Читать книгу Dr. Galen's Little Black Bag: Stories - R.A. Comunale M.D. M.D. - Страница 4

Hey, Berto, let me outta this damned thing!

Sal, is that you?

Sho’nuff, Dottore.

What the hell am I doing here, Sal?

Don’t you know, kid?

“Wake up, City Boy! No bad dreams today.”

My roommate, Dave, stood over me wearing only his birthday suit.

“Wha … what’s going on?”

I lay in a cold sweat, almost as naked as Dave, sprawled half in, half out of my dorm bed.

“You were yellin’ at somebody named Sal.”

I shook my head. I couldn’t get the image out of my mind: my dead friend Salvatore zipped up in a rubber body bag.

“Come on, roomie, let’s hit the showers. Can’t keep the dean waitin’!”

“Welcome, sons and daughters of Aesclepius!”

My mind’s eye sees them all: the extroverted, the silent, the hand shakers and the wallflowers. I remember the ones who made it through four years of medical boot camp and the ones who did not.

It was the first day—young men and women vibrating with an awareness of something indescribable—that magical first day of medical school, that first day of the rest of our lives.

Today’s young doctors tell me their initiation as acolytes of the son of Apollo began with a white-coat ceremony: Friends and family watch, while dignitaries bestow the traditional garb on each new student. Each dons it as a vestment of the priesthood he or she is about to enter, while the Oath of Hippocrates is recited by candlelight.

Youngsters! We had no such elegance. Neither did we share in a very wonderful and new tradition of honoring the memory of those who had bequeathed their bodies, so we could learn from the mortality of others.

No, we had the black bag.

We listened with half-baked attention, while the dean and other school officials welcomed us, but our eyes kept darting toward a row of tables at the side of the conference room.

There sat more than a hundred small, black-leather bags—real doctors’ bags—enticing and bewitching us with their silent siren call. Not fancy and not big. Those would come later; these were easily recognizable as student bags.

And yet—and yet—they held the tools of our future trade: a simple stethoscope, a little metal hammer with a triangular rubber head that made us giddy, as we laughed and tapped one another’s knees to watch the involuntary-reflex twitching, and more.

We had to buy the sphygmomanometers—aka blood-pressure cuffs—and the fancy flashlights called oto-ophthalmoscopes. We bruised our arms trying them out. We also nearly blinded ourselves by shining the white-and-green lights in our eyes, and we induced bleeding in our auditory canals, when we jammed the dark-green, plastic speculums into fellow students’ ears.

Do not laugh.

We clutched those bags tightly, as we walked back to our dormitories, ignoring the knowing smiles and outright derision of the upper classmen. We didn’t care.

“Ow! Damn it, Dave, go easy with the cuff!”

Dave assumed that maximum inflation was necessary in his first attempts to take my blood pressure. My arm was frequently numb and swollen.

“You’re burnin’ a hole in my retina, you moron!”

Ah, yes, the moron was me. My initial ineptitude at trying to visualize the back of the eye—the retina and the optic disc—gave him many a migraine.

Dave, whom I called Country Boy, and I served as guinea pigs for one another. We’d hold open our Textbook of Physical Diagnosis and listen and thump and blind each other in desperate attempts to imitate the “correct way” of examining patients. It didn’t matter that we still knew squat about the human body. It also didn’t matter that we were embarrassed to hell and back at the more intimate examinations, which were more painful than a baseball to the groin. We were playing doctor, and this time it was for real.

“Oh, God, today’s gross anatomy lab.”

My classmate Carol’s tiny voice quivered, as we trotted across the campus to that first lab session. Back then the gross anatomy lab was in a different building—a dirty red brick Civil War relic without air conditioning—and we arrived at the door out of breath.

“Hey, City Boy, what the hell are those things on the walls?”

I had to laugh. Dave was a weed-thin Lynchburg farm boy. If he had grown up in my tenement neighborhood back in Newark, and had gone to my ancient elementary school run by nuns, he would easily have recognized gaslight fixtures that predated the electric light.

A bald-headed gnome and a parrot-faced woman waited impatiently, until we settled down.

