Turnabout
A medical mystery
© Bruce Kaler M.D. 2008
Published by Bruce Kaler at Smashwords 2008
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ISBN: 1-4392-0556-6
ISBN-13: 9781439205563
LCCN: 2008909992
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Chapter I
The constant chill finally aroused me as well as the tangle of covers around my neck and legs. Frustrated by my lack of success in overcoming my twisted blankets and uncomfortable position, I tried to peer through the slits of my barely open eyes. I couldn't see much more than the early morning light. I was drawn back down into sleep refusing to give it up. With a forceful tug of the covers and an athletically timed twist of my torso, I tried with a heave to rid myself of the tangle. As I did, my pillow slipped to the floor, my face contacting the bare cold leather of the bed.
The bed? a voice inside my head said. What the—? It was enough for me to raise my head awkwardly, craning my neck, focusing on—the seat of my office couch! As the cobwebs began to clear and only to reappear in my "morning mouth," I realized I had fallen asleep in the office. From the appearance of the papers on the floor next to me, the table lamp glaring in my eyes, and yesterday's clothes still adorning my crumpled body, I cleverly must have laid down to read a journal and fallen asleep. The wall clock corroborated the ungodly hour of 6:40 a.m. on my wristwatch. I could see mostly clouds out the window with little bits of blue scattered around the sky. The clouds streamed by in formation. It was probably quite blustery out. Only then did the gnawing thoughts of reality start to seep in to my mind.
"Geeze, I've got to work today. I better get movin," I said to no one. Somebody would be in soon, so I needed to shower and change. Fortunately, I was prepared for this. I had spent many working nights at the hospital. I would come back to the office, sleep deprived, but energetic, shower, and rummage through the change of clothes I always kept here. Today I felt old and stiff. I heard some noises in the outer office area. One of the office staff came in early, and I dreaded seeing anyone yet. I needed a hot shower and some time to get my head into what lay ahead. As their footsteps grew closer, I felt increasing embarrassment. Really, I wanted to hide. There were a couple quick knocks at the door as it slowly peeled open. I headed toward the desk and responded with the most upbeat tone of voice I could muster.
"Yeah?" I said responding to the knock.
From behind the door Laura's smiling face leaned out.
"Hi. I thought I might find you here—the famous Dr. Fred Pomeroy—but not like this."
"Oh, hi. I'm glad it's you. I'm not quite ready to face anybody else yet," I said, relieved it was only Laura, my longtime assistant. "How come you're here so early, anyway?"
"Since Joyce took her leave of absence when her mom first got sick, we've been short-handed in the office, especially on days when both you and J.R. are here together. You've been in the office so little the last couple months we've been able to get by," she explained.
"Right! I guess theoretically Joyce still works here. That's a horrible thought. I'll have to put on a good face for J.R. today. You know how he felt about Joyce. I haven't even spoken to him for a couple weeks."
"Why don't you shower and change, then meet me at the deli? With today's schedule it could be your last chance to eat all day. Besides, you don't have any rounds. We can pick up where we left off." It sounded appealing, but she left quickly before I could answer. Some nice hot hydrotherapy is exactly what I needed to get ready to see patients.
When I dreamed of becoming a doctor as a kid I never imagined there would be days like this. The general practitioner I saw for childhood illnesses growing up in Seattle was always genial, calm, and put together. When my ease with science and interest in people came to mind during career talk in junior high, I thought of my family doctor. My parents had made it through high school and gone on to hard-working jobs, and like many folks of their age wanted their kids to aspire for more.
