Love Stories. Will be travelling Monday.

Here are two of the love stories that I have witnessed that are most memorable.

Patsy

I was the third year medical student and Russ was the intern. The interns and students were divided into teams who rotated the handling of admissions of new patients to the hospital.  The admission process generally took a couple of hours with a complete history, discussion with the family if they were available, obtaining xrays and EKGs, and performing basic blood tests, such as the hemoglobin and white count.

Russ and I were called in turn to the emergency room that evening about 9:30. When we arrived, we were given charge of an unconscious middle aged female who had arrived about 90 minutes prior by ambulance from her home. We didn't know her, but from the emergency room chart, her name was Patricia T.

There was very little history, only that she had been well earlier in the day. Her husband was on the way to the hospital and was expected momentarily. The neurosurgeon had already been there and was lighting his ever-present cigar as we entered the small office near the x-ray department. He had tried to do an arteriogram but her blood  pressure was too high. He said that he would be happy to try again if we could manage to reduce her blood pressure.

This was 1968 at Baltimore City Hospital. There were no routine arterial blood pressure lines.  We took the patient to a treatment room and hung an Arfonad drip, a powerful nervous system blocker that could lower blood pressure very quickly and very dangerously.  As the student, my job was to take blood pressures every minute while Russ adjusted the IV rate by hand. There were no IV machines to allow accurately increase and decrease the dose of the drug by small increments.

It was hard work blowing up a manual blood pressure cuff on a heavy woman with a blood pressure that was out of sight. My hands were tired within fifteen minutes.

Our patient lay there, snoring very loudly. As I worked I became more aware of her. She smelled unwashed, the curious mixture of sweat, grime and musky female odor that is well known to all of us who have trained in inner city poverty areas. Her hair was oily and there were scaly flakes of dandruff hanging to strands of hair with a few bits embedded in her eyebrows. Her facial features were coarse with large pores and numerous blackheads in the creases around her nostrils and in the concave portion of her ear above the lobe. She wore no makeup or lipstick. When I adjusted her oral airway I saw that her teeth were very yellow but relatively healthy appearing.

Upon her arrival in the emergency room, her clothes had been cut off.  A large printed mu mu had been removed and that was lying on top of other garments on a chair to the side of the room. As I worked I noticed several food stains down the right front of her dress. They were oily with relatively clear areas surrounding particulate, darker centers. In addition there were a few small through and through holes from cigarette burns. Although I can't remember all of my thoughts, I do know that I regarded her with the same detachment that I viewed most of the unwashed humanity that were part and parcel of the medical school teaching experience in inner city Baltimore.

Russ and I both knew that things were hopeless for our patient.  She had experienced some form of intracerebral catastrophe, most probably a bleed from an artery. The high systolic pressure of more than 300 mm of mercury (300 was the highest reading on the cuff) had been a part of the original picture or had followed closely after the irritating effect of the bleed. Even as we worked , blood was probably continuing to seep out of the artery, increasing pressure on the brain and competing for the limited space within the skull--pushing the brain aside and increasing the pressure on the brain itself.

We repeated the cursory physical examination. She remained unresponsive to command or pain. Russ relieved me as her stertorous breathing began to change and she switched over to Cheyne-Stokes respirations, a curious form of waxing and waning of inspirations that indicates that death is very close.  Her blood pressure began to bottom out. When we backed off the Arfonad, it shot back up. When we increased the IV speed, her blood pressure bottomed out again. We were unable to find the therapeutic window, the appropriate rate of drip that would give her a reasonable blood pressure.  

She stopped breathing within an hour of the time that Russ and I had begun to work. We looked at each other, both exhausted and sweating profusely in closeness of the treatment room.

With the death of our patient, it fell upon us to try to piece together a more complete medical history from the family. In addition, it was our job to obtain, if at all possible, permission from the family for an autopsy.

Russ and I sat in the little conference room adjacent to the emergency room and waited for the husband. He arrived alone, crying. His gait was shuffling and stumbling, perhaps the result of cerebral palsy.

“I’m Jacob,” he said.

He was wearing khaki work pants and a light colored shirt, both of which were quite dirty. As he spoke we realized that he was probably mentally retarded. We had to tell him that his wife was dead. I’m sure we used the standard litany of ineffective forms of medical comfort such as “We did everything that we could. We’re so sorry we couldn’t do more.” He began sobbing, and shaking with the force of his tears. I’m ashamed to say that Russ and just sat there, not really knowing what to do.

