Seven Patients

by Atul Kumar

  ~~~~

  Decontamination, in a word, sucked.

  It was nothing like what we see on television or read about in books. I walked down a dreary passageway where I was greeted by somebody who hated her job.

  I was ushered into a small holding area where I met one of the ID physicians who asked if I was the one squirted by the gonorrhea bag. Word travels fast in the hospital.

  I filled out some paperwork and was led to a barren room with fluorescent lights, a central bench, and a single receptacle which read “medical incineration.” I stripped naked and placed all my clothes there and was instructed by the overhead speaker system to proceed into phase two. Apparently I didn’t require phase one and was told I get to skip phase three, whatever those were.

  The mysterious phase two was simply a shower with four spouts and four different bottles of cleansers. I washed myself in hot water and lathered up with the four cleansers, one at a time, sequentially as labeled.

  After bathing, I exited and entered another barren room with a central bench. There I found a towel, boxers, and fresh scrubs. I tossed the towel into another incineration receptacle and dressed with the new scrubs. Exiting this room the ID doc met me and gave me some hospital socks and Velcro shoes, like those worn by people in the rehabilitation ward.

  “Well Rajen, you’re officially decontaminated. Sign here.”

  Signing, I handed the form back and looked at him, asking, “What do I do now?”

  “Well, most people usually go home, but Peters wanted you back on duty in the ER. Real ball buster she is, huh?”

  I nodded and eagerly left the HazMat unit. I never imagined I’d be treated for a STD because a bag of pus fell off some dude’s abdomen and exploded all over my face. I began to re-evaluate my career as I re-entered the ER.

  Peters waved me over.

  “Roll up your sleeve.” She wiped my skin with an alcohol wipe and jammed a needle into my deltoid.

  “Argh, that burns. That the antibiotic?”

  “Yea, Ceftriaxone, just in case you got infected with the clap from that little explosion.”

  “Great, now I can say I was treated for the clap which I got directly from some dude’s colon.”

  Peters suppressed a giggle; medical humor sure is dark. “Worst thing is that you paid for it … tuition and all, I mean.”

  “I’m never going to hear the end of this, am I?”

  “Nope.”

  “In fact, I think half the ER has been snapping candid photos of you and the room on their phones as soon as word of the gonorrhea got out.”

  “Great. Did you figure out how he got the infection? And why he has a colostomy?”

  “Not yet, the morphine snowed him pretty good. He’s just waking up now. I figured you might want to stick around to get the whole story. Oh, the good news; he’s HIV and Hepatitis B and C negative, so at least we don’t have to worry about you getting any of those. His toxicology was positive for cocaine, but not heroin or any other drugs.”

  If nothing else this year, I’ve definitely learned that bodily fluids can be deadly.

  “Oh, I spoke with Clyde; you’re off the rest of the day. Apparently they didn’t want you back up there today after what happened.”

  “So, all it takes to get out of call is to acquire an STD?”

  “Don’t make it a habit.” Peters smirked at me for a moment before her expression disintegrated back to business. “Well, let’s get to the bottom of this James character’s story and I’ll buy you a drink. Just follow my lead. I don’t think he’ll be very forthcoming with information, but we can strong arm it out of him if we have to. I’ll do most of the talking, but pay attention. Every time I grab the stethoscope around my neck, that’s your cue to speak up. Just say something appropriate so we can get the hell outta that infected room.”

  I nodded my understanding as we donned our personal protective equipment from head to toe. After all, we were entering a chemical warzone in which James was the factory. The room had been cordoned off with two layers of heavy plastic drapes from ceiling to floor, with negative pressure ventilation.

  We dressed in a full “bunny” suit of white plastic vinyl-like material covering us from feet to neck. Hats, gloves, and full face masks with eye shields rounded out the outfit. We didn’t need air tight suits because Gonorrhea isn’t transmissible via aerosolization.

  James was now awake and alert, but he hadn’t moved from his gurney. Then I realized why; he had leather restraints on both his arms and legs. Guess this whole gonorrhea explosion thing was pretty serious.

  Actually, it’s not all that far from chemical warfare. Hell, if he put that pus in a little squirt bottle and just sprayed it around, everybody would get gonorrhea simply by contact with mucosal surfaces of the eyes, nose, and mouth. This again reminded me of poor Cindy and her bout with the much more lethal, but less infective pathogen HIV.

  Upon entering, Peters immediately started the dance of questioning to gather the information she desired. She started with attempting to build rapport.

  “Hi James, how are you feeling?”

  He pulled his arms causing them to tug on the restraints and rattle the gurney. “Like I’m a prisoner! You can’t hold me here.”

  “Your fever has come down and your fluid status has improved after we administered you two units of blood and three liters of fluid. Your heart rate and other vitals are also much improved from when you arrived here in critical condition.”

