VITAL SIGNS
ABOUT THE AUTHOR
Originally from Macon, GA, Herman Toliver has been writing short stories about his hometown and surrounding areas since age ten. He earned a B.S. in Biology from Fort Valley State University in Fort Valley, GA, and later earned his M.D. degree from the Medical College of Georgia. He’s currently completing his residency in Internal Medicine at Tulane University in New Orleans, LA. Toliver enjoys working with his patients, writing, and studying ancient Incan and Mayan history. He recently began learning to translate Egyptian hieroglyphs. To learn more about the author, visit http://hermantoliver.com
VITAL SIGNS
HERMAN L. TOLIVER, JR. MD
BELLETRISTIC PRESS
New York
Belletristic Press, LLC
31-64 21st Street, Suite 190
Long Island City, New York 11106
PUBLISHER’S NOTE
This book is a work of fiction. Names, characters, places, and incidents are either products of the author’s imagination or are used fictitiously. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental. This book is not intended to treat or diagnose any medical conditions, whether known or unknown.
Copyright © 2009 by Herman L. Toliver, Jr. MD
All rights reserved including the right of reproduction in whole or in part in any form. Without limiting the rights of the copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book; except in the case of brief quotations embodied in critical articles or reviews.
Belletristic Press colophon and design
are trademarks of Belletristic Press, LLC
First BELLETRISTIC PRESS Trade Paper Edition 2009
Printed in the United States of America
Library of Congress Control Number: 2009903445
ISBN 978-0979659447
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cover design by Saience
DEDICATION
This book is dedicated to my young sisters and brothers still trying to find their way to success. In this book, I may sound harsh at times, but know that it's all out of love for each of you. Be blessed, and, in all things, strive for perfection!
ACKNOWLEDGMENT
The good Lord comes first and foremost from whom all my blessings have flowed, hands down! Glory be to Him and His son, Jesus Christ, forever and ever!
I honestly could not have completed this project without the help of the following individual: Dare Adewumi, MD
The following individuals have both deeply inspired and supported me throughout this project : Herman L. Toliver, Sr., Patricia A. Toliver, Porsha Toliver, Tandrea Dawson-Toliver, Jason Philip Toliver, Kindra Winn, Joseph Aubert, Taifa Darensberg, Aubrey Randall, Shelvia Stewart, Clarence Ste-wart, Toni Patel-Stewart, Diane Stewart, Martha Thomas, Betty Blount, Marvin and Marcia Pitts, Kemarvin Pitts, Kelly Moran, Pharm. D, Roderick Thomas, Laina Pond, Antonio Byrd, Tiffany Peters, MD, Brandon Gray, Brandon Poole, Gwenneth Thompson, Dante Marshall, Esq., Kamal Aderi-bigbe, MD, Wilbert Warren, DVM, Ortilia Tomblin, Jeffery Wiese, MD, Micheal Fletcher, Jr., Keith A. Chaney, Christo-pher Stewart, Tai Collins, L'Von Collins, Marcellus White, Nathaniel Thomas, Pharm D., Tesfai Tekle, MD, David Webb, MD, Antonio Montgomery, MD, Jonathan Newsome, Pharm D. Preston and Diedre May, Shantae Simmons, Brandon Hagler, DMD, Albert Baawo, Jr., DMD, Horace Braswell, Jonathan Howard, Quentin Alston, Frederick Lamar, Alfred Jarrett, Pharm D., Tyran Nelson, Demetrius Mathis, Cutreal Phillips, and Kesha Edwards
To my publisher who gave me the opportunity to publish my first book, I thank you!
To the distinguished men of Phi Beta Sigma Fraternity Inc, I thank you!
ONE
Yesterday, Krista told me my day would be like this. She said I’d be overloaded with patients. I didn’t believe her. After all, she’s only my better half…what does she know?
It was a Friday morning at St. Francis Memorial Hospital. More important, it was a morning where all hell broke loose. Atlanta has always been known as an unpredictable city; one where even the most subtle everyday occurrences usually led to some milestone that made city, state, and sometimes national headlines. Atlanta is, after all, the city where the most famous Black man in history made some of his most important contributions. It’s a shame really. Dr. King would roll in his grave if he witnessed the things I see in this emergency department.
The nurses dragged a Black man by his armpits and placed him on a stretcher in front of me. I stood with my arms folded and listened to him shout obscenities at my staff, which would normally piss me off, but that day was different.
“Let me go! I don’t want to be here! Nobody asked you sons-of-bitches to lay a finger on me!” the drunken man exclaimed.
His body reeked of alcohol, and I saw linear arrays of track marks decorating his anterior forearms. That was pretty much diagnostic of intravenous drug use. No telling what this man had been shooting into his veins. It could’ve been cocaine, it could’ve been heroin. It really didn’t matter. In the ER, nothing mattered when it came to saving a life. And this man was no different.
“Listen up,” I said, resting my forearms on the edge of the patient’s stretcher and leaning towards him.
“I’m listenin,’ Doc,” the drunk, toothless man responded, still trying to force his way from the grasps of the overpowering male nurses.
“Good, because I’m only going to say this once. You see that White gentleman over in the corner?” I pointed to a secluded stretcher at the far end of the ER. On the stretcher lay another patient: White, full-bearded, and drunk. Yet, he was well-behaved; although he swatted nonexistent flying insects. And there I was with this idiot. “That White man is just as drunk as you are. You see how calm and collected he is? You’re embarrassing me.” The drunk gave me a confused look. He was so drunk he couldn’t keep his eyes aligned, anyway. “Never mind. Hold him down.” The male nurses immediately sprung back into action.
