First, Do No Harm

by Larry Karp

  After dinner we sat in the living room, Samuel reading the paper, Ramona lost in that week’s Life magazine, Roy Rogers and Trigger on the front cover. Funny, the stuff you remember. I sat on the floor with a pad, sketching them. Many fewer lines in Samuel’s face than Ramona’s, but his image still went onto the page darker than hers.

  The phone rang. Samuel walked over, grabbed the receiver, listened for not more than a few seconds. Then he moved toward the door. “Erskine Crosbie, let’s go,” was all he said.

  I followed him out to the Plymouth as if drawn by an energy field. “Ruthie sounded upset,” Samuel said, as we turned onto Thirty-sixth Street. “Erskine’s having worse chest pain, trouble breathing. Damn, I wish I had him in Steinberg.”

  Even the “damn” was said lightly, as if he were talking about some minor inconvenience. By the time we pulled up at the Crosbies’ his face was aglow. I could barely keep pace with him, up the concrete path to the door, knock-knock.

  Ruth let us in. She looked ghastly. Up the stairs, not a word, into the master bedroom, to the bedside. I lowered the big black bag to the floor, snapped the latch.

  Erskine was propped up as earlier in the day, tally sheets still all over the bed, but now his face was gray, lips nearly colorless and twisted in pain. His right hand clasped his chest, fingers outstretched. Each gasping breath was a tormented effort. Ruth pointed a badly shaking finger at Erskine, finally spoke. “One minute he was fine, the next…”

  Samuel patted her shoulder, then knelt to talk to Erskine. “Sorry you’re hurting, Ersk, but hang on. Get you feeling better right away.” He took the stethoscope from me, listened to Erskine’s heart and lungs. As he straightened he motioned toward the electrocardiograph machine. “Can you set the leads, Leo? I’ll give him some amyl and morphine, start strophanthin, maybe diuretics.”

  Which meant Erskine was in heart failure. My own heart pounded into my throat as I pulled the EKG to the bedside, squeezed jelly from a tube onto the undersurfaces of the little suction cups, began applying them to Erskine’s chest as I’d seen Samuel do. Erskine groaned. I mumbled, “Sorry.” My fingers shook as badly as Ruth’s. I could see Samuel drawing medications into syringes, couldn’t help admiring his speed and sureness. He wrapped a rubber tourniquet around Erskine’s arm, swabbed the front of the elbow with an alcohol-soaked cotton swab, then quickly emptied three loaded syringes into the vein.

  “Leads okay?” I asked.

  He glanced, beamed me a smile. “Perfect. Start ’er up.”

  As I turned the switch to set the EKG running, Erskine’s hand relaxed, color got better, breathing became less labored. He blew out a sigh, “Whew.” He and Ruth turned identical expressions on Samuel. Mine eyes have seen the glory…

  Samuel studied the cardiograph tracing as I switched settings from one lead to the next to the next. “Tachycardia, deep Q wave in Lead III. Ventricular premature beats.” He spoke as if he were showing me an interesting bird that had just then alighted on the windowsill, but I caught his meaning. This wasn’t just another attack of angina pectoris; Erskine had had a second coronary occlusion. No more home treatment. Samuel would need to get him into the hospital, and that would take some doing. When Erskine made up his mind, his mind stayed made. But what force on earth could resist Samuel Firestone?

  “Feeling better?” Samuel asked.

  Erskine nodded agreement. “Thanks—that was jus’ awful, Samuel. I thought for sure I was going to die.”

  “Not now, Ersk. EKG does show some changes, though. Your heart’s not getting as much oxygen as it should.” Samuel looked at Ruth. “I know you don’t want to do it, but no choice any more. You’ve got to go to the hospital. You need oxygen, regular medications, strict rest. All of which you can’t get here.” Samuel started for the door. “I’m going to call an ambulance.”

  “Oh now, wait, Samuel, wait just a minute.”

  Samuel turned, locked eyes with Erskine.

  “I sure’s hell don’t need any ambulance, it’s less’n a mile. I could go in your car.”

  “Ersk, you want that pain to come back? Try walking from here to the street. You’ve got to have an ambulance.”

  While Samuel talked, a cagey look spread over Erskine’s face. “You call an ambulance now, Samuel, and I am going to get upset. Very upset. You wouldn’t want that, would you?”

