Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  Then one of his nurses stuck her head through the open door.

  “Dr. Agnelli…”

  She noticed me.

  “You’d better take this call.”

  He picked up the old, heavy, black, Bakelite phone, and his eyebrows rose then creased in an inverted V. He hung up without saying a word and turned to me.

  “Berto … Nicky and Stan … I’m sorry.”

  They had held hands and jumped off the roof of the hospital just before being sent home.

  Not all Romeo and Juliets are boys and girls.

  The mood of that tortuous reverie haunted me, as I walked into the hospital meeting room. The two medical students—Crescenzi and Galkis—sat outside in the hallway.

  They watched me go past silently. I guess the look on my face scared them. Crescenzi reached over and held the other young man’s hand.

  Jacoby and McKaylic were sitting at the table, waiting.

  “Galen, I didn’t know bears worked in hospitals.”

  Jacoby was trying to defuse a bad situation. He had been alone for some time with McKaylic. Neither man liked the other.

  I sat down. McKaylic was scowling.

  “Hello, Liam, Ben.”

  Both men nodded.

  “Liam, I didn’t know you liked Indian food,” I said.

  Ben’s eyebrows rose. McKaylic didn’t reply.

  “Yeah, next time you and … your … uh … wife … stop by Soufi Delight, try the mooli bread. I can’t get enough of it”

  Ben allowed himself a slight smile.

  “Yeah, Galen, it shows,” he said, dryly.

  McKaylic was turning beet red.

  I cleared my throat.

  “Let’s get down to business. What’s the story?”

  “Those two should be dismissed from the program.”

  “What two, Liam?”

  “Crescenzi and Galkis. They’re a disgrace to the hospital. They’re…”

  “What seems to be the problem?” Ben interjected.

  “You know damned well why.”

  I stared at the bald-headed little man.

  “No, tell us, Liam.”

  “They were … uh … you know.”

  “No, I don’t. And if my memory serves me, that wasn’t your wife having dinner with you the other night, Liam. Does the Missus know about your office nurse?”

  Ben couldn’t control himself. He turned to McKaylic.

  “So, you’ve been naughty again, Liam? Does Della know?”

  McKaylic’s expression darkened. His voice slipped into an accented patois.

  “You bloody bastards, who are you to criticize me!”

  “I’m glad you asked, Liam,” Ben drawled. “I think you’re a lowdown son-of-a-bitch for sniffing around my wife like some dog in heat.”

  I started piling on.

  “And what about you and that medical student … what was her name … Angela? As I recall she filed a complaint against you for sexual harassment, and you went out of your way to libel her. Didn’t you even write to her school dean without the permission of this hospital?”

  “She was a damned whore! The little bitch! She came on to me.”

  “That’s not the way the nurses and house staff saw it. Besides, you don’t have the looks for anyone who isn’t blind to come on to you.”

  McKaylic kicked his chair backward and lunged at me.

  That was, shall we say, a major tactical mistake.

  Suddenly I was reliving my college days. My right hand shot out and grabbed his scrawny neck. Only Ben’s shout stopped me from clamping down on his windpipe.

  “Bob, no! He’s not worth it!”

  I released my grip. McKaylic fell back into his chair, holding his throat and gasping. He tried to speak, but his hoarse voice was barely audible.

  “I’ll sue you for this, you fat bastard! I’ll sue you both!”

  “You were the one who went for Galen,” Ben countered. “Besides, I don’t think your wife and patients would like to see the parade of female students and nurses who would be more than happy to testify against you. Imagine how it will look when the student you harassed tried to kill herself, because you maligned her. Damned good thing her resident got to her in time. Lucky for you we convinced her dean there was no substance to your allegations, just like there’s no cause for action against those two kids out in the hallway.”

  I had calmed down some. I stared at McKaylic, laser-like.

  “Look, Liam, here’s the bottom line: We’re not going to let you slander those two talented young men because of your neuroses. You got that?”

