ICD 798.1
Even the Dark Angel has a number.
“Dr. Galen, I think you’d better take this call.”
My secretary was always right.
“Bob, Mary’s gone! My Mary’s…”
Big Dave’s voice dissolved in tears.
I waited until he caught his breath, then I asked him what I already knew.
“What happened?”
“Bob, we was eatin’ breakfast, and Mary got up ta check th’ coffee pot, and she jes’ … she jes’ had a droppin’ spell. I tried what you boys tol’ me ta do, but ‘t’weren’t no use.”
I could envision it happening: the sudden, irregular heartbeat brought on by Mary’s damaged heart valve; the loss of consciousness as the blood flow to her brain dropped, and then the fatal, irreversible heart rhythm that took her.
I felt cold. Rationally I had known it was going to happen—that it would have happened even if Dave and I had been there. But the loss, the never-ending loss, it overwhelms reason, and the irrational grief takes over.
“Big Dave, have you called Dave?”
“N-n-no, Bob. I figgerrd I cud reach you better.”
“Okay, I’ll call him. You stay with Mary. I’ll call the sheriff as well.”
I was two years out of residency. It was before rescue squads and fast-response ambulances emerged, especially in rural Virginia. The sheriff’s department would notify the coroner and, under the circumstances, the appropriate people would reach the little farm in due time.
Meanwhile, Big Dave would need that last bit of togetherness with Mary.
I wiped my eyes and dialed the Florida number I knew by heart.
“Dr. Nash’s office, how may I help you?”
“It’s Dr. Galen. This is an emergency call.”
“Yes, sir, please hold.”
Seconds later, I heard the familiar country twang.
“Hey, City Boy, what’s the problem? Finally lose your virginity?”
“Dave, it’s … it’s your ma.”
I could hear his gulping breaths. He knew, even without asking. It’s the curse of those of us who understand the human condition.
I kept on talking; I didn’t know what else to do.
“I called the sheriff’s office, Dave. They’ll get someone out there.”
“Dad?”
“He’s with her. Do you want me to make the arrangements?”
I could hear him sobbing. I waited until he whispered, “No, I’ll do it.”
Mary Nash had survived almost six years after that first episode the summer before senior med year. She had lived and died on her own terms. Here one second, gone the next. It’s called Sudden Death Syndrome, and in the International Classification of Disease lexicon it’s ICD 798.1. No prolonged stays in hospital or nursing home, and no tubes and wires inserted while families hover over shallow-breathing, almost-corpses.
That year seemed filled with them.
I had inherited some patients from an elderly doctor who literally died with his boots on. They found him sitting at his desk, his pen hand poised over a patient’s chart, when the Dark Angel called on him.
Still grieving, his wife had phoned me and asked if I would accept his patients. Her parting words to me were that he had considered them family, and she couldn’t rest until she knew they would be cared for.
I was young then, and sentimentality was not a word that would have described me. But I liked old Doc Benton, so I agreed.
That’s how I inherited Clarence and Clotilde Culbertson.
I remember my first house call to the stately home of that amazing couple. It was located in an upscale Virginia suburb near Washington. I stared at the autographed, ancient photographs of them, scattered about in silver frames, posing with notables such as Federico Caruso and Cosima Liszt. And I marveled at the personally dedicated paintings by famous French impressionists hung on their walls.
Clarence and Clotilde had passed their century mark by the time I first met them. Clarence was descended from a wealthy family, the typical second son, who did not inherit the family fortune but still had more money then he needed. So, what did he do? He became an explorer, one of those latter-third-of-the-nineteenth—yes, nineteenth—century world travelers and big-game hunters, who went everywhere and did everything. Most of us can only use our imaginations when we read about such folks in the penny dreadfuls of that gilded age.
“Young doctor, ever see elephant tusks? How about African water buffalo?”
I stared at the mounted heads along the walls of Clarence’s study, above photos of the young Culbertson standing over each of his kills.
