Saturday, July 27, 2013

Footprints Across Night Clinic


“Another Saturday night, another stint in the Night Clinic,” I muttered as I snuck in the back door. I wonder what adventures await Miss James and me tonight.
“Good evening, doctor,” an unfamiliar voice greeted me.
“Hello, uh…where’s Miss James?” I asked the heavy set woman dressed in white. I think she sensed my disappointment.
“I’m sorry, Dr. Barnes,” she replied, her voice sporting an edge that said I know I’m not young and blonde and shapely, but I do know my job. “Miss James asked me to cover for her. She had to go out of town suddenly; something about her twin sister and a rash and fever. Anyway, she’s not here. You’ll just have to get by with frumpy old Maggie.”
“Pleased to meet you frumpy old Maggie, I’m chastised young Dr. Barnes. Anything waiting for me?”
“There’s one patient left over from the day shift, older man with pus draining from his penis. I guess Dr. Wacker didn’t have time to get to him.”
I picked up the chart. Fifty-five…no address…arrived at …”three o’clock. Maggie what’s the deal. He’s been here for five hours.”
“I guess they were busy.”
I shook my head and wondered how busy they really had been, then shrugged my shoulders and turned to face the problem at hand.
“Well, I guess I’m off into the world of pus-sy penises. If I’m not out in five minutes, page me.”
I knocked on the door and then entered. Seated on the chair was a very large naked man with a  paper sheet over his groin. A large pannus hung down almost to his knees.
“Good evening, Mr. Jonas. I’m Dr. Barnes. What seems to be the problem?”
“Well, it’s about time. The problem? Can’t you see it? I think it’s about to fall off.”
“What’s about to fall off?” I asked, trying to sound concerned.
“Why, my gentils. Burning and dripping for days. I knew I never should have gone.”
“Gone where?”
“Upstairs at the Palace. I knew I’d catch some disease.”
“When did you go to the Palace?”
“Let’s see it was Tuesday, no Wednesday.”
“So, you went to the Palace three days ago?”
“Three days ago? No, no, no doc. It was, let me think, Wednesday, June 3rd 2010. I just knew that whore would give me the clap.”
“Mr. Jonas. If it’s been three years since you went to the Palace, I don’t think your problems have anything to do with catching the clap from any lady that you might have encountered.”
“It has to be that. I haven’t been to any hookers since.”
“Just tell me when everything started.”
“Well, it was on a dare. Some of my ‘quote…friends…unquote’ said I didn’t have the balls to go, pardon my pun. Well I proved them wrong. I went and now look at me.”
I did look at him and then asked, “you mean that you have all these symptoms you are suffering?”
“No, no, look at how big I’ve become. Back in twenty ten I only weighed a hundred and eighty. Now I must be four hundred…”
“At least,” I observed. This could go on for hours. “Tell you what, let me take a look at your problem and I’ll see what I can do. Can you lie down on the table so I can examine you?”
“OK, Doc.” He pushed down on the table a couple of times, checking to see if it was sturdy enough and then slowly climbed up and lay down. His large belly hung down over the area in question.
“Uh, do you think you can hold your belly up?” I asked gingerly, trying to be at least a little tactful.
“Oh, sure.”
Beneath the massive pannus, which was edematous and red I saw a small, retracted penis and scrotum. After much digging I managed to get a proper hold of it and examined it. There was purulent drainage emanating from a remnant of foreskin and the suprapubic area was ulcerated secondary to irritation from his huge apron of a belly.
“I don’t think your encounter at the Palace is responsible for your current problem, unless you want to count your guilt at having frequented that establishment. No the problem you are having is that your belly is too big and it looks like you’re having trouble keeping yourself clean. Do you have any help at home?”
“Just my mother, but she will let me have it if she finds out I’ve been to see one of those whores at the Palace.”
“Well, you really don’t need to tell her. However, can she help clean you up? I think if you get in the shower and clean yourself well, and then apply one of the medicated patches I’m going to prescribe, you’ll be better in no time.”
“We can give it a try. Mother will do whatever is necessary. It’s what mother’s are for.”
