It’s my first day as SR in the Outpatient Clinic (OPC) located in the old County Workers Dispensary Building, which has been recycled for pediatrics. It’s a small, freestanding four-story brick building with a modest entrance on Gardner St., the opposite side of the hospital complex from the inpatient pediatric building.
The Senior Resident has a small office on the second floor where the older children are seen. The first floor is for infants and toddlers, which makes it easier for mothers with carriages and strollers. Of course there is no elevator, so if anyone is in a wheelchair or on crutches, they also must be seen on the first floor. A rudimentary laboratory with one microscope, a small centrifuge, some basic stains and chemicals, and a granite sink is on the second floor next to my office. The upper two-stories are used by out-patient psychiatry.
Each resident picks up a small number of families upon arrival at the County, and follows them throughout his or her stay. Additional patients are added during the resident’s nursery rotation, and from patients seen in the ER, as well as hospitalized patients who have no other physician. The residents are given two-three hour periods a week in the morning or afternoon, to see their patients, but in the case of sudden illnesses, the residents see their patients in the clinic on an as-needs-be basis. However the majority of patients are unassigned and they usually walk into the OPC without an appointment. The OPC Senior Resident is a consultant for the first-year residents, keeps the resident schedules straight so that there are no conflicts over exam rooms, and acts as backup if a resident is tied up and cannot see his scheduled patients. The other SR’s are pretty good about freeing-up their JR’s for clinic, since they know that they will have a turn in the OPC too, and if they chronically tie up their JR’s that will be remembered when it’s their turn. That may sound petty, but it’s reality.
“I’m here,” says Sal. “Am I too early?” I’m just walking into the County and turning into the left corridor leading to the OPC. It’s 8:30 AM. Clinic starts at 9:00 and runs till 4:00 PM.
Been coming earlier and earlier. Has he got an outside life?
“No, it’s no bother. I’m just going to the OPC.”
“You’ll have the bonus of a late start this month.”
“Just as well, since I’ll start riding the MTA again after Karen goes back to teach and has the car.”
“I’ll be good and stay quiet.”
“No problem if you talk. You’re not the only one who can chew gum and walk at the same time.”
“Touché. I remember when I said that.”
I check the morning schedule with the clinic nurse superintendent, Miss Brennan, before the doors open. It looks like we have lots of open appointments, but since most of our patients just walk in, we never know how busy we’ll be until the patients actually arrive. September is usually a quiet month, at least till the kids are back in school for a couple of weeks and have had a chance to share their germs. For my show and tell, I’d like to show the class Mr. Streptococcus. Mr. Streptococcus likes tonsils, so I’m sure that he’ll want to climb right onto yours.
“You’re sure you weren’t lying when you said that you weren’t around the County?”
“I never denied nor confirmed that I was around the County. I believe I told you that it wasn’t necessary for you to know where I was physically as long as we are friends.”
“Yeah, I guess. I’ll have to go along with your reasons for not telling me more right now. Whatever they are.”
I’m sitting in the cafeteria with Dave, Peter, and Allie at lunch, trying to talk over the usual din.
“I got a letter from Joan,” says Allie. “She says she likes San Francisco, but it’s surprisingly cold and foggy at night. They’re renting an apartment not too far from the hospital. She says San Francisco General is more modern than the County, but she misses us. There are three other residents from the East Coast.”
“How’s Ulrich like his position?” I ask.
“He’s busy getting his lab set up and his research going.”
“Mark is learning to ride a horse,” says Dave. “Says he’ll be home at Thanksgiving, for a week.”
“He write to you?” asks Peter.
“No. Juliet told me.”
Riding lessons? Didn’t think he’d need any.
“So Sal, friends stay in contact by mail,” I think. “How are we going to work it out between us?”
“You’re being anxious again,” Sal says. “Have a little patience. Perhaps it won’t be a problem.”
“Unless I get stationed close by, how can it not be?” Sal doesn’t answer.
“And I heard from Wil,” I say. “He’s settled at his base in Germany in a clinic with three other pediatricians. Says that the older Germans he meets think he’s Japanese and a former ally.”
“You didn’t answer my question Sal, but this is working out pretty well,” I think. “I mean having you with me. I feel very comfortable about your presence. I know you’re there, but I don’t feel invaded or intruded upon. What a difference after a year.”
“And I enjoy your company too. I’m so glad that we are doing this now.”
His mood—something. What?
“Time to get back to work,” says Dave rising.
