Dr. Galen's Little Black Bag

by R. A. Comunale M. D.

  “It’s your call.”

  “Okay, Doc, we’re at the finish line anyway. Yours truly pulled the trigger and shot himself. Justice was served on the head of a copper round last night.”

  He stared at me once again.

  “Justin, when you get out of here, we’re going to keep on talking. Okay? I’ll come by every day, until Dr. Turner thinks you can go home.”

  “My parents have me lined up with a shrink, Doc.”

  “Did they visit you?”

  “Yeah, my mom and stepdad were here this afternoon.”

  “And...?”

  “They’re … uh … really pissed at me.”

  He turned and stared at the wall.

  “Guess that’s the way it always is—seems I’m just trouble.”

  “The shrink is a good idea, Jus, but that doesn’t mean we can’t talk.”

  His good hand reached out to me, and I grasped it briefly before turning to leave.

  I noticed the clock in the hall: 9:30 p.m.

  “Hey, Bob, got a second?”

  “Hey, Macario, what can I do for you?”

  Macario Ghirardelli was one of the finest adolescent and young-adult psychiatrists on the staff.

  “I’m the guy that kid’s parents called in. I heard what you said about us shrinks. Thanks for the good word.”

  “No problem. You do indeed do good work.”

  “So do you.”

  “How much did you hear?’

  “I … uh …was just sticking my head in and…”

  “You heard it all?”

  “Yeah, and what you said to him was right on target. Cutting is very common among teenagers, especially girls. They slice and scar themselves with sharp objects such as needles, razorblades, you name it. It’s a defective yet necessary coping mechanism for anxiety and tension that comes from traumatic emotional and physical experience. It becomes self-punishing, because the teen perceives himself, or herself, as both victim and perpetrator—cause and effect. Bad things happen, because they are bad.”

  “Geez, Macario, I thought I was the only one with logorrhea!”

  “To paraphrase the great Al Jolson, you ain’t heard nuthin’ yet.

  “In Justin’s case, he sees himself as the cause of his mother’s divorce, their ensuing poverty status, and—the final straw—his rape at the hands of a pedophile.

  “In my opinion it’s a variant of post-traumatic stress disorder, so often seen in battlefield soldiers. Rape is also a common factor. So this young man was in agony, physically as well as emotionally.”

  “Okay, Macario. The kid’s in good hands. If I can help in any way, let me know.”

  “Thanks, Bob. Do just what you told him you’d do: listen to him. He trusts you.”

  I headed toward the stairway.

  As I drove home through an unexpected rainstorm, an overwhelming emotional fatigue hit me. My clothes had gotten soaked, when I had run the short distance from my parking lot to the side door. So when I got home I shucked them, changed into pajamas, and hit the mattress. I didn’t feel like doing anything else.

  My bed held only me. I stared at the opposite wall. Leni’s stuffed toy dog and Cathy’s hand-knitted scarf lay on the shelf over the little desk Cathy had given me the year before she…

  Maybe I also had a karmic debt to pay.

  I started talking to them, just as I once did, when they were near, and I needed to vent my thoughts and feelings about the happenings of the day. I told them about Justin—and as usual the tears came.

  Cathy, Leni, is Justin right? Did I lose you both because of something I did?

  I turned off the lights and lay on my side looking at the alarm clock.

  It read 11:30.

  Four weeks later Justin, wearing a special arm sling, was being fitted for an extender brace that kept the fingers on his right hand from becoming permanently curved into his palm. He still had no feeling or movement in that hand.

  I worried about a condition called sympathetic dystrophy, when he told me about the burning-pain sensation he had begun to experience in his right arm. Sometimes a part of the nervous system goes haywire when an injury occurs. It causes pain that is very difficult to treat, a sensation that sufferers have described as burning that pierces the skin.

  Fortunately, in Justin’s case, it was short-lived.

  He underwent intense physical therapy. It restored some shoulder movement, but the forearm and hand remained useless.

