Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  Good, I thought, get through the day and see what Professor Tom will bring up next.

  Five o’clock approached. I was standing by my secretary’s desk finishing some chart work, when I saw Tom’s Ichabod Crane figure coming up the walk.

  “Virginia, it’s time to call it a day. I’ll wrap up after seeing Dr. Regelson. You head on home.”

  She gave me “the look.” She knew how much I enjoyed the verbal jousting that would soon ensue—and she knew some of it wouldn’t be fit for her genteel ears.

  I opened the door just as Tom reached it, and I was about to welcome him in, when he beat me to it.

  “Ni hao ma, good doctor.”

  I attempted to reply, “Hao hen,” and he laughed at my grossly mispronounced Chinese, as he followed me into the exam room.

  I performed some precursive checks and sat down. But what followed surprised the hell out of me.

  “I’ve been thinking about you and your career,” he said. “Actually we were talking about you at the club.”

  He mentioned the name of a very exclusive enclave in Washington for people of world accomplishment.

  “Good doctor, have you ever thought of writing about your experiences in the medical profession? I know some of the stories we’ve talked about. You’ve seen aspects of people that most of us can only imagine. Have you ever considered keeping a diary?”

  “Tom, I don’t feel like either a Boswell or a Johnson, and I’m no Erasmus Darwin, either. What on earth would I be able to write about that would be of interest to anyone else?”

  “Why not write about yourself?”

  I couldn’t help it. I laughed out loud. I should write about the sordid details of my stream of patients? Who would want to read about that—Jerry Springer?

  “Think it over, young doctor,” Tom replied. Then he launched us into a discussion of 1940s film noir and the literary values of Golden Age radio. An hour passed before we decided to call it quits.

  I grabbed a quick bite then headed to the hospital. The neurosurgery wing was nearest, so I stuck my head in room 503 to check on Alex.

  He didn’t need my attention. Half the nurses were standing around his bed, as the fourteen-year-old boy flirted like a pro.

  Must have been the dexamethasone.

  Right.

  The infant ward was quiet. I went to the unit secretary’s carrel and grabbed Seth Meland’s chart.

  “Bob.”

  “Hey, Tom.”

  “Uh … listen, that baby, Seth? He’s got a problem.”

  My stomach knotted. What had I missed? I asked Paulson point blank.

  “Bad?”

  He nodded.

  “Tom, I couldn’t find anything.”

  “He’s got leukemia.”

  Suddenly I had to sit down. My legs felt weak. Tom sat with me.

  “But his last lab was only three weeks ago. It was normal!”

  “It’s bad, Bob—AML. Comes on like a tornado.”

  Acute myeloid leukemia. Even today, with bone-marrow transplants and other forms of chemotherapy, it remains a terrible diagnosis. And the worst prognosis is for babies under one year of age.

  “Think that was making him so fussy?”

  “Hard to tell. Usually doesn’t present that way.”

  “Does his mother know?”

  “Yeah.”

  He paused.

  “Bob, I’m not sure how to put this, but she actually seems relieved.”

  We sat there and stared at the wall.

  It was late September, following a summer when the thermometer had caused those who doubted global warming to doubt their doubts. The usual run of preschool and college physicals had ended, and kids who had reveled in classroom-free abandon now made plans to display their athletic prowess in sports tryouts. Even my Saturdays were booked up with hopeful football players and cheerleader wannabes.

  Ever since Cathy passed away, I worked the weekends alone.

  The phone rang. I was pleased to hear Tom Regelson’s voice.

  “Do you have some free time, young doctor?”

  “Of course. Come on down. Any problems?”

  “Probably a minor one, but I’d like it checked out.”

  Waiting for Tom I signed a sports-physical form and handed it to the ninety-pound, fourteen-year-old boy who desperately wanted to be a linebacker. He strutted out of the office accompanied by two friends, trying to flex his muscles.

