◊ One-Twenty, Eighty
He felt like the new sheriff every morning. He told the image in the bath mirror to “move along.” He was grooming for a new day of natty “g’nfights with Death.” After all. Dr. Rhys iterated the command anew to the aloof, and gloomy figure in the mirror, obliquely adding how CHF, – congestive heart failure, his other nemesis, an adversary favored by the image – was actually a “sage disease,” and Death was going to lose. Today. Ultimately. Eventually. Finally tying his tie, with a huff for the medical profession, which was somewhere generally out-of-doors, Dr. Rhys muttered, “Life is a matter of getting used to everybody else being wrong.”
Dr. Rhys had summoned an “invincible” ally to his side for a mundane Thursday, who had emerged from a book his was skimming, Butler’s “Lives of the Saints,” John of God, and his parting shot at Death, lingering upon the hamper, was a shot, in parting: His habit was to slowly arrange the fingers of his right hand into a pistol, and, one eye a glare at his target, pronounce “Pow!” His private practice in New York had begun in the nineteen-sixties, and Dr. Rhys made occasion to meet Death a’ mano, summoning the implicit Spanish, the proverbial corridor of two matadors alternating in a tussle with two or three bulls at a time. Hence Dr. Rhys was a natural for the ER, the Emergency Room, and gladdened by the christening of the swank new Brooklyn Medical Center; of course, in the very earliest days, the dark figure became another unassuming tenant of the building. It was trademark of the doctor’s tenacity to remark to others how he personally knew “Death, and its entire family,” and rather than recite viruses, and complications, merely offer to them a hard, and steely eye.
The physician did not suffer the illogical very gladly, The forty-year veteran hospitalist was given privileges in the ER, and changed his designation from “internist” to general practice, resumed the ruckus with Death, the Big Jim of the health biz, viewing it as akin to the Bud Light Knight, or the Fugitive. A man of the nineteen sixties, the doctor found great, and minor success in practice utilizing a studied “non-conformity.” His eightieth birthday elapsed in the ER, and, safely out of the eye-shot of the head nurse, sparked a cigar at the entrance, and began to explain to an orderly the very worst, the worst of all the afflictions of heart disease. Dr. Rhys, mindful of how the “heart actually stops when you sneeze,” said the very worst was when a patient “had to do more than one thing at a time.” He said, “The worst is when they have to yawn, and sneeze, and cough at the same time. Not enough juice. Terrible, it’s terrible, – Charlie Chaplin stuff.”
Dr. Rhys had related the anomaly to a Brooklyn native, a college instructor, who was a long-time patient, who developed CHF. It was Thursday, his birthday. The instructor had ferreted him out in the ER, arriving the slow night without an appointment. Dr. Rhys was prompted to mull the value of his time: his backyard deck was sorely in need of repair; in his view, free, pro bono encounters were akin to a $200 or $500 instant loan; enjoying the night air out-of-doors, accepting a fresh Marlboro from the patient’s open pack, the scowl diffused on his face. The doctor asked him, “Do you think I’m overly mercenary? Most of my day is pro bono.” The college lecturer said no, reassuring him, and skipped to the matter at hand, his disease, causing the physician’s mind’s eyes to roll; outside the ER, the new, Brooklyn Medical Center, Dr. Rhys resolved, with a breath of informality, “Well, I can go over the worst of it, the worst of it.”
The instructor, listening to Dr. Rhys, wondered if it was part of a doctor’s training to smooth their prognoses like the cement poured for a new sidewalk, making it new, and fresh, but not very inspirational. Dr. Rhys was grinning, and recalled one CHF patient who continued to swim at the Brooklyn Y. Dr. Rhys said, “I met the fellow at the Y one day. I was playing racket ball, and started to watch him, kind of marveling, you know. He’d swim one lap on his chest, a butterfly, say. He looked almost like a caveman, trudging through the water He had to stop. He had to walk part of the way. It was dreadful. Now, then, he’d switch to a backstroke. This was dreamy. He could glide along like an Olympian, doing the backstroke.”
The professor nodded, puzzling out this one, “The left, versus the right ventricle?”
