The View from the Vue (16 page)

No patient’s story could possibly illustrate this situation as well as Sarah Rosenbaum’s. Hers is the saddest tale of bad luck I have ever encountered or, for that matter could imagine. She might have been invented on a rainy Sunday afternoon by Theodore Dreiser. Perhaps she was Al Capp’s model for Joe Btfsplk. If she had been a sports star, she wouldn’t have lacked for nicknames. Rotten-luck Rosenbaum, Out-of-the-frying-pan-and-into-the-fire Rosenbaum. For-the-want-of-a-nail-the-kingdom-was-lost Rosenbaum. Very definitely, somebody up there did not appear to like Mrs. Rosenbaum

The saga began one wet morning when Mrs. Rosenbaum, a plump sixty-eight-year-old widow, left her Lower East Side apartment to do a little food shopping. She wheeled her metal shopping cart in front of her and moved slowly. Between her stiff hips and her varicose veins, she was just a bit unsteady on her feet. She was being so careful to look ahead of her that she never did notice the paper bag directly under her feet. Her right foot came down on the bag, slid forward, and
wham
—Mrs. Rosenbaum was flat on her back.

When she woke up, she found herself being lifted into a meat wagon, one of the rectangular Bellevue ambulances that bore an unpleasant similarity in appearance to a butcher’s truck. She never did find out who had called the thing. Maybe it had been the keeper of the shop in front of which she had fallen. These bloody bodies on the sidewalk really do kill business.

Mrs. Rosenbaum had suffered a badly cut scalp, and the ambulance attendants applied pressure to the bleeding wound. The meat wagon sped directly to the Bellevue Admitting Office.

Here, the surgical intern and resident attended to the new patient. Scalp wounds are funny things. There’s very little tissue between skin and bone, so that when the scalp is torn away the underlying blood vessels over the skull are easily ripped, and bleed freely. Since they lie directly on the surface of the skull bones, they can’t be clamped, so the only thing to do is to quickly suture the tear and then apply heavy pressure to it. But in the meanwhile, a lot of blood can be lost.

Mrs. Rosenbaum had already bled heavily before she reached the hospital. As the surgeons washed and sutured, they noticed with some dismay that the heavy bleeding was continuing. Their dismay increased as they considered her age and high blood pressure. If she were to lose too much blood too fast, she’d have been a very good candidate for a heart attack. So they called for a pint of blood, and began a transfusion as they continued their suturing. By the time the pint of blood had run in, they were finished. Then they spent the next few hours making certain that the patient’s heart action and blood pressure remained normal. This done, they put Mrs. Rosenbaum to bed till the next day. In the morning they rechecked her neurological status and her skull X-rays. Everything was normal, so they congratulated Mrs. Rosenbaum on her good luck, and sent her home.

With good luck like that…

For a while Mrs. R. felt pretty well, perhaps just a little dizzy now and then. Her stitches came out with no trouble. But a month or so later she began to feel a little sick to her stomach, and before long, she began to vomit. Some days she had diarrhea as well. This distressing state persisted for a few weeks, and then one morning Mrs. Rosenbaum looked into her mirror and noticed that she was a bright shade of yellow. “Mein Gott, I look like a Chinaman,” she muttered, and ran out to catch the First Avenue bus up to Bellevue.

Her diagnosis was not much of a problem for the internal medicine intern. “It’s serum hepatitis,” he told her. “Jaundice. An infection in your liver.”

“Gewalt! From vhere do I get dis infeckshun?”

“Probably from the blood transfusion you had,” answered the intern. “These germs live in some people’s blood.”

“So vhy’d d’nudnicks giff me blood mit joims?” wailed Mrs. Rosenbaum.

The intern gently explained that there were no tests that would have permitted identification of a contaminated sample of blood. He also briefly pondered the fact that it was not strange that the blood was infected, since at that time the city’s blood banks accepted as donors any drug addict or bum who came in eager to trade his reasonable blood count for the price of a fix or a few bottles of cheap wine. What the hell. Business was business.

“So now vot den?” asked Mrs. Rosenbaum.

The intern explained that a few weeks’ rest in the hospital and a good diet should fix her up as good as new. Mrs. Rosenbaum shook her head sadly and lowered herself into the wheelchair to ride up to her ward.

