Sunday, June 29, 2014
Back in the day, that is the distant past of 1985 the word “Internship” could fill a medical student with anxiety and stress. The internship was a rite of passage, a necessary stop on the road to becoming a full fledged, finished doctor, rather than a person with a couple of initials after his or her name.
And, the surgical internship was supposed to be the worst: thirty six hour shifts, every other night call, holding retractors for hours without a break, this was the plight of those of us who chose to pursue the surgical arts. It was a period of initiation which led to joining an exclusive fraternity called “Surgeon.”
I have to report that, at least for me, my internship was nothing like this. I was in a large private hospital where there was no “scut” work, the name given such mundane tasks like drawing blood, starting IV’s, doing EKG’s and such. These duties are important to patient care, but do little to advance the knowledge of the medical trainee. I do think there is some value in learning to draw blood and start IV’s, but doing my own CBC’s or urinalysis would have been a waste of my time.
All this being said there were days when the work was never ending and there was one day in particular which stands out as a shining example of what an internship can be.
It was during my final month, a month I spent away from the safe confines of my mother hospital and its friendly IV, EKG and phlebotomy teams; thus the aforementioned “scut” work still plagued the lowly intern. I finished out my intern year rotating through the Pediatric Surgical Service at Children’s Medical Center (CMC) in Dallas. This included responsibility not only for CMC, but also Parkland Hospital, the county hospital for Dallas. I was paired with a fourth year resident as well as interns and residents from the program at UT Southwestern. We were responsible for all the pediatric surgery which included elective surgeries, trauma, the Parkland Emergency room, surgical consultation for pediatric patients in both hospitals and, finally, the nascent Pediatric Liver Transplant program.
The intern’s duties included: history and physical on all admissions, morning rounds which commenced around 6:00 am, drawing blood on all the liver transplant patients which needed to be done before morning rounds, assisting in surgery, afternoon rounds, making sure all tests that had been ordered were done and being the first to respond to any emergency that should arise throughout the day. In between all this we all hoped to find the time to actually do some surgery, the occasional appendectomy or a hernia, remove some lumps and bumps and so on.
There was a day, an unforgettable day which snuck up on me about two thirds of the way through the month. It was a Saturday which started like every other day. I arrived early enough to help the intern coming off call draw blood on the liver transplant patients and to check on my other patients before the fourth year resident arrived and formal rounds began. So far, so good.
Round and round we went, from Children’s Medical Center, to Parkland, which included a brief stop in the newly minted, but as yet untested, Pediatric Trauma Unit. There was a post op appendectomy, the previously mentioned post liver transplant patients, including little Terry. Terry had received her new liver four days ago, but was still looking green. We were all concerned that something wasn’t right. Diagnosing and treating her was priority number one for this Saturday.
“See if Radiology can do an ultrasound of Terry’s abdomen with Doppler to check her hepatic artery,” the Transplant surgeon attending commanded.
“Yes sir,” the fourth year resident agreed.
Rounds ending, this fourth year resident, who aspired to be a Pediatric Transplant surgeon, which meant an unusual amount of groveling and brown nosing of the Attending staff, turned to me and gave me the job of tending to all of Terry’s needs.
It was seven a.m. and the proverbial shit was poised to hit the fan. I started at the top of the scut list and ran down to Radiology to request the stat ultrasound on Terry. I checked the requisition up and down and front to back, made sure all the t’s were crossed and I’s dotted and ventured in to find the senior radiology resident. I finally found him hidden away in the dark, which is the usual place to find Radiologists, the vampires of the medical world who shun all light and live in shadow. I begged and pleaded and convinced him of the urgent need. I have to admit I almost brought tears to his eyes as I related the “Plight of Baby Terry.” The ultrasound was scheduled stat.
One task settled I moved on to the daily, mundane chores an intern battled. In those days, before computers, I gathered lab results and X-Ray reports and started writing my progress notes on each patient. It wasn't too long when I received the first of many "rude" interruptions.
"Dr. Gelber," the sweet voice called, "we've got a premie down here in NICU with a distended abdomen and the KUB shows pneumotosis."
A bothersome, but ocassionally disastrous NEC watch. One more thing to complicate what was turning out to be a far from peaceful Saturday.
What, pray tell, is "NEC" watch?
NEC stands for Necrotizing Enterocolitis. This is a condition which most commonly arises in premature babies. Whether from ischemia, or infection, or some other unknown agent, the neonate becomes very sick. The child cannot be fed, they demonstrate signs of sepsis and their condition can deteriorate before your eyes.
I made my way to the NICU and took a look at baby girl Nicole born at 28 weeks and now sporting all the findings one would expect in early NEC, distended abdomen, mild tachycardia and an abdominal X-ray which revealed an area of “pneumotosis intestinale” which means air in the wall of the bowel. I communicated my findings and assessment to my fourth year resident, specifically that baby Nicole could be watched, tube feedings were put on hold and she was to start on IV fluids and antibiotics.
One crisis stopped before it started, I hoped.
I had just hung up the phone with the my senior resident when my beeper went off.
Parkland ER. Just great, what now?
“You are the surgery intern on call today?” asked the voice form the ER.
“This is Dr. Gelber, I am on call today.”
“This is Dr. Barry. We’ve got a seven year old who we think has appendicitis. Do you think you can come check him out?”
“OK, I’ll be there in a little bit.”
I took the time to write a couple of progress notes on the patients I’d seen earlier in the day and then made my way through the tunnel which connected Children’s Medical Center and Parkland. It was like moving from one world to another.