Dr, Rhys said,“Well I can’t say, without, without documentation. But it does make you wonder.” He quickly narrowed an eye, then added, “No, probably not.”
He expelled smoke in the lot, and repeated, absently, after searching the medical library in his head, “Probably not. I haven’t read that. Maybe. Well.”
Dr. Rhys puffed the Marlboro, and said, “You need to understand science. Much of the time, we solve what we get paid to solve; it sounds unfair, uneven, but it’s actually very efficient, economical. The money goes where there is a solution. We can fix that, per se. Otherwise, it could be ridiculous. You have a drug that pays billions to medicine, if it is a cure. That’s what they do. It’s a dimension of science, like a second nature. Science mirrors nature, and it’s bigger, it’s wiser than us. There are higher laws. Nature decides where we fit in the grand scheme; maybe, maybe it’s a nonsensical scheme, but people can win, and they do – and we can lose, lose, and that’s all there is; that’s all she wrote. We sift, we can pan away for the gold in the dark, for cures. What I mean is we can never, ever progress, no matter how clear, and rational progress may be, until Nature decides, until Nature finally allows it, until it gives us a clue, – a ‘sounds-like,’ a ‘rhymes-with,’ – until it gives us the slightest hint, one single, new idea, or a fact, something no one has noticed, – it was too remote, it was too mundane. CHF? It’s still a puzzle.”
The Selective Monitoring Unit, known as SUM, was the computer mainframe of the LifeRaft®, and it was used to control all of crafts deployed from the base in the Hydra galaxy. And it was askew. It was skittishly trying to “logicalize,” or assign logic, to a recent video data grab acquired during a trip by an American Legion researcher from Sombrero, and her guest, a college teacher from Brooklyn, New York, – a dark, cloudy “glub,” some form of a molecular cloud, dominating the Milky Way galaxy,
The pair had been dijecting in a LifeRaft® to the Milky Way, and Earth, where New York was located, and SUM had encountered a data sequence where the Sun, and the eight planets, were entirely absent. The Hydra control room discovered the Sun, situated in Centaurus; there, it comprised a four-point diamond, with the three well-known stars, of eleven, Proxima, Alpha, and Alpha-B; bereft of the explanation, SUM reported the Milky Way without a Sun, a “glub,” contained just “the dusty arm of Orion, and Hyakutake comets.”
(The Great Comet of 1996, Hyakutake, missed the planets of the Milky Way, noted SUM, and would certainly have no trouble in the galactic image of the sphere generated by the finding, captured during the return to Earth.)
It was an escape from regular time, the “appointment.” Dr. Rhys was steps away from it, the fanciful drama of a quiet ER; his mind nobly acquainting time with capital, the doctor opted for shorthand, for the list of “everything else.” It is “a formidable list,” he told the lecturer, whose heart fell for the exercise, “but the heart is a formidable organ.” Dr. Rhys contemplated how the size of lists can vary indirectly with how close the present science is from a basic cure. He solemnly railed to him, “Heart disease. Heart disease is a bloody pandemic!”
It was never ascertained whether the doctor was more garrulous, or pedantic. Thus he continued, and comported the statistics. Dr. Rhys said, “Heart Disease. Twice as many deaths occur from heart disease than from cancer, the next one, the one in second place. That’s no day at the beach. Heart disease, cancer, those are one-two. For perspective, natural disasters are thirtieth, death from fires is 26. War is 27th. What else? Let me think:. Homicide is 16. Road injuries? Eleventh. Heart disease claims 17.5 million souls every year. Compare that with deaths from suicide, drowning, malaria, – that awful one, the one with all the mosquitoes? – less than 1 million. It’s a lot, but it’s not even close.”
The instructor shuffled his hands into his pockets, and asked the doctor about the specific statistics for CHF, as if there may be something new. Dr. Rhys was grim. He said the general rule was worse; someone diagnosed with CHF had a 1 in 4 chance of survival, 25%, in the 1st, and 10th years, he said; it was 50-50 in the second to the ninth years. “The end is like the beginning, in the main,” the doctor said. “Yes, now I’m seeing where they say the whole shebang could end in five years.”
