Mash

by Richard Hooker

  “I’m here,” Ugly John said.

  “Good,” Hawkeye said. “I guess you’d better get him asleep and a tube in him if you can. His common carotid is cut, and I can’t do anything with the son of a bitch jumping all over the place. We haven’t got time for any of the preoperative pretties.”

  “Mama, Mama!” the patient was yelling. “I’m dying.”

  “Hold still,” Hawkeye said, “or I’ll guarantee it.”

  Ugly John did a cutdown and got into a vein. He got some blood started, as well as Pentothal and curare, and inserted his intratracheal tube. It was still a toss-up. Although the patient had survived the induction of anesthesia, Hawkeye still had to get the carotid clamped off, and as soon as possible.

  “Get help,” he ordered Knocko McCarthy. “I gotta keep a finger on this or we lose him, and I can’t expose it and get it clamped with one hand.”

  He tried though. Grabbing a scalpel with his left hand, he enlarged the wound around the bare, dirty right index finger which had to stay in the neck. Next he tried to slide a Kelly clamp down his finger into the wound and clamp the artery, but it didn’t work. Then he got a retractor and, managing to hold it in the wound with his left hand, he improved the exposure. He was still in desperate need of help.

  “Look, Ug,” he said to Ugly John who was busy enough with the anesthesia and the new blood, “grab a Kelly, and from where you are I think you can ride it down my finger, grab, and we’ll have this mother under control.”

  Ugly did as told. Reaching the bottom of the wound, he opened the clamp as wide as he could. Sensing that he was around something substantial, he closed the clamp vigorously, asserting, “I got it! I got it!”

  He had clamped the end of Hawkeye’s finger. Hawkeye, by reflex, removed his finger—and the blood flew. When it did Hawkeye went back in, but this time with his left index finger, and now, with luck, he was able to get a clamp on the artery.

  “I’m OK for now,” he told Knocko McCarthy and one of the surgeons from the other shift who came running up with her, “but get the Professor.”

  Most of the surgeons had some locally acquired experience in the care of arterial injuries, but they were still beginners. Therefore the Army had sent a Professor of Vascular Surgery from Walter Reed Hospital in Washington to give lessons throughout Korea. Fortune had placed him, at this time, at the Double Natural, and he bailed the patient, and Hawkeye, out.

  Trapper John, meanwhile, had delved into a chest and Duke was now occupied with several feet of small bowel which were no longer useful to the owner. Hawkeye returned to the preop ward where Colonel Blake had taken charge.

  “What’s the score now?” Hawkeye asked.

  “A major case on every table and ten more that are bad and about thirty that can wait till things quiet down.”

  “Who’s ready?”

  “That one over there,” said Henry, pointing.

  That one turned out to be a very black Negro who was one of Ethiopia’s contributions to the UN forces. Hawkeye repaired the damage to the liver and bowel there just in time to assist Trapper John who had gone into another chest. From Trapper he went to help Duke remove the right kidney and a section of colon belonging to a Corporal Ian MacGregor.

  “What type we got here?” Hawkeye asked the Duke.

  “Don’t y’all know you’re operating on a member of Princess Patricia’s Canadian Light Infantry?” the Duke said.

  “Finest kind,” Hawkeye said.

  That was the way they played it, day after day. As soon as someone finished a case he had to assist elsewhere until another case of his own was brought in. Then, briefed by Colonel Blake, he’d step in and do his best. When the last of the serious cases was allotted, the surgeons, as they became free, would start working on the minor things—debridement of extremity wounds, some with fractures, some requiring an amputation of a finger, a toe, a foot or a leg, but minor as compared with what had gone before. Meanwhile they, and everyone else, would listen for, and dread, the sound of the six o’clock chopper.

  The six o’clock chopper, either morning or evening, was always unwelcome because the very fact that the pilot was risking the trip in half-daylight meant that the soldiers lying in the pods were seriously wounded. So twice each day, at dawn and at dusk, as six o’clock approached, everyone—surgeons, nurses, lab technicians, corpsmen, cooks and mostly Lt. Col. Henry Blake—would listen, and during the time of the Great Deluge, they would hear, not one six o’clock chopper but three or four.

