Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  Fibroids are not malignant, but they can grow to massive size.

  As I completed the exam, I mentally rehearsed what I would tell the couple. After all, they both were highly educated people, and I was sure they would understand what I was about to discuss with them.

  I began my spiel by emphasizing how well the general examination had gone, and then I explained my reasoning and recommendations about the fibroid.

  I suggested two very simple things. One was a home pregnancy test—something Mrs. Delauncy had neglected to do. The other was an ultrasound image of the uterus.

  But as I mentioned the word “fibroid,” I could see the couple’s pupils dilating. Frowns crossed perspiring foreheads, as I continued.

  Suddenly, husband and wife stood up in unison and walked out of the examining room. They remained tight-lipped silent, hustling past my secretary and out of the office.

  “What did you say to those two?”

  Virginia was as stunned as I was.

  “The truth.”

  Two weeks later I learned from one of their friends that the couple was very upset at me for claiming that Mrs. Delauncy was not pregnant. As the messenger of that information had put it, I was—in their eyes—the “tool of the devil and the spawn of Satan” for even suggesting such a terrible thing.

  “Way to go, Galen. I’ve been telling everyone that you’re a bit strange.”

  Jeff Schulman was both a knowledgeable and empathetic OB/GYN with my patients, so I bounced the situation off his brain cells in the hospital cafeteria a few days later.

  “Be careful, Jeff. If the Delauncys are right, just think what the tool of the devil and the spawn of Satan can do to you.”

  “Yeah, you can talk me to death.”

  We laughed and finished our sandwiches.

  By the time a whole month had gone by I had put the episode out of my mind. At that point in my life I had come to realize that I couldn’t please everyone. I only hoped that the couple had found someone else who could satisfy their needs.

  As I tried to catch up on some paperwork, Virginia yelled from the reception room, “Dr. Schulman’s on the phone.”

  “Bob, guess who I just got called to see in the emergency room?”

  Jeff had been summoned by the ER physician to see a patient suffering severe hemorrhaging from her uterus. He had to perform emergency surgery to remove a sixteen-pound fibroid that had outgrown its blood supply and torn a blood vessel.

  “Wow, sixteen pounds! That’s big,” I exclaimed.

  “Yeah, and she still doesn’t believe it.”

  Uh-oh! Now I knew why he was calling.

  “Jeff, are we talking about…?”

  “You got it.”

  Poor woman, I thought. Now she knows for sure. I felt sorry for her and her husband—until Jeff added, “And let me tell you, the Delauncys are really pissed off at you.”

  “Me?”

  “Strangest damned thing, Galen, the two of them kept repeating your name. I heard the wife say you were the tool of the devil and the spawn of Satan, and that you had changed her baby into a fibroid.”

  I hung up, as Jeff was laughing his head off.

  I sat at my desk and stared at the wall.

  Maybe you were right, J.G.

  I picked up the phone and dialed information.

  Three minutes later I heard the old man’s voice.

  “Traywick, this is Galen. Put me down for…”

  Higher education does not convey common sense.

  Dealing with the human condition does.

  .25 Caliber

  “Doc, the condom broke.”

  I answered the phone on the first ring and stared, near-sightedly, at the glowing dial on the clock radio at my bedside: 2:30 a.m.

  One of the blessings of being the son of Antonio Gallini is the automatic on-switch I inherited from Papa. He never needed an alarm clock to awaken at any desired hour of the night. Besides, we couldn’t afford one.

  “Yes, Chet, and…?”

  Another genetic characteristic gave me immediate voice recognition.

  “Katie’s pregnant, Doc.”

  I admit I was stunned.

  “Doc, did you hear what I said? Katie’s pregnant.”

  “Well … congratulations, Daddy.”

  Chet Kamtow was one of my young patients. I had followed his development from a scrawny, withdrawn kid into a smart and savvy young man, someone who was embarking on the same path that had enticed me. He would be heading off to medical school in a few months.