CMC always looked new and clean. It was a place I would want to bring my kids if they were ill. Parkland, although not dirty, looked older and worn, a spot which looked beaten down by years of caring for the sickest, most severely injured patients Dallas could offer.
I found Mikey in the pediatric ER accompanied by his worried mother. He had been sick for three days. From the door way it was obvious he was ill. He lay still on the exam table, his face was flushed. The bedside chart listed Vital signs: heartrate 130, Temp 103.1, blood pressure 86/40, Respirations: 20.
A typical history for appendicitis was obtained and a gentle tap on his abdomen elicited a grimace and wincing that screamed “PERITONITIS.”
I called my senior resident again and schedule Mikey for surgery. My beeper went off again: call the transplant floor.
“Terry needs to go for abdominal ultrasound now. The Radiologist is here and you need to bring her,” the unit secretary informed me.
Four years of college, four years of medical school and almost a year of internship and I’m still just a glorified orderly.
“OK, I’ll be right up.”
I left orders for Mikey and called the OR and told them I would call when we were ready for surgery. One good thing about Mikey and most patients with appendicitis was that an appendectomy was an intern case, so I would get to do the operation. I hustled my way back to CMC to wheel little Casey to ultrasound. On my way my beeper went off again and again and again.
“Michelle has a temp of 102.”
“Michelle who?” I inquire.
“Michelle S. in 204, She had a liver transplant ten days ago.”
“Oh, that Michelle. Get a UA, draw two sets of blood cultures and a CBC. I’ll be over to check her shortly.”
“Are you going to come draw the blood?”
“Yeah, OK, I’ll get to it as soon as I can.”
“IV is out on Darren in 331.”
“He had an appendectomy two days ago.”
“Is he eating?”
“Clear liquid diet.”
“Is he on any meds?”
“Ampicillin, Gentamicin and Clindamycin.”
“No fever for twenty four hours.”
“Was the appendix ruptured?”
“How should I know?”
I looked at my sign out sheet. No mention of how bad the appendix was.
“OK,” I finally answered. “Could you please put everything at the bedside and I’ll be there when I can.”
And the third call:
“Dr. Gelber, Scott in 320 has a headache…”
Finally, something simple.
Now, onto the Transplant floor and little Terry. She was very small for her age and her skin was green because of her liver failure. Even after her transplant she stayed green and now she had fever. Everything said her new liver wasn’t right. But, the question remained: Was it a technical problem? Or rejection? Or infection? Thus the ultrasound and Doppler of her hepatic artery which would start to provide some answers, we hoped.
The nurses already had her loaded up on the stretcher. We began wheeling her down the hall to the elevator. She gave me a weak smile. Father and Mother trailed behind us talking in whispers. Terry was four days post transplant. I knew her fairly well and was very well acquainted with the veins of her right arm where I drew her blood every morning. Her mother was only worried, while her father seemed to mix his worry with distrust, as if the Transplant team was somehow conspiring to harm his little girl.
The Radiologist and the Transplant Attending were waiting for us. The ultrasound clearly demonstrated a patent hepatic artery and we brought Terry back to her room. On the way my beeper went off again. It was my Chief resident. It was a good time to do the appendectomy on Mikey. I called the OR and met the team in the ER and we wheeled our patient up to surgery.
With my Chief across the table from me I started the surgery. This was the final month of my internship and I was pretty adept at appendectomies. I delivered the offending organ, which was ruptured, and completed the surgery like a pro. No sooner had I tucked Mikey into the Recovery Room when my beeper went off again. Terry was crashing.
I raced through the tunnel and up the stairs to her bedside. My Chief was right behind. Her nurse wasted no time informing me that an ICU bed was ready. Terry was barely responsive, her BP was fifty over zero and she looked even greener. I scooped her up in my arms while her father stood behind me, screaming.
“If she doesn’t get better, you’ll never work in this city again,” he shouted. I think he would have punched me if he had the chance.
Meanwhile I laid her in the ICU bed. The Pediatric Anesthesiologist was standing by and deftly intubated her while the nurses opened up her IV and gave her a bolus of fluid.
“Rejection,” the Transplant Attending decided.
Terry was now functioning without a liver, more or less; her transplanted liver was causing more harm than help. She was placed at the top of the list so that the first ABO compatible liver that came available would be hers. Her father came in and stood at her bedside, glaring at me while I stood at the foot of the bed staring at the monitors. Her BP was better at 70/40 and her oxygen saturation was 100%. Still, she wouldn’t last long without a new liver.
It was early evening now and I finally had a few moments to catch up. I finished my charting for the day, drew some overdue blood tests and started a few IV’s which had been waiting for me. I was about to have “breakfast” when my Chief called me.
“A two year old girl is on her way by helicopter to the Trauma ICU. She was accidentally run over by her father.”
A minute later the call came. I was already on my way.
A crowd of nurses and paramedics surrounded the stretched as Christina was wheeled inside.
“BP 60/30, heart rate 125, O2 sat 100%,” a nurse screamed.
Two clear but terrified eyes stared up at me as my Chief arrived just behind me. Christina was awake and alert and breathing comfortably. A quick survey revealed bruising across her lower abdomen and pelvis and blood staining her diaper. There was obvious deformity of both legs.
Two distraught parents waited outside as the trauma team went to work. New IV lines were established and fluids administered. Blood was drawn for the blood bank and baseline lab tests. Antibiotics were given, oxygen administered. We did a quick peritoneal tap which was negative. Her vital signs were holding steady.
X-rays revealed a fractured pelvis and bilateral femur fractures. Her chest X-Ray was normal.
