With all of her fingernails Diana scratches a spot on her lap over and over without any awareness of what she is doing.
“A five-second pinch. Five seconds. A pinch. And they want to destroy me.”
Of all places, this clean, windowless hospital office. Diana at twenty-three has never cried in front of anyone, and now, sitting opposite her with his legs crossed serenely, Dr. Foster here is the first. With patience he watches her daub, snerk, gulp, wipe contrails of snot on her shirtsleeves. She blinks at her lap until her vision is clear enough to reread the letter that lay there, proclaiming in the most horrible little block letters the three charges now being brought against her: WANTON AND RECKLESS MISCONDUCT, GROSS NEGLIGENCE, AND INCOMPETENCE.
Will you look! Look at that bullshit, that profane legalism. The lie printed there plainly with all its intention against her. How even to parse it? “Misconduct” suggested that she hadn’t done the right thing, and “Negligence” suggested that she hadn’t done the right thing properly–but what’s this one? “Incompetence”: she hadn’t even known what the right thing to do had been. It was groundless. Insane. And didn’t the third charge obviate the first two? Perhaps–but this letter, it insisted on all three.
So what abuse of power does this RECKLESS WANTON NEGLIGENT INCOMPETENT MISCONDUCT describe?
A five-second pinch;
A knuckle between the ribs;
A bright light;
Some strong language;
And a pinprick.
Nothing so severe as a schoolyard bullying. Nothing any conscious person wouldn’t have submitted to gladly at a doctor’s request. All of it entirely standard and structured and safe and everything else one might rightly demand of a clinical examination. And yet now these parents want Diana’s career (”This is my whole life, goddamnit, it’s my whole life“), they want it stuffed and mounted.
The incident in question was clear. So unambiguous, in fact, that the parents’ misinterpretation demonstrated their failure to grasp the purpose of medicine-prolongation of life, attenuation of suffering. Somewhere along the historical course of its development (was it psychoanalysis, exorcism, wet nursing?), medicine had become enmeshed with the idea of care. Suddenly the patient had to feel attended to, had to be convinced of receiving a fullness of institutional love. Not just recovery; healing. Medicine became a branch of therapy. But it wasn’t that. Clinic, not church. Diagnosis, prevention, and treatment-not counseling, not cosseting.
INCOMPETENCE. Oh, we will see about that. The authors of the letter might appreciate lay terms. So let’s have the incident, then, for the layman.
There were two young women. The first was Diana Lipton, a third-year neurosurgical resident, yes!, at twenty-three; the other, Suzanne Delano, fifteen, sufferer of hemorrhagic complications following the removal of a large supraorbital mass, sending her into a stable-but-severe ischemic and apparently paralytic coma. (Layman’s terms: bump, brain, blood, bed. Prognosis terrible.) But things could be done, things that Diana, see, had been doing: to evaluate the extent of Suzanne’s coma, Diana had been applying a routine course of noxious stimuli-pain, if you wanted to call it that. Absolutely a thing of procedure. The pinch on the arm, the pinprick: administered to elicit reflexive curling of the arms, testing motor response. Suzanne lay motionless. The process then called for the muscle kneading and the knuckle dug lightly into Suzanne’s chest, the “sternal rub”-didn’t its having a name attest to its legitimacy? And when Diana had yelled and shone a strobe into the girl’s eyes, it had only been to elicit the barest signs of ocular response. But Suzanne’s eyelids remained closed. Pupils remained still as birthmarks.
Here’s the difference: there is pain and then there is the experience of pain. On the Glasgow Coma Scale, Suzanne posted a 4 out of 15-one of those numbers whose true pathos is only intelligible to those acquainted with the metrics. (Perhaps an analogy: say a healthy brain is a power grid. Fainting is a blip, an outage; Suzanne was the cascading blackout, the evacuation order, the toppled civilization.) So, then, if an arm is pinched in a hospital bed and nobody’s around to see it-except Diana, and then, unexpectedly, Suzanne’s parents, who pushed their way into the room after growing concerned about what they were witnessing through the window of the door, interrogating a dumbfounded Diana, asking about this pinch and that word, and leaving only when they realized that Diana was too confused, too affronted to even begin to explain herself… well, but was there really anything to complain about? What Diana should have said was, “Well, would you rather be pinched on the arm for five seconds, or have your skull needlessly sawed open?” And a reasonable person would choose the latter. But parents were not always reasonable.
