Ash Wednesday

February 24, 1971

          Suffering, so much suffering, so much inevitable suffering: drugs helped, wine helped, a kindly word from a friend helped, but suffering simply couldn’t be avoided. The only real way to deal with suffering was to acknowledge it briefly, put a band-aid on it, and then forget it as quickly as possible. There was no blame, no atonement, and no solution to suffering. Everyone ended in ashes and dust.

         Fulvio lifted his gaze from the notes on his desk and told Barbarina to send in the next patient: another middle-aged man? Would it be another middle-aged woman? Or would it be another old widow with nothing to do except dwell on all the suffering in her life, someone who had mornings free to spend hours reading the out-of-date magazines and chatting with the other old women in his waiting room?

          “Doctor, this is Enea Rambaldi.”

          “Enea? What’re you doing here? You should be at the tavern grilling castrato mutton for lunch today. I’ll be by later.”

          “Oh, Doc, I’ve got this pain in my chest. It just won’t go away.”

          “All right, well take off your shirt and we’ll take a look at it.”

Fulvio had known Enea these last thirty years, after taking care of Enea’s mother who had passed away about twenty years ago. Enea was likely to be found at the tavern watching other people playing cards or building a fire and cooking dinner for his friends in the evening. Enea had never married and until about ten years ago, he’d had one companion after another, usually each for about five years at a time. Every successive woman eventually tired of waiting for him to ask her to marry him, which he never did. “If all I want is a glass of milk, I don’t know why I need to have the whole cow!” was his final, frank, and insulting, response. Enea was never eaten by remorse that anyone could tell and he was ready any day of the week to go hunting or scour the countryside in search of a farmer with good demijohns of wine for sale. In the summer, Enea would spend the whole day at the beach tanning until he was toasted just as brown as a berry.

         After Enea took off his undershirt, Fulvio asked him to sit on the examination bed. Fulvio pulled out his stethoscope and started to lay it gingerly across his back.

         “Inhale! Again. Let’s listen here.”

          As Fulvio moved the stethoscope over Enea’s skin, he noticed the erythemas from all his summertime sunbathing.

         “How many years have you been smoking, Enea?”

         “Since I was fourteen, but I’ve had to cut back to a pack a day in the last three weeks. It just gets to me and I wheeze every time I stand up.”

          “Well, Enea old shoe, the first thing you need to do is quit altogether.”

         “Oh Doc, you know I can’t do that. How many pleasures are left me at seventy-five? Can’t do it with the women anymore, and the wine upsets my stomach and I never did play cards.”

        “You need to lose about thirty pounds, too.”

        “So, I can do what?”

         “Enjoy good health.”

          Fulvio knew people and he knew Enea wasn’t going to quit smoking or lose thirty pounds. Fulvio also knew that the erythemas on Enea’s skin and what he heard in Enea’s lungs quite likely meant some form of metastasis might have reached his brain. If that were the case, Enea might live another year and a half but even that was unlikely.

          “How much aspirin are you taking these days?”

          “Funny you should ask. I probably take six a day. I get these curious headaches that come at all hours: early in the morning, in the late afternoon, before or after a meal. They’re so bad sometimes they wake me up when I’m asleep.”

          That was it. Unless Enea was willing to submit to the new chemotherapy, he would be in a clean tomb for the Commemoration of the Dead in November of this year.

          “That much aspirin isn’t good for your stomach. That’s probably why you’re cutting back on the wine. The next time you feel one of those headaches coming on, have a glass of red wine. Just one, don‘t drink the whole bottle. That should make the headache go away. And as for that pain in your chest, I think we need to do a routine x-ray, or better yet, let’s try out the new CAT scan if it is available in Bologna, do you think we can do that?”

         “You’re the doctor, Doc. I’ll do what you tell me to do.”

         “Then have a little piece of prosciutto on some piadina when you drink that glass of wine. Food can cure a lot of ills.”

          Fulvio dictated to Barbarina the prescription ticket for specialist examinations while Enea put his shirt back on. Barbarina could tell from the way her boss raised his left eyebrow and turned his head slightly to the right while speaking, that the Doctor was hiding a grimace. She also knew that when Doctor Raggi ordered a patient to drink a glass of wine and eat a few slices of ham there was either no problem at all, or “bad disease:” cancer. How many times had Fulvio told her about old Dr. Miserocchi whom he’d interned with at the City Hospital?

