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Friday, August 15, 2008
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buy ebook @www.lsspublishing.com/Fiction.htm -hardcopy order at lifecodefrombrooklyn@gmail.com -this blog is to discuss topics raised in Book: 1.Genetic engineering of Foods and useful bacterical. 2.alternatives to crude oil 3.terrorists attacts on US
About Me
- Larry Chiaramonte MD [bulldog]
- Greenwich, Ct., United States
- The best thing Ann my wife and I did was to adopt three childern. They in turn took us to the dog pound to adopt a dog. Nana a pit bull had been the guard dog for drug dealers an was put into the pound for thirty days for adoption. If she was not adopted, she would be killed. My kids out voted my protests that Nana would be too dangerous to have as a pet. They were right she was loving to everyone except when her sixth sense told her they were bad. She was always right. Please post your "tails" about Nana or any pet you have lost.
Excerpt from Life Code from Brooklyn
Chapter 1
The Hospital
I hadn't seen my kid in ten years, only photos. I cursed to myself, he was to come next weekend. I’ve got the Yankee tickets burning a hole in my shirt pocket. Now, he’s three hours late, after that mix up and I’ve go’tta work.
The thought of this visit scared the hell out of me. I felt all my negative thoughts become positive ones as soon as I saw my son, James. His fifteen year old body struggled up the steps of the hospital.
“Bart?”
Not Dad, I nodded. “Yes, James.”
Our eyes met. We shook hands, and I put my arm around his shoulders. We had lost so much time.
" Sorry, but Fred took his time getting me here." James said.
“I’m not surprised. Your step-father used every legal trick. He wants to interfere with our visitation.”
James nodded in agreement, just as the loudspeaker blared. "Dr. Bartolino Ferranti, Dr. Ferranti." And
“Don’t answer that.”
My mind raced, I ‘ve got to answer the emergency call, but after waiting for ten years we deserve to go to the ballgame. “James, I must answer. Come with me, someone might be very sick. You'll get to see what your old man does for a living... besides play golf." I joked to ease the tension.
"What do you say?"
"Come with me.”
His lips, quivered. “"You’re sure? For,real?"
"You bet I am son. Come on lets go!"
I the sickening swell in the pit of my stomach eased, as I ran into the hospital. to pick up the in-house phone “Yes, Bart Ferranti here.”
“Doctor, we’ve got a bad allergic reaction in the microbiology lab.”
I rushed to the medication cabinet, grabbed a bottle of adrenalin, and a syringe with a needle. “There’s an anaphylaxis reaction in the biology lab. Hurry! Follow me. Crash cart! Be sure there’s something to establish an airway.” I ran to the lab. My allergy residents followed.
James folded his computer booklet under his arm. “Neat, I want in on this.” He raced along with me.
I dashed into the microbiology lab. Ann Levine’s face was swollen and distorted. Earlier, when she wished me well with James’ visit, she looked attractive. Now she gasped for breath, her eyes swollen shut, she looked dreadful. I stepped over a fallen peanut butter and jelly sandwich.
Peanuts! There’s always a first time for an allergic reaction, I thought. She collapsed into my arms. I laid her down and ripped her sleeve to expose her arm for an injection. I felt through her sweat for a vein. “Adrenalin, Adrenalin, Adrenalin!”
I gave a deep injection into the muscle mass of the triceps. I hoped the circulation was intact enough to absorb the medication. We would give more though the IV. In moments, the two residents arrived with the crash cart. Now
Ann was out cold and my heart pounded. Her airway closed fast.
“Dr. Balducci, you and Dr. Kim start the IV. Once it’s started, dilute the adrenalin and mete it out through the IV.”
I stepped back to give the other doctors room. “Monitor her blood pressure, heart rate and other signs.”
I turned to Bernie my other resident. “Pull out her tongue. I’ll push a scope into her airway. Now, or she’ll be a goner.” After I struggled with the scope, I gasped in disgust. “Damn, can anyone do this better; I haven’t done this in years!”
“Let me look.” Guy pushed me aside and tried several times. “No, VA NAPLI. I can’t do it! She’s too swollen.”
“No need to swear.” Bernie looked at Guy. “Not even in Italian.”
“Stop it, Guys! No time for chit-chat. It’s tracheotomy time, and fast." I looked at James by the crash cart. "Hand me a thirteen gauge needle. The package is labeled B-D, two inches, thirteen gauge."
James searched for the needle, found it, and handed it to Guy.
"Two fingers above the chest bone in the midline. Then push the needle into the airway,” I chanted from memory. Relief! I heard a pop as the needle entered the windpipe. “Bernie, hook up the oxygen to the breathing bag and pump it into the needle.”
God forgive me but the excitement made me feel alive. I had spent years of dedication and sacrifice to be in this time and place. To be among the few who could save this woman’s life. I had trained to be analytical. To make the right decisions and not get caught up in the fear. I closed my eyes for a moment and said to myself, with your help God; I will use my knowledge without error. I had learned to disassociate from my emotions. I felt a fear for Ann’s life more prominent than if it had been anyone else. No more women, I thought.
I stepped back to give Dr. Balducci room to do as I requested.
This fuzzy bear-like Italian-American bent over to clear Ann's airway. Ann’s color turned from blue to pink as Dr Balducci pushed oxygen into her with a Rubin bag. Ann’s chest began to rise and fall in time with the Rubin bag. Her own breathing emerged.
I turned my attention to the residents starting the IV. “See the adrenalin drip in now. The heart rate is almost 200. The blood pressure is 50 over 30. The edema still has not responded.”
I thought for a moment. “Keep up the adrenalin. Dr Kim, add some Benadryl 100 mgms. and a H2 histamine blocker. Also steroids give her 200 mgms. Someone listen to her chest see if she has any wheezes in her lower airways.”
Bernie listened, “Chest clear. No lower airway problem. Does anyone know if she’s on beta-blockers for high blood pressure?”
I looked up for the first time since we entered the room. This was Ann’s genetics lab. Culture plates were on the lab benches. The odd thought flashed into my mind. Did they have anything to do with this sudden allergic reaction? She worked with some pretty strange stuff. My thoughts went back to Bernie.
“Good thought. " Beta-blockers would make this allergic reaction harder to treat. I have known Ann for years and she would have told me if she had a heart condition or blood pressure problem. “No”, I said, “I don’t think she’s on beta-blockers."
After a minute or two I demanded, “Heart rate?”
“It’s 160.”
“Blood pressure?”
“It’s 110 over 70 there is less edema.”
“Good, let’s get a better airway established. Take a look.”
“I think I can get a tube into her airway now,” said Dr. Guy Balducci.
“Good, do it.”
Guy struggled for a moment to place the tube in the airway.
“There, it’s in,” his body showed his relief. “Do you know what Va Naplie means? Just go to Naples; every one who conquered southern Italy started at Naples and worked down to Sicily. The conquered viewed Naples as hell.”
My son, James, smiled at Bernie and Guy. Then he focused on me. His face flushed with excitement "Allergy attacks can be scary."
I smiled back. "Well, sometimes they are." After a brief pause to savor James’ admiration, I turned my attention back to Ann. “Ok, great job, wrap it up.” I pointed to Dr. Kim. “Get a blood sample for a total allergic antibody level and IgE level.”
