by Larry Karp
Brown looked apoplectic. “But…this girl…my daughter… she’s fifteen years old!” Little globules of spit flew from his mouth.
By then Samuel was flipping pages in the chart. “Rapid pulse,” he murmured to me. “Falling blood pressure, falling urine output. Let’s get started.”
I followed him to the bedside. Brown clenched both fists, shook them at the ground, growled, “Umph! Umph!” Crimson spread up from his cheeks to his forehead, across his bald dome. Samuel studied Rhoda for a moment, then looked at me. “Otoscope.”
He took the instrument, scrutinized Rhoda’s ears, eyes and throat, then grabbed a stethoscope and listened to her heart and lungs. He felt her abdomen, checked reflexes, did a full examination, but quickly, almost perfunctorily. I was surprised. A girl as sick as that, where a very good doctor hadn’t been able to make a diagnosis? Samuel slipped his rubber hammer back into the black bag, then said casually, “She’s got diphtheria. Treat her for diphtheria, she’ll probably be all right. But no time to waste.”
Another surprise. I’d learned early on, a consulting doctor talks over his findings privately with the doctor who called him in, then both doctors discuss the case with patient and family. Dr. Cornwell actually gulped. “Samuel… Diphtheria’s very rare past the age of ten. And there’s no history of a sore throat or a cold, no pharyngeal pseudomembrane, negative throat culture—”
Samuel’s face shone near-luminescent. “Unusual presentation, Art.” He pointed at the pillow next to Rhoda’s head. “See that little stain there? Infection’s in her right middle ear.”
I had to look hard, but yes, there was a small area of faint discoloration next to the girl’s head. Art Cornwell looked unconvinced. “That’s saliva.”
Samuel shook his head, reached back, pulled the otoscope out of his bag, handed it to Cornwell. “Look in the middle ear, Art, you’ll see the pseudomembrane. Diphtheria. Drum’s burst, it’s draining.”
Cornwell’s face said he’d humor Samuel. He rested a hand on Rhoda’s doughy forehead, put the scope to her ear, bent to squint through it. His body stiffened. He slid out the scope, handed it to Samuel without a word.
“Fulminating case, rapid onset.” Samuel spat words like a machine gun. “Must be a bacterial strain that produces a ton of toxin. Take a culture if you want, but I’d just give her fifty thousand units of antitoxin I.V. right away, another fifty I.M. Ice bag over the heart, head and neck. And sick as she is, I’d give her penicillin, soon as possible. Hundred-fifty-thousand units I.V. to start, then fifty every eight hours. She’ll improve by morning.”
I’d never heard such a silence, Martin. Every conscious person in the room glanced at everyone else. Poor Art Cornwell looked as if he’d been stuffed into a close-fitting hair shirt. He seemed to draw himself together by degrees, then said, “Samuel, where in hell are you going to get penicillin for a civilian case?”
My father smiled. “I can get penicillin.” He turned to face Brown squarely. “Enough to treat your daughter. It’ll cost five thousand dollars.”
The previous silence was heavy but this one crushed it. Samuel glared at Brown. “Well, what do you say? Every minute we spend doing nothing makes the situation worse.”
Brown looked at Dr. Cornwell, got no help.
“Do you want me to manage the case?” Samuel snapped.
Silence.
Samuel started toward the door. “I’ll write a note on the chart,” he said. “Good luck.”
“No!”
The first word out of Mrs. Brown since we came into that room split the air. She jumped to her feet, shoved a soggy handkerchief into the top of her skirt. “Samuel, I want you to manage my daughter’s care. If Dr. Cornwell and Dr. Beckwith both said we should call you in, then we need to take whatever advice you give us.” Quick look toward Rhoda. “Especially since yours are the first hopeful words we’ve heard.”
Buskin Brown might add an L to his name and throw his considerable weight around, but it was obvious who played the hand in that family when big chips were down. “You say if we follow your plan my daughter will recover?” Mrs. Brown asked Samuel.
Facing that woman was like standing in front of an oncoming steamroller. I wouldn’t have faulted Samuel if he’d waffled, but he didn’t even hesitate. “Pretty sure, Constance,” he said. Quiet words, gentle but firm. “But I do know what’ll happen if we don’t treat her quickly.”
Mrs. Brown gave her husband a look that could’ve withered a live oak. He answered with a timid little nod in Samuel’s direction.
