If it didn't move before it was cooked, we don't want it!!!
Single ladies free and chairs provided.
If you bring spouse, $10 extra and bring your own chair.)
B. C. Gandhinesan M.D.,
Captain Our Lady's Eleven,
Cricket Commissioner, Our Lady of Perpetual Succour
In the lobby I registered coriander, cumin—the familiar scents of Almaz's kitchen. On the stairs I inhaled the very brand of incense that Hema lit each morning. I heard the faint drone on the second-floor landing of “Suprabhatam” sung by M. S. Subbulakshmi and the sound of a bell being rung, as someone in some other room did their puja. I felt a twinge of homesickness. We paused for Mr. Pomeranz to get his breath. “We had to put industrial-size fans in the hoods above the cooking stoves on both floors. Had to! When they start cooking that masala, forget about it!”
A tall, good-looking Indian man with long hair still wet from the shower came bounding down the stairs. He had big strong teeth, a winning smile, and an aftershave that smelled simply wonderful. (I found out later it was Brut.)
“B. C. Gandhinesan,” he said sticking out his hand.
“Marion Stone.”
“Excellent! Call me B.C. or Gandhi,” he said squeezing my hand. “Or call me Captain. Do you—?”
“Wicketkeeper,” Pomeranz said, triumphantly. “And opening batsman.”
B. C. Gandhi struck his forehead and staggered back. “God is great! Wonderful! Can you keep wickets for a pace bowler? A genuine fast bowler?”
“That's the kind I like best,” I said.
“Smashing! I'm a fourth-year resident. Chief Resident–to–be next year. Deepak is our Chief Resident. I'm also captain of Our Lady's First Eleven. Winners of the interhospital trophy for two years. Until those chutyas from a residency program I shall not name brought in a batsman from Hyderabad last year. Test-level player. I lost big money on that. It took me all year to get out of debt.”
“Jerks,” Louis said, his face dark, referring I think to the other program. “They should have forfeited that last game.”
“Turned out their star's a batsman all right, but not really a doctor,” B.C. said. “The bugger was a photocopy expert. But on paper, by the statutes of New York, he was a doctor when we played, Lou. So we don't get our money back.”
“Cocksuckers,” Lou said. “They killed us.”
“This year we have our own secret weapon,” B.C. said to me, a consoling arm around Lou. “I personally flew to Trinidad with one of our Old Boys to recruit him. You'll meet him soon. Nestor. Tall, strong fellow. Six foot four. Fast bowler, new-ball bowler, seam bowler, body-line bowler. But none of us can keep wickets for him—ferocious pace. Now, with you, we will kill those chutyas, and the trophy will be ours. Go get some rest, Marion. We shall see you at batting practice in twenty-four hours.”
CHAPTER 39
The Cure for What Ails Thee
PATIENT IS UNDER. What are we waiting for? Who is doing the case?” Dr. Ronaldo asked.
“I am,” I said.
Ronaldo spun a dial on the anesthesia cart, as if this news mandated a change in the gas mixture.
“Deepak is supervising me,” I offered, but Ronaldo ignored this.
Sister Ruth, the scrub nurse, unfolding her tray, shook her head. “I'm afraid not. Popsy just called. He wants to operate. Marion, you'd better come over to this side.”
“Popsy! God help us,” Dr. Ronaldo said, slapping his palm to his cheek. “Take the clock down. Call my wife, tell her I'll be late for dinner.”
I picked up the scent of Brut and then Winston tobacco, and seconds later B. C. Gandhi was at my shoulder. He must have had a last drag in the locker room.
“I know. I heard,” he said before I could say anything. “I'm doing that gallbladder in the next room. Listen, Marion. In case Deepak doesn't get here before Popsy, your job is to contaminate the old man as soon as he picks up the scalpel.”
“What? How?”
“I don't know. Scratch your butt and touch his glove. You're a smart bugger. You'll think of something. Just don't let him get past skin, okay?” Gandhi walked off.
“Is he serious?” I asked.
Ronaldo said, “Gandhi is never serious. But he is right. Contami nate him.”
I turned to Sister Ruth, hoping she could help.
“Pray for the intercession of Our Lady,” she said. “And contami nate him.”
