That's Life: It's Sexually Transmitted and Terminal

FOREWORD

Many times in the 60-odd years of our marriage, my wife has asked me a question She usually asks the question at about 11:30 p.m., after we have waved goodnight to the last of our guests of the evening, and have turned off the porch light. The question is this: Haven’t I asked you not to start telling one of your damned stories just when everyone is getting ready to leave?

I usually answer, weakly, that a remark by one of our guests reminded me of the story, and I felt compelled to tell it. Sue usually responds, Well, in the future try to suppress your compulsion. Besides, they probably have heard you tell the same story before. Many times. And so have I.

These damned stories are narrations of incidents that have occurred during my early years and the 50-plus years as a physician specializing in orthopaedic surgery. The people in these stories are real, and the events actually happened. If you think you may have heard one or more of them before, get in line behind Sue.

I have changed the names of some of the people mentioned to avoid embarrassing them. Anyone reading this book will be able to tell which of the characters might be embarrassed to see his or her name mentioned. Then, you can be sure the real name has not been used.

For the title of this group of essays, I borrowed an expression made during a discourse by a clever young man named Dr. Alex Rosenstein. I use it with his kind permission.

Lord knows, the next-to-last thing (or even the last thing) this planet needs is another book by a doctor about patients I have known or cancers I have cured. But my wife needs her sleep. Next time I feel compelled to tell one of these stories, I’ll hand my guest the book, point out the pages and have him or her read it at home─his or her home, not mine.

THE EARLY YEARS

1939-1942

NO STOOL, NO SCHOOL

Every medical school has at least one faculty member who is a legend. In our case, it was Dr. Charles Hendee Smith. The name itself tells you something, doesn’t it? You know that anyone with a name like that has to be slender, six-three and ramrod straight. If a Hollywood casting director was to pick someone to play the part, the character would have thick hair as silvery as a brand new quarter, with a mustache to match. Even as a kid, he would never have been Charlie, Chuck, or Smitty. If he played ball his teammates would have yelled, Throw ‘er here, Charles Hendee Smith.

Charles Hendee Smith was our Professor of Pediatrics. Every day he took the subway to Bellevue Hospital in New York City where he taught and saw patients in the clinic. He probably looked distinguished even while hanging on to a subway strap.

Dr. Smith taught us the practical side of medicine. One of his lectures was: How to pack your medical bag. He convinced us (at least most of us) that the little black bag was reserved for the tools of our trade. The pastrami on rye we had brought along for lunch did not belong alongside our ophthalmoscope and stethoscope.

He also taught us that the cough of croup starts at eight o’clock in the evening you could set your watch on it. He illustrated his point with a story: A woman called me one evening and asked me to hurry to her home because her young child had croup. I looked at my watch and I told that woman, ‘Mother, it is seven-thirty. Your child cannot have croup.’ The child’s mother said, ‘Dr. Smith, I know croup when I hear it. Besides, it’s eight o’clock, not seven-thirty.’ And she was right. My watch had stopped!

Of course, there was nothing mystical about croup starting at eight o’clock. A child with bronchitis would be put to bed at six. It took about two hours for the mucous secretions to collect in the child’s breathing passages. By eight, the frightening, suffocating cough of croup began.

Charles Hendee Smith’s aphorisms made his lectures memorable. Some were simple. He championed breast feeding with: The breast is best. Even today, more than fifty years later, I remember that sugar contains twenty calories to the teaspoon. Twenty’s plenty. Others were more involved. One that never failed to stimulate post-lecture discussion among the students each year was: No stool, no school.

On the day Dr. Smith gave our class his No stool, no school lecture, the hall was filled. Dr. Smith stood at a podium in the center of the semicircular amphitheater where rows of seats rose steeply from floor level. When Charles Hendee Smith lectured, his chin pointed toward the sky as he addressed his remarks to the top row. Most of us believed he was lecturing directly to God.

Dr. Smith said, "Every child should be taught bowel regularity from the earliest age. Without a clean lower intestinal tract, the child is sluggish and cannot think clearly. No child should be sent off to school before he or she has had a bowel movement. Remember the axiom: ‘No stool, no school’."

