Bay State Boulevard begins in the blue collar neighborhoods of Somerville and North Cambridge, running long and straight until, close by the red brick classrooms and freshman dorms of Harvard Yard, it veers to the left, continues through Central Cambridge, and passes the solid, institutional buildings of MIT just prior to spanning the broad, lower Charles River, capped with white sails in season, across to Boston, where it makes its way between what were once the elegant, brick townhouses of prosperous merchants, now cut up into low-rent, rooms and apartments standing above littered curbs and sidewalks, and finally merges into the South Boston Expressway in an area known as the South Side.
The South Side is home to some seeking their beginnings and to others closer to their ends: to immigrants, students, workers, secretaries, project-dwellers, small merchants, drifters, and seniors. Suffolk County Hospital, located one block from Bay State Blvd.’s terminus and often referred to with at least a hint of disparagement as “The SuC,” provides health care to them all. “The County” is what those of us who work there prefer to call it.
The hospital occupies one large city block with Bay State Blvd on its western edge and Franklin Ave. on its northern. Its main entrance is through an art deco, brick-and-concrete, two-story, administration building, four wide concrete steps up from a small plaza off Franklin Avenue. Two pigeon-soiled bronze statues on waist-high granite bases flank the plaza: on the left, Aesculapius, holding a serpent-entwined staff; on the right, a doughboy of World War One, with head bowed, helmet in one hand and rifle in the other. Facing the hospital from the western side of Bay State Blvd. is the Robins Institute of Pathology, world-renowned for its research on alcoholism-related and venereal diseases, and connected to the main campus by a dimly lighted tunnel burrowing beneath the busy boulevard.
A motley collection of red brick buildings, two to ten stories high and reflecting a variety of architectural styles dating from the 1870’s to the late 1930’s, rise within the medical compound. Each building houses a different specialty department–surgery here, obstetrics there, medicine in one, neurology in another. A system of above- and underground passageways connects the buildings, sheltering patients and staff from the cold and sleet of Boston’s winters and the humid heat of its summers.
The nondescript, eight-story pediatric building, completed in 1936, rises close by the entrance of the tunnel to the Robbins Institute. I’ve been at the County as a first year Junior Resident (JR) in pediatrics since July first.
CHAPTER 1. SEPTEMBER
It’s just before eight AM, and I’m coming off Night Float, meaning that last night and for every night except Saturdays this month, I’m first in line to take calls for the pediatric service from the four-inpatient floors, nursery, Labor and Delivery, and ER. Tired, unshaven, grubby in my rumpled, high-collared white uniform shirt, white jacket and white pants, I wait in the hall outside the eighth floor office with Mark Donlan, a second year or Senior Resident (SR), for the other house staff to gather for sign-out rounds. Like many of the male SR’s, Mark prefers to wear an Oxford shirt with a buttoned-down collar, tie, and chino pants under his white jacket.
“Get any sleep, Bob?” asks Mark.
“Nah. There was a lot of little stuff that just kept coming all night. Let’s get rounds over with, so I can head home to sleep, if I can still remember where I parked the car.”
“You mean ‘pahked the cah.’ You’re in Baahston now, you’ve got to learn to tahlk like us.”
“Shove the language lesson, Mark, I’m beat.”
“Whoa, testy. They don’t make JR’s like they used to. When I was Float, I could work all night and pahrty heahrty, next day.”
It’s a point of honor to not ask the Senior Resident for help unless you’re stuck with a major question or really overwhelmed. Since I was able to take care of the calls by myself, Mark got a full night’s sleep, although recently he’s been up late with Juliet, a student nurse.
Sign-out begins promptly at eight. No Float appreciates being kept any longer than necessary. I pass on word to the day staff about three nursery babies who had started to look yellow, the emergency C/section where the baby came out slow to breathe, two IV’s that needed restarting up on Eight, and Alvin, a five year-old boy with rheumatic fever on Six, who was terrified by bad dreams and needed hand-holding.
“How come the floor nurse couldn’t handle it?” asks Joan McKay, another JR.
“Farrell was on last night. You know her–she’s really good with sick kids, but she’s got no patience for stuff like that. So she called me for a sedation order, but I talked with the kid and got him back to sleep okay.”
On the surgical floor, a post-op appendectomy spiked a temp at four AM and the surgical resident asked for a consult.
“Man,” says Vinny, “They’ve got to teach those guys to think for themselves–just a bunch of cutting fools. So what did it turn out to be?” Vincent Colletti’s our chief resident. Square-jawed and square-shouldered, five o’clock shadow, dark hair in a short crew cut, looking like the linebacker and fullback that he was at B.C. before going to medical school.
“Well, the PE was negative, except for the abdomen of course–no bowel sounds yet, and still pretty tender.
“You sure the lungs were clear?” asks Mark.
“Yeah, to auscultation. I didn’t get a chest x-ray.”
“Remember that sometimes the stomach hurts so much post-op that they don’t take a deep breath and you can’t hear rales.”
“Oh–I didn’t think of that, Vinny.”
“So what’d you do?”
“Well, I ran a CBC and Diff, got a urine, drew a blood culture, and told the surgeon that it was okay to start antibiotics. The WBC was 19,000 with a left shift. Urine was clear.”
“Okay, so maybe some kind of infection. Anyway, we’ll round on the kid this morning and see what’s up. Did the surgical guy know the right doses for pen and chloro?”
“I gave him the doses, Vinny.”
“Hah! You were feeling generous, Morton.”
After sign-out I breakfast alone in the cafeteria, back slumped, resting my elbows on the shiny stainless steel tabletop. My head has a mild buzz from lack of sleep, but black coffee should set me up to drive home. The chatter and clatter of the dining room is a familiar background noise, the sound bouncing between the rows of long, rectangular, steel tables and benches, and the fifteen-foot high sooty, white ceiling with thick, black electrical cords dangling down, ending in round, white, metal reflectors with naked light bulbs.
Jeez, how long have I been eating this crap? I think. Powdered scrambled eggs runny as ever. Four years. Since ’56. Med school. Snuck in dressed in uniform whites and ate free. Nobody checked ID’s. Now I’m legit. Coffee always tinny. Franks, beans, and brown bread for dinner every Sunday, never fail, except during Lent. Fish every Friday. Okay. Enough. Get moving. Home to bed.
“Hello Robert.” Distinct–clear.
