Thursday, December 26, 2013

Next Night Clinic


“Come on, come on, change already,” I yelled at the light. “Finally. Seven Forty?, I’ll never hear the end of it… Move it up there… Stay green. Finally, there it is….Seven fifty five…I guess that’s not too late. And, it’s a full moon.”
I should never have finished watching that movie; should have left earlier so that I wouldn’t be late again. I’ve already seen it five times. Galaxy Quest. A stupid movie anyway. “Activate the Omega Thirteen*” and go back in time thirteen seconds; what; I need is the Omega ten thousand.
I tried to sneak in the back, but, no luck. Not only was Miss James not there, but the Medical Director was and he did not look happy.
“Sorry, I’m late, Dr. Olsen,” I tried to explain, “but I had trouble finishing my shift at the hospital and traffic was bad and I had to feed Jenny…”
Dr. Olsen just stood there with his arms folded across his chest. He wore black rimmed glasses, was short, bald, and round and he wouldn’t have known a varicose vein from a hemorrhoid. He was the ultimate pencil pusher, rules and regulations were all he knew.
“Jenny?” he asked in his squeaky, nasal, monotone voice.
“My dog, a mutt, part terrier, part collie, and a lot of parts we aren’t sure of,” I explained trying to lighten the mood.
“Stop, Dr. Barnes,” he held up his hand and shook his head. Beads of sweat landed on my scrubs. “I don’t care about Jenny. I don’t care about your other job. I don’t want any excuses. You’ve been warned repeatedly, we’ve even overlooked a few minutes here and there because you’re a good doctor, but fifty eight minutes is unacceptable. It’s my job to see that this clinic is properly staffed; twenty four hours a day, seven days a week, without interruption. I’m afraid that after tonight your services will no longer be needed here. Good evening.”
That was it. He walked out. No discussion, no appeal, nothing.
“That was rough, Dr. Barnes,” the nurse tried to console me. “I’m Judy, Judy Small. I usually work L&D, so I’ll need a little guidance. All the rooms are full. Fifteen year old with belly pain is in one, eighteen year old girl with a laceration of the arm in two, some sort of altercation I think; a patient with a headache in three and swollen legs in four.”
Just great. A rookie nurse, all the rooms full already and I’m out of a job. I knew I should have stayed in bed today.
I picked up the chart to one. Jeremiah Baker, fifteen, no medical problems, lower abdominal pain for two days. No fever, vitals normal. At least he should be fairly straightforward.
I knocked and opened the door.
“Good evening, Jeremiah. I’m Dr. Barnes. What is the problem you are having?”
“Hi Dr. Barnes,” he greeted me with an enthusiastic hand shake. “Jeremiah. I’m really happy to meet you.”
He flashed a huge, wide grin and then winced slightly, as he held his right side. I wasn’t a surgeon, but I already was making a diagnosis of appendicitis.
“What’s the problem you’re having?” I asked again.
“I’ve got this pain in my abdomen, right here,” and he pointed to McBurney’s point. “it started yesterday and just won’t go away.”
“Any nausea or vomiting or fever?” I continued, taking his history.
“I threw up once last night and I haven’t eaten anything all day. It’s appendicitis isn’t it Dr. Barnes. I’ve got all the symptoms don’t I?” and he flashed his grin again.
“So far I’d say you’re batting a thousand. Lay down here and let me check your abdomen,” I requested.
Jeremiah lay on the exam table as I gently palpated and percussed his abdomen. When I reached his right lower quadrant he visibly winced and the localized rigidity was classic peritonitis.
“Well, young man,” I began, “you almost certainly have acute appendicitis. I’m sure you’ll need an appendectomy, but we don’t do surgery here. I’m going to call Dr. Forstey at University Hospital and get you on his service. He’s a great surgeon and he’ll take good care of you. In the meantime, we’ll start an IV and give you some antibiotics and make the arrangements to get you to the hospital. Are your parents around?”
“My mom was here, but she had to go to work and left about five minutes before you came in, but I’ll call her,” Jeremiah said.
Then he added, “You know Dr. Barnes, I knew it was appendicitis. I did some reading and I knew I had all the classic symptoms. And, I’ve been studying really hard, because I’m going to be a doctor, like you. There are a lot of bad things which go on in this neighborhood, gangs, drugs, lots of crime, but most of the kids they know about you. They know that you come here from the University and that you care. That’s the kind of doctor I’ll be; one who cares.”
He gave me one of his big smiles and I smiled back.
“Thanks for the compliment, Jeremiah,” I replied. “Just lie here and the nurse will be in a few minutes.”
I scribbled some orders on his chart and called Nurse Small and told her to start an IV and begin Jeremiah on IV Zosyn. Then I called Zack Forstey and arranged for transfer to University Hospital. I moved on to room two and the lacerated arm.
I glanced at the chart for Kelly Montague, eighteen, laceration of the left arm. No medical problems, no allergies…
Hmm, did that boy with appendicitis have any allergies? I don’t remember what the chart said.
I went back to room one and looked for Jeremiah’s chart.
The nurse must have it in the back.
 I stuck my head in the room.
“Do you have any allergies?” I inquired. I saw Nurse Small hanging the IV fluids and the medication. One thing about those L&D nurses: they were really good at starting IV’s. I still did not see his chart.
“Not that I know of, Dr. Barnes,” Jeremiah answered. “Do you want me to check with my mom?”
I thought for a moment.
He’s fifteen; he should know.
“That’s OK. I’ll be back in a few minutes and the ambulance is on the way.”
I went back to the lacerated arm.
“Good evening, Miss Montague. How did you cut your arm?” I started what I hoped would be a short interview.
“I did it Doctor, I cut it. I wanted to kill myself. That’ll show that Gerald. He’ll miss me when I’m gone, that miserable creep,” she ranted.
Just what I need, a hysterical, suicidal teenager.
“Calm down, Miss Montague. I’m sorry about Gerald. I’m sure he is the biggest creep in the world, but I need to know about your arm.”
“How dare you call my man a creep. Who do you think you are, Mister Dr. Bigshot? Gerald is ten times the man you are. I’m not staying here and let you insult him and me. Good-bye Doctor Bigshot.”
And she stormed out of the clinic. Oh well, you win some and you lose some.
I made a note on her chart: “Left AMA, did not sign the form” and went on to the next patient, Elias Trowbridge, fifty three, with a headache for twelve hours.
I started to knock on the door when I felt a grab on my sleeve.
“Come to room one, something’s terribly wrong,” Nurse Small shouted. She was white as a sheet and her hand was shaking.
