Authors: Peter Glassman
The next step was getting the product out to a dealer. While every step of his self-operation was dangerous, marketing his heroin had to be done with exactness and definitely not in New York City.
At first Linsky did the process by himself and gave Perkins a token finder’s fee for the heroin plaster of a flat five-thousand dollars. Perkins asked to help Linsky at his home since he worked with Linsky and Mindel on weekends at the Brooklyn warehouse operation. Perkins also wanted to make more money. The cast Perkins brought him tonight at the laundry was a large one. He and Perkins would begin the process tomorrow night. Having Perkins help was profitable to both and the thought of more dollars sparked Linsky to bring him on board to his condo operation only if Perkins brought in more tainted plaster. He dialed Perkins phone number and explained the new deal.
“Okay, Perk, you’ll pull some all-nighters with me and I want this to be a regular situation not just one cast every two-or-three weeks.”
Chapter 9
G-1-Rounds
All six orthopedic wards were organized the same and were in the G-designated wing of the main sandstone brick building. Norman was the G-1 ortho ward General Medical Officer or GMO and met with his direct reports composed of the ward Nurse and now three corpsmen including Kaplan. There were two large rooms on either side of the entrance for individual patient examination. The one on the right was for examinations and treatments and the one to the left was the cast room. All casts were required to be removed and replaced within a week of arrival from Vietnam and a large sign in the cast room declared “Log in Date of Arrival on all New Air-evacs admitted with casts.”
The casts were viewed as being contaminated with organisms and the wounds underneath needed scrutiny. One particular lung disease was actually discovered inadvertently at Queens Naval Hospital by an astute infectious disease internist. LCDR Buzzby Brisbane had been in charge of all antibiotic dispensing and was in charge of the fifty-bed TB unit. Several air-evac orthopedic patients were admitted to the TB unit with lung lesions several weeks after their first cast change. Cultures of sputum failed to reveal the red-staining tuberculosis bacteria but did reveal another species of bacteria called pseudomonas pseudomaleai. The condition is known as meliodosis. The X-ray lesions were identical to that of the tuberculosis bacillus but the disease responded to standard antibiotics and was not lethal if treated early. After this discovery the Navy and indeed the entire military medical corps of all services demanded cast changes and incineration of all removed plaster casts. This phenomenon was found only on casts originally applied in Vietnam. Anyone in attendance of these first-removal cast changes had to wear protective covering and surgical masks.
One nurse at Queens Naval Hospital was in charge for strict adherence to the removal and disposal of the Vietnam-originated plaster casts–LCDR Philomena Skagan. She was a perfectly formed five-foot attractive brunette who demanded a daily list of all newly-arrived Vietnam returnees who came with Vietnam plaster clad anything. It was the ward GMO’s job to do this. Norman should have been more than eager to receive and work with Skagan. She was articulate, beautiful and had a command presence. Her attitude however was standoffish when it came to non-professional discourse. Norman once made a subtle pass at Skagan at the O-club. She always ate alone and he often wondered about that. Zettler was away in Washington DC on some Navy Nurse update course. Norman went over to Skagan’s table where she was sipping a cocktail and looking serene and desirable. He rationalized he just wanted company for dinner–
right?
“Phil I hate eating alone at restaurants, especially the Officers Club, and I notice you’re never with an escort. Would I be too presumptuous to ask if I can dine with you this evening?”
She looked up at him with her sapphire-blue eyes and arms folded under a perfectly proportioned bosom and said, “Yes, you’re too presumptuous, engaged to LT Zettler, and go away. I like my own space.”
Such was LCDR Philomena Skagan and today she was coming for the daily list of newly-arrived ortho patients who would soon need cast changes. He made sure LT Sparrow had it ready.
‡
Boomer Stiles got settled in rapidly with Ike Kaplan never too far away. Kaplan was an amazing corpsman. His medical knowledge and handling of the ortho patients was outstanding. The other corpsmen quickly followed his direction and Norman made him chief corpsman for the ward in total agreement with the other corpsmen and ward nurse LT Sparrow. In fact LT Sparrow looked at Kaplan like she wanted him for her three meals a day.
