Into the Magic Shop Read online

  “I like you, Jim, you’ve done an outstanding job during your rotation here, and I think you’d be an excellent resident.”

  “Thank you,” I said. “I assume that means I’ll start in the fall.”

  “Jim, you know that there is a minimum three-year wait. I will put you in at the end of three years. You should be thankful, as I already have four people who want that slot. You haven’t even formally applied anyway.”

  I looked him directly in the eye and said, “Waiting three years is not acceptable. If you don’t accept me next year it’ll be the biggest mistake you’ll ever make. I’m not waiting for three years. I’m sorry, I don’t mean to be rude or brash, but I just can’t accept that.”

  Even though it was late, I applied for the neurosurgery residency. I believed in the power of my own magic.

  I went back to Tripler and told the chief of general surgery I was grateful for his consideration but I was withdrawing my application for general surgery because I would be doing neurosurgery at Walter Reed. “Impossible, you won’t get in” was his official reply. “I’m not allowing you to withdraw. This is the best group of applicants I’ve ever had to this program, and you’re one of them. I’m not letting you go.”

  “OK,” I said, “but I’m just telling you I’m not going to do general surgery residency, and I will be at Walter Reed.”

  I finished out my internship, visualizing my neurosurgery residency at Walter Reed. Every morning and every night, I saw myself there in my mind’s eye. I wasn’t worried about the outcome, I had learned to visualize what I wanted and yet detach myself from the end result. It would happen, one way or another. That’s all I knew. I did my footwork and trusted the details to unfold however they were meant to unfold.

  As it turned out, the details were a bit salacious. The guy who had been accepted that next year had begun a relationship with a nurse at Walter Reed. The two broke up, and he began stalking her. Apparently there were other issues involved as well, and the chief of neurosurgery revoked the residency offer. He was reassigned to spend the rest of his time in the military as a general medical officer in South Korea. There was no backup for the position, as the other individuals who were slotted for neurosurgery residencies in the future were committed to complete their assignments elsewhere. As the dominoes fell, it turned out that I was suddenly the only person still standing.

  I don’t know if it was a result of my visualizing, a lucky series of circumstances, or something else. All I knew was that, once again, everything had worked out.

  I received my letter of acceptance from the general surgery program at Tripler and from the neurosurgery program at Walter Reed on the same exact day. The head of general surgery had accepted four of us, and the day our letters came he brought us into his office.

  “I want the four of you to know that each of you was my first choice for the four slots here at Tripler, and that this was the best intern class I have ever seen.”

  I looked at the other three who had also been accepted. They had gone out of their way to flatter the chief of general surgery who was also the chief of surgery. They had made sure that they had regulation haircuts and that their shoes were polished. Such was never my concern. I wanted to be the best intern that I could be and more often than not my hair was too long and my shoes were not shined. And I was never good at kissing ass. “I’m going to take you to the officer’s club, and we’re going to celebrate.”

  I interrupted the celebration and congratulatory pats on the back. “Sir,” I said, “I want you to know I can’t accept the position.”

  He looked at me. “Why the hell not?” he asked. No one ever refused once they were accepted.

  “I’ve been accepted to neurosurgery at Walter Reed.”

  His face turned red. He was speechless. “I tried to warn you,” I said. “I told you to withdraw my application.” I stood up, saluted him, and walked out.

  • • •

  THE CHAIRMAN at Walter Reed had told me he liked me during my monthlong rotation, but I turned out to be nothing but trouble for him. I was quick-witted and could use my tongue as a weapon. At Walter Reed I did this often. I felt compelled to stand up and tell the truth, no matter what, and this blunt honesty did not help my cause much as a resident.

  I had become arrogant. The process of getting everything I wanted, and my technical expertise in neurosurgery, made me feel important and special in a way I never had before. The magic I learned at twelve, and had practiced now for over a decade, made me feel invincible. I got in trouble frequently. I had not yet learned discretion or discernment. I was confrontational with my chairman and often in front of others. Even as a junior resident I took being a doctor very seriously. I cared about my patients more than I cared for the pecking order and politics of residency. But my attitude alienated my superiors, and my chairman ended up disliking me intensely because I refused to follow any rules I didn’t like or think were logical. I didn’t care for the way the faculty and many of the senior residents bullied and belittled the residents, myself included, and it reminded me far too much of my childhood in Lancaster. I knew how to stand up for myself, and how to stand up for others, and I did so at every opportunity.

