Herbert S. Heineman, M.D.

FIFTEEN

It had to be a good omen, Debbie reflected on discovering that Josh would be home on the day she visited. Josh now proudly put the letters M.D. after his name, and he was frequently consulted by family and friends for his opinion on all medical matters. Furthermore, he was universally respected for his compassion and decency — qualities that Debbie, whom he had teased mercilessly when they were children, attributed to the love of his life.

Not least, he was in his second year of fellowship in hematology, which meant to her that he had the tools to defuse any emotional overreaction to the news she was about to reveal. And she chose lunch in the Rabins’ backyard to do so. With Con away at the auto dealers’ convention, Debbie felt free to bring the boys along without having a long discussion. After all, the issue concerned both of them, and talking openly about it among the larger family would give them a chance to ask questions too.

Once the lunch dishes had been cleared from the picnic table, Esther suggested everyone relax in folding chairs arranged loosely in a circle. She sensed that her daughter had more on her mind than a social call. So, tilting her head slightly, she looked invitingly at Debbie without speaking. Debbie’s own intuition told her the time was right.

“There’s something I have to tell you,” she said, looking down at the grass. Max nodded. So they’re going to get divorced. What else could merit such an opening? He wasn’t particularly surprised. True, Con seemed personable and had always been respectful to his in-laws. At the same time he projected an air of, well, not being quite good enough for Debbie. A car salesman! Did you need a degree from Oberlin for that? How could he really fit into a family whose members worshiped at the altar of scientific method?

Esther’s mind worked differently. Of course, she too wondered what was coming, but she did not jump to a pessimistic conclusion. She did worry, because Debbie’s expression did not portend good news. “What is it, honey?” she asked.

Debbie looked up at her parents. “You know, Con is sort of macho, and he wants his sons to be like that too.” (Here it comes, Max thought.) “Junior certainly hasn’t disappointed him, but Chris is different. He doesn’t care for sports, especially the rough stuff like football.”

“Yes, he’s less physical,” Esther said. “more likely to use his heart than his muscle, and I don’t see anything wrong with that. In fact, you’re lucky to have two such different sons, both excellent in their own way.” She smiled approvingly at the two boys.

“Yes, I am lucky,” Debbie said, “but Con does have rigid standards. I try to discourage contact sports, but Con says he doesn’t want to raise a sissy. We’ve had some fights about it, but as long as Chris didn’t get hurt, I usually backed down. Then one day Chris wrenched his knee. It didn’t sound all that bad except it hurt more than I thought it should, and the pain got worse and worse. He couldn’t sleep that night, and just touching the knee made him scream.” C.J. silently thanked his mother for not mentioning his unfeeling reaction that night. “It was really swollen too. First thing next morning I took him to the emergency room. The doctor thought it was infected and he expected to find pus, but when he stuck a needle in it —”

“Yikes, that must have hurt even more than the swelling,” Max interjected sympathetically.

“Maybe not,” Josh corrected his father, “just relieving the pressure had to feel good.”

“— the thing is,” Chris wanted to be sure he got his point across, “there was nothing but blood in there. Yeah, the needle was no fun, but letting the blood out was worth it. So you’re both right!” He smiled as though those words of encouragement ended the story. His mother was about to reveal the real ending.

“Long story short,” Debbie said, “The doctor called an orthopedic surgeon, Doctor Prasad, who ordered x-rays. When they came back negative, meaning no fracture or torn ligaments, she ordered bleeding tests.”

“She?” Max had momentary trouble putting that pronoun and “surgeon” together.

“Yes,” Chris chimed in. “She was Indian.”

By now Max had recovered. An Indian female surgeon. Fascinating. He thereupon realized he wasn’t quite where he would wish himself to be regarding diversity, so he simply nodded and said no more.

“She was real nice,” Chris went on. “And after she’d changed out of her surgeon clothes, she looked real pretty too. She was wearing some kind of pink wrap-around, but her waist was showing! Mommy explained to me that that was OK for Indian women. It’s called a sari.”

By now Max was beginning to catch on with Chris’s enthusiasm. A real education! He had a question.

“And was your dad there too?”

“No,” Debbie answered. “I called him over from the dealership. He was even more shocked than you, Dad, and he didn’t recover as quickly as you. I’ll tell you about it another time.” Max understood that hearing those details probably wasn’t in Chris’s best interest.

