After graduation, we former medical students, now Doctors of Medicine, entered a one-year internship where we had hands-on experience diagnosing and caring for patients in the hospital. In the first month of my internship at Mount Sinai Hospital in New York, I was assigned to the obstetrical service and was struck by how frequently one particular doctor, Dr. Blackwood, was paged on the hospital loudspeakers. While assisting in a delivery I asked the chief resident, “Who is this Dr. Blackwood? I hear his name all the time, but I never see him.”
Dr. Gold smiled, and the other nearby staff members chuckled. “I’ll introduce him to you later,” Dr. Gold said. “As soon as we’re finished here.” Later that evening, Dr. Gold escorted me into the doctors’ on-call room, where a spirited poker game was in process. I couldn’t believe my eyes: I felt like a kid in a candy store.
“And which one is Dr. Blackwood?” I asked. “And why is he always being paged?”
Another loud guffaw from everyone. I seemed to be amusing the entire obstetrical staff. Finally the chief resident clued me in:
“Do you play bridge?” he asked.
I nodded.
“You know the Blackwood convention in bridge bidding?”
I nodded again.
“Well, there you have it. That’s your Dr. Blackwood. He exists only as a Mount Sinai poker symbol: whenever there is a hand short in this poker game, they page Dr. Blackwood.”
The players were mostly obstetricians in private practice whose patients were in labor. House staff and interns were allowed into the game only when they were hard up for a player. Thereafter, for the rest of the year, when I had finished my rounds and was on call and had to spend the night at the hospital, I listened for the “Dr. Blackwood” page, and whenever I was free I charged over to the obstetrics department. The stakes were high, and interns were paid only twenty-five dollars a month (plus a free all-you-can-eat dinner, from which we made lunch sandwiches the next day—we took care of breakfast by ordering extra-large breakfasts for some of our patients).
I lost my entire salary at the poker games for the next three or four months before I got a read on the game. After that I took Marilyn to quite a few Broadway shows compliments of Dr. Blackwood.
I rotated through several services during the year at Mount Sinai: internal medicine, obstetrics, surgery, orthopedic surgery, emergency room, urology, and pediatrics. I learned how to deliver babies, how to tape sprained ankles, how to treat congestive heart failure, how to draw blood from an infant’s femoral artery, how to diagnose neurological conditions from observing the gait of a patient. In my surgery rotation I was permitted only to hold retractors for the surgeon. On a couple of occasions when I was permitted to suture the skin at the end of the procedure, the laser-eyed surgeon rapped me sharply on the knuckles with some surgical instrument and barked at me for tying “grocery-store knots.” Naturally I had the urge to respond, “Of course I’m tying grocery-store knots—I grew up in a grocery store!” But I never dared: the senior surgeons were formidable and seriously intimidating.
By sheer chance, three of my close friends from George Washington Medical School were also accepted into the Mount Sinai internship, and the four of us stayed in two adjoining rooms—we would be on call and sleep at the hospital every other night for the entire year.
While on my obstetrics rotation at the end of my first month of internship, Marilyn went into labor and Dr. Gutmacher, the department head, delivered by C-section our second child, Reid Samuel Yalom. It had been my turn to assist in the delivery room that day, but Dr. Gutmacher advised me to observe instead. Standing only a few feet away from Marilyn, I had the great pleasure and thrill of seeing Reid draw his first breath.
Public transportation from our apartment to Mount Sinai was very poor, and taxis were far too expensive. For the first couple of months I drove my car to the hospital, but after accumulating a number of parking tickets, I hit upon the idea of a motor scooter. By chance I learned of an art professor at Yale who had bought a beautiful new Lambretta, but because of a severe gastric ulcer, had been advised by his physician to sell it. I phoned him, took a train one Sunday to New Haven, fell in love with the Lambretta, and drove it back to New York the same day. Thereafter the parking problem was solved: I rode the Lambretta to work, took it onto the elevator, and parked it in my room. Several times, Marilyn and I drove down Broadway, parked the Lambretta easily, and attended the theater.
