Monday, September 16, 2013

Night Clinic and the Garden


“Dr. Barnes, how nice to see you again, it’s been too long,” Miss James remarked as I hung up my coat. “Residency been busy?”
“You have no idea, Nurse. I wish people would only get sick between the hours of 8:30 and 5. It’s so inconvenient when someone decides to have an MI at midnight. Personally, I wish my only night work was here at the Night Clinic.”
I leaned over to give her a kiss, but she turned her head away. I guess two months was too long a time to let pass without seeing, or calling, her. This could be a long shift, I thought, but one never knows what may transpire to bring people back together.
“Anyone waiting?” I inquired, hoping I could break down her icy veneer.
“High fever and a rash in two and vomiting in three. Room one needs to be cleaned. It seems the day shift never went to kindergarten and left One a bit messy.”
I picked up the chart outside room two. Owen Martin, thirty two, no previous medical problems, fever for three days, up to 103, and generalized rash. Here we go.
“Good evening, Mr. Martin, what brings you in here today?” I started my doctor banter.
“Bus,” he answered tersely.
It’s going to be one of those nights.
“I’m sorry,” I started over. “I mean, what’s the problem you’re having.”
“What’s the problem, doctor? Just look at me; you can see the problem.”
“That is quite a rash, no question. When did it start and where did you first notice it?”
“I first noticed it in the bathroom about a week ago.”
I raised an eyebrow at his response and then rephrased my question. “Where on your body did you first notice the rash?”
“Oh, sorry, doctor. It was on my stomach. It just spread each day and then I noticed the fever and some aching in my joints.”
“Been hiking in the woods recently; any bug bites?”
“I was hunting a couple of weeks ago. Didn’t manage to kill anything, though, except about a case of beer.”
Lyme disease popped into my head. “Did you get bitten by a tick? Let me check you. Go ahead and get undressed, here’s a gown for you. I’ll be back in a few minutes.”
I left Mr. Martin and went to room three. Sixty years old…hypertension…vomiting today, nothing much.  Probably a stomach bug. I noticed Miss James looking a bit frazzled as I opened the door.
“It’s going to be a busy night. There are about ten people in the waiting room already.”
I better pick it up.
“Good evening, Mr. Sanchez, what is the problem…”
I quickly dispatched him with a script for phenergan and follow up at the County Clinic in a few days and then went back to search for a tick.
“I’m back,” I announced as I returned to room two. You said the rash started on your stomach?”
That’s right, doctor,” Mr. Martin answered.
I started my search on his abdomen without any luck, moved to his groin and perineum, up and down, everywhere, but the nasty bug eluded me and my magnifying glass.
“What are you looking for, doctor?” my patient queried.
“A bug, a tick to be exact.”
“Oh,” he answered and then he became quiet. After another minute he spoke up. “I did find a little spider, maybe it was a tick, in my belly button. I killed it.”
“Let me look at your belly button,” I requested.
I pulled the skin apart to open it up and got up close and magnified the area. There was a tiny black speck that I pulled out. This could be part of a tick. I didn’t see anything else.
“Mr. Martin, I suspect you have Lyme disease. Here is a prescription for antibiotics, one pill twice a day. It shouldn’t be very expensive. Take it to the pharmacy over on sixteenth. It should only be four dollars. Here is a sample to get you started. And, this is the number for the Infectious Disease Clinic at the hospital. See them within the next week or so. Don’t forget to take the antibiotics and, here’s another script for your aching and itching. Any questions?”
“I’m not going to die, am I, Dr. Barnes? I always heard about Lyme disease and…”
“We caught it early, Owen. Just take the medication and keep your appointment and you should b fine.”
He shook my hand, clutching the prescriptions tightly in his other fist.
“Thanks, Dr. Barnes. I’ll call you if I don’t get better.”
“Go to the clinic if you don’t get better, but be sure to go.”
He left and I went out into the hall. All the rooms had charts on the door and I peeked out into the waiting room and saw about twenty more people seated. No one looked terribly ill until I saw her. She was a little girl sitting by herself in the corner, next to a fake potted plant. She sat with her hands across her knees, fidgeting.
Miss James came out of exam room one.
“Nurse,” I formally requested, “there’s a little girl sitting by herself in the corner out there. Please bring her back next. Thank you.”
“Of course, Dr. Barnes.”
I picked up the chart to room four. “Splinter in hand.”