  By the time McKaylic had sputtered a few unintelligibles and gotten himself up and out of the room, Ben was shooting me a mile-wide grin.

  “You got a way with words, Galen.”

  “Yup, sometimes. So, you think we got enough on that bastard to get him kicked off the staff?”

  “I’ll see what the executive committee and the legal counsel have to say.”

  “Meeting adjourned?”

  He just smiled again.

  When I walked out of the room, Crescenzi and Galkis stood up apprehensively.

  “Why the hell are you two still here?” I growled. “Don’t you have patients to take care of?”

  Crescenzi understood immediately.

  “Dr. Galen … uh … I …we…”

  As Ben joined us, Galkis held out his hand.

  “Thanks, Dr. Galen, Dr. Jacoby.”

  They turned and practically ran down the hall to their ward duties.

  “Galen, you heard what drove me in there, but what’s your demon?”

  “It’s a long story. For now, let’s just say this was my attempt to atone for an old but grave mistake.”

  He nodded and left for another committee meeting.

  I headed to the stairwell entrance and climbed up one flight. George Maitland’s office was halfway down the corridor.

  The door was ajar, and only one small desk lamp lit the room.

  I stuck my head in and called, “Hey, George, problem solved!”

  No response.

  Then I saw my friend. He slumped in his chair, motionless, his late wife’s picture lying across his chest. His eyes were half-open, and a smile graced his lifeless face.

  I already knew, but I had to go through the motions.

  I felt his cold skin and detected no pulse in his neck.

  I opened my bag and took out my stethoscope. I listened to his chest.

  Again, nothing.

  I closed his eyes.

  I sat down in a side chair, my eyes clouded with tears.

  The old Army Air Corps pilot had fought his last dogfight.

  But the Dark Angel had won.

  Circles

  The mind is like a parachute. It works best when open.

  —author unknown

  “Doc, I leave for school tomorrow.”

  We sat in my back yard. The contrast wasn’t hard to see.

  I was getting older, maybe a little more cynical than necessary.

  The young man sitting across from me pretended worldliness, but his body language conveyed palpable fear and uncertainty. Yet there was an eagerness about him that made me … envious?

  When had I lost that spark?

  I had seen it in my colleagues. We call it physician burnout. The rising demands of outside parties and influences—government agencies, insurance companies, and popular misconceptions about what doctors could do—sooner or later take their toll.

  Loss of autonomy is hell for someone who has had to make independent decisions his or her entire life.

  I stood up and stretched.

  “Come on, Rick. We can talk while we walk, okay?”

  Richard Shepland III nodded and rose.

  “Doc, I gotta admit, it scares me. I’ve busted my rump just to get to this moment, and now I’m scared.”

  “You remember how you felt when you got married?”

  “Yeah.”

  “Was it worth it?” />
  He grinned.

  “Best damned thing I ever did. Patty’s kept me focused. She shares my dream. God, I’m lucky!”

  I stared out at my garden. The small memorial plots I had planted long ago in memory of my Leni and Cathy were in full bloom. The daylilies and Hibiscus cast their whites, reds, chocolates, and yellows against a teal-blue sky.

  Oh, how I miss you both.

  “Did you say something, Doc?”

  “Uh … no, Rick, just clearing my throat … ahem. So, your tuition is covered, and you have enough money to survive while Patty settles into her new job in Richmond, yes?”

  “Yeah, thanks, Doc.”

  “Good. What about your apartment?”

  “It’s walking distance from school. You gonna come visit?”

  “I might. You guys have a spare room?”

  “Yeah, but…”

  Thought so.

  “Uh … Doc, can I tell you something personal?”

  “You’re not pregnant, are you Rick?”

  He flashed a smile.

  “No, but Patty is.”

  You sure have taken on a helluva load, haven’t you, boy?

  “Congratulations! Now, how did that happen? I thought we had the birds-and-bees talk when you were fourteen.”