  Several minutes later I saw Tom’s classic Porsche pull into my lot. He got out and walked slowly toward my door. I noticed it immediately. The man was not the same, and he lacked his normally confident stride. The Ichabod Crane figure truly appeared haunted by the Headless Horseman

  “Come on back, Tom.”

  He leaned against the exam table and abruptly said, “I think I have cancer.”

  “What makes you think so?”

  “The left side of my face feels different.”

  “What do you mean?”

  “It feels like there’s something growing in there.”

  “How long?”

  “About two weeks.”

  My fingers moved, as usual, with a mind of their own—pressing, palpating, playing the keyboard of a man’s life under their pads. I scanned my mental database of causalities. Was it a change in the way the nerve supplied feeling to the area? That would have been the best reason. Bell’s palsy was a self-limited condition.

  No, the pattern wasn’t right. There was no drooping on one side of the face or eyelid. That also helped to exclude brain damage of the stroke kind.

  I palpated the glands that helped produce saliva: parotid, sublingual, submaxillary. I couldn’t feel any discreet enlargement. Then I put on gloves and examined the same glands from within the patient’s mouth. Still nothing.

  “Tom, why do you think it’s cancer?”

  “Remember when I had that abnormal skin spot on the left side of my face? You thought it was malignant and sent me to the dermatologist. He removed it and said it was squamous cancer.”

  My eyes closed involuntarily. Yes, it was possible. But this fast? Most likely it was an irritation of the big saliva gland, the parotid—yes, that would be it.

  “Tom, if you go by the numbers this is a gland inflammation. Let’s try a short course of medication. If there’s no relief, then we’ll get some imaging studies.”

  “I don’t want to wait.”

  “Give it the weekend. If there’s no change, we’ll get an MRI on Monday.”

  He agreed and left.

  My intuition—call it my gut—was warning me: Tom would be phoning on Monday.

  And so it happened.

  I arranged for an MRI, and the device spun the water molecules in Tom’s body in an atomic line-dance to reveal what the old professor already knew in his heart: cancer—cancer of the parotid gland, which had spread to lymph nodes in his neck. It was rare, but Tom would probably be right about the type of cancer, too.

  Now began the danse macabre of tissue-typing, staging, and excision. The surgeon’s hands moved about the traffic circle of nerves, glands, and blood vessels compacted around the front and base of the left ear. He attempting to preserve feeling and function in Tom’s face while removing the crab that wanted to take his life.

  It was a tribute to the surgeon’s skill—and the patient’s will—that a week after major surgery, Tom Regelson was up and moving as if nothing had happened.

  But he was no fool. He had done his homework and understood this was just the beginning. Now the fight to prevent or minimize spread by use of radiation therapy began. It would not be pleasant, and the side effects were potentially serious.

  Tom never stopped coming by my office on the weekends to apprise me of his condition. And week by week I could see the effects of the demon monkey that rode his soul. I couldn’t imagine what his powerful intellect did to him during those quiet hours when rest was supposed to purge the body of its daily buildup of physical and psychic toxins.

  “Tom,
how are you holding up?”

  “I’ve become even closer to my studies on the origins and basis of faith, young doctor, and—yes, to answer your unspoken question—at times I am afraid.”

  We looked at each other in silent understanding...

  “Doc?”

  “Oh, sorry. Rick. Guess I got lost in thought.”

  I stared at my surroundings. I was in my back yard, talking to the young, soon-to-be medical student.

  “So, what happened to the professor and Alex and baby Seth?”

  He watched me intently. I had been staring off into a distant past. I rose and walked to the edge of the yard and stood under my oriental persimmon tree. I touched the wrinkled bark surface, as the tree moved in the wind, its branches waving outward in ever-widening circles, circles confluent with one another, each influencing another’s outcome.

  I turned back toward the future doctor.

  “It’s been a number of years now, Rick. I’m sure the good professor has engaged in many a discussion with the original author of Ecclesiastes.

  “You know, I have always wondered at the interaction of events—how a single happening occurs at the same time as others, and together they become a unified wave that rolls over us.”