The instructor breathed, and, slightly changing the subject, offered the doctor the viewpoint from his colleague, Milt, a full professor at Marsh College. “He says that heart disease is the way of life in America, literally, the yearning to breathe free.” Dr. Rhys had a muted smile.
Quizzically, ready again for the ER, and more serious, Dr. Rhys said, “Heart failure is long-term. Heart attacks are acute. We’ve made some progress on the latter. Pacemakers, those.” He added abruptly, with a quick stare, “One-Twenty, Eighty.”
“That’s what,” the physician said. “That’s what you want to know. Blood pressure.”
Dr. Rhys said. “Let’s go over it. You have to get to the proper weight, not make the heart haul around a lot of extra weight. It’s an extra strain. I know one guy, – this is a little new, – who lost weight giving up dehydrates. They always say don’t use salt anymore, or sugar. Salt retains water, and water takes more for the heart to process. Use spices instead. But the spices are also dehydrated, he figured. They retain water. So he got through that awful plateau, a diet, you know, and lost five, ten pounds. Interesting.”
The doctor said, “One-Twenty, Eighty. That’s the banner headline. This disease, CHF, is progressive, it’s a disease that progresses, which means it gets worse. Part of the heart is damaged, and it doesn’t work right. It’s flatter, it’s got a hole, it’s something like that. I don’t sell people rose color glasses. It’s not going to get any better. You’ll probably go – in bed, sudden arrest, arrhythmia. Work around it, this thing. Try to get out, exercise the sound parts of your cardio, the remaining part that works, help the heart work a little better; eat right, find ways that ease the heart’s burdens. Take what I call a ‘cut-below,’ if you have to, – maybe use the carts at the grocery store, once in a while, here and there. You know, a century ago, they’d just say, ‘Well, bud, you’re just getting older.’ Basically, that. It’s just we can see it all now, diagram the darn thing. Unfortunately, there’s no margin of error. You got to know a pinch of salt is too much. A pizza could kill you. Listen up. You like soup? Chicken soup? Soup is a pile of fluid. Think of these things. Three cups of coffee is a liter. Fruit, a lot of fluid there. You have to know. Put it all in a diet plan. Win the inches in the game. Stay on the field. One-Twenty, Eighty. That’s as fast as you go, the new speed-o-meter. I say now, I say, watch blood pressure from day one, from age one. Of course, that’s me.”
Dr. Rhys ducked into the ER, and, hands in his medical coat, slunk back outside to the professor at the entrance lot. “Nothing doing,” he commented. He liked to comment, and observe, a perquisite of his profession, and his place in life, but it was not something to encourage in his patients. He felt they acquired their dilemmas, somehow, they should never have been “at play in the fields of the Lord.” And they didn’t know. “We could talk about meds, and that sh – ,” he gibed.
The instructor said, “Yeah. Those are fine.”
“Fine? Good?” He nodded.
“Good. Good, then. Keep you going.”
“Yeah, I used to take vitamins, and veggie juice,” the lecturer said. “That was it. No I’ve got a dozen to take every day. I think they give a few of them to horses.”
“Yup,” Dr. Rhys grinned, and realized his manner was lacking in cheer. It was the chance to enlist Saint John of God. He asked the patient gratis, “Have you ever had a patron saint?” the doctor asked him. “Just curious. There is one for heart failure.” He rolled his eyes mordantly. He was not an evangelical; to the contrary, it brought to mind a favorite list, a list from the Lives of the Saints. Dr. Rhys informed, “There is quite a spectrum, you know. Man, there’s one for almost everything. I don’t know if you’re religious. Your patron would be John of God. Intimidating name, no? Heck, there’s a patron saint for arms dealers. There’s one for bell makers, printers. Gardeners. My own, my choice, surely, the great Saint Arnold of Soissons, the Belgian, who is the patron saint for hops pickers, and brewers.” The doctor’s eyes gleamed, flicking cigarette ashes to the pavers.