A few hours of sleep scrunched up on a couch would have to do for me that day. The Rosedale Deli was a time capsule of 1956 New York food and atmosphere transplanted in Seattle across the street from the hospital. Open for breakfast and lunch only, the menu was cheese blintzes to matzoh-ball soup. The sandwiches were so ample a person had to be crazy not to share with one or two others. The deli did a thriving business from the bagels alone, which they baked fresh each morning. There were only two things inside that were telltale clues that gave the patrons any idea that it was present-day Seattle. One was the ceiling to floor wall adorned with posters of upcoming events from street fairs, children's theater, and opera. It created a bold, eye-popping montage of color. The other was the $5,000 Italian espresso machine near the front door. At that time of the morning, it was constantly hissing and gurgling out lattes and cappuccinos. No one seemed to understand why more coffee was consumed per capita in Seattle than anywhere in the U.S. And since the U.S. consumed half of the world's coffee, that put us at ground zero with a commuter cup in our hand.
After the shower got my blood pumping, I wasn't feeling too bad. At least I had some temporary energy. Sure, everything that was happening was very depressing. But right at the moment it was not so consuming. As I slid into the booth across from Laura, the aroma of coffee was arousing even though I knew it was decaffeinated. As I broke bread with this friend and colleague, I recalled the evening that my former girlfriend Joyce and her parents were at my place for dinner.
"They treated us so warmly," I explained to Laura, "just like we were another married couple. They always made me feel at ease around them." Her dad, Bill, being a retired businessman, was gregarious and funny. Joyce’s mom Anita, a sitting federal judge, was quiet and warm. She must have had a more assertive side when she was on the bench because I never saw her in any other way. Even though she had achieved some national notoriety for some of her decisions on regional issues and creative sentencing, she insisted on being called Anita from the first moment we met. She never aspired for the celebrity, but her good work couldn't keep it at bay. “When she first mentioned how crummy she had felt, I listened to her chest right away and suggested she come into the office for a chest X-ray the next day. I was concerned about walking pneumonia. I remember the film—or at least, I thought I did—as being quite normal. It wasn't even borderline, definitely no infiltrate.” All the while, Laura listened attentively to my rambling, never even looking away.
"It was a couple days before they flew home. I didn't see them before they left, but we spoke on the phone. She was definitely feeling some improvement after starting on antibiotics. I didn't give it much thought after that. She sent me a thank-you card after she got home thanking me profusely." I was starting to talk myself into doldrums again.
"You can't keep beating yourself up about this. It was an honest mistake. It could happen to any of us," Laura continued in her consoling tone of voice.
"You know how I am about details and not taking anything for granted. The crazy thing is that it was so straightforward then—and now. That damned film is my nemesis. I can't believe I missed something like that."
"Hindsight is always 20/20. Maybe you just couldn't see it."
For some reason, that enraged me, but I was able to choke back the feeling as it swelled in my throat. "For God's sake, Laura; the lady died six months later. The oncologist thought that I should have been able to see something on her chest film from across the street."
"You know how self-righteous those folks get. They're still trying to give another round of chemo when the patient is halfway to the morgue. Besides, you didn't tell me before that the oncologist never actually saw the films taken at our office. What kind of case do they have if they can't find the original chest film?"
"Boy, you've turned into a real legal beagle! You're sounding like my attorney."
Laura stared at me across the table with one corner of her mouth twisted up showing a small amount of impatience for the first time.
"Fred, I have the greatest respect and trust for you. I love working with you. But you've got to move on and get past this. I can't possibly know how much pain you really have with all this. I do know you are a terrific surgeon, and you're smart enough to gain control of your feelings. You're entitled to have them, but not let them have you."
"I appreciate your concern, really. I'm doing much better than you think. The most difficult part of this has been that it was Joyce and her mom. It's compounded my feelings tremendously. At times, it's really thrown me for a loop. It seems ridiculous now, but that weekend that we had dinner with her folks, Joyce and I were talking seriously about getting married."
"I'm surprised," Laura said slowly and thoughtfully. "Most of us, who knew the two of you, saw that you were happy. It's just, neither of you appeared to have the time to get married. Do you know what I mean?"
"Oh sure," I understood all too well. "I'm not going crazy, but I'll tell you what bugs me the most. I'm second-guessing myself all the time about people and medical stuff. Every patient I see looks like a potential lawsuit to me. If I'm making a note in a chart about a damned sore throat, I'm thinking about how the note is going to look in court."
