Lacrimae Rerum

It was twenty minutes before dawn, and, although the sky was half-lit, the narrow valley remained dark and shadowy. The trail leading down to the river and footbridge had not been groomed since the last blizzard and David M – saw that it was icy. Although he had chains wrapped around his boots, he suspected that the steep switchbacks grooving the hillside would be too slippery to traverse and he didn’t want to risk a fall. No one was around – the homes on the river bluffs behind him were mostly dark and the streets deserted. Across the river, the town stood on a terrace above the black waters – someone was walking a dog there, precariously picking a way through patches of ice. A lamp still shone above the dumpster next to the old building that had once been a train station but was now a single’s bar. One car was stopped at the red light on Main Street. A mile away the freeway throbbed with early risers driving to work.

David M – followed the foot path on the hilltop. A dog let out to do its business barked at him from a fenced backyard. The trail was level and crossed the empty fields between School for the Blind and the Medium Security Prison. The wind had cut the snow into elegant porpoise-shaped drifts and the hollows on the hill were blue with shadowy ice. The sun was rising when he came to the railroad trestle and, then, the highway bridge slanting down to cross the valley. As he hiked across the bridge, the buckles of his chains clattering on the concrete, a couple cars passed him. One of his patients recognized him and pulled to stop next to where he was walking on the bridge.

"Do you want a ride, Doc?" the man in the car asked.

"No, I am walking a little for my health," David M – said. "But thank you anyway."

The driver nodded to him and continued on his way.

David M – thought about his medical practice. He remembered patients that he had seen twenty-five years before. Of course, they were almost all dead now. In the end, everyone died notwithstanding his best efforts. The cemeteries around town, he imagined, were full of his former patients. Death wasn’t a thing to be avoided. It could only be delayed.

The sidewalks in town were glazed with ice from a recent thaw. A couple times he slipped, but the chains on his boots kept him from falling.

The hospital and clinic stood next to the campus of the bible college. A carillon hidden in the concrete filigree of the Bible College tower sounded – the bells played a hymn that David M – recognized but couldn’t identify. Shift change was underway at the hospital and the new nurses on-duty were taking report from the night-shift. The parking lot was alive with people coming and going.

David M – stopped at the cafeteria in the hospital. He bought a large cup of coffee and a chocolate chip muffin. It was his custom to spend the first 45 minutes of his work-day reading case-studies in medical journals. He took off his coat and boots and put on a pair of shoes that he kept under his desk. Then, he sat down with a bound print copy of The New England Journal of Medicine, took a pen from his breast pocket and set an opened ledger next to the periodical. He wrote a few notes in the ledger as he read. On the shelf above his desk, there were thirty ledger books, all of them filled with his notes but covered with dust because he never looked at them, indeed, didn’t even touch them after the volume was put away.

Case 23 - 1683 was documented in the medical records of Massachusetts General Hospital and entitled Copious aseptic discharge bilaterally through fistulous apex of olecranon. David M – cocked his head and began to read. From time to time, he stroked his chin and made notes in his ledger.

The account was a collaboration between a Hospitalist at Mass Gen, two interns in internal medicine and orthopedic surgery respectively and two board-certified physicians, also an internal medicine specialist and orthopedic surgeon. David M – speculated as to which specialist had written which paragraph or sentence, suspecting, of course, that the prose by the orthopedic doctors would be clumsy, grandiose and rife with solecisms. But the editors of the periodical had, apparently, combed the prose so carefully that it was entirely without idiosyncrasy, a text that seemed to have been translated not once, but two or three times successively from completely unrelated foreign languages. It was the sort of prose that a space alien might write.

