The View from the Vue (11 page)

In fact, that was precisely what Arthur’s friend had done. They had been playing a game that some people called homosexual roulette: blowing air into their rectums from a gas-station hose. It was not an uncommon practice, and as one might imagine, injuries were not infrequent. But Arthur’s was in a class by itself.

Randy’s surgical team operated on him without delay, and found his rectum literally in shreds. He had peritonitis because the blast of air had sent a fecal aerosol spraying throughout his abdominal cavity. It was touch and go for several days, but Arthur finally survived, though with his rectum resected, he was left with a colostomy as a souvenir. An impacted Coke bottle would have been a bargain.

Generally speaking, homosexuals seemed to have trouble with their orifices. If it wasn’t the anus, it was the mouth. This latter situation was illustrated by one of our admissions during my tenure as intern on male medicine. He was a tall, very asthenic Chinese man who minced and pranced around the ward, causing the nurses and aides to collapse in helpless laughter. One of them teasingly offered to chaperone me while I examined him.

The patient’s name was Charlie Wong, and his problem was a high fever and a sore throat. That didn’t sound like anything special, and I wondered why the doctor in the Admitting Office had seen fit to admit him. As I examined him, however, I stopped wondering. Aside from his 104° temperature, he had a chain of swollen lymph glands the size of walnuts running the length of his neck on the left. And his sore throat looked like no strep infection I had ever seen. The entire left tonsillar region was covered with a very angry-looking red sore which was sending out rays of beefy inflammation so that the whole thing looked like a sunburst. Beneath the sore, the throat was so swollen it appeared ready to pop.

Charlie told me that he had been feeling increasingly ill for about a week, with progressive soreness and inability to swallow, and increasing malaise. I couldn’t begin to imagine what manner of dread disease he had. I swabbed his lesion, made smears, and examined them under the microscope, but I was unable to identify any particular offending bacterium. I thought that the swelling might be an abscess, but after a good deal of poking around, during which time I had poor Charlie swinging from the chandeliers, I was convinced it was merely a severe tissue reaction to the overlying sore, and not a pus pocket. I wondered whether Charlie might have been suffering from leukemia: such patients are subject to unusual types of infection, often of a fungal origin. However, his blood count was characteristic only of infection, and so, with relief, I scratched blood cancer from my list of diagnostic possibilities. Once again I swabbed the sore and prepared cultures for every microorganism I could think of. Then I called my resident, Arnie Handelman, to take a look.

Arnie made a face as he peered down Charlie’s throat. “God, I don’t know,” he muttered. “I’ve never seen a lesion like that before.”

“That makes two of us,” I said.

“It really is an ugly thing, isn’t it?” said Arnie. “I’d sure as hell hate to have something like that in
my
throat.” He paused a moment. “Which makes me think,” he continued slowly, “maybe it could be contagious?”

All of a sudden my entire body began to itch fiercely. I scratched at my left shoulder.

“Let’s get a dermatology consultant,” said Arnie.

“Now?” I asked. “At ten o’clock at night? What dermatologist is going to come see a patient at this hour?”

“He won’t like it,” said Arnie. “But he’ll come. He has to, since we want him to check out a possible communicable disease. Go ahead and call him.”

The dermatology resident was indeed cranky about the after-hours consultation, but he did come and look at Charlie’s throat. He, too, grimaced as he inspected the sore, and then he shook his head. “Beats hell out of me,” he said. “Did you do a Gram stain?”

“Sure,” I answered. “But it didn’t show anything.”

Our pimple-popping friend shook his head again. “I just don’t know,” he said. “But it really doesn’t look like anything that would be contagious by an airborne route. Why don’t you just isolate him in a corner bed with a screen around him and observe handwashing precautions. Then wait for your cultures to come back and see what you get.”

“You think we ought to start him off on a broad-spectrum antibiotic in the meanwhile?” Arnie asked.

“I wouldn’t,” said the dermatologist. “He’s got a fever, but he doesn’t look at all toxic. Better wait a day or two to check the cultures; if you end up having to culture him up any more, you may get inaccurate results if he’s on antibiotics.”

