Julio
 by: Miguel Sanchez

© 2005 by the author

The author retains all rights. No reproductions are allowed without the author's consent. Comments are appreciated at...

I headed to the surgeon's room to change into scrubs. I put my top on and was heading to scrub my hands when I heard "CODE BLUE, HEART ATTACK, OPERATING ROOM 2, STAT! CODE BLUE, O.R. 2, STAT!

I grabbed some sterile gloves and headed into the operating room yelling "STEVEN"

Chapter 10

The surgical nurse put a mask on my face asking, "Instructions, doctor?"

I started giving orders, "increase the temperature in here. Dr., you, yes. Give 50 mg Lidocane IV. Let's get his body covered and warmed up."

The doctor who was to assist me said, "Dr. Sanchez, the medication is on board and his heart is beating normally again."

I asked him, "what's your name?"

"Dr. Lewis," he replied.

The temperature began to rise and Steven's body went from a light blue to a nice pink then finally to his olive skin tone. The head nurse came into the operating room and started screaming about the temperature. Before I could say a word, Dr. Lewis jumped her case.

He shot at her, "did you hear the code called in here? What took you so long? Were you aware of this child's body temperature?"

"I am the head nurse and I know everything that goes on in here."

I said, "I'm Dr. Sanchez, the attending surgeon, why did you allow a child with a fever of 102 degrees into a 60 degree room?"

"I had no idea," she said.

"You just said you knew everything that goes on in here? There is one other operating room in current use. If you can't check one patient before he goes into the OR, you're falling down on the job. Now, ANSWER MY QUESTION AND DO IT NOW!"

"The floor nurse was..."

"Don't pass responsibility, nurse. You are relieved pending an investigation."

Suddenly, Paul's voice came through a speaker from his operating room into ours "nurse, this is Dr. Combs. You were informed about the child with the fever coming up. You told me you would see to it personally. Now you're passing responsibility. You're relieved from your duties and turn in your credentials. Sorry, Miguel. This should not have happened. How's Steven?"

I spoke into the air "he's stable, Paul. But I don't like operating in 70-degree air temperature, but I don't see anything else I can do. Do you, Paul?"

"No I don't. Work quickly, carefully and hang your antibiotics to prevent the risk of infection and holler if you need me." Paul said.

"Right. Alright people, let's get ready. I have to go scrub up then I'll be right back. Get him tubed and put to sleep." I gave the team my orders on the way to go scrub.

"OK," I said. "Are we ready to proceed? Here we go then. Scalpel and a sponge." I made my incision through the skin. Then opened the tissue revealing the internal body cavity. It took me 5 minutes to locate the appendix. It was swollen but had not ruptured. I clamped and tied off the organ along with other blood vessels. It took me 45 minutes to complete the operation.

Steven went into post-op while I went outside to find Luiz and the boys. I filled them in about Steven and then went to go check on him. About an hour after the operation, he went to his room. Luiz and the boys were there. Steven woke up about two hours later. He was in a lot of pain. I gave him his pain medication and said we would all see him tomorrow. He didn't like that idea. I told him the pain medicine would just make him sleep, so he was comfortable with that decision. Before leaving the hospital, I wrote my orders on Steven's chart and dictated my postoperative notes. I looked at my watch and it read 7:30pm. This has been a very long day.

We took a cab home and told the boys that their brother was going to be fine. I explained that I would keep them informed as to his condition and would not keep anything from them.

We arrived home about 9:00 that night. Luiz had fed everyone before getting here. I was tired and needed to unwind. The boys got comfortable and Luiz got me a Bailey's on the rocks. The boys came into the family room in just their underwear and crawled in my recliner next to me. The boys and I talked for a little while about everything that happened including the fact they were scared. After talking for about a half-hour, the boys became very tired. They asked it they could sleep together and I said that was fine. By 10:00, I was ready for bed. Just then the phone rang and it was Paul. He'd checked in on Steven before leaving and he was doing as well as can be expected. I told him I would be in around 8:00 in the morning and that was fine with him. He was on call for the evening and would let me know if anything happened to Steven.

