by Larry Hill
The resident received a call no more than 10 minutes later. “For once, Ralphie, you sent us one that didn’t waste our time and our stuff. Mr. Doe, here, has a huge subdural on the right side; there’s got to be 100 cc of blood in there. Plus there’s a sizable skull fracture under the hematoma on the scalp.” The surgical and radiology residents had been sharing patients and insults for several years.
“How’s he looking now?”
“Same as he did when you sent him to us. Groaning and doing a bit of kicking, more on the right than left. Nurse Knockers tells us that his heart is doing OK. Pacemaker is capturing fine. BP stable.” Knockers was neither the nurse’s maiden nor married name.
“I’m glad I didn’t embarrass myself in front of the two medical students. I told them we’d find more than just a slow pulse to explain his neuro. Guess it’s time to call the always upbeat and never ungrateful neurosurgical team, the dirty bastards.”
One of the bastards grumped on the phone, “You sure you’ve got him worked up completely? I had just fallen asleep after fixing that guy you sent me with the C-spine fracture. You are aware, are you not, that the C-spine didn’t have a urinalysis on the chart?”
“Yes, Milo, your first year reamed out our first year on that subject. A little subtlety might go a long way.”
Doe, all worked up, and his gurney and Nurse Knockers and her crash cart rode the elevator to the second floor operating room, bumped through the easy-open doors and disappeared to a place where only those in blue scrubs dared tread.
ERNESTO
Ernesto Contreras was born outside Guadalajara 37 years earlier, to a single, basically uneducated, mother of 17 years. Four years later, mother and son and infant daughter were transported across the Mexico/Arizona border abetted by a costly coyote. Mother got a job as a “housekeeper” in a ritzy Pasadena Arts and Crafts house and Ernesto entered public school, where he picked up English in a flash, excelled at every grade level, and earned an acceptance, with full scholarship, to USC, in the days when Latinos were not always required to show papers. He majored in business, did well academically and socially and was employed after graduation at a midlevel in a San Pedro shipping company. He developed a penchant for women co-workers older than he. When they expanded northward, the company transferred him to another midlevel slot in San Francisco where he encountered a higher class of sexually experimental middle age women. Less than two years after opening their doors, the company recognized that San Francisco was no San Pedro or even Oakland. There simply weren’t enough ships in port so they battened the hatches and let go of all employees, with a tiny severance, but without offering Ernesto or anyone else a chance to return south. He had difficulty finding another job. Eventually, he signed on as a salesman at an auto dealership peddling Subarus and was pretty good at it, selling a bunch of station wagons to Spanish-speaking family folks. He quickly got bored however and left the agency for a position as a waiter at a high-end downtown steakhouse where, between a modest salary and large tips, he, the only college graduate on staff, succeeded.
Jennifer Taylor was three yours older than Ernesto Contreras, he 31, she 34, when they became lovers. Mrs. Taylor was then into the early decline of her first marriage to Randy Taylor, a multiple franchisee. He owned two of each of the following - fast food joints, movie theaters, tire outlets, car washes and gyms - plus one check-cashing establishment and a nine-hole golf course. Ernesto and Jennifer met at one of Taylor’s car washes and started talking when they noted that they both had black Subarus. Coffee one day, sex the next, and the next. It was not hard to cuckold Mr. Taylor. Constantly in motion and rarely home thanks to his multiple holdings, he also took on an ever-increasing importance in his church, serving as its representative on the regional council of the United Methodists. He was away more than he was home, and since Jen didn’t work, at his request, and had opted against offspring, she had plenty of free time for foreplay and fornication. Ernesto was glad to oblige and for the first several months the dalliances occurred weekly or more. Occasionally, they would smoke a joint that he would come up with from sources about which she never inquired. Jennifer had been a somewhat more than occasional user of the weed at high school in New Jersey, but had switched to beer and wine following college. After a year, plus or minus, of the frequent adultery, she developed a modicum of guilt. She wasn’t prepared to get divorced. Old man Taylor wasn’t mean to her and his combined income from all the franchises made them more than comfortable. The marital sex was, to put it in as kind a way as she could, awful. She didn’t want to give up the affair, but felt it would be more morally acceptable if the get-togethers occurred less often. They would continue to talk on the phone as often as either desired, which worked out to almost every day, but would copulate at a lesser frequency. Jennifer loved to talk to Ernesto about life, her unhappiness at home and sex, and loved to lie with him; she didn’t think she loved him and she had no interest in leaving one husband to marry the immigrant, although she could not give voice to a reason. Perhaps it had to do with the fact that he never asked her to do so. She suspected that she was not her lover’s only lover, but made no attempt to prove or disprove the suspicion.
