The Death Shift

by Peter Elkind

  Gladys Jones pitched in to help. While Genene worked at the beauty parlor, she kept an eye on Edward. Past the age of sixty, Gladys had brought her own demon under control; she had stopped her drinking through Alcoholics Anonymous. Gladys Jones was a survivor; each misfortune just seemed to harden her, like a coat of shellac on a battered chair. But the fates were not through with the old woman—not even close to through yet. In September 1974, her son Wiley, the father of four children of his own, died of testicular cancer at the age of twenty-eight.

  The deaths of her father and her brother from cancer left Genene terrified of the disease. In 1975, she developed an angry skin allergy to the chemicals used on hair. When her doctor ordered tests, she fretted that he was secretly looking for cancer. Genene would confide her fears to friends, then burst into tears. When the test results arrived, she said the allergies left her no choice but to abandon her career as a beautician. Genene described her decision in typically dramatic terms. She said her dermatologist had told her: “Get out or lose your hands.”

  It was during training for a new profession that Genene discovered she was pregnant. Gladys Jones was aghast at her daughter’s plans to have a child out of wedlock, but Genene wanted another baby. To close friends, she confided that the father was her ex-husband, Jim DeLany—that the child had been conceived during another short-lived reconciliation. But to her mother, who despised DeLany, Genene offered another story. She told Gladys—and would one day swear under oath to others—that the child’s father was Keith Martin, a beauty-supply salesman, and that he had perished in an automobile accident. Gladys Jones believed her; she knew nothing about the secrets of her daughter’s life as a hairdresser.

  But there were two problems with the story. The first was that Keith Martin was very much alive. The second was that he was gay.

  When Jimmy DeLany’s wife attended beauty school, she assumed elements of a new identity. She cut her hair short, bleached it blond, and told classmates and teachers that her name was Jojo. The young sailor’s wife quickly became the star pupil at Mim’s Beauty College. Her nimble fingers could bring life to the most moribund head of hair. But her greatest gift was cultivating the loyalty of those for whom she worked. When ladies sat in her beauty chair, Jojo pampered them shamelessly. She gave them massages. She brought them sodas. She used flattery to make them feel important. Jojo’s customers wouldn’t let anyone else do their hair. Classmates thought she was friendly but not one with whom to trifle. They found her profane vocabulary intimidating and reckoned she would make a fearsome adversary.

  She spent much of her beauty career at the Methodist Hospital parlor, where everyone knew her as Genene. It was there that she met Keith Martin, about the time of her divorce, during the summer of 1974. Genene had risen to be manager of the two-employee shop; Martin called on her hawking hair spray from the beauty-supply business he had inherited from his mother. After chatting for hours on one of his sales calls, they decided to see each other after work.

  Martin was a genteel man. At North Texas State University, he had majored in classical music and French literature. He rarely touched alcohol and never sullied his palate with common beer. He and Genene spent quiet evenings together, discussing cosmic matters of philosophy and taking turns on the piano. During their initial encounters, Martin thought he’d found a soulmate.

  But such gentleness did not reflect the dominant side of Genene’s personality. More often, she was coarse, particularly when it pertained to sex. “She’d look at a guy,” recalled Martin, “and say, ‘I could fuck his brains out.’” Genene paraded her lust in part out of sexual frustration; she complained that her appearance deterred men from asking her out. But it also served as a signpost of Genene’s bottomless thirst for attention.

  Although Genene knew Keith was homosexual, she tried to get him to have sex with her; she seemed to regard seducing him as a challenge. According to Martin, he never succumbed. But the two cultivated a strange relationship of convenience. He escorted Genene on double dates with her straight friends. She accompanied Keith to gay bars, where he picked up men. On nights when his forays failed, they often slept in the same bed. As Martin later described it, Genene became increasingly frustrated at his lack of sexual interest in her.

