M*A*S*H

by Richard Hooker

  "All right, you two!" Captain McCarthy ordered. "Get out of here!"

  "What's your maladjustment tonight, Knocko?" asked Hawkeye.

  "Listen," she said. "Your two Cub Scouts want to operate on those patients right away, and they're not ready to be operated on."

  "Now just a minute, ma'am," Duke said. "Just where did y'all …"

  "Attend medical school?" Knocko asked. "Right here."

  "Yes, ma'am," Duke said. "We'll go help." In the preoperative ward the two graduates of the ivory tower surgical training programs were showing their inexperience. The two cases that confronted them were well within the ability of the Double Natural, or any other MASH, to handle. Both patients were in moderate shock, but had no continuing blood loss. Both required preoperative resuscitation by a process well known even to the corpsmen and Korean helpers.

  Captain Pinkham had the boy with the minor but significant chest wound. When Hawkeye and Duke wandered in, he was fussing around the patient, rapping on the chest and listening to it with a stethoscope. He was behaving, in other words, like a doctor and not a meatball surgeon, so Hawkeye took a look at the X-ray, assessed the situation and spoke.

  "Doctor," he said, "this guy obviously has holes in his bowel and his femur is broken. It's not a bad fracture, but he's probably dropped a pint here. There's at least a pint in his belly and maybe a pint in his chest. Agreed?"

  "Agreed," Captain Pinkham said.

  From there Hawkeye went on to explain that the patient also had a pneumothorax, meaning that there was air in his pleural, or chest, cavity because his lung was leaking air and had collapsed. In addition, he suggested, the shock from the blood loss was probably augmented by contamination of the peritoneum, or abdominal, cavity by bowel contents.

  "So what he needs," he said, "before you lug him in there and hit him with the Pentothal and curare and put a tube in his trachea, is expansion of his lung, two or three pints of blood and an antibiotic to minimize the peritoneal infection."

  "I see," Captain Pinkham said, beginning to see a little light, "but we'll still have to open his chest as well as his belly."

  "No, we won't," said Hawkeye. "The chest wound doesn't amount to a damn. Stick a Foley catheter between his second and third ribs and hook it to underwater drainage, and his lung will re-expand. If he were going to do any interesting bleeding from his lung, he'd probably have done it by now. We can tap it after we get the air out and his general condition improves. Right now we just want to get this kid out of shock and into the OR in shape to have his belly cut and his thigh debrided."

  Two corpsmen brought what at the Double Nature passed for an adequate closed thoracotomy kit. It contained the bare essentials for insertion of a tube in a chest, and after Hawkeye had watched Captain Pinkham fiddle around with it for awhile, he spoke again.

  "Look," he said. "All that's great, but there will be times when you won't have the time to do it right. Lemme show you how to do it wrong."

  Hawkeye donned a pair of gloves, accepted a syringe of Novocain from a corpsman, infiltrated the skin and the space between the ribs and shoved the needle into the pleural cavity. Pulling back on the plunger he got air, knew he was in the right place, noted the angle of the needle, withdrew it, took a scalpel, incised the skin for one-half inch and plunged the scalpel into the pleural cavity. Bubbles of air appeared at the incision. Then he grasped the tip of a Foley catheter with a Kelly clamp and shoved the tube through the hole. A nurse attached the other end to the drainage bottle on the floor, a corpsman blew up the balloon on the catheter and now bubbles began to rise to the surface of the water in the bottle. Hawkeye dropped to his knees on the sand floor and, as he began to suck on the rubber tube attached to the shorter of the two tubes in the bottle, the upward flow of bubbles increased as the lung was, indeed, expanding.

  "Crude, ain't it?" said Hawkeye.

  "Yes," said Captain Pinkham.

  "How long did it take?"

  "Not long," admitted Captain Pinkham, who couldn't help noticing that the patient's breathing had already improved.

  Duke, meanwhile, watched Captain Russell apply his surgical resident's approach to the other soldier who, waiting for blood, was still in shock. Captain Russell, afraid that he'd miss something, was examining the patient centimeter by centimeter, fore and aft, while the corpsmen waited impatiently to start the transfusion.

  "Excuse me," Duke said after a while, "but all you're doin' now is holdin' up progress. Why don't y'all let these folks get to work?"

  "But don't you think …" Captain Russell started to say.

  "What I think," Duke said to the corpsmen, "is that we better start the blood."

  Having taken the recruits that far, the two veterans headed for the game in the Painless Polish Poker and Dental Clinic to pass the two hours until the patients would be ready for surgery. When they figured that the patients had been sufficiently transfused and adequately resuscitated, they headed back to the OR, scrubbed and joined their junior partners.

  Duke and Captain Russell had a boy whose small bowel was somewhat perforated, requiring removal of two different areas and closure of several individual holes. This sort of work is done ritualistically in most surgical training programs, because it is basic to belly surgery and should never be learned incorrectly, and as a result, the surgical residents in their third and fourth years of training, particularly in good teaching hospitals, may still be at the ritualistic stage. Captain Russell surely was.