They held him by his armpits and forced all their weight on to his chest. At that point, he was helpless. He kicked and screamed relentlessly as I made my way towards him with an Ativan-filled syringe. I almost hated putting people to sleep like animals, but men like this left me little choice. Ativan calms the central nervous system, thus calming even the most hostile patients. In this man, it served a dual purpose. Alcoholics are prone to developing life-threatening tremors as a result of abstaining from alcohol. Because I couldn’t tell when this man had his last drink, Ativan would thwart off any deadly shakes until he could get his hands on another bottle of whiskey.
“You guys can let him go,” I said to the nurses. “He won’t be up much longer.”
“Dr. Alexander?” One of the nurses called for my attention.
I hate when they call me that. “Call me, Jason, man.”
He laughed. “Okay…Jason, what are we supposed to do with this maniac in the meantime? We don’t have any beds available in the entire emergency department.”
“Put him on the stretcher with the guy in the corner, for all I care. Let them entertain each other for a couple hours.”
“We’ve got another one in curtain five. She’s an older lady in her fifties…says she knows you, Doc.”
“Big surprise. Patients will say anything to skip ahead in line. How many patients do I have left to see?”
“So far, about twelve waiting to be seen and about forty in the waiting room.”
Duty calls, I thought. It may not seem like it at times, but I absolutely love what I do. I couldn’t see myself doing anything but taking care of my people. Seeing young Black men and women trapped in the various situations they find themselves: drugs addiction, unintended pregnancies, or just bad decisions, always made me feel like I failed right along with them. Despite all the pain and suffering I’ve seen in this place, I still believe this is what God called me to do.
I looked around the emergency department. Here, the ER is divided into eight trauma and resuscitation rooms, twenty urgent care rooms, two pediatric trauma and urgent care areas, two family waiting areas, and a trauma bay with at least two ambulances loading and unloading at all times. That makes for a pretty huge emergency department. St. Francis was a relatively new hospital, so we had cleaner facilities than those found at most ERs throughout the country.
Few people realize in this day and age that the term emergency room is a misnomer. With a fully functioning area in one of Atlanta’s largest hospitals, with more than one hundred workers on staff; including physicians, physician assistants, nurse practitioners, registered nurses, nurse anesthetists, licensed practical nurses, certified nurses’ assistants, security officers, custodians, and volunteers, calling this place a “room” was simply impractical. I find it funny when people are instructed to go to the emergency department, they have no clue what the instructor means. Needless to say, the term ER is here to stay.
On opposite ends, a different patient occupied each bed. Some patients had family members by their side who continuously eyed me up and down as if I wasn’t moving fast enough. From what I understand, this year, Atlanta hosted the Black Arts Festival. The festival featured a plethora of prestigious literary and visual arts and artists over a nine-day period of exquisite showcases, and is attended by millions of tourists. There are auctions of rare antique furnishings, jewelry, paintings, and original musical scores by some of Black America’s most influential musicians; including Dizzy Gillespie, John Coltrane, and even Ma Rainey.
It’s unfortunate that such an important event was plagued with vagrants, beggars, and ragamuffins. Making things more stressful was that they all come here when they got sick from overdosing on alcohol or narcotics. That’s usually the price you pay for being an inner-city hospital. Today was going to be different for me. Today, my son turns four. He and my wife, Krista, are my world. And even the patient behind curtain five couldn’t ruin this day for me.
As I approached curtain five, I took a deep breath and stood still a moment, unsure of whom I was about to care for. Emergency medicine is usually a guessing game. I knew nothing about these patients, unlike doctors who have private practices and select patients who can afford to pay them large sums of money to poke, prod, and send them home with a prescription they may or may not need. These were my patients in the same respect, but the difference was I’d never see them again after they left. And even if I did, I wouldn’t remember them. It hurt in a way. At the same time, I figured this was type of doctor I was meant to be; the type of doctor who could treat the greatest number of patients possible.
I took a deep breath and pulled back the curtain. To my surprise, it turned out the patient didn’t lie, after all. She did know me. That didn’t change the fact that she wanted to skip ahead in line.
“Hey, nephew!” the stout woman shouted at the top of her lungs, as only a Black woman could…or would in a public place.
I stood with my mouth open. It had been years since I saw this woman. “Uh, hi, Aunt Josephine!” I greeted her just as disingenuously.
“I didn’t know you worked here until I saw your name on the list of emergency physicians as you come into the waiting room.”
I wanted to call her a liar. She knew damn well I worked here. She even knew the day to show up when I’d be here. Aunt Josephine and my grandmother, Patricia, are sisters. They used to be very close, but Aunt Josephine and I never really got along. She always had a fake aura about her that I never appreciated. To hear her tell it, she loves me like her own son. However, that didn’t come about until after I finished medical school.
“What can I do for you, Aunt Josephine? This is an emergency room. You don’t look that sick.”
“I woke up this morning with this feeling of light-headedness that I just couldn’t shake, Jason. It was horrible! Not only that, I couldn’t walk straight. I couldn’t think straight. My head was throbbing and I couldn’t make out my own face because my vision was so blurry. What do you think all this could mean?”
This was perfect. Not only did I have an ER filled with patients, but an aunt I only halfway liked was sitting in front of me and I had to deliver bad news. “Aunt Josephine, I’m looking at your chart here. Do you realize your blood pressure is 225/130?”
“I don’t see why it would be that high.”
“Have you been taking your blood pressure medicines?”
“I take them when I feel bad. Lately, I’ve been feeling pretty good.”
“Well, Aunt Josephine, I’m glad you came in to see me today because if what you’re telling me about how you felt this morning is true; your blurriness, moderate headache, un-steady walk, and other symptoms I’m sure you’re unaware you even had, it’s safe to say you’re well on your way to having a stroke.”
