Bedside Manners Page 3

Don’t have any of those.

  Was he drunk?

  Maybe so.

  Have anything to do with a woman?

  Maybe so.

  Where did it happen?

  The Cajun Bar.

  Going back?

  Soon as I get out of here.

  How did the police find out about it?

  They can smell blood a mile away.

  Did you tell them anything?

  Nothing.

  Seems like they’d want to know who hit you.

  They always want to know, but they don’t expect to learn.

  By this time I was beginning to notice a certain curvature to the far edge of the wound, the shape a bow makes when its string is drawn tight. My approximation of edges was imperfect. I pondered what to do.

  I had six stitches in. I guessed I’d need three more. I decided to place them like spokes of a wheel whose imaginary center was where lines leaving the curve of the wound at right angles would intersect. My stitches, I decided, would follow those lines. That way the error would be equally distributed over each remaining stitch. Ol’ Mattie Loventhal, my tenth-grade geometry teacher, would be proud.

  Sylvester winced.

  Sorry, I said. I guess I’ve taken so long the anesthesia’s wearing off. I injected and started again.

  And as I did so I felt a strong desire to know more about the life of the person who had become my patient, whose head I was injecting, whose blood and tissue fluid and shaved hair were on my hands.

  Are you really sure you want to go back to the Cajun?

  Yeah.

  What about your, ah . . . friend?

  Aww, he’s done his thing. He’ll be all right.

  Seems to me the police should be taking care of him.

  Sylvester laughed. You don’t know nothing about that kind of life. It’s live-and-let-live over there. The police don’t interfere with us. We don’t interfere with them.

  But how does that work? As soon as I said it, I flushed with the feeling you get when you let your naive stupidity out of the box and you’re just waiting there, hoping the other guy won’t make you pay too bad.

  He sighed. You don’t want to know, Doc. You’ve got your world. They’ve got theirs. You don’t want to know.

  I finished the job and was surprised by the apparent absence of screwup.

  Did you make it pretty, Doc?

  Pretty pretty.

  I guess that makes me your professor.

  Sylvester stood, shucked the drapes like wrapping paper, and started buttoning his shirt.

  You’re worried, Doc. Don’t be. The Cajun is all I got. It’s all most people over there’s got. And don’t worry about my friend. I’ll take care of him.

  The resident popped in to glance at the handiwork, nodded and grunted, and started off for the door. He looked back over his shoulder and caught my eye. Come back next Friday night, Watts—he cast his thumb toward Sylvester— and you can sew up his friend.

  I looked at Sylvester. Sylvester just walked out the door.

  LOVE IS JUST A FOUR-LETTER WORD

  The wards of the General Hospital were large barns, patients lined up along the walls like cows in their stalls. Flimsy off-white curtains on rings conferred semipermeable privacy. The gaps, the absent rings, made it all relative.

  Then, of course, sounds and smells knew no boundaries, bed to bed, stall to stall. They who were there shared one common experience. I saw a black-and-white photo once of the “old days.” Old, old days at the General Hospital. There were no curtains then, but rather an all-pervasive light in the room and radiators lined up in the center aisle of the floor like involuntary radio transmitters in what must certainly have been a room overwhitened and overheated.

  We rounded at eight o’clock. Every morning. Old patients got updates. New ones got complete clinical histories, presented by the intern on call during the previous night. I was the neophyte, the medical student who could not be expected to know much and whose blithered, half-opened eyes blinked from stall to stall, having already learned to expect the same old faces, old bodies, still there it seemed, past death.

  That morning I saw in the distance, a distance usually approximating infinity between bed one and bed twelve, a young Latin woman whose drop-dead beauty was visible even from afar. Her presence made it difficult for me to concentrate on the updates of the old crones, wondering what disease she would have, and why such a spectacular jewel might be lying in our hospital.

  Standing finally at the foot of her bed, the intern recited her history: third admission. All of them for gonorrhea septicemia.