I look around, startled out of my meandering. Who? No one I know here–they’re all working. Must be another Bob. Nobody looking up. Well. Up. To the car. Karen’s already at work.
Hospital parking is one of the perks of night duty–but only after eight PM. One morning during my first week here in July, I tried faking my way in. The attendant, short and blocky, leaned out from the brick booth next to the chained entry and looked at me from under his Red Sox cap with the unblinking, impassive stare of someone in complete control.
“No interns or residents,” he’d said.
“I’m a House Officer, ” I bluffed.
“There’ll be no parking here for students, interns, residents, house officers, or fellows!” he trumped, turning from me in dismissal, showing me the back of his thick neck.
Yeah, crap. No parking for us peons who keep this place going.
I find my car immediately this morning, a five-year-old, white and turquoise, ’55 Chevy coupe that I bought used last year during internship for $795. It has a noticeable driver’s side dent where someone must have banged into me where I’d parked it that first month back in Boston. Of course leaving no note. The sun is up and it will be a beautiful, late summer day. Too bad I’m going home to sleep. I give the attendant an ironic wave as I drive through after he unhooks the chain for me, turn left into Franklin, the sun at my back, then right into Bay State; cranking down the window with my left hand at the corner stop light so the wind will help keep me awake. It’s the end of rush hour, but Boston traffic is crazy all the time. Parking is for once easy to find close to our six-story, brick apartment building on Beacon St. since the other cars have all gone to work.
I’m too tired to walk up to the second floor. The metal cage that is the elevator rises slowly, creaking up its wire mesh-walled shaft in the center of the stairwell. I pull open the metal door, plod down the hall, let myself into our one bedroom back apartment, strip off my uniform, and take a tepid shower in the white cast-iron tub with claw feet. Overhead, a circular frame of pipe supports the light-blue plastic shower curtain. It yields stiffly as I push it aside, step out, dry myself, and brush my teeth. Then it’s into the sack. I’ll be back on as Float tonight at ten.
I can never sleep that soundly during the day, but I do manage three and a half hours before waking up hungry at one PM, perspiring in the midday heat. Karen’s note is on the fridge door–there’s a salami sandwich inside with extra salami if I want it. And a can of Snow’s clam chowder on the table. I retrieve the sandwich from the refrigerator, open the can of chowder, dump it into a pot that I take from the oven, add a bit of milk, and turn on the gas, heating up the kitchen even more. I sit down at the kitchen table in my undershirt and boxer shorts and start on the sandwich while waiting for the soup to heat. After eating, I rinse the dishes in the worn enameled sink.
I startle, my eyes dart around. Alone. Radio’s off. Outside? I look out the window, but there’s no one in the alley two floors below. Who? What? The hairs on the back of my scalp and arms begin to prickle. What’s going on?
“Robert, listen carefully. You are not imagining this. I’m ‘talking’ to you telepathically. I know it will seem strange to you at first, but this is no day dream–this is real.”
Crazy! Strain of work. No sleep. Getting schizy, hearing voices? An icy knot in my stomach and chest. Am I cracking up? No! Everything was going great. Can’t be.
“Bob, listen to my voice. You don’t hear me from anywhere in the room do you? Listen to me! You’re hearing me inside your head.”
Yes. Voice between my ears–inside. So what?
“That was you in the cafeteria,” I say. My voice–squeaky, tight.
“That’s right. I didn’t say more at that time because I didn’t want you to act crazy right then and there. But I did want to make contact once so that it wouldn’t seem totally strange when I did it again. I also had to get to you when Karen wasn’t around, so you’d have time to adjust to the idea.”
“Adjust to the idea! What, of going nuts?”
“And you don’t need to speak out loud, just think the words and I’ll receive them.”
“What’s happening to me?”
“Bob, you’re a latent telepath. You’ve just never run into anyone like yourself before. It’s like having a telephone–unless someone calls you, you’d never know that you own it.”
Talking to someone inside my skull? Feel pretty calm–actually distance myself from this. Feeling detached–symptom of schizophrenia? Funny, no family history of mental illness. Got it all by myself. Way to go, Bob.
“Bob, stop that! Listen to me. There was no easy way to reach you without a shock. I had to get you when your mind was tired and more open to me, and I had to get you alone so that you could get used to the idea without giving me–us–away. This is not schizophrenia. You’re not going nuts. It’s telepathy.”
“Who are you and what do you want? And where are you?” Going along with this? Really possible? Better than being crazy.
“I’m in the Boston area. That’s all I can tell you for now. And I don’t want anything from you except your acceptance.”
“How come you never contacted me before?”
“There is a limit to how far we can communicate–like any form of energy.”
“How far is that?”
“I’m not entirely sure. A large part of it is probably in the individual minds. I first received you when you moved back to Boston from Westchester.”
“Damn! That was over two months ago–you’ve been listening in on me this whole time?” What’s he heard? What’s he know about me–us? Karen?
“I’m sorry that you feel invaded, but no, not the whole time. I needed to find out more about you, and I wanted to be sure that when I did contact you, you wouldn’t go off the deep end. I’ve been waiting for so long to find someone else to speak to. I’ve listened to so many minds, searching for someone like me. But I’ve never found any one to receive me until I found you.”
“Great! Lucky me. Are you a man or a woman?” Could be either. Maybe Bostonian–not heavy accent.
“Right now does that matter?”
“No. I guess not. ”What a shock. Can’t believe I’m not freaking. But a freak I am. How can I work, hearing voices?
“Just continue to do your work at the County as usual and continue to act normally with Karen so that you don’t appear strange. I won’t ask anything of you; it’s enough for me to know that at last I’m not alone. And I will not ‘listen in’ on you in the future without letting you know–I will always ‘ring you’ first. I can see now, that you’re not going to reject me like some fantasy. Thank you. I wouldn’t tell anyone else though, they wouldn’t understand. I’ll leave you alone now so that you’ll have some time to let this all soak in before Karen comes home.”
“Wait. Have you been listening in on Karen too?”
“Just a little. But only peripheral to you.”
“Before you go–if I want to contact you, how do I do it? I still have so many questions.”
“Just think of reaching me like this * * * * and your mind will make the connection. You can’t know how very happy I am to find you and to talk to you at last. Good-bye for now.”
