Millard Salter's Last Day

by Jacob M. Appel

  “I think no such thing,” Millard said firmly. “You’ve experienced a trauma. This is a perfectly healthy reaction.”

  “I went back to her room,” said Lauren. “I wanted to be helpful . . . .”

  “Whose room?” demanded Millard.

  “Ms. Noguerra’s,” said Pastarnack. “I thought she might want to talk.”

  Millard sensed his entire body tauten, each muscle tugging on its tendons—the human equivalent of a tortoise drawing its limbs under a shell. He knew this feeling well: his flesh braced for grave news that it already recognized, but had not yet been voiced. He would have no choice but to phone Dolores Noguerra’s mother—Isabelle’s dear friend Marta—even if that cut into his time with Delilah. Impending death offered no armor to common decency.

  Lauren Pastarnack slowly composed herself; he patted her on the shoulder.

  “So you went back to see Ms. Noguerra . . . to lend an ear,” suggested Millard, “and you found her dead . . . .”

  Millard saw no reason to mention that the visit transcended conventional medical student protocol. Dolores Noguerra hadn’t been the girl’s patient. Although her efforts were obviously well-intentioned, she really had no business stopping by the sick woman’s room on her own.

  Pastarnack shook her head. “No, I found her sound asleep,” she said. “The suicide minder was dead.” The girl’s voice grew animated, her chest heaving. “I found her sitting in her chair . . . . Her name was Mary Catherine . . . . She wasn’t breathing . . . .”

  A flurry of relief passed through Millard. The suicide minder was a complete stranger to him—one of millions of strangers who died each day.

  “I know what you’re thinking,” said Pastarnack.

  “Do you now?” he interjected. “And what, pray tell, might that be?”

  “You’re wondering how I can possibly become a doctor if I fall to pieces every time someone dies . . . .”

  The poor girl sounded so earnest, so desperate. Soon enough, she’d lose this purity—not all of the students did, but he could sense that Lauren Pastarnack would, on the way to becoming a gifted and compassionate physician. (The rare few that didn’t proved a challenge for medical school administrators. Several years earlier, a third-year student had been expelled for repeatedly visiting oncology patients alone to reassure them that their prognoses weren’t fatal, in spite of the morbid certainties of the senior clinicians.) The sad reality was that people died in hospitals. In a prior generation, that was the only reason patients checked into hospitals at all. His aunts, he recalled, had eschewed medical facilities like plague houses. “I’d rather drop dead on the street,” proclaimed Fannie. When she’d ultimately sought care for the lump in her breast, after the agony grew too severe for indomethacin, the tumor weighed more than a cantaloupe and had ulcerated through the flesh below her axilla. Nor did the death of the minder faze Millard. In five decades, he’d witnessed an orderly suffer a heart attack in the radiology suite, visiting children seize in the cafeteria, a junior dietician choke to death on a chicken bone in the nursing station. The law of averages ruled that some people would die in their beds surrounded by loved ones and others would perish while transporting blood or reviewing bone scans. On his first overnight call as an intern—July 2, 1966—he’d admitted seven patients to the hospital; by sign-out the next morning, all seven of them had expired.

  “You’ll get used to it,” said Millard.

  “I won’t . . . . I can’t . . . .”

  “You can’t, but you will,” he replied. “I wrote you a glowing recommendation, by the way. I meant every word of it then—and I still mean every word of it now . . . .”

  His reassurance brought a faint smile to the girl’s lips. Millard surveyed the landing for the first time: Someone had been smoking illicitly a few steps above, leaving butts and ash on the concrete. A patch of graffiti on the wall read: ST. DYMPHNA’S – BECAUSE LIFE IS OVERRATED. Footsteps—boots or clogs—traversed the tunnel on the opposite side of the fire door. Any other day, Millard would have been self-conscious about being alone in a shadowy stairwell with an attractive, twentysomething girl.

  “Are you ready for another quiz?” he asked.

  “Not right now,” she said. “I can’t think straight.”

  “Trust me. This one will be easier. I promise. About psychiatry.”

  “Okay, I guess . . . .”

  “That’s a good sport,” said Millard. “So here’s the question—and this one actually might appear on your psychiatry boards someday. In 1950, before the discovery of medications like Thorazine and lithium, what were the six treatments, other than talk therapy, that psychiatrists used to treat patients with severe mental illness?”

