The Symptom – David Koulack

Izzy Koulack stared out of the rain-streaked, east-facing window in the empty waiting room. After a few moments, he turned and straightened the unread magazines on a table before walking down the hall to his consulting room. Seventeen days had passed since he’d put out his shingle, several small signs really,—“Dr. I. Koulack, General Practice, Apt. 1D”—in the windows of Apartment 1A, windows that overlooked Charlotte Street and hence were visible to myriad passersby; yet there had been not one patient.

Izzy sat down heavily behind the large, faux mahogany desk. For no particular reason, he shifted the note paper and prescription pads from one side of the desk to the other and, as he’d done every other day since he had opened the office, picked up the receiver of the telephone to make sure that it was still working.

He leaned back in his chair, mulled over the circumstances that had brought him to this hopeless situation—an empty office and a wife who had decided that she had to get a job. “We need to eat and pay the rent,” she had said angrily. “We can’t rely on your Uncle forever.”

They had been sitting in this very room, he behind the desk and she in one of the two chairs on the other side that were reserved for the nonexistent patients. “I have a degree too,” she said. And that was true. She had been the first woman to earn a master’s degree in microbiology from MIT. Izzy had been proud of her then but never thought when they got married in Roxbury, Massachusetts—it was a small ceremony in the living room of his Uncle’s house—that his wife would end up having to support him.

Maybe to soften the blow she had added, “It will be just until your practice gets started. Then I’ll come and help you in your office—I’ll arrange the patients’ files, answer the phone and do the lab work.”

And the next day she had taken the subway to Manhattan, presented herself at a research laboratory that was looking for a technician. The chief said he would give her a two-week trial with no pay but made up his mind to hire her before the day was out—she was that good, Izzy knew.

God knows, Izzy thought, I never wanted to be a doctor in the first place. He’d been content with life as a waiter in Tip Toe Inn, a favorite—maybe because of his irreverence, his lefty views, his enjoyments of jokes—among his fellow workers, most of them immigrants like himself. And he likely would have remained a waiter if his Uncle Clark hadn’t hunted him down and collared him one day as Izzy was coming out of the restaurant.

“You can’t do this for the rest of your life,” his Uncle told him and took Izzy back to Massachusetts, installed him in the attic room of his Roxbury home and sent him off to school to get his high school certificate. That’s where he met Annette, a beautiful 18 year-old, certain of what she wanted to do, demanding to know Izzy’s plans. “I’m going to be a teacher, a history teacher,” Izzy told her. It was the first thing that came to mind, but it was true that history was his favorite subject.

Annette started to laugh. “You, a teacher, with that accent? No one would hire you. You’ll go to Harvard and become a doctor.” And that was the first of many decisions that Annette would make for Izzy.

“Why Harvard?”

“Because it’s the best,” Annette told him, more like spat it out.

So he studied to take the entrance exam and was accepted in spite of the fact that Lowell, the president of Harvard, tried to limit the number of Jews that Harvard accepted each year. And then, after two grueling years at Harvard, four more at Tufts Medical School and an internship at Mass General, Izzy became a qualified General Practitioner. The framed diplomas on the wall behind him—above the shelves laden with books and medical journals detailing the latest advances in pharmaceutical and medical science—testified to this fact.          

All that work for nothing, Izzy thought and longed for the carefree days at Tip Toe Inn. He sighed, got up from his chair and moved to the examination room. There he checked, as he did everyday, to see that the examining table had a fresh and un-creased paper cover on its leather surface, that the autoclave was plugged in, that syringes, needles and vials of sera were in their proper places behind the glass cabinet doors and finally that his medical bag with stethoscope, blood pressure gauge, a rubber hammer for testing reflexes and a thermometer was on its the shelf where he had left it the evening before. 

And finally, the laboratory, or so Izzy thought of it, the long narrow room that contained the cumbersome x-ray machine and shelves with empty jars, vials and test tubes, the laboratory where one day Annette would do urine analyses, blood counts and tests for blood sugar levels. Would that day ever come Izzy wondered.