Happy? Good-bye for now? It’ll be back. Can’t tell anyone–not even Karen. Who’d believe? I wouldn’t. What would Karen do? Leave me? Can’t face that. Just can’t tell. And work. If the Chief thought I was cracking up, he’d drop me and send me for treatment. If I’m lucky. Voice said it wouldn’t ask for anything–‘don’t have to do anything but believe in telepathy–right! What if it calls when others are around–I can’t react. If it doesn’t ask me to do weird stuff, maybe I can get by. But if it does then what? Hope I’ll have enough sanity left to stop before I hurt anyone. How will I know that, if my mind really slips? How do I know he’s a he, not a she? Can’t really tell. How’s my voice sound to him?
Voice came again this afternoon. Reassured me about my sanity. Ha. Some way to do it–popping into my mind. Okay, did ask first if I was free. If I felt like visit. Nice. Polite psychosis. Strange–Voice in my head–clear as regular speech. Not like when I talk to myself. Speaks in low-key, ordinary manner. There is a kind of weirdly logical sense, even if. . . .
“You’re not eating; you seem preoccupied,” says Karen, looking at me with a worried frown.
I realize that I’ve been holding my fork for a while without using it.
“Are things all right at work?” she asks.
“Yeah, pretty much okay. Maybe the lack of sleep is starting to get to me,” I reply. I try to smile disarmingly.
“You getting along with Mark and the other Senior Residents?”
“We’re doing fine. I kid Mark a little, and he does the same to me. It’s the same with the others. Don’t worry. I’m not about to get fired.” If I keep hearing voices, who knows.
“It’s just that you seem to have a lot on your mind tonight, and I was a little worried,” says Karen.
“Look, I told you everything is okay. Stop worrying. I’m fine.” My words ring too loud, too sharply, in the small kitchen, and Karen turns away to her spaghetti, long dark hair hiding her face.
Damn. Hurt her. Not her fault I’m hearing things. She’ll be the one most affected if I am nuts. Oh Karen. If I could tell you. Would you go away? Couldn’t risk that.
“Karen, I’m sorry that I snapped at you. I didn’t mean to. Believe me, it’s nothing you’re doing, or anything that’s going on at work. I think that I’m just getting a little edgy and fuzzy from lack of sleep.”
She’s got a wonderful smile. Could be a toothpaste ad. Was lucky to get her. But she not so lucky with me. Not at all. ‘Poor Karen. Hear about her husband? Bonkers.’
“Why don’t you catch a quick nap after dinner,” Karen says, “While I do the dishes. You need to be clear-headed when you take care of those babies. I’ll be sure to wake you at nine o’clock.”
“Come lie down next to me.”
“Then you might not get any sleep,” she laughs, “No, I’ll just read or watch TV while you rest.”
I’m making rounds from floor to floor with Mark as we come on duty, talking with the various floor residents and getting their sign-outs, before the place is turned over to me as Float.
Damn, keep thinking about Voice. Should I tell Vinny? But what–that I’m hearing voices? He’d report me to the Chief. I’d be chopped. And Karen? Ah, what’d Cliff say?
“I’m sorry,” I say to Cliff, the JR on five, “Could you repeat that part about the urinalysis results?”
“Listen up, Bob.” Cliff’s round face frowns and he sounds irritated that he has to keep repeating himself. “It was equivocal, so I sent off a culture and that’s still pending. If she spikes a temp tonight, you can go ahead and start her on treatment.”
“Gantrisin okay?” I ask.
“Sure,” says Cliff, “I think she’s hydrated up enough. She’s been peeing. Have a good night.” Now off duty, he hurries back to the office to pick up his jacket before going to the HOB (House Officers’ Building) to sleep. The HOB in the Hub.
As we walk towards the nursery, Mark inquires, “You feeling okay?”
“You seem to have something on your mind. How are things going between you and Karen?”
“We’re doing fine. It’s just that I haven’t caught up on my sleep.”
“I’m not trying to stick my nose in where it doesn’t belong, but sometimes it’s rough on the wife when you’re on every night. And you two have been married just a year or so, right?”
“Thanks for asking,” I reply, “No, we’re good. We got married the last month of medical school. Bad timing. Went straight into internship and on call every other night. That was harder on her than this month has been.”
“Well, call me if it gets rough again tonight. No sense trying to be a hero and doing it all yourself. You don’t want get all stressed out and crack up.”
Crack up. What’s he mean? Suspect something? Don’t think I’m acting funny. Must be coincidence. Even so, got to keep up guard.
We finish the nursery and it’s still quiet, so we stop by the cafeteria to help ourselves to a snack–coffee and ice cream in my case.
“You ever try putting chocolate ice cream in your coffee? It’s pretty good.” I ask Mark, as I spoon a big dollop into my heavy, navy-surplus china mug.
“Must be one of those California things,” says Mark, as he wolfs down his wedge of pumpkin pie, “We like our foods plain and straight here in Baaahston,” purposely exaggerating his accent. “How’d you get this far east anyway?”
“My high school advisor encouraged me to try for a scholarship to Harvard. He said that he thought I could cut it academically, and I had nothing to lose if I wasn’t accepted. So I thought, ‘What the hell, why not?’ I guess they were looking for geographic balance or something like that, because they accepted me with a scholarship.”
“So your old man didn’t go there?” Mark asks.
I laugh, “No, Dad couldn’t even finish his first year of college before the Depression came along and he had to look for work. Lucky to get it. Mom too. We’re strictly working class.”
“Blue collar, huh? Not blue blood.”
Yeah. Every summer during high school and the first two years of college, I worked in a packing plant. You ever eat California Pride frozen vegetables? That’s where I worked.”
“And here you are a doc. Your folks must be proud of you.”
“Yeah. I guess.” And now I’m talking with some disembodied voice. Terrific. Be real proud if I told them. Our son, the crazy doctor.
“Look, as long as it’s quiet, I’m going up to my room. Call if you need me,” says Mark. “What are you going to do?”
“Guess I’ll sit here a while and have another cup of coffee. Juliet coming by again?” I ask with a smile.
“Ah–you married guys–always thinking about sex,” he says as he leaves.
Bet he hopes she does.
I sit back down with my second cup of coffee and look around the almost empty dining room. Wonder if Voice is asleep? Not that late–10:40. Try what he told me about contacting him? Think like this * * * *
“What’s up Robert? Something happen after we spoke this afternoon?”
Terrific, it works! Although I can’t detect any inflection, I sense that the Voice is sleepy.
“Did I wake you? Sorry, I thought that it was still early enough. It wasn’t anything. I just wanted to see if I could really reach you.”