I nodded my head and called for Maggie. The two of us cleaned him up and dressed the open wounds, which were actually pretty clean, with Duoderm dressings. I gave him a prescription for some antibiotics to treat what appeared to be cellulitis of his huge pannus and a follow up appointment at the family practice clinic at the University hospital, attention to Dr. Wacker.
Revenge can so sweet.
“What’s next Maggie?” I inquired as a rubbed my hands with the waterless cleaner which hung on the wall at strategic points throughout the clinic.
“Back pain for three years in room three, lacerated arm in four and a burn to the hand in five.”
“Is it bad, the burn to the hand, I mean? Because, if it is, then we might as well just call the Burn Unit now.”
“Second degree at worst. You should be able to handle it.”
I nodded my head and then went back to the supply closet to get some a new box of gloves. As I walked I noticed some peculiar footprints on the floor.
“Maggie, did you notice these footprints? It looks like some wild animal has been walking around.”
The footprints were very unusual. They were a cast of dirt and grease, three toes with long claws which looked like the perpetrator walked for a short ways, then jumped to the end of the hall where there was a water fountain, and then jumped back, where there were some more footprints  leading nowhere in particular.
“Very strange, Dr. Barnes, very, very strange.”
“I guess there’s no time to worry about it now,” I remarked, believing that one of the patients or personnel from the previous shift had brought their dog to work. It wasn’t long before I found out how wrong I was.
I checked on the burned hand first.
“Hey Doc,” a familiar voice called out.
“Vince? What are you doing here at this hour?” It was Vince Smialdi, one of the maintenance workers for the clinic.
“Well, you know doc, I was in the back, checking out the store room. I thought I smelled some smoke back there. Anyway, I was in the store room and I found this. What do you make of it?”
He held up what appeared to be half of a large golden eggshell, broken and burned at the edges. The shell was at least twelve inches wide.
“Looks like one of the proverbial golden eggs, but I’d hate to get cornered by the goose that laid it,” I observed.
“That’s what I thought. Looks like a giant egg shell, but it’s only gold color. Look…”
He grabbed some of the broken edge and broke a piece off. It was brittle, just like any eggshell.
“A mystery, that’s for sure,” I replied. Could this have anything to do with those footprints?
“Uh, Doc.”
I looked up from my thoughts and saw Vince with a perplexed look on his face.
“Oh, sorry Vince. I was just thinking. Maggie and I saw some unusual footprints in the back. It wouldn’t surprise me if the two were somehow related. But first, let me look at your hand.”
He held up his right hand. The palm was red with large blisters.
“I got this when I picked up that eggshell. It was like picking up the business end of a branding iron. I rinsed my hand in some cold water, but after I got home those blisters popped up, so  I came back here to the clinic.”
“A good thing, too, although this isn’t terrible. Second degree at most. Let me dress it for you and then you can be on your way. No, on second thought, why don’t you stay for a bit, if you don’t mind and we can investigate some of these strange things, this eggshell and those footprints. You don’t mind, do you? Let me finish up with the patients who are waiting and then we can check things out.”
“No problem, Doc. I don’t have anyone at home anyway.”
Vince had been alone for years. His wife had passed away and both his kids had moved away and lived on the west coast.
I left him in the break room and went back to my patients. I gave the back pain a shot, stitched the laceration, but then had to deal with a cocaine overdose, a baby with a fever, a broken arm, two hookers who got into a fight over a “customer” and a drunk woman who had pneumonia after passing out, vomiting and aspirating. I had to wait for an ambulance to ship her to the County.
It was 3:30 when I was finally free. I found Vince sleeping on the sofa.
“How’s the hand?” I inquired, making small talk as we ventured to the back of the clinic. I left Maggie up front to man the fort, should any patients arrive. Most nights, business slowed considerably after about 2:30 am. The bars were closed, everyone who was going to hook up had done so. Sick kids and their worried parents had fallen into fitful slumber. It was the time I usually managed to grab a couple of hours sleep. Tonight, however, I was a sleuth, investigating a deep, dark mystery.
Sometimes my imagination gets the best of me.
Maggie had cleaned up the tracks by the supply room, but I saw fresh ones near the storage closet. There was a faint scent, like burned plastic.
