Chapter 3: May 2010

 

 

Solomon silenced his cell phone as he assessed the condition of his audience, the students of Frederick Douglass High School. Each of them was dressed in a collared white shirt and khaki pants or a khaki skirt, creating long uneven rows of khaki and white with little dots of brown speckled by the occasional brightly colored hair accessory. He took a seat in a hard folding metal chair on the stage, in front of a heavy black curtain. The only other person on stage, a heavyset woman in an immaculate gray pantsuit, was standing at the podium giving announcements about upcoming school events. She also gave a detailed explanation informing the students that they should not drink from any of the water fountains as lead testing was still underway, as it had been for the past 18 months. Solomon looked out and noted that, despite the long delay in the city’s assessment and intervention of the problem of lead in drinking water, there was little concern in the students’ faces. They were far more interested, it appeared, in texting or talking to one another than whatever it was that Doris Baker, the assistant principal, was saying.

“…and next week, there will be special remediation sessions for students who are on track to graduate but in danger of failing. Now, I want to introduce our speaker for this assembly. Many of you remember Dr. Solomon Bode from last year, when he spoke.”

There was a distinct decrease in the whispering among the crowd of four hundred high schoolers. Solomon smiled.

“Dr. Bode is an alumnus of Frederick Douglass and grew up right here in this neighborhood. He graduated from here in 1990. He went to University of Maryland, Baltimore County, where he was a Meyerhoff Scholar and then went to the University of Maryland Medical School, where he also did his surgery residency and transplant surgery fellowship. Today, he is a surgeon doing research in the field of liver transplantation and we are glad to welcome him back. Let’s give him a round of applause!”

There was a mildly enthusiastic but definitively short round of clapping, during which Solomon rose to stand at the podium.

“Young men and women of Frederick Douglass High, good afternoon,” he said. He heard a few murmurs that sounded like, “Good afternoon Dr. Bode.”

“I’m here today because there’s no place else I’d rather be,” he began. “I know that there’s a lot of places you’d rather be. It’s a nice spring day and I’m sure most of you would rather be outside. So I’ll try to keep it brief. My speech is not going to be terribly different from last year, if you’ll remember. But for the freshmen, I was born and raised here on the West Side. My mother’s house was on McKean Avenue and many of you probably played on the same playground that I did up at Druid Hill.  My experience was probably not much different than yours. I never met my father, who I have learned was in jail when I was born and was shot standing on a corner selling crack cocaine when I was four years old down on Pennsylvania and Fulton.”

At the mention of murder, the teenagers suddenly became less interested in talking to one another and the chatter died down..

“I had an older sister who became pregnant when she was fourteen after she was raped by a neighbor. I had a younger brother who sits in jail today for possession with intent to distribute. I was ten years old when my mother left me with a friend of hers and disappeared. I found out later that she froze to death one night after she got so high that she didn’t come inside when it was snowing.”

Solomon paused for a few moments to the let details of his sordid family history establish themselves in the minds of the students. At this point the whispers were almost entirely absent, though they picked up a little bit after his last statement about his mother. He pressed on.

“I spent plenty of time in between relatives, in foster care, in group homes. You know what that’s like. I got jacked up by two white police officers waiting for the bus one day when they mistook me for one of the boys I lived with. I spent a night down at Central Booking sleeping on a bench just waiting for them to get to my case because there were so many others in front of me.”

He paused.

“I’ll bet some of you have gone through that.” He saw some nods and a few more murmurs.

“I’ll bet some of you have had your money stolen from you by friends who used it to get high,” he said forcefully, watching them respond and smiling as he knew that he had them now.

“You can go home and ask your parents or your grandparents. If you think things are bad now, they were worse then. The late 80s was no time to be here on the Westside. No time to be a young black man. Nearly every single boy I grew up playing with or going to school with is in jail or dead now. I’ve been shaken down, stood up, beat up, and knocked over. And school was no help.”

He saw more nods. In years past, he had allowed his gaze to wander over to Mrs. Baker to watch her react. He had seen it enough times to not let it slow him down, and by this point she had heard this line enough times that she was probably not fazed by it.

“There were a handful of teachers who cared. But most had already checked out and just wanted to get a paycheck or they were scrambling for a better job somewhere else. It made me so mad when I studied and worked hard and some knucklehead who sat next to me high as all get out passed the same class. I was ready to give up.

“But then one day when I was 15, a day in the spring very much like this one, things changed. I was walking home when I saw a man staggering down the road. I still know him– he was a troublemaker then and a troublemaker now. He was a few years older than me. He told me that he’d give me a hundred dollars to sling for a couple hours over there, right on corner of Clifton and Pulaski. You all know the corner I’m talking about, I’m sure. The going was good and they made good money and wouldn’t I like go get in on some of that action? He had asked me before and I had brushed him off before because I was scared, but that day I was ready.”

The murmurs and nods had stopped at this point, as the entire assembly was hanging on Solomon’s every word.

“I wanted it,” he snarled. “I had never held a hundred dollars at one time in my life. I was so angry— I was angry at my father, at my mother, at my foster mother, at my teachers, at the man who got my sister pregnant, at my little brother who was already a lookout for the same man getting forty dollars a day. He was already buying himself whatever he wanted at the age of 12 and he wouldn’t listen to me.

“He held out five twenties and placed them in my hand. So I took them in my fist and I asked him where he wanted me.”

There were a few gasps in the audience, along with a few knowing nods.

“I was a runner. So another boy signaled to me after taking the cash from some white boy in a beat-up old car and I took a little baggie of heroin up to the car. I clenched my fist tightly, then almost threw it at him when he drove over. I felt so sick and awful. I knew then that I had become part of a terrible system. The same system that destroyed my family and every other family on my block. I knew that all of my rage and anger and everything that had ever been done to me was no excuse for dealing drugs.”

He paused again to let the tension in his story build.

“I knew then that I wouldn’t be a part of it. Never. I would not pollute my body or anyone else’s body with that stuff. I threw my hundred dollars down on the ground and walked away. That man, the main dealer, started following me. He told me that I had better get back ‘cause I was a no-good sonofabitch who was disrespectin’ other niggas and on and on. He kept yelling all the nastiest things he could yell and then he said he was gonna cut me, he was so mad. So I turned around and I saw him pull a knife out. He was mad. But I was madder.”

The kids in the audience were now leaning forward in their seats. Even the kids who had concealed their cell phones in their laps up until now were looking up, not down.

“I told him that I wasn’t going to have any part in this, and that he had better put that switchblade away. And you know what? He did.”

There were a few claps and a handful of people saying “alright.”

“He could see that I respected myself too much to be involved in that. He could see that I was not going to be pushed around. He could see that there was no amount of money that could turn my head back. And there wasn’t. Every day after that he tried to bring me back, and I kept telling him no. I turned my grades around. I found the teachers in this school who cared and I pursued them. I asked for extra credit assignments. I knew I wasn’t going to be stuck in the same world as him. I knew that I could make different choices. So I did.”

