The View from the Vue (20 page)

I assured her that my wife was not racially prejudiced but that she probably would take a dim view of my messin’ wif any wimmin’, cullid or otherwise. The patient laughed with gusto again.

By this time I was really enjoying myself. I asked her why she had come all the way down from Harlem to Bellevue Hospital. “OOOOOOH, Doctuh!” she said, opening her eyes so that she looked rather like Louis Armstrong. “Doan you know?” I assured her I didn’t, but that she now had me more curious than ever.

“Waaaaal, it’s like this. D’doctuhs at Hahlum Hosp’t’l, dey fum C’lumbia. Dey use’t’ treatin’ dem rich ‘n’ faymis folks up by Harkness P’vilyun. So when it’s dehr turn t’ come spend a few mumfs at Hahlum, dey figguhs it’s nuff fo’ d’ pore nigguhs jus’ t’ have d’ white doctuhs fum C’lumbia takin’ care ov ‘um. An’ I tell y’, dey shore treats them pore nigguhs like pore nigguhs. But dat ain’t fer me, no sir. Ever’ one in Hahlum knows, d’ doctuhs at Bellevue treet y’d’ same no mattuh what culluh y’ is. Why dey even treets d’ junkies nice, most times.”

I didn’t know whether or not she was putting me on, so I said something to the effect that the Columbia doctors I knew seemed like pretty nice guys. She stopped smiling and pointed her right index finger at me, jabbing as she spoke; “Now, you a nice doctuh, doan try gimme no sheet. Why d’ hell ain’t
yew
at Hahlum, huh? No doctuh dere never talk t’ me like yew do. Dey too damn good to’ joke aroun’ a li’l wif an ol’ nigguh whoremarm. Now, with emphasis via the finger, “I’m tellin’ you d’ troof, so I doan wan’ you t’ try ‘n’ sheet me, heah?”

I nodded, and she began to smile again. I decided it was time for a change of subject, so I asked her whether she used drugs. I quickly explained that if she did and I didn’t know it, she might have a fatal bout of cold turkey after her operation.

“Noooo-suh,” she answered. “Nonna dat stuff fer me. An’ y’ know whut else—I doan ’low dat crap in my place, neider. Dat’s why d’ cops nevuh busts me.”

“Is that the only reason the cops don’t bust you?” I grinned.

“Well, I does pay a li’l bustin’ ’surance too. But lotsa folks pay dat, ‘n’d’ cops busts ’em ennyway. I know dem cops, dey jes’ doan like dat stuff ‘n’ dey doan like d’ folks as uses it.”

I smiled and told her it was time to do a pelvic examination. The nurse put her up on the table. When I inserted the speculum and looked around inside, I noticed that on the left side of her vagina there was a nasty-looking green area surrounded by a gray exudate. I poked at it with a probe, and frantically tried to remember which vaginal infection might look like that. Then I noticed that it was coming away on the probe, so I took out the speculum and investigated with my gloved fingers. I pulled it all out. It was a gray, papery, soggy mess. As I looked closer, I noticed there was a number 10 on it. So I unfolded it and discovered that her infection was a soggy, cruddy, but very legal ten-dollar bill.

“Hey,” I shouted as I waved it in front of my patient’s eyes. “Look what I found.”

She peered up from her supine position and her eyes lit up. “Gawd
damn
, doctuh! I bin lookin’ fer dat fer d’ pas’ fo’ mumfs. I fergot where I put it.”

All of us—nurse, patient, and doctor—laughed until we were weak. Then I finished the examination. Unlike Miss Jones, this lady didn’t leave her removed foreign body behind. After I had finished examining her, I washed the money off, dried it on a paper towel, and gave it to her. As she took it, I asked her to please put it in her bra this time. She slapped her thigh, flashed her golden smile, and collapsed in laughter again. “Gawd
damn
,” she wheezed. “Betcha I’m the onlies’ lady evuh went to a doctuh fer a op’ration ‘n’ made ten bucks on d’ deal.”

Without much doubt, the most dramatic case in this group was that of the woman who requested removal of a lost pickle fork. Yes, that’s what I said. This patient appeared for consultation at 6
A.M.
on a Sunday, and I was not in the best possible humor when I came down after having been awakened. Neither did my mood brighten when I saw her otherwise blank “FB in Vag” A.O. slip, but when she told me what the FB was, I immediately began to perk up. Who could be cranky when faced with a case demonstrating such originality, such flair, such
élan
? My curiosity became overwhelming. I told the patient that I would indeed check her out, and that she didn’t
have
to elaborate, but if she wanted to tell me, I’d certainly love to know how a pickle fork had found its way into (or among?) her private parts. I wondered whether she had been trying to retrieve a previously lost pickle.

