Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  Our patient was young, a lot younger than twenty-two. She reminded me of my Marigold Lady, the dead girl who found me in the river. A slender build capped by golden hair and green eyes, her face was well-known in the local papers as the daughter of a prominent Virginia state senator. She was scared.

  “Hi, I’m June Ross and this is Bob Galen. We’re here to escort you upstairs. How are you feeling?”

  June tried to break the ice, as we entered the room and closed the door.

  What broke was a flood of tears and a desperate moaning, “I want to keep my baby!”

  June and I both averted our gaze. Whether it was anger at what was happening or shame at what was going to happen to this girl, I’m still not sure.

  “Can’t I just go home?”

  The girl stared at both of us with pleading eyes.

  “How old are you, Christine?”

  June was looking at the birth date on the chart, and it didn’t fit.

  “I … I’m seventeen. I’ll be eighteen tomorrow.”

  June sat down and I followed suit. Now we were both smiling. She took the young girl’s hands and held them.

  “Chrissie, do you have any friends you could stay with overnight?”

  “I don’t under…”

  Then a light lit up those beautiful green eyes.

  “Yes … yes, I do!”

  For the first time she smiled, and June and I returned the favor.

  “Now listen carefully,” I whispered. “We want you to leave quietly and go to where you know you’ll be safe. June and I will have to pretend to shout at you to come back, but don’t turn, don’t pay any attention. Just keep going.”

  I reached in my side pocket. I had only one dollar on me. I gave it to her.

  June looked at me as she never had before. It felt good.

  Christine hugged us both and moved toward the door.

  “Slow, don’t run. Don’t attract any attention to yourself. We’ll start to make some noise after you get outside,” June added as our patient started to open the door.

  We saw Christine make it out the big glass doors of the ER.

  June closed the anteroom door then kissed me. She whispered, “I didn’t know bears had feelings.”

  We walked leisurely back through the tunnels to Maggie.

  “Where’s the patient?”

  She did not look happy.

  “She changed her mind,” we said in unison.

  “What did you two do?”

  Maggie was shaking her head now.

  “She turns eighteen tomorrow,” June said. “She’ll be able to make her own decision then.”

  June held my hand.

  “Girl, you don’t know what you’ve done! You don’t know this kid’s father. He will see that it is done, no matter how old she is!”

  With that Maggie turned and walked away.

  It was my turn to be on call that night, but June stayed with me. She even brought me dinner. For a while, things were quiet, and then the duty nurse paged me.

  A patient of Dr. Tomlinson’s is being sent up for an emergency D and C. Do a quick pre-op check on her as soon as she hits the floor. Her name is Christine…”

  June rose from her chair at the name, and we both felt the same chill shoot up our spines.

  The attendant pushed the gurney cart out of the elevator and steered it toward Room 3. June and I ran and saw the young woman lying there with her eyes half-lidded. She had been drugged.

  A voice from behind startled us. It was Maggie. Her face was creased. Was it sorrow, sympathy, pity?

  “I warned you. You don’t know this girl’s father.”

  “Maggie…”

  June started to cry, and Maggie put her arms around her.

  “The senator’s personal physician gave her a shot of phenobarb after they caught her,” she whispered.

  Maggie turned to me.

  “Do you want to scrub in?”

  I shook my head.

  I made rounds then held June’s hand, until the nurse called me to the recovery room.

  That night, Christine died of post-operative hemorrhaging and anesthesia complications. Time of death: 11:59 p.m.

  Things were never quite the same between June and me after that. She seemed to withdraw and focus on her work, but at the same time she became needier. To the male mind, it was a contradiction, a conundrum—just plain screwy.

  An old man looks back and understands—but only to the extent that a man can truly fathom the other half of the human species. My fun-loving, brilliant, independent June was steeped in guilt—as was I. Would Christine have lived if we had not interfered?

  The young me saw only the young woman. June saw the young woman and the child within. No man can truly understand that. No man can truly understand the anger and disgust directed both externally and internally over what another man—a father more interested in his career—could have done to his daughter.

  In my own bumbling way, I tried to refill that void, that loss of confidence in June. Then, my stupid gene took over.

  “Dave, I’m going to ask June to marry me, but I want to get her the best ring I can. I’m going to take on that externship in the Detox unit at night. I think I’ll have enough by May to buy it. Then I’ll propose just before graduation. Whaddya think?”

  Yeah, guys talk, too, and not always about sex. Dave and I had become de facto brothers even in the eyes of his family. I knew that he was totally hooked on Connie and had similar plans in mind.

  As for Bill and Peggy, that was just about a done deal. Bill also spoke of a graduation proposal and marriage.

  But what those two guys seemed to know instinctively, and what I was totally clueless about, was this: The one you love wants and needs your attention. It makes no difference why you are not there when she needs you.

  Dave looked at me and asked me the question that I was too stupid to comprehend.

  “Bob, how are you going to spend time with June if you’re working double shifts?”

  I didn’t hear him. All I could imagine was June being overwhelmed by my sacrifice to get her a ring.

  That May, I stood in her apartment, ring box in my pocket, and I popped the question.