“See that tiger, boy? He killed forty villagers before I brought him down. Got to like the taste of humans. Probably couldn’t catch any real game. Know why?”
I stared at the striped head mounted on a teakwood plaque. The taxidermist had posed it open-mouthed
“Yes, sir, I do. It had bad teeth.”
“Bravo, bravo! I see you are a true diagnostician. Now, can you tell me how that tiger got its revenge on old Culbertson?”
I stared at the old man. One hundred years does a lot to people, but I took a wild guess.
“You caught malaria.”
“Damned straight, boy! Had the aiguë for weeks. Drank quinine water till my tongue wanted to fall out, but here I am.”
We laughed, as I attempted not to cringe. That poor tiger! Dave had been right about the field mouse.
Clarence had come of age in a time when J.P. Morgan and other robber-baron princes ruled the world and its high society. His family was part of that social milieu, and that is where he met the beautiful Clotilde Mayson, inheritress of wealth equal to the Culbertsons. While Clarence sought adventure overseas, Clotilde’s musical talent had earned her a reputation as a piano prodigy by age sixteen.
Soon Clarence and Clotilde’s antics filled the restrained gossip columns of the day. Even old Joe Pulitzer’s scandal-rag newspapers were kind to the wunderkind couple. Their marriage was the talk of high society, and their guest lists could fill today’s history books.
Clotilde once showed me a fabulous machine she called an “Edison.” It looked like the top of the old treadle sewing machines the women had used back in my tenement neighborhood. She carefully removed the curved, wooden cover, took a black cylinder—which I later learned was made of wax—and placed it on the horizontal spindle. The house man (They employed a cadre of maids and butlers.) carefully attached a morning-glory-shaped horn to the gadget, wound the crank, and a Liszt piano mazurka came forth in room-filling volume. Clotilde’s hundred-year-old, water-sapphire eyes glistened, as she told me, “Doctor, I was twenty when Mr. Edison recorded my playing.”
Their home soon became familiar to me—even its smells of furniture polish and dusty damask, which seem to pervade all museums and old homes of the wealthy.
Dare I say it felt strange? After all, here I was, now grown up, but still a product of the New Jersey slums, walking through a living history book.
When the Culbertsons accepted me as their doctor, I became part of their standing guest list, invited for dinner and entertainment after opening my little black bag and waving my witchdoctor rattles while pronouncing them healthier than the majority of the human race.
Did I say entertainment? That’s too mild a term. Imagine a production by the cherubim and seraphim. Dear Clotilde never lost her talent, even as she passed her hundred-year—her cent’anni—milestone. She would take her seat in front of the great, thick-legged, antique, concert-grand piano, a gift from Kaiser Wilhelm II of Germany.
“Oh, yes, my dear, I can still hear old Willie harrumphing, his withered left arm twitching in my face. Never thought he would become the black sheep of Europe.”
She attempted an exaggerated heavy German accent to imitate the Kaiser. And she would click her heels together, just as he must have done in his high Prussian boots.
“Yah, in de-e-e-e-p appreziashun fur helping Frau Wagner with the Bay
reuth Festival.”
Yes, she was talking about the wife of Richard Wagner, albeit of a common-law marriage.
On the evening of Clarence and Clotilde’s one-hundred-first birthday—the Fates had even bestowed on them the same natal day—they once again invited me to drop by for a house call, dinner, conversation, and the music of the spheres.
We arose from the ornately carved, teak dinner table and entered the salon—a room no proper nineteenth-century household would be caught without. The air of aging, hardwood bookcases, and that strange scent of decay emanating from the heavy, brocaded curtains still waft in my mind.
Clarence and I took our seats, as did the maid, the cook, and the butler, on leather-covered, high-backed, mahogany chairs. We watched the grand dame make her entrance.