And call he did later in the night. Paul said the Steven's fever was 103. He told the nurse that I would call for an update and orders. I called the nurse's station and asked for Steven's nurse. She gave his latest condition. His fever was now 103.4 and was having trouble sleeping. Tylenol along with the IV fluids and the IV antibiotics were not lowering his fever. I ordered the following blood tests, CBC (complete blood count), Chem. #7 (liver function test), cardiac enzymes (this tells us if the patient had a heart attack). ABG (arterial blood gas to check the amount of oxygen in the blood). Strip the patient and apply cool towels to his body for 45 minutes and repeat temperature. Have a nurse remain in his room during the use of the towels so he does not get chilled. Call me when the CBC results were done. The nurse called me back in less than one hour with the CBC results. His white count had not elevated beyond what it was in the emergency room. I had the nurse start a second IV to increase his fluid intake. I also ordered a blood and urine culture. This would take 72 hours to know what else was going on, but this was my only option. I would have the other test results in the morning.

I managed to get a few more hours of sleep when I heard the boys running and falling on their butts again. They would remember to wear slippers or they would have bruised butts from the floor, which ever came first. I had my coffee waiting as usual.

Luiz was going about his usual morning routine like he had been in the house for months instead of only days. I think he was happy here. He liked the fact that I was going to work at the hospital not out in the streets taking on Recife's scum. He liked watching his "grandchildren" growing up in a safe place, free of violence. Luiz had never said anything to me but I have learned how he acts and behaves. When Luiz is not cooking or baking, he is mad or worried and now he is happy.

The boys ate and went into the bathroom to take a shower. Luiz had put their clothes away yesterday so the boys had no reason to run around in just their underwear. I didn't mind this but Luiz thought this not ungentlemanly. The boys came out looking rather sharp, if I do say so myself.

I told Luiz I was taking the boys with me to the hospital and did he wish to come? He just shook his head and went on with his bread baking. We headed out to the garage and left for the hospital. It took about 45 minutes to reach the hospital by way of the interstate. I found my parking space in the physician's lot and pulled my Navigator in the space. A security guard asked me for my ID. He only asked because he did not see a physician's decal on the vehicle. After I showed him my ID card, he put a sticker on the bumper and apologized. I told him not to worry about that, he was doing his job. He nodded and we went on our way.

I walked in the front door and saw Paul heading out. We chatted for a few minutes about two of his patients he wanted me to check on while I was there. Then he filled me in on Steven. About 3am his fever spiked to 104.8 degrees then at 6 it broke. When he arrived his temperature was 101 and still dropping. He looked at the blood work and that was fine except for the CBC. Seems his white count is still elevated. Neither of us was worried now since his fever has broken. I told Paul I would repeat the CBC this afternoon and check in on his two patients after seeing Steven. Paul headed out the door and over to the office for morning patients.

As I headed for the elevator, I was one child light. I saw Ronnie sitting by the door but Jay was nowhere to be seen. All the doors required ID cards to unlock them, so he could not have gone into an office. As I looked around, I spotted the chapel. I called Ronnie and we went inside. The lights were dim and there was soft music coming from the speakers. As my eyes became adjusted to the darkness, I saw the back of a child's head. As I realized who it was, suddenly I heard the voice of an angel. The song coming out of the speaker was "Ave Maria" and someone was singing. As I got closer, Jay was kneeling in front of the Virgin Mother singing "Ave Maria." He had the voice of an angel. He new every word, every note. It was perfect. When he finished, he rose, crossed himself and looked at Ronnie and I.

Suddenly, Ronnie burst into tears hollering at Jay. "I hate you, I hate you." he screamed. He started to run at Jay. As he reached his brother, he fell into his arms crying out of control. "I hate God, I hate God!"

"No you don't." Jay said. "Your mad, your sad, but you don't hate God. I'm sorry about your mamma Ronnie."

"That song?" Ronnie said, "That was her favorite. It made me remember her and all the good times we used to have together. Now, now they're gone."

"No, they aren't" Jay said, "they are still in here (pointing to Ronnie's heart) and in your mind. You will always have those memories with you. I didn't know about Ave Maria being you mom's favorite song. I won't sing it any more."