  That damned ring still sits in its box in my desk drawer over half a century later.

  The six of us graduated on a beautiful day in May. One couldn’t ask for better weather. The sun was shining, the temperature slightly cool and dry for a Richmond spring.

  I saw the senator standing next to the university chancellor and the dean of the medical school. He was doing his best to get into as many photos as possible.

  As I said, I hate hawks.

  If It Ain’t Broke

  “Code Blue! Code Blue! Surgical recovery suite 3.”

  I sat bolt upright in the house-staff on-call room. No thought, no hesitation.

  Four years of Pavlovian training summoned me.

  It was my first year of post-graduate internship.

  I raced down the hall to where it seemed half the hospital staff had crowded into that little room.

  Crash carts.

  Sounds of chest compression.

  Calls of “Stand clear!”

  The discharge of the defibrillator paddles.

  Ozone mixed with the sweat of multiple doctors and nurses.

  And a near-lifeless body rising and falling in galvanic response.

  The boy was young, probably nine or ten. He looked like he had been playing with his father’s shaving cream. Pink froth covered the front of his face and poured out of his mouth and nose with every chest compression performed by the resuscitation team.

  His condition: massive pulmonary edema (fluid in the lungs) from heart failure.

  They worked on him for forty minutes. No electrical response on the monitor.

  The chief resident shook his head.

  “Let’s call it. Time of death…”

  I heard the nurses sobbing.

  “What happened, Kathy?”


  The young nurse leaned against the wall, clenching and unclenching her hands. I held her until the sobbing stopped. Then we left for the nursing lounge, where we sat down.

  “That poor kid—he didn’t need to be here. His damned parents wanted him to have his tonsils out. All the other kids in their neighborhood had had them out. But he didn’t need it!”

  The boy had slipped into heart failure from an unusual response to some of the medications used during the procedure.

  The law of unintended consequences: If it ain’t broke, don’t fix it. Or, in medical parlance: First, do no harm.

  I’m ashamed to admit I don’t remember the boy’s name. I’m not sure I ever knew it. Or maybe my old-man’s memory has granted me forgetfulness. But it took a while. For a long time, after I started my medical practice, the image of that little body lying motionless on the hospital bed stayed locked in my mind.

  “What’s the schedule look like, Barbara?”

  I crossed my fingers. It had been a busy week in the office.

  “We got us a bunch of worried well.”

  I sighed. Chest pains, high blood pressure, even bladder infections were preferable. Dealing with a patient’s self-image is the hardest job. I do not envy the psychiatrists or the cosmetic plastic surgeons.

  Jack Collins was my first patient that morning.

  “Hey, Doc, you’re looking good!”

  Jack was six feet tall and one-hundred-eighty pounds of muscle. Life had no meaning for him, unless he worked out at least four hours a day.

  “You, too, Jack. What can I do for you?”

  “I’m not right, Doc. I eat only healthy foods, do my workouts, and still I get colds. Besides, I’m the puniest guy at the gym.”

  Jack could easily lift me with one hand and pitch me across the room. He reminded me of my boyhood friend, Sal.

  “Come on, Doc. Look at me! I’m a weakling. Don’t you have something to bulk me up? I talked with my trainer and he suggested…”

  I listened. It was the usual bad advice about pills, shots, and dietary supplements. By themselves, not bad, but when taken in the doses his trainer wanted, Jack would slip into kidney and liver failure in no time.

  The real question was, why? Why was Jack so driven to bulk up?

  I held up a mirror.

  “Jack, what do you see?”

  “One puny son of a beeswax, Doc.”

  When I examined him, on the surface he looked damned good. But I had learned that doctors can be fooled. So I ordered some lab tests that focused on body metabolism, and I managed to persuade him, temporarily, to hold off on doing anything drastic. I still didn’t know what I would tell him if—and when—the test results came back normal.

  But other events intervened.

  One of Jack’s trainers had begun injecting him up with illegal steroids, and they definitely bulked him up. They also made him very volatile. Eventually the police arrested Jack for beating up his girl friend. They called it ’roid rage.

  Six patients with colds and backaches, then…

  “Come on back, Mrs. Filman.”

  Betty Filman was thirty, a good-looking young woman with auburn hair, bright blue eyes, and a full figure. She surprised me with the first words out of her mouth.

  “I want to have breast implants, Dr. Galen. I need a pre-surgical clearance.”

  Trust me, Betty Filman needed breast implants as much as I did.

  “Why, Mrs. Filman? From what I see, God has already blessed you with beauty and a great figure. Other women would kill to look like you.”

  Okay, I’m not the most subtle of physicians.

  “Bill wants me to have it done.”

  Bill Filman was an up-and-comer in the business world. To hear him tell it the world revolved around him. Keeping his wife in trophy shape would validate that perception. And unfortunately, in Bill’s world, trophy shape meant she needed “big bazookas,” as Thomas, my old neighborhood barber, used to say.

  “Are you sure? Your husband should count himself one lucky guy to have married you. You don’t need to do this.”

  “Yes, I do, because he’ll love me … more.”

  She stared at the floor.