I opened the door and greeted Mr. Billroth. “Good evening, Mr…”
I went through my usual spiel, but my thoughts kept drifting back to that little girl. Something about her demeanor was unsettling. I quickly removed the splinter from Mr. Billroth and sent him on his way. I ignored the patients who had been waiting in rooms one and two and went to three and the little girl.
Her chart was blank, no name, age or anything.
“Hello,” I said gently. ‘I’m Dr. Barnes. Can you tell me your name?”
She looked at me with her big brown eyes, but just sat there, clutching a raggedy doll to her chest. She couldn’t have been more than five years old. Long, curly brown hair fell around her shoulders and she was neatly dressed in a blue dress and pink tennis shoes. She didn’t have any of the grime I’d come to expect on “street orphans” which made me think that she had a home somewhere and she was probably lost or had just run away.
“I promise no one will hurt you.”
Miss James came in behind me.
“We just want to know who you are and where your parents are.”
“Daddy’s at the hospital. Mommy was there, but they took her away and now she’s in the garden. I saw her there today and I wanted to be with her, but she told me I had to leave.”
Miss James knelt beside the little girl.
“What’s your name, honey?” she asked while she slowly stroked her hair. The girl didn’t answer.
“Can you tell me your doll’s name?” I asked. “I’m sure she’s scared, too.”
The girl held up the doll, which looked worn and dirty.
“This is Peaches. Mommy gave her to me before she got sick and had to go to the hospital.”
“Can you tell me your name?” Miss James asked again. “If Peaches gets lost, I’ll know who you are and be able to bring her to you.”
“Jewel,” she answered. “My name is Jewel and I’m five years old. Please, I want to go back to the garden and be with Mommy.”
I took Miss James aside for a moment.
“Do you know of any garden near here? All I’ve ever seen is garbage and dirt and more garbage.”
She shook her head and went back to Jewel.
“Can you tell me about the garden?” she asked.
“It was wonderful, so beautiful and smelled so sweet and fresh. I saw Mommy there. I wanted to go with her, but I couldn’t.”
“Where is the garden? I asked.
“It wasn’t far from here. Mommy was at the hospital. She’s had to go there a lot. I was there with Daddy, but then they took Mommy away. I couldn’t stand it so I ran away to find her. And I did find her; in the garden.”
“Can you tell me about the garden, Jewel?”
“There were beautiful flowers and birds and even a lion. There was a river which sparkled in the sun and Mommy was sitting in the middle of it and she didn’t look sick at all. She looked happy and pretty and I wanted to go with her. I tried to run to her, but she told me I had to wait. Someday we would be together again, she said. Then she went away again and then I couldn’t find the garden anymore. But, I was standing right outside your door after Mommy left. Every other place looked dark and dirty, but it was light here, so I came inside. Please, can’t you go with me to find the garden again?”
I looked at Jewel and then at Miss James, but didn’t say anything. Finally, I told Jewel to wait in the exam room while Miss James and I talked about what to do.
“It’s obvious what’s happened. Her mother must have been sick and died at a hospital. When she learned that her mother had been taken away she ran away to find her and imagined her to be in a beautiful garden. Probably a pretty healthy defense mechanism for the little girl. I think that our task is to figure out which hospital her mother was in, which will help us find her father so we can get her home. Why don’t you start calling the hospitals and I’ll take care of the other patients.”
“Sounds like a reasonable plan, Dr. Barnes. I’ll keep Jewel with me,” Miss James replied.
We went to separate ends of the clinic. Miss James was in the back office while I saw a stream of patients with, luckily, minor complaints. Headaches, backaches, foot aches, neck aches, sore throats, sore ears, sore eyes they all came and went. It was four am when I finally had the clinic cleared out and I could check on Jewel and Miss James.
“Any luck?” I asked.
Jewel was sitting on the floor drawing, while Miss James was scribbling something on the pad.
“Mercy Hospital, Saucedo, you’ll contact her father. OK, but can you give me his contact information, thanks,” she finished her phone conversation and turned towards me. “Her name is Jewel Saucedo, she just turned five years old and her mother, Mary, just passed away. She had been battling ovarian cancer for a couple of years.”
“Do we know where the father is?”
“His cell phone is 906-100-1000. They called him while I was on the phone with them and he’s on his way here.”
“Good, good. At least I managed to clear out all those patients. I’m glad none of them were terribly sick,” I commented, then I turned towards Jewel. “Jewel, your dad is on his way…Jewel…JEW-EL.”