          “He wasn’t really from the twentieth century. He used all the latest methods and penicillin, needless to say, was a lifesaver, a real lifesaver when it came along. However, old Dr. Miserocchi always told me that a good third of the problems the patients had were in their heads or in their stomachs. We could always prescribe a placebo, which they would have to go to the pharmacist and pay for. A few of the patients would eventually discover this therapy was just some old sugar pill."

        “A glass of wine will actually make just about everyone feel better. Moreover, it costs a tenth of what a placebo costs. But old Dr. Miserocchi, he remembered how they practiced medicine before the great Spanish Influenza epidemic of 1918. ‘A glass of red wine for the men, a cordial for the ladies will cure about three-quarters of the patients you prescribe it for. Either you’ve misdiagnosed the other quarter or they’re hypochondriacs or they’ve got ‘a bad disease.’ If they’re still in pain, they’ll come back. You’ll never cure them. Their only hope, the only thing those patients can do is seek a second opinion. And we need to urge them to do that, because they won’t accept the truth until they hear it from several people, and not even then sometimes. No one wants to admit that suffering is inevitable.’”

        Fulvio smiled and grabbed Enea by the shoulder and elbow as he escorted him out of his office. “Be sure and let me know when you get your appointment so I can call down to the hospital and see what they have to say.”

          Fulvio knew he would have to call Elisa, Enea’s sister after the results from the x-ray came back and inform her that her brother had only a few months to live. Fulvio would put it off as long as possible: Enea would never put up with the new interferon they were talking about or chemotherapy. Fulvio needed to think about something else.

         The maid knocked at the door. “Coffee’s ready!”

         Barbarina and her boss left the office to go into his study where strong, fragrant coffee with the maid’s special hypo-concentrated sugar froth awaited them. As they drank, Barbarina remarked: “It’s bad, isn’t it?

        “Well Barbarina, let’s just hope that this new-fangled CAT scan can tell us something that we don’t know.”

         The phone rang and Barbarina answered it while Fulvio went to the washroom. He looked at his reflection in the mirror and winced slightly as he combed his hair into place, and added a tiny whiff of aftershave to his person. When he returned to his office, Barbarina was just putting the phone down.

          “Doctor, that’s the hospital health service. They were asking if you would make house calls this afternoon until ten. There’s this flu, let’s just hope it isn’t that Hungarian flu they keep talking about. Any, this flu is going around and they’re receiving far more calls than the list of doctors can handle.”

         “Oh well, I suppose so. I didn’t have anything special planned except dropping by the tavern for a bite of grilled castrato mutton. This is my job, after all. Even if there’s really nothing we can do about the flu except. . .”

        “. . . prescribe antibiotics, lots of fluid and bed rest. Oh, I know Doctor, but somehow when you go and see a person, they somehow get better a little faster, and suffer a little bit less.”

       “I don’t know how much of that is true, but I’ll take it as a compliment. Let’s empty out the waiting room.”

          Even though Barbarina locked the door to the waiting room at noon and showed patients out through the side door, she and Fulvio worked until after half past one. He missed lunch with his wife and children who ate and left for their afternoon meetings, shopping, and sports. When Fulvio got to the table, the maid waited on him hand and foot, whatever he needed and as much and as hot as he wanted it.  He never asked her for anything; she just scurried.

        “No, Nanny. No wine today. I’ll be making rounds this afternoon.”

          “It’s the flu, isn’t it?”

         “Oh, yeah. So, I’ll prescribe antibiotics . . .

        “. . .  and bed rest and plenty of fluids.”

         Barbarina knocked on the door and came in just as the Doctor was having his coffee.

        “Here’s your list of patients to see from the hospital. There’s no use in waiting around for the phone to ring, today. There are already fifteen calls.”

          “Fifteen!” Fulvio frowned.

          “Yes, but I did manage to negotiate and keep them all in town, and even better they’re all in the Saint Blaise neighbourhood. You won’t have to drive out into the country and visit some cold farmhouse today. Is there anything else I can do, for you? I’ll stay as long as you need.”

