A Practical Decision

Andrew Jeromski
The Fifth Dentist

“You see William, it’s a practical decision. “In truth, it would probably utterly ruin your family, your survival would,” added the doctor.

The sun was starting to slip behind the rooftops of the boulevard when William took his leave of the company and walked outside through the silt-clouded glass door.

“A fine Friday indeed,” he thought to himself, checking the time on his watch.

Yet another relentless week of back-breaking labor behind him, William was in high spirits. There was coin in the pocket and beer in the belly and the earthly cares of a day-laborer seemed as far away as the opulence of Princes and Kings. The streets were cast in evening’s artificial glow: it was always more pleasant to William on Fridays.

He thrust both his hands into the pockets of his worn black woolen great-coat, and with the right began probing for his tobacco pouch. Locating his prize, he began to roll a small pinch of the dark leaf into a crudely formed cigarette as he casually sauntered towards the drowsy sanctum of the terribly small and crowded flat he shared with his wife and young son.

He whistled a tune that they sang earlier that evening amidst the end-week revelry of his fellow day-laborers; it was a jaunty tune, and William–safe within the unassailable walls of recent imbibery–made it even more so with his treatment.

There were many men out of work, and it was not at all unusual to happen upon those who had taken to soliciting charity from the steady flow of foot traffic that passed along the busier streets. There were laws against this sort of thing of course, for the benefit of the wealthier classes, but for the most part, if a vagrant shown no outward signs of mental instability and kept his genitals out of view, he could expect a relatively small and infrequent amount of trouble from the local constabulary.

William passed by them all the time. Sometimes he dropped a coin or two into their cups, other times he didn’t. He never spoke to them.

This night, perhaps because of the slight bacchanalian glow he was wearing, William took offense at the presence of the dark shape huddled low to the sidewalk–unmistakable as that of a beggar–ahead of him on the boulevard. When the inevitable assertions of hardship came, followed by the ensuing call for a modest donation, he felt inclined to challenge the drifter.

“You say I should give you money, because you can’t afford medicine for your sick children,” railed William. “But my friend, I ask you: why should I, a simple day-laborer earning scarcely enough for my own family, give any of what little I have to you? I’m sorry that your children are sick, truly I am, but I must look out for my own.

“Besides,” he continued. “There is said to be a marvelous healthcare system in this land, though personally I do not really know, as I am only a recent arrival here. However, my son took ill shortly after we came, and he received treatment … even though we have no health insurance … what I really mean to say is, don’t you think that perhaps your time and efforts would be put to better use trying to find an honest job, rather than looking for handouts? Times are difficult here, this is true, but there is still work to be had for a man who pulls his weight.”

The dark shape shifted, and removed the ratty hood of an old hooded sweat shirt, revealing a coarse head of black hair and a face that, to William, looked Indian, or perhaps middle-eastern. He experienced a sensation near the base of his brain stem, and were he not so addled and insulated by drink, he would have immediately recognized it as a pang of regret for not simply passing this homeless man without reply, like all the others.

“You ask me why you should give for my children when you have your own, and to this, I offer no answer,” said the man. “I‘m new to this land also: in my country, I was a surgeon. I was fairly well-to-do, and provided a good life for my family. When the revolution came, we were forced to flee. Now they say all my schooling does not count, that I must do it all again at a university here if I wish to resume my practice.”

William thought for a moment, and then replied.

“Yes I agree, that does seem unfair, and it must be terribly frustrating. Still, why not take even a menial job? Just to bring in money for med …”

The man, now standing and a full head taller than William, cut him off mid-sentence.

“No! You don’t understand,” he bellowed, eyes aglow and irate. “My children are very sick! Whatever money I could earn, it wouldn’t be enough! I … I am … not used to desperation; I have never before felt a force as compelling as that which now moves me!”

The glow of the ale completely gave way to a growing sense of apprehension towards the unhinged manner the beggar was assuming, and William was becoming more and more resolved to walk away and extricate himself from the matter entirely. He made cursory gestures in this regard before the vagrant gripped him by the shoulder. Any lingering effects of the brew were now completely surrendered to fear at the sight of the large knife the man now held with his other hand.

“I only asked for help,” he said in an angry tone. “But you, a mere day-laborer, must lecture me like a child!”

The man made an aggressive grab for his wallet, and instinctively William moved to stop him. The beggar froze. He stood still in a moment that seemed to last longer than every other, breathing hard and bursting with incredulity. He glared at William with rage and plunged the knife into his gut.