  In late 1975, he suffered a severe bout of fever. Genene helped nurse him through it, and under the spell of confused gratitude, he consented to their engagement. Martin also saw selfish advantages to formalizing their odd alliance. He had dreams of owning a Cadillac, a large house, and a grand piano—the very things Genene had known as a child. She had told him her mother was loaded. Gladys’s initial reaction to their engagement announcement had been promising. After hearing the news, she loaned them money; they had told her they were going to open a beauty parlor.

  But Genene was already developing other interests. Her employment at the Methodist Hospital beauty parlor had spurred an obsession with the field of medicine. Genene had begun leafing through medical textbooks in her spare time. Her little knowledge was to prove an extraordinarily dangerous thing.

  Genene fretted constantly about her own health. Her terror that her skin allergy was a sign of cancer was only an early manifestation. She soon began to offer dire interpretations of the medical problems of others. “Anytime anyone was sick, it was always extreme,” recalled Genene’s sister, Lisa. “Someone would lose their voice, and she’d see it as cancer of the throat. You’d have a cut, and she’d say, ‘It’s going to be gangrene.’ One of my kids might have an earache, and she’d wonder whether it was a brain tumor.” One night, Genene phoned Keith Martin at 2 A.M. from the Methodist Hospital emergency room. She said she was with her son. “I was reading about symptoms of a rare disease that causes young children to go blind,” Genene explained, “and Edward fits the symptoms.” After a quick examination, a doctor sent them home. “She was always trying to find something wrong with me,” recalled Martin. “I have allergies. She would twist it into a medical catastrophe. She always wanted to make you feel as if you were physically ill. She would conjure up things that didn’t exist.”

  Genene’s absorption with medicine ran to sexual and mystical elements. Among the men she coveted, she reserved her hottest lust for doctors. To Genene, physicians were a turn-on, the ultimate symbol of masculinity. She encouraged Martin to go to medical school—as though it would magically alter his sexual preference. Genene occasionally turned to unearthly forces on matters of health. She liked to play with a Ouija board and appeared to place credence in its wisdom. On one occasion, she advised Martin he had a short life line and would soon be dead. On another, she asked him to join her in a séance.

  In early 1976, Genene began pressing her gay fiancé to set a date for their marriage. Martin balked. Although he was hardly a man of convention, Genene’s eccentricities were intimidating. Her demands for sexual favors were becoming insistent. And her mulishness knew no limits; if Keith didn’t do things her way, Genene would pitch a fit. The notion of marriage—even a platonic one—to this odd, nagging woman was too much to take. By February, Genene realized that Martin would never go through with it. Bursting into his beauty-supply shop one day, she loudly vented her rage and terminated their engagement.

  Genene’s skin allergy had afforded an excuse to drop her beauty career as well. It was medicine that mattered to her now, medicine that was to become her life. In June 1976, after Gladys agreed to foot the bill, Genene enrolled in the San Antonio Independent School District’s School of Vocational Nursing. Like most prospective licensed vocational nurses—known as practical nurses in many states—Genene had entered the one-year training program because she was eager to start work soon. Compared to those of a registered nurse, the pay, authority, and duties of an LVN were usually limited; but earning an RN degree took at least twice as long.

  In LVN school, Genene Jones at last appeared to have found her niche. Most of her grades were in the nineties; in Maternal and Child Care, she achieved a 97. Genene was also popular with her
classmates. Some of the women asked her to cut their hair. After moving back in with Gladys, who minded Edward, she hosted the annual Christmas party at her mother’s home. But Genene also seemed less serious than her peers. She never studied during lunch hour. She peppered instructors with jokes. And she scrawled pictures of male genitalia during anatomy class.

  Graduation exercises were held on May 20, 1977, at a local high school. Among the fifty-eight receiving diplomas, Genene, then seven months pregnant, was one of sixteen to earn honors. The group was serenaded with the class song, a Seals and Crofts tune called “We May Never Pass This Way Again.” After a parting prayer, the graduates rose to recite the vocational nurse’s pledge:…to assist the physician and the professional nurse in performing any service which will improve the welfare of humanity…to safeguard any confidence…[to] apply the Golden Rule, toward friend and foe alike…to serve the needs of my fellow man…

  When Genene took her licensing exam, she scored 559—more than 200 points above the passing grade. The transformation was complete: Jojo DeLany, beautician, was now Genene Jones, licensed vocational nurse.

