The Doctor Patient

“Jenni, you get the prize patient today!" said Susan Davis at morning report. After living in Boston for almost two decades, Susan still spoke with that Georgia twang. She had a starched snow-white nursing hat perched on her mousy gray hair.  Susan did not look like a head nurse on the verge of the new millennium.

The nurses around the table looked at me with pity. They all knew that the "prize patient" was Dr. Abraham Cohen.  Doctor Cohen was at death’s door with pancreatic cancer. Susan told me that for thirty-nine years Dr. Cohen had been a staff vascular surgeon at Boston University Hospital.  Tall, athletic, confident, capable, he used to be a model of the modern medical man.  According to Susan, he had always gotten his way; that is until now.   He detested being a patient especially at Mass General.  As a patient, Dr. Cohen had lost control of his life. Everyday I heard another story about how terrible it was taking care of him and how he was confirming the time-honored axiom that doctors make the worst patients.

Susan looked down at her notes and then aimed her gaze straight at me. "Well Honey, you're the only one who has not had the privilege and honor of taking care of the good Dr. Cohen."  Her touch of sarcasm surprised me.

"Yeah," said Peggy O'Malley.  Peggy had graduated with me from Boston College School of Nursing.  As she spoke, she bobbed her head up and down.  She reminded me of those toy dogs people used to keep on the car dashboard. "It's your turn," said Peggy. "Yesterday, he spit at me. It was pathetic."  Excited, now her head was bobbing as if the car just hit a gauntlet of potholes. Her freckles danced on her face. "Only he's so weak that he spat on his own chin." She looked around at the gathered nurses, making sure she had their attention. "And," she paused "when he was first admitted, he threw the soap at me for no apparent reason."

"Thank God he has a quick growing cancer," said the nurse we nicknamed Precious. "He's getting very weak and his aim is getting worse."  Everyone at the table giggled except me.

I recalled one day when I was a little girl and my mother was so mad, frustrated, and out of controlled that she started throwing her Lennox wedding china. It was the day she found out about my father's mistress.  I remember hiding under the dining room table and seeing the dishes fly.  In vain my father tried to catch them, so she threw them at his feet.

"Hey, wait a minute, Miss Susan," I said, "I don't think you have taken care of Dr. Cohen."

"Rank has its privileges, Honey," said Susan.

Again everyone tittered.

Susan readjusted her cap which she had religiously worn at Mass General since her arrival. I had been a nurse for only four months and with Halloween approaching, I felt like the trick was on me.

After morning report, towels, sheet, and pillow casings in hand, I took a deep breath and plowed open the door to room 319. The supplies seemed a little heavier that morning.

"Good morning, Dr. Cohen."

As I hoped, I caught him off guard.  Nothing flew past me.  Was he dead? Without looking at him I headed for the drapes. With the flick of my wrist, I snapped them open.  The morning sun invaded the room.  Like Dracula in a demonic rage, Dr. Cohen raised his arm to hide his eyes from the light.

"What the hell are you doing?"

I turned to look at him.  I could see why he was so angry. I could not believe how in the few months since I first met him, his stately persona had eroded to a skeleton draped with a yellow shroud of skin.  As he put his arm down, I saw a crudely tattooed number on his forearm. Like a neon light trapped under a urine-stained sheet, the number tried to jump out at me. He caught my stare and glared at me with his wilted daffodil colored eyes.

I took a deep breath ready for a verbal battle with this creature, and then the smell of stool, urine, sweat, and bile mixture made my head spin. I had to do battle with myself not to vomit.  I took a few short breaths with my mouth and resolved to look professional.  He looked like he was about a hundred pounds.  Even when I battled anorexia, I don’t think I looked so horrid.

"Get me my slippers," he snapped. "I want to go to the bathroom."  His jaundiced bald head shined like a lightning bug's behind. He glared at me with those demonic yellow eyes.

For some reason I had this great urge to tell him to go to hell and run out of the room.  But he was my patient. Without a word, I picked him up, sat him on the side of the bed, and slid his slippers onto his swollen feet. He leaned forward to secure some relief from his stabbing, spastic abdominal pain. His stomach was swollen.  He looked like a puffed up yellow toad ready to pop.  I picked him up as if he was a wounded soldier, draped him over my shoulder, and walked him five steps into the bathroom.   Gently, I lowered him onto the commode and closed the door. I heard him moan.

"Are you all right?" I called through the door.

"What the hell do you care?" I thought I heard him hiss.

He was right.  I didn't give a shit.  But it was my job. I didn't know what to say.  My bra strap was cutting into my shoulders, pinching me. That little pain annoyed the hell out of me.  I couldn't imagine the pain this man was going through. After readjusting my bra, I changed the sheets on his bed and ran out of the room.  I didn't even get to my next patient, when his call light started to flash. I rushed back into his room.  It was a premonition of things to come.  By the end of the day, I wanted to take that nurse's call button and wrap it around his chicken like neck.

"Are you all right?"

"I'm done.  Could you help me wipe?"  No please or thank you. We use to joke in nursing school that when a patient could not wipe himself any longer, his next room was a pine box. At that moment, I wished I had listened to my father, followed in his footsteps and had become a stockbroker.

