The View from the Vue (8 page)

Jim thought a minute and decided it was worth a try. So we finished our snacks and walked up to his ward.

Jim led me to the bedside of the meanest, nastiest, scowliest, dirtiest bum I’d ever seen. He was just sitting on the edge of his bed, looking professionally malevolent. For a minute I had misgivings. Suppose he took the spinal needle away and killed me with it? I recovered my courage by reminding myself that there were two of us. Jim went through the ritual of introducing me while I shuffled around and looked embarrassed. The guy didn’t bat an eye. He signed the permit form for the spinal tap. Then he hawked up an oyster and spat it right on the floor at our feet. If I had needed further selling, I was now sold.

The patient lay calmly as I did my “first” spinal tap. He didn’t bat an eye when Jim yelled out such pleasantries as, “My God, don’t get that dirt in there; he’ll get meningitis.” Or, “Stop! Stop! Don’t put the needle in so far; you’ll paralyze his legs for life.” Finally we walked away with our little tube of spinal fluid. The patient favored us with a sneer and sat grinning evilly after us even as we turned the corner.

“I told you it wouldn’t work,” muttered Jim. “I’m going to grab a few minutes of sleep while I can.” He started to leave.

“Wait a minute,” I said. “This spinal fluid looks normal, doesn’t it?”

“Yeah—so?”

“So we still haven’t made sure the knock on the head didn’t do him any harm. That means we’ve got to do a brain biopsy.”

Jim looked at me as though I had just flown in the window and announced that I had arrived from Mars. Then he mumbled, “Why the hell not?” He shrugged, and we walked back onto the ward.

The patient glowered at us when we told him our intentions. “What the hell is
that
?” he growled.

“Well, you just take a needle,” I said, “and you stick it through the skull up here, where you had your soft spot when you were a baby. Then you take out a little piece of brain in the needle and look to see if it was damaged when you got knocked cold.”

“Stick a needle in my head? Shit, don’t you come near me, you bastards. I’ll kill y’ both.”

Jim drew himself up full height. “Well, sir,” he said. “If you won’t allow me to do what needs to be done to check you out after you got knocked cold, I’ll have to discharge you.”

“I never got none o’ these tests before when I got knocked out,” growled the patient.

“Well, sir,” I said as haughtily as I could, “in that case, you got lousy care.”

Jim produced a hospital form for the man to sign which would indicate that he was leaving against medical advice. But he didn’t sign. He looked back at us and asked, “How big’s the needle—like the one fer the spinal tap?”

“Oh no,” I answered. “We need a bigger one than that It’s about this big.” I produced my pencil for him to inspect.

He looked at it and shrugged. Then he reached for a pen and began to sign—not the discharge paper, but the permission for the brain biopsy. As he started to write his name, I looked at Jim and he at me.

What were we going to do now? It would have given us both great pleasure to go out and find the biggest trocar we could, and then make a brain-kabob out of the guy, but we felt that we really couldn’t do that. For example, how would we dispose of his body? Jim began to walk away in disgust.

“You’re very wise, sir,” I said. He stopped writing in mid-name and looked at me. “It’s not bad at all,” I continued. “There’s just a brief second of pain and then when the needle goes into your brain, you go like this.” I jumped off the ground, flung my arms and legs outward, contorted my face, and screamed, “Blaaaaaaaaa!” at the top of my lungs. “Then you don’t feel anything at all.”

He stared hard at me. I leered at him. The tide had turned: now it was he who looked scared.

“God damn, I’m gettin’ outa here. Gimme that discharge paper.”

“Oh no, sir,” said Jim. “You signed for the brain biopsy. I want to do it; I’ve never done one before.”

By
this time the guy was half dressed. “No sirree, you get the hell away from me. I’m leavin’.”

“Well, you know if you sign out against medical advice, you can’t ever come back. If you do, you’ll have to have the brain biopsy.” Thus spake Barkley.

The guy signed the paper and was out the door in a flash. Jim and I shook hands and trundled off to our respective sacks.

Perhaps you find this kind of behavior shocking. Deviance (and deviants) was (and were) tolerated at Bellevue; nonetheless the place was a tenuously balanced society. The filthy surroundings, creaky old equipment, chronic understaffing, and dreadfully sick patients combined to keep us all one step from total chaos. Anyone threatening to needlessly or willfully drop the final straw could not be tolerated. Therefore, occasional individuals had to be evicted. The Bellevue house staffer’s genius for eviction frequently bordered on the unbelievable.

