The Leper’s Burlesque
John R. Guthrie
Aaron Payne stepped out of the funeral chapel and into the parking lot where he stood at the edge of the pavement. In the distance, he saw a hawk that rode the cold currents high above the earth. It was winging its solitary way toward the rounded summits of the Great Smoky Mountains that climbed up from the Piedmont hills of Austerity. That lone hawk approximated the way Aaron felt at that moment; terribly alone. Like always when he lost a patient, he had a sense of not only sadness, but failure. He kicked a stone the size of a ping-pong ball, sending it skittering across the parking lot and scuffing the tip of his wing-tip shoe in the process.
And the LORD said unto Satan,
Whence comest thou?
Then Satan answered the LORD, and said,
From going to and fro in the earth,
and from walking up and down in it.
Austerity is a verdant place of rolling hillsides tucked away in the northwest corner of the state of South Carolina. Aaron Payne, D.O., was a family physician there. On a clear day from his home on the west side of town, you could see the Great Smoky Mountain chain of the Appalachians, ancient, somnolent and mysterious. The view pleased him. It reminded him of the San Bernardino Mountains visible from his Loma Linda, California birthplace. He’d found an opportunity to go into practice with an older doc in Austerity while he was doing a rotating internship in Atlanta eight years before.
Aaron was tall and lean, his russet hair with just enough dusting of gray at the temples to give him an air of distinction. His blue eyes were clear and steady. Should you ask him what the pivotal factors in his life were, he would list the Marine Corps, the Seventh Day Adventist Church, the practice of medicine, his mother, then add quietly, “though not necessarily in that order, and not necessarily in the ways you might expect.”
His life in Austerity was good. He had graduated with honors from the University of California Riverside and then the renowned and historic Chicago College of Osteopathic Medicine. He was independent. His practice thrived. For one thing, he was realistic. A former Marine rifleman, he’d fought in the war in Vietnam before he went to college. It gave him, not cynicism, for he was by nature hopeful, but he had learned to limit his expectations. He considered “Doctor’s orders” to be a misnomer, because as he’d learned, there were limits to all power, even the life-or-death authority of the officers he’d served under in the Marine Corps. Mrs. Smith would not or could not lose the weight. Mr. Jones didn’t take his blood pressure medicine because he felt good and really didn’t think he needed it. Mr. Samuels didn’t take his pills because he couldn’t afford them. Aaron gave him sample meds when he had them.
He urged his patients. He shared experience and expertise. But only rarely did he cajole. When his best advice was shunned, he didn’t take it personally. And when he was able to help, occasionally a great deal, it pleased him.
He lived alone in what had once been a farmhouse, a two-story frame structure with a wide front porch shaded by white oaks whose trunks exceeded the circumference of a hefty man’s midsection. He prized it as a place of respite and resurrection, though of necessity he had phones to facilitate calls from the hospital and from patients in practically every room, including two lines in his bathroom. A cleaning lady, Mrs. Humphreys, a widow of middle years, arrived promptly in her blue and white Ford Falcon station wagon twice a week. She was a plump and pleasant woman who was proud of the work she did for several clients. She also was talkative. She loved to chat with Dr. Payne when he was there as she continued to dust, clean, and bring order to his household. Aaron prized her. She freed him to do what he did best; practice medicine.
Payne was the plant doctor for a number of the local industries, companies that fled northern rust belt cities for the milder climate and more compliant labor force of the Palmetto State. One such company was Gleason Industrial Abrasives Company, Inc. The company dealt in materials the names of which sounded like poetry to Aaron Payne’s ear: Sodablast and bauxite; carborundum, brown and black; alumina and silicon. Gleason’s had moved to Austerity from Pittsburgh two years before.