Esther, who had listened quietly to this exchange, diverted the conversation. “What happened next?”

Debbie took a deep breath, almost a sigh. “The blood test showed that the blood wasn’t clotting the way it should. That was why there was so much in the knee. Just to make sure, she had the test repeated. The result was the same.”

Josh looked up. Eyes wide, he asked, “Were the clotting factors tested?”

“Yes,” Debbie answered. “I guess you’ve already made a diagnosis. Chris has hemophilia.”

“What in the world — ?” Josh said, his mouth agape. “Hemophilia is hereditary. And he can’t have got it from his father. The Y-chromosome doesn’t  — ”

“Why not?” asked Esther. “Don’t you inherit from both parents?”

“You do for most things,” Josh explained, “but hemophilia’s different. Long story short: boys get the disease and they inherit the gene from their mothers. Girls, as a rule, are spared the disease but they still transmit the gene. C.J. was lucky; Chris was not. It’s easier to understand if I draw you a picture.”

“Later, Josh,” Esther said wearily. “We’ll take your word. You’ve studied this.”

“The bottom line for this family,” Josh continued, “is that hemophilia is transmitted by the mother.”

“Does that mean you, Debbie?” Esther said after an uncomfortable silence.

“I don’t see any alternative,” Debbie said. “I’ve seen the inheritance chart, and Doctor O’Leary went over it with me.”

“O’Leary? I haven’t heard of him.”

“He’s a specialist in hematology — just like Josh is training to be — and we’ve never had that kind of problem in our family. Not until now.”

“Is he good?” Esther asked.

“He explains things very clearly and patiently, and I really do like him. He also plays checkers with Chris.”

“Well, good for him!” Max said, clapping his hands. “The human touch. I like that. Though it’s his competence that counts.”

“He’s very competent. Graduate of Harvard Medical. But Con doesn’t care for him.”

“For God’s sake, why not?” Esther asked.

“It so happens that he’s black.”

“What the hell does that have to do with anything? Harvard graduated him, and they must have looked at him now and then.” Max had, for the moment, forgotten his own reaction to Doctor Prasad.

As if reading her father’s mind, Debbie went on. “Con didn’t like Doctor Prasad either. Female and Indian, and I don’t know in what order. I was so mad I didn’t want to discuss it with him.”

“Attitudes like that are also inherited,” Max said quietly, “even if not on chromosomes. I suspect they’re also sex-linked, though I wouldn’t want to be quoted on the gender part. I may not be wholly free of it myself.”

“Oh, I know where he gets it from,” Debbie said with a hint of disgust. “I’ll never forget the time I came across that picture in his home. That was years ago. We were still dating.”

She stopped there, but Max wanted to hear more. “I don’t think you ever told us about that.”

At that point Josh invited the boys to explore Carpenter’s Woods with him. Esther shot him a smile of gratitude. When they were gone, she turned to Debbie, and asked: “No, you didn’t. Why not?”  

“I didn’t want you to overinterpret it. I was afraid of overinterpreting it myself. You see, that was the time I was thinking about his marriage proposal, and after dithering about it so long I just couldn’t see myself starting all over again.” She looked both parents in the face. “Maybe I made a mistake.”

“You didn’t know you were a carrier,” Esther said reassuringly.

Debbie smiled half-heartedly at her mother’s misunderstanding, wondering whether it was deliberate. “That’s not what I meant, Mom.”

“You think Con’s the wrong man for you?”

“He can be a really nice guy. It’s just that he was raised wrong.”

“Why don’t you tell us what the picture showed?” Max asked.

Debbie took a deep breath, as though she was diving into a pool and didn’t know whether she would reach the other end. “It was pretty old. It showed Con’s grandfather with a group of guys in white robes and pointed hoods.”

“He was a member of the Klan?” Esther asked incredulously.

“No, he was not in white, just jeans and a plaid shirt.”

“But what in God’s name was he doing there?” Max couldn’t believe his ears either.

“That’s pretty obvious, I would think. He must have been friends with one of them. Maybe he wanted to belong.”

“But he wasn’t wearing that outfit,” Max observed.

“No, they wouldn’t let him. The Klan wasn’t taking Catholics.”

“Well, they have their standards,” Max said with a hint of sarcasm. “They probably wouldn’t take Jews either.”

“But seriously,” Esther corrected course, “we don’t know Mike that well. I know he wasn’t exactly gushing with joy at his son’s choice of a wife, and he drinks a lot. But that’s about it.”

