Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  Connie and Dave spent a lot of time at her apartment while Peggy was away.

  About June and me, let’s just say that old Berto was no slouch.

  But that’s another story.

  Year four would be starting soon.

  Good Death, Bad Death

  “I hate hawks.”

  Dave looked at me puzzled, his right eyebrow raised. It was truly comical, an expression that didn’t fit his angular face and beanpole body.

  “Okay, City Boy, what’s your beef now?”

  “I grew up in a neighborhood of predators, Country Boy. It was bad enough when we killed and maimed each other out of sheer frustration. But when someone—someone who hadn’t lived through what we did—deliberately preyed on us, well, we considered it a form of cannibalism.”

  “Bob, look over there. What do you see?”

  A hawk sat at the very top of a sycamore tree. Suddenly it swooped down and seconds later flew up again with something wriggling in its talons.

  The wriggling soon stopped.

  The sight made me feel sick. I looked at my roommate and attempted to duplicate his raised-eyebrow stare.

  “That was the death of a living creature, Dave.”

  “That’s right. Now, what would have happened if that critter, probably a field mouse, hadn’t been snatched?”

  “It would have lived out its life, had a family, and died of natural causes.”

  “What the hell are natural causes, Bob?”

  “You’re asking me that, Country Boy? You, especially, should know the answer. We get old. Our organs don’t work as well. Somewhere along the way, our body no longer functions the way it should, and our heart stops.”

  “City Boy…”

  He paused, his voice now reflective.

  “Bob, haven’t you ever had to put down an animal?”

  “You mean…?”

  “Yeah, something you kinda grew up with, petted, maybe milked or rode and loved in a way that only kids can love a pet.”

  I didn’t answer. I stared ahead then closed my eyes, my shoulders slumped.

  No, Dave, but I held too many dead or dying friends in my arms.

  I couldn’t have replied without sobbing.

  “Okay, now tell me the difference between that mouse dying suddenly and quickly, or gradually deteriorating and becoming unable to run and find food? That’s a prolonged death of starvation.”

  “So when your time comes, you want it quick and dirty, huh?”

  He grinned.

  “Yeah, preferably in bed with…”

  Just then we heard Big Dave shouting at us, so we ran across the field to the little white clapboard farmhouse.

  Dave rushed in ahead of me

  We saw Big Dave holding Mary in his arms. She was shaking her head.

  “It’s nothin’. Jes’ one o’ my dizzy spells. Don’t make sech a fuss, Pa.”

  She looked pale, almost gray, but she pushed her husband’s arms away and sat on one of the handmade kitchen chairs nearby.

  Dave looked plaintively at his mother and father.

  “What happened, Pa?”

  Big Dave was wringing his gnarled, work-hardened hands.

  “I jes’ stepped out fer a second, and when I came back in, yer ma was on the floor.”

  I glanced at Dave then walked to the little bedroom where I was staying to get my bag. Every time we returned home, Dave and I would bring our black bags. It made the two old folks so proud to see their “two boys,” as they called us, walking in with them.

  Big Dave had built three bedrooms onto his one-room bachelor house when he and Mary had married. They had planned on a large family, but two years after Mary had Dave, she lost what would have been his kid brother shortly after birth. That third bedroom had remained empty until Dave brought me home on my first visit. Now his folks called it “Bob’s room.”

  “Yer not gonna doctor me, are ya, Bob?”

  I laughed, trying to hide my concern.

  She was still gray.

  By then Dave had retrieved his own bag, and we pulled out our witchdoctor’s gadgets, while Mary kept scolding us.

  “Quit makin’ sech a fuss!”

  Dave wrapped a blood-pressure cuff around his mother’s right arm, while I listened to her chest with my stethoscope. The sounds I heard were unmistakable. I waited until he finished, then we switched places, and I saw the recognition in his eyes.

