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Brian Stauffer

I remember myself as a new doctor. After graduating from medical school in June 1956, I land a surgical internship on July 1 at Mount Sinai Hospital in Manhattan.

Beginner? luck: my first rotation is in the emergency room. Actually a series of rooms, all small, disorienting for me. The whole area smells of arriving tension ?everyone poised for action, like a batter expecting a bean ball. I am at the plate for the first time, hoping to see the ball, to make a diagnosis. Not to get stunned.

I am in all white except for the pink soles of my new white bucks. But inside I am green as a Granny Smith apple, not yet fit to deal with blood on a regular basis. ?m I ready??I keep asking myself. ?m I really a physician??/p>

The first day, I am fortunate. A relative lull, quiet for an emergency room. I suture lacerations, prescribe antibiotics for respiratory infections, admit a heart attack. I practice medical Spanish. No curves. I am almost relaxed. I can do this.

The second day starts slowly. Mostly I chat with a fellow intern, Dick Golinko, a smart guy who will eventually become a prominent pediatric cardiologist. He seems calmer, more settled than I ?the necessary nature of pediatricians.

Midafternoon, a siren sounds, close, introducing a young woman who has jumped several stories from her psychiatrist? office window. One look, even a beginner? glance, and I know she is in trouble.

She is listed as 30, but her face looks 50. Multiple injuries. Looks bad, an odd color, battleship gray, listing. Gray face ringed by long curly black hair, a halo of shade.

Still conscious, but woozy. Blood pressure low. I quickly consult the Merck Manual but find no reference to suicide and multiple injuries. We are on our own.

Dick and I insert several intravenous lines. Tubes go into stomach, bladder. Call for help. Get the specialists, more experienced, cooler, used to tragedy.

I wonder about the family ?has someone notified them? I consider Virginia Woolf: drowning yourself must be easier than deserting your therapist through his window. Suicide alone is one thing, not rare. But for an audience, your psychiatrist? How thick the sadness must be.

The emergency room is a crush of activity ?asking, receiving, checking, patients piling up. Its noises are important, compelling. Yet the focus now is on this one woman.

The nurses, deliberate as a snowstorm, have seen it all. For them, this is just an iteration. They watch over the tyros: they will allow no serious mistakes.

Then I see a man moving through their midst, as if from foxhole to foxhole. He slips into the curtained area where we are working. For a moment he stands, then leans, embracing the wall. Her therapist.

I wonder if he will pass out. I think his blood pressure must be teetering near hers. I pray he will sit rather than pass out and require our care.

What is in his head? In some sense, he must now be her twin, at least emotionally. How does a psychiatrist deal with a patient? ultimate gesture of rejection ?a deadly leap from the therapist? own window? I think it must be the equivalent of a surgeon failing to stop bleeding, or a radiologist missing an obvious lung cancer. No, worse.

Now she stabilizes, looks better, is moved to neurosurgery for observation and further treatment. He slips away, and I never see him again. Where does a doctor go after such an event?

After five decades, I still remember my bewilderment. The woman who jumped was not far from my age. At some time she must have made promises ?to herself and others ?about a life. She must have had hopes and imagination. I had the future; why did she try to lose hers?

In the 1950s, medical school taught us little of depression, never emphasized that suicide was a common result. And little was understood of brain chemistry, of neurotransmitters.

Now, much older, I understand that depression is a terrible disease, one that in its extreme forms can drive its victims ?however young and attractive, however rich or popular or talented ?to self-murder. In his memoir, ?arkness Visible,?the late William Styron explains the ?orrors of depression?as ?o overwhelming as to be quite beyond expression.?

The young woman had no way to express her sadness through language. Instead, she jumped.