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.”

Winter Night Clinic

                             

“I’ve braved the rain and sleet and snow and have returned for another exciting shift here at the fabled ‘Night Clinic’,” I announced as I shook the snow and slush from my boots. “Maybe the bad weather will keep it quiet.”

“Don’t hold your breath; all the exam rooms are full and five more waiting,” Miss James reported. “You can start with the swollen ankle in one.”

Her voice was cold with more than a touch of annoyance.

What did I do now? I put my dirty clothes in the laundry, washed the dishes, put the toilet seat down, let her…

“Miss James,” I began, “have I done something to upset you?” I did my best to feign contriteness.

“The time is 7:30. Our shift starts at seven. Why are you always late?”

“Well, today I had to…”

She just walked away, not really interested in an answer to what I now surmised was a purely rhetorical question. Her point made, we went to work.

“Gregory Jackson, ankle injury playing basketball; nineteen, lives on Maple, unemployed,” the chart reported.

I knocked twice and then went in and saw a very tall, thin young man with his ankle elevated and swathed in an ice pack.

“Good evening, Mr. Jackson, what happened to you?”

“Well, Doc, I was driving to the hoop and was about to do my Dr. J, you know fly under, up and over the hoop to slam it home when this little guy, Bennie, I think is his name, undercuts me. I landed right on my ankle and then it swelled it almost the size of the ball. The other guys almost had to carry me here.”

I pulled off the ice pack and then looked at the X-rays which were already pulled up on the screen. I blew them up as big as I could.

Soft tissue swelling, separation of the joint, nothing broken.

I looked more closely at the ankle which was very swollen and had a slight purple hue. When I tried to move it my patient winced in pain.

“It looks like you have a very bad sprain, Mr. Jackson. I’ll wrap it up for you, but you need to keep it iced down for at least the next twenty four hours and stay off if for about two weeks. I’ll give you the number to the Ortho clinic at the University Hospital, call or go there to make an appointment to be seen next week, OK?”

“Got it, Doc. Oh, by the way, can you get me the number or address for Medusa?”

“Excuse me?”

“I saw her go into one of your exam rooms, this chick we call Medusa. We see her around all the time, but she won’t talk to anyone. But, she’s one hot chick. Every guy I know wants to get ‘in’ with her, if you get my drift.”

“Sorry, you’re out of luck. You’ll just have to do that on your own. Just check out with Miss James at the desk. She’ll have all the instructions and the number to call for follow up written down for you.”

I went on to room two, but I did glance at the chart for room three. Sure enough the name was Medusa , while the rest of the chart was blank. First, however, there was abdominal pain in two.

I glanced at the name, Rufus T. Horsefly, fifty five, abdominal pain for two days.

“Good evening, Mr. Horsefly. I’m Dr. Barnes,” I began, trying not to betray my desire to dispatch him and his abdominal pain as quickly as possible so that I could move on to this mysterious Medusa. “What is the problem you’re having?”

“Hello, Dr. Barnes,” he answered as I sat down across from him. “I’ve had this pain in my stomach and back for two days.”

“How did it start?” I asked, trying not to look too bored.

“It started in my back then moved to the front. Today I had some numbness in my legs and I almost passed out. I figured I better get it checked out, you know, better safe than sorry.”

I was actually beginning to get worried at this point and, as it turned out, with good reason. I quickly gathered the rest of his history: untreated hypertension, cigarette smoking, some alcohol use, father died suddenly at age sixty.

“Let me check you now,” I requested/commanded. He lay down on the exam table and I felt his abdomen. He cringed slightly as I palpated all over his abdomen, particularly just above his umbilicus as I felt what I feared, the prominent thump, thump, thump of what I presumed was an abdominal aortic aneurysm. I felt his femoral pulses, which were only barely palpable, while his carotid and radial pulses were strong. I looked at the chart again, recorded blood pressure was 180/95, heart rate was sixty.

