3. et al

Amazingly Grollman found the lab immediately to his right without mishap. It was much longer than wide. East-west it was about 15 feet; north-south it ran 40 feet. As Grollman entered he noticed three marble tables each of which had a microscope above it mounted on a metal column. There were four people in the room. Three seemed to be working, the fourth was pacing with his hands behind his back and his face pointed at the floor. When he saw Grollman’s shoes he stopped and looked up at him. He had to spend several seconds to go from the floor to Grollman’s face because the latter was almost a foot taller. When their eyes met so acute was the angle between the smaller man’s occiput and the vertical that he fell backwards. To prevent collapse he put out his right hand which lodged in a sink full of rat carcasses.

“Yuck, yuck, yuck,” he said with much emotion as he pulled his hand away. “Towel, towel, towel,” he continued.

Grollman looked for a towel or its substitute without result. Nobody else deviated from their slow routine. With a show of regained dignity the short man wiped his hand on the backside of his pants.

“You must be the new man,” he said with generous condescension.” “Gabriele Adorno Diestro,” he said introducing himself. He held out his gory hand.

Grollman looked for an escape from the handshake. Finding none he offered his fingertips, which he withdrew at the instant of contact. Then the name registered; he immediately heard Cielo di stelle orbato in his head.

“Are you a tenor?” he asked in a small fit of reflex.

Diestro smiled, but Grollman could not tell if he understood the question. “Call me Gabby.”

“Thank God it’s not Ishmael. You like the bulls?” Grollman saw a swirl of magenta. He was convulsed by a storm of mixed literary metaphors.

“You’ll do the osmolalities,” said Gabby unaffected by Grollman’s cultural confusion.

Grollman recombobulated himself and so missed Diestro’s command. “Milt said I should find something to do in here. Got any idea what he meant?”

“You have Alport’s syndrome? I said do the osmolalities.”

Grollman figured he was referring to deafness rather than renal disease and got pissed off, but he didn’t say anything.

“I’m not just talking about ordinary osmolalities either. I mean micro-osmolalities. Ten nanoliters. Use that.” He pointed and a wooden box which was just behind Grollman. “Harvey will teach you how.” He then pointed to a 35 year old man who was smoking a cigarette while peering into the innermost of the three microscopes, which was surrounded by bilious smoke. Harvey gave no sign he heard Gabby’s pronunciamento. Gabby resumed his intense contemplative pacing leaving Grollman standing in the middle of the lab like a floor lamp with a burned out bulb.

After 20 minutes, which seemed like at least 20 minutes, he left the lab. The only other place in the medical center that he could find was the cafeteria. So he went back to it hoping it would be open, though it was still a little early for lunch. It was. There was one person sitting at a table; it was black Milton, the policeman or security guard or whatever he was. He saw Grollman before Grollman saw him and waved at his former client while grinning like a desert sunset. Grollman walked to the table and sat down across from him.

“What’s good?”

“Here?” replied black Milton. “Nothing. Do you like ribs?”

Grollman didn’t know, but not wanting to admit it he said yes.

“Good, let’s go to Mabel’s.”

“Not Mabel Stuart?”

“I thought you were new around here. How’d you know about Mabel’s?”

Though filled with panic, he tried to appear nonchalant. “She famous in Chicago. Maybe we can go some other time. I need to be back in the lab in a few minutes.”

There was no escape; the lab and his place in it would have to be fixed. So he went back.

Gabby was still pacing, his right hand thrust into his partially unbuttoned shirt. Grollman thought that preemptive attack would get him the farthest.

“Why do you have a girl’s name?”

Gabby stopped as if he had been give an ice water enema. Then he turned and started to make a sweeping gesture with his right hand, but stuck as it was in his shirt he tore off its buttoned buttons and wrenched his shirt tails free from his pants; they flapped once and died by his side.

“Gabriele is masculine in Italian,”

“But you’re not Italian.” Grollman guessed that Gabby was Spanish or a derivative.

“Of course not. I’m Cuban.”

“So why do you have a girl’s name?”

“My uncle was Italian.”

“On which side?”

“My mother’s.”