  Right before Christmas, during my first year of residency, I was called in for an evaluation. The chairman was at his desk, and all the attendings were in the room.

  “We’d like to go over your evaluation,” the chairman began. “We have serious concerns, and there have been questions about how you take care of patients.”

  I immediately stood up and said, “Stop right there. If there are questions about my medical care, I want to see the documentation. I take being a doctor seriously, and I won’t accept such accusations without proof.” I had spent too many years watching my mother be ill-treated by doctors who didn’t care. I had seen her dismissed. My family dismissed. I knew how much I cared for my patients. I listened to their stories. I double-checked everything having to do with their care. I came in after hours to sit at their bedside. I knew he was wrong.

  There was nothing but silence in the room. The chairman began shuffling some papers on his desk, awkwardly.

  “W-Well,” he stammered. “It’s not really about that. It’s actually about your attitude. We don’t think you really want to be here because you’re confrontational, and we’ve decided to put you on probation. We’re going to evaluate you for the next six months. If you don’t perform, we’re going to terminate you from the residency.”

  I looked from one face to the other. No one would meet my eyes.

  “If you want to throw me out, throw me out. Right now. Probation is unacceptable. I will not do it. I’ve never been on probation for anything in my life, and I am not going to start now.”

  They were speechless. They couldn’t terminate me, and I knew that they knew it. To do so would have been difficult, as all my evaluations from patients and the faculty were outstanding. It was only the chairman who had given me a negative review. Plus, it would have been a very big embarrassment.

  “Wait outside and we’ll call you back in after we’ve made a decision.”

  I sat outside the office for an hour and a half. I closed my eyes and focused on my breath. I tried to keep myself calm and trust what Ruth had taught me.

  When they called me back in, the chairman cleared his throat and made his announcement. “We’ve decided we’re not going to put you on probation, but we’re going to be watching you. Closely.”

  It took everything I had not to laugh out loud. They were already watching me closely, and while my attitude with my superiors was not good, my way with patients and my talent as a physician were beyond reproach. I was smug, and still believed not only that I was invincible but that the magic Ruth had taught me would never let me down. Now I can see that I had learned the mechanics from Ruth but had missed the heart of her teaching.

  “Well, OK,” I said.
“That sounds like a plan.”

  I antagonized my chairman for years. I was an excellent neurosurgery resident. He knew it and I knew it. I was never on formal probation, but when I graduated he shook my hand, leaned in close to my ear, and said, “I just want you to know that this whole time you have been on probation in my mind.”

  I had no humility, and my success in a white coat was going to my head.

  Residency was serious business, but when we had breaks, it was an all-out party with no thoughts about the consequences. I worked hard, and I partied hard. I felt indestructible. Invincible. Just like I had imagined for so many years, I was wearing a white coat. I was Dr. Doty.

  Nothing could stop me.

  Residencies in the mid-1980s were even more grueling than they are now, a kind of medical boot camp—with as much as twenty-four hours at a time spent on shift. We were sleep deprived and under constant scrutiny and pressure. It became normal to blow off some steam now and then—take a break from the mental and physical demands of residency. Some of my colleagues began drinking more than they should—I recognized the signs in them and also in myself. I knew what alcoholism looked like from growing up, but I was trying to balance on the razor’s edge between drinking too much on occasion and alcohol abuse. Partying on my rare time off wasn’t being out of control, I told myself. I could feel the genetic pull in me at times to seek escape from the pressures and demands of life as a resident, but I wasn’t my father. I would never be my father.

  Gradually I stopped meditating and visualizing. Working long shifts didn’t leave me with the time to practice every morning and evening. At first I started missing every few days, then I practiced only once a week. Until finally I felt there wasn’t time at all. I had stopped adding things to my list. I knew exactly what I wanted, and I also knew just how close the grand finale to my magic show was. I was about to become a neurosurgeon, one of the elite specialists entrusted to operate on the most important part of the human body. The brain ruled all, or so I believed, and I ruled the brain. There was nothing more to learn from Ruth’s magic.