  On July 17, two months after graduation, Genene gave birth to a daughter, whom she named Crystal Jones. Like Edward, the new baby became her grandmother’s frequent ward. Gladys Jones had sold the family sign business after Wiley’s death. She had paid off all her bills, buried her husband and two of her children. At the age of sixty-six, she had little unfinished business left on earth—except to see her wayward adopted daughter settled. However vexing Genene might be, Gladys would do what she could to help launch her promising new career in nursing.

  PART TWO

  The Hospital

  I always cry when babies die. You can almost explain away an adult death. When you look at an adult die, at least you can say they’ve had a full life. When a baby dies, they’ve been cheated. They’ve been cheated out of a hell of a lot.

  Genene Jones

  May 5, 1983

  Three

  It took Genene Jones just eight months to be fired from her first nursing job. After recovering from Crystal’s birth, she had gone to work in September 1977 at an institution she knew well: Methodist Hospital in northwest San Antonio, a quarter mile from her childhood home. The premier private hospital in the city, the 487-bed Methodist had employed Genene previously as a beautician; her two brothers had been treated there before their deaths.

  Genene began on a nursing shift that was to become her favorite: 3–11 P.M. Her salary was $4.02 an hour. Assigned to the cardiac intensive care unit, where patients with life-threatening heart problems received scrutiny around the clock, Genene impressed her supervisors with her enthusiasm, her energy, and her willingness to work extra shifts. A five-month performance review offered an important caveat: “Ms. Jones tends to make judgments that she has neither the experience nor authority to make.”

  In April 1978, she was ushered out. Genene later explained her dismissal this way: “I had a conflict with a doctor. It was a lack of feeling on the physician’s part toward a patient, and I stood up for the patient, and he didn’t like it. They asked me to resign.” Methodist personnel records, however, show that it was complaints by a patient that led to her termination.

  The incident began when Genene was assigned to care for a cardiac patient whose family was visiting her in a hospital lounge. According to hospital records, Genene walked into the lounge and ordered the patient to stamp out her cigarette. She then instructed her to keep her leg elevated; when the woman did not act fast enough, Genene grabbed the leg and abruptly raised it herself, causing pain. After taking the patient’s blood pressure, Genene told her: “Get back to your room and get in bed now!”

  Informed the next morning that the woman had complained, Genene asked her supervisor if she could speak with the patient. The supervisor told her she could not. Arriving early for her next shift, Genene approached the woman anyway. A written hospital report described what happened next: “Ms. Jones began crying in front of patient as she was reviewing the previous evening’s incident. After Ms. Jones left, patient notified 7–3 nurse, complaining of chest pain, nervousness, [and high blood pressure]. M.D. was notified of patient’s complaints and upset. Narcotic and sedative ordered. Cardiac studies initiated.” Genene was dismissed on April 26 for “improper or unprofessional conduct on duty.”

  Unceremonious failure in her first job did nothing to impede Genene’s future employment. Like the nation as a whole, San Antonio was suffering from a severe nursing shortage. And the medical needs of the city were mushrooming. The once rural neighborhood surrounding Methodist Hospital—a dairy farm only two decades earlier—had grown into the mammoth South Texas Medical Center, a 683-acre complex that included six hospitals and a medical school and employed 12,000 people.

  Genene moved across the medical center on May 15, to work in the obstetrics-gynecology ward at Community Hospital, a smaller private hospital. Once again, she worked the 3–11 P.M. shift. On October 16, Genene was forced to resign after undergoing abdominal surgery at a time when she had accumulated no sick leave. Although the procedure was elective, it was surgery that Genene was unwilling to postpone—a bilateral tubal ligation. At the age of twenty-eight, the woman who had grown up wanting a houseful of children had decided that two was enough.