This is well illustrated by the story that involved a resident who was one of my friends, a thoroughly humane and kind person. At one time, he and his ward were stuck with one of the relatively rare female bums. She got over her pneumonia, but wouldn’t leave the hospital. Whenever discharge seemed imminent, she’d fake a faint or a crushing pain in the chest. This would always be good for another few days in The Vue.

She had no family to take her in. All the city convalescent and nursing homes were full. There was nowhere to send her. Ordinarily, she would have been tolerated as a long-term guest, but she, like Jim Barkley’s patient, was a habitual troublemaker. She was prone to midnight screeching when the nurses didn’t move fast enough to suit her. She stole food from the other patients and woke them up at night by dropping bedpans on the floor. The sick patients got sicker, and to avoid her the night nurses and aides began to find reasons to spend all their time on other wards. An attempt to transfer her to psychiatry met with the same result: she’s not crazy, just impossible.

Faced with the imminent total disintegration of his ward routine and services, the resident felt compelled to act At four o’clock one morning, he slipped quietly onto the ward, glided over to his tormenter’s bed, unzipped his fly, and urinated on her bed sheets. As she let loose the first yodel of protest, he lit out for his room.

Ten minutes later, having been summoned by the nurse, the resident went to the ward and called the psychiatrist again. As the shrink arrived, the patient pointed a finger at the resident and shrieked, “He peed all over my bed. The doctor peed on my bed!” The resident shrugged and quietly explained that yes, the patient had been incontinent of urine for a while now, but these nocturnal paranoid delusions were relatively new.

The commitment order was signed without further ado, the nasty old woman was carted off, the nurse and aides returned to the ward, and the resident and his patients had their best half-night’s sleep in days.

Not only is Bellevue Hospital located close to the Bowery, it is as I’ve already mentioned, also very near the Lower East Side area of New York. This helps to explain why Jack Thorn, an intern up from Baltimore, said to me one day: “My admissions all seem to have either the Dom or the Lol Syndrome.”

“What the hell are those?” I asked him.

“Dom. D.O.M. Dirty Old Man Syndrome. And L.O.L. is Little Old Lady Syndrome.”

Jack could justifiably have inserted a J between the O and the second L: Little Old Jewish Lady. This ethnic oddity was explained by the fact that Bellevue was then caring for the last survivors of the once-large Jewish population of the Lower East Side. The increasingly decreasing number of L.O.J.L.’s came to The Vue with their organic and functional
kvetches
, while their children patronized the fency-schmency private hospitals in the fency-schmency Lung Island and New Joisey suboibs to which they had moved. Thus, at Bellevue, for all practical purposes, although every little old lady was not Jewish, every little Jewish lady was old. And their age notwithstanding, more often than not they taxed the ability and understanding of the Bellevue house staff to the very limit.

One of the most inventive L.O.J.L.’s was Mrs. Spray-Me-Dokteh. I first met her about nine o’clock on a September morning during my internship year. We were making rounds with our attending physician, Dr. Carla Slaymaker, when the Emergency Room nurse called to tell us we had an emergency admission. Albert Goodman, the other intern who had also worked on this ward during the previous month, took the call. Immediately upon hanging up, he grabbed an aerosol can of a local anesthetic called Dermoplast, then he headed for the door. Dr. Slaymaker asked what he needed the Dermoplast for.

“Come on down. I’ll show you,” he said. So we all came.

When we got to the Emergency Room, Albert led us to the bedside of a short but massive gray-haired lady who was lying profoundly unconscious in her bed. “It’s Mrs. Goldberg,” he explained. “This is the third time in the last month she’s been in with an insulin overdose.” As he said this, he drew up a large syringeful of concentrated glucose to inject into her vein.

“But what’s the Dermoplast for?” repeated Dr. Slaymaker.

“That’s why she takes the insulin overdose,” said Albert.

“What?”

“Just watch.” He injected the glucose slowly, and within a couple of minutes Mrs. Goldberg’s eyes began to flutter open. Before five minutes had passed she was wide awake, and she flashed Albert a broad grin of recognition.

“Dokteh Goodman,” she beamed. “DOKteh Goodman! Spray me, Dokteh, spray me.”

