This story and its characters are fictional.
For as long as anyone wearing white pants or skirts and white coats could remember ,the Margaret Janson Conference room, located on the third floor of the Magnuson Building, was where medical residents and students presented patients’ case histories to the senior attending physician. We called these sessions morning report. They were a baptism by fire. It was a medical rite(and wrong) of passage ; medical education’s answer to war games but no one died, except the patients. While most people learned in this arena some fell into a trap set by the master or as he would remind us, a trap of our own intellectual and ethical limitations. I knew the place with my eyes closed. There was the smell of coffee, sweat, and fatigue–fatigue laced with a not so subtle touch of fear –fear of death, failure, and humiliation. We experienced humiliation for not knowing a crucial fact or laboratory value or for falling asleep. We became accustomed to the humiliation along with a litany of unimaginable but easily palpable horrors. Ultimately we felt neither humiliated nor horrified, just numb.
We met in a room named for Margaret Janson was the wife of the hospital’s first chief of medicine. Margaret died of leukemia in her thirties, six months after the birth of their third child. Her room seemed designed to elicit fear. One entered and immediately became uncomfortable.. She was just a tough room in every way. Her door was never locked, in fact it was usually wide open unless someone was catching a few moments of illicit sleep on one of the–designed to be uncomfortable–vinyl couches that had been donated by the 1964 senior residents. The black mahogany conference table gleamed. At the proper angle the faces of those assembled from morning reports of year’s past seemed to float from the glass into thin air. The master never arrived before the initiates. The place was our own little shop of horrors, yet I loved learning in this environment. We were served the kind of stick-to-your-ribs knowledge that would later save lives and our own asses.
We were all very young, especially if you count in medical years. They’re like dog years. Remember? Every year for a person is seven for a dog. Dogs die younger than people but people hate to think of anything dying before the correct, proper, acceptable number of years so we multiply by seven and get a more comfortable number. The dog’s still dead in about ten to fifteen years or so. Doctor years or medical years have their own correction factor. You don’t start counting until the person is completely finished with all of the doctor training. That would have made us minus six or so. We were third year medical students. That meant one more year of medical school and three to five or more years of training until we were born…medically speaking.
Those minus years were very tough. There was little smooth sailing. We experienced moments of feeling brilliant and secure, alternating with numbing insecurity and self doubt. I think I hated the lack of perspective more than anything else. It was outer-space, without a spaceship or ground control. We were just out there moving around: one moment feeling like a guided missile the next like a hot air balloon in a wind storm.
One of the people in my third year rotation behaved like a guided missile all of the time. Jerry drove me nuts. He drove most of us nuts, but only a few acknowledged living in rank insecurity. I gave up pretending after about three weeks. I just didn’t have energy for both self–deception and sex. I couldn’t wait for the Missile to take his turn in the chamber of horrors. I felt confidant the master would not let me down. I prayed for a carnage of comeuppance.
“So, Jerry, big day tomorrow.” I tried, with difficulty, not to smirk.
“Drop dead, Jenner.”
“Hey, why the hostility?” I knew why. I knew why. “Ha ha ha, ha ha ha!!” I did not actually say this but did sing them to myself. Infantile, isn’t it? But damn it, no one who looked as good as Jerry Markinson had a right to be equally smart and self confident. He was good. Markinson was masterful and I wanted him to fail. I wanted to watch him writhe in his downfall. I was pathetic. We all were, even Markinson, who, even in failure, would never writhe.
“You’re not as virtuous as you think you are, Jenner.” At the time, I wondered how he knew.
“Have you finished yet?”
“Almost.” No one was ever finished–not until the master had finished.
“I hope so.”
“Hell, if I’m going to go down, it might as well be over a tough case.” He was right, of course.
The hours between conferences were a blur of frenzy. Our short white coats floated through the halls of the university hospital like ghosts. We were a platoon of ghosts ever- present in the war against sickness, but the real battles were more within and between ourselves.
The smell of coffee drifted across the hall from the chief resident’s office into the conference room and awakened me from that night’s sleep–forty seven minutes total . I could not remember not being on call. Life was divided into BC, before call, and AC, after call. A month of fitful sleep and insomnia made the preceding years of unencumbered slumber seem like a perverse joke. I was too exhausted and dirty to even consider why I would have allowed myself to be placed into such a situation, let alone acknowledge that I had done so voluntarily.
“Hey, get up before the chief finds you sleeping in here.” I tried to move but my back was plastered to the vinyl by oil and sweat. Something smelled foul and was making me sick. It was my own body odor. “Jenner, move your slimy ass out of here and take a shower, you stink and students’ report starts in a half hour.” Markinson stood over me oozing energy. He seemed to thrive on sleep deprivation. As a budding psychiatrist, I wondered what disorder and/or drug fueled this machine.