  Ruth stepped forward. “Erskine—”

  He went on, as if she’d never spoken. “Samuel, I ’preciate what you’re doin’ for me, I really do. But don’t move quite so fast. You say I gotta go to the hospital, well, I’m takin’ that recommendation seriously. I really am. Jus’ gimme a li’l time.”

  I felt frustrated, but Samuel’s smile was warm, genuine. “Sure, Ersk. Take a few minutes. You know I wouldn’t do this if I didn’t absolutely have to.”

  Erskine had pinked up nicely. His drawl was more pronounced than usual, a bit slurred from the morphine. “’Preciate it, Samuel.”

  Ruth lit a cigarette. Erskine looked at her with the longing of a baby for its mother’s milk. “Hey, Ruthie, gimme a puff, huh? Just a li’l one.” Ruth stopped him with a glance, stubbed the cigarette quickly into an ashtray.

  Next came forty minutes of amiable maneuvering that would’ve done honor to a couple of world chess champions. Samuel zigged, Erskine zagged. Erskine was clearly feeling much better now, probably figured the longer he held out, the stronger would be his argument to remain at home. And he knew Samuel did not want him to get upset, so in this game he held the trump.

  Then, just like that, the card fell from his hand. Samuel was running another EKG when Erskine stopped speaking, mid-sentence. His hand flew to his chest, then he gasped, twisted violently, threw back his head, cried out. He sat bolt-upright, astonishment covering his face. His eyes went blank and rolled upward, head lolled, hand fell away from his chest. I stared at the tracing, straight up-and-down squiggle-line, ventricular fibrillation. Disaster.

  Samuel muttered, “God damn!” then quickly pounded Erskine over the breastbone with the heel of his hand, once, twice. Nothing. Ruth let out a little cry. Samuel dove into his bag, came out with a small bottle and a syringe. “Epinephrine.” He drew some up, snapped a long needle onto the syringe, stuck the syringe between his teeth, then grabbed Erskine by the shoulders. “Take his feet, Leo,” he muttered, not moving his jaw. We lifted the limp body, lowered it to the floor. Samuel ripped away Erskine’s pajama shirt, felt quickly between ribs, then snatched the syringe from his mouth and plunged the needle into Erskine’s chest. Dark maroon billowed into the epinephrine solution. Samuel pushed the plunger, then threw the empty syringe and needle halfway across the room, and began to pump rhythmically at Erskine’s chest. “Like this, Leo,” he snapped, motioning me down with his head.

  I knelt, took over the pumping. Samuel edged upward, cradled Erskine’s head in his hands, then applied his lips to Erskine’s and puffed.

  Living nightmare. I don’t know how long I pumped at Erskine’s chest while Samuel blew air into his mouth. Again and again Samuel felt for a pulse in Erskine’s neck. “Breathe,” Samuel muttered between puffs. “Erskine, breathe, you’re not dead, goddamn it. Come on, breathe.”

  Ruth pulled at Samuel’s shoulder, cried, “Stop, Samuel, please stop. It’s over.”

  Samuel didn’t seem to hear, just kept blowing air into Erskine’s lungs. I pumped and pumped at his chest. Ruth tugged at Samuel, called his name, yanked him this way and that, finally threw herself across his shoulders, sending him sprawling. She was beyond hysterical. “Samuel, God damn you, stop. Can’t you see he’s dead? Please. Let him go.”

  Samuel balanced on one hand, looked up, slackjawed.

  “Let him go,” Ruth sobbed. “He’s dead.” She clutched at her mouth, then ran out of the room. I heard her heave, then a splash. A second retch, another splash.

  Samuel rose slowly from his knees, the wedding guest after his session with the Ancient Mariner. Down the hall
in the bathroom, Ruth retched, coughed, choked, sobbed. Samuel gazed stupidly around the room. I ran to the bathroom, found Ruth on the floor, keening, one arm draped over the vomit-splashed toilet. Her head rested on that arm; her back heaved with each wail.

  “Done throwing up?” I asked.

  She lifted her head just a bit, nodded weakly. I pulled at her free elbow. “Stand up. I’ll help you.”

  I led her, wobbling, to a little wooden stool, sat her down, then took a towel off the rack, ran water over it, started cleaning the toilet and the nearby floor. “Leo, Leo, don’t,” she said, tremolo. “You don’t need to. I’ll take care of it later.”

  “It’s all right,” I said.

  I mopped. Ruth sat expressionless, hollow-eyed. When I finished I threw the towel into a hamper. “Ruth…” I faltered, pushed myself on. “I’m sorry. I can’t tell you how much I’ll miss him.”