"I'm sorry, Fred," as she reached across the table to take one of my hands in both of hers, "But you have my trust and confidence. We all need you to get back into things. Besides, it's getting late. It's almost nine, and you've got appointments."
"I may not show it, but I do appreciate your faith and support. It means a lot to me," I confided.
Laura went ahead to the office as I took care of the bill. Walking across the street in the blustery chill, I felt some warm sun on my face. But the cold gusts cut right through me. I don't know whether it was the wind chill or the thought of facing my partner J.R. that made me shiver. He was an experienced, skillfully smooth surgeon fifty-six years of age. He was built like a five foot, ten inch bear. He had a similar disposition, sometimes reserved and docile, belying the power and fury that lay beneath the surface. I doubt that he was ten pounds more than his college wrestling weight. His demeanor was always professional and self-assured with clients. He felt as if he had no predators. He was prone to using a sprinkling of home-grown country proverbs and quips in conversation that made his bigger-than-life presence approachable and genuine. He had been raised and educated in North Carolina as Johnston Harrison Reynolds III. Although he had no relation to the tobacco aristocracy of the same name, he played the part. He was actually the son of a plumber and jokingly referred to himself as simply carrying on the family tradition. A nonsmoker for many years, he still chewed on an unlit cigar in private.
I had been so busy with the lawsuit that my caseload was very light. I hadn't spoken with J.R. for more than two weeks. I was anxious about seeing him. Although we were partners, he was definitely the "senior partner" and could wax very paternal and authoritarian. We led different personal lives. I was fifteen years his junior and more interested in people, healthy lifestyles, and enjoying the region where we were fortunate enough to live.
The only thing I ever wanted to do was be a doctor. My own parents never pushed, only encouraged me to go to college and be whatever I wanted to be. That was their only expectation of their only child. Of course, I always tried to exceed their expectations. There was one week when I was a kid that law seemed of interest till I actually read a legal document. I was so flummoxed by the language that I never again deviated from my interest in people, how they worked and were put together. I featured myself as having good hands even among surgeons.
However, J.R. was forever the consummate technician. He was old school and not interested in feelings, only what he could do to repair or excise something. He had a can-do attitude. He liked to quote Mark Twain or Teddy Roosevelt about doing what you could, with what you had, wherever you were. He had no shortage of opinions. He never thought highly of my relationship with Joyce. She was first and foremost in his mind still an employee. Romance with such a person was imprudent according to J.R. It was black and white to him like most things about which he would espouse. Any area of gray should be avoided or excised like a neoplasm.
As I came in the office, he was standing at the front desk reviewing the appointment schedule, making small talk with the receptionist. Even though my lanky build was several inches taller than J.R. I often felt smaller in his presence. As our eyes met, I could feel the resentment and braced myself for his inevitable sermon. He was going to give me the "I told you so" tone of voice. However, he started talking to me about last night's calls as if we had never missed a beat. There were no surgeries, only a few calls. He did have to come to the hospital once to evaluate a belly. They did a white count and sent her home for observation. He never heard anything else about her and assumed it was probably something viral. This sort of debriefing continued without a breath for several minutes, much to my surprise.
After a bit of a pause, he asked, "How ya holdin up?" in a slight Southern Appalachian drawl. I felt relieved at this subtle sign of compassion and said briefly that I was doing all right, but the suit was kind of trying.
He nodded in an understanding way but quipped, "Yeah, and a bull don't take to bein' castrated, but it happens. It just needs to happen." The words weren't exactly kindly. In fact, it hurt. My teeth were grinding hard enough so the words couldn't escape from my throat. About as quickly as he had blurted out what he felt was probably a simple observation, J.R. turned and left abruptly, having no idea the effect his comments had. Moreover, he didn't care. It just wasn't his style to sit and listen intently, exploring the other person's psyche. There weren't a lot of things that sustained his interest unless he thought he could operate on it.