I raced back to one and found Jeremiah on the table, IV in his arm, he was blue from head to toe, convulsing and not breathing.
“What happened?” I screamed as I picked up the ambu bag and tried to ventilate him. I vainly felt for a pulse. “Get the crash cart and give me some Epi.”
I saw the bag of antibiotics hanging, half of it infused and strongly suspected anaphylactic shock.
“Epi, open up the IV, start chest compressions,” I commanded.
Nurse Small dutifully obeyed as I picked up the laryngoscope.
“All I see is a big swollen tongue. I can’t get passed it. Get me a scalpel.”
I’d never done an emergency trach or cricothyrotomy on a live person, only on a dummy, but I had seen my surgical colleagues do them. I saw no alternative at that moment.
I splashed some Betadine on Jeremiah’s neck, felt for the appropriate landmarks and started to cut.
There’s a first time for everything.
After an eternity of slicing through skin and fat and I’m not sure what else, I entered the airway. After a few missteps I managed to slide a size 6 ET tube in and stared to ventilate Jeremiah. I had been at it for a total of twelve minutes, but it seemed like twelve hours. Jeremiah wasn’t responding, however. No effort to breath, no pulse and the EKG was flat.
“Start CPR,” we said simultaneously. But, it was futile. He was gone.
Now what? Call Mrs. Baker and tell her, ‘Good evening, I’m sorry to inform you your son is dead. This night has gone from bad to worse.
“Dr. Barnes?”
“Yes, Miss Small.”
“I’m sorry. I don’t know what happened. I started the Zosyn and then, all of a sudden, he turned blue, he stopped breathing and started seizing. Was it something I did?”
I looked at her face. Tears were streaming down both cheeks.
“No, nurse. It was what I did.”  
Why is it always people like Jeremiah? Why do good people have to die? Why? Why?”
Where is his chart, anyway?
I left to go back to the break room, closed the door, sat down and stared at my hands.
“Dr. Barnes, please come to room two,” Miss Small’s voice sounded over the intercom.
I shook myself free from my moment of anguish and trudged down the hall towards exam room two. I heard a woman scream.
“What’s going on in…?” I started to ask as I bulled my way into the room. My question was immediately answered by the sight of a young woman, maybe fifteen years old, up in stirrups, obviously in labor. Miss Small was checking her as I walked in.’
“She’s ten and ready to push, Dr. Barnes,” Miss Small reported.
I hate delivering babies.
 “It says she arrived two hours ago. Why didn’t she transfer to the hospital?”
“With all the excitement, I guess she feel through the cracks,” Miss Small answered.
I glanced at her name, Barbi Genter, then I donned a gown and gloves and went to work.
“OK, Miss Genter, when I tell you to push, you push, like you’re trying to send this baby across the room. When I tell you to breathe, you should take quick, deep breaths until I tell you to push again, OK?”
She grunted, which I took as an affirmative. I could see dark hair and then the head was all the way down.
“Easy, no Barbi, wait for the next contraction and we’ll have this baby out in no time.”
I was hoping to get the kid out without an episiotomy. I had my hand on the baby’s head when my patient gave a hard push and the head popped out followed by the rest of a healthy looking baby girl, which was followed by a large amount of blood from somewhere. I quickly passed the baby off and then went to work trying to find the source of what was a lot of bright red blood.
“Check the baby fast, Miss Small. I’m going to need some help here. Oh, and turn on that Pitocin.”
Maybe that will help.
No such luck. Blood was pouring out and I was feeling helpless to stop it. I reached my hand up inside and felt the disrupted uterus and then I picked up the sheet which lay across Barbi’s abdomen and saw the low transverse scar.
“How many C-Sections have you had before, Miss Benton?”
There was no answer as I glanced at the monitor which revealed a heart rate of 140 and BP of 60.
“Open up the IV and call an ambulance, Miss Small,” I screamed as calmly as I could, as I quickly delivered a torn placenta. The bleeding didn’t stop, however. I started to pack sponge after sponge into the uterus and vagina and then watched as her abdomen started to get bigger and her blood pressure and then her pulse started to sink even lower.
“Epi, Bicarb, Calcium, the kitchen sink,” I ordered.
The ambulance arrived, finally. She was alive, but barely. She had a heart rate of 120 and BP of 70 as they packed her into the ambulance and sped away, both mother and baby.
How many more hours until seven?
There was a woman waiting for me as I walked out of room two.
“Dr. Barnes?” she asked.
“I’m Dorothy Baker. I got a call about my son? The lady told me it was urgent.”
I’m not ready for this.
“Wait for me in Room three. I’ll be with you in a moment,” I asked, trying to calm my trembling voice.
“Is Jeremiah OK? Please tell me.”
I stepped into the room with her. I’m sure she sensed that something was terribly wrong.
“Jeremiah is dead,” I reported to her, far too matter of factly, I decided, too late. “We were sure he had appendicitis and we were getting him ready to go the hospital, he was given IV fluids and antibiotics, and then he suddenly arrested and I couldn’t save him.”
She looked at me in a funny for a moment, then put her hand to her mouth and her eyes became wide, as she began to fathom the true meaning of my words
“NOOOOO, NOT MY BABY,” she screamed and she pounded on my chest. “Antibiotics? You gave him Penicillin, didn’t you? He almost died when he was two from a dose of Penicillin.”
I took a step back and almost passed out, collapsing into the chair.
“I asked him if he had any allergies and he said no,” I muttered.
“I WROTE IT ON THE FORM, IT WAS THERE IN BLACK AND WHITE, YOU…YOU KILLED MY BABY,” she screamed and then she slapped my face and walked out.
I’m sure it said NKDA, or did it? Did I even look at the history?
I felt my medical career slipping away from me as I jumped up and ran to check Jeremiah’s medical history. The chart had magically appeared at the nurse’s station. She was right. Allergy: Penicillin.
How could I miss that? How can I keep being a doctor when something like this has happened?
Miss Small came in at that moment, ashen, tears streaming down her face.
“How could we both overlook something like that?” she asked, not expecting an answer. She sat next to me, neither one of us knowing what to say.
“There’s only one more patient here, everyone else has left,” she finally remarked. “maybe you can see her real quick and then we’ll close the Clinic for the last hour.”