Weird apologizing to what could be figment of my imagination or something suppressed from my id.
“I’m no figment or repressed desire, Robert. Believe me, I exist as flesh and blood. I am real and we are talking to each other, mind to mind.”
“I keep forgetting that you can hear my thoughts. Can’t I keep anything from you? How come I can’t hear all of your thoughts and find out more about you?”
“Thoughts exist on many levels. You can only read the most superficial thoughts in my mind. Since I’ve been at this longer than you have, I do have the ability to delve deeper into yours. But out of respect for you I try not to go further any more. It’s like opening someone else’s mail. In yours and Karen’s case, I would never do it unless you ask me to.”
“When are we going to meet? Actually meeting you would remove all my doubts about your existence.”
“For now, you’ll have to take me on faith.”
The loudspeaker interrupts us, “Pediatric Float, 3974; Pediatric Float call 3974.”
“Got to get that–it’s the ER. Sorry I woke you.”
“No problem. As I said at first, I’ve been hoping for a long time, to find someone like you. I am just so very grateful that you’re finally here, and that you’re beginning to accept me. By the way, I don’t think there’s a major crisis waiting for you. The ER has a patient with a fever and an ear ache.”
And that’s what it turns out to be.
I go to my room, after finishing in the ER without being paged again. Maybe I’ll be lucky. Get some sleep. Voice was right about the kid–but fevers with ear infection are common. Could be coincidence.
Could this still all be in my mind? Will I ever be sure? Two possibilities. One, he is real and this really is telepathy. If true, I’m sane and will be able to react rationally if he makes weird suggestions. Two, I’m psychotic. If so, all bets off. Still, Voice asked me to do nothing–yet. Whether he exists or not won’t matter if that continues. As long as I don’t fight the idea, accept what’s going on at face value, stay calm. Should be able to function. If he’s out there, hope he didn’t hear me just now. Did say he’d respect my privacy and not tune in anymore without telling me. But then he did do just that before first contact. Always that paranoid doubt. Paranoid’s a lousy choice of words.
Sleep does not come and I stare up at the dim gray ceiling, primed, waiting for the phone to ring. A hot, breezeless night too.
Damn. Can’t relax. Like a rat in a maze expecting to be zapped. Adrenals jazzed. Say this is all real. He said he’s looked into many minds but has only been able to contact me to actually talk. Can I also read minds? Never did, but maybe that’s because I didn’t know how to. Shut my eyes–let my mind go blank–reach out across the city towards Karen. Think * * * * Karen. Nothing. Karen * * * *. Still nothing. Oh baby, I wish you were in bed with me right now. Stop that. Blank the mind. Start over.
I jump when the phone rings. The operator is calling me back to the night’s realities.
“Congrats Bob, you’re nearly half way through your month on Float. You get some sleep last night?”
“Thanks, Mark. Yeah, nice to have an easy one. Two admits and just one after midnight. Glad that was a straightforward croup who settled down in the mist tent so I didn’t have to call you again after she was admitted to the floor. Sorry I had to get you up to do your admission note, but that’s the rules.”
“No sweat. Anyway, Juliet left early.”
“You bragging again? How does that girl manage to keep sneaking out of the nursing dorm without getting caught?”
“Guess she’s smart and I’m worth it,” says Mark.
“Eh, Romeo, watch out if she invites you home to meet her folks in the North End. Remember, the original Romeo ended up dead.”
“Man, you’re so full of crap it’s coming out your ears. You get sleep and you’re still not funny. Come on, let’s go round.” Mark slaps me lightly on the side of the head, and we go out to the hall where the others are gathering by the head nurse’s desk just inside the door to the ward.
“Okay,” I say, “here’s the scoop on the night’s doings. Lucky for me, there isn’t much to tell you.”
As I drive home, I think about my dream from the night. In the ER. Trying to draw blood on really sick baby. Funny–can’t remember face. Couldn’t hit a vein—-arm or hand or even femoral. Sweating bullets. Then the Voice. Whispers, “Do a cardiac puncture.” Evil. Like Bela—what’s his name? “You’ve got to get blood, this is the only way.” Prepped baby’s chest–got long, twenty-gauge needle. My mind screamed, ‘Don’t do it–not in the heart,’ But I couldn’t stop myself. And then, just as I was about to plunge it in, baby became frog in biology class. Woke in cold sweat. Terrible dream. Mean anything?
At our apartment house, I walk up the stairs. Then the after-call ritual of showering and brushing teeth before drawing the blue and white bedroom curtains that Karen sewed when we moved in. Our bedroom overlooks the boxy backyards of other apartments and walkups, defined by white-painted, wood fences. Without the curtains the night games at Fenway would light up our bedroom. As it is, we hear the cheering when the Sox are doing well, especially with our windows open to catch what little breeze there is. To bed. I sleep more than four hours, dreamlessly, before waking and having a snack. By now I expect the afternoon visit of “The Voice.”
“Hello, Robert, how are you? OK to visit now?”
“Yeah–how you been yourself?”
“Oh, pretty much the same as usual.”
“You know, I don’t know anything at all about you. So I don’t understand what you mean by ‘the same as usual.’ For one thing, I now know that you can see what I’m seeing when you’re in my mind, but I can’t see anything through your eyes.”
“True–there are differences between us in the level of telepathic skill. Don’t forget that you’ve just discovered yours, whereas I’ve been using mine for a long time. I didn’t even know the name for what I was doing until I found it in the mind of someone I was listening to.”
Interesting, but evasive. “Are you blocking me?”
“Bob, I assure you that I’m not a supernatural being or a criminal. I’m not going to lure you into some illegal activity. That dream you had, believe me, was only a dream.”
Didn’t answer me. “You picked that up, eh? I sure hope it was only a dream. It was terrible.”
“I hope I can reassure you, as we get to know each other better, that I would never ask you to do anything that you would not do yourself.”
“So why not meet, or at least transmit a picture of yourself?” I ask again.
“Please take my word that it’s impossible for now.” I can almost hear him sigh.
“At least tell me your name.”
“I’ve been called Sal.”
“Oh. Sal–like Sal Mineo, the actor?”
“Now we’re getting somewhere. Is Sal short for Salvatore or Salvador? And would that be a first or a last name?”
“Sure could be either,” says Sal, “But I’m not going to get into that, because I don’t want you to be tempted to waste time going through the Boston phone directory. Could we leave it at Sal for now?”