The gnome harrumphed.

“Ladies and gentlemen, I’m John Hedley. This is Mrs. Gertrude Gable, my assistant. There are some rules of behavior that we expect—no, demand—of you.”

Gable’s gravelly voice cut in.

“You will be assigned four to a table. You will wear your lab smocks and gloves at all times. I hope you are wearing shoes and clothes that you won’t miss at the end of the year. You won’t want to keep them.”

Dave and I looked quizzically at one another.

“What the hell is she talkin’ about?” he mouthed.

But Gravel Gertie was right; I still have my shoes. Sixty years later I can still smell the formaldehyde. It never did come out. The clothes and green smock are long gone, more the product of diet than a lack of sentimentality. I’m still good looking but not as svelte as I used to be.

“At no time will you be disrespectful of the bodies you will be working on. Treat them as you would want your own body to be treated.”

Hear that, kid? Did those police docs treat mine with respect?

Sal, you’re dead. You don’t belong here!

Can’t think of a better place for a dead guy to be, Berto.

I noticed Hedley staring at my name tag.

“Mr. Galen, did you have something to say?”

“Uh … no, sir. Sorry, sir.”

Hedley cast a baleful glance at me then held up a pudgy hand and pointed at us.

“If I catch any one being an ass, violating these bodies in any way, I will have you expelled right then and there. Do you understand?”

Was he looking right at me?

We nodded. Why would anyone even think of doing something as grotesque as violating a cadaver?

You are one dumb shit, Berto.

Get outta my head, Sal.

Unh- uh, kiddo. Just wait. You’ll be glad I’m here.

I was no stranger to death. My old neighborhood hosted a charter chapter of the unexpected-death club. I met my first member when I was eight years old—my beautiful Marigold Lady of the river, a casualty of a back-alley abortion. Still, I admit, nearly six decades later, I felt a cold chill, as Hedley took a key from his vest pocket and unlocked the lab door.

The odor. That’s what hits you first. The vapors of the preservative liquids assault your nose and forever imprint themselves on your olfactory lobes in that most primitive part of your brain. You never forget it.

So, there we stood, dressed in green lab smocks and staring at row upon row of stainless-steel tables. On each lay a dark-brown, rubber bag, its contents elevating the fabric in the unmistakable shape of a human body. It was a classroom of the dead.

“Pair off in fours.”

Two on each side, we all stared down at those zippered containers then jumped as Gable rasped, “Open your bags!”

The four of us eyed one another, each waiting for someone else to make the first move. We were two guys and two girls: Dave and me, Carol, and Tara. The females glanced at us males with nervous smiles, and we tried to feign nonchalance.

But no one touched that zipper.

“Come on, come on!” Hedley’s voice was almost Mel Blanc in quality.

You heard Porky Pig, Dottore Berto, go for it!

As the great Yogi Berra once said, it was déjà vu all over again.

For a moment I was back home, standing in the police morgue beside my mentor, Dr. Corrado Agnelli. Salvatore Gatto, my best and only surviving early boyhood friend Sal, had been brought there. My clothes were still covered with blood and bone spatters from the shotgun blasts that had taken his life an hour before.

Now Sal’s mutilated body lay on the same stainless steel table that had cradled my dead lady, my Marigold Lady, thirteen years earlier.

“Corrado, I can’t go through with this. I can’t!”

The dead lady had decided my life’s work; Sal’s death had made me question my resolve.

“You must, Berto, for Sal’s sake … and your own.”

I watched the police surgeons dissect what had once been a friend, the person who had been my surrogate brother.

You heard Agnelli, Berto. Show me ya got the balls ta do it.

Shut up, Sal

Chicken!

Cut it out, for cryin’ out loud!

Chicken shit, chicken shit!

I took a breath. My hand moved forward and grasped the zipper. I felt my classmates’ hands rest on my own. Together we pulled it down.

Bravo, Dottore, bravo!

Grazie, Sal.

“City Boy, you okay?”

Dave was shaking me.

I opened my eyes.

