But was this just a myth, used to liven up the image of a place known more for death than for procreation? Or was sex somehow inextricably woven into the tapestry of medicine? Intrepid journalist that I am, I decided to become a doctor and find out for myself.

What I’ve discovered is that there are many reasons for having sex, with love being only one of them. Of course, this is true everywhere. But not every work environment actually provides private bedrooms for its employees.

So what does the hospital do to people to allow their subconscious desires to make the jump to actual events? What effects does the hospital environment have over people’s sexual behavior?

One effect of working in a hospital is a feeling of helplessness mixed with frustration. Sometimes patients are simply too sick to live, despite everything medicine can offer. Just because you sit with a patient for eight hours, titrating three I.V. drips of heart-pumping medications on a minute-to-minute basis, doesn’t mean that she will survive. And as her heart rate decreases and her life slowly and steadily slips away before your eyes, there comes a sense of helplessness from knowing what’s happening to every single molecule in her body, yet not being able to do a damn thing about it.

Of course we know, intellectually, that it’s not our fault. But nonetheless, there is the lingering feeling of failure, the feeling that you could have somehow done something more. And it builds up within you over weeks, months and years.

Any adult knows that sex is, in fact, the best way to relieve frustration, with masturbation a distant second. Furthermore, it serves as an excellent means of taking control of some part of one’s life. When everything else around you seems to be falling to pieces, the ability to choose another person and experience intimate physical proximity with that person is a great reminder that you are still able to affect at least some of the daily events in which you are involved. These events were frequent for a tall, square-jawed resident I once knew, who was uniformly lusted after by every young nurse in the hospital and some older ones as well. After his first few distressing weeks on the wards, it became well known that if you caught him at the end of a bad day, especially one in which he had lost a patient, you could coax from him a trip to the call room. In fact, the nurses even began to send spies down to the E.R. on busy afternoons, just to see how he was faring.

Perhaps only God, and maybe some of the janitorial staff, know how many nurses he knew in the biblical sense. He certainly had our support, though no one had the foresight to keep count. Nevertheless, there he always was, with a freshly pressed shirt and chipper smile bright and early the next morning. And if the previous nurse of the day was working, too, there was never any sign of the tryst that may or may not have already been forgotten. And that’s how it went for three years.

The second reason for the prevalence of hospital sex is tension. The pressure of constant decision making, where the result often is a life-or-death situation, generates a great deal of stress. But rare is the time when you can simply go home and let it out at the gym, or on a neighbor’s dog, because most of your waking hours are spent in the hospital, and punching dogs is illegal. And as any good chef knows, too much time in a pressure cooker and your stew is bound to blow.

This is especially true in surgery, where death hangs as loosely and easily as the sterile drapes over the patient. The individuals in my friend’s large university surgery department have solved this problem by blowing their stew at the end of every academic year in an epic, Romanesque three-day orgy. At the end of June, they rent a suite of rooms at a downtown hotel, and the surgeons and nurses simply drink and have sex until passing out, waking only to repeat the process again. Rank plays no part, and there’s no yelling at underlings for incorrect technique. The event is simply a release of the kind of tension that builds up over an entire year of having people’s very lives in their hands.

And when the three-day explosion is over, everyone returns to the operating room to work side by side for another year, to collect 52 more weeks of stress individually before letting it out again together.

A third striking effect of the hospital is boredom. A hospital is one of very few work environments in which people are forcibly confined to the building all night, whether there’s anything to do or not. Often, when the patients are asleep and the E.R. is quiet, doctors and nurses find themselves sitting around, just waiting for something to happen.

Of course, there are many ways of passing the time — reading, crossword puzzles, Game Boys. And sometimes, when the floor is empty, when there’s a bedroom right down the hall that only you have the key to and when one of your co-workers shares with you a mutual attraction, there doesn’t seem to be a reason in the world not to disappear for a few minutes.

Of course, it’s vitally important to keep your pager and your wits about you when doing this, lest you end up like one now-famous resident who not only showed up to an emergency code late but arrived unzipped and unbuckled.

The fourth, and perhaps most important, feeling generated by the hospital is understanding. Simply because of the specialized nature of the job, a nonmedical person, no matter how hard you try to explain it to him or her, will never truly understand what we go through in a day at work. It’s not that someone couldn’t comprehend it; it’s just that the emotions, the proximity to illness and death and the feeling of never knowing exactly as much as you think you should even when others are depending on you for their lives are an experience unique to medicine. And as much as one wants one’s girlfriend or husband to understand exactly what it is one goes through, short of sending them through med school, the loved one simply never will.

Furthermore, many doctors spend more time at the hospital than at home — they sometimes get to know the staff as well as or better than they know their own families. And when you finally do get to spend time at home, you often don’t feel like recounting every single thing that happened at work; sometimes, you just want to leave it all behind.

