Tuesday, December 25, 2012

Night Clinic


                     

Another night in the Free Clinic; I’m not sure it’s worth five hundred an hour and it’s a full moon. There’ll probably be werewolves in every room.

“Dr. Barnes there’s a patient in room 2, infected leg, I think.”

“Thank you Miss James,” nice legs, I thought, staring at my assistants shapely calves.  Keep your mind on work Jimmy boy.

I opened the door and was immediately greeted by an overwhelming pungent force, a combination of month’s old sweat, unwashed clothes and rotting flesh. I called out into the hall. “Miss James, could you help me or send someone in here please?”

“There’s only me tonight, just a moment, doctor,” came the reply from down the hall.

I turned to the patient and tried to smile, while doing my best to keep my dinner down. “Mr. Smythe, I’m Dr. Barnes. What seems to be the problem?”

“It’s these legs, doc. Last month at the clinic they told me they was all healed, but now look at them.” He smiled a broad smile revealing his three remaining teeth and bent over to roll up his pant legs. Crusted dirt fell to the floor. The pants would not roll up over his swollen limbs.

“You’ll need to take them off,” I suggested. Where’s that nurse or aid or somebody.

I helped him unsnap the beltless pants and started to slide them down. He was wearing underwear, at least, although it was stained brown and tattered. As his trousers hit the floor they didn’t crumple into a heap; instead they almost stood up by themselves. His legs were just as I expected, swollen to three times normal size, colored a mixture of violet and brown with valleys of green black tissue, pus dripping from each wound. The ulcers on the left leg were cleaner, crawling with tiny maggots gorging themselves on the dead tissue, while leaving the healthy, vital tissue behind.

“Mr. Smythe, it appears your venous stasis ulcers have returned. How long have you had them?”

Mr. Smythe stroked his gray beard and a roach fell to the floor. “Well, I had those blood clots about ten years ago and ever since then my legs have been swolled up and these sores come and go.”

I looked at his legs again. His thighs sported the healed scars of previous skin grafts. The ulcers had only minimal cellulitis and did not seem to extend to the fascia or muscle. At that moment the nurse came through the door.

“Miss James, I need to clean up these leg ulcers and we need some ethyl chloride for our little visitors here,” I ordered while pointing to the maggot infested wound on the left side.

Together we cleaned up Mr. Smythe’s wounds, removing dead tissue, pus and maggots. I debrided the right leg, while the maggots had done an excellent job on the left, leaving healthy pink tissue behind. We dressed the wounds with sterile gauze and offered to transport Mr. Smythe to the hospital for admission. He politely refused; we gave him a follow up at the wound care clinic, advised him to keep his legs elevated as much as possible, gave him enough gauze for a week of dressing changes and the address to the nearest homeless shelter. He smiled as he left and I went on to my next patient.

Left breast pain; Evella, an unusual name, I thought as I marched through the door.

“Good evening Miss Evella…” I started to say, before I was interrupted.

“I am Evella, Goddess of the Night, young man,” she exclaimed in a loud, melodious voice.

“I’m sure you are, Miss Evella,” I replied in a flippant manner. Sitting before me was a lady, mid fifties, probably over three hundred fifty pounds, white hair on the right and jet black hair on the left, dressed in a skin tight black dress with a neck line that plunged to her navel, but covered by a sheer silk shawl. Despite this covering, her ample cleavage, along with tattoos depicting skeletons, angels, demons and black snakes, was clearly visible.  The left breast didn’t look right, even through the sheer covering. She smiled, revealing her tongue pierced by six gold rings and her top and bottom incisors sharpened into sharp fangs.

“OK, Miss Evella. It says you are having problem with your breast?”

“Please address me as Evella, Goddess of the Night, little man.”

“Very well, Evella, Goddess of the Night, and I am Dr. Barnes. Now how long has your breast been hurting you?”

“What does it matter to you, doctor. It’s obvious you don’t really care. You look at me and think, ‘another crazy old woman, I’ll try to be cordial.’ Meanwhile your body language patronizes me more than your words and your eyes are already looking towards the door and your escape. You don’t have to answer, Dr. Barnes, that look on your face has answered for you. Well, let’s get on with it. My breast has been hurting for about six days. I tried Advil and warm soaks, but now it’s red and swollen.”

I looked into her eyes and then looked away, a bit embarrassed, not at the prospect of examining her breasts, more because she had figured me out so quickly and so completely and called me out on it.

“Was it painful at first?” I asked.

“No, it was just red and swollen. The pain started to be really bad yesterday and I can hardly stand it. I tried some of these, but it only got worse.”

She handed me a bottle of pills, Keflex, expired in 1998.