“That’s the wrong way to look at it, Diana. Nobody is getting ‘destroyed’-definitely not you.” Dr. Foster, M.D./Ph.D, chief of the department, who’d sent for Diana at the end of her shift. Now here’s someone who embodies competence and reason-”fine”, that’s what he calls a crying woman. He gets up from his office chair (uhf) and sits on the corner of his desk nearest to Diana. “It’s serious, but nobody’s destroying anybody. Let’s see this thing for what it is: they want you dismissed. They’re angry right now, of course, stressed. But I want to make sure you understand that this is not your problem. If I’m to understand how things went, you did not act out of bounds. I’m confident that you’re in the clear.”
“Thank you, Dr. Foster.”
“Hey, not so formal! Just Thomas.”
“Thank you, but what I still object to is the pointlessness of the proceedings. There’s no reason anybody has to go through any legal channel at all. They’re going to lose their case, because I didn’t do anything wrong. They’re not even insured-they’re running themselves into debt with the cost of care alone. If we could just get them to understand, then we could avoid all this.”
“That’s true, that’s true. But stop thinking about it.”
“Unacceptable. I mean-the situation is unacceptable.”
Dr. Foster nods without objection. “What would be idiotic is if you stuck your neck out on this. You’ve had parents before, right? It doesn’t matter to them that they’re going to lose. This is just a personal thing for them. Calm down, your face is jumping around all over the place.”
“I am just upset. That I’m not being-accorded professional respect.”
“See it their way: of course they’re upset about their daughter. It’s as big a shock as they can handle. And so any extra little bad thing is going to just blow out their wiring. That’s fine-we just need to encourage them to go crazy on their own time. And by ‘we’ I mean Risk Management. Now I want you to head home for the day and stop worrying. You’re no longer involved.” Dr. Foster stands up and places his hands on Diana’s shoulders until her fingers stop raking away at the spot on her lap.
Diana closes the door to Dr. Foster’s office behind her, feeling afloat, the aftershocks of her sobbing causing her eyelids to flutter. Bescrubbed, with her rough dark hair twisted under her surgical cap, she heads down the hallway toward the elevators, contemplating her predicament in convulsive epithets. Down the hall she approaches the door to the patients’ room where Suzanne lies and she squints through the crosshatching of the window. Under the monitor lights, Suzanne’s face looks as soft and blank as the belts of gauze that enfold her head. Diana ponders now, as she hadn’t then, Suzanne’s skin when she pinched it: cool and oily, the feel and smell of sponge-bathed antisepsis. In texture not so different from the skin of the cadaver Diana had handled and dissected in a memorably gory first year at Johns Hopkins. Just as the cadaver had remained weightily still (aside from the occasional eldritch resettling of organs), Suzanne had certainly, certainly demonstrated no response, no jump in brain monitor output, no subtle shift of breathing, nothing to indicate that she was the slightest bit aware or suffering or preferring. It hadn’t seemed any more likely that Suzanne had felt anything than the possibility that Diana might have felt it herself, the noxious stimuli, on her own body.
Her accusers understood nothing, employed outrage as a substitute for expertise and as a basis for authority. They were philistines of reality who had never seen and would not comprehend, even if it was shown to them, the convoluted elegance inside a person’s skull. The tuxedo darkness.
Pity them both, the weeping girl and the sleeping girl. However imagined their suffering.
You wouldn’t call it contempt, would you? She had always known more, and by natural order this meant everyone else knew less. Native intellect was no less equitable than any other inborn trait, though in this case it was likely not inherited. Mr. and Mrs. Lipton were young, third-generation pizzeria owners, fully cemented into their lives, who each night retired wearily to the living room to catch up on the shows they’d recorded on VHS, an everlasting backlog. Unlike the sort of parents who might have nurtured their daughter’s talents by introducing her to foreign languages or taking her to the local natural history museum, they instead effectuated self-reliance through educational videotapes and tutors and well-planned, well-enforced schedules of chores, raising her quickly to the point where she was able to finish the job on her own. And it so happened that what they wanted of her agreed with what she, even as a child, had in mind for herself.
