A Case of Need

  I stumbled and fell. My knees cracked into the pavement and pain shot through me. For an instant, it cleared my head, and I was able to get back to my feet. The shoes, soaked through, squeaked. My clothes were damp with sweat and rain.

  I concentrated on the sound of my shoes and forced myself to walk. One step at a time. Three blocks ahead, I saw lights. I knew I could make it.

  One step at a time.

  I leaned against a blue car for a moment, just a moment, to catch my breath.

  “THAT’S IT. That’s the boy.” Somebody was lifting me up. I was in a car, being lifted out. My arm was thrown over a shoulder, and I was walking. Bright lights ahead. A sign: “Emergency Ward.” Blue-lighted sign. Nurse at the door.

  “Just go slow, boy. Just take it easy.” My head was loose on my neck. I tried to speak but my mouth was too dry. I was terribly thirsty and cold. I looked at the man helping me, an old man with a grizzled beard and a bald head. I tried to stand better so he wouldn’t have to support me, but my knees were rubber, and I was shivering badly. “Doing fine, boy. No problem at all.” His voice was gruffly encouraging. The nurse came forward, floating in the pool of light near the EW door, saw me, and ran back inside. Two interns came out and each took an arm. They were strong; I felt myself lifted up until my toes were scraping through the puddles. I felt rain on the back of my neck as my head drooped forward. The bald man was running ahead to open the door.

  They helped me inside where it was warm. They put me on a padded table and started pulling off my clothes, but the clothes were wet and blood-soaked; they clung to my body, and finally they had to cut them off with a scissors. It was all very difficult and it took hours. I kept my eyes closed because the lights overhead were painfully bright.

  “Get a crit and cross-match him,” said one of the interns. “And set up a four kit with sutures in room two.”

  People were fussing with my head; I vaguely felt hands and gauze pads being pressed against my skin. My forehead was numb and cold. By now they had me completely undressed. They dried me with a hard towel and wrapped me in a blanket, then transferred me to another padded table. It started to roll down the hall. I opened my eyes and saw the bald man looking down at me solicitously.

  “Where’d you find him?” one of the interns asked.

  “On a car. He was lying on a car. I saw him and thought he was a drunk passed out. He was half in the street, you know, so I figured he could get run over and stopped to move him. Then I saw he was nicely dressed and all bloody. I didn’t know what happened, but he looked bad, so I brought him here.”

  “You have any idea what happened?” the intern asked.

  “Looks beat up, if you ask me,” the man said.

  “He didn’t have a wallet,” the intern said. “He owe you money for the fare?”

  “That’s all right,” the bald man said. “I’m sure he’ll want to pay you.”

  “That’s all right,” the cabby said. “I’ll just go now.”

  “Better leave your name at the desk,” the intern said.

  But the man was already gone.

  They wheeled me into a room tiled in blue. The surgical light over my head switched on. Faces peered down at me. Rubber gloves pulled on, gauze masks in place.

  “We’ll stop the bleeding,” the intern said. “Then get some X rays.” He looked at me. “You awake, sir?”

  I nodded and tried to speak.

  “Don’t talk. Your jaw may be broken. I’m just going to close this wound on your forehead, and then we’ll see.”

  The nurse bathed my face, first with warm soap. The sponges came away bloody.

  “Alcohol now,” she said. “It may sting a little.”

  The interns were talking to each other, looking at the wound. “Better mark that as a six-centimeter superficial on the right temple.”

  I barely felt the alcohol. It felt cool and tingled slightly, nothing more.

  The intern held the curved suture needle in a needle holder. The nurse stepped back and he moved over my head. I expected pain, but it was nothing more than a slight pricking on my forehead.

  The intern who was sewing said, “Damned sharp incision here. Looks almost surgical.”

  “Knife?”

  “Maybe, but I doubt it.”

