Lab work takes a lot of time and detracts from your studies.   Wracks brings his lunch in a brown bag to the lab and Dr. Goodlife tells him he cannot eat it here.

We use a lot of radioactive chromium to label white cells and poisoning with radioactive chromium induces red cell leukemia.  You have to find somewhere else to eat.

The Wracks moves down to the medical center cafeteria on the main floor and has his lunch with the medical students.

You can’t eat here says one of the students, you are not in the medical school.   Find somewhere else to have your lunch.

I will says the Wracks.

He wanders around the medical center and finds a room behind closed doors, inside is a huge glass dome and chairs above an operating room.  He takes a seat and has his baloney and American cheese on wonder bread sandwich and an apple for dessert.  Below him, a tall surgeon is doing laparoscopic surgery on patients.  The primitive laparoscope is a long surgical steel tube and the surgeon inserts the probe in the umbilicus, moves around, and looks into the viewport on the scope as he views the internal organs.  This is the first attempt at laparoscopic surgery.   The Wracks finishes his lunch puts the brown bag in a surgical waste refuge basket leaves and goes back to the lab.  He likes the solitude of the retreat and returns a couple of times and the surgeon notices him chewing on an apple and waves.

Dr. Good Life wants to talk to you says one of the Japanese medical techs who handles the radiologic assays his lab undertakes. 

I hear you are having lunch in the dome area says Dr. Good Life.   You left an apple core on the rim of the dome and the surgical residents want you to stop going to their personal area.

There is never anyone there when I go says the Wracks and I didn’t put my apple core on the view dome.

Yes, you did, says Dr. Goodlife and one of the surgical residents found it.

I guess I have to take my lunch in another area says the wracks.  He leaves Dr. Goodlife’s office

I can’t figure out how I left my Apple core on the viewport thinks the Wracks.  I put my trash in the closest surgical waste receptacle.  Errors of judgment are the way criminals are caught in a crime.  It is just a matter of time before they make an error and I guess this is how it happened.  My fault thinks the Wracks.   I must be more careful. 

The Wracks chooses the steps in the delivery area in the medical center to have his lunch.  Located in front on the side with a parking area where the Wracks arrive at night to do their experiments in the School of Microbiology at the Medical Center.  Time moves on, summer approaches, the summer quarter starts, his term is done and he turns in his keys to the research area to his preceptor.  This is the end of the line at the big U.  The wracks gather his laboratory notes, his statistical analysis, and methodology schema and turn them into Dr. Goodlife.  

The year of work consisted of the analysis of a one-gravity sedimentation apparatus for white cells and neoplastic stem cells.   Testing reveals that big cells fall faster through a column than small cells because the buoyant density of small cells slows their descent through the column apparatus.   His column consists of fetal calf albumen in various concentration steps over two hours of fall time.  He counts cell aliquots at regular intervals establishes a normal bell curve and uses trypan blue to statin the aliquots for histological analysis.   Cancer cells are larger and fall quicker through a gradient column and can be stained with trypan blue or fluorescein.    The result of this work is now a science called flow cytometry.   

The Wracks no longer attends the big U.   His peers harass him sexually.   He attends the extension school at the Big U and takes graduate classes like Psychopharmacology and Public Health.  He is interested in psychopharmacology because the wealthy like to take LSD and other mentally active congeners. 

Time moves on and the seasons do not change in southern California the Wracks does not take the yellow bus to the big U anymore and his grandmother is going to pay for his education in Mexico. 

Eating lunch alone on the steps next to Overguard where the busses run is relaxing and the time is over and the world turns, the night convenes and the stars shine beautifully in the night full of hope and promise. 

I am not cut out for this thinks Dr. Wracks.  I must be smart enough or I wouldn’t be here.

Stop daydreaming says Dr. Clancy, there is a presentation at two on thyroid surgery in the surgeons’ lounge by Dr. Canta.  Go there now.  They will have some bagels to eat

All the surgical residents except the two lead residents are in the lounge for the presentation.  Dr. Wracks grabs two bagels while they are still there.  They go fast.   Dr. Canta is a medium-height man with freckles and greyish-brown hair with huge horn-rimmed spectacles.  He wears a doctor’s smock over his suit and he is at the blackboard, with some chalk, and he begins.  He is an endocrine surgeon.   The thyroid is a wondrous organ that maintains homeostasis in the human being.  People with thyroid disease have heart problems and sugar problems.  Thyroid hormone maintains the body’s metabolism, regulates the heart rate, rhythm, and contractility, and augments metabolism.  People with thyroid disease also are cold and hairless.  A magnificent organ, the thyroid has four arteries that feed the organ, superior and inferior, and this demarcates the thyroid as an extremely important organ.  

To remove the thyroid Dr. Canta states, we must ligate the four arteries before extirpation and remove it from under the cricoid cartilage.    the patient must take the T4 hormone for the rest of their lives.  Be aware that the internal carotids are near the organ and feed it directly through tributaries, so we must be delicate to not sever them when we remove the organ.  Dr. Wracks eats his second bagel and nods his head.  Dr. Canta looks at him. 

Tonight, he is not on call so Dr. Wracks walks to his attic room in town to get needed rest and listen to the radio.  He locks the attic door and sleep overtakes him.

After rounds in the early AM, Dr. Wracks is sipping coffee in the cafeteria with a bun.  One of the lead residents tells him to get to surgery because he is on the board for an early procedure with Dr. Canta.