My tact proved to be unnecessary. She said that she didn’t in the least mind telling me. “We were at a party, my boyfriend and me,” she said. “About ‘n hour ago, he says t’ me, ‘I think I’ll have some breakfast’, so he takes this pickle fork and rams it up my…uh…”

“Up your other end?”

“Yeah, up my other end.” She snickered at me, and went on. “Well, he lets go of the fork, and then we can’t find it. So we figure I better come in and have you guys check me out.”

I assured her that this was indeed a fine idea, and then I asked her whether her boyfriend was with her.

She shook her head. “Oh, no. He was afraid you’d call the cops and have him arrested for assault or something.”

Of course I’d have had no intention of calling the cops. I just thought it might have been interesting to meet this guy. Preferably from a good, safe distance.

In any case, we put her up on the table and I looked inside. Nothing. I didn’t see a single pickle fork. Then I inserted my fingers (gingerly) and examined her entire vagina. It was clean as a whistle. So I told the woman that the fork must have dropped out onto the floor without their having seen it.

“Oh, no,” she said. “We checked all around, on the whole bed.”

At this point I decided she was probably a drunk or just a practical jokester. “Well,” I said. “There isn’t anything in there. I’ve checked you thoroughly.…”

“You sure did.”

“Yes. And there just isn’t a thing there.”

“Okay.” She thought for a minute and then shook her head. “Thanks anyway. Sorry I bothered you for nothing.”

I told her it was all right and then went out of the examining cubicle while she got dressed. I sat down at the desk and began to write up the chart. At this point, the senior resident wandered in. He greeted me and asked me what I had been up to. I told him the story of the phantom pickle fork and grinned at him. He didn’t grin back. “What’d the X-ray show?” he asked.

“X-ray! Why in hell would I get an X-ray?”

“Look, buddy,” he said. “You’re a first-year resident. By the time you’re a wise senior resident like me, you won’t ask why you get an abdominal X-ray when a Bellevue lady tells you there’s a pickle fork in her vagina and you can’t find it.” He drummed his fingers on the desk.

I shrugged and went back into the examining room to tell the woman that the boss doctor thought we ought to get an X-ray, just to be safe. She was willing. A short while later, when her picture was developed, there indeed was the pickle fork, lying in her abdominal cavity, nestled snugly between a couple of loops of bowel. I cringed and called back my senior. He put his arm around me and asked whether I had learned something.

“Yes,” I muttered. “But would you kindly tell me how you knew?”

“We all learn from our own experiences,” he said. “More than once, when I was a first-year resident, I was lucky enough to have a sharp senior resident around.”

We put the lady back on the examining table and searched around the top of her vagina for the puncture site through which the offending instrument would have had to pass, but we never found it. My senior resident explained that these punctures could be very small and bloodless, and often would heal amazingly quickly.

Because of the danger that the fork might eventually puncture the intestine and cause peritonitis, we took our patient directly to surgery. She turned out to be lucky. The fork lay free and was easily removed, and her intestinal tract was intact. The anesthetist leaned over and looked. When he saw the fork, he whistled.

“Man, that’s mean-looking,” he said. “What’re you gonna do with it?”

“We won’t give it back to the patient,” said my senior resident. “When she finds her boyfriend, I’m afraid I know what she’ll do with it.”

The anesthetist looked back at his operative record sheet. “Hey,” he yelled. “What the hell should I call this operation, anyway?”

The senior resident didn’t hesitate a moment. “Why obviously,” he said, “it’s an exploratory laparotomy and a pickle-forkectomy—what else?”

All the singular Bellevue cases involving vaginas did not have to do with foreign objects. At The Vue, even the natural vaginal contents sometimes became aberrations.

For example, a woman was sent for gynecological evaluation because she was complaining of unusual vaginal bleeding. I came in to find her ready for examination, and moaning and weeping hysterically. She was Puerto Rican and spoke no English. The referral slip said she was twenty-three years old, although she looked ten years older than that. I asked whether she were in pain; she shook her head no. When I looked into her vagina, I thought the blood there was similar in appearance to that found with a normal menstrual period. When I asked her in which way this bleeding was different from her normal menstrual flow, she just shrugged.

