First, Do No Harm

by Larry Karp

  “Be right back,” I muttered, then rushed down the hall through stinking air. Screams, wails, howls from every direction. Past the elevator, past the mens’ room, no phone anywhere. Almost ten-thirty. If I was going to call Harmony, I needed to do it then. Any later, I’d wake Dr. Belmont, who’d want to know why on earth I was calling at that hour. No time to take the elevator down to the lobby, hunt up a telephone, make my call, get back. Nurses’ station…yes, there was a phone on the counter. I told the elderly nurse behind the desk I was Dr. Firestone’s summer extern, asked permission to use the phone. She turned a look on me that would’ve stopped a train. “Only if it’s official business, no personal calls. I’ll be listening to every word you say.” I turned away, and damned if the old gargoyle didn’t get up and walk out of the station into the hallway, then stand, hands on hips, glaring. I felt her eyes on me every step back to the little hydrocephalic’s room.

  As I walked in, Samuel was pulling off rubber gloves. “Amytal didn’t work; neither did phenobarb or a spinal tap.” He dropped the gloves onto an open, used procedures tray, then raised an eyebrow at the nurse. “Better call the parents.”

  The nurse looked dubious. “You want them to come in?”

  “Sure.” Samuel looked anything but dubious.

  The nurse glanced at me, left the room. The little girl’s respirations slowed, deepened. Then came a massive seizure. Arms and legs flexed violently, flew outward, flexed again. The head jerked from one side to the other; eyes bounced like small boats on a heavy sea. As Samuel went for his bag, the convulsion stopped abruptly. A finger twitched, then the jaw bounced open, and the tiny figure lay still, eyes staring blindly at the ceiling. “That’s it,” I whispered.

  Samuel’s response stupefied me. “God damn!” He grabbed a clean syringe from his bag, a long needle, and a small rubber-capped vial. “Adrenaline.” Like an invocation. He ripped away the hospital gown, plunged the needle through the child’s chest. Dark red fluid swirled through the pale yellow adrenaline in the syringe. “We’re in the ventricle,” Samuel muttered, then emptied the contents of the syringe. He touched the side of the child’s neck, shook his head. “No pulse.” Then he began to pump at the chest, every now and again stopping just long enough to puff air through the gaping mouth.

  The nurse walked back into the room, went instantly pale. “Leo, do what I’m doing, exactly the way I’m doing it,” Samuel snapped. “Right index and middle fingers over the left, down once a second, not too sharply.”

  Samuel checked the neck again, shook his head, then applied his mouth to the little girl’s. I brought my fingers by degrees to the chest, started pumping, one-and-two-and-three-and-four… The child’s skin was cold and clammy. I told myself I was doing an exercise on a wax doll, then remembered Samuel’s warning. Don’t try to pretend any of it’s not real. Every sixty seconds, Samuel signaled for me to stop so he could palpate for a jugular pulse. On the fourth cycle, his face lit. “Feel it, Leo.”

  I put a shaking finger to the side of the neck. Pulse, slow and thready, but definitely there. As if to put to rest any doubts, the misshapen head began to jerk side-to-side again. Limbs twitched relentlessly. “Got ’er running,” Samuel said.

  I couldn’t say a word. What in the service of hell had we just done? That poor little wreck finally managed to escape, but Samuel Firestone, M.D., didn’t like to lose, so we brought her back to shake and twitch some more. Samuel looked at the nurse. “Let’s get her cleaned up, new gown, fresh blanket. Leo, put the syringes, needles and meds back in the bag. I’ll autoclave them later.”

  The nurse and I did as he said. All the while, Samuel didn’t take his fingers off the little girl’s neck.

  Twenty minutes later, a man and woman rushed through the doorway. The man was about forty, gaunt, with unruly black hair, hollow cheeks and a pointed chin. The woman was more generously proportioned, full face framed by a cascade of dark curls, all the more attractive for its middle-of-the-night wildness. Dark eyes broadcast concern and dread. One step into the room, the woman picked up speed, ran to the bedside, leaned to cradle the huge head against her chest. “Carlita,” she murmured. “My baby.” The man stood next to her. He seemed unsure of what to do with his hands.

  “I’m Dr. Firestone,” Samuel said quietly. “I look after the children here. I talked to you last year.”

  “Yes, I remember.” Without letting go of the little girl, the mother nodded vigorously. “Was when Carlita got sick. She got troubles again now?”