  “That’s a bit too deep for me, Doc.”

  “Me, too, Rick, but I can never erase some memories…”

  December was warm that fateful, long-ago year.

  “Bob, baby Seth passed away this morning.”

  It was Tom Paulson.

  “Thanks for letting me know.”

  He had called at 5:30 a.m. Now it was noon.

  “Dr. Galen, the Daumier boy is here—says he wants to give you something.”

  I got up and walked out to the waiting room.

  “Doc, here’s an invite.”

  Alex had turned fifteen. He was taller now. He handed me a hand-printed card: YOU ARE INVITED TO MY EAGLE SCOUT CEREMONY

  I shook his hand.

  “I’ll try to get there, Alex.”

  “Don’t just try, Doc. Be there!”

  He flashed a grin and left.

  6:30 p.m.

  “Dr. Galen, a call for you.”

  It was Tom Regelson’s wife, Kim. She had remained night and day by her husband’s bedside in the hospital’s hospice wing. I made a point of visiting him as often as I could. Her call caught me just as I was about to head over there.

  I knocked gently on the closed door of room 903. Kim opened it. She was exhausted.

  “He’s had a bad day. I don’t know what to do, Dr. Galen.”

  “Go get some rest. I’ll stay with him for a while. Go lie down, Kim’

  She left. I sat down in the yellow, vinyl-covered chair next to Tom’s bed. He had slipped into a coma before I arrived. Pictures of his family—sons, daughter, wife—were positioned on the table at the foot of the bed. Older pictures of his parents and siblings lay propped up on another bedside table. On the opposite wall were some paintings he had done, scenes of his boyhood in Minnesota.

  Something else caught my eye. It was a small wooden wall plaque, maple, stained a cherry-dark maroon.

  Its letters had been incused with a burning tool. It was the Boy Scout Oath, dated almost seventy years before. At the bottom, scrawled in a childish hand: TOMMY REGELSON.

  Kim came back an hour later. We sat there, until he died at 8:50 p.m.

  I asked her if I could have the plaque, and she gave it to me.

  The following Saturday, I gave it to Alex Daumier at his Eagle Scout ceremony.

  Hey, Rube!

  The woman’s voice was barely audible.

  “This is Beatrice Gordon. My sister Samantha and I live with Maude and...”

  I interrupted her.

  “What can I do for you, Miss Gordon?”

  I was not a patient man in my younger days.

  “Could you come by the house?”

  “Now?”

  That Halloween night the temperature had dropped into the high twenties and the wind gusts gave only a taste of the winter yet to come. Most of the neighborhood parents had kept all but the oldest kids indoors, so the usual parade of trick-or-treaters had withered to an occasional junior high-schooler, something that truly upset my beloved Cathy. She loved to see the costumed munchkins showing up at our door.

  I tried my best to suggest to Beatrice that morning would be better.

  “Are you sure this can’t wait until morning, Miss Gordon?”

  She had called at eleven forty-five p.m.

  “Yes, Dr. Galen.”

  “Why?”

  “Maude’s feeling poorly.”

  I sighed, hung up, and put on my outside clothes.

  “Do you have to go out tonight, Tony?”

  Cathy was sitting in bed reading.

  “’Fraid so. Maude needs me.”

  “You got a new girlfriend?”

  “Nope, can’t handle the one I got now.”

  I bent over and kissed her, grabbed my black bag, and headed out to the car.

  Maude Gordon, nice little old lady—lol to you savvy medical types—had been one of my very first patients the first year I opened my home office. And like all my other early patients, she had walked in unannounced.

  “Is this really a doctor’s office?”

  The air conditioning had been working overtime to repel the heat and cloying humidity so typical of a Northern Virginia summer. The previous week’s rains had given birth to a bumper crop of mosquitoes as well.

  I had worked day and night to get the office ready for its grand opening on the first of July. The smell of fresh paint hung in the air as I called out a response.