“Do you think it’s safe,” I asked, grabbing Vince by the arm. “What do you think is in there?”
My thoughts drifted back to werewolves, vampires, aliens and so many other bizarre things I’d encountered here at the clinic.
“Don’t worry, Doc,” he replied, trying to reassure me. “Two to one it’s an ostrich or something like that.”
Just to be on the safe side I picked up a broom that was in the hallway.
“That’s great. If there’s some sort of monster you can sweep it under the table. You’re not much for adventure, Doc.”
“If I want excitement, I’ll go to an amusement park. I’m just an old country doctor, to quote Dr. McCoy.”
Vince picked up a flashlight as he slowly pushed the door to the storage room open. It gave a loud squeak. I thought I heard some fluttering noises. Vince shined his light to the back of the room, starting at the floor and up to the ceiling.
“There, see them? More footprints. They lead to that back corner.”
He slowly made his way towards the footprints, while I followed closely behind, clutching the handle of the broom, its bristles out in front of me, ready to swipe at whatever vicious brute was waiting out there, surely ready to pounce on us.
We made it to the back of the room. There were greasy footprints all over, but nothing else. Vince shined his light in every corner, but saw nothing. It was at that moment I glanced up and saw the faint silhouette of something hovering in the corner, wings beating against the air. There was a faint glow from two deep red eyes and then flames shot out towards the two of us. I grabbed Vince and pulled him down to the floor as a white hot stream of fire shot across the room, leaving smoke and a blackened wall where the flames had hit.
Vince shined his flashlight at the flying apparition. What was it?
It wasn’t more that eighteen inches tall, had a lavender body, except for its tummy which was orange. It had black wings on its back which were rapidly beating against the air. Its eyes glowed red, illuminated by the flashlight. There were long sharp claws on its feet and shorter claws on its hands. Its mouth was closed, but there were sharp teeth pointing upwards.
“A dragon?” Vince and I both concluded, almost in unison.
“Daddy, daddy,” the little dragon cried out, staring at Vince.
“It thinks I’m its Daddy,” Vince whispered as we both crouched behind some boxes on the floor.
“If you’re its daddy, then go to take care of it, give it a spanking or something” I hissed between my clenched teeth.
“You’re the doctor,” he responded. “Don’t you think you should check it out, you know, just to be sure it’s not injured or something?”
At this moment the lights came on and Maggie came in.
I jumped up and grabbed her as fire shot towards the door. Vince jumped up and raced towards the little monster.
“Aieee…” screamed the little dragon and then it flew into Vince’s arms.
“Daddy, Daddy,” It screamed again. And then, much to everyone’s surprise, it licked Vince’s face and threw its short arms around his neck.
Maggie and I slowly stood up, wary of the baby dragon’s intentions, but Vince showed no fear as he looked up at us, the little beast still clutching his neck.
“I guess he’s adopted you, Vince,” I observed.
“I guess so,” he answered. “Poor little guy. I bet he’s all alone in the world; last of his kind no doubt.”
“No doubt,” I agreed.
Vince put the dragon down and held its hand. They made an odd looking couple. Tall elderly man and short squat monster.
“You know, Doc, I’ve been alone for years now. Lizzy’s been gone for a long time and the kids are all grown and moved away. I was never big on pets, but I think I can make an exception.”
“Just be careful, you don’t want to end up half broiled,” I remarked as the three of us walked back towards the break room.
“What do dragons eat?” Maggie asked.
“No idea,” I stated. “He’s sort of lizard like. Maybe insects or fish?”
“Maybe he’s a vegetarian,” Vince suggested.
Maggie sat down and took out a cigarette. As she put it to her lips a short flame shot out from the dragon and lit it, the flame just reaching the end of the cigarette, carefully measured not to scorch anything else.
“Well, you’ll need to give it a name. Is it a boy or a girl?” Maggie asked.
“Good question,” Vince replied. He eyed his new charge up and down from every angle.
“What do you think, Doc?”
“No idea. Maybe we can do some DNA testing.”
“What about Pat, or Robin, or Courtney?”, Maggie suggested. “Those are all good names for either boys or girls.”