“Miss James, call 911 please and request an ambulance,” I called out to her at the front desk. I started an IV on Mr. Horsefly and drew some tubes of blood to go with him for a type and cross and lab.

“Mr. Horsefly,” I started to explain, “you almost certainly have an abdominal aortic aneurysm, either expanding or already ruptured. This is a very serious condition, one which is life threatening. An ambulance is on the way to take you to the hospital where you will need some sort of surgery. Do you understand?”

The look on his face told me everything as his light hearted countenance was replaced by fear.

“I’m going to call the hospital and ask that Dr. Singer be standing by; he’s the best vascular surgeon around, OK?”

He nodded his head and I left the room. Luckily, Dr. Singer was available and I was able to speak to him directly. The ambulance arrived and Mr. Horsefly was wheeled out to the waiting vehicle, lights flashing in the snow, siren ready to sing.

As he was leaving, I had to lighten the moment a bit, “Mr. Horsefly, by the way. In the movie Duck Soup, Groucho’s name is Rufus T. Firefly, not Horsefly.”

Mr. Horsefly smiled as they were loading him into the ambulance.

“I know, ‘the horseflies were on the Firefly’s and the Firefly’s were on the Mayflower,’” were his parting words as they loaded him in the back. I made a mental note to check on him the next day.

Back to the grind, and Medusa.

I knocked on the door and entered room three.

“Good evening Miss…” I started my usual introduction but stopped when I saw the young woman waiting inside.

She was sitting on the chair, dressed in a very thin coat, her legs were bare and she had her arms wrapped around her chest. She wore ragged boots with a hole in the bottom. She had long black hair with a white bandana and her skin was the color of chocolate mousse, smooth and silky. Her eyes, those eyes were the most amazing eyes I’d ever seen, dark brown with long lashes. All in all, even as dirty and disheveled as she was she was an amazing, striking beauty. I caught myself and started my introduction again.

“Miss Medusa, I am Dr. Barnes. What is the problem that brings you in here tonight?”

“Cold,” was all she said.

I was caught a bit off guard by the brevity of her answer. “Excuse me, did you say that you have a cold?” I asked.

“No, I was cold and needed a place to warm up,” her voice was as silky smooth as her skin and there was an aura about her which beckoned to draw me into her world. I had to stop myself and even shake my head to return my focus to medicine.

“I’m sorry, but this clinic is for those who are sick or injured. I know it’s unusually cold tonight and wet and dreary, but there are other places you can go. There are shelters and there is the mission over on Fourteenth Street.”

“I can’t go to those places. Bad things happen to me. Oh, why did I ever come to this place and time. I never should have been so trusting.”

Her words started to pique my interest. “Place and time?” She certainly was not the Medusa known from mythology. No snakes for hair or gnarly face and teeth. Indeed, she was the complete opposite. There was great beauty which radiated from her and filled the room and that aura, a remarkable feeling which emanated from her soul, reached  out and touched me. She did seem to be in some sort of trouble, but a chief complaint of “cold” did not require my medical services. However, the profound sense of sadness which surrounded her, as well as the inexplicable attraction I was beginning to feel overwhelmed any necessity to follow the book.

“We are sort of busy, but you can stay in our little break room for a little while. You can warm up and I’ll see if we can find a better place for you to go.”

Maybe my apartment.  No,no, don’t forget Miss James.

“Thank you,” she replied.

I led her to the back of the clinic, got her a cup of coffee and a blanket.

“Tea please, if it’s not too much trouble,” she requested, but to me it seemed to be more than a simple request. I fixed her a cup of tea, English Breakfast, from the supply that Miss James kept and started to go back to work, but I almost couldn’t drag myself away from her. Finally, the slightly irritated voice of Miss James snapped me back to reality.

“Dr. Barnes, patients are ready in rooms one, two, three and four and the waiting room is full.”

I felt a jolt back to reality.

“I must go,” I said to Medusa, “but I will come back and check on you when I can.”