Dr. Wracks is late and all the donuts are gone, and he takes a quick slurp of Styrofoam container coffee in the waiting area and then walks to the board.  On the board is written in black marks a lot ink, “Baloney”, 

and he moves to the surgical sinks and scrubs in.   Walking backward into room four, Dr. Canta is waiting for him.   Hold the trocar while I incise, says Dr. Canta, tie off as I enter, the Beauvy makes too much smoke for this procedure.  Lifting the cricoid cartilage, the thyroid is revealed.   It is white and pink and perfused with blood that is not yellow, atrophied, and wasted as described in medical textbooks. 

Hashimoto’s Thyroiditis says Dr. Canta Look closer.

Dr. Canta cuts the inferior left thyroid artery and with his fingers directing the flow, he squirts bright, hot blood in Dr. Wrack’s face until his entire mask and surgical hat are covered.   He then clamps the artery and Dr. Wracks ties the vessel.   He looks up at Dr. Wracks.   Three more to go.

After cutting three more arteries and Dr. Wracks tying them off, he delicately excises the thyroid with a light green scalpel, desiccates the tissue, and then removes the organ.   A nurse appears and the thyroid goes into a surgical stainless steel pathology bucket.  The surgeon then closes, no one without a license in surgery can sew fascia or peritoneum or do amputations. 

The surgeon leaves and Dr. Wracks accompanies the patient to the waiting area the patient’s trachea tube is removed and Dr.  Wracks sits there covered in blood.   Thyroid surgery is extremely bloody. When the patient breathes normally and the vitals are stable Dr. Wracks runs to the locker room to wash off his face.  He discards his surgical gear into the contaminated discard bin and washes his face and head with cephadyl three times.  Lunch time is passed and Dr. Wracks skulks to the library to hide.  No one ever will find him there except his only friend.  Back on the surgical floor, one of the chief residents asks him if he wrote “Baloney” on the surgical board.  Dr. Wracks denies it.   I thought I saw Dr. Cuban do it says Dr. White but I am not sure.  When Dr. Wracks sees Dr. Cuban, he bows his head and makes the sign of the cross.  Is he the next to go thinks Dr. Wracks?   But it isn’t. 

Dr. Canta moves around the surgical floor like a phantom silhouette.   He carries a fresh scalpel in his hand raised to face level to strike.  His face and grey eyes glare in a leer.   When people see him, they start to run.   A scalpel is extremely sharp and can cut through nearly anything.  Dr. Wracks again makes the sign of the cross.  Dr. Cuban was not the next to go.  Dr. Wracks looks out the window on the observation floor at the world in New York in its beautiful summer.  Immense green punctuated with verdant thunderstorms as sudden squalls move into the area and the huge skyscrapers loom in the distance.  Life is really beautiful for the lucky few thinks Dr. Wracks.  If I go back to the surgical floor, they will have me taking blood gas from the ICU.  My mother wanted me to be a doctor.  It’s time to get back to work thinks Dr. Wracks

Another patient is coming in with abdominal pain says the charge nurse.  Dr. Ix wants you to work him up and do a guaiac after a rectal exam.  He is in the emergency room now, Go meet him.  The day moves on into the afternoon and eventually, there will be a “Light in August”.    And so it goes, et mas. 

There was a dream of being a clinical doctor, handing out antibiotics, and reviewing chemistry panels with patients but it never happened.  In surgery, call is every three days.   All the residents get call.   On the third floor in surgery, the call room is a six by six-foot cell, with a small bed, a table, and a reading lamp.   Of course, a phone is also on the table next to the lamp.  Tonight Dr. Wracks is on call.   After dinner at 6 pm, he will try to get some sleep because reality will keep him up all night.  At 10 PM, he makes his first rounds on the surgical floor.  The ward is full of patients preparing for surgery or recently out of surgery before being transferred to a medical floor.  Surgery is in vogue, and all the people with medical insurance ask for surgery because this is what the affluent do, and they want it too. 

Entering every room and speaking his name and position, Dr., Wracks checks the surgical wounds and the heart monitor near the head of the patient.  The wound must be dry, if it is wet or red, there exists infection, and if not treated, dehiscence and sepsis will ensue.  He checks every patient twice a night because bacteria, especially strep and coliforms have a duplication time of 4 hours and then enter an exponential e to the n logarithmic curve.  Looking at the heart monitor reveals arrhythmia.  Bacteria produce acid mainly as a byproduct, and acidosis causes arrhythmia and any change in heart rate or rhythm might suggest an occult infection.  Auscultation with a stethoscope only shows pneumonia or heart valve defects and is useless, but Dr. Wracks carries one anyway for the effect.   After rounds, Dr. Wracks retreats to his cell and tries to get some sleep before the onslaught.  He moves the desk, upside down to block the door entrance, and goes to sleep.  He awakens as someone slips a credit card into the movable tongue of the lock and tries to gain entrance.  The desk moves and creaks and the perpetrator gives up and goes away.  They never need to sleep.  Dr. Wracks sleeps until 2 AM, it seems after 2 AM everything starts to happen.  This is Dr. Ix’s patient and he is the chief of surgery at the hospital.   Dr. Wracks grows tired of Anesthesiologists demanding that the residents do not over-sedate their patients because over-sedated patients stop breathing during surgery and die.  He has

The phone rings.  Dr. Wracks we have a delirious patient in room 355.  We want you to take a look at him.  Dr. Wracks moves the desk back, puts on his smock, and ventures forth.   The nurse beckons him into the room.  This is a recent surgical patient with an abdominal procedure.  

He says, Dr. I am seeing angels, please help me.