Her eyes lit up brighter than the dropping peach on New Year’s Eve in the heart of Atlanta. She was speechless. This 267-pound, non-compliant, medically retired and on disability, former restaurant cook just had her world turned upside-down. It always surprises me how the massive amount of health information available about Black people fails to open the eyes of those it concerns. You can’t turn on the television nowadays without seeing an ad for some anti-hypertensive medication being launched or forced upon an unhealthy public. You can’t pick up the latest copy of Ebony magazine without seeing an ad within the first ten pages for the newest sugar-lowering medication or, supposedly, the most effective HIV medication. I guess those publications are speaking to some-one else. Unfortunately for most of us, we’re all someone else to someone else.
While she sat gathering her thoughts and processing the possibility I just revealed to her, the itinerary of the day’s events began sifting through my mind. There it was, only 9:00 A.M. on a Friday morning, and I had to deliver bad news already. It was an art as much as it was a curse. Delivering bad news can often rip a patient’s life apart. Sometimes it’s a wake-up call; a final desperate attempt to make the changes we all struggle against making.
“Does that mean I’m going to die, Dr. Alexander?”
The tone in my aunt’s voice went from confidence that nothing was wrong and that this minor episode would soon pass, to one of rasp and fear that imminent doom was on its way. I’d prefer the latter given that she talks louder than Samuel L. Jackson giving his best on-screen performance.
“You don’t have to call me that, Aunt Josephine. But what this means is you’re at a highly increased risk for having a stroke. It doesn’t mean you’re going to go home and drop dead tonight.” Maybe I shouldn’t have said that. “Here’s what we have so far: you came in to the ER this morning with typical symptoms inherent to early signs of an impending stroke. You have an extremely high blood pressure; much higher than what you came in with last time according to your records. You’re obese, which adds a significant risk of not only stroke, but heart attack as well. And your current symptoms are the body’s way of letting you know that something is terribly wrong.”
At that moment, she gave a slight sniffle. Two moments later, this woman let loose a stream that I’m surprised her tear ducts could hold. I actually heard her heart beating. I believe I detected a heart murmur, too, but I was more concerned with this woman leaping off the top of St. Francis when she left than I was with any additional medical problems she might be suffering. I could tell she was worried, fearful even. It’s not everyday you see independent Black women, so comfortable with being overweight, breakdown crying because of bad news that they’ll have to pop a few pills everyday.
I guess we can thank certain celebrities and their crusades to have all obese Black women feel it’s okay to be unhealthy and on their way to having a heart attack or stroke, as this poor woman was. But that’s a totally different story. At the time, I focused on making certain this woman realized it wasn’t the end of her world…at least not yet.
“Aunt Josephine?” I attempted to get her attention.
She looked at me with consternation in her heart. The look in her eyes indicated paralyzing dismay. The moles under her eyes submerged in her endless stream of tears. Her eyes were actually quite beautiful…on the outside. When I looked inside her eyes using an ophthalmoscope, I saw damaged blood vessels leaking blood into the vitreous humor. A vitreous hemorrhage, if you will.
It’s amazing how you can tell the overall health of a person just by looking inside their eyes. Blood vessels tell a story worthy of Shakespeare himself. They can be brittle, pale, enlarged, broken, or even newly synthesized. Eyes told the story of the state of a patient’s health.
Her eyes were not only damaged from uncontrolled blood pressure, but her blood sugar was 320. That didn’t help. Blood sugar should range from 70-110. Anything over 110 is worrisome and anything over 200 is suspicious for having diabetes. The bad thing is she didn’t even know she was diabetic.
A diabetic’s eyes contain several new blood vessels the body deemed necessary to sprout because of the high amount of glucose present in the bloodstream. When a diabetic’s blood glucose levels remain elevated for an extended period, blood vessel damage occurs in several body organs, the most sensitive being the eyes. When considerable damage is done to a person’s eyes, the body says to itself, Oh well, since these old vessels have been ruined by excess sugar, let me make some new blood vessels to take their place. It’s a smart idea, but ultimately ineffective. These new blood vessels are not as sturdy as the original ones. These new vessels are imperfect and therefore, leak and rupture frequently.
This process eventually begins to affect the retina of the eye as well, the part that transmits the message to our brain to interpret what we actually ‘see’. Think of the retina as the film in a camera. No film…no picture. And in diabetics, the film is destroyed slowly but surely, leading to what is famously known as diabetic retinopathy. Several of these unfortunate individuals end up legally blind at younger ages, which explains why glucose control is so essential in diabetics.
“Are you okay, Aunt Josephine? Do you want me to get you some water or something? I realize this news can be disheartening, but think of it as a wake-up call.”
“So, what can I do, Jason?”
Dammit! Didn’t we just go over that? “It’s imperative you start adhering to your medication regimen, Aunt Josephine. You should be fine, but I’m not kidding about taking your medications. I’m not prescribing them for my benefit. You need to take responsibility for your own health. This isn’t a joke. We need to discuss a few other things about the labs I got back on you—”
Trauma alert, trauma alert
Unstable adult male, GSW times two en route
All trauma and ER staff to the trauma bay STAT
Dr. Jason Alexander, ER attending
My aunt looked at me with admiration. It was a look I’d never seen from her.
“I’m proud of you, Jason. Your mother would have been so pleased at how you turned out. Hearing that announcement…I don’t think I could do what you do,” she said, clutching the edge of my white coat.
She rubbed the fabric between her swollen hands and looked at me with sad eyes. My heart went out to her. This woman was on the verge of serious medical complications. The route she headed down would probably lead to her dying in her sleep from a silent heart attack or blood clot. Yet, she found it in herself to pay tribute to me for what I take for granted as simply doing my job. For the first time, I felt maybe she wasn’t so bad, after all.
I gave Aunt Josephine a wink, turned and ran to the front entrance of the hospital that led to the trauma bay. The alcoholics, heroin addicts, sex offenders, and even my own aunt would all have to wait. There was a life to save. It was showtime!
