The old building still had a lot of asbestos left and did not burn but smoldered. The fire was extinguished, and Mr. Jax was awakened and discharged to jail, the outcome of the fire being that the day after, fire marshals appeared on every ward. Not to search for potential arsonists, but to remove every piece of paper on the walls—every picture, photo, and drawing. They were fire hazards, the marshals explained.
So after the fire, the walls of E4 were bare. But then another examining magistrate complained that the walls were empty and insisted that patients be allowed to express their personalities on the walls above their beds, which were, after all, their homes. A decree went forth, and a few weeks later, each ward’s activity therapist brought in thirty-four corkboards and set to work. They cut out and pasted pictures from old magazines onto the corkboards—Good Housekeeping, Sports Illustrated, Time. They were random but efficient, and by the time the next investigation came round, every patient did have a personality expressed above his bed.
The patients of E4 didn’t pay much attention either way. There weren’t many walls in the shelters, boxcars, and army barracks they were used to, and none on the streets, and most of them had consolidated their memorabilia all the way to nothing, except for their tattoos, those dermal memories so easy to take from place to place.
If the demented men of E6 were bodies without minds, then the patients of E4 were minds without bodies, and sometimes when I went from E4 to E6, I thought it was a pity we couldn’t take what still worked in each—the bodies of the patients on E6, the minds of the patients on E4—and combine them, transplanting, for instance, Bill Luckly’s still usable mind into Mr. Dell’s still usable body.
Although, on second thought, perhaps not. Bill would most likely go back to his drinking, fall off his bar stool once again, hit his head, and end up paralyzed and back at the hospital, only in Mr. Dell’s body.
In addition to its handsome patients, what gave life and cohesion to E4 were its staff, especially its charge nurse, Christina; its male nurse, Allen; and Lacy, its activity therapist.
Like many of Laguna Honda’s nurses, Christina was from the Philippines; and she was short and stocky, with dark hair, skin, and eyes. But Christina had something special about her. Although most of the Filipina nurses were agreeable, deferential, and warm, they maintained a certain reserve; their polite deference seeming as much a second language as their English. But Christina was warm in both languages. You wouldn’t call her beautiful, and yet she had something in her eyes and her smile—a softness, an intelligent kindness. The thing about Christina was—she loved her patients. She knew every one; she remembered everything about them; and she was proud of them. I discovered this on my second day on E4 when she insisted I walk over to see “her” patient, Mr. Jerry Gillon.
Now, Mr. Gillon was one of the few patients on E4 who didn’t fall into the category I described. Mr. Gillon didn’t have a stroke, multiple sclerosis, or a traumatic brain injury; he didn’t have diabetes or schizophrenia or a drug habit; and he wasn’t handsome or flirtatious either. Mr. Gillon had a birth condition, no one knew what, and had been in an institution since he was an infant, being now fifty-nine years old. He was blind; he had seizures; and he was mentally retarded, with the IQ of a two-year-old, so Christina said. Although I doubted that. Not the two-year-olds I knew, who were sparkly little devils. “Two-year-old” was Christina’s motherly overestimation of her charge’s abilities. Because Mr. Gillon could do nothing at all. He was a wonder to me, a mystery, and a question, the question being, why were we taking care of him in the remarkable way we were?
Not that there was any alternative. Besides, I enjoyed taking care of Mr. Gillon—it was so very impractical. He was never going to get better and be discharged; he was never going to marry, get a job, and become a productive member of society. In spite of or because of this, I took pride in taking the best possible care of him.
But over the years, I did get something from him. Something special. Sitting in his chair with his hands in his lap, his face peaceful and alert, his eyes open though blind, Mr. Gillon came to remind me of those Egyptian statues of the Sitting Scribe—silent but listening, blind but aware, noninterfering but observing. Whenever I walked past him in that busy, hectic ward, repository of so much damage, so much sadness, Mr. Gillon recalled me to myself. He reminded me that there were more ways to be of use than to be of use; that there was something to be said for pure existence; that none of us knows what is valuable to God. Isn’t the Buddha’s description of nirvana “no eyes, no ears, no nose, no tongue, no body, no mind”? And hadn’t Mr. Gillon unwittingly achieved it?
