A History of the Present Illness

by Louise Aronson

  Until the boy’s fall, I had never considered that Josette might be at least partially right about my friend. Listening to Perla tell the story of that Wednesday on Bernal Hill, I was sure the rest of our group—Althea and Sumita are still around (and still together), Lamar was recruited to Stanford as the youngest department chair in that institution’s history, and the others, though spread across the country, keep in touch—would be as shocked as I was by Perla’s choices. They would wonder what physician, former or otherwise, wouldn’t immediately step forward to help an injured child. They would argue that the basics of resuscitation—airway, breathing, circulation—are like riding a bike, and even if Perla couldn’t remember how many compressions or how many breaths to give the kid, she at least should have started some kind of CPR. In other words, just like me, they would have missed the point.

  * * *

  It’s funny how random things can impact your life. Sometimes I wonder whether Perla would have told me about Dylan Hunter’s accident, much less gone into such detail, if we hadn’t had long-standing plans to hang out at my house that Saturday evening. Josette and our boys were spending the weekend with cousins in Fresno, a road trip that I, attending on the wards, had to miss.

  Perla sat across from me at my kitchen table as she told the story, a bottle of Napa Valley cabernet and a plate of artisanal cheeses between us. I tried to picture the characters and events she described so vividly: the dogs and the scream, the injured boy on the road, the cell phone woman and the man with twins, and, of course, Perla herself. When she finished, I felt certain she wanted me to find out whether the boy had survived, and if so, how he was doing. Because she had hesitated initially and then done little to help, I assumed that she didn’t feel comfortable calling the hospital.

  “I’ll check the ER log for you tomorrow,” I offered. “Or, better yet, I’ll swing by the peds ICU.”

  “Tomorrow’s Sunday,” she said.

  “I’m on inpatient this month, so no days off.”

  “Lucky you,” she said, laughing as she did each time I mentioned some of the less glamorous aspects of my work. “Anyway, there’s no need. I saw him this morning.”

  I put down my wineglass. “You’re kidding.”

  “The dad posted a ‘Did you save my son?’ sign on the hill’s upper gate. I called the number, and he asked me to stop by. The kid looks like hell, but they say he’ll pull through.” She smiled.

  “You called?”

  “Well, yeah. They wanted to be called. That’s why Tom put up the sign.”

  “Tom?”

  “Dylan’s dad.”

  So now she was on a first-name basis with the family. I couldn’t think of anything to say that wouldn’t sound accusatory. How could Perla not see how badly she’d behaved? Didn’t she know that dogs can never be put before humans? That once again she’d failed to follow through?

  She poured herself more wine. With her trim, toned body and sun-bronzed hair, she looked as if she belonged in an advertisement for our new black leather barstools and the marble table Josette had said she couldn’t live without.

  “Actually, I think I’ve seen them around. They have a sheltie mix.”

  “You did recognize the boy!”

  Perla laughed. “It’s the dog I recognized, of course. And probably also Tom. He’s seriously cute.” She grinned. “But get this. Turns out the parents separated about two months ago, and Dylan was supposed to be going to his father’s new apartment. He forgot what day it was. He shouldn’t even have been on Bernal Hill!”

  “Wait. You’ve met the father?”

  She grinned again and tossed her hair. It caught the light from the colorful glass diffusers on the Italian light fixture I’d bought in exchange for agreeing that Josette could buy the table. Looking up at me through her bangs, she seemed relaxed and very happy. “In certain circles—mostly those where it’s normal to walk around carrying one or more plastic bags of dog shit—I have quite the rep.”

  She just didn’t get it.

  “You have a medical degree,” I said as calmly as I could, “and you knew what to do, but instead of starting the resuscitation, you checked on dogs and waited for the paramedics. It’s entirely possible that you cost that boy part of his brain and some of his function.” She could make up some bullshit story for herself if she wanted, but those were the facts.

  Her face fell. She looked suddenly smaller and nothing like her usual brash self. She traced the rim of her wineglass with one finger, and I could almost feel her mind turning over what I’d said.

  A moment earlier, I had felt angry at Perla and scared for her. Now I saw that if I could get her to face what she had done and not done on Bernal Hill, she could face everything else in her life too and things would finally come together for her. I put my hand on her forearm. “I’ll help you with this. I’ll be there with you every step of the way.”

  She removed my hand. “There’s nothing I need help with,” she said, her voice hard and so quiet I almost couldn’t hear her. “All is good in my world of dogs and regular, predictable work schedules and people who understand that sometimes in life bad things just happen.” She took a deep breath. “You, on the other hand . . . did you really never ask yourself why you stayed friends with me when no one else did?”