I was shouting because our little Jewel was gone. We called everywhere in the clinic, but she didn’t answer.  Only her drawing remained, a picture of green trees, colorful birds and a woman with long dark hair. Jewel’s Garden. I was starting to feel a bit frantic, first because a little girl was out alone in the night in what could be a dangerous part of town and second because her father was on his way and expecting to find his little girl safe at the clinic.
“Call the police and her father and tell them what’s going on. Close the Clinic for the rest of the night. I’m going out to find her. You wait here in case she comes back.”
I raced out into the night, shouting her name, “JEWEL, JEW-EL.”
I went from street to street. I saw police cars role by several times and stopped and talked to two of the officers. No luck so far.
If anything should happen to her…
But I couldn’t think anymore about that.
It was beginning to get lighter as I was becoming more discouraged. But, then I saw something unusual, extraordinary, wonderful. At first I thought it was the sunrise, but it was to the west and was too bright. A light shining in the distance. I ran towards it and when I saw it I froze.
There, across the wide boulevard was Jewel’s garden. In the middle of dark gray buildings, piles of unclaimed garbage, rats, winos and urban blight was the most beautiful garden I had ever seen. Lush green trees and plants, vibrant, bright flowers, birds with feathers of every color singing and calling; the most splendid beauty filled my eyes. I heard the rush of a swift river and then I saw them, sitting on the far side of the river, mother and daughter, Mary and Jewel, laughing together, happy, more than happy, joyful.
I started to cross the wide street and Jewel looked up at me and waved. As I stepped out in the street I heard the shrill wail of a car horn and stepped back as an eighteen wheeler rolled past. When I looked up, Mary, Jewel and the garden were gone. All that remained was Jewel’s worn, torn doll. I picked it up and trudged slowly across the street.
 I knew I would never find them again, but I also knew that little Jewel was where she belonged. I started to walk back to the clinic, slowly at first, but then I began to run. I was out of breath when I finally made it back, barely noticing the flashing lights as I went inside.
“MISS JAMES. MISS JAMES,” I shouted as I walked past the waiting room.
“I’m here,” she answered softly. Her eyes were filled with tears.
Before she could speak, I blurted out, “I saw, her, Jewel and her mother. And Jewel’s garden. And they were so happy, so peaceful…”
“SHE’S DEAD, JEWEL’S DEAD,” and Miss James broke down crying.
I held my assistant tightly and stroked her hair, not knowing what to say or do. At the same time her words didn’t surprise me. I suppose I already knew the truth, but after seeing her and her mother and their garden, I couldn’t feel sad. I left Miss James and went to speak to the police and a very distraught father.
“She was hit by a bus crossing Elm. Happened about an hour and half ago. The bus driver said he honked and tried to stop, but…”
“Is this her father?” I inquired. There was a man of about thirty, eyes bloodshot and sunken, weariness and anguish radiated from the center of his being.
“Leon Saucedo,” he whispered.
“May I speak to you in private?” I requested. He nodded his head.
I took him into one of the exam rooms and told him my story. I hoped it would provide a tiny amount of solace. He thanked me and went away, carrying Jewel’s ragged doll.
I filled in all the details for the police and they went away. Finally, we were alone. Only Miss James and I remained in the clinic. The next shift would be arriving in less than an hour. I went back to her and sat down on the floor next to her. She was crying, deep sobs and wails. I handed her a towel and then told her.
“You know, what Jewel told us, about the garden, was true. I saw it. It was all she said and more. It was like a glimpse into Heaven here on earth. And when you told me she was dead, I already knew it, But, I couldn’t, can’t,  feel sad, after seeing her in that place. As a matter of fact, I wished I could be with them. More than anything I wanted to be with them. I started to cross the street, and I felt such joy, but I had to stop when a truck came by and then it was too late. I suppose it wasn’t my time, wasn’t meant to be. I don’t know if it’s all good or bad, but I do know one thing. Among all the memorable and extraordinary days and nights I’ve lived as a doctor, in the hospital or here at the clinic, this is the most memorable and amazing of them all.”
Her cries stopped and she stared at me.
“Dr. Barnes, I don’t know what I would do without you. It’s never boring with you around; you most definitely brighten up my mundane life.”
She put her arm around me and gave me a light kiss on the cheek as we waited for our shift to end.