Bedside Manners

By Claude L. Delaverdac D.O.

Dr. Jacques-Pierre Dubonnet, a respected physician, has lived a tumultuous life. Growing up as an immigrant and coming of age in the 60s casted shadows which would hang over his entire adult life. One of those shadows appeared at his colleague's funeral— in the form of a bullet. Heroic efforts of medical professionals on the scene saved him, but they couldn't stop the cascading hallucinations that followed.

"Bedside Manners" is a novel of reflection. A near death experience grants Dr. Jacques-Pierre Dubonet a rare opportunity to revisit his past. He sees the challenges he overcame, the ones he stumbled upon, and the shocking truth that nearly caused his demise.

• Language: English
• Publisher: BookBaby
• Release date: Oct 30, 2020
• ISBN: 9781098332471

Book preview

Bedside Manners

© 2020 Claude L. Delaverdac, D.O.

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

Print ISBN: 978-1-09833-246-4

eBook ISBN: 978-1-09833-247-1

Table of Contents

Chapter 1 Blindsided

Chapter 2 Near Death

Chapter 3 A Legend

Chapter 4 The Nearly Departed

Chapter 5 In a Flash

Chapter 6 Intern Mismatch

Chapter 7 The Farm

Chapter 8 Immaculate Deception

Chapter 9 A Cold Draft

Chapter 10 1954

Chapter 11 Polish Fisherman

Chapter 12 The Fix

Chapter 13 Thin Ice

Chapter 14 Harrowing Ride

Chapter 15 Beeson Surprise

Chapter 16 The Endless Baseball Game

Chapter 17 50 Yardline

Chapter 18 Gonna Have a Party

Chapter 19 Confession

Chapter 20 Crazy Herbie

Chapter 21 Sweet Screams and Flying Machines

Chapter 23 Lake West

Chapter 23 Cold Moon Rising

Chapter 24 Football

Chapter 25 Ricketts Charge

Chapter 26 The Clock

Chapter 27 Nebraska

Chapter 28 Jesse

Chapter 29 Hell week

Chapter 30 Intramural

Chapter 31 Fraternity

Chapter 32 Embarrassed

Chapter 33 Going West

Chapter 34 Brave New World

Chapter 35 Holiday Inn

Chapter 36 Onan

Chapter 37 Bob and Jean

Chapter 38 PDIM

Chapter 39 Lara

Chapter 40 The Interview

Chapter 41 East is East and West is West

Chapter 42 Trojan Horse

Chapter 43 Good Bye East Lansing

Chapter 44 Vive la difference

Chapter 45 What’s It All About?

Chapter 46 Double Cross

Chapter 47 Dog Down

Chapter 48 Canoe

Chapter 49 Alternate

Chapter 50 Becoming a Doctor

Chapter 51 Too Close for Comfort

Chapter 52 Girly Brown

Chapter 53 Feel No Pain

Chapter 54 The Separation

Chapter 55 Tina

Chapter 56 An Inconvenient Guest

Chapter 57 Ménage à Trois

Chapter 58 Promises, Promises

Chapter 59 Inflammatory Response

Chapter 60 Go East Young Man

Chapter 61 Illusion

Chapter 62 The Problem

Chapter 63 The 12% Solution

Chapter 64 Obtunded

Chapter 65 The Letter

Chapter 66 Dental Suspect

Chapter 67 Last Tango

Chapter 68 The Decision

Chapter 69 Doubting Thomas

Chapter 70 The Debriefing

Chapter 71 Not Fair

Chapter 72 Mission Possible

Chapter 73 Mad Hatter

Chapter 74 Sudden Sam

Chapter 75 Missing Passport

Chapter 76 Code Blue

Chapter 77 School bus

Chapter 78 From Russia with Love

Chapter 79 A Missed Opportunity

Chapter 80 Absolution

Chapter 81 A Rare Find

Chapter 82 Guardian of the Person

Chapter 83 Spread Upon the Minutes

Chapter 84 Awesome

Chapter 85 Doctor Dread

Chapter 86 Duly Pronounced

Chapter 87 Leo

Chapter 88 Viet Nam

Chapter 89 Lancaster Trek

Chapter 90 War Stories

Chapter 91 Letter from a Patient – given to me by him and later published in a local newspaper.

Chapter 92 Bad Week

Chapter 93 ICU

Chapter 94 Ashes

Chapter 95Apparition

Chapter 96 Death and Dying

Chapter 97 Here Comes the Sun

Chapter 98 A Broken Heart

Chapter 99 R.I.P.

Chapter 100 Rehabbing the Soul

Epilogue What it’s All About

Chapter 1

Blindsided

I never saw it coming. It might not have even happened had I taken a pass on going to the cemetery that day. There was no heartfelt obligation. Harvey was dead barely 48 hours but could just as well have signed out to eternity a few decades earlier from my perspective. Our paths had rarely crossed once he left my medical training program. And Kit, after reading the obituary, would have shown up in her ridiculous mourning wardrobe dismayed by my conspicuous absence. Maybe other elaborate schemes had previously failed to achieve her objective, thwarted perhaps by faulty planning or simply chance. I had no way of knowing. And I might have gone on much as I had since leaving her which now had the feel of a previous lifetime. In fairness, she never interfered with my new life, other than skillfully managing to extract every last dollar the one sided agreement allowed. But the threat of more insidious reprisals was always on my mind early on and only receded slowly over time. The games we played had no set rules, only ones each of us made for the other. The resulting mayhem was inevitable. Then I up and quit.