  Mary Nash had an irregular heartbeat typical of atrial fibrillation—the rapid, uneven beating of the small upper chambers of the heart. Coupled with that was the harsh flow murmur of aortic regurgitation. The valve through which blood flowed from the big left side of the heart into the aorta—the major artery of the body—was not closing fully.

  “Ma, we need to get you to the hospital!”

  She shook her head, and so did Big Dave.

  “Son, if’n ah’m gonna die, it’s gonna be here.”

  “Yer ma’s right, boy.”

  No amount of talk or reasoning could sway them, so we stopped, put our bags back in our rooms, and went back outside.

  “See what I mean, Bob? Do you understand now?”

  I nodded.

  “I still hate hawks.”

  We left the next day. Our two-week vacation between junior and senior year ended on an anxious note. Dave had offered to stay and take care of his mother, but neither of his parents would hear of it.

  “Now you git yer tail back to school, boy! Yer not gonna drop out jes’ fer a foolish ol’ woman with the vapors.”

  Mary Nash was short and thin, her face wrinkled before her time by hard work. But she was one powerful woman who knew what to say and why. She and Big Dave had watched their son grow into something previously considered unattainable by the family. She wouldn’t let something like her own mortality stand in his way.

  I drove his car down the rutted dirt road, as he craned his scrawny neck to get one last look at his parents standing and waving at us.

  We drove back to Richmond in silence.

  Four hours later we pulled into the parking lot of our row-house neighborhood on Church Hill. Dave went straight to his room. I picked up the mail, tossed out the junk, and paid the bills. Then I headed upstairs.

  His door was closed, but I could hear his sobs. I raised my hand to knock but hesitated. Instead I went to my room and lay down. I decided to rest, just for a moment.

  “Berto.”

  “Si, Mama?”

  “Be very quiet. Your papa, he is sick.”

  I was twelve. Papa couldn’t be sick. Papa was always strong, always well. Papa never cried, never complained. Oh, I saw him tired. I saw him upset when stupid things were done at the foundry. But sick? No, my papa could never be sick.

  I took my shoes off and tip-toed toward Mama and Papa’s bedroom. In today’s world of bloated mansions it wouldn’t be large enough to be called a closet. But in our tenement apartment, it was a bedroom. It was dark. That was not unusual. Electricity cost money. But this was daytime, and the little window shade was pulled down.

  Papa lay there on his back, head elevated by a pillow. What seemed like every few seconds his body would spasm with uncontrollable coughing. Sweat poured off his forehead, but he shook with chills.

  I went to his bedside and whispered, “Papa, can I get you anything?”

  The single moan from his dry lips scared me into running out of the room.

  “Mama, I’m going to get Dr. Agnelli,” I yelled, as I headed for the outside door.

  I didn’t wait for an answer. I forced my shoes on and donned the heaviest coat I had. It was unusually cold even for New Jersey in January. I ran down the three flights of stairs and out the front door of our tenement, moving as fast as I could to the storefront clinic run by my mentor, Dr. Corrado Agnelli.

  “What’s wrong, Berto?”

  I was out of breath. I gasped, “Papa is sick.”

  He didn’t hesitate. He grabbed his coat and reached down by his old desk to grab a la
rge black-leather bag.

  “Come on, boy. Let’s look at your papa.”

  Even running, I could barely keep up with his stride. His long legs devoured the distance to our apartment and took the stairs two, sometimes three at a time. He knocked, and Mama answered the door.

  Dr. Agnelli headed right to Papa’s bedroom and opened the shade. I saw my father lying there, in full daylight, haggard and weak. I had never seen him like that.

  The doctor quickly examined him. Then he opened that magic bag of his and took out a syringe and a bottle of off-white liquid. I watched, as he cleaned the bottle top then stuck the needle into it and drew up a full dose.

  “Antonio, turn over.”

  Mama helped Papa onto his right side, and I winced, as the big needle quickly entered his left buttock. Papa didn’t move or say a word, but then he relaxed and seemed to go instantly to sleep.

  Mama and I followed Dr. Agnelli out into the sitting room.

