Through the dew-covered glass, a single, halo-encircled light shone through the sink window. “It’s the Christmas star,” I thought, staring back at me, close enough almost to touch. My eyes filled, tears overflowing onto my flushed and rapidly disappearing boyhood cheeks. As I cleared the pane with my pajama sleeve, I suddenly realized what I was looking at was the streetlamp across the street. I looked around to make sure no one had seen me, mopped my moistened face, and hurried back to bed.

That September I entered Southern Methodist University in Dallas. With no prior preparation and little idea of what to expect, at registration I wrote pre-law in the space marked major. Adding to my uncertainty, the next day, I was assigned an advisor, who turned out to be from the biology department. Not knowing what else to do, I kept my counseling appointment knocking on his office door.

“Pardon me, sir,” I said to the pleasant appearing man behind the desk, “but I think I’m your four o’clock.”

He looked up at me with warm eyes. “Come in, young man,” he replied, seemingly pleased to see me, and then added as I sat down. “Why do you want to be a doctor?”

“I don’t.” He was a clerical error, I explained.

He laughed. “Where are you from?”

“Houston.”

“I have an aunt who lives in Houston.”

“Being from Houston is better than living in Houston,” I said and ha, ha, again from him. And so on.

We discussed my problem, my career indecision. After awhile and since the freshman courses were pretty much the same either way, he suggested I might want to start out in pre-med and not worry about what came later, the doctor part. As I started to leave, he said something that stuck in my mind, being a doctor might even turn out to be something that would make me happy. “Odd,” I thought as I walked back to my dormitory. “What does happy have to do with the kind of work somebody does?”

College Christmases came and went, and I persisted, mostly because that was what I was good at, persistence. My major was liberal arts with only the required science subjects to meet the med school requirements, just in case. School was just school anyway, I thought. After all, I reasoned, I could switch at anytime. But I didn’t. And since I was a good student, I did well and was accepted to all three medical schools to which I applied. And that next fall, I found myself a freshman again, at the University of Texas Southwestern Medical School in Dallas, a medical student who had never imagined himself a doctor.

The first two years dragged by. The work was tough, and the third year was even worse. My best day was the day when my college sweetheart, who was the love of my life, and I married. My second best came the summer before my senior year, when she announced we were going to have a baby. But, still, medicine, for me, was just school – pages in a text – questions on a test. Meat and potatoes, and nothing more. Nothing I couldn’t handle. And I pressed on.

Just before Christmas week of my fourth and final year, I was informed by the medicine resident on my student service, Dr. Sidney H. Feldman, that the straight medicine intern under him, an Alabama roll tide boy, had a vacation scheduled for that coming week. And, to add insult to injury, the senior student Sid had chosen to take the southern boy’s place while he was away was me. Not good. Meant more work. And responsibility.

“Come on, Sid,” I said, complaining about the extra load at a really bad time. My young wife was about to have our first child.

“You should have thought of that earlier,” Sidney replied. “Sorry, kiddo, but you’re it.” Besides this was a good thing, he added. I should be proud about being chosen, and happy he tossed in there at the end. That word again – happy.

And I knew that Sidney H., the H for Hiram, in his rumpled green surgical scrubs and his stubby short haircut and his black sandpaper chin whiskers, was not to be dissuaded by a clean-shaven, fresh-faced fourth year med student in a corduroy jacket, a plaid four in hand necktie, baggy wheat-colored jeans, and brown loafers. He was already upset about our Birmingham born Baptist intern playing the Christian card and taking the whole of Christmas week off. “Leaving us Jews holding the bag, again,” he said.

“But I’m a Methodist.”

“I know, but I’m your boss and I’m officially making you a Jew for that one week. You can go back to being a Christian at midnight on Christmas.”

“Do I have a choice?”

“Not that I can see.” Sid was from New York, a Columbia graduate with a great uncle named Hiram, for whom Sid had been partially named. Hiram Feldman, the senior, was a retired internist in Jerusalem. Sid insisted his uncle was so old that he was there on Palm Sunday, the day Jesus rode into town on a donkey that had been confiscated by his disciples which, Hiram claimed, was what probably what got him off on the wrong foot with the Roman guys with the swords.