  He blushed.

  “Remember how you keep telling me that … uh … stuff happens?”

  Not quite the word I would use, but his version was cleaner.

  “I see your point. Is that what you wanted to tell me?”

  “Part of it.”

  He paused.

  “Doc, would you think less of me if I told you I was scared shitless?”

  Once again, that mantle of fear arose.

  “About becoming a father?”

  “All of it. I just kinda feel trapped … you know … marriage, school, baby on the way. How’m I gonna do it?”

  “I don’t know, Rick, you just do.”

  He looked at me quizzically.

  “I used to ask myself the same questions. Then I visited my mentor, Dr. Agnelli, and asked how he did it. Know what he told me?”

  Rick shook his head.

  “He looked me right in the eye and said, ‘If this life is for you, you just do it, and don’t ever look back.’”

  “Why not?”

  “Because, your personal demons might just catch you. Besides, you’ll be so busy, you won’t have time to worry.”

  He smiled.

  “One more question, Doc.”

  “Shoot.”

  “You ever make any mistakes … I mean, big ones?”

  Mistakes!

  I stared at the backs of my hands, now beginning to mottle and thin, a parchment testimony of time’s passage. Were these really the hands that had caressed and loved? Were they the same hands that had moved over countless fearful bodies, feeling the river of life flow strongly in some and at the ebb tide in others? Hands and fingers, seeking, searching out what should be and what should not, guiding my eyes, ears, and mind toward a decision—a conclusion.

  Sometimes those hands were wrong.

  I motioned Rick over to the twin benches on the lawn, and we sat down. Light breezes rippled the air, and several geese and ducks idled in flight along the edge of the sky, , eyes closed in the midday warmth.

  I rubbed my knees.

  “If you didn’t already have wavy hair, I could tell you stories that would curl every last one on your head. Now, listen up, boy. If I can impart only one bit of wisdom to you, it’s this: Your patients will tell you their diagnosis.”

  I noticed the tension leaving the young man’s shoulders. The crease of a smile replaced the clenched jaw of anxiety. Good! That was what I had hoped to accomplish.

  At least I hadn’t lost my way with words.

  So the boy/man sat, cross-legged, on the bench across from me, looking like an expectant puppy.

  All right, Grasshopper, let Master Po tell you how much of a screw-up he once was…

  It was one of those days that started out normally—though the first phone call was at 5 a.m.

  “Dr. Galen?”

  “Yes, Mrs. Meland.”

  “It’s Seth, he’s still crying.”

  It was unusual for Sylvia Meland not to call.

  Seth was her first child. He was only two months old, but he had been miserable since day one: eczema, reflux, digestive problems, and colic. The multiple lab studies I had ordered all came back normal, and the pediatricians I had consulted said it probably was the luck of the draw: Seth was just a colicky baby.

  Nevertheless, at least once a week, Sylvia would bring Seth in and show me diapers filled with the normal, pasty-yellow movements of a breastfed baby.

  “Is this really normal?”

  I tried to be supportive. I understood that first babies were a new mother’s most trying experience. So each visit I would look Seth over, weigh him, and run my hands over his head, neck and abdomen. And every visit I would see and find nothing out of the ordinary.

  But that particular morning, Sylvia Meland arrived at my door at 6:30. She was in tears, holding the screaming infant in her outstretched hands.

  “I can’t take it any longer!”

  The same words crossed my own mind.

  “Mrs. Meland, I still can’t find anything.”

  “Please, Dr. Galen, please put him in the hospital.”

  I didn’t want to do it. Call it ego, call it dread of unnecessary hospital admissions and looking bad in front of my peers. But the way things were going, if Seth weren’t hospitalized for evaluation, his mother soon would be. She had drawn very close to a nervous breakdown.

  I called the admitting desk and made the arrangements; then I called a colleague, a top-of-the-line pediatrician.

  “Don’t you ever sleep, Bob?”