One new hire at the Gleason Company was a slender young man with shoulder length hair the color of corn silk and a cubic zirconium stud in his right ear lobe. His name was Damien Frey. He’d taken leave after two years at Brevard College where he majored in music. He was a competent student, well liked and pleased with his studies, but took a job at Gleason’s with the ambition of saving money to finance a long-standing ambition to study at a conservatory in Milan during his junior year. Damien and his family were members of Austerity’s First Baptist Church; First Church as people say. The church has a fine music program. Damien was skilled enough that he had filled in from time-to-time for the pianist there. His arrival as a patient at Aaron Payne’s Family Practice Clinic on that Monday in the summer of 1985 set off a chain of events that would irrevocably alter the measured lives of both Dr. Payne and his head Nurse Alice “Ali” Broome, R.N., M.S.N., as well as that of others.
The smell of disinfectants and Betadine permeated the air, the linoleum tile of the floor was buffed and shining. There was an air of busyness as the lab tech loaded the centrifuge and glassware tinkled in the background. Gloria Estefan’s song of passion and longing, courtesy of a local FM station, was barely audible over the humming of the transformer in the X-ray room. Ali approached Aaron as he stood reading the next patient’s chart in the hall. She had an Italian grandmother, a war bride from the World War II era from whom she acquired a complexion like polished ivory as well as large and expressive eyes as dark as obsidian. Her long hair the color of mahogany was done up primly She wore no cosmetics, for she was more concerned about looking professional at work then in being beautiful. She was beautiful anyway.
For the sake of privacy, she spoke in a subdued voice to Dr. Payne, “We have a walk-in from Gleason’s.”
Payne scowled. Monday was his busiest day. He was already struggling to keep up. “Is it maybe something we can reschedule, like an employment physical?”
“You need to take a look, Doc,” she said. “This fellow’s bad off—got his arm caught in an industrial abrasives roller last week, but didn’t see a doctor. It’s a mess.” Dr. Payne nodded and took the chart. “He’s also got a bad case of potty mouth,” Ali added.
Aaron nodded slightly, said “Thanks,” and turned to read Ali’s efficient note;
20 yo cau ♂, Temp 103, BP 146/76, P 110.
Pt’s flushed, appears to be in considerable distress.
Chief Complaint; caught left arm in an industrial abrasives machine at Gleason Abrasives 1 wk. ago.
L. Axilla denuded, foul smelling, draining pus & serosanguinous fluid.
Aaron entered the exam room where Damien Frey sat on the end of the exam table, shirt off.
“Hi, Mr. Frey.” Dr. Payne noticed the accelerated pulse at the angle of Damien’s jaw. He extended his hand to shake hands with the patient. Damien hesitated, just long enough to make Dr. Payne wonder if the young man was refusing to shake hands. When he finally extended his right hand, it was trembling. It felt hot and dry. “How are you today?” Dr. Payne said.
With the sullenness of a viper, Frey said, “Like shit. If I felt any good I wouldn’t be here, Doc. My left armpit is fucked.”
Dr. Payne was nonplussed. He’d certainly heard coarse language before, though seldom in this context. He pulled on Latex exam gloves and lifted the patient’s left elbow to take a look at his armpit. The skin of that area was largely gone. Muscle tissue was visible fore and aft.
“Damien, you have a serious infection. How long’s it been this way?”
“I got hurt last week.”
“And you haven’t seen a doctor already?”
“No. I just took some sick days and hoped it would heal up. Gleason doesn’t like employees that get hurt on the job. Anyway, I have a life. If I wanted to spend it in a doctor’s office, maybe I’d get a job in one.”
Dr. Payne nodded. “A doctor visit’s no fun for lots of people.”
“Yeah,” he spat out the words. “You got that straight, Doc.”
Watching him carefully, Dr. Payne said, “Damien, you need to go in the hospital.”
“Well, how about tomorrow or next day?”
“You need to be on intravenous antibiotics right away. I’m deeply concerned about this infection. It can spread through your blood stream. That can cause vital organs to shut down, or abscesses in difficult to reach places such as brain or kidneys.
Frowning, Damien said, “Now? Hospital?”
“Scar tissue can form causing you to be unable to lift your arm. And this can be lethal, Damien,” Dr. Payne replied.
Damien managed one last expletive. “Jesus Fucking Christ!”
Dr. Payne cocked his head to the side and said, “Damien, talk with Jesus about it later if that’s your thing. But right now you need to go in the hospital.”
