareness of nutrition in general.

  When I got into Tulane Medical School, Julie and I had to make up our minds what to do. We decided I would go off to New Orleans and she would stay behind.

  We went to see The Way We Were with Robert Redford and Barbra Streisand and cried. The theme song from that movie became our touchstone.

  We could have moved together to New Orleans. Julie could have worked as a nurse while I was a med student. But we were young, and moving to New Orleans together would have been tantamount to marriage. As much as I did love Julie, I wasn’t ready.

  She is now happily married, as am I, so I think we made the right decision. George Blackburn died in 2017 after an illustrious career at Harvard Medical School. In addition to mentoring people who wanted to go to medical school, like me, he made a huge contribution to the field of nutrition.

  42.

  In August 1974 I boarded a train at the Back Bay Station in Boston, heading for New Orleans. Jamie drove me and my two big suitcases, plus a smaller bag, to the station. He waited with me on the platform for the train to what seemed like Neverland.

  Standing with Jamie, I felt mostly afraid. Excited, yes, I’d worked really hard to get into medical school, having had to apply twice, but now that it was upon me, I wondered if I’d done the right thing. The last time I’d boarded a train to go south, it hadn’t turned out so well.

  Jamie made small talk, but I could tell he was sad as well. He would miss me, I would miss him. We’d gone out for “a few beers” as we called them so many times, and now that would end, along with so much else.

  I felt like saying Why don’t I just throw out this med school idea? It was a long shot anyway. I should be an English teacher or go to law school, hit something in my strike zone. Med school is such a reach. I oughta stay here with you and Julie and Tom and Lyn … The thought of Lyn brought me up short. She’d kill me if I backed out now. My lot was cast.

  The train pulled in. Jamie helped me lug my bags onboard and find a seat. I couldn’t afford a sleeping compartment, so I was going to sit up all the way.

  We were not big huggers, but we were at that moment. I was going to miss him so much.

  I waved to him through the window as the train slowly left Back Bay Station. I had no idea what the next four years would bring. I sat back in my seat and said a prayer.

  Some thirty-six hours later, the train pulled into New Orleans. I had found
no companionship on this trip, and when I arrived I was feeling pretty lonely.

  I caught a cab and piled my bags into it. The dorm where I’d live over the next few years was a made-over high-rise hotel. My “apartment” consisted of a tiny kitchen, a sitting area with a desk, and a bedroom. It was about as sterile as it could be, and the minute I walked in I wanted to turn around and leave. Existential crisis, hello!

  Looking out one of the windows, however, I saw a vertical sign that read, from top to bottom, J - O - Y. Talk about a message from beyond. Not only that, but the sign was the marquee of a movie theater. Heaven!

  I quickly unpacked all that I needed to unpack and made a bee line for JOY. When I got there, I saw right away that this theater had seen better days. No problem! Fancy I did not need. A movie I very much did.

  Over the next three days I saw The Sting eight times. Movies have always been my go-to escape hatch.

  Then the day arrived for med school to start. Dr. Walsh, the Dean, welcomed us first-year students with words that warmed my heart. “Now that you’ve been admitted, it is almost impossible to flunk out.” It wasn’t true, some did flunk out, but it was enormously heartening to know the Dean was rooting for our success.

  We were each given a long aluminum box of bones, all the bones in the human body to a box, to take home with us so we could learn about each bone, hold it, and get to know it. I would sit, tapping a humerus on my knee, as I read the anatomy text.

  We had to learn the origin, insertion, the nerve that connected to it, and the action of every muscle in the body. There are plenty of them. I made a flashcard for every muscle, the name of the muscle on one side, the origin, insertion, nerve attached, and action on the other side. It was tedious, but for me there was no other effective way.

  Memorization ruled. There were classic mnemonics for certain topics we had to memorize, like the twelve cranial nerves. Rather than use the mnemonic med students had been using for scores of years—“On Old Olympus’ Tipmost Top, A Finn And German Viewed Some Hops”—I made up my own: “Old Options Occur To Those Of Maximum Means About Finding Very Glamorous Valets And Whores.” It worked, except I had to tell myself whore began with an h for hypoglossal, not a w. Mine was actually better than the traditional one because with “Of Maximum Means” I was able to include cues for the three divisions of the trigeminal nerve, the ophthalmic, mandibular, and maxillary.

  This was the first two years of med school: Dissect and memorize. Be it gross anatomy, histology, neuroanatomy, embryology, biochemistry, it was all about memorization. We tried to take inspiration from the knowledge that we were learning fascinating facts about the human body, facts we would need to have at our fingertips to be good doctors, but it was also hard because we knew we would forget most of it, that doctors retained only what they used. Not many doctors still know the Krebs cycle they once memorized. It’s more a rite of passage than anything else.

  But pass I did, thanks in large part to dinner most nights with my classmate, Steve Bishop. He had been raised Catholic and had thought long and hard about God. We had long talks about religion, as well as literature, philosophy, ethics, psychology—all the stuff we missed from our college days. We’d go to a cheap cafeteria, eat really good food (it’s hard to find bad food in New Orleans), and talk and talk and talk. Steve was a brilliant guy. I never would have been able to tolerate those first two years of med school had it not been for him.

  I found ways to stay interested, and one time almost got into big trouble for doing so. We started the year by taking a class in gross anatomy. We worked on our cadavers in groups of six. Each cadaver was stored in a large aluminum tank the size of an extra-large coffin, but on stilts. We’d open the tank using levers, raising the cadaver so we could dissect it. At the end of each session, we’d lower the body back into the tank and close it up for the night.

