The Last Surgeon

CHAPTER 4

The interior of the Helping Hands Mobile Medical Unit was straight out of a Norman Rockwell painting. Every inch of available space inside the 1996 Fleetwood RV was being used for something-notices, storage, medical equipment, office machines-creating a quaint, homespun feel, which was enhanced by the white honeycomb window shades, beige textured carpet, and incandescent accent lighting. The steamy windows and the grizzled, hardened faces of the three men at the center fold-out table, each in a different posture, each clutching a mug of coffee, completed the masterpiece.

It was a Wednesday, and at this stop-the muddy lot of Jasper Yeo’s Dependable Used Autos-that meant Nick would be teaching his weekly class on obtaining VA benefits for post-traumatic stress disorder. Outside, the heavy rain was continuing unabated, pelting the roof of the clinic, and scrubbing the air clean after what had been an unseasonably warm day. The RV was crowded, so the seven men and one woman seeking treatment were using the covered bus stop at the corner as their waiting room. The inconvenience bothered them little. Most of them were near the bottom of life’s totem pole, and quite used to being put on hold.

Inside the RV, the stakes in the tiny classroom were high. Benefit money each of the three men needed to survive had been denied by a VA review board. In fact, Nick’s credential to run the course he had started was a protracted, ultimately victorious battle for his own benefits. It was a struggle that had begun with a rejection by the antichrist of VA claim evaluators, Phillip MacCandliss, and ended with a high-level review board reversing the decision. Not long after that, possibly because of his heavy-handed opposition to Nick’s petition, MacCandliss was passed over for promotion.

War.

“Sorry to keep questioning you, Doc,” Eddie Thompson said. “It’s just that this is my third go at trying to get my benefit pay. I’m running out of steam and I’ve already run out of cash.”

Nick set his hand on the shoulder of the bullnecked ex-infantryman, whom he knew had witnessed inconceivable brutality-many of the victims, his friends.

“I know, Eddie,” he said, not even attempting to cull the huskiness from his voice. “I know.”

Given the flashback during the ride into D.C., it wasn’t a great night for him to be doing the class. In spite of himself, Nick felt his concentration begin to slip. He glanced up past Eddie at the corkboard wall, festooned with job notices, lists of AA and NA meetings, nightly shelter possibilities, and other hints for survival on the streets. At the center of the announcements was the four-year-old poster requesting any information on the disappearance of Umberto Vasquez. The sepia photograph was slightly faded, but not enough to wash away the visage of the intensely funny, bright, compassionate Marine, who was the only other one to have survived the nightmare of FOB Savannah.

Vasquez, suffering from PTSD at least as debilitating as Nick’s, had nevertheless helped him to grieve for Sarah, and had often held him for as long as it took for Nick to stop shaking, even as Umberto’s own demons, and omnipresent cheap wine, were tearing away at his guts.

REWARD

For Validated Information Regarding the

Disappearance of Staff Sgt. Umberto Vasquez

Last seen 2/20/06; Fort Stanton Park

Call Capt. Nick Garrity 202-966-9115

“Damn, they make it hard,” Eddie moaned.

“For a reason. Three out of ten claims get VA approval. Three out of ten! That’s millions, if not billions of benefit dollars that don’t have to get paid out. They’ll pay it if they have to, but they’ll sure make you work for it.”

“Ain’t right,” Corporal Matthew McBean added in his dense Mississippi drawl.

“But that’s the way it is. When I was diagnosed with PTSD I made the mistake of asking the VA regional office and their lead benefits blocker, Phillip MacCandliss, to expand my claim to include that diagnosis. MacCandliss knew the rules and interpreted my request to mean that I had a claim previously denied. The proper wording for what I wanted to do would have been to ‘amend my claim.’ That misstep cost me four months of tedious paperwork. And that was just my first of a number of mistakes. MacCandliss counts on us caving in at some point and just giving up. He and many of the rest of them equate depression and PTSD with weakness. He underestimated me-at least in that regard he did.”

“Shit, I’d give up all my bennies for one decent night’s sleep,” McBean said.

Nick nodded empathetically.

“Have any of you called the EMDR Institute yet?” he asked. “If not, let’s make that your next homework assignment. Ask for Dr. Deems and tell her I recommended you call.”

“You really think it’ll help?”

Nick hesitated. Did he think it would help? The jury was still out on that one. Even so, the thought of ridding himself of his torment was enough motivation to continue experimenting with the relatively new psychotherapy tool. The idea of EMDR-eye movement desensitization reprocessing-was simple enough, and the technique had been used successfully for a number of conditions including performance anxiety, phobias, sexual dysfunction, and eating disorders.

Working with a therapist in D.C. once each week, Nick was now on phase four of an eight-phase EMDR program. By combining repetitive eye movements with varying mental snapshots of both positive and traumatic images, the treatment purported to eliminate most, if not all, PTSD symptoms. Nick was hardly a poster child for the technique, though.

Behind them, the floor-to-ceiling curtain opened a foot and Junie poked her head out.

“Got a minute to check this kid, Nick?”

If not for the class, both Junie and Nick would have been seeing patients from the beginning of the evening. In almost any situation, the nurse could match her skills and judgment against any M.D. or D.O., but it was Helping Hands policy-and that of the board of health-to have every patient checked by a doc, or else by a physician’s assistant or a nurse practitioner, and tonight there were neither of those on duty, although frequently there were.

Nick passed out a sheet of instructions for the next class, and asked his three students to check it over while he was gone.

“What do you have?” Nick asked as he approached the curtain.

Junie did not pull her head back.

“I have a kid that I think has mono.”

“Did you draw bloods?”

“A mono test, CBC and liver chems, plus an amylase and lipase.”

“Throat?”

“Classic, if there is such a thing. I cultured it and gave him a supply of penicillin, a rinse, and some Motrin.”

“Enlarged spleen?”

“I don’t think so, but you know I’m not the best at that unless it’s the size of a football.”

“You done good. Let’s see him.”

Junie did not move. When she spoke again, it was in a near whisper.

“I looked out a couple of minutes ago,” she said, “and you were staring up at Umberto’s poster. You okay?”

“Hanging in there. The class is a nice distraction-especially these guys-but that nightmare I had on the way here is still resonating. Good thing I don’t have to hold a full cup of hot coffee.”

“Have you tried your eye exercises?”

Nick kissed her on the forehead and motioned to the examining room.

“I’m doing fine. Now, let’s go kick some mononucleosis butt.”

Not surprisingly, Junie was spot-on in her assessment of the seventeen-year-old, whose residence was listed as the 24 Hotel-night-by-night cots for homeless men. With no major trouble swallowing, and no striking enlargement of his spleen, the youth was sent out with a “mono sheet” of do’s and don’ts. As with most of their patients, the caregivers could only hope that he kept his follow-up appointment.

Nick was back giving final instructions to his class when the mono patient passed by them and left, followed moments later by Junie, carrying her umbrella.

“I’m going to grab the next victim,” she said. “I’m thinking of stopping by Dunkin’ Donuts across the street to see if they can donate a Box O’ Joe to our waiting room out there. They’ve done it before.”

“Like they have a chance against you.”

A gust of chilly, wet air blew in as she opened and closed the passenger side door.

Just a few minutes later, the door opened again and a short, stocky, balding man entered. He was wearing a tan trench coat and shaking off an umbrella. He was followed immediately by Phillip MacCandliss.

“Good evening, Garrity,” MacCandliss said, fixing Nick with dark narrow ferret eyes. “May I introduce Mr. Janus Fielding.” He increased his volume so that anyone in the rear of the RV could hear. “He’s with the D.C. Department of Health.”