The Patient Was…

The patient was in his mid-sixties and unique in many ways in my experience. He had emigrated from Italy over 50 years earlier but still spoke in stereotypical Italian-movie-recent-immigrant-accented English. He occasionally came to the office accompanied by rough-looking companions who spoke to him in Italian,  following which he would ask my advice as if it were something he needed to know for himself.  I never examined his companions or questioned him about them, and simply played along with the charade.

I thought he was “connected” in the Goodfellas sense of the word, and a few experiences more or less confirmed that impression. He once I invited me to lunch at an East-side restaurant more or less known as a hangout for “wise-guys,” and I found him seated in the rear with his back in the right-angle formed by two walls and the circumference of the large round table preventing any body from getting to close to him. During the lunch, a few men came to the table as if paying homage, and one even reached across to kiss the hand he extended.

Following lunch, he said we were going to New Jersey to get me an overcoat because he didn’t like the one he saw hanging in my office. We drove to a large  factory of some sort and he pulled a rust-colored leather coat from a rack, draped it around my shoulders, led me out of the building and into the car, and we were driven back to the city.

He was an executive in a union of workers in the garment industry, and every time he visited my office he brought me a dozen dress shirts. They were styles and colors I didn’t like, but I couldn’t refuse them. At one time, I had from the patient alone, over one hundred dress shirts.

Every summer or two, the patient would travel to Sicily where his brother, a wealthy factory owner, lived. His brother’s house had no running water, but he employed a lot of poorer people who carried water from a nearby stream. The stone house was large, with many windows, but neither glass nor screen in any of them. One summer, the flies were really abundant and the patient said if he didn’t see a screen on his next visit he wouldn’t return again. His brother nodded dutifully. On his next visit, the patient found one window with a screen in it while all the others remained open to the outside with no barrier to the flies which were everywhere.

But the most unusual aspect to the patient’s story was, in fact, his medical history.

Giovanni  —  that’s what we will call him  —  had had twenty-eight major operations on his aorta, the major blood vessel that carries blood pumped from the heart around the body. He had an unusual inflammatory condition of the aorta that caused the actual tissues of the wall of the blood vessel to weaken, leading to little aneurysms or bulging areas. Due to the pressure of the pumped blood inside the aorta, these bulging aneurysms could burst at any time causing massive and fatal hemorrhage. Each time a new aneurysm was discovered, his surgeon would repair it with a synthetic graft made of a dacron-like material.

Each of the operations on his aorta had gone well  —   until the last one.

The story, as he told it to me in his heavily accented English (which I will try to reproduce) follows:

“Dottore, each-a time I have operation, I’m-a fine. No pain, no trouble, each-a time.  But-a, after last-a operation, I have-a pain. I say to Dottore, ‘Dottore, I’m-a have a lot of pain.’

Dottore say to me, ‘Giovanni, the operation was-a fine. You no really have-a pain. It’s-a all in-a your head.’ I say, ‘Dottore, the pain is-a in-a my stomach, not in-a my head.’ Dottore say to me, ‘Giovanni, I-a know you well. I-a know you body-a well. This pain is imaginary. It’s-a from stress. You have-a so much surgery it causes you to think you have-a pain, but it’s-a not a real-a pain. You go home-a, Giovanni, and you will feel -a better. You come to see me next-a week and you will-a be  better. You will see.’

So, Dottore, I go-a home. But I no feel-a better. I still have-a pain. So, next-a week I see Dottore in his-a office. I say, ‘Dottore, I’m-a still have-a pain.’ Dottore say to me, ‘Giovanni, I’m-a sure everything is-a OK. To show-a you, I’m-a goin’ to take an x-a-ray. Then, you will-a feel better.’

So, I go to x-a-ray, and when I-a see Dottore he looks-a very bad, He looks-a so sad. He looks-a very serious.

‘Giovanni,’ he say, ‘you were-a right. You have-a real-a pain. X-a-ray show that I leave-a an instrument inside-a you. I leave a big-a clamp in you. And, Giovanni, I must-a operate on-a you again.’

So, Dottore, he operate on-a me again. And I feel-a OK. No pain, no trouble. When Dottore see me, he say-a, ‘Giovanni, I take-a the clamp out. Everything is-a good.’

Then, Dottore look-a very serious again. He say, ‘Giovanni, I did a very bad-a thing when I leave-a the clamp inside you. I have-a no excuse. You can-a sue me and you will get-a one million dollars.’

‘Dottore,’ I say, ‘you operate on-a me twenty-eight-a times. You save-a my life twenty-eight-a times. I’m-a not-a goin’ to sue you. But Dottore’  —  and here Giovanni paused for a dramatic moment  —  ‘Dottore, don’t-a do it again!’”