Hollywood Phil(Peter J Barbour) “Hollywood Phil”
by
Peter J Barbour


Among the resident staff assigned to the neurology ward at the Veterans Administration hospital was a young physician in training by the name of Phil Kent. Hollywood Phil, the other residents, called him. He made it clear to everyone he was putting in his time, nothing more. He'd make rounds each day, as required, write his daily notes, and admit his quota of patients. These VA-type patients were not Phil's kind of patients. Phil talked incessantly about how he was going to open an office in Beverly Hills, cater to the rich, get rich. This stint at the VA was just part of his right of passage. When the ward was quiet, and his work was done, Phil sat in the residents' room away from the ward and read magazines about cars, travel, wines, and fancy foods. Other residents would be reading about their patients' problems or mingling with their patients' families. Those activities were not for Hollywood Phil, not for do-the-minimum Phil.

The attending physicians took to Phil. Masters-of-the-minimum themselves, their concern was first and foremost to maintain a full a census on the ward. A full ward was a justification for their existence, evidence of their productivity. A long length of stay was good with little to do for the attending and maintained a full ward. Phil embraced this concept and came up with the merit reward discovery of the year. Phil discovered he could send patients home on leave. By not discharging the patient, the patient's bed remained technically occupied for the census. Phil's patients' beds remained full albeit unoccupied for rounds. Phil reduced his paper work to the notation, "home on leave." With little to do, Phil had more time to sit in the residents' room and delve more deeply into his fantasies about Mercedes and BMW's.

"Phil," Dr. Lackman, the Chief Attending, stuck his head in the partially opened doorway to the residents' room. "You're not very busy?"
"Just finished rounds, sir."
"I see. Well, I just received a call from a physician at Santa Marie. Wants to transfer a patient to us. It appears the patient is one of ours, a Korean War Veteran. Why don't you handle it.”?
"No problem, sir."
Within a few minutes, Phil received a call from Santa Marie Medical Center.
"Dr. Kent here. What can I do for you?"
"Dr. Samuels calling from the Santa Marie Medical Center. I have a Korean War Vet, named Kohincowicz here. He's a diabetic with chronic back pain from a war related injury. Seems he over did the insulin. I think he's severely injured his brain. When they found him at home he had a blood sugar in the teens. No one knows for how long. He's been here a week, still comatose. I'd like to ship him to you."
"Sorry, no can do. I haven't got any beds. Maybe we can take him when a bed opens up." Phil answered secure in the fact that if Dr. Samuels were to check the census with the admissions office, he'd find the beds were indeed fully occupied.
"Oh? Dr. Backbit didn't think this was going to be a problem."
"Hey, I'm sorry. But, my census is fully max'ed out. No more room at the inn so to speak."
"I see. Well, we can't keep Mr. Kohincowicz here forever. The family wants him at the VA."

Phil thought. ‘Of course the family wants him at the VA. It won't cost them anything. Of course Dr. Samuels wants the patient at the VA. His hospital won't have to lose money on his excessive length of stay - especially if the patient has no insurance or other resources.’
Then, Phil continued, "If I had a place for him, I'd take him. Call back in a week, maybe a bed will open up."
"Thanks for your kind compassionate understanding help." Dr. Samuels said sarcastically, and hung up.
"You’re welcome." Phil said after he hung up the receiver.

With a smug smile and feeling of satisfaction for his ability to shirk work, Phil sat back in his chair and began to thumb through his magazine. Several hours passed during which Phil intermittently slept. He would have continued to sleep had the phone not awakened him.
"Hello." Phil answered, the haze of sleep quickly clearing.
"Phil, this is Dr. Kratzinger. I'm sure you are aware that I'm in charge of the ward these next two weeks, what with Dr. Angellica gone. So, I'm responsible for you; and, what you don't get right comes back to me. Now, one of the things you didn't get right was a phone call earlier today from a former resident of ours practicing at Santa Marie Hospital, Dr. Samuels. Apparently, he wanted to transfer a sick veteran to us?"
"If I may, sir, it sounded like a...excuse the crudeness of the term...dump to me. The patient is over the acute phase of his illness and they just want to get rid of him."
"The man has strong service connections, former hero. I don't care if it's, …what did you call it…a dump."
"Yes, sir, but where am I to put this patient? All my beds are full," Phil said, certain of his truth's veracity.
"I want you in my office now." Dr. Kratzinger demanded.