“Daddy, daddy,” the dragon cried out. “I’m hungry.”
Maggie opened the refrigerator door and said, “Help yourself.”
The little dragon half walked and half flew over to the fridge and grabbed my sandwich off the shelf and wolfed it down. Then it ate an apple, two oranges (which had belonged to Maggie) and drank a carton of milk.
“From what I can see,” I remarked, “food is not going to be an issue.”
I looked at my watch. “It’s almost seven. I think you should be on your way with your adopted monster, Vince. The less explaining we have to do, the better.”
He agreed. He dressed the dragon in a gray hoodie which we kept around for just such occasions and left. As he walked away I called out:
“What are you going to call him or her?”
He screamed back an answer, but I couldn’t quite make it out. At that moment Maggie handed me my coat. It was quitting time. Another eventful Night Clinic had come to an end.

If any readers have an idea fora  good name for the little dragon, please leave it as a comment.

Saturday, July 13, 2013

Prevention or Crisis Intervention

Preventive Medicine. We hear this phrase all the time. It is supposed to be the panacea, the end all and ultimate solution to the nation’s health care ills. And why not? If everyone would just follow doctor’s orders and get their blood pressure checked, have their mammogram and colonoscopy performed, check their PSA, Cholesterol, EKG, bone densitometry and everything else that is recommended by various medical types, then everyone would be healthy and no one would ever get sick or die. Oh, I forgot to add stop tobacco use, wear one’s seat belt while driving, drink a glass of red wine daily, (but not to excess), exercise ten or thirty or forty five minutes three times or five times or six times per week; avoid trans fat, processed foods,  cholesterol, (or is cholesterol OK now?), eat one egg a day, don’t eat eggs at all, avoid red meat, eat only grass fed beef, have regular sex, regular bowel movements, regular vacations, and avoid generalized irregularity and you will live to the ripe old age of infinity, unless you fail to look both ways and get hit by a bus or take a walk in the rain and get struck by lightning.
The point hits one in the face. Is true preventive medicine achievable or is it akin to the holy grail? Just when should screening mammograms be done? Age thirty, forty, fifty? What are the true risks and benefits. Does the discovery of a ductal carcinoma in situ in an eighty nine year old with woman with congestive heart failure and COPD really warrant aggressive treatment or any treatment?
 What about “suspicious” calcifications in a seventy year old patient. How many complications are suffered going after radiologic abnormalities which are of questionable significance? How many perforated colons or bleeding polypectomy sites following colonoscopy are acceptable as doctors search for that one elusive cancer?
 Should preventive medicine be abandoned*? Although preventive medicine gets all the press, in reality the vast majority of healthcare practiced today is what I call crisis intervention.
A woman notices a lump in her breast and goes to her doctor. Or, an elderly man passes bright red blood in his urine or stool and goes to his doctor. Or a child has a temperature of 103 and is vomiting at 2:00 am and his worried mother, who has to go to work in a few hours, brings her to the ER.
Such common conditions occur commonly and are the main reason doctors and nurses exist. Would health care be better if resources were concentrated on improving such crisis intervention? Is it proper that the worried mother has to wait for three hours to be told her daughter has a virus?
Our emergency rooms are much maligned these days. Politicians, insurance administrators and other bureaucrats wail about the high cost of ER care. But, is this truly justified? If a patient of mine, two days post gallbladder surgery, calls me at midnight saying they have been vomiting and have a temperature of 103 I will instruct them to go to the ER. Most ER’s are equipped to do a thorough evaluation fairly rapidly. Thus I can learn in a few hours if my patient is suffering from a serious complication or a minor post op event.
But, what about the woman who shows up in the ER at 3:00 complaining of “back pain for five years?” Surely, that is no emergency. True, it is not, except to that particular patient who can’t sleep because she can’t get comfortable because her back pain has flared. It’s happened before and will happen again. So, give her a pain shot so she can sleep. But, also be sure that she has someone to follow up with. And, if she calls her doctor at 3:00 am complaining of severe back pain it is very likely she will be instructed to go the ER. Where is all this questioning leading? Medicine devotes a great many words to this perfect ideal called “preventive medicine.” Reimbursement is tied to it, journalists write about it and politicians talk about it. But in the trenches of health care delivery it is crisis intervention which drives the system. And, until we humans can be constructed like cars and refrigerators, it will be almost impossible for any other system to be implemented.