  I noticed the IV running. A piggyback infusion bag marked PCN dripped methodically.

  Why septicemia? the resident asked.

  She disseminates, the intern said. She spreads it everywhere in her body.

  Why does she? asked the resident. The pelvis has a spectacular defense mechanism, evolved over centuries of survivalism. A girl just never knows what she’ll come across in this world.

  The resident paused for the expected sniggering, then went on, The pelvis protects against most anything.

  Not pelvis, the intern said. Pharnyx.

  It took a couple of beats to catch what was just said. Not pelvis.

  I grew up in the South with its conservative behaviors, lived in a “Christian” family, and all that—the girls I knew wouldn’t let me touch them, much less give me a blow job.

  The intern went on. She has some kind of localized susceptibility to this organism. The lymphatic system of her throat is selectively deficient. It allows the gonococcal organism, and only that organism, to slip past and gain access to the bloodstream. She doesn’t disseminate from any other source or with any other infection.

  But why three times?

  She’s monogamous. Same boyfriend each infection. The boyfriend refuses to get treated.

  I felt like I was caught up in a freewheeling fiction. The intern continued. She has the Snow White syndrome, he said.

  Part of the job of the intern is to one-up everybody with facts or diagnostic pearls that no one else knows. It’s a little game that keeps everyone on his toes. We suspected he’d made this one up.

  Only in this case the poison apple was the boyfriend.

  The resident was unimpressed. Seasoned. Less inclined to be moved by romantic eponyms. Why does she stay with him? he asked.

  Or why does she keep going down on him? said the intern.

  In that moment we became acutely aware of her, as if the questions we asked turned us that way. Everyone knew she had heard our discussion. Others in nearby beds, if they were conscious, would also have heard. Privacy was difficult, but could have been created by more discretion in what we said. There was something more to this extravagance of information at her expense. To be sure, most of the patients didn’t care or wouldn’t remember five minutes later. But we all knew she was different. Maybe we were just crude. Maybe we hoped this unflinching frankness, bringing her story out into the objective light of a medical teaching exercise, might give her a new perspective.

  I was busy being in shock. First to be spellbound by her beauty and then stunned by the knowledge, entirely new to me, that a beautiful woman, knowing the consequences, would give herself so completely. It gave me goose bumps.

  Ask her, the intern said.

  We did.

  She said nothing. Just turned her head to the pillow.

  The resident stared at her with hard, knowing eyes. Love is just a four-letter word, he said, and moved on.

  All day I watched her out of the corner of my eye. Her willingness, her vulnerability, made her beauty all the more striking. It was too much to bear.

  Truth is, I could fall for her in a moment. She was the kind of woman who “needed protection.” Someone who would keep her from harm. But I was a student, white coat and all that. Professional. We were in different worlds.

  I went to her bedside. I said, You could die from this, you know.

  Her round eyes
misted. But she said nothing.

  He should get treated. My words had no impact. Or arrested, I added with unexpected gusto.

  She looked down at her hands.

  I was overstepping, but I rationalized that it was out of concern for her, and pressed on. If he really loved you, I said, he would get the cure.

  He does, she said. He does love me.

  I realized this was the first time I had heard her voice. It was mellow, softer than I had imagined, but angry and insistent against the sharp sting of criticism.

  You don’t understand, she said. He just can’t admit it’s his fault.

  Too much guilt?

  No . . . he’s . . . he’s the kind of guy that believes nothing’s ever wrong with him. So it’s always my fault.

  I felt rage for the creep, who, because of his own behavior, kept putting her life in danger. But I knew to say so would be futile. I thought I saw her sob gently. And suddenly I realized that if we were in the same world, I could love this woman.

  Snap out of it, I told myself. And then asked her, So what are you going to do? You can’t keep doing this.