  The nurse put a tourniquet on my arm and drew blood. “Better give him tetanus toxoid as well,” the intern said, still sewing. “And a shot of penicillin.” He said to me, “Blink your eyes once for yes, twice for no. Are you allergic to penicillin?”

  I blinked twice.

  “Are you sure?”

  I blinked once.

  “O.K.,” said the intern. He returned to his sewing. The nurse gave me two injections. The other intern was examining my body, saying nothing.

  I must have passed out again. When I opened my eyes, I saw a huge X-ray machine poised by my head. Someone was saying, “Gently, gently,” in an irritated voice.

  I passed out again.

  I awoke in another room. This was painted light green. The interns were holding the dripping-wet X rays up to the light, talking about them. Then one left and the other came over to me.

  “You seem all right,” he said. “You may have a few loose teeth, but no fractures anywhere that we can see.”

  My head was clearing; I was awake enough to ask, “Has the radiologist looked at those films?”

  That stopped them cold. They froze, thinking what I was thinking, that skull films were so hard to interpret and required a trained eye. They also didn’t understand how I knew to ask such a question.

  “No, the radiologist is not here right now.”

  “Well, where is he?”

  “He just stepped out for coffee.”

  “Get him back,” I said. My mouth was dry and stiff; my jaw hurt. I touched my cheek and felt a large swelling, very painful. No wonder they had been worried about a fracture.

  “What’s my crit?” I said.

  “Pardon, sir?”

  It was hard for them to hear me, my tongue was thick and my speech unclear.

  “I said, what’s my hematocrit?”

  They glanced at each other, then one said, “Forty, sir.”

  “Get me some water.”

  One of them went off to get water. The other looked at me oddly, as if he had just discovered I was a human being. “Are you a doctor, sir?”

  “No,” I said, “I’m a well-informed Pygmy.”

  He was confused. He took out his notebook and said, “Have you ever been admitted to this hospital before, sir?”

  “No,” I said. “And I’m not being admitted now.”

  “Sir, you came in with a laceration—”

  “Screw the laceration. Get me a mirror.”

  “A mirror?”

  I sighed. “I want to see how good your sewing is,” I said.

  “Sir, if you’re a doctor—”

  “Get the mirror.”

  With remarkable speed, a mirror and a glass of water were produced. I drank the water first, quickly; it tasted marvelous.

  “Better go easy on that, sir.”

  “A crit of forty isn’t bad,” I said. “And you know it.” I held up the mirror and examined the cut on my forehead. I was angry with the interns, and it helped me forget the pain and soreness in my body. I looked at the cut, which was clean and curved, sloping down from above one eyebrow toward my ear.

  They had put about twenty stitches in.

  “How long since I came in?” I said.

  “An hour, sir.”

  “Stop calling me sir,” I said, “and do another hematocrit. I want to know if I’m bleeding internally.”

  “Your pulse is only seventy-five, sir, and your skin color—”

  “Do it,” I said.

  They took another sample. The intern drew five cc’s into a syringe. “Jesus,” I said, “it’s only a hematocrit.”

  He gave me a funny apologetic look and quickly left. Guys on the EW get sloppy. They need only a fraction of a cc to do
a crit; they could get it from a drop of blood on a finger.

  I said to the other intern, “My name is John Berry. I am a pathologist at the Lincoln.”

  “Yes, sir.”

  “Stop writing it down.”

  “Yes, sir.” He put his notebook aside. “This isn’t an admission and it isn’t going to be officially recorded.”

  “Sir, if you were attacked and robbed—”

  “I wasn’t,” I said. “I stumbled and fell. Nothing else. It was just a stupid mistake.”

  “Sir, the pattern of contusions on your body would indicate—”

  “I don’t care if I’m not a textbook case. I’m telling you what happened and that’s it.”

  “Sir—”

  “No,” I said. “No arguments.” I looked at him. He was dressed in whites and he had some spatterings of blood on him; I guessed it was my blood.

  “You’re not wearing your name tag,” I said.

  “No.”

  “Well, wear it. We patients like to know who we’re talking to.”