My internship offered no psychiatry rotation, but I hung around the psychiatry department and attended clinical and research presentations. One project of great interest to me involved a newly discovered compound, lysergic acid diethylamide (LSD), reputed to have psychedelic effects. Two young researchers in the department were examining whether LSD affected subliminal perception (that is, perception that occurs outside of awareness), and they asked for volunteers for a brief experiment. I volunteered. LSD had been synthesized so recently that the only known way of testing its effects was a loony Siamese fighting fish method. When squaring off for battle, the fish always assumed precise formations, and a very few drops of LSD to their water tank profoundly altered their behavior. The number of drops required to disrupt the fighting fish formation became the measure of the potency of the LSD.
We four volunteers were given LSD-laced orange juice, and an hour later sat before a large screen upon which a tachistoscope projected images so quickly that we were unable to view them consciously. The following morning we were asked to recall all the dream images we had had that night and to sketch them. I drew two types of images: several faces featuring very long noses, and a man whose legs were missing. The following day the researchers projected the same images at normal speed for us to see. One was a popular advertisement for Life Saver candy in which a tightrope walker was precariously balancing a package of Life Savers on his nose, and the other a photo of a guard at Buckingham Palace dressed in a scarlet jacket and black trousers, with the trousers blending into the background of the black guardhouse. I was amazed at these results. I had learned firsthand what subliminal perception was: I had “seen” images without knowing that I had.
At the end of my internship many vials of LSD remained, and the researchers gave them to me for personal experimentation. I, Marilyn (only once), and some fellow residents tried them, and I was fascinated by my sensory changes during the LSD trips: sound and vision were remarkably different. I spent an hour watching my wallpaper change colors and heard music in an entirely new way. I had a strange sense of being closer to reality or to nature, as if I were experiencing sensory data raw and direct with no wadding or filter in between me and my surroundings. I felt strongly that the drug’s effects were major and that it was no recreational toy. On a couple of occasions I grew frightened to realize that I couldn’t willfully turn off the effects, and grew alarmed that they might be irreversible. When I took my last sample on a November night, I went for a long walk outside and felt menaced by the bare November tree branches, which resembled the sinister trees in the Disney film of Snow White. I haven’t used it since, but in the following years, several publications appeared suggesting that the effects of LSD mimicked the symptoms of schizophrenia. After I began seeing schizophrenic patients during the beginning of my residency, I wrote an essay on major differences between the LSD experience and the psychotic experience. This piece, appearing in the Maryland State Medical Journal, was my first published article.
The internship year was transformative: by the end of twelve months I had assumed the identity of a physician and acquired some degree of comfort dealing with the great majority of medical conditions. But it was also a brutal year with long hours, little sleep, and many all-nighters.
However, as exhausting as my 1956–1957 internship year was, Marilyn’s year was even worse. Uncommon as it was at that time for women to pursue doctorate degrees, she and I had always assumed that she would become a university professor. I knew no other married woman with such plans, but I always felt she had an exceptional mind, and her decision to pursue a PhD seemed natural to me. While I completed my last two years of medical school in Boston, she obtained her master of arts in teaching from Harvard, specializing in French and German. As soon as I was accepted for the internship at Mount Sinai in New York, she applied for the PhD program in the Columbia University French Department.
Marilyn’s interview with Norman Torrey, the formidable chairman of the Columbia French Department, remains part of our family lore. Professor Torrey glanced at her eight-month pregnant abdomen with wonderment: he had probably never before seen a pregnant applicant. And then he was even more astonished to learn that she also had a one-year-old child. In an apologetic tone, Professor Torrey pointed out that financial aid required the student to teach two courses and take four, suggesting the interview was at an end. But Marilyn instantly replied, “I can do that.”
A couple of weeks later, his letter of acceptance arrived: “Materfamilias, We have a place for you.” Marilyn found some childcare and plunged into the hardest year of her life. I had the compensatory blessing of comradeship with my fellow interns, but Marilyn was entirely on her own. She took care of our two children, with some help from a housekeeper and almost no help from her husband, who was away every other night and every other weekend. Thereafter, Marilyn always considered this year the hardest one of her life.