Damien looked up in surprise, then managed a tight little smile. “O.K. O.K. I’ll go. But I don’t want to stay there a minute longer than I have to.”
“I’ll gladly discharge you the moment it’s safe,” said Dr. Payne as he stepped out of the room, scowling as he pulled the door shut behind him. In the hallway, Ali looked his way. One eyebrow was raised, her expression quizzical as she looked at him to gauge his reaction to the irascible and profane Mr. Frey. Aaron smiled. He always found Ali’s occasional mimicry of utter perplexity charming.
“I wonder,” Payne said, “if he’s a little addled from his fever.”
”Maybe. Then it could be he’s just mean as hell and happens to have a fever at the moment.”
Payne chuckled out loud as Ali turned and walked away.
As he sat to write further on Damien’s orders, Aaron recalled how he met Ali. It was at a called meeting the year before for local health care providers. The meeting convened in Austerity Regional Medical Center’s Cafeteria. In that time, the mid-eighties, the medical community hadn’t even agreed on a name for the illness caused by HIV infection. Most physicians outside of New York and Los Angeles had never seen a patient so afflicted though that was rapidly changing. The guest speaker was a high octane Ph.D. /M.D. virologist from the Center for Disease Control in Atlanta. A signboard near the cafeteria entrance announced the topic:
IN SELECTED BICOASTAL
The lecturer was lean and tall, his neatly trimmed and graying Van Dyke and hair contributed to his distinguished appearance. His work, involving the minutiae of viral reproduction and transformation, had appeared frequently in leading medical and scientific journals in the U.S. and the U.K. When he began his presentation, he was inaudible. He mumbled into his notes on the podium or toward the mobile screen for a slide projector set up behind him, neither speaking loudly enough nor using the portable sound system, the mike of it flopping off at an indifferent angle on its flexible arm. Dr. Payne leaned forward, straining to make out the speaker’s words. It did not help that the meeting room, a low ceilinged section of the hospital cafeteria, was acoustically poor.
Finally, the woman next to Aaron, a woman in mufti but wearing an American Nursing Association pen with a cloisonné Nightingale lamp on her suit jacket, raised her hand. The speaker didn’t notice, for eye contact with his audience was not his thing. She waved her hand. Still unrecognized, she said, “Sir?” There being no response, she stood and said again, “SIR?” A large part of the audience, including Aaron, looked her way. She was a tall woman, her long dark hair done up in a French twist. Her suit, two-piece wool in dove gray had the padded shoulders popular then. She looked professional, and she was an entirely attractive woman; dark eyes, sculpted cheekbones. The speaker continued on autopilot, “…These phenomena are related in a way ill understood to a previously unheard of virus called the Human Immunodeficiency Virus.”
“DOCTOR,” she said. He finally looked up, as mystified as if someone had interrupted a sound sleep. “Yes, Miss?”
“Please Sir, I’m really intrigued by your subject matter, but it’s very difficult to hear. Could you possibly use the microphone?”
“Oh,” the speaker said looking surprised. “Anyone else having problems?” Nearly everyone in the audience nodded and there smattering of applause.
“Woops,” the speaker said. “Thank you, Ma’am.” He adjusted the microphone and spoke toward it. His voice was now comprehensible. The audience applauded more vigorously. He continued: “The virus is a string of ten thousand or so nucleic acids; code words made of nucleotides strung together like a string of beads. Once in the host’s body, this virus favors cells of the immune system. Like commandos taking over a factory, the virus tricks the DNA of the host’s immune cells into making copies of itself. Billions are churned out. The immune system attempts to fight off the invader, but eventually the virus overwhelms it, leaving the patient unprotected against cancers such as Kaposi’s Sarcoma as well as bacterial pneumonia, especially that caused by Pneumocystis pneumonia….”
When the speaker finished, the audience applauded enthusiastically, stood and drifted toward the back of the room for refreshments and conversation. At the table where a coffee urn the size of a nail keg sat, Aaron filled a Styrofoam cup. He reached for a packet of sugar. At that moment, a cafeteria worker with a cart loaded with racks of clean dinnerware for the serving line at the end of the cafeteria crashed the cart against the other side of the table. Aaron and the woman who’d sat next to him both dodged away, bumping into each other backwards. Coffee sloshed each of them. “Uh, oh,” he said, “So sorry.”