Guess I’m not getting more. “Okay, paisano.”
“I’m glad that you’re beginning to accept me instead of fighting it.”
“Well, Sal, you’ve got to admit that suddenly having a disembodied voice come out of the blue and start telepathic conversations would be enough to make most people doubt their sanity.”
“Actually your experience wasn’t that much out of the blue. Think back–when you were growing up, Bob–didn’t you used to have hunches about people?”
“What do you mean?”
“Didn’t you sometimes just know what someone was going to say before they said it, or have premonitions about what someone was going to do?”
“Now that you mention it, that’s true. I thought it was déjà vu. And when we played nickel-dime poker, I seemed to have a knack for knowing when somebody was bluffing. Picked up some change that way.”
“That was your native, untrained telepathic talent at work,” says Sal, “Actually there are quite a few people who possess it to a slight degree. But yours is more developed.”
“You must have a complete talent,” I say.
“I don’t think so,” says Sal. “Although, unlike you, I can enter and read anyone’s mind, I am only able to communicate with you. I think a complete telepath would be able to do that with everyone, whether or not the others were also telepathic. Of course that’s only a guess, since I haven’t encountered anybody like that.”
“You say that I have a ‘more developed’ skill. I’ve been trying to get into people’s minds this week, but I haven’t had any success.”
“From what I can tell, I don’t think your ability goes that far.”
“Will it ever develop to that point?” I ask.
“Frankly, I don’t know. As I’ve said, many people have a low, unfocused part of what we have. But you are the only one I’ve found who can actually communicate with me.”
“That’s a lot of new ideas to absorb.”
“Perhaps that’s enough for one day. I’d better leave anyway,” says Sal. “Karen’s walking home from the station in Kenmore Square, and should be here shortly.”
“While we were talking, you also checked on her? That’s some mental juggling. Where is she right now and what’s she thinking about?”
“She’s passing the Leggett’s drugstore, and she’s worried that the Chinese take-out that she picked up for dinner is getting cold. Oh, and she’s feeling frisky, just like you are.”
“How come you can pick up emotions, and I can’t feel any of yours?”
“Again, the degree of telepathy is different between us. Maybe your skill will increase with experience. There are minds I enter where I can’t pick up much emotional tone at all, and there are others, like yours and Karen’s, where I can feel a lot. So even my talent is uneven. Karn will be here in minutes, so I’ll leave you two. Good bye.”
Soon there’s the quick staccato click of Karen’s high heels on the yellow linoleum in the hallway. I get off the couch and open the door, surprising her just as I hear her key in the lock.
“Welcome home, Baby. How are the kids treating you?”
She looks good in a white blouse and tan skirt, red purse strap slung over her left shoulder, and carrying our dinner in a brown bag. But she always looks great. I bend forward past the food, take one shoulder in each hand, and kiss her, lean back to look at her, then do it again, longer. Soft lips–cute little nose. And I kiss the tip of her nose.
“I got us some Chinese because I was afraid that it would take too long to prepare dinner,” she says. “But it may have gotten cold. Could you take it to the kitchen while I go in to change and wash my face?”
“I’m a lot more hungry for you than for fried rice.”
“Behave now, you’ve got to leave for the hospital in three and a half hours and you don’t know what kind of a night you’ll be having. You should be saving your energy.”
I take the food to the kitchen and pull out the three boxes. Smells greasy, but tasty. I hear the water running in the bathroom sink. It stops, and Karen comes into the kitchen with her face fresh-scrubbed free of makeup; medium length, chestnut-brown hair brushed back; changed into a thin, pink housedress buttoned down the front. Not wearing bra. I reach out and she moves into my arms, leans close, pressing out the air between us. I stroke along the long smooth curves of her back and hips. Through her thin dress, I can feel that she’s got nothing else on.
“You took off your panties,” I whisper into her hair and breathe in her scent.
“I was a Girl Scout; we were taught to be prepared.”
“Oh Karen, I want you so much.”
“I can feel that you do,” she murmurs, “But are you sure that you don’t want
dinner first?” Her fingers tighten on my back.
Frisky? First time I’ve heard it called that.
The Night Float gets Saturday night off. Six nights shalt thou labor. Staying for Saturday morning rounds with the Chief after working Friday night is optional. This morning I exercise my option and go home to take a nap. Karen and I are attending the Harvard-Columbia game at 2:00 PM, the first game of the season.
After a lazy lunch, we take a street car to Park, transfer to the subway, and get off at Harvard Square, walk up the stairs and around the news stand that carries papers from all over the country, and wait for the light to change before crossing Mass. Ave. We join other fans walking down Boylston St. First past the Easy Music Store, where I bought most of my LP’s as an undergraduate. Then past Kirkland and Eliot Houses, before crossing the Charles River via the Stadium Bridge, to the classic U-shaped stadium. The ivy covering its concrete walls is still green.
“You sure you don’t mind spending my Saturday off going to the game?” I ask. “You’re not that big a football fan. Of course it’s kind of late to be asking you that.”
“Well, Harvard really doesn’t get as serious about football as we did at Cal in the Pacific Coast Conference,” says Karen. “And it’s not my school anyway but yours. So I can listen to the bands, watch their antics at halftime, and not worry too much about the score. Anyway, it’s a beautiful, warm day, and it’s great just to be able to enjoy the sun. We won’t have many days like this in the months ahead.”
“The football team here is just as serious about winning as anybody anywhere,” I say. “It’s just that Harvard and the Ivy League have a sensible perspective about the place of sports in a university. The players are students first and athletes second.”
“I guess a lamb hurts as much when another lamb nips it,” laughs Karen. “As a tiger bitten by another tiger.”
“Well, we have Tigers in the Ivy League–Princeton, and Lions–Columbia.”
“They probably all wear dentures,” says Karen.
Let it go. Not smart to tease her about the scandals and breakup of the PCC.
At half time Harvard leads 13 to 6. There have been 4 fumbles and innumerable penalties. I’m in the coffee line under the stands while Karen waits in the long line for the women’s restroom. Gravel scrunches under my shoes as I shift my weight from one foot to the other. Line moving so slowly. Boring. Can I get a hold of Sal? * * * *
“Hello Robert, are you enjoying the game?” asks Sal.
“Well, we’re ahead, but it’s pretty sloppy. But you’ve got to expect that with the first game. You a football fan, Sal?”