But I was at the Rodef Shalom cemetery that Sunday morning, an unusually mild and sunny mid January day. And incredibly, there she was too, standing not 10 feet to my left, perhaps an osteoporotic inch or two shy of her former slight 5’7" frame, dressed all in black. She sported a wide brimmed straw hat with a shallow crown like a woman might wear to the beach except for the shade of midnight. A short mesh veil dangled from the front brim but failed to mask those blue eyes I had tried really hard to forget. She rarely covered her shoulder length bleached blond hair, maybe partially tucking it into a stocking ski cap or securing it with a visor while sailing as I remembered. The face that now confronted me however, had aged. Rendered of healthy subcutaneous fat, the dry skin was drawn and etched by time and disposition into lines of persistent disapproval. This was the face, my many years of clinical experience were telling me, of a chronic smoker. The lines were not smiling.

A dull pain began welling up in the middle of my chest. I felt its rising wave creep up my throat and spread toward my jaws. Just reflux, I thought, too much coffee that morning. This sort of thing happens to me. But could I be having a heart attack? Was the less than subtle stress of this long delayed yet dreadfully anticipated encounter triggering a sudden release of catecholamines and other hypercoaguable elements into my bloodstream? The immediate resultant syrupy milieu poised to knock off one of my narrowed coronaries? I did see Kit’s right hand reaching into a small black pocket book strung over her left shoulder. The clubbing of her distal fingers was obvious, a finding that had struck me instantaneously twice before, once on a physician colleague and once on the wife of a cheating husband who would soon no longer need to hide his affair. Both were smokers and found to have a lung mass on chest X-Ray. Now it felt like the blood was draining out of my body. I broke out in a cold sweat firmly convinced that this is how it would end. Out of that little black handbag the bulbous fingers produced a small, glistening snub nose revolver. Or was it a cigarette lighter? My mind was getting pretty foggy. I was about to drop dead of an acute coronary thrombosis or get blown away at point blank range by my long estranged starter wife. A profound sadness enveloped me. No chance for goodbyes to those I really loved. Too late for remorse or to say I’m sorry for fucking up your life. My guilt was indefensible. A plea deal not likely forthcoming. My prolonged reprieve gratefully acknowledged but in the end proving to be merely ephemeral. Nothing more to be done. Just accept the delayed sentencing. However, I couldn’t square my bitter disappointed in Kit for resorting to gun violence. In the years we were together, we never owned guns nor even discussed them. We opposed the Viet Nam War and stood with MLK in his stance of non violent protest. Yet we had come of age in the 60’s and experienced the outright murders of the Civil Rights struggle, the political assassinations that black marked the decade and lived the Viet Nam War every day on TV and in our psyche via the uncertainty of its impact on our own personal future. We watched video footage of the Kent State massacre and countless other acts of violence and riots. Yet we remained steadfast against it.

My mind raced on. Was this really happening to me? And why not by someone else? There were several other candidates. Like my former friend and golf partner, a bad actor with a horrible reputation earned through a legacy of mean spirited and inappropriate behavior directed at the nursing and support staff of our hospital, generally always getting away with it. None of the previous Medicine Department Chairmen had the balls to discipline him. I did. Beyond the pale, by his take. Or other disgruntled colleagues on staff who had received uncomplimentary letters about their substandard care of patients during the 5 years I served as chairman of an unprecedented, multidisciplinary general medical staff peer review committee? The decisions were reached by consensus. The signature on the letter was mine. I took regular verbal abuse. I may as well have walked the hospital hallways with a target on my back. Fuck em! I didn’t care. I didn’t need their referrals. Just do your job dammit! The drama and associated excuses were tiring. But no, it wasn’t any of them after all. It had to be Kit.

What happened next came with lightning speed. A million thoughts burst in my brain facilitated by the 20 billion synapses recruited for the moment but it still plays in my mind like the freeze frame, slo mo video of a sports re-play challenge where the umpire or referee’s real time judgment call is reviewed time and again, forward and back by the replay official who then makes the ceremonial thumbs up or down sign. But I must first explain that my decision to attend the service was driven mostly by the opportunity of paying final respects to one of my erstwhile trainee’s since two others had previously met an untimely fate, one drowning in a scuba diving accident, the other suffering a hypertensive brain hemorrhage, and I had only learned of the tragedies after the fact. So Harvey Rosen became the surrogate for all of my departed former charges. I had helped them become polished physicians but didn’t teach them how to swim or how to give maximum attention to their own health. Those kinds of things you need to do yourself.

Dr. Rosen, had been a resident in the Internal Medicine training program at Boardwalk Atlantic Medical Center many years ago during the time I was its Program Director. It was my decision to attend the service alone which the obit stated would occur graveside at noon. Despite not having seen Harvey in years, being we were on different hospital medical staffs, I knew that his health was frail and was well aware of the history of juvenile diabetes since age 12. He had retired from practicing medicine a while back, and I’d heard his eyesight was poor amid rumors of progressive mental decline.

Turning into the second drive off the Black Horse Pike as instructed in the obituary, I guided my new Honda Pilot through a narrow wrought iron gate carefully delaying inaugural damage. The cemetery name was ornamentally displayed in the arch. I followed a paved lane no wider than a golf cart path which quickly changed to gravel past a Holocaust memorial and grave markers with traditional Jewish names - Cohen, Stein, Levin and not so obvious ones like Leland, Limmer and Goss. The sun was out with a few clouds in the sky, its low angle producing passing shadows across the tombstones briefly cloaking them in darkness. I had parked my car along one of these narrow paths being mindful not to obstruct the flow of other vehicles and avoid actually driving over or parking on the soil above somebody’s final resting place. Surprisingly, owing to the mild winter thus far, the grass was not yet dormant and still viably green. There was a canopy erected at the far northwest corner of the cemetery, its borders lined with bare deciduous trees, some of the oak branches still clinging to their brown, dead leaves. Interspersed among these were pines and cedars, splashes of green accenting the otherwise dreary winter landscape and palliating the somber occasion.