  “I’m sorry, she does.” Samuel’s tone was soft, solemn. “Carlita’s having seizures, one on top of the other. No way to stop them.”

  I’d still bet today the parents and nurse heard only resignation in Samuel’s voice, but I picked up on the bitterness in each of the last five words. The mother looked up at him. “She’s going to…die?”

  Samuel took his hand off Carlita’s neck, rested it on the mother’s shoulder. “This is her time.”

  The tenderness in his voice brought me to the edge of tears. The woman began to cry silently. Her husband bit on his lower lip. Samuel pointed toward the edge of the bed. “Sit down.” He bent, lifted Carlita into her parents’ laps, head cradled in the crook of her mother’s arm. “My baby, my baby,” the woman crooned. “Ever’thing’s all right. Mommy and Daddy’re here.”

  The young nurse’s white face bloomed into a rose. She turned away. Carlita’s father leaned toward the child’s ear, murmured words I couldn’t hear. All the while, he held the twitching sticklike legs absentmindedly in both hands. The mother went on cooing and telling Carlita she was going to be fine, nothing to worry about, but after a few minutes I noticed she was no longer convulsing. The father’s face told me he knew what had happened, but the mother kept reassuring her baby, moving a loving hand back and forth across her head. Samuel touched the woman’s arm, whispered, “She’s gone.”

  The mother looked up, startled, then gazed at the still body in her lap. She relaxed her arm. Carlita’s head lolled. The mother reclaimed it, then looked back at Samuel, eyes shining. “She jus’ slipped away, so quiet.” The woman’s voice firmed. “But she knew I was here, I could tell. Don’t you think she knew I was here, Doaktor?”

  I held my breath. What reasonable answer could Samuel give? But he didn’t hesitate. Like a natural athlete, all reflexes, getting to a ball that by every right should’ve been unplayable. “You’re her mother, Mrs. Consuegra,” he said slowly. “If you think she knew, no one can say she didn’t.” As he talked, he took Carlita from her parents, laid her gently on the bed, asked whether they wanted to stay longer with her. Mrs. Consuegra looked at her husband; he shook his head. “No, t’ank you.” Mrs. Consuegra sounded surprisingly steady. “She gone, we go too. But we can have a funeral for her, yes?”

  “Sure,” Samuel said. “Quinn’s, over on Eleventh Av, gives a free service for children who die here. You’ll only have to pay for the cemetery plot. Want us to call them?”

  The couple had a brief, silent consultation, then Mrs. Consuegra turned back to Samuel. “Yes, please. You do that.”

  “I’ll take care of it.” The nurse, back to functioning.

  Mr. Consuegra said a quiet, “T’ank you, Doaktor,” while his wife, crying soundlessly, worked Samuel’s hand like a motorist trying to get air into a flat tire. “Yes, Doaktor, t’ank you so much. I’m so happy I got here in time to say good-bye to my Carlita. If she die’ wit’out me, she’d’a been scared real bad. All my life, I remember you for this, Doaktor.”

  Samuel didn’t say a word, just smiled and let the woman go on pumping. But the nurse spouted, “The doctor kept your little girl alive ’til you got here. When her heart stopped, he started it up again.”

  Mrs. Consuegra looked at Samuel the way the crowd must’ve regarded Jesus when Lazarus stretched his muscles. “I knew you’d want to tell her good-bye,” he said, very lightly. “I’m glad it worked.”

  No need to blow your own horn when
someone else is blowing it so brilliantly for you, and Samuel’s dismissive manner seemed only to increase the intensity of the spotlight on him. He led the couple to the door, gently ushered them out, then came back inside. “All set?” he said lightly to the nurse.

  “All set,” she repeated, then added, “Dr. Firestone, that was wonderful. I couldn’t understand why you were resuscitating that poor thing, but…”

  The nurse’s comments seemed to irritate Samuel. He picked up his bag, said a clipped “Thanks,” then started toward the door. I followed him out of the room, down the hall, but at the next doorway he pulled up short. “Some people I want you to meet.” Then he grabbed my elbow and yanked me into the room.