At this point, in the face of her hysteria, I decided my Spanish was betraying me. So I called for a female Puerto Rican nurses’ aide and told her to ask the patient exactly what was the matter. I left the room so as not to inhibit the conversation.

About twenty minutes later, the aide came out. “You ain’t gonna believe this, Dr. Karp,” she said.

I told her I’d believe anything.

“Well, sir, this lady, she got her first baby when she was thirteen years old. Then she had a baby every year—eleven of them now—and this is the first time she ever had a period.

“You’re right, after all,” I said. “I don’t believe it.”

“No, really, Dr. Karp. I checked it out. She had her first baby before she ever had a period, and she always got pregnant right away afterwards.”

“Jesus Christ,” I muttered. “What are we going to do with her?”

“Oh, don’t worry, Dr. Karp. I told her about periods, that they come when you’re not pregnant, and it’s normal, and all that stuff. Then I gave her a Kotex and told her to go ask her grandmother—she lives with her—and then I gave her a clinic appointment so you guys can give her some pills or tie her tubes or something.”

My very favorite vaginal story began one night at 2
A.M.
with a frantic phone call from the examining room. “Dr. Karp, you on GYN call?” asked the night nurse. “Come quick, we got a lady hemorrhaging.”

I pulled on my pants and tied my shoes as I ran down the two flights of stairs. Arriving at the gynecology examining suite, I hurriedly asked where the patient was. The nurse pointed to a room, and I ran in. Introducing myself perfunctorily, I spread the patient’s legs, put in a speculum, and looked. There was no blood at all.

I looked again. Then I shook my head and moved the speculum around. Still no blood. I pulled out the speculum and put my fingers in. All her organs seemed normal, and on removing my fingers, there was no blood at all on them. I began to get sore.

“Hey,” I said to the patient, “I thought you were hemorrhaging. I don’t see any blood at all.”

The woman sat up. She was about fifty years old and weighed two hundred pounds, with a fat red face topped off by a disarrayed mess of white Brillo. I don’t think I’ve ever seen anyone else so irate.

“You must all be nuts here,” she yelled. “I’ve never seen such a bunch of crazy people.”

“What the hell.…”

“Shut up. I’m talking. I come in and say I’m bleeding to death and some loony nurse rips off my pants and puts me up on a table. Then some jerky young punk of a doctor sticks things up my crotch. What the hell does all this have to do with a nosebleed?” As if for emphasis, bright red blood began to spurt from her left nostril, and she jabbed at it with a bloodstained handkerchief.

The nurses’ aide burst into uncontrollable giggling. I’m sure I looked as though I had been poleaxed. I checked the A.O. referral slip. It bore one word: “Hemorrhaging.” I quickly apologized to the patient, showed her the slip, and explained the misunderstanding. Then I told her that if she would get dressed, I’d take her back to Admitting, and get her nosebleed seen to by the Ear, Nose, and Throat specialist. She looked at me dubiously.

We went downstairs, entered the A.O. by the back door, and I ensconced the lady in an examining room. Then I ran up to the nurse in charge and breathlessly cried, “Get ENT quick: there’s a lady in the back room hemorrhaging from her nose.”

The nurse fumblingly managed to get the call through, and I slipped back to the examining room. I stayed with the patient for a few minutes until I heard the voice of the nurse out front: “She’s in back, Doctor, hurry; she’s hemorrhaging.” I gave the patient a grin and a salute, both of which she returned.

“Goddamned craziest place I ever saw,” she muttered, as I eased out the back door.

The other night my wife looked up from the paper to ask me whether I knew that until the child-labor laws were passed, it was routine for children to work fourteen-hour days in factories. “It even says,” she added, “that when the reformers first tried to get Congress to pass the laws, most of the places told them it was none of their business, that it was a ‘local problem.’” She looked at me in righteous indignation.

I think that my wife’s disbelief over the horrors of child-labor abuses will be as nothing compared to the reaction of the average twenty-first century American as he contemplates the hideous abortion-related statutes that his forebears have had to live through and with. The American of the future may find it incredible that, at one time, a woman was forced to bear a child she did not want, perhaps one that was destined to be born devastatingly and incurably ill. It may be difficult for our great-grandchildren to imagine the dreadful diseases that their ancestors contracted in desperate attempts to end unwanted pregnancies.