Requiem for the Bone Man (8 page)

“As are yours.”

She smiled at him and the lights became even dimmer.

Strange how things get started. If Dave hadn’t pulled that stunt, he probably never would have gathered enough courage to approach June. And if that hadn’t happened, Dave and he probably never would have moved out of the dorm into their own apartment.

At the end of sophomore year, the city boy and the country boy moved to a townhouse on Church Hill. It was in a poor, totally black area of the city and was all the two could afford; the money each earned by tutoring freshmen and doing scut work on the wards only went so far. Neither man had wealthy parents to pick up the tab.

June and Connie also had moved, but their finances were much better, so they had found a nice apartment in one of the old antebellum brownstones in the better section of town called The Fan. Boys being boys, the roommates spent time there as well.

Then the pair of girls became a trio, and June and Connie’s other roommate, Peggy Dalton, had latched onto someone she kept calling Babyface.

“He’s the sweetest thing you could evah imagine. He’s a real s’uthern gentleman,” she would repeat over and over in her North Carolina accent.

They knew immediately who she was talking about. It had to be Bill, Bill Crowley. Stocky, maybe five feet seven on a good day, he really was a gentleman. And, with his rounded visage and hair that tended to either stick straight up or come out in a cowlick, a definite baby face.

“Hey,” Dave asked one day, “if he’s Baby Face, then what do you call me and City Boy?”

The three girls giggled, looked at each other, and giggled again.

“Scarecrow and The Bear!” they shouted in unison.

June looked at the two guys, who blushed.

“And what do you gentlemen call us ladies?”

June arched her perfectly formed eyebrows and other parts of her anatomy at the roommates in catlike grace.

Galen looked at Dave. The farm boy knew what side of the nest he was on. Turnaround was fair play. They had to take up the defense, even though Bill wasn’t there to join in. And knowing Bill, he probably wouldn’t have said a word anyway.

Dave looked at Connie.

“I’ll be darned if you ain’t The Teacher. Sure enough, you are. And you,” he said, looking at Peggy, “well, you gotta be The Southern Belle. Ain’t that so?”

Galen had been holding back, but he finally looked at June. Without blinking, he said, “And you, dear lady, are The Model.”

At that, both guys ran behind the couch to escape the onslaught they knew was coming. Except that they weren’t very good at escaping—and they really didn’t want to be.

...

It made life easier that third and all-important year for each to know that he or she had five other friends, with one even more special. Now they wore whites, with the guys in trousers and either long- or short-sleeve shirts depending on the rotation they were in, while the girls nicely filled out their skirts and blouses. It was only on surgical floors that the difference in the sexes became blurred as they all wore the shapeless blue scrub pants and tops, their heads covered in hair-confining caps, their faces concealed by the ever-necessary masks.

Galen had just begun his first rotation, a six-week stint on general medicine. Here patients from the emergency room who had been determined to need admission for further evaluation and treatment were assigned to the newly minted third-year students.

“Mr. Galen, you have a patient. Please do the initial workup and be prepared to present the case to Dr. Stottler.”

The resident tossed him the admissions file, grinned, and walked away.

Whoa, hey, wait a minute! What the hell do I do now?

This was not like in the books and pictures. He saw the nurses watching him, so he kept a straight face. He picked up his little black bag, the one that all of the students had received their freshman year and had longed to carry for real.

He began reading the file.

Room 506. Patient’s name is Johnny Mangold. What did the ER intern write?

“Twenty-year-old white male, history of metastatic bone cancer of the jaw, admitted for stabilization. Possible brain involvement now. Probable etiology: chewing snuff.”

Dear Lord, twenty years old, younger than I am.

He walked into the semi-private room now occupied by one patient. The lights weren’t bright and it was already 10 p.m.

Great, I’m supposed to work in the dark.

He moved to the window-side bed and started the spiel he and his classmates had practiced since day one.

“Hi, I’m Dr. Galen. May I sit and talk with you? We need to get a bit more information and take a quick look at things before letting you sleep.”

God, what a damned liar he had become. For one thing, he wasn’t a doctor yet. For another, it would probably take him at least an hour to do the student physical, which required every tiny bit of information and a full-body examination.

The biggest lie of all was the bit about sleep.

Yeah, right, with noises, footsteps, and all the other background sounds that made hospitals so restful. Wake up and take this pill so you can sleep. Real restful!