  “Am I supposed to dance for joy? OH WAIT, I can’t cause I’m restrained to this bed like a prisoner. You’re doctors; last I checked your job was to fix people. Can I go now?”

  “Aren’t you wondering why you’re here or what is going on with you?”

  “Not really. Look, I was just tired and bumped my head from overworking. Now, if you don’t mind, I really have to get back to work, so if you’d please … take these off.” He again demonstrated his restraints by flexing both his arms and legs this time.

  “James, if that’s your real name, why do you have a colostomy?”

  “Look, bitch! I don’t have to sit here and answer your questions. I want to leave right now, and I suggest you let me out or else I’m going to sue your ass and this whole hospital.”

  Peters got up from her stool and stood erect to her full height of 5 feet, 7 inches, looking down at James, demonstrating that she was in charge. I figured the Dr. Nice Guy act was over.

  As Dr. Peter’s voice boomed out, I realized I was right.

  “James, I’m a professional and deserve to be treated as such. We just saved your life; if we didn’t suture your scalp you would have easily bled to death on the street. Similarly if we didn’t diagnose your infection, dehydration, and profound anemia in a prompt fashion, any one of those alone could have killed you. The combination of all four without immediate treatment would have meant certain death.

  “Furthermore, Rajen here could have died due to your lack of hygiene and consciousness. If he’d have known you had an infected colostomy he could have properly helped you and protected himself. Instead, he had to cut off your clothes only to find an infected colostomy bag, all because of your unconscious state.”

  “What, he fucking cut my clothes?! Those were worth 2G easy. You owe me for those, Nigga. And where’s my watch??”

  “LISTEN TO ME! You are worried about your clothes?! I just told you he saved your life and in return you almost infected him with the gonorrhea oozing out of your filthy colostomy.”

  There was silence in the room, but the anger on James’ face was growing. He began to thrash against his restraints. There was a tapping against the plastic quarantine. Security was already gowned up and asking if they were needed. Peters told them to stand down, but be ready.

  “I want to get out of here. I don’t have no clap. You can talk to my lawyers; I’m out.”

  “James, you’re not going anywhere. First off, I have placed you on a 5150 hold, meaning for the next 72 hours you have no rights. If
you disrespect me or my team any further I’ll call the psychiatrist on call and have you placed on a 5250 hold for two weeks. Doing so won’t be a problem, as he’s my friend and will do what I request without question. Furthermore, I will attest that I witnessed you intentionally throwing the contents of your colostomy at people on my staff knowing it was infected with gonorrhea. That act alone would be considered malicious intent or worse, and you’d be taken directly to jail. Thus, I suggest you calm down so we can talk honestly.”

  James tensed up all his limbs and thrashed against the restraints to no avail. They easily subdued his outburst. The leather wasn’t even distressed by his flailing. “Fuck that shit, bitch, you bluffing, you a doctor, can’t make up shit like that. I’ll get your license revoked and ass thrown in jail.”

  Peters’ resolve didn’t change. She maintained her cool, detached, professional demeanor. She knew she had already won this verbal skirmish; it was just a matter of time before James realized it, too. The turning point was always the same—it was when they desperately pointed out that a doctor couldn’t fabricate material. The problem was, simply put, a doctor could very easily fabricate material, and not just any material—conclusive material that held up to scrutiny in court. It was this realization that was horrifying, because James knew he’d lost. It was just a matter of when his conscious mind would realize it, as well.

  Peters nonchalantly placed her hands around the stethoscope draped around her neck. Great, my turn to join in, only I didn’t know what to say.

  “James, I could have died today all because of you. I was just trying to help you when I got splattered by your infected excretions. But I’m not judging you; I just want to help you get better.” Wow, I sounded sincere. If I kept this up I might actually one day believe myself.

  I could see we were breaking his resolve. His features softened just a little, but only for a second. It was all I needed to start playing hardball and getting this case settled so I could go home.

  “But you’re not off the hook James. We need some answers, like why you have over $10K in cash in your briefcase? The colostomy bags contained in your briefcase can be explained, but why do you have canisters of douche and foam? And how is it you have the keys to a $150K car but no health insurance?”

  I was ready to go on and drill into this bastard, but before I could begin another diatribe, Peters released the grip on the stethoscope. My role in the interrogation had come to an end. I reluctantly took a backseat and watched the events unfold.

  My confrontation had the desired result, further enraging James with my insinuations.

  “What the fuck, man! You say you’re trying to help me, but you take my keys and go through my valise. That’s illegal without a search warrant and you can add your name to the list that’s getting sued buddy. I don’t buy any of that bullshit of helping me, you just wanna rob me; I had $15K in there.”