Debbie shrugged. “He never liked me from the first, and I didn’t care for him either. But Con defended me and I thought as long as we didn’t cross him we’d be OK. Con was old enough to make up his own mind, and Mike knew he couldn’t stop our marriage, so he just made the best of it.”

“And Con’s mother?” Esther asked.

“Gladys is very sweet, and we’ve got along great. She was born and bred in New York, never exposed to the Southern culture. I don’t know how she and Mike met. His family’s from Georgia, though I never noticed a Southern accent. For all I know, he was also born in New York.”

“Well,” Esther said hesitatingly, “I’d never hold being from the South against anybody. But associating himself with that hate group, I find that hard to take. Do you think any of that rubbed off on Con?”

“I didn’t at first. But after the incidents with Doctor Prasad and Doctor O’Leary I began to wonder. And then I remembered, when we were at Oberlin, he didn’t do well on a test and said the instructor, who was Asian, favored the Chinese students. At the time I thought he was just making excuses and didn’t mean what he said about favoritism. Now I’m wondering whether I shouldn’t have taken that part of him more seriously.”

“It’s quite possible that he’s struggling inside with what he learned at home and what he learned at school as he got older,” Max said. “Oberlin’s a very liberal college. Maybe you should give Con the benefit of the doubt. He could really be trying, and his dad’s influence only shows when he’s under stress. Having a child with hemophilia must be stressful for him, just as it is for you.”

“And Gladys?” Esther asked. “With her background, doesn’t she put a damper on her husband’s . . . ideas?”

“I never told her I saw that picture, nor the conversation I had with Con about it. But she certainly chides him for his drinking and his outbursts. Oh yes, there was the time we went to the baseball game. He had some very definite ideas about black players. Mike is a racist, no doubt about that. And I can understand that’s where Con gets it; certainly not from his mother.”

“Antisemite too?”

“I think so, though he’s never been open about it with me. Just watched me in a knowing way when I didn’t take bacon for breakfast.”

Max took a deep breath. “And on top of all that, Con’s blaming you for Chris’s hemophilia.”

“I don’t want to use the word blame, but he’s reminded me that I’m the carrier.”

Max looked as if he were ready to speak, but he restrained himself. Instead, Esther said, looking down: “You must have got it from someone, and if I’m not mistaken, if I’m not getting the genetics confused, that someone is me.”

Debbie spread her hands. “I’m afraid so. And where did you get it?”

Esther shook her head. “I had no idea it was in the family. Good Lord, but for the grace of God Josh could have been a hemophiliac.”

“Who’s the boss here, the Good Lord or God?” Max asked. No one reacted. “OK, bad joke. I’m sorry.”

“It’s OK, Daddy,” Debbie said. “No harm done by a bit of humor. Do we have a genealogist in the family?”

“All I know,” Esther answered, “is that my mother — who had to be a link in the chain — she was adopted when both her biological parents died in the flu pandemic in 1918. She was barely two years old. Her adoptive parents, the Levys, who had no children of their own, died years ago. If there had been anyone with hemophilia, I’m sure I would have heard about it. Besides, my mother couldn’t have inherited any traits from the Levys. She wasn’t their biologic child.”

For half a minute nobody spoke. Then Debbie threw up her hands and said: “It really doesn’t matter now where it came from. Chris has it, I transmitted it to him, and Con’s unhappy with me.”

“For what it’s worth,” Esther said, by way of ending the conversation, “we’re all lucky that Chris’s case isn’t the worst. He’ll have to be careful all his life, but what he’ll be missing — the contact sports — never interested him anyway.” As she left to bring out refreshments, Max changed the subject.

“Going back to Con, I was surprised that his father didn’t put his foot down about him marrying a Jewish girl….”

“He tried, you can be sure,” Debbie cut in.

“But I have to give Con credit for standing up for his beliefs — and his girlfriend.” Max continued. “I like the diversity; we all do. And obviously it didn’t bother you to marry a Catholic.”

“You and Mom — and Josh — taught me well. But Mike didn’t like the idea one bit. He objected to the marriage in no uncertain terms. His prejudices don’t stop with black baseball players. Con simply asserted his adulthood. Mike was ready to disown and disinherit him, but Gladys, bless her heart, quashed that idea.”

