Royal B

E. B. Risch

I

It was the almost-winter of 2019 and the pervasive chill in the Downtown-Brooklyn air was tempered only by the silence of anticipation and held breath for festive December to drift down from the sky in enveloping, white absolution. As Michael had emerged from the depths of the Borough Hall station, the halfhearted morning sunlight was playing hide-and-seek between the sundry assemblage of brick, stone, steel, and glass structures that populate Brooklyn Heights. Another day of patients in the cozy, art-nouveau office building on Joralemon Street; another day of peering into eyes, of shining lights and examining souls and adjusting glasses prescriptions accordingly. Brooklyn Heights was an eclectic mélange of Little Haiti and Little Guatemala and many people came from the projects on Myrtle Avenue. And there were the celebrities too—the Olympic tennis player and the actor from Game of Thrones.

It was to be a slow and boring morning—no surprise celebrities on the docket, no emergency cases. At five after ten Michael saw that the status had changed for his third patient from “scheduled” to “arrived” and he began pre-filling the patient’s chart. Forty-four-year-old male. Type II diabetes. Royal B Acevedo Barrantes was a new patient which meant that he’d require a battery of baseline imaging that would leave the techs busy for half an hour. But that was a problem for the techs and Michael knew he’d assign whatever testing he felt was needed. With a compulsive yawn, Michael resurrected himself from the half-slumber of the empty-office lull and heaved himself out of the rolling chair. Outside the window the Statue of Liberty held court tenaciously over a barren-looking Governor’s Island and the Narrows flowed under the Verrazzano. What use was the view when the blinds were always down and half the patients couldn’t see?

Mr. Acevedo Barrantes cut an impressive figure when he stood up from the waiting-room couch and sauntered glumly through the doorway. Dressed in a monochromatic black from boots to bomber jacket, he might once have been Jason Statham in a lone-wolf revenge film if it weren’t for his full head of black curls and a nascent belly beneath his hoodie. Regardless, he looked like he might just have stepped off the set of the newest James Bond movie. But this was New York where practically half the people on the street—those who themselves were not professional film characters—dressed like film characters.

“Shalom.” he uttered with a bit of a flat tone and a dash of Brooklyn Spanish as he followed Michael back to the exam room. He must have seen the kippah on Michael’s head. “Gutt Shabbos.” he offered in follow-up. But in fact it was Tuesday and his wishes for a good Sabbath were a few days premature.

“Where did you learn that?” Michael asked as they settled into their respective chairs.

“I used to work security for one of the head rabbis.”

“Really.” Now the man’s outfit made sense and this encounter had suddenly become a lot more interesting. “What do you mean by ‘head rabbis?’”

“He’s like in charge of a lotta people. He’s got a lotta followers. I used to work for him on Saturdays at the temple and he taught me some words.”

“That’s really interesting.” Although clearly the rabbi hadn’t taught him that in a community in which people wish each other “gutt Shabbos” in Yiddish, the “temple” is a shul or maybe a synagogue and the “head rabbi” is probably a rebbe. But Michael kept this to himself and, having gotten to know his patient a little bit, proceeded with the more eye-focused portion of the visit.

“This is your first time here in our office?”

“Yeah.”

“Welcome. It’s nice to meet you.” He regurgitated the usual script. “My name is Michael and I’m going to get you started for the doctor today.”

“Nice to meet you.”

“So what brings you in today?”

“It’s my vision.” he began. “I see this blurry spot everywhere I look, right in the middle. It’s making it hard to see things. It’s been like this for like a couple o’ months. I really need my vision. Last year my daughter was murdered and then my wife took her own life. I’m not working right now and I’m living in my car.” he spoke impassionedly to Michael, almost pleading with him.

“Oh! I’m so sorry to hear that!” Michael managed. This was far beyond what his little, on-the-job training had prepared him for.

“My health is all I have left and without that there’s nothing for me.”

“Okay. Let’s see if we can get an idea of what’s going on.”

They went through the usual visual acuity tests. Blood sugar was controlled. He was twenty-sixty plus two in the right eye and twenty-twenty-five minus one in the left. Best corrected vision couldn’t seem to improve his right eye vision beyond twenty-forty. A slit-lamp exam and a Goldmann eye-pressure check revealed nothing out of the ordinary.

“Okay. Everything looks good at the front of the eye but I want to check the back.” Michael pulled out a laminated half-sheet of paper containing a square grid with a dot at the center—an Amsler grid it’s called.

“Cover your right eye and look at the dot here.” He pointed. “Do the lines in the background look straight, wavy, or broken?”

“Straight.”

“Now cover your left eye. Do the lines look straight, wavy, or broken?”

“Wavy.” The wheels were turning as Michael’s brain traced a path down his mental diagnostic flowchart. Retina, it seemed to be saying. He gave Mr. Acevedo Barrantes dilating drops and sent him back to the waiting room to await the three imaging studies he ordered.

