Not the sort of thing that interested her, but the most spectacular stroke of luck during the year of my internship: if Mrs. Badenhaus’s admission order had been signed a few minutes earlier, Santa Valley Medical Center’s all-time disaster would have fallen upon my shoulders, adding to a list of tribulations that included two obstructed gallbladders, a peri-rectal abscess the size of a hen’s egg, a grandmother in florid delirium tremens, and a half-dozen GI hemorrhages, two of them so obtunded by hepatic coma they had to be diapered.   

The month before I had won the Chivas Regal award for admitting the most jaundiced patient in the hospital. My champion was a Russian émigré whose iron will had survived Stalin’s reign of terror but whose flesh-and-blood liver decomposed in an ocean of vodka. During his last days he slipped into coma – swollen lips, half-closed eyes, a waxy, porous face with the sheen of a ripe lemon. His tears and saliva left yellow blots on the pillowcase. His breath smelled like urine. A condition due in part to bad genes: three of his four brothers had preceded him, each (according to my patient’s wife) lying in his coffin more jaundiced than the last. The wife had a hot temper and puffy cheeks filigreed with purple veins. At ten o’clock in the morning she reeked of liquor. Two hours before her husband’s death, an attack of tremors sent her scurrying to Mellow Dee’s, a bar across the street from the hospital. 

That night I gazed at my own wife as she lay reading under the glow of our bedroom lamp. I tried to concentrate on Harrison’s Textbook of Medicine, but I couldn’t take my eyes off her beautiful, sober face. 

Mrs. Badenhaus brought a refreshing change to a hospital awash in jaundice and hemorrhage. She drank her share – up to twelve beers a day, by her husband’s account – but her liver was fine, a tolerance her GI consultant attributed to adequate nutrition, though adequate, in the case of Mrs. Badenhaus, was hardly an adequate term. At the time of her first admission she weighed 437 pounds. To accommodate her bulk, an orderly wired two beds together with bent coat hangers. The visual spectacle stopped me in my tracks: one head – a large head, perfectly round – atop a mountainous body that seemed to call for two or three. She had huge nostrils, a dreamy morphine smile, deep-set eyes with a Mongolian slant. Her pasty arms were big as thighs and damp with sweat. 

Mrs. Badenhaus had suffocated her own tissues, causing an unclean disease: the apron of fat that hung down to her knees had outstretched its blood supply. The resulting ischemia allowed an ulcer to melt through the skin, dissolving the subcutaneous fascia and gouging out a crater the size of a dishpan. Puss from the wound teemed with staph, strep, pseudomonas, E. coli, almost every bacteria in the book. During dressing changes, the odor crept over C Ward like a pall of toxic gas. Treatment was a challenge. Antibiotics might work, but a tremendous body demands a tremendous dose, and fat has poor circulation, especially infected fat. The blue team’s only hope was to drip six hundred dollars’ worth of gentamycin into her veins every day. 

Yes, Mrs. Badenhaus was admitted to C Ward by the blue team. My service, the red team, shared the same ward, so I saw Big Momma, as she was called, on morning and evening rounds, but I didn’t have to change her puss-soaked dressings or write two pages of orders in her chart every day. The blue team sent out a desperate call for help. Specialty services swarmed round her bed – GI, dermatology, rehab, infectious disease, plastic surgery – all scratching their heads, wringing their hands, making vague suggestions (“ . . . enhance circulation . . . stimulate revascularization . . . increase antibiotic penetration . . .”) for a cure that would go down in the annals of Valley Medical Center as the case of the century. Yet in the end it was not the medical challenge but passion, a love triangle of sorts, that kept tongues wagging throughout the hospital. The C Ward charge nurse fell in love with Mrs. Badenhaus’s husband. 

