A Life in Medicine

by Robert Coles

  Faisal came here from India only two months ago to stay with his aunt while studying at a prestigious boarding school. He is eleven years old. It was shortly after he arrived that he noticed the bruises. Then came the nosebleeds. Then came fatigue for a long visit. By the time he was admitted, he had very few platelets and barely detectable white cells. Pancytopenia. He has been diagnosed with aplastic anemia and he is at the beginning of his disease. He still feels well on rare days. But he does understand that he is sick. He understands that his immune system cannot work without the cells it needs to perform. What he does not understand is that this illness will eventually kill him. It will snatch his life from him.

  I sit down in a large red chair at the foot of the bed. I think of events that day. His family in the States come to see him in droves. The women wear traditional dress—saris of beautiful color and fabric. They welcome me with smiles and hugs and looks of adoration and trust. How can I tell them that he has only a one in five chance of survival?

  I was late today to see him. Hours late. When I finally came in and sat down, Faisal just stared at me. “Where were you today?” he demanded. I had a hundred valid excuses, but I just smiled and apologized. We watched cartoons on television and laughed together. We drew caricatures of each other and laughed so hard that the nurses came in to hush us. I ate the curried lamb his grandmother left for him, since he cannot. He has only juice, Jell-O and occasional bland soup.

  On some days, when the fever is high, he cries to me. He misses his mother, he misses his father. He feels his body fight, betray him and grow weaker. But still, he never complains.

  This is taking too much from me. I can feel it. I cannot leave this room anymore. I am still there, even in my sleep, watching over him. Trying to make sense of things. Working the puzzle. Why has this child with so much promise, so much potential, been divined to suffer like this? I strive for understanding. Or at least acceptance.

  I rise, and at once I realize that I have dozed off, but time is of no consequence to me as this night blurs along. Faisal rustles. I stand over him. He is framed like an angel in this pale pink light. I know that he will wake soon with the needle stick from the early-morning blood draw. And I know that then he will need me. A friendly face and reassurance. I want to be strong for him, but I am terrified.

  I walk out of his room and back down the hall.

  William Carlos Williams

  THE GIRL WITH THE PIMPLY FACE

  No collection of stories about health care professionals and patients would be complete without a selection by American writer William Carlos Williams. Reprinted here is his classic story—one regularly anthologized—about a chance meeting between a busy physician making house calls among the poor and a fifteen-year-old girl with acne who is “as fresh as paint and seeming about as indifferent.” As much a story about Williams’s keen diagnostic powers as it is a portrait of life among the working poor, “The Girl with the Pimply Face” is a timeless examination of human nature through the practice of medicine.

  WILLIAM CARLOS WILLIAMS was born in 1883 in Rutherford, New Jersey, where he practiced medicine his entire professional life. While obtaining his M.D. from the University of Pennsylvania, Williams met Ezra Pound, who was an important influence on Williams’s poetry. Williams’s poetic works include Kora in Hell, Spring and All, and the five-volume epic poem Paterson . Robert Coles compiled Williams’s short stories into a volume called The Doctor Stories, from which this selection is taken.

  One of the local druggists sent in the call: 50 Summer St., second floor, the door to the left. It’s a baby they’ve just brought from the hospital. Pretty bad condition I should imagine. Do you want to make it? I think they’ve had somebody else but don’t like him, he added as an afterthought.

  It was half past twelve. I was just sitting down to lunch. Can’t they wait till after office hours?

  Oh I guess so. But they’re foreigners and you know how they are. Make it as soon as you can. I guess the baby’s pretty bad.

  It was two-thirty when I got to the place, over a shop in the business part of town. One of those street doors between plate-glass show windows. A narrow entry with smashed mail boxes on one side and a dark stair leading straight up. I’d been to the address a number of times during the past years to see various people who had lived there.

  Going up I found no bell so I rapped vigorously on the wavy-glass doorpanel to the left. I knew it to be the door to the kitchen, which occupied the rear of that apartment.

  Come in, said a loud childish voice.

  I opened the door and saw a lank haired girl of about fifteen standing chewing gum and eyeing me curiously from beside the kitchen table. The hair was coal black and one of her eyelids drooped a little as she spoke. Well, what do you want? she said. Boy, she was tough and no kidding but I fell for her immediately. There was that hard, straight thing about her that in itself gives an impression of excellence.

  I’m the doctor, I said.

  Oh, you’re the doctor. The baby’s inside. She looked at me. Want to see her?

  Sure, that’s what I came for. Where’s your mother?

  She’s out. I don’t know when she’s coming back. But you can take a look at the baby if you want to.

  All right. Let’s see her.

  She led the way into the bedroom, toward the front of the flat, one of the unlit rooms, the only windows being those in the kitchen and along the facade of the building.

  There she is.

  I looked on the bed and saw a small face, emaciated but quiet, unnaturally quiet, sticking out of the upper end of a tightly rolled bundle made by the rest of the baby encircled in a blue cotton blanket. The whole wasn’t much larger than a good sized loaf of rye bread. Hands and everything were rolled up. Just the yellowish face showed, tightly hatted and framed around by a corner of the blanket.