"No, Jay;" Ronnie said. "That was beautiful. You sounded like her. I loved her voice. Her voice is now in you. Don't ever stop singing, please? For me? I love you bro, don't you know that." Ronnie raised his head and kissed Jay on the cheek holding him tightly.

"Yeah, Ronnie" Jay said, "I do." Jay returned his kiss and helped him to his feet.

"Have you always sung, Jay?" I asked

"Well," Jay started "I haven't been able to for a while. I heard the music and I just started singing hoping God and The Virgin Mother would hear me and let Steven get better."

"They did son," I said. "Paul told me that his fever broke and he should be getting better each day. Jay, you have a wonderful voice. You should use it. God gave you a special gift and he meant for you to share that gift." Both boys were smiling when I told them that. They each had a hand as we left the chapel for the elevator.

"Dad?" Jay said, "You wouldn't mind me singing in church? I know someone else who can sing. Two other people, ouch!"

"I would be proud. Ronnie don't hit your brother." I said without missing a word. If you boys' can sing that's great. You have to want to, no one can force you. Ronnie I know you like to cook. You boys are gifted and the love you three give me is the greatest gift of all." Just as the elevator door opened, I saw huge smiles on Ronnie and Jay's face. We stepped off the elevator and I saw Steven's nurse. I had the boys go sit outside their brother's room while I read his chart and talked with the nurse. She said he was in a lot of pain and the night nurse wouldn't medicate him according to my orders. She saw an angry look come across my face then told me she was being suspended by the nursing supervisor for failing to comply with a physician's orders. I nodded my head then another nurse asked me how much Demerol I wanted for Steven. "50 milligrams" I said. I logged the medication in his chart, took the syringe and headed down to my son's room. On the way to the room, I had the nurse set out the charts of Paul's patients.

"Morning" I said as I and the boy's entered Steven room

"Hi, daddy" Steven said. "My tummy still hurts."

"I know, son" I answered "I have something......"

"No daddy, please! Not that in my butt again." Steven wailed

"No, son" I reassured him. "Not in your butt. In your tubing. You won't feel anything."

Jay spoke up and said "That's right Steven, dad wouldn't lie to you. He gave me medicine in my tube and it didn't hurt. OK?"

"Jay," I said "Steven is scared because the last time I gave him medicine for his stomach, I stuck the needle in his butt and it did hurt. Steven, I won't do that to you this time, I promise."

"OK, daddy" Steven said. "If both you and Jay say it won't hurt, then I'll believe you."

Before I changed Steven's dressing, I told the boys I had to talk to them about something very important they could be carrying inside their bodies. If we did not find out if it was there, they could get very sick or even die. When everyone was listening, I sat beside Steven and spoke. "Boys you could have something inside you that you don't even know is there. Jay, I know you are fine but you are needed here more that you will ever know. Boys, you may have a disease called AIDS in your blood and not know it because it takes a long time to make you start to feel sick. How did you get this disease? Well, do you remember the things you had to do to get money to eat? Ronnie, do you remember telling me about the man you sucked off to earn 10 Reals and you had to swallow his cum? Well, that is how someone gets AIDS. They either have oral or anal sex with someone. Hey hey, Steven. It's alright, don't cry. I know you were forced to have that man put his thing in your butt. No one here is upset or angry with you. Ssshhh, little one."

"I'm a whore, daddy!" Steven wailed "I'm a little faggot whore who gave men hand jobs and sucks for 5 Reals. No body loves me. wah...."

Jay sat beside him and put his arms around the sobbing child and whispered to him "I did the same thing, buddy. That makes me one too, but you love me, don't you?"

"Yeah" Steven cried. "But that's different."

Jay started again, "What's so different about what I did and you did? It's the same thing. The only difference, if you can call it different, is I was older than you. So, I should have known better because I am older than you are. Dad, Ronnie and I love you. No questions asked or explanations needed."

Steven understood what Jay had said and I finished my talk. As I was explaining more about sex and AIDS, Ronnie's face went pale white with fear and began to cry.

"Oh God!" Ronnie cried. "What have I done? Why did I have to do that? I gave him AIDS. I killed him, daddy. I gave AIDS to Jay"

"What brought this on?" I asked.