Johnnie was an attractive older woman, almost forty, with a willowy figure, an angular face, and long, dark hair – suspiciously dark for her age. I liked Johnnie, liked her more and more as the days and nights wore on. It was my fate to fall at least a little in love with every woman who resembled my wife, a skinny, dark-haired creature who took me captive the first time I laid eyes on her. Since adolescence I had felt a surge of lust every time I met a thin woman whose quiet, subdued smile promised a chilly aloofness from the human race, an aloofness that might give way to the one special person – me – among all the souls on earth. My wife was the chilliest, the most aloof, the most beautiful of them all, and I was desperately in love with her. Cool, solitary, exotically thin – just what I craved. And yet . . . year after year the icy aloofness that bound me like a slave left me desperate and lonely. 

So yes, I was married but drawn to Johnnie because she resembled my wife. When I first arrived on C Ward, Johnnie was skittish, avoided eye contact, kept to herself for a week, but early one morning, over the corpse of a failed resuscitation, all that vanished. My back throbbed, my legs trembled with fatigue. At a moment when futility and exhaustion had brought me to the verge of tears, Johnnie looked at me with a gaze so steady it seemed to hold my body up against the aching force of gravity, then she covered my hand with hers as it rested on the pale, hairless chest of the dead patient. There was warmth in that touch. Its tender pressure lifted my spirits. Here was a loving and lovely woman – but a nurse, a colleague, too risky for romantic entanglement. Just what I needed. My nerves could not endure the turmoil of an affair, but Johnnie’s touch sent a thrill into my barren life. 

Johnnie and I knew well the rules that governed our transient demi-fling. No kissing – except for the occasional peck, of course, almost always in public, and almost always on the cheek. Contact outside the sheltering walls of Valley Medical Center – verboten. If a hand slipped beneath an untucked shirt, it never stayed there for more than an instant. 

But to my distress, Johnnie’s restraint fell flat the moment she met Mr. Badenhaus. The first hint of impending disaster came just two weeks into our non-affair, when a dapper man in a three-piece suit smiled and waved at Johnnie as he trotted by the C Ward counter with a package under his arm. 

“Who’s that?” I said. To my eye he seemed ordinary – short, stocky, his face round and plain as a dinner plate – except he wore the first three-piece suit I had seen since graduating from medical school, certainly the first worn by a visitor to our charity ward. 

“Oh,” Johnnie said, “that’s Jim.” She caught herself, gave me a furtive glance. We weren’t meant to refer to patients, and certainly not to their family members, by first names. “Jim Badenhaus,” she said, “Big Momma’s husband.” 

She blushed and said nothing more. That afternoon I found Johnny and Mr. Badenhaus together in the C Ward stairwell. She stood leaning against a handrail, dragging on a cigarette, while he sat on a step with his hands in his lap. Did their startled glances hint at conspiracy? No one spoke. I trotted up the stairs, my pulse quickened by a jealous surge of adrenalin. 

Then Ike got into the act. Henry Eikenboom, the senior resident on the blue team, whose narrow shoulders bore the burden of Big Momma’s festering ulcer. The man was thin and jumpy, a chronic nervous wreck. He pitched a row with Mr. Badenhaus when an orderly found a heart-shaped box on Big Momma’s bedside table – a pound of See’s chocolates, caramel cream stuffed with almonds and pecans, already half empty. Turns out the husband was bringing her a fresh box every day. Ike pounced on him. 

“Jesus Christ, man, four hundred pounds of infected fat – who the hell’s side are you on?” 

Johnnie laughed as she told me this story, but her eyelashes glittered with tears. She blew her nose. I put my arm around her shoulders. “Oh, fooey, I’m ok,” she said, shoving an elbow in my ribs. Before I could speak she trotted off and locked herself in the drug room. Two days later a chrome-plated urinal filled with roses sat on the ward counter. 

 “Johnnie,” I said, “who’s your lover?”  

“Lover, hell.” She gave me a sullen half smile. “It was Mr. Badenhaus. After that row with Ike he starts bringing roses instead of candy. Heads right into her room the second visiting hours start, then runs out and gives me the old flowers wrapped in newspaper. Clicks his heels and bows like a prince. Makes me so mad I could spit.”

“You’re mad because some guy gives you used flowers?”

“Gamel,” she whispered, her tone low, conspiratorial. I leaned across the counter. “He’s a perfectly decent man,” she said. 