Suddenly, an elegant middle-aged woman swept into the room. She reminded me of a very well-dressed Ann Bancroft. She immediately went to Jacob and hugged him, ignoring the mucous and tears spilling over her beautiful blouse.  Lovingly she sat him down and put her arm around him. He nestled his head into the space between her shoulder and neck.

She said “My sister was normal until she was eight and She got measles. Her brain was affected and she was never the same. My parents did what they could. They sent her to special schools but she was never able to read or write. Then she met Jacob and they married. They have been together for almost 30 years.  Inseparable. Today they went out for an ice cream cone and when they came home, Patsy passed out. Jacob went to the neighbor who called the ambulance. You know Jacob was wonderful to my sister. They were so much in love!”

A stained mu mu, the sound and smell of Patsy on her death bed, and Jacob crying on his sister-in-law’s shoulder  and a sense of awe looking back upon that scene.

May Kiel

My great grandfather, Benjamin, was a rogue.  At 19 he married a woman 8 years his senior and after four children in quick succession, he ran off and travelled as a hobo around the United States. Although of Austrian descent,  he acquired an Irish brogue which he used to good affect for the remainder of his life.

When he left his family, the children were placed in a Catholic orphanage. When he returned home two years later, he reunited with his family. Unfortunately, this was only a temporary respite in his travels and he was off again, finally returning at the age of 27.

Upon his second return, he stayed put for life. He obtained a job in the Mohawk Carpet Factory in Yonkers,  New York, and he shoveled coal into the boilers for the next 40 years.

He was a handsome man.

Here he is on his 80th Birthday

To all he was called "Pop." His wife, "Mom."  Given his history as a rambling man, it is not surprising that Mom devoted the rest of her life to her children, particularly the only son, also named Benjamin, and to my father, the only male grandchild. 

My father told me that he would often go out with his grandfather. Mom would always say “Just one drink, Ben” to which Ben would nod assent. And sure, enough, he would only have one drink, but it was a jelly glass of whiskey, not a shot. My father said he was a teenager before he understood what was really happening.

Mom died in 1945. Two years later, Pop took another bride, May. Most of the family, my father included, disapproved of her. The family considered her too coarse. She was  lacking in people skills, was painfully direct and to the point, was a terrible cook who overlarded everything. But she was devoted to Pop and tolerated no criticism of him by the children.

Pop and May moved away from Yonkers (and Pop's family) when he retired from the carpet mill. He had not worked the sufficient amount of time to draw Social Security and had the most meager of pensions. The newlyweds bought a few acres that contained an old gas station on a back road of Kingston, New York. Some time in the 20’s or 30’s a new highway had been put in and this old road was too infrequently travelled to support a business. The gas station had been left to deteriorate.

Pop cleared the few acres and they began to renovate the gas station itself.

There was no running water. There was a pump in the kitchen sink. To flush the toilet, you filled a bucket from the sink and poured it into the commode. To take a bath, you pumped the water and heated it on the stove. To call it a modest abode is a gross exaggeration. While clearing stumps, Pop had a heart attack. He never lifted anything heavier than a glass or fork after that time. No wonder May had such lumpy arm muscles what with all of the pumping and lifting for them both.

There was also the remnant of the island that one sees in gas stations, the place where the pump goes. The pumps were gone but there was a pipe that extended up from the island for about 6 inches. It was capped off. May had put some plants around to sort of hide the island...but it was clearly visible.

In 1961 I hitchhiked up to Kingston from D.C. to visit them during the Easter recess of my senior year of high school. I’m not sure if my parents knew that New York was a state that permitted alcohol sales to 18 year-olds but I sure did. I got to hang out with Pop and May in the day and listen to stories and go to the bar at night. Sometimes I went twice a day. The bar was three miles away, so I got plenty of exercise.

Pop was dementing. His story telling was no longer sharp. He dozed off a lot and he was taking heart medications as well.

One morning Pop was looking out at the pipe from the island and  he said “May. See that dog out there. He looks hungry.” 

I didn’t see a dog. May didn’t see a dog. Pop was hallucinating. We ignored the comments at first, but a few minutes later…”May, that dog looks really hungry.”

I was amazed when May gathered some breakfast scraps and put them in a bowl. Then she went outside and set the bowl in front of the pipe. I watched Pop as she did so. He was nodding his head.