He brought out a small piece of paper in a plain black frame. “I brought my diploma from Frederick Douglass High here today. “This is from when the school was in a different building, down on Calhoun Street. I brought it here today because I know that some people think that it doesn’t matter even if you graduate, because all you got is a diploma from Frederick Douglass. I’m here today to say that it does matter. I graduated from this school with a 2.9 GPA. Nothing exciting. But one of my teachers nominated me for the Meyerhoff Scholarship at UMBC, and I thought I had no chance. But I kept working hard, and got straight A’s my senior year. I started working down at the New York Fried Chicken, and you know I made less than all my other friends who were slinging. But I didn’t care. I was doing something with myself, not tearing other people down. And I got into the Meyerhoff program. I was surrounded by other black students who worked hard and loved science. I did summer research, graduated, and then went to University of Maryland Medical School. Even there people thought I wouldn’t go far because I was just some kid from the ‘hood who couldn’t talk like the white folks.”

He paused again, letting his eyes scan the crowd. A few of the kids booed. He put the diploma down on the podium in front of him.

“Y’all have had that happen. Someone has looked at you and you just know– whether it’s a teacher, a social worker, a cop, even a relative– that they’re just assuming you’re no good ‘cause of the color of your skin or the way you dress. Tell me, has anyone had that happen?”

A few indistinct voices called out and he saw a couple of hands raised tentatively.

“I’m here today to say that you can prove them all wrong,” he stated boldly, his voice increasing in volume and intensity. “Because I’m darker than at least half of you, and I proved them all wrong.”

He heard cheers and smiled.

“Some of you have already gone down the wrong path. Some of you are thinking that with everything that’s ever happened to you, you ain’t never gonna amount to nothin’. Maybe that’s what a parent or a teacher or some police officer or some judge said. I’m here today to tell you that you can make a different decision. Because I did.”

He turned to Doris, who was already starting to clap and smile.

“I used to wake up every day in a rat-filled rowhouse just a few blocks from here and pull on some raggedy sneakers and walk past my friends in their Air Jordans who were already skipping school to make their hundred dollars. But now they’re nowhere. And I live downtown, I drive a Lexus, and I save people’s lives every single day.”

He lifted his hands in the air, turning them back and forth.

“These hands once held nothing more than twenty dollars of dope,” he said. “And every day now they go to the mouth of hell and pull people back. You’ve heard people tell you before to say no to drugs and stay in school. I’m not going to say anything like that, because you’ve heard it before. I’m going to tell you that if you respect yourself, so will everyone else. And if you work hard, you don’t have to be trapped here. Thank you for your attention, and I’ll see some of you down at University of Maryland.”

The kids all stood to their feet and cheered. While Solomon was certain that only a few kids would take his words to heart and most would continue whatever troubled trajectory their lives were already on, he was glad that he had taken the time to shake them up a little. Doris shook his hand enthusiastically as he stepped down from the podium and walked out of the auditorium.

His phone buzzed in his pocket. He looked at it, composed a brief reply, and put it back in his pocket after pressing send. The kids dispersed after Doris released them, most of them hurrying out of the auditorium as quickly as possible but a good number also moved towards the front to ask questions. Solomon stayed for a few minutes to talk to the kids who were interested in talking, shaking their sweaty hands and slapping their kyphotic backs as they told him about their interests and dreams. He gave out a few business cards and pamphlets for the Meyerhoff program before he moved on out the door, escorted by Doris.

“We’re so glad that you could come,” she said. “You know all the other schools want you to come speak, too.”

“I only have so much time,” replied Solomon. “I wish I could.”

“Well, we are certainly thankful for your willingness to come back and see us.”

“This school served me for a time, Mrs. Baker,” replied Solomon. “I’m happy to serve it.” He gave her a hug and then walked out the school doors. It was an unseasonably warm day, and a few cherry trees along the ridge just beyond the school parking lot were in bloom.

Solomon walked to his car and got in, then drove away, heading towards I-83. He got on just past Druid Hill Park, the dark water of the reservoir to his left covered with ripples from the strong winds that day. He merged onto the thruway and watched the city pass. He went under the bright yellow Howard Street bridge, passed the shining Mercy Hospital building rising to his right, sped over a farmer’s market just getting started for the afternoon, and saw the city jail’s barbed wire rise and then fall on his left. He was quickly disgorged from the expressway into the snarl of early evening rush hour traffic on President Street. He waited five minutes before he was able to advance, then slowly worked his way closer to the harbor, where he parked along a long boulevard bordered by a small pier.

He walked three blocks east past several enormous condos, upscale restaurants, and organic grocery stores that he had not noticed before to a small bar with dark glass doors and a tasteful chalkboard advertising specials out front. He walked in and saw Rita sitting at the bar, signaling to him. He walked over to her table.

The bar was moderately noisy and fairly dark. There were large televisions on either wall and small tables scattered throughout the main area in front of the bar with patrons talking and laughing. A pop song played overhead, filling the room with its monotonous bass thuds. Solomon took a brief look at the long glass shelves backlit in blue and green and filled with various bottles of spirits and wine, then looked back over to Rita. The bottles glowed and their labels sparkled gently in the dark bar, catching Solomon’s eyes for just long enough that he nearly bumped into a waitress.

Rita looked much more composed than the other morning; her dark hair was carefully bobbed and her olive skin strongly accented with dark eyeliner and some blush on her cheeks. Her acne was not at all visible. She was wearing a crisp white blouse and a short khaki skirt; Solomon chuckled to himself as he recalled the school uniforms from earlier that were exactly the same colors. Rita held a large martini in her hand.

“How was your day?” she asked, her voice raised over the din of the bar.

“Not too bad,” he said. “Finally got caught up on e-mail. Went back to my high school.”

“Really!” she exclaimed. “Gave ‘em the old mouth-of-hell speech?”

Solomon laughed. “The same one. When did you hear that? I don’t think I’ve ever given it at the hospital.”

“Solomon, you give that speech in some form or another twice a week. I’ve heard it from our mutual patients coming back and telling me how much they loved you and how much they wish that they could just see you for everything. They even hold up their hands and wave them back and forth like you do!”

Solomon rolled his eyes and attempted to suppress a smirk. “Well, I’m glad to hear that the message is out.”

“I got you a Diet Coke,” she said, passing him a glass. “No ice, just the way you like it.”

“Thanks,” replied Solomon, as he took it and sipped.

“Want to get a table?” she asked.

“Sure.”

They moved, with the help of a waitress, to an area to the right of the bar and further back where it was significantly quieter and darker. They sat across from one another in a booth framed on three sides with the same dark glass as the front doors at a brushed metal table. They both looked disinterestedly through the menu.

“So tell me, Solomon,” said Rita after a short pause, “How did the teenagers of Frederick Douglass High respond to your speech?”

“Same way as my patients,” he replied, allowing the smirk to come through.

“You’re a good storyteller,” she said as she sipped her drink. “I am still always struggling to figure out how to communicate that to my students and residents. They just read the information off a piece of paper in front of them and expect that I’ll understand a string of lab values.”

“Even your beloved Family Medicine residents?” he asked. “Because I know a few attending surgeons who don’t get it.”

“Some of them, yeah,” she said. “Most of them get it by the time they’re second year residents. But I feel like things are changing all the time. We just got EMR last month–”

“Oh, don’t get me started on electronic medical records,” growled Solomon. “They’re pushing for them in the clinic now and I can’t stand it.”