The service seemed to have already started as I walked toward the site, assuming it to be the appropriate one, no others apparent. A small group of mourners huddled near the grave. A Rabbi was already speaking even though it was not yet noon. I quickly joined and made eye contact with the deceased’s brother, Dr. Bernie Rosen, a surgeon, and cousin, Dr. Jeff Rosen, an Internist colleague. The Rabbi spoke about Harvey’s life and made repeated reference to his love of food and frequent habit of supporting the many shore restaurants even though he was diabetic as if this was somehow a personal failure. He lauded his love of family and remarkable professional career and all the great things he had done in his lifetime (I recalled vividly a time in the surgical ICU one Saturday morning on routine rounds, when he’d had a sudden hypoglycemic episode, became violent and several of us had to hold him down to give IV glucose as he actively took a bite of flesh out of a young nurse’s arm while I risked multiple partial finger amputations prying his incredibly determined jaw muscles apart.)

As the Rabbi droned on, reciting well memorized prayers I couldn’t follow, being it was in Hebrew and I only knew a few Yiddish catch words from my old experiences, mostly in medical school, the service became tedious and I recall thinking maybe I shouldn’t have come. I noticed a figure moving toward the group on my left. I remember, once I realized it was Kit, wondering if she had read the same obituary, as she surely had, and probably assumed I would be there, given that we had all been friends and saw each other socially in better times. This I didn’t have time to dwell on, though I would later be extremely happy to have left my overcoat in the car due to the mild weather and instead just going out in my navy blazer, tucking my smart phone into the outside left breast pocket.

The Rabbi continued praying in unintelligible Hebrew then handed a shovel to Bernie who, on cue, lifted a shovelful of dirt and pitched it into the grave, the soft granules plinking gently on the metal coffin. The persistent sing-song incantations started sounding like our priest singing the Latin phrases of a High Mass when Richie and I had been altar boys in catholic school, putting my mind in a dreamy like state. I remember the little gun barrel pointed at my chest. Perhaps Kit had some training that a body is a more reliable target than the head, grateful for that. I swear, as she squeezed the trigger, she mouthed the words go to hell. The first bullet ripped through my blazer and directly into the phone, damping the velocity imperceptibly while drilling shards of plastic and microprocessors deep into my left upper lung. The primary projectile, its path slightly deflected, just missed severing my left subclavian artery. The second shot hit my left collarbone, possibly because I was already falling backwards, and met fierce resistance at a previously fractured site incurred in high school football. We already had a big lead and a trio of defenders decided enough was enough as I caught the final touchdown pass and proceeded to plant my left shoulder into the turf just over the goal line breaking my clavicle. I hung on to the ball but the pain was terrific, worse than any I’d ever experienced only to be surpassed many years later by kidney stones. My sister Gisele was sitting in the stands. Never one to choose words considerately, she later told me, I thought you were dead, Jacques. Who could know that some earlier adversity might save your life later? That bullet ricocheted up and never entered my chest.

As this was happening people obviously reacted, shrieking, dropping to the ground or just running in the opposite direction. Bernie, taking everything in, had the courage to use the shovel in his hands and swing it at Kit, hitting her squarely in the back and knocking her down as she fired a third shot, but this one went straight into the ground. Jeff then pounced on her so she could not get up as I completed my backward death spiral. The whole scene was unreal. Bernie screamed Dr. Dubonnet has been shot! I fully expected him to add round up the usual suspects. In the developing unintelligibly loud confusion, I heard Kit screeching get off of me you bastard! her voice muffled, her face being pushed into the dirt while Jeff wrestled the gun away. I could see the stick trees from my forced supine position and imagined my bronchial tubes, anatomically like their bare, successively narrowing branches, filling with blood from the penetrating trauma and creating the suffocating feeling I was experiencing. Some scientists believe you only have so many heartbeats per lifetime, citing studies that show small mammals have very rapid heart rates and short life spans but larger animals, such as giant sea turtles have a heart rate of six per minute and live up to 200 years. If we are allotted a finite number, my total was about to be cut drastically short despite the savings account I had accrued over the years from taking beta blockers. I could feel myself breathing faster and faster but the air hunger I felt was not improving, and my heart rate seemed to rapidly accelerate in perhaps a belated attempt to get in as many beats as possible, narrowing the gap between the allowed number and my increasingly evident shortfall. Then the stick trees and the green ones started to oscillate simulating the ripples of heat in a summer haze before beginning to swirl round and round as I watched what looked like the final scene in a movie. The guy and girl, finally realizing they’re in love, are kissing passionately as everything around them is spinning faster and faster, becoming a complete blur, as they remain perfectly still in the eye of the storm. Then my whole life flashed before my eyes.

Chapter 2

Near Death

The light was intense. It was bright white, blurring the outside lines of everything else I might otherwise have been able to see. As it came toward me and got closer, I could make out the figure of someone with outstretched arms. He was dressed all in white, a robe or gown but he was clean shaven, no facial hair, and was bald and looked more like Mr. Clean than say, Jesus or Moses. His outstretched arms seemed to beckon me but he did not speak. In my fugue like state, feeling tentative, unsure of where I was or the status of my physical condition, I impulsively reached for his hands. They fluttered in a ghostly wobble and started to vaporize as he faded. The hands were gone before I could grasp them. Something hit me like a thunderbolt and I began falling away from him, floating through space like a disoriented astronaut, untethered from lifeline support and thrust into a vast darkness which had replaced the light. Then a second thunderbolt, not sure when exactly but this one hurt bad like getting kicked in the chest by a horse. I wanted to start swinging at someone, anyone, but my wrists were secured and I could not move them. I tried screaming at the perpetrators to stop – Stop stop no more but no sounds came out of my mouth. There was something in my throat, a hose or so it felt like. I couldn’t breathe. I couldn’t talk.