Samuel pulled the nurse-call string. Almost instantly, a large woman ran in, a tiny white cupcake-paper hat pinned to her beehive of white hair. “Diphtheria antitoxin, fifty I.V., fifty I.M.,” Samuel said calmly. “Ice bags, head, neck, heart. I’ll write orders later.” The nurse ran out as quickly as she’d come in.
Samuel looked at Brown. “I need five thousand, cash. Now.”
Brown spluttered, jabbed a finger toward the window at the darkening sky. “It’s after eight o’clock at night,” he bellowed. “Banks’re all closed. Where do you think I can get—”
Before he finished his question, answer came from his furious wife, now back at the bedside. “Same place you’ve gotten it for a lot of other things, none as important as this. Now do what he says and hurry up about it.”
Brown pursed lips, shook his head like a horse uncertain at the road his driver was directing him onto. Then he growled, “My house, fifteen minutes,” at Samuel, and stomped through the doorway.
Samuel took Art Cornwell’s hand, said, “Thanks for asking me to consult. She’ll make it.”
As we walked out into the hall, Samuel told me to go down to the car, he’d catch up with me in a minute or two. “Got to call a man about some penicillin.” He held out his hand. “Bag.”
I didn’t ask why he needed his doctor’s bag to make a phone call, just went downstairs, through the lobby, out into the car. Not five minutes later, Samuel came rushing down the walk, bag swinging from his hand as if it had no weight. He jumped in, flung the bag onto the back seat, started the car, swung a U-turn in front of an ice-cream wagon, took off uptown. He could’ve powered that car with his own energy. Cheeks glowing, eyes aflame, he was Hippocrates, Franklin Delano Roosevelt, Jesus Christ, and P. T. Barnum. Rhoda Brown would live because Samuel Firestone wouldn’t have it otherwise. “Samuel,” I said, very, very quietly. “How did you know Rhoda had diphtheria when no one else did? You hardly even examined her.”
“Didn’t have to,” he said, eyes still on the road, speedometer moving up on forty-five. “I knew what she had, only question was where. Think back, Leo. When we walked into that room what was the first thing you noticed?”
I thought back. “All the people standing around, how concerned they were. Afraid. Rhoda looked pale, fragile—”
“That’s what you saw. What did you smell? Notice a funny odor? Different from anything you’d ever smelled before.”
“The hospital smell, iodine—”
Samuel cut me off again. “No, no—that, you smell every day. Didn’t you notice a different smell? Sweetish, putrid? The minute I walked into the room I smelled diphtheria. Use all your five senses, Leo, all the time. Find someone unconscious and think it’s diabetic coma, don’t waste an hour sending urine to a lab. Put a drop on your tongue, see if it’s sweet.”
Samuel turned left off Roosevelt onto Ridge, then another left onto Manor. He parked in front of a house out of Gone With the Wind, white columns across a veranda fifty feet wide. As we pulled up, Buskin Brown stomped down the flagstone path toward us, a paper grocery bag in his hand. Samuel got out of the car, motioned Brown into the back seat, followed him. I kept my eyes forward. A minute passed, then Brown blustered, “It’s all there, Samuel, I counted it three times. You don’t trust me?”
Silence. Finally Samuel said, “Forty-nine, fifty. Tell you a little story, Buskin. When I was an intern, electrocardiograms were just
being developed in big city hospitals, and getting one was a big deal. String galvanometer, resistors, camera with motor, light source, all touchy as hell. One day my resident showed me a cardiogram he’d done on a patient, told me to write treatment orders based on it. But the damn tracing didn’t fit at all with clinical findings. So late that night I wheeled the patient into the electrocardiogram room, did another tracing, and guess what—it was normal. The resident had reversed a couple of leads. If I’d treated that patient on faith I’d’ve killed her. Now go on back to the hospital, Buskin. We’ll be there inside half an hour.”
Brown hauled himself out of the car, onto the sidewalk, stamped away to his own car in the driveway. Samuel got behind the wheel and we were off, back down Roosevelt, across Graham Avenue to Lyon, then left on Sixteenth to Jack’s Pharmacy. Jack stood behind the counter, a sneer on his face. “Well, if it ain’t the Angel of Mercy and his little cherub.” He pointed at a brown bag on the countertop.