Mr. Gillon went to school every day. A bus took him in the morning and brought him back at three o’clock, just in time for his snack of graham crackers and orange juice. In the morning the nurses dressed and buttoned him, fed him, and combed the remaining hair over his bald spot, and did it all in reverse when he returned. I was responsible for his medical care. I managed his complex seizure disorder and his occasional pneumonia; I made sure he had his flu shots, his monthly checkups, and his annual physical examinations, and I can assure you, Mr. Gillon was in tip-top health.
Christina was proud of Mr. Gillon, as she demonstrated for me on my second day.
“Come over, Dr. S., and see what Jerry can do.”
I closed the chart I’d been reading and followed her out of the nursing station. Mr. Gillon did have a nice little blind smile, I thought. His clothes were neat and clean, and as we approached him, his head turned a little as if he heard us.
We stood in front of him.
“Jerry! Clap your hands, Jerry!” Christina shouted in his ear. “Clap your hands for Dr. S.!”
She waited.
Nothing happened.
“Jerry! Clap your hands! Show Dr. S. what you can do!”
Mr. Gillon made no sign that he had heard. Christina’s words seemed to hang in the air and then one by one float across the three feet that separated us from him. All of a sudden, his face brightened, and he raised both stubby, uncallused hands and moved them together in a sort of clap, three times.
“There!” Christina smiled. “He can clap his hands.”
Christina knew things like that about all the patients, which weren’t unvaluable to know. For instance, asking Jerry to clap his hands was the best way to tell whether he was sick. It was a mini mental-status examination and a lab panel rolled into one, and over the years I found myself more than once shouting in his ear, “Jerry! Clap your hands!” If they lifted up and moved together three times, then I was safe; he was well. If they didn’t, then X-rays, blood tests, and antibiotics were indicated.
Christina knew about the families of the patients—the divorces, the remarriages, the stepchildren. She knew the foods the patients liked and disliked. She knew the medications that had been tried over the years and why they failed; she remembered the tests whose results our overzealous medical records department removed from the chart. If I had a question or an answer, an idea to try, or a concern about a patient, I asked Christina.
On the other hand, Allen, our male nurse, was the peacock of the staff. He was slim, with even features and a proud, self-conscious carriage. He didn’t talk much. His pride and joy was the BMW he bought with his hard-earned wages. Which he never drove to work, he confided to me once; he took the bus. On the weekends, he would polish that BMW and take it out on the desert roads at 120 miles an hour. Allen was a peacock in the way that all the male Filipino nurses played peacock to the reserved peahens of the female Filipina nurses, who, though they appeared deferential, were in charge. Perhaps it was the matriarchal culture of the Philippines, but it always gave me a sense of camaraderie with those male Filipino nurses. They, too, were subservient and a little afraid of the more powerful opposite sex.
Allen followed Christina’s lead, and they tag-teamed their vacations, their weekends, and their sick days. It was hard work on E4, and I never knew how much it meant to him until later, after E4 was disban
ded, its patients and nurses scattered. Allen was scattered to Dr. Kay’s hospice unit, where, I heard, he wasn’t doing well. He was slumping, gaining weight, losing his vital force in the same way that the hospice patients did, though they were supposed to. We ran into each other—Allen on his way, I am sorry to say, to the morgue with a body.
“Dr. S.!” His face lit up. He gave me a hug.
“How are you doing, Allen?” I asked.
He raised an eyebrow, rolled his eyes, and looked at the gurney he was pushing. “They’re too efficient down there,” he said. “I don’t like it. I like trying to get patients better, keep them alive. Not the opposite.”
“We don’t like death much, do we, Allen?”
“No, Dr. S., we don’t. I really do miss you and Christina and Lacy and the patients on E4.”
Lacy was E4’s activity therapist. She was big, with wide hips and big breasts, and quite black, with round, merry eyes, and the resonant contralto that went with her body.