  “I saw the shrink today, Doc.”

  “What did he say?”

  “Told me I was nuts.”

  “Are you?”

  The question seemed to startle him.

  “What do you think, Doc?”

  His eyes bored into me.

  “You’re saner than a helluva lot of people I know, Jus. Your only problem is that eight-hundred-pound guilt monkey you carry on your back.”

  “Mine’s different, Doc.”

  “How so?”

  “Mine’s an orangutan, not a monkey.”

  Amazing he could joke about it. On one level he knew he didn’t need to ride the guilt horse. But deeper down, the guilt had lodged where his limbic beast lurked, and it still weighed on him.

  Another four months and Justin’s orthopedic surgeon asked me for pre-surgical, medical clearance. He wanted to try a muscle/tendon transfer to restore movement to the young man’s right forearm and hand.

  “Do you want to do this, Justin?”

  “Yeah, I’m tired of using my right hand as a hammer.”

  The surgery went well. Three more months and Justin held up his hand. As I watched, he opened and closed his fingers. He had become fanatical in following an exercise program to increase strength in the damaged extremity.

  We continued our talks. He would stop by several times a week and shoot the breeze about school, friends, parents, and career goals. He also saw the psychiatrist weekly, but he refused to take the pills prescribed for him.

  “Doc, I don’t need them. I’m not crazy, I’m not depressed. I don’t want to be any more of a zombie than I already am.”

  He had a point. I knew the psychiatrist was only trying to help him by leveling off his guilt moods with medication. But sometimes pills aren’t the answer.

  Besides, he had hated zombies ever since he accidently locked himself in a closet as a kid. It had scared the bejesus out of him.

  “Ow! That damned bullet hurts!”

  True to the trauma surgeon’s prediction, Justin’s bullet had started to migrate, as the muscles in his shoulder and back contracted and relaxed over time. Now it rested just inside his back near his scapula, aka wing bone.

  I ran my hands over the area on his back. I could feel it.

  “Think you’ve punished yourself enough, Jus?”

  He nodded.

  The surgeon asked me for another clearance before Justin’s surgery. It seemed a simple procedure to me—one often performed on the battlefield to get soldiers back in the line. But that little bullet had migrated to a spot just over the young man’s lung. It had to be removed under general anesthesia with careful monitoring, just in case the procedure caused the lung to collapse.

  I finished filling out the paperwork and handed it to Justin.

  “Doc, could I ask you a favor?”

  “Name it.”

  “Will you be in the operating room with me?”

  “Sure.”

  Now it was nine months to the day, and Justin had asked the surgeon to remove the bullet on that anniversary.

  I rode with him and his mother at 5 a.m. to the outpatient-surgery center. I walked behind him, as he strode determinedly to the pre-op holding area. I sat quietly, as the unit nurse told him to strip and put on a gown.

  “Doc, this damned thing doesn’t even cover my ass.”

  “So maybe the nurse is hot for you.”

  For a brief moment the tension left him. He laughed and changed into the gown, opened the curtain, and stuck his rump out to moon the fl
oor staff. Then he lay back on the gurney cart, pulled a sheet over his head, and waited for the next visitor.

  That was the pre-op nurse, and she started when the sheet-covered body slowly rose from the cart.

  “Okay, young man, let me see your left arm.”

  He held it out, and she rubbed the top of his hand, waiting for a vein to pop up from the tourniquet she had wrapped around on his wrist. Then she inserted the intracath needle into the vein, removed the metal insert, and capped the hub after drawing a blood sample through it. The plastic tube in his vein had been coated with a chemical to prevent clotting. Then she taped it down, so it wouldn’t slip out.

  “Damn, that hurt, lady!”

  “I would’ve guessed you were a big boy,” she replied.

  “Yeah, wanna see it?”

  “Pay no attention,” I said. “He’s really wound up.”

  She nodded, smiled back at him, and left.

  The parade continued. Next the anesthesiologist arrived and reviewed Justin’s medical history and drug sensitivities.