“Not really, though I have watched some. Could I watch the game with you?””
“Sure, you cheapskate, as long as you don’t root for Columbia.”
“Two coffees, sugar, no cream,” I say as I finally reach the counter and plunk down two quarters.
“I like coffee with a lot of cream,” says Sal.
Karen taps me on the shoulder. “Bet you thought I got lost. You’d think a rich school like Harvard could afford to put in more stalls in the women’s room.”
“Tough, Sal, we’re the ones drinking this.”
“This line was really slow too,” I say to Karen. That’s the second half kickoff. Let’s get back to our seats. Oh, oh, there’s a roar from the Columbia side.”
“But it’s going to come back, Bob. Clipping,” says Sal. “I just checked the referee.”
“That’s impressive, Sal. Could you also get into the mind of the Columbia coach? And then pass it on to Harvard’s coach?”
“Of course, but passing it on is impossible–remember you’re the only one that I can send to. And besides, even if I could, that would be cheating, which I’m sure you wouldn’t want me to be a part of.”
“Want to catch the flick at the Brattle after the game? I think that Casablanca is back,” asks Karen as we climb the steep stairs to the stands.
“Sure. And we can get an early dinner at the Bick,” I reply, “You earn more than I do, so if you think we can afford it, we’ll splurge.”
“It’ll be nice to have you home tonight, big spender,” says Karen, and gives my arm a playful squeeze against her chest.
“I’ll leave you two alone after the game,” says Sal.
The telephone pulls me up unwillingly from the depths of sleep, like a hooked fish reeled struggling up from deep, dark water, towards wakefulness. My mind flops about on arrival, momentarily disoriented about where I am, until I realize that I’m in the HOB and the phone is still ringing. I grope for it in the dark, knocking the hand piece off its cradle before I finally get it to my ear.
“This is Dr. Morton,” I mumble.
“Hi doctor, this is Belle on Seven. Sounds so damn cheerful. I think you’d better come and have a look at that baby, Toby White, who was admitted earlier today after a febrile convulsion. He’s fussy and still running a 103 temp. And I think his fontanel is bulging.”
I’m suddenly wide-awake and focusing. “How can that be? It wasn’t when he was admitted, according to the story we got at sign out, and his admission spinal tap was perfectly clear.”
“Well, I think it’s bulging now,” says the nurse, “and I don’t think it’s just because he’s crying.”
“Be right over.” I reach down in the dark to the foot of the bed for my uniform whites and pull them on quickly. Couldn’t be meningitis. Spinal tap completely clear. White blood count only 10,000, so they held off antibiotics. But if Belle’s right?
Then I’m out of the room, down three flights of stairs to the basement, and striding rapidly along the corridor to the peds building. I run the service elevator up to the seventh floor.
Belle Basilio is waiting for me next to Toby’s crib where Anna Haas, her nurse’s aide, is sponging the baby with cold water to lower his temperature. A gooseneck lamp shines brightly in his cubicle. Night-lights at floor level dimly illuminate the rest of the ward. It’s 1:35 AM.
Toby is a milk-chubby, seven-month old, with golden-blond hair. His cry has a fussy, fretful, rather than lusty, quality. His skin is shiny-wet, pale, with bluish veins visible under the surface because of the cold bath. He lies on a soaked bath towel. Anna steps aside for me. I place my right hand on the top of his head to feel his anterior fontanel or soft spot through his wet hair. Bulging and firm, not soft. Oh, Oh. I slide my hand under the back of his head and gently try to flex his neck. Really stiff. And my effort seems to hurt him. It’s almost a forgone conclusion, but I also try to lift and straighten out his right leg, and it will not straighten. I feel a rush of anxious excitement and a cold sweat. Damn–all signs of meningitis. How, with negative work-up? Call Dave. Dave Siegel is the Senior Resident on with me tonight.
“Belle, you were right; I’m going to call Dr. Siegel. We’re going to have to re-tap him.”
“Hey Dave, it’s Bob. Sorry, but I’m on Seven and Toby White looks like he’s got meningitis. Yeah, the baby who was admitted for observation after a febrile seizure this afternoon. He’s still running a temp and Belle thought his fontanel was bulging and it sure is and his neck is as stiff as a board. Yes, I’m going to set up for a re-tap right now while you come over.”
Belle has already gone for the spinal tap tray. She returns and places the instruments, wrapped in green cloth, on an instrument stand for me to open, which I do. Then I don sterile gloves to sort through the contents.
“You want a twenty or twenty-two gauge needle?” Belle asks.
She opens the tan paper autoclave wrap around the glass test tube containing the lumbar puncture needle, taking care not to touch the cotton-stoppered end, and lets me unplug it; then she dumps the lumbar puncture needle onto the sterile tray. After pouring dark brown Betadine into two glass medicine cups for the skin prep, Belle pulls the crib out enough so that she can get on the other side to hold Toby who continues to cry fitfully.
“You got enough light? Anna can get another lamp. Which way do you want his head.”
“This is enough light,” I reply, “Lay him on his left side, head to my left.”
Belle places him on his side, then rolls him a bit so I can slide the green, sterile drape under him. I dip a gauze square into the Betadine, and carefully prep the skin, staining the area over his lower spine brown-yellow. Then I wipe away the excess.
Dave arrives as I’m feeling through a small sterile drape for the crest of Toby’s hip, a landmark for doing the puncture. He stands looking over my shoulder.
Belle bends Toby’s back into a shallow “C”, one arm behind his knees, one behind his neck, her chin over his ribs. I feel for the vertebral interspace at the level of his hip crest, find it and slide the needle in. Resistance. I pull it back, then redirect it slightly more upward. It’s goes easily this time, but I don’t feel the distinctive “pop” that usually signals that you’re in and, when I pull the obturator out of the needle, the first slowly flowing drop is dark blood.
“Damn! Bloody. Get me another needle.” I pull out the needle and apply pressure. I’m starting to sweat heavily, even under my gloves.
“Anna,” asks Belle calmly, “do you know where the spinal needles are stored? Could you bring us a few more 20’s?”
Few more? She think I’m going to keep missing? I kick the stool aside and get down on my knees so I’m at eye level with his back. Then I insert a new needle, and this time, I definitely feel the “pop.”
“Got it. Felt it that time. I think we’re in business.”
The cerebral spinal fluid (CSF) flows easily after I remove the obturator and I position the first of three collection tubes under the end of the needle. Although the first fast-flowing drops are pink-tinged, the subsequent flow clears.