“It makes me feel more like a data entry clerk. I just click boxes all day long.”

“I guess clicking boxes work pretty well when all you deal with is back pain and runny noses,” jibed Solomon.

“Hey now! We are a full-spectrum primary care clinic providing a variety of services for acute and chronic conditions,” she retorted. “Anyway, It’s nice having the access to old information sometimes in the hospital EMR. But most of the time I could find that anyway if I wanted to in the paper chart. It’s like, we just have something new, so why not use it? But we don’t think about how much more work it creates for us. Or whether or not it actually helps our patients. I dunno. In the end, the system just keeps moving along, and we just keep moving with it.”

She drained the last few drops of her martini and set the glass down. “Let’s talk about something other than work.”

“Sounds delightful,” remarked Solomon. “You go first.”

“Well, I went to see my sister in Florida last week,” she started. “It’s far warmer there than it is here, and every time I go there she tries to convince me to move.”

“And you haven’t because the beaches here are just nicer and the water here is cleaner?” asked Solomon.

“Ha! I wish,” said Rita. “No, despite the fact that I only became residency director because they begged me to, I actually like my job. Oops, there we go talking about work again. I feel like it just kind of consumes our lives.”

“Perhaps,” offered Solomon, not particularly wanting to admit to her observation but also not being particularly ashamed to admit that it was true..

“I guess when your hands go down and drag people out of the mouth of hell every day, it’s hard not to get consumed in it.”

“I guess so.” Solomon chuckled. “As terrible as all the paperwork is, you’d think we’d enjoy it a little less.”

“I feel like I’m just standing on the edge of a chasm, begging people not to walk down that road. No dragging back for me. Although last week I did actually take a bottle of percocet out of a patient’s hand and refuse to give it back to him.”

“Really?” Solomon’s interest was piqued, as he had been immersing himself more in the menu.

“Yup. Stormed out threatening to sue. But it was his fault for waving a prescription bottle in my face that had my name misspelled on it. I still don’t know how he forged the prescription, but apparently he was successful.”

“Our patients are incredibly resourceful,” observed Solomon. “They work hard to fulfill their addictions. If Gainers Goodson had dedicated his life to curing cancer, we’d have to fire the oncology department.”

Rita laughed. Solomon felt the tension of his day easing, as the incessant running commentary was a welcome distraction from his constant inner monologue of responsibilities and tasks yet to accomplish punctuated with medical emergencies. He thought to himself that he rarely relaxed like this, and that he should probably do it more often. He subsequently thought to himself that Rita was probably going to go more and more out of her way to make it happen. He found himself enjoying this thought but also being somewhat frightened by it at the same time; she was just so forward with him that he found himself a little more defensive than he might usually be. The waitress came and they both ordered vegetarian lasagna, then sat in silence for a few minutes. Solomon tried to interpret the expressions on Rita’s face as she occasionally looked at her phone.

“So what do you do for fun?” she asked.

“Emotionally abuse residents,” he said without hesitation.

“That’s not funny,” she chortled, clearly intending for her words to mean something different than they usually did. “I meant, what do you do for fun when you’re not working?”

“You ask a good question,” he replied. “Every now and then I go to an art show or something if someone else invites me. I visit my sister and her kids. I don’t have time for much else.”

“Where does your sister live?”

“Out in Reisterstown.”

“How did she find her way out there?”

“She was actually living at a shelter out there a few years ago, hooked up with some church group and got married. She has the dog, yard, and kid everyone always talks about.”

“I see. Read any good books lately?” asked Rita.

“Not unless you consider the monograph Mechanisms of Hepatic Injury and Repair good. I found it riveting, personally.”

Rita giggled.

“To be honest, this was a reread while working on a paper. I already knew the plot.”

“So you just go to the gym every Monday, Wednesday, and Friday, go to the hospital, operate or see patients all day, go to your lab across the street, and go home and sleep?”

“Yes. Do you see something unusual about that?”

“Do you?”

“I guess it’s a little different from the way that a lot of people live. My sister doesn’t exactly get it and keeps asking when I’m gonna get my own yard and my own damn dog. Even most of the other surgeons have a boat or something like that to entertain them. I just enjoy my life as it is and can’t imagine doing anything other than helping people and working with my hands.”

Rita tried to suppress a snort of laughter. “This is a date, not your med school interview day.”

Solomon seemed a little flustered. “I’m serious! I really can’t imagine doing something other than what I do.”

“I guess I’d say the same thing,” said Rita. “Except that I’m mostly clicking my mouse with my hands, not switching out good livers for bad ones.”

“Well, what you do is important, too. Someone has to try to talk these alcoholics out of ruining their lives before they need me to intervene.”

“I’ll let you know when I manage to successfully talk someone out of it,.” she scoffed. “Like I said, I’m mostly just waving my arms and yelling, ‘Hey! That’s the mouth of hell down that way! Turn around before I sic my friend Solomon on you!’ all day.”

He laughed. “What do you do for fun when you’re not trying to scare people out of bad decisions?”

“Uh, lots of things. I go salsa dancing, I visit my family down in Northern Virginia, I go skiing in the winter… I probably spend too much time on Facebook, honestly. I feel a little old for the whole business.”

“Dancing, huh?”

“Yeah, I wasn’t ever really into it but some of my friends were really pressuring me to go. Now I go every Friday night that I can down at the Talara. It’s only a few blocks from here if you wanted to come with me tonight.”

“This was all part of your plan, wasn’t it?” he asked. “You knew that I was going to be at the school today, and you texted me right when it was over to just get dinner down in Harbor East, knowing that you’d lure me in to go dancing.”

“I didn’t know you were going to the school today. It was just fortuitous that it happened that way.”

“I haven’t danced in 20 years, Rita. The last time was in college, and that didn’t go very well.”

“Well, they have lessons, and I have seen less coordinated men than you learn it and have fun. If you can cut with your Bovie in the OR while stepping on the pedal to turn it on, you can dance. Or are you scared to show off how coordinated you really are?”

Solomon looked away and tried to weigh his inevitable embarrassment against his potential enjoyment. At that moment, their dinner arrived with wine for Rita and water for Solomon. They continued to talk and laugh for a few minutes as they enjoyed their food, which was delicious. Solomon paid for the meal despite Rita’s insistence that she pay since she had asked him. They carefully placed their silverware and napkins on their plates and headed for the door.

It was still warm. They began to walk west towards Talara.

“I’m glad you came out tonight,” said Rita.

“Me too.” Solomon briefly questioned why he kept feeling the urge to go east in the direction of his car, but then decided that it was best to just let that thought go along with the resistance. “You kept asking after I turned you down three times, so I figured it was inevitable.”

“Wow, you sure know how to make me feel special.”

“Can’t say I’m terribly experienced. I guess you could go instead with any number of guys who are more interested in flattering you.” His suggestion was more biting than he expected it to be, and for half a second he felt anxious about how she’d react.

“Oh, I’ve tried,” she retorted. “The flattering comments usually dry up when I–”

Beep beep beep

“Oh shit, my pager.”  He reached for his belt.

“–when that happens. Oh shit is right,” she said. “Call ‘em back. It must be an emergency if they’re paging you at 7 o’clock on a Friday night.”