  “Anna, he has pneumonia. I gave him some penicillin. We’ll see how he does the next twenty-four hours. Just keep trying to feed him.”

  “Dottore, will my papa get better?”

  I looked up at my role model, my eyes trying hard not to tear up.

  Dr. Agnelli patted me on the head.

  “Si, Berto. Your papa is a very strong man.”

  And he did. The next morning Papa was up and eating like nothing had happened. He smiled at me, actually smiled at me, and uttered two words.

  “Grazie, Berto.”

  I smiled back … and awoke.

  The sun was setting. It was after eight o’clock that July evening in Richmond, as I walked to Dave’s room, knocked and walked in uninvited. He was lying face down and didn’t turn, until I said as softly as I could, “I know how you feel.”

  Dave snuffled, turned, wiped his eyes, and sat up.

  “Come on, Country Boy. Let’s see what we’ve got in the fridge.”

  We headed downstairs, and I fixed us a supper of canned soup. We shared some words and then went back to our rooms.

  Senior year started in the morning.

  Med school senior year—one of growing confidence and final decisions.

  Once more we began the first day by walking across the Marshall Street Viaduct from our Church Hill apartment. Once more the early morning Richmond sun reflected off our whites—the pants and shirt combo worn by students on ward duty. But this time was different. We strode up the hill laughing and joking about who and what we would see and what strange cases would astound and confound us. No more upper classmen now. We were the seniors!

  That realization became especially pleasant, when we noticed the third-year kids milling in confusion at the entrance to West Hospital and then shared a knowing look.

  Did we, could we, have ever looked like that?

  Dave yelled out a, “Hey, don’t sweat it. You’ll get used to being eaten alive.”

  “Yeah,” I threw in, “just take the time to make sure you don’t taste good.”

  One girl looked quizzically at us. She was the only one courageous enough to ask, “What do you mean?”

  Her friends laughed nervously, as we headed toward them. Dave smiled and said. “Just don’t worry. It won’t help, and all it does is encourage the bastards who enjoy seeing you sweat enjoy it more.”

  I nodded and repeated the advice our resident had given us the first day of last year.

  “Always expect the unexpected. Always assume that they are out to get you. Remember, even paranoids can be right sometimes.”

  “Sandy, believe only half of what these two guys tell you.”

  Dave and I turned around at the voice behind us. June was smiling at me coyly and licking her lips.

  “Stop by sometime and we’ll tell you the full scoop about these two—especially my farm boy.”

  Connie was with her, now standing on tip-toe and patting Dave on the head. Bill and Peggy, as suited a southern gentleman and his southern belle, stood back and just smiled.

  Dave’s face matched the rising sun on a stormy day. Mine was not much lighter. But we hugged our friends and fairly danced with excitement.

  Our “A Team” was together again!

  Senior year is a year of electives: Take one from column A and two from column B; a Chinese smorgasbord of different rotations, from which everyone could pick and choose.

  By senior year we were expected to have formed a pretty good idea where our medical degrees were steering us. The masochists who loved surgery could enjoy it to the max by taking rotations in everything from general to open-heart to ear/eye/nose/throat. Those who enjoyed surgery, but didn’t like to get their hands dirty, could gravitate toward anesthesiology.

  The crowd that liked kids could specialize in pediatrics, adolescent medicine, or any of the areas, from pediatric infectious diseases to rehabilitation therapy for injured and maimed kids, that fell into the category.

  As for anatomy, we had two major options there: radiology, for those who naturally see the hidden details in shadows, and pathology, for those who could fit fleshy puzzle pieces together to make a diagnosis.

  And, for those who entertained their personal demons, what better pigeon hole than psychiatry?

  So it went. All of us had matched together on three different medical rotations. Then the luck of the draw sent Dave into an intensive-care stint, while I manned the medical emergency room. The following month we would switch places.

  June had filled the latter part of her fourth year with obstetrics and gynecology. That was no surprise. She was a natural at it. I lucked out in doing one of the OB/GYN rotations with her. In retrospect, I wish I hadn’t.