Back once more in the consulting room, Izzy, as was his wont and because he had nothing better to do, pulled a sampling of journals from the shelves and started to go through their tables of contents searching for articles that would likely be of use if his practice ever got under way. The articles about various orthopedic interventions and the usefulness of mastectomies in preventing the metastasis of breast cancer he put aside for later reading. Others—articles on early symptoms of heart disease, various obstetrical procedures, and particularly those in the pharmaceutical journals that described the results of recent drug trials and enumerated the medicines that would be most efficacious in the treatment of various diseases—he subjected to careful and critical scrutiny.

It was during one of these lonely sessions that Izzy heard the sound of his office door opening and went out to investigate.

Standing uncertainly in the front hallway was a woman with a teenaged boy in tow. “Doctor Koulack?” she asked.

“Yes,” Izzy said.

“I hope I’m not disturbing you. The sign says “Walk In” so I did but no one else seems to be here.”

“No, you’re not disturbing me, not at all. You just happen to be my first patient,” Izzy said, and let the ambiguity of the statement ride. “Come into my consulting room.”

Izzy slid behind his desk and motioned to them to sit down. Although the scene was just as he had envisioned it, rehearsed it in his mind many times, it was somehow surreal. Izzy opened the top drawer, pulled out a white file card, picked up his pen and looked up.

“Your name?” he asked.

“Molly Cotler. But I’m not the one with the problem. I want you to look at my son, Robert. See if there’s anything that you can do for him.” Tears welled up in Molly’s eyes. They hadn’t taught Izzy anything about that in medical school. He decided on the gruff, self-assured approach.

“What’s Robert’s problem then?”

“It’s down there,” Molly said, pointing to Robert’s lap. Our doctor, Doctor Kaplan, gave him the medicine, told him to apply heat, do this or that and none of it worked. So I thought maybe we should try someone else and I remembered your sign from passing by the house and that’s why we’re here. Can you help us?”

“I’m sure I can,” Izzy said, not being sure at all. “Let me examine the boy and we’ll decide what to do.”

Izzy led Robert next door to the examining room and closed the door. “What’s the problem, sonny?” he asked.

Robert flushed, stammered that it hurt when he peed.

“Anything else?” Izzy asked.

“No, nothing else.”

“Take off your pants and get on the examining table,” Izzy told the boy.

The penis was slightly red and there was a yellow discharge oozing from the urethra.

“How long have you had this?”

“I dunno. A week, maybe two.”

“Let me put it this way,” Izzy said. “When did you sleep with her?”

“I don’t know what you mean, Doctor Koulack.”

“Sure you do, Robert. You don’t get gonorrhea from toilet seats no matter what people say.”

Robert’s face turned a shade darker as he admitted his dalliance and begged Izzy not tell his mother. Izzy stared at Robert and tried to imagine what Kaplan had said to his mother and more importantly what medicine he would have prescribed—calomel, mercurochrome 220?—must have been the standard stuff. “It’s all Bupkis,”Izzy murmured.

And then, still standing in front of the half-naked Robert, an elusive germ of an idea presented itself to Izzy. It was something he’d read in an obstetrics journal—but what? Something about treating childbed fever, maybe—and then he got it.

“Put on your pants,” he said to Robert and went into the consulting room to talk to Mrs. Cotler.

“Can you help him, Doctor Koulack?” Mrs. Cotler asked.

“I think I can, Mrs. Cotler.” Izzy picked up the file card. “Just give me your address and phone number. I’ll have to do a little investigating but I’ll call you soon. Oh, one more thing. What were the pills Doctor Kaplan prescribed?”

“I’m sorry, I don’t remember. He just gave me a prescription and I took it to the drugstore.”

“It’s okay, Mrs. Cotler,” Izzy said rising. I’ll call you soon.”