I am not calling for elimination of all preventive medicine. There is no question that PAP smears have saved thousands of lives and vaccinations have virtually wiped out some potentially devastating infectious diseases. But, the idea that preventive medicine, if universally implemented, will eliminate most diseases is, in this day and age, fantasy.

*There is an excellent summary of current preventive medicine recommendations, reviewed by a true panel of experts at the following website:

Sunday, July 7, 2013

More Night Clinic


“I don’t know why I’ve come back,” I stated to no one in particular. “Werewolves, vampires, aliens, super hero surgeons; why can’t we have a nice quiet night clinic for once. You know, a sore throat, sprained ankle, maybe a little diarrhea.”
Miss James stared at me and then gave me that smile, the one that says, “You’re sort of cute, but I think trouble follows you.” I sheepishly smiled back.
“At least there isn’t a full moon tonight, just the opposite, new moon and foggy,” she announced. “I think it will be slow, for once. Nobody’s come in yet.”
“That’s fine, Miss James. I’ve got Grand Rounds this weekend anyway. Maybe I’ll have the chance to bone up on parasitic diseases of North America. Can you believe it? We see heart disease, cancer, trauma by the boatload and Dr. Weiss wants me to talk about worms and fleas.”
“Cheer up Dr. Barnes, you won’t be a resident forever.”
I gave her a frosty look which only made me look silly and then announced I’d be in the call room if she needed me. I was deep into the life cycle of the deer tick when the phone rang.
“Per your request, there is diarrhea in Exam Room two.”
“Thank you, nurse. I’ll be there in a few minutes.”
I’m bored with studying anyway.
I picked up the chart on the door. Six year old boy, diarrhea for three days, no fever, heart rate 100, BP normal.
At least it doesn’t look like cholera.
“Good evening, Mrs…Cichello,” I announced, glancing down at the chart. “Did I pronounce that right?”
“Quite so Dr…”
“Oh, it’s Barnes…Dr. Barnes. Now what seems to be the problem?” I asked with my very serious professional tone.
“Andrew has been sick since Monday,” she announced. “He started with fever and then he vomited four…no five times and now he is having diarrhea.”
I looked at the boy. His cheeks were a bit flushed, but he looked alert and certainly was not in any severe distress. Then I looked at Mrs. Cichello. She had on full length leather coat with some sort of fur making up the collar. She had a large diamond ring on her left hand and an even larger emerald ring on her right. She was carrying a Chanel bag and her wristwatch was studded with diamonds. Still she seemed a bit unsettled. She glanced at the door to the exam room several times and then looked down at her watch.
Probably has a date or something. I wonder where the servants are hiding?
As if she were reading my mind, Mrs Cichello announced, “Such a bother and on Marie’s night off.”
“Excuse me?” I asked.
“Marie, little Andrew’s nanny is off on Thursdays. It’s such a bother.”
“I’m sure it is,” I replied and then I turned to Andrew. “Can you climb up on my table here, Andrew?”
In a flash the boy was sitting on the exam table. I went through the usual questions and obtained a perfect history for Rotavirus. The boy’s abdomen was benign and his temperature and all other vital signs were normal.
“I think Andrew just has a bit of a virus, Mrs. Cichello,” I explained. Just make sure he drinks plenty of fluid and he should be back to his old self in a few days.”
“So you think he’s well enough to come home? How can you be sure he doesn’t have appendicitis? Oh, I knew I should have taken him to a real hospital.”
“I can assure you, Mrs., he’ll be fine.”
“This can’t be. I know it’s something serious. I’ll bet he’s got food poisoning, probably Salmonella. Dr. Barnes, if you send him home I know something terrible will happen. Why there’s no question but he should be in the hospital. Oh, why do such things have to happen when Maria is off.”
