First, Do No Harm

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First, Do No Harm Page 3

by Larry Karp


  My father didn’t say a word, just stared. When the man began to shuffle in place, Samuel started talking. “Few things, Jack. I need a pediatric sedative, phenobarb elixir. A tonic, yeast, B-C vitamins, iron. Cod-liver oil. Oh, and roller gauze. Ten packs.” He nodded toward Jack’s black woolly chest. “Don’t get any hair in the medicines.”

  Jack stomped off behind the counter, muttering. He pulled bottles from shelves, measured, mixed solutions through funnels into small brown bottles, all very meticulous. That impressed me. Never mind his nasty talk, no matter how he really felt, if he had to do that job he was going to do it right. Samuel strolled through the pharmacy, aisle by aisle, hands behind his back. Finally Jack waddled up to him, a bag full of bottles in one arm, bag of gauze rolls in the other. “Be six eighty-five, Samuel.”

  “That’s with the doctor discount?”

  Samuel’s voice was calm and level, not so Jack’s. “Doctor discount?” the fat man bellowed. “Shit, Samuel, this isn’t for your own use. Or your family’s.”

  “That sick baby with no watermelon is my nephew,” Samuel said, and now there was an edge to his voice that put me on ready alert. “You can extend my courtesy that far, considering…”

  “Aw right, aw right.” Jack waved a hand of surrender back and forth in front of Samuel’s face, then stormed to the cash register and rang up five dollars and forty-eight cents. “Christ Almighty,” he grumbled. “Get waked up middle of the night to lose money.”

  “When you start with a sixty percent markup you don’t lose by giving twenty,” Samuel said. “If your brain were half as smart as your mouth, you’d say thank you and mean it.”

  Jack gave Samuel a sour look with his change. Samuel tipped his hat as we left. I felt like the invisible boy—all the time we were inside no one said a word to me. I wondered what Samuel meant for Jack to consider, but didn’t dare ask.

  As we pulled away from the curb Samuel said, “She’s going to have to keep that shoulder immobilized a while.” “She,” I noticed, not “They.” “Kids heal faster than adults, but if he moves his arm before the ligament’s had a chance to grow together, his shoulder’ll come apart again. And a kid like that needs tonics and vitamins because he doesn’t get anything like proper food.”

  Back at Lou and Lena’s, the little boy didn’t even whimper while Samuel and I wrapped his chest and arm into a sling. As we put him into bed, Samuel’s hand slid under the dirty pillow, a fast out-and-back like a lizard’s tongue. Lena looked at the bottles and gauze, then at Lou. She worked a button at the top of her nightgown. Finally she said, “Doc, how much’s all this gonna—”

  “Part of the call,” Samuel said. “I’ll put it on the tab.” He pointed to the bottles of tonics. “Teaspoon of each with breakfast and supper every day. And he can’t move his shoulder at all for a couple of weeks. Don’t take off that gauze, not for anything. Bring him to my office in the morning, ten o’clock. We’ll see how he’s doing, take a couple of X-rays. Write it down if you have to, Lena, because if you aren’t there—”

  Lou, all this time slumped against the far wall like a prisoner waiting for sentence to be passed, suddenly went stiff. Lena jumped forward. “I’ll be there, Doc.”

  The two of them nodded like Oriental windup toys. Samuel smiled. “Good.”

  “I’ll be there,” Lena repeated. “And I promise I’ll give him his medicines, just exactly like you said. I won’t let him out of my sight, not for a minute.”

  Lou came forward, grabbed Samuel’s hand. “Hey Doc, thanks. You’re the only—”

  He was going to say my father was the only doctor who’d come Down-river at one in the morning to see an injured kid with stone-broke parents. Who’d not only come, but would make sure the kid had all the medicines he needed. Who’d know the parents had caused the disaster but would treat the kid anyway, and not call the cops. Samuel cut him off with a handshake and a quick pat on the arm.

  Right then the wall phone in the kitchen rang. Lena picked off the receiver, listened, then held it out toward Samuel. “For you, Doc.”

  Samuel said hello, then, “Go ahead, I’m listening.” Could’ve been anything from a stroke to the sniffles, no clue from my father’s face. After about a half-minute, he said, “They think it looks like a heart attack? Call them back, Ramona, tell them I’ll be right over.”

  “Another patient.” Lena’s tone suggested she herself was being put upon. Samuel smiled as he gave her back the phone.