I turned and looked at her, nodded my head and managed to drag myself down the hall to room four. There was a smell emanating from beneath the door, a familiar scent of dried sweat, unwashed clothes and decaying life which was common among the many homeless individuals who came to the Clinic for medical care, warmth and the occasional handout. I glanced at the name, Gladys Wentworth, “Gussie” to those of us familiar with the neighborhood population.
“CC: Swollen legs…”
“Hello Gussie, legs still bothering you?” I asked, obviously barely interested in her answer.
“The demons are out tonight,” she whispered. “They’re all over; saw a nasty one right outside. Full moon. No one’s safe. Here take this quick. It’ll keep them away.”
She handed me a garland of dried apricots and prunes.
“Put it on,” she commanded.
I complied just to speed things along.
Gussie was about five foot nothing, weighed about three hundred pounds, despite having only two teeth. She always wore a heavy coat over seven or eight layers of clothes, even if it was a hundred degrees. Her skin was wrinkled and grimy and she was accompanied by a small cart which contained all her worldly possessions. She was diagnosed with schizophrenia; her state of cognition dependent on whether she had remembered to take her medication. And, she was plagued by chronically swollen legs which brought her into the Clinic on a regular basis.
“You taking your meds, Gussie?” I asked as I started to look at her legs.
“Twice a day, without fail,” she answered. “If I didn’t I’d be seeing things and hearing voices.”
“But there are demons out tonight?” I inquired. Normally I ignored her commentary, limiting my work to treating her legs. However, with all that had happened this night I was grasping at any explanation for the series of disasters.
“Terrible demons. The devil’s workers. That necklace will keep them away,” she whispered in my ear. “If you still see them, add a few cloves of garlic and for sure they’ll leave you be.”
Her legs weren’t as bad as usual. Discolored and edematous, but no ulcers or signs of infection.
“Keep doing what …” I started, but she interrupted me.
“This is the last one. I stole it from Aladdin. His last wish. He thinks it’s in that lamp, but I took the wish and now it’s mine. I just can’t decide how to use it.”
She held up a small glass jar with a cork in the top.
“It’s just an empty bottle,” I said, being in no mood to humor her. I was growing tired of our encounter and just wanted her to be gone.
“Just elevate your legs as much as possible, Gussie and you’ll be OK. I see that you’re supposed to be seen at the Hospital next week. Please keep that appointment.”
“But, Dr. Barnes…the demons, what about them?”
I looked at her eyes, which were looking around wildly and I took the garland from around my neck.
“Here, Gussie. You wear mine too. That way you’ll be twice as protected.”
She smiled at me and took the wreath of fruit and gleefully put it on.
“You’re all set now,” I reassured her.
“Thank you, Doctor, thank you,” she said effusively and she shook my hand.
I saw Jeremiah in that handshake and pulled my hand away.
“You’re OK, Gussie, but please leave,” I muttered as I opened the door.
She looked at my face, her eyes betraying a look of fear, but not fear of unseen demons, it was fear of me, as if I was the demon. She wheeled her cart out the door and disappeared into the early morning. The sun was starting to rise and there was light fog. It was six forty five.
Fifteen minutes left in my medical career.
Back at my apartment I lay down reflecting on the night’s events, mulling everything over and over, but always coming back to the smiling face of Jeremiah and the unseen words written on his chart: ALLERGY: PENICILLIN. ALLERGY: PENICILLIN. ALLER... Of course it wasn’t the first time I’d made a mistake; residency is an endless stream of “learning experiences” as Dr. Gottlieb liked to call them. But, there is a difference between mistakes in judgment and carelessness. It was a difference I didn’t think I could live with.
I lay back on my couch and knocked my white coat to the floor and heard a loud “Thud.”
What’s that?
I picked up the coat and felt something in the pocket, an empty jar, crazy Gussie’s wish in a bottle. I stared at the empty jar and looked at it from every angle. It was just an empty jar.
Hmm… no she’s loony. Still, it can’t hurt to try. Now what were the Genie in Aladdin’s rules?1. Can’t kill anyone,2. Can’t bring people back from the dead and 3. Can’t make anyone fall in love with someone else. I don’t need one or three. But number two is a problem. Maybe there’s a way around it…
“What am I thinking? It’s just an empty jar. Gussie’s crazy. Besides, Jeremiah’s dead,” I concluded out loud. “Maybe if I…”
I took the cork out and closed my eyes.
I put the cork back in the jar, tossed it in the garbage and lay down on the couch, trying to decide if I should become a dishwasher or a waiter.
Maybe I’ll end up in jail.
Hours later I was awakened by the phone ringing.
“Hello,” I answered, sleep still in my voice.
“Don’t tell me you’re sleeping. Get your ass up and get to the Clinic,” Miss James commanded. “You can’t be late again. Edith told me that Olsen is going to be there and that if you’re late one more time, you’ll be fired.”
“Uh, Ok, but I was already fi…” I started to say, but then I stopped myself. “Hold on just a second.”
I looked at my phone. It was yesterday and I had an hour to make it to the Clinic. I looked in the garbage, no empty jar.
“Thanks for calling me, my sweet wonderful nurse. I’m on my way.”
I jumped into a new set of scrubs and hopped in my car. I hit every light on the way and made it to the Clinic twenty minutes early. Dr. Olsen saw me, said “Good Evening” and left.
Jeremiah was there with his mother, was diagnosed with appendicitis and started on Levaquin. He was transferred to the hospital for an uneventful appendectomy. Kelly Montague had her arm sewed up and was released to Psych. Barbi Genter showed up in labor and was transferred to the hospital before she had progressed too far.
Finally there was only one more patient to be seen, a homeless woman with swollen legs, Gussie.
“Good evening, Gussie, what’s the problem you’ve been having? Your legs again?” I started my usual speech, trying to hide the excitement in my voice.
“It’s a good night to be out. No monsters or demons. The streets are safe from evil spirits,” she announced.
“I agree with you Gussie. Now, let me take a look at your legs.”
Her legs showed their usual swelling and changes of venous stasis. I admonished her to wear her support stockings and keep her legs elevated and to keep her appointments at the hospital clinic. As she was getting ready to leave I saw the empty glass jar.
“A wish?” I asked her pointing to the jar.
“A wish? Nope, just a glass jar I found in a dumpster over on Maple,” she said in her mumbling voice. But, she looked at me and smiled as she gathered her cart and belongings and left.
I smiled back.
True second chances should be cherished. They are a rare and precious gift.