Lacy knew quite a few of the patients, “our boys,” as she called them, from some past life she’d led before she came to Laguna Honda. She played poker and blackjack with them. She read them the news and showed them a lot of terrible movies. But mainly she teased them.
“Now, Mistah Bill, why don’t you want to par-tic-i-pate in our little game today? ’Fraid ya gonna lose, hunh? ’Fraid Mistah Gillon’s gonna win, hunh? Come on, just try one hand …. Hey, you got the jack right off!”
It was Lacy who made it possible for Mr. Simon Scurly to get back home.
I can’t say I took to Mr. Simon Scurly. The name, for starters, referencing scurrilous, and Simon, as in the master of some old Southern plantation, which is most likely how Mr. Scurly got his name. Nor was Mr. Scurly handsome and flirtatious. He was irritable, suspicious, and angry. He didn’t want to be in the hospital, he told us, and he didn’t have to be. There was nothing wrong with him. His landlord just wanted his rent-controlled apartment, and he was fair game, being eighty-two years old and a black man.
But there was quite a lot wrong with Mr. Simon Scurly, or so the visiting nurses told me. He’d ignored his diabetes for so long that now he was almost blind. He’d lost a leg from the poor circulation that diabetes can sometimes cause. He was anemic with a low red blood cell count. He didn’t eat right, and he wasn’t able to give himself his twice-daily insulin injections. Worst of all, his diabetes had apparently affected the nerves to his bladder and his gastrointestinal tract, and he was no longer able to control his excretions. Which was, as it so often is, the last straw.
Mr. Scurly, stocky, a freckled brown, and bald, did not agree with any of this. He was fine, he told me, Christina, Allen, and Lacy. He didn’t need the insulin, and if we let him go home, he’d manage. It was just those workers the city sent over to his house—he glared at us—interfering women!
I had more time to fuss with my patients on E4 than I’d had on the admitting ward, and for Mr. Simon Scurly this was a good thing. Because, as I realized after a while, he was right about the insulin. The visiting nurses had been giving him just the tiniest amount of insulin, an amount so small that if you need that amount, you don’t need insulin at all, and when I stopped it—sure enough—Mr. Scurly was fine without it. It was the same with his blood-pressure medication. He was taking it three times a day, but in tiny doses, and I discontinued it, too, without a problem. Mr. Scurly did turn out to have a bladder infection, but after that was treated, and his gastrointestinal tract tuned up, he regained control of his functions, as my patients so delicately refer to the condition.
So one day we looked at one another—Christina, Allen, Lacy, and I. Maybe we could send Mr. Scurly home. We could arrange for visiting nurses, Meals on Wheels, a case manager, a social worker …. What did Mr. Scurly think of that? We asked him at our monthly meeting.
He didn’t need any strange ladies from welfare knocking on his door is what he thought of that, and, he told us, he wouldn’t let them in.
“Just send me home,” he insisted. “I’ll be all right.”
We wanted to send him home, but we were worried. Someone needed to keep an eye on him, and he had no family. But he did have Lacy.
“I’ll go by and see him, Dr. S.,” she volunteered. “He doesn’t live too far from me, and he likes me. He’ll let me in. I’ll make him a pot roast on Saturday. You’d like that, wouldn’t you, Simon? I’ll go by after work a couple of times a week and check up on him.”
We did send Mr. Simon Scurly home, and he stayed home until he died, two years later. Lacy continued to watch over him, and now and then she made him dinner in his own kitchen. It pleased me to imagine the scene: that warm, genial woman, young and pretty, big and black, joshing him in his own kitchen, with him sitting, smiling and thrilled, at his Formica table.
I did wonder what the Department of Justice and the Davis lawyers would have thought of Mr. Scurly’s discharge. Would they have approved because Mr. Scurly was not in an institution but in the community? Or would they have disapproved because his discharge depended on the unmonitored charity of a staff member? At any rate, Mr. Scurly’s discharge meant that E4 now had an open bed, which is how I met Paul Bennett, and how, in a manner of speaking, I fell in love.