Christmas week came and went, and Christmas Eve was my last night on call.  At midnight, the phone rang in the interns’ call room.   The overweight African American woman, Sarah Streetman, I had admitted earlier in the afternoon was reporting shortness of breath.  Diagnosed in the ER as having had a mild heart attack, she had been stable, and so, since intensive care was already overcrowded, she had come to internal medicine – onto my service.  I had had the chance to speak with her and her husband at length in the ER and had a clear picture of what was going on with this lady’s tenuous health.

Arriving at the ward, I found her sitting upright in her bed nearest the window.  She appeared uneasy beneath her light covers, tugging at the neck of her gown.  “How do you feel, Mrs. Streetman?”  I asked.

“Poorly,” she replied, and that her chest hurt, and it was getting hard to catch her breath.  The big smile she had so readily offered only hours before had gone off to another place. 

Sarah Streetman was one of those rare people, almost always women and often women of color, who never know a stranger and who carry their hearts around loosely held and give them out, without expectation of return, to whomever needs them.  She was a retired nurse’s aide from Methodist Hospital in South Dallas and suffered from obesity, hypertension, and adult onset diabetes, all three poorly controlled because she could only afford her medicines once a quarter since her daughter’s three girl children lived with her and her husband, Lonny, and depended solely upon them for support. They also had a twenty plus year old adopted son, Little Lonny, who was living with them while he finished school.   

“She’s not even laughing at my jokes,” Lonny, said, “and that’s a bad sign.” Typical of people of keen intellect Lonny saw the funny side of a comment or a situation and responded in kind before most of us could register what had just been said.  But Lonny had the same basic problems Sarah did, physical, financial, and familial, multiplied by the fact that he was a black male.  Despite having had two heart attacks, Lonny still worked doing odd jobs, especially for the older people in his church who relied upon him to keep their appliances, old AC compressors, washing machines, and refrigerators, running at low or no cost. Lonny was a hell of a guy by anybody’s standard, and the kind of friend anyone would be proud to have.

“What you hear in there, doc?”  he asked, watching me examining his wife. 

Through my stethoscope, I could hear the turbulence inside her heavy chest, fast flowing sounds, rushes followed by popping bubbles.  “Her big heart’s getting bigger.”

“Is that even possible?”

“Not in a good way.  It’s stretching out and not pumping correctly which is causing fluid to back up in her lungs,” I replied.   She was in right heart failure, struggling for air, and in danger of cardiac arrest.  

“What do we do?”

“We give it help.” I needed to act and quickly.  “Be right back,” I told Lonny, and I headed for the nurse’s station to order an EKG and a portable chest x-ray, a morphine injection, and nasal oxygen.  And to put in a call for my resident backup, Sidney H., the H being for Jerusalem’s Hiram, the man old enough to have known Jesus.

“We’ll be right here,” Lonny said, and Sarah nodded her head in agreement, yes, she was going no place.

By the time Sidney arrived, the electrocardiogram and the chest radiograph had confirmed my diagnosis.  The injection I ordered had relieved her pain, and the oxygen, her apprehension.   Now she needed to be digitalized intravenously slowly to allow her heart to function more efficiently.

 “You need me to hang around to push the dig?” Dr. Feldman offered, his way of reminding me she could still go sour.

“No thanks.  I’m good.”

“At least go eat a bite and let me watch the store until you get back.”

I went down to the hospital cafeteria in the basement and returned to the medicine ward as quickly as I could.  Sidney gave me a report on our patient’s condition and told me, he was also covering internal medicine for the ER tonight, Christmas eve, but to have the night nurse call him if I needed him.  And I told him I thought I’d be okay, but I would call if necessary.

“Like right now.”

“Like right now what?”  

“Like right now you’re sounding awful Jewish to me.”

“Well, it’s still Christmas Eve, right?”

“Right.”  And Sidney introduced me to the smallish, light skinned African American man sitting in the lone chair at Sarah’s bedside, holding her hand. 