A schedule of patients had already materialized for me. As much as I felt that I didn't want to be there, the inertia I had kept me doing whatever was in front of me. Sometimes I was actually able to do it with some aplomb and not just go through the motions.
Matthew Bronigan, an eight-year-old who had needed an emergency appendectomy two weeks ago, arrived with his mom. Matt was a nice kid, engaging, inquisitive, and his thirty-something mom was conversational and articulate. They were regular folks. Matt was such a cute kid and quite chatty. He drew me out of whatever fog clouded my demeanor. He asked these very specific questions that were indicative of someone of greater maturity and insight than eight year old. He made me smile.
Millie Samuels was a sixty-two-year-old woman also there for a post-op consultation. We had excised a low-grade rectal carcinoma before it spread six weeks ago. Metastatic work-up had been completely negative. She was lucky to have been scoped early enough to pick it up. She was quiet, polite, and very appreciative. I knew she had been widowed for many years. Although our conversations were mostly limited to the technical aspects of her case, she was appreciative of me for treating her. Her convalescence was unremarkable, but the baked goods she would bring me next Christmas would be quite remarkable in appreciation for what she perceived as saving her life.
It was the first time I met Harold Townsend, a Boeing engineer who had intermittent claudication when walking. Although he was only average in condition for someone of forty-four years of age, he walked miles a day at an airplane manufacturing plant. He had started experiencing leg pain after a few minutes of brisk walking, his usual pace. This had been going on for a month. His description certainly made a vascular origin suspect, but it would require more testing.
Last on the schedule was a forty-year-old overweight Metro bus driver with a hemorrhoid. Instead of a painful surgical solution about which he had been warned, I recommended aggressive medical treatment with soothing rectal suppositories, about which he was hesitant, and lots of warm soaks in the tub. After disclosing the full extent of the surgical option that I felt really wasn't necessary, he eagerly opted for a more painless conservative course that would achieve nirvana just the same.
It was more than I could say for myself. I felt so detached in the office. We had a great little crew. Fran, the bookkeeper, was always very chatty and would go from monthly collections and insurance regulations to her grandkids without taking a breath. I probably stared at her glassy eyed with a smirk, as I had no idea what she was saying. I could only hear my own inner voice of worry and anxiety. My calm exterior would belie the racing thoughts that kept my focus blurred. Fran was training a new receptionist, whom I was seeing for the first time. A stranger's presence also made my own habitat seem off-balance.
As the complexities of the office mechanics were going by in a blur, Laura appeared suddenly to halt the merry-go-round in my head. She had some simple questions about a phone call from one of our old patients. Laura knew the drill and advice perfectly. She was thoughtful and usually had good insight to the client's problem. She was a perceptive clinician herself in her role as a nurse. In reassuring her that she was advising the right things, I felt as if I were transparent. I knew she could tell exactly how I felt and how distracted I was. However, her smile, even tone, and words stopped the emotional vertigo I felt for just a few moments. After seeing the patients, I felt some accomplishment in the familiar routine. I was reminded that I needed to go over to the hospital to review a CT scan with the radiologist and that I was up in the rotation for ER call that day. The last part didn't seem very good, but the more extreme the demands on me, the more I came out of my fog.
The radiology department was in the center of the hospital. It was a maze of small rooms filled with high tech whirring machines. The bustling technicians moved patients in and out like a workforce of ants. The radiologist Larry Green was about the same age as me and appeared cozy in front of the x-ray view box. His face was awash in soft light of the backlit films in an otherwise dark room. He interrupted his dictation when I walked in the room even though he sat with his back to the door. Spinning around in his cushy chair, he greeted me warmly.
"Hey, man, where ya' been? Haven't seen you lately."
I guessed the bowels of the hospital are not on the "rumor-ville" mailing list. "It's been slow. I've been taking some time."
"I wish I could say that," he said sarcastically.
I don't know anyone who had a better schedule than Larry except for maybe one of the senior anesthesiologists. He was usually in the hospital early. After a couple procedures, he would read films faster than humanly possible and be somewhere else by mid-afternoon. If it wasn't golf, it was something preparing him for ski season. The way he talked about it so much you'd think he was getting paid to ski! But he was a top-notch radiologist. He was certainly a journeyman when it came to procedures, but his eye and interpretations were very perceptive and inquisitive. I valued his intuitive nature when interpreting difficult or ambiguous scans. He was right a lot more than he was wrong. And he was able to admit that he was occasionally uncertain.
"You here about that abdomen? What do you know about him?" Larry asked.
"Well, Glassman asked me to see him in consultation. He was admitted for pneumonia, but the guy was complaining about mid abdominal pain. He's a sixty nine-year-old man from the Philippines. He's here visiting his daughter for a month. Physical exam was unremarkable except for the subjective discomfort that is poorly localized. Frankly, his English is so rough, even with the daughter translating I wasn't sure if he was just constipated."
"I'm not sure what this is." Green stared closely at the images before us while holding but not using a magnifying glass in his hand, "There is something here. It's not hot. May be cystic. It's too close to the midline to be a gallbladder, and it doesn't appear to be part of the liver. Liver and spleen both appear normal size. No mets in the liver, pretty homogeneous except for a little fatty infiltration."
"Pseudocyst?" I offered.
"That would be my guess. It's not an aneurysm; aorta looks fine the entire length. Let me do an ultrasound; then we'll see."
My beeper ticked off rapidly. I grabbed it off my belt to quiet it. The small display screen simply showed "ER."
"You won't do that till tomorrow, right?" I asked as I walked out. Looking back, I saw Green nod, throwing up a wave of his left hand. "Later!"
The ER is an unusual environment that is outside the normal experience of most humans, even the ones who work there. The air has a certain quality of staleness, and the colors are somehow off-white to pale green creating an unnatural blandness. Tension and chaos hang like a low fog with a medicinal smell that mesmerizes the brain. It's seductive and horrifying all at once. When you drive by the car accident on the street in a creeping flow of traffic, you have to look. You cannot maintain your forward gaze without feeling you missed something. The ER has that suspense, even when it is dead quiet to the point of boredom. It was only moderately busy as I came through the double doors at the north end. The view down the elongated hallway was of a couple people slowly going in and out of rooms with no sense of urgency.
As I approached the nurse's station, the ward clerk said emphatically, "Trauma-1," without looking up from her computer screen. Approaching the exam room, the sounds of movement and voices grew audible.
"Type and cross 10 units O- neg, portable chest and abdominal series, blood gas, set up for chest tube and gimme an 8-0 ET tube and suction. Peg, slow down your compressions." The last remark was directed at the nurse who stood on a stool so she could get high enough over a bloodied body to do CPR. Her little footstool was in a large puddle of blood. Hal Simmons, the ER doc, was moving to the head of the gurney, preparing to intubate as he barked at me.
"Two GSWs to the anterior Left chest. Only one exit wound. Twenty-six years old. Don't know how long he was down. Got two lines going, started in the field and only have a palpable pressure of seventy!"
As I slipped a disposable gown over my street clothes and readied my sterile gloves, a metal tray stand with the tools for a chest tube was pushed in place at the patient's left side. Hal had the laryngoscope in the guy's throat peering into pink froth hoping to see some vocal cords amidst the bloody secretions. "V-Fib!" the circulating nurse shouted while staring at the cardiac monitor.
I motioned for the defibrillator paddles, and grasped them, saying, "Two hundred!" Placing them on the front and side of a chest slippery with blood, I shouted, "Clear!" to deliver the convulsive blow to reset the heart's rhythm with a soft squeeze of the trigger. After the audible clack and thud of the machine, the body settled, the cardiographic tracing came across the monitor screen unchanged.
"One amp of epi and charge again. We'll go for the gusto," I said. Pausing for a couple of seconds waiting for the whining sound of the charging defibrillator to stop, I remained poised with paddles in place.