Solomon pulled out his cell phone and called the number that he’d been paged to, which he immediately recognized as the University of Maryland Emergency Room.

“Hello?”

“Yes, this is Dr. Bode.”

“Hi, Dr. Bode. It’s Sarah. Your patient Adam Freeman is here.”

“Oh, fuck.” He let out a low moan. “Is he bleeding?”

“Uh, no,” replied Sarah. “ER thinks it’s just another attack of the autoimmune hepatitis. They want to know if the Transplant Surgery service should admit the patient or if Family Medicine should admit the patient, since it’s really more of a medical issue. You sort of set a bad precedent two weeks ago with ol’ Gainers, and now the ER’s all confused.”

“Have you seen the patient?” asked Solomon.

“With my own fucking eyes,” replied Sarah.

“Dr. Janvier, in your clinical opinion, is he an appropriate candidate for the transplant service?”

“Not unless you have a fresh liver for him tomorrow morning.”

“What did the transplant attending say? Isn’t Mark on tonight?”

“He said to call you.”

“Mark, that son of a bitch… just a second,” said Solomon, covering the mouthpiece with his hand. “Rita, it’s Adam. He’s getting admitted for hepatitis.”

“You touched him last!” exclaimed Rita. “He’s all yours!”

Solomon made a very cross face. “Don’t tell me that you’re going to take a side in this fucking turf war.”

“I’m just kidding, Solomon. It’s not really my call because I’m not the family medicine attending right now, although I will be in a few days. Who’s the resident?”

“Sarah Janvier.”

“No, who’s my resident?”

“You are taking sides!” accused Solomon.

“I just don’t want your patient to get killed overnight after you already took a piece of his liver out for your trial!” Rita’s defense was half in jest, but Solomon had to admit she was right.

“Fair enough,” he said. “You do have a few accidental Kevorkians running around.”

“I reform them all in the end.” Solomon decided to acknowledge she was right by allowing her to have the last word. He removed his hand, which had been wholly ineffective in keeping his voice from being heard by Sarah. He could hear barely stifled laughter.

“It’s not funny,” he growled. “Who’s the Family Medicine resident?”

“I’m sorry,” replied Sarah unapologetically. “It’s Vazhir.”

“Vazhir,” reported Solomon back to Rita, covering the mouthpiece again.

“Oh yeah, admit him to family medicine.” Rita nodded enthusiastically. “I’d let Vazhir operate on my dog.”

“Your dog?” exclaimed Solomon incredulously.

“He was a veterinarian back in Romania. Emigrated to the States, went to med school. Hard worker. Smart guy.”

Solomon rolled his eyes. “This veterinarian better pull through, or I am kicking his ass back to fucking Romania.”

“You do that,” smirked Rita. “He’s one of the best residents we’ve got.”

“All right,” said Solomon. “I just don’t like admitting my patients to other services where I don’t know what’s going on as much.”

“It’s a medical issue, Solomon,” pleaded Rita. “Just do it.”

“Okay.” He turned back to the phone. “Dr. Janvier, do you trust Vazhir?”

“He beat me down here to the ER even though they called me first. He’s not bad for Family Medicine.”

Solomon let out a long sigh. “Admit him to Family Medicine, but consult and write a note every day on him. I’m coming now to see him.”

“Okay,” replied Sarah, and hung up. Solomon put his phone in his pocket and quickly started walking back to his car.

“Hey, what about dancing?” asked Rita.

Solomon stopped and turned. “Are you kidding? I have to see my patient! He’s 10% of my study population.”

Rita rolled her eyes. “Well, then, I guess I’m coming with you. I love dates that end at the emergency room.”

 

***

 

Adam laid back and breathed deeply without pain in his ribs for the first time since last night. The Dilaudid had started dripping through his IV just a few long minutes ago and he could finally feel it taking effect. His vomiting had already slowed down, but he still felt rather sick to his stomach. All day long he had felt lost inside of himself, hearing bits and pieces of what other people were saying to him and responding with his own fragments of words, but he knew that whatever he was saying wasn’t quite right. He sighed again, thankful that his right side didn’t send shocks of pain around to his back when he did so.

He looked around his room. He lay on a clean white mattress on a bed with guard-rails on either side and glowing buttons along the rails to move the bed. The room was dark and he could hear his father snoring on the chair next to him. There was a monitor above his head relaying his heart rate, blood pressure, and breathing as interpreted by the cuff wrapped on his arm and the leads stuck to his chest. There was a small closet and a door to the bathroom on the other side of the wall, which he could barely see in the dark.

He wondered what time it was. He had slept on and off since he arrived in the ER after being obtunded off and on all day. The sense of disorientation was no less terrifying than the first several times he had emerged from this altered state. Over in one corner a clock hung on the wall, reading 8:30pm. He could not remember when he had come in– sometime during the afternoon. Losing time like this made him frustrated, which only got worse when he thought about how his liver wasn’t getting any better and thus these episodes of encephalopathy would probably get more frequent. He was already familiar with the cycle: his body’s only toxic byproducts would build up, unable to be excreted and only able to continuously poison him.

He heard a knock at the door and more light spilled in as it opened.

“Hello, can I come in?” asked a deep male voice.

“Yes,” replied Adam.

A tall, heavyset man in a long white coat appeared at the door. His face and head were thick with a gray-black stubble and his bright blue eyes were easy to see before he moved further into the dark of the room. He was wearing scrubs and a thin gold chain hung around his neck, lost in his hairy chest. Adam had a vague recollection of meeting him before, but could not place it.

“Adam Freeman!” he bellowed. “My name is Dr. Vazhir Kazic. I work with Dr. Rita Chambliss over in Family Medicine Clinic. How are you?”

Adam recalled that he’d been seen by this doctor once before with Dr. Chambliss. It had been about a year ago– Adam had seen so many doctors at the University of Maryland that he easily lost track of who was who. This one, however stuck out in Adam’s memory– perhaps it was just the doctor’s enormous size and unmistakable accent, but Adam felt like it had something to do with his broad smile and some persistent sense of reassurance . He wished he could remember their last encounter, but his various admissions to the hospital all ran together in his memory and his head still felt very cloudy on top of it.

“I saw you down in ER, but I don’t think you remember. You were just a little out of it then. You look better already!” His voice was strong, throaty, and undeniably Eastern European. Adam was a little overwhelmed by his friendliness and wondered what he sounded like when he got mad.

“Yeah, I’ve been in and out of it all day. In and out. What happened?”

“Well, we think your hepatitis is acting up again. Your father was very concerned and brought you in because you were mumbling and falling down at your house. You got to ER and started vomiting all over the place.”

“I remember that,” said Adam. “I still feel a little nauseous.”

“I’m so sorry you still feel sick.” He sat down on Adam’s bed and took his hand. “We’re going to give you Zofran around the clock to help you feel better. Are you having any other symptoms?”

“Uh, my pain is a lot better. They gave me some Dilaudid before I came up, and it’s been working great. I still feel kind of woozy and out of it.”

“That will probably keep going for a while,” explained Vazhir. “Your ammonia level was very high when you came in. Your liver can’t process it, and it’s making you feel crazy. Did you have any symptoms yesterday?”