  We were away from the curb, flying up River Street, before I’d slammed my door. I shouted above the wind whipping through the open car windows, “What’d you do right before we left? Your hand, under the pillow?”

  Quick glance sideways, little smile. “You don’t miss much, good. Five-dollar bill. Lena’ll find it soon as she goes to look after the boy. Maybe she’ll buy a little decent food.”

  “You don’t think she and Lou’ll just spend it on liquor?”

  Street lamps made a strobe show of Samuel’s widening smile. “No, I don’t. At least until that kid’s shoulder is healed, every time the two of them turn around they’re going to see my face. And Leo… Sometimes it won’t be their imagination.”

  Chapter 2

  Dad stopped talking as the waiter set plates in front of us. The young man looked at Dad’s empty glass. “Another drink, sir?”

  “Yes.”

  Heavy grease for vocal cords. Dad watched the waiter walk away, then snapped off nearly a quarter of the sandwich, chewed, spoke between bites.

  Where was I…oh yeah. My shoulder whacked against the car door as Samuel peeled a hard right onto Fifth. Cross streets flew by. At Twenty-second, he turned left, braked with a squeal, pulled up in front of a small house behind a chain-link fence. I reached for the door handle.

  “Wait in the car, Leo. Be back in a few minutes.”

  “Wait in the car?” I didn’t stop to think, just fired two barrels of teenage guff into my father’s face. “That’s the way you’re going to show me what it is to be a doctor? By making me sit in a car at two in the morning?”

  Samuel moved his head so the brim of his Panama shaded his eyes. Once, when I was five, he took me to the circus; we watched a juggler throw one ball into the air, then two, three, four, five, six, seven. That man was keeping seven balls going, and all the while the crowd cheered, my father just muttered, “Go for eight. Go for eight.”

  “You said where you went I’d go,” I barked. “What’s in that house you don’t want me to see?”

  Samuel’s smile said both “You win,” and “You asked for it.” He nodded. “Come on.”

  I grabbed his black bag and trotted after him. He was already at the gate, pushing it open. We walked along a concrete path, then up six swaybacked wooden steps. The porch sagged inward and to the right, where three windows were set into a tricornered bay, cheap white lacy curtains behind them. To the left of the bay, the front door, open behind a battered screen panel. Samuel rang the bell, called out, “Murray? Lily?”

  The waiter put Dad’s second Manhattan on the table next to his plate. Without looking away, Dad grabbed the glass, gulped a swallow.

  A light went on over our heads. A few seconds later, a barrel of a man in an undershirt and a pair of grimy work pants lumbered to the door. “Samuel, jeez, what took you so—” He stopped cold when he saw me, then stared at my father. Not quite the reception I’d gotten from Lou.

  “It’s all right, Murray.” Samuel sounded as if he were soothing a kid awakening from a nightmare. “Leo’s working with me this summer, wants to see what doctor-business is really like. We were on a call Down-river, sick little boy. Ramona caught up with me there.”

  I thought my father’s voice changed just a bit on the last two sentences. Little more emphasis on each word, little more time between words? Murray’s eyes told me nothing. He opened the screen door. “Murray Fleischmann, my son Leo,” Samuel said. “Murray and his father and brother run Fleisch
mann Scrap, up Fifth at Wait Street.”

  Like shaking with a ham. My hand vanished. Murray was a round, bulky man with thick, hairy arms and the neck of an ox. Not someone to ever take lightly. He released my hand; I rubbed my tingling fingers. Then he pointed at the wall to his left. “In the living room, Samuel.” Voice like a file on hard wood. “Lily’s in there with him.”

  We followed Murray through an archway into the room behind the angled bay. Furniture straight from the junkyard. Old ugly overstuffed chairs, a sagging couch, nothing matched. At the middle of the floor, a woman stood wringing her hands over a man who was lying on his side, twisted, body bent like a Hallowe’en cat. Relief spread across the woman’s face when she saw Samuel, but as she noticed me her eyes widened and her hand flew up to cover her mouth.

  At the sight of the man’s face I dropped Samuel’s bag. A wide-eyed corpse grinning like a diabolical spirit makes an impression on a sixteen-year-old boy. “He’s…dead?” I blurted, then felt ridiculous.

