by Atul Kumar
“What about your other son?”
“Ah, Jeremy, the baby of the family; he’s only 21 years old, a decade younger than his siblings and hasn’t spoken to me for about ten years. He always hated how I wasn’t around. One day I promised to see him play soccer; it was the regional championship game, but I had an emergency case come up and missed his game and the after party at the ice cream parlor. He always held it against me and refused to speak to me from that time onwards. It was an awkward five years living with him.”
“You mean throughout high school you two never spoke?”
“Well, I’d speak to him, but he never responded to me. He’d talk to his Mom when I wasn’t around and she’d relay his thoughts to me. But he never asked for much or caused much trouble. Between you and me, I think he was involved in drugs, but you’d never be able to tell by his school performance; he was a superstar student.”
“He didn’t get into any trouble?”
“No sir, he was always came off as a straight arrow. I think it was mainly because he was too smart to get caught.”
“Better than the alternative.”
“He skipped a couple grades. His reasoning was it allowed him to leave home that much sooner. I’d offered to send him to Andover or Exeter or any other boarding school of his choice, but his Mom wouldn’t allow it; they got along fabulously and she didn’t want him gone sooner than necessary.”
“But he did leave for college at a young age?”
“Oh sure, at 16 he enrolled in Caltech and graduated with a killer GPA with a double major in math and physics. He was immediately given countless job offers. Took one for a government think tank operation, one of those ‘I’d have to kill you if I told you’ jobs with the highest levels of security clearance.”
“I’d say on paper you have a dream life: beautiful wife, successful career, money galore, and three hugely successful children. But the fact that your wife generally leaves you alone even after major surgery and none of your children so much as visited indicates that the paper version is quite misleading.”
“You don’t know the half of it. I bought Jeremy a new car for his 16th birthday, and for getting into such a wonderful college, he got a new Porsche 911 Carrera. He never once drove it, and the day he left for college he just left a note on the window, ‘return to sender.’ That was the only direct communication I’ve had with him since the age of 11.”
“What are you going to do for him when you get out of here?”
“Good question. I don’t know that there is much I can do. He’s pretty well taken care of from what I can tell. I know he tested positive for some illicit drugs a couple months ago, which is grounds for termination with his level of security clearance. But the powers that be just turned their heads and he’s still doing whatever it is he does.”
I was so engrossed in our discussion that I’d lost track of time. I was jolted back into reality when the whole team entered Dr. West’s room for evening rounds. I was sure I’d get reamed a new one for slacking off, and I had no excuse, given the team had worked seven extra hours yesterday while I napped.
Before I could defend myself, Dr. West spoke up, “Ah, the whole team’s come to pay me a visit. Must be a slow day in the gun and knife club, huh?”
“Hi Dr. West,” Blake took the lead as the team filed into the room behind him. “Just wanted to make sure all was well and the med student wasn’t causing any trouble.”
“Raj here, he’s absolutely delightful. I’m afraid I’ve kept him from his other duties recanting stories about my past. The mix of narcotics and anxiety of awaiting the pathology results after tumor resection surgery can do that to a person.”
“No problem, Dr. West; he’s as much a part of the team as any of us. If you need Ra’s assistance at any time, just let me know.”
“You guys have done a great job. Tell Bert I said ‘Hi.’ All is well here. I’m sure I’ll see you all tomorrow.”
Blake performed a quick exam and we all left Dr. West’s room. Thankfully nobody realized the checklist note I’d taped up on his mirror.
“You’re lucky he took responsibility for making you late Ra, otherwise that would have been your third tardy since starting this rotation,” remarked Lanky.
I managed to make it through the rest of rounds without drawing any further attention. We all left the hospital together. I’d say it was a successful day; nobody died just so the surgical trainees could learn something.
~~~~
I awoke in a startle; I thought I was having a bad dream. Turns out it was the start of a bad day. The startle was from my pager going off. I must not have heard it the first time because there were two identical pages a couple minutes apart. Immediately I called back the number.
It was Blake. “Ra, we need you immediately. There was a nine car collision on the 10 Freeway this morning. Well, it happened about 15 minutes ago. Several surgical trauma cases are coming our way. We need everyone we can get in the OR STAT to help out. See you there in 15 minutes. I’ll be in OR 10. Meet me there.”
He hung up. I blinked a couple times to get my bearings, realizing I was still at home. Fortunately I had fallen asleep in my scrubs on the couch, so with some quick tooth-brushing and a splash of water on my face, I headed straight for the OR.
The life of a surgeon sucks.
The ER was sheer pandemonium. Every trauma bay and individual room was filled with somebody who was bleeding. The overhead loudspeaker was constantly requesting further medical assistance in the ER.
There was blood everywhere. In fact, if a patient wasn’t bleeding they weren’t even allowed to be in the hallway; they were relocated to the waiting area.
For the first time in my life I saw triage tags. They were only used in catastrophic situations; this must have been a serious nine car pileup.