Then I felt someone pushing down on my chest and a feeling of air being pumped into my lungs. I wanted all this to stop in a bad way but it went on and on. Then I started feeling dopey and drifted into a deep sleep for I don’t know how long.

Chapter 3

A Legend

Mitchell Borland walked up to the podium, self assured, erect, purposeful stride, having just been paid homage during the introduction by one of his subordinate colleagues. Mitch had risen through the ranks of Boardwalk Atlantic Healthcare.org starting out as an assistant administrator, earning an MBA along the way and was now the chief Visionary having replaced the original visionary who, coming out of a University system 25 years ago, had taken a struggling, midsize community hospital and parlayed it into a large regional health care organization with two hospitals, independent Surgicenters (which weren’t so independent when things went wrong,) a Trauma Center, out patient facilities for virtually every specialty, regional satellites to feed the main hospitals and had led the way for a modern and superlative Cardiac Center with open heart surgery and a cardiac cath lab with interventions available 24/7, the only one in the area. All this and also managed to nearly quadruple the number of vice presidents in charge of this or that not to mention the many special coordinator’s and managers in charge of one thing or another. For God’s sake, it seemed as though we had a 5 to 1 ratio of bureaucrats to health care workers. Doctors, who had always been at the top of the food chain in most hospitals, were now relegated to bottom feeder status.

That is what Mitchell Borland inherited. He was determined to place his own personal stamp on the organization so he went about raising more money to build new additions to the coastal and inland hospitals which were now called regional medical centers. He also started buying up area private practices in Primary Care. There was now a large network of out patient facilities providing first line care and my practice was one of them.

The Black Tie attendees and their consorts in elegant evening gowns were quiet as Mitchell began to speak. Jenna and I were seated at the first table and that is where Mitch had started his jaunt to the podium. Marcie Borland was seated with us.

Many of you probably don’t know this, but Dr. Dubonnet was the spirit behind the movement to incorporate the primary care practices into our network. He deserves the ultimate credit for what we have accomplished in this important endeavor. Dr Dubonnet tirelessly advocated for change in how we view primary care and consistently asked for the organization’s help in accomplishing what we now have.

Sure, as a former President of the medical staff and chairman of medicine, and having served my time on the medical staff executive committee and Hospital Board, as well as serving as the first chairman of a general staff peer review committee(I was drafted, I did not volunteer,) I had regularly been invited to Board retreats where any number of topics were up for discussion and had always used the opportunity to state the case that the organization could no longer ignore primary care nor expect new practitioners to just show up in the area and start a practice and feed their patients into the network. At one retreat, a Board member questioned if it was the Board’s responsibility to even consider this absurd suggestion of hiring new doctors. I had responded by pointing out that we had already hired doctors; heart surgeons, interventional cardiologists, trauma surgeons as examples, and that primary care was the foundation for the entire colossus. You can’t have open heart surgeries if you don’t have somebody sending you the patients. Mostly my comments fell on deaf ears and I stopped going to the retreats which were ridiculous extravaganzas anyway, usually held at a regional resort destination, with free booze, food and a round or two of golf included.

Dr Dubonnet, Mitchell continued, has served this organization over 4 decades and the contributions he has made are legendary. He is the prototype of an Internist-Cardiologist if there ever was one. I was definitely a hybrid, a dinosaur actually by today’s standards, having been granted cardiology privileges in 1979 when it was still possible, despite having declined a cardiology fellowship at the Cleveland Clinic, which Kit had made clear at the time, that if I stayed in Cleveland, I’d be staying there alone. Later, the By Laws were changed limiting new members to only fellowship trained and Board Certified individuals but I was already Grandfathered. And being an active practitioner in all aspects of cardiology, he never gave up on his main goal of serving as the primary doctor for his patients. He has steadfastly held the belief of treating the whole patient not just one of their organs that happens to have gone bad. Indeed, Mitch’s mother had chosen me to be her Internist/Cardiologist when she developed coronary issues as her husband, Mitch’s stepfather, would do after his cardiologist retired.

Mitch presented me with a plaque commemorating my 40 years on the medical staff now that I was near retirement. Other people, colleagues, friends also spoke and then it was my turn to address the gathering.

But this evening never happened. It must have been a dream. I was waking up and not at all feeling celebratory. It wasn’t just the pain, I was choking or coughing and couldn’t breathe because something was in my throat. I tried pulling this damned tube out of my mouth but couldn’t grab it due to the bulky mittens on my hands. I heard voices and felt the vague presence of others. Machines were clanging, small red, orange and green lights were blinking. IV drip regulators were whirring, heart monitors were beeping, chest tube pumps were suctioning, lower extremity venous compression boots were whooshing, alternately inflating and deflating, and the mechanical ventilator was huffing and puffing as I played the TICU specimen in Pod 3.

Help me, I tried saying but nothing came out. I felt the dark shadow of someone standing over me, fussing with an IV fluid bag hanging from a tall bedside pole, the attached box beeping, a small orange light blinking.

A little more Propofal should do the trick. A voice in the mirage. Then blackness seeped in until I was unaware of anything. I was still, apparently, a legend in my own mind only.

Chapter 4

The Nearly Departed

Dr. Ogilvy entered my room unannounced. He was tall, 6’4, 50ish, looking fit, air of self confidence bordering on arrogance but an extremely competent trauma surgeon. I was not so much as happy to see him as I was greatly relieved that he was actually on my case. His entourage of residents and students followed him in. He had been an invaluable asset to me while serving on the peer review committee I chaired, providing expert analysis and opinion for the surgical cases we reviewed. He was unmistakably surgical, scrub cap atop his silver streaked hair, untied surgical mask dangling at his throat and a white lab coat worn over his green OR scrub suit.