TWO
I never imagined being a school teacher would be so taxing. At the end of a ten-hour work day, you definitely felt the physical effects of the Atlanta Public School system. Not that I necessarily had to stay such a long time. After all, starting work at 7:00 A.M. was more than enough reason to leave at 3:00 P.M. However, few people understand the plight our Black children face in the public school system today. With everything from drugs and sex to sex and violence, it’s a wonder that the very few Black youngsters who make it through junior high school actually go on to graduate. Since my graduation, I often wondered how my life would change the moment I stepped out the classroom and subsequently into the classroom in a much different role.
I remember walking down similar hallways as a teenager. Central High School in the heart of Decatur, Georgia was where I first learned who I truly was. It was the place, in fact, where I learned what I truly was: a Black woman with an insatiable urge to be considered the very best at what she does. I can’t say exactly where my drive comes from. Many folks who know me insist it comes from my grandmother who, in her own right, was a civil rights activist who’d marched alongside Dr. Martin Luther King himself on more than one occasion. I think it comes from the need to be considered just as good as the next man.
You see, I was raised to believe women had particular roles when it came to their positions as wife, social figures, in church, and nearly every scenario imaginable. There was a medieval way of thinking in my household while growing up. I was essentially Queen Guinevere just waiting to be picked up by her chivalrous King Arthur; ride into the endless sunset on the back of his gallant stallion while steadily grasping the armor of the king, which was my privilege to behold. To await his valiant arrival when his day’s work had ended; only to have him sweep me off my feet at that intercession between heartbeats, which would cause that perfect skipped beat. And finally, to lay at night naïvely believing he would accompany me to my everlasting bliss, which shall be his and mine to dwell therein forever. Whatever.
I was almost fourteen-years-old when I first realized how imperfect the world was. In fact, it was during this time that I no longer considered myself a child. I was Krista Towers, grown-ass Black woman, at the tender age of fourteen. It’s unfortunate I chose to lose my innocence at such a young age. It’s more unfortunate that whenever I tell people about this, they immediately believe I’m referring to losing my virginity at age fourteen. I quickly let them know, when they think that, they are sadly mistaken.
Imperfect describes my family’s attitude toward women. Even my mother, at the distinguished age of thirty-five, consistently agreed with my father that it was indeed a woman’s place to be beneath her man…in more ways than one. It was commonplace to hear such nonsense as Krista, you better get your act together, girl, and learn how to cook and clean to please your man. Or, Krista, ain’t no man gone want a woman as skinny as you. Look at you! You ain’t got no booty nowhere, and you think it’s a crime that you wear a 38D bra. And finally, the one that always succeeded in royally pissing me off, Krista, when you gone find a man and have you some babies?
My mother was perhaps the most country, ill-spoken woman I knew. Though her intentions may have been genuinely for my favor, they were not in my favor. My mom failed to realize that even though she had one of the few partially successful marriages I knew of, the marriage was far from perfect. It made me gravely upset that my mother consistently put off her hopes and aspirations in a blind attempt to fully satisfy her man; a feat that is impossible to accomplish. My mother, despite her eerie southern accent, was actually a bright woman. In fact, she made it to her junior year at Clayton Community College near Jonesboro, Georgia, majoring in Criminal Justice. It was always a dream of hers to be a part of the legal system. It was unfortunate that my mother, Ann Towers, never returned that fall semester of her senior year because she “owed” it to my father to stay home and take care of “household responsibilities” while he completed his Master’s in Computer Engineering.
My father, Daniel Towers, was a successful computer engineer with his own consultation firm and contracting company that installed mainframes, circuitry, networks, and a plethora of other computer gadgetry at major manufacturing plants, doctors’ offices, hospitals, you name it. He became immensely popular in the city of Atlanta in a surprisingly short time. He was a smart man. So smart, in fact, he talked my mother into allowing him to legally put everything they owned together in his name alone. I remember hearing the statement made by that man, Baby, it would be better if we kept the house in my name considering I’m the one out busting my ass everyday for you and the kids. Plus, it just makes things easier for us as far as property taxes, state and federal income taxes, banking and mortgage statement, and deed laws to have the owner’s name listed as the individual who is the primary financial provider.
I was too young at the time to realize he was full of shit. In the end, it was effective the way his demeanor, charm, and wit won out over my mother’s intuition. It wasn’t long before Daniel Towers learned he was worth quite a sum of money; a sum he had no intention of sharing with his well-deserving, self-sacrificing spouse. As far as I could tell, my mother had been nothing but loyal and respectful to the man with a penchant for adulation worthy of biblical implication. He, unfortunately, did not interpret her behavior the same way. And the events that ultimately led to their divorce are as heinous for me to think about now, at age twenty-nine, as they were at age sixteen.
I’ve always insisted that no matter what field I went into, I would obtain the highest degree that God allowed. Initially, I was ambitious enough to pursue my doctorate in education, a degree that would ultimately set me apart from those individuals who did the bare minimum to teach. It would set me apart from those who simply enjoyed teaching and those who had a true passion for the discipline. My doctorate in education would be that one accomplishment I never dreamed possible at first, and it would be that shining star on every resume, curriculum vitae, and autobiographical sketch that I’d ever write. That was six years ago. And quite frankly, I grew sick and tired of school.
One of the traits I always admired in Jason was his determination. Once he set out to get something accomplished, he never let anything stand in his way…including me. Jason and I have definitely had our moments, both good and bad, but one thing I have to admit is I’m not the first love of his life. Believe it or not, I’m okay with that.
The first love of his life is God, period. I credit him for helping me acknowledge the need to put God first. He was also quite the mama’s boy. Even though Jason never told me exactly what his mother used to do for a living or, for that matter, why she’s not around anymore, I can tell by the way he talks about her that he loved her dearly. It was always an intense topic to broach. Even when we first met and had our first conversation six years ago, he was hesitant to let anyone know the deal with his mother. But he was damn ready to discuss anything else that pertained to him…
“Excuse me,” I said, looking up at the man who, little did I realize at the time, was chief resident of St. Francis Memorial Hospital; the largest four-level trauma center in the city. “I’m Krista Towers. My godson, Jaylan Sneed, has just been brought in by his mother, Shuntoya Sneed. Can you tell me where I can find them?”