Of the two centenarians, Clarence was slightly the worse for wear. His exposure to foreign climes and bouts with tropical diseases had taken their toll on his skin and looks.
But Clotilde, still straight-backed and regal in pose and poise, sat gracefully at the keyboard. She turned her aquiline face toward us and smiled. Her water-sapphire eyes still glowed intensely. Her voice, untouched by time, carried that distinct, refined, nasal tonality produced by Manhattan’s upper-crust-society. It sparkled with laughter, as she addressed us.
“Ladies and gentlemen, Dr. Galen, my beloved Clarence, tonight’s selection will be a medley. See if you can guess the names.”
I will never forget the power of her performance! I can still see those porcelain fingers flying over the yellowed, ivory keys—keys that were the only earthly remains of some long-dead elephant that roamed the African savanna in the time of Bismarck and Tolstoy. And I was twice startled to realize that the pianist had emerged in the same era.
The magnificent music of Brahms, Chopin, and Wagner echoed through that salon. As Clotilde played, eyes closed in ecstasy, her body swayed in tempo, her sotto-voce humming stayed just barely audible to my young ears.
Her skin, translucent from time-lost layers of fat tissue, made her arms look like praying mantis limbs floating up and down the keyboard. Her feet feathered the three pedals to nuance the musicality of the notes.
Suddenly it was over.
We sat there, entranced by the virtuoso performance of this singular woman.
She rose from the piano bench and bowed to our applause. I imagined her going through the same motions at New York’s Old Carnegie Hall. She looked out beyond us, maybe seeing those great, past audiences granting her the triumph she so justly deserved. Then she gazed down at Clarence, put her right hand to her lips, blew him a kiss—and died!
Even in death, her stage exit was one of grace and class. Her lithe body slowly folded in on itself and sunk to the floor, the pale, antique-blue gown she had worn settling like an open flower around her.
I was much younger then; I didn’t understand.
I jumped from my seat and rushed to her body, mentally ticking off how I would proceed with cardiac resuscitation. But as I reached her and knelt beside her, I felt a powerful grip on my right shoulder and a voice which would have credited a man fifty years younger.
“Doctor, don’t.”
I looked up to see Clarence standing by me. He shook his head, and I stood up. His gray eyes flashed with the energy that must have dazzled his social set a century before.
“Let her have her stage exit.”
I backed away.
He knelt down beside her, talking to her as he must have done when he wooed her. He stroked her silver hair and moved her hands together in prayerful repose.
All these years later I can still hear him repeating, over and over, those final words.
“Wonderful performance, my dear! Wonderful performance, Tillie!”
Then, almost in slow motion, his body folded over hers—and he died!
Several days after that strange and morbidly wonderful final performance, I visited the local funeral home, which had laid out Clarence and Clotilde. There they were, side by side, just as they had been in life.
In those days I made it a point to pay my respects to deceased patients and their families. I entered the candlelit viewing room, moved up the aisle past the mounds of cloyingly sweet scented flowers, and stood next to the twin biers.
I must admit, when I’m a spectator to these occasions, I find myself thinking what anyone else would: They really did look natural.
I closed my eyes and bowed my head in a moment of silent tribute. Then I looked up, alerted to the sound of someone approaching me: their sole-surviving grandson.
He put his arm on my shoulder and, in a voice more appropriate to a carnival barker, actually yelled out, “Everyone, I want you to meet Dr. Galen. He helped Grandma and Grandpa get to where they are today.”
For a brief moment the viewing room grew deathly quiet. Then the sound of stifled snickers arose among the other guests. Quickly it crescendoed into guffaws and even drew the attention of the unctuous mortuary director, who joined the laughter when he heard what had been said.
To be fair, Clarence Culbertson III loudly proclaimed that what he meant was not what he said. But I resolved never to attend wakes again.
Mostly I have kept my resolve.
But little did I know what lay ahead.
The Newbie
“Doc, can we talk?”
