A New York Haunting: Pt. 01

There, under the auspices of the staff pathologists (Drs. Jackson, Miller, and Rosenblatt), a rotating schedule of residents, and a soon-to-be 4^th year medical student named Israel "Izzy" Feinberg, he learned the technique of autopsy dissection. Many an edifying day was spent in the ceramic-tiled morgue overlooking the East River, searching for the corporeal clues to the cause of death. For many a 'customer', the violent manner of death offered no mystery, but methodical assessment was essential in anticipation of a potential criminal trial. Unclaimed bodies were embalmed and, by longstanding arrangements, distributed to the various medical schools in the city.

After several weeks of the demanding work, Anders was agreeable to following the wise counsel of New York City native Izzy in another regard: the importance of occasional recreation. Granting himself a small allowance for that purpose, he joined Izzy and his wife Pauline several Saturday nights that summer on the train to Coney Island or Brighton Beach. There, he discovered a remarkable spectacle: vaudeville shows, carnival rides, boardwalk games, and throngs of diversion-seeking people --- including numerous pretty young ladies. Emboldened by the starlight and festive music, Anders cast his wistful eyes about for amorous adventure --- for the most part unsuccessfully. In this shortfall, he consoled himself in a renewed devotion to his studies.

One afternoon in August as they were conducting two autopsies simultaneously, the morgue received an unexpected visitor. Izzy and Dr. Jackson were performing the external survey of an unidentified male gunshot victim --- Izzy taking notes as the pathologist dictated. Anders and Dr. Rosenblatt were working on a 45-year-old man who had been admitted to Bellevue two days previously with fever and abdominal pain; he had died on the ward.

As Dr. Rosenblatt separated the patient's organ block into thoracic and abdominal portions on the counter at the side of the room, the door to the entry office squeaked and a man with a brisk air entered the morgue. In his early thirties, he had wavy, dark brown hair and a groomed mustache whose ends curled jauntily up. A well-tailored suit showed a lean, sturdy physique.

Dr. Rosenblatt looked up. "Dr. Mullenix, how can I assist you?"

The man scanned the row of autopsy tables, noting Dr. Jackson and Izzy at the far end, then turned his attention to the occupied table at the near end. Unperturbed by the eviscerated body and the rivulets of blood coursing towards the drain of the tilted tabletop, he stepped closer, cocking his head to study the silent face of the decedent. "This looks to be my man," he said.

"This unfortunate fellow was Mr. James Kealey." Dr. Rosenblatt slid the chest organ block towards Anders. "Start on the heart," he instructed. He turned to Dr. Mullenix. "Was he your patient?"

"Indeed he was. I was on the brink of taking him to the operating theater to relieve him of his appendix when the nurses found him pulseless in his bed. I am all eagerness to learn what brought him to this untimely demise. It seems too sudden for sepsis."

"Appendix? Let's have a look." Stepping to the sink where the bowel awaited in a large, enameled basin, Rosenblatt rummaged in the loops of intestine until he brought up the colon. He ran it through his hands to the cecum, while Dr. Mullenix stood back out of the range of potential splatter. Anders, having excised the heart from the block, watched as Dr. Rosenblatt held up the appendix for inspection. The finger like structure was inflamed and mottled with a yellowish exudate.

The surgeon leaned closer. "Well, my diagnosis was dead-on --- no pun intended."

Rosenblatt nodded. "It appears contained --- I see no perforation. I doubt this was the proximate cause." He pursed his lips. "Statistically, in a man of this age, the heart would be the next suspect."

The two men turned towards Anders who was palming the dripping heart in a gloved hand and employing a scalpel to systematically cut cross-sections at eighth inch intervals along the coronary arteries coursing over the surface of the organ.

Dr. Mullenix attentively observed the exercise, one arm crossed over his chest, the fingers of his other, upraised hand twirling the tip of his mustache. "You're remarkably dexterous for having such large hands," he commented.

"Thank you, sir."

"'Dexterous' --- can one use that for a left-hander?" teased Dr. Rosenblatt.

"You pathologists and your Latin!" Mullenix rolled his eyes and said aside to Anders, "Don't pay him too much heed, lest you become a damned fogey before your time."

Adjusting the heart in his hand, he started on the left anterior descending artery.

"Are you a medical student?" Mullenix asked.

"Yes, sir."