“No,” answered Adam. “I felt fine last night. Maybe a little nauseous. My liver was still hurting some after I got the biopsy on Monday, but it felt okay after Wednesday.”

“Any fevers, chills, headache, blurry vision, chest pain, difficulty breathing?” asked Vazhir in rapid succession. Adam shook his head no. “Change in stools, blood in vomit, blood in stool?”

“Nope.”

“Any rashes? How about swelling in your abdomen?”

Adam lifted up his gown to expose his stomach. “Maybe a little bit. It’s hard to tell because it’s a little swollen all the time.”

Vazhir reached his hand out. “I’m just going to press little bit.” He proceeded to mash on Adam’s abdomen in a way that would make a perfectly normal person yelp with his enormous, meaty fingers. First he palpated Adam’s hard liver, tapping along his ribcage and down towards his pelvis until he found a point where the percussed sound changed. His hands then explored around the rest of Adam’s belly. Adam winced with pain a few times but breathed a prayer of thanks for the Dilaudid.

“Looks like pain medicine did the trick!” announced Vazhir. “You didn’t let me do that hour ago.”

“It was nothing against you,” said Adam with a smile. “It must have been the ammonia talking.”

Vazhir guffawed loudly. “You should hear some of the things ammonia says to me! I have met some of Dr. Bode’s other patients and not all of them are as polite as you. Do you remember anything else from today?” His black, bushy eyebrows leapt up and down his forehead as he talked.

“No.” Adam shook his head. “I remember waking up feeling sick and all day long I think my father was trying to talk to me, the ER doctor was trying to talk to me. I tried to talk back to them, but I don’t think that anything I said made any sense. And I remember my stomach hurting and the throwing up. There was– there was a lot of throwing up.”

Vazhir then listened to Adam’s heart and lungs with his stethoscope, examined his eyes and mouth, checked his pulses, and pushed along his legs.

“Do you have any other medical problems?” The thick accent still made Adam want to giggle just a bit.

“Just the hepatitis, really.”

“Tell me a bit about that.”

Adam chuckled. “A bit wouldn’t really do it justice. I was eleven years old when I started getting attacks. I was still living back in Ghana at the time, and I would get nauseous and swollen and my eyes would turn yellow. At first they couldn’t figure it out. So when we moved here when I was 15, my dad took me to a bunch of different specialists. They ran a bunch of tests and then said it was autoimmune hepatitis. My own body attacking itself. They tried steroids, they tried immune suppressing drugs– everything either made me sicker or it didn’t work.”

“I’m sorry to hear that,” offered Vazhir, his volume lowering slightly for the first time since he had entered the room. “But now you are in Dr. Bode’s protocol.”

“Yeah,” said Adam. “This one seems different. I’ve tried a few experimental drugs before. But no one ever told me that they were going to take my liver out, get it sensitized, and then give me a drug to make it grow back. They’ve been hesitant to transplant me because they know I’ll still have the antibodies attacking my liver. Dr. Bode thinks that his treatment can help my liver regrow no matter what.”

“It is a fascinating treatment,” remarked Vazhir. “I have been watching the developments closely. One of my interests is hepatitis C. You know we see it so often in my country.” His tone seemed to drift downward and his voice became inflected with sadness. “…and in this city.”

“There’s no one with hepatitis C in the trial,” explained Adam. “Dr. Bode said that he doesn’t know if the treatment will work with infectious hepatitis or people with liver cancer. But autoimmune, alcoholic, whatever else– he’ll do it.”

“And isn’t your father involved somehow?”

Adam nodded. “He’s the CFO of Verilife, the company that’s funding Dr. Bode. After my mother died, he sold his business in Ghana. He was the president of a medical equipment company and wanted to be involved with something that helped people. So he joined Verilife back when they were starting to do clinical trials in Ghana and he’s worked his way up the ladder. He convinced them to fund this protocol.”

“That is dedication,” said Vazhir. “Of course, I know that a good father would do everything for his child.”

“Yeah. He’s done a lot for me. It was hard for him after my mom died. I know you’re going to ask me about family history, and she had what we think is autoimmune hepatitis too. It’s hard to know because she only had a few attacks before she died. My dad’s pretty healthy, though. Just has high blood pressure.”

“Okay. He must be very tired. Usually I wake people up when I come in the room.”

Adam laughed. “I’m not surprised. It’s been a long day for him.”

“Yes. Have you had surgeries?”

“Just had my gallbladder out in Ghana when they were trying to figure out what was wrong.”

“And do you take any medications at home?”

“I take Zofran, Lasix for swelling twice a day– three times if it’s bad– and some Oxycodone every now and then for pain. Nothing else.”

“Do you have any allergies to medications?”

“No.”

“Do you smoke, drink, or use any other drugs?”

“For a few months I tried smoking marijuana to deal with my nausea. That didn’t really help either. No drinking or smoking.”

“Do you have sex?”

Adam sighed. “Nope. Girls in college aren’t really into skinny dudes with yellow eyes that throw up all the time. I haven’t had a girlfriend since middle school. Most of the time I can’t even fuckin’ masturbate because my liver’s jacked up all my hormones.”

“I’m so sorry,” said Vazhir, shaking his head. “Have they ever given you testosterone or anything?”

“No. Can you imagine having that conversation with Dr. Chambliss?”

Vazhir guffawed. “She is attractive woman, no doubt!”

“Yeah, I don’t ever really bring it up.”

Vazhir moved right along. “And you live with your father?”

“Yeah. I take classes at Towson when I can… it hasn’t been easy lately. I was on the track team and everything. The attacks have just been getting more and more frequent, and I just feel so sick sometimes that I don’t know what to do.”

Vazhir placed his hand on Adam again, this time gently.  “I’m sorry. While you’re here we are going to control your symptoms as best we can and get you back out there for class on Monday.”

Adam appreciated his gesture and thought to himself that he felt better with this enormous hairy mess of a man taking care of him. Vazhir continued. “I don’t think steroids will work, since you said that they not help you before. We’ll keep giving you Lactulose to help your body process ammonia, and wait and see what Dr. Bode says.”

“Gross.” Adam shuddered. “I hate Lactulose.”

“Nobody likes to, uh, have to take a shit all the time. But we have to get the ammonia out.”

“Whatever you say,” said Adam, laughing at Vazhir.

Vazhir shook Adam’s hand, nearly crushing it with his enormous grip. “It was good to see you, Adam. Let your nurse know if you need something. I’m here all night.”

“Thank you, Dr. Kazic,” replied Adam. “We’ll just have to see if we can get through this.”

Just then he heard another knock on the door.

“Adam?” asked a familiar voice.

“Dr. Bode!” exclaimed Adam. He watched as Solomon and Rita entered the room and shook hands with Vazhir, surprised at first that they would happen to come in simultaneously this late at night. He surmised that they must have had some work project together.

“Adam, I’m so sorry that you had to get admitted. Are you okay?” asked Dr. Bode.

“Better now thanks to the miracle of Zofran and Dilaudid.” Vazhir nodded with enthusiasm.

“Best stuff we’ve got.” Dr. Bode turned to Vazhir. “What do you think?”

