Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  As I said, I lie easily.

  “But all my friends are…”

  I cut him short.

  “They’re all following their parents’ genetic blueprints.

  “What’s a blueprint?”

  “It’s like programming.”

  He understood that one.

  “I have a feeling you’re going to start growing a lot this year.”

  Now I wasn’t lying. We determine the pubertal (physical and sexual) development of kids with a descriptive scale called Tanner Stages. Physically, Nate’s body was leaving the pre-adolescent Stage 0 and was showing some of the changes expected for Stage 1. Once that starts, it’s Katy, bar the door. Your nice quiet kid becomes a surly, mall-stalking nocturnal monster.

  The rest of my examination confirmed that suspicion. Nate was right on the verge of joining the human race.

  I noticed something else about him. As he was being examined, he asked a lot of questions:

  “Why do you shine that light at my eyes?”

  “What do you hear in my chest?”

  He wanted to know about the gadgets I used and the maneuvers I put him through. He wanted to hold the toys I played with—to try them out, to know what they did.

  After I finished, he got dressed and I looked him in the eye.

  “Nate, you’re normal.”

  I sat down with his parents and went over my findings. Then I turned to Nate and gave him my usual, sympathetic advice:

  “Kwitcherbellyachin’, kid. Things are gonna get better.”

  The three smiled, as they left the office.

  Two years later I was looking up at a six-foot-two-inch, one-hundred-fifty pound teenager, complete with zits and raging hormones.

  Nate had revealed an aptitude for science. It was not unusual to find him sitting in my waiting room after school with a list of questions about chemistry, biology—and girls. He also hung around and, if I had something interesting going on, he would ask me and the patient if he could sit in on the examination.

  Corrado, my mentor, I think we’ve got another disciple of Aesclepius.

  By the time he graduated from high school, I knew what Nate’s career goal would be. I was the first to learn of his intent to take science majors in college and then try out for a place in medical school.

  Life wasn’t easy for that tall young man. His face still looked dorky, he was awkward at socialization, and coeds remained an arcane mystery—but classes were a breeze.

  The same year his braces finally came off, I suggested contact lenses. It helped make him look less geeky. Then, after much verbal struggle, he finally got rid of the suspenders and wore a belt. The only thing I couldn’t persuade him to do was to have cosmetic surgery for his beak nose.

  So, what finally got the girls to notice him without laughing?

  It turned out Nate was an artist. Give him a piece of wood and, as Michelangelo once said, he would release the sculpture within. Watercolors, oils, and acrylics were an outlet to his mind’s eye. Give him a part, a brief image, and he could envision the whole.

  And when he lacked the right tools, he would invent new ones.

  “Doc, I got accepted!”

  It was March of his senior year at university. He had done well academically and, like puberty, got a late start on dating. Better late than never.

  Now Nate was ready to take on med school.

  He would call me late at night on a weekly—sometimes daily—basis.

  “We named our cadaver George.”

  And…

  “They had this one specimen in pathology that…”

  And…

  “I start on the wards tomorrow.”

  And…

  “Doc, my patient died…”

  And finally…

  “You should have seen the case I had to work up today, Doc. Bet you can’t guess what the diagnosis is!”

  He launched into a long description of a young woman with unusual abdominal pain in the middle of her second trimester (fourth to sixth months) of her pregnancy.

  I hated to do it, really I did.

  “Nate, she’s got an atypical presentation of appendicitis.”

  “Damn, how’d you do that, Doc?”

  “Elementary, my dear Watson.”

  Heh, heh, I lied again—I really enjoyed doing that!

  I attended Nate’s graduation. He actually looked good in his doctoral gown and green-and-gold hood. As he walked up on stage, I remembered another class, another time, when my friends and I did the same.

  He grinned at me, as he walked by me in the recessional. And when he passed, he gave me a thumbs-up.

  “Well, Nate, still think you’re a dork?”