“Doesn’t that make her Italian too?” Grollman was delighted with the way the conversation was going.

Gabby thought for a moment. His incarnadined face got even redder. “He was her half brother. What’s that got to do with any of this anyway? I’m a Cuban with an Italian name; a masculine name. Didn’t I tell you to do the micro-osmolalities?”

Grollman decided to go along with the command rather than face two years of oscillating between standing in the lab and avoiding Mabel Stuart’s restaurant.

“How do I do ‘em?”

“I told you. Harvey will teach you.”

Harvey showed no sign of taking his face away from the microscope or removing the cigarette from his mouth.

“When?”

“Before the Messiah returns.” He started fiddling with his disarrayed shirt.

He was about to declare that there could be no second coming without a first arrival, but Gabby was too occupied with his chemise. He walked over to the nimbus that surrounded Harvey. He stood over him expecting a reaction. Getting none, he blew hard on the circle of smoke.

“You in there?”

Harvey puffed several times on his cigarette hoping to reestablish his smoky shroud. But Grollman blew it away as fast as Harvey conjured it.

“Ok, I’ll show you how to do the micro-osmolalities,” said Harvey, sighing smoke.

“Why?” asked Grollman.

“I thought you wanted to learn.”

“Why am I supposed to do them?”

“I don’t know. Why does anybody do anything around here?”

“Aren’t they done as part of an experiment?” asked Grollman.

“Sure, everything here is part of an experiment,” said Harvey.

“Well, what’s the experiment?”

“I don’t know. I just work here.”

“Oh, you’re just…. you’re a technician.”

“Yeah, I’m just a technician.”

“Then what’s he?” Grollman pointed at Gabby who was still absorbed in his blouse.”

“He’s just a fellow,” said Harvey.

“Isn’t that interesting,” said Grollman.

“No it’s not,” said Harvey walking to the wooden box that Grollman presumed was the gadget that measured micro-osmolalities.

Harvey spent five minutes telling Grollman how to run the machine. “I’ll give you a few control samples to practice on, then I’ll give you some real stuff.” He walked back to his microscope.

Grollman looked at the machine with same lack of comprehension he showed when he examined his first patient. He was going to be given a micro-tube containing less urine than a desert flea with acute renal failure could make in an hour. He was supposed to put the tube into a micro-holder inside the wooden box. A microscope was focused on the spot where the tube was to go. Dry ice was then to be introduced to the box. Grollman was then to watch for the appearance of the first crystal in the micro-tube. When it formed he was to note the temperature on the thermometer that was alongside the micro-tube. It looked like the kind his mother had frequently rammed up his rectum whenever he was pretending to be sick in a sometimes successful attempt to avoid going to school. If you knew the freezing point of the fluid, you could calculate its osmolality.

Distilled water freezes at zero degrees centigrade. One mole of glucose, or anything else that dissociates into one particle in solution, lowers the freezing point 1.86 C. Salt which dissociates into two particles, sodium and chloride, lowers the freezing point 2 X 1.86 degrees. Thus a mole of glucose in solution yields 1 osmole or 1000 milliosmoles. One mole of salt gives 2 osmoles.

That was the theory, but as always there was fine print. The calculation just given was for conditions of standard temperature and pressure. In addition to knowing the depression of freezing point in his microsolutions, he had to know the atmospheric pressure and the temperature at the time he made his measurement. Harvey gave him a card which told how to correct for deviations from standard temperature and pressure.

The Lance Method for Calculating Osmolality

1. Measure the temperature in the room
2. Measure atmospheric pressure
3. Call your mother and ask her if her arthritis is
bothering her if the atmospheric pressure is less
than that in Nome
4. Boil an egg until hard-boiled
5. Eat the egg
6. Measure the freezing point of the water you boiled
the egg in 10 minutes after measuring that of your
sample
7. Subtract this value from that of your sample
if your mother’s arthritis is acting up and Nome is
in a high pressure trough
8. Ignore 7 if your mother is pain free
9. Divide the atmospheric pressure corrected for your
mother’s arthritis by 760 corrected for the
corrected temperature divided by 0 minus the
difference between the temperature in Dallas
subtracted from that in Mineralwater divided into
the observed osmolality provided that the
corrected osmolality is more than 300. If less
than 300 add 300 and use that number.
10. Take this number and add 500
11. Plot this number on the graph of expected results
12. Use if less than 2 standard deviations from the mean
13. If more than two standard deviations, repeat the
experiment