“I don’t know.” Vazhir’s oversize eyebrows squinched together. “Dr. Chambliss called me and told me about this patient before I came in. It might be worms or it might be rabies. We will probably have to do some tests to find out. In my country we usually treat for both until we know for sure.”

Solomon was uncharacteristically silent for a few moments. He opened his mouth to speak and started once or twice, but no words emerged. Vazhir exploded with resounding laughter, finally waking up Kofi from his deep slumber in his chair.

“I see you did talk to Rita before you came in,” muttered Dr. Bode.

“It’s the autoimmune hepatitis. We’ll just treat his symptoms and go from there. Nothing that should slow you down from treating him.”

“Excellent!”Dr. Bode walked over to shake Kofi’s hand. Adam, not quite following the joke about rabies, found himself drifting away into sleep again. He watched as Dr. Bode turned, greeted him again, then quietly observed that Adam was tired and that they ought to move outside. Adam heard the door close just before he fell asleep.

 

***

 

Gainers ambled down the sidewalk towards his house, discarding a styrofoam container full of chicken bones onto the street as he tore off the last few bits of flesh and breading from a piece. The sky was overcast and gloomy; he wondered if it was going to rain and was glad that he had already gone out for the day. He saw one of his neighbors from around the corner walk towards him.

“How you doing, Jimmy?” he called out.

“Fine, fine,” replied his friend. “How ‘bout yoself?”

“Happy to be walkin’ around,” declared Gainers. “Jus’ waitin’ for my new liver to get stuck in me.”

“Really!”

“Yes, really! And it can’t come soon enough. Lawd Almighty, my tessicles is all swole up like a sonofabitch.” Gainers had not hesitated to share this unfortunate consequence of his chronic liver failure all day with his sister, the staff at the fried chicken joint up on North Avenue, or any passers by who might have been familiar with his condition. Indeed, most of the folks in the neighborhood were well-acquainted with Gainers’ various ailments, both real and imagined, as he usually did not hesitate to talk to anyone who would listen to them. He was not particularly shy about talking to anyone who didn’t want to listen to him, either. Depending on how recently or how carefully his psychoactive medications had been adjusted and how stringently he was taking them, his gregariousness ranged from a pleasant cheerfulness to an overwhelming social assault. His neighbors rarely minded, though, as he always had an amusing or clever observation to make and he was always glad to share a cigarette that he had stolen from his sister. He himself smoked very rarely, but he liked to carry a pack of Newports in his pocket for their social resale value. Only absolute strangers would have to part with 50 cents to get a smoke from Gainers, though; even the briefest acquaintances could count on him for their fix. Jimmy, being Gainers longtime friend and on-and-off drinking partner, usually got two.

“Can I borrow a smoke?” he asked.

“Why, certainly!” exclaimed Gainers. “Take two.” He pulled the teal green package out of his tarnished shirt pocket. His shirt, a smooth cotton button-down, had clearly once been white but the pockets and folds had all turned brown and there was a collection of stains ranging in color from faint yellow to grayish sepia. The shirt, along with his plain black fleece jacket, complemented his once-black pants that had faded to dark gray with their own set of stain. He pulled out two cigarettes and passed them to Jimmy.

“So they growin’ you a new liver?” he asked.

“In the lab. Met some pretty young blonde thing last week who told me how she’s doin’ all these tests and making my cells all ready ‘cause they gonna give me some medicine to make my liver regrow. Whoo-ee! It’s excitin’ to be the center of attention.”

“Gainers, you always be the center of attention. I don’t know who you think you kidding.”

Gainers grinned wide. “Ain’t kiddin’ nobody. I gotta go lay down. This is just gettin’ to be too much, just standin’ here with all this fluid weighin’ down on my balls.”

“Alright, you take it easy. Thanks for the cigarettes!”

Gainers slowly moved inside, carefully going up the stairs as to minimally disturb his swelling. He laid down on the couch again and lifted up his shirt to see, disappointingly, that there was more swelling in his abdomen.

“Damn,” he said. “Can’t make it stop.”

“Gainers!” yelled Jessi from the kitchen.

“Jessi!” he yelled back. “What you want?”

“I want you to stop eating that fried chicken!”

Gainers was taken slightly aback. “What fried chicken?”

“That fried chicken I saw you eating as you walked up the step! You know them doctors said that the salt was gonna make you swell up. And you told me this morning that you was all swole again! All that sodium is gonna kill you!”

“They said it was low sodium fried chicken! I asked!” Gainers was well aware that his defense of his dietary indiscretions was going to be soundly rejected, however, he felt obligated to offer it nonetheless in the hopes that it might possibly work.

“Gainers Goodson, you know that there is no such thing as low sodium fried chicken.”

With that, he was silenced.

Jessi emerged from the kitchen. She was wearing a dark blue blouse and clean white dress pants; her short hair had been re-dyed since Gainers saw her earlier. She carried her heavy arms and legs in a dignified way, her hands placed firmly at her hips in a gesture that Gainers had become very familiar with over the years.

“And I also saw you drop your chicken box in the street.”

Gainers decided that lying about this particular incident was futile. “I guess you did.”

“You know that the street cleaner came by this morning, and now you gonna drop your box full of chicken bones out there for the rats to eat. Go out and pick it up.”

Gainers opened his mouth to protest, but just as he was going to say something he found himself without any sort of retort. He had found himself in this situation more frequently lately; although his medications were quite effective at smoothing out the violent waves that his mind frequently created and then tossed him within. They often made everything so still that he could hardly discern that he was experiencing anything at all. It was better, he admitted to himself, than being so overwhelmed with sensations that he could not discern what he was experiencing– the harsh whispers, the distorted memories, the constant sense of disorientation that could only be calmed with a cigarette and half a bottle of vodka. As he lay on his sister’s couch without a clever objection to her demand, he decided to not be frustrated by his wordlessness and instead enjoy his ability to be still for a moment.

“Lemme just sit here a minute and rest.”

Jessi sighed. “You better pick it up before I leave, or your tessicles ain’t gonna just be a little swole.”

Gainers snorted a laugh. “Yes, ma’am.”

Jessi turned back towards the kitchen. “I had prepared you a nice dinner, a little sandwich with some whole wheat bread. You know I can’t be eating no sodium either. I got me some low sodium turkey from the store– which is real– but I bet you spoiled your appetite.”

“Jessi, you know I can always eat somethin’!” Jessi responded with a howl of laughter.

“Well, then, I’ll leave yo’ sandwich on the counter here and you can have it when you pick up your mess.”

“Okay then.”

Gainers reached for the remote. The television had been on but he personally didn’t care for the daytime talk show that had appeared, thus, Gainers began looking for something else that interested him. He came upon reruns of cartoons, which he settled on as the best alternative to all the talking and cooking that was happening on the other channels. It was another several minutes before Jessi emerged from the kitchen again. She came and sat down on the couch next to him.

“I just don’t want to have to take you back to the hospital,” She put her hand on his.

“I know,”  he said. “I just… forgot.”

“And I know you trying real hard to do right by yoself and do right by me. And you done a good job of taking your medicine every day and watchin’ what you eat. But you just gotta be careful!”

“I’m gonna do it,” he affirmed. “I’m sorry.”

Jessi nodded.

“And…” he started. “I wanted to thank you again for takin’ me in. You know you ain’t got no good reason to, not after all I done.”

