Wednesday, April 23, 2014

Night Clinic Raven


“I don't like the looks of this, I said as I walked into the clinic. I looked up at the sign and saw a large black bird perched above the Red Cross. Then I my gaze travelled up to the early evening sky and I saw the full moon and murmured to myself, “It's going to be a long night.”
“Did you see that bird perched outside our clinic?” I asked Miss James as she looked up from the desk where she had stowed her monstrous purse.
“No, I guess not,” she answered. “I hurried in without taking any notice so I wouldn’t be late.”
“Well, it’s got to be the biggest crow ever. Black feathers, black feet, black beak all outlined by a full moon. One or the other and I’d say we were in for a long night, but the two together spells disaster of Biblical proportion. I’m sure it won’t be sore throats and sprained ankles all night.”
Miss James stuck her head outside. The sun was almost settled down in the west and the full moon had taken its place commanding the dusk. She stood opposite the sign which swayed gently back and forth in the light breeze.
“It’s funny how it just sits there, perched quietly, almost serene in the moonlight. It’s a raven, you know, like a crow, but solitary,” she observed.
“It all seems very Poe-ish to me, ‘quoth the raven, nevermore.’ I never did understand that poem.”
I turned to my right and felt a sharp twinge of pain in my side. Miss James noticed me wincing as the pain shot into my thigh.
“Dr. Barnes, are you alright? For a moment you turned white as a ghost.”
I caught my breath and slowly straightened up. “Yes, yes, I don’t know what that was. I guess I just turned too suddenly and had some sort of muscle spasm. But it still hurts. I guess I’ll go sit down for a minute while you get the first patients ready.
“Good idea, doctor,” she agreed with me for once.
Full moon, ravens, talk of turning white like a ghost, Maybe I should call Dr. Maxim to cover for me and take the night off. Two bad omens I can handle, but three surely means this night will never end.
I glanced outside and saw that the raven was still perched above our door. I felt a tap on my shoulder as Miss James beckoned me back inside to start our shift.
“We should close the clinic tonight,” I decided. “I’ve got a bad feeling.”
“Don’t be silly,” she chided me and then she went outside and shoed the black bird away. “See, it’s gone.”
“Not really,” I replied as the raven returned and settled once again on top of our sign.
“It’s just a bird. There’s a child with a fever and sore throat in room one,” she announced.
“Good, something easy for a change,” I said and we walked back towards the exam rooms together.
“You’re walking sort of bent over,” Miss James noticed. “Something wrong?”
“I’ve got this soreness in my right side, seems to hurt more if I stand up straight. Maybe I pulled a muscle running this morning.”
I picked up the chart outside the door of exam room one, “Amber Lynn, 2 years old, sore throat and cough for two days, temp 101, otherwise healthy.”
A nice straightforward five minute visit.
“Good evening, I’m Dr. Barnes and this must be Amber,” I began my usual introduction and held out my hand to Amber’s mother.
We went through the brief history and I checked the little girl’s throat and listened to her chest. As I was writing out a prescription and instructions for Amber’s now relieved Mother I heard a loud crash and shouting from the waiting room.
“Wait here,” I instructed and went out to see what had caused all the commotion.
I walked quickly out to the waiting room, almost colliding with Miss James and her big belly, and arrived at the lobby just in time to see two young men in colorful leather jackets and jeans at each other’s throats.
One of the combatants gained the upper hand and pulled his adversary  up with his arm wrapped around his neck. I started towards them.
“You two monsters take your differences outside. You know the ‘rules’, this clinic is safe…”
“…for what this asshole did there is no safe place.” And he pulled out a blade and slashed it across his opponent’s neck. I raced to the victim’s side, ignoring the now very intense pain in my right side.
“Nobody’s going to bleed to death in my clinic,” I shouted pushing his attacker away.
“You don’t get involved doc. He deserves to die for what he did to my little sister,” the attacker screamed back. “You stay away from him. Just let him bleed. I’m warning you…”
I ignored this warning as I pulled off my shirt and held pressure over the deep neck wound, pushing my fingers into the depths of his neck to stem the blood flow, putting direct pressure over what I hoped was not his carotid artery. The fountain of blood slowed to a trickle as I cradled the victim’s head.
“I warned you,” said a voice behind me.
I felt a sharp pain just above my belly button and then looked up at my attacker as he pulled his knife out of my abdomen. My head started to spin as I heard a vaguely familiar musical jingle in the background. I looked up and saw the raven settling on the light above me. Then I saw the raven open its mouth, as if to speak and I remember eagerly anticipating its words…but there was only silence as everything went black.
The dark dissolved and a refined, sophisticated, slightly British voice began:
“You should feel lucky, you know. You should be dead, but somehow somebody snatched you from the abyss, at least for a moment.”
I opened my eyes and saw the raven. I tried to reach up and grab him; I wanted to strangle the life out of him, I wasn’t sure why I hated him so, but in my mind he was the embodiment of all the evil I had ever known. My arms wouldn’t move.
“You should hate me, you are right to hate me, but you don’t completely understand the whys and wherefores. I’m sorry, that’s redundant.”
A learned Raven?
 “Oh, don’t try to answer. Your arms are tied down and you’ve got a tube in your throat so you can’t talk. You know the kind, an ET tube, you’re on a ventilator, life support. It’s all that stands between you and an eternity with the likes of me. As a matter of fact, you’ve got tubes coming out of most of your body orifices. Therefore, just blink your eyes if you understand me.”
I tried to move but I couldn’t. I tried to talk, to scream at that vile bird, but there was only silence. I blinked my eyes twice.
