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Thursday, February 7, 1985, Miami Medical Center, Miami, Florida
I was late to rounds. Already the group had moved on from the first patient, so I snuck in quietly with the other students at the back of the group. In the pecking order of medical school, we stood behind the interns, who stood behind the residents, who stood behind the professor. My cover was secure.
We congregated outside a private room as the senior resident presented the next case. "Michelle Sacks is a twenty-two- year-old single white female who was admitted to the medical ward from the emergency room last night where she had presented in an unconscious state after she overdosed on amitriptyline."
I pulled out my pocket drug-reference book and discovered that amitriptyline was in a class of antidepressant medications that led to serious heart complications and even death when a patient overdoses.
"First we pumped her stomach, and then we gave her charcoal." The charcoal absorbed any of the remaining drug in her gut, according to my book.
"Although the blood level of amitriptyline was above the normal range, we monitored her heart rate and rhythm through the night and she appears to be doing well," continued the resident.
The crowd moved on to the next patient, giving me an opportunity to have a closer look at our suicide attempt. Her lips were still black from the charcoal that she had been made to drink. Her nose was bent and swollen from the pull of the nasogastric tube, which led to a bag hanging by the side of her bed and contained the former contents of her stomach. Not a pretty sight
. "Mr. Walker, can you give us a differential diagnosis for an elderly man with an enlarged liver . . . ?"
But my thoughts were stuck on the young woman. Why would anyone so young want to take her life?
Our work on the unit took the rest of the morning, and the afternoon was filled with lectures. Later that day the senior resident caught up with me. "You're interested in psych, aren't you? I want you to present a case on Monday. The chief of psychiatry is doing rounds on Monday, so I want you to pick a case with a psychiatric component."
"I'm going to interview that amitriptyline overdose," I told my classmate, Howard, later that day.
"She's cute," he laughed, "but remember, she's one of ours, you know, the Chosen People!"
Howard was my sidekick and mentor that year, our final one of medical school. An Orthodox Jew, he refused to let me drive him to the hospital on Saturdays for morning rounds. I would wind up following him in my car as he walked briskly up the road leading to the medical school, all the time arguing action versus intention. "Just get in the car," I would insist, "it's not out of my way!" But he would persist in his walking, telling me that he didn't expect a shegetz like me to understand.
Howard and I hardly ever talked medicine; instead we spent hours exploring human behavior and debating people's motives all the while fascinated by how, why, and what people think. Like me, he had decided to go to medical school in order to study psychiatry. I wanted to work with children and he wanted to help adults, and together we planned to fix mankind's problems. "You know, Howard, I'm going to specialize in child psychiatry. I'll find a way to cure kids of all their worries. That way you won't have a job when I'm done," I would tease him.
"After they're finished with you, they'll need my help," would be his retort.
The next morning I was early to rounds, but that did not change the hierarchy, and I stood at the back of the group. When we got to her bed, I peered over Howard's shoulder to get a closer look. Later she would tell me that she had noticed me staring. "God, with your big nose and curly orange hair, I thought, 'Oy, a nice Jewish boy.'" The nose is Roman, from Spanish ancestry. The curly orange hair was the unfortunate consequence of having used my housemate's shampoo. She had added a large quantity of peroxide to it to maintain her blonde hair.
After rounds, I stopped back in Michelle's room. The tubes and cables and monitors had been removed. Her dark hair was pulled back tight. Her large brown eyes filled a pretty face. Thin, manicured eyebrows and high cheekbones framed her eyes. Soft cheeks tapered down to a dimpled chin.
And then she smiled. It was a smile that stopped me from thinking. It stopped me from the purpose of my visit and instead left me gawking. Her face seemed so familiar, like that of a friend, but I couldn't place her. I continued to stare, and then it came to me like a strike: She was Vivien Leigh playing Scarlett O'Hara in Gone with the Wind.
I fell in love with Michelle the moment she smiled. It was as simple as that.
"My name is Anthony. I am a final-year medical student. I'd like to know more about you -- I mean, talk to you so that I can present your case on Monday morning to the professor."
She continued to smile, her head half-cocked, as I struggled through my attempt to take a history.
"What is your name?" "How old are you?" "Where do you live?" "What brought you in to the hospital?" "I have to leave now. Maybe I can come back and finish tomorrow?"
"Sure," she smiled. Her smile was her lure; I was instantly seduced by it.
The dance had begun.
Reprinted from Siren's Dance: My Marriage to a Borderline - A Case Study by Anthony Walker, M.D. © 2003 by Anthony Walker, M.D. Permission granted by Rodale, Inc., Emmaus, PA 18098.