“Better stick the obturator back in between tube changes,” says Dave, “it looks like the fluid’s under some pressure, and you don’t want it to come out too fast or lose too much.”
The second and third tubes of CSF are quickly collected and are colorless, but the fluid is definitely turbid, more evidence suggesting meningitis. I band-aid the puncture site after withdrawing the needle.
“It’s cloudy—-I think the kid’s got meningitis,” I say.
“Yeah,” says Dave. “You run the labs on the CSF, and I’ll get an IV going. What bugs (bacteria) are you worried about at this age, and which antibiotics do you want to use, to cover them?”
“Triple therapy until the culture comes back,” I reply, “Sulfadiazine to cover meningococcus, chloro to cover H. flu, and penicillin for Pneumo; most likely it’s H. flu.” For good measure I give him the drug doses.
“Right. I’ll order them up from pharmacy,” says Dave. “Now let’s get a blood culture.”
“Okay. Belle, I’m going to do a femoral.”
With Belle holding Toby on his back, frog-legged, I prep his right groin carefully with more Betadine, and get a free-flowing femoral vein sample for culture, white blood cell and differential counts, and chemistries, on the first try.
“Do you want to wake the JR on call for the floor to take over now?” asks Dave.
“No, let him sleep. Just so long as it stays quiet elsewhere, I can do the rest of the work up.”
After filling out the lab slips, I take the first and second tubes of CSF and blood samples to the central lab. The chemistries won’t be run until morning. The third tube of CSF I take to the small lab in the basement that we residents and the students use, and set two slides aside to dry for a Gram’s stain for bacteria and a Wright’s stain for types of white cells while I do a cell count. The white cell count is over eight thousand. High. Looks like mostly polys–goes with bacterial meningitis. Phone Dave.
“Dave. The CSF white count’s eight thousand, and they look like mostly polys in the counting chamber. Yeah, I’ll do the Wright’s just to be sure. Of course I’ll do a Gram’s–plus a Pandy and Benedict’s.”
I place the Wright stained slide under the microscope and begin to scan slowly. Oh yeah, over 90% polys. Now for the Gram’s. Switch the slides. Lots of pink debris. OK, at last. Looks like a definite Gram negative rod. Find more bugs for confirmation.
I finally finish the lab work and return to the floor. It all points to bacterial meningitis, probably Hemophilus influenzae (H. flu), if the Gram’s stain is right. Dave and Belle have the IV going, with the first doses of antibiotics in. I give him the lab results.
Dave quizzes me at crib side, “Would you base your antibiotic treatment on the result of your Gram’s stain and just use one antibiotic now?”
“No, because the stain isn’t that reliable. I’d keep the triple therapy going until the cultures come back, then switch to one drug based on the result.”
“Good. How much IV fluid? What would you worry about?” Dave continues.
“Two-thirds of maintenance fluid requirements. We don’t want brain swelling. And I’d worry about more seizures.”
“Yep. More seizures would be a bad sign. Thanks for the help Belle, and that was a good pickup you made on the fontanel. Think we can get a special (special duty nurse) tonight?”
“I’ll call my supervisor and see,” says Belle.
“You did a good job, Bob,” Dave says. “That was fast work.”
It’s 3:09 AM.
We’re standing around Toby’s crib while his mother waits in the ward office for us to finish.
Joan McKay, the JR on Seven, fills Mark and me in on the day’s happenings. “His second CSF and both blood cultures are definitely H. flu so we stopped the other two antibiotics today and kept him on just chloro. He’s still having seizures, though they’re more easily controlled than they were yesterday, since we’ve got him really snowed with phenobarbital. Dick Hoffman came by again to follow up on the neurology consult that we got with him when Toby started to seize yesterday, and suggested adding Dilantin, which we started at 2:00. You’re going to need to push the next dose at 2 AM, Bob. At least his fever is coming down.”
I lay my hand on his head. “Fontanel’s still full but not as hard.”
“Yeah,” says Joan, “and we’re also doing daily head circumferences because Dick said that Toby’s a set-up for subdural effusions.”
“What did you tell his mom, just in case she asks us about his condition?” asks Mark.
“That the antibiotics seem to be getting the infection under control, but that we’re worried about his seizures, although they also seem to be responding to the medicines that he’s getting. I didn’t say anything about possible subdurals or long-term residual damage, which Dick feels is possible because of the bug involved and the seizures.”
Damn. Brain’s maybe fried despite what we did.
“You plan to re-tap him to see where you are?” asks Mark.
“Tomorrow morning,” says Joan.
Toby’s special duty nurse slips back into his cubicle as we walk on to the next patient.
Later, Mark and I have coffee in the cafeteria after finishing the nursery.
“Damn it, Mark. I thought that Dave and I really moved fast on Toby; we got the antibiotics in and we were careful about the amount of IV fluids. And now it looks like he’s might have residua. Do you think we should have given him intrathecal streptomycin like Irv Corwin preaches? Think it would have made a difference?”
“Corwin’s the only one who advocates intrathecal streptomycin, and he’s never published a controlled study so it’s all anecdotal,” says Mark. “You can’t just go on the say-so of one expert. It’s neurotoxic, and even Corwin admits that it’s very tricky to use. So it’s hardly innocuous. Besides, Toby was presented to Saul Norman for infectious disease input at Chief’s rounds, and he didn’t have anything else to suggest.”
“Still, I wonder if we could have done something more. I still don’t know what I’m going to say if his mom asks me about him when I go to give him his Dilantin dose at two.”
“Bob, you’ve going to learn that sometimes, even when you make all the right moves, things still turn out badly. If his mom asks you, just repeat what Joan told her. We really don’t know much more right now. Besides, with babies, you just can’t predict how much they’ll come back long-term.”
Mark’s trying to lighten me up. Still lousy way to start the night. Could I find out how much damage? Could Sal can get into Toby’s mind and see how it compares to other babies his age? Sal never said anything about checking babies’ minds. But why not? It’s late, but . . . no, it can wait till morning. No sense waking Sal. Baby’s asleep too.
“Good morning Sal, so do you see what I’m thinking? Can you do it, and would it be meaningful?” I’m sitting by myself in the cafeteria, looking into my coffee mug, after completing sign out rounds.