With that, she lifted her pendulous right breast, releasing a nauseating blast of fetid air. The entire underside of her breast and the subjacent chest wall formed a red, confluent, chronically infected, oozing mess. Albert aimed the Dermoplast at the offending region and let fire. “Ahhh, dot’s gud,” the patient smiled.

Mrs. Goldberg beamed at Albert, dropped the right breast, and elevated the left one, whose undersurface looked as bad as that of the first one. “Now d’udda one, if you would pliss.” Albert promptly anesthetized her left side.

Dr. Slaymaker looked absolutely stricken. “Albert!” she groaned. “You’ve just got to be kidding.”

“No, Dr. Slaymaker. Some time last year, one of the interns kicked her out of the Clinic when she came in for her Dermoplast bottle. Told her if she couldn’t dry her breasts and keep them clean, he wouldn’t treat her. So now when it bothers her enough, she takes an overdose of insulin to get into the E.R., and then she’s got it made.”

Mrs. Goldberg confirmed the story by beaming again at Albert and then casting a fierce eye on Dr. Slaymaker. “And Dokteh Goodman’s deh nices’ dokteh around. He takes gud care uff me!” Albert beamed back at her and smiled sweetly at Dr. Slaymaker, who shook her head and walked out into the corridor, where she proceeded to laugh until the tears ran.

Another frequent visitor to The Vue was Sadie Abramowitz. Mrs. A. was extremely obese, diabetic, and had high blood pressure and heart disease. She was another lady who was difficult to keep on long-term maintenance therapy. The problem was that when she began to feel well, she would stop taking her digitalis and anti-hypertensive drugs. Then she would promptly go into severe heart failure, whereupon she would be rushed to the hospital. She became known as The Bluebird, because once every month or two, she would appear in the Emergency Room, gasping and cyanotic. But the lady had amazing recuperative powers: a night of emergency measures in the E.R. and she was about as good as new. A couple of days to get her back on her medications and she’d return home. But she never seemed to learn. Not even the time she actually stopped breathing in the corridor leading to the E.R. and had to be cardiac-massaged back to life. A month after this particular episode, she was back again.

Every intern tried every technique he could think of to get her to stay on her pills. Explanations—even in Yiddish—did nothing. No more effective were attempts to embarrass her. We asked her whether she knew the medications were free. She did. One resident called in a psychiatrist to try to determine whether Mrs. A. was nurturing a death wish. After three or four sessions, the shrink told us that as far as he could tell, her psyche was in order, but that if he continued to see her, he was afraid that he would develop a death wish. All he could tell us was that she just didn’t see the need to take medication for her heart when it was doing fine.

A different matter, however, was Mrs. Abramowitz’ extremely mild diabetes. She would faithfully test her urine twice a day or more, and would never fail to take her oral medication. Once I asked her the reason for her dichotomous therapeutic philosophy. She gave me the Jewish grandma smile, as though a cookie and milk were coming next, and said, “Dokteh Karp! You know dybeetis kin be dainj’ris.” I nodded and then walked around the corner to bang my head against the wall.

One day I tried talking to her husband. Mr. Abramowitz was a skinny little guy with a hatchet face, a hawk’s-beak of a nose, a few wisps of scraggly gray hair on top, and a pair of eyes that reflected all the sadness and hostility that can be produced by seventy-two years of absorbing abuse from
goyim
. He always looked like he was swimming in his three-sizes-too-large gray coat with snot on the right sleeve and down the front. He was a pathetic little figure as he ran down the corridors trying to keep up with the stretcher bearers as they raced his wife to the Emergency Room.

“Mr. A.,” I said one day, “why doesn’t your wife take her heart medicine?”

He gave me a shrug and a go-away notion of his hand.

I tried again. “Don’t you know that one of these times we may not be able to get her going again?”

The sadness in his eyes receded and the hostility came forward. “Lissen, sonny, I liff forty-fife yeeihs mit her.
You
vant she should take pills—
you
try liffin mit her. Doan hock me a chinig.” (Translation: “Quit bugging me.”) I quit bugging him.

I think I won the 1963 Blue Cross Award for the greatest number of admissions of Sadie Abramowitz. She and I eventually got sort of attached to one another. I may have spent more nights with her that year than I did with my wife.