Philanthropist

by Larry Hill

  “When did you last have a colonoscopy, Mrs. Klein?”

  “Please call me Barbara, Barbara. I’ve never had one. I didn’t see any reason to; there’s no cancer in my family, not even any polyps.”

  “That doesn’t make you immune to colon cancer, Barbara. Why don’t we set you up for a colonoscopy?”

  “OK, but please don’t say anything to either Robert or Phillip or my husband.”

  “I’m not sure that makes any sense, but you make the call.”

  Three days later, the colonoscopy was done “You’ve got something in there; I took a biopsy and we’ll know by tomorrow. Frankly, it doesn’t look good.” The gastroenterologist, a member of her son’s partnership, was direct and honest and scared the hell out of her. There was good reason to be scared. She had a large, ugly cancer.

  Barbara notified the family as soon as she was given the diagnosis.

  “Christ All Mighty – Why didn’t you do something about this before?” yelled Fred.

  “I don’t know. I thought it was the hemorrhoids.”

  Recognizing that there was nothing to gain by castigating her further, her husband turned optimistic. Colon cancer is usually curable – surely, she’d just get the damn thing taken out and be fine.

  The CAT scan suggested that the liver housed metastases, lots of them. She wasn’t going to be fine. A surgeon removed the primary tumor, confirmed the grim findings of the CAT scan and sewed her up. There were too many pockets of evil in the liver to remove them all. Maybe chemo would buy her, and them, some time.

  The twins rallied round. Both they and their wives spent significant hours at the hospital and were there when she came home. Both cut back their schedule of patients to commiserate or sit silently with Barbara and with Fred. Jason was in the middle of a trial when the word came through. “I’ll get up there next week.” Emily couldn’t come at all.

  Chemotherapy hit her like a pack of wolves. After two full courses, her oncologist told her how superbly effective the drugs were – the tumors in the liver hadn’t grown. They hadn’t shrunk either. Barbara decided that she’d had enough, in spite of the protestations of the boys and the tears of her husband. She died three months later, jaundiced, pain-wracked from lung metastases and uncommunicative. Nobody remembered her last words as they were uttered several days before she died.

  The boys’ protestations led to incrimination. Wrongdoing was attributed to the doctors and the widower. The deceased – innocent.

  Jason was the most vociferous. He berated his father mercilessly as they left the synagogue after the funeral service. “Why didn’t you get her to the doctor sooner? Why did you let them do the surgery when they already knew that the tumor had spread to the liver? Why didn’t you take her to Sloan-Kettering or MD Anderson? Everybody knows that San Francisco is a wasteland in cancer care.” Fred’s tears covered his cheeks, but he could not otherwise respond. He walked away from his first-born, toward the twins, like a defeated regiment would retreat behind breastworks. “I’ve got to understand this! Tell me why?” his eldest son yelled as his father retreated.

  “Lay off him, Jason,” pleaded Robert.

  “Tell me you don’t think Mom would be alive today if Dad had paid a bit more attention rather than going out to meetings and poker every night.”

  “That’s not true! What was I supposed to do, tie her up and take her to a doctor? She knew she was bleeding. She was convinced that it wasn’t anything serious. What could I do?”

  Jason, having no answer to the logical question, kept at it. “Then, tell me about you and the secretary!” There had been a short term dalliance with a girl-Friday many years earlier, brought out in the open between spouses and, after some counseling, put behind them. Fred assumed that none of his boys had known about it.

  “Goddamn you,” said father to eldest son, who left the house, retreating to the security of his talented family.