  I saw the fear on her face, and I heard the unspoken thought: Bill was looking for greener pastures. So I completed the required, pre-surgical exam.

  Psychologists call it Body Dysmorphic Syndrome, or BDS. We all suffer some degree of anxiety about our looks—how we appear, how we stack up against the other guy or gal. Ask a teenage male what’s the first thing he looks at in a locker room. He won’t admit it, but you already know, because you did it yourself. Size matters, and so do looks, strength, and all of the other physical attributes that keep the human race dating and mating.

  We remain members of the animal kingdom, competing for the most desired mate or the most powerful position in the pecking order. We lie awake at night and stare in our mind’s mirror at the unwanted hair loss and color changes, and the deterioration of skin and muscle tone.

  Sometimes that anxiety grows extreme, so gnawing that it becomes obsession—it becomes dangerous and self-destructive. We fixate on the unnoticeable spot, the slight crook of the nose. We enrich the plastic surgeons—and justifiably so—for their skills in disguising the ravages of age.

  Betty Filman had her breast implants. The lily was gilded.

  Bill Filman divorced her three months later.

  Another type of demon can lodge inside us, one that makes even the BDS patient seem normal.

  “Dr. Galen, my daughter won’t eat.”

  Lavinia Baker sat across from me. Her daughter, Cassandra, sat beside her, almost invisible, physically and emotionally.

  Cassie had turned fourteen three months earlier. Always slender, with a pleasant, rounded face, the Cassie I saw that day startled me. Her formerly natural, wavy-brown hair looked stringy and dull. She had combed it down over her wan face. Brilliant brown eyes now sat flat and sunken, as if part of a death mask.

  “Mrs. Baker, why didn’t you call me earlier?”

  “I didn’t think anything was wrong. I mean, Doctor, I was worried about my weight at her age. All her friends are model-slim. My husband even used to crack jokes about Cassie’s baby face making her look fat.”

  I closed my eyes. There are times when I have to resist the urge to jump up and throttle the person talking to me.

  Mrs. Baker did not realize it, but her daughter Cassie was slowly dying. Her condition achieves the same mortality statistics as certain cancers: anorexia nervosa.

  Yes, it does affect young women more, but men aren’t immune.

  To the anorexic patients all mirror images are distorted into the circus-fun-house illusion of the morbidly obese. The tall and slender perceive themselves as bowling-ball fat. Food becomes the enemy, obsessed over, never out of mind. Eating must be avoided. If the urge overwhelms, then they take laxatives or diuretics, or they self-induce vomiting (bulimia) to correct the perceived problem.

  “Mrs. Baker, I’m afraid Cassie needs to be hospitalized immediately.”

  “Can’t you just give her some pills or a shot to make her eat?”

  “That doesn’t work, Mrs. Baker. Remember Karen Carpenter?”

  The lead singer of the singing group The Carpenters had developed anorexia, and the condition led to her death at age 32 of heart failure.

  “But Cassie’s not crazy.”

  “Neither was Karen Carpenter. We don’t know why this happens. We have done all sorts of research on the changes in brain chemicals that occur in adolescence. All we have learned is that there is no simple answer.

  “Cassie needs to be hospitalized, worked up for correctable problems, and then intensely monitored and counseled. She needs to have her food intake watched and measured. She needs to be placed where she can no longer do things to compound the weight loss.”

  “I don’t think my husband will agree to that.”

  I stared at her for a moment.

  “Then Cassie will
die.”

  She stared back at me.

  “Come on, Cassie. Let’s find a doctor who knows what he’s doing.”

  The girl hadn’t said a word. She just peered at me with one eye through the hair burka covering her face.

  “What’s eating them?” Barbara asked, as she walked into my office after mother and daughter had left.

  My secretary could always get right to the point.

  “It’s who’s not eating, and that wasn’t a worried well patient.”

  “Yeah, my bad, Doctor. What’s her problem?”

  As I recited the litany on anorexia, Barbara shook her head.

  “That mama won’t listen.”

  “Neither will her father.”

  I called Social Services. They informed me that they couldn’t (read “wouldn’t”) get involved.

  I called Cassie’s school. Same response.

  Cassie’s father hung up on me.

  Four months passed. I was about to sit down with Cathy for a Thanksgiving dinner she had prepared from scratch. She was a great cook.

  The phone rang.

  “Do you have to answer it, Tony?”

  I smiled. She already knew the answer.

  “Dr. Galen?”

  “Yes?”

  I could hear loud noises and shouts in the background.

  “This is Sergeant Janly with county rescue. You got a patient, Cassandra Baker?”

  “I’m not sure she’s my patient, Sergeant. Mrs. Baker left my office very upset some time ago, when I told her that Cassie was anorexic.”

  “Do you know if she’s been seeing another doctor?”

  “No, I don’t. What’s the problem?”

  “Parents found her in the bathroom.”

  “Was she vomiting?”

  “Looked like it.”

  “She’s…?”

  “Yeah.”

  Cartoonist Walt Kelly once imbued his lovable but species-indeterminate comic-strip character Pogo with a bit of wisdom for the ages: “We have met the enemy and he is us.”