  Slight shake of her head as if I’d wakened her. She pushed hair back off her face, then put a hand on my arm, tottered to her feet, hugged me. “We’ll all miss—” She yanked away, eyes like saucers. “Oh my God, the kids. Rob and Josey. I’ve got to—”

  “Where are they?”

  “Summer camp. Near Lake Hopatcong.” Big sigh. “I’ll have to go up there. After we’ve…finished here.” A cough cut in, and she started to cry again.

  Then I heard another sound, somewhere behind the house. A dog baying at the moon? It got louder, then came a crash. Ruth put a hand to her mouth, stopped crying, murmured, “Oh, no.” We trotted single-file into Josey’s room, looked out the window into the back yard, saw a sight I couldn’t have imagined. Samuel swung a red wagon against the support bars of a jungle gym. Crash, a wheel flew into the air, bounced, rolled against the picket fence. Another swing, another wheel. Through all of it, Samuel never stopped howling. A third swing collapsed the body of the wagon, bent it double. Samuel flung it away as if it were contaminated. He lifted his arms, threw back his head, let out a scream that froze my breath in my throat. Then he fell to his knees, pounded the earth, lifted his arms and head again to howl at the skies, a caveman crying bloody murder to gods below and above who’d outraged him.

  “Poor Moses,” Ruth murmured. “Raised his hand, but the Red Sea didn’t give a good goddamn.”

  I couldn’t watch more, turned away.

  “Leo, you do know if you want to cry I won’t tell on you,” Ruth said quietly.

  But I was the only doctor there. I went back into the bedroom, knelt over Erskine’s body. The utter blankness of his face made it clear he was gone. After all his terrible chest pain, all the pumping and pounding to try to revive him… I raised one of his hands, let go. The hand fell with a thud. Every muscle, completely relaxed. I pulled the sheet off the bed, laid it over him. As I straightened, Ruth, behind me, said softly, “I’d like a few minutes with him, please, Leo.”

  I could still hear Samuel’s dreadful howling, wondered whether a neighbor might call the police. Sometimes after my father lost a patient, he came home with eyes like flamethrowers, a landmine ready to blast the first person to step on it, but I’d never seen anything at all like this. “Sure,” I said to Ruth. “I’ll go downstairs, make arrangements, then see about Samuel. Do you have a preference on funeral parlors?”

  I pulled down all the living-room window shades facing the back yard, told the mortuary attendants Samuel had gone to cover another emergency, and that he’d come by next day to sign the death certificate. Samuel himself was a bigger problem. After the attendants left with Erskine’s body, I went out the back door into the yard, but couldn’t get near Samuel, would’ve been killed by the bicycle he was bashing against the jungle gym. When he’d destroyed the bike and paused as if trying to decide what to go after next, I launched myself from his blind side, hit him low, knocked him to the grass, pinned his arms and lay across him. He struggled, but after a minute or so I felt him relax. Slowly, carefully, I let up pressure, then took his hand, pulled him up, walked him back through the house. Quick check on Ruth, then I put Samuel into the car and drove off. All the way home he sat silent, staring, seeing God only knows what.

  One step into the house, Ramona led Samuel off upstairs, not a word. I went to the kitchen, poured myself a glass of milk and took a couple of my mother’s cookies out of the cookie jar. I must’ve been there close to half an hour, sipping milk, nibbling cookies, thinking, when I heard an unfamiliar voice call my name. I looked up.

  Samuel stood in the doorway, leaning against the frame as if he couldn’t support his own weight. His gorgeous face was a wreck. Pallor accentuated the gold stippling over his cheeks and chin. He held an envelope toward me. “Leo, do me a favor.”

  His voice was the screak of a cracked reed. “Sure, Samuel,” I said. “What is it?”

  He waggled the envelope as if any further effort might exhaust him. “Take this to Lily Fleischmann.”

  I looked up at the kitchen clock. Nearly eleven. I almost asked, “Now?” but caught myself in time. “Sure,” I said again. “I’ll get my bike.”

  I pushed away from the table, got to my feet. “Take the car,” Samuel said. “I don’t want you riding a bike down there this late at night.” Every word seemed to require total concentration. He gave me the envelope, then shuffled away without another word, not even thanks. I listened, heard stairs creak as he went up. The idea of my maiden solo voyage in the Plymouth pulled at me but not quite hard enough. I went to the stove, turned on the burner under the tin teakettle, waited for it to boil while I stared at the thick white envelope in my hand.