Nine
HOW I FELL IN LOVE
ON PAPER, and doubtless on the computerized minimum data set form, Paul Bennett was just another of the difficult patients that Dr. Stein was trying to send over—an abuser of cocaine and alcohol, homeless, angry, and self-destructive, with an incurable physical illness. Which shows you just how wrong a form can be, even one with 1,100 little boxes.
The first time I met Paul, he’d been transferred to E4 from the admitting ward, and he was in bed. As soon as he saw me walking down the ward, he went on the offensive. The nurses weren’t changing his dressings correctly, he complained, and his foot was getting worse. He needed to smoke, and he had no wheelchair; plus he had an appointment at the County Hospital. And had it been arranged? Then he glared at me.
He was dark brown and very thin. His cheeks, with their wisp of black beard, were hollow, and his black hair was short, frizzy, and thin on top. He was a tall man and too long for his bed, so that his remaining leg, the one that hadn’t been amputated, was pushed against the end with the foot pressed into the railing. He was unshaven and unwashed, angry and irritable.
And yet there was something about him. Perhaps it was the way he held his head straight on his neck or the way his jaw jutted out. Or perhaps it was that he was not flirtatious; his clear brown eyes had grown-up in them; they didn’t beseech or seduce; they looked into mine frankly, if irritably, as one deserving Self to another.
I’d already spoken with Dr. Romero, and I knew that Paul’s main problem was “peripheral vascular disease.” This is a vague but bad diagnosis that means the circulation to the legs is poor because the arteries have been blocked by blood clots or cholesterol plaques. It usually develops in the elderly, and it was rare to have it, as Paul did, at the age of forty-seven.
It all started, he told me, when he was working at the Monte Antique Show, arranging the furniture for a display. A credenza fell on top of him, and his left hip snapped, which was weird because he was strong and healthy and only forty-two. He was taken to the University Hospital, and they replaced his hip, but after that, he had nothing but problems with that left leg. It hurt him all the time, and his doctors discovered that the main artery to the leg was blocked by a blood clot. So he had another surgery, and they tried to bypass the blockage using one of his veins. But that vein clotted, too. The surgeons tried three times, in three different bypass surgeries, and every time the blood vessels they used clotted.
Then the same thing happened to his right leg. Although he didn’t break the hip, it deteriorated on its own and had to be replaced, and after that, the circulation in his right leg went, too. He had to have that artery bypassed several times. Yet his hips and legs kept hurting him even after he’d had both hips replaced twice and the
blockages in his arteries bypassed four times. Then several months ago, his newest right hip had dislocated out of its socket, and the doctors put him on bed rest. But while he was on bed rest, his left foot got infected, and even with antibiotics, it didn’t get better. So he was admitted to the County Hospital, and the surgeons amputated the infected toes. But because of his bad circulation, that amputation did not heal, and they operated again, and this time they amputated his entire lower leg. The leg still didn’t heal, and they amputated it high above the knee, leaving him with a stub. The stub healed, but he’d had to spend most of his time lying on his right side, and now he had sores on his right foot and a bedsore on his right hip. Plus, he’d lost his job and his place, and everything he owned was now in storage.
Did he have any family or friends? I asked him.
Divorced. He didn’t know where his ex-wife was, and he had a son somewhere.
What about drugs? Alcohol?
A long time ago. Not anymore. Heroin, cocaine, alcohol, but he’d worked hard on that.
How did he get the bullet in his back? The one Dr. Romero had seen on X-ray?
Oh, that. He got that driving a cab, and he didn’t want to go into details.
I examined him. The stub had healed, but the right leg was a mess. I couldn’t feel a pulse in the right foot, and there were several soupy sores on the sole and along the side; the skin over the right hip was gone, and there was a deep, infected hole instead.
It was tragic, and yet it was predictable: In trying to keep him off his left leg so that it could heal, his doctors had had him lie on his right hip, which had developed a bedsore. And here he was on E4, for us to try to heal it and get him home.
God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Page 23