I was trying to figure out where I was needed when the trauma doors burst open, and in came a crib followed by a gurney. The crib had a black tag on it meaning the occupant was no longer alive. The commotion was going on behind the crib. That gurney had a red tag, meaning emergent intervention required. There was a whole team performing CPR on a … person; at this time I couldn’t tell if it was a male or female. Blake was heading up the effort when he caught my eye.
“Ra, help me here. Take this bag and ventilate her fast. Get her to OR 10 STAT; I’ll meet you there. She’s got a right pneumothorax, pelvic fractures, and severe lacerations on both lower extremities. We have a chance at patching her up. Get her intubated and tell anesthesia to pump her full of at least 6 units to start and we’ll go from there.”
I was just given my battlefield upgrade. Instead of being scared and trying to hide, I did as instructed. As scared as I was, the team of nurses, techs, and paramedics were looking for someone to lead, and that was me.
Her right leg was still bleeding profusely from a very deep laceration. “Somebody get a tourniquet on her right thigh,” I shouted with authority as we maneuvered to the elevators.
To my astonishment, by the time the elevators opened up a tourniquet had been placed on her right thigh and the bleeding was significantly less. I could get used to this type of treatment.
“Give her a liter of normal saline and keep pressure on her wounds. Make sure she has a pulse and is getting oxygenated.”
“Pulse is 130 and weak Doc, but definitely present,” someone replied.
“Her left lung sounds are clear, and she has only trace cyanosis,” another reported.
Turns out a trauma response team works great as long as somebody is present to lead it. Before I knew it, we were bursting through the doors of OR 10.
I gave the anesthesiologist a quick report and she immediately intubated our Jane Doe (JD) to obtain control of her airway. Next JD was given some powerful pain medications and muscle relaxants. While this was occurring the OR techs quickly cut off all her remaining clothing using their trauma shears. Simultaneously, the anesthesia resident placed an arterial line in JD’s left arm, and the a
ttending placed a subclavian line on her left side after she was intubated.
Total time to do all this = 3 minutes.
Just as the first unit of blood was being rapidly transfused, Dr. Blake walked into the room. His confidence immediately relaxed everyone. Before he could speak, Blake was handed a chest tube which he inserted with just a couple fluid motions. Within seconds, the right side of JD’s chest re-inflated and her color almost immediately transformed from a mild baby blue to a healthy pink.
“Well, that’s one less thing to worry about. Pneumothorax is fixed. Next we have to amputate that right lower leg; it’s too mangled to salvage. Whoever put that tourniquet did a great job, probably saved her life,” announced Dr. Blake.
And we went to work. Operating with a motivated and well-trained chief resident was a totally different experience than witnessing a hack job performed by Parker. Within three hours we had completely assessed JD, corrected her right sided pneumothorax, amputated her right lower leg, stabilized her pelvic fracture, and sutured all her multiple lacerations.
Stripping out of our gowns Blake pulled me aside. “You did good in getting her to the OR Ra. Without your quick thinking about her bleeding leg she might not have made it at all. I think she’s going to do just fine with some time and rehab. We’ll get her a great prosthetic leg and she’ll be able to run a marathon in six months.”
“Thanks.” We walked out together, the sun just now starting to rise. “Did you see that crib?”
“That was her daughter, only two years old. She was DOA. Nobody had the heart to admit it. I was the one who tore off the red tag and pronounced her outside. Sucked.”
I didn’t know how to respond, so I did what med students do best and changed the topic. “Do you want me to go help out with rounds?”
“Tell you what; Parker has been fucking up lately. Two people died on his watch. He needs time to cool off and get his head on right. Why don’t you assist me today and I’ll have him do the notes. He didn’t respond to my page this morning, anyhow.”
Assisting a seasoned surgeon was a world of difference compared to monkeying around with interns. Blake was all business and a great teacher. He let me see what was going on, and if I answered his “pimps” correctly he rewarded me by allowing me to place a few sutures and even close a large skin incision. At the end of the day with him I felt like I was actually learning and that this whole surgery thing might be something to seriously consider.
On a mild natural high from actually doing something, instead of just staring at shoulders, I was excited to round on my patients that evening and see how their days had gone. Presumably better than the young mother who had just lost her leg and her baby.
Nine made it to the OR last night, of which four died intra-operatively due to the extensive nature of their wounds. Another six didn’t even make it to the OR due to black tags, and six others had less severe injuries. All this because a drunk driver that entered the freeway on an off ramp and hit several cars head-on. The cars thought they were doing the best thing by slowing down when they saw him approaching, but it turned out to be unwise because they were that much closer to each other upon impact. The fact that he was driving a huge SUV didn’t help either.
Thoughts of so many people dying because of a reckless drunkard dampened my feelings, and I felt as though I could use some good news. My wish was granted.
I entered Dr. West’s room and was floored to see dozens upon dozens of flowers filling up the entire space. Instead of hospital odor, the room smelled like perfume.
“Dr. Raj!”
“Hi Dr. West, I’m guessing the pathology results came back?”