  One evening four of us decided to go out and celebrate the end of a particularly grueling rotation. We were a close group. We worked together, ate together, guzzled coffee in the cafeteria together. We had bonded the way people do when they go through a traumatic event or a natural disaster together. We were all fighting side by side in the same war—residency. Because we had no time for anyone else in our lives, by default we had become best friends, and a family, of sorts.

  The pressure was extreme, and our way of relieving that pressure was also extreme. Working in the hospital, you see things that you wish you could unsee, and we found that the magic formula to blur these images in the mind involved a mix of large quantities of alcohol, cocaine, loud music, and half-naked women. Not necessarily in that order.

  That night we started drinking around 8 P.M. at a strip club near the hospital. We threw money at the dancers as if we were guys who actually had money to throw away. We moved on to a Spanish restaurant where we ate paella and jamón serrano, a kind of cured pork served on toast. We drank jug after jug of some kind of Spanish wine. I’m not sure when the cocaine came out, but after pulling antique swords off the wall of the restaurant, and engaging in a life-and-death duel, we were all summarily kicked out.

  It was a damp night in October, and as we left the restaurant, I remember turning my head into the mist and feeling its cool wetness on my cheeks. It felt good to be free of the hospital. It felt good to be alive. It felt good to be me. It felt good to be high.

  The four of us piled into the car, which was littered with empty beer cans. We careened through the dark night with the music blaring. I felt myself drift into a happy stupor. Then I heard a voice in my head that said, “Put on your seat belt. Now!” I jolted alert and looked around. My buddy in the front seat was singing loudly and tossing beer cans out the window. My buddy who was driving was nodding his head in time with the out-of-tune singing. My buddy next to me, in the backseat, was asleep. None of them had told me to put on my seatbelt.

  The car was a 1964 red Ford Fairlane—a classic that belonged to a friend’s mother. None of us knew the tires were almost bald. There were lap belts in the backseat, and I reached for mine just as we hit a sharp curve in the road. The car started sliding and skidding across the wet asphalt, sideways, into the oncoming lane. I felt the seat belt tighten as centrifugal force pushed me against it, and then as if in a dream, I watched as we crashed head-on into a large tree.

  Then everything went black.

  The moaning brought me back into consciousness. I was lying on the wet pavement by the driver’s side of the car. I don’t know if I had been thrown out of the car or if my friends had dragged me out. My buddy who was driving was leaning over the steering wheel not moving. I felt a searing pain shooting up my back, but my legs felt numb. I tried to move them, but they weren’t cooperating.

  I began to vomit and tried to get up. I heard my buddies talking. Rock Creek Park. It’s a mile away. One of us has to go. My knee. You stay with him. I couldn’t piece together what it all meant, and I closed my eyes and let the wet pavement cool my face. My body was on fire, but I somehow believed that if I kept my face cool, I would be OK.

  Walter Reed was only a mile away, so my friend from the backseat, who had only minor cuts and abrasions, set off on foot to get help. Once at Walter Reed, he told the staff they needed to dispatch an ambulance to pick us up. They refused, saying they had no authorization to attend to accidents off the base.

  Undaunted, he requisitioned a government vehicle without authorization and drove back to the site. I screamed in pain as he dragged me into the backseat and delivered me to the emergency room. It was surreal to be examined by my fellow residents in the emergency department at Walter Reed. Hours before, we had been the doctors, but now we were the patients. My friends had torn ligaments, cuts, and one a pretty severe chest contusion and concussion, but in general they were OK.

  I was the only one wearing a seat belt, and I was the one with severe injuries—a transection of the small bowel, a ruptured spleen, and a spinal fracture in the lower lumbar area. The abdominal injuries required immediate attention, and I was rushed into the operating room.

  I had become a patient, and as I saw the operating lights shining down on me, it was as if I could feel what every surgery patient in that room had felt before. I felt the waves of pain, and fear, and worry. I heard voices. It was like being in a room full of people talking all at once. What if I don’t wake up? Please, God. Don’t let it be malignant. I should have told him I loved him one more time. What if I never walk again? What will they do without me? Please. Help. I don’t want to die.