The OR was standing by and at 8:57 pm surgery commenced. My job, as intern, was holding retractors as the Attending and Chief Resident began the task of putting her lacerated perineum back together. Her vagina was torn down the middle and there was a small laceration of her rectum. Her fractures were to be treated without surgery, at least at this time.
The surgery dragged on, past nine o’clock, past ten o’clock, past eleven o’clock. All the while messages came, baby A needs a new IV, Mikey has a fever, Terry’s urine output is low and on and on. As midnight approached I began to feel a little dizzy. I sensed my heart was racing and I remembered I had not eaten anything all day. I concluded my blood sugar was probably around forty. I asked the OR circulating nurse to get me some orange juice.
The nurse found some apple juice and fixed it up with a straw and managed to get it into me. A few minutes later I was back among the living as the sugar filled my bloodstream. I was able to continue my relationship with the end of a Richardson retractor without passing out. Finally, shortly after one in the morning the vaginal and perineal repairs were finished. All that was left was to do a colostomy. I begged to be allowed to leave and finish all my undone work and to check on my other sick patients.
My superiors took pity on me and I was dismissed. I scrounged up a couple of Oreo cookies and went about the business of catching up. I checked on Terry first, gave her some more fluid and was informed that there was a potential liver in Houston. I started IV’s, answered calls for patients with fever or drainage from their wounds, drew the morning labs and thought I could see a glimmer of light at the end of the tunnel.
Christina was now back in the Trauma ICU and she looked stable, if not a little forlorn as she lay in bed with both legs up in traction, IV’s in each arm and tubes going every which way. However, she was OK and she still had those beautiful clear eyes, only now I didn’t see the terror.
Then my beeper went off. It was the ICU where Terry was clinging to life.
My Chief answered, “There’s a compatible liver in Houston. We’re leaving in ten minutes. Make rounds with the next crew and then you can go. We won’t be starting the surgery until about ten.
And there it was. My twenty four hour shift was now growing to twenty six. I did take a few minutes to get a real breakfast before starting morning rounds with the next team of residents.
Rounds were uneventful. We finished around eight thirty, but instead of leaving to get a little rest I stayed around to help with Terry. Dedication or stupidity? Both, I guess, but I assume it was mostly dedication and a sense of responsibility.
We started Terry’s surgery at around ten thirty and I took my position on the patient’s left where I would become reacquainted with my old friend, Richardson. The case went fairly quickly, at least for a liver transplant and after about two hours the new liver was in place. Every one left to take a break, that is everyone but me. Someone had to stay with the patient, who was still under anesthesia while the new liver “breathed.” I sat and watched the liver take on new life as Terry’s blood percolated through its sinusoids and it started to sweat bile. After about thirty minutes the rest of the team returned to do the final step, which was the biliary anastamosis.
I was happy to see the intern on call for that day return with them, which meant I was to be set free. It was almost two in the afternoon. My twenty four hour shift had lasted thirty two; a typical day for a surgery intern in 1985.
Christina, by the way made a complete recovery. Mikey spent about a week in the hospital but also recovered, while Nicole recovered from her NEC. Terry’s new liver worked for a few days, but she suffered through another rejection and this time it was too much and she passed away.
Modern medicine does indeed have its limitations.
Monday, May 26, 2014
“Do you believe this? I mean this can’t be true,” I raved as I read the article in the “Post.”
“City to Shutter Free Clinics
Council cites Cost and Duplication of Services”
“You seem to taking this rather calmly,” I continued, addressing my dear wife, Nurse James.
She was preoccupied playing with our baby girl, Rose Elisabeth, who celebrated her three month birthday that day.
“Happy Birthday, sweet Rose. Who’s my big girl?” she cooed and held the girl up as high as she could reach.
Rose giggled and squealed.
“Forget the paper, at least for a while. Just look at this smile, this big beautiful smile.”
I did put the paper down and stood behind my two girls.
It will be OK. Just remember this is what is truly important. But, our patients? They’re important, too.
“I suppose you’re right, it will work out for the best. But, how many of our patients will be able to be cared for at the University Clinic? Walking two or three blocks is a lot different than taking a bus across town.”
“They’ll never close our clinic. We do too much good work,” she concluded.
“All the politicians care about is dollars, mostly how much they can put in their own pockets. You know what I always say…”
“Yes, yes, they are only two types of politicians, those that are in jail for corruption and those who haven’t been caught yet.”
“I’m glad you pay attention. Let me look at page eight where they go into more specifics about the clinics slated to be closed.”
Pages rustled and Rose laughed as I found the rest of the article.
“The free clinics which are to be closed has not yet been determined, but speculation is that clinics in neighborhoods where there is access to other care, such as private urgent care clinics and free standing Emergency rooms will be the first on the chopping block…”
“See, we should be OK. There certainly are none of those in that part of town.”
“There’s more. ‘In addition, those clinics in parts of the city where the crime rate is high or there is an unusual amount of gang activity also may be shuttered. Public hearings, where private citizens may voice their concerns, will be held in the next few weeks. Exact time and venue will be announced.’ I think that means we’re in trouble.”
Miss James stared at Rose and then held her close to her chest. Rose instinctively tried to help herself to a snack.
“Well,” Miss James began, “we’ve got a few weeks anyway. We should plan to go to those hearings. You know, speak up for the downtrodden.”
“You’re right, like always,” I answered as I looked at the clock. “Six thirty? I better be on my way. I hope there isn’t much traffic or I’ll be late. I don’t want to ruin my perfect record.”
