The Hour of Bad Decisions

by Russell Wangersky

  I’m not a big guy, maybe 5’ 10” in my socks, handsome in that “he’s a doctor so he makes lots of money” kind of way. When I take my face apart in the mirror, though, I always think that too many parts are just too much – nose too big, eyes too far apart, eyelashes long enough for a woman but kind of dopey-looking on me.

  But that’s beside the point.

  I shouldn’t have been so easily cornered, but I was off my game – I was tired. For that, I blame the trombone player. And the coronary from earlier that night – he hadn’t made it – the two drunks who fought with beer bottles “just like in the movies” and had more open bleeders on their faces than you’d normally see in a month. The lady with the kidney stones who was screaming even though we’d laced her up on Demerol.

  I was double-shifted, too, because we were short on doctors and I’d agreed to work two, back to back. That can really drain you. The right combination of nights, and you can fall asleep in the cafeteria, face-down in the scrambled eggs.

  But back to Miller. I just refuse to call this guy Elephra.

  He said he was a taxi driver, that his car had slid sideways in snow down a St. John’s hill, fetching up hard against a light pole. Not much of a margin in the taxi business, so there are a lot of clapped-out, repainted old cop cars with lousy tires. The kind of car where the engine warning light stays on permanently, so the drivers stick a piece of masking tape over it so they don’t have to think about it. The drivers aren’t much better.

  Yeah, I hear what you’re thinking. Another reason to be paying attention.

  So Miller had smashed up a cab, and now his back hurt. He said it had been injured before.

  I had him take off his shirt and his sweater and then he said he had to take his pants off, too, to show me where it hurt, and he spilled everything out of his pockets. Out of one front pocket, change – I remember a balled-up five-dollar bill – and car keys. From the other, the knife.

  One minute, things were normal – well, as normal as a hospital emergency room gets in the middle of the night, and the next I had this big knife in my face. And it wasn’t completely like a threat, although it was threatening. He didn’t say he was going to cut me up, just held it there as if showing me the possibilities.

  Not for long. He put it down on the end of the examining table, but the blade was still open, and not far from reach.

  Then he started to tell me about his daughter.

  “I didn’t know I had a daughter,” he said, “because the doctors” – he underlined the word, I didn’t – “said I couldn’t have kids, but then I saw a girl on the street one day and when she looked at me, I knew I was looking at my daughter. You have kids, doc?”

  Yes, I told him, not quite lying, a boy and a girl.

  “And you know they’re your kids the minute you look at ’em, right?”

  That kind of seized me up right there. It didn’t matter, though. He just kept talking.

  “That’s when I knew, and I tried to figure it out in reverse, you know, figure out how it was possible. I’d had the test and the doctors said I was sterile, that there was nothing there at all, so they must have been wrong again. And my girlfriend didn’t tell me she was pregnant, and then I was gone to Alberta because, you know, we just started pissing each other off, and her mother, man, her mother was a piece of goods – always in my face about the smoking and the weed, so it just seemed easier to start fresh somewhere else, even if it was Calgary. But it should be against the law not to tell someone he’s a father, right doc? Right?”

  “Right.” Sometimes, it’s easier just to agree. He’d broken off talking, and he was looking at me kind of sideways, his head tilted.

  “Are you a blue?” he asked suddenly.

  Now, what’s the safest way to answer that question? I just shrugged, hoping he’d find the answer to be obvious.

  “You look like a blue to me,” he said. “I can usually tell. That’s good.”

  “That’s good?”

  “Yeah, good. Would have been different if you were a red. But I can see there’s a lot going on with you, doc. A lot going on.”

  I made myself busy then, taking pages of meaningless notes, and I looked at his back, since that was what he had come in for. It seemed normal enough – tender when I prodded around, but he still had pretty good range of motion. He turned when I talked to him from behind, turned enough so that I could see that he was turning his head, not his whole upper body. Usually, the pain will stop you if anything’s been torn in there.