Karen helps me unload the groceries from shopping cart into the trunk of our Chevy in the A&P parking lot. She waits in the car while I push the cart to an empty spot.
“Glad there’s no football traffic this Saturday,” I say as I pull out into Memorial Drive.
“Remember last fall when we went to the Harvard-Dartmouth game with Wilson?” she asks. “And now he’s stationed with the Air Force in Germany. We’ll need to decide where we want to go when the Army gets you next July. It’ll be here before we know it.”
And just last September I met Sal. One year.
“I’ll be able to put in our geographic preferences, but in the end, the Army will decide where I—we– go. There’s no a guarantee I’ll even be a pediatrician if they decide they need more general medical officers.”
“I’ll put in my vote now for overseas,” says Karen. “Our baby will be a toddler by the time you’re discharged from the Army. It’ll probably be a long time before we’ll be able to travel after that. Might as well see the world on Uncle Sam.”
Our baby. Thinking like a mommy. Already a threesome. Need to think more like a daddy. Maybe it’s easier—instinctual for women. “For a gal who never traveled east of the Sierras before you came to Boston, you’re really getting pretty adventuresome.” How do I stay in touch with Sal if we end far from Boston? Unless he travels too. Not likely. Got nine months to work it out.
“I flew to Boston and I fell in love with you and I married you. I’d say that gives me pretty good adventuresome credentials,” says Karen.
“True. You learned fast. Glad you had me in your lesson plan. And speaking of marriage, you feeling okay with your mom’s plans to marry David in November? You seemed a little quiet after you got her letter yesterday.”
“It’s just getting used to the idea. Oh, I wish I could meet him first. It’s all happening so fast. I just hope he’s half the man that Mom thinks he is.”
I laugh. “And that’s probably exactly what your mother said when you wrote to her about us.”
“It’s not funny.”
“I’m sorry. No, guess it’s not. Too bad the wedding’s so late in your pregnancy. The airlines won’t let you fly, and even if they would, I’d be worried. Our baby may be an angel, but I wouldn’t want him or her arriving in mid-air.”
I ride the MTA home and say goodbye to Sal as I arrived at our apartment. Check the mailbox in the lobby. Looks like Karen got the mail. What’s with Sal? We were talking about what Karen said Saturday about going overseas. Far from Boston. He kind of brushed me off. Asked him if he was worried about it. Said no. Asked him point blank if something was going on. ‘Not really—nothing new.’ ‘Well, something old then?’ Didn’t answer. Instead he switched–asked about Karen and her mom’s wedding. Evasive. I walk up the stairs to the second floor.
Telepathy business is pretty one-sided. He’s the pro, I’m the amateur. He knows, I don’t. Not a clue.
I put the key in the lock. Becoming parent’s no mystery though. Three months to go. Karen’s baby shower in two weeks. Other teachers sound almost as excited as she. She’s ready to be a mommy. Hope I am. Daddy that is. Need to get bassinette. Pink or blue?
Turn the key and swing the door open. “Hi darling, I’m home.”
“Bob, Bob, wake up!”
Sal’s call pulls me up from drifting pre-sleep to fully awake. “What’s up, Sal?” Never woke me at night before.
“Bob, I only have a little time left, and I will tell you all that you’ve wanted to know. First, I’ve lived for your friendship. You’ve given me the best year of my life. I love you.”
“What are you talking about?” Now I can feel the edge of Sal’s emotions—sadness, fear, and something else.
“Bob, you were right about wondering if I’m at the County. I’ve been a patient here for more than a year, and now I’m going to die.”
A rising faintness–rushing sound in my ears. What? Die? No! Can’t be. We’re friends. Who? Then clinically: What patient stays in the hospital a year, then dies?
“Bob, don’t pass out on me, there isn’t time. You know me–you’ve looked at me so many times, but you haven’t really seen me.”
“What are you talking about, Sal?”
“My mother did call me Sal, but it was short for Sally, not Salvatore.”
“Sally? I don’t know any patient named Sally.”
“See, even now, you can’t see me.” That sadness again. “All of you just think of me by my last name. Say my full name to me–before I die–so I can hear it from you—Sally Rider.”
Wave of nausea. No! No! Sal can’t be–not Rider. Not that Sally. Then immediate shame and guilt for my thought.
“Sally–Sally Rider! You? Sal, I am so sorry for the way I felt. We all thought you were blind and . . . Oh God, I even called you a gork.”