  It was my privilege to be his sounding board, a sympathetic ear sharing the milestones—joyful and awful alike—of Chet’s life. One of the mixed blessings of knowing and following patients over decades was that they often told me first about their college and career hopes, and the rollercoaster maelstrom of their love lives.

  So it was with Chet. When he fell head-over-heels in love with Katherine Howard, my phone would ring at many an odd hour, whereupon the young man would relate his attempts to cope with the emotional flood of the mating ritual. And now that ritual appeared to have reached a crescendo.

  “Doc, she’s amazing. She’s … uh … she’s got it all. You know what I mean?”

  Why do the young always assume they are the first to experience love?

  “We’re gonna get married on Monday!”

  Fair enough. Chet had always been a standup kind of kid, very focused, with a strong sense of responsibility for his actions. Besides, he and Katherine were totally in love, and it would have happened sooner or later.

  We exchanged a few more words, and then I hung up. As I attempted to go back to sleep, I stared up at the shelf opposite my bed. On it sat a stuffed toy dog and a few other tangible memories of my past. I wondered what my own present and future would have been, had the Fates not intervened.

  Once more the phone rang. It was 3:15 a.m.

  “Dr. Galen, this is Sergeant Bachlick of the Fairfax County Police Department. Is Justin Mowbrey your patient?”

  Yes, he was—another promising young man.

  “What happened?”

  My skin started to crawl.

  “He shot himself.”

  “Is he…?”

  I waited an eternal second for the response.

  “No, we’ve got him here in the ER. Shot himself in the shoulder.”

  “I’ll be right over.”

  Medical school trains you to do things at warp speed: eating, dressing, and all the little personal tasks in which normal humans like to luxuriate, such as hot showers.

  Only military people do it faster.

  I was out the door at 3:25.

  I drove in the predawn darkness, car headlights bouncing up and down with each road rut and turn. The racing engine played background to my racing thoughts.

  Justin Mowbrey. Not quite nineteen. College freshman.

  He was relatively new to my practice. A brilliant kid with an underlying sadness that I couldn’t fathom, he seemed to have everything going for him: brains, good looks, athletic build, and a quick wit that could put the late Johnny Carson to shame. I had no doubt he would succumb to the dark side and become a lawyer.

  What worried me was the emotional monkey on his back—hidden, yet coloring everything he did.

  I pulled into the medical staff’s parking lot and pushed open the ER doors. My ID badge and my face got me a wave-through from the guard, who threw in a friendly, “Hi, Doc.”

  I didn’t have to ask where to go. The trauma team had crowded into Bay 3. I stayed clear until an opening appeared, and then I stuck my face in.

  Justin lay naked on the gurney, IVs inserted into his left forearm, an intracath in his left neck. His veins were swallowing bags of blood. The front of his right shoulder was hamburger.

  “He yours?”

  Jake Turner, the trauma-team captain, turned toward me, his scrubs blood-soaked.

  “Yeah, what happened?”

  “Shot himself. Cops say a campus security camera
picked up the whole thing.”

  “Suicide attempt?”

  “Nah, don’t think so. That’s the weird thing. It’s something else—don’t ask me. I ain’t a shrink.”

  “What’d he use?”

  I stared at the shoulder. The entry wound was in the front surrounded by powder burns and large hematomas (blood bruises). It looked like a small-caliber, low-velocity bullet. It should have resulted in a puncture wound, but the nearby tissue was shredded. Hollow point?

  “Cops found a .25 caliber.”

  A pocket or purse gun, easily concealed.

  “Soon as we get him stabilized we’ll do an arthrogram. I have a hunch there’s some nerve damage. There’s no exit wound.”

  He was right. The x-rays showed the small bullet, definitely a hollow-point, still lodged inside. Designed to bring down large game animals, the projectile contained a hollowed-out shape at its point, which caused it to deform rapidly once inside its target—it was designed to cause maximum damage.