  The cadavers reeked of formaldehyde and so, naturally, did we. Once we all got over our initial shock at seeing a stiff, dead body, and set ourselves to the task of exposing and identifying every muscle, nerve, vein, artery, lymph vessel, organ, node, lobe, and bone, we quickly forgot that the entity we were so carefully slicing into was once a living person, as alive as any of us.

  It’s just as well that we didn’t keep that fact in mind because you wouldn’t want to do to a human what we did to those cadavers. We didn’t disrespect them, in the ways you see in B movies about medical students, but the process of dissection is a euphemism for carefully cutting a body to shreds. By the end of the term, the cadavers were barely recognizable as human, having had the skin peeled back, every organ sliced into, the skull sawed open, and every smallest vessel or fiber laid out for identification. The generous people who donated their bodies to the medical school did us a huge favor, but I am quite sure each and every one of them would be grateful that they did not have to watch themselves being dissected.

  I really liked the people on my dissection team. Our leader, by acclaim, was a local boy, Clayton Griffin, about six foot five, and I’d guess around 350 pounds. We all loved him, as he’d keep us entertained with his Louisiana humor, no matter how stressed we got.

  Our team’s cadaver was a large, muscular man who required a lot of strength to dissect. Some cadavers were little old ladies who were so thin it was pretty easy to work on them. But this guy took a real team effort.

  When we opened up his skull, we got quite a surprise. He had a large fluid-filled cyst about the size of a tennis ball in his left frontal lobe. Toward the end of the term, we all learned a bit of background on our cadaver. He happened to be a physician who had committed suicide.

  That cyst had no doubt led to his suicide. Cysts like that in the frontal lobe of the brain are associated with dramatic changes in mood and behavior. I thought we ought to relay our findings to the family right away so that they would know that the man they loved had taken his life not because of anything they had done, or because of some terrible secret he was keeping, but because of an undiagnosed medical condition. The cyst in his brain had made him kill himself.

  When I told my anatomy instructor that I thought we owed it to the family to tell them of this finding, he told me it was against the agreement the medical school made with all people who donated their bodies—namely, that under no circumstances would any findings from the dissection be revealed to anyone on the outside.

  “But that’s to protect them from findings they would not want to know about,” I protested. “This is a finding that would very likely help them to make sense of this man’s suicide and give them some peace of mind. We owe it to the family to let them know.”

  My instructor was a haughty surgeon who also had a Ph.D. in anatomy. He held himself in the highest regard. “If you reveal anything about this man to anyone outside the medical school, I will personally see to it that you are expelled.”

  “But that doesn’t make sense. This information can only help this man’s family.”

  “You heard what I said, and I mean it,” the instructor said, and strode away, his authority established.

  I didn’t think it was worth getting kicked out of medical school to inform the family of what we’d found, but I always thought we should have done so. The comment my instructor wrote for my record read, “This student was more interested in the social history of the cadaver than in the anatomical details.” Although I passed Anatomy, he was right.

  43.

  Although we had little exposure to patients in the first two years, in the second year I was able to take an elective in psychiatry and take on the first patient I ever had.

  I was assigned a forty-year-old man with obsessive compulsive disorder. I was just learning what that disorder was, reading a couple of texts as well as MacKinnon and Michels’s classic, The Psychiatric Interview in Clinical Practice.

  The patient, Hank, needed more than my knowledge from a text. He was crippled by his condition. He could barely leave his house. It’s not uncommon in severe OCD for people to be such slaves to
their compulsions that they can’t even go outdoors, which is another disorder called agoraphobia. Hank had that, too.

  He was deeply embarrassed by his compulsions, but he found them impossible to resist. His only means of coping became staying indoors, at home. He’d lost his job as an insurance adjuster. His wife was getting fed up, and his three children were starting to mock him.

  He told me his story as we sat in a tiny office, barely big enough for the two of us, that was reserved for medical students and their patients. The office had no window, just a desk and two straight chairs, as well as a telephone.

  I was able to read some of Hank’s history before I met him, but not the details of his compulsions. I just knew he’d sought treatment for OCD for a year, and nothing had helped. I was surprised, given all he’d been through, at how friendly Hank was. About five foot ten, with a wiry build, he wore steel-rimmed glasses, a V-neck sweater, and loafers. Until he got into the details of his problem, you’d have had no idea there was anything unusual about him at all.

  But then, he got into the specifics. “Doc,” he said, his hands clenching as he proceeded, “I can’t walk past an ashtray without stopping, picking it up, and licking it. If it’s one of these ones that’s secured to the floor, I have to lean down and lick it anyway. Ashtrays are everywhere, so I can’t go anywhere. And then my other compulsion is when I take off my underpants, I have to put my face into them and smell them. This one isn’t so bad because I do it in private, but it’s still disgusting and I hate myself for doing it.”

  I wanted to burst out laughing. You’ve gotta be kidding me, was what I was thinking inside. Thank God my childhood training in politeness kept me in check. As it turns out, You’ve gotta be kidding me is pretty much every sane person’s honest response when they hear the story of a person who has a serious mental illness.

  But as he continued to talk, and I saw how ashamed he was and how constricted his life had become, my initial naïve reaction changed to empathy and concern. Hank was really suffering. I also was worried because I had no idea how I could possibly help him. If all the pain and embarrassment he suffered was not enough to get him to stop obeying his compulsions, what on earth could I offer?