"What year?"

"Starting my second in the fall."

"What is your name?"

"Anders Røkke."

"Spelled how?"

As he spelled out his last name, the surgeon looked him up and down. Being taller than most men by a half-head or more, Anders was accustomed to such perusals.

"Viking stock, eh?"

"Railroad stock is a sounder investment, judging by Mr. Vanderbilt," Anders said, his countenance impassive.

Dr. Rosenblatt chuckled. The curled ends of Mullenix's mustache lifted as a grin spread over his face. He snapped his fingers and pointed at him. "Capital! I like my wit like I like my wine --- dry."

Anders' knife paused. "I found something, Doctor," he announced. With the tip of the blade, he wedged open the last cut to demonstrate a red-tan thrombus obstructing the artery.

Rosenblatt nodded. "Here's our culprit, I warrant."

Anders excised the section of clot-occluded blood vessel from the surface of the heart and placed it in a jar of formaldehyde. When he then laid the heart on the counter and sliced it like a loaf of bread, it came as no surprise to find an extensive, red swath of freshly dead muscle in the left ventricle and septum --- indeed, the heart was partially ruptured.

"Myocardial infarction," Rosenblatt and Mullenix said as one.

"And a whopper at that," Rosenblatt added, "You needn't await my final report. You can safely inform the family it was a heart attack."

With a brief salute and thanks, Dr. Mullenix departed the morgue.

Anders' next encounter with Dr. Mullenix was a few months later. By his second year of medical school, he had resolved upon a career in surgery and chafed over having to wait until the third-year surgery course to pursue his ambition. Hence, in the unclaimed hours between lecture didactics, he decamped to Roosevelt Hospital across the street from the Medical College and slipped into the operating theater where third- and fourth-year students observed procedures.

In the small, solemn auditorium, he would quietly descend the steep stairs between the tiered rows of wooden observation benches, sliding into a seat as close as possible to the operating table to raptly attend the staff surgeon's instruction. He was enthralled by the methodical exhibition --- the surgeon's deft manipulations, the nurse briskly passing the gleaming instruments, the anesthetist thwarting suffering with the astute application of chloroform drops to the mask over the patient's face.

One afternoon when he eased shut the door at the top of the theater, his gaze dropped past the backs of the audience to the operating floor below to realize that the attending surgeon today was Dr. Mullenix. Two similarly white-gowned resident physicians were standing at the table with him, one at his side and one opposite. As Anders crept down the stairs, he recognized the watching students as third-years, one year ahead of him.

He crouched next to a fellow on the aisle. "What is the operation?" he whispered.

"Gallbladder."

Anders found a seat in the third row. For some time, he observed the proceedings, leaning forward with his forearms on his spraddled knees, taking notes in his book. It was damnable --- this method of learning surgery. Even if he had a telescope, he'd be hard put to see the critical maneuvers of the surgeons' hands inside the patient's abdomen. How he envied the residents with a first-class view at the table!

Dr. Mullenix described the correct technique of retracting the bowel and liver, nodding when the proper exposure of the gallbladder was achieved. "Pean hemostat," he said. The nurse lightly slapped the metal instrument into his outstretched, gloved hand. "The Pean hemostat is your best friend --- its uses extend far beyond the obvious clamping of vessels. In fact, this is my preferred instrument for dissection. Instead of closing it, I spread it thus to gently separate tissues." He raised his hand from the operating table to demonstrate the motion to the audience before applying the technique to the patient, continuing to describe his ministrations.

"Now," he said presently, "what is Calot's triangle?"

The resident standing next to him started to speak, but Mullenix silenced him with a shake of the head. "Mr. Bayles!" he called out.

A student to Anders' left abruptly sat up. "Yes, sir?"

"What are the boundaries of Calot's triangle?"

A long silence. "I ... umm ... I don't know, sir."

The entire class was suddenly engrossed in their notebooks.

"Mr. Goldberg? Have you the answer?"

From the front row came a voice: "The common hepatic duct, the hepatic artery, and ... and the superior border of the pancreas, sir."

Dr. Mullenix adjusted a retractor being held by one of the residents. "I admire your inventiveness. When Goldberg's triangle is heralded as the anatomical innovation of the decade, we can all congratulate ourselves on having heard it here first."

A snuffle of laughter from the students was quickly smothered.

