We call him Hempel’s Disease, with the flippant arrogance of third year medical students. The four of us are fresh from two years of basic sciences, the first half of medical school. This is our first “clinical rotation.” For the first time we bear some responsibility for real people. We listen to their stories, trying to remember all the questions to ask. We examine them, draw blood, and list the most likely diagnoses, all under the supervision of a resident.

For the four of us, Dr. Karl Hempel is that resident. The previous two years have crammed thousands of new facts into our heads. It is not yet clear whether anyone can fashion them into something useful. Hempel will try.

Hempel is slight, with thick glasses. His white resident’s garb makes him seem even smaller. While reading, he worries a straggling pimple, left over from adolescence.

He is lighthearted, and good at what he does. He keeps us from bogging down in the despair of the chronically ill or the sadness of the death sentence he gently delivers to my Tuesday morning workup.

He is all of twenty-seven years old, just three years older than we, yet he commands our complete respect. We are awed by his knowledge. An enormous gulf separates us. Even if an illness stumps all of us, Hempel emerges from his evaluation with a diagnosis that usually stands the challenge of the staff physicians who monitor us all.

How can he do this? Was he a born physician, or will the next three years somehow also transform us?

The previous two years have changed us little. We are still just four overgrown kids in ties and white clinic coats bumbling through a workup that may take us four hours. Hempel teases out more information in forty minutes.

So, we call him Hempel’s Disease trying to bridge that gap, to get a handle on his expertise and connect to his world. Trying to grab his belt loops and leap that divide.  

We do not yet understand that we lack more than knowledge. We have not yet gone nose to nose with death and lost.

Two years later I meet Sherrie Martin (not her real name).

I see her on the left side of a four-bed pediatric ward, hidden somewhere inside hospital pajamas that accentuate her pallor and thin frame. Stringy dishwater blond hair nearly covers her face as she leans over a picture in her coloring book. She looks up as I enter her room. “Would you pick up my crayon?” she searches my face. I am sure she wonders what torture we plan for her, but I see no fear in her eyes. I place the crayon on her table and tell her we need to draw more blood.

Early in my training, I worked in a research lab where I regularly drew blood samples from the ear veins of rabbits. So, I come to this internship year with great confidence in my ability to place a needle cleanly inside any vein I can see or feel. Sherrie has neither, except for her external jugulars. We draw blood from those.

She knows the procedure well. On her back, drop her head slightly over the edge of the bed and gently turn to the left. Swab the right side of her neck with disinfectant. As the jugular swells with blood, slip a needle in. Sherrie remains silent. 

Draw the syringe’s plunger back very slowly. 

Withdraw the needle and apply pressure to the puncture site. Next time we’ll use the left side.

She goes back to her coloring book. 

Sherrie’s quiet stoicism becomes a legend among the house staff and the attending physicians. Consultations abound. Attending physicians shake their heads in amazement at her courage and in despair at her prognosis.

Solutions to her renal failure and hypertension are either impossible or ineffective. One long weekend I spend at her bedside, adjusting minute by minute, the intravenous dose of a medication designed to control her dangerously high blood pressure. The pressure swings back and forth, from too high to too low, and back again. Monday morning, I sign out to the resident and stumble off to bed, control no closer than when we started.

She celebrates a birthday, her tenth. It is a simple affair, with cake and a new coloring book. I’m sure it would have been much more elaborate if we knew it would be her last.

I am sad I was not there the day she died. Her autopsy lingers in my memory.

A stainless-steel autopsy table dominates the center of the room. On top of the table rests a small mound covered by a sheet. The room is unusually quiet. A young attending pediatrician attempts small talk, as though to pull us back to some reality where ten-year-olds do not die, but it seems like sacrilege. No one responds.

The pathologist, a short man in white gown and gloves, removes the sheet and begins the quiet drone of the post-mortem examination. He describes everything on the outside, then makes that terrible incision that opens her wide. He drones on, describing each internal organ. For the chief of surgery, it is too much. He groans and hurries out.

Afterward, I walk the halls. The hospital hustle offends me. Ambulances deliver the ill and injured to the emergency department, babies scream their way into the world in obstetrics, and in surgery an orthopedist drives a pin home like nothing has changed.

Back in pediatrics nurses hurry in and out of rooms, give injections, hang bottles of IV fluid, and comfort children. At the nurses’ station, the fat chart that was hers is empty. The name tag gone. I poke my head into her four-bed ward. The bed is neatly made up.

It is as though Sherrie Martin never lived.

That was more than forty years ago. Yet today, in a quiet corner of the minds and hearts of those who knew her, a small brave girl still works on a coloring book. I sometimes go there, looking for a fresh infusion of her spirit.

As I approach, she looks up with unflinching eyes. I smile and nod. She returns to her crayons.

As I stand in the doorway and watch, hardly breathing, I think of the Hempels and Sherrie Martins who make us who we are. Slowly I ease the door closed and hurry on, called by the clatter of life.

The End