So we sent Charlie to the farthest reaches of the ward, put a screen around his bed, and ordered his temperature to be taken every four hours. I went back to the intern’s quarters and scrubbed myself in the shower until my skin was raw.

For the next day and a half, Charlie Wong’s temperature fluctuated between 98° and 103°, but he continued to feel well, except for his local symptoms. On the afternoon of his second day on our ward, the reports on his throat cultures came back. They were all negative. During rounds that afternoon, Charlie received only the most perfunctory of greetings. Not only was he making us feel unpleasantly incompetent, but the more negative findings that accumulated, the more mysterious his ailment became, and the less anyone wanted to get close to him.

After we had finished rounds, Arnie and I were sitting in the ward examining room entering notes on charts. Suddenly Arnie stopped, put his pen in his mouth, and looked thoughtful. “I’ve got an idea,” he said.

“About Charlie Wong?”

“Yeah. You know what I’m going to do? I’m going to call Dr. Erickson over to take a look at him.”

Naturally I wondered why I hadn’t thought of that. Dr. Erickson was the dean of the dermatology staff at The Vue, a stocky little man, not much taller than five feet, with a bald head full of wisdom, and with blue eyes from which emanated considerably more mischief than one would expect in a seventy-year-old. When Arnie got him on the phone, he said he’d be glad to come by first thing in the morning.

We were all waiting for him when he strode onto the ward at eight o’clock. Arnie described The Mysterious Case of Charlie Wong, and when he had finished, Dr. Erickson asked one question:

“This patient, is he what you fellows might call…a little bit on the faggoty side?”

A couple of snickers in our rank answered the question, but I said, anyway, “We’re quite certain he is.”

“What made you ask that?” said Arnie.

“Let’s just go see the patient,” replied Dr. Erickson.

As we walked to the back of the ward, Dr. Erickson kept up a nonstop banter, making fun of us for being so afraid of a homosexual that we had to hide him behind a curtain at the rear of the ward. He told us he wanted to make certain that we knew that homosexuality was not catching.

Arnie introduced Dr. Erickson to Charlie, and the old man took out a tongue blade and a flashlight and peered into the patient’s throat. As he did, a truly wicked smile broke out on his face.

“Aha, young man!” he fairly bellowed. “I know what
you’ve
been doing.”

Charlie turned bright red and grinned sheepishly. The members of the house staff looked around at each other. One pair of shoulders after another shrugged.

Dr. Erickson patted Charlie on the shoulder, assured him that he’d soon be feeling better and then led us back to the front of the ward. There he explained that Charlie’s sore was a very typical chancre, a primary syphilitic lesion. “Every one of you would have recognized it if it had been on his genitals,” he said. “But you never stopped to think that homosexuals engage in, shall we say, sexual acts that are a little different. Therefore, they can get chancres in the rectum, or in the mouth and throat. Gentlemen, you must learn to keep your minds open.”

Dr. Erickson was right on target. Charlie’s bacterial cultures had been negative because the organism which causes syphilis is very fragile outside the human body, and difficult to grow. But when we went back, scraped the lesion, and examined the scrapings under a dark-field microscope, we found battalions of the characteristic corkscrew-shaped bugs. After that, a little penicillin, and Charlie was as good as new.

Very different was the case of Sylvia Pancoast. Sylvia was in her early fifties, and even her dyed hair and about a pound of facial makeup couldn’t disguise the fact that she had a foot and a half in the grave. Her eyes were sunken and lusterless, the skin was drawn tightly over her cheekbones, and every detail of every bone in her body stood out in relief under her skin. Her general build suggested that she had once been a strong, even muscular, woman, but that had been before her lung cancer had gone to work on her. The cancer was obvious on her X-rays, and it was also clear that the lesion was beyond all help. She sat patiently as I examined her, wheezing with each breath, but when it came time to do the pelvic exam, she demurred with a vigor that amazed me. “No man ain’t gonna put anything in there on me,” she said firmly.

I considered the situation for a moment. “Would you like me to call a lady doctor?” I asked. “Would that make you feel better?”

“No sir; no sir!” said Sylvia. “You ain’t gonna call no doctor, man or lady. I never did let no one ever touch me down there, and I ain’t about to start now.”