“Let’s hope that he doesn’t blame hemophilia on the Jews,” Max said, “They’ve got trouble enough in matters of blood, Christ’s blood.” With that he got up to help Esther in the kitchen.

❖❖❖❖❖

“How did it go?” Con asked, buttering a dinner roll.

“What do you mean?”

“Telling your parents. What else?”

“As good as you could expect. They were shocked, of course, but they didn’t give me a hard time for not telling them sooner.” Debbie omitted all reference to so-called responsibility. “Now it’s your turn.”

“I’ll call Mom right after dinner,” he said. “She’s been complaining about her knees and she’s afraid she might need surgery. I’ll pay her a visit. Want to come?”

“I think you should do this alone. I don’t want to get caught up in a family discussion. And I’m afraid of what your father might say. He scares me.”

“I think I can deal with him. I’m not scared.”

He went to Brooklyn that Saturday and found his father in a particularly good mood because the Islanders had crushed the Flyers 7-1 the previous night. “So much for your wife’s Philadelphians,” he announced as Con was taking off his jacket. The expression “your wife,” even without change in tone of voice or facial expression, never failed to irritate Con, as it was intended to do.

“I’m not sure my wife knows or cares who the Islanders and the Flyers are. She never got enthusiastic about ice hockey like her friend Eden did. Too rough, she says. Some women see how graceful the game can be; they even compare it to figure skating, but Deb doesn’t like the way the players bounce each other around and get into fights on the ice. Now Josh is another matter. He appreciates hockey. If he watched last night’s rout, I don’t think he slept too well.”

“Give him my sympathy,” Mike said with a laugh as he took a long draught of beer. “Maybe next time they’ll only lose 6-1!” This declaration was accompanied by a peal of laughter so loud that Gladys came limping in, hoping to get in on the fun. She soon discovered that her sense of humor was not attuned to the subject under discussion and gave her husband a disparaging look.

Con thought this sufficiently covered the preliminaries, and he turned to his mother to help her serve dinner. He declined her offer of wine and, instead, took a can of beer. “Good man,” Mike said. “Beats wine any day. Keep me company.”

Keeping his father company was not the reason he chose beer; getting his father — and himself — in a reasonably good mood would improve his chances of surviving the next half hour.

“I have some unpleasant news to share,” he finally began.

“Better pop another can then! Take the edge off.” Maybe his father was in too good a mood, Con thought. But he went ahead.

“It concerns Chris.”

Gladys’s eyes opened wide. “Oh dear. He’s such a sweet boy. He can’t possibly be in trouble!”

“No,” Con answered, “not in the way you’re thinking. It’s worse.”

As his parents listened with utmost attention, he detailed the events leading up to the diagnosis of hemophilia.

Mike spoke first. “But were those real doctors? An Indian woman? A surgeon, you said? Orthopedic? Good grief! At least the hematologist, O’Leary, sounds like he can be trusted.”

“I hate to disillusion you, Dad, but Doctor O’Leary is black.”

“What!” Mike rose unsteadily from his chair and almost fell over. “He gives himself an Irish name, and by the time a patient sees him for what he is, it’s too late!”

Con felt trapped in a triangle of fury in which Doctor O’Leary, target of both father’s and son’s racism, came out the clear winner. Not least because of the way he had captured his young patient’s enthusiasm. Con, like many a victim of his own anger, vented at the closest offender. But he did not match his father’s outburst. Instead, looking fondly at his mother’s homemade blueberry pie and forking a slice of it, he said: “Doctor O’Leary plays checkers with Chris every time he sees him; I think he’s started to teach him chess. Fabulous pie, Mom. Can you give Debbie the recipe?”

It was too much for Mike. He threw the half-empty beer can across the room and yelled: “What the hell’s happening here? My grandson — your son, Con, by the way — can’t stop bleeding, and you’re talking about a pie recipe while an incompetent so-called doctor plays checkers with him! Bring Chris up here, and I’ll find him a doctor who knows what he’s doing and doesn’t play games!”

Con wiped his mouth and slowly got up to face his father.

“Please, Con,” his mother said, reaching for Con’s hand, “your father’s had a beer too many. Now both of you calm down.”

“Mom,” Con said calmly, “maybe Dad has had one too many, but I haven’t, and there are a couple of things I need to tell him.”