“Thank you, Doctor,” she replied, clutching the mug of tea tightly in two hands,

I picked up the chart for room one, Mo Smith, lacerated arm. I knocked on the door and went in to find Mr. Smith sprawled out on the table, a towel soaked in covering his left arm.

“Good Evening Mr. Smith, what happened …”

And so it went room one, then two, then three, four, back to one and on and on, diarrhea, fever, back pain, headache, belly pain, broken ankle, broken arm, broken hand until it was four a.m.

“Just one more patient, Dr. Barnes, waiting in room two,” Miss James reported. “A Mr. Persy, sore neck.”

“Thank you, Nurse. I think I’ve earned my money tonight. How many patients have I seen?”

“Forty eight. Mr. Persy will make forty nine. I think that’s a record. The cold weather brings them in, I think,” She concluded.

I knocked on room two and went inside.

“Good morning, Mr. Persy. I’m Dr. Barnes. What is the problem you are having?”

“Is she here?”

“Is who here?”

“Medusa. I’ve been searching for her for quite a while.”

What does HIPAA say?

“I’m sorry Mr. Persy, but I do not know any ‘Medusa’ and if I did and she was a patient I would not be allowed to tell you; rules you know.”

I wasn’t sure why I didn’t give him some intimation that I had at least seen her. Technically, she had not been a patient, just cold and all I had treated her with was a cup of tea. I tried to learn more.

“Maybe, if you could tell me something about her I could help you. She may have passed through here under an assumed name. It has been known to happen before. After all, we are here to help people who are ill or injured. All we want to do is make them better. Most of the time we don’t care if the name is real.”

He scratched his head and then stroked his chin.

“OK, let me tell you about her. Medusa was born in what would be modern day Turkey, a long time ago. Nothing is known about her parents, but she had two sisters, both of whom are dead. They were all hideously ugly and the two sisters pined away, wishing to be beautiful, like Medusa. Medusa, however, was a real beauty, but this beauty was more of a curse.

 “She is most beautiful,” I blurted out, before I realized I’d blown her cover.

Mr. Persy smiled before he continued. “As I stated, she was a beauty. But, Medusa, ah Medusa, she was always lost in thought. She could read and write and could remember every little detail of everything she had ever seen, heard, or done. And, more than anything, she was wise. From the time she was twelve people came to her for advice.

“Kings would come and ask if they should go to war or surrender. Men would ask about marrying, women would ask if they should accept proposals. When was the best time to plant, if the rains would be coming and on and on. And, she was not clairvoyant, just wise. She had a way of sifting through a mountain of information and distilling it down to its essentials and then rendering precise and accurate judgment. This was a gift from the gods. Being human she could not help but boast. She was reported to have said she was wiser than Zeus and Athena.”

“Wait,” I interjected, “are you telling me that she has been around for thousands of years. That the Medusa who is or was sitting in my little break room, drinking tea and wrapped in one of my blankets is the same Medusa from Greek mythology?”

“Yes,” was his terse reply, “but she is far different from the beast depicted in the mythology.”

“That is for sure,” I answered, “but, I should not have interrupted. Please go on with your story.”

“Medusa is and always has been the epitome of beauty, grace, charm, the perfect embodiment of womanhood. You have, I’m sure, seen her, been with her and felt the strange allure. That is Medusa. Think of history, the great beauties men have given their very being to possess; women that men have fought and died for: Helen of Troy, Nefirtiti, Bathsheba, and how many other nameless women. She was all of them. Medusa was Solomon’s favorite concubine, coming to his chamber night after night, she was consort to Roman Emperors, Arthur’s Guinevere and so many more. She is ageless and she is timeless, yet through it all she suffers.”

“Suffers?” I asked. “I would have thought she would have everything she could want, but, from what I’ve seen, she has nothing.”

“Of course she has nothing. She wants nothing but to be alone, to be removed from the curse?”

“I still don’t understand,” I had to admit.

“That is because all you see is a beautiful woman and in your mind beauty opens many doors. You feel the intoxication, but don’t see that there is a person there. I, on the other hand, know what she wants all too well and I can help free her from her sorrow. I have pursued her for all these years, because I want to take her away and free her from her burden.”

