at the terrain of their future speciality and transfer into dentistry. And then?and only then?let the ones who still have the stomach for it start on the preclinical years.'
It was brilliant, as expected. But how did it help us now?
'But that doesn't help you now, 'cause now you've invested, and now you're trapped. So? So there are many different specialties you could choose. Most of them involve the same close contact you've had with patients all this year?touching, being tortured, killing yourself with night call. These are the 'PC?Patient Care' specialties. PC specialties will not be considered, here. The masochists may leave.'
No one left.
'I myself am going into a PC specialty, Gastroenterology. I have my reasons. I am a very special case. Where I'm headed, GI is what's best for me. A rare gift, eh? Right. But the NPC?No Patient Care specialties number six and only six: Rays, Gas, Path, Derm, Ophthalmology, and Psychiatry.'
The Fat Man listed these six on the blackboard and told us he would list, with our suggestions, the advantages and disadvantages of each. 'Game theory,' he called it. This chart would 'optimize' our specialty choice.
'First,' said Fats, 'is Rays. Advantages of Radiology?'
'Money,' said Chuck. 'Big money.'
'Exactly,' said Fats, 'a veritable fortoona. Other advantages?'
Aside from the assumed 'No Patient Care,' no, no one could think of any other advantages, and Fats asked for disadvantages.
'Gomers,' I said. 'You do bowel runs on gomers.
'Narcolepsy,' said Hooper, 'you're always in the dark.'
'Gonads,' said the Runt. 'X rays can fry your sperm. Your first kid comes out with one eye, two teeth, and eight fingers to a hand.
'Terrific!' said Fats, writing them down. 'Men, we're on our way!'
We proceeded to construct a table of the NPC Specialties:
RAYS Money (100K/annum) Gomers.
Dark offices, narcolepsy.
Damaged gonads; 8?fingered progeny.
Barium enemas and bowel runs.
GAS Money (100K/annum) Gomers.
Boredom punctured by panic.
Astronomical malpractice premiums.
Noxious gases, producing bizarre personalities.
Contempt, daily, of surgeons.
PATH No live bodies. Gomers (rare).
Low malpractice Dead bodies.
premiums Smell of dead bodies and formalin
Basement office.
Contempt, daily, of all but other pathologists.
Depression.
DERM Money (100K/ annum) Gomers.
Travel to sunny conventions Contagion.
Naked skin attraction Naked skin repulsion
OPHTHAL? Astronomical money Gomers
MOLOGY (millions/annum) Astronomical maplpractice premiums
Opportunity, daily, to Surgical internship required
torment GAS. Occasional patient care
PSYCHI? NO GOMERS! Hourly wage.
ATRY Never touch bodies Hard on lumbar spine.
except in sex-surrogate Multiple accusations from rightwingers,
Voyeurism, perversion, cf. 'communist,' 'queer,' 'pervert.'.
eroticism, autoeroticism,
polyeroticism.
Easy on feet.
Long lunch hours.
Cure?alleged-many others
By the end of the Fat Man's colloquium, the remarkable had happened: on paper, Psychiatry was the clear winner.
On the canoe trip, Psychiatry loomed even larger. Chuck had organized this final intern outing, and one bright, sweet?breezed summer day we signed out to the House residents, loaded the beer, and headed for the shore, into the foothills of the marshland to the tidal river, winding through the grasses to the sea. As we paddled lazily downriver, Berry and I found ourselves in a race with the two policemen for last. Gilheeny, a great red? feathered mallard in the bow, continued to curse his rudderman, Quick, as their listing canoe smacked first one bank and then the other. And yet what could have been better than drifting along, drinking cool beer, listening behind us for the deep carmine baritone of the redhead and the insistent tenor of his mate crooning 'a lament from the Emerald Isle'?
We stopped on an island for a picnic. In a pine grove dappled with shadow, we found ourselves drawn to Berry. She listened to our discontent; she agreed that the year had been a horror:
'It's been inhuman,' she said. 'No wonder doctors are so distant in the face of the most poignant human dramas. The tragedy isn't the crassness, but the lack of depth. Most people have some human reaction to their daily work, but doctors don't. It's an incredible paradox that being a doctor is so degrading and yet is so valued by society. In any community, the most respected group are doctors.'
'You mean the whole thing's a deception?' asked the Runt.
'An unconscious one, a terrific repression that makes doctors really believe that they are omnipotent healers. If you hear yourselves saying, 'Well, this year wasn't really that bad,' you're repressing, to put the next group through it.'
'Well, then, my clever woman,' said Gilheeny, 'why is it that these fine young men do this at all?'
'Because it's so hard to say no. If you're programmed from age six to be a doctor, invest years in it, develop your repressive skills so that you can't even recall how miserable you were during internship, you can't stop. Can a star take himself out of a ballgame? No way:'
She was right. What could we say. We sat, still, absorbed, hushed, as the afternoon shadows inched on. Berry answered some questions about psychiatry, and as we awoke to what she was saying, she turned our picnic into a sort of group session. The theme was loss.
'What all loss do you mean?' asked Chuck.
'What each of you has lost this year. I know it first hand only from Roy but I've heard about the MORs and RORs and . . . and Eddies break and . . ' She paused, and then, her voice trembling, said, ' And Potts. You lost Potts. If you felt that loss, you'd still be crying. You're crippled by your guilt, the guilt of killing off the cherished parts of yourselves:'
In the darkening grove, silence hung somber as a shroud. I felt choked up. What had I killed off? Days like this one, my creativity, my ability to love. Gloom. Stasis. Doom. Finally, with the sun curdling down its the reddening hills, Gilheeny asked softly, 'These men are wounded. Can anything still be done?'
'Guilt's a hot potato?whoever holds onto it burned. You're all doing a slow burn. Give it up. Get mad. Give it back to the ones who infantalized you. Is there a House shrink to talk to?'
There was: Dr. Frank, the psychiatrist at the B-M Deli lunch on our first day in the House. He'd mentioned suicide, and the Fish had canned him. He'd stayed canned the whole year. Why? Returning to the canoes, we floated toward the sounds of oceans, each wondering what had been lost, how this Dr. Frank might help find it, and