He stared at me with a look in his eyes I remember even to this day. It was a look, not necessarily intimidating, but commanding. Authoritative, confident, unassailable even! The name tag on his white coat read Jason Alexander, MD. Emergency Medicine, Resident Chief. If I had read the name tag before I opened my mouth, I probably wouldn’t have bothered asking him such a trivial question. After all, I knew they had clerks for that sort of thing. Still, there was something about this guy. He already looked like he could lock jaws with a sister. I wanted to know if he could match wits as well. His response was even more commandeering than his presence.
“Are you familiar with HIPAA?”
What the hell was that supposed to mean? Was it some sort of medical lingo? I hated doctors who insisted upon laying all their fancy terminology on you; words they know we have no clue what they mean.
“I can’t say that I am,” I said with the same disdain in my voice he had in his.
If he wanted to try to make someone feel intellectually inferior, he’d have to try someone else because I’d learned to match wits with the best. It’s what I did for a living. It’s why I do what I do. It’s why I teach today’s youth to empower themselves to conform to a society that expects them to know more than the bare minimum…and to confront arrogant assholes like the one who stood before me.
“Health Insurance Portability and Accountability Act, passed by Congress in 1996, specifically states that health care information concerning an individual is limited to, and strictly limited to, that individual and the immediate health care providers he or she has been assigned to. Therefore, it would be against the law for me to inform you that she’s in curtain six, in the pediatric resuscitation unit around the corner to your left.”
A huge smile came across his face at the end of his inane speech. The hubris that poured from him didn’t leave much elbow room in the hallway. This guy was that sure of himself…and I absolutely loved it.
“Don’t tell me I didn’t just break the ice into a dozen pieces. I’m quite proud of it, frankly.”
Kind of corny, but I could tell he was genuine. He was also fine as hell. Jason stood about 6-1, with a smile you’d swear he’d just pulled off the box of some denture cleanser. He had a slick bald head that I could tell suffered from premature male pattern baldness; and the sexiest lips I’d ever seen. His body was ripped from what I could tell. That long white coat left a whole lot to the imagination, but I tried to work around it. The blue scrubs he wore complimented his butt quite nicely, and I’d never seen a doctor walk around a hospital in a pair of $150 Nike Air Max; but I guess he kept it tight even while saving lives. Even on his white coat, he had his name sewn in cursive blue letters that, again, complimented not only his scrubs, but his shoes. White teeth, white coat, blue scrubs, and my red blushing face made for one hell of an American flag right there in the ER hallway!
“I have to admit, you had me for a moment there. I actually thought you were serious.”
“Actually, ma’am, I am serious. If I was to mention that I allowed a non-blood relative to see this patient during such a critical time, I’d be in for a serious reprimand. But Jaylan’s mother has already mentioned she expected her son’s godmother to show up. It’s funny. She refers to you not only as one of his godparents, but a godsend as well.”
He was right. As far as Shuntoya went, I was a godsend. Shuntoya is one of those people I consider a ‘last-minute-mom’. She waits for the last possible minute to do anything when it comes to her child. And I was constantly there trying to get her to do what was necessary for the health and well-being of her child, often to no avail. I remember when Shuntoya first found out she was pregnant with Jaylan. She waited until the end of her second trimester to even go see an obstetrician! I’m going to make an appointment for tomorrow morning, she always said. She must have made five or six months worth of damn appointments before she finally decided to get off her ass and be seen by an OB/GYN. Also, I usually went with Shuntoya whenever Jaylan needed to see a doctor.
Even something as simple, yet vital, as immunizations was an inconvenience for her. Jaylan had his first Hepatitis B vaccine the day he was born. How come that’s the only immunization he’s ever been on time for? This girl has been called so many times by the city health department for failure to have the child’s vaccines administered, they have her number on speed dial! It doesn’t help that Jaylan is on Medicaid, and they actually require the child be seen for scheduled doctor visits—because Shuntoya never made them! To this day, I still don’t know why this girl put street life and pleasing her guy friends ahead of Jaylan’s welfare, but she did. Perhaps having a child at the impressionable age of seventeen had something to do with it. However, there in the ER on that fateful day, she paid for it; as she would for the rest of her and her child’s life.
“I'm sorry. I didn’t mean to put you or the hospital in—”
“Stop apologizing and let’s get going.”
He was even more commandeering than I originally thought. And I was soaking in every bit of it.
“Curtain six is right around the—”
We have a code blue in curtain six
Code blue in curtain six
The intercom’s message felt like a stiletto daggering its way through my eardrums. My godson was in trouble. I suspected there was little I could do to help save him…except support the man who was going to damn well try!
Jason paused for a second as the message sounded. He then looked up and glanced into my eyes. His gleaming smile subsided behind a serious demeanor.
“It’s showtime.”
The words rolled off his lips like his personal battle cry. As we raced around the long curved corner of the ER, fear flooded my mind. I was deathly afraid for the two-month-old infant who lay waiting in curtain six that day. I walked with purpose alongside a man I barely knew. A man who no longer chatted, but now took driven strides towards curtain six. The way his white coat glided on air with every step assured me this man had gone through a curtain six of his own to earn the right to wear that coat. He now took on the responsibility of saving others from their curtain six.
As we turned the corner, I saw Shuntoya in the hallway crying. She was terrified by what was happening. She ran to me and grabbed me around my neck and began apologizing. She began sobbing and streams rolled down her face, ending up in my bosom. I had expected this to be serious, but this was too much. And I had yet to find out what was wrong with Jaylan. I started crying with her. I sat Shuntoya in the one of the chairs in the hallway then made my way behind the curtain.