“Gainers, for some reason God’s givin’ you a second chance with this liver thing. And if He gonna give you a second chance, I figure that’s good enough reason for me.” She stood up. “Plus, now that I’m payee for yo’ check, we might be able to afford a car payment.”

“My check?” Gainers was briefly surprised by this revelation.

“Yeah. You know, the one that usually goes straight from some hardworkin’ taxpayer’s wallet to Doc’s Liquors down the street. You signed it over to me last week with that social worker from the hospital.”

Gainers felt his earlier buoyancy begin to fade. Since the age of 25, when he had officially been decided to be disabled from his schizoaffective disorder, he had been collecting and spending his own disability check. While Jessi was quite right to observe that the majority of each check did support one particular neighborhood business, he felt as though things were going to be different now. He was upset with himself for allowing his freedom to be so quickly revoked with his own signature. He vaguely remembered the event.

“I signed it over to you?!”

“Yes, you did, Gainers, and don’t tell me you don’t remember. We talked about it for a long time, and we agreed that if you was gonna be sleepin’  on my couch and not with your good-for-nothin’ friends or the sidewalk downtown, I was gonna be yo’ payee.”

“But it’s my check!” he protested.

“Yes, it is,” she said. “But we gonna spend it responsibly.”

“Hell, I just–” Gainers found his frustration growing, but he knew that, having signed some sort of legal document, he had no recourse. The best that he could hope for at this point was that Jessi would give him some portion of his check to spend as he pleased and let things go from there.

“Probly better off this way anyway,” he conceded, trying to convince himself.

“Glad you agree,” said Jessi. “I’ll be back late tonight. Don’t know how long the meeting will go.”

 

***

 

Jessi took her jacket and an umbrella that were leaning against the other couch, went to the door and walked outside. She locked the inner door and then the outer security door. It still looked like it might rain, and Jessi quickly donned her jacket as the wind was picking up. She walked briskly over to Fulton Avenue, then turned south. Fulton ran from Druid Hill Park just a few blocks north all the way down to Route 1 out of the city with a narrow median strip in between. The median alternated between plain concrete, fading grass, and collections of litter, lined on either side by elegant rowhomes in various states of disrepair. Most had formstone facades, but some were simply well-worn brick, forming a checkered pattern of tan and red stretching towards the horizon. The road was straight all the way south, though there were numerous short hills and drops along the way. Jessi waved and nodded to several people as she went, exchanging a familiar “How you doin’ ” with a great variety of neighbors. The gray sidewalk slabs were frequently broken and often filled with trash, with big tree roots snaking through the cracks towards the boarded-up houses in front of them. As the weather was turning, people who had been sitting on their stoop enjoying the afternoon were moving inside or calling their children to do the same; the children were riding their scooters or bikes up and down the sidewalk in an attempt to squeeze as many seconds of time outside as they could.

She passed a barbershop, Doc’s Liquors, two churches, and another store called Fox Liquors before turning left to get to the police station. Lined up in front were six well-worn police cruisers and a jeep, as well as a few unmarked cars. The building, which was two stories of brick with plain marble columns in front above a well-worn brick staircase, read “Western Police District” in gold lettering on the glass of the front door. She entered into the building and nodded hello to the officer sitting at a large desk in front. He greeted her in return and she walked to his right down a long hallway to a small room where tables were gathered around a raised platform holding a single fully uniformed police officer and a plain wooden podium. Arranged around the room were various plaques dedicated to various officers who had faithfully served the department for some length of time interspersed with fading pictures of various city politicians and officers standing and smiling together. A large American flag stood on the platform, slumping into itself as if it were intimidated by the impressively sized fake plants next to it. The officer had a sheaf of papers in his hand and was quickly flipping through them as he spoke. Jessi stood at the doorway to look for who else might be there.

“You can see here that robberies are down 14% in this past quarter compared to last year, while there was one more car theft this year. We have heard rumors that there’s a gang that’s stealing cars and selling them to a fence up in Liberty Heights, so if you hear anything please call our confidential tip line…”

Jessi’s eye was caught by the long, straight blonde hair to her right, sticking out rather obviously with all the dark-haired, bald, and blue-capped heads in the room. Hannah was following along with the officer as he gave detailed crime statistics, scribbling something in the margins of her handout. Jessi could see that Hannah had her own carefully written notes with her, and was turning back to them every few seconds or so. Jessi slowly moved down the table behind the seats, slipping into a chair two seats down from Hannah next to a short, thin woman with her dark hair pulled back. The woman smiled as she took note of Jessi and reached over to give her a hug.

“Jessi,” she whispered. “It’s been too long.”

“Ida,” replied Jessi. “It’s good to see you back in the neighborhood. This lady brought you?” Jessi nodded to Hannah, who turned and shook Jessi’s hand.

“I was going to come anyway. I’m glad you told her to come,” explained Ida.

“Well, when she says that you done sent her down to me, can’t help but do something for an old friend, even if she ain’t callin’ too much…”

Ida smiled and raised her eyebrows. “Good to see you ain’t changed, Jessi.”

They sat and listened for a while longer about crime statistics. Jessi mused to herself that clearly data was being mistaken for information and information in turn was being mistaken for knowledge. The prospect of wisdom entering the matter seemed right out, echoing a thought that her pastor had shared during last week’s sermon. She heard her own inner scoffing and tried to resist it, reminding herself that these cops get up every day and bust their asses in the name of protecting her and her neighbors. The same forces that had been pushing her down all of her life were pushing them to act in the ways that they did, and their best way of making sense of all the brutality and wickedness they faced was to turn it into easy, simple numbers. Record one number, compare it to the next. She had watched this happen with Gainers time and again: doctors would tell her about various labs that they’d drawn, telling her how one number was falling and the other number was rising and by golly, did they have a plan to fix it. Except for when they didn’t. That’s when their faces got more solemn and their sentences more drawn out, like when the officer in a black shirt studded with shining accessories and black leather straps came to the subject of shootings in the neighborhood. Five more this year than last in the first quarter. It would be tough to deal with in the face of some decreased shifts precipitated by city budget cuts, he admitted. But the Western District would continue to aggressively pursue justice. There was no other option, Jessi thought. For every drug dealer carted away from the corner where he lay in a pool of his own blood to Shock Trauma downtown, there would be a reckoning.

Jessi’s train of thought ended along with the statistical recitation segment of the meeting. They transitioned to community announcements as Ida strode to the podium. She took slow steps, but they still exuded the confidence that Jessi had always admired in her friend.

“Friends,” she started in her nasal, friendly voice. “I’m so glad to see so many of you here showing your concern for your community. I remember when I was 8 years old seeing Dr. Martin Luther King, Jr. coming down Pennsylvania Avenue and getting to shake his hand when he came to speak in Baltimore. Some of you can remember the energy of those times, how we worked so hard and saw so many victories.”

There were a few nods and murmurs throughout the room.

“But many of you also remember how things changed over the years. Stable families started moving out. A lot of blue-collar jobs started leaving, too, and when they left, so did all of the businesses here in the neighborhood. The riots, the drugs, the abandoned houses, the broken families– things that we didn’t want just kept moving in. People in our community are hurting, and so many don’t have the opportunity to make it and take care of themselves and their families.”