  “Yes, ma’am, what can we do for you?”

  “Are you the doctor?”

  “Yes, I am.”

  I wasn’t wearing the prerequisite white coat and tie considered de rigueur for doctors back then. I never did like them—still don’t—but I must admit that my Hawaiian short-sleeve shirt and khaki pants disconcerted the prim, elderly woman.

  “Can you see me? I seem to be having a problem with my skin, and my regular doctor is on vacation.”

  Young doctors better get used to hearing the expression “regular doctor.” I always wondered if that meant I was irregular, maybe having a bowel dysfunction that attracted patients who couldn’t see their own normally bowelled physicians.

  “Please come in, Miss…”

  “I’m Maude Gordon.”

  She was one of those diminutive women who turned heads in their younger days and still possessed an indefinable something that spoke quality. Silver-gray hair flowed above a faultless, clear-skinned face with sapphire-blue eyes. No makeup—none needed—even now in what I presumed to be her early seventies.

  The simple, white, long-sleeved blouse and light-tan skirt showed a well-kept figure, with thin but muscular calves that reminded me of a professional ballerina.

  “What seems to be the problem, Miss Gordon?”

  “My back and left arm feel like they’re on fire, and now these welts just appeared.”

  I held my breath. I was hoping it wouldn’t be what I suspected.

  She unbuttoned the sleeve on her blouse and the diagnosis was obvious: shingles. Herpes Zoster—adult chickenpox, shingles.

  Back in those primitive days we didn’t have anything to treat it except pain medication, topical lotions and an anti-seizure drug called Dilantin to try to block the nerve pain.

  Imagine a hot poker touching your skin that no one can take away. The burning, shooting pain runs a course from back to front along a highway of nerve fibers. That’s what shingles can feel like.

  “Miss Gordon, I’m sorry to say you have shingles.”

  Before I could continue, the old woman interrupted.

  “Don’t be silly, young man. My house has a slate roof.”

  Uh-oh. I started to wonder if Maude Gordon was dealing with a full deck.

  Then she laughed, as my face gave my thoughts away.

  “N
o, young man, I’m not nuts—I just couldn’t resist saying that.”

  She giggled like a school girl and gave me a coquettish look.

  “I’m sorry. I owe you an explanation, too. But tell me, what can I do for this … this stuff on my arm?”

  I waved my magic doctor rattle, told her about the lotions and pills, and warned her there really was nothing medical I could do.

  That was then. Today I can whip out a prescription for drugs that will stop the virus in its tracks or even give a geriatric patient a vaccination to prevent it.

  But Miss Maude seemed so understanding, even downright stoic, about the prospect of post-herpetic neuralgia—the lingering, persistent pain.

  “Now, Doctor, would you like to take my history, such as it is?”

  I did. There was something very compelling about this woman. She seemed uniquely young for her age, yet she showed signs of an ancient wisdom—I just couldn’t put my finger on it.

  I grabbed one of my brand-new, freshly printed, medical-history data sheets and placed it in a clipboard. I snatched a pen and sat down across the examining table from her.

  “Miss Gordon, let me get your full name and address first.”

  Maude Mehitibel Gordon. She didn’t live that far away: four blocks and turn right at the first light, then four blocks more.

  “Your birthday?”

  “Doctor, don’t you know that a gentleman never asks a lady her age?”

  “Yes, ma’am, I do, but unfortunately I need to ask.”

  She gave me a birth date from the time of William McKinley.

  “What type of work did you do?”

  I assumed she was a retired teacher or government worker. She beamed at me. I could have sworn she was a part of some cosmic joke.

  “Well, young man, my two sisters, Samantha, Beatrice, and I were barnstormers and dinger girls. We had one heck of a G-bit, too.”

  Her look just dared me to ask what the hell she was talking about.

  Holy smoke! She was a carny!

  Now it was my turn. I gave her my best, enigmatic, male version of a Mona Lisa smile and fake Virginia accent.