Requiem for the Bone Man

by R. A. Comunale

  “I’m Bob Galen.”

  Definitely not from the South by the sound of his voice. New York?

  “Where you from, Bob?” The soft, lilting sway of a Virginia gentleman came through.

  “I’m a carpetbagger, Bill. Just got in from New Jersey.”

  “Didn’t we beat you guys at Appomattox?” He waited to see the Yankee’s response.

  “Sure, and Jeff Davis is president.”

  They took an instant liking to each other, and Bill thought he knew why. There was something melancholic about the big guy—something he could relate to—only he knew it couldn’t be worse than his own burden.

  “Damn, it’s the Benadryl Lady again!”

  “Who’s that, Bob?” Crowley saw the frustration in his partner’s face as the elderly black woman walked through the ER doors.

  “She’s a waste of time. You know the routine. She comes in complaining of being ‘short of wind.’ She’s had every asthma and heart workup we’ve got—but there’s nothing wrong with her. All she wants is a shot of Benadryl!”

  “How about I take a crack at her?”

  “Yeah, fine. There’s a DOA coming in. I’ll take that one while you go nuts with our frequent visitor.”

  As Galen skulked away, Crowley sat down next to the doll-sized figure sitting in the emergency room waiting area. She was dressed in a petite yellow housedress with a checkered apron-like front. Her hands kept twisting and untwisting a pale pink cloth handkerchief.

  “What’s the trouble, ma’am?”

  He reached over and held her mahogany-colored hands in his own pale white fingers. He could feel the arthritis and the tension in her.

  “Can’t breathe. Mah wind’s short agin.”

  “Please tell me more.” He studied her body language, the words not spoken.

  “Ah was sittin’ theah in mah livin’ room an’ it come on me.”

  “Was anyone with you?”

  He felt her fingers tighten and her body begin to tremble.

  “Mah son dun come in fra’ work.”

  “Then what happened? Did he try to help you?”

  “No, suh. He wer havin’ de shakes.”

  Now it made sense.

  “Ma’am, did your son have the shakes the last time you lost your wind?”

  Her tension increased. “Yassuh.”

  “I think I can help you. Excuse me for a moment.”

  He got up and went to the nursing station.

  “Annie, could we get Social Services down here? I think the Benadryl Lady’s real problem is an alcoholic son.”

  “Yes, Dr. Crowley,” she replied, watching him walk away.

  Strange to find compassion in such a young man.

  Dr. Crowley!

  Not yet, he thought, but it sounded so good! And coming from a nurse with more experience than most of the doctors working the ER, it was a real compliment.

  The night proceeded with the usual knife, gun, and club injuries, plus chest pains, earaches, and stomach cramps. Galen and Crowley worked well together, and soon the full waiting room was emptied.

  “Let’s take a quick break, Bill. That was a good call with the Benadryl Lady.”

  “Thanks. I think there’s a coupla sodas in the fridge.”

  They sat in the back lounge, and Galen recounted his experience with the person who was brought in dead.

  “You know, Bill, I remember getting that man as one of my admissions last year. He’d come in to the ER with chest pains, and they sent him up to rule out a heart problem. That, to me, was a dump job from someone here who didn’t want to spend the time evaluating him.

  “Anyway, here I am, it’s 2 a.m., and I’m talking to this poor guy who’s scared out of his mind that he’s going to die. Seems every male member of his family died at age forty-five. He had just had his forty-fourth birthday and was starting to get chest pains even lying down. So I did the million-dollar third-year student exam on him, and guess what? Nothing, absolutely nothing! The only positive bit of information I had was that damn family history—every male on his father’s side gone at forty-five.

  “So, Stottler walks in at 6:30 for rounds and I give him my workup. He tosses it on the table and we all follow him like a royal entourage to the guy’s bed. Stottler stares at the guy, listens for about ten seconds with his scope then turns to us.