I listened closely, not sure if any of it was true or if this Mr. Persy was merely a pimp trying to get his hooker to tow the line.

After a bit of thought and reflection, I knew that it was up to Medusa to make some sort of decision.

“Wait here, Mr. Persy,” I instructed.

I went back to our break room. Medusa was still there, still wrapped in the blanket, sitting on the chair with her arms holding her knees tightly to her chest, slowly rocking back and forth.

“I’m still cold,” she cooed and then she gave me her smile and I knew why men throughout the ages would fight and die over her. But, my professional demeanor took over.

“There’s a man here looking for you, Medusa. He says his name is Mr. Persy. Do you know him?” I asked softly.

 I put my hand on her shoulder and she pulled away and shook her head violently back and forth.

“NO, NO and NO,” she shouted. “DON’T LET HIM, DON’T LET HIM, please?”

I saw the fear of the caged animal in her eyes as the door burst open and Mr. Persy entered.

‘Medusa, my Medusa, you’ve eluded me for so long, but now I’ve found you, alone, and I will have my victory. I will fulfill the task set before me and she will be mine forever,” Persy hissed.

“You’re mad, Perseus. She’s been dead for thousands of years. No matter what you do to me you can’t have her. She’s probably nothing but dust by now, dirt which has grown op and become grass, then consumed by some lowly animal, a cow perhaps, or a bull, or the Minotaur. Yes, consumed and digested and rejected like dung. That’s all your precious Andromeda is; Minotaur dung and that’s all you deserve.”

Miss James came in to check out all the commotion, startling Mr. Persy, that is Perseus, and I took the opportunity to step between Medusa and Perseus, but the crazed Greek “hero” pushed us all away, reached into his overcoat and pulled out a very long, very sharp gleaming knife.

“There is no help for you here. No king’s guards to protect you, no smitten Alexander to offer you refuge. Only these pitiful mortals. I’ll have your head and my happiness. Andromeda will be free and we will fly away together.”

He moved closer towards Medusa, his knife held high.

I heard a loud thump in the waiting room.

Maybe it’s the police or a disgruntled patient tired of waiting.

There was a loud crash as the door to the break room ripped away from its hinges and fell to the floor. A sleek white horse bolted through, its black eyes determined, white wings sprouted from its back as it reared up and brought its front legs down on Perseus, knocking him to the floor and then kicking him to the side like a the piece of garbage he truly was.

Pegasus.

The winged horse bounded towards Medusa and she effortlessly climbed on its back. The powerful beast kicked a huge hole in the back wall and the two rode off into the east towards the just rising sun. A faint glow arose from horse and Mistress as the snow fell around them and they made their escape. Miss James and I stood silently and watched.

“Perseus,” I exclaimed.

He was up on his feet, brandishing his knife at us.

“I have no quarrel with either of you. But, if you should ever see her, call me. The things I told you are all true. What she said is mere fantasy; the product of a deranged mind. I bid you farewell.”

He left a card on the table and stepped towards the opening in the wall.

“But, let us check you. You may be seriously injured. Pegasus’ kick packs quite a wallop.”

“I have lived for all these thousands of years and suffered far greater injury than a trifling kick from an old nag.”

He stepped through the hole in the wall and was gone. I looked up to see him flying towards the east, his boots had wings.

Like Hermes’ boots.

I turned away and looked into my companion’s eyes.

“Do you believe any of this, Miss James?” I asked.

“What’s not to believe? There is a big hole in the wall and then there is him.”

“Him?”

She gestured for me to look behind and there, standing in the doorway, was the Minotaur. He was dressed in a black suit and had a gold ring on his finger, but there was no doubt as to the beast’s identity.

“This is not some sort of Halloween gag, is it? Because, trick or treat and Halloween were months ago.”