"Clear!" followed by the convulsive heave again. For another brief moment all eyes were fixed on the cardiac monitor waiting for the rhythm line to return. The slowly appearing waves on the monitor of a normal sinus rhythm allowed the whole room a momentary sigh of relief.
"No pressure with that," the nurse opposite me said.
"Hal, are you in, up there?" I asked.
"Yeah, but still no breath sounds on the left," he replied.
Staring at a moist glistening hole in the chest, I said, "Besides the hemo-pnemo on the left, I think he may have got the left ventricle with this one." I pointed to the entry wound along the left sternal border. The bullet's path had probably torn the lung apart, causing it to collapse like a flimsy balloon. Its continuing path had led it to the tip of the heart, piercing the most important part of the pump, the left ventricle.
"I'm going to crack him here and see if I can slow down the bleed, otherwise he'll never make it to OR anyway," At that point I knew we were on thin ice and may be too late. The extensive internal damage was fixable only if we could control the blood loss, which had already been substantial. Hopefully vital organs had not been deprived too long of oxygen before we stabilized the bleeding. We all knew the odds. There were no other choices on the menu at that moment.
"Rib spreaders!" Hal responded as he made his way around to the patient's right side.
"Scalpel," I asked. I saw a bottle of betadine within reach, which I grabbed and poured copiously over the guy's left chest and scrubbed with gauze pads for all of three seconds. If this guy survived the treatment, maybe he wouldn't get the inevitable infection. In my outward extended hand, a number ten scalpel was firmly slapped into my palm. Everything became a long-playing, slow-motion, virtually silent movie.
The rounded belly of the scalpel blade seemed to have eyes. Without hesitation one smooth pass of the glistening tool along the contour of the fourth rib silently opened a deep furrow. A second soft pass and the sharp blade opened the chest cavity. Blood flowed freely as the bullets had torn and damaged the lung, its life-giving fluid accumulating inside the chest.
"Suction," I heard myself say, focusing hard as if driving in the fog, hoping to get a glimpse of the bend in the road. On that same cue, Hal slipped the spreaders into the chest cavity; its ratcheting widened the view. The warmth on my probing hand as it entered the chest was familiar and oddly comfortable. Feeling for the firm movements of the heart before it could be seen; I found it’s throbbing in my hand reassuring. Already my little finger had slipped into a tight little hole at its apex.
"4-0 Prolene on a large needle." Again I heard my own voice as if I was only an observer. I knew with some awkward pressure from my left hand, elevating the heart slightly and some suction of the pool of blood by an assistant, I could over-sew the hole with just a couple strokes, closing the dam to the flood. After tying the knot and a snip of the thread from across the table, the pool of blood was reduced to a small puddle and ooze. The regular sinus rhythm still raced across the monitor. The pressure was back up to a detectable and audible level of seventy again.
"I think we can pack his chest and get him upstairs. Put some pressure on that infuser. Both IV's still going okay?" I asked.
"They're running fine," the nurse replied.
As my mind returned to its normal default speed of reality, I looked at the rest of the people in the room. The respiratory therapist to my right who controlled the lung's ventilation manually was temporarily smiling at me.
"Well done, lad." Hal said, from across the gurney.
The two nurses moving about the room seemed content and more relaxed in their movements. Two medical students against the far wall were statuesque as if they were uncertain whether they should be there, and a male nurse's aid was already throwing towels at the mess on the floor, trying to blot the considerable red tide. Half of the double door to the room rumbled opened as Doug Ravitz, cardiovascular surgeon, walked in with moderate pace. However, I never saw Doug in any other than the one speed.
"What'ya got?" he calmly asked.
"GSW x 2 to the chest, only one exit wound," Hal quipped.
"I over-sewed a hole in the L.V., but I left some work for you on his lung." I added, "No films yet, so I don't know where the second bullet is."
Doug flashed a quick sarcastic smile, like "Aren't you the comedian?" "Why don't we scoot upstairs, and we'll get them in the OR? You always have your hands in some kind of mess lately, eh, Pomeroy?"