Cold water and caffeine kept us going. The large metal urn in the chief resident’s office was always on…as were we. I usually forced myself into a cold shower after a night on-call but today I luxuriated in warmth while trying to convince myself that I would still be able to stay awake during the Jerry Markinson show. As I finished shaving, I began thinking if the face in the mirror belonged to this body, I should have looked a hell of a lot worse. A knock on the shower door jarred me from my thoughts.
“Jenner is that you? You’ve been in there over fifteen minutes.” Brenda Muldoon’s voice always hit me directly in the crotch. “Com’on, I want to rinse off before report.” I opened the door. “Did you hear the case Markinson’s picked for report today?” she said.
“He’s dead.” Brenda began unbuttoning her blouse. She moved into the shower area as I moved out. I stared.
“Naughty, naughty. You shrinks should learn to check your libidos in the admitting office.”
“You’re mean, Brenda.”
“But what a set, right Jenner.” She smirked, winked pulled the door and vanished into the still steamy warmth. I stood trembling, barefoot on the cold ceramic flooring.
For me Beethoven’s Fifth Symphony was the music of students’ morning report. The sound reverberated in my mind only. I first imagined the famous four notes on the morning of my student presentation. But today was Markinson’s moment to perform.
Robert Elliot Thompson was the director of the medical housestaff program for over twenty years. His entrance to the student’s report was always the same. Students were already seated around the coffin-our nickname for the conference table. Residents, interns, fellows crammed into every other square inch of space available. Dr. Thompson entered in shirtsleeves, coffee cup in his right hand and “the folder,” in his left. One could see that he was walking, but for those assembled his feet never touched the ground. His first word was almost always the same.
“Well.” He laughed this word. “Who’s going to begin?” Markinson raised his hand decisively. “Dr. Markinson.” Dr. Thompson stood and began pacing. “I read your note Dr. Markinson. It was very good.” Markinson was dead and he knew it. “Did you discuss this patient with Dr. Jenner?” I felt the sudden rush, then nausea. The music definitely stopped.
“Jenner you plan to enter psychiatry after you finish here?”
“Yes…” I cannot remember whether any sound escaped my lips.
“You should use all of your resources, Dr. Markinson. I know your team has concluded that your patient has a classic case of sarcoidosis. But maybe she’s just a crock? I mean Jenner might have been able to help you there. Could it all be psychiatric problem? Maybe Mrs. Tipton needs a tranquilizer along with the prednisone you’ve given her? But go ahead, go right ahead, you can begin now.” Dr. Thompson returned to his seat. “I think you should all know that Dr. Markinson wrote a terrific note. You’re at the top of this class aren’t you, Markinson? What is it number two or is it three? You’re going to be a heart surgeon, isn’t that right, Jerry?” Markinson nodded. “That is excellent. Go ahead. Please begin.”
Markinson began and for ten minutes Dr. Thompson sat silently but not passively. “This really is an excellent note. You’ve got great handwriting. Catholic school?”
“Yes, Dr. Thompson.”
“Well it is excellent. Um, I believe you’ve just finished with the family history? I noticed you asked about tuberculosis.”
Everyone knew that tuberculosis was one of Dr. Thompson’s favorite diagnoses, so everyone asked every patient.
“Yes, I asked her if there was any family history of tuberculosis.”
“I saw that in your note. It was superb of you to have specifically asked and written about that because we sure would hate to give prednisone to a lady with tuberculosis, wouldn’t we Dr. Muldoon? I mean what might happen if we did that?”
“The prednisone would further suppress her immunologic response and the TB would spread. It could kill her.”
“It could kill her.” Dr. Thompson whispered these words. He stood. “Kill her, Markinson. Good thing you asked about that family history of TB. That’s important isn’t it, Brenda. I mean, my God…” Dr. Thompson began laughing. It was frightening sound. He only used students first names, when he felt something particularly terrible had happened. He wanted to make our work as personal as possible. “This family history is important. Dr. Muldoon said prednisone could kill a person with tuberculosis.” Dr. Thompson, moved back to his seat at the table and put his coffee cup on this folder. “Common, lets go talk to Mrs. Tipton. We began looking at each other. “All of the students. She knows we’re coming. She really liked you, Dr.Markinson.” Markinson’s sickened smile hid nothing. The dagger was in and now Dr. Thompson would begin the evisceration. Out with the bad, in with the good.
“Your note gets an A Markinson and your handwriting is even better. I also suggest all of you students read Dr. Markinson’s review of the literature on sarcoidosis. It was wonderful the way you listed the references. But, Jerry, I think you may have failed Mrs. Tipton. She really likes you, Jerry. After I finished looking down you’re reference list, and adding a few of your references to my files, I had only one reference I thought you might want to see. I mean it is a fairly old one.” Dr.Thompson stood and began handing a copy of his reference to each student. “I think there might be few left for the housestaff.” The title “M. tuberculosis in lymph node biopsies of patients being treated for sarcoidosis,” from the June 1958 issue of Annals of Pathology.. We marched in ones and twos to the patient’s room. Although the coffin was left behind, this was the funeral procession for Jerry Markinson’s presentation.