“I’m sorry,” the monster apologized, speaking impeccable English with a slight accent. “I saw that you’re light was on and that you were open, so I thought you might be able to help me. You see I have this rash…”

“Miss James, would please take Mr. Minotaur…”

“Just the Minotaur, if you please. It commands more respect.”

“Would you please take the Minotaur to room one. I’ll be there in a few minutes.”

What time is it? Isn’t this shift over yet? Five thirty, an hour and a half to go. I guess I need to face the Minotaur.

I did remember reading something about the Minotaur recently, but the details eluded me at that moment.

I knocked on the door to room one as I glanced at the chart:

Quinton Arbus Taurus Aegus Minos, “Minotaur”, DOB unknown, originally from Crete, previous neck trauma, recently hospitalized following severe exposure with dehydration, previously prolonged exposure to cold, starvation…chief complaint: rash on upper chest.

“Good evening, Minotaur, or rather, good morning. What’s the problem that brings you in this fine morning?” I asked, trying to maintain my professional appearance.

“I’ve had this rash along my upper chest for almost two weeks now, right where my body transitions from fur to hairless skin. I’ve tried all the usual creams and nothing is working. It’s driving me crazy,” he reported, his manner polite and refined.

“You’re in luck. I’ve been rotating through Dermatology this month. I’m pretty well up on all the rashes. Let me take a look. Does it itch a lot?

“Horribly, day and night. I can’t sleep. I thought I might have fleas, even went to the vet for a flea dip, but nothing helps.”

“Well, let’s take a look.”

He took off his black overcoat and suit coat, followed by his white shirt and tie. There was an abrupt transition from the short, coarse hair of his bullish shoulders, neck and head to the smooth white skin of his human half. At this changeover point the skin was red and thickened with vesicular lesions. There was some excoriation where the Minotaur had been scratching.

Very strange, very unusual indeed.

“I need to take a closer look at the hairline, but I think I know what the problem is,” I informed the Minotaur. I found a magnifying glass in the exam room drawer and began a very close inspection of the beast’s hair. Sure enough they were there, tiny whitish “nits” on the hair and I noticed some tiny bugs moving about.

“You, my dear Minotaur, have lice. I’m surprised the flea dip didn’t help, but sometimes these tiny monsters can be very tenacious. Give me some time and I’ll do my best to get rid of most of them. It might be best to shave a lot of your hair, particularly along this transition zone. But, first you’ll need a shampoo.”

Lice was a fairly common complaint at the clinic and we maintained a supply of medicated shampoo which usually worked well to kill any adult forms of the vermin. I gave him a vigorous lathering, let it sit for a bit and then rinsed.

Next, I pulled out a fine comb and began going through all is hair, brushing away some of the whitish eggs, while pulling out hairs that stubbornly held on to their cargo. This, I had learned over the years, was the only way to get rid of the nasty “nits” which were cemented to his hair.

“While I’m working, Minotaur, I was wondering if you know anything about Medusa and Perseus? I assume you were around during their time. What is the truth?”

“A sad story, that’s for sure. The events actually took place before my birth, but I did get a firsthand account from one of the old guards in Minos’ palace, before I was locked away in the Labyrinth.

“Medusa always had amazing beauty, but also intelligent and wise. So beautiful, in fact, that all the lady “gods” were jealous. They concocted the story which has become the myth which has survived all these years. Medusa, one of three Gorgons, was supposed to be so ugly that anyone who looked at her would be turned to stone. She had hair which was snakes and eyes which turned anyone who gazed into them to stone. This kept most everyone away. But, this was not enough for Athena and Aphrodite. They were so jealous of her that they plotted to have her killed.

“Perseus was their dupe. He really did venture out on a quest to kill her and to bring her head to King Polydectes, as recounted in the myth, but, like most myths, that was the only kernel of truth in the story. The gods promised Perseus that he would have Andromeda as his bride if he could vanquish Medusa. Andromeda was young and very pretty and her father was very powerful. Perseus immediately was smitten by her charm and the prospect of ruling the land as the next king and vowed to return after he was successful.  