“What?” 

“He’s wonderful. A fine haircut. That suit – with a vest – hasn't got a spot on it. His nails are clean. You should smell his cologne. He’s a nice man, a gentleman.” 

Johnnie thought she knew a lot about men. She had met her last husband on the ENT ward, nursed him through throat cancer, got him off booze, but he kept smoking – right through his tracheostomy. One night while she was on duty, his bed caught fire and almost burned up their apartment. Now she lived alone. 

After my surgery rotation I began a month on pediatrics. A shock to the system: one day I was caring for swollen alcoholics and wheezing, blue-faced smokers, the next day innocent children. Things got off to a bad start. A young Hispanic couple, tiny and precious as Dresden dolls, became alarmed when their month-old son no longer took the breast with his usual vigor. To my unlearned eye, the kid seemed healthy, an olive-skinned cherub with a button nose and a shock of black hair, perhaps sleepier than most. Yes, a bit lethargic, and a trace of jaundice showed around his brown irises. I pressed my stethoscope against his chest, pressed my fingers against his sweet little belly, found nothing out of the ordinary, but his blood tests revealed multi-organ failure: liver, kidneys, pancreas – all dangerously inflamed. He was near death. 

This kid added a dimension to my universe. Looking into the dark, tragic eyes of the parents, I saw what love – in its deepest part – is all about. Almost children themselves, they wanted nothing in the world but that their son should live. I was up all night drawing blood, threading an IV needle into a vein on the top of the infant’s tiny foot, running the latest test results up to my resident, who sat in the library poring over journals in a desperate search for a diagnosis and, with any luck, a treatment. At midnight he called the chief of pediatrics to report that the child’s amylase was dangerously high, his BUN rising every hour. 

Mine were routine tasks, demanding little skill and no intellect, but during the twenty-four hours I labored at their son’s bedside, the parents came to see me as a god, their only hope. The wild, staring terror drained from their faces, the eyes that followed my every move glowed with a calm and trusting spirit. I consumed their faith, drank it down like a draft, but in the end this adulation cost me a broken heart. 

Ten p. m. Forty hours without sleep. I briefed the intern on duty that night, introduced him to the parents, then told them the simple truth – I must go home. Now their faces showed the price I had to pay: slowly, as the meaning of my words took hold, the terror returned. Their eyes grew wide with fear. The mother slumped against the father’s shoulder and wept. An hour later, as I sat at the ward counter writing my final notes of the evening, the father touched my shoulder. His hand was delicate as a child’s, with ragged, bitten nails. I looked up at the boyish face, the olive skin, the dark eyes. 

“I must speak with you,” he said. I winced from the pain of his tremulous, pleading smile. “My wife . . . she says . . . you must not go.” 

I did go home but slept badly. By morning the child was dead. The autopsy confirmed peritonitis with massive organ failure, yet the cultures and H & E stains came back negative. Two weeks later someone in the Stanford Microbiology Department finally looked at the electron micrographs, and there lay the answer, hidden among the ominous black dots and lines that spell the end of a human life: toxoplasmosis. The cysts were scattered everywhere, melting the liver and kidneys into useless pulp. My resident called the family, and yes, the grandmother had a cat. The cat had kittens. A litter box alive with spores had killed their firstborn son. I had failed to ask the right question, missed the telltale clues, but antibiotics are notoriously slow in their effect on toxoplasmosis, and during that era there was no quick method to secure a diagnosis. The child was doomed the first instant I saw him. That’s the story I tell myself, even to this day.  

And that’s the story I told my wife the night after the infant died. I needed . . . well, something. She said nothing. Marked her place, laid her book on the table, sat beside me on the sofa and took my hand. We sat for a long time in silence. I needed to sob. I needed her arms around me, my head cradled between her breasts, but that, I knew, would never happen. 

All this while Big Momma’s wound continued to fester. Ike finally bundled together her lab results and Kodachromes of the ulcer and presented them at Stanford’s surgical grand rounds. The case caused a riot. The Stanford faculty chewed out Ike and his attending for waiting so long, then voted for a panniculectomy – amputating the infected apron of fat that hung down to Big Momma’s knees. 