Dr. Wracks listens to his chest, it is clear.   The wound is dry.  He tells the nurse to contact the primary Dr. Ix because his patient is regressing.  All surgeons are on call always and they live near the hospitals where they work.   Dr. Ix arrives in Jeans, orders statutory blood work on the patient, and gives the patient 10mg of morphine subcutaneously to calm him down.  Morphine works quickly, and the patient sleeps and Dr. Wracks says goodbye to surgeon Ix.   He returns to his call room.  From Psychiatry at the Veterans Dr. Wracks remembers what Dr. Lecture told him.  When a patient says they are seeing angels, death is imminent.   Korsakov’s psychosis due to alcoholism produces hallucinations but the hallucinations do not have religious context.  Atropism can cause hallucinations but this condition is acute and usually follows an overdose of atropine. He has tried oxazepam, the benzodiazepine with the shortest half-life but it doesn’t work.  A thirty-milligram dose of Dalmane puts all the patients at rest while they scream for deliverance before a surgery that might result in their demise, but the anesthesiologists threaten the residents with termination if their patients stop breathing during surgery.  Like anything in life, an intrepid soul is damned if they do and damned if they don’t.  It seems all the patients get Dalmane before surgery anyway.  At two o’clock, Dr. Wracks makes rounds again, introduces himself to patients barely sleeping, and checks their wounds.   He sits in the nurse’s station waiting for any immediate entrance from the emergency room.  Trauma occurs mainly at night.   At four o’clock AM, he will go back to his cell and try to pick up two hours of sleep before showering and going to morning rounds. 

He moves the desk upside down in front of the door and wedges it in.  Now I lay me down to sleep, I pray my lord my soul to keep, if I die before I wake, I pray my lord, my soul to take. 

It is 6 thirty AM and Dr. Wracks is in the cafeteria, alone, drinking coffee with plenty of creamers.   The night emergency room crew arrive and wave to Dr. Wracks.   He waves back.  Dr. Wracks says to himself, I think I am smart enough, four months to go, and it happens again and again, every day without fail.

Not a soul in the cafeteria after the seven A.M. surgical rounds.    Dr. Wracks savors his cup of coffee with a cinnamon bun on a bench in a chair in the corner of the lunch hall.

Get to surgery says the fifth-year resident.   Dr. C liked the way you helped him put a new hip in the egghead yesterday and now Dr. Lick wants you to assist him now.  There is a Saudi in the ER who went off the Brooklyn bridge in a limousine and he is all broken up.  They have given him 3 units packed and he is being prepped and get up to the floor and scrub in. 

Dr. Wracks downs his bitter cup of coffee moves to surgery and enters the secret combination on the pad at the door at the entrance to the surgical suites.   He goes to his locker, puts on a clean set of green scrubs, hat, and paper shoes, scrubs his hands in the huge stainless steel surgical sink just like the surgeons taught him in Mexico, and walks backward into room 4.  The patient is suspended in an ortho rig over the table, and his dark eyes and bushy black hair stair upwards into nothingness

He got packed three, and his heart rate and blood pressure were stable according to the surgical nurse.

Dr. Wracks moves to the table.  Dr. Lick is a tall, lanky, Anglo-Saxon doctor with huge glasses and long hair slicked back under his surgical mask. 

Glad you made it he says.  Hold up his leg while I make the long incision on a femoral axis.  He has a comminuted fracture on x-ray and the bone is broken in several places.   We will insert a pin in the boned shaft, staple it with surgical steel bands, and close it.  Monitor his vitals.  He might have internal bleeding and we have to watch the hematocrit in case he needs more blood. 

Vital tissue is pink and glistening all the wounds are closed and the heart rate consistent.   This person is a survivor thinks Dr. Wracks.   The patient is in the rig, suspended over the table and the breathing is slow but stable.  Blood drips onto the floor and in a soundless operating room the drops impact with an unearthly drip.   Fresh blood when it pools on the ground, turns brown and clots into a gelatinous mass.  When the blood doesn’t clot, the liver has failed and the patient dies.  Dr. Wracks looks into the patient’s eyes and they are sightless but they haven’t clouded over like dead people’s eyes do.

I think his pupils are reactive says Dr. Wracks

Stand there and watch my patient, because I have some business to attend to says Dr. Lick.    He pulls off his surgical gloves, drops them in the bin grabs the red wall phone present in all the operating rooms, and calls his financial consultant. 

The doctor proceeds to buy and sell stock over the telephone in the operating room and Dr. Wracks stands over the Saudi patient and counts the blood drops hitting the floor.  He crosses himself and says a novena.  The surgeon is on the phone and intent on the stock market index.  Dr. Wracks begins his second novena and the patient hangs motionless in the rig, and the blood stops dripping onto the floor.

Dr. Lick says time is money, how is my patient doing Dr. Wracks?

His vitals are stable and he is not bleeding that much now.   No tachycardia and the oxygen pressure is normal.   Good, says Dr. Lich.   We can move him to recovery now and you will sit with him until his internist arrives to take over.   Thank you very much for assisting me in this rigorous case of femoral break with associated lacerations and possible internal bleeding.  I think he is a hardy soul.

Dr. Wracks and the surgical nurse disengaged the patient from the rig and gently lay him on the gurney.

