Good Intentions

I believe that every single person on Earth will experience a moment during their lifetime that completely changes the trajectory of their path. Frame it as the mandatory fork in the road, the event that results in a complete change of course, whether it’s desired, or not. And when I reflect on my long surgical career – the countless patients I’ve cared for, the thousands of operations I’ve performed, the mostly good outcomes and rare devastating ones, I often think about the one day that permanently altered my own journey.

You see, I didn’t start out as a surgeon. I wanted to be a psychiatrist. I was fascinated by the inner workings of the brain, and in my mind, the more extreme, the better. The manic patients who were convinced they ran the world, owning every major sports league or Hollywood studio. The borderline patients who adored me one day, then despised me the next. The severely depressed patients who couldn’t even muster the energy to say a word during our sessions, just sat slouched in their chair, a hoodie obscuring their languid eyes.

I opted to learn psychiatry at an inner-city hospital, where the patients were generally poor or uninsured, and thus underserved. At the time, I felt it was important to serve a population that needed it most desperately. I was young, in my early 20s, when I graduated from medical school. I had achieved high marks and accolades, and tended to work like a dog. The combination of talent and grit had led to my academic success, and I felt both blessed and untouchable.

The hospital neighbored a topiary garden, through which one had to walk in order to reach the city’s public library. On the right day, when the sun was out and my workload was light, I'd treat myself to a walk through the garden, then a visit to the library. The combination of the garden and the library would enchant me by dragging me out of the banal and monotonous nature of the week. It was a delightful respite from the arduous hours spent caring for the patients.

One autumn afternoon, a late appointment canceled at the last minute, and my preceptor released me for a short break. I checked the temperature outside: it was unseasonably warm, and the sun was just starting to set, so I decided to perform my garden-library ritual. I removed my white coat and left the hospital, blissfully walking the single block to the garden. I recall that the topiary garden at that time of day felt utterly magical. The waning sun hung low in the sky and washed the greenery in a gentle glow. Playful shadows spilled from the feet of the animals and figures and splayed themselves across the grass and paths. The ballerinas and fairies and elephants still held their lush verdant coats, not yet afflicted by the harsh winter winds and snow. I crossed my arms over my sweater, the barest chill in the air with the approach of dusk.

I had always admired the library’s stately façade. The construction had been funded by Andrew Carnegie in the early 1900s, and subsequently built using white Vermont marble in a Beaux-Arts style (resembling a mansion of the Gilded Age). The wide entrance featured cherub statues, columns, and arches, and a frieze atop the main entrance read “Open to all” in bold capital letters. Apparently, Carnegie mandated that his buildings welcomed humans from all walks of life. A fountain sat in the plaza in front of the building, a bronze statue of Peter Pan playing a flute standing tall in the center.

The atrium lobby featured 40-foot ceilings, with a checkout desk to the left, and the new fiction displays in the middle. A stairwell to the second floor stood off to the right, and a small gift shop ran along the back wall. Upon entering the lobby, I was greeted by the familiar scent of worn, well-loved paper. The woman at the checkout counter glanced up at me and smiled. “Hi there. Just so you know, we’re closing in ten minutes.” I nodded and circled the round tables in the lobby, taking my time to examine the laminated covers of the hardcovers, opening some of them to read the book summary located on the inner jacket. I noticed that I was the only patron there at that hour. My eye met the cover of a book that I had recently read a raving review about, and I felt fortunate to have tracked down a copy. I impulsively lifted it from the table and brought it to the checkout counter. The woman behind the desk handled the transaction, and slipped the receipt between the pages. Satisfied, I started to head back towards the hospital, and exited the library to enter the foyer, the cross-space between the outdoors and the library. I looked over to my right and noticed a homeless man sitting on a backless leather bench. He hadn’t been there when I entered, and I wondered when he had materialized.

I often saw the homeless at this library, especially in the wintertime, when the weather turned frigid and they needed a warm place to loiter. They tended to live around this part of town, and the staff generally turned a blind eye to their presence, as long as they weren’t disruptive or dangerous. I felt comfortable around the homeless population, and so I was never perturbed by their proximity. They were sometimes even my patients, when I covered the inpatient acute psychiatric ward. Because of my clinical experience with the homeless, I felt confident in my ability to evaluate them in a fair and judicious manner, and thought I knew when they were approachable, and when they were a threat.