“Sure. Let me have a try. Hmm-—his mind is pretty sedated from the medicine for seizures. There’s not much coordinated activity but there is some–kind of a dreamlike jumble of memories of mother, family, of being fed, being held, some pain, some pleasure; tactile, visual, and auditory; some emotional. So there is an identity present-—he hasn’t been destroyed by the infection. But I’m afraid I can’t give a very specific answer to your question about his future right now.”
“So you’re saying that his mind is okay?” I ask.
“Sorry. All I can say is that his mind is very sedated but it does retain memories. That’s different from saying there’s active thinking and processing; I can’t tell about those because of the medicines he’s on for seizures.”
“I guess there’ll be no way to tell until after his phenobarbital dose is lowered and he wakes up,” I say, disappointed.
“Not if you want to draw meaningful conclusions,” replies Sal.
I look away from the black and white images on the television screen to my watch. Damn–9:30. The first presidential debate is about to start, but I’ve got to go. I lift my right arm off Karen’s shoulder.
“Time for me to go, Baby. You tell me how the debate turns out. Nixon should eat Kennedy alive; after all, he was a star debater in college.”
“Yeah. Star debater with limited principles,” she snorts.
Karen gets off the couch, walks me to the door, and kisses me goodbye. “Anyway, I hope you have a quiet night. See you tomorrow.”
I tune the radio to the debate on my drive in–through the dark Fens, then along Westland Ave., across Mass. Ave, to Bay State–managing to hear most of the opening statements of both men before I arrive at the hospital lot. Surprising. Kennedy speaks with more vision and vigor than I expected. Nixon sounds bland and flat—thought he’d do much better than Kennedy. Right now I’d say they’re even. Too bad I’ll miss the rest of it.
“Did you hear the start of the debate?” asks Joan, “How’d Kennedy sound? Let’s get rounds done quickly so I can catch the end of it in the HOB lounge. I bet you’re for Nixon since you’re from California too.”
“What stereotypic thinking. After the crap he pulled in his senate race against Douglas, and then that maudlin Checkers speech? At least I’m keeping my mind and options open, and that is more than you’re doing. Anyway, tell me what’s going on here on the floor.”
“Let’s start with Toby.”
Sal’s gone, and I’m lying on the couch feeling down because of what he told me about Toby. What a shame. Do I really want to get into minds like Sal? To know the good and the bad things about people? To find what people really think and feel? Must be like falling into a cesspool sometimes.
I hear Karen’s steps in the hall outside our apartment. She gets the door open before I can reach it.
“Hi Baby,” I say, “So how was your day?”
“Good,” she says as she comes into my arms for a hug and a kiss.
I hold her close after the kiss with my arms tight around her.
“Hey,” she says against my shoulder, “Something up?”
“It’s Toby, the baby that had meningitis. Last night I found out that it looks like he does have subdural effusions and they’re debating about whether or not he’s going to need taps.”
“Oh, I remember you mentioned that they were worried that he might have water on the brain from his infection,” she says, leaning back in my arms to look at me, brow furrowed.
I let my arms fall away, then walk with my right arm around her waist, to the bedroom.
“Right. They’ve been measuring the size of his head every day, and it’s been growing, and the soft spot on his skull has continued to feel full, not flat.”
“So what do you do if he has water collecting? Won’t that hurt his brain?”
I sit on edge of our double bed and watch her change. What a great body. Slim waist, cute rear. Her class is lucky. Never had a teacher that looked like her. Not close.
“They used to put a needle through the skull and drain off the fluid, repeatedly if necessary. But it’s now thought that maybe you can just leave it alone if the head stops enlarging, and if it doesn’t become infected.”
“Oh that poor baby-—that’s terrible. Do his parents know? Is he completely awake now?”
“Yeah, and his mother thinks that he may not be using his right arm as much as he was before, so possibly that’s from the meningitis too. Our neurologist, Dr. Hoffman, says we really won’t be able to tell until some time in the future. I felt so good that night when we first diagnosed and treated him. I thought that we had moved quickly. And now it looks like he has some brain damage anyway. Just how much is hard to say right now.”
“Well, you did your best, and from what you told me before, no one thinks that there was anything more that should have been done.”
“It’s just discouraging that the first patient with meningitis that I treat, gets complications.”
“There are no guarantees in medicine. The important thing is to do your best each time—-isn’t that what you told me once? And you did that, Honey. So don’t feel like you let him down.” Karen reaches out and pulls on my hands to get me to my feet. “Come with me to the kitchen, you can help me peel some potatoes for dinner.”
Peel potatoes! How can she pass over Toby so glibly! Kid’s now maybe a gork, and she’s about peeling potatoes? Hope he’s not a vegetable.
Dumb. Dumb as hell. Upset at Karen. Only trying to make me feel better. She’s probably right. Why should I feel guilty? Moved quickly. Made right plays. Okay to feel sorry for Toby–stupid to take responsibility. Mark tried to tell me. We’re not gods. That’s for some surgeons.
“Here’s the potatoes, and here’s the knife,” says Karen, as she seats me at the nicked-up maple, drop-leaf table that we got at St. Vincent DePaul.
“You want me to peel all of them?”
“Yes. What we don’t eat today, I’ll use for shepherd’s pie tomorrow.”
“Oh yeah–you got a letter from your mom today. I didn’t open it. It’s on the coffee table.”
“Thanks. I’ll read it after I get dinner going.”
Can’t tell her Sal thinks Toby’s mind is not quite right. Not so receptive and retentive as other babies his age. So maybe intellectual deficits. Sad. Only seven months old. Down side to telepathy. Knowing too much. Wasn’t that Eve’s problem? Better to remain in dark? To stay hopeful. Mother asked Father Salerno to bless him today. Small miracle would help. Such a cute baby. Damn it.
“Did you catch any of the debate on the radio last night?” asks Karen.
“Some of it on the way in. That’s all everybody was talking about today-—how Kennedy really waxed Nixon. What did you think?”
“Well I was happily surprised at how assured and knowledgeable Kennedy seemed. On TV he came across much more positively than Nixon, who looked tired and seemed frankly defensive. Kennedy definitely won it.”
“Hmmm. That’s what I heard too. I was surprised though. I thought they were even from what I was able to hear. I’ve always thought of Kennedy as a rich lightweight. Guess I’ll have to watch the other debates, and keep an open mind. Here–the spuds are done.”
“And thank you for trying to cheer me up. You’re right of course. We can only do so much. And try not to screw up.”