Reading the card filled Grollman with a sense of awe and wonder. Maybe he was on his way the becoming a scientist. After two hours of messing with the micro-osmometer, which was what the wooden box was called by the cognoscenti, he wondered whether theoretical science might be more fitting to his talents. The catch was that there were lots of problems getting the contraption to work. First, you had to take the very tiny tube holding the fluid you were going to freeze in a very tiny forceps which you stuck in the machine using the blunt instrument that is the hand. Looking through the microscope you tried to locate the tube and place it in the receptacle which was supposed to keep it in the scope’s field of view. Since everything was magnified the micro-tube jumped around like a drunken flea fed speed. Every time Grollman’s heart beat the tube bucked out of sight. Then there was the crystal formation problem. One second there was no crystal; an instant later all the fluid in the micropipette froze and shattered the minute glass filament. On average it took Grollman an hour to get one of the tubes in view. He decided to modify the process and use the temperature he observed when the pipette broke. The “break temp” he dubbed it feeling that this name would enhance the scientific value of his observation.

Several days later he had about a dozen numbers written in a little notebook that had suddenly materialized next to his micro-osmometer. He then went into a small library next to Dr Walker’s office that was used exclusively by the renal fellows. He took out the card containing Lance’s directions on how to calculate the corrected osmolality.

“Shit,” he said as he realized that he had measured neither the atmospheric pressure nor the temperature as he was making his observations.

“What’s wrong?” asked Tim Stuart who was reading the Wall Street Journal. Stuart had finished an endocrine fellowship and was taking a research year in the renal lab working on the effects of vitamin D on claw growth in the hind limbs of thyroparathyroidectomized rats with chronic renal failure. Being an endocrinologist, he was barely tolerated by any of the renal staff or trainees. Endocrinologists were felt by nephrologists to be effete.

“I didn’t measure the temperature or atmospheric pressure when I made my measurements.

“They conned you into doing the micro-osmolalities, didn’t they?”

Grollman looked at him suspiciously. He didn’t like the word “conned”. “Whadda ya mean conned?” He didn’t consider who “they” were.

“Just use today’s temperature and pressure. It hasn’t changed much in the last week.”

Grollman thought for a moment and then decided Stuart was right.

“How’s your mother’s arthritis?” asked Stuart with a smirk. “You’d better call her.”

“Shit.” Grollman hadn’t called his mother in more than a month. He knew she was going to give him the business when he did so he didn’t. But now he had to. “Can I call on the departments dime?” he asked Stuart.

“I don’t see why not,” he answered. “Everyone else always does. And this is official business.”

Grollman almost went for the phone that was on the window ledge, but decided that he’d better do his groveling in private – so he went home.

“Hi Mom, this is Richard.”

“Who?”

He knew what she was up to and had a plan ready for this contingency.

“Oh, I must have the wrong number. Sorry.”

“Richard, If you hang up I’ll never speak to you again.”

“Promise?”

“How can you say that to your mother. Until you went to Chicago you were such a dutiful son.”

“I was never a dutiful son. Your other son is the dutiful son. What’s his name again?”

“Why don’t you ever call him?”

“Mom, I never call you. Why should I call him?”

“What do you think my friends would say if they knew you hardly ever call. You know, I have to lie to them and make up imaginary calls from you.”

“What do I say?”

“Don’t you love me? I’m so proud of you.”

“Of course, I love you. You are the Winston Churchill of mothers.” That sounded good so she decided to let the matter drop, for now. What he meant was that in a crisis she was unbeatable, but when thing were going well she was best rusticated and avoided.

“So, how’s your arthritis?” He couldn’t think of any way to segue into the subject.

“What arthritis? I don’t have arthritis. You know that. Why did you ask me that?”