I looked at the remains of Ann's lunch, the peanut butter and jelly sandwich still on my shoe. “Get an allergic R.A.S.T. test for peanuts. Ann never mentioned having an allergy. Compare an old sample of her serum with the new. It’s in the lab freezer.”
After the fellows had gone off James and I had a few moments alone. James shifted from one foot to the other, stuffed his hands in his pockets and looked at the floor. He shrugged off his backpack and, all his pens fell from his shirt pocket. I bent down to help. I kicked myself. Fantastic, not even a few minutes into our new relationship and I had to take care of a patient.
He was wearing a blue blazer, school tie, and gray flannel pants. He was six feet tall and just one hundred and thirty pounds. “I’ve heard so many stories; even Fred was my real father. Please tell me your side.”
“I met your mother on a blind date. We fell in love at first sight and eloped ten months later. We moved to Baltimore for my training.”
“My mom told me I was born there.”
“Yes, when you were a baby, we enjoyed fine times as a family.”
“Why did you move to New York?”
“I got a job with a renowned New York allergist. Your mother needed knee surgery. So we moved in with your grandparents, because we needed their help.”
“Young couples need to be alone,” James said.
“I wasn’t too comfortable with this, because your grandfather’s family was from Castellammare del Golfo, Sicily, the town where most of the New York mafia originated. Your grandfather dealt with large real estate investments. He became deaf and had lost most of his family’s money when he invested in Arizona land with the head of a mafia family.”
“Was my grandfather in the mafia?”
“No, your grandfather’s family made their money legally with several Italian pastry shops, but the government had a surveillance van in front of our house. The FBI executed a search warrant because of your grandfather’s Arizona land deal.”
“My mom said she lost her cool with the knee pain and the FBI pressure. She let slip she had been married before, when she had never told you,” James said.
“Yes, the other husbands were news to me. I’D caught her in quite a few lies, ranging from little white ones, to big ones like her undisclosed marriages. I was unhappy. Your mother met Fred Fabbricante at the gym, where she was rehabilitating her knee. She forced me out so Fred could move in. So James, what do you think?” I whispered.
He just changed the subject. “Neat, the treatment was neat. No joke. At home everyone told me allergists are treating phony diseases.” James laughed, “Boy, they’re wrong. Wait until I tell what happened. You all saved the woman’s life.” He had my cheekbones and smile. He had his mother's green eyes and chestnut brown hair. His nose was a little too big for his face but it gave him character. He was a better-looking version of me. Biology could not be denied.
“How do you feel about this first visit?”
He hesitated. “It’s too soon to tell. I’ve heard too many contradictory stories since I was young. I want to make up my own mind. Give me some time. Do ya have those Yankee tickets?”
“Fair enough, Yes, I have baseball tickets, but for the wrong days.” I said.
“Not to worry. I’ll handle it so we can go.’
After Ann was in the ICU, the fellows sat around our table to discuss cases. One of my students, Bernie wore a yarmulke. He had elected to learn allergy at our training program rather than the more prestigious one at Harvard. Why? He wanted to be near his community of religious Jews. So he could follow their laws.
Just like the Italians, the Jews maintained shared factors of life. Their children were working in the American world but still living in the neighborhood. Bernie was tolerant of other cultures. However, he regarded some more liberal Jews as not being Jewish. “My patient is an orthodox four-year old Jewish girl. She’s pretty, but disfigured by eczema. She has a long, strong family history of allergy.”
I asked "Why is she at our hospital rather than a Jewish one?"
"We Orthodox Jews marry our own. A high incidence of allergy is the result. The parents don’t want her to be viewed as damaged goods when they try to arrange a wedding. I’ll treat with Eladil, and follow with some topical steroid cream.” I agreed. I knew little about Brooklyn before I came here a few years ago. This was an opportunity to become a real leader in the field. I was not joining this hospital as the junior member of an allergy team to waste years in the political maneuvering. I had the ball at Brooklyn Academic Hospital and was free to run on my own ability.
Guy Balducci began to tell us about his patient. “Michael Scialiano is a longshoreman. He had an asthma attack in the hold of a ship.”
“Green coffee beans!” I interrupted.
Guy’s face fell. “Gees, Chief it took me two hours to figure it out. Let me tell the case. I wanna show what I’ve learned.”
Gitano was right. I interrupt people too much. He was from Benson Hurst, an Italian community where the people huddled together in small row houses. Unlike the Ivy League Italians from Connecticut, like me, who had tried to become the ideal ‘White Anglo Saxon Protestants’, Gitano wanted to maintain his ties to Italian culture and Brooklyn. He was a teddy bear, but street wise and tough, after all he was raised on the streets of Brooklyn.
“You’re right, sorry,” I said.
Guy’s face lifted. “The roasted beans are less allergic.” A formidable woman slid by towering over my seated form. She had on a floral top with white pants. Not the traditional ‘70s nurses’ uniform. The nametag had in large letters:
MS.BERTHASMALLWOOD,RN
HEALTH CARE PROVIDER
WARDINSTRUCTOR
I had heard her challenge almost every doctor she met. Ms. Smallwood looked at me. “We’ll tag along on rounds. I hear you are a good teacher.” There was a gaggle of student health care providers or nursing students behind her. I seemed to have no choice but agree. I opened my mouth to say something, but Ms. Smallwood interrupted. “Students, make written assessments on each of the patients we see and then make treatment plans.”
I looked at James’ smile and thought, Assessments and treatment plans? Sounds like doctor’s diagnosis and treatment orders to me. This was just another way to join the HMOs in eroding the doctor’s position. How could I tell them the doctor was still the captain of the ship and legally responsible in a court of law, without a fight from Ms. Smallwood?
Tiny Dr. Kim stood up to Ms. Smallwood. “The doctor is still responsible in a court of law.”
Ms. Smallwood was silent.
“Dr. Kim, could you present your patient?” I asked.
“Jamal is a seventeen-year old, black male who was hospitalized with a severe asthma attack last night. I’ve been following Jamal in the clinic for several months. I’ve prescribed an inhaled bronco-dilator and anti-inflammatory for him. I’ve skin tested him and started weekly allergy shots.”
“Very good, Dr. Kim. Did Jamal follow your advice?”
She sighed. “Jamal came only when he was sick. I had to stop the allergy shots. He wasn’t taking his inhaled steroids. He took the stuff advertised on TV.”
“Dr. Kim, we need to talk privately.” I didn’t want to embarrass her in front of everyone.
Guy was leaving to bring Ann’s specimens to the laboratory. "Anyone got a number for the Cambino lottery?”
The neighborhood numbers were a chance for social exchange in many different neighborhoods. Salvatore Cambino hired the right front men in each ethnic neighborhood. I laughed, “I don’t play, but if I did, I would play the legal state lottery.”
Guy looked at me and said, “The local numbers run by Salvatore Cambino are a better deal for the players than the state lottery and are more honest with no taxes to pay.”
“Tell me, Guy, who is this Salvatore Cambino?”