  Duke having determined that all they had to do was fix the small bowel and that time, up to a point, was not going to be a factor, decided to sweat it out. For two hours he stood there amusing himself by mildly insulting Knocko McCarthy, who wouldn't hurt him while he was scrubbed, and assisting in wonder as Captain Russell performed a small bowel resection as performed by the residents in a large university hospital.

  "Do y'all mind if I do this one?" he asked, as Captain Russell finally advanced on the second area needing repair. "I lost twenty bucks in that poker game, and I'll never get even at this rate."

  He didn't wait for an answer. In twenty minutes he removed the damaged segment of bowel and sewed the two ends together.

  "Y'all probably noticed," he explained to Captain Russell as they were closing, "that when clamping and cutting the mesentery, I wasn't quite as dainty as y'all were. Y'all will recall that I didn't do the anastomosis with three layers of interrupted silk, like y'all did. I used an inner layer of continuous catgut and interrupted silk in the serosa. Where y'all put twelve sutures on the anterior side of yours, I put four. Y'all observed that the lumen in my anastomosis is as big as yours, I've got mucosa to mucosa, submucosa more or less to submucosa, muscularis pretty much to muscularis and serosa to serosa, and there ain't any place where it's gonna leak. It took y'all two hours, and it took me twenty minutes. Your way is fine, but y'all can't get away with it around here. Y'all will kill people with it, because a lot of these kids who can stand two hours of surgery can't stand six hours of it."

  "But …" Captain Russell started to say.

  "That's right," Duke said, "and if I'm really in a hurry I'll ride with just the continuous catgut through all the layers."

  So it went, for several weeks. The recruits, being polite, listened and, being intelligent, learned. They had both, however, been born and bred, as well as formally educated, to be fastidious, so the shucking of old habits did not come easily. Captain Pinkham, in particular, still tended to get bogged down in detail. He would become completely absorbed in repairing damage to a hand and ignore or sublimate the obvious fact that the patient could die of his abdominal wounds. Once, in fact, on a busy night while Hawkeye was occupied elsewhere, he spent six hours on a case that should not have taken more than two hours and managed to miss a hole in the upper part of the stomach. The patient almost died, early, from too much surgery and, later, from the missed hole. Hawkeye took that one back to the table and, two days later, with the patient well on the way to recovery, he was able to
make this the case in point.

  "Now I'll offer you some thoughts," he told the much relieved Captain Pinkham. "This is certainly meatball surgery we do around here, but I think you can see now that meatball surgery is a specialty in itself. We are not concerned with the ultimate reconstruction of the patient. We are concerned only with getting the kid out of here alive enough for someone else to reconstruct him. Up to a point we are concerned with fingers, hands, arms and legs, but sometimes we deliberately sacrifice a leg in order to save a life, if the other wounds are more important. In fact, now and then we may lose a leg because, if we spent an extra hour trying to save it, another guy in the preop ward could die from being operated on too late.

  "That's hard to accept at first," he said, "but tell me something, doctor. Do you play golf?"

  "I do," Captain Pinkham said, "but I haven't been getting much in lately."

  "Then let me put it this way," Hawkeye said. "Our general attitude around here is that we want to play par surgery on this course. Par is a live patient. We're not sweet swingers, and if we've gotta kick it in with our knees to get a par that's how we do it."

  "I can't argue against that," Captain Pinkham said.

  "Good," Hawkeye said. "Come on up to The Swamp for a drink."

  Colonel Blake, of course, was enormously pleased. He had not only hit upon a project that was at least partially intriguing Captains Forrest and Pierce during their final months, but also Captains Pinkham and Russell were obviously benefitting. He had established a kind of teaching hospital. Then Captain Pinkham came to see Colonel Blake and Colonel Blake came to see Captain Pierce.

  "Have a drink, Henry," Hawkeye said.

  "Yeah," the Duke said. "Join us."

  "No, thanks," Henry said. "How's it going?"

  "Good," the Duke said. "Can we go home now?"

  "No," Henry said. "What I want to know is how Pinkham's been doing lately."

  "Good," Hawkeye said, "although the last couple of days I've had the feeling that I'm starting to bore him."

  "He's got a problem," Henry said.

  "We all have," Hawkeye said.

  "Not like his," Henry said.

  "What's wrong with him?" the Duke said.

  "His wife," Henry said.

  "Too bad," Hawkeye said, "but he married the broad. You didn't, so why is he bothering you?"

  "Yeah," the Duke said.

  "Ever since he landed here," Henry said, "he's been getting letters from his wife saying she can't live with his parents and their kid is sick, she thinks, but the doctor doesn't, and why doesn't he come home and take her off the hook? The damn fool woman seems to think the guy can break it off over here any time he wants to."

  The two Swampmen were silent. Henry looked from one to the other.