  The mist became a tear brimming the deep well of her eye. She rolled to the side, turning away from me and everything I stood for. She drew her hair back with two fingers, snuggled into the pillow, and closed her eyes, squeezing the reluctant tear into the space between us.

  Close the curtain when you go, she said.

  CIRCUS

  Word sure do get around when the circus come to town, don’t it, he said, referring to the crowds of nurses and interns come to see the cowboy who wouldn’t take off his boots. Only when I sleep and make love, he said, and the hospital’s no place for neither.

  Vernon Dalton had a heart murmur. Fine by me, he said, five holes better than four any day. More love gets out. The problem was it gave him extra beats that bumped and rattled inside his chest. His heart flopped around like a bass in a bucket. His doctors sent him to the city to find out if it was dangerous.

  In his hospital gown and boots, Vernon got hooked up to telemetry—heartbeat and misfire sent along radio waves to the nursing station down the hall, where the cardiac nurse watched for evidence of misfire.

  We gave him IV Xylocaine to numb the errant heartbeat. Problem is, it numbs part of the brain as well—makes some people go nuts.

  Vernon was lying in his bed, minding his own business (which wasn’t very much at the time), when one of his chest leads came unsnapped. Bells went off, lights flashed, and Vernon looked up to see a flat line on his monitor screen.

  I’m dead, he said, and closed his eyes.

  And he felt himself falling backward, space closing over him like water over stone. He felt something cool and attractive off to his left. His mother’s voice seemed to be calling him there. But he seemed instead to be headed to that hot place off to his right.

  Just then the nurse walked into the room and snapped the lead back on his chest. The alarm stopped. Heartbeats appeared on the screen. I’m alive, alive again, he said. I’m resurrected. I must be Jesus Christ!

  Vernon stood up in the middle of his bed, boots and all, and began reciting scripture. He looked over at the wizened old lady in the bed beside him, pointed his finger at her, and said, You will be my first disciple.

  The nurse shut off his Xylocaine.

  It took a long time for Vernon to touch ground again. By then he had deputized eleven souls and delivered his Sermon on the Mount in the doctor’s coffee room.

  His heart condition was harmless and we sent him home. Last I heard, he’d become a right Christian young man who wanted to be sure he’d get to see his mother in heaven. He started appearing at revivals in those big tents, the ones with the out-of-tune pianos and the wide-vibrato gospel choirs, telling the multitudes that came to hear him about the time he died with his boots on and came back to life.

  SURGICAL WOUND

  Before he could even get to the bedside of his waiting patient, Dr. Bosky intercepted him, pulled him into a room for yet another of his little disciplinary lectures that were the only means of communication between the two doctors, once colleagues, now undeclared enemies passing unspeaking in the hall. Bosky was chief of the outpatient surgical unit, a position that, in the opinion of Dr. Heart-field, he had earned, but that gave too much power to his dark side, a power that had awakened what could only be described as a desire to discredit his competitors.

  The patient, the lady with a little ganglion in her wrist, would need sedation in addition to local anesthesia. She was nervous — he knew that from what he had observed in the office. His attention had to be focused on her, ensuring that she was ushered through this little surgery with grace.

  He walked alongside the gurney, opposite the nurse, Karen, who had witnessed the altercation but was silent. He had seen this silence before. Karen knew where her allegiances had to lie. She had a good job. She did what her chief said, even if it meant applying the rules of the unit unevenly.

  He could feel her silence. He was in no mood to involve her at any level with this conflict. Her sympathies were predictable.

  He spoke in even tones to his patient. This is simple, he said. I’ve never lost anyone during this surgery and I don’t intend to do so today.

  I needed to hear that, she said. But I still want drugs.

  Drugs you get. Kickapoo Joy Juice, if you want. We’re going to make you comfortable.

  And how are you today, Doctor? she asked.

  Fine. The doctor had paused a beat before answering. Now he rushed through the rest. I’m just fine.