The Taylor’s called it quits about two years after Ernesto surfaced. Shockingly for Jennifer, the breakup resulted not from her affair but from his. He came home one afternoon after working on the books at the golf course and notified her that he was in love with the pro, a gentleman who Taylor said had a swing like Arnold Palmer. The split was surprisingly amicable. He offered her one each of the franchises of which he had two and the check cashing store; she insisted on and was given lots of money instead. With it she bought a fine, but small, home in Pacific Heights and the pug Bernie, the whelp of champions. Jennifer and Ernesto had systematized their lovemaking. They coupled twice a month, usually on Tuesday, until she met and married Fred Klein who spent most of his time at home. At that point, they had to work it out to suit her new husband’s philanthropic and poker playing schedule. The occasional, rewarding relationship had continued for the entirety of her second marriage with, to her knowledge, no suspicions at home.
It was well after midnight and Fred had not returned from his cultural committee meeting. The twins and their charges had gone to bed, comfortably ensconced into two of the three guest rooms of the mansion, adults in the queen beds, kids on air mattresses on the floor. At the time they retired, there was minimal concern about his whereabouts. An hour later, Jennifer decided to call Ernesto, her closest confidant and her personal font of wisdom. She, by then, was close to panic, fearing that her husband had committed suicide; she sought both reassurance and advice. She was not particularly close to her stepsons and had an underlying fear that they somehow blamed her for his predicament. She didn’t want to call the police, fearing that it would only aggravate them and make his chances for judicial leniency that much less. Calling the lawyers, either Schofield, whom she knew well, or Greenberg, whom she had met only the previous day during the transaction with the bail bondsman, did not seem wise.
Ernesto knew only what he read in the papers and heard on local news broadcasts. His lover’s spouse was in major trouble. He felt sympathy for her and even for her husband. On the other hand, he was not totally upset by the circumstances as they might greatly simplify, and possibly embellish the still torrid affair. Jennifer’s call was answered quickly but sleepily. She started as if he knew nothing of the events, an illogical thought as she knew Ernesto to be always aware of what was going on internationally, nationally, and locally. “Fred killed a woman.”
“I know, I know. I heard about it yesterday and they just had a story about him getting out on bail on the 11 o’clock news.”
“He went to one of his board meetings even though he just got out of jail and, now, he hasn’t come home. He was supposed to be here more than two hours ago and he hasn’t even called. He always comes home when he says he will. If he’s stuck in traffic, or his meeting goes longer than planned, he calls me,
even if he’s only going to be ten minutes late. It’s the only time he ever uses a cell phone. I’m really worried about him. It’s just not like him.”
“You know, he’s gotta be stressed, really stressed. He’s not going to be acting like usual. Think about what he might be doing that’s not normal.”
“I guess he could be drinking with somebody from the committee, or one of his poker buddies. He doesn’t drink much but I did hear from his kids that he hit it pretty hard when Barbara died.”
“Barbara?”
“His first wife.” She was sure that she must have told Ernesto about her and that she had almost certainly used the name lots of times over their later years together. “So, what should I do?”
“Did you try his cell?”