          “No, no, nothing. I was hoping to get some ice cream for the kids and myself, but I guess that won’t be possible.”

        “Doctor, don’t forget, it’s Ash Wednesday. La Signora won’t much appreciate your giving the children ice cream at the beginning of Lent. You know how she feels about eating meat and drinking alcohol and meat and sweets especially on Ash Wednesday and Good Friday.”

        Fulvio clucked his tongue very quietly and shook his head, very slightly.

       “But I think I could smuggle a pint of hazelnut into the house, if Nanny here . . .”

        “Can keep it out of the Signora’s sightlines until the children have inhaled it? I think I can do that. I’ll give it to them for their afternoon snack of course. La Signora will undoubtedly be out until six. Barbarina, can you drop the ice cream by my house? I’ve got my family to feed and an appointment with my hairdresser before I come back to fix supper this evening.”

       “Oh, I think we can do that. Anything else, Doctor?”

       “Don’t get sick, either of you. Keep covered up when you go out and keep your kids apart as much as possible. The whole flu thing is coming out of the elementary schools. Children are spreading it everywhere they go.”

        It was the same, house after house. Everyone was glad to see him, they took his coat, led him into the bathroom to wash his hands, and then into a bedroom where a child or a grandmother or an adolescent or an adult male was trying to sleep with a temperature of 103. Fulvio would sit by the bed and take the patient’s hand in his as he started speaking to them. All his patients felt immediate relief at this: Doctor Raggi was there. Little did they realize that Dr. Raggi was trying to determine:

1)    what their pulse was,

2)    more or less how much fever they had,

3)    how much they were sweating.

       He’d pull down the bedclothes and touch them under the liver and in their armpits, under their necks and in the middle of their bellies. The flu. It was always the flu, in different stages. He would pull the bedclothes back up, give the patient a squeeze on the shoulder and tell them to rest.

       Once he got out of the bedroom and washroom, the relatives would offer him coffee or water or even a slice of piadina. He would tell them they needed to give the patient antibiotics, and lots of liquids and plenty of bed rest and it would all be over in five to ten days.

       The day had been relentlessly bleak and ominously cold, and then about five a thick, bright aluminium fog had started to roll in. By six, it gave the entire town the appearance of being frozen in time, with no future and no past, only the damp, opaque present.

          It was just after nine o’clock and Fulvio was driving to his last appointment. He pulled up to the address and aligned himself to park his fire-engine-red Alfa Romeo in a spot right in front of the apartment building.  But out of nowhere, a sleek black BMW appeared and zipped right into his parking place. This piqued Fulvio enough to get out of his car and walk over to the driver’s window.

      “Excuse me, sir.  Didn’t you see me backing into position for this parking space?”

        “With that red car in this fog? NO, I’m afraid I didn’t. You must have been moving so slowly that I thought you were double parked on the street.”

        “Well, that was not the case. I’m terribly sorry, but I have urgent business and I do need this space.”

       “Finders keepers, losers, weepers. ‘Fraid not. I’ve got urgent business too, pretty much more important than anything you could possibly invent.”

        “Well, I’ve never seen such poor manners.”

        “Fuck you, asshole. Now get out of my way, and find yourself a fucking parking spot, if you can.”

        The man slammed his car door and walked off into the fog.

It took Fulvio a good fifteen minutes to find someplace to park: it was late and everyone had already come home for dinner that evening. He had had to walk four blocks back to the house. When he rang the doorbell, a nervous young woman opened it, and ushered him in.

       “Oh, thank you Doctor. We’ve been waiting all afternoon.”

        “I know poor thing, but you have no idea how many calls I’ve had today – you’re the last of fifteen. Now, who has the flu?”

        “The children. Both of them. And their temperatures have been wavering between 100 and 103 all day. This way please.”

          As Fulvio turned the corner to go into the children’s bedroom, he heard the front door open and slam shut. “Honey, I’m home! I just popped around the corner for a glass of wine and some cigarettes. Did the fucking doctor ever get here? Couldn’t he come earlier?”

         It was the man who had taken his parking place: “Oh, so it’s you again.”