Samuel pulled a folded wad of money out of his shirt pocket, passed it across the counter. “Shekels for the Prostitute of Pharmacopeia.”
Jack snickered, then made a show of counting bills. Twenty hundreds. He took out his wallet, slipped in the money. Forget the cash register. Samuel opened the paper bag, pulled out two little bottles, looked at them closely. “Right. Two weeks’ worth. You’re an honest crook, Jack.”
As we squealed away from the curb, Samuel said, “Leo, you’re seeing something glorious tonight.” He glanced at the bag on the seat between us. “Rhoda’s too sick for antitoxin alone to do much good, but this antibiotic, penicillin, knocks diphtheria bacteria cold. It’s almost all going overseas for the Armed Forces, but who’s going to tell me Rhoda’s life is worth less than some soldier’s?”
Not me. I was shaking.
“If getting penicillin for her means bending a rule, it’s an easy choice.” Samuel paused, sighed. “Maybe she’ll take after her mother.”
All the way back to the hospital I thought about rules, bending them, breaking them. I’d heard my father count Brown’s money, fifty hundreds, five thousand dollars. He gave Jack two. What about the other three?
I followed Samuel inside the hospital, up to the second floor. At the door to the mens’ room I called, “Be right along,” then ran inside with the big black bag, charged into a stall, threw the lock behind me, sat down.
I waited half a minute, held my breath. The outside door didn’t open. Carefully, quietly, as if the stalls on either side of me were occupied by spies, I clicked the latch, pulled the bag open, reached past little compartments full of tablets, capsules, bottled liquids, down into the space below. Stethoscope, reflex hammer, rubber tourniquet, ophthalmoscope, otoscope…paper crinkled against my fingers. I pulled out a bag, rummaged inside it. Couple of autoclaved syringes, several 25-gauge needles, and a glass vial of morphine sulfate, hospital stock, no prescription sticker. No hundred-dollar bills, either.
I put the narcotic back into the paper bag, stuffed it underneath the ophthalmoscope, then clicked the latch closed and walked slowly back to Rhoda Brown’s hospital room. Just inside the door I stopped in my tracks. A sweetish odor, unpleasant, hint of something rotting. Faint, but definitely there. Samuel stood at the bedside, holding up a bottle of penicillin, telling the nurse exactly how and when to give it, warning her no mistake could be made, not a pinch of that precious powder could be wasted. Art Cornwell was gone. Buskin Brown seemed to be studying the progress of a fly on the far wall. But Mrs. Brown, wide-eyed, open-mouthed, gazed at Samuel with the adoration of a true believer.
As we left, Samuel told the nurse to call him for any problem. “I’ll be back in the morning,” he said. “By then we should see a nice turnaround.”
Mrs. Brown burst into sobbing. Her husband draped an arm around her, rumbled, “You’d better be right, Samuel. I’ve got connections in this town.”
Any boy of sixteen knew Jersey politics, but if Samuel felt concerned, he didn’t show it. “Be back at nine o’clock,” he said quietly. “I expect I’ll see you both talking to your daughter.”
Down the stairs, into the lobby, no conversation. Finally I muttered, “What a jerk.”
“Brown?” Samuel slowed pace. “I don’t know. Buskin’s used to having his own way, and right now he’s in over his head, thrashing around like a man drowning. But a few years back, when one of his machine operators got careless and lost a hand, Buskin covered all his medical expenses, then got him trained as a salesman. The man makes higher pay now than he did in the mill. You like to paint, Leo. Can you paint a man’s portrait using only one color?”
As we walked up our front steps, Ramona opened the door. Eyes staring, black pupils huge, hands shaking, arms covered with gooseflesh. If I hadn’t been on alert I’d have missed both the silent question in her eyes and the little nod Samuel gave in answer. He lifted his Panama, brushed hair back off his forehead, shot me a sideways glance. “Whew, long day. I could use a dish of ice cream, chocolate if possible. What say you go to Felix’s, get a pint.” He pulled a bill from his pocket, held it out to me.
Ramona sniffed, wiped at her nose. “Oh, that sounds wonderful on such a hot night, after such a hot day.” Her voice shook as badly as her hands. Samuel told her with his eyes to let him handle this.