He sat next to the bed. His patient was no more than a boy, but he was dying. They talked about his condition—the tumor found growing in the bone at the back of his nose and jaw. Galen went through all the memorized questions he had to ask and then said, “Johnny, I need to look at you. Is that okay?”

The boy smiled and Galen heard something from out in the hallway near the door.

He looked up to see some of the nurses seeming to stand around a medication cart but peering into the room. They quickly moved away when they saw him looking.

“Doc, hold on a second, I just need to remove this,” Johnny said.

While Galen watched, the boy reached up to his face. Galen heard the snick-snick of latches as the boy removed the entire left side of his face and skull. It was a prosthetic, a synthetic replacement covering the surgically removed cancerous bone and tissue cut away in an attempt to save Johnny Mangold’s life.

He stared at the boy, now half-human, half-skeleton.

“That’s a very nice piece of prosthetic work, Johnny.”

He couldn’t think of anything else to say. He picked up his light and began to examine the boy. Exposed blood vessels pulsated in time with his heartbeats. From the corner of his eye, Galen saw the nurses furtively watching him again.

Now he understood.

Okay, ladies, did I pass your test?

He finished, thanked his patient for the time spent and began to put his equipment back in his bag. But something wasn’t right. In the shadow-filled room he sensed a palpable darkness hanging over the boy’s bed.

It was 3 a.m. by the time he had written up the extensive paperwork he had been warned Dr. Stottler would expect. He had heard through the grapevine that Stottler was a tough taskmaster. He dozed sitting up, his head propped on his medical textbook. Next thing he knew, his managing intern was shaking him awake.

“Come on, that kid in 506 is going sour!”

He awoke with a start. He had just been talking with Johnny.

They ran down the corridor. The nurses had lined up the crash carts filled with medications to use in an emergency. The resident was already there, pounding on the boy’s chest as the floor nurse attempted to increase oxygen flow through a nasal cannula in the remnant of the boy’s face. Student and intern stood by, watching the final struggle.

The resident, two years post graduation, stopped, looked at the nurse, and shook his head.

“Time of death: oh-four-thirty,” he called out, and the nurse recorded it on the chart.

“Annie, who do we have to baby-sit tonight?”

The emergency room floor nurse picked up the assignment sheet, which listed the fourth-year medical students rotating on ER service. She handed it to the nursing supervisor, who quickly scanned the names under the day’s date.

“We got Baby Face and The Bear. Should be okay.”

“Yeah, compassion and competence, a good pairing.”

“Hi, I’m Bill Crowley.”

He held his hand out to the heavyset character leaning against the wall. The room was crowded with all his future classmates trying to introduce themselves to one another. This one was different.

“I’m Bob Galen.”

Definitely not from the South by the sound of his voice. New York?

“Where you from, Bob?” The soft, lilting sway of a Virginia gentleman came through.

“I’m a carpetbagger, Bill. Just got in from New Jersey.”

“Didn’t we beat you guys at Appomattox?” He waited to see the Yankee’s response.

“Sure, and Jeff Davis is president.”

They took an instant liking to each other, and Bill thought he knew why. There was something melancholic about the big guy—something he could relate to—only he knew it couldn’t be worse than his own burden.

“Damn, it’s the Benadryl Lady again!”

“Who’s that, Bob?” Crowley saw the frustration in his partner’s face as the elderly black woman walked through the ER doors.

“She’s a waste of time. You know the routine. She comes in complaining of being ‘short of wind.’ She’s had every asthma and heart workup we’ve got—but there’s nothing wrong with her. All she wants is a shot of Benadryl!”

“How about I take a crack at her?”

“Yeah, fine. There’s a DOA coming in. I’ll take that one while you go nuts with our frequent visitor.”

As Galen skulked away, Crowley sat down next to the doll-sized figure sitting in the emergency room waiting area. She was dressed in a petite yellow housedress with a checkered apron-like front. Her hands kept twisting and untwisting a pale pink cloth handkerchief.

“What’s the trouble, ma’am?”

He reached over and held her mahogany-colored hands in his own pale white fingers. He could feel the arthritis and the tension in her.

“Can’t breathe. Mah wind’s short agin.”

“Please tell me more.” He studied her body language, the words not spoken.

“Ah was sittin’ theah in mah livin’ room an’ it come on me.”