“Huh? Oh …uh … yeah, Dave. Sorry guys.”

The girls smiled at me. It made me feel good.

Now, wasn’t that worth it, paisan?

Suddenly we heard retching and a male voice crying out, “Oh, sweet Jesus!” and then the sound of a collapsing body.

Hedley and Gable raced to that table and helped our classmate stand back up.

“He worked for my father! He used to play with me when I was a kid!”

Chet’s tearful voice kept repeating those words. Hedley and Gable re-zipped the bag and wheeled the cart out of the lab. Within minutes the morgue attendant arrived with another body.

We began examining our cadaver.

In life he had been a big man, powerfully built, like a boxer. African-American, he didn’t appear to be older than his mid-to-late forties. What could have killed a man like this? We would soon find out.

Hey, Sal, bet this is what you’d have looked like in twenty five years!

No answer.

“Listen up, peepuwl.”

Jeez, now he’s Elmer Fudd!

Hedley continued: “What happened to your colleague this morning is a reminder; death overtakes us all. At some point, each and every one of you will see someone close to you—someone you know—die.”

Carol nodded.

I remembered Angie, Tomas, and especially Salvatore; all my early childhood friends now gone, snatched from life before my very eyes.

“We’re going to remove the brain first. It’s the most fragile and difficult organ to preserve and some may … uh … not be in …uh… good shape.”

Gable and Hedley exchanged glances.

At that remark a group of graduate anatomy students arrived, each carrying an electric circular saw and a large morgue scalpel. One walked to our table, and, as we watched, he made a semicircular cut two-thirds around the cadaver’s scalp. He reached out and in one, sock-removing motion, pulled the scalp up and forward. Then he placed the saw against the now-bare skull, and the rotating blade easily cut through the bone.

Dead bone smells like burning dog hair when it’s cut.

“Voila! Ladies and gentlemen, I give you the human brain.”

Our graduate student bowed as we applauded.

Once more the sounds of retching, but this time it was a response to the terrible, rotting-flesh odor filling the air.

“Sorry, folks,” Hedley said, “but as I told you, sometimes the preservative doesn’t reach the brain.”

Damned good thing my brain was fresh, right Berto?

Sal, you didn’t have one.

That wasn’t an insult. One of the shotgun blasts had taken half of Sal’s head off.

Two rows down a foul-smelling pablum oozed from the brain case of the cadaver lying there.

The graduate student at the table cleaned up the mess. Meanwhile Hedley and Gable circulated, eventually reaching us.

“Ah, splendid!” Hedley gushed, as he noted our cadaver’s intact brain.

Well, not truly intact. A large, preserved blood clot had indented a good portion of the left side.

“This is wonderful, students. It’s obvious what killed this man.”

Gable seemed in ecstasy.

Whatever turns ya on, lady.

Shut up, Sal.

Our cadaver, whom we soon nicknamed “Harry,” had died of a massive stroke. A major artery had ruptured in his brain, probably killing him instantly. In life, like many African-Americans, he had suffered from uncontrolled high blood pressure. Unfortunately, like most men of any skin color back then, he probably ignored the symptoms or had no inkling that he had a problem.

I think of the myriad drugs we have today to treat elevated blood pressure and the ethnic-specific drugs that can be even more effective. Back then we had fluid pills—diuretics—and a drug called alpha methyl dopa, which caused people to pass out when they stood up too quickly. Our biggest gun was a hideously powerful and unstable medication called nitroprusside. It often killed more than it helped.

Once more Hedley’s voice changed, this time a close match to Daffy Duck.

Wonder if he can do Bugs Bunny.

Each of you has your disthecting kit, yeth?

His pronunciation of “dissecting” would have made Daffy or even Sylvester the Cat proud.

We all nodded. The wallet-sized, plastic kit held a large bladed scalpel, semi-dull scissors, pointed probe and tweezers.

“For the most part, the best tools you have will be your fingers,” Gable added.

Quit lickin’ yer chops, Berto.

I couldn’t help it; I let out a snorting laugh, which drew a glare from Gravel Gertie.

