It was the black bag.  The one he bought in Newark the week before he started medical school.  The first object that he purchased as he paused to pass the threshold of a life’s dream.  It was just like the doctor’s bag in the Depression era black and white photo classic.  The doctor from the Midwest…. tired, grim and determined, leaving his old Ford truck and about to enter through the screen door of a humble house of someone sick and suffering, someone crying out for relief.  This was such a home and he clutched his bag and summoned the spirit that drove him to this place…..this tiny town on a stretch of paradise.  Its beautiful rolling green meadows and colorful lily bulb fields lay buffeted between the giant redwood studded hills of verdant glory and the blue green luster of the pure Smith River, close to where it embraced the sea.  He had come to this modest home, with its porch that faced the old school house, in response to a phone call from a family he had never met.  They were in trouble and needed a doctor.  And so he knocked on the door, holding his black bag.

     “Oh hello doctor, I’m so glad you came, please come in” she said, “ my husband’s just inside in the living room.” 

     Mary was sweet, middle aged, thin and plain to look at but clearly focused in her devotion and concern for her ailing husband who sat on the couch.  

     “Hello Jim, I’m Doctor Thomas, I hear your leg is really in bad shape.”  

Jim flashed a weak smile and waved his hand in greeting.  

     “Doc” he said “I’m not going to the hospital.  I’d rather die, but I can’t take this pain.”         

     “Well, let’s take a look.” said the doctor.  

His right leg had been amputated above the knee a few years ago but the trouble lay on the left.  As he lifted his pant leg he could smell the foul pungent odor of advanced infection and he saw the large gaping, oozing ulcer surrounded by hot red flesh that was consuming his shin.  Slipping off his slipper his blueish foot and blackened toes confirmed that gangrene had set in.  This leg must be sacrificed if he had any hope of survival.

      “Jim this is bad, we need to send you to the hospital now for surgery and antibiotics”.

     “No” he said, “I lost one leg to diabetes and Im not going to be a no legged cripple sittin’ on the porch watchin‘ the traffic go by.”   

The doctor looked up at his wife and he realized that a grim determination had seized this house.  She was ready and Jim was far down the road to his fate.  Yes, the healer had been called but only as an observer, a facilitator.  This was not a rescue.  

     “How old are you?” the doctor asked.  

     “Forty eight” he said with a hint of defiance.  

Just then his son, John, walked into the room and said hello.  He appeared to be about twenty five, a slim , small framed young man with soft almost fragile features.  He stood resolutely next to his mother.  Doctor Thomas could feel their question bore into his soul:  Will you help?

     “I don’t know what to say, we can save your life if we act quickly.  We should save your life.  I know you’re depressed, who wouldn’t be … but your family Jim, they love you, it’s obvious.”  

Jim shook with a chill, clearly feverish.  Beads of sweat formed on his brow and his pain was palpable as he squirmed a bit into the couch. 

     “Can you help me with the pain Doc…it’s awful bad?”   

The doctor paused, pondering the situation, but then focusing on his patient’s immediate concern said,  

      “ Yes, I can help”.  

How could he not.  On the one hand he could provide comfort, but he knew he was not in control.  Events were beginning to carry them all away as surely as that blue green river flowing to the sea.

     He opened his bag and drew up a syringe of morphine.   The injection took effect quickly and Jim relaxed a bit.  They all took a moment to breathe.  The home was tidy, bathed in beige and brown.  Simple but functional old wooden furniture filled the room.  Traces of the smell of breakfast still hung in the air and the warmth from the wood stove closed in a bit.  What now, what now?

     The doctor took out his prescription pad and wrote a script for liquid morphine.  

     “Here” he said “this will buy you some time, but my very strong advice is to go to the hospital immediately.  Will you at least take antibiotics?”  

     “No way” Jim said with dead certitude.  

With that, the doctor gathered up his things and with an empathetic gaze he wished patient, wife and son a sorrowful goodbye.  

     “I’ll be back in the morning, please call me if you need anything”.  

     He closed the screen door behind him and as he stepped outside he grappled with what had just occurred.  The moral, ethical and legal questions swirled.  What should be done, what could be done?  His feet found the truck and after a short ride north on the coastal highway he was back in the fold of his family and home.



        The next morning he knocked on their door not knowing what he would find.  There had been no phone call during the night.  Mary opened the door.  She was tense.  A jumble of fear, pain,confusion and determination like that which inhabits a battlefield seemed to have gripped her.  He knew then it had been a long hard night.  He braced himself and struggled to summon the right solemnity to suit the strange and pitiful moment he could feel he would soon be sharing.   

     She led him into a side porch that had been enclosed to form a long narrow bedroom.  Jim was lying on a bed.  He was ashen, racked with torment and perspiration, but clear minded.  He turned his head toward the doctor, 

     “ Hello Doc”.  

     “Morning Jim, you’re not looking too good.”  

     “I ain’t too good.”

He laughed faintly and his weak  smile was uplifting to us all.

     “You know it’s still not too late to turn this thing around,  we can call an ambulance”.  

     “I ain’t goin’ nowhere” he glared defiantly. 

 He settled down a bit and took a deep breath.  Regaining his composure he asked softly,   

     “How much of this morphine would it take to kill me?”  

The doctor was taken aback by this logical question that should never be asked but now seemed unavoidable.  

     “There’s a lot of medicine in that bottle but you should take it as it says on the label”.

     Their son John walked in and stood next to the bed.  He put his hand on his father’s chest and Jim grasped it tenderly.  It was then that the first tears welled up in Mary’s eyes. 

     “He begged me last night to shoot him but I just couldn’t do it” she said. 

Doctor Thomas looked at her earnestly, “You must promise me you won’t.   After this is all over  you’ll still be alive and you’ll have to answer for it like a criminal, people may not be able to understand why you did it, they may not let it go”.

He turned to Jim and said, 

     “Don’t let them do it.  If it has to be that way, you need to pull the trigger yourself.”  Somehow I knew he couldn’t do it.  Jim lay there quietly and looked away.

     There are times when logic deserts us and the wind drives our sails.  The good doctor said his goodbyes and their eyes embraced with sorrow.  

     “God bless you and guide you” he said as he stepped out into the morning sunshine and rejoined the living world.

     That was the last time he saw or spoke with any of them.  Jim died sometime that night without any signs of violence.  He was buried after a wake in the nearby church cemetery.  Doctor Thomas heard of no inquest or inquiry.  He was glad of that.  It was better that way.