  In the dim light, our shadows fell across two cribs. Samuel pointed at the sleeping child in the crib to the right, a boy of about three or four with coarse facial features and light spiky hair. He breathed slowly, deeply. Even in the poor light I could see how white his cheeks were. “Mongolism,” Samuel whispered. “Lovable, but mentally retarded, very clumsy. Mongoloids have a high risk for congenital heart abnormalities and leukemia; this boy’s got both. Won’t be with us much longer.” He led me to the other crib, where a child maybe a year old moved restlessly, every now and then making an odd sound like a cat’s meow. Its head was small, tiny compared to Carlita’s, with a sloping forehead. “Undiagnosable severe mental retardation,” Samuel said. “Might live another day, a month, or twenty years.”

  Samuel turned, then walked out of the room. I thought we were finished, but no. We’d only just begun. I followed him from room to room, each chamber of horrors worse than the last. Damaged children, like exhibits in some ghastly museum, whimpering, wailing, throwing their arms and legs about, dreaming of what I couldn’t begin to imagine. Samuel laid his hand on the troubled ones, patted them, stroked them. The smell was unbearable. “Can’t be helped,” Samuel said as he saw me wrinkle my nose. “Only three nurses to take care of fifty children.”

  “The war?”

  Samuel shook his head. “That’s what they’ll tell you. But there weren’t any more nurses here before the war. These kids don’t have much influence at County Council meetings.”

  A little boy sitting crosslegged on his bed stared curiously at us as we walked in. “Hello, Alex,” Samuel said. “Staying up late tonight?”

  The boy looked like a miniature Gandhi, bald head, wizened face. He nodded slowly, as if whether to answer and how were major uncertainties. “Anything hurting?” Samuel asked.

  “No. I just don’t want to sleep.” The weary, piping voice of a petulant geezer. I looked more closely. Was this a child?

  “Alex, this is Dr. Leo,” Samuel said. “He’s learning to be a doctor.”

  The little man turned a weak smile on me, then slowly raised a withered arm and grasped at my hand. “Pleased to meet you,” I said, and for just an instant his smile widened. As it faded, he pulled back his hand. We left him staring into the distance.

  Out in the hall, Samuel said, “Alex is here because he’s a bit…backward.” Devastating scorn in the word. “His condition’s called progeria. For some reason, all the aging processes go wild, right from the day of birth. Poor kid’s only twelve, but he’s got severe arthritis, coronary heart disease, all the things that are supposed to go wrong when you’re seventy. He won’t be around much longer, either.”

  In the next room, a horribly deformed dwarf, more than a hundred fractures all over his body. Didn’t dare touch him; I’d break another bone. Samuel led me past him to the second crib. “This one’s a little tough.”

  I gasped, gagged. A small baby, not much past newborn, lay on the bed. Where the navel should’ve been, a mass of intestines bulged and writhed through a clear, thin membrane. Wide red clefts ran up from each lip toward a single, central eye; above that eye, a tiny rudimentary proboscis of a nose. Samuel put a hand on my back. I jumped. “Cyclops monstrosity,” he said. “Don’t usually live past birth, but some hang on a little while. This one’s three days old.”

  I thought I’d seen the ultimate, but Samuel wasn’t through. He marched me into the next room, and as we came up to the single crib, every hair I owned stood on end. I grabbed Samuel’s arm with both my hands, tried to look away, couldn’t. By comparison, the cyclops was a beauty queen. This poor creature was hairless, skull indented here, protruding there. Left eye rudimentary, right eye bulging. Mouth twisted, nose an irregular blob. No hands. No left leg, a stump on the right. In all the other children I could make out an underlying order, nature’s processes disturbed but still perceptible through the malformations. But this came across as random damage, as if a particularly malevolent demon had amused itself by touching the baby here, there, wherever, cackling all the while at its production of devastation and horror. “Samuel—” I began, but stopped as the child shifted, raised its right arm, extended the stump toward us, and made a ghastly groaning noise like a cry for help from the deepest pit in hell. I tried to talk, tried a second time, a third. Finally I managed a whispered, “Samuel, why are you doing this to me?”

  In that dark room, his eyes blazed. He put a hand to my shoulder, moved me through the doorway, out into the corridor, against the wall. His face bent into a terrible smile. “These children, Leo—they had the bad luck to come off the production line on Friday afternoon or Monday morning. We hide them away here because they remind us too well what a God-damned bunch of long-term birth defects we all are, out of warranty from the moment we leave the factory. Our hearts fail, our livers, our kidneys. We go deaf and blind. Cancers blast through our bodies like Sherman’s troops through Atlanta. We get diabetes, rheumatic fever, hypertension, lupus, cerebellar ataxia, multiple sclerosis. And doctors are God’s licensed maintenance men, under contract to keep His cheesy merchandise operating. I want you to understand that. Will you remember walking through this place with me at one o’clock in the morning? Will you?”