        “I don’t believe we’ve been introduced, I’m Dr. Fulvio Raggi, Ma’am. I need to wash my hands before I examine the children. If you could just show me where the washroom is?”

        While Fulvio washed his hands, he could hear the father muttering curses under his breath. Situations like this didn’t happen often, and Fulvio knew it was likely to get worse, since it was evening time. People always behaved their worst then, especially if they had not dined yet. Neither the woman nor the man had offered to take his coat, which he had laid across the other sink in the washroom.

        “Now, ma’am, just direct me to the children and we’ll see what I can do for them. I apologize for being so late, I did come as quickly as I could.”

          “Well maybe if you’d come earlier in the day, things wouldn’t be so bad.”

        “I doubt things can get much worse. Just let me see your kids.”

          The woman ushered him into a children’s room with two low beds and every imaginable kind of stuffed animal lined along the walls. Fulvio sat by the little girl and talked to her quietly, and then pulled out his stethoscope when he examined the little boy. The woman and man looked anxiously on.

          The three of them left the bedroom. While Fulvio was washing his hands, he told them: “They have the flu. It’s not too bad really, even if their temperatures are so high. It’s painful, but they’ll get through it. The little boy however seems to have a problem in his lungs. When was the last time he was outside?”

         “Oh, he insisted on playing soccer yesterday.”

          “In the rain?”

          “It wasn’t my call. Ciro here is the coach for his team and it wouldn’t do well for the coach to make the little boys practice in the rain if his own son were not there, even if he was starting to look a little sickly.”

          “Well, that explains it.”

          “Explains what?” the husband asked.

          “Incipient pneumonia in his right lung, would be my preliminary diagnosis. It’s just the start. If you treat it immediately it shouldn’t get any worse.”

          The parents both gasped. “What can we do?”

          “Don’t let him go outside.  Call your family doctor tomorrow and see if he can come check on the boy. Your doctor will know what to do, which medications and therapies to prescribe.”

          “But our doctor is skiing!”

          “Well, he should have a substitute. Who’s your doctor?”

“Loris Macri.”

         “His substitute has just finished her internship in the geriatric ward at the hospital and I know that she’s in town. Her name is Doctor Nucci. But for tonight just try to keep them asleep, if their fever goes up to 103, try to bring it down with wet compresses on their foreheads. Then call Dr. Macri’s office first thing in the morning, or better yet, go there in person early so you can be the first in line. This flu epidemic has got us all working overtime.”

        “Compresses all night? Who’s got the time for that?”

         “A child’s parents usually do. But you can always see about finding a nurse. It won’t be easy to find one this week. Now, here’s the prescription for antibiotics for both children. Give them each a pill according to the directions: one after breakfast, one after lunch, one before dinner and one before they go to bed. Keep giving them as much to drink as they want, they need lots of fluids. I might add you’ll want to keep them as warm as possible.”

          “Isn’t there anything else you can do? Couldn’t you come back tomorrow and check in on him? I mean, if you’d come earlier today, this might've all been averted, mightn’t it?”

          “I’ve already come today, and this was supposed to be my afternoon off. I don’t have any other slots available for the rest of the week. I’m afraid you need to wait your turn like everyone else.”

          Under his breath, the man uttered the words “Fucking asshole” once again. Fulvio ignored him and walked to the door. The woman sounded slightly more desperate.

        “But doctor, haven’t you got some samples of the antibiotics for this evening. Going out in this cold is . . . “

         “I know what the cold’s like, I’ve been driving around town since lunch time. I had to park four blocks away because someone took my parking space as I was backing into it. I’ve used up all my samples; but the pharmacies in the square and at the hospital are open twenty-four hours a day. You’ll need to go there.”

         “Couldn’t you run up and get them for us? I mean, you’re going out anyway.”

          This was a little more than Fulvio wanted to hear. He took a deep breath, stared at the woman and wryly responded.

          “Well, I could, but I also have two children at home and I haven’t had any dinner. Indeed, I haven’t even been offered a glass of water for the last half hour I’ve been here with you. I need to get home. And I’m parked four blocks away, as I mentioned earlier.”