In fact, most of the report was written by a second-year resident in internal medicine, Evgeny Sugata. Evgeny was the eldest son of Russian Jews who had emigrated to the United States in 1988 when he was only one year old. His parents settled in Brooklyn and were both quickly disenchanted with life in the United States. The Jewish community in the neighborhood was very orthodox and conservative – but Evgeny’s parents were secular and didn’t attend the synagogue. Evgeny’s mother had been a gynecologist with a substantial practice in Leningrad; his father was a cardiologist. Neither of his parents spoke English when they came to the United States and they had difficulties with the language. Evgeny’s father drove cab to support the family and came home each day exhausted from fighting the traffic in the city. On a couple of occasions, he was mugged and beaten. Sometimes, drunken passengers threatened the cab driver or insulted him and this seemed a grave indignity to the older man who had, in fact, been a prominent physician in his native land. Evgeny’s mother had things worse – she was afraid of the neighborhood where the family lived and, so, she kept to herself and would not leave the apartment unaccompanied. People knew that she had been a gynecologist and, after a while, she began performing abortions for girls in the neighborhood. But one of those operations resulted in an infection and, then, death and, so, Evgeny’s mother was prosecuted for practicing medicine without a license. She pled guilty to the charge and spend two months in jail; part of her plea was that she agreed to never re-apply for a medical license in the United States. This aspect of the sentence she experienced as a profound insult and indignity – in her heart, she knew that she had been a capable, generous, and caring physician. One day, she said that she was going to visit a relative on Staten Island. She bought a ticket for the ferry but never arrived at her destination. A couple days later a featureless corpse washed up near Rockaway Beach wearing her clothes.

Evgeny’s father was broken by his wife’s death. He ignored his family, now consisting of Evgeny and his little sister, Sophia. Alcohol ravaged the family and Sophia was taken from the home to be raised by her Aunt on Staten Island. Finally, Evgeny’s father bought a one-way ticket to Moscow and went back to Russia without saying goodbye to his twenty-year old son, then, attending Columbia on a scholarship and enrolled in pre-med classes. The whole story was too complicated to tell and, so, Evgeny simply said that he was an orphan and, even, implied that his parents had died in a pogrom of some kind in Russia. One of his girlfriends said: "I don’t know how you’ve been so successful in school with this terrible tragedy in your family." Evgeny told her: "I’m an immigrant. I don’t have time for grief or sorrow. My children, I suppose, will mourn all this misfortune – I don’t have time." Later, his girlfriend accused Evgeny of being cold and, even, emotionally shallow: "If you won’t shed a tear for your parents and your sister, I’m pretty sure, you won’t have much compassion for me." Evgeny told her that his life would be lived in opposition to what happened to his parents:

"I will succeed where they failed." "I am revenging them," Evgeny said.

A professor at medical school encouraged Evgeny to consider writing case-studies to advance his career. "A case-study in a peer-reviewed journal" the professor said, "is quite a feather in your cap." Accordingly, Evgeny kept notes on some of his patients. His ambition was to have an article bearing his name published in the New England Journal of Medicine.

After graduating from Columbia, Evgeny commenced a residency in Internal Medicine at Mass General. It was there that he met Farrington W– . At the time of his illness, Farrington was living in Fall River, but had been raised West Roxbury, an elite neighborhood in Boston. Evgeny recognized the surname – most people living in Massachusetts would have read about Farrington’s family from time to time in the financial and social pages in the newspaper. Of course, Evgeny dutifully concealed the identity of his well-known patient. The case study begins: "A 24 year-old WM presented to his dermatologist with symptoms of psoriasis bilaterally at the apex of each oleocranon. The erythematous papules showed copious joint effusion. Fluid cultured from the discharge sites was aseptic and saline with trace amounts of lysomal enzymes as well as amylase. Treatment with topical cortisone and ultra-violet radiation was unsuccessful. Thereafter, systemic corticosteroids were prescribed without any long-term benefit to the patient. A course of methotrexate followed, also without any apparent benefit. The patient was referred to Massachusetts General Hospital where skin biopsy studies were conducted."

One of the key words searchable under the case study abstract is "tropical infections". To understand that reference, additional case history data is required.

Evgeny saw Farrington W– sitting on an white-papered examination table. He was slender with a sardonic smile. At first, Evgeny thought that he was homosexual but his somewhat affected, slightly British accent was an artifact of his education and status. He was blonde with bushy eyebrows that were remarkable fair, almost white. His eyes were blue and he had no discernible lips, merely a very slightly purplish trace outlining his mouth. When Evegeny looked at this tongue and uvula, he noticed that Farrington’s teeth were perfect, straight as little pale soldiers standing guard over pink gums – the order in his mouth seemed implausible, obviously the result of very expensive orthodontic treatments and dentistry. Evgeny noted that the patient was height-weight proportionate with narrow shoulders and narrower hips. His fingers were long, pale, and delicate. When he stretched them forth to itch at his inflamed elbows, Farrington’s fingertips had the aspect of a blind man’s fingers tentatively stroking a page pimpled with braille.