Phil acknowledged the request and hung up the phone. He got up from his chair slowly, in no rush to get to Dr. Kratzinger's office. Phil went to the door, and tried to push it open. The door moved several inches and stopped. Something obstructed the way. Phil pushed harder but to no avail.

"Hey, is anyone out there?" Phil called several times until he heard commotion on the other side of the door. Several nurses had gathered about the obstruction, a litter, which they moved to the opposite side of the hall. Phil stepped through the doorway and joined the nurses. Upon the litter was a patient strapped safely and covered by a blanket. Someone had pinned a note to the blanket just below the neck. Phil unpinned the note and read it.

Dr. Kent,
This is Mr. Francis Kohincowicz.
Diagnosis: 1. Coma secondary to hypoglycemia - self
induced by insulin over-dose
2. Diabetes mellitus, insulin dependent
3. Chronic low back pain due to previous trauma.
Full discharge summary with a list of his medicines attached.
Dr. Samuels

Phil's first reaction was anger. He hadn't agreed to accept the patient, therefore he would just send him back, and Samuels be damned. As Phil fumed, mulling over in his head how he'd deal with this predicament, one of the nurses brought him back to reality.
"Finders keepers,” Susan said with a smirk.
"Do you have any orders for your patient?" Another nurse asked tauntingly.
"Orders? Why should I write orders? This isn't my patient. I'll, I'll...." Phil knew that he wouldn't succeed in any protest to Dr. Kratzinger. He was stuck, and Francis K. wasn't going home on leave. Phil started to panic.
"I didn't find him. You did. He's yours." Phil blurted.
"I'm only the nurse, Doctor. What are your orders for your patient?" Susan inquired.
"My census is max'ed out, one-hundred per cent full, no room at the inn. Do you understand?"
Susan said no more as she spotted Dr. Kratzinger turn the corner at the end of the hall.
"So, Dr. Kent, I see you did the right thing." Dr. Kratzinger said as he approached.

Kent, pale now, trapped, had no choice. He could not protest further. There was only one thing to do, take credit for the good deed Dr. Kratzinger believed he had done.
"Yes, sir, Dr. Kratzinger, we're going to get this sick puppy a bed." He turned to Susan. "Could you put Francis' chart together, I'm going to examine him and I'll need to write some orders."
"I expect you to be prepared to present this patient to me in the next hour. We'll go over the orders at that time." Dr. Kratzinger said and left.

Phil gathered up the paper work Dr. Samuels had sent with the patient. The story was as it had been presented. Mr. Kohincowicz had attempted suicide by injecting too much insulin. The profound drop in blood sugar that the over-dose caused was as devastating as if he'd put a plastic bag over his head and suffocated. Unfortunately, Mr. Kohincowicz had succeeded in killing just enough of his brain to prevent him from regaining true consciousness, but not enough to have succeeded in his effort to kill himself. Here, he was breathing on his own, heart beating strongly. His bodily functions functioned, but he had no soul that had already gone to Heaven or where ever souls go. Mr. Kohincowicz had left a note to which Dr. Samuels had referred in the discharge summary. Mr. Kohincowicz was a bonafide war hero. Shrapnel had torn up his back and left him with chronic pain. He had suffered for years, addicted to drugs, always in failing health. In the note, Mr. Kohincowicz expressed his feelings of worthlessness and the desire to be rid of his pain and the burden he felt he had been to his family. Phil put the paper work aside and went to examine his patient.

Phil found Mr. Kohincowicz in a semi-private room, placed his bag of tools on the bedside table, and he looked at his patient. The patient appeared to be asleep, eyes closed, breathing slowly and deeply. He appeared peaceful.

Phil moved closer to the bed and gently called, "Mr. Kohincowicz, Francis, can you hear me?"

