University of Maryland School of Medicine - Terrae Mariae Medicus (Baltimore, MD)

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saloon called The Cultured Pearl. Then, for me, Christmas in California. My folks have resigned from their club. The dial on my dad’s oxygen is turned up high. The skin of his hands is paper-thin and bruises at a touch. But he hosts Christmas dinner — roast goose — for family and friends at a nearby restaurant. He lets a son-in-law push my mom’s wheelchair. May 1985: The preclinical years are over at last, and the class frolics in the IPHB courtyard. Soon that sunny lawn, almost the last greenery of the campus, will be torn up for the Trauma Center. I go to Washington on Memorial Day and find an old friend’s name on the Vietnam War Memorial. June 1985: The evening sky shimmers with loveliness as I reach home after the National Boards (Part I) are over. I put on a record and potter placidly about my study, reshelving textbooks left in piles for weeks, listening to neighbor children playing on the sidewalk. The phone rings. It is my sister Jo. Our dad died this afternoon, at home as he had wished. July 1985: Surgery. We take an 81 year-old woman with infarcted bowel to the OR. On the table, her pressure drops to zero and she turns blue. The team works at CPR. Whenever they stop compressions, the cyanosis returns. They keep trying because the monitors still show cardiac electrical activity. Finally someone remembers the patient has a pacemaker. November 1985: Pediatrics. The metallic cry of Avery, a four month-old boy with biliary atresia and progressive liver failure, dominates the nursery. His skin is the color of tarnished brass. A biracial child, his mother and the pediatrician did not recognize his jaundice until his liver damage was irreversible. Now his only hope is a liver transplant, for which his youth makes him a remote candidate. When we run out of peripheral veins, we work for two hours, the brassy cry filling our ears, to get jugular access. The patient’s father is in prison in Colorado. December 1985: Christmas in California. My mother looks relaxed, at peace. An invalid herself, she has nursed her husband almost singlehandledly through his last illness. ‘‘Fifty-five years, nine 5

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Life Cycles 00 sont les neiges d’antan? Where are the snows of yesteryear? — Frangois Villon, 15th Century March 1987: “UNIVERSITY OF MARYLAND AT BALTIMORE,” read the stencilled blue capitals on the cover of the tattered green notebook. I dissect the notebook, pitch the obsolescent notes, and mount the green cover in my scrapbook to mark the start of the pages from medical school. The snapshots and memorabilia prompt a crowd of recollections. August 1983: On the hot sidewalk outside the School of Medicine, I sit atop a gray trunk about the size of a military footlocker, waiting for a ride. Inside the trunk is a disarticulated human skeleton. Classmates — a day ago, strangers — haul their bulky trunks to their cars or, like me, wait on the Baltimore Street sidewalk for transport. Carrying soda cans, passersby thread their way through our impromptu boneyard to the bus stop. October 1983 : 1 abandon the lofty goal of getting a medical education for the realistic one of passing a series of exams. I quit attending class because my grades improve when I study at home. My cats seem pleased to have a human around the house, and it is peaceful to watch the leaves fall. December 1983: Christmas in California. The “idiopathic” disease that is slowly destroying my father’s lungs has forced him to take oxygen by nasal cannula around the house. His physician struggles for a gentle way to tell me that his course will be ineluctably fatal and agonizingly slow. My parents and I dine at their club; my dad slings his portable oxygen cannister over the handles of my mother’s wheelchair and pushes her briskly to the dining room. June 1984: CAPP summer. I do a rotation at Springfield State Hospital, but get away for concerts at the Meyerhoff and weekends at the beach. On the phone, my dad asks me about the side effects of prednisone. December 1984. The class celebrates the end of finals with a bash at a local 4

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months, and nine days.” She counts off her marriage like rosary beads. Her eyes fill with tears. ‘‘Gosh, I miss him,” she says. February 1986: Psychiatry. Job Randall is a 26 year-old graduate student with a bachelor’s degree from Yale. His degree was delayed for two years because he could not finish one last assignment. He has not completed any of his graduate courses. He complains of ‘‘passive suicidal ideation” and demands electroconvulsive therapy. The team argues over a diagnosis but agrees that this unusually resistant young man is unlikely ever to realize his potential. May 1986: Medicine. Austin Drover is a 19 year-old bisexual man who contracted AIDS on the Block. As a new member of his treatment team, I gown and glove to introduce myself and start his IV — he will receive Amphotericin B for his cryptococcal meningitis. He tells me about himself, about his unwillingness to die: he has a girlfriend and wants to marry her. Soon he is sobbing. I put an arm around his shoulder and he buries his wet face in my yellow gown. October 1986: Subinternship, after a month of coast-to-coast travel to residency interviews. I come home late and find a message on my answering machine: the training director at my first-choice institution is offering me a position. March 1987: Austin Drover somehow accepted his death, asked for an end to medical intervention, and died of meningitis. Job Randall has dropped out of graduate school and is working as a waiter. Avery never got his transplant. My mother manages at home, alone, in her wheelchair. The bones in the gray footlockers have taught gross anatomy to three more classes of medical students. Yet scarcely have the leaves of summer fallen from the trees; scarcely have the rains of spring carried off the snows. 6