“Good morning Mrs. Tipton.” The elegant sixty three year old woman from Snida, Missouri thrust her hand toward Dr. Thompson.
“We just thought we’d spend a few minutes with you this morning.”
“Take as long as want, doctor, I ain’t got nothin’ but time these days.”
“Mrs. Tipton, as you can see, I brought a few of the medical students with me today.” Mrs. Tipton reached behind her and pulled out a box of chocolate covered cherries.
“Any you kids like a chocolate? Dr. Markinson over there had himself three whilst he was talkin’ to me the other day. Tell ya Dr. Thompson, Dr. Markinson one good talker.” Mrs. Tipton was enjoying the attention.
“You’re not too bad in that department yourself, Mrs. Tipton.” Dr. Thompson sat on Mrs. Tipton’s bed as she had arranged herself in the recliner chair next to the bed.
“Guess did bout chew your ear off yesterday.” She smiled while holding the chocolates out toward the students.
“Maybe you could tell these students that story about your cousin Mavis?”
“Glad to. Actually, she wasn’t really no cousin, felt like one but there wasn’t no blood. Miss. Mavis lived in an old shack behind our cabin in the mountains. Mavis was one good cook and fixed meals for me and my brothers and sisters for as long as I could remember…that is ’til she took sick. Didn’t do much cookin’ after that.”
“What happened to Miss. Mavis?” Dr. Thompson asked.
“She come down with worse case of consumption that ever lived and died. Doctors said she’d a goner sooner if not for my attention. Spent the better part of her last year right there by her side. Spect I slept there most nights toward the end. Hell of a cough. Done good didn’t I Doctor Thompson.”
“You did an excellent job Mrs. Tipton. Any questions, Dr. Markinson?”
“Mrs. Tipton, do you remember when I asked you about your family history of tuberculosis?”
“Spect I do, but Mavis ain’t no blood relation. She’s what you meant wasn’t it, Doctor Markinson?”
“Of course.” Markinson looked as sheepish as his heart surgeon soul permitted.
“Thanks so much Mrs. Tipton.”
“You children come back any time.”
No one spoke on the way back to the conference room but no one ever spoke after one of Dr. Thompson’s visits to a patient’s room. Going to a patient’s room was a bad sign. We told ourselves that Dr. Thompson could afford to find out everything because he was a one patient a day man, but this didn’t work since we were one patient a week people. Markinson could take some solace in the fact that student’s applying for surgical residencies were not required to get a reference from Dr. Thompson but, in the end, Markinson asked him for one anyway.
“I’m betting that most places will know all about Thompson and will be happier with my handwriting and literature reviews than the fact that I totally blew Mrs. Tipton’s TB exposure history.”
Markinson was right and so was Dr. Thompson. Our next stop after Mrs Tiptons room was a detour to the pathology lab.
“Jerry, they have a few slides set up for you.” Dr. Thompson poked around the pathology lab while Markinson bore witness to his entire team’s misadventure. “Anyone want to guess what Dr. Markinson is looking at, Dr. Muldoon?”
“A lymph node biopsy?”
“Was that a question, Brenda?”
“No, sir. I think you asked the pathologists to recut Mrs. Tiptons lymph node and stain it for TB.?”
“You’re a fast reader.” Brenda was neither number one or two in our medical class. She was number five o r six but, unlike numbers one through four, Brenda not only had an amazing body, she also had a social life and could read faster and remember more than anyone I have ever met. “I recut the node myself and after four hours finally found the cut that contained the offending agent.”
“I’ve got it, Dr. Thompson.” Markinson stood up from the microscope. “Why don’t the rest of you take a look.” Markinson grabbed the phone to call his resident.
“I stopped the prednisone yesterday, Jerry. She’s been started on three antitubercolosis drugs.”
“You’re smelling a lot better.” Brenda moved closer while we waited our turn at the microscope.
“Who made you such a smart ass, Muldoon.”
“Yeah, and it’s not even my most endearing quality, is it Jenner?”
Dr. Thompson wrote Markinson an excellent letter. Jerry Markinson became the chief resident in cardiovascular surgery at New York’s leading heart hospital. Mrs. Tipton left her life savings to Sarcoidosis Society. “I’m hopin’ they’ll realize most of their customers has got TB like me.”
I became a psychiatrist and married Brenda Muldoon, a noted pathologist. Despite years in my own analysis, the smell of the Margaret Janson conference room still jolts me from sleep.
“Hearing Dr. Thompson again, honey?” Brenda was the best medicine for my chronically troubled psyche.
“You always know.”
“Hey, he never said there was anything wrong with psychiatry. Crocks need doctors too.”