“Was anyone with you?”

He felt her fingers tighten and her body begin to tremble.

“Mah son dun come in fra’ work.”

“Then what happened? Did he try to help you?”

“No, suh. He wer havin’ de shakes.”

Now it made sense.

“Ma’am, did your son have the shakes the last time you lost your wind?”

Her tension increased. “Yassuh.”

“I think I can help you. Excuse me for a moment.”

He got up and went to the nursing station.

“Annie, could we get Social Services down here? I think the Benadryl Lady’s real problem is an alcoholic son.”

“Yes, Dr. Crowley,” she replied, watching him walk away.

Strange to find compassion in such a young man.

Dr. Crowley!

Not yet, he thought, but it sounded so good! And coming from a nurse with more experience than most of the doctors working the ER, it was a real compliment.

The night proceeded with the usual knife, gun, and club injuries, plus chest pains, earaches, and stomach cramps. Galen and Crowley worked well together, and soon the full waiting room was emptied.

“Let’s take a quick break, Bill. That was a good call with the Benadryl Lady.”

“Thanks. I think there’s a coupla sodas in the fridge.”

They sat in the back lounge, and Galen recounted his experience with the person who was brought in dead.

“You know, Bill, I remember getting that man as one of my admissions last year. He’d come in to the ER with chest pains, and they sent him up to rule out a heart problem. That, to me, was a dump job from someone here who didn’t want to spend the time evaluating him.

“Anyway, here I am, it’s 2 a.m., and I’m talking to this poor guy who’s scared out of his mind that he’s going to die. Seems every male member of his family died at age forty-five. He had just had his forty-fourth birthday and was starting to get chest pains even lying down. So I did the million-dollar third-year student exam on him, and guess what? Nothing, absolutely nothing! The only positive bit of information I had was that damn family history—every male on his father’s side gone at forty-five.

“So, Stottler walks in at 6:30 for rounds and I give him my workup. He tosses it on the table and we all follow him like a royal entourage to the guy’s bed. Stottler stares at the guy, listens for about ten seconds with his scope then turns to us.

“Pompous jackass that he is—and you’ve suffered with him, too—he doesn’t even bother to lead us out of the room. He stands there in front of this terrified guy and starts berating him for being a hysterical personality with conversion reaction symptoms. In short, he was calling the guy a fake, a malingerer. He points at the resident and orders him to discharge the guy. When the resident starts to ask for at least a day for more testing, Stottler gives him that drop-dead stare of his, and the resident backs down. The guy goes home, and I felt so sorry for him it surprised me.”

Bill looked at his friend and nodded. “There’s still hope for you Northerners.”

Galen laughed, then caught himself and continued.

“Well, tonight they wheel in the Go-to-Jesus cart from the ambulance, I pull back the covers, and there’s my man. His forty-fifth birthday was a month ago! Right now, I would love to have Stottler here. I’d shove his conceited mug right against that poor dead guy’s face and ask him how hysteria and conversion reactions did that. If nothing else, I’m going to make sure Stottler is the star performer at pathology rounds when they do the postmortem on him. And I’m going to be damned sure to emphasize that family history.”

The siren of an arriving ambulance dispelled the hope of any further rest as it pulled into the ER driveway. It could be anything from a heart attack or trauma injury on down, so they waited, feeling the usual tension build in anticipation of what would come next.

“Take it easy, guys. This one’s easy,” the ambulance driver said as he jockeyed the rescue cart through the doors, the patient covered from head to toe with a sheet—another Go-to-Jesus cart. DOA. Dead on arrival. All they had to do was make sure the vital signs weren’t there, sign the release papers, and send the corpse to the pathology department morgue.

“Whose turn is it to do the pronouncing?” the floor nurse asked.

Bill looked at Galen and reluctantly nodded. “You did the last one. This one’s mine.”

“Dr. Galen, we’ve got a kid in sickbay 3.”

“Call me if you need anything, Bill.”

As Galen left, Crowley walked to the back holding area, where the dead were routinely wheeled to avoid upsetting the living. He unhooked the stethoscope from around his neck, reached down, and pulled the cover sheet back.

My God! My God!

The derelict stared back up at him, unseeing eyes open to eternity. Crowley fell to his knees and began to rock back and forth. His moaning got louder and louder until the crescendo ended in a wail.

