Man's 4th Best Hospital, page 9
“Our little secret. Safe with me, Joe. And y’know what you’re here for, Joe?”
“Tech support.”
“Nope. You’re my Soul. S-o-u—”
“I heard that before. A pun. Truth is, I like being somebody’s soul. Roger and out.”
* * *
At the end of that first afternoon, when most of the patients had been seen, Dulci summoned all of us docs to come out to the nursing station, stat.
“I scheduled all of you for an open hour. My girlfriend who used to work at the Jupiter told me that there was a big family who’d been patients there forever, and she said they always liked to come to see their doctors at the same time. They can arrange to do that because they have a family business everybody works in, from the founder to the grandchildren. Very close family. You’re going to have to work together. As best I can, I’ve sorted ’em out to match up with each of your specialties.”
We looked around at one another, not sure what to make of this.
“The good news is that they’re a nice family—‘salt of the earth,’ my girlfiend said. Actually, that’s their job—the earth. The grandpa—actually, great-grandpa now—Otto Vance, started it, and everybody works in it: Vance Gardening, Landscaping—and Taxidermy.” Turning toward the waiting area, she said, “So now I’ll—”
“Hold on hold on,” said Hyper Hooper, always into the worst, thinking doom and death. “What’s the bad news?”
“Like with your other Jupiter patients, we got no records.”
Groans all around.
Again she turned, and called out, “The family Vance?”
We watched as a group of about a dozen stood up and started toward us, led by a wiry, white-haired African American man of at least 70, wearing a neat plaid shirt and neat pressed jeans. With him, limping, was a pale white woman with red hair, of about the same age, wearing a tastefully flowered dress. One by one came the next generation—a set of middle-aged identical twins, stocky but not fat, outdoorsy-tanned, both with their overweight wives, and then at least five children, from a few years old to teenage. One teenager was strange, twitching, affectless—rule out autism spectrum.
“So,” Dulci went on, “Nurse Angel and I’ve sorted them out as to who would take who . . .” Noticing our discomfort with this huge new load with no records, she said, “Don’t worry. With all the gardening, snowplowing—and taxidermy—they’re all kinda healthy.”
I doubted that. In fact, as we all intuitively did our quick Sherlock Holmes checks, it was clear to me that here before us in these three or four generations was a history of the progression of disease in America. The oldest couple thin and—but for her limp—fit and alert, the middle generation with the male twins kind of heavy and maybe a bit dulled down, and the kids of various ages, from chubby to obese, slow to fractious. Lots of spectrums. Probably a family in which diabetes ran, if not raced.
Angel started calling out names, matchmaking. In the House of God, she never finished a sentence with words, only with gestures. Now she was fluent! Gestureless, yes!
The youngest children and their mothers—one with a screaming baby—were assigned to Naidoo and, because of nutrition and “rule out diabetes,” to Hooper. Eat My Dust got the twins, Runt the “rule out autism.” I got the patriarch, Otto Vance, and Chuck got his wife, Desirée.
As I began leading Otto Vance to my office, we heard a loud exclamation behind us. We turned and saw one of Eddie’s middle-aged twins collapse, fall hard against a woman, and then crash headfirst to the floor.
Screams, bedlam.
“Get the crash cart!” I shouted, and went down on the floor, assessing. “Not breathing, no pulse. Call a code.”
We lifted him onto the stretcher, and on reflex, all of us started in, coordinating like musicians who all knew the same score, but there was a bloodcurdling scream—the woman whom he’d hit on the way down was clutching her hip, which was sticking out at an ungodly angle.
“I got her!” Eddie said, going to her while Chuck and Hyper and I thumped the guy and put an IV in and bagged him and Naidoo hooked up the EKG and it was flatline, so we got the paddles and jump-started him and luckily got normal sinus, but then I felt something spill onto my shoes and it was vomit from another one of the family Vance.
The woman who’d hit the floor was in terrific pain, and we called Gath stat to assess her hip.
The cath lab doc came in, and he and a nurse took the Vance son away.
