The Recidivist

“Hello,” I said. “Dr. Larco, Metropolitan Kidney Dialysis. Dialysis without violence.”

“Larco, it’s Sweeney, from the network. What’s this dialysis without violence?  What’s that say about the rest of us?” I pictured his fat hand covering the receiver and heard him whisper, “God damn smart ass. He’ll get his now.”

“Who you calling smart ass?” I asked.  “You know what it says about the rest of you.”

He was one of the doctors who sold their dialysis patients to a for profit chain for lots of money.

“Listen, Larco, you better stop talking like that,” he said. “I’m in charge of the network.”

“You sold out and bought your position,” I said. “You kept billing patients after they died to float the money and show more profit on the books.”

“Your just jealous. You still have to work. You know what my call is about?”

“No,” I lied. I knew he was going to dump a bad patient on me.

“You have to take Dempsey Curtis.”

“No way. That guy is scum. My kidney center is too small to absorb a patient like that. Give me a couple of schizophrenics instead, not Curtis.”

“You’ve dodged the network too many times.  It’s your turn to take a bad one,” he said.

“I’m small. Give him to one of the chains. The big dialysis outfits can absorb a patient like that. You guys went along, took the pay off while they built a monopoly. They have the resources, security, and metal detectors.”

“You should have sold out like we did. You could have been part of the monopoly.”

“They’re bigger scumbags than Dempsey.”

“Dempsey’s yours or you’ll be sanctioned. He is the worst we’ve had in a while. He would have died in prison if he didn’t get sick. Now he can die in your unit. Anyway, check him out on the offender registry. And, by the way you can still sell out to the dialysis chains. It’s sixty thousand per patient–you have eighty patients; do the math.”

“I don’t buy and sell people. What’s your cut?” I asked.

He hung up. His cut, I already knew, would be ten percent.

When a patient bounced around dialysis clinics, they were either a drug addict or violent. I found Dempsey in the state offenders registry. He was both. After five years in prison on a drug charge he lasted six months only to be sent back for the murder.  He got seventeen years for second degree. He’d been out now for seventeen years. Evidently, he was violent, but not calculating.

Dempsey was on home hemodialysis, which meant he was not stupid. He managed his own dialysis and was responsible for his care. I would have to accept him and have him come to the office monthly to pick up his dialysis supplies. I worried that once my patients saw him, they would find another doctor.

* * *

Monday came and I met Dempsey. He was white, but dressed in black FUBU warm-up pants, a black turtleneck sweater, black bandanna– and the tattoo.

The left side of his face was tattooed. I thought it was a dragon but it turned out to be a snake.  It curled around his lower jaw, up his cheek, and encircled his eye. Green, yellow, and red. Mouth open, fangs exposed.

“What you looking at?” he asked.

“Nothing.”

“Bullshit, Doc.” He pointed to the tattoo. “I got it before I went to prison. Thought it would keep the boys away.”

“Did it?”

“No.”

“I’m sorry.”

“Not as sorry as the guys who did it.”

“Who would mess with you?” I asked.

“I wasn’t always like this. I went in a skinny kid. I thought the tattoo would keep people away. Problem was, in prison nobody gives a damn.”

“Mr. Curtis, step into the office so I can take your medical history and do a physical exam,” I said. “It’s routine.”

He looked at the yellow paper examination gown I handed him, then at me. He pointed at the latex exam gloves.

“Doc, you’ll keep your hands off me. When you have nothing, respect means everything. You’ll have to earn mine. Now give me the supplies, and I’ll get out of here.”

“There are several boxes, and they’re heavy. I’ll help you.”

“Do I look like I need help?”

Dempsey was built prizefighter strong. Large, veined forearms, thick biceps.

“No. You look like a middleweight champ.”

“That’s no joke, Doc. I won the prison middleweight boxing championship.”

Dempsey took his supplies and left.

Our nurse manager, Amy, walked in and asked, “How did your meeting go with Mr. Curtis?”

“So-so,” I said.

“Why would he tattoo his face?”

“Ward off evil.”

“He is evil.”

* * *

A month later Curtis came back for his appointment. Since he was on home dialysis, we would only have one encounter per month. I tried to schedule his appointments during off-hours.

“Hello, Mr. Curtis. Amy will take your blood pressure.”

He took off his jacket, his black sweater. He was ripped, stomach muscles perfectly arranged. Amy began to place the blood pressure cuff on his left arm, but pulled back when she saw a long, ropy scar.

“Use his right arm,” I said.