  “Pompous jackass that he is—and you’ve suffered with him, too—he doesn’t even bother to lead us out of the room. He stands there in front of this terrified guy and starts berating him for being a hysterical personality with conversion reaction symptoms. In short, he was calling the guy a fake, a malingerer. He points at the resident and orders him to discharge the guy. When the resident starts to ask for at least a day for more testing, Stottler gives him that drop-dead stare of his, and the resident backs down. The guy goes home, and I felt so sorry for him it surprised me.”

  Bill looked at his friend and nodded. “There’s still hope for you Northerners.”

  Galen laughed, then caught himself and continued.

  “Well, tonight they wheel in the Go-to-Jesus cart from the ambulance, I pull back the covers, and there’s my man. His forty-fifth birthday was a month ago! Right now, I would love to have Stottler here. I’d shove his conceited mug right against that poor dead guy’s face and ask him how hysteria and conversion reactions did that. If nothing else, I’m going to make sure Stottler is the star performer at pathology rounds when they do the postmortem on him. And I’m going to be damned sure to emphasize that family history.”

  The siren of an arriving ambulance dispelled the hope of any further rest as it pulled into the ER driveway. It could be anything from a heart attack or trauma injury on down, so they waited, feeling the usual tension build in anticipation of what would come next.

  “Take it easy, guys. This one’s easy,” the ambulance driver said as he jockeyed the rescue cart through the doors, the patient covered from head to toe with a sheet—another Go-to-Jesus cart. DOA. Dead on arrival. All they had to do was make sure the vital signs weren’t there, sign the release papers, and send the corpse to the pathology department morgue.

  “Whose turn is it to do the pronouncing?” the floor nurse asked.

  Bill looked at Galen and reluctantly nodded. “You did the last one. This one’s mine.”

  “Dr. Galen, we’ve got a kid in sickbay 3.”

  “Call me if you need anything, Bill.”

  As Galen left, Crowley walked to the back holding area, where the dead were routinely wheeled to avoid upsetting the living. He unhooked the stethoscope from around his neck, reached down, and pulled the cover sheet back.

  My God! My God!

  The derelict stared back up at him, unseeing eyes open to eternity. Crowley fell to his knees and began to rock back and forth. His moaning got louder and louder until the crescendo ended in a wail.

  “Come on, Bill.”

  Galen had his arms around the shaken Crowley. He gently shifted him over to a folding chair then turned to the cluster of ER personnel staring at them.

  “It was someone he knew as a boy; someone who worked for his father.”

  He hoped that excuse was good enough. Quickly he signed the papers, handed them to the nearest nurse and asked one of the attendants to take the body to the morgue.

  “I’d better stay with him for a while. Can you get the intern to take my patient?”

  The floor nurse nodded, and the crowd left them alone.

  “Tell me what happened, Bill.”

  “I killed a man. I’m a murderer! God’s punishing me!”

  He was trying to curl up into a ball. Galen held his breath then said something he was not used to saying.

  “Tell me about it. Let me help you.”

  The story poured out between gasps and muffled sobs. Galen finally understood the underlying sadness of his friend. He looked within himself and realized he had found the meaning of the word empathy.

  “Dr. Galen, we got another one for you,” th
e floor nurse whispered. “It’s a little girl. Bad asthma. The family was just driving through on their way up north.”

  He heard a voice loudly calling for someone to help his granddaughter. It sounded familiar, but he couldn’t place it, and he didn’t have the time. The girl, about seven years old, was in status asthmaticus, the worst form of asthma, usually controllable only if you were lucky.

  He set up the IV drips to hydrate her as the nurse put the moisturized oxygen mask on her face. She was gasping, fish-mouthed in a desperate attempt to breathe. Her face was pale, her eyes closed. She didn’t even move when Galen inserted the large-bore needle into her tiny vein.

  He tried the standard approach first: adrenalin in 0.5 milliliter doses subcutaneously. No luck—she still struggled to breathe.

  Next, he started an IV drip of aminophylline. He hated that drug. Therapeutic dose and toxic dose rode side by side.

  He felt for an arterial pulse, found it weak and thready, and then jabbed the special needle into the artery and pulled back on the plunger, drawing her blood. When he had collected enough, he pulled out the needle, threw the sample into an ice bucket and handed it to the nurse, who took off down the hall to the lab.

