The View from the Vue (12 page)

Charlene’s situation was not as unusual as I thought at the time; I’ve since been involved in three or four similar cases. At the root of the problem is the psychological mechanism of denial. A young, unmarried girl, to whom pregnancy would be a thorough disaster, subconsciously refuses to accept the possibility that she might in fact be in a family way. She suppresses recognition of all the usual symptoms of pregnancy and carries on, merely believing that she’s gaining a bit too much weight. This self-deception continues until the inevitable labor ensues, at which time the true state of affairs can no longer be denied.

I delivered Charlene, uneventfully, of a normal seven-pound boy. She surprised me by showing considerable affection for her new offspring, even to the point of cooing at great length. To put it mildly, her behavior would have caused much pain to those who deny the existence of maternal instincts.

After I had sewed up Charlene’s bottom, the nurse wheeled the baby to the nursery. As I was taking off my gown and gloves, my patient called out, “Oh—Dr. Karp.”

I asked her what was on her mind.

“I was just wondering,” she said. “My friend is outside; she came to the hospital with me. Would you tell her about my baby for me?”

“Better than that,” I answered, “let’s get you on this stretcher here, and I’ll wheel you out to the ward. You can tell her yourself, on the way.”

In retrospect, I recalled that Charlene looked a little dubious at that point. But she said okay.

As we went through the swinging doors into the corridor between labor and delivery and the ward, a woman stepped forward from against the wall. Her girth rivaled her height. She had close-cropped, mouse-colored hair, and she was wearing no makeup. Furthermore, it did not take an unusual degree of perception to see that she was smoking mad.

Charlene said, “Hi, Paula,” but got no further. Paula waddled up to the side of the stretcher, bellowed, “You’ve been unfaithful to me!” and delivered Charlene a slap across the cheek that caused the entire stretcher to vibrate.

For a moment I stood there in fascination, watching the drama unfold. Paula proceeded to grab Charlene by the ear, and pummeled her about the head while yelling at the top of her lungs that she was going to teach a good lesson to her unfaithful little bitch. At that point I decided that intervention was necessary, so I grabbed Paula around the midsection and managed to wrestle her off her friend. By now, both women were in tears and near hysteria.

“Get out of here,” I said to Paula, pointing at the stairs. “Go on home until you get yourself under control. Then you can come back.”

“Huh!” she snorted. “You can’t kick me outa here.”

“Maybe not,” I said, “but the guards can, and they will, if I tell them you were beating up on one of the patients.” Once again, I pointed to the stairs.

Paula snorted again. “I’ll be back later, dear,” she said sarcastically. At first I thought that she was talking to me, but then I realized she was looking directly at Charlene.

She did come back later, and she had indeed cooled off. So much so that she showered Charlene with kisses and told her she had decided to forgive her. Charlene, for her part, accepted her friend’s apology and spent the rest of the evening on the ward in her arms, cooing at her in the same tone of voice she had used earlier on her baby.

The next morning, on rounds, Charlene proudly told me that she had made her decision. “We’re going to keep the baby and bring him up,” she said.

“We?” I asked, knowing too well the answer.

“Oh, yes. Paula just loved the baby when she saw him. She said she thought it’d be nice to have a baby in the house. And she says we can bring him up as well as any
man
and woman could.”

“Well,” I said, and stopped there, except for a bit of hemming and hawing. “Oh, hell,” I finally burst out. “Look, Charlene, do you, uh, really think that’s a good idea?”

She looked at me, all innocence.

“I mean, with you and Paula being…well, the way you are, do you really think you can do a good job of raising a little boy?”

Charlene looked as though
I
had slapped her. “Paula told me you doctors wouldn’t approve of it,” she wailed. “But I thought maybe
you
were different.” She rolled over in bed to face the wall and started to cry.

“I’m sorry, Charlene,” I said. “But think it over a little, would you, please?”

During the next couple of days, whether or not Charlene thought about it, her mind didn’t seem to do any changing. She and Paula fussed over the baby, took turns giving him his bottle, and argued over who was going to get to change the next diaper. Finally, I went down to speak to the social worker; I outlined the case to her, and she promised to look into it.