I took Samuel’s dollar, went out to the garage, got my bike and rode up Roosevelt to Felix’s Pharmacy, just below Thirty-third. Ice cream was in short supply, but white-haired old Felix Moskowitz somehow managed to always have a container or two in his soda fountain. One pint per customer, no more, and sometimes the choice was vanilla or vanilla. I waited while Felix finished filling the prescription he was working on, then sold a card of barrettes to a young woman. Finally, he trudged behind the soda fountain and struggled to scoop a pint of hard-frozen chocolate ice cream, working with the same patient thoughtfulness he gave to mixing tonics and elixirs. He molded a square of light waxed paper carefully across the top of the little white carton, shook the carton into a paper bag, rang up the sale and counted my change into my hand, one coin at a time.
By the time I pedaled home, Samuel and Ramona were sitting in the living room, talking quietly. They looked up as I came in. “Want me to dish it out?” I asked. “You bet,” Samuel said. “I’ve worked hard enough today.” Ramona’s smile was almost beatific. Her face was relaxed, pupils so small I could barely see them.
After the ice cream I excused myself. “Want to read about diphtheria,” I said, and went into Samuel’s library. I actually did read about diphtheria, didn’t want to leave myself vulnerable to a pop quiz, but when I finished, I flipped to the pages on narcotics addiction. “Withdrawal is most unpleasant,” said the book. “The addict becomes agitated to the point of shivering, suffers waves of gooseflesh, gets a runny nose. As time passes, he suffers abdominal pain that can be excruciating, with bouts of watery diarrhea. When he finally secures and administers himself more narcotic, he may achieve what is called a rush, a sensation said to be equivalent to sexual satisfaction, with flushed face, evident tranquility, and reversal of all withdrawal signs and symptoms. An unmistakable sign of recent narcotic use is pinpoint narrowing of the pupils.”
The next paragraph told me addiction to morphine and other narcotics is not uncommon among medical personnel because of the ease with which the susceptible personality can obtain drugs. “Unlike the usual addict, these medical addicts do not suffer complications related to impure drug or unclean apparatus of administration. They can carry on thus for years, performing their professional duties quite satisfactorily and functioning well in society, no one suspecting their addiction unless they’re caught stealing narcotics.”
“Stealing narcotics”! Samuel runs into the hospital, saves a girl’s life by making a diagnosis no other doctor could, then steals needles, syringes and morphine to feed his wife’s habit. You need more than one color to paint a man’s portrait? How about black and white? I slammed the book shut, went upstairs to bed.
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Chapter 7
I held up a hand to Dad, time out, then trotted down the little hallway to the men’s room. Inside, I pulled out my cell phone, punched in my home number. Couple of rings. “Firestone residence.”
“Helene…”
“Martin? Is something the matter?” Helene’s whiskey-and-cigarette inflections, more noticeable through the phone than face-to-face.
“No. I just took a break from Dad’s story, and I wanted to hear your voice.”
“You’re sweet, Martin, but you really don’t have to check up on me. When you’re done, come home. I’ll be here.”
“Old habits,” I muttered, then quickly chirped, “Good. See you then.” A New York minute later, I slid back into my seat.
Dad lifted his drink, sipped, then took my measure. “Got a time problem?”
Had he seen me on the phone? I was inside the bathroom, but I’d long ago learned to put nothing past my father. “I’ve got all afternoon,” I said. “Go on. What happened to Rhoda Brown?”
Dad laughed, a throaty rumble, shook his head as if he still couldn’t believe what he’d seen sixty years before.
Next morning, nine o’clock, Rhoda looked pale and drawn, but right on with Samuel’s prediction, she was talking to her parents. She managed a weak smile as Samuel and I walked in. Mrs. Brown jumped up, embraced my father fiercely. “Thank you, Samuel, thank you.” She pulled away just far enough to look up into his eyes. “I don’t know how we can ever properly thank you, let alone apologize for not calling you in the first place.”
“No apology needed,” Samuel said. “And as for thanking me, you just did, didn’t you?” He looked at L. Buskin Brown, who’d stood silent, classic hangdog face, through the entire exchange. “Maybe you’ll feel better when you see my bill.”
Samuel and Mrs. Brown laughed. L. Buskin smiled reluctantly. Then he lumbered forward, arm and hand out in front of him like a battering ram. He grabbed Samuel’s hand. “When I’m wrong I say I’m wrong,” he boomed. “From now on, whenever anyone in my family’s sick, I’m calling you. If you’ll come, that is.”