I was starting to wonder more about Mrs. Cichello. A mother would normally be relieved when told that her son did not have a serious illness, but this mother was anxious for her son to be sick enough to be hospitalized. I put two and two together and asked, “Why don’t you want your son at home, Mrs. Cichello?”
At first she gave me a look of feigned indignation and she started to raise her voice, but I held up my right index finger, sort of a signal for her to stop. She glanced at the exam room door again and then opened her purse and fumbled for her wallet.
“I don’t want any of your money, just tell me the truth.”
“Well, it’s just that my club is meeting at my home tonight and I don’t have my usual help and Andrew being sick. I thought that maybe he should be in the hospital.”
I looked at Andrew and then at his mother. I felt no pity for his heartless mother, but I did feel for the boy.
“Let me take another look at him,” I said softly. I gazed into his eyes and felt his tummy again, moved his head back and forth.
“Well, I think it might be best to watch him for a few hours. I think we should keep him here, until, say, midnight; just to be on the safe side.”
“Thank you, Dr. Barnes. I’ll pick him up by 12:30.”
“Goodnight, Mrs. Cichello,” I said. “make sure we have your number in case Andrew takes a turn for the worse.”
She gave me an indignant look and then left, closing the door with a bit more force than necessary.
“Looks like it’s you and me and Miss James, Andrew. You can wait in the break room. Miss James will find you some games or something to keep you from being bored.”
“I think I’d like to lie down for a while,” he answered.
“OK, OK, you can have my call room.”
I fixed him up in my room and then returned to work.
The next few hours brought a steady stream of vomiting drunks, sniffles and minor injuries. Nothing very exciting and nothing very taxing. Miss James and I checked on Andrew every twenty or thirty minutes; he seemed to be content just sitting in my room, playing games on the computer or drawing pictures with the magic markers and paper Miss James had scrounged up.
It was now after midnight and I was expecting Mrs. Cichello to walk through the doors at any moment. We had finished with the last patient and there was a brief lull. Instead of Mrs. Cichello, it was Daniel who walked through the door.
He was in exam room two and the chart said “Chief Complaint: bald patches.” The rest of the chart was blank, the spaces for date of birth, address, phone number, and everything else were all empty. I wasn’t sure what to expect as I knocked on the door. Seated on the floor was a boy, perhaps eight years old and holding a dog of no particular breed. The boy was dressed in a filthy gray coat, his blondish hair had a mind of its own as it stuck out in every direction, he wore dirty, torn jeans and tennis shoes which were also dirty and worn with frayed laces which didn’t match. His eyes , however, were another story, big and blue, full of curiosity and sensitivity. The dog growled at me as I walked in and I immediately noticed several bald patches on the mutt, with some sores which were a mixture of dried blood and dead skin.
“If your companion wants to be seen, I suggest he stop growling at his doctor,” I remarked. “I’m Dr. Barnes, young man. You are Daniel?”
He stood up and held out his hand before speaking, softly, “I’m Daniel and this is Becky. She’s sick.”
“You know this isn’t a veterinarian clinic, Daniel, and I’m not a veterinarian.”
He looked down at the floor and then replied, “I know, but some of the others said you were a good guy. I waited three days until I saw you were working. Please, Dr. Barnes, can’t you just look at her?”
Daniel gave me big smile and then picked Becky up and held her to his chest.
“OK, OK, let’s take a look. I’m not guaranteeing I’ll do anything, but…what’s this?” I asked as I gazed at the bald patch on the mongrel’s neck. I pinched a spot at the edge of the bald patch and looked between my fingers. “Ctenocephalides canis I believe, otherwise known as a flea. As a matter of fact, she’s got lots of fleas.”
I ran my fingers along Becky’s back and three little black bugs jumped off. I quickly gathered them up in a Kleenex and flushed them away.
“I would say that Becky here needs a flea bath as the first step in her treatment. Unfortunately, flea shampoo is something we don’t usually keep here in the clinic.”
“I could go out and steal some,” Daniel volunteered.
I gave him a false stern look, before remarking, “I think we can buy some, but not at this hour. Maybe there’s some sort of home remedy for fleas.”
We looked at the computer together and found a few different home remedies. One was plain old Ivory soap.
