The View from the Vue (13 page)

“Aw, come on, Doc,” he whined. “I’m not a bad guy; I knew that. But you know what that li’l bitch was doin’ to me?” His eyes flashed with anger, and suddenly his voice lost its peevish quality, the tone becoming one of injured pride. “She went and put on her nightgown, one o’ them things you can see through, and then she began makin’ fun of me, telling me I couldn’t have any for six whole weeks. Well, that was enough to give me a pretty good hard-on, but I still didn’t do nothing; I didn’t even touch her. So what’d she go an’ do?”

I shook my head from side to side, although I had a pretty good idea of what she had gone and did. I was beginning to have a terrible feeling of remorse in the pit of my stomach.

“I’ll tell yuh,” said Mr. Hernandez. “She came over to me and started rubbing her tits against me, and then she jammed her cunt—excuse me, Doc, but that’s what she did—into my knee. Then she started kissing me on the neck and all over the place—well, I’ll tell you—”

I don’t think I’ve ever seen another man so angry. For a moment I was afraid he was going to jump off the table.

“—God damn, she
is
my wife, and I wasn’t gonna let her get away with shit like that. I figured, that’s the way she wants it, that’s okay with me. Y’ understand what I mean, Doc?”

“Yeah,” I said. “I understand.”

Chuck had stopped working during the monologue, and now he was staring malevolently at me.

“You bastards!” he hissed.

I walked quietly out the door, and back up to the obstetrics floor.

Happily, I never saw either Hernandez again, but did I learn from my experience? Only a few months later one of our patients appeared for her weekly examination in the prenatal clinic, about two weeks before she was due to deliver. She looked as though she had been used for first base in the seventh game of the World Series. Her face was cut and bruised, one eye was tightly shut, and her body and extremities were a mass of black-and-blue blotches. I asked what had happened to her.

“Mah huzbin’ done beat me up las’ night,” she drawled. Then she favored me with her shy ear-to-ear grin.

I had known this woman for several weeks, and I had long since concluded that she was the most blatantly stupid patient I had ever treated. She was seventeen, and had come to us courtesy of her twenty-four-year-old husband, a welfare recipient, who had impregnated her during one of his visits back to his little home town in southern Alabama. Then he had made an honest imbecile out of her. When I had first seen her in the Clinic, I had thought that she was beginning to retain too much fluid, so I told her to avoid salt. A week later, she was five pounds heavier, but she said she had indeed avoided salt. So I asked her what she had had for supper the previous evening,

“Hot doags,” she answered with her oligophrenic smile. “An’ peets-uh. Then ah hayd sum popcohn fo’ dee-zuht.”

I tried to explain that these foods were loaded with salt, but she objected: “Waal, ah dint
ayid
enny salt, jes’ lahk y’ said.” So there.

At that point, I gave her a spelled-out, salt-free diet. When she returned the following week, I asked her whether she had stuck to the diet. She said she had. “Did you like it?” I asked. She said she had indeed.

Now I thought I had her. Any person who admits she likes a salt-free diet must be cheating; the food has all the taste appeal of well-soaked blotting paper. But then I looked at her chart and discovered she had lost eight pounds during the week. The girl was so stupid that she not only had stuck to a salt-free diet, but had actually liked it. I suppressed the urge to sprinkle salt on her head to see whether she would dissolve like a slug, and went on to the next patient.

Thus it went for several weeks until the current episode. I quickly made the decision that it would be best to keep her in protective custody in the hospital until she delivered, and I so advised her. She—what else?—smiled.

That girl was the sensation of the maternity ward. The nurses took one look at her and turned pale. They shrieked aloud about what kind of animal her husband must have been, and proceeded to shower her with attention and tenderness. Later that afternoon, the head nurse came up to me. “She’s such a sweet little thing, she crooned. “I’d sure like to get my hands on that husband of hers.” I, however, allowed that after having seen what he was capable of doing to his wife, did not share the nurse’s desire to get my hands on him.