  “Justin, I’m going to give you something now to relax you. It’s called midazolam.”

  He took the vial from his pocket, drew up a dose, and stuck the syringe needle into the rubber port on the side of the intracath needle.

  I could see Justin’s facial muscles relax, as the chemical flowed through his blood stream. He was still awake but, as he said later, he wouldn’t have cared if the ceiling had fallen on him.

  As the anesthesiologist headed for the door, I told him I would be accompanying Justin into the OR. I would need to change into full scrubs, so I asked him to wait five minutes. He agreed.

  I headed to the surgeons’ locker room, where I grabbed scrubs that I thought would fit a bear, and started to change. One of the residents recognized me.

  “Hey, Galen, finally decided to become a real doctor?”

  “Nah, I’m opening a butcher shop, and I want to study your techniques.”

  I put on the shoe covers and head cap and hurried out the door.

  I walked that green mile beside the cart, as the attendant wheeled my sedated patient down the hallway to the OR. Before he slipped into unconsciousness, Justin had asked me to hold his left hand, and I did so. It seemed to take away those jitters that even the sedative could not suppress.

  The OR nurse helped me into sterile gown and gloves and put the mask around my face. I took my place at the operating table on Justin’s left side. He looked up at me and tried to talk, but the drug had dried his mouth. I patted his arm, and he smiled. I had seen it many times on many patients.

  It was a little boy’s smile.

  The anesthesiologist hooked up an IV to the tube in Justin’s arm and nodded at me.

  Now it would begin.

  He placed an oxygen mask over the patient’s face and an oxygen sensor on his left second finger then told him to take some big breaths. As Justin inhaled, I saw the other doctor push down on syringe plungers containing knock-out drugs and muscle paralyzers.

  Within seconds Justin’s eyelids fluttered then closed half-way. His jaw dropped, and his chest stopped its normal breathing motion.

  The anesthesiologist pulled his jaw down even farther, stuck the laryngoscope down his throat, and quickly inserted a tube into his windpipe. Then he connected the tube to a machine that would do Justin’s breathing for him.

  The scrub nurse taped the tube in place, applied lubricating ointment to Justin’s half-open but unconscious eyes, and taped his eyelids shut.

  “He’s under.”

  The OR attendants rolled the unconscious patient onto his left side and strapped him into position. They extended his right arm above his head to give a better view of the bullet site on his shoulder.

  I moved to the other side and stood behind the surgical assistant, who performed the multiple skin cleanings and preparation. Then the surgeon moved forward and the instrument litany began.

  “Scalpel.”

  He made a three-inch incision into the skin and fat. Blood oozed out, and the assistant used the electrical cautery to seal the leaking small blood vessels.

  “We got a pumper! Clamp”

  The incision had nicked a tiny artery. It was spurting. The surgeon clamped it and tied it off.

  “Retractor.”

  He placed a small gadget that looks like two forks bent sideways in the wound and expanded it to spread the muscle fibers apart.

  “Thar she be! ’Tis Moby Dick, the great white whale!”

  “I didn’t know surgeons could read, Tom,” I muttered.

  He chuckled softly and called for the bullet extractor. He grabbed the dark-gray ball of metal and gently wiggled it out. I could see the lung lining, the pleura, glistening at the bottom of the bullet hole.

  The surgeon waved the bullet extractor in triumph.

  “No doubt now, Galen. Your patient is the proud father of a baby hollow point .25.”

  The nurse held out a glass specimen jar filled with preservative fluid, and the surgeon dropped the bullet into its bassinet. I heard the clink when it hit bottom.

  “Okay, Sam, irrigate and close. He’ll need a drain left in for a few days.”

  The wound would fill with body fluids and blood and not heal properly, unless the stuff could easily drain out.

  The assistant inserted the rubber drain after carefully flushing out the wound three times. He checked for any remaining bullet fragments then closed the opening in layers from the deepest on out.