  The next voices I heard were arguing. I opened my eyes and could see I was in the intensive care unit. The pain was severe, beyond anything I had ever imagined. My stomach was bandaged. I closed my eyes against the light, and listened to the chairman of the General Surgery Department and the vice chairman of neurosurgery arguing. The argument was about me.

  It wasn’t good. Even through the pain, my medical education kicked in. My blood pressure had dropped precipitously since surgery. It was so low that there wasn’t even a diastolic pressure being recorded. My systolic pressure, the higher number in a blood pressure reading and what measures the pressure in the arteries when the heart beats, was only forty. My blood pressure should have been at least two to three times that. My heart rate, however, was over 160. It was clear—I was in shock from blood loss. But I was still losing it and losing it rapidly, an indication of internal bleeding. Soon there wouldn’t be enough pressure to supply my critical organs. I knew what this meant. I was going to go into cardiac arrest shortly. My brain was going to die. I was going to die.

  I thought to myself that this wasn’t how my life was supposed to turn out. I wasn’t supposed to die like this.

  In the next moment, I felt as if
everything shifted and tilted. I was suddenly looking down at myself from the corner of the ceiling. I didn’t feel any pain. I could see the rays of light coming off the lightbulbs in zigzag patterns. I could see every droplet of liquid in the IV bags. I could see the top of the chairman’s head, and the sweat that dotted his forehead. I looked down and saw myself in the bed. I looked small and vulnerable, and very, very pale. I could see the monitors, their lines and numbers moving up and down erratically, and it seemed as if I could hear the blood in my vessels moving, and could sense that there wasn’t enough. I could hear my heartbeat. It sounded like a far-off drum, pounding out a rapid rhythm. I observed all this without emotion. I didn’t feel sad, just acutely aware of everything that was happening to me and around me.

  The chairman of general surgery was insisting that he couldn’t possibly have missed a bleeder in the abdomen, and this could not possibly be the source of my blood loss.

  “You obviously missed something,” the vice chairman was yelling. “He’s oxygenating and has no major fractures. He’s bleeding into his belly. You obviously missed a bleeder.”

  It was like watching a play, and at the same time I could feel both the frustration and fear of the vice chairman, and the pride and certainty of the chairman. I could feel what everyone in the room was feeling.

  I saw the vice chairman put his hand on my leg. “You idiot, if you don’t take him back into surgery, I’m going to. Now!”

  Finally the chairman agreed. I watched from above as they wheeled me back into the operating room. One of the nurses leaned in and whispered in my ear, “Stay with us, Jim. We need you. You’re going to be OK.”

  And then blackness.

  My experience after this blackness is something that I could never adequately explain nor ever forget. It is all the more puzzling for being a rather common and yet extraordinary experience. One that has been repeatedly reported over the centuries.

  Suddenly I was floating down a narrow river. I was moving slowly at first. Ahead I saw a bright white light, much like the tip of the flame I used to stare into at the magic shop. I began to speed up, and soon I was rushing toward it. All along the sides of the river I saw people I had known, crowding along the banks of the river. I thought I saw my father. I thought I saw Ruth. I felt loved and accepted in a way I never had before. Many of the people I saw were still alive. I saw my mom in her bathrobe. My brother laughing with me from our bedroom in Lancaster. I saw the girl Chris who I had a crush on in junior high school. I saw my old orange Sting-Ray bicycle. I saw myself on the bus to Irvine, and I saw myself trying on a white coat for the first time. I saw myself turning my face into the mist on that very same night. I felt the white light getting warmer and closer. It was getting bigger. I somehow knew that this light was love, and it was the only thing that meant anything in this universe. I just had to reach it, and I knew that when I did, I would be one with all things. This is what I had been searching for. This was the only thing I needed. I wanted to merge with the light. And suddenly I realized that when I merged with that warm, inviting light, I would no longer be part of this world. I would be dead. “No,” I screamed. Or, at least, I thought I screamed. And suddenly I was going backward, away from the light. As if I had stretched a rubber band to its maximum and let go. I was going in reverse so fast that I could barely comprehend it. I felt the presence of all those who had greeted me now falling away.