Norman and at least one corpsman made informal rounds daily–either in the morning or in the afternoon depending on when they were in the OR doing surgery. Formal rounds were usually done in the morning. The staff orthopedic surgeon, orthopedic resident and Norman went from patient-to-patient reviewing each patient’s hospital course and plan. The sickest patients were the immediate post-ops and they were at the front of the ward.
Just before rounds LT Sparrow came over to them with a look of stressed-out fear. “Dr. Norman, LCDR Skagan just called and she wants your list as soon as she sets foot on G-1. Those were her exact words.”
Norman’s pulse picked up speed. The only one who seemed to have no reaction was Kaplan but he had never met her nor was he aware of her extreme work ethic. Norman handed the list to Kaplan. “Are you familiar with the stateside policy of immediate removal–whenever feasible–of all casts initiated in Vietnam?”
“No sir. I was there when most of the casts were applied to the air-evacs I arrived with. What’s the problem?”
Norman described meliodosis and the protocol for removal, replacement and disposal of all plaster casts. “This list goes to the Queens Naval nurse in charge of this. She takes her job very seriously and has no sense of humor. LCDR Skagan will go over the list of each patient with you and will try to be there when you remove the casts of any such patient on G-1.”
“Should I wait until after rounds?”
“Skagan is coming within the next few minutes. You can catch up. Take the charts of the patients on the list. She’ll want to look at their admission notes and past history. Skagan has a fetish of writing down where the casts were applied. It seems to matter to her whether they were from Saigon, Danang, Subic Bay and Yokosuka or wherever from over there.”
Kaplan complied and Norman added, “Remember. No sense of humor. She never laughs or smiles.”
Norman left with the other corpsman, resident and staff orthopod who had remained silent during his interaction with Kaplan. Norman and Sparrow kept looking back at the G-1 entrance for Kaplan’s first encounter with the intrepid LCDR Philomena Skagan.
‡
Kaplan’s mouth dropped open when the short, attractive Skagan came onto the ward.
How can this cute caring nurse induce such distancing among her peers?
Skagan stopped at the entrance to the cast room and she looked at the group making rounds and caught LT Sparrow’s eye. “LT Sparrow.” Skagan held eye contact when Sparrow looked her way.
The voice was neither angry nor threatening. It sounded like what it was–a summons. LT Sparrow left the ortho team and practically ran to Skagan. Sparrow stood at attention next to Kaplan who was now face-to-face in front of the “Nazi” cast-removal officer.
“LT Sparrow is this the new senior corpsman in charge of the cast room?”
“Yes ma’am.” Sparrow swallowed before and after her reply.
Skagan put her hands on her hips and looked Kaplan over. “Is that my list in your hand Mr. Kaplan?”
Kaplan looked down at the stern yet comely face. “Yes ma’am.” He maintained eye contact and didn’t flinch.
Skagan snatched the paper from his hand and scanned it from top-to-bottom and back again. “You have one with a total body cast–SGT William Stiles. His cast is to be removed and replaced at the earliest possible time.” She paused and waited for Kaplan to blink. He didn’t. “When is that going to be Kaplan?”
“Dr. Norman is going to review his admission X-rays after they’re taken tomorrow and a decision will then be forthcoming ma’am.”
“I can see from here Stile’s head is incorporated into the cast. That means the cast must be removed in the OR because of possible spinal column injury. I want you to schedule it with the OR as soon as you have a removal date. And that means you’re to give me the date tomorrow after you and LT Norman come to a decision.” She turned to LT Sparrow who looked pale. “LT Sparrow call me when the casts on these others are to be removed for placement in the bio-containment sealed disposal bags.” She turned back to Kaplan. “I personally see to the collection and disposal of these casts. They represent biological contaminated waste. Both you and LT Sparrow are to sign off on their transfer to my toxic waste team.”
“Yes ma’am.” Kaplan had to suppress a grin.