"Ronnie talking through tears said "Remember when Jay and I rubbed ourselves the other night..."

I interrupted him saying "Son, you can't get AIDS from that. Neither of you had any of the other's semen go into your body, I mean into your mouth or butt. That is the ONLY way you can get AIDS from sexual contact. That is the truth, son. I would never lie to you about something this important. OK?"

Ronnie took in a deep breath and said "Thanks, Dad. I feel a whole lot better. I would just die if I knew I gave my brother this illness."

I finished my talk saying "Boys, I know every one of you would feel very guilty if you knew you passed this disease one to one another. Later today, I will have someone come in here had take blood from all three of you and run the test. We should know the results in three to five days."

Steven wined "Will it hurt, daddy?"

Just as I starter to answer, the nurse came in to draw their blood. Steven how about I do you and Ronnie? The nurse can do Jay because he has had blood drawn before and he knows what to expect."

"OK, daddy" Steven sighed, "How about you do Ronnie then me?"

"Is that OK with you sport?" I asked Ronnie.

"Sure, dad" Ronnie said. We'll show the little chicken there is nothing to be scared of."

Just then Jay started playing "Ow! Hey easy. That hurts!"

The nurse said "hey come on little baby, now sit still for the nurse." She had just finished drawing Jay's blood when he started playing up but she got him good.

"Hey, Jay" Ronnie said. "Who's the baby, now?"

I put the band around Ronnie's arm and started feeling for the vein. He had a real big one pop up and I new I could hit that one in my sleep. I told Ronnie not to move and I hit the mark. Quickly and painlessly, Ronnie sat there with a smile on his face so Steven would not be afraid when his turn came. I smiled and winked at Ronnie for being so good and impressing his younger brother. Then it was Steven's turn. He held his arm out like Ronnie did and didn't move when I wiped his arm with the alcohol pad. He did however wince when I slid the needle into the vein. He sat there still as could be and smiled when he saw the blood go into the tube. He never made a sound, unlike Jay. He even made a point of saying so when I was done.

When I was done with the boys, I chatted with Steven while I examined him and changed his dressing. He never hid that he was naked from his brothers, in fact I think he liked letting them see him naked. Once, when Steven saw Ronnie looking at him while was changing his bandage, he got a little boner and even giggled when Ronnie said something to him. When Ronnie told him about Jay singing, he had to have Jay sing while I worked on him to take his mind off the fact that it hurt a little. After the dressing was changed, all three were singing until Steven's stomach started hurting. I had to give him his Demerol and he drifted off to sleep. Jay and Ronnie said they would watch TV in his room while I checked on Paul's patients.

The first patient was a boy, 14 years old. He was in a motorcycle crash and had his spleen removed. He was bruised and had several major cuts on his arms and legs. I increased his pain meds from 50 mg to 75 mg of Demerol after conferring with Paul first. He told me I didn't need to check with him but I said that was just the way I was until he knew me better. He reminded me that we went through med school and did our intern and surgical resident training together. I said alright, you win.

The last patient was a 13-year-old girl. She just had her appendix removed. Her mom was wary as to who I was until I mentioned Dr. Williams' name. The girl said he was cute and she really liked him. She said she heard him say something about my boy and asked how he was. I slid her gown up and looked at her incision and told her all about Steven at the same time. She never realized I was seeing her abdomen and privates until she felt me pull the covers back up. After that she said I could examine her anytime I needed to. I just smiled and told her I would see her later while I was washing my hands.

I went to the nurse's station and wrote my notes in their charts and made a note in the boy's chart about increasing his pain medication. I handed the charts to the nurse and went to get my boys.

As I was about to check on the boys, I heard my name called over a speaker. "Dr. Sanchez, Dr. Miguel Sanchez the voice said" and I went into Steven's room to use telephone and call the hospital's operator. When I walked in, I had a mighty big surprise on the bed. There under the covers in Steven's hospital bed were Ronnie and Jay snuggled together like they belonged there. Before I said anything, I answered my page. I picked up the receiver, pushed one button and said "Dr. Sanchez here. Do you have a page for me?" I was informed Dr. Williams in emergency needed to speak to me. I called and was told a victim of an assault was due at the ER in ten minutes.