The operation turned into a saga fit for The Annals of Surgery. An engineer from biomedical support bolted two operating tables together. Since fat soaks up anesthetic agents as readily as the brain, it took a massive dose of halothane to put Mrs. Badenhaus under. Hoping to prevent the soupy ulcer from contaminating the wound left after amputation, two residents scrubbed Big Momma’s belly with Phisohex and Betadine for hours, scrubbed until finally, in desperation, using bone wire and huge autopsy needles, they hoisted her panniculus out of the way by tying it to an overhead light fixture, then sliced it off at the base with a sterilized autopsy knife. A pathology resident I met in the cafeteria the day after surgery told me the specimen was shipped down from the OR in a trash can. He claimed it weighed 43 pounds. 

Thanks to the retention of halothane by her fat cells, it took Big Momma almost two days to recover from anesthesia. A recovery-room nurse swore that the whole time Mr. Badenhaus sat beside his wife’s bed, pressing her puffy, lifeless hand against his cheek. 

After my pediatric rotation, I looked forward to a happy reunion with Johnnie, but when I found her walking alone down a dark hallway, she resisted my hug – stiffened in my arms and backed away. Her heart was taken by another, and her inconstant passions were governed by a peculiar sense of loyalty. Later that night, over cups of scorched coffee in the deserted cafeteria, Johnnie told her awful story. She had declared her undying love to Mr. Badenhaus, and he had responded – or so she swore – with equal passion. It was just a matter of time, a week or two after his wife’s discharge from the hospital, until all would be settled. 

“But Johnnie,” I said, “that’s terrible . . . ridiculous. You’re a nurse, for god’s sake. If the California medical board finds out they’ll pull your license.” 

 “Don’t be so narrow minded,” she said, scowling and leaning across the table to stare me in the eye. A cigarette smoldered between her fingers. Her breath smelled like an ashtray. Her fake lashes were absurdly long, matted with mascara, and the bluish fluorescent light showed the crows feet on her lower eyelids. She took a slow, meditative drag, then turned her head to exhale. “Jim’s a wonderful man. And you know damn well he deserves better than that creature. . . that beached whale. We’ve been careful. Very discreet.” 

 “Well, let me wish the lucky couple all the happiness in the world,” I said, struggling to control the quaver in my voice. Her rejection, her stiffening against my embrace, had infuriated me. “Have you two love birds done the deed?” 

“What deed?”

I pinched my left thumb and forefinger into a circle, then poked my right forefinger rhythmically in and out of the hole. 

She – “Ouch!” – kicked me under the table. 

“Of course not. He’s not that kind of man.” 

But I soon discovered that Johnnie had seduced only herself, not her beloved Jim. The two of them had never laid a hand on each other. Over a late-night dinner at the International House of Pancakes, when Johnnie had blurted “I love you” to Badenhaus, he, driven by politeness or confusion, had let slip the fatal words, “I love you, too.” Now the woods were on fire. 

It ended badly. As I suspected, the man adored his enormous wife, had always adored her, cherished her every crease and every pendulous fold. Those deep-set eyes were heaven to him. Betrayal was the last thing on his mind, even though his beloved lay stuporous from morphine, her body fouled by a ragged wound. If he “loved” Johnnie, it was only because she took care of his wife and kept him company during the lonely hours of the morning. But Johnnie was a fool when it came to matters of the heart. Having suffered a string of faithless lovers, she treasured loyalty like a jewel, and never had she seen such marital devotion as that shown by the man she hoped to lure astray. 

I don’t know what Mr. Badenhaus finally said to straighten her out, but one night I found Johnnie fuming behind the C Ward counter. My “What’s up?” brought an explosion. 

“That creep Badenhaus,” she growled, her face dark with rage. “Thinks he’s king of the world, wants to sit there holding that beached whale’s hand all night long. ‘No way,’ I told him. ‘Visiting hours here are eight to eight.’ ”

“Johnnie,” I said, “how could you – after all those flowers?” 