Guy looked at me as if I had asked who was Jesus Christ and said, “Boss, you spend too much time with the books. He is the head of the Cambino mob family. He is called Don Cambino, people both respect and fear him.” After a slight pause as if to emphasize his importance, Guy said, “Ok, I am outta here."
I turned to Bernie. “Keep an eye on Ann in ICU. Late phase reactions can happen in six to eighteen hours; just keep pushing the steroids. We’ll try to meet at Fitzgerald's bar and grill for a break. We’ll finish rounds later. The beers are on me.
Dr. Kim I would like to meet a little earlier so we could talk a bit before the others come.” “Yes, sir.” bowed Dr Kim. I was learning about this special place called Brooklyn. The late ‘70s were a time of economic hardship for all of New York City. When the Dodgers moved with the migration of people to California, Brooklyn declined and had not yet recovered. Those remaining would still say with pride, “I’m from Brooklyn.” People from the other boroughs, like Queens, would always say the name of the neighborhood they were from and not the borough by name. Only in Brooklyn did people have a great pride in the whole borough.
“Neat, we’re going to a bar and grill. What’s Fitzgerald's like?” James asked as we walked out into rain. We put newspapers over our heads to ward off the water in the short dash to the grill.
From under the paper I said, “You’ll get to meet Anthony Cambino and other characters from Brooklyn.”
Chapter 2
A View of Brooklyn
"Neat, we‘re might meet a real life Mafia boss. A Don! Like the Godfather!" James raced ahead.
Now I could attempt to form a bond with him. "Anthony is only the son of a Mafia leader. He is just a union leader. Brooklyn is a different world."
We walked into odor of beer and the buzz of Fitzgerald’s. As she washed glasses at the long oak bar, Mary Fitzgerald looked out the window.
“Any one has a black Honda outside?”
A widow, She had hung onto the Bar and Grill. “A cop is beginning to write a ticket.”
Alfonso Falcone was the man’s given name but he was known around these parts of Brooklyn as Alibi Albert. Of course no one called him Alibi to his face. They just called him Albert. His eyes darted around. He tried to sneak unseen, by Tony Barrone, who grabbed his arm and said, “Albert, so nice to see ya, where’s the money you owe?”
Alibi Albert looked at Tony and said, “I-I-If you ever w-wan-want to get paid let me go to t-t-talk to the cop, wait a few minutes, come out with a c-c-cough and have trouble breathing.” Alfonso went out to the policeman. James and I followed to see the show.
“E-E-Excuse me o-o-officer, but I just stopped to pick up my f-f-friend who is having an a-a-asthma attack, here he is!”
As he struggled out the door, Tony gasped for air. Alibi Al grabbed his arm and pushed him into the passenger seat, hopped into the other side to drive off before the cop could finish writing the ticket.
James hid his laughter with his hand as we went back inside.
Good, he’s having fun. I thought
The Brooklyn Heights neighborhood changed into a haven for yuppies who walked across the Brooklyn Bridge to Wall Street. For the hospital staff this was a recovery room. Mary served a mean cabbage and corn beef with Roebling Beer.
“Look at those pictures above the bar,” James said.
“They’re scenes of the Brooklyn docks and the longshoremen.” I pointed. “See the ships unload with huge cargo nets, to the men below.”
James gestured. “Why does the other picture have ships with their navigation lights off as they leave New York harbor?
Mary looked up from behind the bar. “My husband was an amateur artist. He tried to show the ships attempt to slip by the Nazi submarines ready to pounce on them as they left the harbor."
I turned toward James. "In those days Lucky Lucanio controlled the Brooklyn waterfront from his prison cell. He put the word out to help the US government beat the Nazis. Ships began to get out safely. He was rewarded after the war was over with prison release but had to return to Italy."
Mary pointed. “Those are the large metal containers used today. Large cranes do all the work. The cargo nets and longshoremen are obsolete.”
The Italian longshoremen lived in nearby close-knit community of Cobble hill. Their jobs as dockworkers are disappearing and the men are growing old. The children have been educated and are moving on. The kids were in two worlds. They lived in this Italian neighborhood and worked jobs in nearby Manhattan.
In a room just off the bar area, the men played cards and supported each other. Most sat at a large round table. An opera from Verdi played in the background. We smelled stale cigarette and cigar smoke.
“Look, more pictures in this room,” James said.
“They’re Anthony Cambino, as an alter boy, college football hero, army helicopter pilot, and with important politicians,” I said. “See his MBA from Harvard Business School.”
“But he’s the son of the local Mafioso Salvatore Cambino,” James said in disappointment.
We heard the longshoremen. “My cancer is back. It’s those darn cigarettes. They’re killing me. Oh, I wish for the days before containers.”
“I remember the docks stacked high with cargo. Now my joints hurt all the time.”
“Forget about it. Have a drink.”
They touched their glasses. “To the longshoreman's tariff, when we could pilfer more than our wages.”
Longshoreman Michael Scialiano looked up from his poker hand “Doc, have a drink, give the kid a soda,” he persisted. “I’ve gotta thank you. My asthma is 100% better since I’m away from the raw green coffee beans. The roasted ones are ok. Thanks for ya help.”
I’m glad James heard. I looked at his approval. Embarrassed, I grabbed our drinks and changed the subject, “Did anyone see Dr. Kim?”
“Not I,” Michael Scialiano pushed some chips into the pot. “We hear you may join our gene venture, Anthony has us running errands, I guess soon we’ll run them for you.”
“I don’t know, Ann mentioned something about Anthony talking to me. What’s he like?” I asked.
“Anthony is a straight shooter. His father won’t let him get involved in anything illegal. He’s going to make it big time, legally. I was in his helicopter unit in the army. He was born to be a leader like his father.” Michael laid down his hand and pulled in the pot.
Dr. Kim walked into Fitzgerald’s bar and grill. I stood and waved to her and then took her to the grill in the back. The grillroom had a painting of the Brooklyn Bridge with its walkway to another world in lower Manhattan and Wall Street. Its stone pillars and graceful suspension cables were a memorial to the father and son team,the Roeblings, designed it. James and I sat across from Dr Kim. We all exchanged greetings. She smiled at me knowing she was to receive a lecture.
I knew how sensitive she was. I gave a bogus message for James to deliver to the longshoremen in the bar. It was my role to see she became the best doctor she could be. “Dr. Kim your patient Jamal doesn’t take his medication.” I tried to be gentle.
“I know what to do for asthma, I’ve read the N.I.H. recommendations but I cannot get my patients to listen. In Korea the people are happy to have a doctor and don’t question doctors’ advice.”
“I know. You know your stuff, but Dr. Kim, this is America. You have to find out how people feel about what you tell them. You can’t expect them to do what you tell them unless you know how they feel. Perhaps your research should be a study of a patient’s beliefs about their asthma and medication. The chances they will listen and comply can be improved if you can understand what they think about their asthma. We need to communicate in their language and get them to think about their asthma as we do.”
“I just need a little time. Don’t worry. In my country we learned how to deal with two cultures, Chinese and Japanese. We Koreans survived and even had our own culture. Medicine is very important to me but right now I am busy getting ready for marriage.”
“Great. Who Hae Ja,” I replied. Just then James returned.