“Once is enough. You don’t need to shout. I know what you’re thinking. What does a raven have to do with you or your precious night clinic or anything at all? You’re a smart doctor; you should know. You have this notion that I am wicked, but we ravens are not evil harbingers of ill will. Truly, we are one of god’s chosen messengers, like angels. Oh, you don’t believe me? Don’t take my word for it, just look in the Bible. Who did God choose to feed the prophet Elijah? Ravens. And who did Noah first send out from the Ark to ‘test the waters?’ A raven. So don’t go carrying on about evil and the dark side of humanity. You don’t have to say it; these thoughts fill your head. I wish Edgar Allen Poe had never been born.”
I wished the raven would stop his incessant chatter, but I was helpless. All I could do was lay there and listen.
I must be in a hospital on a ventilator which means the Raven is correct that I can’t talk. Maybe, I died and this is really Hell. Is this my fate? To be trapped for Eternity listening to the rantings of a deranged crow?
“Crow, did you call me a crow. Why, I’ve never been so insulted. Crows are vicious and petty. Just look at what a group of them is called: a Murder. How appropriate. Every time I see one of those little flying rats I’d like to murder it. But, ravens, we are a different breed, the most noble of all birds. Solitary, thoughtful, central to such a variety of myth and legend. Why, it’s the ravens of London Tower that maintain the British Empire. The ravens are part of the great Norse god king Odin. So, please don’t offend me by calling me a crow.”
His voice had grown loud and pierced my brain, but I guess he realized how shrill he had become and settled down.
“Now, where were we? Ah, yes, the nobility of the raven, a favorite topic of mine. But, enough about me, let us talk about you. Rather, I will talk, you listen. You really do listen very well, although I suppose you don’t have a choice.”
There was a sigh and then he continued, “I wish all doctors were such good listeners. It’s the ability to listen and hear what their patients are saying that makes a doctor a truly skilled healer.  But, are you really a good doctor? Are you even a good person? You think you performed a brave and righteous act when you thrust your fingers into that dying boy’s neck wound and saved his life, but was it in fact righteous? Do you know what he did to provoke such an attack? I’m sure you remember his assailant shouting about his sister, his baby sister, his nine year old baby sister who had just been brutally raped and then mutilated by the monster you saved. Does that make you feel noble? Don’t try to answer. And, closing your eyes tightly won’t make the truth go away. That beast deserved to suffer, deserved to die. Is it wrong for a brother to take vengeance on the person who attacked his sister and left her scarred beyond all hope, for life? However, you did not know, you could not have known. And, if you had known the truth, if you had witnessed the atrocity, would you have been in such a hurry to save that boy?
“Your eyes plead ignorance, while your soul is in turmoil. But, there is no amount of penance which can undo such damage. Maybe, just maybe, you were right, you should have saved him. It’s your job, you took an oath, to treat the sick and injured to the best of your ability. It isn’t your place to sit in judgment. Are doctors exempt from simple human decency?
“Let us forget about your attacker and his victim for now. Let us look at something closer to you, the lovely, decent and resourceful Miss James. She has almost molded you into an acceptable human being; one with a true conscience and respect for others. She drew you away from your shallow dreams and brought you into a bizarre world filled with society’s outcasts, rejects and downtrodden. She faces each day with a smile and a helping hand not because it is a job, but because she cares about every drunk, junkie and schizo that wanders into her clinic.CAN YOU SAY THE SAME?”
The raven paused from his soliloquy for a moment and took a deep breath.
“I’m sorry I raised my voice. You, Dr. Barnes, you would escape from the Night Clinic in a moment if she would agree to join you and, now that you’ve suffered this terrible injury, she just might do that, just for you. But, can you ever truly escape? Your past will be with you. Yes, I know; I know all about a lazy, abusive, alcoholic father who cast his son out when the boy was barely fifteen. I know about this boy who survived on streets not unlike those which surround the Night Clinic, who lived by his wits, managed to go to school, worked every sort of odd job and maintained an equilibrium that carried him to scholarships, then to one of our finest universities and, finally, medical school, all the while vowing to never return to the poverty of his childhood days.
“There is, however, a demon lurking in the shadows. Guilt. We all must deal with our guilt. Dermatology in Hawaii is as far from the Night Clinic as you could go and the prospect of a soft life on the beach unchained the guilt from the depths of your being and brought it to the surface where, eventually, it would have torn you apart. The presence of Miss James allows you to rationalize your decision to stay at the clinic. You say it’s for her, but truly it’s your guilt which keeps you surrounded by winos and hookers. I tell you the truth: if you were to try to leave this sordid world behind and abandon those members of society who most need your help, this guilt would devour you. Oh, you would surely feign happiness, drive around in your big, shiny Mercedes or BMW or Lexus, live in a big house on the beach, but underneath guilt would be gnawing away, scratching and tearing at your soul, never allowing you a moment’s rest. Maybe it would have been a little thing like insomnia or something worse like uncontrollable fits of anger, or infidelity, but it would have been something. And then, because of this guilt, booze or pills or worse would have consumed you and, in the end, you would have ended up in exactly the same place you are now, except without hope.
“Oh, I’ve offended you, I’m sorry. Truth is always a burden and facing the truth within us is an even greater weight to shoulder, a weight which suffocates. That sounds very profound, doesn’t it?  ‘Truth is always a burden, truth suffocates.’ But it’s just drivel, no, it’s worse than drivel, it’s foolish nonsense which deceives. It is running from the truth which creates the burden. However, admitting that there is truth and accepting it brings freedom, and freedom releases us from the troubles of this world. Well, maybe not us, at least not me, after all, I’m just a big black bird. But, humanity is crushed by its refusal to face truth or even admit that there is such a thing as absolute truth in this world. And, what is this truth? Just three things: you are born, you struggle for a brief period of time and you die and on the day an individual accepts the reality of this truth real freedom begins.
“I’m sorry, I’ve wandered off into the world of philosophy. I’ll get off the soapbox and, let us see, where were we? Oh, yes, Miss James.