  Looking for her third nursing job in thirteen months, Genene answered an ad for intensive care positions at Bexar County Hospital—the giant public hospital that cared for San Antonio’s poor. “I originally applied to the coronary care unit, and there wasn’t an opening,” Genene recalled. “They asked about pediatrics, and I had questions, but I said ‘yeah.’”

  On October 30, 1978, Genene Jones began working in the pediatric intensive care unit at Bexar County Hospital.

  For fifty years, San Antonio’s charity hospital had a reputation as a butchershop. The city’s unwashed were treated then at the Robert B. Green Memorial Hospital, in downtown San Antonio, near the slums where they lived. When it opened in 1917, with 208 beds, and partitions separating wards for patients of white and colored races, the Green was actually regarded as a major public improvement. Prior to that time, Bexar County had no charity hospital at all. Citizens too poor to pay had been shuffled about a series of makeshift institutions; in the early 1800s, the Alamo had housed hospital beds.

  But the burden of caring for San Antonio’s indigent was crushing even for the newly opened Green. The city’s West Side was one of the worst slums in America—a huge, unrelenting barrio where thousands of Mexicans lived in corrales, tiny stalls opening on a common court, without toilets or running water. Periodic flooding flushed human waste from open sewers into the shacks. Many on the West Side shelled pecans—finger-numbing work that offered feeble pay; in 1934, the average wage for a fifty-four-hour week was $1.56. On San Antonio’s West Side, only a few could speak English; but most in the community could not read or write in any language. Isolated from twentieth-century medicine, midwives and curanderos—Mexican faith healers—held sway.

  Such conditions served as a hothouse for disease. San Antonio’s tuberculosis rate led the nation; Mexicans died from the affliction almost three times as frequently as Anglos. Infant mortality soared. Mexican children were three times as likely to die from intestinal problems. Venereal disease was rampant. Not all the medical problems were germ-borne. The stifling conditions sparked frequent outbreaks of violence. Bar brawls, gunfights, and knifings filled the hospital’s emergency room with the battered and bleeding. The city’s far smaller black community inhabited the East Side, in comparably squalid conditions. Doctors at the Green spoke of their patients as casualties of “the battle of San Antonio.”

  Confronting this onslaught, the Green was itself a pauper. Young medical residents, overworked and underpaid, staffed the hospital, with help from private doctors who volunteered. Operating tools were so scarce that surgeons brought their own. Food rations were so paltry that patients recovered from medical problems only to succumb to poor
nutrition. On several occasions, the hospital ran out of cash entirely and had to pay its employees with scrip.

  The Green was perpetually short of money because the elected county commissioners, who provided its budget, could take the votes of the poor for granted. San Antonio’s minority groups sold their franchise to a corrupt Anglo political machine. And there was no pressure to act on conscience. While a few high-minded patricians made the Green their cause, most whites wouldn’t dare set foot in the place—and didn’t bother themselves about the conditions facing those who had no choice. To the affluent white majority, the Mexicans on the West Side were a faceless rabble, fine as domestic help or gardeners but lacking the need for decent medical facilities possessed by those of a higher species. This disdain was endemic, part of what one Texas writer labeled the old Spanish patrón mentality. As late as the 1960s, a San Antonio mayor dismissed the city’s Mexican-American population as a pack of childlike manual laborers “who just like to sing and dance and have a good time.”

  While World War II recharged the business community and Anglo neighborhoods, the harshness of the barrio was unaltered. A new wave of Mexican immigration overfilled the West Side with unskilled laborers who worked at the lowest wages. Conditions at the Green worsened. In 1946, the local medical society branded the hospital “a disgrace to Bexar County.” An independent inquiry offered a disgusting bill of particulars: ants, roaches, and fleas covered the baby beds; overflowing garbage cans sat uncovered in the kitchen; patients with highly contagious diseases, including typhoid and diphtheria, were left on stretchers in the hallway; few patients received baths. A local doctor publicly compared the county hospital to a charnel house. In October 1947, amid squabbling about what to do, the remaining medical residents quit and the Robert B. Green shut its doors. San Antonio became the only major city in the nation without a charity hospital.