“Everybody calls me Little Lonny,” the smallish black man said, “for obvious reasons, if you’ve met my father.”

He explained Big Lonny had to get home to see about the girls.  Tomorrow was Christmas, he reminded me.  Yes, it was, and, no, I hadn’t remembered.

But I had had the presence of mind to give my wife a call from the nurse’s station earlier to let her know I’d be home for breakfast in the morning.  I was to be relieved at seven a.m. by a real doctor.  Jingle bells.  Shot gun shells.  Batman smells.

Sidney again volunteered to hang around and help me to push the intravenous digitalis, the medicine Mrs. Streetman needed to increase the strength of her heart muscle, in safe increments, and reminded me again that she wasn’t out of the woods yet.

“No,” I said, “I’ll do it.”  After all, she was my patient.   “But don’t cut off your beeper.”

He checked his beeper.  It worked.  “Brand new battery.”  

Although Little Lonny’s features were clearly African American and his hair short cropped and as thick and rough as Sid’s chin whiskers, his skin was walnut colored, not mahogany like his mother and father.  And his eyes were as green as the summertime grass at my parents’ home in Houston.  Little Lonny was with Sarah and Lonny by choice, not as the result of a combination of their genes, which would have made him blacker than just blackish and much bigger.  Little Lonny was for sure adopted or at the very least obtained.  After a bit, he could see I was wondering about him, and he volunteered that his real name was Norman, and that he was a bad alcoholic from his teen years who had been living on the streets until he was given his first real home by Sarah and Lonny. He had been sober for five years, had gotten his high school degree, and was in the medical technician training program at El Centro downtown, thanks to God, Sarah, Lonny, and the good people of their church.  He had decided, also, long ago to take on his adopted father’s name and his outlook on life. 

We both sat back and looked out the window at the dark North Texas late December night. Every so often I would give Sarah the proper amount of digitalis in her IV and again relax and smile at Little Lonny who was monitoring my every move.   It was a cold, clear North Texas December night outside. Through the window glass, we could see the street lights following Harry Hines Boulevard up the hill, for me, toward our rented house where my young wife, lay sleeping, pregnant with our first child, and for him, on past to the highway that led to Cedar Hill and his father and his three nieces anxiously awaiting the first light of Christmas morning.

As the time passed, we talked of many things, his opportunities for a job as a med tech, and his parents’ failing health.  I suggested he talk to them about coming to come see Dr. Feldman in the Parkland Internal Medicine Residents’ Clinic, that he could help them with their medical problems and to get the medicines that they so badly needed ongoing at a much lower price at the Parkland pharmacy. 

“Can’t they just come to see you?”

“No, because I’m not a resident yet and they need to get things turned around long before I’m ready for them.”   And Dr. Feldman, the Jewish fellow, from New York, with the retired physician uncle named Hiram in Jerusalem who, allegedly, had been an eyewitness to Jesus’s palm branch littered donkey procession to the temple, was not only ready but also an especially good doctor. Little Lonny nodded, yes, and gave his mother’s hand a squeeze.  Whatever he was, a mix perhaps of many things, bloods and religions and perhaps miracles, the mix was God-given.  This woman had saved him, and he was intent upon saving her back.

The night passed with me checking Sarah’s vital signs, adjusting her oxygen flow, administering her life-giving medicine, and staring at those streetlights along Harry Hines, particularly at the bright one at the crest of the hill, steady, unchanging in the night sky.  Little Lonny helped me when he could, holding this and that, doing the things he was learning to do at El Centro.  

As dawn neared, my steady light at the top of the hill suddenly blinked.  Little Lonny and I saw it at the same time.  “Did that streetlamp just blink,” I said.

“It did.  Maybe it’s not a lamp at all,” he replied, and he smiled knowingly at me and shrugged his narrow shoulders.  And the distant light suddenly blinked again just as Sarah’s pulse slowed and became regular.  Her breathing calmed, and, finally comfortable, she fell off to sleep. Little Lonny noticed it, too.  She seemed much better to us both.  “Why don’t you run get a couple of winks before you go home this morning,” he said, knowing I had been on duty for thirty-six hours.