” I know, the hydrocephalic with a sack of water in place of a brain. That’s what you and the others thought of me. But how could you know? Kathy is about to phone you to tell you that my head ulcer has finally eroded all the way through. I’m leaking and it can’t be stopped. I wanted you to know before you get called to the floor. I couldn’t just leave you and have you wonder why Sal disappeared.”
“Sal, you can’t. You can’t die. Not like this. Please don’t die.”
The phone rings and it is Kathy, the Night Float
“Hi Bob, sorry to wake you, but I’m up on Eight. You know Rider, the hydrocephalic? Well her head ulcer has finally eroded all the way into her ventricle and she’s pouring out CSF (cerebral spinal fluid). You’d better come over.”
“Yeah—I’ll be up.”
“What’d you say, Bob? I can barely hear you.”
“I’ll be up.”
“No need to shout.” She hangs up.
“Sal, you just can’t die. There must be something we can do to stop the leak.”
“Bob, don’t you think that I’ve been searching in the minds of all the specialists here in Boston ever since I first realized what was going to happen? There’s nothing anyone can do. I’m sorry that I didn’t have the courage to tell you sooner, but I didn’t want to risk discovery because of some quixotic action on your part to try to help me that would have endangered you and the precious remaining time that we’ve had together.”
“But Sal—Sally, how. . . you’ve got no . . . you’ve got so little . . .”
“So little brain? You can say it. I know what all those caring for me have thought. Perhaps brain tissue is different from personhood. What’s ahead for me? I don’t know, but I will soon find out. What happened to me, happened just to me. I’ve tried to reach the minds of other hydrocephalics, but as far as I can tell, I am unique. I learned early to stop asking ‘why,’ because there never was an answer. You’d better get dressed and come over or Kathy will wonder what happened to you. There’s so little time. Here–my mind is open—-come and look anywhere in me. Know me, so you can remember me. Please don’t let me die forgotten.”
That line from Ecclesiastes? A time to die? Don’t, Sally, you can’t. But I enter her mind and she guides me along quickly as I numbly make my way down the stairs, through the long corridor to the Pediatric building, and into the service elevator.
The elevator door opens on Eight. The only sound is of liquid dripping rapidly onto the concrete floor. It is dark except for the circle of light from the goose-necked lamp where Laurie, the night nurse, and Kathy are standing by Sally Rider’s crib, looking at her, backed up a bit so they don’t get splashed upon. Clear CSF is leaking from a deep sore in her enormous head, pooling around her, then flowing off the mattress to splatter into a rapidly expanding puddle on the floor. Her head is already sagging in on itself like a used Jack o’ lantern collapsing. Her eyes continue their ceaseless scanning, but more slowly. Like a pendulum stopping. Time and life running out.
“Now you finally know the truth about me, Bob,” she says, and now I can feel the irony in her thought.
“Laurie said that she heard the CSF start to drip and called me when she saw what was happening,” Kathy says. “I phoned you after I checked. I guess it’s for the best. There’s nothing we can do.”
“Good-bye Bob,” says Sally. “Thank you for giving me a wonderful year. It would have been terrible to die without ever knowing a friend, without ever making a difference in another’s life. How I wish it could have been different. I love you.”
“Oh, Sally–I’m so sorry—about everything we thought and said about you.” Disconnection, more final than our past good-byes. “Sal? Sally!” Nothing.
“Bob, did you hear me?” asks Kathy.
My first, huge gulping sob bursts out, shocking Kathy and Laurie and myself. More spill-out.
“Bob, it’s always tough to lose someone, but it really is a kindness for her to go this way,” says Kathy.”
“She never had a chance all her life,” I blubber.
“I love you. Remember.” Back, amazing, a fading echo.
“Sal–Sally Rider, I love you too. I’ll always remember you.” Gone. Eyes still jerking a little.
The wall clock shows 11:59.
The rest of the night is a confused nightmare. I tell Kathy to go back to the HOB and sleep, even though she must think that I’m acting weirdly. Laurie gives me an awkward pat on the shoulder, pausing a wordless moment before walking away. I wait with Sally’s body until an orderly comes at last with a gurney, to take her away. He grimaces and grunts with the effort as he lifts her still-heavy, still-dripping head. I picture her being rolled along that long dim passageway under Bay State Boulevard to the morgue. The aide begins to mop up around Sally’s crib as I leave. I go back to my room to lie on my back and stare at the dark ceiling, waiting for the dawn, my stomach knotted, thoughts milling about, looking for meaning in all of this, and finding none.