  Five minutes later she returned with the numbers: still no change in arterial oxygen.

  He was growing desperate.

  “Nurse, would you get me an ampoule of IV Solu-Cortef?”

  “Dr. Galen, only the attendings are allowed to use that!”

  He looked at her, then at the girl who was still using all the chest-wall muscles she could just to breathe, then back at the nurse without saying a word.

  She unlocked the special cabinet and handed the small container to him. She was going to stay and watch. It was a CYA maneuver on her part. She could always say he had forced her to do it, but she also had heard that The Bear often pulled rabbits out of his hat in critical medical situations.

  What’s he doing? She had never seen a contraption like the one he was assembling. He was hooking up another glass IV bottle with Ringer’s lactate and injecting the whole vial of Solu-Cortef into it. Then he piggybacked the second bottle onto the first through a side fluid port in the plastic tube and opened up the flow. The girl was now getting both aminophylline and Solu-Cortef.

  Young doctor and veteran nurse stood side by side, watching.

  The trick, Galen knew, was to medicate without overloading her with fluids. She could die just as quickly from that as from her asthma. Children were not just small adults, and adult drugs often caused unexpected effects in them.

  Galen kept his fingers crossed. He wished he had access to some of the experimental drugs that he knew were now only in early development—beta-agonists, the pharmacology boys called them. But he had to use what he had.

  Slowly, the girl’s chest wall stopped its heaving. Her neck and rib muscles no longer distorted her face and torso with tightening. She began breathing more easily. Even her face was pinking up.

  Galen exhaled for the first time in what seemed like several minutes.

  “She’ll need to be admitted at least overnight for monitoring. Better let the on-call peds interns know they have a close one to watch.”

  The floor nurse left him with the little girl. He looked down at her.

  Maybe someday you’ll be famous, or you’ll do something good for humanity. Or maybe best of all, you’ll have a little girl of your own. Uh-oh, I’m getting maudlin!

  The gurney attendant arrived, followed by the pediatric admitting intern.

  “Good job, Galen. We’ll take her from here.”

  He started to walk to the nursing desk. As he approached the door he heard the nurse.

  “She’s out of the woods now. Would you like to talk with the doctor?”

  He pushed open the swinging door and the nurse spoke again.

  “Oh, here he is now. Professor Freiling, this is the doctor who took care of your granddaughter. This is Dr. Galen.”

  CHAPTER 7

  Crescendo

  Galen sat alone at the desk. All of the detox-unit patients had lined up and gotten their 11 p.m. medications. Now, he hoped, they were sound asleep and not causing any problems.

  Just a few more nights and I’ll be able to get that ring.

  He smiled at the thought.

  You’re getting soft, old bear. Can girls really do this to guys?

  He took out his notepad. Time for another letter to Dr. Basily. Actually, past time, he realized. Had things moved so quickly?

  The last note he had written was to pass along the name of the Hospital for Special Surgery, the only facility in the country experimenting in new back-surgery techniques that might help his old professor. That had been in January. Now it was April. Strange, the man hadn’t replied.

  Well, here goes:

  Dear Dr. Basily,

  I hope things are going well with you. Have you looked into that new back procedure yet? So much has been happening since we last wrote. Graduation is coming up in less than a month and, oh, yes, I’m buying a ring. Yeah, I told you about June. I think I’ll wait until May to propose, just before graduation. Never thought I would do that, did you? Now, if I can only survive doing extra shifts and ward work to pay for it!

  He paused, thinking of his beloved June. Hard to believe he was dating such an intelligent, good-looking, personable girl—or rather, that she was dating someone like him! He hoped she understood why he had been so busy lately. He hadn’t told her about the ring, but he was sure she wouldn’t be upset. She was so compassionate, so loving, so …

  Okay, hotshot, focus on the letter!

  People never cease to amaze me with what they say and do. Remember that first year when I told you about my trip down here?