  We were standing outside the auditorium. A girl stood next to him. She looked up at his hatchet face.

  “What’s a dork, Nate?”

  He blushed.

  I took a piece of paper and printed out:

  DORK

  I shook his hand.

  “Congratulations, Dr. Criswell.”

  The Garden

  “You’ve got a good-looking colon, Dr. Galen.”

  I would have preferred, “hey, good lookin’,” but I had just awakened from the anesthesia used for my routine colonoscopy, so I took the comment as a compliment.

  I lay there dressed in a gown, hat, and support stockings, an outfit that made me the spitting image of J. Edgar Hoover, pre-drag.

  I stared up at the young nurse who was removing the IV needle from my hand and belched out a “thanks.”

  They do use a helluva lot of air in a colonoscopy.

  Please, no jokes.

  Getting dressed restored a modicum of my dignity, but it promptly disappeared, as they required me to sit in a wheelchair and be pushed out to the car, where my designated driver waited to take me home.

  It was a short ride back, but I remained silent. Even a normal colonoscopy was nothing to sneeze at, especially at my age. Yet it was always something to be desired. Why couldn’t that have been “St. Nick’s” diagnosis?

  Charlie Willard. Santa Claus.

  It was one of those mid-spring Sundays in northern Virginia, when the weather was faultless. A Mediterranean-blue sky lit by a golden sun rested lightly on the natural air conditioning provided by a light breeze. Dressed in my old scrub shirt and pants, I was trying to hand-turn an eight-by-eight-foot section of clay and rock out in the yard. I had hoped to grow tomatoes. It was my first real home—a little house with grassy yard—and I actually believed the plant catalogue pictures of bountiful harvests with little or no work involved.

  Uh-huh. The blisters rising on my palms belied that prospect.

  I didn’t hear the car pull in behind me, but I did hear a deep voice bellow, “My wife just cut her finger fixing dinner, Doc. Can you sew it up?”

  My face was covered with sweat and grime, when I turned to see the living personification of Thomas Nast’s Santa Claus protectively holding his wife’s hand like a pet dog’s injured paw. I didn’t say a word—I felt a little ticked off at being disturbed in my garden reverie. So, I just nodded my head, waved my arm in a “follow-me” motion, and headed inside.

  I carefully scrubbed the dirt off my hands, cleansed and prepared the woman’s skin, and proceeded to numb up and suture the wound.

  Each and every time I attended to this basic medical chore, my mind brought me back to that first equivalent of a house call, when I cut my proverbial medical teeth as a kid by sewing up a wounded gang member, a feat that had earned me the nickname Dottore Berto.

  While I sat there gloved and masked, Santa introduced himself.

  “Doc, I’m Charlie Willard. This is my wife, Sarah. We saw your sign go up a few months ago, and since we live just down the street from you … oh, hell, I didn’t want my Sarah to have to sit in some damned emergency room!”

  I laughed through the mask.

  “Yeah, I can understand that, Mr. Willard. I’ve been the guy in the ER having to see folks like you in betwee
n auto accidents and other goodies.”

  His deep laugh only needed a “ho-ho-ho” to complete the picture.

  Sarah Willard, sitting across from me, with her arm lying on the exam table, added just the right touch.

  “Oh, hush up, Charlie. He’s just a big baby, Dr. Galen. I thought he was going to pass out, when he saw the blood on my finger.”

  The big guy blushed. He shot a look of embarrassment at the round-faced, white-haired woman who had shared his life for three decades. They were truly Mr. and Mrs. Claus in the flesh.

  Charlie had just retired from over thirty years service at an unnamed government agency and lived just a few houses down the street from me. He proudly boasted of his grown children and their accomplishments, and he winked at me knowingly when he mentioned a new generation was on the way.

  I finished suturing and dressing Sarah’s hand and administered a tetanus shot in her left shoulder. As they headed past me toward the door Charlie turned and patted me on the shoulder.

  “Go rest up, Doc. I’ll finish for you.”