As most of us frantically scribbled the nuggets of wisdom in our notebooks, Stuart Brooks from a seat high up in the back row, waved his hand. Brooks was one of the brighter members of our class. Eventually he would become a psychiatrist.

Dr. Smith nodded in recognition.

Brooks said, Dr. Smith, aren’t you putting too much emphasis on bowel movements? Don’t you think this might lead to an anal fixation?

All eyes gazed up toward Brooks. Charles Hendee Smith glared at him in silence for a few seconds. Then he raised himself to his full height and blew through his magnificent mustache―his way of showing annoyance. Young man, he thundered, Did you have a bowel movement this morning before you came to class?

Brooks flicked a glance to either side, then answered in a voice barely above a whisper. No sir.

That is obvious, said Charles Hendee Smith, jabbing the air with a bony index finger. Because if you had, you would not be talking such utter nonsense!

What a nice way of telling Brooks that he was full of shit!

THEY DO SUCH STRANGE THINGS ON THE BOWERY

In 1941, with the planet still crawling out of the Depression of the Thirties before the start of the second World War, my parents were finding it increasingly difficult to fund my medical school tuition and living expenses. The Student Loan program was many years in the future, so I was ecstatic one day to find a notice posted on the bulletin board in the student lounge at NYU College of Medicine, offering free room and a seven-dollar-a-week salary in exchange for serving as house physician for the Bowery YMCA, about two miles from the school.

Hoping that none of my other semi-destitute classmates had seen the notice, I tore it off the bulletin board, dashed to a bus, then ran the remaining few blocks to the Bowery Y. Pat McDonal, one of my classmates, had beaten me there and was already in the Administrator’s Office.

My disappointment was short-lived: it turned out two positions were available, and we were both accepted.

It was my fourth year of medical school. The senior year of medical school is a fun year. Those of us who’d made it that far no longer lived in fear of flunking out. What little class work remained consisted of lectures, but most of our time was devoted to clinical duties on the wards of Bellevue Hospital across the street from the medical school. We were called Clinical Clerks, and each of us wore a white jacket embossed with a red caduceus on a sleeve. As far as most of the patients, all of them indigents, were concerned, we were doctors, even though we were still a few months from the day we would clutch to our chests the diplomas that would declare us Doctors of Medicine. We examined patients, performed blood counts and urine tests, all under the supervision of the staff doctors and residents.

The Bowery Y was located in the heart of what was then New York’s skid row. A five-story dirty red brick building, it was surrounded by equally dirty gray tenement buildings on a street littered with trash. The ground floor of the Y consisted of a large lobby occupied by a registration counter and usually a dozen or more derelicts who sprawled on the rows of wooden benches that took up most of the space. The second and third floors were combined into what had been a gymnasium: a large, high ceilinged basketball court encircled by a narrow spectator balcony. It had been many years since the gym had seen any type of sport. By the time I arrived, it had been converted into a huge dormitory, the floor crowded with rows of bunk beds. Even the balcony had been stripped of spectator seats and was occupied by as many narrow army cots as could be jammed into it.

Each night, the dormitory was packed with transients: homeless men thankful to find a place to sleep softer than the cement sidewalk of the Bowery, and protected from rain and snow and cold. Even though shelter was free, it was permeated by the odor of a hundred or more unwashed bodies, their snores, their coughs and the moans of their troubled dreams.

The basement had been converted into a cafeteria where a meal cost ten cents when the main course was chicken, stew or meat loaf, and twelve cents on the rare days when what was laughingly referred to as steak was available. A vegetable and mashed potatoes came with the main course. Coffee or tea cost an additional penny.

The upper two floors consisted of rooms flanking both sides of long corridors, each room about the size of a monk’s cell, and occupied by one or two permanent residents. The occupants were men who had jobs and paid rent of twenty-five dollars a month.

Pat McDonal and I had the only suite in the Y, two adjoining rooms, one of which was our bedroom, the other a study.

My clinical duties at Bellevue Hospital frequently lasted until early evening, after which I would take a streetcar to the Y. A small room furnished with an examining table and instrument cabinet served as our doctor’s office. For two to three hours each evening, McDonal and I took turns attending to the illnesses of any of the transient or permanent residents who needed our services.