Kathy filled out Sally’s death certificate, and just like that, officially dead. Gone. Just a hollow shell left—-like her collapsed head. A husk. Nothing left of my friend. But what could I have done, even if I knew who she was earlier? We had surgical consults look at her to see if her ulcers could be treated. But what if the surgeons weren’t really trying because of what they saw as a useless situation? Kathy said what everyone will believe-—that it was all for the best. But all they saw was Sally’s head. How could they even imagine whom it contained? I sure didn’t. Oh God, I even called her a gork at crib-side-—more than once. How could I have done that? Just to sound experienced to the students I was with. She must have heard me. How could she still talk to me after that? It’s a wonder she didn’t go mad once she realized who and what she was. When she first saw herself through someone else’s eyes. Yet I’ve never met a saner person than Sal. Her actual brain was no more than a water balloon. All fluid and just thin membranes holding it in place. How could she think? It’s impossible. But she did. What did she say to me tonight-—that maybe personhood is different from just brain tissue?
My thoughts keep circling but find no perch, and I’m too drained to even cry anymore. My window finally shows early gray dawn, and I’m grateful that there were no more calls for me during the night. I wouldn’t have been in good shape to react clearly and swiftly. I get up ahead of the alarm and go to wash up, shave, and brush my teeth.
The Outpatient Clinic is closed on Saturdays, so I don’t have any official duties before Dr. Wasserman’s Saturday morning conference. Usually, after being on-call, I make rounds with the Float on Saturday morning, then go to the cafeteria. By now word must have gotten around that I was oddly affected by Sally’s death, and Lou and Allie make a point of asking me how I’m doing this morning. Even Dave, as chief resident, checks on me. Guess they’re attributing my state of mind to overwork, which is okay by me. If they knew what the real reason, they’d have me committed.
I linger over coffee, not saying much to the others. I don’t have an appetite for the mushy scrambled eggs and greasy bacon that I usually take. When the others leave for Chief’s Rounds, I stay behind.
I’m heading home, I don’t care if my absence is noted, or what others might think about it. But I can imagine what they’ll say: ‘What’s bothering him? She was only a gork.’ ‘It was better this way for her than going to Lexington State.’ ‘He wasn’t even the SR on the ward with Rider.’
I go to my car and drive off numbly. After reaching the Fens, I decide to stop, to walk and gather myself before going home to face Karen. My mind registers the bright sunshine, the soft, green grass, but the fact that I will never again talk to Sal hasn’t really sunk in.
What will I tell Karen when she notices that I’m home early? Sal, I need you. I’ve got to keep from breaking down–Karen will worry about me if I do it in front of her. Hope that it’ll sound plausible if I say I got no sleep last night and that I lost a longtime patient. Just a gork–a hydrocephalic named Sally. Damn, I’m doing it again. Got to stop this. Just walk some more till it gets later and Karen won’t be suspicious that anything’s different.
I wander aimlessly along a path by the bulrushes. After a time, I find a bench in the shade of willow trees, sit, and stare at the still, dark water, hearing splashing in my mind.
Will I think of last night every time I hear water running?
Sally’s autopsy was today. Peter, the SR on Eight, called to let me know because he thought that I might want to attend since I seemed to have some special feeling for Sally. I felt sickened by the news but thanked him. Of course I didn’t go. Later, before Chief’s Rounds, Peter told me that surprisingly, there was no sign of ventricular infection despite the long-standing ulcers. He briefly presented the results of the post-mortem to the department. There wasn’t much discussion.
I manage to get through his presentation by focusing hard on the clinical findings and thinking about the patients that I saw in the OPC earlier today. No autopsy is going to explain Sally Rider.
The ride home on the MTA is a void. It is good that I have to stand, since the act of hanging on to a strap and shifting to maintain balance helps me keep my mind empty but still thoughts and questions creep in.
When I was driving home on the evening of September fourteenth, did Sally give me any sign of fear or knowledge of what was about to happen to her? No, we talked blithely of how much she enjoyed being with me during clinic. And we went over some of the problems of that day. She must have known. She kept it from me till the last moment. That must have been why she asked to stay with me at the end of August. She was lonely and afraid that it could happen at any moment. How brave she was. I couldn’t have done it. I suddenly tear up and turn my head away, hoping that the passengers standing next to me won’t notice. I’m glad that Karen and I had a busy weekend. It would have been hell to mope around the apartment the whole time. What would I have said to Karen as an explanation? I should do something for her. I need to show Karen how much she means to me. Flowers—-haven’t brought her flowers since before her mother came.
