HEAVEN AND HELL, by Carl Douglass, the retired neurosurgeon turned author, finds young Garven Wilsonhulme back in Arizona because he cannot return to Stanford with any degree of peace of mind. His financial straits require him to room with his alcoholic high school classmate and two other semi-literate Neanderthals who live in a dilapidated, cluttered, and uninviting apartment. They get him a job at the Union Pacific Railroad trucking docks where the law of fang and claw is in force without any gentlemanly niceties. Once again, the small man from Cipher has to fight for his spot. He manages to visit his long-neglected mother, to ride the red-rock hills with his old nemesis and friend, an apache Indian, and to have a serious and life-changing conversation with his ailing adoptive father. With the help of Dr. Wilsonhulme and his two professor friends from the University of Arizona, Garven makes a critical detour in his university career. He has to say a little insincere prayer that his run-in with the Stanford psychology professor will never come to light.
He finishes his undergraduate education with honors at the U of A without the temptations to get involved in childish pranks but not without the considerable angst that goes along with being a pre-med student who will succeed no matter what the cost to himself or anyone else he can use or who gets in his way. The school is like his brawling work, except the opponents are more subtle and use better language. Garven is momentarily distracted by the seductions of working in a car parts department and by the owner’s daughter, both of which he determinedly rejects, just as he decides not to follow the glory trail of working to conquer communism in Washington D.C. for Senator Joe McCarthy. Back on track, he applies to numerous medical schools and is rejected by most of them, and cannot afford some which do accept him. Finally, he gets his acceptance into the Arizona Faculty of Medicine beginning in 1952.
On his first day of orientation into the class of 1956, the dean of the medical school gives the freshman students an admonition:
“Medicine is a jealous mistress. She will require that you choose her over wife, children, church, community, or personal pursuits. If you cannot give her what she needs, this is the day to recognize that in yourself and to quit. Go on to something easier and more fun. Be a Renaissance man or woman, be an artist, a Thoreau, a business tycoon. You will not be a doctor. Save yourself misery, and the profession shame.”
It is worth a quote from HEAVEN and HELL to understand what the first day of medical school and the first class of the day, Gross Anatomy, is like:
“The smell was sickening and pungent…For many students it was the first time they had seen a dead person…Garven inhaled a deep breath and pinched himself hard enough to raise a visible welt to make sure he would not faint. All around him there were pale green faces…One of the men in the group turned ghastly white, took two steps backward and fainted into Dr. Yosobuchi’s arms…
“Kind of looks like roast beef, doesn’t he?” Garven said to Maria.
Elijah David whispered, “Kinda does, all right. Doesn’t look kosher,” he grinned.
Brent said, “Hey, lay off. Nothing about this reminds me of food. I don’t know what restaurant you’ve been getting your roast beef at, but let me know; so, I can keep clear of it, Garven.”
Thus chastened, Garven makes it a regular practice to eat roast beef sandwiches for lunch while he and his lab-mates dissect their cadaver. The daily grind consumes the lives of the students, and half of them are gone by the time the class limps its way to graduation. They immerse themselves in an ocean of arcane and crucial facts, endure exhaustion and humiliation, and carry out some classical medical student pranks. Garven cannot resist and, once again, is the ring leader of several, such as putting an amputated penis into the lab coat of a visiting student from the community.
The need for money takes on grim overtones. Garven works as a lab assistant for a biochemist and runs afoul of the director of the lab. He gets a job as an assistant to the county medical examiner. Because the ME’s office is so swamped, he does autopsies by himself to which the ME’s signature is affixed. He obtains a student loan at a usurious interest rate. He lives on two meals a day, mostly stolen from the hospital. He gets seriously behind on his rent. Finally, in his copious free time, he takes on a second job. Who needs to sleep, anyway?
That job becomes the catalyst for his future. He becomes a lab assistant to the med school’s new neurosurgeon and has an epiphany: he determines that he will be a neurosurgeon after developing a serious case of hero worship for the icily calm and proficient brain surgeon. Thereafter, Garven encounters his hero in a variety of serious situations and becomes increasingly impressed with the man and his specialty. Garven Wilsonhulme also begins his career-long interest in academic research and a soaring ambition to become one of the princes of academia.
The clinical years, 1954-1956, are Garven’s first encounter with the realities of caring for living patients, and are full of the stuff of fear, pathos, depression, and exaltation. He learns to be a doctor and loves all of it. Garven makes mistakes and becomes the subject of public criticism, and he has small triumphs of one-up-mans-ship which keep the spark of his ambition going. He meets death and untreatable disease head-on. Among the lessons he learns are the fact that he is not built to be anything but a surgeon. The mundane lives and passions of the “swamis”—internists—are more than the budding surgeon can endure, and he develops all of the prejudices of the “real doctors”—the surgeons.
In his new job as an extern in a local private hospital, Garven comes face-to-face with the grim specter of a grossly malformed baby about to be delivered. What he and the attending physician do shock him to his core and make him question his own and his chosen profession’s ethical base. Later on in his obstetrics rotation, he runs afoul of the influential chief of the service and starts what will be a smoldering feud with a powerful adversary. The second time he runs afoul of the chief’s rules come when he delivers a baby in the mother’s kitchen in a Phoenix slum. He makes an incision that is not the traditional sort required by the chief and has to pay penance for the rest of the rotation. A strong mutual dislike colors his relationship with the unforgiving professor.
“Young man,” Dr. Caesar said, “you are at strike two. I will personally monitor your progress. One more foul-up, and I will recommend that you repeat your tour on OB. Now get out of my sight.”
And Dr. Caesar does everything he can to make Garven’s life a daily hell. The maltreatment only comes to an end when Dr. Caesar delivers a fetal monster and ends its existence before it can destroy the lives of its parents. Knowing that Garven is a witness makes the senior obstetrician relent, and the two men share a secret that Garven tucks away to use another day.
Lack of money becomes a deciding factor in Garven’s career and threatens to end it before it can really begin. It is a serious but necessary financial drain for him to visit hospitals where he might become an intern. He discovers a secret room in the hospital where he can live rent free and steals food from the trays of patients too sick to eat in order to keep his own body and soul together.
At this critical juncture of his life, he meets the daughter of the richest man in Arizona; and, despite her psychological issues and lack of real beauty, he woos and wins her as the answer to his otherwise insoluble financial woes. Her father has seen a string of gold-diggers come and go in their quests to marry into his fortune and determines to get rid of Garven as the latest in the line of dishonest suitors. In the dramatic last scene in the book, the antagonistic prospective father-in-law offers Garven an insulting, but huge bribe—one that could cure the young man’s every financial ill. For Garven, it is extremely tempting; but he is playing a much higher stake game of social poker. He defies the important businessman by refusing the proffered check and holds on to it to show his fiancé.
The author, Carl Douglass, ends Book Three with these sentences: “It was a colossal bluff, the most audacious of his young life. Emotionally, Garven was somewhere in a place between heaven and hell.”
-Paul Olson, M.D., F.A.C.S., Ophthalmology