I could feel my eyes starting to bug out. I herky-jerked across the room like a defective marionette, scooped up the nearest telephone receiver and dialled Dr. Stone’s number. He picked up on the third or fourth ring. I could hear some trippy jazz music playing in the background.

“Hello?”

“I NEED HELP NOW!”

He didn’t even ask what the problem was. All he said was, “I’ll be there in 10 minutes.” And he was.

Even the Cool Kids Can Fall

Mark was a crazy friend of mine back in the early years of med school. He was the most chill guy I’d ever met. The ultimate non-conformist, he did whatever he wanted, whenever he wanted to do it.

On the day of med school interviews, Mark was one of the few applicants who chose not to wear a monkey suit. He showed up at the designated time sporting his trademark handlebar moustache, a couple of earrings, a CAT Diesel baseball cap, a leopard-skin muscle T-shirt, jeans and sneakers. He didn’t try to snow the panel with treacle about wanting to save the whales, either. Undoubtedly they found his attitude refreshingly different and he was accepted into medical school.

During our first year Mark continued to be coolness personified. He was a knockout tae kwon do black belt. He dressed like a hard-core punker. He slam-danced to bands like the Dead Kennedys and rode the lightning with Metallica. In addition, he was a bright, energetic and thoroughly likable guy.

Mark would bow to no Moloch. To that end, he quickly worked out a system for not letting medical school take control of his life. This primarily involved studying at home rather than coming to our downtown campus every day for lectures. If he showed up for a lecture and it turned out to be shite he’d usually be able to convince several of us to ditch the class and take off with him. We would invariably end up playing pinball or shooting pool in the student lounge. A couple of times a month our low-life crew would head over to the local watering hole to swill beer and watch strippers. Can you think of a more entertaining way to learn surface anatomy?

Two-thirds of the way into first year, Mark started to run into trouble. His driving became more erratic. His amusing collection of unpaid parking tickets gradually morphed into a serious problem. He found it increasingly difficult to keep up with the demanding med school workload and his grades began to slip. At the end of first year he was told he’d have to write an exam during the summer holidays to determine whether he would need to repeat the year. He hit the books hard and eked out a passing grade.

Unfortunately, things continued to unravel during second year and by the end of it Mark had become visibly disillusioned. He decided to take some time off to travel to the Far East and find himself. The faculty strongly recommended Mark wait until he graduated before embarking upon any long trips, but our turbulent anti-hero had already made up his mind. He bought a backpack and an open-ended ticket and set off for Thailand with high hopes. Nine months later a complete stranger returned.

When Mark got back, the first thing evident was his pierced nose with its diamond stud. But right after that you couldn’t help but notice his eyes. They had become ancient. There was a huge emptiness behind them. When he looked in your direction you got the impression he wasn’t really seeing you, but rather that he was staring right through you into some other world. A bleak, unhappy place.

Who knows what he was seeing? He didn’t talk much, and when he did his voice was toneless and subdued. He would often start a sentence and then stop halfway through it, as though his train of thought had derailed. Occasionally the old spark would briefly reappear and he’d go on a spiel about something in his usual manic fashion, but before long his words would trail off into silence.

What had happened to Mark in Asia? Rumours began to swirl. Had he gotten into some bad drugs? I don’t think so – he had never been into anything heavy prior to the trip. Had mental illness struck? There were whispers of schizophrenia, bipolar disorder, PTSD… . No one but Mark knew the whole story, and he wasn’t telling. Each time we tried to probe deeper to find out what had gone wrong he retreated behind a stony wall of silence.

That September Mark joined the medical class one year behind us to resume his training, but within a few months he had washed out miserably. He took some more time off to regroup and tried again the following year. Things went better that time and he was able to stay afloat long enough to complete the theoretical portion of the curriculum and advance to the dreaded wards.

I don’t know how things are now, but back then the wards of our teaching hospitals were harsh environments where only the strong survived. Every four to eight weeks medical students were tossed into a new subspecialty ward populated with its own unique mixture of complex patients, overworked nurses and terse staff physicians. You had to land on your feet, integrate seamlessly with the new team and quickly learn the ropes. No one was assigned to hold your hand. No one wanted to hear about how sleep-deprived you were. Nobody was even remotely interested in the fact that studying for the mandatory bimonthly exams while working almost every day (in addition to being on call for 24 hours every three days) was nearly impossible. Even well-balanced, mentally healthy students often cracked under the intense pressure. Mark didn’t stand a chance. He went down without a trace.

The last time I saw him was about 20 years ago. I used the phone book to figure out where he was living. It turned out to be his mother’s place in the north end of town. When I telephoned no one picked up, but I really wanted to see him so I took a chance and drove over to the address anyway.

I knocked on the door for nearly five minutes before Mark shambled out. He had gained a lot of weight. His skin was pasty. The cool hair, leather jacket and easy grin were gone, as was his confidence. He looked haunted. It was painfully obvious he was embarrassed about the way things had turned out for him. During the course of the conversation I mentioned the Asia trip a couple of times but it seemed to make him edgy, so I backed off. We sat on his front steps and small-talked about bands, motorcycles and the good old days for awhile.

Needless to say, it was an awkward reunion. I didn’t stay long. On the way home hard tears stung my eyes.

Dude, Where’s My Stethoscope?

By 1989 I had completed my basic four-year MD degree and was more than halfway through an additional three-year residency in family and emergency medicine. That summer I took a break from the crucible of my ER and ICU rotations and travelled to McMaster University in Hamilton, Ontario for a leisurely month of training in dermatology. The specialist to whom I was assigned was a leader in the field, so I got a lot of great hands-on experience.

One Friday morning I was busy working in his outpatient clinic. It was nearly noon and I was getting hungry. I had just finished dictating what I hoped would be my last note before lunch when Dr. Crowe tapped me on the shoulder. I groaned inwardly when I realized he was holding a chart in each hand.

“Two patients left,” he said. “One’s new and the other’s a follow-up. Which would you prefer?”

“I’ll see the new one.”

“Okay. Come and get me when you’re done.” He passed me the chart and ambled off.

The referring physician's letter indicated the patient had an eight-week history of an itchy, red rash that hadn't responded to steroid creams and two courses of Nix. Seemed straightforward enough. I opened the door and walked into the treatment room.