Grollman was thrown into a panic. He knew what do if her arthritis was flaring or was in remission, but he was unprepared for its nonexistence.

“Are you sure you don’t have arthritis? I always assumed you did.”

“Richard, what is this obsession you have about rheumatology? I thought you were going to be a urologist.”

“A nephrologist.” He knew she was saying that to bug him, but it worked anyway.

“Sure. How do you spell that?”

“What?”

“What you just said. What kind of a word is that any way?”

“Greek.”

“Ology is Greek?”

“I don’t know.”

“Well it’s not.”

“How do you know.”

“From Scrabble. It’s Middle English.”

“It is?”

“Yes. And I’m coming to visit you next week.”

“You are?

“Yes.”

“Will you have arthritis by then?”

“No, I’m never going to have arthritis. But I do have bursitis.”

“Is it bothering you?”

“Only when I play tennis.”

“You don’t play tennis.”

“I know. I made a joke.”

“So can I assume that your bursitis is not bothering you at this instant?”

“If you want.”

“That’s what I want.”

“That’s ok by me as long as you call me at least once a week.”

“Why are you coming to visit?”

“Don’t you want to see your mother?”

“Is that a trick question?”

“Richard, stop it.”

“Sorry. But you never came to see me the whole four years I was in Chicago.”

“That’s because Chicago is a real city – almost.” Mrs Grollman thought only New York was a real city. “But Mineralwasser,” she pronounced the w like a v.

“Mineralwater.”

“What kind of a cockamamie name is that?”

“I don’t know.” It was clear that she was winning.

“No matter, I arrive a week from today on American flight 232 at 2:32 PM. I can take a cab. Give me directions.”

War would ensue if he let her take a cab. “I’ll meet you,” he said.

“Good. You want me to bring some lox and bagels? How about some chocolate bit pie?” He was appalled by the idea of her schlepping a ton of food on the plane with her, but lox and bagels and chocolate bit pie sounded good. And he knew she’d do it regardless of what he said. So he said nothing. “Is there anything else you want to tell me?” she asked. Again he said nothing. “Do you love me?”

The second iteration of that question was the signal that the conversation was over. He bit his lip and said, rather softly, “I love you.”

“What?”

“What son doesn’t love his mother?”

“That’s an answer?” She hung up.

When his pulse had fallen to less than 100, he decided that the putative inactivity of her bursitis would substitute for the absence of arthritis.

Now that he thought he had all the information necessary to calculate the corrected osmolality from his raw data, he sat by the glass table with an umbrella in its center that served as his dining room table. On it he placed 12 colored pencils, two bubble gum erasers, a compass, a protractor, a slide rule, two reams of multicolored paper, a large box of Goobers, a package of petite-sized Kleenex, a Waterman fountain pen that had been a Bar Mitzvah gift and which had mysteriously surfaced for the first time in 16 years that morning, an unopened bottle of Mineralwater generic ink which he had filched from the Department of Medicine’s supply cabinet, a 12 inch wooden ruler, a pad of graph paper also filched from the well stocked cabinet, the libretto to I Masnadieri, a magnifying glass, a jar of Vaseline, 16 pennies, a comb lacking two teeth, a pencil sharpener, and a note that read “American flight 232, 2:32 PM. Next Wednesday.” Next to it was a skull and crossbones.

Suitably accoutered he opened his note book to the page that had his data and removed the card that had the Lance Method on it. He read the card carefully and then looked at his numbers. He didn’t know the atmospheric pressure in Nome. He decided it must be the same as Mineralwater, which he forgot he also didn’t know. There wasn’t an egg in the apartment and even if there were one, he couldn’t measure the freezing point of the water he would have boiled it in because he had neglected to buy a micro-osmometer from Melvin’s. So he plugged another assumption into his Rube Goldberg scheme. He called the weather bureau and got the temperatures in both Dallas and Mineralwater forgetting that it was a different date from those during which he had made his measurements.

