Bad Blood

I had to give my supervising resident, Dr. Robin Richards, the bad news. This was no way to meet him. I picked up the phone, paged him, and waited. The more experienced and confident the resident, the longer you could expect to have a call returned. The phone rang and I answered it.

“Don’t ever answer that phone. That’s the secretary’s job.”

Sarah Shiflette, the nurse coordinator, stared at me and shook her head.  A couple of years younger than me, she oozed authority, her skin, olive and smooth, her walnut-brown hair long and pulled back with a no-nonsense plastic clip. Her glossed, thick lips were, I assumed, collagen-injected.

“I’m sorry. I’m expecting a call back.”

“From whom?”

“Dr. Richards.”

“Then you’ll wait a long time. Never answer the phone before a unit secretary. It pisses them off and makes you look like a stupid, anxious intern. Calls are usually for somebody else anyway, and then you have to play receptionist.  That’s not doctor’s work.  You’re a doctor, not the unit assistant.”

“Sarah, I won’t do it again.”

“And another thing. You can call me Ms. Shiflette, or Nurse Shiflette. People call you doctor, even though you’re only an intern. You’d be offended if they called you Dave.”

“I never thought about it.”

“Nobody does.”

The phone rang.  The secretary answered it, and called out, “Dr. Richards.”

I picked up the receiver. “Dr Richards?”

“Yeah,” he said with a Brooklyn accent. I could hear his lips smacking as he ate and talked, then the slurp of some liquid.

“I lost a patient,” I said.

The chewing stopped then he yelled, “Why didn’t you call a code for Christ’s sake?”

“I’m not sure if he’s dead.”

“If you’re not sure, call a code anyway.”

“I lost him.” My voice failing. “I mean, I really lost him. I can’t find him. He’s not in his room. I checked his closet. I looked in the pantry. I asked the nurses, but they hadn’t seen him. He’s not signed out. He left his hospital clothes on the bed.”

“God damn, Larco, which patient was it?”

“Some guy named James Putnam.”

“Oh, Jimmy Boy. It’s okay, he just escaped again.”

“What?”

“Escaped, he’s demented.  He thinks it’s World War Two and we’re the Germans and it’s his duty to escape. He was a cook or something in the Army. What floor are you on, Larco?”

“Barringer Three.”

“Stay there.”

*     *     *

Eventually Dr. Richards showed up, a Styrofoam cup of coffee in his hand. How he could drink coffee in this anxiety-ridded, steam bath of a hospital was beyond me.

He approached me and said nothing. He looked me up and down and led me into a conference room, still not talking. Short and stubby, he wore a bow tie and Gucci loafers. He pulled out a pack of Marlboros, tapped out a cigarette, and lit up. The tip glowed stovetop orange and, however minutely, added to the July heat. He filled his lungs with smoke and exhaled and talked simultaneously: “Dr. Larco, the skin man. You’re with us for only one year, and then you’re back to Boston to do dermatology, pimp medicine. I heard about you. How come you’re here?”

“This is one of the few places that still have a rotating internship. My derm program requires it.”

“Too bad. I’ll teach you so much this year, and you’ll leave, do derm, and never really be a doctor. You’re smarter than you look, Larco. Anyway, this year you get to take care of James Putnam; he’s a lot of fun.  He claims to be a war hero. A celebrity. He’s disoriented to person, place, and time.  Come here.”

He motioned for me to step to the window.

“See that lunatic, the tall thin black man?  He’s preaching on the corner. That’s him, your patient. Go and get him and bring him back. Don’t let the Chief see him on the street; you don’t want to get on the bad side of the Chief during your first week as an intern. He could throw you out, and then your skin man days will be over. No mega-bucks for Larco.”

“How do we get him back into the hospital?”

“What do you mean ‘we’? He’s your problem.  Now go get him, and bring his ass back before security spots him. They can get a little rough. They’re police wantabes. They don’t think anything’s funny. When you get him back, put him in four point leathers, and increase his dose of Haldol.”

“We can’t put people in restraints anymore,” I said.

“Bullshit.  More people have died because the Feds won’t let us restrain them. When he’s in bed at night, it’s four point leathers or he’ll be back on the street.”

*     *     *

I ran down the steps and into the heat. In front of the hospital, near the neoclassical gates of the University, Putnam was giving a sermon to the passing crowd. He stood at the top of the marble steps that led to the student union. He wore black wool pants, a white short sleeve shirt, and a thin black tie.  He had grey hair, a short patchy beard, and bad teeth. Most of the students ignored him. Some smiled. Young kids laughed at him and mimicked him.

“Open the book to Jeremiah, chapter fifteen,” he shouted. His body jerked as he emphasized each down beat in his sermon’s rhythm, and the kids imitated.

“Jeremiah was worked hard by the Lord. Hey.”

The kids shouted, “Hey-yah.”