Jaylan shook more uncontrollably by the second. Jaylan looked as if nature was starting to take its course on an infant who had thrived on his own for far too long without a caring parent.
The emergency team made their way in behind Jason. Wires were unraveled, monitors were turned on, syringes were filled, other doctors were called in, and nurses jumped into action. Only one thing remained calm in curtain six: Jason Alexander. His poise, his stance, his demeanor were all so calm and so confident. Though everyone in the immediate area was on the verge of true panic, Jason stood still. As I looked on, I saw him say a silent prayer. It was brief. He acknowledged his God. He acknowledged the Almighty who put him in the position to save this child’s life. After opening his eyes, Jason disrobed.
“He’s going to make it, Ms. Sneed.” Jason glanced back as Shuntoya walked in.
I didn’t know how he came to that conclusion so quickly, but I felt in my heart I could trust this man. Everyone in the room looked to him as the team leader in that instant. If Dr. Alexander insisted everything was okay, then that was good enough for them…and me.
“He’s been at this for over two minutes, now. He’s heading towards status epilepticus. If he reaches status, it’ll be that much harder to bring him out of it. We have to make sure that doesn’t happen. Keep Jaylan on his side in case he vomits. The last thing we need is aspiration pneumonia on top of a sustained seizure.”
“Dr. Alexander, his pulse is dropping. He’s satting seventy-seven percent on room air, and his pressure’s dropping!” The nurse’s voice rang through the room like a liberty bell; a siren, which served its purpose of pushing everyone over the edge into true panic.
Shuntoya was hysterical. I was afraid she was going to faint and need emergency attention herself. But she had to stay strong for Jaylan. She had to help him pull through this.
“Bag him!” Jason had placed an oxygen mask over Jaylan’s face before yelling those words.
Two first year residents were in the room during this ordeal. Part of being a good ER doc, I’ve learned, is being able to focus on more than one problem at a time. Jason had practically mastered the art. While resuscitating the failing infant, Jason found time to quiz the ER staff so they, too, could get something educational out of the experience. Before his educational session began, Shuntoya attempted to leave while the doctors did their work.
“Shuntoya!” Jason shouted in an abhorrent tone. “You stay. I want you to hear this so there won’t be any confusion if Jaylan has any longterm complications from this.”
It seemed a little cruel for him to insist she stay and listen to what the doctors had to discuss, but deep down I really didn’t blame him. Everyone in the room knew Jaylan’s prolonged seizure had to be the result of something Shuntoya had done, or failed to do. And Jason wasn’t above letting her know just that.
“Does anyone know why we’re doing this? Does anyone know what the hell we’re here for?”
The room went quiet. The logical answer was they were there to save a child’s life that afternoon, but Jason was getting at something deeper.
“This child has a history significant for late prenatal care at twenty-seven weeks gestation. In addition, the child was born at 4lbs 2oz, which is far below normal birth weight.” Jason continued squeezing the resuscitation bag, delivering heavy boluses of oxygen to Jaylan’s lungs, which apparently could no longer breathe on their own. “Jaylan came into the ER today with what his mother, Shuntoya, claimed was drowsiness and loss of appetite. The child has been displaying these symptoms for the past five days. Shuntoya claims she got scared and finally decided to bring the child to see a doctor.” I was getting a bit perturbed with Jason’s tone. He had no right to ridicule my friend in front of so many people. “The child didn’t have a fever, so an infection causing his symptoms was unlikely. Dr. Cannon,” Jason caught the first year resident standing idly by off-guard. “If a two-month-old comes in with altered mental status and a fever, what would you be most concerned about?” The question came out of nowhere. I had little idea what Dr. Alexander was getting at.
“I’d be thinking some kind of upper or lower respiratory tract infection that may lead to decreased oxygen, Dr. Alexander.” The first resident’s response clearly did not impress Jason as he moved right along to the second unsuspecting soul.
“Dr. Ming, can you help him out?”
Oh c’mon. This guy is Chinese. You know he knows the answer!
“You’d have to keep meningitis at the top of the differential diagnosis,” he responded with a confidence similar to Jason’s.
“That you would, Dr. Ming. But in this case, there is no fever. In addition, Jaylan’s white blood cell count is normal, meaning there is no infection his body is trying to fight off.”
I remembered reading in my college biology textbook that white blood cells were kind of like red blood cells, except they have entirely different functions. White blood cells fight off invading organisms that may attack the body, such as bacteria or viruses. This is why their numbers are elevated during an active infection. That’s all I remember, however. I really wish I had paid closer attention during that particular lecture.
“His condition leaves me to look at Jaylan’s electrolyte levels, particularly his sodium level. Sodium is one of several electrolytes our body depends on for homeostasis, the natural state of metabolic process that our body is in most of the time. If homeostasis is disturbed, then we suffer the consequences. In this case, Jaylan’s sodium level is extremely diluted and lower than it should be. But what does this mean, Dr. Cannon?”
Again, Dr. Cannon, a tall White gentleman with a clean shave and baby face, was caught off-guard. He actually reminded me a lot of Brad Pitt, but…not as pretty.
“Salt is the primary osmotically active substance in the body. In other words, water goes where salt goes. It’s the reason one can pour salt on a slug and it will shrivel up and die because the water that resides in the slug will be osmotically attracted to the salt on the outside. That water will leave the slug and travel to the outside, thus essentially drying out the slug.”
Jason seemed impressed by his response. He didn’t seem to expect such an elaborate analogy, especially one that actually made sense.
“When a cell is placed in an environment where salt concentration on the inside of that cell is higher than salt concentration on the outside, the cell will swell. This is because water follows salt. And brain cells are exceptionally susceptible to this effect because, as we all know, the brain is not like our biceps, which have an unlimited amount of room to grow. If our brain is placed in an environment of lowered salt concentrations, our brain cells will actually swell. Not only will they swell, they will swell to the point where they cannot be contained in the small space that is our cranium. The brain will then ‘push’ down on itself in an attempt to relieve pressure inside the cranium.