William fell to the ground; the man took his wallet and the contents of the great-coat–some important documents, a passport, work-visa and the gold pocket-watch his grandfather had given him a few months before he passed away. The vagrant stood, grim and stoic, over the motionless mound for a moment and then ran off down the boulevard.

There were witnesses, several as it happens. However, as city protocol demanded, they walked on, not wanting to get involved in the affairs of the potentially insane and clearly dangerous. No one called the police. Stories of violent retaliation against witnesses were no rarer than the homeless.

The pain was sharp and abrupt; William yelled out at first, upon the initial act, but quickly gave himself over to his self-preservation instinct and lay perfectly still and silent until he was sure his assailant was gone. He felt the blood flowing from the wound, and for a moment, was a little surprised he wasn’t already dead. Quickly assessing his position, William’s main concerns were twofold: try to stop, or at least slow down, the bleeding, and get to a hospital right away.

When he first tried to reach for the great coat, which was just a bit out of his grasp and required stretching to retrieve, William yelped with pain at the act of attempting to extend his body. He was forced to drag himself the foot and a half or so into a position where he could collect the jacket without crippling pain, and upon doing so, set about fashioning a makeshift tourniquet from the great-coat. He knew it wouldn’t do much, and wouldn’t do it for long. He had to move. Either that, or sit right there and die on the boulevard. William had been in his adopted land long enough to realize that he didn’t want to place his life in the hands of the crude, thuggish police and paramedics if he could at all avoid it. Besides, it was a hand of blackjack whether they would come at all and the dealer was definitely showing an ace.

With considerable difficulty, he managed to get himself upright and, braced with a hand against the front of one of the brick-fronted row houses that lined the boulevard, began the daunting task of getting himself to the hospital. His jury-rigged bandage succeeded in slowing down the bleeding to some degree, and though he was still losing blood, William felt like he could now make it a ways at least without dropping dead.

He only knew where one hospital was, but luckily it wasn’t very far away. City Hospital, his wife had taken their son in the first week they arrived when he developed a high fever. William had met them there the moment he could free himself from work. He had taken extra shifts at his job for three months afterwards to pay the bill. It was just a few blocks past his home; the sprawling campus of the city’s privately-owned public hospital was hard to miss, as it utterly dominated the surrounding landscape and caused a traffic snarl worthy of even the most congested metropolis at each rush hour.

Being still early evening, William passed many groups of people along the way. Some looked as though they were on their way home from work, while others looked as if they were just out for a stroll. The common thread: nobody paid him the slightest mind. Just your garden-variety robbery victim, slowly bleeding to death on the city sidewalk. Many would silently nudge each other and whisper after he went by. He was aware of them being aware of him, but none offered even the slightest measure of aid. Some would cross the street at his approach, and some climbed into cars which could have conveyed him to the hospital in mere moments. No one acknowledged him at all.

When after an arduous and painful journey he finally came within sight of the towering edifice of City Hospital, William was staggered by the immensity of it. He was relieved to have made it, but noticed that it looked very different from the last time he was there. The sign that came into view as he passed the first gate, moving towards the main entrance offered an explanation: “Please pardon our appearance while we are remodeling,” it read. It looked as though they were finished. There were some piles of torn down staging and scaffolding near a fenced off area that was labeled as “Property of Metropolitan Construction,” other than that there were no outward signs of ongoing renovations. William found that he had considerably more strength now that he was at the hospital, and apparently safe.

“Surely, I will be all right now,” he thought as he crossed through the courtyard that led to the hospital’s giant glass doors.

It was with obvious difficulty that William endeavored to open one of the tall doors, and he was surprised when a smartly-clad doorkeeper leapt from someplace unseen to help him.

“Let me get that for you sir,” said the doorkeeper with a broad, friendly grin. “My name is Phillip, please do not hesitate to ask me if you need anything.”

William nodded with astonishment. He hadn’t known what to expect here, since the time his wife had brought in his young son they were already picking up the prescription at the pharmacy when he finally arrived. To say he was stunned by the grandiosity of the hospital’s main reception area would be a grievous miscarriage of reality. William was absolutely floored. The stories he heard all seemed far short of the glorious splendor that was the decorously appointed lobby of City Hospital: there were spectacular chandeliers dangling austerely from the magisterial high-ceilings, and a horde of attendants of every rank and description buzzing about the room, looking after the patients as though each one was the heir to an unfathomable fortune.