“Call me Hazel; it is a more American name. People communicate with the name Hazel better. Dong Jong Park is a Korean Karate instructor. Our families in Korea matched us up. Will you and James come to the wedding? I would like you to sit with Ann Levine, if she has recovered. Do you know she is Italian and from Connecticut like you?”
“All the time at poker and she never told me. She’s Italian with a name like Levine?” I asked.
“It’s her marriage name. She’s divorced like you. She’s too shy to tell you. I think she can be good for you.”
James, listening to all of this, laughed at my plight. His father was being fixed up on a date.
I was embarrassed for the second time.
Hazel then said to James, “I hope you don’t mind James, but would you keep my niece, Kyra, company at the wedding. She is about your age and into computers."
“Many people will be at the wedding,” said Dr. Kim.
"Neat, a karate instructor!"
I looked at James. He nodded his head yes. The idea of meeting a Karate instructor excited him.
“My husband is Buddhist. I am Methodist. It will be a Methodist ceremony. It seems Buddhists can tolerate other faiths better than Christians can,” said Dr. Kim.
"He’s a karate teacher and a Buddhist too!" James nodded his head in a firm ‘yes’.
I answered, "Yes, we would be honored. I’ll try to arrange James’ visitation so he will be here."
The bar suddenly grew quiet. Six-foot-three Anthony Cambino marched in. With his black muscle shirt, he moved like a white Lawrence Taylor, the New York Giant’s football linebacker. He was not a Harvard Business School graduate now but one of the longshoremen. His eyes were taking every one in greeting. He had used his skills acquired at Harvard Business School to protect the men at the bar. He was legitimate but contaminated by his father’s reputation.
He was second generation. He had negotiated a great deal for the dockworkers for hospitalization at Brooklyn Academic Hospital and always schmoozed with the doctors, especially the Italian ones, to get better care for his workers. They stood to allow Anthony into the poker game. Out of the corner of my eye I saw him win two quick hands, then lose a big pot and stop playing as if he really did not want to take their money.
Just then the other residents arrived. I sat at the table and asked, “Whaddaya you think?” Guy and Hazel began to talk at once.
My chief resident Victor had joined us. “This is not a typical severe food reaction. I’ve known Ann a long time and she never told me about any allergies. This is strange.”
“What’re you guys having?" asked Mary.
“Corned beef and Roebling Ale,” Victor looked up from the menu. “May be it’s the strange stuff she’s working on.”
“Me too, I’ll have Brooklyn food,” Dr. Kim put down her menu.
“Corned beef. And what do you have to drink with no alcohol?” asked James.
"Try a chocolate egg cream,” smiled Mary.
"Neat, what’s a chocolate egg cream?”
“It’s chocolate syrup, milk and seltzer, a Brooklyn special. It’s all promotion, no cream and no egg.” This is great; I’m a father explaining to his son. “For me, corned beef and Roebling lager.”
Anthony Cambino came over to our table, “Doc, can I join you?” When he sat our heights became a little more equal. “I just visited Ann; she told me what a great job you all did. Saved her life. This is on me for taking such good care of everyone.” He looked at me and James, "Father and son?” He looked at James, then toward me. "James, you’re not from Brooklyn. Is this a visitation weekend?"
James just looked at him. We both were surprised at how perceptive Anthony was. Anthony laughed and rubbed James’ head. “What do you think?” he asked.
"Real mafia," said James.
“Just my father not me.” Anthony arched his back and interlocked his hands stretching in some sort of abbreviated yogi position. “You know, my father never wanted the mafia for me. He sent me to get educated. We want out. I’m here in part to see how we can work in our common interests. My father is the best businessman I’ve met.” He called out to Mary, “How about some vegetarian chili?”
Dr. Kim looked at Anthony. “You and your family are coming to the wedding?”
“Yes. Dong Jong Park asked me at the Dojo. Dong Jong said to have the Senator stop by your wedding to share in a toast. I will tell him to make it brief. You have to be careful with politicians,” replied Anthony.
“Did you know we are going to be required by Medicaid and Medicare to give a three digit diagnostic code on every patient we see?” Guy asked.
I interrupted, “It soon will become five digits. Asthma will be 493.00. The last two digits will be required later to classify the type of asthma and the private insurance companies will follow.”
“Procedure codes need to match the diagnostic codes or we’ll not be paid. A clerk will pass judgment on payment.” Guy slammed the table. “The insurance companies claim this is not the practice of medicine. They are exempt from anti-trust laws so they can pressure doctors to agree to this.”
Anthony motioned to me and handed me a paper and pencil. He whispered in my ear. “Doctor, you are a bright guy. It’s in our common interest; I know the thoughts jump into your head. Write them down, even draw a picture, but don’t interrupt. It gets people mad.” He handed me an item under the table. “Also, here is a hair bush. Get your cowlick down.”
This guy is like a coconut, a hard shell on the outside with a tender sweet interior. He is right and wants to help me. I thought.
Anthony looked at James and me. “Perhaps I can help you two get reacquainted. Tomorrow is Saturday. We have Karate school in the morning. I can show you around the docks in the afternoon," he laughed. "I might want you to be in our new company, Bart.
“Is it legal?”
“Yes, and for the common good. You can take the boys out of the country but not the country out of the boys. You’re going to get a Brooklyn education. Have another round of Roebling Beer on me.”
“Let me think about it. Talk to Ann.”
I continued rehashing the events and how strange it was to have such a violent allergic reaction just out of the blue. Anthony kept ordering more rounds of beer. “Next time Ann and I go diving we want you to come. Some of your fellows and even James should come along for the ride. It would be fun. You could fish a little before we used the diving sub. We might get you to come down with us. I want to get your interest in this venture.”
“We have to check on Ann. There might be a late phase reaction. I’ll sleep on it.”
Anthony turned, “Mary, check please.”
Mary Fitzgerald came over handed Anthony the check. She looked over all the empty beer bottles. “Thanks be to God, he made beer only six percent alcohol.”
We passed the waterfront on the way to the hospital. The Brooklyn docks sit on the East River across from Manhattan. Our view of the harbor was blocked by thousands of cargo containers. We had arrived just in time for the afternoon shapeup.
On a dock with broken floor members stood Alibi Albert, aka Alfonso Falcone, and some other longshoreman. They were unloading a small non- containerized cargo ship on to small trucks. A sling net was filled with loose cargo on the ship and hoisted to the dock. It was to be placed on to the truck.
The cargo net spilled something on the dock. It was Johnny Walker black label scotch. I-I-It’s one for the truck. “I-I-It’s one-two for us,” said Alibi Albert.
On the reconditioned dock were thousands of cargo containers. These were all in standard sizes to fit on a flat bed railroad car or trailer truck. Something like eight foot wide, eight and a half feet high and twenty or forty foot long. The containers were stacked up to six on top of each other in rows.
“Shape-up,” yelled the hiring foreman, on a newer dock. Hundreds of men appeared to work. Less than half were hired. As the men milled about a black car stopped and Brooklyn’s Bishop Capone garbed as a simple parish priest jumped out of the car. The men fell silent.