Her parents’ laissez-faire parenting having paid off, Diana skipped the third, sixth, and ninth grades, then finished her junior and senior years concurrently. At each leapfrog of a grade she faced anew the awesome collective growth of her classmates, who, as they grew, resembled her less and still less and then not at all. From second to fourth grade, conversations with her lengthening peers began to oblige head-craning; from fifth to seventh, male voices plunged, leaving hers stranded in a humiliatingly prepubescent coo on the rare occasions when she said anything at all. And then in transit from eighth to tenth, when the setting changed from middle school (where she shared an age bracket with the general school population) to high school (where she trailed behind the next-youngest classmate by three years), Diana peaked at 4′ 11″ and a hundred-odd pounds, her voice still stuck in the upper piccolo register. After her mother had twice declined the pediatrician’s gentle offers of hormone therapy for Diana, Diana made firm her resolve: if she was going to lag in age, height, and vocal timbre, then she might as well outpace her classmates in that which mattered more: complexity. Nobody would challenge the authority of test scores, verifiably correct answers, and an overall snappy stimulus-response, and in the contest of brains, her youth was her advantage-what was IQ, after all, but a proportion of ages, mental over chronological? The denominator of her age, tiny as the rest of her, inflated her IQ even further past those of her classmates, and her accelerated youth meant that with every year that she aged, she would seem even younger compared to her so-called “peers”. (Was there by any chance a Stanford-Binet test that measured mental age over apparent age?)
It was a quest that suited her. Diana held few beliefs or preoccupations to divert her from headlong pursuit of scholarship. Though unsurprising, given how little they were practiced or preached in the household, her opposition to the arts was unequivocal and intense. She supposed, yeah, that she could accept visual art and music on their evolutionary merits, their capacity to satisfy primeval, inherited urgings for color and tune. But she was more intolerant with respect to literature and–bleh–poetry. Now there was a useless thing. That old saw about good literature raising more questions than answers. Here were Diana’s questions: what human improvement might poetry further? Where was the need? What great worth had it ever conferred upon people? In what did the beauty of words inhere–their arrangement, their pronunciation, or in the minds of sentimental readers? What was any poem but the pompous lyrics to an unwritten pop song? And good lord, this notion of classics: what claim had they to truth, the unvaccinated sages? For decorative information there was no place in the world, the world of matter and things that mattered. Nobody goes in for a classical appendectomy, nobody seeks a root canal of antiquity.
And it was no surprise that Diana also scorned religion, art’s abstemious sibling. Yet the religious kids who constituted a sub rosa, cross-tucked-into-shirt minority of her high school mistook Diana’s withdrawal for meekness, her studiousness for piety. They were warm, eager to connect. Diana would every so often open her locker to have one or two flyers whiffle out and land by her feet. They were photocopies on colored paper, typically depicting a backwards cap-wearing boy or barretted girl and some sort of exclamation: YouthYelp, S.T.A.I.R.S., Teen Alliance. Besides offering a date, place, and enticements of karaoke or Xbox, there usually wasn’t much else to them, and Diana got used to kicking them aside, whenever new ones came whiffling out.
Letters, arts, and the divine were all swept aside to accommodate more structured knowledge and regimented thought. From the untouchable heights of her virtuosity, Diana gazed down upon her classmates, the mentally impoverished, inhabiting the tenements of . They were tall, loud, able to make diving catches, physically substantial, and yet deficient in rigor and gravitas. Rigor and gravitas, that true basis of adulthood.
These convictions, plus her initiation into orthodontia just three weeks into freshman year, made a life of the mind-and early matriculation-seem every bit urgent, every bit worthwhile.
Diana, fourteen and with a curve-thrashing GPA, should have been an easy call for valedictorian, but instead it was Mari Castillo who delivered the commencement speech. Head of the water polo team, the Kiwanis Key Club, the Gay/Straight Alliance, the Film Appreciation Club, and Student Council Co-Chair, Mari had never once uttered a word that hadn’t met with unconditional approval. In the one class she had shared with Mari–”World and Cross-Cultural Literature[s]“, which their small Northeastern private school required (and for which it offered no accelerated alternative)-Diana would watch in routine silence as Mari winsomely fumbled her way through class discussion, offering up insights subjective enough to dodge accusations of incorrectness but particular enough to insinuate that she’d actually done the assigned reading: “To me, what Farewell to Manzanar is about, in my view anyway, is the whole experience of the Asian-American peoples in America, during wartime. Like, for example, I’m half-Japanese, and half-Latina, too, and probably the number one thing I felt when I was reading this book was that, like, hey, this is probably exactly how I would have felt if I was in the position of the protagonist, and so I discovered that I could really relate to it.” …then, compounding the horror, Mari would attempt to steer class discussions towards subjects she felt more comfortable with: “And wouldn’t you agree, Mr. Kemfer, that this book was, in many interesting ways, similar to the film ‘Memoirs of a Geisha’? Did anyone else see that and love it? Am I alone here?”