After the Cotlers left Izzy poured over his journals until he found what he was looking for—an article about the successful use of a new drug, Sulfa, to treat septicemia at childbirth. That was it! Why couldn’t Sulfa be used to treat other infections like gonorrhea?

In Izzy’s head it seemed like an obvious step—not a leap, even. Someone probably had already tried it, written it up in an article he hadn’t read as yet. Maybe the use of Sulfa in cases of gonorrhea would even be mentioned in one of the advertisements for drugs that festooned the pages of his pharmaceutical journals. But Izzy could find nothing. Now he had a plan and after putting it into operation he leaned back and smiled. He couldn’t wait until Annette got home to tell her what he’d done.


 “How much did you charge her?” was Annette’s first question.

“I forgot to ask her for money.” Izzy smiled sheepishly. “I was too excited at having my first patient. I’ll ask her next time.”

Huchem. You’ll have a wonderful practice treating patients for nothing. And how will you afford the Sulfa, are you going to ask the drugstore man to give it to you for free?”

“As a matter of fact I already did,” Izzy said trying to suppress the note of triumph creeping into his voice. “I called the drug company in New Jersey and they’re sending me the Sulfa by taxi. Can you imagine that, all the way from New Jersey to the Bronx?

“But I figured as much. I figured they’d be happy to let me have the Sulfa. If it can cure gonorrhea it will be yet another use for their drug. I’ve already called Mrs. Cotler and she’s bringing Robert in tomorrow.”

“Don’t forget to charge her,” Annette said, “at least two dollars for each visit and maybe extra for the Sulfa too.”

A week later, Izzy got an excited call from Molly Cotler. The medicine was working. “It’s a miracle, Doctor Koulack, I can’t thank you enough. I’m telling everybody in the neighborhood.”

And at noon the next day as Izzy came down the hallway from Apartment 1A to open up his office, he was surprised to see a lineup of people in front of his office door.

“Are you Doctor Koulack?” It was one of the people on the line. A short, plump woman with a babushka—someone’s bubheh for sure, Izzy thought.

“Yes, I am,” Izzy replied, as he opened the door.

The woman smiled, turned to the others and said, “See I told you, it’s the miracle doctor.”

And it was a miracle, Izzy thought. Overnight his practice began to thrive. Annette, reluctantly, did what was expected of her—gave up her laboratory job in order to oversee the office routine. She ushered the patients in, kept track of their files and made sure that they paid for their visits. And when, as was invariably the case, Izzy still had patients to see after the office hours were officially over—Annette had tried to get Izzy to stop his schmoozing, “Just examine them,” she’d told him. “There’s no need to listen to their life stories.”—she’d usher the patients out and lock the door behind them.

And it was on one such evening after the last patient had left—Izzy was putting away his instruments and Annette was straightening up the file cards—that there came a tremendous pounding on the office door.

“I’ll get it,” Annette said. “I’ll send them away.”

“Unless it’s an emergency,” Izzy said.

Huchem,” she muttered to herself. “He’s still got calls to make.”

But it wasn’t a patient at the door. It was Doctor Kaplan who, in spite of Annette’s protests, pushed his way into the office and found Izzy in the examination room.

“Koulack,” he said, “I came to tell you that you’re in big trouble.”

“For what?”

“For what,” Kaplan sneered, “it’s for malpractice, it’s for what you did to Robert Cotler…”

“I gave him Sulfa, is all.”

“So you admit it,” Kaplan said.

“Of course, why shouldn’t I. It cured him, didn’t it?”

“You don’t know what you’re talking about,” Kaplan growled before turning on his heel and leaving. “It was me that gave him the right medicine. All you did was cure the symptoms.”

Annette went after Kaplan to lock the door. When she came back she had a smile on her face. “Some doctor you are,” she said to Izzy.”

“What do you mean?” he asked.

“You’re a symptom curer, is all,” she giggled. “But make sure next time you don’t do it for free.”

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