“Oh, me too,” the nurse said. They both gabbed up a handful of paper napkins. In a classic approach withdrawal, Aaron started to dab at the nurses’ suit, thought better of it and handed the wad of napkins to her as she handed one to him. “Thanks,” she said, as she dabbed at the brown stain on the midriff of her garment. Payne mopped the stained front of his clinic coat. He glanced again the nurse’s garment with dismay. “Oh, my. That’s a lovely suit, now with that coffee stain on the front.”
She smiled, and said by way of reassurance, “Thank goodness for good dry cleaning. If they can’t get the stain out, maybe I’ll claim I paid extra for it. Besides, your clinic coat got coffee all over it also.”
“No harm done. I'll send it to the laundry. I’m Aaron Payne,” he added. “I’m a family doc.”
“Alice Broom; Ali, R.N.,” she replied. “What did you think of the lecture?”
“Interesting. But before you spoke up, I couldn’t hear a word he said.”
“I don’t think anyone did.” Ali replied. “I’m especially interested in the subject. I worked in the Peace Corps in Ghana for three years after graduate school. The incidence of HIV infection is remarkably high there. They call it ‘slim disease’ because the patient wastes away before death. More often than not it’s a heterosexual disease in that setting.”
“Really?” Aaron replied. “I’ve never seen a case, and don’t know anyone in County Medical Society who has.”
As the conversation evolved, Aaron learned that Ali was between jobs, intent on interviewing for a position at Austerity’s Regional Medical Center.
“My clinic nurse who’s been my good right arm is leaving in less than a month,” he said. “If you feel you might be interested, let’s talk.…”
Returning to the moment, Payne wrote out Damien’s hospital orders:
Dx: Acute Cellulitis, L. Axilla due to industrial injury.
Stat culture & sensitivity wound left axilla x 3.
Blood and urine culture and sensitivity….
He ordered antibiotics by IV every six hours, then handed the chart to Ali saying, “Additional diagnosis: Angry young man.”
“Bitter as aloe,” she said.
“Unseemly in one so young,” Aaron said solemnly.
Ali smiled that lovely smile again then turned and walked away to see that the admission was called in. Aaron watched her for a brief moment. Despite her innate dignity and professionalism, she had a sense of fun that made her eyes sparkle when she saw humor in something, which was often.
Aaron was studying the chart for the next patient when the door to Damien’s room opened. “Doc, please come back in for a minute.”
Ali joined him as Payne stepped back in, holding the next patient’s chart in his hands.
“Doc, there’s something I should’ve told you.”
“What’s that, Damien?”
Damien shrunk back a little. “I’m HIV positive.”
“How do you know that, Damien?”
“I went to Arborville and got tested at the health department.”
The room was silent for a moment. Damien looked expectantly at Dr. Payne who took a deep breath and finally said, “Thanks for telling us, Damien. I’ll have to modify your orders a little. We’ll need to talk further about this later, get a better understanding….” Ali handed the hospital orders back to him.
Damien’s eyes were brimming now. “Sure. There’s not much to tell about it. I pretty well know who I caught it from. He glanced at Ali, looked suddenly uncomfortable and said, "Yeah. We need to talk about it later. Privately. That’s why I didn’t want to come to the doctor. I just don’t want everyone in Chickasaw County to know. I really don’t know what to do right now.”
Payne said softly, “Hey, Pal, take your time. You’ll figure it out. And we’re glad to help.”
Damien’s face paled suddenly. He collapsed against the table, then fell to his knees. Aaron and Ali both grabbed him and helped him lie recumbent on the exam table again. After a few seconds, he started crying in great wracking sobs. “Oh, man,” he said, “I can’t even fucking stand up.”
“You’ve got a lot going on,” Ali said. “And Damien,” she added, her eyes brimming also now. “We’ll be here for you. We really will.”
To Be Continued…