  Karen was applying the EKG leads, speaking softly to the patient, informing her what she was doing and what to expect next. He chose not to look at Karen, not needing to field whatever aggravation might surface there.

  I’m going to make a little incision and just pop that thing out. It’s very simple. And I’ll sew you up real purdy-like.

  The patient laughed. Karen smiled a little and went on with her work.

  He knew he had not worked through the altercation in his mind or his heart. Both were necessary, but they would have to wait. He would set it aside like an unanswered page from the answering service.

  The wrist was in position, operative light in place, surgical set open aseptically on the Mayo stand. He was gowned and gloved and masked for action.

  I like to use a little Versed and Demerol, he said. The Versed is a quick-acting Valium, the Demerol a light narcotic. Together they’ll make you silly.

  And make your work easier, she said.

  And make my work easier.

  He felt himself moving through the scene as if he were watching from the outside, a reader of an Edgar Allan Poe short story in which he knew the circumstance but maintained the reader’s distance. Even the figures in the drama moved with deliberate grace, as if in a long literary sentence in which every detail sparkled with clarity.

  The patient was drifting now. He knew he would not be required to entertain or reassure her much longer. He would only have to walk with her a short distance more in the lighted hallway of consciousness and then a solitude would come in which reflection could return. He wasn’t sure he wanted reflection. The event of the morning trembled inside him even while his attention was fully elsewhere.

  He began the surgery. Karen was at his side, anticipating. He didn’t like her political stance, but he had to admit he admired her professionalism. They rarely exchanged compliments, or glances, like those congressmen across the aisle from one another who don’t feel compelled to call attention to the virtues of their political rivals. Still, she admired him, he could tell. Both for his smooth, careful way with patients and for his surgical technique. More than once she had said, You make it look easy. I wish the residents could see you work.

  Another sore point. Bosky had all the residents. By stealth he had squeezed out his competitors. There was no talking to the man. It was clear that it was best to simply show up, shut up, and scoot home with the minimum of interaction. Fewe
r heart attacks that way.

  Funny how reflection surfaced now and not while he was coaxing his patient into a sense of confident relaxation, as if reflection and attending to the patient occupied the same space, but now, while performing a simple but delicate surgery in which highly focused concentration was required, he could feel the rush of—what was it?—anger? frustration? Maybe it was that cancerous mass of emotion that sprang from the sense of not feeling valued.

  Karen was attentive, quiet.

  I think she could use a little more Versed, he said to her.

  Karen reached over his arm for the three-way stopcock that housed the tip of the loaded syringe attached by its tubing directly to the patient’s brain. It lay on the bed-sheets a little way from her. Instead of walking around, or pulling the IV tubing to draw it near, she leaned gently into his arm as she reached over him to open the stopcock and slowly push in 1 cc of velvety fluid.

  He was aware of her pressing against him, of the soft beginnings of her breasts under her gown as at first they grazed his upper arm, then pressed confidently to him. He felt no need to withdraw, or to ease her access to the Versed. She felt no need to alter the arrangement by which he now had come to feel strangely warmed, this proximity of femaleness, this softness into which he could fall into the lover, the mother, into forgiveness in all its unspoken terms.

  She said nothing, as nothing was expected. Both looked only to their tasks. Outwardly she could have no safe way to offer her sympathies, if she had any. Yet the body could speak in ways untraceable and immeasurable. She was taking a long time to push in the Versed. Time slowed and did not want to speed. No one was impatient or anxious.

  There was just an open wound and a confident sense in the room that all would be well again.

  TELEPHONE TREE

  Mary Casey needs her Zyrtec refilled. She’s having an allergic reaction and she’s out of pills. Her chart appears on my desk, and because she’s in an HMO, there’s a Post-it attached with an 800 number written on it.

  I dial the number. A message says I have reached the National/International Consolidated Prescription Service Center and the call may be randomly monitored to ensure quality. I know what I’m in for, and here it is. I am given four options: