Skates, Spaldeens and Buster Browns

When I was a kid we lived in the Pomonok housing project in Flushing, Queens, a half hour’s subway ride from Times Square, long before the projects turned dangerous or the borough went Asian. The car-free playground just out the door always offered a glorious assortment of games, and after school I’d play punchball with a spaldeen, run bases, shoot marbles, play jacks, or jump rope with a clothesline chanting “Policeman policeman do your duty, Here comes Susie the American beauty” until my father whistled out the window or it was too dark to catch the ball, whichever came first. My usual means of transport was clamp-on roller skates.

Jack the Ice Cream Man, a neighborhood institution, didn’t only sell popsicles and chocolate marshmallow push-up sticks, he also organized races and yo-yo contests, with bird whistles and glow-in-the-dark plastic skulls as prizes.

Everyone stayed home from school on the Jewish holidays, even the black kids, with the exception of me and a few other red diaper babies unfortunate enough to have principled left-wing parents. I remember two ways a marginally better-off kid might lord it over the rest of us: to own a baseball glove, and to play potsy (that’s Queens for hopscotch) by tossing a red checker instead of the standard-issue bottlecap onto the squares.

There were other tomboys on the playground, but I was the only one who convinced my mother to let me wear boys’ shoes under my dresses – in the fifties that meant not sneakers but Buster Browns with leather soles – so I could run faster.

We had a piano for my father to play Bach, Mozart, and Count Basie. At age four I sat down on the stool like he did and slammed my open hands on the keyboard expecting music to come out – I still remember my shock at the cacophony! I got to start piano lessons afterward, learning to read notes about the same time I learned to read words.

In 1954 I was scheduled to be a guinea pig for the Salk polio vaccine but I hated injections (I still do, that’s why I’m so good at giving them). My mother spent hours giving me make-believe shots with a bobby pin so I wouldn't pull my arm away at the moment of truth. She told me I had to get used to needles because I would need them to take away the pain of having a baby – an issue fresh in her mind since my little brother was just two years old. At the last minute I caught a cold and didn't get the vaccine after all, disappointing everyone except myself.  When they taught us in medical school that some of those first batches hadn't been adequately inactivated and had given lots of kids paralytic polio, I took it as a sign of personal grace.

My health suffered no serious threats. Perpetual scabs adorned my knees – when my mother once hinted there would come a day when I would no longer have them, I didn’t believe her. I landed on my coccyx roller skating and couldn't sit down for a week, I split my chin open showing off at potsy, and there were warts to paint, but no broken bones and no appendicitis. I even managed to hang on to my tonsils.

Pomonok has changed some, but – according to one contented denizen recently – “Residents are born, raised, and never leave here!” So next time you hear anyone badmouthing “the projects” maybe you’ll remember my project: kiddie heaven.

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Convicts, Cons, Cosa Nostra

drawing by Suzanne Dunaway

In Italy as in Tony Soprano’s New Jersey, the garbage business is traditionally in the hands of the Mob.  

The ubiquity of organized crime is no surprise when it comes to Italy's South, cradle of the Mafia and its regional offshots. Nobody’s shocked to hear that the Calabrian ‘Ndrangeta runs hospital kitchens and has the corner on artificial limbs. It’s par for the course if Goodfella funeral directors wander the hospital wards in Naples with impunity in search of imminent cadavers to snatch, or if Sicilian regional administrators let public hospitals deteriorate so their Mafioso friends can build private ones. But when we read reports of Mafia-owned businesses getting the contracts to build and renovate hospitals in previously off-limits northern cities like Verona, Savona, and Milan, I for one find it frankly amazing.

Convicted Mafia bosses are always getting assigned to house arrest instead of prison on the grounds of ill-health. Failing which, they arrange transfers from jail to cushy private hospitals on trumped-up medical excuses. One easy trick is to buy off a surgeon to perform a biopsy and then switch the histological slides, so the pathologist will diagnose a healthy boss as having cancer. In my favorite case the gentleman had been passing himself off as a kidney dialysis patient. When a suspicious judge sent around an inspector to check with his own eyes that the near-death lab specimens came, indeed, from the man of honor, cooperative doctors rigged up a bag containing the blood of a real dialysis patient on the boss’s back and ran a catheter down through the sleeve of his hospital gown. That way a nurse who was in on the scam could by a little sleight of hand draw a diseased blood sample, in front of the inspector’s eyes, from the plastic tube instead of the vein. 

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Bargain Hunting

drawing by Suzanne Dunaway

My patient Gayle lived hand to mouth with an Italian mechanic boyfriend, her sole income selling homemade preserves at the weekly village market. She decided to consult me after giving up on her National Health Service General Practitioner: she’d been experiencing gnawing abdominal pain for months, then started having bloody diarrhea. It was obvious that she needed colonoscopy to figure out what was going on, and fast, but how was she to get one? Her local public hospital had an eight-month waiting list, and she couldn’t afford €900 to have it done in the private clinica I usually recommend.

Gayle asked around and found a cut-rate private operator who quoted her €250. I turned thumbs down at her doing such an invasive procedure with someone I didn’t know – I’ve seen too many colonoscopies gone wrong. Sometimes the doctor got only halfway up the colon and turned back. Other times he or she saw polyps but left them in place instead of removing them, or omitted biopsies that need doing. In the worst case, a hole was poked right through the bowel wall.

Next I asked my trusted gastroenterologist colleague whether he could get her hospitalized on the public ward where he worked. He rolled his eyes and told me his hospital was so short of beds that an ulcerative colitis patient of his was parked at that very moment in the Emergency Room hallway with a high fever, passing bloody diarrheal stools every hour, waiting for a hospital bed to open up and in the meantime getting no treatment at all. No chance that my patient, who was sick but not at death’s door, could get admitted.

For decades, there’s been a tug-of-war on between full-time National Health Service hospital doctors who want to supplement their salaries with private practice, and governments that aim to keep public medicine strictly public. An uneasy compromise lets hospital docs see paying patients, but – theoretically – only inside the hospital. This has been dubbed intramoenia, Latin for within the walls. If you get a colonoscopy on the public system you’ll pay next to nothing, but unless you arrange it a year ahead of time you’ll feel every painful twist of the tube. If you do your colonoscopy privately in the same hospital, with the same gastroenterologist, in intramoenia, an anesthesiologist will be glad to knock you out for the duration.

In their battle to hold on to outside offices, the physicians have found strange bedfellows in the left-wing hospital workers’ trade union, which opposes on principle the mixing of public and private medicine on hospital grounds. Both groups have been appeased by a sleight-of-hand redefinition of “hospital grounds” that can stretch to include offices anywhere in town…

Back to Gayle. My trusted colleague eventually came up with a splendid solution: he referred her to his own trusted colleague who did the exam on intramoenia three weeks later for €450, about what Gayle and her boyfriend could scrape together. The diagnosis? Crohn’s disease, which now that it had been diagnosed could be treated perfectly well in the public system where she doesn’t have to pay a penny. Much of my professional life is spent helping patients run this kind of daily slalom between public and private medicine. Quite a job in its own right.

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