*In the movie “Galaxy Quest”, the Omega thirteen is a device which, when activated, allows an individual to relive the last thirteen seconds of his or hers life.

Tuesday, December 24, 2013

Christmas Carols


                             A Message for the Season

This Christmas season brings memories of growing up in the quiet village of Scotia New York. The winter holiday season was always highlighted by the Lincoln Elementary School carol sing. This was a mandatory school event which featured all the students of the school assembling in bone chilling cold to offer heartfelt renditions of a variety of Christmas classics.
The songs were always Christmas songs, some with religious themes and some with wintertime and seasonal themes. There was never any apology made to non-believers and there was no such thing as political correctness and,  as far as I know, no student was ever excused because “we don’t believe in that.” So, we took turns lining up in front of our freezing parents, singing our little  hearts out and, afterwards, we were treated to Christmas cookies and other delights.
Thoughts of this annual event came to me the other day as I posed the question to the operating room crew: “What is your favorite Christmas carol?”
My assistant across the table offered up “O Christmas Tree”, a wonderful song that speaks of the steadfast, faithful and unchanging nature of God. The others in the room were stumped and did not give an immediate response. Years ago while I was reading the autobiography of Harpo Marx there was one anecdote recounted where he and some of the very literate people of his day asked a very similar question; only their question was “name the best song of all time”. Their collective answer was “Silent Night”.
I really believe that “Silent Night” is a beautiful song that captures the holy nature of the newly born Jesus, but it really does not do justice to the events surrounding that wonderful Christmas Eve.
Christmas Eve started as thousands of other nights had begun, quiet, cold, mundane. But, all of a sudden, for no obvious reason, the shepherds in the field have this quiet solitude rudely interrupted. An angel comes to announce a birth, the birth of a Savior. Then, the night sky suddenly becomes bright and is filled with all the Heavenly host announcing the birth of a new King, but not just any old earthly king. This is the King of the universe, a baby, God’s own Son, sent to save the world. This is an event that was anything but silent. It was and is, rather, a reason for shouting; shouting with joy as the angels announce a new order for our world, one that promises Peace and Goodwill.
The shepherds leave their flocks and investigate and what do they find? The baby, lying in a manger. Perhaps at this moment there is silence as they, along with Mary and Joseph, ponder the cosmic implications of this singular event. The silence is brief, however, as the shepherds leave and spread the news to everyone that can hear, all the while singing praises to God. Definitely, the Christmas story is not one of silence.
My response to the question, “What is your favorite Christmas carol?” results in a tie. My first favorite is “Hark the Herald Angels Sing”. This song brings all the joy and exaltation of Christmas, while also summarizing all the hopes for mankind that Jesus brings. It is best sung with all the power and force one can muster; a true celebration of the true meaning of Christmas.
My other favorite carol is “The Little Drummer Boy”. It is a relatively modern song, written in 1958, but it carries a message that I think we all should heed. Christmas is about giving. God gave this world the greatest gift imaginable, his only Son. But he didn’t just send his son to live among us. Jesus came for one purpose: to reconcile a wayward, sinful people to their Holy God. It is this great spirit of giving all that you have that “The Little Drummer Boy” presents. This spirit of giving and hope is the true message of Christmas, a message for the Christmas season and all the year.