And the reason Mari got away with it, the only reason Mari could not only abide but flourish brilliantly in school and with people, was her laughter. Tourettic, non sequitur, oddly machine-like laughter with which she ingratiatingly punctuated other people’s sentences, regardless of what had been said. Mari was dumb and energetically hospitable: a human puppy. And teachers, friends, even members of rival water polo teams were, in their vanity, gratified. But nobody even seemed to be conscious of it; Diana, the only one irrelevant enough to the social order to fall outside of Mari’s consideration, was the only one who seemed to notice this spasmodic tic of Mari’s. Certainly she was the only one who objected.
Laughter is infectious; it infects. The usual response to Mari was more laughter: at her obvious stupidity, but not as disdain–as approval. If Mari’s laughter contained a certain self-deprecating aspect, then the laughter she received in reply expressed sympathetic encouragement: “No, but we like you this way!”
As the school prepared for commencement, unease spread among the more sentimental students, who feared they would have their important day fucked up by the likely valedictorian. Would she struggle to adjust the microphone at the podium, prolonging the moment by having a teacher come and do it? Would she deliver some godawful nerdy speech–or wait, come to think of it, could she speak? Was this maybe a case of that smart-type autism, that Whatsit’s Syndrome? (In all fairness, Diana had wondered the same before.) Nobody actually knew Diana well enough to say for sure, but come on: Diana had no friends, nor had she ever tried to make any. Walking in the hallways, she stared at the floor only just far enough ahead of her to sidestep foot traffic.
Valedictory concerns became more public in the spring as ceremonial preparations got underway-the white event tent unfurled across a shaded quadrant of the field hockey green, congratulatory banners slung across the colonnade at the front entrance. There began an informal campaign among the students to amend school tradition, and a special afternoon assembly, given the title “What is a Valedictorian?”, was scheduled to allow students to put questions forth to the Academic Dean and the Headmaster in an atmosphere of enlightened and moderated discussion: Headmaster Harman, why shouldn’t the students decide who gets to speak at Commencement? This is our ceremony, a ceremony of and for the students, so why should some random custom, some marker of status based on meaningless test performance and some retarded (excuse my language, sir!) measure of academic “success” determine who gets to represent our class? Since when does the so-called smartest student make the best representative? Shouldn’t the most representative student be the representative? Our parents pay twenty-thousand a year–I think that gives us a say in how things are run! (Chatter in the auditorium-direct mention of tuition, especially in any kind of dissenting tone, was an implicit no-no.)
For her part, Diana paid little attention at this assembly, occupied with the copy of the Aeneid that sat in her lap, awaiting translation.
The special assembly, as with all public discussions, affected no real policy change but did establish the battle lines, dividing the school into those in favor of a student-elect valedictorian (practically everyone) and those against (practically no one besides a handful of chain-wallet wearing contrarians who didn’t actually care either way). In one of her moments of magnanimous outreach, Mari intercepted Diana as Diana was leaving the lunch hall with her prepared meal in a sack–by special request, she was permitted to bring her lunch into the library, so she could spend the period studying while eating.
Mari was smiling.
She’s coming to make friends with me. Because befriending the most obviously friendless girl will make her more popular. Oh, look at her nice skin. So why do I care if she’s popular? Because she doesn’t deserve to be. Then who do you think deserves to-
“You’re Diana, right?”
“I’m Diana, right.”
“I mean, of course you’re Diana. I sit across from you like everyday. Ha-ha-ha!”
Oh, the pain of that laughter. I will not encourage it by smiling.
Mari rolls with Diana’s dropped cue: “You like eating alone, huh?”
Her tone of voice–she thinks I’m scared. “Yeah. My parents raised me that way. When I was a baby they would just give me the bottle and leave the room.”
“Oh, that’s funny! Where is that from?”
“Where is what from?”
“That line you just said.”
“It’s not from anywhere. It’s not a line. It was me talking.”
“Oh. Still, that’s awesome.”
Still?
“So, I hear from everyone that you’re going to be the valedictorian.”
“That’s probably true.”
“That’s so awesome! Because you’re so young! Are you nervous?”
“No.”