  And finish he did! Twenty minutes later he returned, driving a little pickup truck. Shortly thereafter I heard the “brapp-brapp” of a power tiller starting up. Charlie handled it like a bucking bronco, as it broke up the ground’s rock-hard red clay into soft clods.

  His six-foot-two-inch, three-hundred-pound frame hefted a four-foot bale of peat moss and four bags of composted cow manure off the truck’s bed like bags of feathers. He tossed them onto the now-turned ground, bent over, split the bags open with his combination bottle opener/pen knife, and spread them over the patch of earth. Then he drove the bucking-bronco tiller again, until the plant savers were thoroughly mixed into beautiful, dark-brown soil.

  The tomatoes that erupted from my little garden later that summer were the best I had ever tasted.

  Several years passed. Charlie and Sarah became routine visitors to my office. So did their kids, who soon enough had kids of their own. I saw them all. And every spring, like clockwork, Charlie would show up with his tiller and mix more goodies into the soil. My backyard garden produced harvest after harvest, as did Charlie and Sarah’s children.

  Then one morning Charlie dropped by unannounced. I could see his red-faced embarrassment, as he blurted out, “I noticed some blood in the toilet bowl this morning, Doc.”

  I didn’t want to wait until he had done a bowel cleansing. I had him lie down on the examining table, while I pulled out one of those primitive torture devices we used back then: an eighteen-inch, metal proctoscope. Solid chrome steel and totally inflexible, the Silver Stallion, as it was nicknamed, was considered state-of-the-art before the days of fiber optics. Patients dreaded it. They didn’t appreciate the sensation it produced as it threaded its way up their lower intestines.

  I pumped air into the scope to inflate and push the bowel walls away from its tip.

  “Oh, hell.”

  I couldn’t control the expletive, and Charlie Willard heard me.

  “What is it, Doc?”

  The blood-red living devil stared back at me from inside Charlie’s bowel.

  Santa Claus had colon cancer.

  The surgeon did a masterful job removing fourteen inches of Charlie’s colon. He gave me a thumbs-up and a muffled, “We got the bastard out,” from behind his mask then exited the OR.

  We all thought that the tumor had been found early, but the Fates weren’t going to let Charlie Willard off that easy.

  Several months after the surgery, I spotted the insidious enlargement of Charlie’s liver. Despite attempts at chemotherapy, he began the inevitable wasting process of uncontrolled, widespread, metastatic cancer.

  An old man wonders: With the imaging technology and targeted chemotherapy we have available today, would things have gone differently?

  It was late spring of the following year, and I was outside playing in my vegetable patch once more. But Charlie didn’t appear to perform his tilling; the cancer had weakened him too much.

  By then I could turn over the ground by hand without suffering blisters. Charlie’s labors had transformed the soil into loose, moist clods. My shovel easily sank twelve inches into the grave-dark depths, as I prepared holes for the tomato plants.

  Then, out of the corner of my eye I spotted movement. I turned to see Charlie standing there patiently watching me.

  Suddenly I felt puzzled: Charlie had terminal colon cancer. I had seen him at home earlier in the week. He wasn’t doing well. My anger and frustration at not being able to restore this man to health had made me somewhat testy.

  “Charlie, what the hell are you doing out here? It’s too hot for you.”

  His jowly face, thinner now, still broke a grin.

  “Just taking care of some unfinished business, Doc.”

  I settled down.

  “Charlie, do you want me to drive you home?”

  He shook his head.

  “Okay, why don’t you head back, and I’ll stop by after I clean up. Let Sarah know I’ll be coming over.”

  “Okay, Doc.”

  I turned away to drop the last tomato plant into its hole. I turned back and Charlie was gone.

  I finally got all the plants in the way I wanted. Then I washed up, changed into my khaki walking trousers, and headed down the block, my black bag making a pendulum bob of my right hand.