This particular young man was sleeping while sitting, his head slightly slumped onto his shoulder. He wore the stereotypical dirt-caked and tattered clothes, but his face held a peaceful, almost boyish expression, his long eyelashes fluttering as if deeply dreaming. In fact, he resembled one of my favorite patients, a schizophrenic man I typically cared for in the psych emergency room.

I sensed a degree of vulnerability from this man, and felt the urge to help him in some way. Before I could consider my actions, I began to approach him slowly. As I moved closer, he startled awake, like a sleeping cat would. “Whaddaya want?” he asked warily.

I showed him my hospital ID badge, which I wore on a lanyard around my neck. “Sir, I’m a doctor. Are you hungry? I have a protein bar in my pocket.” I reached into the back pocket of my scrubs, and held out a small rectangular protein bar, the oaty kind that hikers eat for energy.

He looked at my face, then at the proffering, then at my face again, his eyebrows furrowed together. “What’s wrong with it?”

I shook my head. “Nothing’s wrong with it. I always have one on me, in case my blood sugar suddenly drops. It’s unwrapped. I haven’t messed with it. It’s fine.”

He leaned in and squinted at the label. “What flavor is it?”

I lifted it to my own face and read it aloud. “Chunky peanut butter,” I replied. My eyebrows lifted and I gave him a small smile. “Interested?”

His face then darkened with anger. “I’m allergic to peanut. Whaddaya trying to do, kill me?” He then rose to his feet, towering over me. He glowered and took a step in my direction. “Try again next time, miss.”

“Oh, okay, sorry,” I stammered, and turned to leave through the main entrance, quickly shoving the protein bar back into my pocket. My other hand gripped my book, and I started towards the topiary garden. By now, it was dark out, and scattered pathlights had begun to illuminate the walkway towards the Peter Pan fountain. The topiary garden appeared desolate, but I knew I had to pass through in order to reach the hospital. I was walking at a normal pace, my book at my side, until I turned around and saw the homeless man about 20 feet behind me. His head was tilted slightly downwards, as if bracing himself against an imaginary wind. He seemed dead set on catching up to me. I began walking faster without outwardly running; I knew that handling the homeless was similar to being around a bear, or a shark, or a bee. One could not show their fear, but instead had to maintain a sense of tranquility, by remaining calm and composed. I entered the topiary garden as he continued to pursue me.

The magic of the garden had dissipated in the dark. Only the occasional streetlight lit the path, and the shadows cast by the animals threatened me as I strode past them. The ballerinas and fairies seemed to have gone home; in its place, lions and bears loomed over me, their paws and claws posed for attack. The man seemed to be getting closer, his long legs lumbering in wide strides. I began panting then, and my heart began to pound. Still not running, I saw the exit of the topiary garden straight ahead, the hospital lights burning bright just beyond the gate. I walked the slightest bit faster; only 10 more feet and I’d be free. But just before I passed through the gate, the homeless man attacked me from behind, hurling his hulking body onto my narrow frame. We struggled on the sidewalk, his sour breath hot on my face and his ragged clothes reeking of rotted trash. He had me pinned, and I started to panic as he grabbed my lanyard and began to wrap it around my neck. Fortunately, in a burst of adrenaline, I was able to pull myself out of his grasp, and the lanyard, as it was designed to do, separated into two strands, the plastic clasp located behind my neck snapping apart. I ran then, to the hospital. The last image I possess from that night is of the homeless man standing on the sidewalk, holding my badge with the two strands of the lanyard hanging limply towards the ground. The library book laid abandoned at his feet.

When I reached the entrance and recounted my story, the security guard let me past without my ID, and I returned to my clinic, where I shook and sobbed and my preceptor kindly helped me settle down. The next day, my ID was discovered lying facedown on the sidewalk near the topiary garden’s entrance. The book was never recovered. They never found the homeless man either, despite my numerous recounts of his description.

After that incident, I decided to pursue a surgical career, with the desire to first learn and subsequently perform tangible operations with the goal of permanently curing my patients. Psychiatry suddenly seemed too abstract, too invisible, too incorporeal. I did love my psychiatric patients, and felt that my role held a lot of meaning, but I couldn’t bear the thought of my work not improving, or, better yet, curing, a fellow human’s pathology. In psychiatry, you can provide medications, and therapy, and recommendations, but the patients don’t necessarily need to comply. They could, and often do, continue to pose a threat to themselves, or others. At least with surgery, the organs are at my mercy. They have no choice but to surrender, and as the surgeon, I luckily always win.