“Well if you get nervous, I just want to let you know that I am at your beck-and-call. I can totally help you with your speech. Like, if you wanted it to be more funny. Not that you aren’t funny! You’re hilarious! I mean, duh! But what I’m saying is, I’m pretty on top of speechwriting, from being on Council and whatnot. And if you wanted a writing partner, like if you wanted to bounce ideas around, or, I know, you could like, try to do a skit, all like, ‘Wow, Mari, I can’t believe we’ve made it all the way to graduation…’”
“I’ve already prepared my speech.”
“Oh, awesome!” Was it possible-Mari missing a laugh cue? But she recovered as gracefully as one would expect: “Well, still, totally let’s hang out sometime. All these years and I’ve talked to you like, three times, which I find ridonkulous. Okay, I gotta go eat lunch! Ugh, cafeteria food, right? Seeya!”
“Okay. That’s-” But Mari had left.
Sometime after this, the informal agitation became formal-formal, at least, in the petition that was drafted, demanding a Student-Run Commencement. Nobody asked Diana for her signature, though from the volume of petitions she’d seen circulated during classes, during Council meetings, via email, she couldn’t imagine that they’d need hers. Eager to encourage initiative and civic participation in an otherwise Barnes-and-Noble progressive student body, the faculty accepted the proposal (whose origins could not be definitively traced back to Mari), and a month before commencement it was announced that the student Commencement speaker would be determined by vote, with a week for nominations. No mention was made of the discarded tradition, though, as is common in all elections, the mechanism of voting and the rubric of democracy were invoked to mask what was really just a popularity contest. No matter: Diana had missed most of these proceedings as, once more, finals drew near.
And so Mari was elected by overwhelming majority (applause meeting laughter greeting applause) not to the newly defunct office of the Valedictorian, but for the experimental student-initiated, student-elected appointment of Fellow Speaker. Her Commencement speech was so unbearably improvised and undignified that, although Diana had of course previously declined submitting her own name for consideration, she wished all throughout the ceremony that she had. For it would have spared her the punishment of watching Mari climb up to the podium with her prepared speech in hand, only to stagily tear the speech up, provoking immense applause, and begin:
“Okay, okay, ha-ha-ha-ha-ha! Okay, thank you, everybody. Thank you, Mr. Harmon, Mr. Persshon. Oh, why don’t I just thank everybody again? Ha-ha-ha-ha-ha! Today we’re here because we all worked hard and studied a lot-well, maybe not a lot! Ha-ha-ha-ha-ha-So today, we’re being rewarded for our hard work. Each one of us will get something much more important than just a piece of paper-today we’re getting our education. Like, did anyone see Wizard of Oz? It’s like when the Cowardly Lion gets his diploma, and that makes him smart. Wait, was it the Lion? Okay, no, the Lion gets the heart. And the Tin Man got some oil. Oh, it was the scarecrow! That’s right.” [Diana allowed a little sound escape through her teeth-tsssh-as here, in the only calculated moment in the speech, Mari sang.] ” ‘If I Only Had A Brain!’ Oh man, who doesn’t love that movie! Did anyone ever do that thing with the Pink Floyd album…”
For another ten minutes, Mari thanked her friends by name. Her voice wavered predictably at solemn moments, and then recovered speedily. It was like an award speech with no orchestra cue. And worst of all: from Diana’s seat (onstage, facing the audience, among faculty and other student honorees), she could see clearly that everyone had loved the speech. Mothers leaned across their spouses’ laps to whisper to other mothers. What a funny girl! Their eyebrows arched with impressed serendipity. What’s her story? Is she a hundred-percent Japanese, or? Do you know what she does at school? Gol-ly, it’s so impressive that she’s the valedictorian, too!
At last it all fell upon Diana, who’d swept Math, Biology, Chemistry, Latin, English, and (with satisfaction) CCWL[s]. And a surprise coup in Spanish, of which she had barely spoken a word in class (stiff tongue) but whose syntax she had been able to employ by rote in written examination. After each head-of-department’s encomium, she was called up to receive the corresponding award, holding her papery honors sash fast against her hip with her wrist as she gained center stage, shook with right hand and accepted award with left, faced the audience for photographs (a feeble click-flash from somewhere in the crowd-her parents had not told her where they would be seated), and returned to her onstage seat with one more leather-bound certificate of merit to add to the stack under her chair. The exchange was silent and indisputably ceremonial, the opposite of Mari’s performance, that aerosol of words. The speeches, the relics, the silence, they confirmed the authenticity of… well, she didn’t have to say it. That was the point of having awards: here was a sash with two stripes and a half-dozen certificates, telling you. There’s the proof. The ratification of cultivated intelligence. Look, it said so right there.