“Sounds like a plan,” I replied, and we shook hands.  “Thanks for your help, Lonny, and you’re going to make a fine technician,” I said and then told him to call the nurse if he needed me, that I’d be just up the hall in the interns’ room and she could get me quick.  And then I replaced Mrs. Streetman’s chart at the head of the bed and made my way down the dark, empty hall to the interns’ call room to lie down on my metal squeaky bed.

An hour later, I was up and about again.  My parents were coming to town for Christmas, and my wife and I had lots to do.  It was Christmas, it dawned on me, and I had forgotten all about it, again.  As I left the call room I ran into Sidney.

“Good job last night, kiddo,” he said.

“Thanks.  Maybe my being Jewish helped?”

“I’d say, yes, except you’ve been a Christian since midnight,” he replied, pointed at his wristwatch, and moved away quickly toward the stairs that led down to the ER. 

Hurrying up the hall to the ward, I peeked in at Mrs. Streetman one last time.

Little Lonny was gone.  Sarah had sent him home.  “He can’t wait to see what Santa brought the girls.  They’ll all be coming up later to show me.”

“You’re feeling better then?” I said.  Her round-faced smile was back.   It had returned from the dark into the light.  Night again was day.  Winter had become spring.   

“I am, thanks to you.”

I said I was happy she had improved.  I heard myself say the word and knew it was exactly the right one.   We both were happy because of what I’d done, what I’d been able to do because of those tests and the pages I’d read.  And what doctors like Sidney H. Feldman, H for Hiram, were teaching me about the way this work should be done.  

Reaching out, she took my hand and stroked it with her own.  “What you gonna do today?”  

I cleared my filling throat.  “My mother and father are coming up from Houston to see us.  My wife and I are expecting our first child, and they haven’t seen our place yet, with the baby stuff and all.” And then I suddenly I remembered that Christmas was my birthday, too. 

“You know,” I said, “I almost forgot, today is my birthday.”  

She lifted my hand, kissing the back.  “It’s a special thing to be born on a day when people don’t have to be afraid to show their love for others, like you doctors get to do everyday.”

A short while later I was on my way home.   The sun was up and the boulevard lights going off one section at a time.  The turnoff to our street was just ahead, as the lamps above me on Harry Hines went out.  And still there was that single bright light at the top of the hill, the one that had winked at me from the window, twice, just hours before.  

“What do you know,” I found myself saying as I came to the top of the hill. “It’s not a streetlamp at all, it’s a star.”  And I thought about Little Lonny’s smile and his shrugged shoulders.  And I decided he had known what it was from the first.  He was just waiting for me to figure it out for myself.

Moments later I was pulling up at the curb and getting out of my old car when my next-door neighbor waved at me with his morning paper.  “Merry Christmas, doctor,” he shouted.   

“Feliz Navidad to you, Mr. Hernandez,” I said, returning his wave. 

“Have you been working at the hospital?” he replied.

“I have.”  And I found myself smiling unexplainably.

He crossed himself.  “What you doctors do there is a good thing.   God has made you able to help others.  You should be very happy.”  

 And I was. 

My wife was waiting for me in the open doorway, wearing her favorite robe, an old pink chenille affair, now greatly overfilled with our son.  “How was it?” she said.    

Still smiling, I came onto the porch.   “It’s was good actually.”   

“Oh, I almost forgot,” she added.   “Happy birthday.”

“Thank you, Sweetheart,” I said.  And I put my hand on her burgeoning tummy.  “You’ll never guess what happened to me last night.”

“What?” she asked, kissing my cheek.  “Something wonderful I’ll bet.”

The beginning.

 Four years ago, soon after I retired from fifty years of practicing medicine in Texas, I was due for my yearly checkup with my internist.  I went the day before for my labs and, since I was feeling fine, I went alone the day after to see my doctor.  He greeted me with the news that my liver functions were high.  The pattern suggested a gall bladder blockage, this in the face of no symptoms.  My physical was normal, and we agreed I needed a sonogram which we obtained that day.  After the test, the radiologist called me back and showed my exam.  There was no gall stone but there was a mass in the head of my pancreas.  The CT confirmed the impression, the mass in the head of my pancreas was blocking my bile duct and was responsible for my abnormal liver tests.  Not good sounding to a non-medical person.  Really bad to a physician.