Miss James smiled at me and my “perfect record,” but didn’t comment. I kissed Rose and my lovely wife.
“I wish it was next week and you were back at work,” I commented as I gathered up my white coat. “The other nurses are OK, but they are not Nurse James.”
I began the usual thirty minute drive to the clinic.
Not too much traffic for a change. I can’t believe they would even think about closing our clinic. On the other hand, if we moved maybe there could be a proper medical facility with a real modern lab and state of the art imaging. Dream on, doctor. This is not Beverly Hills or Beacon Hill. As far as politicians are concerned: no money, no voice. Then again, maybe I shouldn’t be so cynical. Here I am entering the “clinic neighborhood” and it’s not so bad. There are some trees over here and a little park. And, on the corner, members of one of our many independent youth group are hanging out. There’s even some new construction going up. It’s hard to believe, but someone, somewhere, actually has an interest in developing this part of town. Funny, I don’t know why I never noticed it before. Whatever that building’s going to be it looks very elaborate.
My head shifted away from my troubles as the radio blasted out some classic rock:
“Sitting on a park bench
Eyeing little girls with bad intent…hey Aqualung”
Jethro Tull seems very appropriate for this part of town.
I arrived at 6:55 and was greeted by Miss James sub, Mrs. Selma Cranston. She looked exactly like one would expect someone named Selma Cranston would look, mid fifties, matronly, dull brown hair tied back into a bun, adorned with a white, knee length dress, white stockings and white shoes,
I’m surprised she isn’t wearing a white nurse’s cap.
“Good evening, Dr. Barnes, I’m Mrs. Cranston. I’ll be helping you tonight. This is my first night here and I’ve never been in a clinic like this, so I hope you’ll be patient.”
“Glad to meet you. I’m sure you’ll do fine. It’s a bit of work, because it’s just the two of us. No techs, no aids, but we usually manage.”
What did she mean, “clinic like this?” We’re just like any other clinic; that is if those other clinics are visited by Ravens, bizarre superheroes, vampires, werewolves and mythological beasts.
“There’s a patient in room one, Milo Campo, 63, complaining of a non healing wound. He’s wearing a pith helmet and carrying a toy rifle. Oh, and I brought some fried chicken to eat, in case you get hungry later.”
“From Purdy’s Chicken Shack?”
“Well, then let’s get to work.”
I picked up the chart for Mr. Campo. “Nonhealing wound on right buttock, no allergies, travelled to Tanzania recently, no other medical problems.”
I did my usual quick knock and went in.
“Good evening, Mr. Campo. What is the problem which brought you into our fine clinic this evening.”
“Get down, get down or he’ll get away,” he hissed through clenched teeth.
I looked back over my shoulder and then around the room.
“Who or what will get away,” I wondered out loud.
“The rhino, of course. Now get down before you get trampled.”
This can’t be happening.
Mr. Campo was dressed in beige safari gear, sported a gray pith helmet and was carrying a large, plastic hunter’s rifle. He grabbed me by the arm and pulled my arm, with considerable force, I must add. I joined him crouching behind the exam table.
“I don’t see the rhino,” I whispered.
He handed me his glasses.
“They asked me to check your wound, the one on your buttock,” I said. “How did you get it and when?” I added.
He looked around, pointed his toy rifle but then put it back at his side. He put his mouth against my ear.
“I was attacked by a rhino, a rare, vicious black beast who gored me in the buttock with his horn, almost a year ago,” He replied in a very low monotone. “But, I’m on the trail of that black demon. It’s not just any old rhino, you know. The monster I’m trailing is the rare Sumatran Three Headed Rhino. That’s right, three heads, three horns and a heart as black as its hide. When I get the rhino’s three horns, I’ll grind them up and sprinkle some of the dust on my wound. Its special properties will make it heal in a few days. The rest of the dust will be saved for the future. One can’t be too careful or unprepared these days.”
I nodded my head in agreement.
“Speaking of wounds,” I countered. “I believe you are here to have that wound checked, by a doctor, specifically, Dr. Barnes, who is me?”
“Oh, yeah, right. I’ve lost the trail anyway, Dr. Barnes.”
“Well, just drop your jeans and I’ll take a look.”
Mr. Campo slid his beige khaki pants and underwear down to his knees revealing a wound on his right cheek which was open to the air, about twelve by ten centimeters, extending into the subcutaneous tissue, but not involving any muscle or bone. There was some yellowish drainage, but no redness.
“How do you take care of this?” I queried.
“Take care of? I just leave it alone. It doesn’t hurt. I just have to change my underwear every few days.”
“Well, I think,” I began, “if you cared for it properly and kept a bandage on it, perhaps it might start to…”
“There it goes,” my patient screamed, “you won’t get away, you brute.”
And, Mr. Campo burst out of the exam run, trying to run while pulling up his underwear and pants at the same time. It was all I could do to hold the laughter inside as he finally got his pants pulled up and fastened and then bounded away, chasing his imaginary, three headed rhinoceros.
Oh, well, you lose some and then you lose some. Onward to new frontiers,
I moved on to room two, Myron Davis, 38, complaining of abdominal pain for five days. No previous medical problems, no allergies, no meds.
Should be simple.
“Good evening, Mr. Davis, what brings you into our night clinic?” I began.
Myron Davis was dressed in a black suit, white shirt with French cuffs, blue paisley tie, black socks and shiny, black leather shoes. He definitely did not have the look of our usual client. He was half sitting, half laying in the chair, his black hat perched on his chest, and did not get up to greet me. His face was flushed and beads of sweat dotted his forehead.