IT WAS THE TWELFTH WEEK of my surgery internship at Our Lady of Perpetual Succour.
Little did I know that the thirty-minute drive from the airport to the Bronx would be the only glimpse of America I would have for three months.
After just a week in the hospital, I felt Id left America for another country. My world was a land of fluorescent lights where day and night were the same, and where more than half the citizens spoke Spanish. When they spoke English it wasn't what I expected in the land of George Washington and Abraham Lincoln. The bloodlines from the Mayflower hadn't trickled down to this zip code.
Three months at Our Lady of Perpetual Succour had gone by at lightning speed. We were severely shorthanded, compared with the norm in other American hospitals, but I didn't know the norm. At Missing, there were only four or five doctors at the best of times; here we had three times that number of physicians in surgery alone. But at Our Lady of Perpetual Succour, we saw more patients. We kept so many complicated trauma patients alive on ventilators in the ICU, generated so many lab tests and so much paperwork, that the experience was completely different from Missing, where Ghosh or Hema rarely made more than a cryptic entry in the chart, leaving the rest to the nurses. I learned those quiet, long American cars, those floating living rooms on wheels, caused monstrous injuries when they crashed. The ambulance crews brought the victims to us before the tires on the wreck stopped spinning. They salvaged people we'd never see in Missing, because no one would have tried to bring them to a hospital. Judging someone to be beyond help never crossed the minds of police, firemen, or doctors here.
AT OUR LADY, we pulled every-other-night call. I had no time to be homesick. My typical day started in the early morning, when I made rounds with my team leader, B. C. Gandhi. Then my team and the other surgical teams came together to make formal rounds with Deepak Jesu-dass, the Chief Resident, at 6:30 a.m. On operating days, which were Tuesdays and Fridays, we interns manned the wards and the emergency room. We worked till early evening. Then if I was on call, I simply worked on through the night admitting patients from the emergency room while caring for my existing patients and those of the interns who were not on call. Our chances to assist or even to operate as interns came when we were on call. It was rare to get any sleep on call nights. I didn't even try. The next day we kept going till the late afternoon, when I was finally off. For my off night all I could do was fall on the bed in my quarters and sink into a deep sleep. The next morning, the cycle started again. My senior resident, B. C. Gandhi, asked me late one night when we were both punch-drunk from lack of sleep, “Do you know the disadvantage of every-other-night call?” It was an imponderable question. I shook my head. He smiled and said, “You miss half the interesting patients.”
The schedule was brutal, dehumanizing, exhausting.
I loved it.
At midnight, when the corridors became deserted, there were places in the hospital where the lights dimmed and where I could see traces of Our Lady of Perpetual Succour's past glory; it showed in the gold filigree work above the archways, in the high ceilings of the old maternity wing, in the marble floor of the administrative foyer, and the stained-wood cupola of the chapel. Once the pride of a rich Catholic community, and then a middle-class Jewish community Our Lady of Perpetual Succour went the way of the neighborhood: it became poor in catering to the poor. B. C. Gandhi explained it to me: “The poorest in America are the sickest. Poor people can't afford preventive care or insurance. The poor don't see doctors. They show up at our doorstep when things are advanced.”
“Who
pays for all this, then?” I asked.
“The government pays with Medicaid and Medicare, from your taxes.”
“How come we can afford a helicopter and a helipad if we're so poor?” The bull's-eye atop the newer four-story part of Our Lady, with the blue flashing perimeter lights and the shiny helicopter that came and went, seemed incongruous for our setting.
“Salah, you don't know about our claim to fame? Our number one industry? Sometimes I forget you just got off the boat. Man, that helipad was paid for by hospitals that are the opposite of ours. The helicopter is really theirs, not ours. Rich hospitals. Taking care of the wealthy, the insured. Even if some of them take care of the poor, they have a big university or a university private practice to underwrite their costs. That kind of ‘taking care of the poor’ is noble.”
“And our kind of taking care?”
