Just Like Someone Without Mental Illness Only More So by M.D. Mark Vonnegut

resident’s office. In a fitful half-sleep dream I watched myself bent backward across Malvesti’s knee, him pulling my head back by the hair with his left hand as he transected my heart with the knife in his right, entering my chest at the anterior axillary line between ribs nine and ten and pulling it to the midline.
    A few hours later I got up, had some coffee, and went to senior rounds, where we discussed Prince of the River Nile Smith and all the other admissions from the previous twenty-four hours.
    “There was absolutely nothing wrong with that baby,” I was compelled to throw in.
    “There might have been,” countered Louis, “Besides, there was a court order. We had to admit and treat that baby. It was the people at Children’s who gave us no choice.”
    On to the next case. As I got on my bike and pedaled home, I half hoped that Malvesti or one of his lieutenants might run me over before I could cross over to the Charles River.

    I had a job lined up with a small respected pediatric practice. In a month I would be calling the shots, doing my best to keep kids out of emergency rooms and getting tests they didn’t need.There were pediatricians practicing in their eighties who still seemed to be having a good time with it.

    The last thing I did as a senior resident was to transport a critically ill newborn girl who was thought to have an overwhelming infection from an outlying hospital to Mass General. I made the guess, which turned out to be correct, that she had congenital heart disease even though she didn’t have a murmur or blueness or any other sign of heart disease. I treated her for heart failure instead of infection and she responded well and survived the trip back to MGH. Her heart was 100 percent fixable. Instead of being dead or crippled, she would grow up with as good a chance as the rest of us.
    When the cardiologist praised me to the parents and said that their little girl hadn’t been hurt by her rough start and was going to grow up 100 percent normal I felt sick and couldn’t get out of that room fast enough.
    I was just doing my job. It had been a lucky guess. I hadn’t actually diagnosed the specific cardiac defect their daughter had
.

    The day after I finished my residency, my mother had an operation that was supposed to be for a uterine fibroid that turned out to be stage-four ovarian cancer. I hadn’t admitted to myself the possibility of something being seriously wrong till I got the phone call.

    Enthusiasm

    (Vonnegut family photo)

chapter 9
Crack-up Number Four
    It’s important to me that I owned the house they took me out of in a straightjacket
.
    I loved the rhythm and rank of being a primary-care pediatrician. I started paying down the money I had had to borrow to get through medical school and residency. I’d tried to cut down a few times but still smoked two packs of cigarettes a day. I’d take care of a couple of patients, go out to my car to have a cigarette, and come back and see a few more patients.
    I was dealing mostly with self-limited viral illnesses in otherwise well babies and children, but life and death wasn’t the point. I didn’t feel
less than
neurosurgeons, oncologists, or cardiologists. Someone had to be looking through the haystack to find treatable diseases in salvageable patients. Leukemia or brain tumors would always be trying to sneak through, and I was ready to catch them. Maybe I was the catcher in the rye.
    I didn’t want to be rich or famous. I didn’t want to write again. I wanted nothing more than to keep doing pediatrics forever.
    ——
    For a year or so before I went crazy for the last time, an odd feeling of panic would take hold of me almost every night driving home from work. I’d feel sick to my stomach, my heart would race, and I’d have chest pain. I’d imagine getting into accidents or getting dragged out of my car and beaten. I went to a cardiologist, got on a treadmill, and passed my stress test. He reassured me that my