You are an exceptionally lucky man, Dr. O. exclaimed as much to his staff as to me directly. Funny, I wasn’t feeling exceptionally lucky, there was this tube in the left side of my chest intermittently sucking out bloody crap into a water seal bottle below the bed. Every breath I took was a painful effort what with the chest tube and the cracked ribs courtesy of the prolonged CPR. My head throbbed but my mind was no longer fuzzy and I was finally fully awake and aware of what had happened to me. Then, to my surprise, he asked his staff to wait outside and we had a one on one.

The bullet fragments and all that shit from your phone breaking up just pickled your lung, Jacques. There was bleeding everywhere. I had no choice but to remove the entire upper lobe. In fact, when you arrived at Trauma, you were in full cardiac arrest with CPR in progress. Fortunately, the paramedics were able to intubate you in the field so we had airway control. Still, I thought you were history but we managed to get a chest tube inserted and that changed the equation in your favor. Most gunshot victims don’t survive a tension hemo/pneumothorax. We did have to shock you back in rhythm but managed to get you to the OR and get control of things.

I was impressed, and grateful, to hear of the evident heroic effort made by the paramedics and my colleagues to save me.

I remember the shock. I said. Both of them. Dr. O. looked at me quizzically. I remember being intubated and wanting to pull out the tube but my hands were restrained.

Amazing Dr. O. said. It’s true that you were shocked twice and incredible that you remember it since most of us thought you were already dead.

I think I was. I told him about Mr. Clean. Now his look took on an even more skeptical nature but he’s a surgeon and surgeons don’t have time for irrelevance.

We’ll take the chest tube out in a few days Jacques, and get you to rehab as soon as possible. When doctors say We it usually means someone else will actually perform the task. And he departed briskly to rejoin his, not so much in a hurry, subordinates. I was left to contemplate my situation, murky and unbelievable as it was. Why had Kit tried to kill me? I had not even seen her nor been in any contact with her for over 35 years. There were moments of baseless paranoia those first few years that she might retaliate in some fashion. I would vary my trips to and from work since there were a few different options, making it difficult for anyone to lie in wait on any given day or night, chuckling to myself at the overkill and spurning any strategic relevance. One winter evening after a long office day, I started up my Peugeot sedan in the parking lot and felt a muffled boom under the hood while smoke streamed out of the seams, certainly not in the tradition of the Godfather but startling nonetheless. When I cautiously lifted the hood, it was obvious that the battery had exploded.

The old guilt, long submerged, began resurfacing. We failed each other but who bears the ultimate blame? I had long been unhappy and looking for a way out but the sense of abandonment was overwhelming and never fully reconciled in my mind. It’s not working for us. I had said. We both need a fresh start. Of course, my view was enlightened by the prospect of a totally different life, a life with someone who honestly loved me and who intensified my long suppressed desire of raising a family with someone just like her. Kit’s much darker view focused on her sense of having been wronged again. A sense that her affair had never been serious and in fact monogomous in stark contrast to my own transgressions. What about me, don’t I matter? She had asked. Are you just going to dump me for a younger model?

But now? Why after all this time? What could have happened to make her snap? Or had she entertained the thought for a long time and finally set up a plan to go through with it? Had she brooded over time, emotions quietly simmering to the boiling point, the sudden volatility then exploding into such a hostile act? Hell hath no fury like a woman scorned! But with a 35 year deferment? Was it even her? At the time, I was sure of it, now after an episode of hypoxic encephalopathy, though brief, I had doubts about everything. Having been initiated into the limited membership club of the nearly departed, I had been afraid to ask anyone what happened to Kit and no one was offering a clue. Not the doctors, nurses, Jenna nor my kids.

Chapter 5

In a Flash

What is your full name? Darren Knox,D.O. asked, despite having all of my electronic medical records in front of him. A step in the EMR requiring documentation no doubt, that he was actually interviewing and examining the right patient. He was an incredibly talented snot nosed kid, a stickler for detail who, having obtained specialty training at a University hospital, the type that had been denied to me two generation ago, now held a full time salaried position at our shore hospital where the Neurology and Interventional Neurovascular Institutes were located. He looked up from his lap top.

Marcus Welby,D.O. I responded in monotone.

You can’t be serious! He seemed annoyed.

‘It’s a joke, Darren. Lighten up will you. My staff gave me a T shirt with that name on the back in the 80’s when the show was still popular. I had complained about Medical TV shows always being about M.D.’s. What about D.O.’s, I asked? They are the real Family Doctors. You probably never heard of the show but come on, you damn well know who I am!"

I know who you are, thank you. I need to know if you know who you are! Please give me your full name. He persisted.

Jacques-Pierre Dubonnet,D.O.

What is your date of birth? I gave him the correct response.

What is today’s date?

Last I knew it was sometime in January 2015.

Where are you now?

In your glorious trauma unit providing you and your underlings a unique learning opportunity. He barely looked up while furiously punching the keys on his device.

Where were you born?

France.

He proceeded to ask further questions while tapping my knees with his little rubber hammer and running a small metal pinwheel up and down my arms, legs and torso. He asked more questions to confirm my current orientation to time and place and questions about who the president was and sampled parts of my career and life to verify remote content.