A small satisfied smile came across my face as they started to move the gurney out of the room. I had been standing in the same puddle of blood for the last forty minutes. As the doors swung closed, I peeled off my gloves and red-splattered gown to wash my hands.
Joined by Hal at the sink, we shared the faucet to rub away the residuals of the mess.
"We haven't seen you around much lately," he said. Although my legal problems were common knowledge, not all the staff kept up with such titillating news. Obviously Hal did not. On the other hand, I wondered what Doug meant by his parting remarks.
~~~~~~
Chapter II
The late August sunset created a canopy of spectacular colors overhead. As we came about Brown Island heading west into Friday Harbor, the day's warmth was beginning to fade. The gulls rode an imperceptible breeze while a solitary eagle perched motionless, its baldness punctuated the dark green hillside. Wavelets against the port side hull and the low throaty gurgle of our gentle wake ushered us in closer to home. The mainsail, much like its sailors, lay crumpled and relaxed along the low profile of the deck and boom. The illumination of the cloud strata made the marina lights seem to twinkle as they came into view.
I gazed at Joyce, almost up at the bow, from my seat at the rudder arm. I felt her closeness even with thirty feet of boat and lots of breeze between us. I knew that moment was one I wanted to cherish, as I tried to memorize and savor every bit of it slowly unfolding. Our relationship was very special. Although not married, we had some special affinity for each other, sharing more interests than not. I'd seen many couples professionally, as well as friends, who didn't really fit together. It made me tentative about ever getting married. We both were quite capable types, independent, and accomplished in our professional roles. At that moment, we were one, with no distractions. It came easy and naturally. I wasn't much on the metaphysical, but the sense of destiny and correctness of my feelings for Joyce made me re-evaluate the spirituality in our lives. I studied her natural beauty and athletic appearance even though she was as coordinated in sports as two people in a three-legged sack race. I couldn't stifle the slight grin that edged over my face as I thought how much love we had together. I had virtually no memories prior to meeting Joyce. I had no regrets.
"Why should I?" I said out loud to myself. "It just doesn't get any better than this."
As if responding to some invisible cue, we both stood and gathered our lines and got into position. I stood at the stern to guide the boat's quiet drift into the dock for the last sixty yards, while Joyce dropped the fenders over the starboard side and continued to get the bowlines. It had grown dark quickly. The lights on the dock and up at the restaurant were already on. As Joyce bolted onto the dock to secure the bowlines, I reached out to grab the piling close to the stern.
I recalled the time I met Joyce.
"Hey, hun? Do you remember when we met in Boston? I felt like such a bozo! You virtually grabbed that record right out of my hand!" I said to her.
"What made you think of that?" she replied, as she rolled her eyes.
We both found an old, out-of-print recording of Ella Fitzgerald/Louis Armstrong at the same moment in a huge Boston record store. I loved old jazz even though I had trouble remembering the artist's names. I had been looking for a copy of that album for years. I was in town for a continuing medical education conference. Since I did some of my training in Boston, I still had some friends and colleagues in the area I looked forward to seeing. I really did not relish those conferences. Usually only thirty minutes out of a whole day of classes was actually worthwhile. My interest in the conference was really inspired by the trip to Boston. Joyce had just finished her nurse's training at one of the famous hospitals in the area. She was pretty much a hotshot herself, having quickly risen to a working position as director of one of the emergency rooms at a teaching hospital in Boston.
"Oh, what a great album!" she said as she snatched it from my hands. "I've always wanted to hear them together."
I was somewhat startled by her demeanor and just a little off balance by her stunning presence. Her jeans, rumpled long sleeve shirt, and hair loosely up in a clip made her appear like a woman on the go, but unconcerned about certain details of vanity. Her beauty was immediately striking to me in spite of her very casual appearance. I didn't quite know what to say. She was incredibly attractive, but that album was mine. It was as if fate had led me to this record bin once and for all to own one of the best jazz recordings ever made.