Sex, Drugs, and Public Health

March 23, 2015

Gorgas

Filed under: Uncategorized — cbmosher @ 4:27 am

Jerry was a cool guy for a boss. He wore a beard, which was against the former boss’s rules, spoke fluent Spanish, and had spent a year at the Cordon Bleu school in Paris. A great mix of rebellion, cultural sensitivity, and gastronomic priority setting.

So I was counting on him to see my point of view and support it.

“Chuck, the Ambassador wants you to take one of his officers to Panama for medical care.”

There. He’d delivered the message, like a good politician who hung out occasionally at the U. S. Embassy in Paraguay.

“Well, tell him I can’t. My prime responsibility is to the Peace Corps Volunteers, not to his Embassy staff.”

“Sit down, Chuck. Let me explain something to you.”

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So the officer, a diplomat named Jim, and I arrived at Paraguay’s airport on the designated day.

“I know you’ll be needing immediate access to oxygen,” the Paraguayan woman in charge of the Braniff Airlines desk said in perfect English. “In case anything…” she glanced toward Jim, paused, then tried to extricate herself, “In case you… want it, Dr. Mosher. In case you want it. So. We’ve seated you in the very front with an oxygen bottle on the bulkhead.”

She exuded a whole lot more anxiety about this than I had mustered, still fuming and muttering about how politics had hijacked me. Her words were like sharp jabs with a sword called “responsibility”. My mood darkened.

Not Jim’s. “Aw, oxygen, smocks-ygen. It’s nothing. Fly up. Get zapped. Fly back. Do you have cocktails on board?”

The Paraguayan agent smiled, nodded her head, and smoothed an imaginary wrinkle in her uniform. “For the other customers, of course.” She shoved our tickets toward us, and changed her voice to the standard industrial chipper, “Have a good flight!”

“No fuckin’ secrets in this cow country,” Jim mumbled as we walked toward the tarmac. “Oh, sorry,” he jolted. “Do you swear? ‘Cause if not, I’ll try not to.”

It was a short walk across the asphalt to the waiting plane, but a lot of stuff flooded into my head. Stuff I’d tried to set aside so I could fume and mutter. He was in Atrial Fibrillation, due, the Embassy physician believed, to excess alcohol use.

The local physician had refused to perform cardio-version on the alcohol-loving diplomat there in Paraguay, insisting that the nearest “competent” cardiologist with a cardio-version machine was 2,000 miles to the north.

He’d obviously decided that, if the Embassy functionary died in the attempt, the blood would, metaphorically, be on his hands. Even if this simple electrical intervention had taken place in Argentina, Brazil, Venezuela, or Columbia. Let alone his home country of Paraguay.

He was protecting his golden-egg laying chicken called ‘the Embassy of the United States’, and placing the patient, heart still thrashing irregularly, into my hands. Hands so fresh from Med School and internship, that they had very little dexterity with the profession’s skills. All my experience has been in the highly controlled, fully equipped confines of teaching hospitals and emergency rooms.

The Devil advocated all over my brain during the short walk to the portable steps, rolled into place against the plane’s fuselage, on a mercifully un-rainy day: as we climb, the oxygen pressure in the air will drop, stressing his heart; The irregularity could worsen, perhaps speed up to over 200 when blood circulation will drop drastically; Maybe even degenerate into Ventricular Fibrillation with a complete paralysis of the heart; Only C.P.R. and thumping his chest with my fist would offer any hope, 30,000 feet up; I need to be prepared.

“Stewardess,” Jim called once we’d clicked ourselves in. “Could I have a Manhattan, please?”

“Jim, no alcohol,” I whispered in my serious Doctor tone. “Let’s not make things worse.”

“Aw, one won’t hurt.”

“You can have all the drinks you want,” I promised, “once you’re back in Asuncion. None ‘til then.”

He pouted.