Your mind and memory seem to be remarkably well preserved, Jacques. That’s very impressive considering the unknown amount of time the anoxia and resultant encephalopathy may have lasted. I preferred to call it Hypoxic (low oxygen) rather than Anoxic (no oxygen) but had no desire to get into a terminology squabble with this little prick. My memory was in fact, sharply intact. That’s what a flashing life scene will do for you. It happened in an instant yet left an indelibly dense data stamp in my brain. It was like the grand finale of a July 4th fireworks in a baseball stadium, filling the night sky with seemingly endless and colorful starbursts, the incessant blasts of the explosives reaching their climactic ending, pop pop pop pop pop, then nothing. Only smoke wafting off into the distance as the crowd slowly recovers and starts to cheer. Snuffed out as likely happens in the usual life flash when the last remaining energy of the neurons, feeding off their stored substrate as the blood flow and oxygen cease, create a burst of long stored and mostly forgotten images in those final microseconds of the big picture show. Then it’s lights out forever. Except in my case the energy delivery cycle to those dying brain cells was restored at precisely the right moment.

I thought Dr. Hard-Knox would be largely disinterested in my theory and didn’t mention it. I’ll be back to recheck you in a couple days just to make sure you don’t regress cognitively but I think you’ll be fine.

Thanks Darren. I said. We shook hands and mercifully, he left the room without further comment.

In those first few days when I was finally conscious and able to speak, I talked endlessly into my Lanier voice recorder, brought in by Ari (my medical practice partner Aaron Levenson,M.D.) at my request, detailing everything I could remember from the final life flash experience. I did this whenever no one was in my room and stored the cassettes in the night stand for future transcription although as I played back and listened to my rambling narrative, I knew I would never be able to give these tapes to Rita who had transcribed my office notes for decades and often returned the typed pages with a sarcastic note attached expressing her highly opinionated, sometimes acerbic take on the patient complaints.

Tell him to take a shit before he leaves for work! She scrawled on one regarding a young man, a truck driver, with chronic constipation because he refused to have a bowel movement in a public rest room and was on the road all day.

Tell this loser to get a life and stop cavorting with sluts about a divorced man whose girlfriend announced she was pregnant with his baby when he’d previously had a vasectomy. No, I reasoned, it might just be easier to type this story myself.

But that might turn out to be the least of my problems. The final life flash, for anyone fortunate enough to live through and tell about, as I had already learned, was far from a smooth chronological sequence. It resembled more so a bombshell of people, places and events. Pieces of my life scattered all over the landscape, like mindless debris, the fallout randomly deployed. Disappointment, disturbed thoughts, haunting images, missed opportunities and rueful decisions co-mingled with periods of intense happiness, enough laughter and a few moments of triumph. Organizing this mess and making sense out of it would be no easy task. And writing about it obviously begs the question. Who cares? What does it really matter? Well, it matters to me. Everyone has a story. Now I can write mine. Further, how often does someone get a second look at their life with the opportunity of reviewing and critiquing how it was handled the first time? As Tante Madeleine would have said, faut profiter. Some editing will be needed, obviously, what to put in, what to leave out. That will certainly require further exploration into the deep recesses of my sub-conscious as well as reestablishing the time zones for my mélange of memories.

Chapter 6

Intern Mismatch

I directed the rental Chevy onto the ramp for the Walt Whitman Bridge heading toward the expressway that would take us for our first visit to the South Jersey shore. Graduation from The Chicago School of Medical Osteopathy (CSMO) was less than a month away and I had matched with an osteopathic hospital in Saginaw Michigan for my internship. Unfortunately it was not my first choice and I was disappointed. So was Kit who much preferred staying in Chicago where she had a suburban teaching job. But the decision was final as far as the American Osteopathic Association (AOA) was concerned.

Unless, I took a bold step and signed up to do my internship in an AMA program! Some of my classmates had already done just that and were set to enter one of the few such programs that allowed D.O. graduates an opportunity to complete their training in an AMA mainstream program as opposed to staying inclusively within the Osteopathic domain. I was on my way to that hospital.

An interview at a hospital in Evanston, just north of Chicago had gone well. I was encouraged by the tone of the interviewing M.D. who promised to notify me within the week but the call had left my ego deflated. Sorry! The voice on the other end of the line announced brusquely. Some of the housestaff threatened to strike if we hired an osteopath.

Kit and I were put up in the intern quarters, a former motel now attached to the hospital’s emergency room. I was given a tour of the facility by the Director of Medical Education, Dr. Thompson and later interviewed by him in his office. That is where I first met Mrs. Gabby Hagen, his secretary and, perfectly obvious, his chief of staff. She looked cute (for an old lady) in her straight white hair cut evenly just below ear level and with short bangs over her forehead. She produced the gravelly voice of an inveterate smoker, smiling and taking my hand during our introduction.

In the interview, Dr. Thompson posed a hypothetical question to me. You are called to evaluate a patient who has gone bad on a medical floor at 11 pm. You are the only doctor in house. How would you proceed?

Well, at that point in my career I was about as green as they come. I had some book knowledge but what little clinical experience I had as a student always came as low man on the totem pole. Interns, residents and fellows all claiming incrementally higher status but as the trainees were always eager to impress their superiors, I usually let them take the heat, remaining piously in the background. I looked the clean shaven, completely bald Director in the eye, contemplating my options. My gut reaction at the time was to say I’d go looking for the oldest nurse on the floor and ask her what to do but at the risk of creating a first impression of a smart ass, resisted the impulse and instead said. I would ask the staff about his admitting diagnosis, past history, recent lab or x ray studies and current vital signs so I could call and give the attending physician a proper report. It was a fairly lame response to an ambiguous question and Dr. T. just sat there unamused in his stiff, starched white lab coat and shirt with tie firmly knotted in choke hold position. There was an awkward silence but he finally smiled, and went on to a less threatening line of questions. In the adjacent room, I thought I heard a wheezy cough and the sound of a chair being pushed backward and imagined the smirking Mrs. Hagen trying to hold back laughter. I got the job anyway and the rest, as they say, is history.