“Hiya doc, I hope you can help me,” he replied to my introduction. He looked around the room as if he there were other people present.
“It’s just you and me, Mr. Davis. Now what seems to be bothering you.
“It’s my gut, Dr….Barnes,” he answered staring at my name tag. “it feels like someone is driving a metal stake through it.”
“When did this pain begin?” I asked.
“Twenty years ago.”
“Did you say twenty years? Why did you come in tonight?”
“Excuse me Dr. Barnes, but are you recording this?”
“No,” I responded truthfully.
“Is any of what I say going into any sort of database or computer?”
“No, I’ll write it down and it will go into a chart.”
“A written chart, nothing electronic?”
“Sorry, to disappoint you Mr. Davis, but we are not a very well funded clinic. Computers and Ipads cost money; money the taxpayers are apparently loathe to spend. So, here we are, paper, pens, stone knives and bearskins.”
“That’s good, very good,” he concluded. “They won’t be able to find me.”
“Excuse me?” I had to ask, “But, who won’t be able to find you?”
“The spies, the government, our government, the Russians, the Germans, the Japanese, the Chinese, insurance companies, credit bureaus, credit card companies, banks, Disney; they’re all spying on us, spying on me, all the time, watching every move you and I make, watching every moment of our lives with massive computers.”
“Are you sure about this?”
“No question. Tell me, if someone makes an unauthorized purchase with your American Express card, do you get an e-mail or text message or phone call? Or, maybe all three. How do they know?”
“Hmmm…” was my reply, “but what about your abdom…?”
“Don’t trust anyone is my creed. No credit cards, no bank account, no social security number, just pay cash for everything, leave no digital footprint and no one will knock on your door in the middle of the night and cart you off to CIA headquarters.”
“Your abdominal pain,” I tried again to get a history, “When does it occur?”
He looked at me and then at his stomach and then took a deep breath.
“I began with this pain about twenty years ago when all this computer stuff started to grow. It was the World Wide Web which made me realize that no matter what I do, someone somewhere is going to find out or be affected. Then it was online banking and credit cards and My Space then Facebook and Twitter. But I learned the truth. Someone is always watching, always monitoring. I couldn’t find any peace. Sleep has become a luxury I just can’t afford. What if I say something about my pain? Someone will be listening. Well, my pain has just stayed with me. So, I took a chance and went to see doctors. I tried Tagamet, then Zantac, Prilosec, antacids. I had EGD’s and gallbladder surgery and finally resigned myself to my throwaway diagnosis: IBS.”
“So,” I interjected, “Why are you here tonight?”
“Oh, I need some meds refilled. If I call a pharmacy to get my prescription refilled they’ll put it in their computer and that’ll be the end. They will know where I am.”
“So all you want are some free samples? That’s easy. If we have any, you are welcome to them.”
“Just Carafate, it’s the only thing which helps.”
“Give me a minute and I’ll check in the back.”
“Uh, what are you writing?”
“Just your diagnosis and treatment. Probable gastritis, treat with Carafate. Samples given.”
“But, didn’t you hear anything I said. Everybody’s watching, they’ll find out. Sure, you only write it down now, but next month someone scans that chart and then, boom, I won’t be able to get health insurance, find a job, anything. I’ll be labeled, branded for life with…just the sound of it is ominous…gas-tri-tis. A mixture of gas and garbage. Just forget I was ever here. And, please, shred that chart.”
Mr. Davis got up, put on his fine black hat and walked out.
Two for two. A great start to the night.
“Room three,” I murmured, “Misty Rowe, ten, fever, cough, history of leukemia. No allergies.”
I knocked and went in starting my intro before I even saw my patient’s face.
“Good evening, Mis…” I started, but stopped when I was greeted by Evella, Goddess of the Night.
“Dr. Barnes, congratulations,” she said softly, her voice a bit raspy.
“Thank you Evella, Goddess of the Night,” I answered, but I was a bit shocked at her appearance. In the six weeks since I’d last seen her at my wedding, she had wasted away. Her skin was now a pasty yellow and her eyes almost glowed with jaundice. But, she still had her smile and her feisty demeanor.
“This is Misty, Dr. Barnes, a friend of mine. We met at the hospital while we were being treated. She’s in remission from ALL. Her mother works nights a lot and I watch her when I’m well enough. I do have a consent from her mother so that I can make medical decisions for Misty, if you’re worried about the legal niceties.”
“No, no, I’m sure everything is in order,” I said softly, a bit distracted by Evella’s cachectic appearance. I recovered my composure and added, “What’s the problem, Misty?”
“I’ve got a bad cough and my chest hurts. My fever today was 102.8.”
“Have you been treated for your leukemia recently?”
“My last chemo was four months ago. I thought I just had a cold, but Miss Worry wart here insisted we come to see you.”
I listened to her chest, which was clear, inspected and palpated, shot a Chest X-Ray which was normal diagnosed her with a cold and gave instructions for her to call her Pediatrician and Oncologist the next day.
I’m more worried about Evella.
“Misty, if you don’t mind,” I asked my young patient, “I’d like to talk with Evella, the Goddess of the Night, alone.”
“You don’t have to worry about me, Dr. Barnes,” she answered. “I know she’s got bad cancer and I know she’s probably not going to live much longer. Just like my friends, Justin and Liv. They died of their cancer. I cried for them, but, at least they didn’t have to suffer very long.”
“Kids with cancer live with death hanging over their head every day,” Evella explained. “You’re a doctor, you should know that. Anyway, anything you have to say, you may say in front of Misty. We have no secrets and she knows I’m dying. I assume that’s what you wanted to talk about.”