"My elbows have this wicked itch," Farrington said, groaning a little at his use of the word "wicked."

He tilted his shoulders upward so that Evgeny could examine his elbows. At the apex of both elbow bones, the olecranon, Evgeny observed a puffy reddish inflamation around the crater of a small urethral opening. Colorless fluid was oozing from the opening.

"This is fistulous," Evgeny said.

"Fabulous, you say," Farrington responded.

Evgeny probed both openings with a stainless steel sound. Farrington winced but didn’t complain of pain.

The discharge from the points of both elbows was copious, wetting the tissue on the examination table. Evgeny captured some samples of the discharge. It was both colorless and odorless with a slightly viscous or slimy texture.

Farrington had first noticed symptoms about four months earlier, a couple weeks after a trip to Bimini in the Bahamas.

It was not his first trip to Bimini. Farrington’s father had bank accounts on the islands and, in fact, was involved in some sort of business involving currency exchange. "Don’t ask me about it," Farrington said. "I never grasped what exactly my father did and, in fact, it was understood not to discuss that subject either publicly or privately."

Evgeny nodded.

It seemed that his father had been injured while using a jet-ski rented to him at the resort where he was staying. Some barrels were floating in the cove, mostly submerged, and the jet-ski crashed aground on them. Farrington’s father was flung clear but suffered a painful back injury. On the telephone, his father said that he had two compression fractures that were untreated except for a corset that he was wearing. "I will get my back fixed in Miami," his father said. He told Farrington that he had to facilitate an exchange and that, due to his injuries, he couldn’t accomplish this transfer. "So I need you to come down and make the transfer."

Farrington asked him why the transaction couldn’t be accomplished by a wire or some other electronic means. "You don’t understand," his father replied. He told him that a plane ticket was waiting for him at the airport in Boston.

Farrington flew to Nassau and stayed overnight in a hotel in Cable Beach. The next morning, he took a cab to the airport and where the once-daily flight to Bimini was scheduled to depart. The airline was called "Flamingo" and the little propeller-driven plane was painted a bright pink color. The sky was clear and cloudless to the far horizons and the archipelago of islands was spread below on an ocean dabbed and swathed with every imaginable tint of blue. Some of the islands were densely encrusted with houses and the lagoons were streaked with the wakes of speed boats. Other islands were uninhabited, swaddled in mangrove swamps or dissolving around the edges into dunes of lime-colored sand.

The plane landed on the North Island of Bimini. Farrington’s father was staying at an All-Inclusive on a pine-shadowed cove. The resort’s bar and restaurant were floating on pontoons in the limpid water. His father was confined to his room, propped half-upright on a mound of pillows. A cinnamon-colored nurse seemed to be staying with him or in the adjacent room. The older man looked haggard and his complexion was grey with streak of red flaring in his cheeks. He was drinking vodka and medicated so that he slurred his words. He explained the transfer to Farrington.

This case history need not be burdened with unnecessary detail, particularly when it doesn’t pertain directly to the syndrome at issue. It suffices to note that there was a rental car located in the resort’s parking lot and that, at a certain time, just as the sun was setting, Farrington was to drive the vehicle to a shed in Alice Town. Farrington’s father sketched the route from memory.

No one reminded Farrington that he had to drive the SUV on the left side of the road. The steering wheel and transmission were on the left side of the car just as you would expect in Massachusetts and, so, Farrington forgot the local rules of the road and almost crashed within the first 300 meters of his mission. But he recovered, made his way to Alice Town and found the shed, a rusting metal building with a badly storm-damaged roof located next to a particularly murky-looking slip. A big commercial fishing boat was moored there and some men wearing sunglasses notwithstanding the darkness – the sun had set en route to Alice Town – were standing next to the vessel. A couple men helped Farrington lug several heavy boxes from the back of the SUV to the boat. There were no introductions and Farrington didn’t say anything to the men at the slip. Driving back to the resort, Farrington was blinded by the oncoming headlights, coming at the front of the car from an unfamiliar angle, and he felt very dizzy – the air was humid and smelled of rot and crab-sized bugs with wings were buzzing around the street lamps.