  HENNESSEY VSOP

  Aware that he wouldn’t be cavorting with his fellow boardspeople, Fred continued walking down Eddy Street in the heart of the notorious Tenderloin District, so close but so far from the magnificent City Hall. The Tenderloin houses, feeds and liquors-up the downtrodden of San Francisco. Klein was certain he’d benefit by some liquoring up and entered a bar, any bar. There was nothing elegant, handsome, pretty, historic or even OK about the place. It smelled bad – cigarettes, booze, stale fried snacks and distinctly, urine. It looked bad – dark, dank, unswept and unmopped. Behind the bar, a surprisingly sprightly woman, dressed in jeans and a man’s dress shirt, no tie, spent most of her time washing glasses and juggling the order of the bottles under the huge, faded black and white photo of the Bay Bridge and the City as it had been in the 60s, including the long forgotten Embarcadero Freeway. Fred did notice that the bar totally lacked colors other than off-white, gray, brown and black. Even the Johnny Walker Red label looked gray through the smoke filled air. He couldn’t tell if the bar lady was a blond or a brunette, as the part in her hair looked darker than the sides. He assumed she was a bleached blond; the closer he got to her, the less sprightly she looked. His original estimate of her age being 30 climbed two decades as he sat on an unbalanced stool near her sink.

  The establishment was more crowded than he would have guessed. Fred was not a frequenter of bars, especially in his home town. He occasionally stopped in one when he was on business travel elsewhere, to watch football or basketball. A real fan, he despised watching alone in a hotel room. At the bar, every second stool was taken – five patrons, 3 men, including him, and 2 women bent over their beers or cocktails, looking up at the TV when the baseball announcer’s voice made it sound worthwhile to do so, not speaking to anyone except the barmaid and then only for refills. Two of the half dozen booths had patrons. One, the furthest from the entrance, was occupied by a man in an expensive suit, a hand-painted tie, loosely knotted and pulled down, a crocodile brief case by his side and a much, much younger woman, probably blond, across. She looked young enough to require carding; he certainly would have qualified for AARP membership. They both drank white wine; a bottle of a Grand cru Chablis that Fred recognized, and was surprised to find in the Tenderloin, was nearly empty. Midway down the row of booths sat a group of 4 white men, also cardable. They were uniformed in that they dressed alike - tight jeans, tighter tee shirts, mainly off-white and menacingly scuffed shit-kicking boots. All had lighted cigarettes in spite of local ordinances to the contrary. The bar lady made no effort to have them cease or go outside. In spite of the quietude of the rest of the room, they spoke as if they needed to be heard at a rock concert. One of the four was the alpha. He didn’t look any different from his mates; in fact his biceps and triceps were on the puny side. He sported only a single visible tattoo, while the others were more densely decorated. His alpha status was seemingly a result of his ability to craft a coherent sentence with limited numbers of fucks, shits and cunts. Plus he spoke more softly, and much less frequently, than the rest. It was simple to see that his cohorts bowed to his wisdom and sought his concurrence on the rare opinion that they proffered, invariably with more‘. “How ‘bout those fuckin’ cops bustin’ that bitch for leaving her kid in the car? She’s good shit, that one. I know her and her kid’s an asshole – always screamin’ and shittin’. Kid didn’t fuckin’ die – the motherfuckin’ ambulance got him to the ER in time.” “Yeah,” said the other two betas in sotto voci and the alpha nodded his approval.

  Klein ordered cognac. The bar didn’t offer the great XO’s that he would always buy duty free when he returned from foreign travel. But they did have a Hennessy VSOP and even had a short rack of brandy snifters. He ordered a double, which he consumed without sniffing or sipping. He swallowed it in three mouths full. Then he ordered another and another. He wanted to get drunk but to do it in style, or at least as stylistically as one could do in a dive like this. He gave not a soupçon of thought to how he might get himself and his dented ride home.

  After his third double Henness
y, his senses blurred, producing an even greater grayness to his immediate environs. His hearing, on the other hand, became more acute and he could not but avoid hearing the nastiness that emanated from the table of the four manchildren. Saying nothing to her, he made eye contact with the bent-over woman two chairs down, exchanging their mutual disgust for the language and the intensity of noise from the booth. “Shit-eating Raiders don’t fuckin’ belong on the same field as the Niners. No team with a spook at QB should be allowed in the fuckin’ stadium.” The betas talked, the alpha nodded and smiled or frowned to send his message of approval or disapproval.

  Klein had had enough. The barmaid was certainly not about to do anything to quiet the boys down. Both women at the bar non-verbally expressed their unhappiness, so somebody had to take a stand. The accused felon, the events of the last two days suppressed deep in his cortex, chose to be that somebody. He got off his stool and spent a few seconds establishing his balance; he knew that a fall would make his effort to make change less likely to succeed. His head was swimming from the fine cognac but he knew that once he started walking, he could negotiate the several steps between the stools and the booth.