  I decided to handle her as I would a difficult patient. I walked around to her side of the table and used my most empathetic facial expression and tone of voice. “You don’t have to pretend with me. We could talk through it together, review the protocol, and then next time—”

  “Rey!” she interrupted. “Stop. I’m done talking about the boy. I didn’t tell you the story so you could diagnose and treat me. I told you because it was a horrible experience and you’re supposed to be my friend. So, since me getting sympathy obviously isn’t happening, let’s move on to something more interesting and not ruin our Saturday night.” She topped up our glasses and squinted slightly as she handed me mine. “Remind me. What sort of painting was it that you wanted to do after college?”

  As my faithful companion at art shows for more than a decade, she knew the answer to that question as well as I did. “That’s not what we’re talking about.”

  “Isn’t it? C’mon, Rey, you want to talk motive, means, and opportunity. Well all right, mister big shot doctor. But don’t pretend you don’t know what’s really going on here.”

  I took her glass, placed it carefully on the table, and grabbed her arms. Then I pulled her toward me until her face was just inches from mine.

  “Rey!” she screamed. “What the fuck?!”

  Her lips and tongue were purple from the wine, and her breath smelled sharp from cheese and alcohol. I couldn’t tell what I wanted more: to punish her or to devour her.

  We stared at each other, breathing hard. She tried to wriggle free, but I wrapped her arms behind her back and held on tight. I could feel her, hot and rigid and foreign, along the length of my thighs and torso.

  “Rey,” she said. “Get off me.”

  My younger son often used the same words when the older one had him pinned. I imagined my boys bursting through the front door, home a day early and eager to see Daddy, with Josette following close behind.

  I let go. Perla grabbed her purse off the floor. I sat down in what had been her chair. “Oh shit,” I said. “Oh my God.”

  Seconds later, the front door banged shut.

  * * *

  Over the next few weeks, I caught sight of Perla several times at the general—in the cafeteria she’d always griped about, on the pediatrics unit I loved and she dreaded, and in the stairwell we’d both always preferred to the elevators. If she saw me, she didn’t let on. But apparently Althea also ran into Perla at SFGH, and the two of them rekindled their friendship. Althea said that Perla visited the boy most days around lunchtime—between her morning and afternoon dog groups, I figured—even though Dylan was too impaired to recognize his parents, much less appreciate a stranger’s attentions. Eventually Perla ad
mitted to Althea that her presence at the hospital had more to do with the father than the son; she and Tom Hunter were dating.

  For a while I worried that Perla would say something about what happened that night in my kitchen, but I don’t think she will. Knowing Perla, she probably just put the whole thing behind her and moved on.

  Not me. After she left, I cleaned up, finishing off the bottle of cabernet. Then I went into the den and looked up at my art books. I keep them on the top shelf of our huge built-in bookcase, just under the ceiling’s polished, naked beams and well out of the children’s reach. They all have moved with me, my painters and sculptors, from East Coast to West, from apartment to starter house to the three-bedroom Potrero Hill home Josette and I recently bought, with its views of downtown and the East Bay. It’s a beautiful house, and I am very pleased to provide such a home for my family.

  Over the winter holidays, Josette noticed that I was spending more time with my art books, and she bought me a drawing pad, charcoals, and watercolors. Now I occasionally steal away from work, drive up to Bernal Hill, and plant myself on a patch of grass or red rock. Then, for thirty or forty minutes, I capture some piece of my world, upping the ante on the challenge to my fledgling skill set and offering a slight nod to modernism by using charcoal when watercolor might be best, and vice versa. So far I have rendered a giant ant colony against a tiny downtown San Francisco skyline; the famous Bernal coyote slouching in the high winter grass, her eyes as sentient as any human’s and the backlit sky framing Mount Diablo in the distance; and a pack of dogs running down the pedestrian-only portion of Bernal Heights Boulevard alongside a trim, athletic woman, the wind blowing fur and hair, and their bodies loose and carefree, as if they might keep running forever.

  Returning to work after such jaunts, I often pause before that internship photograph hanging behind my office desk. I notice not just the clothing and facial expressions but our positions and postures on the steps as well: Josette, shy and awkward, laying claim to me with her hip; Lamar flexing his muscles; Nam pretending he isn’t taking seriously the business of being a doctor; and Sumita and Althea positioned both close enough to each other and far enough apart to heighten the charge between them. I stand front and center, a place I fought for, while Perla stands off to one side, at the edge of the frame. It’s funny, but I’ve only just recently realized that if we have changed over the years, it’s only in the most superficial of ways, and also that most of us have ended up right where we wanted to be that very first day.

  The Promise

  Hattie Robinson was a jazz singer in the 1930s, the only female black labor leader in Northern California in the ’50s, and a regular in the Letters to the Editor section of the San Francisco Chronicle for decades. At ninety-six, she began nude painting—not portraiture of disrobed others, but art made by her in a totally naked state and in the absence of most other social conventions. I met her the following summer, called to her home by a social worker for Adult Protective Services.