  Charlie’s house was an oyster-white Cape Cod with green shutters framing the windows. I rang the doorbell, and Sarah opened the white-paneled front door. Her ashen face revealed that something was not right.

  I stood there somewhat sheepishly.

  “Hello, Sarah. Charlie stopped by my place earlier, and I told him I’d come by after I finished planting.”

  She stared at me then silently pointed to the stairs leading up to their bedroom.

  I climbed up the eleven steps before entering the tan-carpeted room. A poster-style, king-size bed sat in the middle. The western-sky sun was casting light and shadow through the two windows on the far wall.

  Charlie, in light brown pajamas, lay propped up on pillows. His skin was jaundiced, and his eyes were filmy and sunken. His chest was rising and falling in shallow motions.

  As I approached his bed, his mouth opened, fish-wide, in a futile last gasp. Slowly a stain spread across his pajama pants as his bladder sphincter failed. He died in front of me.

  A tearful voice behind me whispered, “He hasn’t left this room the entire week.”

  I turned and held his widow.

  An Eagle Flew West

  The old farmhouse was gone.

  So, too, were the unpaved, dirt roads and much of the wooded areas in the little enclave just west of Lynchburg.

  Big Dave and Mary were gone, too.

  But I remembered.

  Hey, City Boy, why don’t you just roll around in the cow patties? You’ll get less of it on you than you’re picking up now.

  I heard the familiar, nasal drawl once more, but only in my mind.

  Country Boy was gone.

  The woods were still there, or maybe they were the descendants of the trees and scrub underbrush where Dave and I had walked over forty years before. I could see houses through the leafless branches on that cold November day. The tobacco fields were now five- and ten-acre spreads of enormous homes filled with city folk who had sought the dream of country living. Now their lifestyle polluted the former open spaces.

  I walked through the woods again that day.

  I got lost at first and wandered around until the wind told me, that way, City Boy.

  I entered the little clearing. The peaks and valleys were not as prominent—over four decades of seasonal changes can do that to overturned soil, but two were still fairly fresh. I stood there, eyes closed, head bent, remembering the old folks who had treated me as a second son, who had laughed at my city ways, and then consoled me and taught me what life could offer.

  I felt the chill in my bones. Two-score-plus years can do that, too, but I removed my gloves and reached
into an inner pocket of my heavy, gray-knit coat. The small glass container, given to me by the funeral director in Florida, was still in there, still holding some of the gray-white powder that had once been the man who walked here with me, loved a wife, and raised two children.

  I opened it and held it up to the sky. A gust of wind coursed through the naked trees, and the dust that had once been my friend joined that of his ancestors.

  It was too late to drive back to Northern Virginia. Once I would have done so without hesitation. Now I feared the limitations of mind and body that had been imposed upon me. Truth be told, I no longer enjoyed driving, especially at night, and the November sunlight would soon vanish.

  So I placed the empty vial between the two mounds and cast one final gaze at my past.

  I would never return here.

  I drove down the highway a few miles and spotted a roadside motel. This time of year vacancies were not a problem. The graveled parking lot was empty.

  Minutes later, key in hand, I walked out of the office and down the row of closed doors to my room.

  I wasn’t hungry. I lay down on the little bed and closed my eyes. I felt at ease, so I drifted into slumber.

  But it wouldn’t last long.

  I awoke to a sudden loud scream and a shout.

  “Easy, honey, easy, I’ll call the ambulance. Just hang on!”

  I heard the young man’s panicky voice and the woman’s crescendo moans and her stifled screams penetrating the wall of the room next to mine. They must have checked in after I arrived.

  I got up, smoothed my wrinkled clothes, and grabbed my black bag. I always carried with me on my travels, even in the twilight of my career.

  The door of the next room lay partly open. I raised my hand and knocked. I called through the opening, “May I come in?”

  I saw the young woman lying on the bed, her knees drawn up, her belly a watermelon mound under the sheets. She was pregnant, very pregnant.

  “Are you the doctor?”