“Here is a place where everyone is equal,” thought William. “I’m certain that I have nothing to worry about now. The bleeding has slowed to almost nil and I still feel alert, if a little unsteady perhaps, but that’s to be expected I suppose …”

One of the orderlies approached, wearing a warm and welcoming smile. She had sympathetic eyes and spoke with a sweet voice, consoling him in a song-like cadence. Immediately, William was put at ease.

“Hello sir, what seems to be the matter?”

“I’ve been stabbed in a robbery,” replied William, motioning towards the wound under his great-coat. “I think it’s rather serious … it’s quite painful ma’am, but I think I slowed the bleeding down some.”

“Ohhh … you poor dear!” Exclaimed the nurse with a genuine look of concern. “Let’s just have a look at your health insurance card, and we’ll get you patched up at once. You’ll be back on your feet in a few days, at the most.”

William was in no mood for the foul reek of bureaucracy. He glared at the grinning nurse for a moment, just to see if she would realize the sequence of words that came from her mouth. She didn’t.

“I’ve been robbed,” repeated William. “All my things were taken. My passport, my work visa and identification … all gone.”

A faint spark of comprehension glimmered in the sympathetic blue eyes of the orderly.

“Oh, I see. Well, I’m sure we’ll have no trouble locating your records in The System,” cooed the nurse. “What kind of insurance did you say you had?”

“I have none, ma’am,” he replied. “I am new to this land, I have only been her for a few months. I am just a day-laborer, with a family to tend to and I haven’t been able to afford any health insurance yet. Surely, I will still receive treatment here?”

The attendant’s face became dour and cold. The warmth and sympathy of her eyes and smile had vanished into a sheer rock face of indifference and contempt.

“Oh dear, I am so sorry sir,” she said. “There has been a terrible mixup: you need to be downstairs. Of course you will receive care, it is the law, but this area is only for those with premium-grade private health insurance.

“They shouldn’t have let you in here,” she added, looking around the room as if to spot the perpetrator of William’s entry into this sacred station.

“Phillip!” She yelled sternly. “Phillip, come here at once please!”

The doorkeeper reappeared as quickly as he had materialized when William first walked in, and the nurse immediately took him aside and whispered in his ear for a few moments. When they turned back to face him, neither one was smiling.

“Phillip here is going to escort you downstairs, to the reception area for the uninsured,” said the nurse firmly and without feeling.

William nodded, and went to follow the suddenly severe doorkeeper, but was startled to find a rigid hand upon his arm. Phillip had lost all of his good-naturedness, and looked down at William with an even, flat expression as he ushered him towards a door to the back of the lobby, off to one side of the main concourse.

“We’ll take the service elevator,” said Phillip. “Don’t want to disturb any of the first-class patients …”

William didn’t catch the doorkeeper’s comment, or if he did, showed no outward indications of it. He was aware at the stark shift in his treatment, but thought little of it. A poor man here and in his native country, William wasn’t accustomed to being dealt with on even terms, so it didn’t alarm him all that much when he resumed being treated like a poor slob. He expected it, actually. To him, things were as they should be. He had no business mingling with VIP’s and that was perfectly fine as far as he was concerned.

The change that occurred in decor as they left the main lobby was infinitely more dramatic and interesting: the gilded opulence gave way to stark and bare walls that went on for what looked like a great, great distance. Looking down the long expanse of hallway, for the first time since the robbery, William began to feel faint, presumably from loss of blood. Nonetheless, he kept pace with the silent Phillip as best he could, as the doorkeeper led him down a serpentine maze of corridors, staircases, chambers and antechambers that were recognizable to William only in so far as they were clearly leading the men further and further into the bowels of the expansive sub-structure of City Hospital.

Finally, the last corner was turned and the last bend bent and they came to an old metal freight elevator that bore a sign reading: “authorized personnel only,” on the steel-caged door. Phillip bent down and took hold of the door’s fabric handle and pulled upwards, revealing little-by-little the bare gun-metal grey interior of the compartment.

Once inside, William looked at the elevator’s control panel and noticed that there were only three floors lower than where they currently stood.

“We’re going to floor two,” said Phillip, noticing the wounded man’s interest. “Third floor is for public insurance, and floor two for the uninsured.”

“What’s on the first floor?” William asked.

“The morgue.”

“It’s too bad you don’t have anything to trade,” said Phillip once he had closed the elevator door and started the car’s descent. “I’ve been known to accept bribes.”

William took the bait, though he knew he was without anything to offer.

“Like what?” He asked. “And what would I get in return?”

“Well, my personal motto has always been: ‘In god we trust: all others, pay cash,’” Phillip retorted. “Absent the presence of any dead freemasons, I am a collector of antique gold pocket-watches and cuff-links, but that’s about it.