  “What the hell is going on up there, anyway?” Colonel Blake asked no one in particular one 6:00 P.M., the roar of the choppers filling the postop ward, where the colonel was assessing results with the Swampmen.

  “The Chinks,” Trapper John said, “are obviously holding a Gold Star Mothers membership drive.”

  “And it’s up to us,” Hawkeye said, “to stamp out that organization, so let’s get to it.”

  “Right,” Duke said. “We can fix ’em just as fast as they can shoot ’em.”

  “Right, hell,” Henry said. “You guys can’t go on like this forever. You haven’t had any sleep.”

  “Right,” Duke said.

  “How the hell do you feel?” Henry said.

  “Better than the patients,” Duke said.

  “Then what the hell are you doing, standing around here?” Henry said.

  The new group was truly international. Hawkeye drew a Turk, and repaired his lacerated colon. Duke took off the right leg of a Puerto Rican kid, portions of whose femur, shattered by a mortar up on Pork Chop Hill, had punctured the chest of his fox hole buddy, who was now on the next table under Trapper’s knife. When Trapper finished there, he closed the ruptured diaphragm of a Chinese prisoner of war, while Duke assisted the Professor of Vascular Surgery who was trying to save the left leg of a Netherlands private by fashioning an arterial graft out of a segment of vein from the other leg, and Hawkeye, with Pete Rizzo assisting him, went into the belly of an Australian.

  “Dammit,” he said, after about a half hour of it, “we just need more hands.”

  “I know,” Pete Rizzo said, “but I only got two.”

  “Knocko!”

  “Yes, sir?” Captain Bridget McCarthy answered.

  “Put on a pair of gloves and help us for a few minutes, will you?”

  “Can’t, Hawk,” Captain Bridget McCarthy said. “I’ve just got too much to do already.”

  “Then find somebody else.”

  “Yes, sir.”

  Ten minutes later, Hawkeye was aware of the help—gowned, capped, masked and gloved—at his left. Without looking up he reached over and put the new assistant’s hands on a retractor.

  “Pull,” he said.

  “How, Hawk?” he heard Father Mulcahy say. “This is a little out of my line.”

  For days, now, and for nights, too, Dago Red had been doing his part. All day and all night he had been going from patient to patient—black, white, yellow—friend and foe. Some of them didn’t know who he was, but they all knew the side he was on. A confident patient does better in surgery, and so does a confident surgeon, and Dago Red had the right words for both.

  “Just pull,” Hawkeye was saying now. “Right there, and toward you. More. Good. And when we get out of this you can put in the first sterile fix in the history of surgery.”

  And still they came. Bellies, chests, necks, arteries, arms, legs, eyes, testicles, kidneys, spinal cords, all shot to hell. Win or lose. Life and death. At the beginning of it, all of the surgeons, and particularly the Swampmen, had experienced a great transformation. During periods of only sporadic employment they often drank far too much and complained far too much, but with the coming of The Deluge they had become useful people again, a fulfilled, effective fighting unit and not just a bunch of semi-employed stew bums stranded in the middle of nowhere. This was fine, as far as it went, but it was going too far. By the end of the second week they were all wan, red-eyed, dog-tired and short of temper, and it was obvious
to all of them that their reflexes had been dulled and that their judgment had sometimes become questionable.

  “This can’t go on,” Lt. Col. Henry Blake was saying at five forty-five one afternoon, for the fiftieth or sixtieth time within the last three or four days. “Goddam it and to hell, but this just can’t go on.”

  Henry was standing, with the Swampmen, just outside the door of the postop ward. Once again, somehow, they had managed to take care of all the major cases, and the debridements and fractures and amputations were now being handled by others. They had ostensibly stepped out for a smoke, but each knew that they were all there to post a watch to the north and hope against hope against the appearance of the six o’clock choppers.

  “It’s gotta end sometime,” Henry was saying. “It’s gotta end sometime.”

  “All actions and all wars,” Trapper John said, “eventually do.”

  “Oh, hell, McIntyre,” Henry said, “what good is that? When? That’s the question. When?”

  “I don’t know,” Trapper said.

  “But who the hell does know?” Henry said. “I call three times a day, but those people in Seoul don’t know a damn thing more than we do. Who the hell does know?”