There was no response. Phil shook the patient gently. No response. Phil took out a Q-tip and pulled the cotton tip into a long wisp. He took the end and used it to tickle Mr. Kohincowicz's nose. The eyes opened and there was a reflexive grimace. The eyes moved back and forth. Phil thought Mr. Kohincowicz was about to talk, he appeared to alert, but no sounds passed Mr. Kohincowicz's lips. The eyes moved, the pupils reacted to light, the face grimaced, but there was no awareness. Phil worked his way through his exam, and was in the process of positioning the patient so he could listen to his lungs when he was interrupted by the sudden entry of family into the room.
"Who are you? What are you doing to Frank?" shouted an elderly diminutive woman Phil immediately assumed was Frank's mother.
"It's the doctor, Mama," a younger woman said in Phil's defense. The women's resemblance to each other suggested mother and daughter, Phil observed. Phil started to introduce himself but was overwhelmed as the room filled quickly with men, women, and children, three, maybe four generations. They filed into the room and surrounded the bed. Phil found himself maneuvered into a corner. The matriarch of the family made her way to the head of the bed.
"I'm here, Frank," she whispered loudly into her son's ear.

Phil watched for a moment and considered discretely making his way to the door. Perhaps, if able to slip out now while everyone was focusing on the scene at the head of the bed, he'd escape the inevitable inquisition. As he tried to get through the door, he was blocked by a succession of people, varying in age. Finally the procession of family ended, each member proceeding to the head of the bed, under the direction of the matriarch, to offer Frank a greeting and announce their arrival. He counted twelve people in all, the extended family, all here. Phil tried to leave again. Mama Kohincowicz stopped him.
"Are you his Doctor?" She asked.
"Yes, Mr. Kohincowicz is my patient,” Phil choked on the admission and offered no more information.
"Do you know he has sugar problems?"
"Yes. He came with information from the other hospital."
"Do you know what happened to him?"
"He tried to kill himself with insulin," Phil responded matter of fact.
"No!" Mrs. Kohincowicz responded angrily staring directly into Phil Kent's eyes. "He would not do that."
Okay, Phil thought, I can see I'm going to be in a little trouble here. He decided to take a different tact.
"I'd like to know what happened. Please tell me."

She recounted what Phil, for the most part, already knew, in far more detail than he felt he needed or had patience to hear. Phil sensed a need for Mama to unburden herself. Trapped by the mass of humanity in the room, Phil made no attempt to interrupt her. The facts still sounded like suicide to Phil, and this catharsis, on the part of Frank's mother, was a reconstruction of the facts, a tailoring of the truth, to erase her shame. The records accompanying Mr. Kohincowicz mentioned a note that was left by the patient that would support the notion that the over-dose had been deliberate, a reality, Phil decided not to test at this moment. Mama was desperate, passionate, and sad. She had lost her son, but this was a loss without the finality of death, a partial loss that created hope that a miracle could restore her son to normalcy, a false hope that would never be realized. Phil held on as long as he could.
"Excuse me," Phil interrupted. All eyes turned to him in curious wonder that he had dared to cut Mama short. "Thank you for clarifying the facts for me," Phil tried to sound sincere without being patronizing. "What have you been told about your son's prognosis for recovery?" Phil asked in an attempt to learn to what extent she had accepted the reality of the situation.
"I don't care what they say."
"Excuse me," Phil said, taken aback by the full implication of the simple sounding pronouncement.
"I don't care what they say. He's going to get better." With that, she moved back to the head of the bed. "Open your eyes. Open your eyes, Frank." She caressed Frank's face and his eyes opened, roved back and forth, and then closed. "You see," she said, "he's awake, he hears, he responded to me."

Phil maintained his expression, flat. There was no hope. He considered telling her. He thought about hammering it home, beat her with the reality, destroy her hope, suggest appropriate withdrawal of support, allow nature to take its course - a euphemism for allowing Mr. Kohincowicz to die, comfortably. Phil touched Mama's arm to try to pull her from the head of the bed. The whole family watched the interaction intently.