She came back to see me the same afternoon, shaking her head sadly. “I don’t think there’s anything we can do, Dr. Karp,” she said. “It’s awfully hard to take a baby away from its natural mother; you have to prove she’s totally unfit. And all we’ve got is an unmarried mother and a woman who claims to be nothing more than her good friend who’s going to take her in, shelter her, and help her care for her new baby. That story could melt the heart of any judge in New York City.”

“They’re a bit more than good friends,” I said.

“You may know that,” replied the social worker, “but you can’t prove it. No one else witnessed their little lovers’ quarrel after the baby was born. And they haven’t done anything on the ward that they couldn’t justify as just affection between two good friends. Furthermore, there hasn’t been a new mother in Bellevue in the last twenty years who’s given her baby the attention that this one’s gotten.”

“But my God,” I yelled in exasperation. “What the hell are those two going to do to a little boy?”

“Frankly, I shudder to think,” the social worker said. “But you might as well calm down. There’s nothing you can do about it. You just can’t set right all the wrongs in this world, so why don’t you just relax, and act like a doctor instead of a social worker.”

The next morning, as I stood by and advanced my day of total baldness, Charlene and Paula took their baby home. Since then, I’ve often wondered what became of him. Probably in a few years I’ll be watching him play tackle for the Los Angeles Rams.

Now that homosexuality has gone public, the peculiar medical problems attending the condition are also better known, and so homosexuals probably receive better care than they did fifteen years ago. But I’ll bet that plenty of them still get their treatment at The Vue. Depending upon the eyes of the beholder, gay may be beautiful, but it still has a way to go before it can claim to be a truly accepted way of life.

One of the most intriguing things about working at Bellevue was the manner in which we were repeatedly shown how stupid we were. Although most of us had left medical school with a good grounding in treating various diseases and with a fine appreciation for the scientific method, very few of us knew how to listen intelligently to what our patients were telling us. This knack eventually came with experience, but before we had learned our lesson, we often managed to make ourselves look very silly.

The problem of marital disputes was unconditionally guaranteed to provide an inexperienced physician every opportunity to make a fool of himself. Students and residents on obstetrics and gynecology were especially susceptible to this snare, since difficulties related to the reproductive system frequently led the complainant across a very tenuous line into a discussion of the problems of her married life.

For example, the ever-patient and long-suffering wife of the drunkard was a classic situation at The Vue. “What in the world am I going to do?” the patient would ask us, as the stereotyped tears began to form a puddle in her lap. “My husband goes to the bar every payday, and the money he doesn’t spend on booze he gambles away. Then when I tell him they shut off the phone because we didn’t have the money to pay the bill, he beats me up.”

We thought the answer was obvious. “Admit your mistake,” we advised. “Get a divorce from him. Start fresh. Profit from your mistake.”

We really should have known better. For many years wiser heads than our own had been correctly diagnosing these interpersonal relationships. If any of us had bothered to read George Ade’s
Fable of Flora and Adolph and a Home Gone Wrong
, we’d have saved ourselves a good deal of trouble and embarrassment. The little story of Mr. and Mrs. Botts’s day in divorce court would have taught us that marriages are indeed made in heaven, and that it is not for us to interfere.

But in our ignorance and innocence, we almost invariably rushed in foolishly, as a number of us did in the case of Adelina Hernandez. Adelina was a cute little nineteen-year-old with a thirty-five-year-old husband. At the time she and I became acquainted, she had just delivered her first baby and was ready to be checked over before being discharged. I examined her and found everything to be in working order, whereupon I gave her the usual going-home instructions. These included no intercourse for six weeks; at that one, she covered her mouth with her hand and giggled. Then the nurse began to tell her about feeding and bathing the baby, and I went on to check the next patient.

I didn’t give Adelina another thought until she showed up late that same evening. The aide from the A.O. wheeled her in. Her face was swollen and suffused with tears, and she was pressing a bloody turkish towel against her nether regions. I asked her what had happened.

She managed to hold back the snuffling and sobbing long enough to choke out, “My husbin’, he done it.”