The next day, Farrington drove his father to Alice Town. The nurse directed him to a baseball diamond on the edge of town and, after a few minutes, a helicopter appeared marked with insignia of a Miami hospital. The helicopter landed about where the shortstop would be positioned during a game. The nurse helped him into the ‘copter and it levitated over the pitcher’s mound, flattening some of the tall grass in the outfield with its rotor-wash. Then, the helicopter climbed and set out across the ocean.

Farrington drove the nurse into town and let her off at the clinic. He returned the rental car because he found that driving on the left side of the highway was disconcerting. A cab brought him back to the resort. His father had rented the room for a week and he had a couple days remaining at the All-Inclusive.

That night, at the floating bar, Farrington talked to an attractive young woman. She smelled slightly of cocoa-nut butter lotion and had braided hair that the sun seemed to be brightening to the color of corn-bread. The girl let Farrington buy her a few drinks. She said that she was a guest at the All-Inclusive but that her companion had jilted her.

"That show’s poor taste," Farrington said.

The drinks were watery and didn’t pack much punch. But the spongy floor of the floating bar was a little had to navigate. The sun set was too glorious: it brayed at them, orange and purple, like a hundred trumpets.

Farrington asked her about her date.

"It’s complicated," the girl said.

Farrington suggested that they go for a walk on the beach. "Too many bugs," she said. She told him that she had a reservation to visit the island’s famous "healing hole", a freshwater spring where the mineral-laden waters were supposedly medicinal. "It’s supposed to be wonderfully relaxing," the girl said. She told him that Ponce de Leon had discovered the spring and that it was reputed to be the Fountain of Youth. Farrington asked her to come to his room. "Have to leave early tomorrow on the excursion," the girl said. "You should go with me." Her name was Mandy.

"What’s early?" Farrington asked.

"Ten o’clock," she said.

"That’s not early," Farrington replied.

"Speak for yourself," Mandy said.

The next morning, he met Mandy at the dock. She was wearing a sleek black one-piece bathing suit and had wrapped her hips in a big, orange towel. "Where’s your swimming suit?" Mandy asked. "I didn’t bring one," he said. "You’re gonna skinny-dip?" Mandy asked. "I’ll swim in my underpants," Farrington told her.

An old woman wearing a windbreaker but with bare legs met them on the dock. A big black man with a round barrel-chest skillfully slid a flat-bottomed boat beside the dock. The black man’s head was shaved bald and glistened in the sun. He was very, very dark so that his features were hidden in the gloom except for the shark-flash of his teeth and the whites of his eyes were like the flames of an acetylene torch. The man spoke with a slight Scottish accent and his "r"-sounds were round with the roll of his brogue. Farrington thought to himself that the guide sounded like a suave and deadly villain in an old James Bond movie.

The old woman in the jacket, Mandy, and Farrington boarded the shallow-draft boat.

"We have to make time here," the James Bond villain guide said. "You can only reach the Hole at mid-tide."

The three tourists sat at the front of the boat and the guide fired the engine so that they flew out of the cove and around the point of land where some palm trees were embedded in big boulders all white with bird-lime. They followed the pale sand beach to a place where it began to dissolve into reefs of wet gravel interspersed with great half-drowned ranks of mangrove trees. After a while, there was no trace of the beach at all and flat-bottomed boat was whirring through a channel surrounded by bushes that seemed to float on the salt swamp water. The canal beneath them looked pale and milky and the mangroves were green, heaped with leaves on spidery branches that rested atop a crooked tangled of bare roots. The roots were like puzzles embedded in the swamp-water, reaching down to the pale, white-veined sand at the bottom of the channel. The whole floating jungle, with its water and labyrinth of narrow canals, changed color every time a cloud crosse the sun and dimmed the light – in the sun, the mangrove swamp glittered and raw, salt-encrusted roots seemed fragile and dead, but when the shadows slipped over the watery landscape the leaves on the trees looked grey and the water changed to the color of brown silt and the crouching tangles of roots looked animate, tense and coiled as if ready to spring.

A couple of times, they stopped in the channel, at wider places where there was space to swim, and the tourists jumped in the water. It looked as if the water was very shallow, only a couple feet deep, but where they slid into the sea, the water was deep enough to swallow them to the neck.