“How’s your health besides this?”

“Oh, the usual, diabetes, high blood pressure, high cholesterol. Here’s a list of my meds and allergies. Dr. Stanly Fried is my regular doctor.”

I examined the list: Lipitor, Metformin, Metoprolol. Allergies to Codiene, Demerol, Dilaudid, Morphine.

“You’re allergic to lots of pain meds. What happens when you take it?”

“Let’s just say me and narcotic pain meds don’t get along, Dr. Barnes. Aren’t you going to check my breast?”

“Right away, Evella, Goddess of the Night. I’m just waiting for the nurse.”

At that moment Miss James popped her head in. “Do you need any help Dr. Barnes?” She smiled a broad smile and showed me a bit more leg than necessary.

“I need to examine the goddesses’ breasts. Could you get her ready? I’ll be back in a minute.”

I stepped out into the hallway, took a deep breath, waited about a minute and then stuck my head back into the room.

“She’s ready Dr. Barnes,” Miss James informed me.

“Good, thank you,” I answered. “Lay back and put your arm behind your head,” I instructed the Goddess. I lifted the gown away to find a red edematous breast, skin dimpled, a hard mass in the axilla; clearly inflammatory breast cancer.

“How long has this breast been swollen, Evella, Goddess of the Night?”

“Maybe a few weeks. Is it something bad, Dr. Barnes?”

“It looks like what we call inflammatory breast cancer. Have you noticed this lump under your arm?”

“Not really,” she replied. “Is it bad?”

“I can’t say for sure without sampling the tissue, but it is almost certainly a type of cancer. You’ll probably need chemotherapy.”

I went on to explain the serious nature of her condition, that a biopsy would be necessary and I gave her the name of an Oncologist at University Hospital, and I called him to let him know that she would be seeing him Monday morning. She thanked me for my time and disappeared into the night, clutching the paper with name of the Oncologist and the time of her appointment two days hence.

Are there two full moons tonight? Please make the next patient a sore throat. I picked up the chart outside the door to Exam room 6: Edward Hyde, anal pain. Probably a thrombosed hemorrhoid, finally, something simple.

I knocked and then went into the room.

“Mr. Hyde, I’m Dr. Barnes. What seems to be the problem?” A middle aged man stood in the corner, impeccably dressed with a brown derby on his head, black overcoat and pants and fancy, black polished shoes. He fidgeted a bit and had a distressed look on his face. Must be a thrombosed hemorrhoid.

“Pleased to meet you Dr. Barnes,” he answered with a slight British accent. “I have this sharp, throbbing pain in my bum, for five days now.”

“Have you had pain like this before?” I asked, a routine question. “Any bleeding or swelling?”

“This is the first time, doctor, no bleeding, but it feels as if my backside is the size of my hat. I suspect it’s a thrombosed hemorrhoid. I have had some medical training as a doctor of sorts.”

“Let’s take a look, OK?”

He changed into a gown and I checked his backside which confirmed a single, thrombosed external hemorrhoid.

“You are correct, Mr. Hyde or should I say ‘Doctor’, a thrombosed hemorrhoid. I can remove that for you now if you wish.”

“Thank you, Dr. Barnes.”

I set up a procedure tray and slathered Mr. Hyde’s swollen bottom with four per cent lidocaine and took a ten minute break while the lidocaine kicked in. Nurse James was in the break room, smoking a cigarette.

“Those are bad for you, Nurse,” I remarked.

“Oh, I know, but sometimes these nights get to me and I just have to have something to calm me down. I only smoke when I’m stressed out. Full moons always do it to me. I guess it’s the werewolves.”

“I haven’t seen any werewolves, Miss James. We’re in the middle of a city. Do you really believe there are werewolves out and about?”

“No doubt about it; there were four, no five, that came in last month. There was some big rumble between the vampires and werewolves and some of those boys were pretty beat up. Dr. Lyons spent five hours sewing them up.”

“They didn’t try to attack poor old Jack?”

“Well, they were a bit vicious at first, but five of Dilaudid and four of Haldol kept them quiet. We kept them locked up until the sun came up, they reverted back to their human forms and then they left quietly.”

I put werewolves out of my mind as we left the break room to lop off Mr. Hyde’s thrombosed hemorrhoid.

“OK, Mr Hyde, this might sting a bit,” I warned as I cleaned the area around the hemorrhoid with some betadine. A purplish hemorrhoid the size of a jalapeno stared at me. I grabbed the syringe filled with lidocaine with epi and started to inject. I felt my patient tense up as I numbed the area, but, beyond this normal response to my jabbing him with a needle, the area around the hemorrhoid changed. The skin became a bit darker and hair popped up on his buttocks. Don’t tell me he’s turning into a werewolf.