  “I don’t know,” Hawkeye said, “but maybe Radar…”

  “O’Reilly, sir,” Radar O’Reilly said, at the colonel’s elbow.

  “Goddam it, O’Reilly,” Henry said, “don’t do that!”

  “Sir?”

  “What the hell are you doing out here, anyway?”

  “I thought you called for me, sir,” Radar said.

  “Look, O’Reilly…,” the colonel started to say.

  “Look, Henry,” Hawkeye said, “maybe I’m going off my nut…”

  “Maybe we all are,” Henry said.

  “Then maybe Radar can help us.”

  “We are crazy,” Henry said, shaking his head. “We’re absolutely mad.”

  “Look, Radar,” Hawkeye said. “What we…”

  “Let me handle this, Pierce,” Henry said. “O’Reilly?”

  “Sir?”

  “Now don’t lie to me…”

  “Why, sir! You know that I never…”

  “Never mind that, O’Reilly,” Henry said. “I don’t want to listen to any of that, but I want to know something.”

  “What, sir?”

  “Goddam it,” Henry said, turning to the others. “I haven’t really gone out of my mind, have I?”

  “No you haven’t, Henry,” Trapper said. “Go ahead.”

  “Yeah, go ahead,” Duke said.

  “Look, O’Reilly,” Henry said, looking right at Radar. “What do you hear?”

  “Nothing, sir.”

  “Nothing!” Henry said. “What the hell do you mean, nothing?”

  “I don’t hear anything, sir.”

  “Well, what does that mean?”

  “I believe it means, sir,” Radar said, “that the action has subsided in the north.”

  “Good!” Duke said.

  “Look, O’Reilly,” Henry said. “Are you telling the truth?”

  “Why, sir! You know that I never…”

  “Stop that, O’Reilly!”

  “Yes, sir.”

  “Radar,” Hawkeye said. “Tell us something else.”

  “Yes, sir?”

  “Do you hear the six o’clock choppers?”

  “No, sir.”

  “You sure?”

  “Yes, sir.”

  “Well, how the hell are you going to hear them, anyway, standing here?” Henry said, and he pointed toward the north. “You should be listening out there.”

  “Yes, sir,” Radar said.

  Radar started to walk slowly toward the north then, and they followed him. They formed a small procession, Radar in the lead, his ears at the right-angle red alert, his head turning on his long, thin neck in the familiar sweeping action. They walked across the bare ground the fifty yards to the barbed wire, beyond which lay the mine field, and they stopped.

  “Well?” Henry said.

  “Nothing, sir.”

  “Keep trying.”

  “Yes, sir.”

  To the north the valley was blanketed in shadow now, the hills to the left dark, but the sunset colors still bathing the tops of the hills to the east. They stood behind O’Reilly, where they could watch him and the sky at the same time, and they maintained absolute silence. As they watched, the last of the colors left the eastern hills, the dusk mounted in the valley and only the sky held light.

  “O’Reilly,” Henry said, “it’s six o’clock.”

  “Nothing, sir.”

  “It’s six-oh-five.”

  “Nothing, sir.”

  “O’Reilly,” the colonel said, at about six-fifteen, “I can’t see my watch any more.”

  “Nothing, sir.”

  “Glory be!” the Duke said.

  “Good work, O’Reilly,” the colonel said. “Dismissed.”

  “Thank you, sir.”

  “And by the way, Radar,” Hawkeye said, “stop by The Swamp tomorrow for a bottle of Scotch.”

  “Thank you, sir,” Radar said. “That’s very kind of you, sir, but you were thinking of two.”

  “OK,” said Hawkeye. “You’re right, and you’ve got two.”

  “Thank you, sir.”

  “We’re all crazy,” Henry said.

  There was no jubilation. They were all too tired. In fact, they were exhausted, completely spent, and the Swampmen hit their sacks. When 6:00 A.M. came and went, and there were no choppers, they slept on, and at 8:00 A.M., when Radar O’Reilly, accompanied by an associate lab technician, entered The Swamp, he could have made any of the three the victim of his desperate need, not for two fifths of Scotch, but for a pint of A-negative blood, quantities of which were on order from Seoul but had not arrived.

  “Captain Forrest?” he said, shaking the Duke. “Sir?”