  I can still retrace that night, Martin, step by step, see every disfigured face and distorted body. “I’ll remember,” I said, then added, very softly, “Now, please can’t we go home?”

  Samuel blinked, then suddenly put his arms around me. “Sure, Leo. I’m sorry.”

  Not sorry he’d brought me there, that wasn’t what he meant. I saw my own pain reflected in his eyes, and an overpowering wave of sympathy washed over me. In that instant I felt closer to my father than at any other time in my life. Just a flash, but if those moments lasted any longer they’d burn us to cinders.

  We sat silent in the Plymouth as Samuel drove home, more slowly than usual. A thought occurred to me. “Samuel?”

  “What’s that?” Unusual calmness in his voice.

  “Didn’t you once tell me there’s a lot of T.B. in county hospitals?”

  “Yes, but don’t worry. To catch it you need closer exposure than just walking into a room and looking at a patient.”

  Was he being obtuse, or playing a game? “How about mouth-to-mouth resuscitation?”

  A smile took root, grew. “That would be more dangerous, yes.”

  A game, then, but what kind of game? Did Samuel think the contract he’d signed granted him some kind of immunity? Then it hit me—he didn’t sign that contract. No limited license for Samuel Firestone, M.D.! I could see him reading the offer, fury mounting at every line, until he crumpled the paper, flung it into the face of the Writer, and stormed away to spend his life daring, double-daring, triple-daring. “Go for eight.” Sure, he knew he was vulnerable, otherwise why even bother trying to get that eighth ball in the air? Now I understood how my father could do an abortion in the morning, then that same night go to the furthest extreme to keep a hydrocephalic child alive long enough for her parents to tell her goodbye.

  Chapter 15

  Loud crash behind us. Someone in the kitchen must’ve dropped a tray of dishes and glassware. Dad nearly sent our table over into my lap. He shook his head, swallowed a handful of cheese and grapes, sent the food on its way with
a gulp of Manhattan, then began to speak rapidly, as if he didn’t dare hesitate for fear of stopping altogether.

  Past two o’clock by the time Samuel steered the Plymouth into our driveway. Lights on all over the house, something up. Ramona in her bathrobe met us two steps into the kitchen, pupils wide, hands shaking at her sides. She glanced from Samuel to me. “Leo, go upstairs.”

  She needed to go upstairs, was obviously late for her appointment with a needle. I held my ground. After that visit to County I was ready for anything. Samuel said, “Ramona…” in a tone that added, “Spit it out!”

  Ramona’s jaw twitched. She shivered like someone with a sudden high fever. “Get over, fast…” She aimed a shaking finger vaguely toward the door, then redirected it toward the Belmonts’. “Harmony’s in the Steinberg E.R., someone beat her up. I tried to get you at County, but you’d left—”

  Samuel and I must’ve looked like two soldiers, about-face! Ramona’s fluttery voice came at my back. “Leo…Leo. You shouldn’t go.”

  I paced Samuel to the Plymouth. We flew down Roosevelt to the Steinberg, tore out of the car, into the emergency room. A nurse led us to a treatment cubicle. As Samuel rushed in, Dr. and Mrs. Belmont caught sight of him and thanked God extravagantly. Laura, Harmony’s sister, fired me a look that said, “What are you doing here?” I didn’t answer, just stared at Harmony, motionless on a wheeled stretcher, eyes taped shut, sheets bloodstained.

  At the far side of the gurney, Ernie DeNooyer, one of the senior E.N.T. men, pumped air from a black rubber bag through a trach tube in Harmony’s throat. Two techs were going double-time, setting up a pulmotor…

  “Martin, what’s the matter?”

  “Nothing.” I shook my head. “Just your story. Go on.”

  Dad stared at me for a few seconds, popped a grape, then started talking again.

  DeNooyer stepped away to let one of the techs attach the breathing machine to Harmony’s trach. “Brought her in, oh, half an hour ago,” DeNooyer said. “Unconscious, unresponsive. Extensive trauma, head, trunk, limbs. Collapsed right lung. We’re getting total body X-rays; O.R.’s setting up.”