“Don’t worry about it, Doc. My blood pressure’s the same in both.”

“How did you get that scar?”

“Those sissies could fight.”

“Dempsey, you’ve had it rough,” I said.

“How would you know?”

“Just from what you have told me.”

“I had to fight all my life. When I was nine years old, people would lay in wait for me. I stopped going to school in the third grade.”

“You never learned to read and write?”
“I learned in the penitentiary.”

“What did you read?”

“Everything.”

“Would you like to see our library?”

“Yeah.”

I took him to the back of the office and showed him our medical library.

“Damn,” he said.

He walked slowly along the bookshelves, reading and whispering the titles to himself.

“All of them about medicine. That’s power, Doc. Can I read in here?”

“Sure,” I said.

I went back to seeing patients. As usual, I was overbooked.

Soon Amy approached me and said, “Go to the library.”

Dempsey was at the library table. His face was close to the page of a medical textbook, his index finger following the words, keeping his place. His lips moved as he read.

“Dempsey, you’ve been here all afternoon?”

“I guess so. I lose track of time when I read.”

“Do you understand what you’re reading?”

“Doc, I did the same thing in the penitentiary, only it was law books. The law is much tougher than medicine.”

“Take a few books home with you,” I said.

“Thanks.”

He took a medical dictionary and a pharmacology text.

Amy examined an open book.

“Oh, that’s gross,” she said.

“What?”

“He reads with his fingernail. You can see scratch marks where he reads.”

“His eyes are probably bad from boxing.  I’ll send him to an ophthalmologist. Most of those books are out of date anyway. Nobody reads them.”

“Nobody would want to read them now.”

* * *

The service that was to deliver Mr. Curtis his dialysis supplies called me to say they refused to deliver in Dempsey’s neighborhood. It was a dangerous area of drug dealers and gangs.

“You have to deliver his supplies,” I told the owner of the service. “What’s he supposed to do, die?” I asked.

“Not a bad idea. That guy’s a killer. I’m not sending another truck into that neighborhood. One guy was almost killed in a drive-by. He’s suing me and I don’t blame him.”

“How’s Dempsey going to get his supplies?”

“I’ll drop them off at your office and you can figure out a way. Sorry, Doc but that’s the way it is.”

“Damn,” I said and hung up the phone. Then I called Dempsey.

“Dempsey, this is Dr. Larco. The company won’t deliver to your home anymore. It’s their new policy.”

“It’s bullshit. They won’t come to this neighborhood because it’s poor.”

“They say they won’t come because of the crime.”

“Same thing,” he said. “I can’t get to your office. I don’t have a car.”

“I’ll drive supplies out to you,” I said.

“What’s that?”

“I’ll drive them to you. What’s the address?”

“Six fifty-five Brewster.”

“Okay. I’ll be there in a few hours.”

I hung up the phone and put the address in Map Quest. I loaded up a week’s worth of dialysis supplies into the Hummer, then decided a month’s worth would be a better idea. I took the expressway down to Five Mile. I never got off on Five Mile. Nobody did.

I drove past once elegant brownstones. Now most of them abandoned wrecks of burned blackened walls and charcoal-scaled skeletal frames.

The graffiti changed from the Aryan Nation, to the Latin Kings, to Crips and Bloods. I turned on Brewster and saw Curtis sitting on the curb. He stood as I pulled in.

“Doc, you came.”

“It’s about respect, right? Let’s get the truck unloaded.”

“Doc, you unload it and I’ll guard it. That’s what I told the deliveryman. But he   drove off. Take the stuff up to the third floor. The door is open.”

I walked into the building. The boxes of supplies prevented me from watching my step. I was afraid of falling. I saw a yellow light at the top of the third floor. The outside of the door was painted green. The number six was hand-painted poorly on the door. The smell of mold and dampness became stronger. I walked into the apartment. The light was on. The apartment looked like a book warehouse.  Used hard covers and paperbacks were stacked to four feet, framing the periphery.

Sitting at a table in the kitchen reading, was a middle-aged black woman. She had gray hair, thick features. She stood. She was about six feet tall, built sturdy. Not fat.

“Hello,” she said. “You must be Dr. Larco.”

“Yes” I said. “Did Dempsey read all these books?”

“With my help. I taught him while he was in prison.”

“He seems to have learned well.”

“He’s a genius. Imagine what he could have done if he had an opportunity like yours. But, he got into drugs. Did things.”

“You’ve met my wife.”

I turned. Dempsey entered the flat.

“Yes, I did. She taught you to read?”