Later we found out that her hoarse voice was the result of a rare condition affecting her vocal cords. It would ultimately take her life.

“Blunt dissection is always your best bet. You won’t damage structures that way.”

While we looked on, Hedley’s hands reached like ice-cream scoops on either side of Harry’s brain, his gloved fingers gently loosening the tissues from the boney case we call the skull. He motioned for me to cut underneath where the telephone cables of the brain—what ultimately becomes the spinal cord—exit through the base of the skull.

The entire class watched Hedley triumphantly holding that tan-gray object above his head like a proud father.

All that Harry had once been, all that he had once felt and experienced—love, hate, happiness, despair, ecstasy—vibrated as electrical and chemical impulses through that amazingly compact, organic computer.

Where was Harry now?

Ya don’ wanna know, kid.

Days, weeks, months passed. Gradually we got to know Harry more intimately than any partner he had had in life. We spent extra time on weekends and evenings studying him, often bringing snacks and sandwiches to munch on. We’d quiz one another on the various structures such as Harry’s cigarette-smoke-stained lungs, his enlarged heart surrounded by fat, his coronary arteries already almost completely occluded. If the stroke hadn’t killed him Harry would have died almost as quickly from a massive heart attack. And if that hadn’t done him in, the aneurysm in his aorta, a balloon-like weakness in the artery wall, would have sparked a fatal hemorrhage if someone had punched him in the gut—or even if he had sneezed too hard.

Harry’s other internal organs were no better. His liver was also enlarged, and his pancreas was scarred from too much alcohol. His gallbladder was filled with stones; his kidneys shrunken, the effect of the prolonged, high blood pressure.

This man had felt pain and ignored it for most of his adult life.

No doubt about it, Harry had lived hard and died young. The scarring from gonorrhea and syphilis, and the premature enlargement of his prostate, betrayed his penchant for the ladies.

The only organs that seemed intact were his stomach and intestines—until Gable pointed out the ulcers, a result of his alcohol intake.

We examined Harry’s muscles, separating each one out and noting how it created a particular motion. It was a difficult study; the preservative fluids had made the muscle fibers brittle, and the evaporation and drying out made them less comprehensible.

We spent time on another cadaver as well—a necessity for learning the distaff anatomy. During our first trade, we learned that the other group had named her “Shirley.”

Reminds me of the gal that was with me when I got whacked. Remember her, Berto?

The old nursery rhyme is wrong; women aren’t made of sugar and spice, and not everything is nice. They, too, can live hard lives and suffer the consequences, often more severely than their male counterparts.

Sometimes I dream of Harry and Shirley.

Did they ever meet in life?

By early spring our cadaver was now in pieces. We had been tested many times on him and the other bodies in grimoire-march practical exams.

We had suffered routines like this throughout college, moving in single file past various stations of the biologic cross, given twenty seconds to identify ambiguous structures in sea creatures, plants, frogs, cats, and dogs.

Now the human counterpart challenged us: dried-out pieces of humanity with pins stuck through them and a question scribbled alongside that taxed our brains:

One: What the hell was that small dried-out macaroni-like tube that bore no resemblance to its real-life appearance?

Two: What did it do?

Three: What other action did it work against?

And so on.

Our first year was coming to an end. We had studied the normal aspects of the human body: its chemistries, its physiology, and its large, small and microscopic structures. We had attended physical-diagnosis sessions, seeing and talking to live patients. At first clumsy and uncertain, then with more and more self-assurance, we examined them in front of our professors.

Each time we attended, we carried our little black bags like talismans, self-consciously removing the tools of our trade, as we performed for grades.

And Harry? By the end of the term we had reduced him to skeletal bone and dried-out gristle. The lab assistants had removed his dissected body parts, and we were told they would be cremated in a non-denominational, religious ceremony.

We could not participate.

Once more I envy the present generation.

Hedley and Gable were more animated than usual that second-to-last day in the gross-anatomy lab.

“Ladies and gentlemen, we have a rare treat for you,” Gable trilled.

Uh-oh, she’s getting another…

Shut up, Sal! She’s one of the nicest people you could ever meet.