  His mind drifted back to that six-hour train trip from New Jersey. He was still smarting from the final argument with his father, so he didn’t react much when the conductor walked through the coach car calling out in good humor, “Ladies and gentlemen, we’ve just crossed the Mason-Dixon Line. All you Yankees be on your best behavior, now, ya heah? Y’all now in the South!”

  He had gotten off the train at the Broad Street Station of the Richmond, Fredericksburg, and Potomac Railroad, the old RF&P, and sought out a bus headed for the medical school. As he boarded, he saw a seat two-thirds of the way back and headed for it. Suddenly he heard this voice yelling at him from the front. It was the bus driver. And what was he saying?

  “Boy, get yo’ ass back up heah! Now you listen up, boy. Ah knows you ain’t from aroun’ heah. But you stand right theah behin’ me.”

  What was going on? The whole bus was laughing at him! Then it hit him. The bus was an open Oreo cookie: front half white, back black! He knew about the various demonstrations building up in the South. But he also knew the rest of the country had its share of the same problem. The race riots in Boston, the riots and lynchings in 1920s Oklahoma, Knoxville, Detroit.

  He remembered taking the train into Manhattan when he was a child and wondering why some of the cars were filled with whites, while others were exclusively black. Pennsylvania Station had separate waiting rooms, bathrooms, water fountains, and snack stands for whites and “colored.”

  But the buses, well, seats were supposed to be catch as catch can, no matter who or what you were.

  This was different.

  Now, four years later, he could laugh at his former ignorance and relative innocence.

  Well, Dr. B., this next bit ought to top that little story. As you know, the junior and senior medical students here are the first lines of care for patients in the hospital. We get to do almost everything. My roommate Dave (aka Country Boy, aka Scarecrow) and I were assigned to the same ward, so we got to know each other’s patients. I was assigned an old gentleman who just happened to be the chief of one of the local Virginia Indian tribes. The chief had come in with what’s called unstable angina, heart pain not controlled by his nitroglycerin tablets. Dave was assigned to the chief’s roommate, Bobby Lee Withers, who ha
d shut his kidneys down drinking moonshine whiskey.

  It turns out that Bobby Lee is a dyed-in-the-wool Southerner who hates everyone from blacks to Catholics to ‘furreners,’ and is a full-fledged member of the Ku Klux Klan. My roommate is a good ol’ boy, so he knows how to talk the lingo with Bobby Lee. We would sit there and listen as Bobby told us about the meetings and the secret passwords and handshakes.

  Did you know that when a Klansman meets another man but isn’t sure if he is also Klan, he offers the secret handshake and says ‘AYAK?’ Are you a Klansman? And if the other guy is Klan, he answers ‘AKIA.’ A Klansman I am.

  It just so happened that Bobby knew of a KKK meeting coming up and Dave, devil that he is, dared me to go with him and see if we could sneak in. The passwords worked, although I got strange looks from the Klan guard at the tent entrance. The stuff we heard wouldn’t have made sense to a third grader, but all of those men were cheering and chanting.

  Then we got lucky, because I spotted one of our professors there, so we high-tailed it out before he saw us. (Note how I am picking up the lingo here. And I’ve been told I no longer sound like I’m from “Joisey.”)

  Bobby Lee didn’t make it through the kidney failure.

  My Indian chief, who reminded me of you whenever we talked about philosophy and other stuff, also didn’t make it. I miss him.

  You know that Dave and I are living in an apartment on Church Hill. I don’t think I told you about our neighbors and the time we were almost lynched. After seeing the difficulty the kids in the neighborhood were having getting medical care, we decided to set up a clinic in our apartment. Yes, I know, it really isn’t legal but, Dr. B., I have seen kids die from simple ear infections that spread to their brains because their parents didn’t have or wouldn’t spend the fifty cents for the pills that would have cured them. So Dave and I and our friends Bill, Peggy, June, and Connie decided to see the kids in the evening when we were there. We had some friends in the pharmacy department who saved us the antibiotics and other general stuff that was nearing expiration date but was still good. They normally just pitch it in the trash, so we thought it could be put to better use. We didn’t want or take any of the pain pills, like codeine, because that really would have gotten us into hot water.