  “Spine’s fused,” he said.

  I looked, but there weren’t any signs on his back that he’d had surgery – no scars, not even a stitch here or there. Sometimes scars can fade to quite fine lines, but nobody’s perfect, and you almost always see a loop or two, a place where a stitch has gone too far before being pulled tight. So, spinal fusion? Not possible.

  I was beginning to think – hell, I already knew – the guy was psychotic, or at least delusional. Didn’t know any more about the speci fics, because it wasn’t really an emergency room thing – but I thought if I could get past him, I could at least rally the troops and get him sent upstairs for a psych exam. Or at least I could get a few of the bigger guys to pin him down so they could get the knife.

  “How about we get an x-ray of that back, have a look and see what’s exactly going on in there?” I moved towards the door.

  “I don’t like x-rays,” he told me, his hand reaching across the sheet. “Doctors don’t know how to read them.”

  Then he said he had been left alone in the examining room the first time he hurt his back, with the x-rays up on the big light box in front of him.

  That he had turned the light on, and had seen everything the doctor had missed.

  “Inside my ribcage, you know, there’s a calci fied fetus,” he said, his eyes wide. “Never even knew it was there, but clear as can be on the x-ray. And under my shoulder blade, there’s a fishhook – just a plain fish-hook, and I got no idea how it got in there.”

  He dug his fingers in under his armpit – “I can’t even feel the bugger. But the doctors didn’t see any of it. It’s like they can’t see what’s right in front of their faces.”

  There was a singsong quality to his voice, a sort of hypnotic rhythm. Sometimes a person’s voice gets that way when they tell a familiar story, one they’ve told many times before. Like the one where you drive your suv head-on into someone else’s car because you’re driving too fast and you’re way too tired. And you’re the only one in your family who even gets to walk away, and you go over it and over it with the cops and the lawyers and your parents and your wife’s parents, too.

  Like that.

  It was really hard to pay attention to Miller. Hard to focus on what he was saying about police of ficers following him, about the cab company’s owners wanting him to deliver liquor, about everything else. The words were just blurring.

  I couldn’t help it. I was tired.

  Hell, I was already tired when I came on shift.

  See, I live in an apartment right now and in apartments, you’re always at the mercy of the neighbours. You can complain when they’re noisy, of course, but that often makes things worse, and most people just can’t seem to fathom what a 24-hour emergency room shift is like.

  Sometimes, that kind of shift is a whole night of next to nothing – picking broken glass out of tumbledown drunks, and sprains that need nothing more than ice and pressure bandages. You get a fair amount of sleep, and only get woken up occasionally to write a prescription for strep throat or for painkillers.

  Other times, it’s flat out from the moment you get to the hospital, and every time you turn around, there’s another car crash or a great huge knife wound where you have to spend a couple of hours just making sure you pick up all the nerve and tissue damage so some idiot doesn’t turn around in three months and sue you silly. Sue you, because you patched him up after a knife fight, and now he’s only got half a smile.

  And th
e trombone player in the apartment next door to me is driving me mad. He’s been there a month now, in addition to the people downstairs who work night shifts and put their laundry in at the strangest of times. I’ve complained to the landlord, but they can’t seem to pin the guy down – it’s like cops, they’re never there when you need them, and this guy, he never seems to be playing when the landlord comes around.

  At first, I thought he was right next door – I’d wake up and hear him as if he was in the room with me. But go out in the hall, and it’s hard to find where exactly the sound is coming from. When I talk to the landlord on the phone, I can practically hear the shrug coming right back at me over the phone lines. I don’t even think he believes me that the guy is there.

  As for the trombone player himself, I don’t know if he just doesn’t realize how thin the walls are, or if he’s trying to push me over the edge. Or whether he just doesn’t care. He plays scales, fractured scales – one, two, three, four, five, one two, three, four, five – over and over again. Sometimes the same song – Blue Moon – so that, for a day or two, it peals in my head like ringing bells. You must know that old Sinatra classic – “Blue moon, you saw me standing alone …” I’m pretty sure he’s playing it with a mute – and that he knows just how loud the trombone is, and that he’s making at least some effort to muf fle the sound. But not enough effort, because I can be in the apartment trying to sleep and he can drive me right back into my clothes and out onto the street.