“Dr. Hedley has been experimenting with new and improved preservative fluids. These allow the body tissues to appear more normal, more … uh … lifelike in their flexibility.”

In a flourish more appropriate to a Cordon Bleu Parisian chef, Hedley pulled the cover off of a small, wheeled table, and we stared at disembodied arms, legs and heads that looked as though they had just fallen off someone walking by. He proudly picked up an arm-forearm-hand combination and pulled on the exposed tendons.

Those of you who are old enough to remember a TV show called “The Addams Family” may understand why some in our class began to laugh and clap, as Hedley the puppeteer manipulated that limb to move across the table. Then each of us experienced the frisson of shaking hands with it.

What about those heads?

If you are squeamish, skip the next paragraph.

Hedley took a flexible tube and inserted it into the stump of the trachea—the windpipe. He held the mouth of the disembodied head open and blew into the plastic pipe. An eerie “ahhhhhhh” resulted, as Hedley’s breath activated the vocal cords of a dead man.

Congrats, kid. You didn’t even flinch.

Thanks, Sal.

Time for me to go, Berto. You’re gonna do just fine now.

Don’t you want to see me make a fool of myself?

Nah, I know you won’t. ’Sides, Corrado and I … we’re gonna have a gab fest with Harry and Shirley.

Good-bye, Sal.

Nope, it’s arrivederci or ciao. See ya in … oops—not supposed ta tell.

Sal … Sal?

On the last lab day, Hedley and Gable congratulated us all for making it through the course. Gable had lost a considerable amount of weight over the year, and Hedley stood more and more at her side to steady her.

Gable, looking very tired, sat at her desk and smiled, as we all came forward to shake her hand and Hedley’s. Then she gave her valedictory.

“You are my last class, ladies and gentlemen. I am, as the more astute of you already know, dying of a particular form of cancer. I want to let you know that I am donating my body upon death to this very lab. I know that John,” she turned toward Hedley, “I know John has also made arrangements for himself.

“God bless you all.”

Our first year was over … right?

Guess again.

Now we faced the dreaded week of comprehensives.

Our little black bags sat on the shelves in our dorm rooms. We sweated in Richmond’s oppressive heat and humidity, as we pored over all of the notes we had taken during the past year.

Pass them and move on to second year; flunk and you were either out or—the greater ignominy—forced to repeat year one.

You know the sensation from hearing finger nails scraping a blackboard? (Do they still use blackboards?) By day seven of the comps we would have torn the head off a chicken if it looked at us sideways.

“You’re breathing too loudly, City Boy.”

“Do you know how annoying your nasal whistle is, Country Boy?”

It actually helped. After we wrestled each other to the floor, we sat there laughing. Then we hit the books again.

That final day of comps, we turned in our last exam booklets and headed out.

Dave was going to spend two week at his family’s farm before returning to his summer job at the school. I had a job lined up as well. It would be two whole weeks of doing nothing, hearing nothing.

“Wanna come home with me, City Boy?”

We left together.

On schedule two weeks later we were back in the anatomy building. Dave and I worked as gofers for several graduate students, doing the scut work and bone articulations of skeletons for teaching assistants.

“Galen, Nash, would you guys wheel this over to the ENT lab in West Hospital?”

Charlie Nestor, our boss, was winding up his Ph.D. in human anatomy. His research developed the new preservative fluids for lab specimens. He was pointing at a medium-sized, wheeled table with large, dark-plastic jars on each of its three shelves. It was surprisingly heavy and needed both of us to maneuver it through the streets. We looked like demented hot dog vendors, dressed in foul-smelling, green lab smocks.

Two blocks and two elevator rides later we reached the lab where the residents specializing in head-and-neck surgery honed their skills on cadaver specimens. The lab master signed our slips and helped us park the table along the wall.

As we headed out, we heard him laugh.

“Hey, guys, who’s the joker who played makeup artist?”

We turned.

He had opened one of the jars and taken out its contents. It was a human head—hair combed and tied in a ribbon, wearing lipstick and facial makeup.

Gertrude Gable really did look natural.