Urine was spraying into the air, while my fellow-intern at Morrisania Hospital in the South Bronx stood by holding a bladder catheter ready for use. Water retention due to heart failure had poor Mr. Jones’s body so swollen from the waist down that the business end of his urinary system was buried in edema, and the high-dose diuretic we had shot into his vein only made matters worse by turning him into a human fountain. My job, which I confess was complicated by spasms of laughter, was to squeeze away the excess fluid from his foreskin so my similarly incapacitated colleague could have a chance at finding the hole.
This may have been the only time I laughed out loud in three years of hospital duty as a resident specializing in internal medicine. A more typical form of emotional self-expression was crying in the stairwell.
We eventually managed to get the catheter in, stop giggling, and retire to our on-call rooms for a few hours sleep. It was only at morning rounds, presenting the case to our team, that we caught on to what was really going on with Mr. Jones. His problem lay as much in his isolation as in his heart: for weeks, while his legs ballooned progressively from human to elephant proportions, he had been holed up in his single-room-occupancy digs without any human contact, before his landlady happened to knock at his door, see the state he was in, and call an ambulance.
During my medical training in 1970s New York City we saw patients like that all the time, so bereft of social connections that they could slide downhill toward end-stage disease, or into the grave, without anybody pushing them to seek medical care. I’ll never forget one 17-year-old heroin addict, infected by a dirty needle, who lay in septic coma for five days on the floor of her studio apartment, before a sister chanced to stop by just in time to save her life. In Italy, where as Luigi Barzini said the only fundamental institution is the family, a teenager would never be abandoned like that to her own resources. Here, even junkies bring their dirty laundry home on Sunday for mamma to wash.
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