  He took a deep breath, then said, “Sir, I’m a fourth-year student.”

  “Jesus Christ.”

  “Sir—”

  “Look, son. You’d better get some things straight.” I was grateful for the anger, the fury, which gave me energy. “This may be a kick for you to spend one month of your rotation in the EW, but it’s no kicks at all for me. Call Dr. Hammond.”

  “Who, sir?”

  “Dr. Hammond. The resident in charge.”

  “Yes, sir.”

  He started to go, and I decided I had been too hard on him. He was, after all, just a student, and he seemed a nice enough kid.

  “By the way,” I said, “did you do the suturing?”

  There was a long, guilty pause. “Yes, I did.”

  “You did a good job,” I said.

  He grinned. “Thanks, sir.”

  “Stop calling me sir. Did you examine the incision before you sutured it up?”

  “Yes, s—. Yes.”

  “What was your impression?”

  “It was a remarkably clean incision. It looked like a razor cut to me.”

  I smiled. “Or a scalpel?”

  “I don’t understand.”

  “I think you’re in for an interesting night,” I said. “Call Hammond.”

  ALONE, I had nothing to think about but the pain. My stomach was the worst; it ached as if I had swallowed a bowling ball. I rolled over onto my side, and it was better. After a while, Hammond showed up, with the fourth-year student trailing along behind.

  Hammond said, “Hi, John.”

  “Hello, Norton. How’s business?”

  “I didn’t see you come in,” Norton said, “otherwise—”

  “Doesn’t matter. Your boys did a good job.”

  “What happened to you?”

  “I had an accident.”

  “You were lucky,” Norton said, bending over the wound and looking at it. “Cut your superficial temporal. You were spurting like hell. But your crit doesn’t show it.”

  “I have a big spleen,” I said.

  “Maybe so. How do you feel?”

  “Like a piece of shit.”

  “Headache?”

  “A little. Getting better.”

  “Feel sleepy? Nauseated?”

  “Come on, Norton—”

  “Just lie there,” Hammond said. He took out his penlight and checked my pupils, then looked into the fundi with an ophthalmoscope. Then he checked my reflexes, arms and legs, both sides.

  “You see?” I said. “Nothing.”

  “You still might have a hematoma.”

  “Nope.”

  “We want you to stay under observation for twenty-four hours,” Hammond said.

  “Not a chance.” I sat up in bed, wincing. My stomach was sore. “Help me get up.”

  “I’m afraid your clothes—”

  “Have been cut to shreds. I know. Get me some whites, will you?”

  “Whites? Why?”

  “I want to be around when they bring the others in,” I said.

  “What others?”

  “Wait and see,” I said.

  The fourth-year student asked me what size whites I wore, and I told him. He started to get them when Hammond caught his arm.

  “Just a minute.” He turned to me. “You can have them on one condition.”

  “Norton, for Christ’s sake, I don’t have a hematoma. If it’s subdural, it may not show up for weeks or months anyway. You know that.”

  “It might be epidural,” he said.

  “No fractures on the skull films,” I said. An epidural hematoma was a collection of blood inside the skull from a torn artery, secondary to skull fracture. The blood collected in the skull and could kill you from the compression of the brain.

  “You said yourself, they haven’t been read by a radiologist yet.”

  “Norton, for Christ’s sake. You’re not talking to an eighty-year old lady. I—”

  “You can have the whites,” he said calmly, “if you agree to stay here overnight.”

  “I won’t be admitted.”

  “O.K. Just so you stay here in the EW.”

  I frowned. “All right,” I said finally, “I’ll stay.”

  The fourth-year student left to get me the clothes. Hammond stood there and shook his head at me.

  “Who beat you up?”

  “Wait and see.”

  “You scared hell out of the intern and that student.”

  “I didn’t mean to. But they were being kind of casual about things.”

  “The radiologist for the night is Harrison. He’s a fuck-off.”

  “You think that matters to me?”