Dr. Cohen didn't eat anything for breakfast.  Every time he put something to his lips, he retched until yellow liquid spewed out of his mouth.

After I changed the sheets for the third time and gave him a sponge bath, he looked at me the way my mother used to when I did something special or kind.  His eyes captured my soul. Until then, I didn't think he had even a grain of humanity left in him.

"Thank you Jenni."

Good lord, the man was human after all.  His kind, soft whisper of my name touched me.  A hundred different emotions consumed me.  I didn't know how to react.

"You're welcome," I heard myself say.

He requested a Compazine suppository before lunch to stop his retching and vomiting.  But it didn't help. If I pinched his skin, like a soldier at attention, it would stand there for a few minutes. Of course he refused intravenous fluids.  "Why delay the inevitable?" he said as he looked out the window at the dying autumn leaves.

Thank God Susan had the other nurses help me with my other patients. After sign out, I told her that I was going to tell that "old goat good-bye" and thank him for a "beautiful day."  I don't know why I still felt so much animosity towards him.   Maybe it's because in some strange way he reminded me of my mother.

My mother is and was a good Irish Catholic while my father is Protestant.  As long as I can remember, I have called my mother a "flying nun."   She believes in the Holy Trinity, the Pope, the saints and prays on the rosary daily.  All my life, I have refused to go to church with her just because she wanted me to go.

There was also something religious about Dr. Cohen.  Maybe it was his martyr attitude.

Susan looked at me and grabbed my arm.  "Honey, you can do anything you like, but let me give you a little advice."  I froze in a sea of disbelief.  Susan reminded me of a white Aunt Jemima and she had me by the arm.   "If you see a turd in the middle of the street, don't kick it, or it may smell."

I laughed at her crazy Southern wisdom.  I was going to handle him just the way I use to handle my mother. I was still smiling at Susan's wit when I knocked on his door.

Silence. Was he going to rob me of the satisfaction of telling him off?

As I walked into the room, the rays of light coming from the small lamp seemed to be wrestling with the man who was writhing in pain.  I lost my anger.

"Can I get you a pain shot?"  I knew the answer even before I asked the question.  During my shift, Dr. Cohen had taken only one injection. Despite his pain, he did not want to give an impression of weakness. I felt his strength.  He wanted to fight the Angel of Death head-on, and for that I respected him.

He shook his head.  The spastic wave of pain left him.   He had won this round.  Exhausted, he glanced at me.  "Isn't your shift over, Jenni?"

“Well, yes but ...”

Again he disarmed me by using my name.  Damn it. I had no problem telling my mother she was a real bitch.  I had no difficulty telling her that it was her fault that Dad left us.  This little encounter with a patient was not going the way I had planned it.

"I just wanted to see if you needed anything before I left?" I lied.

He looked around his bed.  There among the sheets lay a small yellow pencil used to fill the daily menu and a legal pad that almost blended with the color of his skin.  He pointed to them.

"Can you please help me write a letter?" said Dr. Cohen.  "I'm having trouble seeing."  Now it was his turn to lie.  I could see that he almost didn't have enough strength to pick up the little pencil.  He waved his stick arms in a disorganized fashion looking like a puppet without strings.

I hesitated.  "Sure," I told him while inside I just wanted to run to the closest bar and put down one or two White Russians. Son-of-a-bitch, Susan was right about that turd stuff.  I looked at my watch hoping this would not take too long.

I crossed my legs like a personal secretary waiting for his words. It was the first time I had a chance to look around his room.  His night stand, except for a small lamp, was empty.  No "get well" cards.  No balloons with an attached card wishing him a "speedy recovery." The white Formica table  stood empty against the wall with the usual hanging television above it.

"Dear Joseph" he finally said while adjusting the bed so he could lean forward as much as possible.  "I write this letter to tell you good-bye." He took a deep breath and swallowed. "I love you.  My last thoughts are with you and your mother."

I stopped writing for a second to look around the room again.  Maybe I overlooked a card or the flowers.  No.

"I want to tell you that I have missed you for the last nine years."

The pain gripped him again. He clutched his stomach, rubbing it as if trying to get a charley horse out.  I was hoping the afternoon nurse would walk in and rescue me from my agony.  But no one came. Somehow he found the strength to go on. "On your birthdays, I thought my heart would break.  Every year I would open your childhood photo album, and in my mind relive your birth and childhood.  I would hide from your mother and cry until my soul begged me to stop."

When he spoke about his wife, he looked into my eyes as if knowing my deepest secrets.  "Every Mother's Day, until the day she died, your mother would never leave the house.  She would not admit to it, but she prayed you would find the kindness in your heart to call her.  She feared that if she went away from the house, she would miss the call that never came."

He jerked his head back and groaned. I leaned forward in my chair to see if he wanted help, but he found the strength to lift his hand like a policeman and signal me to stop.

"Your mother and I might not have been the best parents in the world, but we tried.  Everything I did, no matter how distasteful it might have seemed to you, I did because I love you."