Our patients suffered diseases ranging from colds to pneumonia, from eczema to louse infestation, from upset stomach to peptic ulcer, frostbite to heat rash. Most of the diseases were accompanied by or associated with chronic alcoholism. At least once or twice a week, one of us would be awakened at night because someone, usually one of the transients, was suffering from DTs delirium tremens─a condition of acute alcoholic psychosis characterized by hallucinations. Pat or I would rub the sleep out of our eyes and hurry down to our office to attend one of the men who sat or lay curled into a corner shaking in terror, screaming or moaning. These tortured souls would plead through dry, cracked lips for us to seal the keyhole or the space under the door to keep out the army of imaginary roaches, or rats, or fire ants that were crawling into the room. We would inject the men with a sedative to quiet them until the arrival of the Bellevue bus, the ambulance summoned to take them to the hospital’s psychiatric ward.

Although comic strips amuse readers portraying someone with DTs being pursued by pink elephants, after one of the men jumped to his death from the dormitory balcony trying to escape beasts that lived in his brain, we learned that there was no humor in the affliction

I was in my study one evening when the clerk phoned from the lobby desk informing me that I was needed for an emergency. The man I was asked to see was in his room on the floor below mine, and was too sick to come to the doctor’s office. When I arrived, ten or twelve permanent residents stood crowded in the hallway in front of the room. Those in the back row were on tiptoe, peering over the heads of those in front. I recognized Jim wearing only his BVDs, and Clay in boxer shorts, and Shanty and, of course, Eddie, the elevator operator. Eddie spotted me striding down the corridor and pushed those next to him to one side. Okay, gangway. Here comes the doc.

The door to the room was partly open, and from it came sounds like those of a wounded animal. I said, Who is it, Eddie?

Mr. Howell.

Weaving my way through the crowd, I hurried into the tiny room. Mr. Howell lay curled up in a fetal position, moaning, retching, and shaking with a violent chill. Strewn on the floor were a dozen empty medicine bottles. I picked one up on my way in; it was unlabelled. I smelled it. Licorice. Big help. I could name a dozen medicines that smelled like licorice. Mr. Howell’s shirt and vest were drenched with sweat, the knot of his tie was pulled down from his collar. Strings of mucous dripped from his nose. His trousers, always so neatly creased were now wrinkled and urine-soaked at the crotch. His legs twitched convulsively. Actually, his good leg twitched. His other leg, a peg leg, beat against the linoleum floor like a dog’s tail.

I sent Eddie to call for an ambulance, Mr. Howell was plainly too sick for me to treat. While I waited I squatted down beside him. What’s wrong?

Unintelligible sounds came through his chattering teeth. Maybe the empty bottles would provide a clue. What medicine have you been taking?

His slurred words sounded like, Paregoric.

Paregoric, I recalled, is camphorated tincture of opium, one of the most common remedies for diarrhea. I was quite sure that Mr. Howell’s condition was not caused by diarrhea.

After covering him with a blanket, I waited until the ambulance came to take him away. Hard to believe this was the same man I’d stood alongside many times waiting in the lobby for the elevator, or with whom I’d exchanged comments about the weather while Eddie piloted the rickety cage up to our floors. Under his arm he always carried a thick volume from which protruded the tassel of a bookmark. Once I sneaked a glance at the title: Philosophies of the Ancient Greeks.

All the other permanent residents of the Bowery YMCA were known only by their first names. You wouldn’t call Mr. Howell by his first name any more than you would the governor. I don’t know how long he’d lived at the Y, but he’d been there long before I started working there. The contrast couldn’t be greater between this slim, clean-shaven, clear-eyed man in his fifties, and the emaciated, tubercular transients who crowded each night into the cavernous dormitory downstairs packed with two-tiered bunk beds.

I don’t know where Mr. Howell ate, but I’d never seen him in the basement penny cafeteria. I wondered what could have brought on the sickness that changed this gentleman into a puling and puking wretch who lay writhing in his excretions. Before this, he’d appeared healthy. At least he’d never stood in the queue of grizzled, stubble-cheeked men outside my medical office, waiting to be seen. No, Mr. Howell was unlike any of the other men who lived at the Y.