  Peters crossed her arms, further exuding authority. This was about to get good.

  “James, you clearly forgot what I had mentioned about attempting to maintain a professional demeanor and not insulting my team. Raj here is the only reason you are alive right now. We did open your belongings in an effort to obtain more of a history so we knew what we might be dealing with. It’s perfectly legal in life or death situations, perhaps your need to refresh yourself on the law.

  “Here’s what I have learned. You are obsessed with money and respect only it and the power it brings. You work with educated individuals, but lack the appropriate education yourself. You have a problem with authority. The poor quality of the tattoo on your right shoulder indicates you’ve been incarcerated before, and that you were low man on the jail totem pole. The small scar near your colostomy tells me you’ve been shot, likely by something small such as a .22 caliber.

  “You use drugs, but only high grade cocaine nowadays, probably to help you stay awake so you can work long hours. But the mild scarring on your forearms indicates a history involving heroin or methamphetamines.

  “Your name isn’t James, but since you came into money I’m sure your affluent and connected white clientele prefers that to Leroy Grims. It also helps you deny your relationship to Grims senior, your older brother who is known to be involved in some very public gang activity. I bet you changed your name shortly after you were admitted here through this very ER about 11 months ago.

  “You might remember that you were brought in after being shot at a drug transaction that went south. You had an emergent exploratory laparotomy where the surgeons found that your colon had been perforated by the bullet. The bullet was successfully removed and you were left with a colostomy. During your hospitalization somebody came looking for you, likely to finish you off, seeing as how they failed the first time. That’s when you checked yourself out AMA. Now you return, never having had your colostomy taken down and repaired. I suspect you found another use for it, which is how you came into money.

  “By the way, your brother paid your last hospital bill, anonymously of course. You owe him 96 thousand dollars.

  “Now, either you tell me I’m wrong, or you fill me in on what happened over the past 11 months.”

  James was caught as off guard, as was I. How in the hell did Peters get all that information? She must have done it when I was “decontaminating.” Later I found out Higgs was able to pull this information for her while I was in the basement.

  James, or Leroy, remained silent. His resolve had been fractured by Peters’ recounting of his history.

  “Cat got your tongue? No matter, I’ll tell you what’s going to happen next. You will be admitted to the hospital. We will treat your gonorrhea and get you stabilized and then you will undergo surgery to have your colostomy properly repaired.”

  That last part struck a nerve with Leroy; he suddenly became defensive. “You can’t operate on me without my permission, and I don’t want any more surgery. I’ll live with my colostomy.”

  I couldn’t fathom why somebody would want a colostomy. That’s when it struck me; I looked at Peters in disgust. While Peters had already figured it out, I just now understood how he made his money and acquired his infection.

  “Leroy, how long you been in the schlepping business?” inquired Peters.

  “What?”

  “Don’t think I didn’t put it all together. You were a mediocre gang banger and you couldn’t even get a small time drug deal to go down right. Your brother protected you as best he could, but you were a nobody, probably a significant liability, in his world. Then you got your big break with that gunshot. I’m guessing you dabbled in prostitution before, but male ass doesn’t make one rich these days. However, if you can offer a special service, such as a colostomy for your clients to fuck, you can enter the world of sick specialty fetishes, which pays much better. But to enter this market you had to clean up your act. That’d explain the clothes, watch, car, and valise; because most people who pay top dollar for such sick shit want somebody who can fit into their high-priced world of spoils and vices.”

  I didn’t know if I should gag or laugh. I did both. I sounded like a monkey coughing. I’d never heard of people paying to have sex with a colostomy! Apparently the rich are always looking for new ways to unload some of their wealth. I just nodded my head in shame.

  “Leroy, just to be straight, you are going to be turned over to the police as soon as I leave this room. You will go to jail. And you will have your colostomy taken down.” Peters turned to leave, and as a last minute thought added, “And you will need to notify the authorities of who your clients are so that they can be treated as well. I’m sure your brother will be proud when he learns of his little bro’s exploits into specialty fetish homosexual prostitution.”

  And with that we exited Leroy’s makeshift isolation room. He had just started sobbing when we left.

  I’d never have believed that in medical school I’d witness a grown man restrained to a hospital gurney sobbing like a high school girl after a break-up while oozing gonorrhea out of his
abdomen.

  Fact is far scarier than fiction. The kicker is he made more money per hour than most of the CEOs that he serviced.

