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Whys and Wherefores, a Short Story by William Cass

A doctor

Luis had been a patient of mine for less than a year.  He’d been referred to me by his primary care physician on the south side of San Diego, but he didn’t really require my care as an internist anymore. Spikes in his cholesterol levels and some unusual side effects involving his statin drugs had led to the referral, but those had been quickly remedied after med adjustments I made and a few subsequent office visits.  Additionally, he’d also followed my advice about exercising more regularly and losing weight, which had contributed to his improved condition.  I’d kept on seeing him for routine check-ups, but knew he no longer needed my services.  The truth was, I liked him and his quiet, appreciative, positive manner after so many other encounters to the contrary.  And he appeared to enjoy coming to see me.  So, I hadn’t yet formally discontinued our association, although that was something I’d made up my mind I had to do.

            I shared the second floor of a medical building and its waiting room with several other doctors of internal medicine and related specialties.  Our offices ringed the waiting room on three walls, each with plastic windows behind which our receptionists worked.  It was my practice to come into the waiting area myself to greet my patients and bring them back for their appointments, something of an oddity, I guess, that I’d borrowed from a kindly older mentor of mine with whom I’d done part of my residency.  It was in that waiting area that I saw Luis and James Pernell at the same time.  Luis had come quite early, as was his custom, and sat flipping through a magazine, while James slouched across from him next to his mother wearing his tattered ball cap, cell phone in hand like usual, tapping his foot to whatever music blared that afternoon from his earbuds.  At the sight of the young man, I resisted an urge to scowl.  James had briefly been a patient of mine, as well, but when his condition began to warrant it, I’d referred him on to a nephrologist colleague of mine whose office was on the opposite side of the waiting area.  James’ mother had to have had him quite late in life because her hair was almost completely white and she already used a cane.  My next patient, a well-dressed woman about her same age, rose from her seat without even waiting for me to acknowledge her and followed me back to one of my exam rooms.

            A couple of patients later, I returned and greeted Luis.  Like always, he smiled and shook my hand warmly in both of his.  He couldn’t have been sixty years old, yet his mahogany skin had a leathery quality to it that reminded me of an old recliner I had at home, and his grasp was just as comforting.  His eyes were down-turned at the outside edges and a little moist, giving them a tender, gentle quality.  He called me “Doc”.

            Our appointment followed its typical quick pattern.  I reviewed his recent lab results on my laptop while Luis inquired about my own health and how my wife and young son were doing; he’d remarked on their identical red hair in the photo on my office desk during our initial consultation and never failed to ask after them.  As I completed his check-up, he told me with some delight about a woman he’d met beforehand in line downstairs at the pharmacy whose parents, like his, had crossed over the border from the same rural area of Mexico many years ago to pick crops in the Imperial Valley. 

“What are the chances?” he asked, shaking his head with his quiet smile.

“Pretty amazing,” I said and shook my own in agreement.    

I confirmed with him that there had been no changes in his medical status, made a few entries to his chart on my computer, and once again saw no need to make any adjustments to his medications beyond reviewing their dosages with him.  He nodded thoughtfully to everything I said. 

As I readied myself to finally explain to him about not needing to see me anymore, he tilted his head, frowned, and said, “Doc, there’s something I think I’d like to do, but I could use your help with it.”

“That so?”

“Yes, I believe it is.”

I swivelled on my stool to face him more fully and told him, “All right.  Shoot.”

He rubbed his chin a few times before saying, “Well, there was this young man sitting across from me in your waiting room a little while ago.  I’m pretty sure it was his mother with him.  So, anyway, I watched him use this kit and prick her finger, I guess to check her glucose levels.  Figure she has diabetes.  Watched the way he was with her, you know, how slow and careful.”

He paused then and looked at me with those eyes.  My heart fell a little.  A tip of cypress tree branch outside scratched against the exam room window on the spring breeze.


“So, anyway,” he continued, “the waiting room wasn’t very crowded, and I could hear them talking after he finished doing that with her about the appointment he was waiting for with his…”  Luis grimaced slightly.  “His neffer…”

“His nephrologist,” I finished for him.  “She’s a colleague mine.”

“Okay, fine.  And after you came into the waiting room, he mentioned about having been a patient of yours.”

Although it was probably a HIPPA violation, I found myself nodding without further consideration.

Luis’s eyes brightened.  “Well, that’s good.  So, anyway, the two of them were talking about his appointment with your colleague, his mother and him, and it seems that young man is needing a kidney transplant.  Anyway, that’s what he said.  And they looked pretty glum about things.  Talked about him being on some sort of long waiting list.”