This little Napoleon of a nurse was a real control freak.
‡
Sparrow and Kaplan resumed rounds and Kaplan gave his report about the casts along with a question. “Where do all the removed casts go?”
“They go to some biological waste-control contractor who sees to their cremation.” Dr. Stanley Caruso, the G-1 staff orthopedic surgeon, looked up from Stiles medical chart. “Did Skagan ask about Boomer?”
“Yes sir. She wants to know when and where we remove his plaster and insists on being there in-person.” Kaplan looked at the smiles developing on their faces.
“She’ll be there all right or there’ll be hell to pay. You do know of the lung disease from the pseudomonas organism transported from Vietnam in these casts Kaplan?” Caruso was the tallest of the team at 6-foot-4.
“Yes, sir.”
“Okay.” Caruso turned again to Kaplan. “Dr. Norman will present Boomer’s admitting X-rays. We’re not going to get a repeat series unless we really need to. It would take all afternoon to re-X-ray Boomer from head-to-toe. We’ll make our decision from his recent air-evac films.”
‡
Norman had Boomer’s huge and heavy X-ray envelope from Vietnam and the other overseas Navy medical facilities in the G-1 conference room. The room was a small rectangle with 8-X-ray view boxes on a wheeled stainless steel unit and covered one wall when Norman set it up. He selected sample X-rays of recent vintage to display Boomer’s injured bones.
“Let’s start at the neck since this is the most serious. There are in-line osteophytic bright areas suggesting healing of traumatized cervical vertebrae. Moving downward, the next film has his right and left clavicle with in-situ hairline fractures–also healing well. The right arm has a swollen elbow joint but no visible fracture and the left shoulder joint is inflamed from a previous dislocation but no fracture. The ribs are okay. Boomer’s right hip has the anterior iliac crest with an overlying tiny bone chip and its opposite hip bone is free of any bone injury.”
Norman next showed the leg bone X-rays and they were also unremarkable as to any bone surgery having taken place. “There were no fractures but the admission note from Subic Naval Hospital in the Philippines agreed with the total immobilization from Boomer’s total body cast application in Danang. The primary concern from Danang was a total bone concussion effect to the spine and all long bones. The chief ortho guy was emphatic about a two month immobilization with special care taken at the next cast change to be done under anesthesia with neck and lower spine immobilization. They made sure his bodily functions were intact and kept recycling Boomer’s sedation with Valium and opiates for his pain during his stateside transport.” Norman was done with his presentation.
LCDR Martin Jacobs, the ortho resident, spoke first. “Boomer doesn’t seem to require much pain medication and he only needs a sleeping pill at night.” Jacobs directed his next comment to Dr. Caruso. “Is a total body cast really needed for concussion blast injury with non-displaced bone trauma?”
“It’s a safety precaution as premature movement could turn a hairline fracture into a real broken bone anywhere in the body. Let’s give ball-buster LCDR Skagan the two month time frame for cast removal and adjust the date in three weeks when we do get new X-rays and assess Boomer’s physical status.” Caruso stood up indicating the conference was over.
‡
Perkins now began to check every air-evac for possible diversion of casts he would not have to be accountable to LCDR Skagan for. It had been two weeks since the long leg cast caper was done and he hadn’t seen a dime’s return yet.
“Don’t worry about it Perk.” Linsky hated the annoying impatient phone calls from Perkins. “The other money came in didn’t it? It took up to a full month for that hip-spica cast we did and we got more than we thought, right?”
“It’s easy for you to say. I have to live off a Navy Corpsman’s salary. My weekend work with you in Brooklyn gives a slight financial boost but I’m living outside the hospital base. I still just barely clear my financial obligations.”
“Well look Perk, if we had more than just your occasional sample from the hundred you process with the Navy every month we’d have a steady cash flow. I have to sell this stuff not only out of state but out the country. If we get caught we’ll have our balls and peckers removed and stuffed in our mouths while we’re still alive or worse. Remember?”
And Navy Corpsman Second Class Amstel Perkins did remember–with a shudder.