  “Only the good sleep, Tom. You know that.”

  “Yeah, that’s why you woke me up. Whatcha got?”

  I ran through Seth’s story, and Tom Paulson interrupted me several times with a “are you sure it isn’t just really bad colic?”

  Finally he agreed to examine the baby.

  So Sylvia took Seth out to the car and drove to the hospital. She seemed relieved. If nothing else her baby would be taken off her hands for a while.

  Then the guilt hit me. I realized that I simply had grown tired of hearing her cry wolf day after day. And I understood that I now felt the same way about her as she did about Seth.

  The day progressed as I expected. There were the usual back pains, headaches and runny noses. Then I met Alex.

  “Wanna see someone on your lunch hour?” Barbara called back from the reception desk.

  “Why?”

  “Parents say their kid’s arms and legs don’t work right.”

  The Daumiers were what you might call citizens of the world. Representing our government in numerous countries over the years, they had just returned from Europe and were still setting up house nearby.

  Their Alex was fourteen and all boy. But when they brought him in, he stumbled down the hall, even though they were supporting both his arms.

  “What happened, Alex?”

  “I fell.”

  “And…”

  “He was practicing for a merit badge for his boy scout troop. He had to climb a tree to demonstrate limb cutting.”

  “I slipped.”

  “How far did you fall?”

  “Twenty, maybe twenty-five feet.”

  “Mrs. Daumier, Alex needs to go immediately to the hospital.”

  “We just came from there. They said he only had bruises and discharged him. On the ride back, he started to complain about pain then numbness in both his arms and legs.”

  I grabbed a cervical (neck) brace from my closet and put it on the boy. Then I did a quick check of his reflexes and his response to different sensations on the skin of his arms and legs. Muscle-strength testing showed marked loss of his ability to flex arms and legs.

  Alex Daumier had suffered spinal-cor
d trauma. His parents were thinking he had received a minor injury. But I knew it was already a fifty-fifty chance he would become paralyzed.

  I called the rescue squad and put in a call to a neurosurgeon.

  “What’s the story, Bob?”

  We exchanged information on Alex’s medical status in the typical staccato code lingo doctors use to communicate with each other fast.

  “I’ll meet him in the ER. Good call, Bob.”

  While we waited for the ambulance, I sat down with the Daumiers.

  “Sometimes this type of fall—the impact from it—causes tissue swelling around the base of the brain and spinal cord. In Alex’s case, the injury is in his neck. That would explain why he has both arm and leg symptoms. The wires that give feeling and the ability to move start at the top and move downward. Put pressure at the top and you can affect any or all levels of function.”

  The ambulance siren echoed through the office as I finished. The EMTs rushed in with their cart. They slipped a board under Alex and carefully positioned him on it then inserted two IVs—much to the boy’s dismay.

  I gave them a quick rundown, making sure they understood that the neurosurgeon was waiting at the hospital.

  Two hours later I got the call.

  “We got him—just in time,” my colleague said. “He was starting to lose sphincter control (bladder and bowel). He’s on high-dose dex (dexamethasone—a steroid used to reduce swelling quickly).”

  “Many thanks, Ron. I’ll be by this evening.”

  I looked over the appointment book on my secretary’s desk. The rest of the afternoon was routine: chest pains, difficulty breathing, headaches. Then I spotted the last name scheduled: Tom Regelson.

  I had treated Tom and his family—actually two families—for a number of years, and the wordplay and literary discussions I had enjoyed with him became a favorite part of my day-to-day routine.

  Tom was a retired college professor, a transplanted Minnesotan, who had become a world-renowned expert in Sinology. He was expert in other Asian languages and cultures as well.

  And he was a deeply religious man, heavily involved in his church activities. Retirement allowed him to delve deeper into the philosophical mysteries that drive all thoughtful people. Tom had no doubt there was an afterlife, but his keen intellect and overwhelming rationality could not refrain from seeking causality.