The anesthesiologist removes the intubation tube from the patient’s throat and he coughs and spits up a huge bolus of bloody phlegm.   His eyes momentarily blink, and he breathes, and his life is his and the earth revolves another day.  The Wracks waits in the recovery room with the patient, and his vital signs are stable and blood pressure good.  He does not need any more blood.   His internist arrives, an older man with a beard and glasses and an expensive suit with a stethoscope around his neck, and Dr. Lick is on the phone in the nurses’ station with his bookie.   Some hot sporting events are going down for betting in the Big Apple.   He waves at Dr. Wracks.  Dr.  Wracks waves back.   The big clock on the wall, tick-ticking ceaselessly, signifies almost eleven thirty, time for lunch if he can sneak away unnoticed.   The procedure took nearly five hours.  Dr. Wracks runs to the dressing room, takes off his dirty scrub suit, hat, and shoes, redresses, and runs down to the cafeteria.  The cheapest thing on the menu, the fricassee chicken is red and stewed with peppers and piping hot and Dr. Wracks buys a plate.  The black cook smiles at him, he smiles back and then he digs in.   Freshwater never tasted so good. 

The curly-haired chief resident has found him.   I knew you would be here he says.    Dr. Cantacion is giving a lecture on the surgical floor about thyroid surgery and you should be there.   I have a lot to do.  See you later.

The world outside is a bright green and the glorious spring changes to summer in the temperate deciduous forest biome attributed to New York.   Dr. Wracks cannot see it.   If another procedure comes up in the late afternoon, he will assist, then he will try to get a nap on the call floor for he is on tonight and he will be up all night.  Dr. Wracks does not know why he is here, and he is not the right person for the job, but you will have to convince the employers otherwise. 

Dr. Lick saw him on the floor and he says the word. “Butazolidin”.  

The days go on and the nights are long and so it goes because “The sun also rises”.

Witness the wonderful 80s, prosperity, happiness, national
unity, and the benefits of high technology. 
Ronald Reagan was in office.  He
employs supply-side economics and Loeffler’s Economic curve and corporations grow,
and the gross economic product increases.  
He might have gotten shot because he suggested a flat-line tax, but it doesn’t
matter anyway because he was prepared and survived another day.   The eighties rolled by like a grand tsunami,
and then they were over, and the baby boomers started to die and Generation X took
over.  

Where was the Wracks? 
He probably waits in the ready room in surgery, sipping coffee and
eating doughnuts before his next assignment. 
He is not aware of the booming economy or Ronald Reagan’s pretty
daughter who is a denizen of Tranquil Hills too, just one state away. Today he
meets the guy from NYU.  Like all ivory
tower iconoclasts, the guy from NYU is tall, with Sheldon-Kretchmer ectomorphic
habitus, in green surgical garb with a green hat and a large light on his
forehead.  He seems to be made of Norwegian
or Anglo-Saxon stuff, and he moves slowly, turns slowly, and begins to talk to Dr.
Wracks.

The apparatus in question is situated on top of a securely
movable cart with feet that lock to the floor. 
A long spigot, about six inches long and one-quarter inch in diameter blends
into a square body with two stainless steel tubes arising in parallel from the
far end.  The entire fixture is made of
24-carat gold and must be worth at least one hundred thousand dollars in ingot value.  

We had to go to gold says the man.    All other metals get brittle and crack at
the temperature of liquid nitrogen.  
Assisting me at the station with the patient in a stereotactic headset
and temperature-regulated vest, you will instill liquid nitrogen into the
device which inserts into the brain of a patient with a large glioblastoma
multiforme tumor.   The liquid nitrogen
will freeze the tumor, thus destroying it and the expanding gasses will exit
through the other aperture in the device, through a tube into the ambient air
after being filtered.  I will monitor the
entire procedure, in real-time through a fluoroscope and then you will bring
the filter unit to Pathology for analysis. 
Don’t forget to tell Dr. Santos I said hi.

Today is a slow day. 
Dr. Wracks will have to settle for a tendon release rhabdoplasty in a
woman stenographer with carpal tunnel syndrome.    The plastic surgeon is Chinese and he tells
the Wracks he will make five thousand dollars for each radial release and I
should be a cosmetic surgeon just like him. 
All surgeons say the same thing.  
They want you to think that the tons of money they make is worth the constant
stress and subterfuge they encounter daily in the e-coli-infested surgical
rooms that used to be sanitized in the 19^th century with
phenol.  They don’t use phenol anymore,
only cheap emergency rooms in the inner city put up with the smell.  Poor people can’t complain much.   Dr. Lister tosses in his grave and they are
thinking of installing black light panels on the ceilings to bombard the DNA of
microbes when the operating room is not in use. 
Dr. Wracks looks at the board.  He
is up for an Orthro procedure after this where a Saudi in a one hundred-thousand-dollar
Mercedes Benz went off the Brooklyn bridge and ended up in the drink.   He is broken up well.   Dr. Ich is his surgeon.    Dr. Wracks pulls another Marlboro cigarette
from the pack on his fanny belt and lights up.  
It is going to be a long one and nicotine and caffeine will get me
there. 

It is hot and it is summer in the smog-infested central
inner city of LA.  The Wracks wears a
beret and his cheap glasses bear flecks of paint in the shade of beige.   He now is an apartment redeveloper in the
inner city and drinks a lot of Coca-Cola.  
He likes to roll paint because a sprayer gets paint on everything.  His two helpers hide and get some sleep
underneath the kitchen sink and in the hall closet because they are illegal
immigrants and work two jobs to support their families.   On payday, the Wracks brings them to Western
Union and they wire their paychecks directly to their families in Central America.   These people live five to a room and live on
McDonald’s cheeseburgers for sustenance.  
His main man Ramon says that since he doesn’t live on beans and rice
anymore, and he eats quarter pounders all his hair is falling out but the
Wracks don’t dare to tell him otherwise. 
He is happy, his brother offered to sponsor him for citizenship if he
agreed to work as a slave for seven years, and the Wracks light up a filter less
Pall Mall to keep going and then extinguish the smoke and put the but in his
front pocket. Everyone is happy, it is the eighties, and the Wracks is happy to
have a job and make some money.   He couldn’t
cut it as a surgeon and they let him go. 
He was tired of blood squirting in his face and having to shower after
each procedure.  The Wracks wonders what
happened to Ronald Reagan’s daughter. His friend from the upper class whose
father was on the medical faculty of the big U would drive by the Reagan house
and shoot all his nightlights out and then scream like a crow and smoke some
black hash.  She had pretty dark hair and
the eighties are up in flames and soon we will experience Clintons and the white
house a three-ring circus.  President Clinton’s
wife was the sister of an infamous rock singer of the eighties who turned
southern California upside down with his antics.  