“As far as what I can do for you,” added the doorkeeper, “Let’s just say that a person could end up on any floor of this hospital regardless of insurance status or financial background, provided he knew the right person. Now that’s the rules, according to Hoyle.”

William did not reply.

He tripped over the phrase: “that’s the rules, according to Hoyle.” It was an expression that his grandfather used to favor, gleaned from a summer spent traveling abroad as a young man. Hearing it spoken by Phillip had only served to rub salt in the wound–no, the other wound–left by the loss of the cherished pocket-watch. As a young man, after his grandfather passed away, William would take it to bed with him at night, as if someone were going come and take it away from him, the way they had taken away grandpa, if he took his eyes off it even for a moment. Now it was gone, and there could never be another one. The last and only physical link to his past was in the pocket of some violent lunatic, or on a pawn shop shelf somewhere, just waiting to gather dust and be forgotten.

The elevator came to a halt, and Phillip again lifted the large steel door. He led William out into another bleak system of hallways, this time painted in an antiseptic shade of light green as opposed to the plain off-white of the previous catacomb. After another lengthy trek, Phillip and William, who was now visibly pale and seeing double, came through a set of doors that opened into a cavernous waiting room.

The room was the same sickly light green as the hallway for the most part, with large sections of metal chairs arranged in perfect squares throughout the interior. At the center, William thought he saw a pair of desks occupied by a pair of old, haggard looking nurses. Phillip walked him to the desk, helping to keep him upright, and he soon discovered that, upon closer inspection, there was but a single desk and the beat looking nurse was flying solo as well. He was set down in a metallic chair, and Phillip left the way they had come, without a word to him or the old woman.

She looked at William for a moment with a mixture of contempt and pity before asking him for his identification.

“I have none,” he whispered. “I was robbed … I already told them all of this upstairs …”

“Well excuse me, your lordship but tell me again!” Barked the severe looking nurse. “You sure as hell ain’t upstairs anymore young man.”

William coughed some blood onto the floor, and hesitated before speaking.

“I am new to this land, I am a day-laborer and I was stabbed during a robbery,” he explained. “Please help me, I’ve been waiting for a long time and I am feeling very weak … I’ve lost so much blood …”

The nurse punched in a few quick keystrokes on her computer, and looked at William coldly.

“Of course, show me your work visa then,” she said. “That will do to verify your identity.”

“It was taken too!” William declared forcefully, now becoming quite exasperated. “Everything was taken!”

“Well, you shouldn’t be carrying important documents like that around with you anyway,” said the nurse condescendingly. “It’s dangerous out there.”

She nodded at him disapprovingly and entered a few more keystrokes into her computer.

“What’s your name?”

William told the weathered and bad-tempered nurse his name, relieved that at last, he seemed to be getting somewhere.

She responded with a torrent of typing, staring at the screen of the sacred machine with an intense focus.

“Where do you live?”

Another answer, another cacophony of keystrokes; William heard them now as if they were very far away.

“Very well,” the nurse said after entering the remainder of the information. “Fill out these forms, initial every third page, sign your name and date every fourth page and don’t make a mistake or you will have to do it all over.”

She handed over a tremendous ream of documents that was so heavy it almost knocked William from his chair onto the ground. He was still mostly lucid, and began to tackle the massive pile of papers one page at a time. Before long, he began to feel like he was going to pass out and alerted the nurse to his condition. There were still a considerable amount of forms to fill out, but William felt like he needed help immediately.

“My dear woman, I implore you,” protested William. I am hurt quite badly; couldn’t these forms be delayed until I am tended to? I feel terribly weak, and if it’s all the same to you, I’d just assume see a doctor right away.”

The nurse seemed to take great offense at this suggestion. She recoiled in horror at the thought of patients being seen before filling out all the requisite documents, and looked at William crossly, with her head cocked off to one side and her hands angrily upon her hips.

“Absolutely not!” She replied. “I suggest you save your strength for all that paperwork, rather than wasting time being a pain in my ass.”

After several hours time, William had filled in all the fields, crossed all the T’s and dotted the I’s, and with much struggle, rose and delivered the carefully filled out documents to the sour old nurse. She eyed him suspiciously and put on her reading glasses before beginning to scrutinize the forms for errors.

“You must be hurt,” she said after a while. “There are no mistakes that I can see in these forms.”

The nurse seemed to be almost disappointed at being deprived of the opportunity to watch William bleed to death right there in the waiting room, and appeared visibly downcast at not getting the chance to make him begin the entire ordeal again.