"Mrs. Kohincowicz," Phil said softly, "I've examined Frank. I've read the opinions of the physicians that cared for him before me. Yes, he breathes and occasionally opens his eyes. He even appears to be looking around, but he does this all without any understanding. He can no longer experience the world around him the way you and I experience the world." Phil paused. All eyes were riveted upon him, hostile eyes, as everyone anticipated that he'd tell them just what the other doctors had told them. "He’s...he's like..." Phil was stuttering trying to find the right word, fearful of the hostility and mistrust that he read on the faces around him. "A body without a soul, a thing, no longer human, no longer capable to thinking." A vegetable, he thought, but couldn't bring himself to say that. Yes, that is what he was, a vegetable. But, the penetrating eyes about him prevented him from being his usual, abrasive, blunt self. Their neediness and belief that their love and devotion for each other could reverse the irreversible staid Phil's tongue from assaulting their hope further.

Mama spoke before Phil could talk again. "Maybe he will not be what he was, but there is hope. Others have discouraged hope. We believe he will get better." She had drawn out the "believe" lest anyone doubt their collective will to believe. The company surrounding her was all nodding, "yes".
"But, I'm afraid there's not much hope." As Phil listened to what he was saying, he realized he could no longer say, no hope. Even with this less dismal retort, all nodded, "no", and looked away.
"You may not see hope. The other doctors did not see hope. We see hope. We see it in his eyes when he looks at us. We see it in his breathing. We see it in the color of his skin. He will awaken from this. You keep him alive."

Phil looked at her in disbelief. He could see her strong will and adamancy in her belief and desire. Phil could see similar hope and tenacity in the relatives surrounding Mama. Phil looked at each face and each face looked back at him with the hope he would agree with them, with the hope he would pledge to support Frank, to sustain Frank, with the hope that Frank would return to his former state.
"I would hope you," Phil started, "that we could..." he paused, "that we could..." He had trouble bringing himself to say, let him die, but, "let us do what we can do.", came out instead.
Mama turned away from Phil and placed her mouth close to her Frank's ear. Her hand caressed Frank's face. In a stage whisper, she said, "Now you have a real doctor." All nodded, "yes", and smiled at Phil as they read hope into his final statement.
Phil pressed toward the door through the sea of humanity. As he departed, he saw Mama pull a book from her purse. He stopped to observe further. She opened the book and began to read softly by her son's ear. "In the beginning...."

At this, Phil exited. He was distraught at having failed. He had failed this family by allowing them to cling to the false hope that this breathing heart-beating corpse was alive. By the same token, Phil could not find within himself the ability to take away all of their hope and found himself committed to fulfill their wish to sustain Mr. Kohincowicz.

Phil remained on the ward for three months. Frank remained his patient. He saw members of the Kohincowicz family daily and marveled at their devotion. Periodically, always kindly, Phil tried to counsel the Kohincowicz family on the hopelessness of Frank's condition; but they remained steadfast in their desire to keep Frank alive. Phil never firmly grasped what sustained them. Had it had been Frank's stoicism regarding his pain and illnesses while he truly lived? Had it been Frank's personal sacrifice? Were they venting their guilt for what they hadn't given him? Whatever it was, Frank's family remained by Frank's side. Each day someone read to him, read to him as if Frank were really there, as if he could hear. And, Phil did as the family directed. He supported Mr. Kohincowicz, defended him against pneumonia and urinary tract infections that could have easily ended his ordeal. With time, Phil saw a certain satisfaction on the family members' faces as they read to him. They seemed proud of their contribution, perhaps settling some debt with Frank, or some greater debt to being allowed to be whole themselves, or just more whole than their Frank.

On his final day as a resident house officer on the ward, Phil made his last round on each of his patients. When he walked into Frank's room, Phil stood for a long time at the bedside. Phil looked deeply into Frank's eyes and saw the vacuous oblivion they reflected, and felt sadness. He touched the book perpetually left on Frank's night table, picked it up, opened it according the marker left in place, and began to read. "Now there arose up a new king over Egypt, which knew not Joseph..."

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