“Come on, Bill.”

Galen had his arms around the shaken Crowley. He gently shifted him over to a folding chair then turned to the cluster of ER personnel staring at them.

“It was someone he knew as a boy; someone who worked for his father.”

He hoped that excuse was good enough. Quickly he signed the papers, handed them to the nearest nurse and asked one of the attendants to take the body to the morgue.

“I’d better stay with him for a while. Can you get the intern to take my patient?”

The floor nurse nodded, and the crowd left them alone.

“Tell me what happened, Bill.”

“I killed a man. I’m a murderer! God’s punishing me!”

He was trying to curl up into a ball. Galen held his breath then said something he was not used to saying.

“Tell me about it. Let me help you.”

The story poured out between gasps and muffled sobs. Galen finally understood the underlying sadness of his friend. He looked within himself and realized he had found the meaning of the word empathy.

“Dr. Galen, we got another one for you,” the floor nurse whispered. “It’s a little girl. Bad asthma. The family was just driving through on their way up north.”

He heard a voice loudly calling for someone to help his granddaughter. It sounded familiar, but he couldn’t place it, and he didn’t have the time. The girl, about seven years old, was in
status asthmaticus
, the worst form of asthma, usually controllable only if you were lucky.

He set up the IV drips to hydrate her as the nurse put the moisturized oxygen mask on her face. She was gasping, fish-mouthed in a desperate attempt to breathe. Her face was pale, her eyes closed. She didn’t even move when Galen inserted the large-bore needle into her tiny vein.

He tried the standard approach first: adrenalin in 0.5 milliliter doses subcutaneously. No luck—she still struggled to breathe.

Next, he started an IV drip of aminophylline. He hated that drug. Therapeutic dose and toxic dose rode side by side.

He felt for an arterial pulse, found it weak and thready, and then jabbed the special needle into the artery and pulled back on the plunger, drawing her blood. When he had collected enough, he pulled out the needle, threw the sample into an ice bucket and handed it to the nurse, who took off down the hall to the lab.

Five minutes later she returned with the numbers: still no change in arterial oxygen.

He was growing desperate.

“Nurse, would you get me an ampoule of IV Solu-Cortef?”

“Dr. Galen, only the attendings are allowed to use that!”

He looked at her, then at the girl who was still using all the chest-wall muscles she could just to breathe, then back at the nurse without saying a word.

She unlocked the special cabinet and handed the small container to him. She was going to stay and watch. It was a CYA maneuver on her part. She could always say he had forced her to do it, but she also had heard that The Bear often pulled rabbits out of his hat in critical medical situations.

What’s he doing?
She had never seen a contraption like the one he was assembling. He was hooking up another glass IV bottle with Ringer’s lactate and injecting the whole vial of Solu-Cortef into it. Then he piggybacked the second bottle onto the first through a side fluid port in the plastic tube and opened up the flow. The girl was now getting both aminophylline and Solu-Cortef.

Young doctor and veteran nurse stood side by side, watching.

The trick, Galen knew, was to medicate without overloading her with fluids. She could die just as quickly from that as from her asthma. Children were not just small adults, and adult drugs often caused unexpected effects in them.

Galen kept his fingers crossed. He wished he had access to some of the experimental drugs that he knew were now only in early development—beta-agonists, the pharmacology boys called them. But he had to use what he had.

Slowly, the girl’s chest wall stopped its heaving. Her neck and rib muscles no longer distorted her face and torso with tightening. She began breathing more easily. Even her face was pinking up.

Galen exhaled for the first time in what seemed like several minutes.

“She’ll need to be admitted at least overnight for monitoring. Better let the on-call peds interns know they have a close one to watch.”

The floor nurse left him with the little girl. He looked down at her.

Maybe someday you’ll be famous, or you’ll do something good for humanity. Or maybe best of all, you’ll have a little girl of your own. Uh-oh, I’m getting maudlin!

The gurney attendant arrived, followed by the pediatric admitting intern.

“Good job, Galen. We’ll take her from here.”

He started to walk to the nursing desk. As he approached the door he heard the nurse.

“She’s out of the woods now. Would you like to talk with the doctor?”

He pushed open the swinging door and the nurse spoke again.

“Oh, here he is now. Professor Freiling, this is the doctor who took care of your granddaughter. This is Dr. Galen.”