One other thing made him different: his peg leg. Not a wooden artificial leg with a foot, but a peg leg that appeared to have been made out of a baseball bat with the handle end down. The stump of his below-knee amputated leg fit into a small, rounded leather bucket at the upper end of the peg. His empty trouser leg was folded in the bucket to act as a pad. A strap that looped around his lower thigh, was connected to the bucket and held the peg in place. On the bottom of the peg was a rubber crutch tip, which kept the peg from slipping on smooth surfaces.

The ambulance had finally arrived and I glanced up to see Hal Burns, the Bellevue intern on ambulance rotation, followed by his driver carrying a canvas litter.

Hal said, Another DTs?

Not this time, Hal.

He scanned the floor. What’s with the bottles?

I shrugged. Paregoric.

He furrowed his brows. You want to plug this guy forever?

Not my doing.

He briefly examined Mr. Howell. We’ll have to take him in to find out what’s going on.

They bundled him on to the litter and carried him down the stairs; the elevator was too small.

Next day, I stopped in on the Medical Ward at Bellevue Hospital where I was serving a three-week rotation on the Neurology Service. Where is Mr. Howell? I said to the ward nurse.

Transferred to Riker’s Island this morning.

Why Riker’s?

She turned up a corner of her mouth. We don’t do withdrawal here.

I mentally kicked myself for not recognizing the symptoms. During my third year in medical school, I’d visited the Riker’s Island prison hospital, a drug abuse treatment center. There, Mr. Howell would be given cold turkey treatment all drugs withheld except for some non-narcotic sedatives. He’d receive psychiatric counseling for a day or two, and be released after serving the fifteen- or thirty-day prison sentence assessed for narcotic possession and use.

I didn’t know how Mr. Howell was able to afford his habit. Most addicts, stole money or earned it as prostitutes. Mr. Howell didn’t have a job according to Eddie, nor was he agile enough to be a second-story burglar, and was too recognizable to be a holdup man. I didn’t think there was much of a market for a peg-legged male prostitute.

Four weeks after I sent Mr. Howell to the hospital, he returned to his room at the Y. I visited him and found him seated in an easy chair, a pair of crutches at his side. His peg leg was on the floor beside him. His face was thinner than it had been before he went to the hospital, but he was, as always, neatly dressed wearing a tie and vest, his shoe polished to a high gloss. On an end table beside his chair sat the ubiquitous tome.

I said, Glad to see you back.

Thanks for your help.

What happened?

Well, you probably know, I went into withdrawal.

What drugs were you on?

Morphine and heroin.

Where did you get it?

A doctor on the lower East Side. I also did some peddling myself.

That answered the question of how he supported his habit.

Then the well dried up, he continued. One of the other customers robbed and beat my supplier. He’s still in the hospital. Probably out of business for good. Going to jail.

I was curious about the paregoric; the amount of opium it contained was too small to satisfy an addiction.

Mr. Howell chuckled. When I couldn’t get the hard stuff, I went across the bridge. In New Jersey you can buy paregoric without a prescription. Trouble is, it’s mostly alcohol. In order to get enough of the opium that’s in it, I got drunk on the alcohol. It didn’t work out.

His background interested me, and he wasn’t a bit reticent in discussing it. How long had you been addicted?

About thirty years. I can thank your medical profession for getting me started. It was after my amputation. He glanced down at his detached peg leg sprawled on the floor. That was for an infected compound fracture. Every time I’d have a twinge of pain they’d order a shot. Someone forgot to discontinue it.

I was sure there was more to the story than his short version, but I didn’t press the issue. Nor did I bother to ask if he was planning to stay clean. After an addiction of that length. I supposed, like most addicts he’d resume his habit, but on a reduced, more affordable scale until he built up a tolerance for increasingly larger doses. If he couldn’t support his addiction, withdrawal symptoms would develop and he’d return to Riker’s Island for recycling.

For the next seven months my days were crammed with medical school activities. Each evening I bolted down supper in the Bellevue Hospital cafeteria, cat-napped during the fifteen-minute trip on the First Avenue bus back to the Y, where ten or more coughing and sneezing men in frayed clothing waited in line to be examined and treated. It was usually ten o’clock or later before I trudged up to my tiny fifth floor cell and propped my eyelids open while I tried to study in preparation for the next day’s classes.

Thoughts of Mr. Howell could not have been more distant from my mind that evening in late May