Graduation came and went uneventfully although six of my classmates and I held our breath until we were sure our Diplomas were authentic. Some of the faculty and administration at our school, having learned several of us were bolting, had insinuated we were showing disloyalty to the profession. We were often referred to us as the Chicago Seven after the infamous group led by Abby Hofmann that was put on trial after the 1968 Democratic Convention for inciting riots there in response to the growing anti Viet Nam War Protest. We were presented with the threat that appropriate action might be taken. It wasn’t, not then anyway but I would feel the sting of their latent hostility many years later when I was initially denied approval to be director of our hospital’s first Osteopathic Internship Program. One of my former Professor’s in Chicago, who was at the time Dean of the New Jersey School, fixed the problem. Still waters run deep.

Despite a lingering foreboding, I made the decision to start my post graduate training at Boardwalk Atlantic Hospital as a straight surgical intern. This meant spending 8 of the next 12 months on surgical services in order to receive credit for the first year of surgical training toward general surgery or a surgical specialty. The other four months would be divided between medicine, pediatrics and OB. We never thought of ourselves as pioneers at the time but in retrospect I believe we were, many more D.O. graduates would follow our lead in the next few years. The hospitals willing to provide us these opportunities were also sticking their necks out as I would soon learn. Kit wasn’t nearly as pleased as I was. She found the area to be unfriendly and foreign. She didn’t like the first apt we rented, nor the second and by October, we were in our third, leaving behind some of my classmates/colleagues that lived in the second apt complex with us. The guys all got along well, the girls not so much, if I was correctly reading Kit’s reactions.

We found a nice apt on the second floor of a house downbeach which overlooked the bay, allowed an opportunity for wonderful sunsets which I rarely got to see, made my commute to work much longer and served to isolate us socially from the others. Kit soon found a job with a state agency that dealt with domestic issues and the position seemed to suit her interests. I noted a positive attitude adjustment following that and for a time she was easier to live with.

How I ended up in medicine after starting a surgical internship reflected the instability and uncertainty of the fragile relationship between the osteopathic and allopathic branches of medicine at that time. The program director for the surgical residency at Boardwalk Atlantic then was a portly, kindhearted Harvard Medical School Graduate who had done his surgical training in NYC but apparently failed to land the type of position he desired and finding living expenses there a bit hostile, had lowered his aspirations and brought his family to the south Jersey shore where the living was easier and the salary guaranteed. Dr. Elvern had taken a liking to me and readily offered me a place in the next year’s surgical residency program which I accepted. I was on a roll.

Unfortunately, it didn’t last long and I came up snake eyes on the next toss. Dr. Elvern called me to his office several weeks later to deliver the bad news. The American Board of Surgery, which sanctioned all AMA surgical training programs in the country, had made contact and informed him that the surgical program at Boardwalk Atlantic would be decertified if it hired a D.O. I’m sorry, there’s nothing I can do about it. He had said.

I was sorry too. My longtime dream of becoming a surgeon dashed unless I was willing to tuck tail and return to an osteopathic program. I suspected I might face a little animosity if I did and would surely be required to complete an osteopathic internship first.

Dr. Thompson, sympathetic to my predicament, offered me a position in the medical residency program and I scrambled to set up the next eight months of training in order to get a first year credit in medicine. So, the world’s first AMA trained D.O. surgeon would not be me but someone else would have the honor a few years down the road.

Chapter 7

The Farm

My earliest memories are of my grandmother’s farm. That is where my parents, sisters and I stayed when we arrived from France in 1947. It was located in southeast Michigan a few miles south of Menlo. Maman’s (Muh-mah) sister, aunt Yola and her family, uncle Armando and cousin Sophia also lived there as did uncle Nick and uncle Pete who had come over from Italy with my grandparents. The farm had cows, pigs, chickens, goats and several dogs always running and yapping about. Maybe twice a year, a pig would seemingly go missing. This was always closely followed by the most wonderful pork sausages, Sunday hams, chops and pork roasts and the gone grunter was soon forgotten. A Billy Goat named Bennie was a surly rascal who liked coming up behind to butt you with his short horns. I took this as a sign of affection since the effort was typically playful. He was also a junk food junkie, once eating the tar paper off the doghouse roof before it could be shingled. There was nothing not on his diet.

The main crops were corn, soy beans and winter wheat. Uncle Armando and Uncle Pete had been hired at Ford’s and my Uncle Nick, by default, was farmer in chief. Papa(pup-pah) was expected to volunteer as his assistant in return for room and board for his family. That only lasted as long as it took for him to find a real job and eventually put a down payment on a two bedroom tract house outside of Menlo. Later, Uncle Nick also got hired at Ford’s on the afternoon shift forcing his farming duties to the early morning hours so as to be at work on time. Uncle Pete, a short fleshy weasel who was good at card games, was often ‘spent’ following his normal day shift and unable to contribute much to farm work. Uncle Armando’s main goal in life was a staggering resolve to not allow the homemade stash of red wine, produced each fall with grapes shipped in from California, of aging unnecessarily. This restricted his farming contribution. So did his lean frame maintained with the help of one or more packs of Camels daily. Both Pete and Armando would eventually retire from Ford’s with a pension. Pete returned to Italy and lived well off his for years. Armando’s life style prevented him from fully cashing in on his and he died of lung cancer at age 68. Nick, an intense, hardworking dude, who was small but wiry and strong and never smiled much, suffered a heart attack one hot summer morning out in the fields. He was treated at home as was customary then. I remember the Doctor coming to the farmhouse every day and telling the family how great he was progressing. Then, about day seven, Nick got up to use the bathroom and dropped dead on the living room floor. He was 55.

My grandfather was an inmate at the Pontiac State Hospital for reasons unknown to me but was regularly retrieved for Sunday dinner. I remember him as an old man with white hair in a three piece pinstriped suit, humming softly as he paced slowly around the house. He was allowed one beer and always offered me a sip which I never turned down.