But co-workers, who are there with you every minute of every day, not only understand but are going through the same events and sensations, often right by your side. That creates a very strong bond, because you share a connection that doesn’t need words or explanation.

A resident I knew loved her boyfriend so dearly that it became legendary. We used to hear about this guy so much, we felt we were not just friends with him but that we’d grown up with him. Every year, I still remember his birthday.

But one day this resident found herself in the rare situation of running a code on a young overdose patient who, if the code was successful, would actually have a good chance of continuing on with a normal life.

The code lasted almost an hour and a half, 90 minutes of frenzied pumping, injecting and shocking. But no matter what the resident did, the patient’s systems were just too depressed, and as the effects of each injection wore off, he would once again continue his slow, inexorable descent toward death. Finally, despite innumerable electric shocks to his heart and what seemed like gallons of excitatory medications, the patient died, with the resident still thrusting rhythmically on his chest.

Her shirt was soaked through with sweat. Wayward strands of hair fell everywhere, some plastered to her face with what might have been tears. She took several long, deep breaths, straightened herself up and slowly walked from the room, motioning for one of the male respiratory technicians to follow her. They disappeared down a hallway and into the call room, from which a soft symphony of creaking ensued.

Ten minutes later she emerged, posture erect, hair combed, and went back to work. Not a word was ever breathed of the incident again.

Now, I don’t mean to give the impression that the hospital is a den of sin, threatening to turn anyone who looks back at it into a pillar of salt. Plenty of people are able to work there, day in and day out, without causing an overflow in the obstetrics ward or a backlog in the STD clinic.

Sex is a daily, undeniable part of everyone’s life, even if only in our thoughts. It just happens that the hospital, a building and a culture that are unparalleled in our civilization, creates in us a unique set of pressures and emotions that every once in a while pushes sex from our thoughts right into our actions. Just as I learned so long ago on TV.

“No,” she replied. “I feel much better
now,
doctor.” I smiled glassily. That’s
what made me hate
this so much.

“Mrs. Brown,” I began, shuffling jerkily
toward
her bed. “I need to ask you something.”
Her smile
bade me continue. “Now, we think you’re
going to do
just fine and I don’t think anything bad
is going to
happen. We know what’s wrong and we
know how to treat
this. I think everything’s going to be
absolutely
OK.” For just an instant I could see
the smile
waver. She sensed a “but.”

“But if something should happen. Well,
I mean,
more specifically, if your heart should
stop beating,
such that we would need to start
compressions and
maybe even shock you, like on TV.” The
smile was
definitely gone. “Not that I think
that’s going to
happen. Not at all.” I found my gaze
drifting down
to the floor.

“Or if you stopped breathing for some
strange
reason, which I also don’t think will
happen, and
needed to be put on a breathing machine
which we may
never be able to take you off of.” I
forced my eyes
back to her face. It was wrapped in
confusion and
increasing dismay.

“Are these things you would like us to
do?” I
asked, handing her a blue mimeographed
piece of paper.
“Because if you don’t, I’ll need you to
sign this.”
She started to read, then stopped.

“What does this mean?” she asked. “It
just says
DNR/DNI.”

My internship mainly consisted of one
uncomfortable episode after another.
Informing people
of a loved one’s death, dealing with
difficult
patients and staff and being vomited
upon were,
unfortunately, rather common
occurrences.

However, the most disquieting part about
internship for me was meeting each new
patient, reassuring him that we had
state-of-the-art
facilities and were going to work very
hard to get him
better, and then asking him to sign a
waiver saying
whether or not he would desire treatment
in case his
heart stopped or he couldn’t breathe.

As the member of the medical team who
knew the
least (except when we had med students
on the team,
and even then it was a tossup), it
always fell to me
to perform the delicate task of
discussing do not
resuscitate/do not intubate orders. It
was a job I
feared.

After all, patients are admitted to the
hospital
either for a new and scary disease or an
old familiar
one that may finally be getting the
better of them.
It takes a lot of work to calm them down
and make them
feel safe, which is not just nice for
the patient but
can actually affect the course of their
hospitalization. And once this tenuous
bond of trust
is forged, about the best way for a
doctor to screw it
up is by asking a patient if, in the
scariest of
situations, they’d rather have us help
them, or sit by
and watch.

That’s what I had to do, usually about
seven times per night when on call, two
times a day
otherwise. One would think that I’d get
good at
it, or at least not have it make my
hands sweat and my
voice shake.

But one would be wrong.