After a half hour gliding through the swamp, the guide stopped the boat, shut off the outboard, and moored the vessel to a tree.

"Here we go by foot," he said. A hundred feet ahead of them another flat-bottomed boat was bobbing in the channel, also anchored to the roots of mangrove.

"Are you kidding me?" Mandy said.

"It’s not far," the guide said.

"By foot?" she asked.

"We wade," the guide said.

The water was waist-deep, brackish, and warm as bath water. They followed the guide along a narrow opening between the closely clustered trees. At times, branches gathered over them as a canopy and they had to duck and swim with their chins in the water to keep from being scratched by tangle of tree above. Once, a big pelican-like bird stirred up directly ahead of them and flew skyward, dangling down legs like a serpent’s body. A fat greenish spider sat on one of the branches that they glided under.

The swamp-bottom was sandy with dead leaves that, sometimes, swirled in fragments up and around them so it seemed that they were splashing forward in tea.

The guide stopped. They heard voices. For a moment, it was uncanny, a vibrating hum in the tangle of mangrove trees. "Om Vashrahani Uum." The chant continued. The guide dramatically drew apart a veil of mangrove branches. The hole was elliptical, roughly the shape of a pear, although this was something you gathered only by measuring out the spring with your body. The water smelled faintly of sulphur and it was suddenly, startlingly cold – there was no gradient between the soup-warm lagoon water and the scrotum-tightening chill of the spring boiling up in the middle of the swamp. Four women were arranged on their backs, floating on surface of the hole, and they made a pattern like an Escher print, interlocked arms and legs. The women were wearing bathing caps and yellow suits and floating with their eyes closed, chanting at the sky. A skinny charcoal-colored tour-guide wearing a baseball cap and soccer jersey stood at the opposite edge of the spring.

After a few minutes, the women floating on their backs stopped chanting and dropped their feet to the sandy bottom of the hole. Cold currents brushed their shins and calves, as if icy fish were finning by them. The more they splashed and moved the more the air reeked of sulphur. The women apologized and bowed to them and, then, their guide led them back toward the main channel.

"It’s nothing like I imagined," Mandy said.

The trees dangled branches down very low, so that they had to wiggle through them, and the cold draft of water rising from below numbed their feet and thighs. The water was chest-deep and they crouched to submerge themselves in the spring. The guide opened his mouth and swallowed some of the water although he spit it out.

"It will heal you," the guide said. "It will make healthy and strong."

He began to sing the hymn "Amazing Grace." His big bald black head made him look like a seal.

After he was done singing, Farrington and the old lady clapped. The old lady said that the spring water was rejuvenating – "I don’t feel a year older than fifty," she said.

Then, they turned and waded back to the flat-bottomed boat. The guide pulled out a cooler and offered them each a beer, Dockyard Pale Ale. The old lady and Farrington sipped the beer. He had a bottle of tequila in the cooler as well. Mandy said she would like to drink a few shots and so he handed her the bottle.

On the way back to the resort, the guide pointed out a bronze monument to Martin Luther King, several unusual birds standing on one leg on a mud-flat, and a large skinny fish with the hide of an alligator – it was some kind of salt-water sturgeon. A frog jumped from a lily pad and landed in the bottom of the boat. Later, Farrington told Evgeny that he had touched the frog and, then, possibly brought his hands up to his mouth while sipping the beer. He denied intentionally drinking water from the spring although he said that some drops might have got in his mouth. He had some suspicious-looking insect bites that he discovered on his buttocks and shoulders after the trip through the mangrove swamp but they healed right away.

At the resort dock, Farrington told the guide, whose name was Baron, to wait there so that he could go to his room to get him a tip. "No, sir," Baron said. "It’s all-inclusive."

"I want to tip you," Farrington said.

"If you wish," Baron replied. But when Farrington came back to the dock with a 20 dollar bill, the guide was gone.

That night, Farrington hooked-up with Mandy. Mandy said that normally she charged for her services but, in his case, it was "already bought and paid for." She told Farrington that she was returning to Miami the next morning. Farrington told Evgeny that he used a condom when he had intercourse with her. Mandy said that the water of the spring was evidently good for your skin – she told Farrington that her C-section scar was almost invisible after bathing in the "healing hole" and that some stretch-marks on her upper thighs had simply vanished.