That night the husband came to visit. He was a six-foot greaser, dressed in a zoot suit. He cruised around the ward, jollying and pinching the nurses, and then made his way into the ward kitchen, opened the refrigerator, and helped himself to some of our food. Then, restored in body and soul, he came to the desk, where he proceeded to thank me profusely for caring so well for his wife. “Ah’d lahk t’ give yew a cee-gar,” he said with a smirk, “but ah cain’t afford it on mah welfare check.” I assured him I appreciated the sentiment. Besides, I didn’t smoke cee-gars anyway.

As he left the ward, he gave his wife a tender pat on the butt, and told her to be sure and mind all that the doctors and nurses told her. She, of course, smiled at him and nodded yes.

It was during rounds the next morning that the revelation came to me. I was in the middle of checking my little friend’s abdomen when a question suddenly popped into my head. I really don’t know why. Looking up at the girl, I asked her why it was that her husband had decided to beat up on her.

She flashed me her biggest smile. “Oh, ah jes’ got tard o’ havin’ him alla time drinking down at the bar with his friends,” she said calmly. “So, ah went aftuh him wif the biggest carvin’ knife we got.”

The head nurse, who was standing behind me, turned chalky and staggered out of the room. I eased myself into the nearest chair and began to laugh. The girl, delighted at having been able to bring a little cheer into our day, beamed at me and added, “Ah reely wuz gonna kill ’im, too.”

That episode finally caused me to become considerably more wary of accepting one person’s stories of his or her marital woes. From that time on, I never felt the same when a patient told me a tearful tale about how her husband was drinking away the family food money, or how he had brought her a gift of a case of clap. I’d simply suggest that she go and seek the advice of a professional marriage counselor; I even began to make referrals. For my own part, I figured she might just as well go home and count her blessings. Undoubtedly, her marriage was made in heaven.

One night during my third year of medical school, I was covering the general pediatrics ward, and my hands were full to overflowing. The last thing in the world I needed or wanted right then was a new admission. Every bed was occupied; we had just admitted a baby with a hideous case of the galloping green shits, and there was more than the usual workbookful of general scut to be taken care of. I simply didn’t have any time to spend on a new patient.

My heavy workload had lowered my mood about as far down as it ever goes. Nor did it help matters that I detested pediatrics. I couldn’t wait to finish serving my time so I could get off the service, never to return. It was bad enough to have to watch those kids dying of some of the most dreadful diseases one could imagine, but on top of that I managed to catch every non-lethal illness they had to communicate. Both my nose and my intestines ran constantly. Furthermore, drawing blood samples on them was the nearest thing to being put on the rack: if they didn’t spit on me, they peed on me; and if they managed to remain continent, they bit me. Worse than the patients were their bitching and bitchy mothers. I’d have preferred to serve my pediatrics clerkship shoveling out latrines.

Thus, I considered throwing in the towel when I saw the messenger wheel in a little girl and leave her at the nurses’ desk. She appeared to be about three years old, had long blonde hair and the pallor of chronic illness. She wore a listless, sad expression. Her mother and father stood behind the chair, she biting her lower lip, and he picking at his fingernails. The three of them were dressed in plain, shabby garments. The child had generous smears of dirt around her mouth, and the father looked as though he delivered coal for a living, which he may well have done. I watched as Joel Gaylord, the intern, walked over and introduced himself. He scanned the admission slip, and then said, “What’s the trouble with Rosie tonight?”

The father looked at the mother. She shrugged, and then, realizing that the burden of communication had been placed upon her, mumbled, “She don’t feel so good.”

“Well, don’t worry,” said Joel, using his most professionally reassuring voice. “We’ll see what’s bothering her.” He looked in my direction, raised his voice, and called out, “Dr. Karp. Would you come here a minute, please?”

“Yes, Dr. Gaylord,” I growled through my clenched teeth as I walked up to the little group.

“Dr. Karp, this is Mr. and Mrs. Murchison and little Rosie,” said Joel, dripping oil all over my shoes. “I’d like you to take a history and check her over. When you’re done, give me a call up in my room.”

I felt utterly exasperated. “Joel, for God’s sake,” I said. “I still haven’t cultured up that baby with diarrhea, and I’ve got a mountain of scut. Can’t you just work this one up yourself?”

“One thing at a time, Dr. Karp, and I’m sure you’ll get it all done by morning,” pontificated Joel. “Besides,” he added out of the corner of his mouth, “just remember: it’s all a learning experience.” With that, he took off down the hall.