“Such remarkable intuition, Evella, Goddess of the Night, of course that’s what I want to talk about. Our first meeting taught me more about healing and the proper way to be a physician than all the lectures and rounds combined. And, you make great cookies. I’ll miss them and you.”
“You’re sweet, Dr. Barnes,” she said in that special voice she had as she patted me on the cheek and then on my derriere. “However, even though this vile cancer has had the gall to invade most of my vital organs, I am not planning to check out as soon as everyone thinks. I’ve got a lot of years of livin’ to pack into the time I have left. See this?”
She held up a colorful brochure.
“Two week cruise in the Mediterranean. Barcelona, Monte Carlo, Venice, Rome, Athens, all the food I can eat, first class all the way. If I’m going out, I’m going out in style.”
“Sounds great,” I observed. “You don’t need a companion, do you? Because, the news is that this place may be shut down which will leave me out of a job.”
“You’re still sweet, but not my type. Don’t worry about me, I’ll find some young buck to keep me company.”
“I wish you nothing but the best, Goddess,” I added.
I gave her a kiss on the cheek and, at that moment, we heard music coming from the lobby. The familiar strains of “Night Clinic Blues” no doubt being strummed by the talented hands of Wild Fingers.
Two in the morning? Very strange, very strange indeed.
We all went out to the lobby where Wild Fingers Dixon sat strumming his guitar, softly humming along. There were a few patients waiting to be seen and they seemed to appreciate the early morning concert.
“…Oh Night Clinic Blues”
A familiar bluesy voice joined the guitar.
“Dear Nurse James, what are you doing here at,” I looked at my watch, “Two eighteen in the morning and who’s watching the baby?”
“She’s here, with me. Neither one of us could sleep and she kept pining away to see her father, so what could I do?”
She held little Rose up and I gave both my girls a big kiss.
“You do your work and all of us will keep Rose entertained,” she decided. “Good evening, Evella and…”
“This is Misty, a friend of mine who wasn’t feeling well, but, your wonderful husband has made us both feel better,” Evella answered.
“I’m not so sure of that,” I replied “and, if you’ll excuse me, I have a few more sick people to see.”
I left them in the lobby as Wild Fingers shifted to “God Bless the Child,” one of my favorites. I listened for the deep soulful voice of my wife while perusing the chart of my next patient.
“Elsa Walderstein, 78, deaf, complaining of severe headache.”
I hope she brought an interpreter.
I knocked and went in to room one. Fortunately, there was a younger woman seated with my patient.
“Good evening, I’m Dr. Barnes, what’s the problem you are having?”
The older woman sat in her chair and stared at me with a smile on her face, but it was obvious she did not comprehend. She was wearing a light jacket which covered her thin short dress, slightly worn white tights and square toed ballet slippers.
“Hello to you, Dr. Barnes,” the younger woman replied. “My name is Eva Schosser and this is my mother, Elsa Waldenstein. She has been having headaches for about three weeks and they seem to be getting worse. I’m sorry she can’t tell you herself. She’s almost totally deaf and only speaks German.”
Eva was middle aged, neatly dressed, with light brown hair and blue eyes which revealed only concern and worry.
“Why did you decide to bring her here tonight?” I queried.
“She told me that her headache was much worse and she felt like someone was pounding on the inside of her with an ax.”
“That’s how she described it? Pounding with an ax?”
“Yes. Does that mean something?”
“Probably not, but it is an interesting choice of words.”
“How’s her health in general?”
“Considering her tortured past, excellent.”
“Dr. Barnes, Elsa Waldenstein was famous in the old country. She was on her way to becoming Prima Ballerina for the top ballet company in East Germany. Unfortunately, one of the party officials took an unusual interest in her, a very intimate and unnatural interest. The rest of the story is not pretty. Let’s just say that she escaped East Germany and came to this country with nothing except the clothes on her back and a baby growing inside. Her flight to freedom was arduous with danger constantly lurking, but she survived and made it to this country. Unfortunately, there was a price. Hardship and injury caused her to lose her hearing, thus ending her dance career. She was granted political asylum here, but has lived a very hard and difficult life. A deaf woman with a newborn baby who doesn’t speak the language has few prospects. But, we survived. Only now she has these headaches and she cannot find rest. I’m afraid for her; afraid that this relentless malady will finally break her spirit.”
An amazing story.
“I will certainly do my best to help her,” I said hoping both Eva and Elsa sensed the genuine concern in my voice. “Let me examine her now.”
I started at the top and worked my way down. Everything was normal. As a matter of fact she appeared remarkably healthy for a 78 year old woman.
“Was she doing anything unusual when the headaches began? Or, has she suffered any injury, even something very minor?”
“Not that I’m aware of, but I’ll ask.”
Asking Elsa a question involved a complex series of hand gestures and written notes in German, which were followed by head shaking, nodding, more notes and finally, calm.
“She says no,” was the final result.
“I wish we had a CT Scanner, but we’re just a poorly equipped community clinic. Let me try something. I’ll be back in a minute.”
I asked Mrs. Cranston to start an IV on Elsa and then took care of the other two patients who were waiting, both with simple problems which were easily treatable with medications. They were sent on their way and I returned to Elsa and Eva.
“I’ve got something here that I think will help Elsa’s headache,” I explained to Eva. “It’s some medicine that will relieve any tension she may have in her muscles. It works almost immediately.”
“Thank you, Dr. Barnes,” Eva said and then she wrote a message to Elsa who looked up at me with hope in her eyes.