“It does this by pushing down on the spinal cord through a large opening called the foramen magnum, which is the entry point of our spinal cord into our vertebral columns. This essentially would not be a problem if our respiratory centers were located somewhere other than medulla oblongata, the area of the spinal cord that actually becomes compressed during downward brain herniation. In other words, Dr. Alexander, a swollen brain impinges on the medulla that drives our breathing and causes us to cease breathing.”
Hell, even I was impressed with his answer, and I barely understood a thing he said.
“One of the primary ways hyponatremia, or low blood sodium, occurs in infants this age is when parents insist on giving the child water. Too much water can actually dilute the salt concentration in the blood, resulting in hyponatremia, and can lead to this picture here that Jaylan is suffering from. It’s why water intoxication is so dangerous. Just ask some of the idiotic fraternities who pull the stunt of making their new recruits drink gallons and gallons of water until they vomit.”
It’s funny Jason mentioned that. I recalled an instance, not so long ago, where a college fraternity caused a guy to go into a coma from drinking too much water. I had no idea water could be so devastating. It was the reason people who nearly drowned remained in comas for extended periods. Their brains were just so incredibly swollen because of dilution of their salt stores.
“The number one reason for seizures of undetermined cause in infants is dilution of formula with water by ignorant parents. Shuntoya has already admitted to diluting the child’s formula with water ‘to make the formula last longer because formula is just so expensive.’”
The cynical tone in Jason’s voice was undeniable. Clearly, he blamed Shuntoya for what was happening to Jaylan, and he intended to let her know it.
“I can only hope that the EBT credit she saved by half-assing his formula supply went to his pre-established college fund and Shuntoya’s 401K. I can only imagine what else she could have done with her resources.”
As he said that, he looked at Shuntoya’s six-inch professionally done orange and blue fingernails, which matched her toenails, hair, and outfit perfectly. She was undoubtedly the best dressed, most hated mother in the ER at that moment. I knew Shuntoya well enough to know she would have lunged at Jason in a heartbeat for making a humiliating statement like that, had he not been the primary doctor attempting to save Jaylan’s life. I saw the rage her eyes batted against him as they filled with tears of joy and fear. Jason knew she was pissed, homicidal even, but he kept working.
“Shuntoya, we’re at the point now where we’re going to have to actually breathe for your son. His respiratory function has deteriorated and will stay that way until we can get his brain swelling under control. We’re going to have to put a tube down his throat to better deliver oxygen to his lungs, and put Jaylan on a ventilator to breathe for him until he makes it through this. Do you understand?”
I could tell Shuntoya’s heart skipped several beats when Jason informed her her son would have to be placed on a ventilator. I always saw that as the dark cloud surrounding the silver lining. I’d heard of patients who never came off ventilators. These unfortunate folks never regain the ability to breathe on their own and are left on a ventilator for the rest of their lives, which could sometimes be years. I didn’t want that for Jaylan. I’d rather he’d gone to heaven then and there than remain on a ventilator for years to come.
As his body began to give way to fatigue, the seizures became less pronounced. Somehow I thought this was a bad sign. As long as we could see him seize, we knew he was alive, at least. But I had faith in Jason that afternoon. Even though I knew absolutely nothing about him, I knew that a doctor who prays realized it’s not actually him doing the saving, which made me all the more confident in his abilities.
“Gram of Ativan, IV push, please. Come on people, let’s move!”
“Ativan in,” one of the nurses informed Jason.
I could tell Jaylan’s body responded rapidly to the Ativan. His body grew limp and he no longer shook. That still left one problem: the baby couldn’t breathe!
“Vecuronium, IV push,” Jason said, steadily holding his hand over the facial mask that was the child’s only oxygen supply.
I remembered hearing about Vec during a lecture that a former military espionage instructor gave to my university United States history class. He mentioned that Vecuronium was used as a muscle relaxant, sometimes even as a paralyzing agent. Why Jason wanted the child essentially paralyzed was beyond me. Suddenly, Jason stopped bagging. He then moved with a swiftness I had not seen from him until that moment. Jason threw the facial mask on the floor as if saying It’s now or never.
With a curved blade extending from a straight lever-like object, Jason forced his way directly above Jaylan’s head at the front of the examination table. By this time, the incarcerating metallic bars had already been taken down to allow the good doctor room to work. Jason arched Jaylan’s neck backwards, so that his chin pointed more towards the ceiling, and pried open his mouth. In one smooth motion, he placed the blade down Jaylan’s throat, pushing his tongue downwards as to not interfere with his view. He was looking for the child’s wind pipe. I remembered in biology class, when we were forced to attend an advanced cardiac life support session, also known as ACLS, that the wind pipe, or trachea, leads directly to both lungs. By placing a tube there, air would be delivered directly to his lungs and thus, oxygen delivered to Jaylan’s tissues and, more important, his brain.
When Jason slid the small pediatric-sized intubation tube down Jaylan’s trachea, I felt a sense of relief fill the room. Apparently, this was not an easy procedure, especially on a two-month-old.
“I’m in. Bag him.”
With those words, the nurses sprang into action and fastened a stiff, crinkled blue plastic hose to an attachment at the end of the intubation tube. This hose led directly to a moderate size machine that had several different display screens. Obviously, this was the feared ventilator that was the essence of intensive care. And Jaylan was its most recent victim.
“That’s it. We’re done. Dr. Cannon, call pediatric neuro-surgery and tell them to get their asses down here STAT. Dr. Ming, I need a noncontrast head CT, portable chest, repeat serum electrolye profile, and a social work consult. I need this done in the next fifteen minutes. Let’s move.”