Still vivid in my memory is Ellen
Greenwood, an
87-year-old woman who weighed no more
than 70
pounds. She was dying of stomach
cancer, and there
was nothing that could be done other
than try to make
her comfortable and see if she’d make it
through this
episode of internal bleeding. The
prevailing thought
was that she would not.

When I sat there on the nearly empty bed
with her
at 2 a.m., though, seeing her shivering
beneath four blankets, scared to death
that she’d
never see the outside of a hospital
again, I simply
could not bring myself to bring up the
DNR/DNI form.
I knew that without it, we would be
legally bound, in
the case of an emergency, to perform
heroic action for
as long as it took until she was
absolutely,
undoubtedly dead. But I also thought
that discussing
the possibility of her heart suddenly
stopping or her
breath no longer coming to her could
cause her to have
a heart attack right there on the spot.
So I held
off. She’d at least make it through the
night, I
thought.

At 5:20 that morning, my beeper went
off.
Terrified in the way that I always was
when being
awakened by a loud noise, I looked at
the call-back
number and recognized the sequence for a
“code.” I
jumped out of bed, trying to recall who
was in room
1102. But when I arrived to see 11
respiratory
technicians, nurses and doctors in
frenzied activity
around what looked like an empty bed, I
remembered.

“What happened?” I asked my resident
breathlessly.

“A-fib,” she replied, never stopping the
rhythmic
compressions she was applying to Mrs.
Greenwood’s
chest. Atrial fibrillation — her
ventricles were
squeezing in a random, uncontrolled
pattern that would
not push blood through her body. I took
my place at
the head of the bed.

With some help from the respiratory tech
I got
the breathing tube into place, right
between her vocal
cords, and started pumping air through
it with
rhythmic squeezes of the big, blue
oxygen bag. Air
movement could be heard on both sides of
the chest, so
we knew she was getting the oxygen she
needed. Now
all she needed was blood flow. Her lips
had turned a
purplish blue.

“What’s the story?” I looked up to see
my
attending, clearly still half asleep
despite his drive
in from home, taking up most of the door
frame.

“Eighty-seven, advanced unresectable
stomach
cancer in a-fib,” replied a nurse,
filling the last of
six vials with blood that was to be
rushed down to the
lab.

“Does she want this?” he asked as a
portable
X-ray machine the size of a tractor
dislodged him from
the doorway. Another nurse shrugged.

“No orders,” she replied, and injected a
syringe
full of epinephrine in hopes of getting
the heart back
into a synchronous rhythm.

The next 30 minutes involved a set of
clearly
futile activities surrounding Mrs.
Greenwood, not the
least of which was my attending
screaming at me the
entire time that so help him God, if I
ever forgot to
discuss DNR right when a patient was
being admitted
again, I’d be cleaning up the
colonoscopy suite for a
year. I didn’t forget.

Of course, the odds wouldn’t have been
bad that
Mrs. Greenwood would not have signed
such a waiver.
Most patients watch people getting
healed by electric
shock and miraculous injections on TV
all the time.
What my attending really meant wasn’t so
much that he
wanted me to get my patients’ opinions
as that he
wanted me to convince those people who
were very, very
sick to sign the form and give away
their right to
heroic measures.

This bothered me for quite some time.
After all,
the purpose of a waiver form is to give
the patient
the option of accepting or declining.
With my white
coat on, I knew I could sway the
patient’s opinion
whichever way I wanted, and that made me
feel
uncomfortable.

But as the year went on and I continued
to
outgrow the old shoes of the med student
and began to
fit into my new ones as a doctor, I
realized
that this was not an issue of me forcing
my opinion on
somebody, but rather me making just
another of what
would be dozens of clinical judgments on
each
patient. And after all, as a doctor,
that was my job.

So as my internship wound down, I still
found a
heavy feeling in my stomach and beads of
sweat on my
forehead every time I broached the
subject with a new
patient. But I did come to take a more
active role
as a patient advocate, by giving my
professional
opinion as to whether it was likely that
resuscitation
and intubation would be helpful or
whether they would
artificially prolong a life that had,
for all intents
and purposes, ended.

On one of my last on-call nights I
admitted a frail
83-year-old man who had suffered his
second mild heart
attack in two weeks. He was friendly
and outgoing and
talked to me of his great-grandchildren
for quite some
time before I decided to pop the
question. If his
heart stopped beating or he couldn’t
breathe, did he
want us to take every measure we could
to get him
going again, even if it meant being on a
ventilator
the rest of his life? He was very sick,
I reminded
him. I had checked his EKG, and it
showed a very
ominous pattern. He was in extremely
poor health. He
paused and thought, for only a moment.
“Why yes, of
course.”