I never wanted to be a doctor in the first place thinks the
Wracks as he drinks a coke and takes some Herbalife ephedra.  I am just not nice enough or stable enough in
this great big, wonderful world.  I hear
some old timers say that the quality of life was better in the eighteen
hundreds but they are all dead now and it doesn’t matter. 

GENGHIS KHAN:

The basis of all nations is war, because of this we must examine it closely

MAO TSE TUNG:

All communist regimes eventually become a monarchy

RENDU:

The people will have your soul.

It has been so long, very long ago that it happened.  The Wracks remembers and the image floods into memory and the realization that hindsight is 20-20 but the lessons learned in a brief moment last for a lifetime, even if unused. 

The Wracks is glad to get out of surgery.   The pace and work are demanding, call it every third day and people cry out for sedatives in the middle of the night.  Anesthesiologists ask the surgical residents to not administer neuroactive sedatives to their patients before surgery because they might stop breathing during the procedure.  The patients cry out in the middle of the night, they know they might die and they want to be sedated while it happens.  In Ob-Gyn, women go into labor at inopportune times as dictated by the maker so the staff must always be there and awake to bring new life to the earth

I am glad I am out of surgery says Dr. Wracks.  I cannot take the stress.   All I wanted to do was hand out antibiotics and treat venereal infections in a beach consultation, but I ended up removing organs, doing cancer ablation techniques, and putting people back together who had been broken in car accidents.

You are in internal Medicine now says Dr. Q.   Remember to keep your mouth shut.

The people in the ward in medicine are mostly well-to-do elderly gentlemen who have stressful high-power existences and have high blood pressure and or a stroke.  They lay in beds, propped up, with the TV on and an I.V. bag drips a clear solution of heparin into their arms around the clock.  Heparin is an ideal anticoagulant because overdosage is nearly impossible.  Coumarin causes severe bleeding and none of the patients like it.   Dr. Wracks sits in the nurse’s unit with a warm cup of tea, a teaspoon of sugar, and a smile on his face.  His real education will soon begin

The Italian is a small man about five feet six inches tall who dresses impeccably.  His grey suits must cost at least five hundred dollars apiece and everyone knows he is the best at what he does.   These intangibles make him famous.    His eyes are like laser beams and they burn through your very soul and he decided to keep Dr. Wracks alive.   

Look at the charts he says as Dr. Wracks sits in white, hygienic luxury, in a chair, somewhere, in a nurse’s station.  His right hand pulls a three-by-five flash card from his coat pocket and it says stenciled in black Sharpie marker

Atropine.

This is a busy man, a rich man, and he is gone.  He has better things to do than nurse Dr. Wracks.

Another day in internal medicine and he is there again and he points to Dr. Wracks, and puts a patient chart on the desk and points to it and his left hand pulls a flash card from his wallet pocket in his coat and it says:

Strychnine

A hand flashes up into the air, and he makes one gesture with his index finger, turns, and is gone.   All the patients on heparin smile, and Dr. Wracks has another day in Medicine, taking blood pressures and looking at coagulation parameters.   

About a week elapses and he strides into Medicine in a new expensive pinstripe suit like Don Corleone used to wear in the Movie, “The Godfather.”   A chart in his hand, he sets it in front of Dr. Wracks, taps it and his right hand pulls a three-by-five flashcard from his lapel pocket and in black stenciled sharpie letters it says:

Arsenic

After looking at all his patients he vanishes again like a whirlwind and Dr. Wracks never saw him again.  Dr. Wracks sees an elderly man with white hair looking at him in the distance it is Harvard, and he doesn’t realize what is happening now, then, or in the future.  Most acute hospital admissions are poisonings.    Dr. Clancy finds him.  

We need you back in surgery.   You are on the board.

Surgery is too much for me says Dr. Wracks, I can’t take the pace.

You either come back to surgery or we are sending you back to Mexico.   Do you understand me, says Dr. Clancy.

Yes, I do says Dr. Wracks

I will see you tomorrow at seven AM for rounds on surg floor., He strides away

Internal medicine is a vacation, the ICU is a vacation, taking blood gases and watching the heart monitors around the clock.   If you are in the ICU the attending watches the heart monitor., Heart drugs are toxic and a physician watch for dropped p waves, QRS asynchrony, and inverted T waves. 

Dr. Wracks is not a doctor anymore like he was in New York State.  The brain needs time to process the information and data fed to it and it wasn’t for a while that the Wracks understood.   He finally understood.   The world is a world of people and people do crazy things all for the smell of olfactory money.  The only thing the devil can’t give you is love.   Love is all-powerful and a gift of God and the Wracks hope he gets a second chance.   He goes to church now, sits in the back, and prays for better things.   The Italian had a son and I hear he is good, hopefully as good as his dad.   Summer is in bloom everything is green and the cycle renews, and the tomatoes are growing well.   All in all, in the twenty-first century.   

