"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, Mclntyre," 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 su
rgeons 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 surgeon 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.
When leisure came his way, Ugly's first duty was to repair his intratracheal tubes. These are tubes placed in a patient's windpipe through the mouth and attached to a machine, controlled by the anesthesiologist, which delivers oxygen and anesthetic agents in the concentrations desired. Inside the windpipe the tubes are held in place by small balloons which are inflated after their introduction.
The balloons on Ugly's intratracheal tubes, like all balloons, kept blowing out. The supply of new tubes was limited or nonexistent, for reasons never quite clear, so it was up to Captain Black to keep them in constant repair. There was only one source of new balloons.
Every week or ten days the PX received a shipment of the various things PX's receive shipments of. This always caused a line to form, and the line always included most of the nurses. At the head of the line, however, would be Ugly John Black. As the PX opened for business, Ugly John would step up and announce in a loud, clear, purposeful voice: "I'll take sixty rubber contraceptive devices. I hope to hell they're better than the last batch. They all leaked." Then he'd turn around and look austerely at the interested throng, few of who knew what he did with sixty such items a week.
When not working or blending intratracheal tubes and contraceptives into efficient units, Ugly was known to have a drink or two. In these situations, he usually wound up in The Swamp and vented his spleen upon the entire medical profession of the British Empire.
"Those lousy bastards!" he would yell. "There isn't a goddamned one of them would shake hands with his grandmother. He'd rather knock her on her ass with half a grain of morphine and then drown her with a cup of tea."
Such a man was bound to be held in high esteem by the Swampmen and was considered a warm and welcome friend. Actually, the incident involving Hawkeye and Ugly John was a minor one—at least, as it concerned them—but it was the first sign of things to come.
In The Swamp, every problem case ever done at the 4077th was discussed, dissected and analyzed from every possible angle and in every conceivable detail. The Deluge had left much for discussion, and two nights after its end the Swamp-men were thus engaged when the door opened and a corpsman stuck his head in.
"Hey, Hawkeye," he said, "they want you in the OR."
"I'm not on duty. Tell them to go fry their asses."
"The Colonel says to get your ass over there."
"OK."
Over in the OR, two of the night shift had the typical difficult war surgical problem with major wounds of chest, abdomen and extremities. The abdominal wounds alone made it a bad risk, and there was little margin for error. They needed help and advice. Hawkeye scrubbed up and was briefed by Ugly John.
"So how much blood," Hawkeye wanted to know, "did they give him before they started operating?"
"One pint," said Ugly.
"For Chrissake, John, why in hell do you let these cowboys start a case like this on one pint?"
"Well," Ugly started to say, "they …"
"Look, goddamit," Hawkeye went on. "You know as well as I do he should have had another hour and at least three pints before they brought him in here. What the hell's the matter with you, anyway?"
"I can't do everything around here," Ugly said. "I'm just the goddamned anesthesiologist."
"That doesn't stop you from thinking, does it?"
"The surgeons said he was ready," Ugly said. "These guys have been doing OK, so I haven't been arguing with them …"
"Then don't argue with me," Hawkeye said.
"So you're right," Ugly said, "but I'll tell you this. You're getting pretty hard to live with, Pierce."
"And that kid on the table may be pretty hard for someone to live without," Hawkeye said.
Then he got into the case and took it over. He concluded it as quickly as possible. He used every trick he'd learned in ten months of war surgery, and then he called in Dago Red to put in a fix.
"Please, Red," he said, "bring him in."
Too much is too much. Despite all efforts and fixes, the boy died an hour after surgery.
Father Mulcahy led Captain Pierce to Father Mulcahy's tent, gave him a cigarette and a canteen half full of Scotch and water. Lying on Red's sack, Hawkeye dragged on the butt, swallowed the drink and said, "Red, my curve's hanging, and I lost the hop on my fast ball."
"Speak English, Hawk. Maybe I can help you."
"Listen to Losing Preacher Mulcahy," Hawkeye said. "You'd like to get me snapping the mackerel, wouldn't you?"
"Oh, come off it, Hawk," Dago Red said. "You know me too well to say something like that."
"Yes, I do, Red. I'm sorry. I seem to be a little overextended these days, but I'll get over it. I can be a little nutty now and then, but I ain't a nut."
"I know you're not," Dago Red said, "but you people in The Swamp have got to get over the idea that you can save everyone who comes into this hospital. Man. is mortal. The wounded can stand only so much, and the surgeon can do only so much."
"Red, that lousy can't-win-'em-all philosophy is no good. In The Swamp the idea is that if they arrive here alive, they can leave alive if everything is done just right. Obviously this can't always be, but as an idea it's better than fair, so spare me all the rationalizations."
"Hit the sack, Hawk," Father Mulcahy said
. "You still need sleep."
Hawkeye hit the sack, but the sleep he found was troubled and restless. At nine o'clock the next morning he entered the life and abdomen of Captain William Logan.
Captain William Logan, the still fairly youthful manager of a large supermarket, had joined the Mississippi National Guard soon after his release from five years of service in World War II. When the Mississippi National Guard was summoned to Korea, Captain Logan had left the supermarket, his wife, his new set of Ben Hogan matched clubs and his three kids to go with them.
Captain Logan, Major Lee, who was an undertaker, and Colonel Slocum, who owned the Cadillac distributorship, were all from the same town. They belonged to the same Masonic Lodge and the same country club. Colonel Slocum, Major Lee and Captain Logan were very disturbed the morning the gooks lobbed one in on Captain Logan's 105mm howitzer battery, and Captain Logan's abdomen got in the way of a couple of shell fragments.
When Hawkeye Pierce operated on Captain Logan he had had enough sleep, and too much of everything else. He removed a foot of destroyed small bowel and re-anastomosed it, that is, reunited the ends of the remaining intestine. When done, he thought that the anastomosis might be too tight but he elected to leave it. That was a mistake, but only one of two.
For the next eight days Captain Logan did poorly. Each day he was worse. Hawkeye watched him, worried and worked, and every time he turned around he encountered Colonel Slocum and Major Lee who wanted to know how things were going.
"Not too well," Hawkeye kept telling them.
"Why not?" they asked.
On the eighth day, they asked three times why things weren't going too well.
"Because, goddamn it, I did a lousy anastomosis," Hawkeye informed them.
On the ninth day, Hawkeye took Captain Logan, now desperately ill, back to the OR. He fixed the inadequate anastomosis, discovered at the same time that he had missed a hole in his rectum, did a colostomy, and five days later Captain Logan, much improved and out of danger, was evacuated. This was Saturday, and on Saturday night people from everywhere came to the tent which served as an Officers' Club for the 4077th.
Hawkeye Pierce, having learned a valuable lesson, having retrieved Captain Logan from the brink but still disgusted with himself, entered. Standing at the bar with a bottle of fine Scotch whiskey were Colonel Slocum and Major Lee, who beckoned to him.
M*A*S*H Page 10
