August 2019

He is dying, and they will not have visitors. He is my closest sibling in age and my closest emotional connection. He’s my big brother who had my back on numerous occasions. Okay, I had his, but less often and less serious, like the time I put him to bed when he came home drunk, after a few beers in high school. 

It was 1962. I was in my third year of medical residency at Philadelphia General Hospital, the only charity hospital in the city.

I was in the outpatient clinic, seeing an African-American patient for the first time. I noted that he was on an anticoagulant, Dicoumaral (similar to Coumadin).

His prothrombin time (a test that indicates the level of blood thinning) was very low—in fact, outside of the therapeutic range. When the range is too low (meaning the blood is too thick) or too high (the blood is too thin), the patient is at risk for serious complications such as clotting or hemorraghing.

Without thinking, I said, “You must not be taking your medicine.”

Always occupied with the needs of others, medical students often put their needs and wants aside. Sometimes for an unhealthily long time.

Although the consequences of such self-inhibition are not readily apparent, they can have an insidious impact on academic and clinical performance. But the story I am about to tell is something far worse.

I ambled with squirrels and rabbits on an urban trail overflowing with chaparral and mossy oak. Early morning bird chatter, drone of bugs in rays of sun, and the crackle of underbrush beneath my feet kept me company. My thoughts wandered brisk as the sound of river water on rock.

A man wearing a holey T-shirt and sweatpants approached me, accompanied by a large German Shepherd. The dog was off leash but seemed friendly. The man had a vacant stare, and as I passed him I gave a perfunctory smile and “Good morning.”

He didn’t even note my existence nor change his faraway gaze, and I immediately snickered at his lack of basic human decency. Shaking my head, I glanced back at him. He had stopped, looking up at the cloud-threshed sky, and suddenly emitted an unearthly wail.

The movie, One Flew Over the Cuckoo’s Nest, became popular the year I was working on my hospital’s med/surg psych ward as a nursing student. While this cult classic raised awareness about injustices in mental institutions, the public assumed all administrative nurses were cut from the same cloth as the film’s RN whose name rhymed with wretched. On more than one occasion, I had to restrain myself when someone said, “Bet you’re Nurse Ratched, ha, ha, ha. Only kidding.”