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It was ten years since I had been seriously crazy. I had done medical school and was finishing up residency. The year 1981 was a much better one than 1971.

I wondered how it had all come to pass, but it always hurt when I pinched myself.

It was early spring when I arrived for my last night as senior in charge of the ER, and there was one “expect note.” Sometimes there would be half a dozen or more. I checked the crash cart and the laryngoscope batteries. Whenever I was in the ER and had small bits of time with nothing else to do, I’d scan dermatology texts. Sooner or later I’d run into someone with the disease in the pictures and it would click that I’d seen it somewhere, even if I couldn’t remember what it was.

EXPECT: Prince of the River Nile Smith. One-week-old black male with conjunctivitis. Born at home, did not receive silver nitrate or erythromycin prophylaxis.

Care and Protection order. Child must be admitted and treated for presumed GC conjunctivitis.

Gonococceal (GC) conjunctivitis was the number one cause of blindness before there were laws mandating treatment of all newborns. The closest I’d ever come to seeing a case of GC conjunctivitis was a woman who had a positive GC culture one week prior to delivery. There were lots of ideas about what we should do, and in the end we decided to do them all. The mother and baby each received so many different antibiotics via different routes before and after delivery that whatever germs were there were ripped to shreds worse than Bonnie and Clyde in that machine-gun ambush.

Textbooks show massively swollen, very red, weepy eyes with copious pus.

I got a call from the chief resident at Mass Eye and Ear Infirmary. “We have a seven-day-old baby here with eyes that look fine, but there’s a care and protection order on him because the parents wouldn’t comply with treatment at Children’s Hospital. Our pediatric floor is full, so we’re sending him over to you.… I don’t want to make you nervous, but the father has about a dozen very quiet friends dressed in camouflage fatigues and combat boots. Our security people have already talked to your security people.”

I had about fifteen minutes before the Smiths could get over to MGH and register, so I headed down to the basement for my last ten o’clock meal. Whatever hadn’t been eaten that day and the day before at the ten o’clock meal was dolled up a little and put back out there one more time. Amazing numbers of calories were consumed by deranged absentminded overstressed hospital personnel. It was free. Whenever anyone said that there was no free lunch, I always thought, “No, but there is the ten o’clock meal.”

Malvesti Hedley Smith was about five feet nine, 190 solid pounds; he looked like he was carved out of ironwood. He had jet-black African skin, wore designer jeans and a free-flowing bright African-print shirt, and walked slowly on the balls of his feet like he wouldn’t make a sound walking through tin cans in clogs on a tin roof. It was hard to look at Malvesti and not feel inferior. He checked out the waiting room briefly and ushered in his wife, their one-week-old son, and three colleagues in battle fatigues and combat boots. They took stiff seats in hard plastic chairs.

“Prince of the River Nile Smith,” called out Helen, the triage nurse, just as she would call out any other name.

Mother with babe in arms, Malvesti, and three friends rose in unison and allowed themselves to be led into one of our small exam rooms.

“Undress the baby down to his diaper so we can take his temperature and the doctor can examine him,” said Helen.

“My baby’s only problem is with his eyes. He has been examined many times. We prefer that you not take his temperature. I would like to talk to the doctor in charge.” Each word was clipped, enunciated perfectly and with a slight British-colonial accent that suggested English wasn’t his first language.

His wife, Asanti, was a very pretty, soft-featured, medium-complected young woman of about twenty, one or two inches taller than