After a few weeks had passed, the house staff on Mrs. Rosenbaum’s ward began to get concerned. The blood tests were showing no resolution of the hepatitis. Furthermore, Mrs. R. was, if anything, more yellow than ever. So the gastroenterologist was called, a needle was passed into Mrs. Rosenbaum’s liver to take a biopsy, and the verdict of the Great Omniscient Pathologist was awaited.

It came the next day: subacute hepatitis. Actually, the intern had not lied to Mrs. Rosenbaum. Hepatitis usually does last only a few weeks, but occasionally, for reasons entirely unknown, the infection fails to resolve, and persists in an active state. As in Mrs. R.’s case, when the disease doesn’t clear up within a few weeks, we call it subacute hepatitis. Then, if it lasts even longer, we change its name to chronic hepatitis. If we can’t treat it, maybe we can confuse it. In any event, subacute and chronic hepatitis are very serious conditions.

The ward house staff met in consultation with the gastroenterologist, and further plans were formulated. It was decided to give Mrs. Rosenbaum steroids: these are drugs related to cortisone which have salutary effects on long-standing inflammatory diseases, such as rheumatoid arthritis. Hepatitis being an inflammatory disease, some attempts have been made to treat it with steroids. The results have been equivocal, but this was perceived as better than the unequivocally dead patients who had received no definitive therapy.

So Mrs. Rosenbaum began to take her steroids and, lo and behold, her yellow color began to fade and her blood tests improved. She was really getting better. The staff congratulated her on her good fortune. Mrs. Rosenbaum, however, regarded them with a somewhat jaundiced eye.

After about a month on steroids, one of the interns suddenly recalled that these drugs sometimes cause bleeding from the stomach. So he got Mrs. Rosenbaum to save a stool sample to test for blood. It was positive. So was the next sample. So was the one after that.

This caused no little consternation among the doctors. The miracle drug that was apparently bringing the (by now) chronic hepatitis under control was at the same time apparently producing bleeding from the stomach. This could be dangerous. But so could the hepatitis if it were once again allowed free rein. As the group contemplated the possibilities, one bright fellow had a great idea: maybe the bleeding was not being caused by the steroid drug. Maybe Mrs. Rosenbaum had another cause for her internal hemorrhaging. So they drew straws and the loser went off to tell Mrs. Rosenbaum what lay in store for her now. A sigmoidoscopy and then a barium enema X-ray. Should these prove negative, then an upper G.I. X-ray series.

For a sigmoidoscopy, a patient gets on a table and points her rear end at the ionosphere. A man stands behind her with a ten-inch-long metal tube, which he gradually inserts into her rectum. Then he and his associates look up into the tube. Generally this is called a pornographic, multiple X-rated movie, but when it is performed in a hospital by physicians, it is then considered socially acceptable behavior. Acceptable, that is, except to him or her who is being scoped. For the uninitiated, let me say that it feels as though a freeway were being constructed between the rectum and the belly button. In any event, Mrs. Rosenbaum’s sigmoidoscopy failed to show a cause for her bleeding.

So on to the barium enema, a procedure which involves filling the rectum full of dye and then taking X-rays to look for any irregularity within. This was more revealing. The cause of the bleeding was apparent. Mrs. Rosenbaum didn’t have to stop her steroids. She had cancer of the rectum.

Now came an even more spirited discussion among the members of the house staff. Between her hepatitis and her high blood pressure, Mrs. Rosenbaum was a poor surgical risk. However, not to operate was to abandon her fate to the whims of her cancer.

Once again the straws were passed around, and the holder of the short one trudged out to discuss the problem with Mrs. Rosenbaum. As tactfully as he could, he told her that she had a cancer in her rectum, but it did not appear to have spread, and seemed curable by appropriate surgery.

Mrs. R. seemed to accept the news philosophically. I suspect that by this time she had seen the handwriting. She sighed and shrugged, and then asked, “This soij’ry, it’s gonna be a beg on mein stomach?” The intern figured out that she meant a colostomy, squirmed a little, and nodded. Mrs. Rosenbaum nodded back. That afternoon, she was transferred to the surgery ward.

She remained there for a week, while surgeons and anesthesiologists planned and plotted the procedures which would offer the patient the best possible chance of leaving the operating room alive. Then, after seventy-two hours of enemas and purgatives to empty the bowel, she was pronounced ready for surgery the next morning.

About five hours before the proposed operation, the intern was called to the ward. Mrs. R. was complaining of severe pain in her chest, was pale and clammy, and was gasping for breath. The cardiogram was a formality. She had suffered a severe heart attack. Without ado, she was returned to the medicine ward from whence she had come.