Dr. Rhys found a roll. He said, “You know, there’s a patron saint for artillerymen. For Italian prison officers; advertisers, wool combers, odd lot dealers, shorthand, jurors. Wheelwrights, barbers. Saint Cosmas, for doctors. That’s a good one.” He recited, “Cobblers, blacksmiths, people who work at great heights. Radiologists, okay; equestrians, clowns, lumberjacks, washerwomen. ice skaters, and popes. Tin miners.” He gazed at his patient, adding, with a laugh, to see if the instructor, was still with him, “There’s one for undertakers. Make of that what you will.”
“Who is that?” the instructor replied.
“The famous Joseph of Arimethia.”
“John of God?”
“Saint John of God,” Dr. Rhys smiled. “He’s a good one. He’s the one for Heart Disease. Born in Portugal. Soldier until he was forty. Helluva book, really. Butler’s Lives of the Saints. They usually give out a card for John of God. You can get, there’s probably one, around here, somewhere. It’s got a prayer to him.”
There’s was a silence, no subject coming to mind. “One-Twenty, Eighty,” Dr. Rhys said, after a moment. “Just keep it there.”
The instructor began to chuckle about it all, a gallows’ moment, and it was contagious. Dr. Rhys began to laugh, too, impishly and less happy, and shook his head. He allayed, “Here’s what we’ll do. We’ll see what we find. Try something. Anything. See what we can do. I mean, it’s up to you. We can see you back in six months, and start over. A new stress test, a holter.”
“It’s not a bra,” Dr. Rhys chuckled. “It’s called a holter,” the name for a device worn by patients for a continuous forty-eight hours, in order to record the rhythms of the heart.
The lecturer shrugged. He asked, “What will it be like, the end?”
“The end? Well, the medications will still prop you up. Like I said, the end will be a lot like the beginning, the end-of-life. Some – disorientation. It’s a progressive disease. You need to adjust. You need to adapt. Stay ahead of it, stay on top of it, the complications, the indications. I guess the word is indefinitely. One-Twenty, Eighty. Who knows? They could come up with something tomorrow. Be there. You just don’t know. You know, if there was ever a place, New York, you know. It’s cynical, admittedly, but at Level Four, and Five, you’re better off in a big city, if you can get a transplant.”
“A transplant,” he repeated.
“Million, and a half USD,” said the doctor, with an empathetic grimace. “Two thousand or so transplants a year, pretty good success rate, though. But a half-million people have heart disease. It’s one of every four deaths.” He paused, and said, “Still, once in a while, all the stars fall into place.”
He were quieted, but strangely not depressed; more resolute. Dr. Rhys added, “Definitely get a box, a CRT, a pacemaker. That will help some. It’s a game of inches.”
The college instructor juggled his keys, and used them to open the door of a new vintage car, another Malibu. Dr. Rhys watched as the tail lights of automobile depart from parking lot of the emergency room, and walked inside. The nurse asked him, “Did you set an appointment?”
“Can’t say that I did, no,” the physician said, with a heavy breath; with a shrug, he espied a new patient behind a privacy curtain. The nurse joined to examine him, a high-school youth, who was sporting a new cast on his ankle. “Did we do that?”
The youth quickly said, “No. I was playing basketball.”
“Well. Well good!”
“Broken ankle,” the nurse reported, glancing inestimably at the patient. “Mmm, no cure for a broken ankle,” Dr. Rhys said, turning towards her, with a question, and slightly glassy eyes. “We bandage it, and send him home; is that – good?”
“Yes doctor,” she smiled, proudly. “It’ll heal in time.”
The doctor looked at her, and nodded. “Anything?’
The nurse said, “Nope.”
The physician stepped back outside the ER through the sliding doors, in a mood to ponder more fully. He blinked, and decided his eyes seemed to be wet from the ducts; brightened, and then Dr. Rhys frowned, quickly, like Bogart, formed a pistol with his hand, and waved it at the dark. He proclaimed,“No mas!” ◊
¤ JUKE BOX ¤
Theme: “He’s Smiling Down On Us,” George Carlin| playlist, “Flea Markets, Nos. 51-,” a myopic vaile, (No. 49)
..… from “^; or, CARET,” III of III,
The Echo By Seas; & Other Stories, by Soda Tom
[Complete Works, No. 01]
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