  The bullet was too near the main nerve cable of the shoulder, the brachial plexus, to remove safely at this point. All the surgical team could do was patch things up and see how much harm had been done.

  They cleaned Justin’s wound and bandaged it. The orderly was preparing to wheel him out of the ER, when his morphine-clouded eyes opened.

  “Hey … Doc … thanks … for … com…”

  The morphine put him out again.

  “No sense hanging around, Galen,” Jake said. “We’ll know better in a couple of hours. I’ll call you.”

  I nodded and turned away.

  “Oh, hey, Galen.”

  “Yeah, Jake?”

  “Funny thing. The kid didn’t ask for his parents. He wanted you here.”

  I returned home around 5 a.m., normally the time for my early morning walk, but I had already exercised enough with the hospital visit. So I lay down, alone. Cathy had been taken from me two years before. I no longer could hear her comforting, “Wanna tell me about it?”

  I closed my eyes and dozed off.

  “Galen, GS, incoming.”

  In my slumber I returned to my days as a senior med student doing an elective in the surgical ER. My resident was one helluva doctor, and even though he worked my rump off, he was a teaching machine.

  I washed the sweat off my face, sterilized my hands, and gloved up. Gunshot wounds are messy.

  Very soon we heard the siren and the ambulance screeching to a halt in the turnaround. Doors slammed, and the techs rushed the cart in. The sheets covering the patient were solidly saturated with blood.

  The nurses huddled around the resident, who pulled the sheet back. Everything was blood. A hole the size of my fist took the place of what should have been the woman’s left breast.

  Then I saw the victim’s face, and a bolt of stomach acid shot up my esophagus.

  “God, no! It’s Carol!”

  I almost threw up before turning away.

  She was past any help. A .45 caliber bullet to the chest directly over the heart at close range doesn’t leave much to work with.

  The resident approached and sat me down.

  “You knew her?”

  “A classmate.”

  In freshman year Carol was the nervous girl at our anatomy table. I remembered hearing her unique, musical laugh.

  What the hell had happened?

  June, Connie, and Peggy told me and Dave later.

  Carol had arrived home that evening to find her husband entangled with another woman in their bed. It wasn’t the first time. She took his revolver from the bedroom dresser drawer and aimed it at the couple, then turned it around, placed it against her breast, smiled—and pulled the trigger.

  I awoke. It was 6:30 a.m.

  My schedule was full that day, so I didn’t have time to think. That was good.

  My last patient left at seven that evening.

  I drove to the hospital and climbed the stairs to the surgical-recovery suite. As usual, it was full.

  Justin lay propped up in his bed, head turned to the left, staring at the wall.

  “Wouldn’t it have been easier to go bungee jumping?”

  His head turned toward me, and his pain-med-dulled eyes tried to focus.

  “I can’t … move … my … right … arm … Doc.”

  I pulled over a chair and sat down.

  “Feel like talking?”

  “No.”

  “Your parents here?”

  “No.”

  “You want me to call them?”

  He shook his head.

  “Okay, let me check your chart. I’ll be right back. Don’t go away.”

  That one actually got half a smile.

  The surgery notes said it all: severe nerve and muscle damage. Justin wouldn’t be able to use his right hand. Maybe, just maybe, later on he could undergo a procedure that would relocate muscle tendons to replace the damaged ones. That might give him some return of function.

  I returned to his bedside and sat down again.

  He watched me, looking for clues.

  “Sure you don’t wanna talk about it?”

  “I wasn’t trying to kill myself, Doc.”

  The pain meds had begun to wear off. I could see him wincing, and his speech was clearer now.

  “Well, are you taking a skeet-shooting course?”

  “Jesus, Doc, don’t you get it?”

  Suddenly it hit me. I saw the marks on his good arm and forearm. No, not needle marks like the druggies have. These were cuttings. Justin’s shooting was an extreme form of cutting.

  “Justin, why do you think you have a karmic debt?”

  His eyes widened.

  “You do understand!”