“She’s your savior you know. I know it’s not a pretty picture, but look at what you were before she came into your life. A heartless womanizer, studying the intellectual side of medicine, but without a soul or true compassion. Intelligence and hard work may carry you a long way in the medical arts, but without a large dose of kindness and concern for others you could never be a true healer. Miss James, surrounded by the deprivation she lives with and fights on a daily basis in the clinic, opened your eyes to this world you knew all too well; one you had buried away deep in the recesses of your brain and hoped to escape forever. It was Miss James who guided you and showed you the true meaning of responsibility, compassion and, in the end, love. It’s why you are lying here now instead of being safely ensconced in that cushy job treating annoying itches on the buttocks of fat, wealthy socialites.”
I had been listening to his speech quietly, my eyes closed, each word boring into my brain, but now I wanted to answer him, tell him how right he was, but also how wrong.
He knows what’s in your head, you don’t have to tell him.
I opened my eyes. I wanted to speak to him and tell him, but he was gone. For a brief moment I heard the steady beeping of monitors and the whoosh of the ventilator, but these noises faded as reality receded and everything went black.
After a time, the black began to withdraw as streaks of light poked out from the edges of emptiness until I saw the silhouette of the Raven perched above me.
“I hope you had a peaceful respite,” he began, “but, I see that was not the case. Perhaps I will be able to put your mind at ease. How can I do that? Surely you don’t blame me for the turmoil you feel. I am not the one who stabbed you, I did not make you sick or harm you in any way. I did not suffer poverty and deprivation with you. I am only here now, a messenger to help, to bring peace to a tired soul, perhaps eternal peace. Death? Perhaps, but perhaps not. I know you’ve wondered about death over the years, pondered, searched and even glimpsed a taste of what may come after one’s breathing ceases, the heart beats its last, the brain becomes quiet. Is it the beautiful Garden? Is it complete and total nothingness, is it anything? Here let me show you, let me take you.”
The Raven spread its wings and started to beat the air ever so slowly. It hovered above its perch for a moment and then moved closer, drawing me out of my bed and carrying me away. The wind raced past, bringing a delightful relief from the chaos in my soul. A patch of green began to grow in the distance, then it was split by a river of blue. Bits of color grew into radiant collages as flowers appeared and we stopped. The Raven, gently holding me aloft, hovered over the Garden. Not just any garden, The Garden. The exact garden that took Jewel and her mother, the same Garden I’d thought about almost every night since that fateful day. Here it was again and here I had a second chance. I knew what waited for me in that place: Peace. Peace and Eternal Happiness.
“It’s yours, if you wish. Choose. You know what waits for you here in the Garden. Or, you may choose an unknown future. But, you must make a choice. You’re a doctor. Every day you make life and death decisions. Now it’s your own life. Choose.”
Sick children, injured teens, hopeless diseases, death and destruction weighed on my head and then I saw the Garden, beautiful, peaceful, serene.
Is there any choice?
I reached down and tried to grab a branch to pull myself down, down into the Garden and away from the Raven. I had almost touched the top of one of the trees when the Raven left me and settled on a nearby tree branch and fixed his stare upon me.
“CHOOSE,” he screamed.
And, above me, I saw the Goddess of the Night and Captain Surgery and the Dragon and Caleb and so many others shouting at me, begging for me to come back, to help them, to ease their suffering and I pulled my hand back. Below was Jewel beckoning, mouthing “It’s OK.”
I heard the screams of a woman in labor, Miss James suffering for our child, for me and then a final blood curdling scream and then crying, first soft and them louder: the cries of a baby and her father.
“NO,” I screamed as I ripped the endotracheal tube out of my throat and sat up in my hospital bed screaming, “NO, NO, NO.”
Arms reached against my shoulders and held me down and I opened my eyes and saw Miss James, dear Miss James and I felt her hand on mine. I settled back, comforted by the soothing, steady beeps of the EKG and pulse oximeter and her sweet voice.
“It’s OK, doctor, It’s OK.”
“I’m thirsty,” I croaked out. “I won’t need that tube anymore.”
 I felt the cold plastic of an oxygen mask settle on my face as I lay back and fell asleep to the lullaby of the ICU.
The Raven was gone.
I awoke to the caresses of Miss James stroking my cheek with her soft hand.
“You’re looking much better, I must say. You’ve been through quite an ordeal. Did you know that besides being brutally stabbed while attempting to save a young man’s life you also had a ruptured appendix. It was all Captain Surgery could do to stem the bleeding and clean up all the infection. And then, despite the Captain’s efforts, you’ve been on seven drips, suffered through ARDS, Renal failure and shock liver. I don’t know what was going on in your head, but your behavior was a little bit bizarre. They had to keep you tied down most of the time and you seemed to be staring at something, even though I don’t think you saw any of us hovering over you. All I can say is that it’s a good thing you’re young and strong. At least it looks like you’ll be around to see your daughter come into this world.”
“Daughter? A baby girl?” My eyes lit up and I’m sure a big smile creeped onto my face. “Wonderful…I’m glad,” I murmured as I sank deeper into my bed.
“Now, my dear Miss James,” I added, “do you think you can get me a rack of ribs from Louie’s…and some cole slaw?”
Two weeks later I was back on my feet and made my return visit to the Night Clinic.
I walked towards the front entrance and saw the Raven perched on the sign above the door. Its gaze almost burned a hole in me as I walked by. I stopped in the doorway, turned and smiled at my black benefactor and tormenter. Its beak opened as if it was going to address me, but then it smiled, closed its mouth and I watched as it spread its wings and flew away.


Saturday, April 19, 2014

Night Clinic Zebras

      “Less than two months to go and I’ll finally be a real doctor,” I announced as I walked through the door to the Night Clinic.
“I know, I know,” Miss James answered, not even looking up from her desk. “Then, you can spend every night here at the clinic, instead of two or three times a month.”
“Dermatology, remember… southern California, beaches, sun,” I replied, “a better, safer place to raise our daughter?”
“But, what about all the good you can do? These people love you. So many have said they wait for those nights you’re working to come in.”