He pumped my hand with vigor, “You betcha, and I bought my wife here some flowers to celebrate the fact that I had completely clean margins.”
“I’d say you bought her a small florist shop.”
“Well, ‘go big or go home’ is what they say, don’t they? And from here on out, the Wests are going big.”
Mrs. West started weeping again. She was sitting on the side of the bed with her husband and they resembled a happy newlywed couple. She leaned over and gave him a hug and peck on the cheek.
“So, back to the grind next week?” I jokingly (well, half jokingly) asked.
“No, I’m true to my word. Medicine was my profession, now Pauline is my life. We have a lot of fun to make up in the next few years. Hell, I just realized I hadn’t taken a real vacation in the past 34 years, only trips to conferences that’d I’d call ‘vacations.’”
Their enjoyment/elation/relief was palpable. She lovingly rubbed his head and he held her hand. It was moving to see how different their demeanor was compared to the past couple days. “So what’s first on the agenda?”
“Well, Burt is a slave driver, he says I gotta stay in the hospital at least two more days and then I need to follow up with him for staple removal and post-op care routinely over the next two weeks. Then I have to watch my diet and take it easy for another couple of weeks.”
“Not bad, you went from having a life threatening cancer 4 days ago to being totally cured. I’d say a month of recovery is reasonable.”
“Every minute I’m not doing something fun I feel like I’m missing out.”
“I thought you forgot what it’s like to have fun?”
“Hmm … that sounds like something I’d say doesn’t it? Well, I’m going to have fun trying.” He leaned over and Pauline was more than willing to accept a peck on the cheek.
“I notice that’s a car magazine over there. You done reading the medical journals?”
“Well, we’ve both driven the same cars for the past ten years. I figured it’s finally time we go from place A to place B in some style. Any recommendations?”
While medicine was my major, automobiles were my lifelong minor. I knew just about everything about any car manufactured since ‘93 and was always happy to share my knowledge. They were content to know that they had a resource to exploit for their purchase. We traded contact information and I got through rounds with my head spinning.
That was the first time I’d witnessed a miracle of modern medicine. To go from being given a death sentence to being cured was a rare occurrence, and to be a part of it made all those long hours and late nights of study worth it. I made a mental note that I’d have to reconsider surgery as a career path.
~~~~
That mental note lost some of its appeal when my alarm clock buzzed at 3:40 a.m. the next morning, though many would (probably correctly) argue it was still night.
Dr. West continued to recover like a champion, and that evening I found him walking laps around the nursing station and flirting with the young nursing students a third his age. I had to admit he was quite the charmer, and I could definitely see why his patients loved him. He had an endless supply of energy; his confidence coupled with the commanding nature he used in telling stories was so engaging, it was hard not to be drawn in. And a group of nurses has clearly fallen under his spell.
I ran into his wife gazing intently at her husband from near the water cooler. She was staring at him as only someone smitten can.
“He’s quite the life of the party, isn’t he?” I asked.
“That’s the man I married decades ago.”
“I’m glad he’s back.”
“Sure took long enough! I want to thank you for all you’ve done, and don’t say it was nothing. I really appreciate how long you chatted with me the other night, and Peter said he’d had a couple engaging discussions with you, too. Though he wouldn’t tell me what that note he tore off the mirror said. He just referenced a medical student, and you’re the only one that’s been around.”
“It’d be better you experience that note than have me ruin what it said.”
She patted my back and joined the group of listeners as Dr. West recounted how he treated a celebrity’s erectile dysfunction before the advent of Viagra.
There was only one scheduled surgery the next morning, likely due to the fact i
t was Saturday, but surgeons didn’t seem to differentiate between week days and ends.
After morning rounds the Wests were packing up. I caught them just as they were about to leave their room.
“And to think if I didn’t come by you’d have left without saying goodbye.”
“Hardly,” replied Dr. West as my pager went off. “I bet that page is from this here nursing station. I asked our nurse to page you and check if you were free.”
Indeed he was correct.
“We need all the manpower we can get. These flowers aren’t going to move themselves.” He winked at me.
“I’d be happy to help.” And I started to scoop up some flowers.
“No no, put them down. I was just joking.” I actually couldn’t tell.
“I called you here because I wanted to thank you and give you a little memento of my, our, appreciation for your gentle nature and willingness to listen to a grumpy, old curmudgeon.”
He handed me an envelope.
I tried to open it but he stopped me. “Not here, open it when you get home.”
I tucked it in my pocket and insisted that I push his wheelchair to his car. Hospital policy forbids anyone from walking out of the hospital even if they are more than capable.
Once we arrived outside we were greeted by a handsome gentleman standing next to a SUV, though his expression was a bit dour. He warmly hugged Pauline and patted Dr. West on the back as he stooped down to the wheelchair in one of those pseudo-hugs.
“Raj, meet my oldest son, Jamison.”
We shook and helped the West’s into their car. Despite beating cancer, Dr. West still had a long road of recovery ahead of him, especially if he was going to save his family. I wondered if he’d really keep me posted. After all, talk is cheap. Actions are what matter.