“Well Daniel, let’s give her a bath. Wait, I’ll get some help.”
I found Andrew sleeping in my break room, his head cradled on my textbooks. Probably the best use for those books, I thought as I gently roused him.
“What…wha, is my Mom here?” he asked as he sat up rubbing his eyes.
“Not yet, but I need your help; I need you to help give Becky a bath.”
“I can’t give a bath to some old girl,” he protested.
“Come on, you’ll see,” and I motioned for him to follow me.
Well, his eyes lit up when he saw the dog and he and Daniel got down on their knees and scrubbed Becky from nose to tail. I saw some fleas fall off and wash away down the drain. Becky, to her credit, stood like a statue as the two boys scrubbed and combed and scrubbed some more.
While the two boys were occupied I had to attend to a few sick patients, a sore throat in a four year old girl and a laceration to the arm in a man who decided to hang some pictures at two am. Miss James brought some towels for Becky as the boys finished washing her down. Of course, she had to shake herself dry first, giving Daniel and Andrew a good washing, as if they needed any more. Miss James helped dry all three of them.
After the bath I gave Becky a closer inspection. I was no veterinarian, but I had always had a dog up until I started medical school. Her teeth were white and intact, I estimated she was pretty young, no more than two years old, probably younger. Although she was thin with all the bald spots, she otherwise looked to be in pretty good health.
The bald spots were red in some spots and there was some drainage which was yellowish. I decided to treat them as burns. I pulled out a large jar of Silvadene cream and told the boys to put it on the Becky’s bald spots, like they were icing a cake. As they were finishing, Mrs Cichello finally made her return. It was 2:30 in the morning.
“You’re a little late, Mrs. Cichello.”
“I guess I lost track of the time. Is it really after two? You know how girls can be when we get together.”
She seemed to be nervous, looking over her shoulder at the parking lot, as her facial expression alternated between a forced smile and worry.
“Please, I just need to pick up Andrew and then you’ll never see us again.” She glanced over her shoulder again.
“OK, just follow me. He’s feeling much better, by the way. I thought you’d want to know.”
“Oh…really? That’s great. You must be a really fine doctor. I thought for sure he’d end up in the hospital.”
I brought her into exam room 3 just as the two boys were finishing dressing Becky’s wounds. Both boys had as much Silvadene on themselves as they’d managed to get on the dog.
“We need to go now, Andrew,” Mrs. Cichello commanded, her voice carried an abrupt edge and more than a touch of worry.
“Just let me get cleaned up and then we can go,” Andrew replied. He went to the sink and started to wipe away the white cream.
“Now, young man,” she said even more forcefully.
Becky started to growl and then the door to the exam room flew open.
“I’m tired of waiting, bitch,” a heavy set man screamed as he grabbed her by the arm. He grabbed her and Andrew and started out the door when there was a loud, deep bark, a growl and then flurry of silvadene and canine as Becky jumped on the neck of the man. Mrs. Cichello managed to break herself and Andrew free as that little dog showed just how ferocious a street mongrel could be. Daniel, demonstrating some of his survival skills, started pulling the man’s hair. The man tried to reach around and pull his attackers off, but both Becky and Daniel were tenacious. In the midst of all this excitement Miss James stepped out, returning a minute later with a syringe filled with something which she jabbed into the man’s leg, as he struggled to pull Becky and Daniel off.
After a few minutes he quieted and Daniel gave a short whistle and Becky left the man alone and returned to her master’s side.
“A little Thorazine and Morphine works quite well,” Miss James announced.
I called the police, while Mrs. Cichello stood in the corner cradling Andrew. Daniel sat on the floor with Becky, dutifully reapplying the Silvadene cream which was now smeared all over him, the room and the would be attacker.
“What is it all about, Mrs….” I started to ask.
“Please, call me Lucia,” she said, before I could ask for more details. “That is Cosmo, hired help. It’s pretty complicated. Let’s just say it has a something to do with drugs and smuggling and kidnapping and I’m, no we, were in big trouble. That’s why I left Andrew here and that’s why I’m so late picking him up. I kept trying to figure out some way to stop what was happening.”