Now she was a fourteen year-old authority. Entitlement-this was what it was.
But it went wrong, or else, something about reality had always been wrong, and it was now at age fourteen, at the very moment of her authentication-too late, she later supposed-that she acquired one of her most basic tautologies: disappointment as the coefficient of merit. Call it the Axiom of Faint Praise, Lipton’s Constant.
This was the new knowledge coming to her through the common silence. For Mari there was laughter; for Diana there was that deep, disabusing yawn of impassivity.
It amounted to some casual remark on her youth: in smiles, in pouts of amusement and soft awws of endearment. Aww. Oh yes, there was the aww, but where was the awe? What existed inside Diana’s head had to matter to somebody, for there was simply so much in it. How many of the adults in this audience, Diana wondered as the hired chaplain delivered his Latinate benediction, could even properly be considered adults? Diana understood adulthood as a function of mental development. Perhaps a quarter of them, then. Most had probably never distinguished themselves in any way for their intelligence, except perhaps in having exceptionally little. But Diana had a title: whether or not anyone else accepted it, she was the valedictorian.
They were all called to rise, and after searching the crowd Diana found her parents waiting by the car. “Good job. You should be proud.” On the drive home, scenery unchanged, her hairline prickled, her back became moist with nervous sweat. She took off her sash. It was the sensation of hostile time: time passing, advantages eroding, each second of motion through time undermining her mental-over-chronological ratio as the treacherous denominator swelled, the great glittering title of prodigy applying to her less and less. Advancing in years, to remain a prodigy would require the mental age of a sixty year-old, a seventy year-old, and at last, in her final years, when others in their senescence would have trouble remembering the names of their spouses and their children, Diana would need to have attained a mental age beyond the length of life, the mental age of someone long dead.
2. The Idealist, The Mercenary, The Mule, and The Sponge
Not quite as much to be said of Diana’s higher education; repetitive acts are easily abridged. It couldn’t be said that those five years (two undergrad, three med) didn’t live up to her expectations, expectations of solitude and of unconstrained learning, but she still felt a tug of unfulfillment. University, from universitas: the whole. If higher education fell short only insofar as it failed to make her feel whole.
Given her one-room dorm single and her handily-won scholarship, Diana found that she could enjoy total seclusion rather than mere social invisibility, and so took immediately to self-incarceration. Remember, remember, remember-in those years it was all Diana did, and yet afterwards she could barely recall her experience of it. She lived her time in moments: removing the print-out name tag that the Freshman Orientation Committee had taped to her door upon her arrival. A dorm fire drill leaving her completely undisturbed in her room, so effective was the social baffle she’d erected. Skipping breakfasts and bringing her lunches and dinners from the dining hall to her desk, where she would center her plate under the round spotlight of her desk lamp to be consumed beside an open textbook. As bare as her desk and her walls were, the rest of the room was a cringing mess. Laundry, dirty and clean, avalanched from her closet and drawers, and many weeks’ worth of dining hall dinner plates, frescoed with blackened food, were stacked under her bed until the room began to reek and warm perceptibly with the onset of compost.
A long lecture of silence. The whack of an unarrested Frisbee against the façade of the dorm, the low frequencies from a neighbor’s speakers faintly jittering the pens in the cup on her desk. Hysterical festivities erupted on her dorm floor like flash floods every Friday, concussing the hallways with music and leaving behind a flotsam of plastic cups and chips trodden into carpet. For one whole week the girl in the next room over could be heard steadily weeping by herself, for what reason Diana never learned. In this way she experienced her dormmates as moments of interruption, nothing more. She lost her former drive to outdo her peers, mostly because at this point she was unsure of who might qualify as her peer: a fifteen year-old sophomore in high school, or one of these incomprehensibly alien dormmates, set apart not only by appearance but by origin, accent, occasionally language? The very medium of communication seemed changed: speaking to them would have been like trying to speak with whales, with bees.