“Shameful. The work of untouchables. Those rich hospitals up and down the East Coast got together and paid for our helipad so they can fly here. Why? Ischemia time! You see, what we have here in our neighborhood is an abundance of guns, ABMs, and ALMs—Angry Black Males, Angry Latin Males, and actually angry males of all stripes, not to mention jealous females. The man on the street is more likely to carry a gun than a pen. Bang! Bang! Chitty! Chitty! And so we wind up with too many GPO patients—Good for Parts Only. Young, otherwise healthy, but brain-dead. Pristine hearts, livers, and whatnot. Under warranty to keep going long after your pecker droops. Great organs. Great for transplant. Transplants which we can't do. But we can keep them alive till the vultures get here. They get the organ and run. Next time you hear the whup-whup-whup, don't think helicopter blades. Think paysa, moola, dinero! Heart transplant costs, what, half a million dollars? Kidneys a hundred thousand or more?”
“That's how much they pay us?”
“Us?They don't pay us a fucking cent! That's how much they make. They come, cut, and take, show us the middle finger, and ride off in their whirlybird leaving us on our camels. Next time you hear the helicopter, come see what masters of medicine, the sahibs, look like.”
I had seen them more than once, their white coats emblazoned with vivid university logos on breast and shoulder, and the same icons on ice chests, on the igloos on wheels, and even on the helicopter. I saw in their faces the same variety of fatigue that I experienced, but theirs somehow seemed more noble.
DR. RONALDO CROSSED and uncrossed his arms, looking at the clock, then the door, for any sign of Popsy. I draped the sterile towels to outline a perfect rectangle, the portal to Hugh Walters Jr.'s abdomen.
Mr. Walters, a graying gentleman, showed up in our emergency room the week before. That particular night, stretchers spilled out of the ER's trauma bays into hallways. Alcohol had leached out of the lungs, out of skin pores, out of the secretions of enough men and women to make the place smell like a cocktail lounge. There were two inebriated men vomiting blood, competing to see who could be louder. When Mr. Walters arrived, also vomiting blood, I unfairly assumed he was one of their kin, related through alcohol and cirrhosis. I assumed that his bleeding came from wormlike varicose veins blooming in his stomach from the scarring in the liver. Over the course of the next twenty-four hours, I slipped a gastroscope down each bleeder's throat and peered into the stomach. Unlike the other two, Mr. Walters had none of the angry redness of alcoholic gastritis, and no bleeding varicose veins to suggest cirrhosis. What he did have was a large oozing gastric ulcer. I took biopsies through the scope.
A few hours after the endoscopy Mr. Walters, in a quiet dignified voice, again assured me that alcohol had never crossed his lips, and this time I believed him. He was a man of the cloth. He taught junior high school for a living. I chastised myself for lumping him in with the other two stomach bleeders. We started intense therapy to heal his ulcer.
Mr. Walters, I found, knew about my birth land. “When Kennedy died, I watched that funeral on TV. Your Emperor Haile Selassie came all the way. He was the shortest man there. But also the biggest man there. The only Emperor. The only Emperor. He was in the first row of dignitaries walking behind that coffin. He made me proud to be bl-ack.” When Mr. Walters said the word, he gave it a weight and a heft.
Mr. Walters read the New York Times every day. That and a Bible were a constant at his bedside. “I could never afford college. Just Bible school. I tell my students, ‘If you read this newspaper every day for a year, you'll have the vocabulary of a Ph.D. and you will know more than any college graduate. I guarantee you.’ “
“Do they listen?”
He held up a finger. “Every year one does,” he said, grinning. “But that one makes it worthwhile. Even Jesus only did twelve. I try to get one a year.”
Despite antacids and H2 blockers, Mr. Walters s ulcer was still bleeding. His stools remained the consistency and color of tar, a sure sign of blood being acted on by stomach acid. Five days after his admission, our troop had gathered at his bed during evening sign-out rounds.
Deepak Jesudass, our Chief Resident, sat on the edge of Mr. Walters s bed. “Mr. Walters, we have to operate tomorrow. Your ulcer is still bleeding. It isn't showing signs of stopping.” He sketched out on a piece of paper what a partial gastrectomy would look like—removal of the acid-producing area of his stomach. I admired Deepak's quiet careful manner, his way of being with patients that made them feel they were the focus of all his attention and that there was nowhere else he had to be. Most of all I admired his wonderful, very British accent, which seemed doubly exotic in that it came from a South Asian man. It was the result of his having lived in Britain for years. Deepak inspired confidence in patients.