“He never turns it on unless he’s going to call me. I tried it anyway. No answer. Just voice mail.”
“I guess you are going to just have to wait ’til he comes home or calls. If it would make you feel better, why don’t you call the hospitals and find out if he checked himself in or was brought in?”
“They would have called me. If he was dead, or not able to talk, they would have checked his wallet; he carries business cards even though he doesn’t do business anymore.”
“But why don’t you call anyway. It’d make you feel better.”
“Would you call for me?”
“OK. I can do that. I’ll call the private hospitals. Can’t imagine he’d go to County or the VA. I’ll call you as soon as I know anything.”
He got the series of numbers from 411 and called the emergency department of California Pacific, St. Mary’s and St. Francis. “I am looking for a Mr. Fred, or Frederick Klein. He might have been admitted tonight.” In each case, he was given some variation of no. To be even more complete, he called the ERs at St. Luke’s, San Francisco General, Seton in Daly City and Marin General Hospital. Nobody had a Klein on the list.
“Good news, mi amor. None of the emergency rooms in the area saw anybody named Klein tonight.”
“I guess that’s good news. But I’m still really scared.”
“You’ll just have to wait a while. I’m sure he’ll come back soon, maybe drunk as a skunk.” Jen recognized the irony of the possibility that he would drive himself home inebriated.
Robert shuffled into the den, having heard the phone ring, seeing that it was almost 2 AM and knowing that when he went to bed his father hadn’t come home.
“Was that about Dad? Is he OK?”
“That was a friend who I asked to call hospitals. They haven’t seen him in any of the emergency rooms. That’s good, I guess, but I’m still worried.”
“Jesus – would he have done something to himself? Could he be lying dead in the park? Oh God, could he have jumped off the bridge?” The Klein’s did not own a gun and they didn’t have any pills that could kill you. Fred had always seemed fascinated by jumpers, questioning their sanity. No way that he’d be one of them. “I guess we should call the police. They’ll know who we’re talking about.”
When Robert, now with his twin brother at his side, called the SFPD and got through to the appropriate extension, Sgt. Gallardo, the on-call cop, indeed knew the name Fred Klein. “Is this the same guy who is charged with the hit and run that killed the woman on California?”
“Yes, sir, it is.”
“We haven’t heard anything about any jumpers recently. The hospitals would know if any bodies had turned up; the ambulance takes ‘em all to SFGH for pronouncing. Give me your number and we’ll call if we hear anything.”
Evacuation of a subdural hematoma, a collection of blood between the thick lining of the brain and the brain tissue itself, is a quick procedure. It can be done in a minute or two, through a burr hole in the skull in an acute emergency. A more definitive operation can be done in half an hour or less. Doe’s surgeons, the dirty bastards, were, in spite of their nasty disposition, efficient. The blood was removed and drainage established in twenty minutes, relieving the pressure on the brain, and he was moved to recovery, a breathing tube in place with a respirator connected. The effects of the anesthesia and the residuals from the swelling kept him under; he was still John Doe.
After the blood was removed from around his brain, his heart became the subject of greatest medical interest. His blood tests showed that he had had a heart attack. The myocardial infarction was obviously the cause of his complete heart block and, as a result of damage to the electrical conduction system in the heart, the critically slow pulse. As a consequence of the slow heart rate, the brain didn’t get enough oxygen, causing him to fall which, in turn, led to the subdural hematoma. A temporary internal pacemaker would have to be placed via a big vein to replace the less reliable external one that had been attached before his surgery. That was straight forward for the cardiology fellow who had been standing by in the operating room. Doe was stable and after an hour in recovery was moved to the ICU where he began to thrash.
Two hours later, he stopped thrashing and was clearly awake. The tube in his trachea prevented him from speaking and the nurses were unprepared to wake the surgeon for an order to take out the tube. The dirty bastards had been up all night on the C-spine case and Patient Doe. She handed the patient a clipboard and a ballpoint.
Where am I?