“Social Justice,” The Bishop said, as he waved his right hand. “Your brother’s family needs help after his death.” He shook the cigar box in his left hand. He put a generous amount in the box. He passed the box to the men.
One of the men passed the box to me. “Sad, he was killed in the hold of a ship. He was so dirty and dusty the city hospital just let him die. The cargo net let go. He was a leader for the men to rally their protests against the ship owners. This really was no accident. You see why the union has to play hardball?”
A light rain began to fall. “Sorry, we’ve got to go. Come on, James. We’ve got to see Ann.
The Hospital
I hadn't seen my kid in ten years, only photos. I cursed to myself, he was to come next weekend. I’ve got the Yankee tickets burning a hole in my shirt pocket. Now, he’s three hours late, after that mix up and I’ve go’tta work.
The thought of this visit scared the hell out of me. I felt all my negative thoughts become positive ones as soon as I saw my son, James. His fifteen year old body struggled up the steps of the hospital.
“Bart?”
Not Dad, I nodded. “Yes, James.”
Our eyes met. We shook hands, and I put my arm around his shoulders. We had lost so much time.
" Sorry, but Fred took his time getting me here." James said.
“I’m not surprised. Your step-father used every legal trick. He wants to interfere with our visitation.”
James nodded in agreement, just as the loudspeaker blared. "Dr. Bartolino Ferranti, Dr. Ferranti." And
“Don’t answer that.”
My mind raced, I ‘ve got to answer the emergency call, but after waiting for ten years we deserve to go to the ballgame. “James, I must answer. Come with me, someone might be very sick. You'll get to see what your old man does for a living... besides play golf." I joked to ease the tension.
"What do you say?"
"Come with me.”
His lips, quivered. “"You’re sure? For,real?"
"You bet I am son. Come on lets go!"
I the sickening swell in the pit of my stomach eased, as I ran into the hospital. to pick up the in-house phone “Yes, Bart Ferranti here.”
“Doctor, we’ve got a bad allergic reaction in the microbiology lab.”
I rushed to the medication cabinet, grabbed a bottle of adrenalin, and a syringe with a needle. “There’s an anaphylaxis reaction in the biology lab. Hurry! Follow me. Crash cart! Be sure there’s something to establish an airway.” I ran to the lab. My allergy residents followed.
James folded his computer booklet under his arm. “Neat, I want in on this.” He raced along with me.
I dashed into the microbiology lab. Ann Levine’s face was swollen and distorted. Earlier, when she wished me well with James’ visit, she looked attractive. Now she gasped for breath, her eyes swollen shut, she looked dreadful. I stepped over a fallen peanut butter and jelly sandwich.
Peanuts! There’s always a first time for an allergic reaction, I thought. She collapsed into my arms. I laid her down and ripped her sleeve to expose her arm for an injection. I felt through her sweat for a vein. “Adrenalin, Adrenalin, Adrenalin!”
I gave a deep injection into the muscle mass of the triceps. I hoped the circulation was intact enough to absorb the medication. We would give more though the IV. In moments, the two residents arrived with the crash cart. Now
Ann was out cold and my heart pounded. Her airway closed fast.
“Dr. Balducci, you and Dr. Kim start the IV. Once it’s started, dilute the adrenalin and mete it out through the IV.”
I stepped back to give the other doctors room. “Monitor her blood pressure, heart rate and other signs.”
I turned to Bernie my other resident. “Pull out her tongue. I’ll push a scope into her airway. Now, or she’ll be a goner.” After I struggled with the scope, I gasped in disgust. “Damn, can anyone do this better; I haven’t done this in years!”
“Let me look.” Guy pushed me aside and tried several times. “No, VA NAPLI. I can’t do it! She’s too swollen.”
“No need to swear.” Bernie looked at Guy. “Not even in Italian.”
“Stop it, Guys! No time for chit-chat. It’s tracheotomy time, and fast." I looked at James by the crash cart. "Hand me a thirteen gauge needle. The package is labeled B-D, two inches, thirteen gauge."
James searched for the needle, found it, and handed it to Guy.
"Two fingers above the chest bone in the midline. Then push the needle into the airway,” I chanted from memory. Relief! I heard a pop as the needle entered the windpipe. “Bernie, hook up the oxygen to the breathing bag and pump it into the needle.”
God forgive me but the excitement made me feel alive. I had spent years of dedication and sacrifice to be in this time and place. To be among the few who could save this woman’s life. I had trained to be analytical. To make the right decisions and not get caught up in the fear. I closed my eyes for a moment and said to myself, with your help God; I will use my knowledge without error. I had learned to disassociate from my emotions. I felt a fear for Ann’s life more prominent than if it had been anyone else. No more women, I thought.
I stepped back to give Dr. Balducci room to do as I requested.
This fuzzy bear-like Italian-American bent over to clear Ann's airway. Ann’s color turned from blue to pink as Dr Balducci pushed oxygen into her with a Rubin bag. Ann’s chest began to rise and fall in time with the Rubin bag. Her own breathing emerged.
I turned my attention to the residents starting the IV. “See the adrenalin drip in now. The heart rate is almost 200. The blood pressure is 50 over 30. The edema still has not responded.”
I thought for a moment. “Keep up the adrenalin. Dr Kim, add some Benadryl 100 mgms. and a H2 histamine blocker. Also steroids give her 200 mgms. Someone listen to her chest see if she has any wheezes in her lower airways.”
Bernie listened, “Chest clear. No lower airway problem. Does anyone know if she’s on beta-blockers for high blood pressure?”
I looked up for the first time since we entered the room. This was Ann’s genetics lab. Culture plates were on the lab benches. The odd thought flashed into my mind. Did they have anything to do with this sudden allergic reaction? She worked with some pretty strange stuff. My thoughts went back to Bernie.
“Good thought. " Beta-blockers would make this allergic reaction harder to treat. I have known Ann for years and she would have told me if she had a heart condition or blood pressure problem. “No”, I said, “I don’t think she’s on beta-blockers."
After a minute or two I demanded, “Heart rate?”
“It’s 160.”
“Blood pressure?”
“It’s 110 over 70 there is less edema.”
“Good, let’s get a better airway established. Take a look.”
“I think I can get a tube into her airway now,” said Dr. Guy Balducci.
“Good, do it.”
Guy struggled for a moment to place the tube in the airway.
“There, it’s in,” his body showed his relief. “Do you know what Va Naplie means? Just go to Naples; every one who conquered southern Italy started at Naples and worked down to Sicily. The conquered viewed Naples as hell.”
My son, James, smiled at Bernie and Guy. Then he focused on me. His face flushed with excitement "Allergy attacks can be scary."
I smiled back. "Well, sometimes they are." After a brief pause to savor James’ admiration, I turned my attention back to Ann. “Ok, great job, wrap it up.” I pointed to Dr. Kim. “Get a blood sample for a total allergic antibody level and IgE level.”
I looked at the remains of Ann's lunch, the peanut butter and jelly sandwich still on my shoe. “Get an allergic R.A.S.T. test for peanuts. Ann never mentioned having an allergy. Compare an old sample of her serum with the new. It’s in the lab freezer.”