Hark! The Herald Angels Sing

Hark! the herald angels sing
Glory to the new-born King!
Peace on earth and mercy mild,
God and sinners reconciled!
Joyful, all ye nations, rise,
Join the triumph of the skies;
With th' angelic host proclaim
Christ is born in Bethlehem!
Hark! the herald angels sing
Glory to the new-born King!

Christ, by highest heaven adored;
Christ, the everlasting Lord;
Late in time behold Him come,
Offspring of the Virgin's womb.
Veiled in flesh the Godhead see;
Hail, the incarnate Deity,
Pleased as man with man to dwell;
Jesus, our Emmanuel!
Hark! the herald angels sing
Glory to the new-born King!

Mild He lays His glory by,
Born that man no more may die,
Born to raise the sons of earth,
Born to give them second birth.
Risen with healing in His wings,
Light and life to all He brings,
Hail, the Son of Righteousness!
Hail, the heaven-born Prince of Peace!
Hark! the herald angels sing
Glory to the new-born King!

Come, Desire of nations come,
Fix in us Thy humble home;
Rise, the Woman's conquering Seed,
Bruise in us the Serpent's head.
Adam's likeness now efface:
Stamp Thine image in its place;
Second Adam, from above,
Reinstate us in Thy love.
Hark! the herald angels sing
Glory to the new-born King!

Little Drummer Boy
Come they told me, pa rum pum pum pum
A new born King to see, pa rum pum pum pum
Our finest gifts we bring, pa rum pum pum pum
To lay before the King, pa rum pum pum pum,
rum pum pum pum, rum pum pum pum,

So to honor Him, pa rum pum pum pum,
When we come.

Little Baby, pa rum pum pum pum
I am a poor boy too, pa rum pum pum pum
I have no gift to bring, pa rum pum pum pum
That's fit to give the King, pa rum pum pum pum,
rum pum pum pum, rum pum pum pum,

Shall I play for you, pa rum pum pum pum,
On my drum?

Mary nodded, pa rum pum pum pum
The ox and lamb kept time, pa rum pum pum pum
I played my drum for Him, pa rum pum pum pum
I played my best for Him, pa rum pum pum pum,
rum pum pum pum, rum pum pum pum,

Then He smiled at me, pa rum pum pum pum
Me and my drum.

Sunday, December 8, 2013

Night Clinic Christmas


“I’m here, bearing gifts on this glorious Christmas Eve,” I announced as I placed my packages on the table in the break room. “Just a few special items for my special nurse and friend.”
“Only two minutes late; you’re improving.” Miss James remarked and then gave me her special smile.
“Christmas Eve, a new moon, fifteen degrees outside, it ought to be a quiet night,” I responded. “What am I saying, I’m sure I just jinxed us.
Miss James looked at the presents, each carefully wrapped with shiny silver and gold Christmas paper.
“Oh no, you can’t open them yet; not until midnight. I’ll put them under the tree in the lobby.”
I carried the packages to the front and placed them under the small tree which was perched on the reception desk. There was another present there already with my name on the card.
Dear Miss James.
At that moment an elderly couple walked in, both neatly dressed, holding hands, each with a twinkle in their eyes.
“Good evening, Dr. Barnes,” the man greeted me, staring at my badge. “My name is Curley and this is my wife, Cupcake. We need some help.”
“Certainly, sir, that is why we’re here.” I answered, trying to be polite. “What is the problem?”
At this moment Miss James appeared.
“We need some basic information before we can see you, Mr…” she said before she was interrupted.
“Curley,” the man replied. “Curley Fries is my full name and my wife is Red Velvet Cupcake. Give me your forms so we can get started.”
He took the clipboard form Miss James and they turned to sit down in the lobby. He gave me a wink and a nod as he sat down to fill out the necessary papers, never breaking his hold of Cupcake’s hand.
I went to the back while Miss James manned the reception desk. A younger man came in with a noticeable limp.
So much for a quiet night.
After a few minutes Cupcake and Curley were brought back to exam room one. I picked up the chart and perused their information:

Complaint: Chest Pain
Patient name: Curley Fries
Age: 87
Occupation: Song and Dance
Address: 214 Blakemore, #330
Current Medications: Lisinopril, Crestor
Allergies: None known
Do you smoke: occasional cigar
Do you drink alcohol: not to excess
Any previous surgery: none

Nothing unusual.
I gave two short knocks on the door and went inside. Curley and Cupcake were seated next to each other, still holding hands. He was thin, short, maybe five five, with white hair and thick black glasses which magnified his sparkling eyes and he had an infectious smile on his face. Cupcake was shorter, maybe five one, black hair with a touch of gray and very smooth skin for an elderly woman. All in all, they were a very handsome couple.
“Good evening, again, Curley and Cupcake. What is the problem that brings you in here?” I asked in my usual professional tone.
Curley jumped out of his chair and extended his hand. He grabbed mine and started shaking it effusively.
“Good evening. I’m Curley Fries and this is Cupcake, Red Velvet Cupcake to be exact. You’ve heard of us? No. you must be living under a rock. We’ve been on the circuit for over sixty years. We were very big in the Borscht Belt.”
I gave him a confused look.
“The Borscht Belt, you know, the Catskills, Long Island, New Joisey. You have to say it right. Joisey. We don’t tour anymore. Now it’s just local weddings, Bar Mitzvahs, Graduations, birthdays. Here’s our card. When you and that lovely nurse finally tie the knot, don’t forget about Curley and Cupcake. Oh, but I’ve forgotten my manners. Dr. Barnes, how nice to meet you properly. It’s not often I get to meet a legend.”
He offered his hand again and I shook it again.
“Legend? I think you have me confused with another Dr. Barnes. I’m just third year medical resident trying to make a few extra dollars. Now what can I do for you?”
“You mean you’re not the famous Dr. Barnes, founder of the Barnes Institute for Penile Rejuvenation? Then I’m not sure you can help us. Oh, wait, I almost forgot. I’ve been having pain in my chest. Right here next to my sternum. Like Zero Mostel was sitting on it.”
I looked at him with a smile on my face. I was beginning to like Curley.
“How often are you getting this pain?”
“Whenever me and Cupcake have sex. Three or four times a day.”
Cupcake gave her a companion a short kick.
“Tell him the truth, Curley,” she demanded.
I turned to her, “What is the, Cupcake?”
“Well, the truth is we only have sex twice a day, except on Sundays, when it’s three times.”
They both smiled and then Curley said, “The pain comes on when I’m active, you know, lifting, pushing. It had been happening once every couple of weeks, but yesterday and today it’s been more often and lasting longer. Usually one Nitro and I’m good, but these last couple of days it’s been…”
And he burst into song:

“A Heartache tonight, A Heartache tonight, I know…”

“OK, OK, I get the picture. Let me check you real quick. Do you have a regular Cardiologist?”
“Dr. Steinberg, a nice Jewish doctor, really schmart, if you get my drift,  and, not a bad singer.”
“Good, he’s at the University. I might be able to access your records, get an old EKG.”
I felt his pulse, which was strong and regular. I listened to his heart, which was loud and clear. Lungs were clear, No evidence of cardiac enlargement, pulses all strong, abdomen benign.
“You look good on exam, Curley. Miss James will be in to do an EKG and draw some blood.”
“Good, good. She’s a real keeper, just like Cupcake here, don’t let her get away. Sixty five years tomorrow, Dr. Barnes. I’ve been on the lookout for a better model all these years, but nothing’s come along.”
And he smiled at her and took her hand in his again.
I stepped out into the hallway where I found Miss James coming out of room two.
“Lacerated leg. He says he cut it on some glass, but it looks like a razor to me. Pretty deep. He may need to go to the hospital,” she reported.
“Thanks. EKG in one, if you can. He’s been having increasing chest pain, but he looks strong as an ox. Anymore out there?”
“Too many. Shouldn’t they all be going to church?”
I went into room two. Rodney Smith, twenty two, unemployed, no medical problems.
“Good evening Mr. Smith. What happened to you?” I began
“Cut myself on this metal table, doc,” he answered.
“Let me take a look,” I requested as I unrolled the gauze dressing to reveal a deep laceration, almost ten inches long, on his left lateral thigh. It was straight and clean, extending to the fascia, but only about one centimeter of muscle was exposed.
“That must have been quite a metal table, Mr. Smith. I hope the other guy is OK.”
“Chicken shit ran away.”
“Never heard of a table running away. Never mind, we’ll get this sewed up.”
The tray was there, opened and ready with appropriate suture, Lidocaine and Betadine. I took off my white coat and went to work and, in what I thought was no time had my patient sutured and bandaged and ready to go. As I left his room I heard singing from the lobby.

“Joy to the world, the Lord is come
Let Earth Receive her King…”

Curley and Cupcake were standing in front of what was becoming a very full waiting room, singing. I have to admit they had pretty good voices and the waiting patients looked very appreciative. I noticed that Mr. Smith lingered in the waiting room, rather than brave the cold, the temperature outside was down to ten degrees and snow was falling. I saw some familiar faces in the crowd: the Goddess of the Night holding a tray of cookies, Caleb was there, staring down as he drew on a large pad, Derek, without any Tribbles I hoped, Vince and others. The pile of gifts under our little tree was bigger. The coffee maker from the break room was on the counter, along with some cider. Miss James stood beside me.
“Here’s Curley’s EKG. Looks like he’s had an old MI, nothing acute,” she reported.
I glanced at the cardiogram and agreed with her assessment.
“No one has registered. I guess they just wanted a party and a place to get away from the cold.”