  “You know how it is,” he said.

  “Yes,” I said, “I do.”

  The whites came, and I climbed into them. It was an odd feeling; I hadn’t worn whites for years. I’d been proud of it then. Now the fabric seemed stiff and uncomfortable.

  They found my shoes, wet and bloody; I wiped them off and put them on. I felt weak and tired, but I had to keep going. It was all going to be finished tonight. I was certain of it.

  I got some coffee and a sandwich. I couldn’t taste it, it was like eating newspaper, but I thought the food was necessary. Hammond stayed with me.

  “By the way,” he said, “I checked on Roman Jones for you.”

  “And?”

  “He was only seen once. In the GU1 clinic. Came in with what sounded like renal colic, so they did a urinalysis.”

  “Yes?”

  “He had hematuria, all right. Nucleated red cells.”

  “I see.”

  It was a classic story. Patients often showed up in clinic complaining of severe pain in the lower abdomen and decreased urine output. The most likely diagnosis was a kidney stone, one of the five most painful conditions there are; morphine is given almost immediately when the diagnosis is made. But in order to prove it, one asks for a urine sample and examines it for slight blood. Kidney stones are usually irritating and cause a little bleeding in the urinary tract.

  Morphine addicts, knowing the relative ease of getting morphine for kidney stones, often try to mimic renal colic. Some of them are very good at it; they know the symptoms and can reproduce them exactly. Then when they’re asked for a urine sample, they go into the bathroom, collect the sample, prick their fingers, and allow a small drop of blood to fall in.

  But some of them are squeamish. Instead of using their own blood, they use the blood of an animal, like a chicken. The only trouble is that chicken red cells have nuclei, while those of humans do not. So nucleated red cells in a patient with renal colic almost always meant someone faking the symptoms, and that usually meant an addict.

  “Was he examined for needle marks?”

  “No. When the doctor confronted him, he left the clinic. He’s never been seen again.”

  “Interesting. Then he probably is an addict.”

  “Yes. Probably.”


  After the food, I felt better. I got to my feet, feeling the exhaustion and the pain. I called Judith and told her I was at the Mem OPD and that I was fine, not to worry. I didn’t mention the beating or the cut. I knew she would have a fit when I got home, but I wasn’t going to excite her now.

  I walked down the corridor with Hammond, trying not to wince from the pain. He kept asking me how I felt, and I kept telling him I felt fine. In fact, I didn’t. The food was beginning to make me nauseated, and my headache was worse standing up. But the worst thing was the fatigue. I was terribly, terribly tired.

  We went to the emergency entrance of the EW. It was a kind of stall, an open-ended garage where the ambulances backed up and unloaded their cargoes. Swinging, automatic doors, operated by foot-pressure pads, led into the hospital. We walked out and breathed the cool night air. It was a rainy, misty night, but the cool air felt good to me.

  Hammond said, “You’re pale.”

  “I’m O.K.”

  “We haven’t even begun to evaluate you for internal hemorrhage.”

  “I’m O.K.,” I said.

  “Tell me if you’re not,” Hammond said. “Don’t be a hero.”

  “I’m not a hero,” I said.

  We waited there. An occasional automobile drove past us, tires hissing on the wet streets; otherwise it was silent.

  “What’s going to happen?” Hammond said.

  “I’m not sure. But I think they’re going to bring in a Negro and a girl.”

  “Roman Jones? Is he involved in all this?”

  “I think so.”

  In fact, I was almost certain that it had been Roman Jones who had beaten me up. I didn’t remember exactly any more; the events right before the accident were hazy. I might have expected that. I didn’t have true retrograde amnesia, which is common with concussions and extends back for fifteen minutes before the accident. But I was a little confused.

  It must have been Roman, I thought. He was the only logical one. Roman had been heading for Beacon Hill. And there was only one logical reason for that, too.

  We would have to wait.

  “How do you feel?”

  “You keep asking,” I said. “And I keep telling you I’m fine.”