After the fellows had gone off James and I had a few moments alone. James shifted from one foot to the other, stuffed his hands in his pockets and looked at the floor. He shrugged off his backpack and, all his pens fell from his shirt pocket. I bent down to help. I kicked myself. Fantastic, not even a few minutes into our new relationship and I had to take care of a patient.
He was wearing a blue blazer, school tie, and gray flannel pants. He was six feet tall and just one hundred and thirty pounds. “I’ve heard so many stories; even Fred was my real father. Please tell me your side.”
“I met your mother on a blind date. We fell in love at first sight and eloped ten months later. We moved to Baltimore for my training.”
“My mom told me I was born there.”
“Yes, when you were a baby, we enjoyed fine times as a family.”
“Why did you move to New York?”
“I got a job with a renowned New York allergist. Your mother needed knee surgery. So we moved in with your grandparents, because we needed their help.”
“Young couples need to be alone,” James said.
“I wasn’t too comfortable with this, because your grandfather’s family was from Castellammare del Golfo, Sicily, the town where most of the New York mafia originated. Your grandfather dealt with large real estate investments. He became deaf and had lost most of his family’s money when he invested in Arizona land with the head of a mafia family.”
“Was my grandfather in the mafia?”
“No, your grandfather’s family made their money legally with several Italian pastry shops, but the government had a surveillance van in front of our house. The FBI executed a search warrant because of your grandfather’s Arizona land deal.”
“My mom said she lost her cool with the knee pain and the FBI pressure. She let slip she had been married before, when she had never told you,” James said.
“Yes, the other husbands were news to me. I’D caught her in quite a few lies, ranging from little white ones, to big ones like her undisclosed marriages. I was unhappy. Your mother met Fred Fabbricante at the gym, where she was rehabilitating her knee. She forced me out so Fred could move in. So James, what do you think?” I whispered.
He just changed the subject. “Neat, the treatment was neat. No joke. At home everyone told me allergists are treating phony diseases.” James laughed, “Boy, they’re wrong. Wait until I tell what happened. You all saved the woman’s life.” He had my cheekbones and smile. He had his mother's green eyes and chestnut brown hair. His nose was a little too big for his face but it gave him character. He was a better-looking version of me. Biology could not be denied.
“How do you feel about this first visit?”
He hesitated. “It’s too soon to tell. I’ve heard too many contradictory stories since I was young. I want to make up my own mind. Give me some time. Do ya have those Yankee tickets?”
“Fair enough, Yes, I have baseball tickets, but for the wrong days.” I said.
“Not to worry. I’ll handle it so we can go.’
After Ann was in the ICU, the fellows sat around our table to discuss cases. One of my students, Bernie wore a yarmulke. He had elected to learn allergy at our training program rather than the more prestigious one at Harvard. Why? He wanted to be near his community of religious Jews. So he could follow their laws.
Just like the Italians, the Jews maintained shared factors of life. Their children were working in the American world but still living in the neighborhood. Bernie was tolerant of other cultures. However, he regarded some more liberal Jews as not being Jewish. “My patient is an orthodox four-year old Jewish girl. She’s pretty, but disfigured by eczema. She has a long, strong family history of allergy.”
I asked "Why is she at our hospital rather than a Jewish one?"
"We Orthodox Jews marry our own. A high incidence of allergy is the result. The parents don’t want her to be viewed as damaged goods when they try to arrange a wedding. I’ll treat with Eladil, and follow with some topical steroid cream.” I agreed. I knew little about Brooklyn before I came here a few years ago. This was an opportunity to become a real leader in the field. I was not joining this hospital as the junior member of an allergy team to waste years in the political maneuvering. I had the ball at Brooklyn Academic Hospital and was free to run on my own ability.
Guy Balducci began to tell us about his patient. “Michael Scialiano is a longshoreman. He had an asthma attack in the hold of a ship.”
“Green coffee beans!” I interrupted.
Guy’s face fell. “Gees, Chief it took me two hours to figure it out. Let me tell the case. I wanna show what I’ve learned.”
Gitano was right. I interrupt people too much. He was from Benson Hurst, an Italian community where the people huddled together in small row houses. Unlike the Ivy League Italians from Connecticut, like me, who had tried to become the ideal ‘White Anglo Saxon Protestants’, Gitano wanted to maintain his ties to Italian culture and Brooklyn. He was a teddy bear, but street wise and tough, after all he was raised on the streets of Brooklyn.
“You’re right, sorry,” I said.
Guy’s face lifted. “The roasted beans are less allergic.” A formidable woman slid by towering over my seated form. She had on a floral top with white pants. Not the traditional ‘70s nurses’ uniform. The nametag had in large letters:
MS.BERTHASMALLWOOD,RN
HEALTH CARE PROVIDER
WARDINSTRUCTOR
I had heard her challenge almost every doctor she met. Ms. Smallwood looked at me. “We’ll tag along on rounds. I hear you are a good teacher.” There was a gaggle of student health care providers or nursing students behind her. I seemed to have no choice but agree. I opened my mouth to say something, but Ms. Smallwood interrupted. “Students, make written assessments on each of the patients we see and then make treatment plans.”
I looked at James’ smile and thought, Assessments and treatment plans? Sounds like doctor’s diagnosis and treatment orders to me. This was just another way to join the HMOs in eroding the doctor’s position. How could I tell them the doctor was still the captain of the ship and legally responsible in a court of law, without a fight from Ms. Smallwood?
Tiny Dr. Kim stood up to Ms. Smallwood. “The doctor is still responsible in a court of law.”
Ms. Smallwood was silent.
“Dr. Kim, could you present your patient?” I asked.
“Jamal is a seventeen-year old, black male who was hospitalized with a severe asthma attack last night. I’ve been following Jamal in the clinic for several months. I’ve prescribed an inhaled bronco-dilator and anti-inflammatory for him. I’ve skin tested him and started weekly allergy shots.”
“Very good, Dr. Kim. Did Jamal follow your advice?”
She sighed. “Jamal came only when he was sick. I had to stop the allergy shots. He wasn’t taking his inhaled steroids. He took the stuff advertised on TV.”
“Dr. Kim, we need to talk privately.” I didn’t want to embarrass her in front of everyone.
Guy was leaving to bring Ann’s specimens to the laboratory. "Anyone got a number for the Cambino lottery?”
The neighborhood numbers were a chance for social exchange in many different neighborhoods. Salvatore Cambino hired the right front men in each ethnic neighborhood. I laughed, “I don’t play, but if I did, I would play the legal state lottery.”
Guy looked at me and said, “The local numbers run by Salvatore Cambino are a better deal for the players than the state lottery and are more honest with no taxes to pay.”
“Tell me, Guy, who is this Salvatore Cambino?”
Guy looked at me as if I had asked who was Jesus Christ and said, “Boss, you spend too much time with the books. He is the head of the Cambino mob family. He is called Don Cambino, people both respect and fear him.” After a slight pause as if to emphasize his importance, Guy said, “Ok, I am outta here."
I turned to Bernie. “Keep an eye on Ann in ICU. Late phase reactions can happen in six to eighteen hours; just keep pushing the steroids. We’ll try to meet at Fitzgerald's bar and grill for a break. We’ll finish rounds later. The beers are on me.