“Yeah, everything that’s creepy, strange and bizarre manages to find its way to our clinic. But, be reasonable for once..,”
She raised an eyebrow at this request.
“…We’ll have a new baby. My derm residency will be at a brand new, modern hospital, in a clean, safe part of town and it will be regular hours. What have we here? The dregs of society, maggots, winos, addicts…”
People,” she said in a forceful voice, “people who have nothing else and nowhere to turn sometimes. How can you just turn your back and leave?”
She’s right. Far too often I forget why I became a doctor. Still there’s something to be said for a quality lifestyle and Dermatologists really do help their patients. Maybe, not in quite the same way…
“Enough discussion for one evening, let’s get down to work,” I announced.
“Oh, was that a ‘discussion’? I thought it was an argument,” she retorted.
I started to say something and stopped myself.
Let the pregnant lady have the last word.
“Any patients ready?”
She gave me a look that could have melted Antarctica and then her expression mellowed as she announced, “Marta Valdez, four years old, failure to thrive. She and her mother are in room one.”
“Thank you, dear, lovely nurse,” I answered, doing my best to be charming.
“Save it,” was her reply.
I picked up the chart. “Marta…four years old, twenty eight pounds, thirty four inches tall, well below normal parameters, no allergies…”
I knocked and entered.
“Good evening, I’m Dr. Barnes,” I said and extended my hand to greet Marta and her mother. “You must be Marta,” I added as I shook the little girl’s hand, “and you are Marta’s mother?”
“Dora, Dora Weisel. I hope you can help us.”
“I will certainly do my best,” I replied. “Now can you tell me more about Marta, please?”
“Well, as I wrote on the history form, she’s four and she just doesn’t seem to be growing. She gets tired all the time; sometimes she’s short of breath just from walking up the stairs. And, this evening, she had some blood when she went to the bathroom. That’s why we came at this odd hour.”
“I’m glad you brought her tonight, particularly if she is having bleeding. When did you first notice a problem?”
“Maybe six months ago. We went to the park and after playing for about fifteen minutes she came and sat down next to me. She said she felt tired. I know that by itself doesn’t mean much, but she’d never done that before. She had always been a little whirlwind. I mean I could never keep up with her.”
“Has she always been small?” I asked. I wasn’t sure if Dora could sense the concern that was growing inside me.
“Why, yes, but she doesn’t seem to be growing much now.”
I asked Marta if she hurt anywhere and she shook her head.
Small, but otherwise healthy appearing child tires easily and growth is stunted. Cardiac anomaly? Childhood cancer? Malabsorption? I started my exam. I examined her from head to toe. She had a small purplish skin lesion on her arm, probably an insignificant hemagioma.
Then I heard them, the bruits, everywhere, pounding in her chest and abdomen. What was that condition? The skin lesion, that insignificant hemagioma steered me to the diagnosis, a hopeless diagnosis for someone so young: Osler-Weber-Rendu, a syndrome with multiple arteriovenous malformations. I had no doubt, although I knew I’d need to send her to the Pediatric Oncology clinic for confirmation. I’d only read about this disease. I don’t even know why I remembered such a rare illness.
She’s awfully young to get this disease. Maybe it’s something else. It doesn’t really matter, whatever it is, it’s bad.
I looked at her Chest X-Ray and labs and noted the abnormalities.
I steeled myself as I prepared to present all this information to a very worried mother.
“Ms. Weisel,” I began, “it is very likely that Dora has a rare disease, a disease that is even rarer to be found in a child her age. I think she has this condition called Osler Weber Rendu. I know that means nothing to you. What it means is that as her blood circulates it goes through these things called Arteriovenous malformations. In doing so it bypasses the body’s tissues  and, as a result, those tissues and organs don’t get their proper nutrition, like they are being starved. That’s why she is so tired and that’s why she isn’t growing. Adults with this disease have finished growing and can compensate, but someone like her, well, to tell you the truth, I’m not sure what will happen.”
“Are you sure about this, Dr. Barnes?” she wondered.
It’s just an educated guess.
“I’ve only done a history and physical and a few labs and Chest X-Ray, but the findings are pretty striking to me. But, to be sure she would need more testing, probably a CAT Scan or MRI to make a definite diagnosis. That’s why I’m sending you to University Hospital, Dr. Katy Lenore. She’s wonderful with the kids she treats, caring and brilliant. She’s the smartest doctor I know.”
“What should we do for now?”
I saw tears filling her eyes and then I saw Marta tugging on her mother’s shirt.
“It’s OK, Mommy. I’ll work real hard to eat and grow and get better. I don’t want you to cry,” Marta said in a small, but determined voice.
Ms.Weisel dried her tears and picked up her little Marta. “I’m sure you will, my little darling and then we can come back and tell Dr. Barnes just how wrong he was.”
She turned to me and shook my hand. I had to force myself to look into her eyes.
“I hope I’m wrong, truly I do and I look forward to the day when you and Marta comes back to tell me so.”
I gave Ms. Weisel copies of my notes and the test results and wished them well and then went on to my next patient, Harry Wilcox, 29, abdominal pain and nausea for three years.
Harry Wilcox…Harry Wilcox, surely it can’t be the same person. He should be back in Virginia.
Harry Wilcox is the name of a classmate of mine from high school, very popular, a three letter man, football, basketball and track and one of the biggest bullies I’d ever met. I always had assumed that he had gone on to great things. Surely he wouldn’t show up late at night in our little clinic.
I knocked on the door and went in and was greeted by Mr. Harry Wilcox, Class of 2003, Jefferson High School. We recognized each other immediately as he rose and held out his hand.
“Dr. Barnes, Dr. Barnes,” he stated loudly, “I always knew you’d end up as a doctor or astrophysicist or something intellectual. Still playing chess?”
“Not too much,” I replied, “sick people keep me sort of busy.”
I was doing my best to not show any animosity, but hatred that had been buried inside for years was starting to claw its way to the surface of my brain.