Half an hour later Mr. Acevedo Barrantes wandered out of the doctor’s room to the front desk, followed by the doctor himself.

“I’m going to have you see Dr. Sheyman, our retina specialist.” the doctor said. “He’s at our office in Manhattan Beach on Tuesday afternoons twice a month. Will you be able to make it down there?”

“Yeah, no problem, doc.” Mr. Acevedo Barrantes said unconcernedly. But Michael was concerned. Being sent to Dr. Sheyman meant that things weren’t looking too good. It meant retinal issues, often with poor prognoses and permanent vision loss.

II

As the winter weeks ferried Michael over a sea of medical school interviews and onward toward an academically uncertain future, his mind kept returning to the Hispanic former bodyguard who’d lost his family and was losing his sight and possibly his will to live. Was he still living in his car, freezing in the bitter breath of the New York City winter? Was that even truly living?

One January afternoon—it was one of Dr. Sheyman’s days—he saw Mr. Acevedo Barrantes at the Manhattan Beach office. Mr. Acevedo Barrantes had macular edema secondary to diabetes which fortunately enough was treatable with injections.

“It’s nice to see you! How are things going? Are you doing alright?”

“Yeah, I’m doing alright.” the kind, burly patient responded with a hint of forced enthusiasm. Michael wasn’t convinced but he didn’t know what else to say or do. And already he had two more patient charts waiting for him in the bin next to his door. Retina days were always like this. Painstaking fluorescein angiographies, forty-minute laser sessions, too many eye injections to count… He listened for a little while as Mr. Acevedo Barrantes talked about learning krav maga from some ex-military Israeli guys and then completed his exam, scribbled “FA” on the back of the chart, and dropped it in the testing bin, eager to move on to the next patient in a ceaseless quest to empty his own bin of its charts.

At home with his parents one evening, Michael mentioned Mr. Acevedo Barrantes’s plight at the dinner table.

“Do you know any rabbis or shuls in need of a security guard?” his mother inquired.

“I’m sure there has to be something somewhere.” said his father. “It’s not like antisemitism is dead and buried.” Feeling bad for the jobless, homeless, lonely former bodyguard, Michael and his parents lingered on the issue for a few minutes longer but nothing ever came of this discussion.

III

March blew in with the snow-melting humidity and the early-morning fog and soon the songs of spring filled the air. In February Michael had won an acceptance to medical school and so was relieved by the peace of a temporary victory in the struggle of becoming a physician. Mr. Acevedo Barrantes, whose vision finally seemed to be stable, had made a total of three appearances while Michael was in the office. Although stable vision aside, when one has diabetes, once a retina patient means always a retina patient.

One fateful Friday—it was the thirteenth, come to think of it—Michael packed up his scrubs and slid the dust cover over his slit-lamp and put away his history-taking skills to be brought out again the following week.

“I’ll see you next week.” He wished his co-workers, excited to get a weekend’s rest before returning to work on Monday for more of the usual lights and lenses. But this was not to be the case as he was not going to return to work there anymore. Life changed ever so drastically the following week as the coronavirus epidemic made landfall in the United States after having been unsatisfied with the death and chaos and conflict it had unloaded in China and Italy. Michael, like so many others, made an extemporaneous decision not to return to the office and filed for unemployment. It was just like that—one week he was seeing patients just as he’d been for the last year-and-a-half and the next week it was all done with. At home he quickly found himself rather alone with little to occupy his time since there was no eating at restaurants, no shopping in supermarkets, no going to antique shops, no attending cars-and-coffee meetings, no going to synagogue services; in fact, nearly all traces of community and society had disappeared from life with no return in sight. The world hibernated anxiously while hospitals and nursing homes and college dormitories bred death and contagion.

“It’ll last six months to a year.” the medical establishment prophesied. Others said that the virus would forever be an unwelcome guest alongside the flu and the common cold. Five months of summer stretched on and on through the end of firefly season in the middle of August and then before Time had a chance to catch up with him, medical school was upon Michael with an absolute inevitability the likes of which he’d never before experienced. And amid the loneliness and boredom of months of quarantine and the all-consuming studying of a mostly-virtual medical school, Royal B Acevedo Barrantes—his loss and sadness and perseverance—was all but forgotten.

IV

This is not a good story as it does not have an ending; there is no “happily ever after.” Not even an “ever after.” The characters and their sagas are still in play, the action still unfolding. Will Michael remember this special patient who graced his exam-room two years ago? (Yes, he will.) Will Michael decide to find a way to reconnect with him, maybe even to act on the conversation he once had with his parents? (Perhaps, now that he’s remembered.) You see, Michael is like many of us—kindhearted and empathetic and also a little too prone to leaving the sufferings of others to the confines of the medical office, packing it up and putting it away with his slit-lamp and history-taking skills when he leaves to go home for the weekend.