“…Shall I play for him? Par rum papa pum
On my Drum…”

“I like Curley’s choice of music,” I commented. “None of this politically correct ‘seasonal’ music that leaves out the true meaning of Christmas.”
I stood and listened, but then I heard something odd.
“HOLD IT,” I shouted. “Stop for a minute!”
Silence filled the air, except for one distinct sound, a baby’s cries. I stood up on a chair and saw it, a large shoebox, just inside the door, clearly illuminated by the light at the entrance. I ran to it and picked it up.
Sure enough, carefully wrapped inside was a baby, a very small baby. I carried the child towards the back and handed it to Miss James.
“Keep them going,” I whispered to Curley. And I left to go examine our new young patient.
It was a baby boy, maybe only a few hours old, but healthy. And, he sure had good lungs, crying the entire time I was listening and palpating. He had been wrapped in a thin blanket and an old worn jacket had been stuffed into his makeshift cradle. His diaper was a soiled handkerchief.
We’d received abandoned babies before; usually they were accompanied by a note which would read something like this:

“I’m sorry, but I can’t take care of “Walter (or Judy or fill in the blank). Please help him find a good home.”

“I’ll call him John,” I announced. “He is a John Doe, at least for now. We need to call CPS.”
Miss James winced at those three letters. She hated turning children, especially babies over to the system to be shunted from foster home to foster home and, far too often,  finishing their childhood on the streets or worse.
“Who’s on for them today?” I asked.
“Just our luck, it’s Jody. Poor John will be here for a while, especially on Christmas Eve.”
Miss James dutifully made the call to CPS, not expecting a return call for several hours. JODY was a case worker who took the expression methodical to its zenith.
We fixed John up with a proper diaper and wrapped him in a clean blanket and gave him a bottle filled with proper newborn formula.
“Looks like a beautiful, healthy boy. Just look at those eyes and so much black hair,” Miss James observed.
“He is a good looking boy, that’s for sure. I’ve never seen a newborn who was so alert; look at him staring at me, sizing me up. He’s got a bit of a dark complexion. Maybe, he’s of Mediterranean origin. Well, no matter. Let’s go back to the celebration.”
We put young John in a proper cradle, one of our clear plastic bassinettes, and carried him out to the lobby. Curley and Cupcake were keeping the party rolling along with a few jokes.

“What’s the difference between a Jew and a canoe?”
“I don’t know, what is the difference?”
“One tips.”

“Two stupid guys want to go bear hunting, so they ask the Ranger where they can find the bears. He answers ‘that’s easy, just follow the signs.’
So they drive along and see a sign which says ‘Hunting, Bear Left.’ So the turned around and went home.”

“Maybe, we better stick to singing,” Curley remarked and they started in on a new song.

“Joy to the World, the Lord is come
Let Earth receive her King…”