“What can I do for you,” I asked, changing the subject. “What brought you into our quiet little night clinic?”
He would not be deterred, however, as he went back to reminiscing.
“Remember the time we were playing Central for the division championship in basketball. We won on my last second shot from the corner. Anyway, you couldn’t make it because someone had locked you in the janitor’s closet? Did you ever figure out who did that?”
“Not definitely, but I’d always assumed it was you or one of your cronies. You know I almost died of dehydration.”
“Really, that must have been terrible for you.”
Quite the understatement. Locked in a closet on Friday and forgotten. At least there was a bucket. With every tortured minute I vowed revenge. But, I’ve grown since then; revenge is such a petty thing. Or is it?
“Listen, Harry, I would love to sit and talk about ancient history, but you are not the only sick person here tonight. What can I do for you?”
“Well, Dr. Barnes, sort of rolls off the tongue, Doc…tor…Bar…nes, I’ve had episodes of abdominal pain and nausea off and on for about three years. I’ve been to doctor after doctor, specialists from Johns Hopkins to the Mayo Clinic and nobody can figure it out. I heard from a friend of a friend that you moonlighted at this clinic, so I figured, why not go see my brilliant, intellectual former schoolmate. Maybe he can figure it out; maybe he knows me well enough to get to the root of the issue. And, here I am.”
Now’s my chance to get even, settle the score. Maybe serial enemas or placement of a thirty French foley catheter. Wait a minute, doctor, don’t forget Hippocrates. But, Hippocrates was never locked in a closet for three days.
“I would assume you’ve had a complete work up? You know, blood tests, X-Rays, GI endoscopy and such,” I asked.
“You better believe it. Upper and lower GI’s, Cat Scans, nuclear studies, I even had my gallbladder removed and I’m still sick.”
“OK, Mr. Wilcox…”
“Harry, please call me Harry, after all, we are old friends.”
“That is a matter of opinion. Let’s keep it on a professional level, Mr. Wilcox. I guess I’ll start with the basics. When did you first start having symptoms?”
Harry Wilcox breathed a deep sigh and then began his story.
“It was three years, one month, fourteen days and three hours ago that I felt the first twinges of pain. I remember clearly because I had just finished a late dinner, fettuccini  alfredo with shrimp, sautéed spinach, poppy seed rolls, Italian salad and raspberry white chocolate cheesecake for dessert. It was at La Trattoria in Baltimore where I had just closed a business deal. Shortly after dinner as I was sharing a few drinks with a young lady in my hotel room, and progressing quite well, if you get my drift, I was struck by waves of nausea, followed by intense pain in the middle of my abdomen, then I vomited about ten times, then more pain and finally, after about an hour I was better. Food poisoning, I figured. Of course, any thoughts of continuing my amorous ways went away with the buckets of puke, so I gave my companion a twenty and went to bed. It’s been the same thing off and on for the last three years. Waves of nausea, aching sometimes intense pain, more nausea, vomiting, pain and then it goes away.”
“Tried taking any medication for these symptoms?” I queried.
“Advil, Pepto Bismol, Pepcid, Prilosec, Bentyl, Librax; none really help,” Wilcox answered.
“Any particular food that triggers it, or stress or anything you can think of that may be associated?”
He thought for a moment before answering, “I’ve noticed there is usually some sort of excitement before the symptoms commence. Gambling, or an impending female submission, or anything which causes a bit of mental strain.”
Now it was my turn to think. “Do you get any headaches with these GI symptoms? Or any feeling that you are about to have an attack?”
He shook his head, “No, never have any headaches. It always starts with nausea first, then pain, then more nausea and vomiting, usually.”
I was beginning to get an idea, an unusual but not unheard of cause of abdominal symptoms, abdominal migraines, more common in children, but also found in adults. Treatment was a bit of a problem as there was not accepted therapy.
“I’ll be back in a minute,” I said and I stepped out into the hall.
I hate to have to look things up on the fly like so many of the other residents, but…
I did a quick search for Abdominal Migraines and found very little which was helpful. There was a suggestion for tricyclics and anti anxiety meds. I went back to the exam room.
“Mr. Wilcox, I think I’ve found a medication that may help you. Take it twice a day, after breakfast and at bedtime. Come back and see me or your Primary Care doctor in about two weeks.”
I wrote out a prescription for Limbitrol DS and sent him on his way.
It’s time for a nice case of the sniffles.
“New patient in room four, abdominal pain, rash, hair loss, diarrhea. I’m not sure what he’s got, but he looks sick. Let me know as soon as you need an ambulance; I’m pretty sure you’ll be sending him to the hospital.”
“Serge Mostov, 58, no allergies, hypertension, c/o…hmm,” I murmured and then I knocked and went into room four.
“Good evening Mr. Mostov, what brings you in here tonight?”
“Didn’t you read the forms, Dr., what is it?” he inquired squinting at my badge.
“Oh, I’m sorry, Dr. Barnes, it’s Dr. Barnes and I did read the chart, but I like to hear it from the horse’s mouth.”
“Well, I’m no horse but I get your meaning,” he replied.
Mr. Mostov had an eastern European accent, Russian, I thought. He definitely looked ill, skin had a gray pallor and I could see small clumps of hair on the floor.
Hypothyroid perhaps?
“When did your symptoms start, Mr. Mostov?”
“A few days ago. I went out for brunch, had my usual tea, a bagel with cream cheese, a bit of smoked salmon. That night I didn’t feel well, so I only drank a bit of tea and went to bed. I’ve eaten nothing since and then I started with the hair falling out and diarrhea and pains.”
“What do you do for a living, Mr. Mostov?”
“I’m in international trade. I expedite shipments of manufactured goods from Russia, Czech Republic, Turkey, all the eastern European countries. Here’s my card.”

Mostov Importing
PO Box 4005
New York, NY 10017

“You’re a long way from New York,” I observed.