As I watched him go, I silently prayed that his mattress would be infested with armies of hungry crotch crickets. Then I sighed, turned back to the Murchisons, and asked them to come with me into the little waiting room off the corridor leading to the ward. There we sat down, and I proceeded to pull teeth.

Getting a history out of these people was a truly frustrating assignment. The father proved to be totally non-verbal; his communication was limited to gestures and grunts. Rosie sat in the wheelchair, stared blankly into space, and appeared to not even hear the questions I put to her. That left only the mother, a retiring little woman whose speech, like her dress, conveyed the extreme poverty of her lifelong environment. But at least she talked.

By keeping the questions brief and straightforward, I was able to learn that for the past few months Rosie had been behaving oddly. There had been stretches of time during which she had seemed perfectly all right, but at increasingly frequent intervals she had been acting irritable and drowsy. In addition, her appetite was failing. Four days previously, she had caught a severe cold that the mother claimed had been in circulation among all the neighborhood children. Then, for the past two days, she had been vomiting and complaining of headache.

“Has she had any fever?” I asked. Specters of meningitis danced in my mind.

“No, I’ve been taking her temperature all the time. She’s been acting so funny,” the mother said. “But even when she had the cold so bad last Monday, there wasn’t no fever.”

“What made you bring her in tonight?” I asked. “She’s been sick, you say, for about three months. Did something special happen tonight?”

For the first time, the mother seemed animated. “Oh yes, Doctor. Tonight, I knew we had to bring her in. About two hours ago it was, she was standing right in front of me when she got this funny look on her face and her eyes rolled way up, and then she fell down on the floor and had a fit, you know, shaking her arms and legs back and forth.”

“Did she bite her tongue?” I asked. “Or wet her pants?”

“Well, I did see a little blood coming out of her mouth afterwards,” replied the mother. “And she went potty, like you said, right on the rug.”

About this time I began to feel very sad. The mother had given me a classic history for a brain tumor, and brain tumors in children are usually highly malignant and beyond surgical cure by the time they manifest themselves. My physical examination didn’t make me feel any better. Rosie’s pulse rate was very slow, and when I looked into her eyes with an ophthalmoscope, there was obvious swelling around the optic nerve, a sign of increased pressure within the brain. These, too, were findings suggestive of a brain tumor.

I called Joel, and he came down and checked my findings. He agreed with the grim diagnosis and prognosis. “But we ought to do a spinal tap,” he said. “If there’s increased protein or an elevated number of lymphocytes in the fluid, that would just about clinch it.”

We did the tap. A short while later, the night emergency lab reported a protein content that was twice normal and ten times as many lymphocytes as there should have been. My depression reached an unprecedented low.

Rosie had been put into a bed with side rails, and I went back to the waiting room to talk to Mr. and Mrs. Murchison. Briefly, I outlined the findings. “It looks very much as though she’s got something growing in her head,” I said.

Mr. Murchison just continued to sit there, picking at his fingernails. Mrs. Murchison asked me whether that was bad.

“It’s not good,” I said.

“Can you get her better, Doctor?”

“I’m sorry,” I said, “I really don’t know for sure now. We’re going to run some more tests in the next few days to see how big the growth is and where it’s located. Then we’ll be able to tell if we can get it out with an operation.” I considered the fact that I had only five more weeks to spend on pediatrics; if I was lucky, Rosie would last beyond that time, and I wouldn’t have to preside over her demise.

Mrs. Murchison wrung her hands. “I want to talk to you every day, Doctor,” she said. “Are you here about five o’clock in the afternoon?”

I told her I would be available at that time. “But maybe you’d rather speak to Dr. Gaylord,” I suggested. “He’s actually in charge of my work.”

The woman shook her head. “You’re her doctor,” she said, “so I want to talk to you.” That was that. Lucky me.

The next morning, Joel and I made rounds with Charlie Evers, the resident. I presented Rosie’s case to him. He nodded, checked out her physical findings, and said um-hum. “You’re sure you’re not overlooking anything,” he added. “Could she have meningitis? Or encephalitis? Or even a brain abscess?”