I needed a biopsy to determine whether the lesion was benign or malignant.  Malignant was more likely, though the local lymph nodes appeared uninvolved on my CT.  I was released and would return later for my biopsy.  On my way home to tell my wife and family what had happened and what came next, I realized my likely diagnosis was cancer of the pancreas, one of the worst cancer diagnoses for survivability rates.  Being almost out of gas, I stopped at a gas station near the highway to fill up.  The station was one where the homeless population of the area came to ask for help from the customers, men like me, many of them doctors on their home from the hospital.  

As I pumped my gas and thought about what lay ahead, my mood darkened.  A man approached me, an African American man with black curly hair and whose skin showed evidence of a blend of bloods.   He asked for my help which was what I had been used to doing for the last fifty years, helping others with their medical problems.  Almost as if a reflex, I forgot myself and looked in my wallet.  All I had was my credit card to pay for my gas and a twenty-dollar bill.  I gave him the bill, and he smiled and put out his hand.  Without thinking I offered him mine.  Instead of shaking, he pulled me to him, leaned in, and touched his forehead to mine.  We stayed like that while he blessed and prayed for me, not for me to be well or even for me to be relieved of distress, but just for me, showing his gratitude for my willingness to give.  It was not the words he said that affected me as much as it was the touch of his head against mine that made me feel lighter.  As he withdrew, the pump dinged at me.  Removing the nozzle, I replaced my gas cap, and closed the door.  When I turned to wave goodbye to the man, I was alone on the concrete drive of the station that led to the cashier inside.  The light-skinned, curly black-headed man was gone.

I felt better despite what lay ahead.  I had not been looking for Jesus, but he had found me.  Within a week I was in surgery for my cancer which was followed by complications, and, then in a couple of months, by chemotherapy.   I remain well thanks to support from my wife and my family and the skill of my doctors and never again, since that day, even when I am alone, have I felt alone.

The day I received an urgent call from one of the neurosurgeons with which I worked I knew what he wanted.  It was a Wednesday, my regular afternoon off.  The neurosurgeons covered their service on a rotating schedule for the level one emergency room where we all took call.  When they admitted a non-paying patient that needed an orthopedic spine man to help them with a stability-challenged spine, they would often post the case and call me for that day when they knew I was free to help.  This doctor, a good doctor whom I knew and worked with each week,  had been consulted on such a patient in the ER, a homeless black man with a cauda equina (the bottom of the spinal cord resembles the tail of the horse) syndrome who needed a surgical decompression to save the function of his legs and his bladder and bowel.  The problem was the man had previous surgery in the same area and was showing characteristic radiographic changes of a spinal bone slippage as part of the problem that was leading to his lower lumbar spinal stenosis (tight section).  No one knew how long his symptoms which were weakness in his legs and incontinence of his bladder and sometimes of his bowels had been present.  If left unrelieved, the result would be an inevitable permanent paralysis. The neurosurgeon needed to act to decompress the stenosis and wanted me to stabilize the spine to prevent a second recurrence.  That day would be the best for the patient, and he knew I would likely be available.  It was early in the days of spinal instrumentation (metal rods and hooks) placement surgery, in which I had been trained for my work in scoliosis (spinal curvature), and most of the orthopedic doctors at our hospital were not yet doing that type of work.  Not only was I the neurosurgeon’s best bet I was his only bet.

I agreed to help, and he scheduled the case for that afternoon.  His decompression, which he was the best in our hospital at performing, went well, and I was left with the task of fusing the involved levels with a bone graft taken from the man’s pelvis after I had fixed two titanium rods, one to each side of his spine, to jack it in back into place.  In those days we were using hooks to fix the rods to the bone.  These days buried screws are the preferred method.  My part proceeded without a hitch, and I left a long flat suction drainage apparatus in place to keep a hematoma (blood clot) from forming and recompressing the damaged spinal nerves. Standard operating procedure, literally. 