“Orders from Gorgas,” I added to heap on more ponderous medical authority. I don’t recall, at this remove of time, whether any physician at Gorgas had said such a thing to me. Or even, whether I’d communicated with them from Paraguay at all. But if I had, I’m certain they would have agreed.

I spent the flight glancing at his red-cheeked and red-nosed face, to confirm that blood was still circulating from his fibrillating heart. I clenched the arm rests with all the anxiety a cardiac arrest in my patient might provoke, doubting whether this long-distance transfer with a fledgling non-cardiologist was, really, in the patient’s best interest. Sure as hell wasn’t in mine.

Jim spent his time commenting on the size of the stewardesses’ breasts and the mobility of their asses. Twice he unbuckled and excused himself to seek out the bathroom. Because that’s awfully close to where they keep those little bottles of vodka and scotch, I accompanied him on both trips.

“You’re my patient,” I said in what I hoped was a jocular tone. “Can’t let you out of my sight.”

Except for when he slid the “occupied” sign from the inside of the little door. He was on his own in there. Limits to this doctor-patient thing do exist.

Hours later we landed. His cheeks were still red and the stewardesses – all three of them – were pretty done with him. The air of Panama, even in the evening, was heavy, thick, wet, and hot. As, I am told, it always is. My glasses steamed up the instant I stepped from the airplane’s door.

We were met on the tarmac by some Embassy driver and were checked into some excessively luxurious hotel.

“Let’s get some dinner!” Jim enthused, his hands rubbing together in anticipation of something. Something within his brain that I suspected he didn’t want me to know about.

“Downstairs is the hotel dining room,” I prescribed. “Then off to bed. It’s an early day for you tomorrow at the hospital.”

The disappointment in his eyes reminded me of my first dog, a sad faced beagle incapable of hiding his thoughts. Or emotions. Or whatever dogs have. Jim’s look also confirmed my fears that he had plans.

I got him through dinner without alcohol and then, into bed. Luckily, we were in the same suite. Unluckily, his Atrial Fibrillation didn’t stifle his snoring.

In the early morning, we were driven to Gorgas. The Embassy vehicle cleaved the Panamanian air, which was hot, wet, heavy and laden with the myriad perfumes of the city and surrounding jungle. I delivered him into the hands of a cardiologist and felt a sudden and complete relief a lot like – (medical metaphor warning) – unburdening a full colon.

I wandered the banks of the famous canal for as long as I could tolerate moving and breathing through the jelly-like mass of the Panamanian atmosphere, then returned to the air conditioned hotel to await news.

“They’re keeping me overnight,” Jim reported by phone. “For observation.”

I smiled, relaxed, enjoyed the feel of the hotel’s air.

“Then they want me to stay at the hotel tomorrow night, too. Just to be sure.”

Crap! I’d hoped I could just get him back to Paraguay immediately upon discharge. Still breathing. “Okay,” I said.

“Man, my chest is sore. That defibrillator packs a punch. See you tomorrow.”
The Embassy took care of plane tickets and another night at the hotel. I wandered outside into the evening to look for a restaurant. But I returned quickly to the hotel to eat. And to breathe.

Next day, Jim was delivered to me at the hotel, all chipper and oblivious, as usual. He insisted on seeing the canal so we ventured out, allowing the environment to drain us of copious sweat and most of our energy. We returned to the hotel at siesta time, removed our sodden shirts and hung them up to dry in the conditioned air, then lay down for siestas.

I awoke near dusk to find his bed empty. I knocked on the bathroom door. No answer. Pulled it open. Empty.

“Jim?” I called into the obviously empty room.

“Jim?!!” louder.

Shit!

I yanked open the door and looked down the hallway. No Jim.

I picked up the phone and hit “O”. Hard.

“Is Mr. ______ from this room down there?”

Of course he wasn’t.

“Did he leave a message?”

Of course he didn’t.

I called Gorgas Hospital. “Is he there?”

“No, Doctor. He’s been discharged. Didn’t you know that? It says he was discharged to your care.”