Hannah leaned over and whispered to Jessi. “Did she really meet MLK?”

“Of course she did!” exclaimed Jessi, perhaps a little too loudly. “My momma said I did, too, but I was just two years old and don’t remember.”

“Wow!” said Hannah.

Ida resumed her thought. “And one of the opportunities that I know has been a struggle for everyone is health care.”

There were more murmurs of affirmation.

“This year, my friends, another bill has been introduced in the Maryland House of Delegates to provide health coverage for every man, woman, and child in this state. For too long, our neighbors have suffered because they could not afford to see a doctor and get the basic health care that they need. Medical Assistance helps many people and we all have friends who are on it, but so many people don’t qualify and so many people in our communities die too young. I am going to bring my friends up here to talk about it.”

Hannah pushed her chair back and stood up almost too quickly, clutching her sheaf of papers to her chest. She moved towards the podium, but then slowly decreased her pace and turned around, looking at Jessi. Her nervous exuberance faded; she looked at Jessi expecting her to move but Jessi responded with a mildly exasperated countenance. Hannah seemed to realize very quickly that Jessi was not going to come up with her and tried to suppress the fear that Jessi saw creeping across her face. Turning back, she strolled up onto the platform, put down her sheaf, and gripped the wooden podium.

“Thank you all for being here,” she began. “My name is Hannah and I’m a medical student from the University of Maryland. I’m not entirely sure what to say. After all, I think you all are much more familiar with all the ways that lack of health care access hurts people. I meet patients all the time who aren’t able to afford the medications that keep them out of the hospital and won’t come to the clinic because they have no insurance. Then they get sicker, live in pain, and have to use the ER. I don’t think this is right.”

There were a few claps from the small audience. Jessi kept carefully studying Hannah from afar. Her long, straight blonde hair shook with energy when she spoke. She was wearing a long, smooth black skirt and a tight green blouse that just barely allowed what little curves she had to show. She wore almost no makeup except for a little bit of eyeshadow and mascara, which helped her light blue eyes to look even more radiant. She paced a little as she continued to describe the bill that was coming before the House of Delegates, which Jessi found more and more intriguing as she spoke.

“There are a lot of people like me– medical providers– who want to see this change happen in our state. And I know that you want this change to happen in our state. But it’s going to take all of us to make it happen, because this could be really unpopular in a lot of places. We will be rallying in the City Hall at the end of the summer to support the bill, and if we can get thousands of people to show up and say that they want universal health care, we can show the Governor that it matters!”

Jessi calmly pushed her chair out and walked around her table towards the front. She moved outside of Hannah’s field of vision and slowly strolled up onto the platform, putting a long right arm around Hannah midsentence. Hannah, surprised, stopped talking and turned her head first to the side that Jessi’s hand was on and then to the side that Jessi was on.

“Friends, I just wanna say that you know I been livin’ here all my life and that I be awfully suspicious of white people comin’ round with their high-and-mighty ideas about how to help us black folk.”

There were a few chuckles and murmurs in the room. Jessi smiled.

“Well, I just want to tell you that between me, Ida, and Hannah, this is gonna happen. And if you’re gonna come along with us, then you had better jump on board now! Go on out to your churches and tell ‘em to sign up and come. Go on out and tell your neighbors that we goin’ to the halls of power and we gonna make our voice heard!” There were more claps and cheers. Jessi gave Hannah’s shoulder a vigorous shake and then began to amble back down to her seat. She gave Ida a hug as well, and as they did Ida whispered in her ear, just barely audible over the continual clapping.

“I’m so glad you came back,” she whispered. “All those kids from the university I sent to your house these years, and you finally came back.”

“Because you was too scared to call me yoself.” Jessi snorted.

Ida shook her head. “I was waiting for you to be willing to work with someone else again.”

Jessi nodded. “It wasn’t easy.”

“I know. What was it about Hannah?” Ida folded her eyes as she stared at Jessi’s face.

Jessi pursed her lips. “I… just saw somethin’ in her. Like she was willin’ to listen.”

 

__________________________________________________________________

 

DISCHARGE SUMMARY

UNIVERSITY OF MARYLAND MEDICAL CENTER

22 S. GREENE STREET

 

PATIENT: ADAM FREEMAN

DOB: 6/13/88

MRN: 128093456

DATE OF ADMISSION: 4/22/10

DATE OF DISCHARGE: 4/25/10

ATTENDING: DR. BARUCH FRIEDMAN

ADMISSION DIAGNOSIS: 1. AUTOIMMUNE HEPATITIS WITH ACUTE FLARE 2. DEPRESSION

DISCHARGE DIAGNOSIS: SAME

PROCEDURES: NONE

CONSULTANTS: DR. SOLOMON BODE, TRANSPLANT SURGERY

 

HOSPITAL COURSE: The patient is a pleasant 22 year old Ghanaian male with a long history of autoimmune hepatitis status post multiple admissions who was admitted to our service with a chief complaint of nausea, vomiting, and altered mental status. For details of his admission history, please refer to the written admission history & physical. The patient’s mental status improved with oral lactulose and IV fluids. His liver function tests were initially high on admission, but they improved somewhat over the next two days and trended towards his baseline. There were no problems with his INR or with his platelets during this admission.

He did have a lot of nausea and inability to tolerate oral fluids for the first two days, which did not respond well to IV Zofran but did respond to IV and then oral Reglan. His abdominal pain improved with IV Dilaudid and then oral Oxycodone. He was evaluated by physical therapy for some concerns about his balance and weakness with walking brought up by his father. PT/OT recommended discharge home with no need for rehabilitation services as he had regained full strength by the time that they evaluated him.

He was also evaluated by the transplant team under Dr. Solomon Bode, as the patient is currently part of a research protocol regarding liver regeneration. There were initially concerns that since the patient had had a recent liver biopsy this was the cause of his admission, however, it was felt that the patient simply had another attack of his relapsing autoimmune hepatitis. When the patient tolerated oral fluids and medications he was discharged home.

There was also some concern because of the patient’s mood. The patient was not suicidal but did admit to feeling depressed and down lately because of his illness and missing school. The patient’s father requested a psychiatry consult or an antidepressant while the patient was admitted for concerns about depression, but the family medicine team felt that this was an issue best discussed with the patient’s primary care doctor at his next follow-up appointment. The patient was in agreement with this plan.

 

DISCHARGE MEDICATIONS:

Lactulose 30 grams by mouth four times a day.

Lasix 20mg by mouth two to three times a day as needed for swelling.

Reglan 10mg by mouth three times a day as needed for nausea & vomiting.

Oxycdone 10mg by mouth every four hours as needed for abdominal pain, #30 given.

 

DISCHARGE INSTRUCTIONS:

Patient is to follow-up with his primary care doctor, Dr. Chambliss, within one week.

 

CODE STATUS: FULL

 

DICTATED BY: Vazhir Kazic, M.D.

SIGNED BY: Rita Chambliss, M.D.

Solomon Bode, M.D.

 

Chapter 4 will be released on December 1, 2014.

Go to the discussion page.

 

Creative Commons License
Trousseau Syndrome by Matthew Loftus is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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