I put her up on the examining table and looked. Then I groaned. Her repaired episiotomy—my beautiful work of art—was gaping wide open, with threads of catgut suture hanging out here and there. Deep in the base of the crater, a large vein oozed lazily but steadily.

“Your…husband?” I asked. “But why?”

“I dunno,” she wailed. “He jes’ say he’s my husbin’ and he ain’t gonna wait no six weeks.”

I called Vince Ciccone, the senior resident, and repeated the story to him. Vince came down to the floor, inspected the casualty, and began muttering quietly to himself. He sutured the bleeding vessel shut, and then sat for a moment, reevaluating the situation.

“It looks clean,” he said. “Let’s close it again.” He put a new layer of gut stitches into the wound, after which he waved his index finger at Adelina.

“No more
contacto
,” he growled. “
Comprende
?”

Adelina nodded her head.

Vince motioned me to leave the room with him. “I’ve seen this happen before,” he said out of the corner of his mouth. “Usually the bleeding scares the shit out of the husband, and it’s months before he’ll go near her again.”

“Good,” I said, and we proceeded to forget about Adelina—at least until the following night, when she turned up at The Vue again in pretty much the same condition as the night before, except that she wasn’t bleeding quite as heavily. This time, my senior resident on call was Bud Romansky. Bud came down to the floor, sewed up Adelina’s bottom, and then proceeded to deliver a lecture to her, describing the horrors of infection in vivid detail. Adelina was shaking as she went out the door.

Nevertheless, she was back again the following evening. Tears, wailing, and ripped-out suture material were all carbon copies of the previous two nights. Wearily I stuffed a gauze pad into her traumatized perineum and called Vince Ciccone, who was back on service for the night.

When Vince stormed into the examining room, Adelina was sending heart-rending Ay’s heavenward, and the nurse was clucking over her, saying words of comfort interspersed with curses directed against that sex maniac of a husband of hers. Vince unceremoniously ripped out the gauze I had put in to slow the bleeding and stared for a moment at the gaping crater. “Jee-sus Christ,” he roared. “I’m gonna fix that son-of-a-bitch.” He turned to the nurse. “Get me some number 0 wire sutures,” he said.

Then Vince proceeded to sew together the deeper layers of the episiotomy with catgut, as usual, but when he came to repair the lining of the vaginal wall, he used the wire, cutting each stitch so as to leave a line of sharp little barbs running the length of the vagina. Then he stood up and sighed contentedly.

“Okay, Mama,” he said to Adelina. “Now, you go on home. But you’ve got to come back to the Clinic in ten days for me to take out these stitches—you got that?”

Adelina, as usual, nodded.

The next night I got a phone call from the Admitting Office. Chuck Markowitz, the urology resident, wanted me to come down for a minute. “Thought you might like to see the fruits of your labor,” he said.

When I walked into the room, Chuck greeted me with a grin. “You got him,” he said. “I’ll say one thing for you OB guys: you sure do know how to make the punishment fit the crime.”

Chuck was working on a guy who was gritting his teeth just as hard as he could; periodically he would fling his head sharply from one side to the other. He was covered with sheets from his chest to his knees, with his penis protruding through a little hole cut at the proper level. At least I assumed it was his penis; it looked more like a skinny, raw meat loaf. Chuck was dabbing at it with antiseptic, applying minute dressings, and occasionally carefully placing an ultrafine suture through one of the deeper, bloodier gashes.

Pausing for a moment, Chuck looked back at me over his shoulder. “It’s a miracle he missed cutting the urethra,” he said. “Then we’d have had a repair job and a half on our hands before he’d ever pee again.”

Just watching was making my groin twitch sympathetically. “Looks bad enough to me, urethra or not,” I said.

“Oh, he’ll feel this for a good long while,” said Chuck. “Long enough, I’d say, for that episiotomy to heal up.”

I walked the few steps to the head of the table. “What do you say, Mr. Hernandez?” I intoned righteously. “You think you can manage to leave Adelina alone now for a few days?”

Hernandez focused his bloodshot eyes on me. “Yeah, I guess so,” he muttered.

That wasn’t good enough for me. “What’s the matter with you, anyway?” I said. “You ought to know you’ve got to stay away from your wife after she’s had a baby.”