“Doctor O’Leary,” Con, suddenly all in favor of diversity, continued, “is a graduate of Harvard Medical School and he’s a board-certified hematologist. And no, he isn’t Irish. He bears the name of his ancestors’ owner because those ancestors didn’t have their own names after a couple of generations in the original O’Leary cotton fields. For all I know, one of the original O’Learys could be in that picture with you and your Klan brethren.” He sat down without acknowledging his own first reaction to the doctor.

Gladys laid her head on the table and muttered: “Oh God. That!”

Mike, suddenly out of ammunition, sat down and said no more. Gladys raised her head and turned to Con.

“Where did it come from, Con? Isn’t hemophilia inherited?”

“Yes,” Con answered. “For practical purposes, only males have the condition, bleeding and all, but they inherit the gene from their mothers — who, by the way, don’t even know they’re carrying it.”

“Meaning Debbie?”

“Yes, Mom.”

Mike had reloaded and was ready to attack again. “Well, I’m not surprised. I had my suspicion all along. It’s a Jew disease, isn’t it?”

Con turned on him. “That’s absolute rubbish, Dad. Absolute, racist, anti-semitic rubbish! The last Russian Czar’s son had it, and it came to him from the English Queen Victoria. Are you going to tell me they were Jewish?”

“All right, all right. I guess my history books were wrong.”

“More likely, you never read them.”

Mike, defeated, looked down sullenly. Gladys started collecting the dishes. “Who wants tea?” she asked cheerfully.

Con, still standing, said: “I think we could all use a cup. Let me help with the dishes.” Gladys accepted the offer without comment. Mike was left alone to reflect on what he’d learned and how he’d reacted. By the time Gladys and Con returned with the tea, Mike had gone upstairs.

Mother and son sat at the dinner table. “I’m sorry Dad blew up like that,” Gladys said. “It’s like he’s blaming both you and Debbie for Chris’s misfortune, and neither of you deserves that.”

“You shouldn’t apologize for Dad. He doesn’t seem to know any better, and he hasn’t learned a thing since the days of that picture. By the way, Debbie’s seen it.”

“You showed it to her?” Gladys said, shocked.

“No, the album was lying on the coffee table and she leafed through it while I was upstairs. That was years ago, before we were married. We almost broke up over it.”

“I’m glad you didn’t. Don’t tell Dad that Debbie knows.”

“Right now I don’t feel like telling him anything. And I don’t want to hear his apologies after he sobers up. So I’m not planning to be here tomorrow morning. I hope you understand. You’ve really been wonderful where Debbie’s concerned, despite the religious difference, and he’s been — pardon the expression — a total asshole, his all-too-usual self. He’s my father, and I suppose I love him. But I hardly know what that word means anymore.”

Gladys went around the table and hugged her son tightly. “If you want to go back tonight, I understand. Just tell me, what should I answer Dad when he asks in the morning?”

“Use your judgment. I trust you. And by the way, we never got to talking about your knee.”

“We’ll talk next time. A good reason for visiting again soon. And we won’t let family business distract us.”

❖❖❖❖❖

“So how did it go?” Debbie asked.

“Don’t ask.”

Debbie looked at him with quizzical amusement. “Oh? That bad?”

“Yeah, that bad. What’s worse, I have to go back soon to talk with Mom about her knee surgery. That’s what I supposedly went for, and we never got to it, thanks to Dad.”

“Too bad,” Debbie sympathized. “Parental support could surely help in our situation.”

“You didn’t tell me much about your visit.”

“My parents were shocked at first, like I told you, but supportive. Josh was home too, and that helped, because he knows how it works, the genetics and all that. We got to talking about where did I get it? From my mother, I guess. And she? That’s a dead end, because her mother was orphaned and adopted in the 1918 flu pandemic.

“When are you going to Brooklyn again?”

“As soon as Dad has sobered up, which could be any day now. I suppose a weekend day would be best, but I can switch days off. Actually I’m not looking forward to it, because the old man’s going to apologize for some of the things he said, and I don’t want to hear it.”

“Why not? If he’s sincere.”

“Oh, he’s sincere all right. But that’s his pattern. Insult, apologize sincerely. Insult, apologize. Like washing your dirty underwear and then getting them dirty again.”

“How about your mother’s knee?” Debbie asked.

“She’s probably going to get a new knee. But we were too busy dealing with Dad to talk about it.”

“That’s serious surgery, isn’t it?”

“The orthopedist says it’s becoming routine. And, by the way, he’s male and Caucasian. Dad approves.”

“Thank goodness for that.”