Just Like Someone Without Mental Illness Only More So (14 page)

I wondered how it had all come to pass, but it always hurt when I pinched myself.

It was early spring when I arrived for my last night as senior in charge of the ER, and there was one “expect note.” Sometimes there would be half a dozen or more. I checked the crash cart and the laryngoscope batteries. Whenever I was in the ER and had small bits of time with nothing else to do, I’d scan dermatology texts. Sooner or later I’d run into someone with the disease in the pictures and it would click that I’d seen it somewhere, even if I couldn’t remember what it was.

Gonococceal (GC) conjunctivitis was the number one cause of blindness before there were laws mandating treatment of all newborns. The closest I’d ever come to seeing a case of GC conjunctivitis was a woman who had a positive GC culture one week prior to delivery. There were lots of ideas about what we should do, and in the end we decided to do them all. The mother and baby each received so many different antibiotics via
different routes before and after delivery that whatever germs were there were ripped to shreds worse than Bonnie and Clyde in that machine-gun ambush.

Textbooks show massively swollen, very red, weepy eyes with copious pus.

I got a call from the chief resident at Mass Eye and Ear Infirmary. “We have a seven-day-old baby here with eyes that look fine, but there’s a care and protection order on him because the parents wouldn’t comply with treatment at Children’s Hospital. Our pediatric floor is full, so we’re sending him over to you.… I don’t want to make you nervous, but the father has about a dozen very quiet friends dressed in camouflage fatigues and combat boots. Our security people have already talked to your security people.”

I had about fifteen minutes before the Smiths could get over to MGH and register, so I headed down to the basement for my last ten o’clock meal. Whatever hadn’t been eaten that day and the day before at the ten o’clock meal was dolled up a little and put back out there one more time. Amazing numbers of calories were consumed by deranged absentminded overstressed hospital personnel. It was free. Whenever anyone said that there was no free lunch, I always thought, “No, but there is the ten o’clock meal.”

Malvesti Hedley Smith was about five feet nine, 190 solid pounds; he looked like he was carved out of ironwood. He had jet-black African skin, wore designer jeans and a free-flowing bright African-print shirt, and walked slowly on the balls of his feet like he wouldn’t make a sound walking through tin cans in clogs on a tin roof. It was hard to look at Malvesti and not feel inferior. He checked out the waiting room briefly and ushered
in his wife, their one-week-old son, and three colleagues in battle fatigues and combat boots. They took stiff seats in hard plastic chairs.

“Prince of the River Nile Smith,” called out Helen, the triage nurse, just as she would call out any other name.

Mother with babe in arms, Malvesti, and three friends rose in unison and allowed themselves to be led into one of our small exam rooms.

“Undress the baby down to his diaper so we can take his temperature and the doctor can examine him,” said Helen.

“My baby’s only problem is with his eyes. He has been examined many times. We prefer that you not take his temperature. I would like to talk to the doctor in charge.” Each word was clipped, enunciated perfectly and with a slight British-colonial accent that suggested English wasn’t his first language.

His wife, Asanti, was a very pretty, soft-featured, medium-complected young woman of about twenty, one or two inches taller than her husband. The three friends were all about six feet tall, clean-shaven, athletic, in their mid-twenties, distinguished only by their military attire, ramrod-stiff posture, and deference to Malvesti.

Malvesti had a spooky left eye that would break into herky-jerky circles while the right stared fixedly ahead. Then the left would be drawn back into line as if by gravitational force. I tried to map out what pathways must be broken to make his eye act like that but couldn’t help finding it just plainly unsettling. He also had ceremonial scars on his face.

“Every patient has to have vital signs taken before being seen by the doctor,” explained Helen, who stood a good four inches taller than Malvesti.

“I will see the doctor now. I do not want you touching my child.”

“What’s going on here?” I interrupted cheerfully. I had been watching and listening through the two-inch round hole in the door. “I’m Dr. Vonnegut, the doctor in charge tonight.” Any senior resident in his right mind would have sat back and let the intern handle the case. The truth is that I got bored when I wasn’t taking care of patients, and this case seemed way more interesting than most.

“He doesn’t want to undress the baby or have us take his signs,” said Helen, rolling her eyes behind and over Malvesti.

“It can’t hurt to talk a little before taking vital signs.” Sometimes I make myself gag.

Helen rolled her eyes again and left.

I reached out my hand to Malvesti, who ignored it. I did my best to ignore that he ignored it. If I was armed with a stun gun and a baseball bat and Malvesti was blindfolded with both hands tied behind his back, he could have destroyed me in a minute or less. I knew from his patient-registration data that he was thirty-four years old, almost exactly my age.

“I am expecting that you will tell me what is necessary to make sure my son does not go blind from the infection in his eyes.”