Farrington took the Flamingo flight back to Nassau at noon and, then, returned to Boston.

About two months after his trip to Bimini, police executed a pre-dawn raid on the West Roxbury home where Farrington’s father was living. Computers and financial records were seized and Farrrington’s father, who was then encased in body cast, was briefly taken into custody. Farrington’s mother called him to say that she suspected all phone lines connecting to the West Roxbury address were tapped.

At the same time, Farrington noticed a reddish rash at the points of both of his elbows. The rash was uncomfortably itchy and Farrington scratched at his skin until his fingernails were specked with blood. He consulted with a general practictioner who suspected that the inflammation was some form of contact dermatitis. The GP told him to change his shower soup and use a different laundry detergent. Farrington was given some topical salves and told to return in ten days.

Farrington was living in Brooklyn at that time, part of a team of writers providing comedy material to a late night TV show. He worked out in the gym four times a week. In the gym, he wore athletic tape wrapped around his elbows and told his trainer that he had a susceptibility to bursitis and elbow dislocation – "it happened when I was playing tennis last year," he said. He didn’t want others to see his elbows because they were red, scabbed over where his fingernails had cut his skin, and the inflammation was puffy and purulent. One day, after exercising, Farrington noticed that he had trouble pulling his shirt on over his biceps. Those muscles seemed to have become hypertrophic. He wasn’t conscious of doing a lot of exercises to build muscle mass in his upper arms and so this puzzled him. Furthermore, his enlarged bicep didn’t feel hard and muscular – instead, there was a swampy, puffy feeling to the muscle.

Farrington met his mother at a delicatessen near JFK. She told him that she was now under indictment and that she suspected the federal government of threatening her with prison as a way of inducing a guilty plea from his father.

"I’ll be next," Farrington told her. He put his fingers to his eyes, expecting to find his cheeks wet with tears, but no moisture was there. The itching in his elbows was maddening him.

"What do you mean?" his mother asked him. Farrington said that he didn’t want to tell her.

"The lawyer says that it will all work out," she told Farrington.

Farrington was wearing a long-sleeve shirt and the cloth at the elbows was soaked with discharge.

A few more weeks passed. Farrington saw a dermatologist who suggested that that elbow inflammation was some sort of parasitic infection. An intravenous infusion of antibiotics was administered. Medi-honey leptospermum gel was applied to the wound and sterile dressings were wrapped around both elbows. Farrington had to change the dressings three-times a day and this was difficult for him to accomplish without help. He was ashamed of the condition and felt that it was stigmatizing and, so, he had to attend to the wound on his own.

One night, he was performing some new material in comedy club in the East Village. Farrington had written some jokes about his father, whom he called "the Racketeer." The show was stressful and some of the material flopped and, while he debating the gags with a heckler, the dressing on his left arm ruptured. A flood of warm, slippery fluid poured down his forearm. At first, Farrington thought that a blood vessel had torn and that he was bleeding to death. The colorless fluid spilled off his finger tips and when he moved his hands droplets were flung in all directions. People in the front tables leaned back in their chairs because Farrington seemed to be dissolving and melting before their eyes. So much fluid poured out of his left elbow that his shirt was soaked and a puddle formed on the floor and, when he cut short his routine, and tried to exit the stage, he slipped in the fluid and fell. Some people in the audience thought this was an intentional pratfall and guffawed. Farrington went back stage and found that his left bicep muscle seemed deflated and slack. When he flexed his arm, fluid squirted from the tip of his elbow. The next morning, Farrington awoke in a bed awash with fluid. His right elbow was squirting fluid into his sheets and mattress whenever he moved his arm.

Farrington took the train to Boston where he had several friends in medical school. One of his friends was interning with Evgeny at Mass General and it was, at that place, that the discharge though his elbows was treated.