“San Francisco General Hospital – you are in the intensive care unit and just had surgery.
What kind of surgery?
“Surgery to take blood out from around your brain. You fell in some bar because of a heart attack and hit your head on the floor. By the way, can you tell us your name? And, where do you live? You didn’t have any ID on you when you came in.”
I’m Fred Klein. I live in the City.
“Are you married? If so, what’s your wife’s name?”
Barbara.
“We’ll call her. What’s your number?”
I don’t remember.
“Hey. You aren’t the same Fred Klein that ran into that mother the other day, are you?”
He shrugged his shoulders. No.
A nurse’s aide had heard the question, took a look at the patient and was sure he was the same guy whose picture she had seen the day before. “That’s the man. Let him die,” she said loud enough for the patient to hear. She was the mother of a three-year- old.
The nurse knew that she had a unique problem on her hand. She needed advice from on high. She called the Supervisor of Nurses for the night shift.
“Should I just call the wife? He tells me he’s married to someone named Barbara.”
‘“Are we sure this is the same Fred Klein?”
“Hard to say with all the bandages and tubes, but he sure looks like the guy I saw on TV. Natasha thinks it’s him too.”
“We better call the cops first. This could be real sticky.”
They reached Sgt. Gallardo, the SFPD person who two hours before had been talking to the Klein household and told him about Fred Klein, John Doe and his saying that he lived in the City and was married to a Barbara. She included the fact that he wore a designer suit, now bagged in paper, and well shined Bruno Maglis. “Yeah, I gotta presume that that’s the same Fred Klein. His family has been trying to find him – left home and didn’t return. We have no other candidates behind bars or in the morgue and the son said that they had checked the ERs. I’ll call them and try to tie it together. But as to what we need to do if it is the same Klein, probably nothing. If it is the same guy, he’s out on bail and it doesn’t seem that he’s going any place real soon with all the tubes and catheters and IVs you put into anybody unlucky enough to end up in your shop. Plus, we don’t have any spare cops right now to sit outside his room. I’ll call the family. I just happen to have their number right here on my desk.”
Jennifer picked up the phone on the first ring. “Hello, this is Sergeant Gallardo from the San Francisco Police Department. Is this Mrs. Barbara Klein?”
“Huh. No, Barbara Klein doesn’t live here anymore. She passed away several years ago. Why…why are
you calling? Aren’t you the same officer that talked to my son-in-law two hours ago?”
“Yes, Mam. But you say Barbara died years ago? Who are you then?”
“I’m Jennifer. I’m Fred’s wife now. Stop. Just a second, speak to my stepson.” She was sure she was about to hear that she was a widow.
Robert took the hand-off. “Hello Sergeant, this is Doctor Robert Klein.”
“Doctor Klein, how you doin’?”
“OK, OK. What? Why are you calling? My stepmother seems very upset.”
“We may have found your father. He’s in the ICU at San Francisco General Hospital, but he says his wife is named Barbara. He’s pretty sick – something happened to his heart and to his brain. They say he’ll probably survive but they’re not sure.”
Robert gave a thumbs-up to Jennifer and continued talking to the Sergeant. “Barbara was our mother. She’s dead – long time ago. He’s married to Jennifer now. If, as you say, something happened to his brain – I presume that means a stroke – he may have lost his short term memory.”
“Could be. Doctor, do you know if he had a pair of Bruno Magli shoes?”
“No, I have no idea what kind of shoes he has. Jen – did Dad have Bruno Maglis?”
“Yes. I think he had them on when he went to his meeting. Why?”
“Yes he has some. And…”
“I heard her. Then this has to be the same Fred Klein.”
“Can you tell me anything more about his condition? How did this happen?” Robert asked.
“All I can tell you is that he’s at the General in intensive care. They say he had a fall and a heart attack. They found him in a bar in the Tenderloin. He needed some sort of surgery on his brain, but he’s doing a little better now.”