He said nothing.

She told him to have a seat in another section of the immense waiting room, where the chairs were also arranged in perfect squares, and wait until his name was called. William nodded and shuffled off, holding one hand to the throbbing wound. He was getting very weak now.

The area where he was supposed to wait was the same as the other side of the room, except for something he hadn’t noticed before. The walls were stained in some spots, above the area where the head of a sitting person would be, but not all that much higher. The walls were stained orange or pinkish, it was hard to say. William could barely focus, and when he did, there were as like as not to be more of what he was looking at than there ought to be. He took a seat on the cold uncomfortable metal chair and waited.

He was trying to keep himself awake now. He was half-delirious with blood-loss, and fading quickly.

“What kind of place treats human beings like this?” He wondered. “Where is the wonderful and equitable healthcare system I was told of?

William was beginning to realize that modern democracy can be reserved and enjoyed freely by those with the means to do so, but for everyone else, it was emphatically first-come, first-served.

He wondered if he would die in that terrible place, that awful waiting room.

After what seemed like an interminable amount of time had passed, William became aware that the blood from his wound had soaked through the great coat and was starting to drip onto the linoleum of the waiting room floor. He watched several rivulets form on the cuff of the coat’s sleeve and swell before falling to the floor.

Long after William had given up any hope of survival, he finally heard his name: he slowly labored himself onto his feet and followed the old nurse down to another room, off the main waiting area. The new room was smaller. It was an examination room, he reasoned by the paper-covered table in the center.

“The doctor will be right with you,” said the nurse coldly.

William remained silent.

The doctor hadn’t appeared after what seemed like a reasonable amount of time, but William had no clue how long he waited since there was no clock in the room. He realized that he hadn’t seen a single clock anywhere in the hospital outside of the brilliant main lobby. He was sure it was merely a minor detail.

After a long, long while more, the handle of the door began to jiggle, then turn and the doctor finally entered the room like a glowing white messiah.

He was young. Not youthful, but young. He nodded towards William as he entered the room and took a seat in the other chair. After exchanging greetings and looking over William’s charts, the doctor instructed him to remove the great coat bandage, which, caked with dried blood, was difficult and painful to remove.

“Let’s have a look at it then,” he said. “How did you say this happened again?”

“A robbery,” William replied weakly. “I was stabbed … in a … robbery.”

“Hmm, I see.”

“Well, you should have gotten in here sooner. You’ve lost quite a bit of blood, you know,” said the doctor.

He began to examine the wound.

“Hmm.”

“What is it?” William asked.

The doctor looked puzzled.

“You’ve been stabbed. Why, you told me as much just a moment ago.”

William shot the doctor a look that implied a rhetorical question: really?

“No, I mean what’s to be done,” he replied.

“Hmm. Hard to say, really,” the doctor said. “I need to run some tests. Yes, that’s the thing … run some tests.”

He wrapped the wound in a fresh bandage and informed William that he would order the necessary tests at once.

“Just wait right here,” he said and took his leave.

William was barely conscious now, and his head hung loosely from his neck.

The doctor returned after what may or may not have been a long absence.

He looked at William for a moment, shook his head and sighed.

“I’m sorry,” he said without any pleasantries. “But there is no point beating around the bush here.”

He placed a small wood-handled revolver on the paper-covered examination table.

“I have read your file, William. I know you have a wife and a young son and I ask you to think of their well-being now. To keep you alive much longer, with transfusions, surgery, medications and machinery will end up costing you more money than you are likely to earn in the next twenty years working as a day-laborer. Also, you would be unable to work for some time, and therefore wouldn’t be able to support your family, never mind handle the medical bills. Rest assured, this is a debt that would be collected swiftly and without mercy or pity. I would certainly hate to think of the Debt Collectors paying a visit to you and your family … it’s true what they say you know, once they get you in The System, it’s almost impossible to get out.

“You see William, it’s a practical decision.

“In truth, it would probably utterly ruin your family, your survival would,” added the doctor. “So, basically we can keep you alive and your family will starve, while you’ll probably still die anyway before long, or you can do the honorable thing … the right thing by your family.”

The doctor left William to weigh his words.

After a while William looked around the examination room and noticed the same off-colored stains on the walls. It looked like someone tried to clean the area with mixed results. William finally realized what they were, and why they were there.

He picked up the revolver and fingered the wood handle. It was heavier than he’d imagined.

___________________________________________________________________________________

Photo: Purple Phoenix (flickr)
URL: http://www.a-w-i-p.com/index.php/2011/05/03/a-practical-decision