I explained that we would be giving him
a lot of
good medications, but that he was too
old and had too
much kidney disease to allow us to
perform surgery.
If the medications didn’t work, he would
die anyway,
since they were his only option. If he
started to die
and we revived him, he would still be
left with only
the same medications, but he would be
hooked up to
machines, totally incapacitated. Was he
sure he
wanted that?

This time he thought for a while longer.
I
provided a firm, reassuring nod each
time he looked at
me. After quite some deliberation, he
finally let out
a long, low sigh, and nodded his head.
“OK,” he
said. “That’s fine.” He signed.

I wasn’t convinced that it was fine with
him, but
I knew it was right. The odds of him
making it
through resuscitation to live any kind
of life
thereafter was unbelievably small.

Several days passed, until one afternoon
my
beeper called me out of a lecture.
“It’s Mr. Weiner,”
the nurse said. “He’s failing.”

My heart sank. In the past few days I
had grown
to like this old man immensely. He had
once worked at
NASA, and was there for the original
flight into
space. He had been married to the same
woman for
53 years.

I ran up to his room in intensive care
and got
there to find it empty except for a
nurse watching his
monitor and the thin, frail man on the
bed.

“Mr. Weiner,” I said, pulling a chair up
next to
his head. “How do you feel?”

“I pushed 60 of lasix,” to try to rid him of some of the extra fluid collecting in his lungs, the nurse
reported. Mr. Weiner
simply shook his
head.

His heart, weakened by the heart
attacks, was no
longer able to push the blood around his
body. It had been trying to make up for
it by beating
faster, but the muscle had clearly tired
out, and
there was little else we could do. I
checked the rate
of his IV medication, designed to make
his heart pump
as forcefully as it could. It was
dripping out as
fast as possible. There was nothing
left to do.

I watched as he lay there alone, his
face pale,
looking even older than his 83 years.
His
wife was dead, and his son was on his
way in. Other
than the ever-slowing beep from the
cardiac monitor,
everything was quiet.

I watched for half an hour, then an
hour, as his
heart gradually wore itself out. The
medicine wasn’t
working. There was nothing I could do.
He kept his
eyes closed and didn’t talk, saving
every ounce
of energy to keep his heart going. But
it was a
losing battle.

I continued to watch, but could only
think of one
thing. I could push his heart for him.

It would circulate the blood to his
body, and
give his heart muscle time to rest and
recuperate. It
wouldn’t have to be for long, but it
would give him
enough time to build up more strength.
I knew inside
that it wouldn’t matter — his heart
would just tire out
again, half an hour later. It would
only prolong the
pain. But as I sat there and watched,
saw the lines
of pain slowly creeping across his face,
I couldn’t
think of anything else I could do. I
squeezed his
hand, and he opened his eyes to slits.

“Mr. Weiner,” I said softly. “I can
call a code.
We can do compressions and make your
heart beat for
you.” He didn’t answer. “I know you
signed the
waiver, but if you tell me to do it now,
we can have
it going in 30 seconds.” The eyes
closed.

I waited as the lines on his face
crinkled an
extra bit in thought. I wished he would
hurry, before
it was too late. The beeping on the
monitor was
getting slower. I needed an answer.

“Mr. Weiner?” I asked, leaning over him,
almost
ready to shake him to get an answer out.
He opened
his eyes again, this time all the way.

“Mr. Weiner?” He looked at me for a
moment, and then slowly,
ever so slowly, shook his head no.
After another
moment, he closed his eyes once more.

I sat back down and held his hand. The
beeping
grew slower still. Then I heard a new
sound, like a
box whose hinges needed oil being
opened. I looked,
and his mouth was ajar. I leaned
forward.

“Thank you,” he whispered, and closed
his mouth
once again. I watched as the lines of
his face
settled back into their natural pattern.
Ten minutes
later, he was dead.

Every decision a doctor makes has the
potential
to be emotional. As someone with
many years of
training in exactly the right measures
to take in each
specific situation, I have worked hard
to make the
unemotional, “correct” decision. But as
a human being
who often comes to genuinely like his
patients, it is
easy to let my emotions take over.

Although people want to be liked by
their
doctor, the reason they go to him, in
the end, is so
he can make the correct decision — the
rational one.
Though only he knows, I believe that Mr.
Weiner
appreciated the fact that he was not
surrounded by
tubes and machines and yelling and
frenzied activity
at the end. He was glad to die
peacefully. Despite
the minuscule chance it would have
worked, he was
happy I had convinced him to become DNR.

I still think about Mr. Weiner from time
to time.
Not because he was funny or because he
was brave or
because I knew him very well. I
remember him when I
find myself afraid to discuss some
delicate issue with
a patient or when I am about to do
something
motivated more by emotion than by
rational thought.
That’s when a doctor or, really, anyone,
I think, can
start to get into trouble.