“That’s just my business address. I travel all over the country. I had a meeting here in town which is why I’m in your clinic at this late hour.”
“You aren’t a spy are you, Mr. Mostov?” I wondered out loud. “Because your symptoms could be due to radiation poisoning.”
He gave me a funny look and then clutched his stomach and moaned for about one minute and then he relaxed.
“That’s how it has been for the last two days.”
“Let me feel your pulse, please.”
He held out his wrist and I put my fingers over the radial artery; the pulse was present but definitely weak. I looked down at the chart. Vital signs were normal.
“Lay down on the table here so I can check you out,” I requested.
There were sores in his mouth which bled easily and there was a slight conjunctival hemorrhage which I hadn’t noticed when I first walked in the room. His abdomen was diffusely tender and there was frank blood in his rectum. I checked his blood pressure and it was 80/45 and heart rate was 115.
“If I were to bet, Mr. Mostov, you have been poisoned. An ambulance is on the way to take you to the hospital. I will call to let Dr. Astor in the ICU know what’s going on. Do you have any family? Because you should call them.”
“Is it that bad, Dr. Barnes?”
“I think it’s worse.”
“Then, please, call this number from the pay phone which is down the block and tell the person who answers your suspicions. First give them this number 545-234-323. You have my permission. They will know what to do. And, now I will leave you.”
But, the ambulance is on its way. If you leave I am sure you won’t survive twenty four hours.”
“And if I go in your ambulance, how long will I survive? Perhaps twenty five hours? I have unfinished business to attend to. I thank for your time, Dr. Barnes. For your own safety, please leave no record of my visit here. Good evening and thank you again.”
He picked up his coat and walked out. I called the number on the card he had given me from and reached the Russian Embassy. I delivered his message, they thanked me and I hung up. I stayed in the shadows as I made my way back to the clinic, just in case.
I reached the clinic entrance unseen. As I pulled the door open I heard a noise, like hoof beats on a cobblestone road. I turned and saw two zebras run by. I walked back into the clinic shaking my head.
Not surprised.
“Where’d you go?” Miss James queried, “four patients are waiting.”
“Simple things, I hope,” I answered, ignoring her question.
“Back pain in one, swollen hand in two, fever in three and “black penis” in four.”
“That’s what he put down. His vitals are normal, but I didn’t examine his chief complaint. You men are so funny about down there.”
“Shouldn’t we be? I think I’ll save ‘The Black Penis’ for last,” I remarked as I picked up the chart to room one.
“Michael Smoots, 38, back pain for four hours, no medical problems, normal vital signs.”
With any luck a shot of morphine and follow up at the Ortho Clinic will do the trick.
I did my usual knocking and went in. I found Mr. Smoots stretched out on the exam table, staring at the ceiling. He was pale and from the doorway I could see tiny red spots covering his body.
Here we go again.
“Mr. Smoots, I’m Dr. Barnes, what seems to be the problem?”
“The problem? You’re a doctor; look at me. My back feels like someone stuck it with a cattle prod and now my toes are going numb and I may have had an accident while laying here.”
“And all this just started four hours ago? What about all those red spots?”
“They just appeared while I’ve been laying here. What’s going on, Dr. Barnes? I feel like I’m about to die.”
“I’m not going to let that happen, Mr. Smoots, but we need to get you to the hospital.”
I pushed the intercom button, a device I hated and rarely used because it broadcast all over the clinic.
“Miss James I need you, now.”
The door promptly opened and my able assistant appeared.
We need an ambulance, I need an IV set up and I need some antibiotics, Rocephin, everything five minutes ago.”
She didn’t ask any questions as I applied a tourniquet to my patient’s arm and started an 18 g IV in the antecubital area. I opened up the fluids and pushed the Rocephin the moment Miss James put it in my hand.
“What is it Dr. Barnes?”
“Most likely Meningococcal meningitis, but it could be a spinal cord abscess or tumor. Whatever it is, it’s an emergency which needs more treatment than we can provide here.”
“Ambulance will be here in two minutes.”
“Good, good. Mr. Smoots are you OK?”
“I’ve developed a terrible headache and the numbness is worse.”
“Just hang in there. The ambulance is here. You’ll be up dancing in no time.”
I saw him visibly wince at my words and then I realized why. Michael Smoots, was a dancer and choreographer for City Center Dance. He was famous. I saw him on television and he’d even done a stint on Broadway in “Pippen.”
They loaded him on the stretcher as I silently berated myself for my lack of insight.
“Take good care of him boys,” I exhorted the ambulance attendants.
And they wheeled him away into the night.
I looked at my watch, 3:34.
This night is never going to end.
Room two, John Hedrick, 41, swollen hand for three days, no fever, history of Type I Diabetes, no allergies. I paused for a moment and then forged ahead, knocked and greeted Mr. Hedrick.
“Good evening Mr….” before I could finish I was welcomed by a man waving one of those big fake hands with the index finger sticking up shouting “We’re Number One,” most commonly seen at sporting events.
“Dr. Barnes, he’s our man, if he can’t do it nobody can, Rah,” he shouted jumping up and down.
He was wearing the local football team’s red and white colors with Mustangs plastered across his chest, his face was painted red on one side and white on the other.
“I don’t take care of delusional patients,” I began, “our Mustangs haven’t come close to finding their way out of the cellar for what is it? Eight years?”
“But, we’re poised for the big break out,” he cheered.
“Uh, Mr. Hedrick, I wish I could humor you in your fantasies, but I have a very sick man dying from a black penis waiting to be seen. Is there something I can help you with?”
“Like I wrote on the paper, I’ve got a swollen hand.”
“I see that, very clever.”
“It’s this hand, Dr. Barnes,” and he held out his left hand which really was swollen and slightly bluish.
I cradled his hand in mine and felt for the radial pulse, which was present and bounding. He winced slightly even though I grabbed his hand ever so gently.
