1
Dr. Alan Bulmer
"Can you feel this?"
Alan gently pricked the skin of her right leg with a needle. Fear glittered in the womans moist eyes as she shook her head.
"Ohmygod, she cant feel it!"
Alan turned to the daughter. Her face was the same shade of off-white as the curtains surrounding and isolating them from the rest of the emergency room.
"Would you wait outside for just a minute, please." He made sure his tone would indicate that he was not making a request.
The daughter found the slit in the curtains and disappeared.
Alan turned back to the mother and studied her as she lay on the gurney in the fluorescent-lit limbo, letting his mind page through what he remembered of Helen Jonas. Not much. Borderline diabetes and mild essential hypertension. She hadnt been to the office for two years, and on that occasion had been dragged in by her daughter. Then, half an hour ago, Alan had been sitting at home reading a journal when a call came from the emergency room that one of his patients had arrived, unable to walk or talk.
Hed made his diagnosis within minutes of seeing her, but followed through with the rest of the examination. He moved the needle to the back of Helens right hand.
"How about this?"
Again she shook her head.
He leaned over and touched the point to her left hand and she jerked it away. He then ran his thumbnail up from her bare right heel along the sole of her foot. The toes flared upward. He raised her right hand and told her to squeeze. The fingers didnt move. He let go and the arm dropped back to the mattress like dead meat.
"Smile," he said, showing her a toothy grin.
The lady tried to imitate him, but only the left half of her face responded. Her right cheek and the right side of her mouth remained immobile.
"How about the eyebrows?" He oscillated his own, Groucho Marx style.
Both of the womans eyebrows moved accordingly.
He listened to her heart and to her carotid arteriesnormal rhythm, no murmur, no bruits.
Alan straightened up.
"Its a stroke, Helen. An artery"
He heard the daughter say, "Oh, no!" behind the curtain, but he continued speaking. He would deal with her later. The main thing now was to reassure Helen.
"An artery on the left side of your brain has blocked off and youve lost the power on the right side of your body."
The voice came through the curtain again: "Ohmygod, I knew it! Shes paralyzed!"
Why didnt she shut up? He knew the daughter was frightened, and he could appreciate that, but the daughter was not his primary concern at the moment, and she was only making a bad situation worse for her mother.
"How long it will last, Helen, I dont know. Youll probably get some strength back; maybe all of it, and maybe none. Exactly how much and exactly how soon are impossible to say right now."
He put her good hand in his. She squeezed. "Were going to get you upstairs right now and start running some tests in the morning. Well start some physical therapy, too. Well take good care of you and check out the rest of you while youre here. The stroke is over and done with. So dont waste time worrying about it. Its history. From now on you work on getting back use of that arm and leg."
She smiled lopsidedly and nodded. Finally he pulled his hand away and said, "Excuse me."
He turned and stepped through the curtains to where the daughter was talking to the air.
"Whatamygonnadoo? I gotta call Charlie! I gotta call Rae! Whatamygonnadoo?"
Alan put his hand on her shoulder and gave her trapezius a gentle squeeze. She flinched and stopped her yammering.
"Youre gonna clam up, okay?" he said in a low voice. "All youre doing is upsetting her."
"But whatamygonnadoo? Ive got so much to do! I gotta"
He squeezed again, a little harder. "The most important thing for you to do right now is go stand by her and tell her how shes going to come stay with you for a while after she gets out of the hospital and how youre going to have everybody over for Easter."
She stared at him. "But Im not . . ."
"Sure you are."
"You mean shes going to be coming home?"
Alan smiled and nodded. "Yeah. After a little stay in rehab. She thinks shes going to die here. Shes not. But she needs someone holding her hand now and talking about the near future, how lifes going to go on and how shes going to be part of it." He steered her toward the curtains. "Get in there."
McClain, head nurse for the ER, pushing sixty and built like the Berlin Wall, saw him from the desk and held a tPA package with a questioning look. The CT scan had shown no bleed, but from what hed gathered from the daughter, the stroke had occurred more than three hours ago. That eliminated tPA as an option.
Alan signed the orders, wrote the admitting note, then dictated the history and physical.
After giving final reassurances and saying good night to Helen Jonas and her daughter, Alan finally got out of the hospital, into his Subaru Outback, and on his way back home. He drove slowly, taking the short route through downtown Monroe where all the buildings clustered around the tiny harbor like anxious bathers waiting for a signal from the lifeguard. He liked the solitude of a late night drive through the shopping district. During the day the streets would be stop and go all the way. But at this hour, especially now that all the construction was done and he didnt have to dodge excavations or follow detour signs, he could cruise, adjusting his speed so he could hit the lights just right. A smooth ride, now that the trolley tracks had been covered with asphalt. He pushed a CD into the player and The Crows came on, singing "Oh, Gee."
He watched the clapboarded shop fronts slip by. He hadnt been in favor of the downtown restoration at first when the Village Councilwhy did Long Island towns insist on calling themselves villages?decided to redo the harbor front in a nineteenth-century whaling motif. Never mind that any whaling in this vicinity of the North Shore had been centered to the east in places like Oyster Bay and Cold Spring Harbor, the village wanted a make over. Passing the newly faced seafood restaurants, clothing stores, and antique shops, Alan had to admit they looked good. The former lackluster hodgepodge of storefronts had taken on a new, invigorated personality, fitting perfectly with the white-steepled First Presbyterian Church and the brick-fronted town hall. Monroe was now something more than just another of the larger towns along Long Islands "Preferred North Shore."
The illusion almost worked. He tried to picture Ishmael, harpoon on shoulder, walking down to the harbor toward the Pequod . . . passing the new Blockbuster.
Well, nothing was perfect.
A red light finally caught him and he pulled to a stop. As he waited he watched Clubfoot Anniethe closest thing Monroe had to a shopping bag ladyhobble across the street in front of him. Alan had no idea of her real name and, so far as he knew, neither did anybody else. She was known to everyone simply as Clubfoot Annie.
He was struck now, as he was whenever he saw her, by how a misshapen foot that no one had bothered to correct on a child could shape the life of the adult. People like Annie always managed to get to Alan, making him want to go back in time and see to it that someone did the right thing. So simple . . . some serial casting on her infant equinovarus deformity would have straightened it out to normal. Who would Annie be today if shed grown up with a normal foot? Maybe she