I thought of my own mother as he labored to suck in some air.  "If I have hurt you, then I am sorry.  Now that you have a son of your own, you will see that being a parent is not easy.  If I am sorry for anything in this life, it is that I did not have the privilege to meet my grandson.   I hope that little Noah is doing well."

My throat went dry.  I looked up from my pad.  The old man was trying to cry, but could not find the tears in his prune like body. It was if he was trying to squeeze water out of a dry sponge.

“If you don’t mind me asking, what happened between the two of you?" I said.

"Do you have any children of your own?"

I shook my head no.

"I worked very hard when Joseph was young to give him everything possible.   I admit I was strict.   In fact my nickname at the house was The Enforcer." He managed a half-smile. "I took my parental responsibilities seriously.  I knew it was not a popularity contest."

He stopped for a minute obviously drowning in a flood of memories.

"Joseph was a great kid.  He studied hard and did well in school.  He played basketball. He did so well at his Bar mitzvah that for a short time I thought he would become a Rabbi." He closed his eyes. "Eventually, he went to Princeton and got into Harvard Law School. You can't believe how proud I was when he got into law school."  He opened his eyes and appeared to come back to reality, but his voice continued to express his excitement.  "Harvard Law School of all places!"

Suddenly, I recalled how proud my mother was when I graduated from nursing school. Having grown up in Boston, I was not impressed with Harvard but, to Dr. Abraham Cohen, that school represented success, acceptance, triumph, and conquest.

"When I applied to Harvard, they had a quota on Jews," said Dr. Cohen. "My name, my Polish accent and the number on my arm all unmasked me.  My grades did not matter." He grabbed the emesis basin and retched two or three times though nothing came out.

"Do you know what one of the doctors asked me during my Harvard interview?  This Harvard man asked me where my horns were.  Can you believe the narrow mindedness of some educated men?”

"Even though I did not get in, my son Joseph Aaron Cohen, a Jew, went to Harvard Law School."  No amount of pain, nausea, or vomiting could take the pride away from his face.

"Do you know he has his own law firm now?"

"So what happened?" I finally blurted out.

His tongue looked like dry leather as he stumbled on his words.

"One day he came home with this girl named Mary.  A shiksa.  A non-Jew.  It wouldn't have been so bad if she would have considered conversion.  But she was one of those Southern Baptists who felt that her mission in life was to convert every Jew to Christianity; even if she had to marry all of them." He stopped and sucked in some more air.

"Before coming to this country, both my wife Rachel and I were in Auschwitz death camp. When we got off the cattle car, the Nazi soldier, not much older than me signaled for me and Rachel to go to the right. The rest of my family was directed to the left.  I smelled my mother and father, my two brothers burning in the ovens."   An unguarded shift of his eyes spoke his thoughts.  "The Germans tried to destroy me and all Jews.  The Baptists are much more cunning and dangerous.  They steal our future."

I could see the horror in his eyes as he abruptly stopped. After a moment of reflection, he resumed.

"Law school had really changed Joseph," Dr. Cohen told me.  "There was no longer any right or wrong for him.  No God.  No honor.  He became stubborn as a stone. He forgot the breasts that nourished him." Dr. Cohen covered his face with shaking hands. "I am convinced that his mother died of a broken heart."

"One day when he had Mary come to the house, she saw some forks and knives stuck in the ground. When she asked him about it, he insulted his own mother by telling Mary that she was a little off the wall.  He did not know that she overheard him." Dr. Cohen gazed up towards the sky as if looking for his wife.  With clinched teeth, he reaffirmed his love for her.  "My Rachel, my wife, my angel was not crazy, she was a great woman.   All she was doing was trying to kosher the utensils.  We kept a kosher home and sticking knives and forks into the ground is one of the ways to make things Kosher."  He smiled.  "Our non-Jewish neighbors used to laugh that my wife was trying to grow knives and forks. But enough about my life, let me finish this letter so you can go home."

I read him back the last sentence and he continued.

"Please don't forget me, your mother or where you've come from.  Kiss Noah for me. Please find it in your heart to tell him about me, your mother and your past so we can continue to live in his memory."

Exhausted, he drifted off to sleep.  The afternoon nurse finally came in with his dinner which was destined for the garbage.

Quickening my step to put distance between myself and Dr. Cohen, I rushed to the nursing station.  I found his son's address in his chart.  That empty table in Dr. Cohen's room became emptier when I found out that his son lived only four blocks from the hospital.

I read the letter again.  I added "Shalom" which I knew in Hebrew meant hello, peace, and good-bye.

I was going to mail the letter on my way home, but decided to deliver it personally.

I walked to the edge of Beacon Hill overlooking The Commons.  The lights were off in the Federalist brick mansion of Joseph Cohen. As I stepped on the porch, the knife cold air crawled under my skirt. The night veil was spreading over the city trying to hide the full October moon. I knocked on the door.  There was no one running to greet me.  I wanted to give the letter to Joseph before it was too late. I rapped my knuckles against the door.  Silence.  I slid the letter through the mail slot at the bottom of the door.  As I bent over, I saw in the corner of the front window a blue and white sticker with a cross inside a Star of David.  Written below the cross and star was "My savior is a Jewish carpenter."