  Samuel crouched over the body, took the man’s right wrist between thumb and forefinger, dropped it, then looked up at Murray and the woman. “Lily, this is my son, Leo,” Samuel said, just as matter-of-factly as he’d told Murray a minute before. “He came along on a call Down-river. First time for him, seeing a dead person.” He looked me up and down, smiled. “At least as far as I know.”

  I nodded. Everyone in that room knew the man on the floor was dead, but only Samuel could pronounce death. I couldn’t pronounce anything, just extended a shaky hand toward Lily.

  Boiling summer night or not, Lily’s hand was icy. She was tall, slender as Murray was round, with features as delicate as his were coarse. She wore a light blue summer bathrobe, obviously nothing underneath. Shining black hair, dark eyes, eyebrows plucked. I heard my mother’s voice, “A cheap woman.”

  Samuel straightened, which drew my attention back to the man on the floor. Eyes bulging, skin bluish, purple lips twisted into an expression of anguish nearly a laugh. A froth of saliva ran from the lower corner of his mouth. Dead, but he looked still in agony. “What happened?” Samuel asked.

  Murray looked at Lily. She returned the look. “Tell him.”

  “No, you tell him.”

  “No, you.”

  “Aw right,” Murray growled, then pointed at Lily. “She was upstairs sleeping, which I couldn’t do—too goddamn hot and humid. I was sitting down here, looking at the paper.” He pointed toward a brown leather chair in the far corner, next to a cardboard-shaded floor lamp; pages of newspaper lay scattered in front of the chair. ALLIED AIR FORCES BLAST RUHR. “I hear someone on the steps outside and think to myself, what, past one in the morning, who’s coming? Screen door opens, then I hear a shuffly noise. I’m up on my feet, going through the room, when something goes thump in the front hallway. I run on in and there’s Jonas, down on the floor, holding his chest, groaning something terrible. ‘Murray, help me, I can’t breathe.’”

  The big man snorted, covered his eyes. His shoulders heaved. Lily put a hand on his arm. He cried harder. “Christ, Samuel.” Murray pulled a crumpled handkerchief out of his pocket, swiped his face, then extended both arms, a silent plea for help. “There’s my brother on the floor, he can’t breathe, terrible pain in his chest. I tell him don’t worry, I’ll get you comfortable and call Samuel Firestone. So I lift him up, walk him into the living room, I’m gonna put him on the couch. But all of a sudden he falls down, right where he is now.”

  “Murray hollered, woke me up. I ran down, thought maybe we should try giving him mouth-to-mouth…” Lily’s small voice petered out. She looked about to cry too.

  “It wouldn’t have mattered,” Samuel said. “He was probably dead before he hit the floor, massive heart attack. Nothing would’ve brought him back. Last time I checked him, couple of weeks ago—” Samuel stopped just long enough to take in Murray’s and Lily’s astonished faces. “You didn’t know? He didn’t say anything to you?”

  “About?” Murray looked at sea.

  “His heart condition.”

  Murray and Lily gawked at each other, dumb-struck twins.

  “He was in the office once or twice a week the past few months,” Samuel said. “Shortness of breath, chest pain. I put him on medication, nitro and digitalis, told him to take things a little easier, cut down on cigarettes—”

  “Cut down on…?” Murray wailed. “Guy smoked two packs a day since forever. And he didn’t let up at work, never for a second. Always schlepping that heavy crap around the yard. If I’d’a known, I wouldn’a ever let him—”

  “Like you could’ve stopped him.” Lily patted Murray’s hand. “What your brother wanted to do, he did. He only knew one way to live.”

  “And now he’s dead. Thirty-six years old.”

  Samuel took Murray by the shoulders, propelled him into the hall. “Go in the kitchen with Lily, drink a cup of tea. Your family have a preference in funeral homes?”

  Another silent exchange between Murray and Lily. Lot of lines to read between in this house. Finally, Lily said, “Most of the Jewish families around here use Rappaport.”

  “No family besides you and Oscar?”

  Murray shook his head. “Nope. Just me an’ Pop.”

  “Jonas never got married, did he?”

  Murray chuckled. “No way. Jonas loved the ladies all right, but never the same one for long enough to get any knots tied.”

  “Okay, I’ll take it from here. Go on, both of you, get a load off your feet. I’ll call Rappaport.”

  Samuel dialed, talked, hung up the phone. “They’ll be here in a few minutes to pick up the body,” he said to me. “I’ll sign the death certificate, and that should do it.”