“How long has this been swollen and tender?” I asked.
“Started four days ago at ten in the morning. I was loading crates on a truck when I felt a twinge in my finger…”
“Which finger?”
“The middle finger, right here.” He held up his middle finger and pointed to the area of the metacarpal-phalangeal joint. It was definitely swollen and hot.
Gout? The start of Rheumatoid Arthritis? This was going to take more testing than we could do at our clinic.
“Have you had any fever?”
“Just in my hand.”
“I’m not sure what it is. It could be gout or some type of arthritis. I don’t think it’s any infection. We’ll check some blood tests and do an X-Ray and then we’ll know more.”
“Thank you, Dr. Barnes,” Mr. Hedrick answered.
I always like polite patients.
Miss James will be in here to take your blood and get the X-Rays done and then I’ll be back.
I went back to the break room before tackling “The Black Penis”. I opened the back and stood in the alley and heard hoof beats again. Once again I saw zebras run by, only this time there were four. I watched until they faded from site and then I took a deep breath and marched to room four where “The Black Penis” was waiting.
“Elmore Doddington, 29, no previous medical problems, complaining of penis turning black for eleven hours.”
Not surprised he didn’t wait too long before coming in. Miss James is right about men and their penises.
I knocked loudly, waited a few seconds and then forged ahead.
“Good evening, Mr. Doddington, what is the problem you are having?”
“My problem? Just look at this.”
He pulled the paper sheet away that was covering his groin area and revealed his private parts which were, just as reported, black, but also swollen and starting to rot.
“How did this start?”
“I think it was this afternoon. I was sitting in the park, feeding the ducks, like I always do in the morning. I had finished tossing bread crumbs when I sensed the presence of someone or something sitting next to me and then I felt a sharp pain in the tip of my penis; I thought it was a bug bite. Of course, I couldn’t just pull my pants down and check right there, so I dumped out the last few bread crumbs and went behind the bushes, just to take a quick look.
“Well, there was a tiny black spot on the end which was painful. Spider bite was my first thought. But, I didn’t find a spider. Anyway the black spot started to grow. That was when I figured it out.”                             
“What did you figure out?” I asked.
“Who or should I say what had bitten me. Actually it was staring me in the face the whole time: ‘Invisible Gay Zombies from the Underworld’.”
“Excuse me?” I stumbled over my words.
“It’s right here,” and he held up a copy of the Daily Encounter, a tabloid paper well known for over embellished reporting.

“Invisible Gay Zombies Invade Our World and Accost Teenager,
         Fifteen Year Old Boy is in Catatonic State”

I glanced through the article which touched on a boy named Chase, the fifteen year old who had been assaulted, but never saw his assailant. The boy then turned into a “Zombie” which in his case meant he entered a catatonic-like state, unresponsive to any stimulus, eyes staring blankly at the distance.
I wonder where the Underworld comes into play.
Mr. Doddington continued, as if he’d read my mind, “They must be from the Underworld because they come out of the sewers. And, there’s a manhole cover not more than twenty feet from where I was sitting in the park. I’m sure I heard the sound of that cover being replaced and then, Whammo, my penis starts to turn black and before the day is out I’ll be a Zombie, nothing but rotting flesh and malevolence.”
I stared at my patient and the look on my face must not have instilled any confidence.
“If you don’t believe me, then how do you explain my symptoms?”
“Necrotizing infection secondary to Strep…”
“With no fever, normal vital signs and no pain. I work as a nurse, I have a bit of medical knowledge.”
“You certainly are correct; there should be some systemic signs of infection if this is truly a necrotizing infection.”
Definitely one of the more bizarre conditions I’ve ever encountered. Maybe he stuck his privates into a vise or zapped it with a cattle prod. What to do? What to do?
An idea popped into my head.
Won’t cause any harm and I can always send him to the hospital.
“Mr. Doddington, I’m afraid Zombies are a bit out of my field of expertise, I think I skipped that lecture; but I do know someone who can help. She’s an expert in Zombies and voodoo and such and she lives only a short distance away.”
“Well, you better get her here fast, because in fourty three minutes and eighteen seconds the zombification process will become irreversible.
I nodded my head as if I understood completely. In reality I had no idea what he was talking about. I have to admit the finer points of Zombies have not been a part of my medical studies and I’ve never watched “Walking Dead.”
I searched on the computer for “” specifically looking for Madame Marie, Voodoo High Priestess.
If anyone can help me with a Zombie problem it’s her.
Miss James saw me clicking through the pages.
“Another voodoo problem?”
“Zombie,” I corrected her.
“I have Madame Marie on speed dial,” and she stooped over to help me, giving me an eyeful of her cleavage in the process.
Once a letch, always a letch,
“Good evening, Madame? Dr. Barnes over here at the Night Clinic wants to talk to you.”
Here you go and she handed me her phone.
“Good evening, Madame. How’s the weight loss business?...I’m sorry, but we’ve got a bit of an emergency over here..;No not really voodoo, at least I don’t think so…It’s a Zombie problem…almost twelve hours…eleven hours and forty minutes give or take a few seconds…You’ll be right over…thanks.”
I turned to Miss James, “She’s on her way, she has to stop and pick up a chicken foot and said that the victim needs to have a valuable personal item and $225 cash.”
“Good old Madame Marie,” Miss James commented.
“Oh and why do you have her number listed with your contacts?” I wondered.
Miss James looked up at the ceiling, “I hope she gets here soon,” she added.
“Don’t try to change the subject. Why does a nurse for this clinic have a voodoo high priestess on speed dial?”
“Come, come, Dr. Barnes, with everything that has happened since you’ve been working here? Besides Madame, I’ve also got a Priest, a Rabbi, a Buddhist Monk, a Hindu Shaman, the FBI, the CIA, the Fire Department, Animal Control, the Police Department, the Sheriff’s Office, and Ghostbusters listed.”