          “But Doctor, oh please come back tomorrow morning. First thing. We’ll pay you.”

        Fulvio turned to put on his scarf and walk out the door, then he looked back at the couple and said: “I’m afraid you haven’t got enough money for me to come back, but you can call the hospital tonight if you like. Someone might be along around one or two in the morning, but they won’t tell you anything different from what I’ve just said.  Good evening.”

          “Some people only think of themselves!” the woman shouted after Fulvio as he walked down the stairs. He also heard the man mutter “Fucking asshole!” as he slammed the door at Fulvio’s back.

          Fulvio didn’t get back home until just before ten o’clock. He took off his coat and his wife came towards him, clutching her dressing gown tight around herself. He noticed she still had the trace of an ashen cross on her forehead.

        “Fulvio!”

        “Well, hello.”

         “I know you’re tired, but Donato’s not feeling well. He’s running a fever and feels all achy.”

         “It must be the flu. Can’t I get a bite to eat first?”

         “It’ll only take a few minutes. I mean after all, he is your son. I do think that’s more important than stuffing your face.”

         Fulvio knew any comment would only lead to an argument. He went to his son’s room, pulled up a chair by the bed, and took Donato’s hand. Of course, he had a slight fever. It was the flu. Fulvio sat there and sighed a minute or so, while his wife looked on. Fulvio was beat, he was tired, and he knew there was nothing he could do except prescribe antibiotics, lots of fluids and bed rest. He almost fell asleep sitting there.

       “Pops.”

         “Donato, you need to go back to sleep. I’m going to give you some antibiotics. Francesca, can you go into the kitchen, bring back a glass of water and a packet of Allmusan? It’s in the tin next to the wine bottles.

        While his wife was away Donato said: “Thanks for the ice cream, Pops. I just wish you’d remembered I don’t like hazelnut.”

         Fulvio sighed. “I’ll eat it, don’t worry.”

        “Oh, we already ate it all, Pops. Just next time remember, hazelnut is your favourite flavour, not mine. That is, if you really want to make everyone happy and not just yourself.”

        When Fulvio finally made it to the kitchen, he saw that the maid had left his place setting laid out. Francesca was heating the soup and had put the fish in the oven. They chatted for a moment, and when Francesca poured the soup into the bowl, she announced:

        “Time for me to go to bed. I’ve got a big day in front of me. You can just put the dishes in the sink when you’re finished.”

        At this, Fulvio didn’t even lift his head from his plate. “Good night.”

        “Good night.”

        As he sat at the table over the bowl of steaming soup, he turned around to look at the pallid flounder in the oven behind him. Once Fulvio heard Francesca’s bedroom door close, he stood up, walked over to the counter, opened the bottle of wine, and poured himself a glass of garnet red Sangiovese with bright orange overtones. Then he went to the refrigerator and felt under the celery in the crisper. Sure enough, there was the package he was expecting, where he knew that Nanny would leave it for him.

          Fulvio stood there at the counter and opened the folded butcher’s paper to reveal a prairie of gentle waves of perfectly sliced, orderly rows of paper-thin ham gleaming pink against the slick white background. It emanated a lusciously plump aroma of lovingly cured pork with smoky hint of cloves. He broke a piece of audibly crusty bread, picked up a slice of prosciutto bathed in a subtly golden iridescent sheen, and held it up in front of the kitchen’s single bulb. The ham glowed with all the translucent opulence of the stained glass in one of the Rose Windows in Notre Dame de Paris.  Fulvio laid the slice of the ham on top of bread and bit off half of it. Then he drained the glass of wine, and poured himself another one. Still standing there, he finished off the ham and bread and then he sat down and fixed himself another open-faced sandwich.

         “Some people only think of themselves. The people who say it are usually experts, that’s for sure. Well, they’re something more than experts, they’re licensed masters in zoological selfishness.”

          Fulvio poured himself his third and final glass of wine. His day was over: he could put all the fatigue and injustice and suffering behind him. The thought of repentance and atonement and expiation did not even enter the ante camera of his brain; he had no room for needless suffering there. He did not utter his final thought for the day. Even if there had been someone there to listen to him, Fulvio would never say anything like that out loud:

          “Fuck Ash Wednesday.”