I get off a stop early at Kenmore Square and stop by a florist. The roses are more expensive than at the Malloy’s shop, but I can afford three. Can’t keep bringing just one rose bud home. As I walk along, holding the tissue-wrapped red roses, I try to focus on Karen and our coming baby. Mostly it works.
I let myself into the apartment and hear Karen in the bedroom. “Here, honey, for you.” And I hold the roses out to her with a smile.
“Bob, thank you. How thoughtful, and for no reason at all.”
“There is a reason. It’s because I love you so much. Thank you for being here for me.” My voice breaks and I tear up.
“Oh Bob. You’re so sentimental. I’m really touched.” And she comes to hug me and we hold each other tightly for a long time. “I love you, Bob.”
Oh Karen, I wish I could tell you everything, but how can I? I’ll never be able to tell anyone. This must be how Sally felt before she found me. What did Sally say when she contacted me? ‘It’s like owning a telephone. How would you know you have one if no one calls you?’ No one’s there to call anymore.
Another Saturday morning driving home. How things have changed in a week. No Sal—Sally. Use her full name. Sally, Sally Rider. You knew me so much better than I knew you; better than I know myself. Talking–awkward compared to what we had. Why didn’t you tell me? Didn’t trust me? Afraid I might reject you? Did you know that I was so shallow and superficial that I’d run from the physical you? I wouldn’t have done that. I might even have been able to do something to heal the ulcers. Bullshit. I am that shallow. Weak. Maybe I wouldn’t have been able to handle it. And I know I couldn’t really do anything to heal those ulcers.
As has happened all week, my eyes fill with tears without warning as sadness, doubt, guilt and self-pity rise in me. Even now, I grieve more for myself than for Sally. I make an effort to stop these thoughts. I will to go on for Karen and our baby. I must get over losing Sally. But I will never forget you, Sally Rider.
I find myself turning into Beacon, and can’t recall how I got here. A parking space is available right near the apartment. I dry my eyes carefully, get out, and lock the car. It’s a short walk to our building where I let myself in and walk up the stairs to our second floor apartment. Karen is in the living room sorting laundry on the couch. I cross over and bend down to kiss her. “Sweetheart, I love you.”
“I love you too, Bob. But how was your call night?” she says, smiling. “Did you get any sleep?”
“Yeah. It was pretty quiet. I got a fair bit of sleep.” Not–thoughts of last Friday night kept returning. Sally waking me. The call from Kathy on the floor. The sound of dripping.
“Then maybe we can do our grocery shopping right after lunch if you don’t need a nap?”
“Sure. How did you sleep last night?”
“Really well. Want to see a movie tonight?”
“Got any suggestions?”
“Anything you want to see will be okay with me.”
“You look tired though. Maybe we shouldn’t.”
It’s been a month and a half. The black days have gradually lightened. I’ve managed to carry out my duties at work. It’s really a relief when I can occupy my mind with medical matters. At home, I’ve tried to focus on Karen and our coming baby, which has kept me from wallowing in self-pity and loss. Most of the time.
My head is resting on Karen’s thigh on a lazy Saturday afternoon. I look up at her once slim and flat waist, now growing with our child, and sigh contentedly. Our baby. We made you with love.
“It’s nice to see that you’re feeling happier,” says Karen, fingers combing through my hair.
“You’ve been very patient with me, Karen. I haven’t made it easy for you. I know I’ve been moody. While you’re getting bigger and heavier every day and still working. Haven’t given you much support.”
But God, I miss Sally. At least she’s free of her body and her pain. It must have been so hard for her, imprisoned in her body, able to see and hear through others, but not communicate until I came along. There was that other telepath at the State Hospital, but finding her insane must have been frightening and frustrating for Sally. Then she found me. We became friends. I’m glad I could do that for her. Now she’s gone. Maybe it would have been better if I’d never met Sally. Wouldn’t have had a taste of telepathy. Then lost it. Is it better to have telepathed and lost than never to have telepathed at all? That the way it goes? Sorry for myself? Mourning what I lost rather than her death? How selfish is that? Or could it have all been a delusion? What real evidence do I have? Could I have imagined everything? Will I ever be sure? But regardless, I’ve still got Karen and the baby. I’ve got to be right for them. I’m a lucky man. Our baby. Our little one, waiting to be born. Hello in there, little one.
With a shock I feel the connection being made. Who—Sal? Sally! Is that you? No words, no thoughts, just a sense of vast contentment and security—drifting–darkness. Who’s there? Tell me!
“Baby’s starting to kick a little more,” says Karen with a smile, taking my hand and placing it on her abdomen. “Here, feel.”