“Perseus did manage to find Medusa with the aid of the gods. But, he first had to deal with Medusa’s two sisters, who were truly ugly just as it says in the myth. Their job in life was to shield their stunning, gifted sister from unwanted visitors. Perseus was a truly great warrior, however, and he was determined to vanquish Medusa. He brutally murdered Medusa’s sisters.

“He came upon the young, innocent, beautiful maiden and threatened to kill her if he did not tell him where he could find the supremely ugly Medusa. He was still expecting a Medusa with snakes for hair and hideously gnarled features, which is what the entire world assumed Medusa to be. That young maiden, who really was Medusa, realized the danger she was in and tricked Perseus. She sent him up into the hills, saying that the repulsive Medusa was in one of the caves. Perseus charged up the incline, his sword raised and his shiny shield slung over his back, ready to do battle with a monster. Meanwhile, Medusa made her escape on the back of Pegasus. And she’s been on the run ever since.

“It’s sad, so sad,” he continued. “Medusa has only good qualities. She has to be the most beautiful and tragic woman to ever live. Meanwhile, Perseus has lived with this obsession for thousands of years. Andromeda is long dead, the Greek gods have been relegated to myth; only a few of us live on. Myself, Pandora, Perseus, Medusa, Hercules, and a few more have survived through the ages, through all the sordid years of human history.

“Pegasus, by the way, the winged horse, is Medusa’s greatest friend and ally. She raised him from a colt and he is never far away from her. That is one reason she has managed to survive and escape all these years.”

The Minotaur finished his story and sat while I continued to comb through his hair. Miss James, by this time, had joined me.

“Finished,” I announced. “I think all the nasty little creatures and their eggs are gone. To be really thorough you could slather on some olive oil and leave it over night. That will suffocate any little beasts who may be lingering. Oh, and good look on you new job at the University. I do remember reading about you and your remarkable life in the paper. I think you will turn the Department of Antiquities on its head.”

“Thank you, doctor and nurse,” the Minotaur answered. “I wish you well. And, don’t worry about Medusa. She will be alright. Look for her, someday, on a movie screen or on the arm of a powerful senator or prince. Oh, and look for my story. I think you would enjoy it. Good morning.”

And he left.

Miss James and I stared at each other, shrugged our shoulders and waited for the next shift.

“Breakfast? Or a bath?” she asked.

“Both,” I answered.

A few minutes later we left together.

Bedside

                

Today, for an unknown reason, I thought about sitting at the bedside of patients. I wasn’t thinking about sitting down in the consultation room when first meeting new patients that crossed my mind, although this is always a good practice. This type of sitting sends the patient the message that you care about them and are willing to spend the time to listen them. Rather, it was sitting at the bedside of a very sick patient; being right there to tend to their needs should an urgent situation or sudden change develop.

That’s the nurse’s job, one may say, and that would be correct. But, sometimes, it’s a doctor who needs to be present. I never was part of such a scenario while in medical school. I did see sick patients as a medical student, but, as a student, was never allowed to truly get involved in their care. My first experience with a really sick patient was during the first month of surgical internship.

One night on call I was called to the ER for a patient who had been stabbed in the upper abdomen. The patient was unstable, with severe tachycardia,hypotension and a stab wound between the xiphoid process of his sternum and his umbilicus. He was whisked away to the OR in short order, where the Chief resident and second year resident spent the better part of the evening battling to keep the patient, Jose Gonzales, alive. He had suffered injuries to the stomach, colon, superior mesenteric artery and vein and duodenum. I wasn’t with them in surgery, but I did receive a call at about one am to come to the ICU. They had just brought Mr. Gonzales from surgery and it was now my job to sit with him and attend to his needs.

I immediately noted the drains coming out of his abdomen, filling up with bright red blood.

“Just transfuse him as needed,” were all the instructions I was given.