  The noise is so pervasive that I’ve made up my own image of the guy – I assume it’s a guy, although I’ve never seen him.

  I picture him as late middle aged, paunchy and standing there playing the trombone naked, with a roaring great erection. He can play naked at home – in my imagination, that gives him some kind of charge. I don’t want to think what that says about my head – I’m no expert, I only spent one rotation in psychiatry as an intern, just enough to know that it was all my mother’s fault. Hey, I’m kidding, all right?

  For sure, though, I’m not known for my pysch skills. They brought me the guy they call the Major once, wanted me to commit him permanently. Two police of ficers, and a slew of angry firemen to boot. The Major was a favourite trick they used to play on the new guys, the probationary firefighters. The fire alarm would get pulled at the Major’s nursing home, always around ten at night, and the trucks would pull up and the fire fighters would put the new guys in breathing gear and send them inside. They’d crawl up the stairs to the alarm station, and there’d be the Major. Uniform hat and jacket, one hand at his forehead, saluting.

  He’d be staring at the spinning red lights flashing though the windows, and whacking off with his other hand.

  Funny stuff, hey? At ten o’clock at night, maybe.

  But not at three in the morning.

  I told the fire fighters they were being paid to answer fire calls, not me, and why were they waking me up for that kind of crap anyway? What did they want me to do, prescribe some ky jelly to the old geezer so the Major wouldn’t light some kind of friction fire? I didn’t take even a moment to consider the underlying pathologies, to ask the “what if ” question, like, what if there’s a day when pulling the fire alarm isn’t enough, and a bunch of old people die in their beds because the Major lights up the toilet paper in the bathroom? I thought about that for weeks, waiting to read about the fire. I probably should have sent him upstairs to see the pro shrinks – at least then it wouldn’t be on my conscience if anything happened.

  Maybe, just maybe, if I cared more about the “underlying pathologies,” I would have spotted Miller earlier, right? I’m rambling – I know it, but it’s hard not to ramble when you’re just trying to do the best you can, and all you really want to do is sleep. Ever fall asleep while you’re driving? That’s what it’s like – you’re so tired that you can feel your eyelids dropping, even though you know exactly how dangerous it is. Your head messes you up – just for a second, your eyelids say, just for a second. Coming back from a day in the country, everyone a little sunburned and sleepy, and the next thing you know you’re in a hospital bed and you’re alone, everyone else having died in the emergency room hallway or before the fire fighters could even cut them out of my suv.

  Sorry. I’m just sorry. So I work harder, and carry crosses like this guy.

  I was fading right there in the room with Miller, fading, though he seemed like a real dangerous guy to be ignoring, even for a moment. He was telling me about his apartment, about how it was bugged, about how his knees were shot from driving and he lived above a stereo shop.

  “That’s what I did, see, is I took all the styrofoam from the empty boxes, just the flat sheets from in front of the screens, and I put that down all over the apartment floors, see, because it lessens the impact. Also the noise.” He was talking faster, kind of gabbling, and I was still collecting symptoms, or at least keeping track of them, checking them off as he went. Nothing I could cure in this guy, so I wanted to be rid of him – although the styrofoam, that seemed like a good idea.

  Impatience – that was a big problem with me. If you can’t fix ’em right away, make the diagnosis and shift ’em upstairs. That’s one reason I work well in emergency – you keep them moving, and only do the magic that you’re sure you can deliver.

  I always thought my hands were magic – that’s the kicker, really. I’d be sewing someone up – real fine work, a cut over an eyebrow or somewhere a scar would show real easily, and it would be as if I was standing back and my hands were doing the work all by themselves. Fine work, too, not the slap-dash needlepoint that some doctors call stitches – if it was someone I ran into again later, I’d always keep an eye out, to see if the scar was as fine as I expected it to be.