  “Gentlemen, would you be so kind as to keep your voices down a little bit? There are ladies here that you are making very uncomfortable.”

  “Fuck the ladies. We’re just having a good time. You know, Mr. Suit, you’re in the Tenderloin, not Nob Hill. There’s plenty more bars around – you don’t like our talking, get the fuck outta here.”

  “Neither the ladies nor I want to go anyplace else. Would you just be a little quieter and stop the swearing.”

  “Hey, aren’t you the guy I saw on TV this afternoon. The guy who killed the woman with the kid on California?” asked one of the betas, looking first at Klein and immediately thereafter at the alpha.

  “Good call, Jackie, “responded the alpha. “That’s the motherfucker, or should I say mother killer, ha ha. You’re the Jewguy, aren’t you?”

  Klein didn’t hesitate. “Yeah, that’s me, Jewguy, but I didn’t kill anybody and that’s not what we’re talking about here right now. I, and my friends over there, want you to be just a little quieter.”

  The biggest and youngest beta responded, “You and your friends can just go fuck yourselves.” As the decibels of discussion rose, the mismatched couple with the Chablis and one of the men at the bar made their way around the discussants and left for the safety of the mean streets of late night blighted Central San Francisco. The barmaid kept washing glasses and juggling bottles.

  Klein could never remember having been in such a situation. Of course, he couldn’t remember much of anything as a result of his drunken state, but being in circumstances where his rational persona could not deal effectively with unthinking thuggery was a novelty. He could turn around and return to his stool and have a couple more doubles. He could leave the bar. He could threaten to call the cops. He could plead with the barkeep to exercise her responsibility and solve the dilemma. He, at 75, could act like a retired pugilist and try to scare them into submission. He did none of those. He collapsed to the floor as if he had been shot in the head.

  The trauma group on call for the night shift at San Francisco General Hospital ER was made up of a fourth year resident, a first year resident (nee, intern) and two medical students. Like every night, the ER had been busy. Two teens badly broken from driving a stolen car into a light pole in the Mission District, but alive and likely to stay that way. A gunshot victim, no more than 16, from the Western Addition, DOA. A nonagenarian who broke her hip, while buying gloves at Macy’s. But around midnight, there were a few quiet moments, allowing for donuts, coffee and some teaching. There’s no such thing in the trauma center as time for napping. Before the first donut was down and the first mnemonic memorized (Never Lower Tillie’s Pants, Mother Might Come Home – the first letters of the bones of the wrist), a city ambulance radioed in.

  “We’re five minutes out with an old guy picked up at our favorite Eddy Street establishment, out of it, but responsive to pain and to yelling in his ear. Pulse real low. 34. BP is 140 over 90. Respirations OK. Stinks of booze. Big bump on the head. Pupils responsive and equal. Heart and lungs good except for the pulse. Guy’s got no ID on him. Bartender thinks he may have been robbed by one of her customers after he fell. She says that there was no fight – at least no fisticuffs. He was in a verbal battle with some punks when he just went down.”

  The hoar-frosted triage nurse called the 4th year resident, a tall looker in his late 20s who reminded her of Dr. Kildare from the 60s. “Ralphie, we got an old drunk coming in from the Tenderloin – big bump on the head and bad bradycardia – 34. Got no ID, but is probably one of our regulars.” The Tenderloin was more than adequately represented at the ER and most of the diagnoses had to do with alcohol – DTs, liver cirrhosis with bleeding, heart failure, stab wounds, gunshot wounds and damage induced by “blunt objects.”

  “Hey, you two,” Ralphie shouted out to the third year medical students on their first night in the ER. Both students were female, short, slim, and Asian. “Get a quick look at this dude. Make sure there’s nothing going on with his chest or legs and let X-ray know that he needs to be CT’d stat. …Quick, before he gets here. What causes a heart rate of 34?” The two Asian women, already standing straight, straightened even more. “Third degree heart block from AV node disease or an MI. Drugs like digitalis and beta blockers. Hypothermia.” They knew the lingo, and the science.