  ~~~~

  Having the rest of the day off meant I had nothing to do. Thus, before going home I decided to log onto the computer system to check on the most recent lab results for my patients. Pulling up my patient roster I noticed that Duane was again an ‘active’ patient. That could only mean he had been transferred back to the hospital from the rehabilitation unit.

  Clicking on his name pulled up the tests that had recently been ordered: blood counts, urine, and blood cultures. He probably had developed a fever and was transferred to the hospital for some antibiotics.

  What the hell, I figured I’d pay him a visit on my way out. That decision changed my life.

  Duane was in a regular hospital room with no precautions. That was a good sign, meant he didn’t have some highly contagious infection or anything.

  Reviewing his chart before entering painted a completely different story. It’d been over four months from when I’d last seen Duane, since that time his wife had filed for a divorce and he’d amended his will leaving his entire estate to his daughter on her 18th birthday, almost a decade away.

  Despite intensive physical and occupational therapy, Duane had regressed, he remained non-verbal, only able to grunt ‘yes’ and ‘no’ … well, one grunt for ‘yes’, two for ‘no’.

  His paralysis had not improved, he continued to be incontinent of both bowel and bladder function. He’d had several urinary tract infections due to the constant indwelling catheters. He had non-healing decubitus sacral ulcers. His numerous skin grafts left him looking like a horrible disfigured patchwork quilt.

  He’d even undergone two corneal transplants in his left eye, but both had failed resulting in so much scarring that his eyes were labeled ‘inoperable’ and more than ninety percent blind. The prognosis was grave; the last note stating that he’d likely be completely blind in both eyes within a few months with no hope of any future intervention.