The 180 Degree Rule – Michael Ellman

If you have no wounds, how do you know you’re alive. – Edward Albee

ASAP numbers flash on my beeper. The chief, Dr. Mollman, pronounced like gun-moll, definitely not mole-man, is annoyed. Except for these morning conferences, I’m supposed to be in the laboratory with Drs. Frank Brennan and Sarah Todd, and my beeper should remain silent, except, of course, for the on-call weekends we’re burdened with.

“Who is it?” Dr. Mollman asks, stopping his lecture for my scolding, “Your bookie, your inamorata?”

Not only is Dr. Mollman smart and famous, he possesses a repository of fancy words.

My fellow hematology residents snicker. But quietly.

I show him the numbers on my Motorola. It’s an inside one, it’s important, and I leave to answer it.

Prince Jaboor, known simply as Jordan, next in line for the throne, and his royal entourage are residing in our hematology unit under the care of Dr. Mollman and just about everyone else who is anybody at the university. When I checked on the prince several Sunday’s ago, interrupting the IV nurse who was botching her attempt to find venous access for his packed red blood cell transfusion, I offered to help. I can insert an intravenous line into a trout. Now, I was on the prince’s call list for just about everything.

Same age with the same appreciation of beauty, same love of arguing politics, arguing just to argue—a difference of opinion is what makes horse racing and missionaries, I tell him. “Will Rogers,” he says. We laugh—it’s a guy thing, snappy erudition and humor that lift his spirits. For me, and I think it’s the same for almost everyone; it’s intriguing to see what makes famous people tick.

I visit every day, an order carrying weight even Dr. Mollman understands—the royal family has donated millions to our institution.

It’s always the same story. The prince, a student in economics at the graduate school, and the ruler-in-waiting of his oil rich nation, visits the student health service. A sore throat—everyone gets a sore throat at one time or another—it’s not a big deal. A pat on the back, return in a week if not better, a course of an antibiotic because he’s royalty, then another course, until someone discovers lymph nodes everywhere and they aren’t so little. The world-wide news about his lymphoma shreds any semblance of the prince’s privacy.

There’s a satisfying response to therapy, per our world-wide-expert on lymphoma—Dr. Mollman. The good doctor: his descriptions of chromosomal deletions, re-arrangements, and their associations with blood cell malignancies make him this close to medicine’s Nobel Prize. His carefully written epistle to the student health service doctor labeling him a dolt for the delay in the obvious diagnosis will be a collectable someday.

The bodyguard doorman and I are on first name basis: “The prince is giving an interview with Ms. Stallings,” he whispers, and he wants your photograph sitting next to him. You’re not in the witness protection program or anything like that are you?” The bodyguard laughs and opens the door.

Diane Stallings is as attractive in person as she is on television and in magazines. It’s just her, the photographer, the hospital PR hack, the prince, the prime minister, and now me. No Dr. Mollman, and he will be pissed once more.

“It’s the youth in our countries that will make the world a better place. But slowly, very slowly, years, maybe in a decade, maybe two,” Jordan says, eyes roaming between me and the blonde curls staging Diane’s handsome face. I’m reminded of the giant coin tossed before the Super Bowl kickoff: one side and the prince is the whiny patient battling lymphoma, the other, today’s loquacious and progressive son of the stodgy ruler of his oil-blessed nation.

“Business, it’s business—your country provides protection and we provide oil. I don’t think that a country that had over one-hundred-and-fifty years of human slavery, closed their doors to refugees in the last world war, and has prisons overflowing with minorities, should lecture to us about our social structure shortcomings.”

The non-elected prime minister, suddenly alert and quick moving in-spite of his corpulence, sandwiches himself between the prince and Diane and suggests it’s time for a break. “Maybe a photograph of the prince and this young American doctor emphasizing the solid bond between our friendly countries would be a good ending to the interview.”

“Diane,” Jordan says, “before you leave—please—I want to emphasize the beautiful people working here at the university and the excellence of the medical care, especially Dr. Ted and his boss and mentor, Dr. Mole-man.” Jordan, but not his father, likes to play games with Dr. Mollman’s patience. “Dr. Ted is my spiritual American friend and he and I would—since we’re speaking about beautiful people, like to entertain you and any of your single friends for dinner and dancing, as soon as they let me out of here.”