  “Good. Now save this drunk’s life.” The two young women assigned themselves tasks.

  “I’ll do the physical, you do the EKG and call X-ray.”

  Precisely five minutes after the radio alert, the ambulance pulled up and the ER techs jumped into action. Door open. Gurney extracted from the vehicle. Wheels lowered. IV bottle secured. Oxygen flowing. Wheel him in.

  The patient and staffers sped past the front door and the desk of the triage nurse. “I don’t know this guy – I’d swear we’ve never seen him before.” She’d been the one who differentiates not sick from sick from very sick for more than 25 years; she wore a pin to prove it. The quarter century of experience licenses her to call senior residents Ralphie. “Hey, get a load of the suit – our regular visitors don’t dress like that.”

  The techs rolled the gurney into the ER trauma bay, pulled the suit jacket off, unzipped the pants and yanked them down, covered him with a gown and cut the underwear off, saying nothing about the silk boxers. The expensive looking suit was unceremoniously shoved into a bag and the undergarments tossed into the recyclable waste. They took off his shoes and socks last. One of the techs looked inside a shoe – “Bruno Magli! This old guy’s got something in common with OJ. I bet these things cost him five hundred bucks.” Nobody else responded but the comment registered.

  “So, what have we got?” asked the senior resident of the students. The first year resident stood right behind her charges ready to jump in if needed. One of the young women quickly took control of the physical examination and the other slapped on the electrocardiogram leads, printed out a tracing and went to the phone in the exam room to set up the CAT scan. The examiner shouted out in a voice as loud as her diminutive stature and cultural background allowed.

  “Pupils both reactive and same size, but the right one is sluggish, suggesting possibly early problems in the brain. Pulse still in the mid-30s and regular. Breathing normal. BP OK. Chest is clear – no evidence of pneumothorax (an air leak around the lung but in the thoracic cavity.) I don’t hear any murmurs or rubs. Reflexes intact and he moves appropriately with painful stimuli. EKG shows complete heart block.”

  “How about that thing on his head?”

  “Oh, sorry. He’s got a four centimeter hematoma over the right temple. Skin is intact. And, by the way, his mental status shows severe obtundation – he groans but can’t respond to commands.”

  “And, why do you think he’s obtunded?

  “The bradycardia, maybe?”

  “No
t usually. A slow pulse doesn’t very often stop you from talking and responding to commands. How would we find out?”

  “Not sure, Doctor.”

  “How would we make his heart go faster?”

  “You could give him atropine.”

  “Yeah, I could, but that probably wouldn’t speed up the ventricle with third degree block. How about a pacemaker?”

  “Oh, right. A pacemaker.”

  The resident nodded at the charge nurse who got out the external pacer and slapped the pads on the patient’s chest. She had the rate set at 80 and immediately the pulse rate, felt at the wrist and confirmed by the monitor, was 80 beats per minute.

  “See how that worked on his brain.”

  The student yelled into the patient’s ear. “Wake up! Open your eyes! Squeeze my fingers! Nothing happened, Doctor.”

  “What does that tell you?”

  “Maybe we haven’t given him enough time to wake up?”

  “Huh-uh. Increasing the pulse should reverse any neurological issues of bradycardia right away.”

  “So he’s got something going on in his head?”

  “Good. It’s either that or something toxic. Doesn’t look like narcotics – he’s got no needle marks and people with expensive suits and Bruno Maglis don’t usually shoot up heroin. And, when the ambulance guys started the IVs he was given Narcan – it’s policy when they find a patient that’s out of it for no known reason. The anti-opiate would eliminate, again almost immediately, any confusion or coma from narcotics.”

  The time between the beginning of the exam by the student and the placement of the pacer was about 90 seconds. The next moment, the radiology technician came into the room and wheeled John Doe, his official name until he was tagged in the system with his real one, off for his CAT scan. Following in his wake was a cardiac nurse and her crash cart, containing a defibrillator and all the other high tech meds and gadgets to be called on if he tried to die.