While we waited for the Voodoo High Priestess to arrive I went back to room three to finish up with Mr. Hedrick. His X-rays revealed bony destruction involving the third finger.
I went back to room three.
“Mr. Hedrick,” I began, “it looks like you have some sort of infection or inflammation involving the bones of your left hand.”
I re-examined his hand and his forearm. There was an area of swelling above his elbow, which was also tender.
“Have you been scratched or bitten by a cat recently?”
“Not that I remember,” he replied.
“Any exposure to tuberculosis?”
“No. Nothing unusual has happened. I’ve done nothing but go to work, eat and lay on the beach.”
“Lay on the beach? That could be the answer,” I decided. “I think you have some unusual form of infection, a rare type of bacteria, sort of like tuberculosis, but not exactly. Unfortunately, we don’t have the means to test for it here. I’m going to write you out a prescription and I think you should go over to the hospital ER. I don’t think we’ll need an ambulance, but I will call them and tell them you’re on your way.”
“Which hospital?” he asked
“University. I think if they’ll be able to fix you up.”
We sent him on his way and called the University ER and told them to expect his visit.
 About a minute later the sound of the bell out front chimed, ringing over and over as someone was banging it repeatedly.
“Some people can’t read,” I muttered referring to our sign which said “Please ring the bell one time for service.”
The bell kept ringing and I when I arrived at the reception desk I found a short, thin, dark skinned woman pounding away. She was dressed in a colorful wraparound dress and had a matching scarf on her head. She was carrying a canvas bag.
“Good morning, Dr. Barnes. I’m Madame Marie,” and she held out her hand. “Now, take me to our poor Zombie.”
She had a definite Caribbean accent, was about five foot nothing, very white teeth, except for a single gold tooth in the front, and she smelled of flowers.
Reminds me of Dr. Adams.
I led our High Priestess to room four and introduced her to Mr. Doddington. She stared at him up and down and then opened her bag and started putting things on the counter: a small doll which looked like our victim, a metal plate with some coal on it, a string of garlic and two raw bird’s feet one larger than the other.
“Now, young man. I’ll need a valuable personal item and $225.”
“That seems a bit steep and I didn’t bring anything of value with me.”
“OK, Ok, young man,” she responded as she bounced up and down on her heels. “But, your pecker is about to fall off and in thirteen minutes you will be entering the irreversible state of Zombification. It’s your choice. You have a very nice ring on your right hand, only fourteen carat gold, but at least it has a real diamond, SI2, H color, good cut. That will suffice for our purposes.”
Doddington peaked under his gown and then pulled the ring off his finger and handed it to Madame along with $225 he pulled form his wallet.
“One more business item before I get to work. Which raw bird’s foot would you like? We have the standard raw chicken foot, which will return you to your original state and size. Or, we have the ostrich foot, which will provide significant enhancements for an additional $75.”
Doddington looked a little perplexed.
I interjected, “If I understand Madame Marie correctly, you may have a Ballpark Frank for $225 or a Hebrew National Knockwurst for $300.”
“I guess I’m not very hungry, so Ballpark please,” he decided.
Madame shrugged her shoulders, took his money and his ring, and lit a match to the coals which were glowing hot in about a minute. She threw the ring in with coals and then tied a sort of athletic supporter around Doddington’s waist.
Next she poured all the hot coals but one, along with the melted ring and the chicken’s foot, sans one toe, into the athletic supporter and waved the lone chicken toe and the doll over his waist. She chanted a few incoherent words and danced around the table, holding the coal in her hand.
The smell of burning flesh, from Madame’s hand and Doddington’s necrotic penis filled the room as the lights went out and the room took on an unworldly eeriness as the only illumination came from the glowing coal in the High Priestess’ hand.
Finally, Madame Marie thrust her hand into the athletic supporter and there was a scream, from the High Priestess, I think. The lights came on and the burning smell vanished.
I looked at the clock, one minute four seconds to spare. My patient looked under his gown and took off the athletic supporter.
“Looks good as new,” he reported. He pulled out his ring, which was truly looking sparkling and brand new. Everything else also is better.
“Let me check the results, just for my documentation,” I requested.
Sure enough he had a normal appearing penis, pink and healthy.
Madame Marie held up her hand which was free of any burn or scar. She fastened the chicken toe to a leather cord and handed it to our patient. The toe looked like it had been cooked.
“Wear this around your neck for at least six months, night and day, even in the shower or bath. It will keep those Invisible Gay Zombies from making a return visit.
“And you, Dr. Barnes, this clinic is also vulnerable. For $75 I’ll leave the ostrich foot here to ward off any evil interlopers.”
I looked at the big ostrich foot and then handed it back to the High Priestess.
“Without a steady stream of ‘evil interlopers’ this clinic wouldn’t have any reason to stay open,” I informed her, “so you may keep it. Save it for someone who really needs it.”
Miss James and I escorted Madame Marie and Mr. Doddington out of the clinic and watched as they went their separate ways. The clinic was empty now and the sun was just peaking out of the horizon in the east.
“How did you know?” Miss James asked.
“How did I know what?”
“About the Zombies? That Mr. Doddington didn’t have some sort of dread disease that was about to kill him?”
“I didn’t. All I knew was that I’d never heard of any disease which caused only necrosis of the penis. Usually it’s quite the opposite. I’ve seen patients come in with terrible infections in the groin area which, after proper investigation, started from a bite on the penis. In everyone of those cases the penis, for whatever reason, is spared the tissue necrosis. I guess God made the penis almost indestructible.”
“I’m glad,” she answered. “But, maybe you should have kept that ostrich foot. Madame Marie did promise that it could bring significant enhancement.”
“I’ve never had any complaints,” I remarked.
At that moment I heard hoof beats pounding on the pavement. A few moments later a herd of zebras ran in front of the clinic, their stripes lighting up pink and yellow in the soft light of the rising sun.
“Back to normal, I guess,” we said in unison.