  “Hey, you two, we got a direct admission coming through Surge’ ER. She’s Dr. Tomlinson’s patient. Therapeutic D and C for DUB. Oh, and don’t get lost in the tunnels, understand?”

  Dr. Maggie Tronell, our resident, winked at June, who smiled noncommittally.

  What the hell had she told Maggie?

  One of the staff gynecologists, a Dr. Tomlinson, was admitting his private patient to the special deluxe floor for wealthy patients who suffered from what we commonly called “female problems.” Our patient was being admitted with a diagnosis of dysfunctional uterine bleeding—DUB. Strictly speaking that meant she was having heavy, irregular periods. Tomlinson was going to do a dilatation and curettage—a scraping procedure to remove the overactive lining in her uterus to be sure there was no malignancy.

  June looked at the admitting sheet.

  “Bob, she’s only twenty-two.”

  We shared a suspicious look.

  Usually D and C was done on older women, and usually only after a trial of hormone treatment to attempt to chemically cause the lining to slough off. We didn’t see any notation of that having been done.

  I bowed to June’s superior knowledge and asked the big question.

  “Then why…?”

  “I got a bad feeling about this one. Let’s see if they did a pregnancy test on her.”

  It wasn’t there.

  We both turned to Maggie, but June had the cojones to ask, quietly, “What’s going on?”

  Maggie Tronell was a bit older than the other residents. She had been an army nurse before going back to school to get her M.D. She closed her eyes and shook a head covered in dusty gray hair.

  “Are you two that naïve?”

  In fact, we were. This was another time, almost another world from the one we live in today. Roe versus Wade was still in the distant future, and deliberate abortion was considered illegal, immoral, and every other bad word you can think of.

  Yes, there were exceptions where the life of the mother was considered at imminent risk, but in Virginia, a legal abortion could be performed only if a committee of doctors and lawyers presided over by a judge permitted it.

  I make no moral judgment either way. My entry into the world of medicine was arranged by a dead girl, killed by a backroom abortionist when I was eight years old.

  June and I also
manned the OB/GYN pregnancy clinic, where busloads of scared, barely teenage, poor and pregnant girls were brought in to have their babies delivered in facilities that were old when our grandparents were born. The faces of those kids—and that’s what they were—lying on their backs, moaning in agony and being given inadequate pain medication, because we didn’t have enough, remain vivid in my mind.

  And, there was a flip side. There always is.

  We dealt with patients in the OB/GYN clinics, too. Prenatal care and counseling was done there. It was not unusual to see one patient who was the proverbial Mother Hubbard with so many children—you know how it goes—and then see desperate couples who could not conceive.

  “June, why can’t we match these two groups together in some informal adoption arrangement?”

  Talk about naïve. Another resident overheard me and verbally ripped my head off.

  June remained silent, until the resident asked if she agreed with me.

  “Why not?” she replied.

  I think we spoiled that guy’s day.

  The third side? That was what we were now going to learn.

  Maggie took us into the resident’s lounge—actually a converted closet—and sat us down.

  “Listen, kids, the world ain’t fair. You know that.”

  Dear God, yes, I knew it well, even then. My old neighborhood would have turned even Maggie’s hair grayer than it was.

  “Here’s how it works. Now, don’t interrupt me, young lady!”

  June was rising to protest, but I put my hand on her arm, and she sat down.

  Maggie’s eyes were tired now. What unimaginable things had this woman seen in war?

  “You two know that legal abortions are as rare as hen’s teeth, but legalities never stop people with money. That’s a fact. You understand? Now, go and escort our patient to the floor.”

  We nodded, stood up, and walked out quietly.

  June kept biting her lip.

  I started to say something then didn’t. This was one time when my stupid gene mercifully didn’t assert itself.

  We walked through the connecting tunnels in silence to the surgical emergency room. There were private anterooms that served as holding areas for patients who were bypassing the ER to be directly admitted.