I took a syringe from my pocket and injected one milligram of Versed through her IV. She winced a little when it first went in.
Eva and I watched as the forlorn look on Elsa’s face began to fade. She closed her eyes and then the corners of her mouth began to turn up and a smile appeared. She opened her eyes and I saw a twinkle of life appear which had been absent a few seconds before. She jumped up from her chair and took off her coat, revealing her light dress and dancer’s body. She took my hand lightly and caressed it and then she did a pirouette.
“I think the medicine has helped,” I observed.
But there was more. She exited the exam room and when she saw Wild Fingers with his guitar she gestured for him to play. She stared at his fingers as he started to play, a classical piece which I didn’t recognize. Elsa, however, saw something that must have been from her past.
She began to dance, en pointe, moving gracefully across the waiting room on her toes, jumping and spinning in perfect rhythm to the music. The first rays of the sunrise pierced the clinic windows creating a dazzling display of colors and illuminating Elsa in an array of red, orange, yellow, green, blue and purple. She danced to me and curtsied, she elegantly leapt over chairs and spun around tables as those of us in audience stood in awe and applauded.
But, it could not last. The beautiful display was interrupted by three men, dressed in three black suits, wearing three pairs of black rimmed glasses and carrying three identical black briefcases.
This has to be bad news.
“Doctor,” man number one began, “I am Mr. Jacobs, from the Department of Health, this is Mr. Binder from the City Inspector’s Office and that is Mr. Berkowitz representing City council. May we talk to you.
Jacobs, Binder and Berkowitz. Perfect name for a law firm.
“Certainly,” I answered. “We can talk here.”
“Is there some place more private?” one of three inquired.
“Anything you have to say, you may say here, as I’m sure it may have some effect on my patients.
Wild Fingers, Evella and Misty, who was holding Rose, Eva and Elsa and Mrs. Cranston all stood silently, anticipating bad news. Miss James had vanished.
“As you wish,” Black suit number three answered. “We have an order here for this clinic to be vacated immediately. It is the conclusion of the City Inspector’s office that this building is unsafe and poses a hazard to anyone who occupies it. City Council has voted that this clinic be closed immediately. We are now requesting that the premises be vacated immediately.”
“But, Mr…uh…Berkowitz, what will become of the people who live in this neighborhood, who depend on this clinic for their well being, where will they go?”
“Doctor, I’m sure your intentions are most noble, but this building is unsafe. Would you want to be examining a sick child and have the building collapse? Of course not. All of your patients will be more than welcome at the County Hospital Clinic.”
“County? That’s five miles away. Do you expect our patients to walk?”
“Doctor…Barnes, I will not argue any further. The decision has been made. This building will be demolished and County Hospital will assume the care of your patients.”
“I won’t leave. I’m staying right here,” defiant words came from behind me, from Miss James. “You’ll have to cut my arm off to get me to move.”
At that moment there was a faint “click” and my dear wife handcuffed herself to a sink which was behind the reception desk.
“Misty, if you could please hand me baby Rose. Thank you.”
And, there we were, a stand off. On the one side were three carbon copy bureaucrats waving legal papers and, on the other, Miss James and Rose, battling for the little people. I was putting my money on my wife and baby.
The three men looked at each and then at Miss James and then at each other again.
I think she may actually win.
A voice interrupted the confrontation.
“THERE IT IS, THAT THREE HEADED MONSTER.” it shouted. Milo Campo returned.
“I’ve finally tracked it down after all this time. You won’t get away from me this time you vicious rhino. Black as night with a black heart to match. You’ll pay for what you did to me.”
“That’s a real rifle he’s pointing,” I whispered to Evella, who was standing close to me. Maybe we should get down.”
She nodded and we both stated to lower ourselves to the floor, as did the others in attendance.
My wife and Rose, they’re stuck.
“Prepare to pay,” Mr. Campo hissed through clenched teeth as he pulled the trigger.
Shots were fired and then there was a short scream. I jumped up and shielded Miss James and Rose, just in time to see Elsa jump, pirouette and push Jacobs, Binder and Berkowitz out of harm’s way. Evella tried to tackle Mr. Campo as he kept shooting, only now his rifle was pointing harmlessly at the ceiling, knocking out the lights and setting off the sprinkler system. Finally, the shooting stopped as Wild Fingers and Evella wrestled the gun away.
There was another scream as Eva knelt beside Elsa, who was lying in pool of blood.
I ran to her side as sirens whined in the distance.
Misty hung up the phone and shouted, “Ambulance and police are on the way.”
I felt a very thready pulse on Elsa as she smiled at me, struggling to breathe.
“Good doctor,” she whispered to me in English.
The pulse vanished.
I started CPR, but Eva stopped me.
“Please,” she said, “Please, don’t; you gave her a few minutes of peace and joy, but let her go. Just remember; remember the smile on her face and remember her dancing.”
Eva looked at her mother’s lifeless face and buried her face in her chest. Tears streamed down her cheeks when she looked up.
You know,” she began, trying to speak through her tears, “I had never seen her dance before. Oh, I’d seen newspaper clippings and photos in her scrapbook, but never the real thing. You gave me a gift that will be with me forever. And, I will be able to watch her happiness over and over.”
She had recorded her mother’s dance on her phone and now the graceful beauty of that dance would live forever.
The police came and took Mr. Campo away in hand cuffs. Jacobs, Binder and Berkowitz left their papers with the day shift crew who started to appear and begin the task of moving everything out. The police cordoned off where the shooting had occurred and went through the motions of performing an investigation. I resigned myself to looking for a new work venue.