I scribbled a note: “Jim – When you get back, STAY HERE!!
I’ll be back soon. Doctor’s orders.”

Increasing frantic, I checked out the restaurant, the bar, the pool, the gym (that’s a joke, I thought), and the sidewalk outside the hotel, as far as dusk would allow my eyes to penetrate.

Shit!!

Shit! Shit! Shit!

Back to the room to wait, seething. Like Gorgas said, – – – into my care – – –

He waltzed into the room three hours later, whistling.

In spite of my relief to see a live Embassy officer, I fear that my question to him may have been sharply worded, for his eyes dropped to the floor, his lips pushed into a pout, and I swear he looked exactly like my beagle for a few seconds there.

“I just went out to find a hooker,” he explained in all innocence. “I wasn’t gone that long.”

“Hooker? Are you nuts? You could have been robbed. Murdered.”

“Oh, nonsense,” he shrugged, smiling as naively as an altar boy.

“Didja find one?”

“Oh, yeah! They’re all over. You want one? I know where…”

“Jim!” I jolted him. “Did you have a drink?”

“Well, Jeez. You can’t find hookers in ice cream parlors. What do you think?”

For the remaining twelve hours in Panama, I camped outside the bathroom door when he showered. I laid awake all night, watching the room door, which I had locked and chained. I confirmed that the Embassy car was downstairs, waiting, before I opened the door and we went down.

The Braniff plane for home had, I recall, one of those gaudy paint jobs for which the airline had paid an artist named Calder. All the way south, Jim smiled and jabbered and regaled me with stories about the nurses of Gorgas and the whores of Panama City. I kept feeling his pulse to confirm sinus rhythm. As long as he had a regular pulse, I allowed his enthusiasm to wash over me like Panamanian air.

“There was this nurse in Cardiology. She was just gorgas.”

“She was what?”

“You know, beautiful. She had the most beautiful body.”

“You saw her naked?”

“Of course not. She was wearing a uniform.”

“Then how do you know she had a beautiful body?”

“Her smile.”

Is this part of his job skills as a diplomat? I shook my head.

“If I could paint, like those Italian guys from the Rainy period – ”

“The what period?”

“You know, the 1400’s.”

”Oh. The Rainy-sance?”

“Yeah. That’s it. I could paint all of her just from her eyes. She’d be like the sea-shell lady.”

The joy his face exuded was so intense, that I expected him to spasm his fists up to his mouth, and begin chewing on them, overwhelmed by it all like a five-year-old on Christmas morning.

“How do you like being a diplomat?”

“Oh, it can be boring – parties, dinners, talking, kissing asses that don’t even speak your language. And it can also be scary – say just one wrong word and you’re fucking up things for a whole lot of people.”

A stewardess walked by, distracting him.

“But the world is still fun,” he continued, “wherever you are. Flowers to smell, women to see – sometimes touch, scotch to drink.”

It was pouring in Asuncion when we landed. They swung the plane’s door open and the sound of torrential splashing flooded in. Jim jumped up and charged for the door, but the stewardess intervened.

“We are bringing you umbrellas, Señor Ambassador,” she inadvertently promoted him. Please wait here and remain dry.” Two Paraguayan agents for Braniff, with rain dripping from their hair, ducked onto the plane, opened two umbrellas, and handed them to us. The outside air that snuck in with them was cool and clean smelling.

He stared at me. “I’m going to miss you, buddy. It’s been fun.”

“Sure has,” I replied diplomatically.

“Bad luck.” He grinned and pointed to our open umbrellas within the plane.

And down the steps he went, rain rattling off his umbrella, bound for the Embassy, to resume his unique approach to official U.S. diplomacy.

Actually, I admitted to myself, would be nice if I could be a little less terrified of my responsibility as a doctor and a little more into smelling the flowers – – –

“Naw,” I smiled to his descending back. “Bad luck’s all behind us now.”

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