After surgery, the patient did not improve. If anything, he got worse.  After the drain was removed, the follow up studies showed the lower cord was no longer under pressure, and the rods and the bone fusion mass were in good position.  The neurosurgeon felt there was no reason to re-explore the well decompressed and stabilized spine.  His decision was to move the patient across the street to our rehabilitation hospital where the man and our physical medicine rehab doctors could work with their therapists to maximize his recovery.  The patient accepted the neurosurgeon’s solution.  He asked me what I thought, and I told him I agreed with the neurosurgeon and would continue to make rounds on him across the street in rehab as often as I could. 

Four weeks passed and the man had not improved.  It appeared he would spend the rest of his homeless life in a wheelchair.  I was visiting him once or twice a week, checking for neurologic improvement.  In that time, I got to know him.  His first name was Robert, and he had been on the street for many years.  When it got too cold outside to sleep in the open, he would go to a local church’s homeless center downtown and stay.  I began to round on him daily, even coming at least once on weekends.  I enjoyed hearing his peace-filled take on life, his simple view of God and the wonders of nature, and I worried that we, that I, had not done enough or that we, or I, had done something wrong.  I kept the neurosurgeon abreast of Robert’s neurologic progress which was nonexistent. He was able to transfer himself in and out of his bed to his wheelchair and back again but had no function in his legs or feet and required a catheter in his bladder.  He was a small man, small and black-skinned, very black.  His hands and feet were calloused, his skin rough and resistant to all but the heaviest of lotions.  And yet, only his outside was rough.  On the inside, he was a soft, blameless person, kind to those helping him, and gracious to me, one of the two men, highly trained men of medical science, who had not been able to help him.

One late afternoon after a long, tiring day in surgery, I needed cheering up and went by for a dose of Robert.  We were alone.  With no other doctors, no nurses or physical or occupational therapists present, we chatted as we often did about this and that, about how the tree outside his window knew when to leaf out, and about nothing.  As we talked, I watched his feet and legs which lay outside the bed coverings. I thought I might have seen a flicker of great toe motion from his right foot.  I asked him if he were noticing anything new in his feet.  He replied he thought he might have felt the touch of the sheet against his right big toe the night before.  I touched the toe, and he shook his head, no.  He felt nothing.  I squirted a palmful of farm-workers’ lubricant in my hands and rubbed his feet and asked him to try to move them.  He tried, and nothing happened.  I asked him to try again, and I looked up at him.  There for the briefest of times, a man with quickly pleasant eyes and a speechless Aramaic mouth smiled down at me.  I was looking at someone other than my patient.  In the next second, my patient with the feet too old for his years was back, and the springtime tree outside his window continued to leaf loudly out in silence, and Robert’s right big toe moved.  

During the weeks that followed, Robert made steady progress.  He moved his feet and legs and was able to take steps with the use of braces and crutches.  He was noting sensation where there had been none, and his bladder tone was returning.  One day near the end of the second month of his stay, I came to see Robert and was informed by the charge nurse that he was gone.  That morning he had gotten up, put on his braces, said goodbye, and walked out of the hospital on his crutches.  Neither the rehab staff nor I had any idea where this man with no next of recorded kin might have gone.  My neurosurgeon friend offered no explanation other than we had done the right thing, and it was because of us that our patient had gotten better.  I was not convinced.  In the end what I remembered most about Robert was the gift he gave me the day we were alone in his room.  I knew I did not have to, but I felt I would like to repay him in some way for what he had done for me.  And so, that same year my wife and I opened a surgical clinic at his church’s homeless center’s medical facility.  We went there on Monday afternoons for several years until the clinic closed.  During those years when we were in and out each week, I looked for Robert but never saw him or met anyone who said they knew him.  Yet, I remained grateful to my soft patient with the rough feet and to his friend with the quickly pleasant eyes that I met for the briefest of times at the rehabilitation hospital.  And never again have I taken the spring or a leafing out tree for granted.