At last he was ready to make his calculations. He sharpened four pencils and stared at the directions on the card Harvey had given him. He sharpened another pencil and looked at the card again. He kept sharpening and looking until he ran out of unsharpened pencils. Then he got up and got a bowl of cornflakes. He stared some more while eating the cereal which he had covered with four tablespoons of sugar. This is as bad as Gross Anatomy, he thought while turning as red as Gabby Adorno had when he told him he had a girl’s name.

Dr Walker had returned from Tibet and Milton Lance had decided to take a break from his piano lesson after Bubbles had disappointed him. She had preemptively announced that the deal with Milt was off because she wouldn’t screw an uncircumcised man. Milt was the only uncircumcised member of the Department of Medicine. The upshot of all these simultaneous sensations was that a nephrology research conference had been called for Friday afternoon at 4.

“Friday afternoon,” Frank Another – like Grollman a new first year fellow – complained to Gabby and Grollman when the conference was announced. “Who has a research conference late on Friday afternoon?”

“Gonna interfere with your golf game?” asked Gabby. Another didn’t reply. “And by the way, present your micro-osmolality data to Milt and Dr Walker,” he said to Grollman with a faint smirk that made him look taller.

Grollman gathered his crisply sharpened colored pencils and went into his bedroom trying to figure a way not to look like a moron at his first research conference. The rest of the stuff on the table remained there for a month.

The research conference began precisely late. Dr Walker was on hold trying to talk to the Deputy Surgeon General of the Army who was desperately trying to avoid him. Walker had recently returned from a tour of all the army’s medical facilities in Europe – just before he had gone to Tibet, that is. The Deputy Surgeon General had sent him there because the phone lines between the European hospitals and the Pentagon were down and the general reasoned that he would be safe from Walker’s constant telephonic harangues about the medical corp’s overall shitty organization in general and its lousy retention rate of doctors in particular. He was right. Walker had been unable to get him on the phone for the whole four weeks he was in Germany. Naturally he couldn’t reach him from Tibet. Back in Mineralwater he wasted no time in calling the beleaguered major general several times a day. Milt had forgotten about the conference and was playing golf. Frank Another has been sent to fetch him. Gabby Adorno was also not yet there. He had gone to the airport to greet a new renal fellow who due in from Madrid.

Grollman sat at the table in the library next to Dr Walker’s office with the other renal fellows and Dr Irvin Trucker waiting for something to happen. Grollman’s head was covered by a black cloud, a real peasouper. He felt more like a nephologist than a nephrologist. That morning he had gone on rounds with Dr Trucker and those renal fellows who could be persuaded to show up at 7 AM.

Trucker had graduated from Mineralwater in the same class with Milton Lance. And though he was several years older than Milt, he was junior to him in the academic pecking order. He was still an assistant professor, while Milt had recently become an associate professor. Though extraordinarily bright and knowledgeable, he was intimidated by Milt and awed by Dr Walker. He made up for this by being a real dork to everyone else. He was so mean that everybody liked him.

At exactly 7 AM everybody met in the cafeteria to drink coffee for an hour. Grollman didn’t know who his fellow rounders were and didn’t soon find out because no one talked. After 60 minutes of scowling into his coffee cup, Trucker got up and headed for the elevator leaving everybody bobbing in his wake. Grollman was the next to last bob and almost missed the morning’s last elevator to the medicine floor.

Dealy Hospital was Mineralwater’s county hospital. It served as the teaching hospital for the medical school. The hospital’s governing board and officers were appointed by the county commissioners who controlled its budget. This arrangement saved the state the expense of building a teaching hospital for the medical school and ensured that the school and the hospital would hate each other until good triumphed over evil, until the lion lay down with the lamb, and until congress went on a kosher diet. The school’s faculty provided free medical care for the indigent patients that filled all of Dealy’s beds. The school was still years from realizing how screwed it was by the one-sided contract it had signed years ago with the hospital.

William Black was one of two clinical fellows. His job was to present the patients he had seen over the previous week that needed faculty input or who he thought had some teaching value. Grollman’s fellow bobbers were a gang of students, medical residents, and a few research fellows seeking a respite from veterinary medicine.