I couldn’t do anything but nod.  The need he described wasn’t a surprise; it’s frankly what I’d been expecting when I’d referred James to her.

“So, anyway,” Luis said.  He rubbed his chin some more.  “I think I’d like to do that.  Give him one of mine.”

I felt my eyebrows knit.  “Do you mean become a living donor?  Donate one of your own kidneys to him?”

Luis’s nod was slight, but clear.  “I do, yes.”

I sat and stared at him.  I realized I didn’t know much about Luis beyond the few things he’d told me or were in his record.  I knew he had always been single and worked as a night custodian at an elementary school.  I knew that he liked woodworking.  My knowledge about James was only slightly more extensive, but it was plenty.  I’d seen the “Put America First” bumper sticker on his pick-up truck.  And I could still remember the shock and disgust I’d felt when I recognized him in television news footage shouting angrily and shaking a “Build the Wall” placard at an anti-immigrant rally in Phoenix the previous summer.

Luis returned my gaze, nodding slowly.  “Other than my cholesterol thing,” he said, “which you’ve got fixed okay now, I’m in pretty good health, so I figure I might be a fit enough donor candidate.  I live alone, don’t have any family counting on me.  I’ve read a person can function just fine with one kidney.  So…”   He shrugged, pursed his lips.  “And then I found myself thinking about when I was about the same age as that young man living with my mom and helping her with her medical problems.”  He chuckled, his eyes glinting at the memory. “And believe me, she had a few.”

I didn’t know what to say, so I just sat there looking at him.  He was still perched on the edge of the exam table.  The space was small enough that our knees almost touched.  A kind of numbness crept over me as my mind toggled back and forth between Luis and James Pernell.

“So,” Luis said.  “I was hoping you could tell me how to go about pursuing that.  Maybe you could talk to your colleague, see if that young man and me match up right.  You know my blood type, probably have his, whatever else you need.  See if that’s something that could get done.”

“There’s a lot involved,” I heard myself blurting.  “Tests beforehand, insurance considerations, possible side effects afterwards…”


“All that’s fine.”  Luis held up his hand to cut me off.  “Just hoping you can get the process started, Doc.  I can take it from there.”

I studied him, blew out a breath, and said, “What you’re suggesting is pretty extraordinary.  For someone who’s a complete stranger to you.”

“Not complete,” Luis replied.  His voice had softened.  “We shared that waiting room.  I heard them talk, know that young man has this challenge, this considerable challenge, and that I can maybe help.”  He paused again.  “So, what do say, Doc?  Can you talk to that colleague of yours, get the ball rolling?”

I knew I could.  She and I had already spoken about James Pernell.  She knew about his political inclinations, too; she’d told me he’d come right out and all but bragged to her about them.  She was as appalled with him as I was.  But, of course, those weren’t anything I could ethically share with Luis; HIPPA regulations were absolutely clear about that.  I pursed my own lips, met his moist-eyed gaze, and nodded.

“Okay, then.”  He slid off the edge of the exam table and offered his hands.  I folded them into my own and we shook.  He smiled and said, “Pass on whatever information about me to her that you need to.  You know how to get ahold of me.”

“I do.”

“All right, then.  Thanks.”

And just like that, he was out the exam room door and gone.  The doorway stood agape, and I sat staring at its emptiness for several long moments.  I hadn’t said a thing to him about him not needing to see me anymore.  Instead, he’d had ideas of his own to discuss, decisions he’d made in a very short time that were beyond my understanding.  I looked out the window to the parking lot below and watched Luis walk across it and climb in his car, an old sedan missing one hubcap.  He backed up carefully and drove away.  Almost immediately afterwards, James Pernell led his mother on her cane out to his pick-up truck a few spaces away.  It had a raised suspension, and he had to help her up into it.  A few moments later, it roared off, too, exhaust billowing up over his bumper sticker.

            Then the parking lot sat still and motionless in the early afternoon’s clean, white light.  I was vaguely aware of muffled voices from my staff in the hallway.  I had other patients waiting for me, but I stayed where I was, thinking.  Out in the hall, one of my staff laughed quietly and another answered in kind.  The cypress branch scratched lightly at the window.  Finally, I shook my head, forced myself to my feet, and prepared as best I could to go about the rest of my day. 


William Cass has had over 300 short stories accepted for publication in a variety of literary magazines such as december, J Journal, and Ruminate.  He won writing contests at and The Examined Life Journal.  A nominee for both Best Small Fictions and Best of the Net anthologies, he has also received five Pushcart nominations.  His first short story collection, Something Like Hope & Other Stories, was published by Wising Up Press in 2020, and a second collection, Uncommon & Other Stories, was recently released by the same press.  He lives in San Diego, California.


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