  Not a lot of people like to work the emergency room shifts. The hours are a killer for family life, for one, and then there’s the chance of doing something wrong: get someone on the table with their chest filling up with blood, a crushing chest injury like hitting the dashboard when you’re speeding along at 100, and you’ve got to get a tube in there and drain things before the lungs collapse.

  But the emergency room is to medicine like slaughtering cattle is to working in a French restaurant – the emergency room is fast, messy medicine, and you’re pushing a tube in between someone’s ribs and hoping you don’t accidentally do more damage in there.

  It’s got to be done, and quickly. Otherwise some-body’s wife just dies there in the hallway while her husband’s unconscious and can’t tell the other doctors what they should be doing. It’s best guesses, and heaven help you if you guess wrong, because even if the families never figure out what you did wrong, you know it. I always figured that if anything happened, I’d be able to do something about it – I never figured I’d be a patient, too, the kind who wakes up three days after an accident and can only remember what they tell him about it. Flail chest – all the ribs broken on one side – it must hurt like hell, but I know what to do about it, damn it, I know exactly how to put in the drain, and do it right away to lessen the stress on the lungs. That way, everything won’t just shut down while she’s out there lying on a gurney, waiting for somebody to get around to wheeling her down to x-ray. Enough blood inside the chest wall and the lungs collapse, away she goes, unable to even call out to me for help. I don’t let it get that far, because I don’t second-guess, waiting on x-ray time.

  Miller was pissing me off. Maybe, I thought, maybe I’ll tell him he needs a rectal exam just for spite, or order up some particularly nasty diagnostics, just to get even for all the time he’s wasting – no, no, really, doctors don’t do things like that, no matter what kind of jerk you are.

  And then I realize he’s stopped talking, and he’s just sitting there staring at me, and he has to realize that I’m not paying attention at all. And that’s just about the worst thing I could do, because it’s feeding the pathology – the guy already thinks doctors are the enemy, unwilling to listen, and I’m proving the point. And it’s not even b
ecause I don’t care. It’s because I’m so damned tired that my eyes are starting to cross, and even I know that I’m a danger to patients when I’m like this.

  And now I’m a danger to myself as well. Miller has picked up the knife.

  The strange thing is, the only thing I can think is that I’m going to get stabbed because a trombone player wants to get a hard-on, and how fair is that?

  No one from the floor had been in to see if everything was all right – sooner or later, a nurse would have to poke her head in to tell me we had a cardiac on the way – Friday night, there’s always one or two, but it was near shift-change and they were probably all finishing up their paperwork.

  “You should just tell him to stop,” Miller says, digging under his fingernails now with the tip of the knife. “Haven’t tried that, have you?”

  “What?” I wasn’t sure what he was talking about.

  “The trombone player,” he said.

  I hadn’t told him a thing about the trombone player.

  “You could ask him to stop. That is, if he’s really there at all.”

  I lost my temper then, and banged my hand flat and hard on the countertop, the noise loud enough to startle even me.

  “What the hell do you know about my life, buddy?” I shouted at him. “And what’s it matter anyway? I’ve got better things to be doing than dealing with you.”

  “I know you’re pretty out there, doc. I know you’re wound right up. And I don’t know if you’re in any shape to be treating patients.”

  I just stared at him. “Is that your diagnosis?” I said coldly.

  “I don’t know,” he said. “You’re the doc. At least I know what’s going on with me. How about you?”

  He grabbed his clothes with one hand, slouched down from the table, and touched me under the ear with the tip of the knife.

  “I think maybe you’re not a blue after all.”

  Then he walked out the door of the examining room and headed down the hall. I heard him whistling in the hallway, whistling Blue Moon, so I must have said something about my trombone neigh-bour, but I don’t remember when or what.