Thursday, April 8, 2010

One percent

It’s Saturday night in San Francisco. I’m huddled into a doorway against the gentle rain, in the afterglow of a date, when a distinguished black man walks by me frenetically and says “Shit!”

“Sorry if I bothered you there,” he apologizes.

“No problem,” I mumble, still trying to hit the little tiny keys on my Iphone. Illyana is a gorgeous Russian Jew with a nervous lip tic and red scarf. We drank Moroccan tea for eight friggin dollars a cup, stared into each other’s eyes and tried to pretend we didn’t meet on an internet dating site. I look good in my suit jacket and black sneakers, a dot-com dress-casual clone, but apparently not good enough for a post-date kiss.

[[Illyana, had a great time. You are beautiful and charming, and I hope to meet with you again.]]

The tea has an aftertaste of ash. The sky is wet iron, rusted yellow from the reflected lights of San Francisco. Rain patters the concrete, nips at the hem of my bluejeans.

“Listen, sir, perhaps you can help me out,” he says. “My name is Roland Chase. I’m from Burbank. I was driving up the coast when I was carjacked. They took my wallet, man.”

Up close I can see that his salt-and-pepper beard is shaved very close. Clean leather shoes, but a cheap watch. Drier than one would expect for someone that had been carjacked in the rain.

There is power in details.

Before I moved to San Francisco, I was a medical professor in Brooklyn. I used to hold court in my ER, surrounded by medical students. Every patient was a learning opportunity. Mr. Johnson had eyes like my well-dressed supplicant. He was a morbidly obese man. He proclaimed to be allergic to nitroglycerin, which medicine for the heart, and the only medicine that would relieve his pain was morphine. What about the EKG, I asked?

The EKG is normal, a student told me. Her short white coat is pressed. She smells like Ivory soap and textbooks.

And the intervals? I ask sagely. No one ever looks at the intervals on the EKG.

The intervals are the distances between peaks. When you’re hiking, no one ever talks about how long it takes to get to the mountain, but it’s all part of the journey.

“Listen, I’m not a bum, I’m a real estate broker, but I lost everything,” Chase says. “My wife and kids are in the car waiting for me. I can give you my watch as a deposit…”

I never give money to people on the street. Most of them use it for drugs, not food or shelter. I might as well give it directly to their dealer.

My phone blings a text.

[[Had a great time. Loved hearing about your adventures in Thailand, and your views on stem cells. Next time I can show you the stairways of San Francisco – Illyana]]

Ah, Illyana. Beautiful, educated, stylish. Snobby, priviledged, elitist. Potential but fraught with complications. Maybe fifty percent likely that I'll get another date, 25% chance that we'll actually start dating. What's the chance that she's the one?

I want to text her back, something witty and seductive, but the man’s need is burning in front of me. I can see despite his dark skin, his lips are white and trembling.

“I called the CHP and they won’t help me. It’s only 12.87 for a can of gas…”

I’m pretty sure I’m being hustled. He starts laying it on thick, about how his wife or kids are in the car. I must seem like another kid on the town with more money than sense. I wish I had the grey hair to match my almost-forty years of life and centuries of cynicism. Clouds pout overhead.

80% chance of downpour. 90% chance of scam.

I’ve lost a lot of patience for street people, and I’ve lost a lot of patients in the ER. I’ve worked in the worst neighborhoods of South Central LA, Philly, and Brooklyn. Sometimes they’d just bring dead people in, all grey and blue and colors that people shouldn’t be, and I’d pump on their chest for awhile and try to bring them back. I’d juice them with adrenaline, shock them with electricity, pump them full of saline and and plasma and blood, even cut open their chests to squeeze their hearts back to life.

Dead stays dead. When you don’t take care of your diabetes or your high blood pressure, you’re asking for reprisals. Crack cocaine, heroin and Mad Dog don’t make for good bedfellows. Dead stays dead.

With every death, I lost ground. I lose heart. I lose strength.

But I never lose kids, I used to say. No kids die in my emergency room. I had been beaten down, but I had drawn a line in the sand.

Baby Jessica was only eleven days old. She was tiny, small even for a newborn. I’ve eaten bigger burritos. Her mother said she wasn’t sleeping well. Her skin was grey and her arms lay limp at her sides, but she was still breathing.

We took her to the resuscitation room. We put a tube down her tiny throat and pumped in oxygen. We gave her saline and sugar, fluids and antibiotics.

We worked her for six hours.

She died at twelve days old. The intensive care pediatrician, a tiny little woman that could have been anyone’s mom, said I didn’t have a chance. One percent at best.

“Sir, can you just help me out with a little something….” Chase pleaded with me, pulling at the sleeves of his coat like a junkie.

One percent.

I was in my final year of residency. I hated medicine. I hated the hours and I hated pumping on dead people and I hated trying to take care of idiots that didn’t care for themselves.

They paramedics rolled her in, while she flailed in the throes of a seizure. She had just had a baby six weeks earlier, and her sister, stained with tears, told me she had been feeling depressed since then. She writhed around the stretcher, and the worst thing was none of us knew why. We pumped her full of sedatives but kept thrashing. Her blood pressure falling. Her brain was frying in her skull.

The bumps and lines of the EKG seemed like a trivial detail, but something was off. The QT interval was too long. Consistent with tricyclic antidepressant overdose. One of the most dangerous manmade toxins, caused unending seizures, a drop in blood pressure, and death. Turns your blood into acid. I picked up an enormous syringe of sodium bicarbonate. Baking soda in water. It is the only antidote.

My attending physician, an insightful man with a child’s face and a shock of grey hair, shrugged his shoulders. He had seen too many grey and blue bodies, grasped at too many straws, to gain any hope. I saw my chance and took it.

She woke up three days later, and admitted she had stolen the tricyclics from her brother. I watched her take the first steps of her new life. “My legs hurt,” she said. “Can I have a pain pill?” I guess I expected gratitude.

Every year on Christmas eve, I toast to myself that there is one less orphan in the world, one more mother at Christmas.

Yesterday I saw a gallon of blood drain out onto my shoes while I struggled to keep a man alive after he flew off his motorcycle on the freeway. At seventy miles an hour, asphalt is like a grinder. I still scream at them “Don’t you die on me!” and yet they still do. Even children.

I handed twenty dollars to my Mr. Ronald Chase, or whatever his name was. He who rushed off, his heels clapping wet pavement. Ninety-nine percent likely he was off to buy a 40 of Budweiser, crack or black tar heroin or whatever.

But maybe, just maybe, he would be filling his gascan and rescuing his family from a dark street on a rainy night. Maybe I’d get a second date with Illyana, and a third and a fourth, and maybe we’d fall in love and have kids and hold hands when we’re seventy.

I have to believe in my one percent.


Anonymous said...

Not bad, buddy.

Shauna Roberts said...

Since Katrina, I usually give money to panhandlers because of that chance they're telling the truth.

Anonymous said...

great post!

Katy Young said...

You are more talented than you think you are.