  What’s the matter with her, I asked.

  I dunno, said the girl as fresh as paint and seeming about as indifferent as though it had been no relative of hers instead of her sister. I looked at my informer very much amused and she looked back at me, chewing her gum vigorously, standing there her feet well apart. She cocked her head to one side and gave it to me straight in the eye, as much as to say, Well? I looked back at her. She had one of those small, squeezed up faces, snub nose, overhanging eyebrows, low brow and a terrible complexion, pimply and coarse.

  When’s your mother coming back do you think, I asked again.

  Maybe in an hour. But maybe you’d better come some time when my father’s here. He talks English. He ought to come in around five I guess.

  But can’t you tell me something about the baby? I hear it’s been sick. Does it have a fever?

  I dunno.

  But has it diarrhea, are its movements green?

  Sure, she said, I guess so. It’s been in the hospital but it got worse so my father brought it home today.

  What are they feeding it?

  A bottle. You can see that yourself. There it is.

  There was a cold bottle of half-finished milk lying on the coverlet the nipple end of it fallen behind the baby’s head.

  How old is she? It’s a girl, did you say?

  Yeah, it’s a girl.

  Your sister?

  Sure. Want to examine it?

  No thanks, I said. For the moment at least I had lost all interest in the baby. This young kid in charge of the house did something to me that I liked. She was just a child but nobody was putting anything over on her if she knew it, yet the real thing about her was the complete lack of the rotten smell of a liar. She wasn’t in the least presumptive. Just straight.

  But after all she wasn’t such a child. She had breasts you knew would be like small stones to the hand, good muscular arms and fine hard legs. Her bare feet were stuck into broken down leather sandals such as you see worn by children at the beach in summer. She was heavily tanned too, wherever her skin showed. Just one of the kids you’ll find loafing around the pools they have outside tow
ns and cities everywhere these days. A tough little nut finding her own way in the world.

  What’s the matter with your legs? I asked. They were bare and covered with scabby sores.

  Poison ivy, she answered, pulling up her skirts to show me.

  Gee, but you ought to seen it two days ago. This ain’t nothing. You’re a doctor. What can I do for it?

  Let’s see, I said.

  She put her leg up on a chair. It had been badly bitten by mosquitoes, as I saw the thing, but she insisted on poison ivy. She had torn at the affected places with her fingernails and that’s what made it look worse.

  Oh that’s not so bad, I said, if you’ll only leave it alone and stop scratching it.

  Yeah, I know that but I can’t. Scratching’s the only thing makes it feel better.

  What’s that on your foot?

  Where? looking.

  That big brown spot there on the back of your foot.

  Dirt I guess. Her gum chewing never stopped and her fixed defensive nonexpression never changed.

  Why don’t you wash it?

  I do. Say, what could I do for my face?

  I looked at it closely. You have what they call acne, I told her. All those blackheads and pimples you see there, well, let’s see, the first thing you ought to do, I suppose, is to get some good soap.

  What kind of soap? Lifebuoy?

  No. I’d suggest one of those cakes of Lux. Not the flakes but the cake.

  Yeah, I know, she said. Three for seventeen.

  Use it. Use it every morning. Bathe your face in very hot water. You know, until the skin is red from it. That’s to bring the blood up to the skin. Then take a piece of ice. You have ice, haven’t you?

  Sure, we have ice.

  Hold it in a face cloth—or whatever you have—and rub that all over your face. Do that right after you’ve washed it in the very hot water—before it has cooled. Rub the ice all over. And do it every day—for a month. Your skin will improve. If you like, you can take some cold cream once in a while, not much, just a little and rub that in last of all, if your face feels too dry.

  Will that help me?

  If you stick to it, it’ll help you.

  All right.

  There’s a lotion I could give you to use along with that. Remind me of it when I come back later. Why aren’t you in school?

  Agh, I’m not going any more. They can’t make me. Can they?

  They can try.

  How can they? I know a girl thirteen that don’t go and they can’t make her either.

  Don’t you want to learn things?

  I know enough already.

  Going to get a job?

  I got a job. Here. I been helping the Jews across the hall. They give me three fifty a week—all summer.

  Good for you, I said. Think your father’ll be here around five?

  Guess so. He ought to be.

  I’ll come back then. Make it all the same call.

  All right, she said, looking straight at me and chewing her gum as vigorously as ever.

  Just then a little blond-haired thing of about seven came in through the kitchen and walked to me looking curiously at my satchel and then at the baby.

  What are you, a doctor?

  See you later, I said to the older girl and went out.

  At five-thirty I once more climbed the wooden stairs after passing two women at the street entrance who looked me up and down from where they were leaning on the brick wall of the building talking.

  This time a woman’s voice said, Come in, when I knocked on the kitchen door.

  It was the mother. She was impressive, a bulky woman, growing toward fifty, in a black dress, with lank graying hair and a long seamed face. She stood by the enameled kitchen table. A younger, plumpish woman with blond hair, well cared for and in a neat house dress—as if she had dolled herself up for the occasion—was standing beside her. The small blank child was there too and the older girl, behind the others, overshadowed by her mother, the two older women at least a head taller than she. No one spoke.

