The Making of a Doctor

By Bernard Mansheim

The Making of a Doctor is a novel about a young physician, Dr. Luke James. The story chronicles his year as a medical intern, the most grueling year of any physician's professional training. The book is a prequel to the novel he published in 2017 entitled A Doctor a Day. The first book tells of Dr. James's experience in medical practice, as he suffers unending emotional pressure from caring for dying patients year after year.

The current novel weaves Luke's life experiences with his medical training, where he evolves from a new medical school graduate to a seasoned physician during an unforgettable year. Not only does he suffer through the physical exhaustion of his internship, but multiple external factors have an impact that makes the burden even heavier.

He learns first-hand how to blend art and science into the practice of medicine, and to learn empathy for his patients without being drowned in a whirlpool of emotion. At the other extreme he needs to learn that cold objectivity is not a solution because it detracts from his ability to understand each patient as an individual.

This book is the second in a planned series called Everydoctor.

• Language: English
• Publisher: Gatekeeper Press
• Release date: Oct 15, 2018
• ISBN: 9781642373233

Book preview

This book is a work of fiction. The names, characters and events in this book are the products of the author’s imagination or are used fictitiously. Any similarity to real persons living or dead is coincidental and not intended by the author.

The Making of a Doctor

Published by Gatekeeper Press

2167 Stringtown Rd, Suite 109

Columbus, OH 43123-2989

www.GatekeeperPress.com

Copyright © 2018 by Bernard Mansheim

All rights reserved. Neither this book, nor any parts within it may be sold or reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems without permission in writing from the author. The only exception is by a reviewer, who may quote short excerpts in a review.

ISBN (paperback): 9781642373240

eISBN: 9781642373233

Printed in the United States of America

About the Author

Prior to enrolling in medical school, Bernard Mansheim received a Bachelor’s Degree in English Literature. After he completed medical school and post-graduate training, he began his career with academic appointments at Harvard Medical School and the University of Florida College of Medicine as an Infectious Disease specialist. He left academic medicine for private practice, then, after ten years began a career in medical management. He spent the last ten years of his medical career as Chief Medical Officer for a national health insurance company.

Over four decades he has lectured extensively on various topics, including medical ethics and managed health care, and has served as an expert witness in medical malpractice cases. He received awards from the Florida Medical Association and the Florida Hospital Association for a monthly newspaper column he wrote for a few years. After retiring from his medical career he became a health care consultant, has been on the boards of several non-profit organizations, and continues to volunteer as a physician one day a week.

Most recently he has begun to pursue his lifelong interest in fiction writing. He published his first novel, A Doctor a Day, in 2017, available on Amazon as a print or e-book. It is the story of a physician who becomes emotionaly overwhelmed after caring for sick and dying patients for many years. The current book is a prequel that chronicles the internship training of the physician protagonist in the first book. These two books are part of a planned series called Everydoctor.

So, what does Bernard Mansheim do in his free time? His outside interests have included marathon running, golf and other active sports, traveling with his wife, visiting their three grown children, reading, and studying Italian. He recently co-authored with an Italian friend, a book entitled Todi Walking Tours: Self-guided Tours of an Ancient Italian Hill Town, also available at Amazon.

The author lives with his wife and their Havanese puppy Layla, in Charleston, South Carolina and Santa Fe, New Mexico.

To the memory of my role model: my father, Dr. Bernard Mansheim, Sr. and my mentor: Dr. Milton Hamolsky

Chapter 1

June 1972

The worst of Hurricane Agnes had passed on, leaving much of the eastern seaboard flooded in its wake. But the rain in the aftermath of the ferocious storm hadn’t let up for a minute all day, hammering the windshield of the U-Haul van as the young couple made their way eastward. After eleven long, miserable hours, they turned off the interstate, heading into Amsterdam, New York, for the night.