It was call and response.

“Amen,” he replied. “Jeremiah asked, ‘Why me? Why do I have to take all this travail?’” He raised up his arms to the sky, then threw his head back. “‘Why do I have to take all this punishment, Lord?’ Heyah.”

The kids laughed and repeated, “Hey-ah.”

“Because Jesus is the Lord. Amen. Because the Lord has you on the Potter’s wheel. Amen. Because the Lord has you on the Potter’s wheel. Molding us with adversity. Amen. It is by adversity that God molds you, on the Potter’s wheel. Amen. Then you can be washed in the blood, so you can be saved by the blood. Amen.”

I was the only one watching him now. He noticed me, wiped the sweat off of his face with a handkerchief, and said, “Who you?”

“James, I’m your new intern, David Larco. Will you please come back to the hospital with me?”

“Sure, sure. I’m captured. James R. Putnam, 99th Fighter Squadron. The Red Tailed Angels. Can my wife come with me?” He leaned in toward me. “I get lonely when she’s not with me.”

“Sure,” I said. “Where is she?”

“Right here. Mary, say hello to Dr. David Larco.” He had his arm around an imaginary waist. “Dr. Larco, say hello to Mary.”

“Hello Mary.”

*     *     *

Dr. Richards was waiting for us as we entered the hospital.

“Jimbo, back to your room,” he said.  “Hello, Mary, you look swell today. Nice hat.”

James said,  “You know she isn’t wearing a hat today, Dr. Richards. It’s too hot. Don’t make fun of her.”

“Sure, James. Anything you say.”

James saluted Richards and headed towards his room. I followed.

“James,” I said once he and I were inside. “I have to examine you and get some history on your condition.”

“Can my wife stay with me?”

“No, I should take your history and examine you alone, like we do all the other patients.”

“Then the answer is no. You’ll find I’m not like all the other patients.  Mary stays with me. We were separated once, twenty years ago, and I couldn’t stand it. I went crazy, right Mary?”

“That’s right,” he answered for her.

“It’s okay, Mary, you can stay here,” I said.  I had to take his history and discover what combination of drugs, disease, or alcohol had gotten him in this condition. Maybe I could come up with something and cure him, untangle everything. I’d be able to rest on my laurels for the year, then the derm residency. Now I was being delusional, though not as nervous.

“Jimmy,” I said. “Let’s get started.”

“James,” he said.

“What?”

“The name is James. Jimmy is a fool’s name, like Jim Crow. And there ain’t no Jim Crow in me, right, Mary?”

“Indeed not,” he said for Mary.

“And,” he said as himself, “in your doctor’s notes refer to me as a gentleman of color, not black. I used to get into fights when people called me black.”

He whispered in my ear, so Mary wouldn’t hear. “Don’t call Mary black, colored, or African American. She’s octoroon. She thinks it’s the perfect mix for a female. So do I, look at Nurse Shiflette.”

I heard a laugh. It was Sarah.

“I’ll leave you three alone now,” she said. Her eyes caught mine and she whispered, “You be gentle with that man. He’s had a hard life.”

“James, let me ask you some questions and examine you,” I said. “Let’s start with where you live?”

“Mary and me, we live alone in the little house near the Holmes. Dr. John Holmes. Now there was a man. He was my doctor for years. I’d come to his office and bring him the pippins and brandy.”

“What’s a pippin?”

James laughed. “Pippin’s an apple. I grew the King of Pippins, the Albemarle Pippin, invented by Mr. Thomas Jefferson. My trees came from Monticello.”

“Never heard of them.”

“Don’t expect a Yankee to know about them. Most folks have forgot about the Albemarle Pippin. They’re a yellow apple. The markets think an apple must be red. But  they snap when you bite them, and they’re sweet.”

“What about the brandy?”

“The brandy’s from the pippins.  Used to make corn liquor till the Klan found me out. I served my country and fought the Germans, but when the war was over, I came back home and the Klan burns a cross in my yard and tells me next time it’s a lynching unless I get out of the corn liquor business.  So instead I make brandy from apples. I made more money with the apple brandy, selling it to the fancy white restaurants in Washington. The Klan kept making cheap corn liquor and got into it with the revenuers. Revenuers are meaner than poachers, and better trackers. The government men finally got wise and followed where the sugar went. Apples don’t need sugar, so they couldn’t trace me. Joke’s on those crackers.”

“Were you really in the army?”

“Air Force.”

“Air Force?”

“I flew planes for the United States of America. I flew fighter escorts. The Germans would see the blood red paint on the tail of my plane, and they’d scatter like crazy bees. Nobody messed with the Tuskegee Airmen. We flew two-hundred  missions and didn’t lose a plane.  Our formation was  wing tip to wing tip like crosses. Big flying crosses and we crucified them.  The white pilots loved us.”