With no required classes or family obligations or Mari Castillos hamstringing her, she cleared several years of biology and chemistry courses in months, and during her inexorable sprint towards another matriculation, she had the first of several encounters with a phenomenon from which she had believed herself exempt: collapse. It hadn’t even been precipitated by one of the occasional deadline convergences that compelled her to stay at her desk stretching into early morning darkness. No, it was just a Thursday. She had been at her desk for a typical seven hours and then with the suddenness of a magic spell she was afflicted by goosebumps and raw sickness, and then she heard but did not feel the edge of the desk striking her forehead, heard but did not feel her body sliding off its chair onto the floor, seeding many bruises on the way down, landing on her back with her upper half fallen under the bed. A few gray minutes later she came to with an all-over ghostly feeling, the sensitivity you feel when someone else brings their fingers very close to your skin, and her sight resolved and right there in front of her face were the ink-stamped words PROPERTY OF TUFTS HOUSING DEPT. (Diana was fifteen-the same age as the comatose Suzanne. Although with Suzanne it went bump, brain, blood, bed, with Diana, it was blood, brain, bed, bump.)
As she grasped of the back of her chair and tested her legs, she had a moment of ambivalence during which she appraised the merit of, on the one hand, seeking help, which entailed her leaving her room and choosing a door to knock on and then, after first humiliatingly explaining to some complete stranger who she was and why she was standing there with shaking knees, reiterating and reliving the incident, and in the event that the stranger even cared, they would have to decide what to do next-creating, in the process, the misleading impression that she wanted to speak to these people, that she was reaching out, which would lead later to those same people checking in with her and asking how she was doing, toppling at last a domino-chain of social obligation and quid pro quo and the exhausting not to mention time-consuming meeting of new people and then more new people, all of it unasked-for and potentially irrevocable, with the added concern: What if I actually enjoyed it?
And then, on the other hand, there was what she did instead: she sat down, opened to the glossary pages of her medical reference, and looked up the causes and treatment for the thing that had just happened, the thing she preliminarily diagnosed as a mild case of orthostatic hypotension.
The knot and bruise her fall left on her scalp felt for days afterward as if they were constantly being pressed.
The self-prescribed iron, sodium, water, and dutiful stiffening of the abdomen whenever she stood upright didn’t prevent the second occurrence, or the third or fourth, quietly, in the library and in the back rows of lecture classes, in her own bed. In Diana’s view the incidents were not reasons to stop working, but rather incentives to work smarter-in this way, she uncovered the connection between exhaustiveness and exhaustion.
Though she had avoided meeting her dormmates in any direct fashion, she started becoming known among them-which was something in itself-as the Zombie Girl. (Although of course they had simply meant that she was anemically sallow, stringy-haired, porously complected, and averse to light, the nickname suited her in one other important respect-the undying, insatiable, and single-minded hunger for brains.) After finally pitching sidelong off of her bicycle on a nighttime ride home from her orgo lab, she’d taken herself to the Tufts-New England Medical Center ER, where their initial assessment of cranial hairline fracture ended up being a misdiagnosis due to what was literally a hair on the x-ray (and did you see her suing anybody?). The only people she’d had to deal with as a result of these fainting spells was the ER staff, whose bloodless efficiency in inserting Diana’s IV needles only bolstered her confidence in the suitability of medicine as a profession. She had been annotating the margins of the Youmans volume she’d brought along with her and her attendant nurse snatched the book from her lap and clapped it shut, as if it were a matter of procedure. Diana had liked that.
And still, trauma or no, relapse or no, Diana gave her mind other than what it wanted. But that was not her custom alone-it was true of any medical student, anyone who had absorbed a certain number of case studies, to anyone who had read, cover-to-cover, dozens of books intended for reference; anyone who had memorized nearly every function of every mechanism of the most complex part of the body, from the inside out; someone who had crafted so many mnemonics that she could barely shop for groceries without subconsciously memorizing the order of the cereal boxes and then reordering them by color, brand, or grain derivative. Medical knowledge did not come gently; it had to be knelt upon.