Towing an aging VW, the U-Haul struggled like a blindfolded elephant as they picked their way up and down the roller coaster of brick streets into the meager commercial section of the forgotten small town. Amsterdam, once a bucolic village born of the dreams of German and Dutch settlers, was now a run-down town reflecting the broken dreams of makers of carpets, rugs, beds and brooms. It is unlikely that those across the country who had wiped the grime of their lives on its doormats had ever given a thought to the place. Still, it had provided a home to many over the centuries, and it would do so for them on this dark, cold, drenching night, hardly in keeping with the early summer date.

Do you suppose there’s a HoJo in this godforsaken place?

Huh, what? Luke responded. Carol, who had left the driving to her husband, Luke, had said nothing since they turned off the interstate until now.

A HoJo. Do you think there’s a HoJo? I can’t believe you had to drive us all the way into this dump of a town to find a place to stay. We should have stayed on the interstate.

Howard Johnson hotels were frequent along the interstate, but Luke knew they could find a cheaper motel in a town—not what Carol wanted. She had reached her limit, for the fourth time that day, her tirade breaking Luke’s reverie as he listened to the rhythmic swish-swish of the windshield wipers. Mercifully, he spotted a pink neon Vacancy sign just down the street on the right. He guided the truck into the parking lot of the Flamingo Motel, killed the engine, and breathed an exhausted sigh of relief.

The sparsely furnished room was mostly taken up by a double bed, flanked by side tables with their veneer peeling off. The green linoleum floor shone dully beneath a naked ceiling light. A floor lamp stood beside a moth-eaten chair in the corner, but when Luke tried to turn it on, only the first click of the three-way bulb worked. It didn’t take long for Carol to rummage through her night bag and get ready for bed. Then, crawling beneath the faded yellow chenille bedspread, she tucked into a fetal position, facing the door.

Turn off that obnoxious ceiling light, she mumbled angrily before falling asleep.

The floor lamp wasn’t bright enough to read by, so Luke soon climbed into bed himself, facing the window, his back to Carol. The streetlight shone through the rain as it pelted against the window. Tired but not sleepy, he lay there, eyes wide open, watching the drops trail down the glass. His thoughts turned to the day now ending. Despite the long hours on the road in the driving rain, with little if any support or even company from Carol, he had felt happy, eager to reach his destination and new life. But now, a wave of deep sadness rose from the soles of his feet, filling his entire body. Late at night, in that fleabag of a motel, he felt broken, lost and alone. He knew his short-lived marriage was ended. It had been in a steady decline over the past three years. He was confused, flummoxed. Yeah, he thought, flummoxed was precisely the word for how he felt. His thoughts went around in circles, going nowhere. He closed his eyes, and his mind wandered.

He recalled standing at the bedroom window one winter evening in his final year of medical school, waiting for Carol to return home from graduate school. He saw himself staring out that window, puzzling over questions that continually bothered him. What is marital happiness? Can it be a continuing sense of pleasure day after day, year after year? Or, for some, is it simply the acceptance of the predictable world of a steady relationship, replacing the loneliness of being single? He stood at that window, only halfway wishing she were home. Then, suppressed suspicion began to creep like a fog into his mind. Could all the complimentary things she had recently said about her professor subconsciously reveal deeper feelings? He told himself that part of him was jealous; the other part just didn’t care. Then he went back to his medical books.

Still lying on his side in a hypnagogic state, Luke recollected a haunting memory of a childhood experience that had been imprinted in his brain, vivid as the day it happened—he was seven.

It was late afternoon on a summer Saturday. He had walked into the house and called for his parents: Mom? Dad? The house was silent. Realizing he was all alone, he began to cry and dropped onto the faded red, deep-pile rug. Its dusty smell had remained in his olfactory cortex all these years. He could see himself sobbing on the carpet, as though his parents had abandoned him.

Sometime later he awoke. Hearing his parents walk into the house, he called, Where were you? I couldn’t find you.

His mother said, We were just down the street at the neighbors’, talking. We’re back now. Everything’s okay.