Dr. Kim I would like to meet a little earlier so we could talk a bit before the others come.” “Yes, sir.” bowed Dr Kim. I was learning about this special place called Brooklyn. The late ‘70s were a time of economic hardship for all of New York City. When the Dodgers moved with the migration of people to California, Brooklyn declined and had not yet recovered. Those remaining would still say with pride, “I’m from Brooklyn.” People from the other boroughs, like Queens, would always say the name of the neighborhood they were from and not the borough by name. Only in Brooklyn did people have a great pride in the whole borough.
“Neat, we’re going to a bar and grill. What’s Fitzgerald's like?” James asked as we walked out into rain. We put newspapers over our heads to ward off the water in the short dash to the grill.
From under the paper I said, “You’ll get to meet Anthony Cambino and other characters from Brooklyn.”
Chapter 2
A View of Brooklyn
"Neat, we‘re might meet a real life Mafia boss. A Don! Like the Godfather!" James raced ahead.
Now I could attempt to form a bond with him. "Anthony is only the son of a Mafia leader. He is just a union leader. Brooklyn is a different world."
We walked into odor of beer and the buzz of Fitzgerald’s. As she washed glasses at the long oak bar, Mary Fitzgerald looked out the window.
“Any one has a black Honda outside?”
A widow, She had hung onto the Bar and Grill. “A cop is beginning to write a ticket.”
Alfonso Falcone was the man’s given name but he was known around these parts of Brooklyn as Alibi Albert. Of course no one called him Alibi to his face. They just called him Albert. His eyes darted around. He tried to sneak unseen, by Tony Barrone, who grabbed his arm and said, “Albert, so nice to see ya, where’s the money you owe?”
Alibi Albert looked at Tony and said, “I-I-If you ever w-wan-want to get paid let me go to t-t-talk to the cop, wait a few minutes, come out with a c-c-cough and have trouble breathing.” Alfonso went out to the policeman. James and I followed to see the show.
“E-E-Excuse me o-o-officer, but I just stopped to pick up my f-f-friend who is having an a-a-asthma attack, here he is!”
As he struggled out the door, Tony gasped for air. Alibi Al grabbed his arm and pushed him into the passenger seat, hopped into the other side to drive off before the cop could finish writing the ticket.
James hid his laughter with his hand as we went back inside.
Good, he’s having fun. I thought
The Brooklyn Heights neighborhood changed into a haven for yuppies who walked across the Brooklyn Bridge to Wall Street. For the hospital staff this was a recovery room. Mary served a mean cabbage and corn beef with Roebling Beer.
“Look at those pictures above the bar,” James said.
“They’re scenes of the Brooklyn docks and the longshoremen.” I pointed. “See the ships unload with huge cargo nets, to the men below.”
James gestured. “Why does the other picture have ships with their navigation lights off as they leave New York harbor?
Mary looked up from behind the bar. “My husband was an amateur artist. He tried to show the ships attempt to slip by the Nazi submarines ready to pounce on them as they left the harbor."
I turned toward James. "In those days Lucky Lucanio controlled the Brooklyn waterfront from his prison cell. He put the word out to help the US government beat the Nazis. Ships began to get out safely. He was rewarded after the war was over with prison release but had to return to Italy."
Mary pointed. “Those are the large metal containers used today. Large cranes do all the work. The cargo nets and longshoremen are obsolete.”
The Italian longshoremen lived in nearby close-knit community of Cobble hill. Their jobs as dockworkers are disappearing and the men are growing old. The children have been educated and are moving on. The kids were in two worlds. They lived in this Italian neighborhood and worked jobs in nearby Manhattan.
In a room just off the bar area, the men played cards and supported each other. Most sat at a large round table. An opera from Verdi played in the background. We smelled stale cigarette and cigar smoke.
“Look, more pictures in this room,” James said.
“They’re Anthony Cambino, as an alter boy, college football hero, army helicopter pilot, and with important politicians,” I said. “See his MBA from Harvard Business School.”
“But he’s the son of the local Mafioso Salvatore Cambino,” James said in disappointment.
We heard the longshoremen. “My cancer is back. It’s those darn cigarettes. They’re killing me. Oh, I wish for the days before containers.”
“I remember the docks stacked high with cargo. Now my joints hurt all the time.”
“Forget about it. Have a drink.”
They touched their glasses. “To the longshoreman's tariff, when we could pilfer more than our wages.”
Longshoreman Michael Scialiano looked up from his poker hand “Doc, have a drink, give the kid a soda,” he persisted. “I’ve gotta thank you. My asthma is 100% better since I’m away from the raw green coffee beans. The roasted ones are ok. Thanks for ya help.”
I’m glad James heard. I looked at his approval. Embarrassed, I grabbed our drinks and changed the subject, “Did anyone see Dr. Kim?”
“Not I,” Michael Scialiano pushed some chips into the pot. “We hear you may join our gene venture, Anthony has us running errands, I guess soon we’ll run them for you.”
“I don’t know, Ann mentioned something about Anthony talking to me. What’s he like?” I asked.
“Anthony is a straight shooter. His father won’t let him get involved in anything illegal. He’s going to make it big time, legally. I was in his helicopter unit in the army. He was born to be a leader like his father.” Michael laid down his hand and pulled in the pot.
Dr. Kim walked into Fitzgerald’s bar and grill. I stood and waved to her and then took her to the grill in the back. The grillroom had a painting of the Brooklyn Bridge with its walkway to another world in lower Manhattan and Wall Street. Its stone pillars and graceful suspension cables were a memorial to the father and son team,the Roeblings, designed it. James and I sat across from Dr Kim. We all exchanged greetings. She smiled at me knowing she was to receive a lecture.
I knew how sensitive she was. I gave a bogus message for James to deliver to the longshoremen in the bar. It was my role to see she became the best doctor she could be. “Dr. Kim your patient Jamal doesn’t take his medication.” I tried to be gentle.
“I know what to do for asthma, I’ve read the N.I.H. recommendations but I cannot get my patients to listen. In Korea the people are happy to have a doctor and don’t question doctors’ advice.”
“I know. You know your stuff, but Dr. Kim, this is America. You have to find out how people feel about what you tell them. You can’t expect them to do what you tell them unless you know how they feel. Perhaps your research should be a study of a patient’s beliefs about their asthma and medication. The chances they will listen and comply can be improved if you can understand what they think about their asthma. We need to communicate in their language and get them to think about their asthma as we do.”
“I just need a little time. Don’t worry. In my country we learned how to deal with two cultures, Chinese and Japanese. We Koreans survived and even had our own culture. Medicine is very important to me but right now I am busy getting ready for marriage.”
“Great. Who Hae Ja,” I replied. Just then James returned.
“Call me Hazel; it is a more American name. People communicate with the name Hazel better. Dong Jong Park is a Korean Karate instructor. Our families in Korea matched us up. Will you and James come to the wedding? I would like you to sit with Ann Levine, if she has recovered. Do you know she is Italian and from Connecticut like you?”
“All the time at poker and she never told me. She’s Italian with a name like Levine?” I asked.
“It’s her marriage name. She’s divorced like you. She’s too shy to tell you. I think she can be good for you.”