  Chapter 8

  Dad wiped out Drink Number Four, looked around, motioned to the waiter. The man scurried over, fired me an eyeball query. I shrugged, nodded.

  “I’ll get it right away, sir.” Just a bit too polite.

  Dad watched him all the way to the bar. As the bartender started mixing, the waiter ducked behind the counter, came up with a small tray, pulled away cellophane wrap, then stood, tray balanced on the fingers of his right hand. The instant the drink was ready, he hustled back to unload at our booth. Dad studied the tray, a nice little arrangement of cheese and crackers in circles, with some grapes and a few strawberries. Meaningful glance from the waiter. “Compliments of the management.”

  Dad nodded thanks, grabbed a couple of crackers and a few slices of cheese, washed them down with Manhattan, cleared his throat.

  I edged the Plymouth to the curb in front of the Fleischmanns’, then ran up the walk, onto the porch. Murray, in an undershirt and grimy gray pants, answered my knock. “Christ, Dockie, you know what time it is? You’re as bad as your old man. Eleven at night’s same to him as eleven in the morning.”

  I waved the envelope. “Sorry. Samuel wanted Lily to have this tonight.”

  Screen door opened before I finished. “Hey Dockie, ain’t I ever gonna get to see you smile? Come on in, it’s okay. Lily’s still up. She’s part-time over at Crystal’s Coiffures on Twenty-second Street, so she don’t gotta get in to work tomorra ’til ten.”

  Murray led me into the kitchen, where Lily sat across the table from a girl about my own age. Unlike Shannon, this one was dark, lovely black hair and eyes, clear olive skin. She looked at me with the expression of a deer surprised by a hunter. My stomach lurched.

  Lily smirked. “You’re here without your old man?”

  I handed her the envelope. “He wanted you to have this tonight, asked me to bring it. He’s exhausted. Just finished a tough case.”

  Lily studied the front of the envelope, turned it over, looked closely at the back, then slid it behind the top of her nightgown. I felt my face go warm, shuffled my feet. “Samuel Firestone is exhausted?” Lily murmured.

  “He’s very upset,” I said. “One of his friends died tonight, Erskine Crosbie. Heart attack. Samuel was taking care of him.”

  I didn’t like the way Lily and Murray looked at each other. Trying to redirect conversation, I stretched my hand toward the girl and
said, “I’m Leo Firestone. My father’s a doctor; I’m helping him this summer. Pleased to meet you.”

  Lily shook her head. “Sorry, no manners.”

  The girl pulled herself halfway up, leaned across the table, took my hand. Hers was warm and dry. “Likewise, I’m sure.” She smiled. “My name’s Teresa Baker. Your father’s taking care of me. He’s really peachy.”

  I looked down. Yes, Teresa’s abdomen bulged under her light blue nightgown. “You’re Lily’s niece?” I asked.

  Teresa looked at Lily, who flipped me a glance that said watch your step. “Just a way we’ve got of talking here,” Lily said. “Some of the girls call me Aunt Lily so they can feel like they’ve got family close-by.”

  “Maybe I’ll be here for your delivery,” I said to Teresa. The poor girl went red. I backed away from the table. “Guess I’d better get along, it’s late.”

  Lily stood up. I could see the outline of the envelope under her nightgown. “Let you out,” she said.

  As she pushed the screen door open, Lily pulled out the envelope and stage-whispered, “If you’re gonna use a teakettle, you better learn how. Too much steam bends the paper, also leaves little water spots.” She held my clumsy work under my nose.

  “Thanks for the tip.”

  Lily refiled the envelope. “You’re smart, like your old man. Maybe you’ll be a good doc too, but you got a lot to learn.”

  I stopped halfway out. “I’m learning that in a hurry.”

  She smiled like Mona Lisa. “See ya.”

  Another rough night, drenching humidity sticking me to the sheet while I asked myself over and over what in hell was my father doing, giving Lily Fleischmann three thousand dollars? Meanwhile, from down the hall came, “Erskine! Erskine!” Samuel, trapped in a nightmare. Toward dawn, I finally dropped off.

  Past nine-thirty when I woke. I practically leaped out of bed, ran downstairs, found Ramona in the kitchen, sitting over coffee. She looked the way I felt. “He’s gone?” I asked.