“The patient is a 27 year old man who was admitted to Dealy Hospital 10 days ago with a chief complaint of mid-epigastric pain. He was observed on the surgical service for 3 days. During that time his temperature spiked to 102⁰. A week ago he developed board like abdominal rigidity and was taken to the operating room where he was found to have a perforated appendix. The appendix was removed, numerous drains were left in place, and he was started on gentamicin – 7mg/kg. The next day his creatinine, which had been 1.0, was 2.1. His IV fluids were increased to 6 liters a day, but his creatinine rose to 3.2. Following an IVP he became oliguric. His fluids were increased to 8 liters a day, perhaps more the I & Os are not complete. We were consulted last night because his creatinine was 12.0. The physical exam is remarkable for a BP of 212/140, a pulse of 120, bilateral rales, and anasarca. Noteworthy labs in addition to the creatinine, are a BUN of 210, a CO₂ of 14 (his anion gap is 26), and an albumin of 1.3. He needs dialysis and fluid restriction, which is why I transferred him here”

Grollman was very impressed by the robust succinctness of Black’s presentation. Trucker’s mien did not suggest that he was impressed. He looked like Vesuvius in 79 AD.

“Transfer him to Howard Johnson’s,” said Trucker so indistinctly that Grollman involuntarily said “What?”

“I said transfer him to the fucking Howard Johnson,” screamed the incensed nephrologist with such energy that the large blue vein running perpendicularly down his violet forehead seemed certain to rupture. Grollman was genuinely startled. He had never heard an internist say “fuck” in a public part of a hospital. Maybe nephrologists weren’t really internists, he thought – not for the last time. No one else seemed to pay any mind to the outburst including the nurses, clerks, and attendants who were within earshot, which was everyone one the floor. Grollman didn’t get the context of sending someone to Howard Johnson’s until he remembered that the firm had motels in this part of the country in addition to the ice cream parlors he was used to.

“$12 a night including TV and breakfast,” said Trucker his engorged vein receding a bit. “No antibiotics, no X-ray dye, no fucking fluid overload.”

Bill Black had been a resident at Dealy so he calmly waited out the tirade. Expletives aside, Grollman recognized the problem as well as Trucker. The surgeons had missed an acute appendix, but that happened even to the best of breed, they then compounded the problem by giving the patient a large dose of a nephrotoxic antibiotic, double compounded it by continuing the dose as the patients renal function went south, triple compounded it by giving him contrast dye which finished off what little kidney function he had left, and then put the cherry on the sundae by infusing enough saline to launch a destroyer.

When it appeared that Trucker had run out of wrath, Black tweaked him by remarking, “The surgeons want to know why he has renal failure and congestive heart failure.”

Herculaneum buried, it was now Pompeii’s turn. “Because a surgeon does not have a cerebral cortex. Because….”

Before he could complete his rant, Biff Bullock, a fourth year surgical resident ambled by. Whadda ya think about our boy? Does he need more fluids?”

The eruption miraculously ceased, Trucker smiled like a seraph and said, “No, I think a little dialysis will fix him up. Bullock, who had been a linebacker at Ohio State, nodded gravely and left the uncomfortable quarters of the medicine floor.

“Stupid son of a bitch,” said Trucker as soon as the surgeon was gone. “He probably was a football player. So, why haven’t you started to dialyze him?” he asked Black.

When renal rounds ended, Black began arranging the patient’s dialysis. The attending who was to supervise the procedure was Sinbad Washir, a Lebanese immigrant who had just finished his fellowship and was now the most junior member of the renal faculty.

Trucker, Lance, and Walker above all, considered dialysis déclassé. It wasn’t as sexy as doing experiments on animals. It required patient contact. And, most important, they didn’t know how to do it. Thus Washir. He had taken his residency as well as his fellowship at Mineralwater. He was of average height, far above the average intelligence of academic nephrologists, was recently divorced, and wore a sporty mustache on odd numbered days.

Grollman, he wasn’t sure his presence was needed, went to the dialysis room where he joined Washir, a nurse, a technician, Black, Henry Allen (the other clinical fellow), a few anonymous persons, and presumably the patient – though Grollman couldn’t find him among the medical chorus gathered around a large gleaming stainless steel object that looked like one of the industrial strength dishwashers he had used when working his way through college. The small room reminded him of the ship cabin scene in A Night at the Opera.