Once again, I considered. It didn’t seem reasonable to pursue the issue: with what Sylvia had growing in her chest, it didn’t really matter much what she had in her pelvis. I couldn’t see any purpose in trying to force or persuade a dying woman to submit to a pelvic examination. So I omitted the pelvic from my write-up, and when I presented the case to the resident, I also skipped the pelvic part. I figured that Sylvia was either an extremely stalwart virgin or an old butch who just wanted to give me a tough time.

During the subsequent week and a half that Sylvia lived on the ward, we simply tried to keep her comfortable with narcotics. Every morning we said hello to her, and reordered her medications. The last thing on my mind or anyone else’s was her unfathomed pelvis.

Finally the evening came when the nurse called to inform me that Sylvia had stopped breathing. I went down to the ward and officially certified that fact. Then I went to the chart rack to make the final entry into Sylvia’s folder, and to see whether there were any next of kin to be called. Meanwhile, the nurse and the aide began to prepare the body to be shipped down to the morgue.

I was in the middle of writing my note when I was interrupted by a shriek in the purest hi-fi stereophonic sound. I dropped the chart and started running. The nurse and the aide met me halfway. Each seemed to be trying to outdo the other in generating hysteria; they were screaming and gesticulating wildly. Finally the aide managed to direct my attention to Sylvia’s bed, as she yodeled, “Dr. Karp! Oh, Dr. Karp! She’s a he—a man!”

I galloped over to Sylvia’s body. The reason for her reluctance to have a pelvic examination was plainly evident. She very obviously had been a man, and one with a real problem. She had been a transsexual, an individual who believes he has been trapped or imprisoned within the body of a member of the opposite sex. Sylvia probably took estrogens to feminize her physical characteristics, and she may have undergone electrolysis to remove most of her facial and body hair. It certainly was a good job; it had all of us thoroughly fooled.

Today Sylvia might have been eligible for a sex-change operation so that she’d have been able to live entirely as a woman. In 1963, though, such procedures were extremely difficult to come by, and the vast majority of transsexuals were forced to practice the kinds of deception that in the end permitted Sylvia to die among the women of Bellevue Hospital rather than among the men.

Homosexuals and their difficulties turned up in some unlikely parts of The Vue. For example, there was the case of Charlene McGinnis. Charlene was one of my obstetrics patients.

She was a dainty little woman who couldn’t have weighed more than a hundred pounds, but when I first saw her on the labor and delivery suite, she was letting out noises worthy of a bull moose in rut. Charlene had been wheeled up from the Admitting Office, where she had presented herself with a severe stomachache, nausea, and vomiting. It had been determined without undue difficulty that these symptoms were those of labor, and she was therefore shipped in haste to us. The intensity of Charlene’s howls alarmed me, and I examined here immediately; the exam revealed that the baby was ready to be born. As we proceeded toward a delivery room, I asked, “Is this your first baby.”

Charlene stopped roaring long enough to look at me in wonder, and say breathlessly, “are you telling me I’m going to have a baby?”

I thought she was kidding. “What do you think you’re carrying around in here,” I asked, patting her on the belly, “a basketball?”

“Some of my friends have been telling me I was putting on weight,” she answered. “In fact, I had myself on a diet a few weeks ago, but I haven’t been able to lose a pound. Actually, I gained three last week alone.” At that point, she started to cry.

I administered a saddle block anesthetic, which relieved her of her pains, but the tears kept coming. I though I understood the situation. “What’s the matter?” I asked. “You don’t have a husband?”

She shook her head. “I never even dreamed I could be pregnant,” she said, wiping her forearm across her eyes. “I never felt any movement, and I wasn’t sick a day, at least till this afternoon. Now what in the world am I going to do with a baby?”

As I talked, I was getting ready to perform the delivery. “Seems like you’ve got two choices,” I said, as I pulled on my gloves. “You can either keep it or you can have it adopted out. I admit it’s a hell of a time to start making that sort of decision, but I don’t see how it can be helped. Anyway, you’ll have a few days to decide after you deliver. Which reminds me: Do you think you’ll want to see the baby, or would you want to do some thinking first?”

“Oh, no,” Charlene said rapidly. “I want to see it. I don’t think I’ll believe I had it unless you show it to me.”