  I’d been staring at the dead man on the floor. “Samuel, how did you diagnose a massive heart attack?”

  He smiled, then pointed at the body as if it were an exhibit in a grand museum of death where he was curator. “Medical history of a man with severe coronary artery disease who won’t admit to it, won’t slow down. A bomb waiting to go off. Tonight it went. Murray said Jonas clutched his chest, complained of severe pain. The pain of a heart deprived of blood is terrible. You cut off blood to the heart, the heart can’t pump nearly as well, so less and less oxygen gets circulated to the body. Skin goes from pink to blue, patient dies.”

  “Why couldn’t it have been a stroke?”

  “With chest pain? A stroke, he’d have grabbed his head, complained of headache.”

  “How about a…what do you call it? When the aorta blows out in the chest?”

  “Aneurysm?”

  “That’s it.”

  He clapped my shoulder. “Good thinking, Leo. Symptoms might be similar with an aneurysm, but that’s where probabilities come in. If you’re out in the street and hear hoofbeats, more likely you’ll see a horse than a zebra. Aortic aneurysm blowouts are very rare, but severe heart attacks happen every day. On top of that, Jonas was a hard worker and a heavy smoker. All adds up.”

  “But you still can’t tell for sure without an autopsy,” I said.

  Samuel shrugged dismissal. “Seems clear to me Jonas had heart disease, but all right—just for a minute, suppose I’m wrong. Let’s say he did rupture an aneurysm. Think, Leo. Would that matter to Murray and Lily? Or Pop Fleischmann? What’d be the point of doing an autopsy? Why should we inflict more pain on the family, never mind the cost?”

  Samuel never scored intimidation points in arguments, didn’t have to. He nailed you on reason. Still, I wasn’t satisfied. I stared at the body. Jonas Fleischmann’s eyes stared back at me. I knelt beside him, brought myself by short degrees to touch his hand. Warm. But when I lifted it, his entire upper body came along. Like moving a deformed wooden statue.

  “Rigor mortis,” Samuel said from behind me. “After death, muscle proteins coagulate, make the body stiff. Lasts several hours.”

  “It must come on pretty fast.”

  Samuel nodded agreement. “
Yes.”

  “All right.” Then I asked if he knew where the bathroom was. He looked me up and down. “You’re…”

  “I’m fine,” I said, trying to sound manful. “Just have to pee.”

  Samuel led me out of the living room into the hall, past a flight of stairs, into the kitchen. Lily and Murray, each with a teacup, sat at a small white table in front of a stove. Samuel pointed to a doorway at the back of the room. As I walked off, Samuel said, “Murray, did you call Oscar?”

  Murray looked like a sixth grader who forgot the big assignment ’til teacher called for the papers. “I wasn’t sure if I oughta wake him up to tell him a thing like that.”

  I wanted to hear more, but was already at the bathroom. Inside, I pressed my ear to the wooden panel, no good. Voices, but I couldn’t make out words. Finally I did what I went in there to do. When I came out, Murray, Lily and Samuel were on their way into the hall. I ran after them. They let in the Rappaport Funeral Home attendants, led them into the living room. While Samuel filled out the death certificate, the two attendants worked Jonas Fleischmann’s body into a canvas bag. Samuel wrote quickly. Cause of death, massive coronary thrombosis. Underlying conditions, severe arteriosclerotic coronary artery disease. Then he signed his name, and we all followed the attendants outside, to the open rear of the hearse. The two men slung the bag, thud, then slammed the door, hustled up front, got in, drove off. Samuel saw the expression on my face. “All in a night’s work for them,” he said. “Too easy to get used to some things we never should take for granted.”

  Lily walked over, rested both hands on my father’s forearms. “Samuel, thank you. I just don’t know what we’d’ve done—”

  “My job,” he said casually. “Sorry, Lily.” He took Murray’s hand. The big man looked ill at ease. “Hey, Samuel, you’re sure you don’t mind…I mean about telling Pop? What with the way him and you—”

  “No sweat,” Samuel said, sharply I thought. “We’ll stop on our way home.”

  As Samuel started the Plymouth, he looked my way. “Tough for a parent to lose a child, tough for another child to break the news. Murray couldn’t bring himself to tell his father, so I’ll do it.” Samuel hung a quick midstreet U, then drove to Fifth and turned left.

 

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