  I walked around to the other side and watched Justin lying there in that chemical state somewhere between sleep and death. Technically and legally he was an adult, but in reality he was a child, a helpless and emotionally bruised child.

  Why did this happen to him?

  “You guys finished?” the anesthesiologist asked.

  “Yeah, go ahead, bring him up,” the surgeon responded.

  The nurse and attendant rolled Justin onto his back and removed the straps.

  The anesthesiologist turned to me.

  “Your patient isn’t going to like what comes next.”

  Yeah, I knew that. The doctor would stop the drugs that kept Justin’s muscles paralyzed. Then he would administer the reversal drugs—chemicals that counteracted the medications that had rendered the patient unconscious.

  At just the right moment, after removing the tape from his eyelids and face, the anesthesiologist would yank the breathing tube out of Justin’s windpipe. When that happened, the slowly awakening patient usually tried to sit up and cough his head off.

  That’s exactly what happened. Justin’s eyelids fluttered then opened. The anesthesiologist yanked out the tube, and Justin tried to sit bolt upright, coughing and squeaking out a hoarse “shit!”

  As they wheeled him out to the recovery room, I turned and looked once more at the bottle containing the bullet.

  He opened his eyes. The drugs weren’t quite out of him yet.

  “Is … it… out?”

  “Yep. One helluva big orangutan, boy.”

  He smiled and quickly fell asleep.

  I walked to the waiting room, where his mother had been dozing. When I cleared my throat, she woke up, startled.

  “Is he … is he all right?”

  “Just fine. He’s in recovery now. I’ll go back in and check on him in a few minutes.”

  “Thank God!”

  “Tough time, huh?”

  “You don’t know the half of it, Doctor.”

  She told me about her life and the difficulties both she and Justin had experienced, after her first husband deserted them. It was straight out of a soap opera.

  By the time she was done, all I could do was shake my head. And I thought I had been through the wringer!

  I returned to the recovery room. Justin was awake.

  “Ready to pee, kid?”

  “Wh … wha…?”

  His voice was still hoarse from the breathing tube.

  “When you can pee and hold down some fluids
we can take you home. Wanna give it a try, big fella?”

  He nodded, and I waved the recovery-room nurse over.

  “Let’s try him out.”

  She pulled the curtains closed around his cart and handed him a plastic male urinal.

  “What am I supposed to do with that?”

  He coughed to clear his throat.

  “Guess.”

  He actually blushed.

  I tossed it in his lap and stepped outside the curtain. I could hear him succeeding. When he finished I poked my head back in.

  “Here. Hope it tastes good, Doc.”

  “Good boy. Now, hold down the apple juice and you’ve made it to third base.”

  He sucked on the straw stuck in the juice container then belched.

  “How do I get to home plate, Doc?”

  “First, don’t throw up. Second, try sitting on the edge of the bed. I’ll stand beside you. Third, if you make it that far, get out of your beautiful designer hospital gown and put your clothes on. I’ll help you with that.”

  “Tired of seeing me naked, Doc?”

  “Justin, I’ve been doing this longer than your mama’s been alive. There’s only two basic body models, and I’ve seen more than my share of both of them.”

  Justin was still not quite with it, but he smiled when his mother rushed up and hugged him. He winced and let out an “ow,” when her hand pressed on his back.

  An hour later and changed back into my civvies, I walked beside the wheelchair, as the attendant pushed it out to the waiting area.

  Back home and sitting on the edge of the bed in my pajamas I spoke again to my beloved ghosts. It ended when I broke down and cried. I couldn’t shake off my demons as easily as Justin had.

  At 11 p.m. I lay back on the bed, my mind wanting to scream.

  Leni, Cathy, why couldn’t I have saved you? It was all my fault.

  I waited for an answer, knowing all the while there would be none. Finally I fell asleep.

  The phone rang. The clock dial read 4:06.

  “Doc? Hey, Doc?”

  “Yes, Chet. What’s up?”

  “Doc, it’s a boy!”