“Are you alright, Mr. Hyde?” I asked, but he only answered with a grunt.

“Miss James, is everything OK?” I asked again, a touch of worry in my voice.

“Vitals are normal, Doctor,” she answered.

I grabbed the nasty hemorrhoid with a clamp and started to cut along its base. Halfway through there was a loud “BANG” and a crash.

“Mr Hyde, what’s gotten in to you,” Miss James yelled, her voice now filled with alarm.

Before I could finish snipping off the offending hemorrhoid, Mr. Hyde had jumped off the table and was flailing away with his walking stick, a heavy wooden staff with the head of a wolf sculpted in to its top. I grabbed Miss James hand and we raced out of the room. Shortly afterwards Mr. Hyde followed. Only he had changed. His face had grown long, unruly whiskers, his white teeth were now yellow and crooked, his hands had hair on the knuckles and his manicured fingernails had become long and dirty. He was hunched over as he bolted out of the clinic and into the night.

“He should have less pain from that hemorrhoid anyway,” I concluded as I held up the clamp with the offending tissue held tight within its jaws. Will this night ever end? I went to the break room for a cup of coffee before seeing my next patient, a Mr. Pire, Chief Complaint: anxiety and suicidal ideation.

I glanced at Mr. V.M. Pire’s chart before going into the room. The space for age was left blank, his vitals were: BP 60/30, heart rate 40, respiratory rate 12, temperature 92.

“Miss James, are these vitals correct,” I asked, not believing the numbers.

“Took them three times, Dr. Barnes, but there’s no need for alarm. You’ll see what I mean when you see Mr. Pire,” She answered in her most professional tone.

This night gets more bizarre every minute. I took a deep breath and let it out slowly, knocked on the door and went in to see Mr. V. M. Pire. I saw a pale, young man sitting on the chair in the corner, dressed in black pants, black shirt and wrapped in a black coat. Even with his coat he looked cold, shivering, his arms held tightly across his chest.

“Good evening, Mr. Pire. I’m Dr. Barnes. What brings you in here today?” I asked in my usual doctor’s bedside tone.

“What’s that supposed to mean? Do you think that I changed myself into a bat and flew in. Or maybe I just danced along the full moonbeam. I know what you’re thinking: Another deluded, crazy who can’t cope with reality,” he spouted with venom in his voice.

“Actually, the way this night has been going, I was truly expecting a vampire. Who else could have vital signs like yours and not be in a coma? So tell me, what’s the problem? If you don’t want to say, you are free to leave. I have plenty of other sick people to attend to.”

He calmed down, stood up and started to pace around the room.

“I’m…I’m not sure where to start. You see, I…I’ve been having these fantasies and, well, with the full moon and everything, I just couldn’t stand it. I even went to their meeting, thought about joining in their activities.”

He paused for a moment. I could see he was upset and I tried to calm him down. I put my arm around him and lead him to the chair. He almost had tears in his eyes. “Go on,” I said in a soft voice. “What are these fantasies?”

He looked at me with his dark, deep set eyes. “To be a wewuff,” he whispered in a muffled voice.

“I’m sorry, I didn’t understand what you said,” I replied with true concern in my voice.

“To be a WEREWOLF,” he answered loudly. “It’s driving me crazy. I know it’s ridiculous. I mean, I’m a vampire, the best of the best. Last month I downed six units of AB neg in under thirty seconds, all from the same vic…same donor.”

“Sit down and tell me about it,” I suggested, doing my best to imitate a Psychiatrist.

“I guess it started last full moon. I was out at night, like usual, and, as I was flying around the neighborhood, thinking about dinner, I saw a whole pack of them, werewolves. They were circling around some helpless wino and then they attacked. After their kill they all howled at the moon, gave each other high fives and then there were the girls. Dozens of them, all gathered around these vicious beasts, oohing and awing. Meanwhile, every night I’m out, shivering, looking for blood. Alone, hated by everyone, even other vampires who would just as soon cut your head off as share a drop of their precious stash.”

“It must be a tough life,” I observed.

“You don’t know the half of it. Dr. Barnes. So, a couple of weeks ago, I’m laying in my coffin, trying to sleep. It must have been noon and I start to thinking, Wouldn’t it be great to be a werewolf. Get to wear a fur coat, not be cold all the time, only worry about being a vicious monster once a month. Then I say to myself, ‘Get over it, you’re a vampire, you’re better than them.’ But, I can’t get over it; I can’t get the thoughts out of my head. I tried to talk to one of the Elders. Well, you would have thought I was wanting to become a priest, the way he reacted. After that I got scared, I guess, and then I went to see them tonight. All the werewolves were gathered together, I even went inside, tried to meet them. As soon as they saw me they surrounded me. ‘Look at sissy boy,’ they taunted. ‘Afraid of the big bad wolf?’  I tried to talk to them, but they just laughed. I left, feeling more and more depressed. I just wanted to end it all. I even broke into the hospital and stole this.”