The haunting notes of Grieg’s “The Last Spring” had been drifting through my waiting room that blessedly quiet, late-spring day. I was thinking maybe I could relax a bit. But the young man slowly making his way up the walk erased that hope.
“What can I do for you, Rick?”
How many times had I said those very words? How many people had passed through my door to sit in that very room while waiting to be examined?
The shy, fragile, homeschooled boy I had first seen as a baby two decades before had blossomed into a tall, muscular, pre-med student. Now he was following the path taken by his grandfather almost forty years before.
His grandfather. Yes, I had first met the young ambulance driver/EMT in the emergency room back then, when he had wheeled in a snakebite case. Now, he was Dr. Richard Shepland, and Rick III was my patient, preparing to follow his grandpa—and me—along the Via Dolorosa of medical school.
“Dr. Galen, you and Gramps have seen and done so much in your life. Why did you decide to become a doctor?”
“Are you having a crisis of faith, Rick?”
Hey, if the clergy can say that, why can’t I?
He laughed, but I saw the haunted look in his eyes.
I stared at the wall. My mind conjured up that life-changing moment in my childhood, when my Marigold Lady’s dead hand beckoned me toward the river where she lay. Her unspoken words echoed in my mind.
Don’t leave me!
I turned back to Rick.
“Like everything else in my life, a lady conned me into it.”
I noticed that Barbara was about to speak up.
“More likely the devil made him do it, and that’s not the whole story,” she said. “The lady was dead—floating in the river—and he was eight years old. Told you he was weird, didn’t I?”
My secretary was her usual charming self.
“Well, Barbara, if I had told this young man that I found a coupon on the back of a Captain Marvel comic book, would he have believed me?”
“Comic book?” Rick asked.
“Yeah,” Barbara snorted. “It said you could make easy money in your spare time with their little doctor kit. You didn’t think he went to medical school, did you?”
I watched his reaction. Now he was truly confused.
“She’s right, Rick. The lady was dead. But I have to give credit to one man, a true sage, who saw a wide-eyed, eight-year-old boy and became my mentor.”
My other secretary, Virginia, had arrived, and she seemed stunned by what I had just said—I had never mentioned it before.
“Anybody we know?”
“No, his name was Corrado Agnelli. He was my guardian angel,
my role model—more than my parents. He shared my dream. Even more important, he showed me wisdom…”
My eyes filmed over, as Corrado’s uniquely accented voice echoed in my mind.
“Berto, come over here. Take a look at this!”
By the time I was thirteen I had become a constant visitor to the storefront free clinic run by the immigrant doctor.
“I don’t see anything wrong, Dottore.”
“Look at the baby again, Berto. See anything unusual?”
“Uh … no sir.”
“Ah, Berto, learn to observe with your mind as well as your eyes. You see a baby lying here. It has two arms, two legs, and two feet. You automatically assume that everything else is normal.”
He held up the baby’s right leg.
“How many toes, boy?”
I stared at the tiny foot.
“Geez, there’s six toes!”
“Six toes.”
“What did you say, Dr. Galen?”
Rick had risen from his chair during my reverie.
“Boy, the one thing my mentor pounded into me was never to assume something is true or normal just because you expect it to be so.”
He stood silently for a few seconds.
“Dr. G., what was it like when you first started out in practice?”
“I was the typical new kid on the block. Thank God the older, established docs were empathetic to newbies like me.”
When I was just beginning my practice, I would often visit patients in the hospital and make rounds with some of the med students. One day it was lunchtime, and my stomach was demanding sustenance in its own, uniquely vocal manner. I quickly scribbled some discharge notes for an elderly patient who had recovered from pneumonia, checked my bag to be sure I hadn’t left anything behind in the patients’ rooms, and headed toward the stairway down to the cafeteria.
That’s when I heard a familiar voice.
“Hey, kid, wanna get something to eat? Our treat!”
Dr. Galen's Little Black Bag Page 7