“Hold it,” I said. “You were a Tuskegee Airman?”

“As God is always my witness.”

I examined James. He flinched back abruptly as I shined my penlight into his eye. He was sensitive to light. His pupils did not constrict. They accommodated, but would not react to light.

He continued with war stories: “Sank a German destroyer with my machine guns. No bombs, no torpedoes. Got the Distinguished Flying Cross.”

I tapped below his kneecap with my rubber mallet. Nothing no reflexes. Nerve damage.

“After the war I couldn’t find work, so it was back to the moonshine business. I’d load up the truck with barrels of apples, but some of the barrels were filled with brandy. Mary and me would drive that old truck with the wood panels and sell the apples and brandy in Washington, D.C. The money was flowing in, and Mary and me would get ourselves the fanciest room in the best colored hotel.”

He smiled, his lined face, smoother.

“Though Mary, now Mary could pass. Never tried. She thought it would make me feel bad. But we’d have a ball right there in the Nation’s capital.”

“I think I’ve learned enough for one day, James. And, James, please don’t try to escape. They’ll blame me.”

“You’re a good boy, Dr. Larco. If you let Mary stay, then I stay.”

“Deal.”

*     *     *

I went to the university library and did a search on The Tuskegee Airmen. I read books and old newspaper clippings. I obtained rosters, lists of dead and wounded, but  there was no James Putnam.

I went to the hospital records room to pull James’ charts. I had a hunch. I could find nothing to add to the history I had taken a few days earlier.  I came upon the autopsy record of Mary Putnam. It was a violation of confidentiality, but I couldn’t resist. Mary’s autopsy showed that of a fifty-year-old “mulatto female” who died twenty years earlier of a ruptured aortic heart valve. The autopsy was done by doctors from the Public Health Service, not the staff of the University. That was odd. The Feds should never have been involved unless something big was going on. Looking through Mary’s records was now a federal offense.

I decided to write the Air Force to get James’ medical records. I forged his name on the release papers.  This was a long shot. I indicated that it was a medical emergency, and they sent his records to the hospital. Another federal offense.

The records validated some of his story. He had been a Tuskegee airman, but was released in six weeks because of “bad blood.” He was sent to the black only Tuskegee Veteran’s Hospital.

Bad blood, the Tuskegee Veteran’s Hospital, Public Health Service, ruptured heart valves: now it all made sense.

*     *     *

A day later, James’ lab work came back. On the VDRL slip was printed the word POSITIVE.  It gave me the same feeling as the time I drew blood from a Jewish patient and saw the crude, blue-black, spidery numbers tattooed on her forearm. You only need to see that once and it stays with you for life as indelible as the ink. Doctors were involved in that one, too. I was sure James had untreated latent syphilis.

I told Richards.

“How do you know he has syphilis?”

“His VDRL is positive.”

“Larco, what am I going to do with you? Most old people have a positive VDRL. It means nothing. The test is non-specific.”

“I also checked the FTA-ABS and it’s positive. It confirms he has syphilis.”

“Oh, shit. He’s had syphilis for years; he has neurosyphilis, general paralysis of the insane. Frontal lobe signs, delusions of grandeur. Of course. This is fabulous. We’re a good team, David. This will make me chief resident. We need to do a spinal tap.”

“There is more to it than just syphilis. He is a survivor of the Tuskegee Syphilis Study.”

“You sure?”

“It’s in his records. His wife’s autopsy was done by the Public Health Service.”

“So, James really is a celebrity, sort of like the last surviving Confederate war hero. Only they won’t be parading him around on Memorial Day. The study ended quite a few years ago, in the early seventies. He’s probably the only one left. Most of our politically correct professors were in their prime when the study was on going. The results were published repeatedly in medical journals. They can’t plead ignorance.  They won’t like this. Old Dr. Holmes was a civil rights marcher, and he was James’ doctor for years. But he missed it. If I reveal it properly, it can make my academic career.  We need to do a spinal tap, show those spirochetes are still in his brain after forty years.”

“There’s no reason to do a spinal tap. We can assume it’s in the brain. A spinal tap would frighten him. He won’t come back.”

“If he doesn’t come back, so what? Remember, there’s no patient like no patient. But this is such a great case. Have you ever seen a syphilitic brain at autopsy?”

“No,” I said.

“It’s cool. The syphilis bacteria act like microscopic corkscrews. They tunnel through the brain. I bet James’ brain looks like an ant farm. We need to do the spinal tap. If you don’t do it, I will.”

I knew he would. I knew he would not be gentle.

“Okay,” I said. “I’ll handle it.”

“Do you think you can do the tap?”

“Sure,” I said. “I’ve already seen one.”

“Sure, Larco, his spine is so old, I bet you don’t get squat. You’ll have to shove the needle through bone to get at the fluid. Your medical school didn’t have a veteran’s hospital. You had nobody to practice on. It’ll be a bloody mess.”