Dr. Sarah usually answers the telephone when it rings in the laboratory. It’s her wont. I’m the newest member and I should do these menial tasks. But Sarah is Sarah, helpful, overly polite, and formal. “The phone is close to me, and who knows, maybe it’s the Peron’s, Juan or Eva or both,” she tells me. I think she’s kidding.

Sarah is an Argentinean physician studying antibody production in ill patients under Dr. Brennan’s tutelage, and by default guides my way through the complexity of the laboratory. Under the guise of practicing my Spanish, we share coffee-time in the cafeteria every late afternoon.

“Just so you know upfront,” Sarah has said to me on several occasions, always with eye contact that stirs a man’s soul: “I have a beau back home, an air force pilot, handsome, smart, and our families are close. Family ties are important to Argentineans.”

I’m skilled at ignoring trivia.

“Sarah, guys are enchanted when meeting smart, capable, and, of course, beautiful women like you. They can’t help it. It’s coded in their DNA. They love smart. My Nobel Prize speech will be in Spanish, thanks to you,” I say, as my fingers reach out for hers.

“Oh thanks, yes, you’re right—men especially like intelligent women,” she says laughing loud, enjoying herself and adjusting her chair to be out of my reach. “That’s why when they slide their hands under your blouse they’re searching for your university diploma.”

* * *

Sarah cups her hand over the telephone and mouths police and pantomimes it by shooting at me with her index finger.

Two policemen will meet me in a private room adjacent to the cafeteria in an hour, she tells me. Don’t worry, you’ll recognize them, they said, and Dr. Mollman insisted that you talk to them.

I have a standing appointment with Dr. Mollman. Actually, all of the hematology trainees do. We meet with him once every two weeks. The sessions vary from a few minutes to half a day. His wisdom, although entwined with cynicism, comes from the heart—and of course the brain. But quote some mediocre literature or a scientist he doesn’t respect and he’ll borrow a stare from a prison warden. Some people give good silence, but not Dr. Mollman.

Tall, and too good-looking for a doctor—nothing resembling corduroy, or anything argyle in his wardrobe, and shoes with laces and shine, Dr. Mollman is a poster boy for medicine. His telephone calls come from Washington, London, and other world capitals.

I think he likes my enthusiasm and my ability to flick off his barbs so easily. But then again, maybe he is relishing the year-end review when he’ll advise me to try stand-up comedy rather than laboratory research.

My quest for explaining why many patients with autoimmune diseases such as lupus have low platelet counts but seem to have strokes and not bleeds is already running into conundrums. Platelets are those little particles in blood, not blessed with nuclei that form clots and stop bleeding. Take it from me, they are not easy to handle in the laboratory, and they seem to clump and become worthless to work with even when I just yell at them.

Dr. Mollman thinks the inflammation in my patients suppresses the entire bone marrow and the antibodies directed against platelets may have little consequence.

It will be fun proving him wrong—and I think he respects that aspect of me.

Frank and Joe, names like the Hardy Boys, are not city policeman at all they tell me, but CIA agents, while quietly flipping their ID badges.

“How are your parents, Fenton and Laura Hardy?” I inquire. They don’t respond. They’ve heard it before.

Ordinary looking, like mid-level bankers, polite and smiley—maybe too smiley—I’m big and I think I could take them, but probably can’t. They stand out in the cafeteria, but I’m not sure exactly why. Maybe it’s because they appear rested.

“Get a drop bolt for your door at home,” Joe, the dark-haired one says, pointing a finger at me after his Hulk Hogan handshake. “I could enter your apartment with spit and a nail file.”

I give him a thumbs-up.

It’s about Prince Jordan, of course. It seemed that his country is close to a populist revolt and the prince might be a compromise for both sides.

“But the prince and his policies are unpredictable,” Joe says.

“As an American and patriot, you’ll want to help us.” The polysyllabic American is presented to me as a psalm or commandment.

“Invite yourself to accompany the prince when he returns home—we have Dr. Mollman’s OK.” It’s Frank talking now. I have trouble deciding who’s in charge. Probably it’s Frank; he’s the quieter one with the confident stare.

“We have to decide between offering the prince friendship or enhanced friendship, depending on how the situation at home sorts out,” Frank says. “Our country needs his loyalty and his oil. You’ll tell us about his friends and keep us informed about developments.”

“And hey, get this,” Joe says, giving me an elbow to my side, “Diane Stallings will accompany you for the first week or so. It’s a medical-political kind of news thing. She’s on our side and will work with you.”