"Tie on a stick." With one hand yet inside the patient's belly, Mullenix held his other out for the instrument. Without looking up from his work he called, "Mr. Røkke? What say you?"

Startled, Anders straightened. Several students nearby glanced at him. Dr. Mullenix leaned over the table, now with both hands in the field. Anders cleared his throat. "The common hepatic duct, the cystic duct, and the cystic artery, sir."

"There it is," Mullenix pronounced.

One of the residents raised his head from the operating table to look in his direction.

Dr. Mullenix proceeded to expound upon the significance of Calot's triangle and the anatomic variations that might be encountered in the cystic duct. Anders endeavored to visualize the operation as the narration continued, drawing a diagram in his notebook. At last, the stone-laden gallbladder was delivered.

When eventually the chloroform was lifted, and the groggy patient was wheeled from the theater attended by the residents and anesthetist, the students began to file out. Anders started up the stairs only to be halted by a calm "Mr. Røkke" from the floor. Turning back, he saw Dr. Mullenix stripping off his bloodied gown. "Mr. Røkke, a moment if you will."

He made his way down to the floor. Was he to be taken to task for intruding into a third-year course? The surgeon tugged off his knit cap and tossed it into a soiled linens basket with the gown. He cocked an eyebrow at Anders. "Anders Røkke, what sort of physician do you aspire to be?"

Squaring his shoulders, he rejoined, "A surgeon, sir."

Mullenix's mustache highlighted his grin. "Bully for you --- and bully for surgery. The field will be the better for it, I warrant."

Anders couldn't help a quick grin too. "Thank you, Doctor."

Mullenix glanced at his pocket watch. "I shan't beat about the bush. I am in need of an assistant on a research project which I hope to publish in the New England Journal of Medicine and Surgery. Would you be interested in participating in such an undertaking?"

He nodded without hesitation, his hands tightening on his notebook. "Yes, sir."

"Splendid." Mullenix outlined his proposal: he wished to study patients who had undergone appendectomy, to determine which signs and symptoms prior to surgery best predicted a truly inflamed appendix upon removal. "Our collaborator will be the pathologist Dr. Prudden here at the Medical College. He'll be evaluating the appendices. I anticipate you meeting with him and me on alternating weeks to collect the data."

Thus began Anders' association with Dr. Mullenix. For the remainder of his second year, he met with the two physicians in their offices --- with the surgeon to review the charts of the appendectomy patients, and with the pathologist to review the microscopic sections of said patients' appendices.

A few months into their collaboration, Dr. Mullenix invited him to dine at his home, which unexpectedly proved to be a grand mansion on Madison Avenue near Central Park. Admitted by a uniformed butler, Anders looked about in wonder at the lavish appointments in the high-ceilinged, marble entry hall. When Mullenix appeared in a tuxedo, the younger man felt all too acutely the plainness of even his best suit.

"Anders! So good of you to come." The surgeon shook his hand. Noting his guest's discomfiture, he added in a low voice, "Do not distress yourself --- although we are compelled to adhere to certain conventions in dress, I trust you'll find us a convivial lot." He cast his eyes about the hall and smiled ruefully. "I would not wish to unduly excite your anticipation as to the lucrativeness of the surgical profession. All that you see is courtesy of my wife's filthy rich family."

Dr. Mullenix steered him into a drawing room off the hall. "If there's one piece of wisdom I can offer you beyond surgical instruction, it is this: marry well." He winked.

That night Anders met the man's family. Mrs. Ellen Mullenix was an attractive, finely-gowned woman who treated him with perfect graciousness. If her welcome was more reserved than her husband's, Anders could only speculatively attribute it to her sex, her elevated class ... or perhaps a puzzlement about their humble guest. The couple's two sons, Alexander (aged 7) and Gavin (aged 5), had clearly inherited their father's lively demeanor, and without a hint of snobbery, at once set upon the strapping, young male visitor with a barrage of observations and questions.

A few weeks later, a second invitation to dine was extended: this was to be at the rarefied restaurant Delmonico's in honor of Dr. Mullenix's visiting guest from Johns Hopkins, Dr. William Halsted, who had been Mullenix's mentor during his residency. Anders gulped at the honor --- the renowned Dr. Halsted! A giant in the field of surgery, his accomplishments ranged from countless innovations in surgical procedures, to pioneering blood transfusion, to the advancement of antisepsis protocols --- including introducing rubber gloves into the operating theater.