Maman was fluent in both French and Italian, having lived in both countries as a young girl. She was able to communicate with her mother, who had abandoned her in Italy along with the other three girls after my mother was born there once WW I dragged Italy into the fracas ruining an otherwise blissful reunion with their Italian heritage. My grandfather had elected to stay home and had not made the trip with them. Our parents spoke French to us kids and we first learned English from our older cousin Sophia. I picked up enough Italian to converse with my grandmother but that language didn’t stick after she died when I was seven.

Once we moved into our new house near Menlo, my sisters were enrolled in the Immaculate Conception Catholic School in town where I would join them the next school year. Mercredi was the day for Maman ‘a faire son Marche’. There really wasn’t anything quite comparable in Menlo in 1950 like the open markets she had been accustomed to in France so we just trudged ‘a pieds’ the mile up county line road to the local Kroger Store. I always accompanied her being I had just turned 5 and wasn’t allowed to stay home by myself. Papa had the only car, at the iron foundry where he had found work, and Maman had not yet learned to drive. The walk into town, Mamam’s methodical shopping out of necessity for efficiently and affordably feeding a family of five and carrying the grocery bags back home was painstaking and took up most of the morning. I hated Mercredi.

Chapter 8

Immaculate Deception

That all changed once I had to spend the whole week at Catholic School. The nuns were downright scary looking to a 5 year old. Their face was framed in a white cardboard like box which surrounded it and had a 3 inch elevated piece above their forehead to which a long black veil hung down in the back. You couldn’t see any hair. The veil blended in with the all black, full length habit that was cinched at the waist with a belt resembling large rosary beads. I had been given an option, 1st grade in the Catholic School where my sisters were already embedded or Public School Kindergarten. It was a no brainer. Even though K might have been easier, it would have just delayed the inevitable. I was destined to serve the full sentence, eight years without parole.

I had to go. I should have used the bathroom at recess but didn’t want to give up any of the precious 15 minutes of play time. Our Nun was teaching the second graders something about Saint Anonymous. It was a small building with 4 classrooms necessitating 2 grades per room and alternate instruction. The other side was to honor vows of silence, studying whatever materials were provided and strongly encouraged not to interrupt.

I held it as long as I could, then suddenly I couldn’t anymore and stood up and blurted out may I use the lavatory please as urine began visibly flowing down my pantleg.

Rapidly assessing my embarrassment and continued discomfort, Sister Mary Euthanasia gave a little sarcastic snicker Well, it looks a tad late for that now but please, go ahead as both sides of the class erupted in laughter and got unruly at my expense, including my sister Gisele a second grader. This was obviously funny to everyone but me. I was mortified and quickly left the classroom trying, unsuccessfully, not to cry on my way to the bathroom. I finished relieving myself and tried to dry my pants with paper towels. A big wet stain down the right pantleg just would not go away. No one came to the lavatory to check on me. I was too humiliated to go back to the classroom, so I snuck out the back door, crawled below the large windows of the 7th and 8th grade classroom, slipped past the back of the church and headed to North street to walk across town towards Dexter street following the route my dad always used on Sundays, then up to county line road, which I knew well, and home.

Needless to say, Maman was quite surprised to see me and would surely have freaked out if not for the frantic phone call from the school reporting I was missing. I was then forced to retell the embarrassing episode. My punishment? No outside play time after school the rest of the week but the worst part was having to put up with Gisele’s teasing a lot longer than that. I’d need to work a quick pit stop into my morning routine.

Catholic school was stressful, demeaning and barely tolerable. Trouble was, I wasn’t so much as interested in the lives of the patron saints or the mystery of the Holy Trinity as the Nuns, my teachers, were. Then there was the specter of Sister Superior, Lucretia MacEvil, the enforcer, her permanently engraved mean facial wrinkles acquired through to many years of passionate duty. She was licensed to carry a 12 inch ruler, always ready to smack your hands if you deviated and accompanied by the sorrowful qualifier This hurts me more than it hurts you! Excuse me? The other problem was my sister Gisele who was one year ahead and therefore in the same classroom with me every other year.

Mrs. Garrity says there is no such word as can’t! my sister Gisele said emphatically, offering her opinion of the word the nun had written on the blackboard during a grammar lesson. I groaned and pretended not to have heard her but I was embarrassed. Mrs. Garrity, a neighborhood fixture and strong advocate for all of us kids did say stuff like that but my sister was making herself out to look like a fool.

Another time, Gisele’s class was getting a geography lesson about Canada and Sister Magellan asked if anyone knew why the Maritime Provinces were so called. Hand up by my sister (again) while she blurted out as a question, Because people there have a merry time? I buried my head on my desk.

Once Maman learned how to drive, she would sometimes pick us up at the school to have lunch together in the back lot of the foundry a few blocks away. At noon sharply, the whistle would blow and within seconds, Papa would emerge from inside through a heavy sliding door of the plant in black face, the area protected by his eye goggles in exception. We ate our lunch, packed by Maman, in our new 1950 Dodge Coronet, an old sheet covering the passenger seat for Papa’s soot infiltrated clothes.

This was our first car with a radio and we listened to a noon time program called Queen for a day hosted by an announcer named Jack Bailey while we ate. He would start each show by exclaiming Who wants to be queen for a day? Four different women would then state their case, one of them being crowned Queen at the end of the show based on the applause meter response generated by the audience. Their wishes were usually simple and somewhat sad. A new winter coat, for example, after the budget got busted on the rest of the families needs. Or a new couch to replace an old worn and torn one. One contestant asked for a nice dress she could wear to her daughter’s wedding because they had maxed out on the event itself. Someone might ask for nice silverware or tableware because of an important guest coming to dinner. Whoever had the sorriest story usually won and my sisters and I were happy for them but felt