"An old lady died. About eighty-five years old. A private patient on Ward F, second floor."
There was a pause. I didn't say anything, expecting to be told more about the problem. Straus's breathing could be heard on the other end of the line, but he apparently had nothing to add. Eventually I spoke.
"Okay, so an old lady died. What’s the problem?"
"No problem, really. But would you mind coming over and taking a look?"
"Look, Straus, she's dead, right?"
"Right."
"Well, what do you expect me to do? Perform a miracle?"
There was another brief silence. "I just thought you'd want to see her."
"Thanks a million, old boy. But I think I'll pass it up."
"Peters?"
I'm still here."
"What do I do about the family and the paper work?"
"Just ask the nurses. They're old hands at this stuff. All you have to do is sign some papers, notify the family, and get an autopsy."
"An autopsy?" He was genuinely surprised.
"Sure, an autopsy."
"Do you think the private doctor wants an autopsy?"
"Well, he ought to, that's for sure. If he doesn't, he can turn it down. But we should get autopsies on everybody who dies here. It might not be easy, but get the family to agree."
"All right, I'll try, but I'm not guaranteeing anything. I'm not sure I'll be able to communicate much enthusiasm for an autopsy."
"I'm sure you can handle it. Ciao."
"Ciao."
He hung up and so did I, thinking once again about the yellow woman in the autopsy room in medical school. Jan interrupted me.
"Something wrong?" she asked.
"No. Someone died, and Straus wants to know what to do."
"Are you going over to the hospital?"
"Are you kidding?"
Jan was helping me pack. Actually, she was just there. We certainly didn't need any excuse to be together; we'd been spending a lot of time with each other. So much, in fact, that my imminent departure cast a shadow over the evening, although we had stopped discussing it.
The point at issue was whether I loved her enoughs— her wording — to ask her to follow me to my residency. I had implied as much many times, yet something kept me from asking straight out. What I had tried to tell her was that I wanted her to make the decision, without my direct interference. I didn't want the responsibility of forcing her to come with me. That was how I viewed it. I mean what if we didn't make it after we got to my residency? If I had forced her to leave Hawaii, then I'd undoubtedly feel bound by some sort of guarantee, and I just couldn't do that. I wanted her to come, all right, but on her own.
Jan and I had had a ball. It had been a relief to build a significant relationship with her after the debacle with Karen Christie and her screwed-up fiance. Although I had gone over to Karen's a few times after the confrontation with her boyfriend, I eventually realized that I couldn't keep seeing her. So I stopped.
The phone rang again. "City morgue," I answered, in a loud and cheerful voice.
"Peters, is that you?"
"At your cervix, Straus, old boy."
"You really threw me for a second. Don't do that," said Straus.
"All right, I'll try to be more civil. What’s up?"
"I got a call from the ICU, and there's a patient having difficulty breathing. The nurse said it was probably pulmonary edema. Apparently the private doctor is worried about heart failure."
"Pretty good nurses in there, huh, Straus? Diagnosis and all. That’s real service. Do you agree with them?"
"I haven't seen the patient yet. I'm just on my way up there. I wanted to call you in case you care to be in on the action from the start."
"Straus, your courtesy warms my heart. But why don't you hustle up there, check it out, and then give me a buzz, okay?"
"Okay. I'll call you right back."
"Fine."
Jan was absorbed in trying to fit my medical library into several trunks. It was obviously a problem of Gordian complexity requiring an equally drastic solution. I had to decide which books to leave behind — a terrible tragedy to a doctor. A lot of people appreciate books, but doctors worship them and communicate with them almost sensuously. If a doctor is at all realistic, he quickly grasps the fact that he can never match wits with his library. Consequently, he surrounds himself with books, greedily searching for reasons to buy a new text, whether he will ever read it or not. Books are a doctor's security blanket, and they were mine.
The mere thought of discarding any of my texts smacked of sacrilege — even that psychiatry text, or the one on urology. Urology wasn't my favorite specialty, by any means. I frequently wondered how anyone could spend the rest of his life fooling around with the waterworks — although the field couldn't be too bad, because urologists seemed a pretty happy group, on the average. Undoubtedly they had the best repertoire of dirty jokes.
"You're never going to get all these books in here," said Jan.
"Will, let’s take them all out and start over. In fact, let’s try to stand them up rather than lay them flat." I showed her by propping up approximately forty-eight pounds of Comprehensive Textbook of Psychiatry in the corner of the trunk. Then the phone rang again. It was Straus; his voice carried a sense of urgency.
"Peters?"
"What’s wrong now, Straus?"
"You know the patient I told you about before, the one the nurses thought had pulmonary edema?"
"What about him?" "Well, I think he does have pulmonary edema. I can hear bubbling rales with my stethoscope up both lung fields almost to the apices."
"Okay, Straus. Calm down. Did you telephone the resident on call?"
"Yeah."
"What’d he say?"
"He said to call you."
"Oh, fine." I hesitated, collecting my thoughts. "Is it a private patient?"
"Yes, Dr. Narru, or something like that."
"Is it a teaching case?"
"I don't know."
"Well, check, Straus." I played with the bell of my stethoscope while Straus left the line. Jan was making good headway with the books; it began to appear that she would get them all in.
"Yeah, if s a teaching case, Peters," said Straus.
"Did you call Dr. Narru?"
"Sure. I did that first."
"What’d he say?"
"He said to go ahead and do whatever was necessary, that he'd stop by later and check on things when he made his evening rounds."
With my index finger, I tipped my watch over so I could see the dial. Five after eleven. Either Narru was putting Straus on or he really did make late-evening rounds — very late. Somehow I couldn't imagine that.
"Jan, why don't you put Christopher's surgical text in before those little books? Just a minute, Straus. Christopher's is that big red one. That’s it." It was going to be close. "All right, Straus, what kind of surgery did this fellow have?"
"I'm not sure. Some sort of abdominal surgery. He has an abdominal dressing."
"Does he have a fever?"
"A fever? I don't know."
"Is he on digitalis?"
"I don't know. Look, all I've done is listen to his chest."
"Did you listen to his heart?"
"Sort of."
"Was there a gallop rhythm?"
I'm not sure," he said evasively.
Good God, this guy is really eager, I thought sarcastically. "Straus," I said, "I want you to examine the patient, keeping in mind three possible diagnoses — pulmonary edema, which he probably has, pulmonary embolism, and pneumonia. Read the chart and find out about his cardiac history. Meanwhile, get a chest film, a complete blood count, a urinalysis, an EKG, and anything else you think you want. Is he very stuporous?"
"No, he's quite alert."
"Okay, then give him 10 mg. of morphine and put him on oxygen with a mask. But be sure to watch him carefully when you first give the oxygen. Then, when you get everything organized, call me back."