We explained to the rest of the family that son Lance would be in the cath lab for a while, and they could go and sit there or have their appointments and they’d be notified of any news immediately. Lance’s wife and his mother said they’d go, but Otto said he was having some pain in his chest too. He was ashen, breathing hard and sweating, with the classic “fist to the sternum” sign of cardiac pain. I was worried.
“I think you’d better stay,” I said. “Come into the office and I’ll check you out.”
Angel hooked him up to the EKG, ran a quick strip—normal, as was the full EKG.
“Good news, Otto. Your EKG is perfectly normal. Your pain’s not a heart attack. Thanks, Angel.”
“Here’s a wipe, Dr. Basch,” she said. “For the vomit on your shoes?” Not pointing—even to my shoes—she left.
I smiled, took a quick swipe, faced Otto, shook his hand. It said a lot about him. Three of the fingers on his right hand were old stumps—probably from work accidents. Rough palm, swollen joints, leathery skin with keloid scars. We talked. Turned out, he had been born and bred in Louisiana; he’d met his future wife, Desirée—he called her “Des”—while caring for her plantation gardens, and both fell hard in love. Across-race love. To both of their families’ dismay. They eloped to the North, created a life. “A right good life,” Otto said to me. “I went from bein’ in sin, headin’ toward hell, to living a life of blessings.” How was his health? “Well, y’all know, at my age—seventy-four—and a life of hard work, everything’s goin’. Hearing, sight, skin cancers gettin’ burned off over and over—but the real bad thing is arthritis. Can’t work like I usedta for the arthritis. I don’t mind not working with my boys in the landscaping, but damn, I miss my taxidermy.”
I went through more questions and the exam. Nothing. “Anything else, Otto?”
“Well, no, just arthritis and this pain-in-the-heart thing—I’ve gotten it before today.”
“Your heart is fine. Know what I think?”
“Whut’all do you think?”
“I think it’s just worry—it kicks up like when you got scared just now, seeing your boy fall down. I bet you feel things in your gut, that you got worry inside, right in your stomach. Is that right?”
“In my gut? Maybe. Maybe not. I heard that EKGs can miss things. Are you sure?”
“Yeah, but let’s do a little test.” I got up and got a bottle of Maalox, poured out a big slug. “Take this, and see if it helps?”
He drank it down. In a minute or two, he said, “I dunno. Maybe. Maybe not. I can say I got a twitchy gut though. Y’think it’s my nerves?”
“Probably,” I said. “Now, you make another appointment to see me, and then go sit with your wife and boy at the cath lab.”
As I walked to the bathroom to clean the recalcitrant vomit off my shoes, I was of mixed feelings: pride in how well we had all worked together, dread at just how hard this might be.
* * *
Luckily for Otto’s son Lance Vance, Man’s 4th Best, like all big, modern hospitals, was superb at emergencies and stents and bringings back from the dead, at research, at any high-tech, complex medicine or surgery—like transplanting hands or even, last week, a face—and at finding just the right stem cells or immunogenic creations to beat back cancer a helluva lot longer than years before. And I was, for the first time, impressed with HEAL. It was kind of a miracle machine for sending me specific information about the patient. Almost in real time, all the data from the cath lab was available to me, even videos of the insertion of the stent. Lance Vance would soon be the proud possessor of a stent in his anterior descending coronary artery—“the widow-maker”—and TURFED to intensive care, and then, most likely, back home to landscape, snowplow . . . and taxiderm. He would have been dead, but now he was saved. A medical miracle: a sure death for all of history until the last few years, but now a sure save.
* * *
My last patient of the day, just before six, was Horace Haskins. I stood at the “in” gate and called out his name. A light brown African American, he got up slowly and, helped by an ebony cane with a silver knob, walked to me with a creaky gait that, with his height—about six five—and trim build, told me he’d been an athlete, was now plagued with arthritis. I was struck by his grace, his presence, his cane. His cool. Long, freckled face, a couple of nasty scars. A hard life, now easier. A remarkable, all-in smile. He wore a dark suit with a red carnation in the lapel, a blue shirt with a pink cravat. Diagnosis? Alcoholic/addict, chronic. In recovery. How did I know? By seeing thousands of addicts. He sat easy in the chair, straightening a crease. Took off his hat—balding, another long scar from forehead on back, as if from a scythe. No way I wanted to interrupt this show by inviting HEAL to it.