Walking over to the bed I said, "What are you two doing in there?" While speaking, I pulled the covers off them and got surprise number two. Not only were they naked, they had woodies to boot.

"We got comfortable" Jay said "and we wanted to have some fun."

"Comfortable, my ass! If you get caught, it's is my butt on the line" I replied.

"Don't worry" Jay said, "The nurse said we could lie here."

I answered "If you two get caught fooling around, I will get in big trouble and I will not take kindly to that. So, if you do fool around be a bit more discreet and do it in private it. Can you handle it so that it won't be a problem?"

"Fair enough dad" Ronnie said "can I suck Steven off?"

"Not yet, son" I answered "we just did the blood test, remember?" I finished telling the boys what they could and could not do, then I headed to the ER. Just as I got to the ER door, an ambulance arrived.

As the doors slid open, the EMT's were working on the patient while a cop was trying to shake him and yell at him. I walked towards them and reached my hand out and grabbed the cop by the arm. He tried to pull away but all I did was squeeze even harder. "Look!" I said, "This is my area! Don't you dare talk to anyone like that in here. You might be the law outside, but in here you are just another person in my way. YOU GOT IT?"

"I ought....." he started saying

"To do what?" I snapped back.

"Arrest you." the cop spat.

"Dr. Sanchez," a voice said behind me, "quick. The child is awake."

The cop tried to rush past me, but I grabbed an arm and he dragged me along. "You shut your..." the cop tried saying.

Just them, security came in and I had them detain the police officer. Dr. Williams saw the cop in cuffs and said, "This is the third child this month he has brought in here like this."

"C.D. Garcia" the name tag read. Bill Williams told me where a private phone was and as I turned to head into the doctor's private lounge the cop glared at me. I called a friend who was with the FBI and I had him run the officer's name. He said he would call me back and I gave him my cell number before hanging up.

As I came out the doctor' lounge, I noticed a male nurse slip into the examination room where the assault victim was wheeled. I asked the charge nurse, who I got to like very well in the last 48 hours, who he was and she had no idea.

I had a plain-clothes security officer keep an eye on him. Dr. Williams was wondering if any of those other kids who Officer Garcia had brought in were treated by the same male nurse. When I asked why, he said he never saw the kids after they left emergency. I had thought that male nurse looked familiar, he looked like the ticket agent who made a smart remark about Julio.

The cop had managed to talk his way out of his problem security had released him. I saw him enter the examination room and this pissed me off to no end and I was bringing up the rear at almost a full run. When I entered the room, the cop had the nurse by the nads and the child was bound, gagged and bleeding.

Seems this cop was undercover from the state police trying to bust up a child porn ring and the nurse was a procurer for filmmakers. The nurse had just finished raping the child and was going to clean him up and take him over to the producer when we entered and saw the whole thing. The cop "squeezed" the truth out of him and the state police, along with the FBI busted a major pornography ring.

I examined the child and Paul had to come in because I was in no condition to operate on this helpless waif. I found a chair and cried my eyes out and could only think of my boys.

Bill helped me into the lounge and fixed me a cup of coffee so I could regain my senses. After finishing the coffee, I joined Paul in the exam room. He was trying to talk to the boy but he said he couldn't understand what he was saying. I took a stab and discovered he spoke very broken English and Portuguese. I had to take over the exam but come to find out, we had a dozen or so nurses who also spoke the language. I was relieved that the boy could be understood and knew why I left medicine. This was a side of medicine I hated and I vowed I would never see again.

I went back upstairs and found my boys. They had just finished eating lunch and were watching TV when I arrived. Ronnie and Jay were lying in the extra bed in the room and Steven was finishing some ice cream. I walked over to Steven's bed, kicked my shoes off and lay down beside him.

"What's wrong, daddy?" Steven asked.

Reaching over, drawing him close to me I said "not a thing." I held him, closed my eyes and all four of us took an afternoon nap.

Steven didn't really buy what his dad was telling him but he loved being cuddled so he closed his eyes and slept with his daddy.

To be continued...

Posted: 06/06/08