Nervous about eating at the elite establishment in such exalted company, and recalling with chagrin his plebeian suit, he fretted over the upcoming dinner until he thought to seek advice from his savvier friend Izzy Feinberg.

Izzy's eyebrows lifted and his eyes glinted behind his spectacles. "Dining at Delmonico's?! Mazel tov! That's quite the ascent from a Coney Island hot dog cart, old chaver!" When his teasing abated, he gave Anders the name and address of his cousin who was a tailor. "He'll get you suited for a fair price. Beyond that, just remember to chew with your mouth closed and keep your elbows off the table."

Anders had not anticipated that moving across the state from his home town of Rochester to New York City would have effected any measurable alteration to his frugal wardrobe. But he quickly discovered that being a medical student in a cultural metropolis presented both novel obligations and opportunities --- and, as his association with Dr. Mullenix demonstrated, such opportunities were not to be taken lightly. Accordingly, he invested in a tuxedo and top hat. Although not up to Savile row standards, they were well-made and serviceable, satisfying at least his own standards.

His conduct at dinner evidently occasioned no embarrassment to his mentor, for over the next year, more dinner invitations followed.

Anders occupied the summer between his second and third years again working at the City Morgue and writing the article for the appendix study. That Christmas holiday, a new type of invitation was tendered by Dr. Mullenix: to accompany him and his sons to the Woodstock Inn in Vermont for a skiing excursion. He and his family were eager to learn the sport, and he offered to pay for Anders' lodging in exchange for lessons. Although the resort reportedly was equipped with skiing instructors, the surgeon preferred to entrust his and his offspring's bones to someone with, as he put it, "ancestral aptitude" in the exercise.

"But don't worry," Mullenix said. "We shan't monopolize all your time. You have certainly earned a respite after the past semester."

Having no family and no other place to go for the break, Anders accepted. It was an excellent adventure --- riding up on the train, experiencing the novelty of luxurious accommodations, and teaching the boisterous Mullenix clan how to ski. As promised, he also was able to devote some time to his own diversions, including racing down the more advanced ski runs and embarking on an awkward flirtation with the daughter of another family staying at the resort. This venture quickly terminated when the young lady discovered he was without financial means.

During his third year of medical school, he launched himself with zeal into his formal surgery curriculum and continued to participate in Dr. Mullenix's scholarly research. The summer before his fourth year, the surgeon facilitated a miracle with the hospital review board, enabling Anders to be paid a salary as a surgical assistant.

In that glorious summer, he at last stood at the operating table with his mentor and the residents and was able to demonstrate his burgeoning knowledge and skill. Most thrillingly, he had the unforeseen opportunity at the end of summer to improvise a new suturing technique on blood vessels --- a technique that he and Mullenix were keen to submit for publication to the Boston Medical and Surgical Journal. Anders had been working on the article the past month.

Reviewing his first three years of medical school, he felt himself to be fortunate indeed in the generosity of his mentor. If ever he appeared overwhelmed by Dr. Mullenix's favor, the man humorously reassured him his motives were purely selfish in that he meant someday to establish a private surgical practice and hoped to persuade Anders to be his partner in the enterprise.

Chapter 2. LONG AGO AND FARAWAY

Anders sat back in his chair as the Delmonico's waiters cleared the empty plates. He again surreptitiously tugged his tuxedo straight. Yes, despite the intermittent apprehension of being judged an interloper, he continued to accept Dr. Mullenix's invitations. For one thing, the food was exceptional --- no slight intended to his landlady Mrs. Sullivan's simple meals. For another thing, the conversation was infallibly stimulating. And lastly, if he ever hoped to dispel the feeling of being an impostor, he must avail himself of every opportunity to become comfortable in this milieu that epitomized success in America.

"I apologize for the interruption," said Dr. Mullenix, resuming his seat at the table. "Social obligations! Sometimes I wonder what is the maximum ratio of obligations to pleasures that is compatible with a tolerable existence, eh?"

With the arrival of the brandied pears and plombiere of marrons, they discussed their current project. Anders updated his mentor on the journal article's progress. "I've collected all the literature citations and have written a preliminary outline. The figures are the next hurdle. I anticipate it necessitating four diagrams."