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 truth..er, 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.”
“Done.”
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
Troubadours
Weddings, Bar Mitzvahs, Birthdays
Bachelor and Bachelorette Parties
877-555-0000

“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.”