  Then the floodgates opened. Justin told me about his parents, how his father had divorced his mother and left her and the children semi-destitute. The young boy faced taunts from classmates, because of his small stature and his mother’s lack of money. Sometimes he heard her crying and, to his child’s mind, it could only be because he was to blame for his father leaving.

  He remained a short, thin kid through middle school—so thin that his teachers often suspected he was being abused at home. When he attempted to bulk up by going to the local gym, his self-improvement efforts led to his being raped by one of the gym’s male employees.

  Eventually he reached the conclusion that he was responsible for what had happened to him. In his mind, everything bad was his fault.

  “Doc, I thought about it a lot. Still do. That day I sat on a bench near the school parking lot. Can you believe it? I talked to myself. I actually had an effing conversation—me to me.”

  “What did you say to yourself?”

  He stared at me, decided I wasn’t making fun of him, cleared his throat, and reenacted the scene.

  “It’s go time. Has been for a while, I s’pose.”

  You sure as hell got that right, big guy.

  “Yeah, no shit. You ever wonder how we got this far? I can’t even tell you how many times I’ve begged God to smack the crap out of me. Seriously, it’s a great way to feel amped.”

  I looked at the young man who saw himself a despicable, ugly little boy instead of the six-foot-tall, brilliant Adonis he had grown into. Edward Arlington Robinson’s poem, “Richard Cory” crossed my mind.

  So on we worked, and waited for the light,

  And went without the meat, and cursed the bread;

  And Richard Cory, one calm summer night,

  Went home and put a bullet through his head.

  No, that wasn’t right. This was not depression. This was, to Justin’s mind, karmic payback, retribution against that bad little boy who had caused so much trouble. Why else would he have been raped at the dawn of his manhood?

  “You wanna hear more, Doc?”

  “Yes.”

  Again he stared at me, daring me to display disdain, daring me to make fun of him. He took another breath and continued the dialogue with himself.

  “God doe
sn’t care what I do when I’m alive. He cares who I am when I die.”

  Well, hah, hah, hah, I guess we know why we’re here. There isn’t a soul alive who can make you pay for what you’ve done. And since you can’t fix it, God doesn’t care, and no one else except for me would dare risk their soul to expunge your record, this is the option. We’ve been over this.

  “I know it. I do. But what if … what if it kills me? Can’t we do it in my hand? What about my foot? Why can’t I just apologize? Why can’t I just tell people I’m sorry? They’ll forgive me.”

  You’ve been so wayward for so long, apologies aren’t enough.

  “But I don’t want to die. I love this life. Please, I don’t want to die! Please! Please!”

  Stop your whining! If I wanted you to die, I’d pump one into your brain. The shoulder’s perfect. Nothing too significant’s in there, as long as I avoid the artery. So let’s place the shot … here. You dig?

  He pointed right at where the bullet had entered.

  “We’re really doing this, aren’t we?”

  Yessiree, I’m serious as sin.

  He turned to me.

  “Doc, it took me about five minutes more, me talking to me. Then I took the gun out of my pocket, removed the clip, checked the action, and otherwise inspected my equalizer: Beretta Tomcat .25 caliber pistol. Like holding a god right in my hand!”

  His lips trembled. He shrugged his good shoulder and sucked his breath in.

  “I deliberately pulled back the slide. Few men will ever know how heavy a gun can seem, when you know with one-hundred-percent certainty that the next time you pull the trigger you will hit your target.

  “It made a ghastly KACHENK! when it rammed the round halfway home. I figured to shoot him/me at point blank range. It would decrease the probability of hitting something vital.

  “Jesus, Mother Mary, I was wrong—very, very wrong—about the vitality of the shoulder. My hand did not shake, my resolve did not quiver. I summed up all of my disgust for his/my karmic debt, and I pulled the trigger.”

  I tried to stop him.

  “Justin, you don’t need to continue this.”

  “Dammit, Doc, lemme finish! Or do you want me to say twelve Hail Marys and an Act of Contrition instead?”