  His challenge served its intended effect. Pastarnack’s grief gave way to the urge to prove herself; color returned to her cheeks. She crossed her legs, exposing a run in her stocking.

  “Fair question?” he asked.

  “Fair enough . . . but difficult.”

  Millard let her think. His evaluations from the medical students perennially accused him of answering his own questions too quickly.

  “ECT?” she guessed.

  “Yes, indeed. Shock therapy. That’s one,” said Millard. “But without anesthesia. My mentor at NYU began his career doing ECT during the afternoons in his home office. On his mahogany dining room table. His wife would scrub down the wood after lunch, they’d treat a depressive or two, and then she’d serve supper on the same surface. Every few weeks, a patient might fracture a long bone and require emergency pinning.”

  “That’s surreal.”

  “It was a different world,” said Millard. “Five to go . . .”

  Lauren Pastarnack studied the backs of her pale hands, her brow puckered, an adorable dimple appearing in her chin. “Lobotomies?”

  “Correct. Transorbital lobotomies. Egas Moniz won a Nobel Prize for perfecting the procedure. They performed twenty thousand in the United States alone.” The image of the lovely but star-crossed Rosemary Kennedy, presenting herself at the court of King George VI, had haunted him ever since he’d learned of her fate. “That’s two.”

  Gone was the girl’s grief, supplanted by confidence.

  “Insulin comas,” she said—now a statement, rather than a question.

  “Three for three,” agreed Millard. “You’re halfway there.”

  Even during his training, there had still been codgers who swore, despite overwhelming evidence, that using low blood sugars to induce coma or convulsions cured schizophrenia. To the current medical students, this seemed as bizarre as trepanation.

  “Any more guesses?” he asked.

  “I give up,” said Pastarnack. “My brain is tired.”

  Unlike earlier, he chose not to hound her. “Three for six is impressive for a third-year medical student. You should be proud,” he said. “For future reference, the other three are ice baths, malaria exposure, and the placement of baboon testicles under the skin.”

  “Baboon testicles?”

  “Chimpanzees, too. And even gonads harvested from executed murderers. Crazy, no? You should read Voronoff’s Rejuvenation by Grafting. Probably the strangest mainstream medical text ever published. The poet E. E. Cummings called Voronoff that ‘famous doctor who inserts monkey glands in millionaires . . . .’ ”

  The girl’s smile dissolved into laughter. “Monkey glands . . .” she said between paroxysms. “Monkey glands in millionaires . . .” Millard couldn’t explain why the quotation was particularly humorous, but he soon found himself laughing too. Pastarnack apologized for her frenzy through tears, then burst out laughing again.

  “Oh, God, I’m sorry,” she pleaded.

  Millard bit his lower lip until he tasted blood.

  “Well you should be,” he said. “There was nothing funny about simian grafting therapy. It ruined the lives of hundreds of people.”

  “How?”

  “Infection. Dashed hopes,” said Millard. “Except for shock therapy, none of
these treatments offered any benefit beyond placebo—and some, like lobotomy and insulin, killed or maimed lots of people.”

  Now he had Pastarnack’s rapt attention.

  “The point I’m making is that the greats of psychiatry—Meyer, Kanner, Sullivan—left a trail of dead bodies in their wake. Krugman and McCollum fed feces milkshakes to mentally impaired children to trace the natural course of hepatitis. And these were the good guys,” explained Millard. “They thought they knew everything and now we know they knew nothing. In thirty years, someone else will come along and say, ‘Salter, that crackpot, he treated patients with Prozac and Zoloft.’ So don’t be too hard on yourself. You’re a talented young woman. You do the best you can. Nobody can expect anything more.” Millard uncoiled the stethoscope from the handrail and passed it to her. “End of sermon.”

  “Thanks,” said Pastarnack. “Wow. I feel better.”

  “Good. Now time for you to study and me to head home.”

  He waited for her to button her white coat and followed her up the stairs.

  Outside, the bloated air held the promise of rain. Pea soup, thought Millard, recalling a favorite joke of his boyhood. What is the difference between mashed potatoes and pea soup? Anyone can mash potatoes. At seven, that had tickled him breathless. On the corner of 97th Street, a man in a derby hat and suspenders hawked umbrellas. Downtown traffic inched forward, unable to keep pace with the crush of pedestrians.