“What’s up, Mr. Haskins?”
“Call me Horace H.” It confirmed he was in recovery. “Twenty-eight years. Word on the street is this new clinic has a guy specializing in addictions—rare to find.”
“How can I help?”
“More like, how can I help you? As you know, one founder of AA was a doc, the Akron surgeon Dr. Bob Smith, known for saying, ‘Our service keeps us sober.’” I nodded. “I no longer have a paying job. My life’s to serve the suffering alcoholic and addict.”
“Good. Do you want to tell me your story?”
“Not now. Y’know—from Park Avenue to a park bench, Sing Sing. Still here.”
“Against all odds.”
“The odds now, looking back, are one hundred percent. Same as yours. I can’t talk now. Got a call while I was waitin’ that there’s a guy who needs me. Gotta take him to a meetin’. I want to offer myself to you as a bridge to the twelve-step community. If you see someone in the office and give him a list of that night’s meetings and tell him he should go, he ain’t gonna. But if you say, ‘I know someone who’ll pick you up, drive you to a meeting, drive you home’? He might.”
“I’d welcome that help. By the way, how’d you find me?”
“I started doing this same liaison thing with a doc you knew, out at Mount Misery. He told me all about you.”
I knew before he said it.
“Leonard Malik. Bless his heart.”
A jolt went through me.
He nodded. “Like he used to say, ‘Spirituality is our connection to reality. We’re not the main show. We’re just part of the cast. In clear view, for the rest of the world.’” He left.
Malik. My beloved psych resident. A thin, athletic version of the Fat Man, with a mantra of “You can tell everything about a person by the way they play a sport.” Back in the office I sat and grieved a little for the loss, all the losses, as one does. As Chuck always put it at times like this, “Man, y’know how it is.”
I pulled myself together. Went to the conference room for the Fat Man’s checkout.
* * *
“Wowee!” cried Fats, both he and Humbo, for some reason, wearing butcher-length white coats speckled with blood. “Great work with the family Vance. Sorry I missed it—but clearly you don’t need me around anymore. Maybe I will retire to Kuala Lumpuuuur!”
“Kuala Lumpur?” Hooper asked. “Why?”
“So,” Fats said, “how’d the rest of the first day go?”
Each of us said it was good except for HEAL.
“This razor-sharp mind,” Hyper said, “got dull. Smart screens make dumb docs.”
“The only good thing about that dog,” Eat My Dust said, “was when it died. And then it was heaven!”
“I grew up in the dodgy part of India’s HITEC City, in Hyderabad,” Naidoo said. “Did my first degree there, immersed in computer high tech. I love the aesthetic of elegant IT. HEAL is crap. But thank your lucky stars it isn’t a worse machine.”
Chuck said, “HEAL was cool. Nuthin’ to it.” Startled looks. “’Cuz I ignored it.”
“Naidoo,” Fats said, “I too love elegant info. Sometime I’ll show you the programs we built for my calcium boxcars venture—talk about poetry! So I too am pissed we got, here, crap. But moving on. Anybody get the puzzler DAMNAP?” Nobody. “Okay. I’ll eat the reward myself. Next, Dulci, let’s talk about how our PATSAT was today.”
The Patient Satisfaction Score was a numeral, from one to ten, for how satisfied patients were with their doctors—how much they liked us. This one numeral was key to how much money insurance paid to each doc in Man’s 4th. It was worth millions. A low score could demolish a career, even a department. On our HEAL dashboards, our FMC running average, to three decimals, flashed continuously, like the Dow Jones.
“I collected all your patient PATSATs, every one—including the Vance family. Today’s average rating? One hundred percent.”
“That’s all?” Fats said. “I was hopin’ for one hundred ten at least. Everything rides on those numerals. They go down, we go down. Okay, see you all t’morrow—”
“Hey, Fat Guy,” said Hooper, “what does DAMNAP mean?”