I was awestruck. I had just witnessed a child’s life saved. Jaylan would have died that day had it not been for Dr. Alexander. I almost regretted the initial interpretation I made of his character. Clearly, first impressions aren’t always accurate. I knew, however, that it was indeed over; especially whatever initially existed between us. I can’t deny I felt a spark whenever Dr. Alexander was around. When I first approached him, I was flabbergasted by his authority. He towered over my five-foot-six-inch frame. I had to look up to see into his eyes, which were consequently as beautiful as the act he just performed. I couldn’t help fear that day would be our last interaction…until he turned and focused his attention on me once again.
“Now, Ms. Towers…where were we?”
THREE
I passed several colleagues on the way to start my third period class. I couldn’t help notice that some of the younger ones gave me malicious stares from time-to-time. I didn’t understand why; perhaps because I was outspoken. Maybe they were jealous of my higher salary because of my higher degree. Perhaps they were envious of my marriage, I had no clue. I often overheard many of them comment there were no good Black men left. I disagreed with that extreme, but there is certainly a shortage and I had to keep that in mind. I figured their anger stemmed from them not being able to find a good man. It was okay, though. God had sent me my knight in shining armor. So I suspect, in return, He expects me to be humble when combating vicious negativity from those not as fortunate.
Third period was always my favorite class of the day. Not only were the students the brightest of my five classes, it involved my favorite subject: Sociology. For a group of young and dumb high school kids, they were incredibly sharp when it came to matters involving them, society, and race relations. Jason and I have had some knock-down, drag-out debates regarding issues that face not only Blacks today, but issues involving all races. That’s what sociology is: the study of the origin, development, and structure of human societies and the behavior of individuals and groups in society. It is perhaps the heart of all things known to man about culture, emotion, racial differences, and even genetic variance.
It often irritates me when I hear the misnomer social studies yet in schools where we teach social studies, we teach a watered-down, barely legitimate and largely omitted history. Correct me if I’m wrong, but social studies should involve much more than learning how a European man sailed across the great western seas to become the mighty discoverer of this country. It amazes me how, even in 1492, someone could be so dense as to actually claim to have discovered a land mass where generations of groups of people lived, raised livestock, grew crops, and had a fully functional society for hundreds of years prior to his stepping foot on American soil. Just imagine if aliens suddenly landed here on earth and claimed that they had discovered earth. They wouldn’t have discovered a damn thing. Be that as it may, according to my teacher’s edition, Columbus discovered America. That, however, was social studies. My passion was studying society.
As my students began filling the classroom decorated with stunning African garments and memorabilia, I noticed several walked with a stride in their step that filled my heart with pride. They knew they were about to step into a world that few people in this school could. They were Black and they knew that. They realized that their history is one of trial and triumph that ultimately shaped and defined our people as the cornerstone of what this country truly is. The American dream rests on the foundation that one from another country can come here and start a new existence that overshadowed anything one once previously knew.
African-Americans were the embodiment of the American dream as far as I was concerned. We were brought from another country, and had our lives changed against our will. By rolling with the punches and weathering many storms, we rose in a way unlike any race in the history of this planet…and these kids knew that. No matter what they were told or what they were led to believe, they knew in their hearts they descended from of a faction of people whose spirits intertwined with every hardship they faced daily. It was an honor to be here to further learn about our culture, our social status, our racial relations with other sets, and our interactions and covenants with ourselves.
Students continued piling inside the classroom. It was quite a large class, consisting of more than sixty students. Usually, no more than forty students are allowed per class, out of concern for lack of individual attention. I had to receive special authorization from the principal to allow the twenty additional students. It was that popular; the most sought after class in the student union. However, it came at the expense of having an outrageous number of papers to grade and narratives to read. I was actually finishing up last week’s set as students continued pouring in.
Out the corner of my eye, I caught a glimpse of a corpulent damsel standing in my door frame with one hand on her hip and the other balancing herself on the side of the wooden podium. Her snug mid-thigh candy green skirt with matching blouse, showing ample cleavage, screamed professional ghetto. The green highlights in her hair and the smell of Victoria’s Secret Love Spell perfume were virtually diagnostic of Shun-toya Sneed’s presence.
Shuntoya was hired at my high school shortly after the ordeal with her son, Jaylan. She had decided it was high time to stop depending on Uncle Sam to provide for Jaylan, and for her to step-up and take responsibility. I guess Jason’s public flogging of her in front of the ER staff six years ago inspired her to prove him wrong. She was doing a great job here. And she had damned well better because I recommended her for the paraprofessional position.
“Girl, I completely forgot that today was Brandon’s birthday! Why didn’t you remind me?”
That was Shuntoya: last-minute-mom and now, last-minute-godmom. We had always decided we would be godmothers of each other’s children. Even though I never actually expected her to really take the title seriously, it was a fun formality to have established. Our son, Brandon Jaylan Alexander, was born four years ago today; a year after Jason and I married. Shuntoya’s son, Jaylan, played a far more significant role in Jason’s and my relationship than he would ever realize. Jason insisted we name our first son after the child who originally caused our paths to cross.
“You knew today was Brandon’s birthday. I just reminded you last week we had a huge birthday bash planned later today at Chuck E. Cheese in College Park. And for that, he’s expecting an extra special birthday gift from Godmother.”
“Has anyone picked up the cake?” she asked.
“I’m going to pick it up from the bakery right after work, then head straight to the party.”
The bakery where we usually ordered our cakes was located fairly south of where I work. But it’s an exceptional bakery that I highly recommend. In fact, I discovered the establishment while planning Jason and my wedding.
“Are you sure you wouldn’t rather me drop by the bakery to pick up the cake while you pick up Brandon from preschool?”
Shuntoya was a sweetie, but she was so damn unreliable. I couldn’t possibly leave the welfare of this party in her care. We’d paid Chuck E. Cheese’s ass too much money, and I wasn’t about to have Brandon’s last-minute-godmom arrive late with his birthday cake.