  “Not now, honey,” the Duke mumbled. “Gobacksleep.”

  Gently, Radar straightened Duke’s right arm. Deftly, he injected Novocaine over a vein. Duke stirred but did not awaken, and while the assistant tightened the sleeve of Duke’s T-shirt to serve as a tourniquet, Radar skillfully inserted a No. 17 needle into the vein and joyfully extracted a pint.

  “Where’d you get it?” Colonel Blake asked, after Radar had hurriedly cross-matched it and proudly presented it to his chief. “Twenty minutes ago you said there wasn’t any.”

  “I found a donor, sir,” said Radar.

  “Good boy,” said the colonel.

  Two hours later the colonel himself was a visitor to The Swamp. By now Hawkeye was in the middle of Muscongus Bay between Wreck Island and Franklin Light. He and his father, Big Benjy Pierce, were hauling lobster traps.

  “Finest kind,” Hawkeye was saying.

  “C’mon, Pierce,” Henry was saying, shaking him. “C’mon. Wake up!”

  “What’s wrong, Pop?”

  “Pop, hell!” Henry said. “It’s me.”

  “Who?” Hawkeye said.

  “Listen, Pierce,” Henry said. “There’s a Korean kid in preop with a hot appendix. Who’s going to take it out?”

  “You are,” Trapper John said, rolling over in his sack.

  “Why me?” Henry said.

  “Because,” Trapper mumbled, “although you are a leader of men, there are no men left.”

  10

  The business of doing major surgery on poor-risk patients can be trying and heartbreaking at any time, and when it is done regularly it can have an increasingly deleterious effect upon those who are doing it. It was therefore inevitable that The Deluge should have its after-effects, not only on the patients who survived but also on the surgeons who contributed to that survival. The first of the Swampmen to give outward evidence of what they had all been through was Hawkeye Pierce, and the first man to get caught in the fall-out was the anesthesiologist—Ugly John.

  A good anesthesiologist is essential to any important surgical effort. Without one, the greatest s
urgeon in the world is helpless. With one, relatively untalented surgeons can look good. If the man at the head of the table understands the surgical problem and the surgeon’s needs, if he understands the physiology and pharmacology of carrying a patient through a hazardous procedure, if he can have the patient under deep and controlled anesthesia when it is needed and awake or nearly so at the end of the operation, he is an anesthesiologist and a boon to all mankind. If all he can do is keep the patient unconscious, he is just a gas-passer. There were more gas-passers than anesthesiologists in Korea, but in Captain Ugly John Black, limpid-eyed, dark-haired, and the handsomest man in the outfit, the 4077th had an anesthesiologist.

  Ugly John probably worked harder than anyone else in the unit. Theoretically his responsibilities consisted only of supervising the anesthesia service. Actually, as the only one formally trained in anesthesiology, he was morally if not militarily bound to be available at all times. Too often this involved day after day of twenty-four hour duty, with only an occasional catnap. During busy periods like The Deluge the surgeons were constantly aware of his almost perpetual state of exhaustion and his greater than average effort. Nevertheless, when they had a tough one, they either wanted Ugly John to give the anesthesia or they wanted him to be around to check on it. Just his presence, or the knowledge that he was sacked out around the corner in the preop ward, was emotional balm to the man at the knife.

  One of the most consistent customers of the 4077th MASH was the Commonwealth Division, consisting of British, Canadian, Australian, New Zealand and other assorted British Empire troops a few miles to the west. Captain Black had an intense, burning, complete, unremitting hatred for all the medical officers in the Commonwealth Division. His reason was very simple: they gave half a grain of morphine and a cup of tea to every wounded soldier. If the soldier was incapable of swallowing the tea, he still got the half grain of morphine. As a result of this treatment, it was frequently necessary to wait for the morphine to wear off before a patient’s condition could be assessed. If early surgery seemed reasonable or mandatory, Ugly John, in the process of getting the patient to sleep, often caught the tea in his lap. Frequently the patient had holes in his stomach or small bowel. In this situation, Ugly did not catch the tea in his lap. The surgeon would aspirate it from the abdominal cavity where it had leaked through the holes. The surgeons of the 4077th had the largest series of tea peritonitis cases in recorded medical history.