I gave him a quick once over. His pupils were nonreactive, his extremities were cold, there was no urine forthcoming from the Foley and three abdominal drains were already filled with blood. His heart rate was 130 and BP 75/35. I pulled up a chair, but didn’t sit. For the next four hours the nurse and I pumped blood and plasma and platelets and cryoprecipitate and more blood into poor Mr. Gonzales. As fast as we pumped it in, it ran out: through the drains, through his mouth, through his endotracheal tube, from everywhere. It was my first encounter with a severe coagulaopathy. He was cold, he had already received massive volumes of transfusions and his blood would not clot.

Finally, shortly after five am, I called the Chief resident and asked this question:

“How long do you want me to do this?”

I explained the situation and told him that Mr. Gonzales had been transfused over two hundred units of blood products and we were still at square one. I knew I was just a lowly intern, but I gave my opinion anyway.

“I think it’s hopeless.”

My Chief agreed and we stopped. Mr, Gonzales died about one hour later, never having regained consciousness or any signs of life.

Although Mr. Gonzales may have been the most desperate and intense bedside vigil I’ve sat through over my many years in practice, there have been many more.

I’ve written about some in my books, Behind the Mask and Under the Drape. Chapters in those books recount my experience with one unnamed patient who had a stormy immediate post op course after an elective aortic aneurysm repair and with Gerald, who experienced one complication after another and required multiple operations, surviving the worst case of ARDS (Adult Respiratory Distress Syndrome) I’ve ever seen.

These examples demonstrate that a sick patient often requires constant vigilance. It has been my practice to stay with my very sick patients in the immediate postoperative period until I’m sure they are stable. Most of the time this is a short vigil, sometimes only a brief visit in the Recovery Room or ICU, while at other times I will stand at the foot of the bed, staring at the monitors and foley bag, waiting and hoping and praying for the blood pressure to rise or the urine to start flowing or the pulse oximeter to begin displaying a true waveform, while trying to decide if I’ve forgotten something important or if something else needs to be done. Such physiologic indicators all tell me the same thing. When they are good it means that the patient is probably perfusing vital organs adequately, but when they are bad then the whole patient is bad.

Dora was such a patient. She was old, almost ninety. She had lived in the county run nursing home for longer than she could recall. She came one evening with a very distended abdomen, obstipation and vomiting. She told me her belly had been hurting for three days. In the course of my evaluation I asked her how old she was.

She answered, “Old enough to know better.”

Her workup suggested a cecal volvulus with perforation. This means that the right side of her colon had become twisted, then blew up like a balloon and finally popped, causing peritonitis, a very serious, life threatening condition. She arrived in surgery at about ten o’clock at night and underwent a right colon resection and ileostomy. This means the right side of her colon was removed and then the end was brought out to the abdominal wall where it would empty into a bag, like a colostomy except involving the small bowel rather than the large bowel. The reason the surgery is done this way is that in a very sick patient healing is of major concern and reconnecting (anastamosing) the two ends of the bowel may not be successful, which could lead to a similar problem all over again.

Surgery finished around midnight. I stayed around in the ICU while she woke up. Her blood pressure hovered in the 70/30 range and her urine output was minimal. I was in and out of the ICU, ordering fluid boluses, anxiously awaited lab reports, watching the Foley bag, trying to wish a few drops of urine into the tubing.

Dora lay still in her bed, although she did open her eyes after a while. Her post op CBC came back and the hemoglobin was higher than it had been pre-operatively, even though she had not been transfused any blood. I checked again. Sure enough, her preop hemoglobin/hematocrit was 11.1/33.3 and now it was 11.6/35.0. These numbers told me two things. First, it was unlikely that she was bleeding and second, that she was hypovolemic. I drew these conclusions because bleeding will cause the hemoglobin level to fall. This fall may not always be immediately apparent, but in a patient like Dora, who had already received large volumes of IV fluids, bleeding of any significance would almost surely cause the hemoglobin level to fall.