Welcome to advanced Immunology Elective says Eli.  This quarter we will be studying the possibility of grafting bone marrow between donors and synergistic recipients in a closed system.  The mice we will be using are Balb/c  inbred mice.  A mouse’s immune system is housed in the spleen which is the murine version of the bursa of Fabricius progenitor organ.  In mammalian systems, the anti-body-producing immune system is the gut-associated lymphoid tissue found in the alimentary tract.  We will irradiate some mice to make them aplastic and then transplant different spleen cells and gauge an immune response by the Ouchterlony technique.  I will need some students to take the mice to the Cobalt 60 facility and irradiate them.  Who would like to go?

The students in the class all point to the Wracks

Beauty before age they say.

I don’t have a car says the Wracks.   I am ineligible

I have a car says Mr. Simms I will drive you

Thank you very much, Mr. Simms, says the Wracks.   You are a scholar and Gentleman.

The Wracks have a large three-foot square cage full of screaming and chiding mice. At least twenty of them.

Put them on your lap says Mr. Simms.   I don’t want   waste on my upholstery.  This is a new car

They are not rats says the Wracks, they are mice.  

They look like rats to me says.

The dark war-green Volkswagen bug plods down the side streets to the Veterans Facility

The Veterans facility at the Big U is a bucolic, idyllic retreat where the men and women who serve the United States military go for housing and medical treatment.  The green expanse of beauty with red brick buildings cast about, almost a forest with park benches and walking paths.   The people who agree to fight for our country deserve the best the nation can offer and it is here, and they offered their lives to inherit it.  So shall it be.  In God we trust.   Then there is building 3C.

Building 3C is a government Cobalt bomb facility with marines, cocked and loaded M16, s and bayonets.  They stand at the ready with their fingers on the rifle safety, on the side, slightly out of sight.  A tall man with goggles and freckles asks, May I see your identification, please?  Wracks and Mr. Simms hand him their student I.D.s.   He looks at the pictures and then hands them back.  You both are on the list he says

Go into the room he asserts.   Put your animals on the stand near the center of the room.  The source is in the middle of the room under ten feet of lead armor.  When you hear the sirens go off, head to the door and exit promptly because when the door closes it locks until the source goes back into the earth.  Turning off the sequence takes time and you will be exposed to the bomb if you hesitate.  Irradiate your animals and come see me before you leave

Cobalt 60 is a man-made alloy of the nuclear age.  Emanating intense Gamma radiation for a half-life of 5000 years, the metal is used by industry to preserve anything because the radiation kills everything.

The Wracks and Mr. Simms bring the mice into the room and Mr. Simms is the first one out.  The Wracks scrambles, a loud siren goes off, flashing lights all around spin around in red and blue, the steel and lead door closes with a loud snap, and heaven comes to the earth.    A person can feel intense gamma radiation even through a four-foot-thick lead wall.   Intense gamma feels like a person is being placed into a huge magnetic field and time stands still, and then the alarm stops after about a minute and the atmosphere smells like chlorine bleach.   Radiation and its parameters must be the key to transposition.  You can feel it. 

Mr. Simms says, Atomic

The Wracks says, Heavy

You go in and get the mice says Mr. Simms.   I will wait here.

The Wracks goes into the room and retrieves the cage.   The mice are stunned and barely breathing and the source is back deep in the floor.  Let’s go back to the lab says the Wracks, these mice need some water and food.   Don’t dirty my upholstery says Mr. Simms.  I won’t says the Wracks.  I promise.

Out of the twenty mice, four died immediately from the intense radiation.  The sixteen now have no immune system.   To transplant an immune system in a mouse, a ground-up spleen, forced through a wire screen and loaded into a syringe is injected into the peritoneum of the mouse.  This action renders them immunocompetent.  In ten of the mice revitalized with spleen cells, only eight survived long enough to be assayed for immunocompetence.  A new graft doesn’t always take.   The rest of the mice display an intact immune system as revealed by a plaque-forming assay in gelatin that probably now is paseo.   Half of the surviving mice show self-rejection of the lupus type with running and eventual death.

Out of ten mice transplanted with identical cells only four survived to assay.

Well students, what do you think?  Are bone marrow transplants viable for human beings?   Eli wants to know what you think.  Even in syngeneic highly inbred litters of mice, there exists enough genetic variability to cause graft versus self-reaction.  Eli looks around and listens.  The students are perplexed.  Eli states transplantation of a related strain CJ157 into the rest of the hosts results in an immediate graft versus host reaction with a mortality of 100 percent.

Is what you are saying, that bone marrow transplants don’t work, asks a senior graduate student.    I didn’t say that says Eli.   We are still working on that issue.   For the rest of the semester, we will study how using extracts of cancer antigens can produce viable IgG production in an appropriate host.  We will be working on immunotherapy of cancer for the rest of the quarter.

What is the carrier for the tumor-specific transplantation antigen going to be asks the Wracks?

We are going to begin with polylysine and peptide linkage says Eli.   Dr. Molinero peers in the door.   He has big horn-rimmed glasses and bushy hair like Samy Hagar.   He is Eli’s partner and cohort.

Class is over.   The Quarter is over.  The Wracks will go on to transplant lymphoma between mice and then be expelled from the program.

I knew it was Eli, exclaims the Wracks to himself.   I knew it all the time.

Once a person becomes a pariah, they can’t live it down.  Either can the Wracks.  His father flew back with him to Mexico in case a legal imbroglio existed to get him back in school.  They play rough down here says Father Wracks.   A fellow student pokes his head in the room and says to the Wracks,

Es muy fuerte el, no le preocupes.