The hole he had felt then, to the depths of his being, came back to him as he lay watching the rain sluice down the motel window. Only now, his parents were not coming back to pick him up from the floor. He had lost his father to a heart attack and his mother to cancer, leaving him alone as an only child. The dependence of his youth was gone, a fact he came to accept over the years. He missed his parents, and still felt their presence imprinted deeply within himself. Now he had to be a parent for his patients. It was he who helped them up, held them, cured them, brought them back to life, or watched them die. Just four weeks ago—he thought to himself as he lay in this sad motel room next to a woman who was becoming a stranger to him—he had become a doctor.

His mind jumped back in time again, this time to the obstetric suite’s medical student on-call room, where he sat in a corner chair in the dark staring out the window. As he ran his sweaty palms across his surgical greens, he watched the roaring, downshifting trucks roll down the street, outlined by dotted lights along the trailers, headed for the highway and somewhere far away. He sat waiting for the nurse to call him with an urgent voice, Come right now. The baby’s crowning. We’re wheeling her into the delivery room.

The obstetric resident had told him she would be right back; that was thirty minutes ago. She had said, You know what to do if she starts to deliver before I get back.

Yes, he knew what to do. He had watched the whole process before—like being a quarterback: push, push, push. But what if the perineum was tight, and she needed an episiotomy? Could he make that call and take a scissors to her perineum? What if the baby got stuck? What if the husband was standing with his hands along his wife’s face, with eyes that said, Don’t screw this up; that’s my wife and child.

The seconds ticked by in slow motion as he sat there, ignoring the bunk beds, their sheets rumpled, against the far wall. Somewhere deep inside, he contemplated running from the hospital, sticking out his thumb, and climbing into one of those eighteen wheelers he had been watching roar by—just leaving it all behind him and going where the road took him. Finally, the footsteps of the returning resident punctured the balloon of anxiety that had driven him to near panic.

Morning in Amsterdam brought no respite from Hurricane Agnes. The wind and rain were unrelenting as the Northeast continued to be lashed by the storm. He heard on the radio that the water they drove through on the interstate had become a torrent, and the road had been closed a half hour after they exited it. They crawled through Stockbridge, Ludlow and Chicopee. After three long hours, they turned south on Route 146 into Rhode Island, leaving the heavy rain behind. Carol remained silent, and Luke allowed the radio’s drone to fill the vacuum.

Detours led them down pot-holed, narrow, winding roads around derelict warehouses in the gray, cold drizzle. As they approached their destination, Luke discovered he had to make a right turn off the highway and then swing left onto the crossroad, which he found somewhat archaic. A short distance ahead, he saw a sign that read: Welcome to Providence. This prompted him to recall a cynic who once said he knew no one from Rhode Island and, moreover, knew no one who knew anyone from there.

Of several thousand hospitals in the U.S., his future as a new doctor would be tied to Providence General Hospital, a giant monolithic structure nestled in the bend of a large interstate highway that carried traffic north and south through a state so small it could be missed in the blink of an eye. Luke never imagined planting his internship flag in a place with names like Quonochontaug and Misquamicut. His favorite medical resident had advised, You need to go east, to the cities, to the urban poor, to the sickest of the sick. You need to roll up your sleeves and get the hell in there where the train wrecks (his name for the seriously ill) are if you want to learn to be a doctor.

They drove down a tree-lined street in an oddly suburban-looking neighborhood planted in the middle of the city only blocks from the highway. This area seemed light years away from the abandoned mills and tenement houses that stretched for miles on the other side of the interstate. He parked the van in front of a three-story brownstone—old, but well kept up. Their new home was the second floor, one room wide, four rooms deep, with a small study stolen from the now galley-sized kitchen.

Carol spoke unenthusiastically, Well I guess this is it.

Luke unpacked the van and carried their meager belongings up the narrow staircase—a few chairs, a mattress for the bedroom floor, and countless boxes, mostly of books.

Chapter 2

June 1972

Luke’s breakfast of scrambled eggs moved uneasily in his stomach as he passed through the automatic doors of the hospital’s main entrance. A spacious lobby, with large floor-to-ceiling