As Deepak spoke, B. C. Gandhi looked at me and rolled his eyes. He was reminding me of something hed told me just the previous night. “You can be a cretin, but if you have the Queen's accent, next thing you know you are on Johnny Carson and he'll laugh at anything you say.”
B.C. was being facetious, but on the sitcoms I caught while going in and out of patients’ rooms, I had so far seen a black but very British butler serving a black American family; an eccentric Englishman who was the neighbor to a rich black family on the Upper East Side of Manhattan; and a rich British widower with a pretty Brooklyn nanny.
Mr. Walters had hung on Deepak's every word. At last he'd said, “I have faith in you. But for you-all, there wouldn't be any doctors here. I have faith in someone else, too,” he said, pointing to the ceiling.
The day of surgery, I rose at four-thirty to review the steps of the operation in my Zollinger's Surgical Atlas. Deepak had let me know that it was my case, and I would stand on the right while he assisted me. I was thrilled and nervous. It would be my first time to work directly with the Chief Resident.
But Popsy had ruined our plans. I stood on the patient's left, awaiting the legendary Dr. Abramovitz. I had yet to meet him. There was no sign of Deepak.
AND SUDDENLY POPSY WAS THERE, his head perilously close to the operative lights. He had a deeply furrowed face, kind blue eyes, the pupils rimmed with gray but retaining a curious, little-boy quality. His mask hung just under his nose, wire-brush hairs poking out from his nostrils. He held out his gloved hand for the knife. Sister Ruth hesitated, glancing at me before putting it in his palm.
Popsy made a sound in his throat. The scalpel quivered in his fingers. Sister Ruth nudged me. Before I could do anything, Popsy made his incision. It was bold. Very bold. I dabbed and I clamped tiny bleeding vessels, and when Popsy didn't move to tie them off, I did. Popsy handled the forceps to pick up the peritoneum. He couldn't get purchase on the tissue.
For good reason. In one spot his skin incision had cut through fascia and peritoneum. Liquid matter, looking suspiciously like bowel content, welled into the wound. Ronaldo peered over the anesthesia screen and his eyebrows disappeared under his surgical cap.
Popsy tried again with the forceps, but the instrument slipped from his fingers and clattered to the floor. He brought his hand up, minus the forceps. “I touched the side of the table …” He wa
s looking at me, as if I might dispute his account. “I've contaminated myself.”
“I think you did,” Sister Ruth said hastily when she saw that I was tongue-tied.
“You did, sir,” Ronaldo said.
But Popsy still looked at me.
“Yes, sir,” I stammered.
“Carry on,” he said. He shuffled out of the room.
“POPSY, WHAT DID YOU DO?” Deepak muttered under his mask as he brought out the injured loop of small intestine. I stayed on the left side of the table. “They say there are old surgeons, and bold surgeons, but no old-bold surgeons. But whoever said that never met Popsy. Fortunately it's a small-bowel tear and we can just stitch it over.”
“I tried to—” I stammered.
“We have a bigger problem,” Deepak said. He pointed to what looked like a small barnacle on the surface of the bowel. Once I saw that first one, I saw them everywhere, even on the apron of fat that covered the bowel. The liver was misshapen, with three ominous bumps within making it look like a hippo's head.
“Poor man,” Deepak said. “Feel his stomach.” The stomach wall was rock hard. “Marion, you biopsied the ulcer when you ‘scoped him, right?”
“Yes. The report said benign,” I said.
“But this was a large ulcer on the greater curvature?”
“Yes.”
“And which ulcers in the stomach are more likely to be malignant?”
“Those on the greater curvature.”
“So your suspicion for malignancy was high, right? Did you look at the slides with the pathologist?”
“No, sir,” I said, dropping my eyes.
“I see. You trusted the pathologist to read the biopsies for you?”
I said nothing.
Deepak's voice wasn't raised. He could have been talking about the weather. Dr. Ronaldo couldn't hear him.
Deepak explored the pelvis, swept with his fingers to those places we could not see. Finally he said, almost under his breath, “Marion, when it's your patient and you are basing your surgery on a biopsy, be sure to look at the slides with the pathologist. Particularly if the result isn't what you expect. Don't go by the report.”