This was the point at which I personally entered Mrs. Rosenbaum’s life for the first time, although she had long since become a hospital legend in her own time. During the week she had spent on the surgery ward, I had become the intern on her medicine ward.

So now, as though chronic hepatitis, rectal cancer, and a heart attack were not enough, Mrs. Rosenbaum’s misery was compounded by having a whole new crop of doctors to take care of her. She responded by becoming deeply depressed and totally negative.

She needed more than just medical treatment. I tried to tell her that in six weeks she’d go back for her operation and that this was only a temporary setback. “Hoo hah,” said Mrs. Rosenbaum, stretching her arms forth so that the entire ward should hear her. “Me he tells about temp’rerry setbecks.” Then she turned to face the wall.

I tried to cheer her up by bringing one of her former interns to see her. Mrs. Rosenbaum looked daggers at him, said, “Foist he desoits me, den he comes ‘n’ giffs me leckchizz.” Once again, she turned to face the wall.

One of the gastroenterologists thought that a psychiatry consultation might be of help. The shrink talked to Mrs. Rosenbaum for a while, and then wrote a nice note on the chart to the effect that Mrs. Rosenbaum had a “reactive depression,” that anyone who had her problems was perfectly entitled to be depressed, and that maybe the gastroenterologist needed a psychiatry consultant.

As the days passed, Mrs. Rosenbaum became more and more withdrawn. Finally, she stopped eating. So I went to talk to her. “Mrs. Rosenbaum,” I said. “You’ve got to eat. Your heart isn’t going to get better if you don’t eat.”

I was ready for an argument or a so-what statement, but what came back was, “De food ain’t kosheh.”

“But Mrs. Rosenbaum, you’ve eaten the food all along. Why all of a sudden do you decide it’s not kosher?”

“I never t’ought about it before.”

I decided to play the game, so I called the rabbi. He came right up to talk to Mrs. Rosenbaum, and assured her that not only was she permitted to eat non-kosher food when she was sick, but that he would arrange for her to receive kosher food from the hospital kitchen.

“Dot’s no good,” she said. “De pots ‘n’ pens here ain’t kosheh.” That was that. She turned to the wall.

That evening my wife and I sat in the examining room, and I told her about Mrs. Rosenbaum, who by this time had not eaten a thing in the previous forty-eight hours. My wife asked why I didn’t pass a stomach tube and force-feed her. I explained that the battle it would cause might well produce another heart attack. My wife thought for a moment, and then said, “I think I can get her to eat.”

“Be my guest, I said.

My wife got up and walked over to Mrs. Rosenbaum. “Hello, Mrs. Rosenbaum,” she said. “I’m Myra Karp.”

Mrs. R. turned and looked my wife up and down. “You Dokteh Kahp’s wife?”

Myra admitted to the fact.

Mrs. Rosenbaum focused on the white coat. “I seen you here before, but I didn’t know you was Dokteh Kahp’s wife. You a dokteh too?”

Myra explained that she was not a dokteh, but that she came to the hospital at night to keep me company and to help me out by doing laboratory work and filling out charts.

Mrs. Rosenbaum smiled. “Now dot’s nize,” she said. “Dot’s rilly, rilly nize. At night you come to dis place, to be mit your husbin. Vot you do all day?”

“I’m a schoolteacher,” said Myra.

“A scullteechuh! Vot grade you teach?”

Myra explained that she taught home economics—sewing and cooking. This led up to the direct attack. “Since my husband says you won’t eat the food here,” she said, “tomorrow night, I’m going to bring you a chicken. And it will not only be kosher, it will be
good
.”

Mrs. Rosenbaum’s eyes lit up. I was astonished. First, I had seen her smile, and now I had seen her show some interest in something—even if it was only a boiled chicken. The old lady grabbed Myra by the arm, and cried, “You mean dot? You are rilly gonna bring me a suppeh tomorrow?”

“Yes, I mean it,” said Myra. “But I want you to be here to eat it. My husband and the other doctors are worried about you, you don’t eat anything. I can’t bring you three meals a day, so you’ve got to do something.”

“Ah, no problem,” smiled Mrs. Rosenbaum. “De rebbe sez I kin eat food dot ain’t kosheh if I’m sick. So, I eat a little—just enuf to keep alife, till you bring d’ chicken.” Then she turned toward me and hollered across the room, “You got such a wife, Dokteh Kahp, I hope you’re grateful for it.” She patted Myra on the head.