James, listening to all of this, laughed at my plight. His father was being fixed up on a date.
I was embarrassed for the second time.
Hazel then said to James, “I hope you don’t mind James, but would you keep my niece, Kyra, company at the wedding. She is about your age and into computers."
“Many people will be at the wedding,” said Dr. Kim.
"Neat, a karate instructor!"
I looked at James. He nodded his head yes. The idea of meeting a Karate instructor excited him.
“My husband is Buddhist. I am Methodist. It will be a Methodist ceremony. It seems Buddhists can tolerate other faiths better than Christians can,” said Dr. Kim.
"He’s a karate teacher and a Buddhist too!" James nodded his head in a firm ‘yes’.
I answered, "Yes, we would be honored. I’ll try to arrange James’ visitation so he will be here."
The bar suddenly grew quiet. Six-foot-three Anthony Cambino marched in. With his black muscle shirt, he moved like a white Lawrence Taylor, the New York Giant’s football linebacker. He was not a Harvard Business School graduate now but one of the longshoremen. His eyes were taking every one in greeting. He had used his skills acquired at Harvard Business School to protect the men at the bar. He was legitimate but contaminated by his father’s reputation.
He was second generation. He had negotiated a great deal for the dockworkers for hospitalization at Brooklyn Academic Hospital and always schmoozed with the doctors, especially the Italian ones, to get better care for his workers. They stood to allow Anthony into the poker game. Out of the corner of my eye I saw him win two quick hands, then lose a big pot and stop playing as if he really did not want to take their money.
Just then the other residents arrived. I sat at the table and asked, “Whaddaya you think?” Guy and Hazel began to talk at once.
My chief resident Victor had joined us. “This is not a typical severe food reaction. I’ve known Ann a long time and she never told me about any allergies. This is strange.”
“What’re you guys having?" asked Mary.
“Corned beef and Roebling Ale,” Victor looked up from the menu. “May be it’s the strange stuff she’s working on.”
“Me too, I’ll have Brooklyn food,” Dr. Kim put down her menu.
“Corned beef. And what do you have to drink with no alcohol?” asked James.
"Try a chocolate egg cream,” smiled Mary.
"Neat, what’s a chocolate egg cream?”
“It’s chocolate syrup, milk and seltzer, a Brooklyn special. It’s all promotion, no cream and no egg.” This is great; I’m a father explaining to his son. “For me, corned beef and Roebling lager.”
Anthony Cambino came over to our table, “Doc, can I join you?” When he sat our heights became a little more equal. “I just visited Ann; she told me what a great job you all did. Saved her life. This is on me for taking such good care of everyone.” He looked at me and James, "Father and son?” He looked at James, then toward me. "James, you’re not from Brooklyn. Is this a visitation weekend?"
James just looked at him. We both were surprised at how perceptive Anthony was. Anthony laughed and rubbed James’ head. “What do you think?” he asked.
"Real mafia," said James.
“Just my father not me.” Anthony arched his back and interlocked his hands stretching in some sort of abbreviated yogi position. “You know, my father never wanted the mafia for me. He sent me to get educated. We want out. I’m here in part to see how we can work in our common interests. My father is the best businessman I’ve met.” He called out to Mary, “How about some vegetarian chili?”
Dr. Kim looked at Anthony. “You and your family are coming to the wedding?”
“Yes. Dong Jong Park asked me at the Dojo. Dong Jong said to have the Senator stop by your wedding to share in a toast. I will tell him to make it brief. You have to be careful with politicians,” replied Anthony.
“Did you know we are going to be required by Medicaid and Medicare to give a three digit diagnostic code on every patient we see?” Guy asked.
I interrupted, “It soon will become five digits. Asthma will be 493.00. The last two digits will be required later to classify the type of asthma and the private insurance companies will follow.”
“Procedure codes need to match the diagnostic codes or we’ll not be paid. A clerk will pass judgment on payment.” Guy slammed the table. “The insurance companies claim this is not the practice of medicine. They are exempt from anti-trust laws so they can pressure doctors to agree to this.”
Anthony motioned to me and handed me a paper and pencil. He whispered in my ear. “Doctor, you are a bright guy. It’s in our common interest; I know the thoughts jump into your head. Write them down, even draw a picture, but don’t interrupt. It gets people mad.” He handed me an item under the table. “Also, here is a hair bush. Get your cowlick down.”
This guy is like a coconut, a hard shell on the outside with a tender sweet interior. He is right and wants to help me. I thought.
Anthony looked at James and me. “Perhaps I can help you two get reacquainted. Tomorrow is Saturday. We have Karate school in the morning. I can show you around the docks in the afternoon," he laughed. "I might want you to be in our new company, Bart.
“Is it legal?”
“Yes, and for the common good. You can take the boys out of the country but not the country out of the boys. You’re going to get a Brooklyn education. Have another round of Roebling Beer on me.”
“Let me think about it. Talk to Ann.”
I continued rehashing the events and how strange it was to have such a violent allergic reaction just out of the blue. Anthony kept ordering more rounds of beer. “Next time Ann and I go diving we want you to come. Some of your fellows and even James should come along for the ride. It would be fun. You could fish a little before we used the diving sub. We might get you to come down with us. I want to get your interest in this venture.”
“We have to check on Ann. There might be a late phase reaction. I’ll sleep on it.”
Anthony turned, “Mary, check please.”
Mary Fitzgerald came over handed Anthony the check. She looked over all the empty beer bottles. “Thanks be to God, he made beer only six percent alcohol.”
We passed the waterfront on the way to the hospital. The Brooklyn docks sit on the East River across from Manhattan. Our view of the harbor was blocked by thousands of cargo containers. We had arrived just in time for the afternoon shapeup.
On a dock with broken floor members stood Alibi Albert, aka Alfonso Falcone, and some other longshoreman. They were unloading a small non- containerized cargo ship on to small trucks. A sling net was filled with loose cargo on the ship and hoisted to the dock. It was to be placed on to the truck.
The cargo net spilled something on the dock. It was Johnny Walker black label scotch. I-I-It’s one for the truck. “I-I-It’s one-two for us,” said Alibi Albert.
On the reconditioned dock were thousands of cargo containers. These were all in standard sizes to fit on a flat bed railroad car or trailer truck. Something like eight foot wide, eight and a half feet high and twenty or forty foot long. The containers were stacked up to six on top of each other in rows.
“Shape-up,” yelled the hiring foreman, on a newer dock. Hundreds of men appeared to work. Less than half were hired. As the men milled about a black car stopped and Brooklyn’s Bishop Capone garbed as a simple parish priest jumped out of the car. The men fell silent.
“Social Justice,” The Bishop said, as he waved his right hand. “Your brother’s family needs help after his death.” He shook the cigar box in his left hand. He put a generous amount in the box. He passed the box to the men.
One of the men passed the box to me. “Sad, he was killed in the hold of a ship. He was so dirty and dusty the city hospital just let him die. The cargo net let go. He was a leader for the men to rally their protests against the ship owners. This really was no accident. You see why the union has to play hardball?”
A light rain began to fall. “Sorry, we’ve got to go. Come on, James. We’ve got to see Ann.