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?"
We’ll have fun later.”
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’ve 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
WARD INSTRUCTOR
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 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.”