The commitment surpassed dedication in any normal sense. Why learn, then, if not for competition or for love of knowledge? At Johns Hopkins Diana had been exposed to the many arguments defending the doctor’s life, one of labor, voluntary dispossession of leisure, and tiring, liability-prone work in an institution beset by every imaginable law, ordinance, and regulation (hospitals are, for certain, the least free places on earth). The first reason, usually offered upon introduction by eager, hygienic first-year students, was out of sheer agape, boundless love for the miracle of human well-being. The tidy young med student leans in to explain his motives sotto voce: a close relative had once fallen ill, and, shucks, it was his life’s work to see to it that nobody would ever again have to face alone the hardship of… and on and on. This type of med student Diana dubbed the Idealist, and in her experience, this particularly flimsy strain of altruism was generally squished out in the first year of med school, in order to make room for more study-conducive attributes such as the ability to study with an ergonomic posture, or to usefully regulate caffeine intake, or to compile endless lists, the lists of invisible parts of parts introducing a battery of weirdly chauvinistic mnemonics, e.g.
the deep cerebellar nuclei (lateral to medial):
Ladies [Lateral]
Demand Dentate
Exceptional Emboliform
Generosity Globose
From Fastigial
Men Medial
Or cranial innervation by type,
Some Sensory
Say Sensory
Marry Motor
Money, Motor
But Both
My Motor
Brother Both
Says Sensory
Big Both
Boobs Both
Matter Motor
Most Motor
And don’t forget the nerves themselves,
Oh, Olfactory
Oh, Optic
Oh, Oculomotor
To Trochlear
Touch Trigeminal
And Abducens
Feel Facial
Virgin Vestibulocochlear
Girls’ Glossopharyngeal
Vaginas Vagus
And Accessory
Hymens! Hypoglossal!
-the cruder, the more effective.
The Mercenary, a second type of medical apologist that Diana encountered somewhat more frequently, were in it for the money, and the occupations and intricacies of the field often blinded them to any tensions between altruistic work and extravagant pay.
And the Mule did it to live up to expectations which, having been placed upon them by parents and everyone else who had a part in their upbringing, accepted their destiny with heavy sighs, eye-rubbing, and a grim bedside manner, as well as expectations of their own: at least they would be making lots of money.
Having classified and having become expert at identifying these types, Diana felt satisfied that she did not belong to any of them. She kept her real motives a competitive secret, drawing upon them often in her six years of academic kamikaze, during which she met nobody, forgot nothing, and studied with absolutely zero self-pity. What compelled her wasn’t anything as obvious as money or people, neither of which she had much use for: she remembered a first-year introductory O-Chem lecture in which the professor, a thin-haired woman whom Diana identified as belonging to the first category of medical apologist, had asserted: “If you aren’t completely dedicated to the task of saving human lives and treating people as people, then you will have neither the endurance nor the motivation to complete a rigorous course of medical education.” Diana had taken a moment to write in the margin of her tidily composed lecture notes: We’ll see about that.
No, Diana’s reasons were intrinsic and pure, or at least concerned with purity. Fact: people were nothing more than their brains. Both body and brain deteriorated, failed, and ended-but the brain, subject to change by will and by conditioning (and by a clever scalpel, if it came to it), was under one’s control. Mental strength was unlike physical strength in that discipline entailed more than just thinking a lot or very hard or very long. It was about forcing yourself sometimes to think when you didn’t want to, to think carefully about things you didn’t care about. In great quantity. If you had to choose a name, try the Sponge, for the element of soaking appealed to Diana: you took in a lot of substance and that substance became an aspect of you. You had to process ideas like water and store them like fat. That was what made it difficult, what made it worthwhile. No sense investing in the limited or the common. Why not perfect what was perfectible?
She would overhear classmates, dropping their books spitefully onto their study ledges, maligning the 8 AM lectures, their poverty of spare time and their guerrilla eating habits, their student loans, the constant sense of trial. But here Diana was, nailing exam after exam, recalling the answers to (and even the wording of) review questions with mimeographic fidelity. Call it Zen, or whatever, but she saw no reason why anyone supposedly committed to a set of goals should have any trouble investing ten or eleven hours of a typical weekday (and more, not less, on weekends) to achieve them. If she could do it, if a seventeen year-old could do it, well, what excuse did anyone else have? What did people do all day? Okay, yes, she was lonely, but sacrifice attended all worthwhile endeavors, and besides, she could tolerate loneliness. What she couldn’t tolerate was the idea that she might fall short of fulfilling the promise of her youth. That she might never reach the end of it.
Such was Diana, a study in study. To the extent that her mind’s inventory was vast and intricate, so too was she. The discipline mattered only insofar as it was obviously difficult and obviously necessary, and it was only proper that mastering the brain required a mastered brain. What was inside her head was only what she had put there deliberately and on her own terms. Was there a better way to define self-determination?
In perfect knowledge, completeness. Complete as in whole, complete as in all that sufficed.
[Excerpt ends here. If you'd like to read more, let me know.]