  “Thank you for cheering me up,” said Pastarnack.

  “My pleasure. Now go ace that exam.”

  He waved to her, wishing her well. In response, she stepped forward and hugged him—her breasts pressing against his constricted arm. He patted her back gently. Over her shoulder, his eyes made contact with Stan Laguna. Lauren Pastarnack released her grasp and departed toward the medical library just as Millard’s colleague approached.

  If Stan Laguna appeared scruffy at the start of the workday, by quitting time he looked positively disheveled: coarse stubble varnished his nascent jowls; the residue of lunch—pasta sauce, cheesecake crumbs—clung to the wrinkles of his shirt. In one hand, he carried the paper shopping bag that served as his makeshift briefcase.

  Laguna’s gaze pointedly followed the girl’s derriere down the sidewalk. “A date with destiny,” he said, punctuating his comment with a whistle.

  “I’m writing her a recommendation.”

  “Sure you are,” said Laguna.

  Millard didn’t know whether his colleague was joking, but he no longer cared. So what if grubby minds drew sordid conclusions. He’d be dead. Yet he didn’t want anyone connecting his suicide to his wholly innocent relationship with Lauren Pastarnack—or worse, Stan Laguna blaming himself for catching them in a moment of supposed intimacy.

  Laguna wore a curious, live-and-let-live grin.

  “One of the suicide minders died,” Millard explained. “She found the body.”

  “Yikes,” said Laguna. “I thought you were taking the day off . . . .”

  “I did,” replied Millard. “I visited Isabelle’s grave.”

  That knocked the glow from Laguna’s face. “I’m sorry.”

  “Did I miss anything?”

  “Nothing to write home about. We saw that woman who blew up the building across the street. She’s still out cold—but she’s not going to be a happy camper when she wakes up.”

  “I imagine not.”

  “And the Royal Embellisher came looking for you. She kept babbling about ‘changes coming to the service.’ Should I know about this?”

  “All of the changes are in Hecuba’s imagination.”

  “A place where I’m glad I’m not,” said Laguna. “All in all, a quiet day. Nothing stirring, not even a lynx.”

  “She’ll turn up,” said Millard.

  The bells of the Russian Orthodox cathedral tolled the hour. Scotch mist had given way to ominous gobbets of rain.

  “I have to run,” he said.

  “See you tomorrow,” said Laguna.

  “Yes, see you tomorrow.”

  But he wouldn’t see Stan Laguna tomorrow . . . or ever again. As he hurried toward the IRT through the drizzle—a cab in rush hour traffic would take too long—the hard reality of his death finally took hold of him like a summer flu, pounding in his head, stanching his breath. He couldn’t shake Lauren Pastarnack’s intense despair at the demise of a stranger. How much worse for his colleagues, his friends, his children. Was there any crime, he asked, in postponing his plans with Delilah for a few more days? Choosing his birthday had been arbitrary, not based on any empirical evidence regarding her health or well-being. Surely, he might convince her to live a wee bit longer. Maybe he could meet Maia for dinner that evening after all—and bring her back to Delilah’s apartment for introductions. What was the worst that the Compassionate Endings folks could do? Expel him? Exile him to Mexico like Trotsky? The more he considered a deferment, the less unreasonable it sounded.

  The drizzle ripened into a steady, windswept shower. A man dashed toward a vacant cab with a newspaper braced over his head; nurses in turquoise scrubs and floral-print smocks huddled under awnings. Trash sopped and swirled in the gutters. Millard, buoyed at the prospect of longer life, of a few more days with Delilah, relished the rain. He’d buy more flowers, he decided. Maybe rent a movie—although he had no inkling how to rent a movie anymore, now that his corner video rental shop had gone the way of eight-track tapes and cathode ray televisions. (He remembered shopping with Carol for their first VCR, debating the merits of VHS and Betamax; they’d argued bitterly, but he’d gotten his way—and chosen wrong.) Nothing could dampen his mood, not even Denny Dennmeyer, who squeezed into the seat beside Millard on the southbound train.

  “If it isn’t the man of the hour,” said Dennmeyer.