The fact that she was hypovolemic can be concluded because the rise in hemoglobin suggests hemoconcentration, a long word which means she had lost fluid from her blood stream or intravascular space into the surrounding tissues, the extravascular space. Think of the blood vessels as a sieve. Fill the sieve with marbles and water. Before pouring the mixture into the sieve the combined volume of marbles and water may be one quart, with 50% of the volume marbles and 50% water. The marble level can be considered to be 50%. But, when you pour the mixture into the sieve, the water leaks out and the marble level becomes 100%. The hematocrit level is akin to the marbles, that is it is the percentage of blood volume made up by red blood cells. The fact that it has gone up suggests that fluid has been lost from the intravascular space (bloodstream) into the extravascular space. The bottom line was that she needed more intravenous fluid to fill up her tank, that is the intravascular space.

I stayed at her bedside for a bit more than two hours, until I was sure she was stable, then disappeared for a few hours of sleep before the next day’s trials began. Dora, after the first few rocky hours, perked up and sailed through her postoperative period like a twenty year old. I was able to do surgery to reverse her ileostomy about three months later.

Two years later I was called to see and elderly lady with a distended abdomen. Small bowel obstruction was suspected. I went to the ER and found a very old patient with a very distended abdomen.

I asked her how old she was and she answered, “Old enough to know better.”

“Dora, how nice to see you again,” I answered. “I wish we could meet under different circumstances sometime, however.”

She agreed. Her X-Rays suggested she had a small bowel obstruction and lab tests were worrisome for ischemic or gangrenous bowel. Therefore, at about eleven o’clock that night she went back to surgery where I lysed adhesions, resected an ugly segment of gangrenous bowel and settled down at her bedside and repeated the events of two and half years before.

Once again, after a suffering through a few hours where her condition was touch and go, she stabilized and made an uneventful recovery. I didn’t have the pleasure of seeing her again and I don’t know at what age she finally passed away, but I hope I gave a few more years of quality life.

I still make it a habit of staying around until my patients are stable after major surgery, particularly when the patient has a life threatening condition like those suffered by Dora and Jose. I don’t seem to have to do it as often as I used to. I credit this to improved intraoperative care by anesthesia, better preoperative preparation and, maybe a bit of fortune which has allowed me to avoid operating on extremely ill patients in the middle of the night.

One question does remain.

Have I ever sat at a patient’s bedside just to sit with them?

What I mean is have I ever had a patient who I had grown close enough to and who was so ill that I wanted to stay with them just out of concern and worry over their condition? Even if there was nothing I could do?

I actually thought about this before I even began writing this article about being at the bedside and then, ironically, it came to the forefront during a recent conversation, which was held in the operating room while removing a nasty appendix. The anesthesiologist and circulating nurse asked me just that question. Apparently the topic had come up during the day and they wanted my input.

I thought for a while and I couldn’t come to a definite answer.

I have had innumerable patients over the years I in whom I have a taken a personal interest in their care. Most often these were very sick ICU patients who needed very close attention as their condition had the potential to rapidly deteriorate. Patients like Albert who was admitted with a Neurosurgical condition, but developed sepsis from an intraabdominal source, requiring emergency surgery, and Doris, a victim of a motor vehicle accident who had a missed colon injury and came to our ICU with severe sepsis, or John who also came to the ICU after inadequate treatment for a perforated colon.

These and so many other patients have received my utmost, careful attention to help them through the most critical parts of what were often very complicated illnesses. I never, however, developed a truly personal relationship with any of these patients. I only saw them in a professional sense during their illness and once or twice after they had recovered. I never went out with them for a drink or to play golf. I guess I have taken the medical school teaching to heart: Maintain a detached concern.

The acute nature of surgical diseases, particularly general surgical conditions, rarely allows the development of a close relationship prior to a surgical intervention. Even those patients with cancer who are scheduled to undergo surgery are seen only once or twice before their operations. I care a great deal about my patients from a professional perspective. But, I see my task as one of helping them through the most serious part of an illness or injury; to get them healthy enough to return to their lives apart from being sick. That is the job of a surgeon.

 Perhaps, however, I am missing something?