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.