ICU.
The stairs were made of metal with an embossed surface like beaten silver. The color had been orange but now had become something approaching a dirty tan except in the center of each step, which was worn shiny by multitudinous footsteps. The walls of the stairwell were made of cinder block, painted dark gray. But the paint was old and peeling. Some previous plumbing catastrophe or accident had provided a series of longitudinal stains that descended from above along the wall to the right. The stains reappeared each time. Susan rounded the platform and started down another flight. The only light in the stairwell came from a bare bulb at each floor landing. On the fourth floor the bulb had blown, and because of the relative darkness Susan had to proceed with caution, advancing her foot to find the first stair on the next flight down to three. The distances between the floors seemed remarkably long to Susan.
By leaning out over the metal banister Susan could see down into the subbasement and up to where the spiraling stairs became lost in collapsing perspective. Susan felt slightly ill at ease in the stairwell. The decaying darkness of the walls seemed to move in on her, awakening some atavistic fear. Perhaps it reminded her of a recurrent dream she used to have as a child. Although she had not had the dream for a long time, she remembered it well. It did not concern a stairwell but the overall effect was similar. The dream involved moving through a tunnel of twisted shapes which would progressively impede her progress. She never made it to the end of the tunnel in her dream despite the fact that the goal seemed very important.
In spite of the mildly disquieting atmosphere in the stairwell, Susan descended slowly, step by step. Her deliberate footsteps rang out with a dull metallic echo. She was alone. There were no people and it gave her a few uninterrupted moments to think. For a short period of time the immediacy of the hospital receded from Susan’s consciousness.
The encounter with Berman became more complicated in her mind. The lack of professionalism was diluted because, in reality, Berman was not Susan’s patient. She had been called simply to provide a peripheral service. The fact that Berman was a patient was important only in facilitating their chance meeting. But Susan wasn’t sure if she were just rationalizing. Rounding the landing on the third floor, she paused at the head of the next flight.
She had reacted to Berman as a woman. For a constellation of inexplicable reasons, Berman had appealed to her in a basic, natural, even chemical way. To an extent that was encouraging and reassuring. There was no doubt in Susan’s mind that she had begun to think of herself in a sexless sort of way over the first two years of medical school. She had used the word neuter in talking with Berman but only because she had been forced on the spur of the moment to find a term for it. Obviously she was female; she felt female and her monthly menstrual flow emphasized its reality. But was she a woman?
Susan started down the next flight of stairs. For the first time events had forced her to intellectualize a tendency which had been developing for several years. She wondered if Carpin had been called instead of her and if Berman had been some equally attractive female, would Carpin have responded as a male? Susan stopped again, considering this hypothetical situation.
From her experience she decided that there was a very good possibility that Carpin would have performed in an equivalent fashion.
Susan recommenced descending the stairs, very slowly now. But if it were true that a male would respond in a way similar to hers, why was it so different for her? Why did she dwell on it?
It was more than the debatable question of medical ethics. Berman had made Susan feel like a woman. All at once it came to Susan. The biggest difference between herself and Carpin was that Susan had an extra obstacle. She knew that both of them wanted to become doctors; to act like doctors, think like doctors, to be taken for doctors. But for Susan there was an additional step. Susan wanted also to become a woman; to feel like a woman, to be taken for and respected as a woman. When she had entered medicine, she knew it was a male-dominated career choice.
That had been one of the challenges. Susan had never imagined that medicine would make it difficult for her to achieve fulfillment in a social sense. Academically she could compete; she was reasonably sure of that.
The next step was going to be harder, an uncharted course. And Carpin?
Well, for him the social part was easy. He was a male in a recognized male role. Being in medicine only supported his image of himself as a man.
Carpin only had to worry about convincing himself he was a doctor; Susan had to convince herself that she was a doctor and a woman.
Arriving on the second floor, Susan was greeted by a sign which stated in bold letters: “Operating Room Area: Unauthorized Entry Forbidden.”
But the sign wasn’t necessary. To Susan’s momentary consternation, the door was locked! Her overly active imagination suddenly had all the doors from the stairwell locked, and she thought of herself caught within a vertical prison. It was a fleeting thought, totally irrational. “Wheeler, you’re too much,” she said aloud for her own benefit and encouragement.
She quickly descended to the first floor. The door opened easily and Susan joined the surging mob on the main floor.
She took the elevator and returned to the ICU entrance. It took a bit of fortitude to begin to open the door. Once she started, it took strength. The ICU door was massive and very heavy.
Susan stepped once again into the nether world of the ICU interior.
One of the nurses looked up from the desk but then went back to an EKG
tracing in front of her. As Susan scanned the room, she was again struck by the purely mechanical appearance, the lack of human voices, even the lack of movement save for the fluorescent blips tracing their incessant patterns. And there was Nancy Greenly, as immobile as a statue, a casualty of medicine, a victim of technology. Susan wondered about her life, her loves. Everything was gone, all because of a simple menstrual irregularity, a routine D&C.
Susan forced her eyes away from Nancy Greenly and ascertained that her group had since departed from the ICU, presumably for Grand Rounds. At the same instant Susan acknowledged to herself her acute discomfort about being in the ICU. The psychological and technical complexity of the room caused any residual euphoria from the I.V.
episode to vanish. Her imagination forced her to ponder the situation if something suddenly went wrong with one of the patients while she was standing there. What if someone expected her to make some life-death decision to go along with her white coat and her impotent stethoscope in her pocket?
Controlling the urge to succumb to a minor panic, Susan tugged at the inertia of the door and escaped into the corridor. Retracing her steps to the elevator, Susan mused about the difference between fact and fancy, between reality and mythology, between what it really was like being a medical student and what people thought it was like.
Remembering Bellows’s comment about Grand Rounds on 10, Susan pushed the tenth-floor button and allowed herself to be compressed toward the rear of the elevator. It was a miserable trip. The car was a potpourri of human beings with every conceivable affliction, and it stopped at every floor. The air was heavy and hot, particularly since one rude passenger was smoking despite the sign plainly forbidding it. The occupants did not look at each other; they stared blankly at the light progressing from number to number, as did Susan, wishing the doors would open and close more quickly.
Impetuously she pushed her way to the front of the elevator at the ninth floor. At 10, she broke from the crowded cubicle with relief.
The atmosphere changed immediately. The tenth floor was carpeted and the walls shone with an even luster of newly applied semigloss paint.
Gilded frames set off portraits of former Memorial greats in their sartorial academic splendor. Chippendale tables topped with a variety of lamps were interspersed between comfortable chairs along the length of the corridor. Neat piles of New Yorker magazines were arranged at rational intervals.
A large sign opposite the elevator directed Susan to the conference room. As she walked down the corridor she could see into the offices.
These were the private offices for some of the more established doctors at the Memorial. A few patients were scattered along the corridor, reading and waiting. They all looked up as Susan passed. Their faces were uniformly expressionless.