  The accountant wore a bandage around his forehead and another that looped under his jaw; he reminded Millard of Boris Karloff playing The Mummy. Millard pretended to blow his nose, creating an excuse to shield himself from Dennmeyer’s mortal breath with a handkerchief. He felt the fat of the man’s thigh crushing into his own. A creature of his proportions, grumbled Millard, ought to pay twice the fare on public transit.

  “I want to commend you for delivering your report, Dr. Salter,” said Dennmeyer, at a volume fit for a crowded saloon. “You’re a man of your word.”

  Dennmeyer’s tone insinuated that he’d expected otherwise.

  “Looks like you got beaten up pretty bad,” said Millard, speaking into his sleeve. “I guess that post office wasn’t there when you expected it, after all.”

  “Everything in a day’s work, Dr. Salter. A prepared manager has to expect the unexpected . . . I didn’t realize you’d been injured as well.”

  “Neither had I.”

  “I suppose we both should have ducked. In any case, I’ve got your report right here,” said the accountant, slapping his attaché case. “It’s my bedtime reading. I’m looking forward to it.”

  “May I see it?”

  Dennmeyer removed a manila envelope from the side pouch. The sight of the report confirmed Millard’s plans and he snatched it from Dennmeyer’s grasp. If he intended to return to work for another week or two, there was no reason to antagonize the bean counters yet. “If it’s all right with you,” he said, “I’m going to hold on to it for another day or two. I just realized I’ve left out some key data . . . .”

  Dennmeyer’s narrow eyes bulged with alarm.

  “You can always file an amendment,” he pleaded.

  Millard rose, using a pole for assistance. His knee ached; his cheek throbbed. “This is my stop,” he said, inching his way toward the exit with the envelope tucked under his elbow. “Good to see you.”

  “But Dr. Salter. Really, I must protest—”

  Luckily, Dennmeyer’s protest was lost to the roar of the station and the closing subway doors. The platform bustled with anonymity. Millard slid the envelope into a nearby trash can and climbed the stairs into daylight. Sunlight greete
d him in vibrant sheets. On 68th Street, steam rose off the asphalt; oil shimmered in puddles. All that remained of the brutal downpour were tidal pools around the sewer heads and flares of gray in the distant sky. A delicate sheen of rebirth hung over the city.

  Millard snatched up a bouquet of tiger lilies at the nearest bodega and waited impatiently for the cashier to ring up another customer’s lottery tickets. Now that he’d decided on extending his time with Delilah, he felt a deep yearning to see her. Already, he found himself planning their upcoming days together. They had still never listened to Christel Goltz perform Turandot or Antigone; he’d reserved the CDs at the public library, but another opera fan had dibs. Nor had they ordered in escargot from La Sirène. And why shouldn’t he rent a private ambulette to show Delilah around the Bronx? He could certainly afford it. Paying for the flowers—Millard shelled out a ten and didn’t bother to wait for change—he even wondered if he hadn’t been wrong about marriage. He’d treated a federal magistrate for anxiety after a bout of bronchitis several months earlier; he imagined he could persuade the judge to stop by Delilah’s apartment as a favor. Instinctively, his fingers reached for the ring suspended below his throat.

  Yet as he hurried down the avenue toward her apartment, he checked himself: The whole purpose of rational suicide was to be rational—not to be swayed by hope or sentiment or love. Following your emotions is what landed you in the ICU, speckled in bed sores, with tubes and catheters protruding from all of your orifices. Millard valued his own dignity far too much to take such chances and he loved Delilah too deeply to play roulette with her future. No, he dared not fall into that trap. So that was that. The clock was still ticking. Subdued, he greeted the burly Montenegrin guarding his paramour’s building.

  “How’s Miss P.?” inquired the burly doorman.

  “Swell,” replied Millard.

  “Glad to hear it. We’re pulling for her.”

  He rode the elevator to the sixth floor. One by one, he unlocked the deadbolts, and stepped into her foyer for his final entrance. As always, he called out her name. While he waited for two minutes to roll by, he found a second vase and arranged the tiger lilies. He set the vase on the countertop beside the toaster. She had already removed the helium canister and hood from the kitchen, as well as her lethal library and the anthology of Teasdale poems. His own footsteps reverberated in his ears as he followed the hallway into her bedroom.