Meeting the chief in the early evening is different than our biweekly appointments. The trappings of a doctor-scientist remain the same, no matter the time of day: journals, manuscripts and a stack of papers requiring signatures are piled up, but now, in addition, there’s a plethora of VIPs and organizations the chief needs to telephone before he can call-it-a-day, head home, sip a dry martini, and revel in normal conversation.

“Ted, I apologize for putting you in an untenable position. I had little choice. The inquiry came from Washington,” Dr. Mollman says. “I’ll support any decision you make. They, the insiders, and sorry about the use of they, mentioned no particulars to me. And if they want to expose you to danger—please decline it. Remember there’ll always be a position for you in my training program.

“Ted, one other thing, and be sure to understand it, and I suspect you do, being the prince’s friend is different than being his physician. Don’t be caught between the Hippocratic Oath and the machinations of his and our nation’s politics.”

“I definitely would be more comfortable with you around,” the prince tells me after hearing about Frank and Joe. “There are good doctors at home, but no one knows more about my treatment than you. And who else brings me back down to reality and occasionally makes me smile. But, remember, I’ll be in the limelight, and alcohol and girls will be at a premium. Still, you and I together—we’ll have fun. There will be demonstrations, but we’re not basically a violent people. On the other hand, who can predict how it will end.”

You wouldn’t think I would have difficulty making decisions. Generally I don’t. But that’s for the minor things: surgery—no surgery, start an antibiotic stat or wait for culture results, which patient to check on first in the morning. But life-altering decisions for myself, that’s another matter. I’d been on a roller-coaster ride for years. Psychiatry one month, endocrinology another, then surgery, then nephrology, and on and on—reading Dickens on a daily basis before sleep, and I’m only on page 34. An invitation from Nurse Anna to join her family picnic: “No,” I say, “I can’t. I’m sorry. I’m in the ER that day and I can’t switch with what’s-his-name because he’s ill and I owe him a favor from my cardiology month, etc., etc.”

There isn’t even time to know if I like myself.

The prince and I meet in the hospital coffee shop. In spite-of the rattling of cups and saucers and the blend of whispering and expositions, hospital coffee shops are the loneliest place in the world. Anonymity has vanished for the prince; he and I draw polite attention. People smile and look away, respecting his privacy. He’s recovering well and has a decent chance of making it; food has begun to taste good to him again and sleep now comes easily. He wears khaki-colored chinos and New Balance shoes like every other American graduate student, but his button-down shirt with sleeves rolled-up past his elbows display the needle sticks and bruises detailing his medical travails.

“You know about those planets that are thrown out of their orbit and end-up wandering willy-nilly through the universe?” the prince asks. “They’re called nomads,” he says. That’s what you’ll be if you accompany me home—a nomad—out in the open with few options to change course. Better yet, think of it this way, Ted,” the prince says, as he pats me on the shoulder.

“Travel with me and our life will be like a chain reaction leading to more and more of I don’t know exactly what.”

The prince is not settling my heart, never mind the befuddlement of my goal-oriented life.

“Let me tell you something they don’t teach in medical school,” the prince says. “It’s not part of your medical curriculum. It’s spook business.” The prince says it again: “It’s spook business. Too bad you don’t know about it because it’s something Frank and Joe may ask you to consider. They know a lot about it—it’s part of their code. Friendship and enhanced friendship, let me repeat that, friendship and enhanced friendship. Do you know the difference? Do you know what it means?

“No,” I say, shaking my head no.

The sun, sneaking through the windows, splays patches of sunlight on our faces. Our coffee has gone untouched.

“Friendship is an old English word—a sweet word,” the prince says. “It’s not so difficult to understand. It’s the verb enhanced that tickles the senses. That’s when I’m killed. That’s the enhanced part. That’s the enhanced part,” he says again, losing his concentration for a moment, stretching his neck and taking in the bustle of the room.

“It would be easy, don’t you think? Killing me. Very easy. Think about it. A little bolus of potassium or a syringe filled with air. Who would know?”

I nod my head again. There is a sense of quiet around us in-spite-of the normal hospital scurry. Even children speak with muffled voices here. This is a place and time where lives change. I’ll speak to Dr. Mollman and talk to Sarah; and my research, as its wont, has become consuming, but I think my mind is made-up.

Image via Pixabay

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