“Here, dump this in the bath,” someone said to Grollman. Two hands gave him a large plastic bag of the type that might contain fertilizer.

“What bath?” No one answered. Left on his own, he eventually noticed a green garden hose filling the dishwasher.

“Are you going to eat it or will you dump it into the bath?” asked a different voice. He tried to tear the bag open, but it stretched without tearing. Yet another hand appeared and grabbed the bag. Grollman involuntarily tightened his grip on the manure sack. The latest hand withdrew into the crowd around the dishwasher the stretched piece of sack slinking after it like an ever narrowing sliver of Turkish toffee. At last the suspense and the bag broke simultaneously followed by a splash.

“God damn it Warren, get your ass out of there.”

Grollman didn’t recognize the voice nor did he know who Warren was. As the manure was potentially out of the bag, he tried to find his way to the bath and carry out his task. But the bag was snatched away. Then he heard what sounded like a giant Alka-Seltzer fizzing in a colossal glass. This effect produced a large wooden oar which passed overhead until it reached the invisible bath. Several hands were visible using it to stir the solution that presumably had been added to the dishwasher. A series of commands followed, none of them directed at Grollman.

“Put this in.”

“Ok.”

“No not there.”

“Where does this go?”

“Ouch! Watch where you put that.”

“Jesus Christ you’re a moron.”

“Does this go on the venous or the arterial side?”

“Does anyone have a hemostat?” Silence. “OK, just crimp it.”

“Where’s the electrical outlet in here.”

“I can’t find the patient.”

“I’m over here.”

Grollman was seized by the same feeling that had propelled him out of the OR about five years ago and left the room determined henceforth to be a theoretical dialyzer. He spent the rest of the day trying to massage his pitiful numbers into something that would not disgrace him at his first research conference.

At 4:20 Milt arrived, still wearing his plus fours and spiked shoes. Ten minutes later Walker followed his furrowed brow into the room.

“Whadda ya got,” he asked Bill Black..

“We’re still recruiting patients.”

Walker’s furrows furrowed. “I think you need to infuse the calcium from midnight to 2 AM.”

Grollman, though he had no idea what Walker was talking about, was glad he was not a clinical fellow. Then he panicked ; could his boss invent rat experiments that required nocturnal execution? Black somehow maintained his composure. Walker next looked at Washir who looked back at him without blinking. After 30 seconds of locked looks Sinbad blinked and then started to babble.

“I have the 24 hour calcium excretion, but the phosphates got lost. I did the urea balances and corrected for the creatinine excretions. Tim has the samples for PTH measurement.” Stuart was at the end of the table opposite from walker surreptitiously reading the Wall Street Journal. He blinked, but didn’t look up at the mention of his name. “I’m going to collect more samples for phosphate measurement.”

Grollman was as unenlightened about Sinbad’s work as he was about Black’s. Everybody, except him seemed gainfully active. He felt a controllable urge to call the Nome weather bureau.

Lance who sat just to Walker’s left opened his eyes for a moment, but left his hands clasped over his abdomen. He looked at Sinbad and then at Walker. The latter sensed his gaze and accordingly felt compelled to hold forth on phosphate metabolism. He brilliantly described Fuller Albright’s major contributions to metabolism in general and phosphate in particular. He also mentioned that Albright’s niece had been the first American woman to win an Olympic gold medal in figure skating in 1956 and that like her uncle she too had graduated from Harvard Medical School. Then he focused on chronic renal failure and PTH release.

“Though PTH release is increased in renal failure, it still follows a diurnal rhythm. It peaks at 12 AM, at least in the central time zone. That’s why Billy has to infuse calcium precisely at the stroke of midnight. That’s when we’ll see the biggest fall in urinary phosphate excretion.”

Walker looked as pleased as The Prince of Darkness at a wine tasting party in a Baptist church. Black radiated impassivity of such intensity that Grollman averted his gaze from Black’s blank look. Then a roll of distant thunder came from Lance. It gradually grew louder until everyone in the room realized that Lance was speaking.