Licensario Aces is the superintendent of students and legal officer for the University.  The Wracks has an appointment with him today.  He waits outside the office in the stone room with the stone chairs and small windows and the electric bug zapper that is never turned off.   A pretty, tall woman who is probably part of the landed aristocracy ushers him into the lawyer’s office.   The lawyer beckons the Wracks to sit down.   He is a man of average height with white skin, and thick Indian hair cut short with a slight red tint to it.  His eyes are grey.

Hello, wracks.   I hear you had a problem with the police.  They wonder if I should let you back in the university and not expel you.   You might get into trouble again.   All the students at the university come from professional or upper-class families and they do not tolerate an outsider causing a commotion.   If you get into one more fistfight, you will expelled and escorted to the consulate.  Do you understand Mr. Wracker?  The only reason I let you back is because you have a near straight A average. 

Yes, I do licensure

I will admit you back to the university and you will start clinical respiratory medicine in one week.  Situate yourself appropriately and keep a low profile.   Do you understand Mr. Wracker?

Yes licensario, I will be on my best behavior.

The lawyer for the university and unquestionably one of Mexico’s elites stands up and offers his hand.  The Wracks shakes it.

Good luck and you will need it says the licensario.  Goodbye.

The Wracks are having a hard time finding accommodations.  No one will rent to him.  They run away saying, El es loco, sale.!  Finally, in the daily newspaper, they find an ad asking for a student to rent a room in the neighborhood next to the plaza.   His father says, take it, if no one will rent to you, your career here is over.  Father and son in a rented Volkswagen go to the house on the cobblestone street next to the Patria. The house is made of stone and has an eight-foot-high stone fence, and a steel garage door designed to stop high-power rifle bullets.  Father and son ring the bell and a small elderly lady with whitish hair that used to be blond, and grey eyes opens the door.

I hear you have a room for rent Madam.  Do you speak English?

My name is Ophelia and I am originally from Chicago. Would you like to see the room?

Yes, we would say the Wracks, can we come in? 

Yes, you can she says.

Ophelia has a small white poodle, daintily groomed by the local animal handler.  She sits on a cushion and wags her tail.   It is an adobe hut she says.   It is in the back of the property.  It has a bathroom adjoined to a single room.  It is five hundred pesos a month.  Do you want it?

Yes, I do says the Wracks.   When can I move in?

Anytime says Ophelia

Wracks and his father go back to the motel and get the luggage then go back to the house and move the Wracks in.  The unit has a single glass sliding door.  A small bed sits in a corner next to a small desk and chair.  There is electricity.   The bathroom is small and tiled and the water runs. The Wracks has a small tensor light he brought from the States, sits down and plugs it in and the semester begins.

At first, the Wracks couldn’t figure out why he would wake up in the morning with bite marks all over his body and a swollen face.  He finally realizes he is being bitten by reduviid beetles that are indigenous to southern Mexico.   These kissing beetles are known affectionately to the Mexicans as Cinche.  They hide in cracks and sit suspended upside down underneath the mattress of the bed.  The Wracks try mosquito netting but the maneuver is of no avail.   The black cockroach-like animals with a proboscis are smarter than he is.  He buys spray insecticide from the store and sprays his bed and floor before he goes to school but it is of no avail.   Either the bugs are immune to the poison or they keep coming.  The latch on the window sliding glass has a key but the mechanism is easy to pick and he can not believe his landlady is letting people in his room when he is at the university.  The best solution is to shower as soon as a person arises in the morning to wash the bug feces off your body.  The dreaded American trypanosomiasis or Mal de Chaga as it is called in Latin America transmits when the bug feces are rubbed into the bug bite by itching or scratching.  The infestation continues for a year until the Wracks secured habitation elsewhere with an American expatriate living in Mexico.

Ophelia periodically requests the Wracks to have coffee with her and talk.  She slides a coffee cup from the cupboard and shares a decanter with the Wracks.  She offers pasteurized crème in a ceramic pourer.  The Wracks notices she slides the same cup from the same place level to the table each time they meet.  The Wracks thinks she puts something in the coffee cup before, setting the cup in front of her and pouring coffee into it so the Wracks thinks the cup is clean and empty.  After all, she is the Landlord and the Wracks complies.  He pours some crème into the cup and only drinks half of it.  And so, it goes.   She speaks of all her luxurious Mexican friends, the help they have, and the marvelous life they live.  She says her friends have live-in maids who constantly wash vegetables and prepare food for them all day long.   In Mexico, the farmers use sewage to fertilize and the crops grow huge and fast but they are covered in Salmonella Bacteria.   It is wise never to eat a salad in Mexico unless the cook prepares it himself or herself.  She also talks about Juan Bond who sells chiclets on the street in a stand in front of the barrio.  The children scurry about and play with their toys and Juan Bond sells chiclets and Mexican cigarettes to the Wracks.  Juan Bond is the richest man in the city and he is small, Indian, with greying black hair, wearing thick cotton peasant clothes, and sporting a black mustache like Salvador Dali.  He smiles at the Wracks.   Ophelia also states that the city is getting too expensive to live and because she is a widow, she would like to move to Cuernavaca, would the Wracks like to come with her and share a mansion in this city?  When the Wracks tells her he is moving out, she swings a fist in an overhand right and tries to the Wracks in the head and he is finally gone to an apartment a mile away situated next to a tennis court.  The court is in Mexican clay, the finest surface in the world.