She snarled and shook her fist at me. “He can take those and stick 'em you know where. I'm boss around here, and I don't put up with that kind of crap on my shift. If I let that son of a bitch get away with it, then every sleaze bag on the ward is gonna want her sweetheart to sit around rubbing her feet – or her pussy – ‘til the sun comes up.”

Big Momma’s love triangle had collapsed, probably without her knowing anything about it, but her recovery was far from complete. After surgery the stitches fell out, the wound gaped and festered. Her IV infusions were switched from gentamycin to ampicillin, her cavernous wound was repacked twice a day – two interns held it open while Ike tucked in four pounds of sterile gauze – and her fifteen-hundred-calorie diet melted away the fat. Two months later, when the wound finally healed, she was down to a little under three hundred pounds. 

Her discharge from the hospital turned into a celebration. Almost everyone on C Ward, including half-a-dozen patients in wheelchairs, crowded into a conference room on the rehab wing. There were balloons, flowers, a muscular gentleman in a tuxedo who stripped down to a g-string while gyrating and lip-synching a hip-hop version of “You Ain’t Nothin’ But a Hound Dog” as it blared from a portable tape player. Ike let Mrs. Badenhaus eat a piece of the chocolate cake her husband had made. Fifteen candles burned in a circle – one for every ten pounds she had lost during her stay. 

But this celebration was not the end of Big Momma’s story. Her husband admitted that, on the way home from the hospital, they stopped to buy a case of Coors and a KFC family bucket. It took her only three months to gain back a hundred pounds. The panniculus bulged out tense as a pregnant belly, until it again outstretched its blood supply. The scar broke down and ulcerated. The day my internship ended, Mrs. Badenhaus was lying in her old double bed, an IV drip in each arm, gazing up at the ceiling with morphine-glazed eyes. 

By that time Johnnie had transferred to the orthopedics ward at Stanford. During the three years of my ophthalmology residency, I saw her several times in the Stanford cafeteria, but she met my gaze with cold, unfriendly eyes. We never spoke again.  

Romance is a strange business. Especially the sort that lasts. When I knew Big Momma and her husband, they had been together twenty years. During her first hospital stay, he told me that since their wedding he had massaged her feet every night. (No doubt she was heavy even then; all that weight tears hell out of the arches.) My Russian émigré and his puffy-faced wife – both drinking like fish, shouting and fighting and ugly as sin – stuck it out to the end. All over the world unattractive people lie down together in the same bed, night after night, year after year, until one of them dies. 

I’ve always been drawn by the icon of physical beauty. My wife was thin, cool, astringent, and to me – perhaps only to me – she was the loveliest of women. She had a narrow face and sparkling, long-lashed eyes. Was it her lips – soft and red, with a delicate fullness inherited from her father – that tormented me, turning me into a priapic adolescent, or was it the fact that she disliked kissing? The summer months were precious, for it was only then that I enjoyed in abundance the sight of her bare arms and legs as she lounged about in shorts and sleeveless tops. Her pale skin was all but flawless: from ankles to nape of neck only a single blemish intruded, a tolerable nevus the size of a fingernail below the right shoulder blade. When the two of us attended a nude swimming party given by an eccentric Stanford law professor, the unfamiliar women that swarmed about caused me no difficulty, but my gaze had to be carefully directed away from my wife to avoid an awkward arousal. Yet she trembled at my touch. Tenderness alarmed her. 

Here was the rarest of creatures – a multi-orgasmic woman who despised foreplay. A woman who worked four years at a mind-numbing job to pay my way through medical school, who read books with the telephone in her lap lest a call should disturb my slumber after a night on duty, who carted me off to the ER when a drug reaction drove me into a panic at four in the morning; yet who admitted, in the end, that she did not like men. Or was it my infidelities, two sleazy trysts early in the marriage that I confessed in a weeping fit of remorse? 

Yes, my wife was the most beautiful of women. I emphasize “was.” By the end, after a decade of marriage, she gagged every time I laid a hand on her. I haven’t seen her in twenty-five years.