“Bullshit.” The consonants and vowels were so drawn out that it took 10 seconds for Lance to roar the word.

Grollman was shocked beyond anything in his experience. Walker looked startled. “What did you say?” he asked.

“Bullshit.” This time there was a flash of lightning before the sound which in its turn reverberated around the room for 15 seconds.

Walker turned to Lance and hurled a rejoinder at him faster than Sandy Koufax’s fastest pitch. It was the start of Walpurgisnacht. “Bullshit bullshit.”

Quicker than an itch, Lance fired back, “Bullshit bullshit bullshit.”

“Bullshit bullshit bullshit bullshit” was followed by “bullshit bullshit bullshit bullshit bullshit,” etc.

And so the two best minds in American nephrology threw wicked barbs at each other in ever increasing tonnage threatening to last beyond the end of recorded time had not Gabriele Adorno Diestro rushed into the room breathless and red-cheeked. Grollman was sorry to see the debate end as he was taken with the subtlety and intricacy of their arguments.

“Did you get him?” asked Walker as if he and Lance had just been discussing whether it was cheaper to ship fertilizer via the US mail versus UPS. He was referring to the new Spanish fellow Gabby had been detailed to retrieve from the airport.

“Yes,” answered Gabby who then remained mute. An attitude that was so unusual for him that everyone in the room, including Walker, began to squirm as though suddenly infected with malignant Shpilkes.

Finally, Walker who could endure a thousand “bullshits” better than silence, asked, “How’s his English?”

More unendurable silence. Even (especially) Gabby was affected; he then began to chatter. “His Spanish is very good.” The new Spanish fellow, Juan Pablo Mercado, had been sold by his chief in Madrid (a source of free tapas when Walker was in Iberia) as fluent in English. He was also in possession of a stipend from The Spanish Government alleged to be sufficient to meet all his needs while in training in America. Thus, Walker saw him in the same frame as Grollman – free labor. “He has a wife. She’s very pregnant. She also speaks very good Spanish. His stipend is in pesetas. Five hundred a month. He has no place to live.”

Tim Stuart surreptitiously looked up the exchange rate in his Wall Street Journal while Gabby was jabbering and then whistled.

“What did you say, Tim?” asked Walker. “Didn’t I tell you not to bring that in here?” Gabby, I expect you to fix this for me,” said Walker deciding to let the Journal slide to another day. “You won’t let me down, will you?”

“Dr Walker, 500 pesetas won’t even pay part of the rent.” The declaration was a dagger to the chief’s heart.

“I’ll supplement it. He…. they….won’t starve.” He looked calm, but inside a blender was liquefying his intestines.

Gabby started to depict another problem, but Walker stopped him before he could emit a sound. “Gabriele,” he pronounced the name Gab-ree-el, accenting each syllable equally as well as elongating each one for at least a second, “I’ve done my part now it’s up to you to take care of them. You do speak Spanish.” It was a statement not a question. It’s logic, however, was lost on both Grollman and Gabby.

Suddenly, Grollman realized that Dr Walker had a New York accent. In fact, it was a Brooklyn accent. What the hell is he doing out here? he thought. Then he thought about himself and laughed quietly.

“What’s so funny?” asked Walker in an unfriendly tone.

Grollman decided that silence would serve him best, but Walker kept looking at him in expectation of an answer.

Gabby sensed a chance to permanently direct the interrogatories to someone else; he said, “Tell us about your micro-osmolality data, Rich.”

“You have data already. Didn’t you just start, Robert?”

“Richard.”

“Don’t contradict me during the research conference.” Grollman sensed that the boss wouldn’t allow contradiction outside the conference either. “So show me what you got.”

Everybody, except the other first year fellows, started to giggle like school girls at a wake. Walker looked around the room, then he saw the card on which Grollman had copied the Lance Method. He got up, walked to Grollman’s spot at the desk, grabbed the card, tore into tiny pieces and dropped them in Grollman’s lap. Suddenly Grollman realized that no one had asked his name.