It is just hearsay, and conjecture at this point but the Mexican students tell the Wracks never to go to Cuernavaca because it is the city of the Vampires and the inhabitants bleed livestock and live on their blood.  Of course, the Wracks have never seen a vampire but from experience know they exist and now Ophelia is moving to Cuernavaca so she can be one of them.   The Wracks went to the house of justice in the city and told them about Ophelia but they told him politely to leave.  She has influential friends and the Wracks has left less than a year to go with life so strange, destination unknown. 

The rainy season begins in Mexico.  The vegetation is everywhere, greens and grows.  The Wracks stands in front of the foreign students’ office of the University.   He has acquired a house to rent and needs to find 2 or three roommates.   He waits outside the office on the stone abutment that even in the tropics, is cool to the touch.   In the tropics, they are built from stone because it lasts, doesn’t burn, and insulates well.

The first person he encounters has sandy blond hair, is about five feet nine inches in height, and dresses in wranglers’ cargo pants with a clean linen shirt and Sperry topsider shoes.   He must be of the upper class so the Wracks approach him.  

Are you a student here asks the Wracks.   Would you like to rent a room in a house close to campus?

Yes, I would say the blond.   My name is Mr. Madera and do I get my choice of rooms?  

Yes you do says the Wracks, here is the address.   See you there

Mr. Madera smiles, turns like an automaton, and enters the foreign student’s office.  I have business he says

Next up is a tall man with black hair and a big nose.   He dresses in casual clothes unlike a local in the tropics and wears black socks.   He must be from the east coast of the U.S.    Would you like to rent a room in a new house close to campus, asks the Wracks.

Yes, I would say the tall student with bushy black hair.   My name is Mr. White.  

Here is the address says the Wracks.  See you soon.

They are the roommates for the first year.   And so, it goes.   The year begins

Mr. White is a jet setter.   He likes to go out twice a week to Mexican discothèques.   He dresses up, and in a shirt open to reveal his chest, he takes a taxi and leaves till late at night.   The wracks can not understand how he passes his classes.   Learning science is hard.  Learning science in a foreign language is harder.  His room is meticulously kept clean and ordered and he hires a housemaid to clean his room and the shared bathroom once a week. 

Mr. Madera is an athlete.   He has been chosen for the varsity water polo team at the university and goes to the campus pool three times a week from four to seven o’clock.  He studies until two o’clock at night and even later and lines up his coffee cups on the stairway rail for everyone to see.   They must be a badge of courage.   He has little need of sleep, and his schedule keeps the Wracks in awe.   Girlfriends from the United States fly in to see him and he has a Mexican girlfriend too who obtains the exams for him to study that he does not share.   He seems like an all-American, upper-class, success story in the making and the Wracks envy him until…

The Wracks sleeps a lot and sleeps hard but he dreams in the middle of the night that Mr. Madera is standing over him in a gold priest robe with a chalice and beginning a mass and the Wracks wakes up.  No one is there and it is two o’clock at night the wracks look outside of his room and Mr. Madera’s door is closed but a light shine outward from the space between the door and the floor.  The Wracks makes certain that the door in his room is functional and he checks it, locks it, and goes back to bed.  

The Wracks gets up early and goes to class.  He has a Mr. Coffee coffee maker in his room that is promptly broken so he goes to instant Mexican coffee.   Mr. Madera is up making his ethereal meal of fried egg on bimbo bread three or more times a day.  Mr. White goes out to eat breakfast every day.   The year goes on and time flies and the night becomes dark and finals in the first block occur.  The Wracks are up late making instant coffee with a traveling water boiler and smoking Mexican cigarettes.

Going up the stairs he spies Mr. Madera’s room light on.  A girlfriend from the United States is visiting him.  She is of average height, wears tight jeans, and has a good figure.  Her brown hair is cut short.  She darts out of Mr. Madera’s room in a towel and runs in the bathroom and turns on the shower.   The Wracks retreats to his room.  He is studying Gross Anatomy.  His wristwatch shows past eleven and he locks his door and goes to bed alone in the large bed that comes with the house.  Dreams begin.  In the Wracks’ dream, Mr. Madera’s girlfriend is in bed with him, like any young red-blooded American would and then he wakes up with a start because a woman is sitting on his face.  It is her, and she looks at him, and he looks at her, and Mr. Madera’s head looms over the bed and smiles and then he is asleep again.  He wakes up frightened and no one is in his room, just a vacant bed and a desk, and he peers outside and Mr. Madera’s room shows the light out the crack of the door.   Mr. White is gone for the night.  He double-checks the lock on his door, closes it, and goes to sleep. 

Mr. Madera says nothing about the incident and the Wracks wonders.   He comes home one day and Mr. Madera is buck naked on the floor, spreading his buttocks and saying, sodomy is an oath of fealty.  Mr. White is drinking a glass of baby formula and laughing and the Wracks until he gives up his house in June of next year and barricades his bedroom door every night with his desk and chair.  Sometimes late at night, Mr. Madera heads out the front door and visits the neighbors at two o’clock at night promptly returns in about an hour, and heads to his room.  Occasionally a pack of wild animals concentrate and growl and howl outside his room at night but he is dreaming.  One night before the barricade, the Wracks dream that a vampire is biting his neck and drinking his blood, and Mr. Madera is in his gold robe.  He wakes up in the morning and sees two fang marks on his neck.   The Wracks becomes a religious man and he lives in harmony with the others to survive

Mr. Faulkner was correct when he wrote the Great Gatsby novel.  The Great Gatsby says that the rich are different from you or me.   The Wracks secures his desk against the door, says a prayer and goes to bed.   I hope I transfer he thinks and he doesn’t know why.

A