As the singing started Cupcake whispered something into Miss James ear and the two left together. I was curious, but stayed behind, keeping one eye on the baby who was now safely tucked away in his clear cradle sitting in front of the reception desk. After a few minutes Miss James returned.
“Can you come look at Cupcake,” she whispered in my ear.
I left the party and went back to room one where Cupcake was on the exam table wearing one of our paper gowns.
“I noticed it about a month ago. I didn’t want to worry Curley, but it’s gotten bigger. It doesn’t hurt.”
“What is it” I asked.
“She has a lump under her right arm,” Miss James reported.
“No fever or pain?” I asked.
“No, it’s nothing I’m sure,” Cupcake decided. “just forget about it.”
“No, you’re here. I might as well check it.”
I probed under her arm and immediately felt a golf ball size mass which was mobile, nontender. I palpated above her clavicle and felt several more lumps, all hard and slightly irregular.
“Lay back and put your arm up over your head, “I asked.
I began examining her right breast and felt the mass at 10:00, about two and a half centimeters, hard, irregular, almost certainly a cancer.
“I’m sorry Cupcake, but this is almost certainly a breast cancer. Of course a biopsy needs to be done, but I’m 99% sure. We can refer you to one of the surgeons to do the biopsy and then you should see Dr. Bakemyer, a very good and compassionate Oncologist.”
She stared down at the floor and then jumped off the table and started to get dressed.
“Don’t tell Curley. It’s Christmas and our anniversary. I don’t want to spoil it for him.”
“Don’t you think he would want to know?” Miss James asked.
“He probably knows already, just won’t admit it. What we said before is not far from the truth. I know I shouldn’t say this, but sex just gets better and better even when you’re no longer spring chickens. When you’re young it’s all hurry up and then what? When you get older you can take the time to be indulgent and after sixty five years we don’t have any secrets. You two should remember that. Now, let’s go back to the party.”
The lobby was full as Curley stood on a table, leading the way with a vigorous rendition of “Angels We Have Heard On High.” And then ‘hark the Herald.”
He looked a bit sweaty to me, but he still had his ever present smile. Cupcake climbed up on the table next to him and took his hand in hers. He turned to her, smiled his special smile and then he collapsed, falling forward into her arms. The two of them fell from the table, their fall broken by myself and Miss James.
“LOOK AT CURLEY” Cupcake screamed as tears welled up in her eyes.
Curley was ashen gray and was not breathing. I put my fingers on his neck and did not feel a pulse.
“CRASH CART” I yelled to Miss James but she was ahead of me, wheeling the red cart out as I lay Curley flat on the floor and pounded on his chest.
“SOMEONE CALL 911, PLEASE,” I shouted, hoping one of the revelers would respond.
We took a quick look with the monitor and saw V. Fib. We prepared to shock him as Miss James manned the ambu bag.
“EVERYBODY CLEAR?” I asked/screamed as I pushed the buttons and Curley jerked off the floor. With that shock the lights went out. Our monitor still reported V. Fib as the emergency lights came on and a few of our shocked onlookers lit candles.
I warmed up the paddles to shock him again. Once more he jerked off the floor. This time he responded with a faint regular blip on the screen. I felt his carotid, but still there was no pulse And started chest compressions.
“AMBULANCE IS ON THE WAY,” I heard someone scream.
All this commotion and noise and not a peep from that baby boy. Very odd. It’s strange the things which go through your mind in moments of crisis.
In the midst of all this chaos I heard the clock chime twelve.
“Give Epi.” I ordered. Luckily Curley still had an IV in his arm.
“Already done.”
“Bicarb, Calcium.”
No pulse still. We’re going to lose him.
The chiming of the clock stopped and, all of a sudden, for a moment the room became eerily quiet, almost like time had stopped. There was silence and the only light was the candles and a faint light from baby John’s bassinette.
All of a sudden I felt Curley move. He took a big breath. I felt his neck and was rewarded with a strong carotid pulse. Curley sat up and looked around.
“Did I miss some excitement?” he inquired.
I sat back on the floor, wiped the sweat away from my forehead and stared in amazement. Twenty seconds earlier Curley had been prostrate, dying, and now he looked like he was ready to go out dancing with his precious Cupcake. Curley got up from the floor, while I helped Miss James to her feet.
Cupcake came running and put her arms around Curley’s neck and showered him with kisses. Then she slapped him on the cheek.
“Don’t you ever scare me like that again, you understand?” she scolded.
Curley’s look of surprise was replaced by his smile, “Yes dear,” was all he could say.
“Open the presents,” Vince shouted.
So we celebrated that Christmas with our patients. We had had quite a haul. Two cheap stethoscopes, a chrome urinal, a box of condoms, some candy, “The Complete Kama Sutra”, His and Hers underwear and a few other things which escape my memory.
It was after we opened the presents that the true extent of the Christmas miracle became apparent. I ran another EKG on Curley. It was normal. I don’t mean it was back to his baseline. I mean it was cold normal. No sign of previous MI or anything.
Cupcake beckoned for me to follow her back to one of the exam rooms. She pulled up her blouse and asked me to examine her again. To our amazement, the lump in her breast and under her arm were gone.
Then Rodney Smith stopped me and pulled up his pant leg. His laceration was completely healed. As a matter of fact, it was like it had never happened. No sutures, no scar, nothing.
I wondered how many others who were there were cured of their maladies Was “the Goddess of the Night” free of her cancer, were Caleb’s headaches gone forever? I didn’t bother to ask. It was three am and they all started to file out, with many “Merry Christmas’s heard in the waiting room and out on the street as they left.
“Thank you Dr. Barnes for saving my life,” Curley said as he effusively shook my hand once again. I gave him a smile and he smiled back. “Although I wish you really were the Dr. Barnes of “The Institute for Penile Rejuvenation.”
“I don’t know,” I answered. “From what Cupcake said I don’t think you need any help in that department.
We all turned red at my comment as they left.
Cupcake turned to us as she walked out the door. “Don’t forget about us when it’s time for you two to tie the knot.”
Finally, everyone was gone.
“What about baby John?” Miss James wondered.
“Where is baby John?” I asked with more than a hint of worry in my voice.
The bassinette was gone and so was John. The phone rang at that moment. It was Jody, finally answering our call.
“Get a number and tell her we’ll call her back,” I requested as I desperately searched the waiting room.
“You don’t think someone took him, do you?” I asked.
Miss James appeared remarkably calm, considering we’d misplaced a newborn baby.
“Maybe this is the answer?” She stated as she held up a drawing, the one Caleb had been frantically working on.
It was a manger scene. There were sheep and cows and Mary and Joseph. Shepherds were at the door and there was Jesus. Only he wasn’t in a manger. He was laying in a clear plastic bassinette with the words “Clinic” clearly stenciled on the side.
“It can’t be, can it?” I asked.
There were some words at the bottom:
“God touches our lives in mysterious and unexpected ways.”

The clinic was empty now. The ambulance finally arrived and we sent it away. We called back Jody and told her “never mind.”
I looked at the card Curley had given me.

Curley and Cupcake
Weddings, Bar Mitzvahs, Birthdays
Bachelor and Bachelorette Parties

“Happy Aniversary,” I whispered and I took Miss James hand.
The snow had stopped and we went outside to a cold, clear night filled with stars. There was a bright star in the distance which seemed to be moving to the east.
“Merry Christmas, Doctor,” she whispered.
“Merry Christmas, Nurse.”