“I can do it, I’ll have Sarah help me.”

“You got a thing for Sarah. I mean, nurse Shiflette. Nice-looking, great body and those lips, God what she could do with them, but she’s untouchable. She’s ice.”

“I don’t have a thing for her. She’s the best nurse around, that’s all.”

“Don’t try to hit on her. She’ll write you up for sexual harassment. The hospital hates that more than malpractice. Can’t defend it.”

*     *     *

I approached Sarah at the nurses’ station.

“Sarah,” I said. “I need a lumbar puncture tray.”

“For whom?”

“James.”

“He’s already had his dementia work-up. He doesn’t need a tap. He has Alzheimer’s.  That asshole Richards put you up to this.” Her dark hair fell across one eye.

“He has syphilis. I have to do the spinal tap before he’ll let me treat him.”

“What?”

“He’s had syphilis for forty years. The doctors knew it but didn’t treat him.”

“The University doctors didn’t treat him?”

“No. Remember the Tuskegee Syphilis study?”

“Yes, it happened in Alabama.”

“James was in the study. They didn’t treat his syphilis; they told him he had bad blood.”

“Not him,” she said.  “It was big news back home. Bad blood, I haven’t heard that term in years.”

“So, James ended up as an untreated Guinea pig. They weren’t thinking,” I said.

“They were thinking,” said Sarah. “They needed a way to grow the syphilis bacteria so they could develop the VDRL test for a mass market. They blamed the study on the South, but it was strictly a Federal program. They made a lot of money with the VDRL test.”

“They could have grown the bacteria in rabbits,” I said.

“Too expensive,” she said. “You have to feed them.”

“Richards wants me to do a spinal tap so he can prove it’s in his brain. He wants to present him at Grand Rounds.”

“If James sees that needle, he’ll bolt. He won’t come back.”

“I have an idea. I can fool Richards. Order the spinal tap tray.”

*     *     *

The tray came up and we went into James’ room.

Richards came in.

“Hurry up Larco. Do the tap, then get down to the emergency room. There’s a train wreck down there, you’ll need to do a lot of scut work for me.”

“What kind of train wreck?” I asked.

“Some guy attempted suicide. Shot himself in the stomach.”

“Gunshot wounds should go to surgery.”

“That’s what I said, but the guy used a .22, missed all the vital structures, and the bullet came out his side. All he needs is a tetanus shot and some antibiotics. He comes to us. I’ll tell him to use a shotgun next time. Let me do the tap on James. It will be over before he knows what hit him.”

I had to get rid of Richards. “Robin,” I said. “Go back to the E.R. The spinal tap is an intern’s procedure. I’ll tell the Chief you’re stealing procedures  from the interns. Compromising my educational experience.  Now leave me alone.”

Richards glared at me. His pager went off, and he left for the E.R.

“We don’t have any spinal fluid,” said Sarah. “He’s going to want to see the spinal fluid.”

“Spinal fluid is clear. I’ll put water in the vials.”

“Water is clear. He knows you’re not that good an intern yet.”

I put the three vials in a row and poured water into them. I looked at the fluid. I had to make this work. I took a lancet and jabbed my finger. I milked the blood out of the wound and placed three drops of blood in the first vial, two drops in the second, and one in the third, since a traumatic but successful spinal tap would show diminishing amounts of blood in each successive vial.  The fluid was now cloudy, the first vial reddish. I went to the E.R. and showed the specimens to Richards.

He swirled the specimens up to the light.

“Pretty bloody, Larco.”

“Well it wasn’t easy.”

“Now go tell him he has syphilis so we can treat him and present him at Grand Rounds.”

“I don’t want to treat him. His life is as good as it’s ever going to be. It’s too late. I don’t want to show him off at Grand Rounds. If we cure him, he loses everything. He will realize he’s not a preacher, nor a war hero, and that Mary’s dead and the syphilis he gave her, killed her.”

“If we present him at Grand Rounds and tell our professors we didn’t treat him we’re going to look like fools. We’re doctors. We diagnose, we treat, and occasionally, we cure. If the patients can’t handle a cure, too bad. If we withhold treatment, we’re making the same mistake they did forty years ago. Give me the God damn penicillin.”

“Richards, don’t you see? The bacteria tunneled out his bad memories, and preserved his good ones. Let it be.”

“Larco, you’re as crazy as Jimbo.”

He grabbed the syringes from me, which I knew he would, and went into James’ room. I heard him say, “James, you need a shot. Now drop them and bend over.” Then I heard two shrieks of pain. Richards walked out of the room, nodded toward me, and threw the needles away.

For several weeks, then months, we observed Mr. Putnam. He never came out of his wonderful parallel universe dementia.

Richards never learned I put water in the vials for the spinal fluid – –  and in the penicillin syringes.

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