Evgeny’s treatment, supervised by several senior doctors, involved draining and electro-cauterizing the interior of the cysts located bilaterally in the tissue of his biceps. The course of therapy was complex and involved skin auto-grafts. By the time of the trial in Federal Court of Farrington’s father, drainage through fistulas had been controlled and Farrington was well on his way toward recovery. His mother told him to keep his distance from his father and not attend the trial. When he next saw his father, he had been released on bond pending his appeal of the jury verdict against him. Farrington’s father looked exceedingly weak and thin – he seemed to be in a great deal of pain from the compression fractures that he sustained in the Bermudas. Farrington saw him at a restaurant in a famous hotel in Boston where they met for lunch. While they were eating, a man came up and tried to take their picture. Farrington stood and punched the man in the face. The journalist was expelled. He waited outside on the sidewalk and, when Farrington came outside, the photo-journalist swung his camera tripod into his face and broke his nose. Farrington sat on the curb, holding his smashed nose between his thumb and forefingers, dizzy and waiting for an ambulance. A month later, Farrington’s father committed suicide.

Evgeny published two more case studies after the note about Farrington. The first of these studies was printed in the Journal for Infectious Diseases, peer-reviewed and very highly regarded. The article was entitled "On a possible correlation between Fruit Bat Syndrome and infectious hemorrhagic fever." Evgeny was invited to the World Health Organization’s International Conference on Infectious Disease Control in Geneva, Switzerland where he presented his Fruit Bat paper. After that presentation, Evgeny became a post-doctoral research fellow at the Mayo Clinic in Rochester, Minnesota. After two years at the Mayo Clinic, Evgeny was terminated and ignominiously marched to this car by Mayo Clinic security. Another researcher had discovered that Evgeny had falsified the data in his laboratory work and key microbiological studies reported in the Fruit Bat paper could not be reliably replicated. A statistician retrospectively reviewing Evgeny’s data concluded that his mathematical analysis was flawed, although it was unclear whether the errors in the management of that data were due inadvertence (as opposed to intentional falsification) or simply the result of unchecked confirmation bias. Evgeny’s claim that he had personally visited several sub-Saharan African countries could not be independently verified.

Evgeny’s third case-study was published on-line in the proceedings of Revitalization – the Journal of Rejuvenation. This study was not peer-reviewed. The title for the article as "The Use of Embryonic collagen as an anti-oxidizing dermatological agent." Evgeny currently directs a research laboratory at Shanghai for Aveda, a wholly owned subsidiary of the Estee Lauder Companies.

When his coffee cup was empty and the chocolate chip muffin reduced to a scatter of moist crumbs on the desk, David M – closed the bound volume of The New England Journal of Medicine and replaced it on the shelf. He put down his ballpoint pen and set aside his ledger book. He swept up the crumbs and muffin wrapper and threw them in a waste-basket. Then, he put on his white lab jacket.

The hospitalist on-duty knocked on the door to the office and, then, entered.

"Always studying?" the on-duty hospitalist said.

"Indeed," David M – replied.

"Anything of note?"

"I read four notes," David M – said, "they were mostly unilluminating except one about Poland Syndrome. It’s a congenital asymmetrical weakness of the chest."

"From Poland?"

"No," David M – replied. "It’s an eponym."

The on-duty hospitalist handed David M – the census. The patients were listed in order of the perceived severity of their illness. The census was high and several of the cases demanding. Mid-winter in this climate is cruel: you count yourself lucky if you survive until Spring without pneumonia or flu or a bad fall on the ice. The cold and dark had driven several patients mad.

David M – looked at the chart material showing vital signs, blood-work and, then, tests, and took report on those patients whose conditions seemed to be deteriorating. He made notes on 3 by 5 cards that he arranged in an array in his black log book.

"I’ve got more than an hour of charting," the on-duty hospitalist said.

"Well, I’m off – " David M – said, rising to start his rounds.

David M –‘s shift was 36 hours. When he left the hospital, the weather had changed and a warm, wet wind was blowing. The moon was low and bright enough to cast deep blue shadows. The ice in the narrow valley had thawed and David M – crossed the black river on the footbridge among the bare trees. Rafts of ice under the bridge groaned and there were jams where the stream was tightly braided so that sheets of dark flood water stretched between the bends in the river. His boots wrapped in chain gripped on the upward trail and he reached the bluffs overlooking the river with no difficulty.

David M -- was tired but felt radiant and ennobled by the work that he had completed. Death had been kept at bay – at least, during his shift at the hospital. His home was warm and quiet. He drank a bottle of Belgian beer before retiring to his bed.