The police arrived at that moment and Cosmo, still out like a light, was handcuffed, loaded on a stretcher and carted away. I started to say something to the officer, but Lucia shook her head and then she spoke.
“Officer, I had left my son here to be observed because he was ill and Dr. Barnes thought he might need to be in the hospital. My boy, however, is much better and so I came to pick him up. That hooligan followed me in here and broke into the exam room demanding drugs. He would have gotten away, too, except for this little boy and his dog. They saved the day.”
The police took down everyone’s name and contact information and then went on their way. After all the excitement I took a seat in the waiting room with Miss James and Mrs. Cichello.
“OK, Lucia, what’s it all about. Certainly not that fairy tale you told the police. The way things seem to happen around this clinic you’re probably some sort of international spy caught up in espionage with the fate of the world hanging in the balance. Or, you’re really a vampire and you’ve been out hunting up victims to feed your son.”
Mrs. Cichello looked at me and then at Miss James. She straightened her designer jacket and started to speak:
“Dr. Barnes, I am certainly no spy nor am I a vampire or any other sort of monster. I was involved with some bad, dangerous people from Mexico, but that is all over now. With the local police involved and Cosmo in custody, I don’t think I’ll have any more problems.”
“Are you sure? Some of these crooks can be pretty vengeful, at least that’s what I’ve heard.”
“Trust me, I’m sure. Just bring me Andrew and we’ll be on our way.”
Miss James went to get the boy while his mother sat silently. Finally, she spoke.
“I love him more than anything, you know, Andrew that is. That’s why I left him here this evening, to keep him safe. I’m sure you thought I was or am a terrible mother, but I really was trying to keep him out of harm’s way. Please don’t ask me anything else; just believe that everything is fixed and neither Andrew nor myself are in any danger.”
“If you say so. I’m just a hired gun here at the clinic. I certainly do not want to be involved in any Mexican drug wars, smuggling or kidnapping.”
At that moment Miss James returned with Andrew, Daniel and Becky.
“Time to go, Andrew,” Lucia announced.
Andrew hesitated for a moment. “What about Daniel and Becky? Where are they going to go?”
Lucia looked at the two orphans. “I’m sure Daniel’s mother is worried…”
“Daniel doesn’t have a mother, nor a father or any family, Lucia,” I informed. “He lives moment to moment on the streets, like too many others. Why do you think this clinic is here? There are a lot more like Daniel out on the streets.”
“Can’t Daniel stay with us, please?” Andrew asked, his eyes pleading. “I helped him with Becky and we got to be good friends.”
Lucia stared at the thin boy and then at Becky, letting out a smirk at the sight of the dog and her patches of white Silvadene cream.
Andrew added, “Mom, you know how you always give me things, toys and stuff to play with. And, you know I take them and play with it for a few minutes? But, a lot of the time I bring those toys to school with me and give them to other kids. And you what? I feel much better giving the toys away than getting them. I think I’d like to give my room to Daniel and Becky. Can’t I do that, Mom, please?”
Lucia smiled, first at her son, then at me and finally at Daniel. “What do you say, young man? Would you like to come stay with us? And Andrew doesn’t even have to give up his room, we’ve got an extra bedroom, for you and Becky.”
Daniel smiled from ear to ear, a clear answer to everyone present. The four of them walked out together. The sun was releasing its first rays of the day as they piled into a black Mercedes and drove away.
“I’m not sure we should let you moonlight here anymore, Dr. Barnes,” Miss James remarked. “You bring too much excitement.”
“I thought it was you, Miss James. Come on. It’s quitting time. I’ll buy you breakfast.”
Months later I did learn more about Lucia and Andrew. Although there were some sketchy reports in the papers, it was only after I ran into them walking in the park that I learned the truth.
Lucia was married to the CEO of a big Mexican drug manufacturer, but was separated from her husband and trying to get a divorce, something about his being abusive and a number of mistresses. That fateful night she had gone, supposedly to meet her husband and settle things once and for all. Unfortunately, her husband had sent Cosmo who followed her to the clinic and was trying to force both of them back to Mexico. As it was, her husband had been arrested and now she was safe, with Andrew, Daniel and Becky, whose fur had grown back, by the way.