“I promise you that we will not let this infection harm your son’s eyes,” I said, standing slightly stiffly and speaking with a clipped, vaguely British-colonial accent that made it sound like English was maybe not my first language.

The baby was resting quietly in his mother’s arms. His eyes were not even a little bit red or swollen. There was a very small amount of crust where the upper and lower lids came together at the nasal bridge.

“I understand from the last place we took our son that the germ that might blind him is one that is passed by sexual activity. I do not have any symptoms of disease, and my wife has never been with another man. How is it possible for our baby to have this germ?”

At Children’s Hospital Malvesti and his wife had balked at allowing the doctors to swab their son’s eyes or apply antibiotic ointment, insisting they be allowed to treat him at home.

There were now nine sidekicks in battle fatigues left in the waiting room. And more and more of our beefy security guys milling around.

“The doctor there filled a care and protection order,” I said. “If a doctor thinks that parents are not acting in the best interest of their child and that their child might be at risk of serious harm, he can ask a judge to temporarily give custody of the child to the hospital,” I explained.

“We will do the ointment and go home now,” said Malvesti.

I later learned that there were twenty-four state troopers backing up hospital security out front.

“We believe in preparedness and self-defense but not hurting people. It’s very good for the morale and discipline of my men to be taken so seriously,” said Malvesti.

Everyone else was blending into the woodwork. “I’m afraid I’m going to have to make some calls,” I said.

The judge was not in a good mood. No compromises, no deals: Prince of the River Nile Smith would be admitted for observation and treatment of conjunctivitis that wasn’t really there.

“There will be no blood tests or injections, right?” Malvesti asked, realizing that the trap was swinging shut.

“I’m just the doctor in charge down here.” My heart was in my throat, and racing. My goal right then was to not throw up.
“You will stay with him of course. And when the culture comes back negative, you can go home and forget about this place. I’m sorry.”

Malvesti looked like he had a bad taste in his mouth and nowhere to spit it out.

Half an hour after the family went up to the floor, Louis, the weasel of a junior resident who would be Prince of the River Nile Smith’s admitting doctor, called me. “Do you have any idea what was in the herbal compress they were using? There was a case once where a baby almost died from herbal tea.”

“The eyes don’t look all that bad, do they?”

“No, they don’t now, but I’m not comfortable admitting this baby without doing some sort of a work-up.”

“We already have done a work-up, Louis. MEEI has the cultures cooking. And we’re observing the baby.”

“It’s my case, and I can’t see the harm in doing a septic work-up.”

A septic work-up means obtaining blood for culture and complete blood count, urine for culture and analysis, and spinal fluid for cell count and culture. Most unnecessary tests have the good manners to come back normal. But if they come back abnormal, you become obliged to do more tests to confirm or refute the abnormal test. You can end up miles from where you started chasing your tail.

Lynn, a cheerleader-type bubble-brain fourth-year medical student, did the procedures. She got blood on the first stick, the lumbar puncture on the second pass, and the bladder tap. She stopped by to talk with me in the emergency ward.

“What’s wrong with the dad’s eye? It almost seems like he can control it and uses it to spook people.”

“It’s central,” I said.

“Oh. Thanks,” said Lynn. “Louis has agreed to no more tests unless the baby acts sick or has new symptoms. The dad must have taken off while we were doing the tests. At least his mother’s still with him. Is it true that black people are better at breast-feeding?”

I tried to sleep on the sticky black vinyl couch in the chief resident’s office. In a fitful half-sleep dream I watched myself bent backward across Malvesti’s knee, him pulling my head back by the hair with his left hand as he transected my heart with the knife in his right, entering my chest at the anterior axillary line between ribs nine and ten and pulling it to the midline.

A few hours later I got up, had some coffee, and went to senior rounds, where we discussed Prince of the River Nile Smith and all the other admissions from the previous twenty-four hours.

“There was absolutely nothing wrong with that baby,” I was compelled to throw in.

“There might have been,” countered Louis, “Besides, there was a court order. We had to admit and treat that baby. It was the people at Children’s who gave us no choice.”

On to the next case. As I got on my bike and pedaled home, I half hoped that Malvesti or one of his lieutenants might run me over before I could cross over to the Charles River.

I had a job lined up with a small respected pediatric practice. In a month I would be calling the shots, doing my best to keep kids out of emergency rooms and getting tests they didn’t need.
There were pediatricians practicing in their eighties who still seemed to be having a good time with it.

The last thing I did as a senior resident was to transport a critically ill newborn girl who was thought to have an overwhelming infection from an outlying hospital to Mass General. I made the guess, which turned out to be correct, that she had congenital heart disease even though she didn’t have a murmur or blueness or any other sign of heart disease. I treated her for heart failure instead of infection and she responded well and survived the trip back to MGH. Her heart was 100 percent fixable. Instead of being dead or crippled, she would grow up with as good a chance as the rest of us.