  I’d recently given up my clinic and academic responsibilities as the family medicine program director at San Francisco General, but unwilling to fully succumb to retirement, I had begun spending my mornings making house calls to patients in homes and apartments across the city. My wife, Carly, a former advertising executive, suggested that I call my new venture From Projects to Penthouses. Throughout the twenty years of what had been for both of us a midlife second marriage, Carly had expressed both pride and fascinated repulsion at how I sometimes spent my days. She felt that a catchy, accurate, but possibly misleading title might be my only hope of building a viable practice.

  As it turned out, no marketing was necessary. More so than most urban centers, San Francisco’s world-famous hills have produced a city replete with ancient and otherwise disabled people rendered invisible by their inability to go out. Referrals poured in by word of mouth alone, and within months of starting the practice, I had to increase my work hours to keep pace with demand; I couldn’t abide the very real possibility that the time a potential client spent on my waiting list might exceed his or her life expectancy. Carly noted that most retirements looked significantly different from mine, but I could see no better way to spend my time than to offer patients good care and a dignified death at home.

  The social worker told me that Hattie had been seen in the emergency department several times in the space of a month, each time for something silly: an ingrown nail, a bruise not black and fresh but with a halo of lighter brown, a cut so small no sutures were needed. Each time, her daughter brought her in, dropped her off, and disappeared. Each time, the daughter was slow to return when the hospital called to say there was no reason to keep her mother.

  They lived in a worn but still handsome Victorian in the Lower Haight, a neighborhood of drug addicts, pierced and tattooed young professionals, and people like Hattie, who predated not only the current counterculture fashionistas but also their flower child predecessors. In the broad, high-ceilinged foyer, I was greeted by a huge Benin plaque and African masks elaborately decorated with feathers and what looked like real human hair. Framed reprints of book covers lined the long, wood-paneled hallway in pairs: Cane and Their Eyes Were Watching God, Another Country and Native Son, Black Fire and Letter from Birmingham City Jail, Beloved and The Color Purple. Just before we turned into the bedroom, a collage of the numbers 1, 9, and 3 provided the single false note in an otherwise impressive decor. Nineteen thirty-one, explained Hattie’s daughter, Patricia, was the year of her parents’ marriage. They lived in Harlem then, but came to San Francisco after the war.

  Hattie stood in one corner of her room, naked and painting as promised. She sang an aria of sorts and turned circles on a tired patch of carpet. When at last I got her attention, she couldn’t tell me who she was or where, though she remembered how to scream and scratch and kick, all of which she did when I examined her, careful to steer clear of the urine-soaked rug and elaborate swirls of stool on the walls and bed. (Later, Carly cringed at these graphic details when I told her about my new patient. “Oh God,” she said. “I had no idea it could get that bad.”)

  When I finished my evaluation, Patricia brought two chairs in from the kitchen and said, “Momma always did tell me she planned to live forever, but no way did either of us ever imagine something like this.”

  “What did you imagine?” I asked.

  Patricia glanced up at me, surprised. “I suppose we thought she’d be like my daddy. He took sixteen pills a day and needed a wheelchair his last two years, but he was still himself, right up to the end.” She pointed at her mother’s vanity, where a halo of photographs encircled the mirror: Hattie and a bald man about my age waving from a car beside Willie Brown; Hattie speaking through a bullhorn outside a factory while the same man—younger and with a full head of hair—stood to one side holding a picket sign; Hattie posing in front of the Victorian at a time when the paint looked fresh and new, while the man—middle-aged but sporty-looking despite the cane in his left hand—grinned up at her.

  “So now you’re wondering how best to take care of your mother?” I asked.

  Patricia nodded and looked across the room. Hattie sat on the sofa rapidly turning the curled pages of an old magazine.

  Seeing Patricia’s profile, I realized she too was quite old, early seventies at least. (“Quite old,” Carly said that evening with a laugh. “Should I remind you of your own birth date?”)

  “Sometimes,” I said to Patricia, “we can make an educated guess about what a person would have wanted based on their choices when they could make their own decisions. How did your mother handle her health? Did she go for regular checkups or just see a doctor when she got sick?”

  Patricia threw back her head and hooted. “Mother never did care for doctors, said they were always thinking they knew best and how could some stranger who saw you once or twice a year know what was best?” She smiled. “No offense, Dr. Westphall.”

  The tone of her apology concerned me. It was the over
ly accommodating tone of a caregiver pretending that she wasn’t exhausted and angry and utterly convinced that there wasn’t anything that could be done to improve her situation.

  “But your mother did see someone occasionally?”

  “Not unless I dragged her. And that never did any good anyhow, because she’d just refuse the mammogram or Pap smear or whatever else they wanted to give her.”

  That morning, I spent more time with daughter than with mother. We talked of Hattie’s weight loss and her incontinence and how hard she fought when Patricia tried to clean her up. And then we discussed what could be done and what couldn’t, what should be done and what shouldn’t. When I proposed a fairly conservative approach to Hattie’s care, Patricia said, “Whatever you think, doctor. You’re the expert, not me.”