  Hello, I said to the girl I had been talking to earlier. She didn’t answer me.

  Doctor, began the mother, save my baby. She very sick. The woman spoke with a thick, heavy voice and seemed overcome with grief and apprehension. Doctor! Doctor! she all but wept.

  All right, I said to cut the woman short, let’s take a look at her first.

  So everybody headed toward the front of the house, the mother in the lead. As they went I lagged behind to speak to the second woman, the interpreter. What happened?

  The baby was not doing so well. So they took it to the hospital to see if the doctors there could help it. But it got worse. So her husband took it out this morning. It looks bad to me.

  Yes, said the mother who had overheard us. Me got seven children. One daughter married. This my baby, pointing to the child on the bed. And she wiped her face with the back of her hand. This baby no do good. Me almost crazy. Don’t know who can help. What doctor, I don’t know. Somebody tell me take to hospital. I think maybe do some good. Five days she there. Cost me two dollar every day. Ten dollar. I no got money. And when I see my baby, she worse. She look dead. I can’t leave she there. No. No. I say to everybody, no. I take she home. Doctor, you save my baby. I pay you. I pay you everything—

  Wait a minute, wait a minute, I said. Then I turned to the other woman. What happened?

  The baby got like a diarrhea in the hospital. And she was all dirty when they went to see her. They got all excited—

  All sore behind, broke in the mother—

  The younger woman said a few words to her in some language that sounded like Russian but it didn’t stop her—

  No. No. I send she to hospital. And when I see my baby like that I can’t leave she there. My babies no that way. Never, she emphasized. Never! I take she home.

  Take your time, I said. Take off her clothes. Everything off. This is a regular party. It’s warm enough in here. Does she vomit?

  She no eat. How she can vomit? said the mother.

  But the other woman contradicted her. Yes, she was vomiting in the hospital, the nurse said.

  It happens that this September we had been having a lot of such cases in my hospital also, an infectious diarrhea which practically all the children got when they came in from any cause. I supposed that this was what happened to this child. No doubt it had been in a bad way before that, improper feeding, etc., etc. And then when they took it in there, for whatever had been the matter with it, the diarrhea had developed. These things sometimes don’t turn out so well. Lucky, no doubt, that they had brought it home when they did. I told them so, explaining at the same time: One nurse for ten or twenty babies, they do all they can but you can’t run and change the whole ward every five minutes. But the infant looked too lifeless for that only to be the matter with it.

  You want all clothes off, asked the mother again, hesitating and trying to keep the baby covered with the cotton blanket while undressing it.

  Everything off, I said.

  There it lay, just skin and bones with a round fleshless head at the top and the usual pot belly you find in such cases.

  Look, said the mother, tilting the infant over on its right side with her big hands so that I might see the reddened buttocks. What kind of nurse that. My babies never that way.

  Take your time, take your time, I told her. That’s not bad. And it wasn’t either. Any child with loose movements might have had the same half an hour after being cared for. Come on. Move away, I said and give me a chance. She kept hovering over the baby as if afraid I might expose it.

  It had no temperature. There was no rash. The mouth was in reasonably good shape. Eyes, ears negative. The moment I put my stethoscope to the little boney chest, however, the whole thing became clear. The infant had a severe congenital heart defect, a roar when you listened over the heart that meant, to put it crudely, that she was no good, never would be.

  The mother was watching me. I straightened up
and looking at her told her plainly: She’s got a bad heart.

  That was the sign for tears. The big woman cried while she spoke. Doctor, she pleaded in blubbering anguish, save my baby.

  I’ll help her, I said, but she’s got a bad heart. That will never be any better. But I knew perfectly well she wouldn’t pay the least attention to what I was saying.

  I give you anything, she went on. I pay you. I pay you twenty dollar. Doctor, you fix my baby. You good doctor. You fix.

  All right, all right, I said. What are you feeding it?

  They told me and it was a ridiculous formula, unboiled besides. I regulated it properly for them and told them how to proceed to make it up. Have you got enough bottles, I asked the young girl.

  Sure, we got bottles, she told me.

  O.K., then go ahead.

  You think you cure she? The mother with her long, tearful face was at me again, so different from her tough female fifteen-year-old.

  You do what I tell you for three days, I said, and I’ll come back and see how you’re getting on.

  Tank you, doctor, so much. I pay you. I got today no money. I pay ten dollar to hospital. They cheat me. I got no more money. I pay you Friday when my husband get pay. You save my baby.

  Boy! what a woman. I couldn’t get away.

  She my baby, doctor. I no want to lose. Me got seven children—

  Yes, you told me.

  But this my baby. You understand. She very sick. You good doctor—

  Oh my God! To get away from her I turned again to the kid. You better get going after more bottles before the stores close. I’ll come back Friday morning.

  How about that stuff for my face you were gonna give me.

  That’s right. Wait a minute. And I sat down on the edge of the bed to write out a prescription for some lotio alba comp. such as we use in acne. The two older women looked at me in astonishment—wondering, I suppose, how I knew the girl. I finished writing the thing and handed it to her. Sop it on your face at bedtime, I said, and let it dry on. Don’t get it into your eyes.