“‘Do as much nothing as possible.’”
We burst out laughing. It was Law Number 13 of the House of God!
“Not fair!” shouted Hooper, twitching. He was the most competitive of all of us. “That is not the complete Law Thirteen. You left out ‘TDOMCIT—The delivery of medical care is to.’ Trick question. Look.” He held up several pages of Excel. “I spent a shitloada time on this, Fat Guy. Not a fair contest. I claim the prize.”
Tighter than ever. Must be MOR again—Marriage on the Rocks.
Fats stared at him, then nodded to Humbo. “Sí, Señor Nervioso. I get you prize.”
“Freud’s law?” said the Runt. “‘Flies cause disease. Keep yours zipped.’”
Fats sighed, as in “Behold yon lost soul.” “Okay. All good. See you tomorrow.” We all started to leave. Fats grabbed my arm. “Basch? We need to talk.”
“I’m late already.”
“It’s crucial.” The others left. He sat me down, pacing, munching a chalk white health bar with a strange high glitter—calcium? He looked spooked. Fats scared?
“Last night, as attending doc on Ward Thirty-four, I went up there to check on things. I tried to find the Nocturnalist on call—their shift is seven p.m. to seven a.m.—no luck. It’s rare to catch sight of one in the wild. Me and Humbo were there all night long cleaning up his messes. We gotta do it again tonight so Krash realizes that this necromancy is being witnessed and stops it. I need you with us tonight.”
“You want me to stay all night in the hospital?” He nodded. “Nope. You promised no night call, and tonight’s Olive’s birthday party at home. I’m already late.”
“Olive?”
“Spring’s bunny. She’s two. Turns out, it’s a big birthday for a bunny. I promised.”
“But y’gotta see this. Especially Mrs. Burke.”
“What? I thought she had gone home okay.”
“Because of Jack Rowk Junior, she’s going down the tubes. We have to save her. Pleeze?”
Fats asking for help? “Shit. Lemme check.” I called Berry. Explained.
“I thought he promised no night call?”
I explained it was an emergency. Fats, and patients, needed me. Silence. “I know, I know. I promised Spring. Olive’s birthday—”
“Which starts in an hour, at seven. All her new school friends—Razina, Johanna, Katie, Eliza, Kendall—and their parents will be here. Fathers too. Even crazy-driven fathers. Who left their work early. I’m trying to build new friends for her, and us.”
“Maybe I can make it for Olive’s ice cream and cake at eight?”
“Carrots and cake. And hay.”
“Hold on.” I explained to Fats and Humbo what was going on.
“Okay,” Fats said, “just give me two hours. Till eight?”
“I can be there a little after eight. Maybe you can hold the hay?” She did not laugh. “I’ll be there to help put her to bed. Her and Olive.”
“Fine.”
“What do you mean, it’s fine? I know it’s not fine, and so do you.”
Fats and Humbo were pointing at their watches.
“It’s the same old story between us,” she said, “‘I’ versus—”
“‘You.’ I know, I know.”
“No. It’s ‘I’ versus ‘we.’ The family ‘we’—which includes me, you, Spring, Cinny, and Olive.”
“Got it. Really and absolutely. But I gotta go.”
“Not before you tell Spring yourself. Here she is.”
“Hi, Daddy.”
“Honey, I was planning to come home for Olive’s party but I’m a doctor and there’re some sick people in the hospital who need me tonight.”
Silence. More silence. Ugh!
“You won’t be at Olive’s party? Olive wants you at her party, Daddy.”
My heart twisted on its stalk.
“She’s a very opinionated bunny.”
Amazed, I stifled a laugh. “‘Opinionated,’ is she? How can you tell?”
“Da-ad! She’s my bunny!”
“Sure, yes, right. I’ll be home in two hours. I’ll do ‘Happy Birthday’ then.”
“She’s dressed up like the White Rabbit in Alice in Wonderland, and Cinny’s wearing a Mad Hatter’s hat. They want you to see ’em.”
“I will! I’ll just be a little late.”