My dear Miss James, however, remained defiant.
“Call the papers, call channel twelve,” she screamed, “I can see the headlines:
‘Bureaucrats try to oust Mother and Baby.’
“All the publicity will surely keep us open.”
“Are you sure about this?” I asked. “Is this what’s right for Rose?”
This cannot end well.
But, our luck was about to change.
I heard a car screech to a stop outside the clinic and looked up to see a big black limousine.
Even more trouble?
A burly chauffeur stepped out and opened the rear door. Out stepped a woman dressed in pink, bright pink which shimmered as the morning sun outlined her perfect figure. A broad white hat and dark glasses shielded her face. There was the sparkle of emerald and diamond earrings and emerald and diamonds rings adorning her perfect beauty. As this mystery woman walked closer, ignoring the police barricade, I realized I knew her.
I looked up at the sky and was not disappointed as Pegasus circled overhead. There was a faint whinny as that noble equine acknowledged me.
“Medusa…” I began, but she held up her hand.
She gave me a light kiss on my cheek as I took her hand and led her into the clinic lobby where she removed the hat and sunglasses, allowing her long silky hair to fall about her shoulders. She was even more beautiful than I remembered.
“I see you’ve moved up in the world,” I observed.
“My life is a rollercoaster. The fruit of immortality, I suppose. He’s good to me, fun and rich and generous. Which is why I’m here.”
“You’re going to make a donation to the Dr. Barnes Survival and Party Fund?” I asked facetiously.
She looked me in the eye and then answered, “Not quite, but close. Have you seen the new building going up a few blocks over? The fancy one?”
“Yeah, I was wondering what it was going to be.”
“That, dear Dr. Barnes, is going to be your new home, that is, the new Clinic. I read about the budget cuts and I was worried that this clinic might be in line to get the ax.”
I was speechless for a moment and then I said a soft, “Thank you.”
“No,” she replied, “Thank you.”
She looked down at the floor and then stared into my eyes again.
“I was cold and you made me warm,” she explained. “For that simple act of kindness I am grateful. And for all the acts of kindness you and the people at this clinic perform, we are all grateful and indebted to you.”
She reached into her Chanel purse and fumbled around for a moment before pulling out a big manila envelope.”
“Here are all the details. There is an endowment of $150 million to keep the clinic funded. The new clinic will have a larger waiting room, eight exam rooms, a procedure room, a complete lab which will be properly staffed, Radiology with a CT Scanner and ultrasound, also staffed, a kitchen, storage and doctor’s offices. You also have my pledge that you will not want for anything as long as I’m alive, which, as you know, will be a long time.”
“I don’t know how to thank you, for myself and all the people who live here. When will it be ready?”
“About two months from now.”
“And between now and then?”
“You’re stuck here, I’m afraid.”
“But, the building’s been deemed unsafe; we’re supposed to vacate.”
“Ah, yes, that. Politics and graft. My husband did some checking. Some of our less scrupulous political servants were trying to get this space at a cut rate price. They bribed a City Inspector to condemn the building so that they could put up some sort of shopping mall or low rent housing or something. Whatever, they’ll be on their way to jail soon.”
“Did you hear all that, Miss James?” I turned to my wife, still handcuffed to the sink. “I guess you can set yourself free.”
“Yes, it all sounds wonderful,” Miss James answered. “Now, if you’ll just get me the key, I’ll set myself free.”
“The key? What key?” I asked.
“The key in the desk in the back. It’s where you keep your stuff. I found these cuffs back there and came up with the idea to chain myself to the building.”
“I’ll go look, but I’ve never seen those handcuffs before. In the meantime, maybe Medusa would like to see beautiful baby Rose?”
I took Rose from my wife and handed her to Medusa and went into the back to find the key. I searched high and low, up and down, back and forth, but there was no key. I had no choice but to report my failure and suffer Miss James wrath.
“WHAT, NO KEY? DO YOU EXPECT ME TO STAY CHAINED TO THIS TOILET FOREVER?”
“It’s a sink,” I corrected.
She tried to kick me. Medusa once again came to my rescue.
“I think I can help,” she offered, “rather, Pegasus can help.”
“What can a horse do about handcuffs?” Miss James wondered, showing a distinct lack of faith and understanding of things mythological.
“I’m game to try anything,” I added.
Medusa let out a loud long whistle and Pegasus alighted outside the clinic door. Medusa whispered in his ear and he turned around so that his hindquarters faced my wife.
“Close your eyes,” Medusa commanded.
Both myself and Miss James closed our eyes. There was a sharp noise as Pegasus gave a precise kick and the handcuffs opened up.
Miss James rubbed her wrists as she got up and bowed before the winged horse.
“Thank you, both of you,” she addressed Medusa and Pegasus. “I wish you both a long and happy life.”
I also thanked them and walked Medusa to her limousine.
“Will we see each other again?” I wondered out loud.
“Perhaps, should the opportunity or need arise. I have a special place in my heart for you. The envelope I left has the name of the builder and architect for your new clinic. Good luck and be happy,” she advised as she climbed into her fancy limo and drove away.
“Rose,” I said, holding up my daughter, “I think you are due for a change. A diaper change.”
Miss James and I carried her to the back.
“And, just what were you doing with handcuffs?” she asked as she grabbed my arm.
“Me, I thought they were yours,” I answered. “What could I possibly do with a pair of handcuffs?”
“I can think of a few things,” Miss James remarked as she bent over to change Rose’s diaper, trying to hide the smirk on her face.