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When I was a junior resident in the neonatal ICU and a little 800-gram preemie was trying to die by rupturing one lung and then the other and then the first one again and the air from the ruptured part kept filling up the chest and squeezing the good lung tissue and the heart, I put in three chest tubes to drain off the air. The senior who was backing me up mentioned on rounds the next morning that maybe I should have woken him up. If another patient had crashed while I was putting in all those chest tubes, I would have, but it seemed under control at the time.

Attitude is everything. I had more than my share of days where IVs all went in, I got spinal taps on the first pass, and I caught everything before it could hit the ground. It was a blend of will and attitude. When I felt well, things went well. I had a Teflon jacket of positive expectation that got me into and through medical school, internship, and residency. The universe wanted me to succeed.

The stark facts about medical care are that needing a doctor is, in fact, a bad sign, and needing an ICU is a very bad sign. The pediatric intensive care unit (PICU) is a great place to disabuse yourself of notions of fairness. Here, whatever doesn’t kill you doesn’t make you stronger. It makes you weaker and kills you tomorrow or the next day. Things don’t even out.

Christmas Eve ’81 it was snowing. I was the senior resident in charge of the PICU. There were maybe one or two patients in the unit who had any chance of surviving, walking, talking, and going to school. Most were on ventilators. One had drowned in a wading pool and was resuscitated but never woke up. They called it a near drowning because his heart and lungs and kidneys survived. One boy was brain-dead from being beaten by his mother’s boyfriend, but we couldn’t let him go because then the mother’s boyfriend could say it was us who had killed him. The sweetest little boy in the world with the nicest parents in the world was getting weaker and weaker and couldn’t breathe on his own because of some mitochondrial defect. We knew exactly what was wrong but couldn’t do anything about it. A patient with meningococcemia in the isolation room looked like she might do okay. A one-month-old who’d had her heart operated on the day before was not doing well. And so on.

I went out of the unit into the hall on my way to the on-call room to have a cigarette and heard gales of laughter. The families of the patients in the PICU were playing charades, gesticulating, shaking their heads, not talking. Just like anyone else playing charades.

——

For three years, with one week a year off for vacation, I rode my bike four miles to the hospital and back, even in bad weather, every day, sleeping over when I was on call every other or every third or fourth night, depending on the rotation. I was working a one-hundred-plus-hour workweek, but it didn’t seem that bad. Sometimes on call I actually got to sleep a little.

I learned everything I could about taking care of sick children. I was in very good physical shape, as fast as the wind on my ten-speed bike and able to beat most people at squash. I was a good intern and resident. In the beginning of my senior residency I was asked if I would consider being the chief resident. I was honored but too much in debt and not getting any younger. At thirty-four, with a second child on the way, I felt it was time to look for a job.

If the thing you’re best at is being a resident, maybe you’ve peaked too early.

My second son, Eli, was born December 3, 1980, the year of my senior residency, right before the charades game in the PICU family room. I loved my children but often had to stop and think of what a good father would do. I was doing my best imitation of a good parent. I was also doing my best imitation of a good husband.

I had a serious sleeping problem and started taking Xanax for it and feeling much better. I associated not sleeping with going crazy. I didn’t want to leave it up in the air whether or not I would sleep at night. Xanax seemed to make me the person I was meant to