He smiled at her and said, “She also helps with the dialysis. You should see her insert needles. She could have been a doctor.”

“I’m a teacher, Dempsey,” she said.

There was silence. Then Dempsey laughed. His wife got a bottle of rubbing alcohol, took a cotton ball, saturated it, and wiped her finger. She took a lancet, pricked her finger, and placed a drop of blood in the glucometer.

“One hundred and twenty-five. And that’s two hours after dinner.”

“How long have you been diabetic?” I asked.

“Ten years. My kidneys are fine and my eyes are good. I’m doing okay.”

“That’s good. Keep your blood pressure under control and your sugar in the normal range and you can avoid the dialysis machine,” I said. “I’ll be back in one month with another delivery. It was a pleasure to meet you Mrs. Curtis.”

“The pleasure was mine, Dr. Larco,” she said. “I’ll see you in a month.”

* * *

Dempsey’s behavior changed. He became a model patient. He was on time for his clinic appointments and took his medications as directed. He allowed me to do the physical exam required by the network. I documented a dozen violent scars, all on the front of his body. He continued to read in our library. Always returned the books. I was relieved. Respect went both ways. Months passed without incident. This was working out.

* * *

Then a call from the intensive care unit.

“Doc, Doc you got to help me. My wife’s in your hospital, and they’re trying to kill her. The have her hooked up to a breathing machine. She’s in a coma. You got to help me.”

“Sure, Dempsey. I’ll come down.”

I got dressed. The beeper went off, it was the ICU.

“Dr. Larco, it’s Annie, the charge nurse in the ICU. There’s a horrible man.  He says he knows you. He’s going to kill the resident. He has a tattoo on his face.”

“I’m coming down. Call security.”

“They’re here. They brought the dog. He said he would kill the security guards, and the dog. It’s a stand off. You’re the only one he trusts. Hurry– I think he has a gun.”

* * *

I entered the hospital. Ran up to the fourth floor, entered the ICU.

Dempsey had a young medical resident pinned up against the wall. The dog was barking. One of the security guards was calling for back up.

“You mother,” Dempsey was shouting. “What did you do to my wife? She comes in here; she was talking. She had some back pain. She gets a CAT scan, and now she’s in a coma? People get CAT scans everyday.” As he screamed at the resident, his facial muscles contracted and relaxed. The snake tattoo seemed to move back and forth; nurses, doctors, and security, formed a circle.

“Hey, Dempsey,” I said. “What’s this all about?”

“This bastard is trying to kill my wife.” He pointed at an isolation room.

I looked in. I could hardly recognize Mrs. Curtis. She was covered in a white sheet to her neck, a tube in her mouth connecting her to the ventilator. Her catheter bag was empty. Her body was bloated.  The hiss of the ventilator kept her alive.

“That’s Dr. Patel,” I said. “He’s a good doctor. Don’t hurt him.”

“Yeah, well, my wife’s almost dead.”

“What’s the matter with her Dr. Patel?”

“Lactic acidosis. There is no reason. She got the CAT scan and went into a coma.”

“We’d better put her on dialysis,” I said. “There’s a slim chance we can save her. We got to move fast.”

“Will you take care of her?” Dempsey asked.

“If Dr. Patel will consult me.”

“Of course,” said Dr. Patel.

“Okay, Dempsey. We’re going to have to place some large IV lines in her neck to start the dialysis. Just like we do for you.”

“Can I stay?”

“Sure. What medications is she on?”

“I don’t know. Blood pressure pills. Heart pills. And her diabetic medication.”

“Dempsey, did you give her those medications after she checked in here?” I asked.

“Yes. They weren’t giving her the meds from home, so I brought them and gave them to her. They were screwing up from day one.”

“We didn’t know he was bringing her medications,” Dr. Patel said.

“I know,” I said to Dr. Patel. Then I turned to Dempsey and said, “Dempsey,

go home and call us with the names of those medications.”

I went to the bedside and with my thumb and index finger I gently pried her eyes open. The glazed, black pupils were as big as quarters and would not react to light.

We placed her on the kidney machine and tried to clear her blood of toxins. This took a while. Then I asked:

“What’s her lactic acid level?”

“Twenty-eight,” Dr. Patel said.

“And her pH?”

“Six point nine.”

“She’s dead,” I said.

Curtis came into the room.

“How’s my wife? Is she going to make it?”

“Did you bring the medications?”

“I got them in the bag.”

“Can I have them?”

“Sure, Doc.” He handed me the bag.