He held up a case of thrombin.

“A couple of swigs of this, then all my blood congeals and it’s the end. Well, I got scared and I wasn’t sure what to do. I saw the Clinic sign and decided to stop in. So, here I am.”

I stared at him for few moments, not sure what to say or do.

“Let me get you a blanket, you still look cold,” I observed. “Stay here, I’ll be back in a minute.”

I stepped out into the hallway where Miss James was waiting.

“Dr. Barnes, you look a bit pale. Mr. Pire didn’t attack you, did he?”

“No, Miss James, he only told me his troubles. I need to find the number to that Psychiatrist, the one that takes charity cases; Dr. Van Something….Van Helsing. Here it is. Oh and I need a blanket and a couple of milligrams of Haldol, for the patient, not for me. Thanks.”

I went back in armed with the blanket, a syringe filled with Haldol and Dr. Van Helsing’s office number. I made a mental note to call Van Helsing later this morning and let him know about the referral.

“OK, Mr. Pire. I’ve got a shot for you that will help you calm down and here’s the blanket I promised. Oh, and this is the number to a Psychiatrist I know. He’ll take care of you for free. He does amazing work. After a few visits you’ll forget that werewolves even exist. Now I need you to roll up your sleeve.”

I gave him the shot and let him sit in the room for about thirty minutes, wrapped in the blanket. I definitely needed a few minutes alone after my visit with him and took refuge in the break room, drinking coffee while Miss James took care of a baby with diarrhea and a teenage boy with a sprained ankle.

After finishing my coffee I stuck my head into Mr. Pire’s exam room and saw him sitting up, smiling, the blanket neatly folded on the exam table. He was holding his black jacket and, although still with a ghostlike pallor, he appeared to be in much better spirits.

“I feel much better, Doc. That shot really did the trick.”

“I’ll give you a prescription, Mr. Pire, and don’t forget to call Dr. Van Helsing after nine this morning. I don’t want to see you back here again.”

“Thanks a lot, Dr. Barnes. It is a bit hard for me to call during the day, but I’ll do what I can. Say, you don’t happen to have any old pints of blood laying around, you know, a bag that might be expired that you’re going to throw away anyway?”

“Sorry, we don’t. Good night, Mr. Pire.”

“No harm in asking. Good Night, Dr. Barnes. See you around.”

As he walked into the night, I heard a loud bang followed by howling.

“They’re here, Dr. Barnes, worse than last month.”

It was Miss James at the front door, which she had locked. Outside stood a half a dozen creatures, half upright, cloaked in brown and black fur, displaying long white fangs, deep red eyes and unpleasant dispositions. I looked at the clock, four am, still two and a half hours until it was light.

“Shouldn’t we call the police?” She asked, fear in her voice.

“Take a close look, Miss James. They are the police.”

The six monsters each had a shiny gold badge pinned to their fur and a few sported remnants of the blue police uniform. I thought for a moment and then turned to my frightened companion.

“Let them in, Nurse. We’ll deal with them. Oh, do we still have that nitrous  canister, you know, the one we use for little kids?”

Miss James smiled and replied in the affirmative.

“Could you please wheel it into exam room eight, thank you.”

We left the front door unattended, locked every exam room but number eight with its door left ajar. I put some old food from the fridge, along with some bloody gauze bandages, in that room, opened the nitrous tank and let it flow. It wasn’t long before the entire police force had broken in to our clinic and, following their noses, went straight into room eight. They attacked the food and the scent of blood made then even wilder. I quietly emerged from room seven and slammed the door to eight shut and locked it. After ten minutes the growling ceased. Miss James and I relaxed while we closed the clinic for the night and surveyed the damage. The front entrance was torn off its hinges, furniture upended and torn in the waiting room and there were bloody stains on the floor and walls.

A short time later the sun came up and we let the town’s police force out, gave them paper gowns to wear home as they sheepishly emerged wearing nothing but their badges and slight grins. As they left I presented the Chief with a bill for the damage done, the cost of a tank of Nitrous Oxide and use of the exam room for two and a half hours.

The day shift crew arrived thirty minutes later and Miss James I left together, went to PJ’s Diner for breakfast, both of us vowing never to work Night Clinic during a full moon again. At least not until next month.

Look for more episodes of “Night Clinic” in the weeks and months to come.