“Dr. Patel, read the labels to me.”

“Insulin, lisinopril and metformin.”

“Metformin. Did you give her contrast with the CAT scan?”

“Of course,” Dr. Patel said.

“That did it,” I said. I looked at Dempsey. He appeared to be stunned. I guided him to the grieving room just outside the ICU.

“Mr. Curtis, sit down, please.”

“What’s going down here? What have they done to my wife?”

“Dempsey, we don’t allow family to bring patients’ medications from home. Sometimes drug interactions can occur and can be fatal. That’s what happened here. It wasn’t Dr. Patel’s fault. Metformin is like cyanide if the patients gets a CAT scan with contrast.”

“I had no idea.”

“Dempsey, it’s okay. Most doctors don’t know of the interaction.”

“This is horrible, I’ve done it again.”

“What?’

“Murder.”

“This is an accident. There is no comparison.”

“Families don’t believe in accidents.”

“I’ll talk to them.”

“Doc, she isn’t dead yet.”

“Dempsey, I want to stop treating her, take her off the ventilator. No more dialysis. She can’t survive this.”

“Doc, you have to do everything.”

“I can’t do any more.”

“I’ll call the head of the hospital. You keep her on the ventilator and the dialysis machine, or I’ll hold you responsible.”

I was steadfast. Dempsey called the director of the hospital, who assembled an emergency meeting of the hospital ethics committee. It was decided all care should be given to Mrs. Curtis, futile or not. The hospital ethics committee always did what the family wanted. It was easier that way, especially if the patient was going to die.

It took three days– chest compressions and broken ribs, electric shocks and burned skin– but eventually and mercifully and predictably, she died.

* * *

I didn’t want to see Dempsey. In his emotional state, I didn’t know what he would do. After what he encountered in prison, I would be an easy target.

But then, there he was in my office.

“Dr. Larco.”

“Yes, Dempsey.”

“Thank you. You did all you could.”

“I’m very sorry, Mr. Curtis. If I can help in any way.”

I shook his hand, which felt like stone.

“I’ll see you next month in the clinic?” I asked.

“Of course, Doc. Things will be just as they were before. You had nothing to do with this. You tried your best for me. That means respect.”

* * *

A week later, two African American men in suits were in the waiting room. They were large, trim, ex-athletes that looked too healthy to be in my office.

“Can I help you?”

“Are you Dr. Larco?”

“Yeah.”

“We’re detectives from the city.” They showed their gold badges. “Can we talk to you?”

“What’s this about?”

“Mr. Dempsey Curtis and the death of his wife. Do you think he had anything to do with it?”

“No,” I said.

“A Dr. Patel from your hospital thinks Mr. Curtis poisoned his wife.”

“No. It was a drug reaction. Curtis had no way of knowing.”

“Dr. Patel says Mr. Curtis brought her medications from home.”

“He had no way to know she was going to get a CAT scan.”

“Dr. Patel says he ordered an MRI for Mrs. Dempsey but Curtis insisted on a let me see…” The detective looked at his notes and read, “Mr. Curtis insisted on a contrast-enhanced CAT scan rather than an MRI.”

“I don’t get it. Why would he?  This is absurd.”

“A teacher gets a nice pension, which would go to him. Nobody’s going to hire a guy with a tattoo on his face, let alone a prison record. He needed money.”

“Still, he would have no idea. He’s not that sophisticated.”

“Don’t sell him short, Doc. It’s a mistake.”

“I never did,” I said.

“Well, think about it. If he says anything suspicious, let us know. We have to take your testimony.”

“Certainly, Mr. Curtis had nothing to do with this.”

“Doc, you’re a nice guy. You don’t understand people like Dempsey Curtis. He doesn’t seem to like his wives. He got second degree for the murder of his first wife.  He’s a recidivist.”

“But he’s been out of prison for seventeen years.”

“It took him seventeen years to come up with the perfect crime. He said the death of his first wife was an accident, too. He’ll live well on his wife’s pension. They didn’t even live together. Like I said, he’s a recidivist. If you find out anything call. But remember, he’s dangerous in a way you can’t understand.”

“But he respects what I’ve done for him,” I said.

The detective smiled and shook his head. He handed me his card, and left.

I went to the library and opened the pharmacology book Dempsey borrowed. I opened the chapter on metformin. Etched into it was a fingernail-thin line under these words:

 If metformin is given prior to a contrast enhanced CAT scan a fatal lactic acidosis will occur.”

2009 Writer’s Digest Award Winner for Popular Fiction

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