  "Come on, you guys," he said. "You always got ideas. What the hell am I going to do? I didn't think I was sent over here to run a kindergarten."

  "If I was y'all," said Duke, "I wouldn't do a goddamn thing."

  "Sure," Henry said. "That's the obvious answer, but I have a hospital to run and you know how hard replacements are to get, and I have to make the ones we get as useful as I can. This guy was just starting to shape up, but this week he got four letters, all saying the same thing but each one worse than the one before. She'll drive him nuts."

  "I don't know," Hawkeye said.

  "Me neither," Duke said.

  "Thanks a lot," Henry said, as he departed.

  The next day Captain Pinkham received another and more desperate letter from his wife. This time he didn't tell anyone about it, but at 2:00 a.m. it was obvious to Hawkeye, who was watching him closely, that Captain Pinkham was trying to concentrate but that he was failing. Between cases he gave the Duke the word and they took Captain Pinkham to The Swamp, gave him a beer and asked: "What's the trouble? Anything we can do?"

  Captain Pinkham showed them the letter. After reading it, they took him to his tent, gave him a sleeping pill and said: "Sleep and don't worry about the work."

  The next day Captain Pinkham awakened still impaled on the horns of the kind of trouble only hardnoses can survive, and Captain Pinkham was no hardnose. Two days later, fortunately for all, salvation came. It came to Colonel Blake, via the Red Cross and the Army, in the form of orders to send Captain Pinkham home on emergency leave. His wife had folded and been placed in a private fool farm.

  The two Swampmen found that they missed Captain Pinkham, who had proved himself willing to try, so they were particularly nice to Captain Russell, who missed his buddy even more. Between themselves the two made noises about how they would handle that kind of grief if it ever came their way, but they both had the same doubts. They thanked their good fortune for wives who didn't bug them from 9,000 miles away, and they sat down and wrote identical letters:

  Darling,

  I love you. I need you, I hope you love me and need

  me. If so, you can have me in two weeks by following

  these simple instructions:

  (1) Go crazy.

  (2) Notify the Red Cross.

  Love,

  15

  The days passed, among them Christmas and New Year's. On Christmas, Dago Red said four Masses at nearby troop concentrations, another at the Double Natural where he also conducted a non-denominational service. Then he pulled all the strings behind the scenes at the party in the mess hall where a red-suited and white-bearded Vollmer, the sergeant from Supply and center from Nebraska, a pillow strapped to the stomach where the ball had once been cradled, handed out clothing, cigarettes and fruit to a gaggle of Korean house boys while their benefactors among the personnel of the 4077th applauded.

  For dinner on both holidays, Mother Divine put down excellent repasts. Mother, still president of the Brooklyn and Manhattan Marked-Down Monument and Landmark Company, and still doing business with Caucasians from south of the Mason-Dixon Line, was in a beneficent mood. For a while during the autumn, business had slackened off, but the onset of the holiday season had brought on a gift-buying stampede, and Mother had even managed to unload two items in which little interest had previously been shown.

  The first of these was the Soldiers' and Sailors' Monument at 89th Street and Riverside Drive. It was purchased by a Private First Class from Hodge, Alabama, who mailed the postcard picturing it to his fiancee, with the following message printed on the reverse side:

  Huney:

  I just bot this for you. They will delivur it in a cuple weeks. Have them put it in yur side yard and wen we get marreed I'll get Puley to help me muve it to our own place.

  Merry Xmas. Your frend and husbend to be.

  His buddy, and near-hometown-neighbor from Dutton, bought Fifth Avenue (Looking North From Forty-Second Street) as a surprise for his father. On the back of the card, circa 1934, he wrote:

  Pa:

  Merry Christmus. I bout this strete for you. You can see that all of the cars that use it are olden, so I figger you can move the garege up there and will get all the busines you can handel. I'll help wen I get home. Merry Christmus agan.

  The holidays over, time dragged for Hawkeye and Duke. The 4077th was reasonably busy, so they had enough to do. When Henry was afraid they didn't, and still on his teaching hospital kick, he had them shepherding associates with less experience over the rocky pastures of meatball surgery, until one night, early in February, he entered The Swamp, kicked the snow off his boots, helped himself to a large shot of Scotch, made himself comfortable on one of the sacks and announced to Captains Forrest and Pierce: "I've got orders for you two eightballs to ship out of here a week from today."

  Duke and Hawkeye jumped, laughed, hugged Henry, hugged each other. Spearchucker, with two months left to go, congratulated them warmly. In the far corner of the tent, Trapper John Mclntyre with almost six months of servitude still ahead of him, lay on his sack and looked at the roof.

  The last week was interminable. Preparation for leaving involved very little so, considering the importance of the event, The Sw
amp was pretty quiet. Finally, Duke and Hawk-eye shaped up for their last night shift, and the demands it made upon them brought them back to earth.

  Arterial injuries were not unusual, but this night they caught two. Trying to save the right leg of a G.I. from Topeka, Kansas, and the left leg of a Tommy from Birmingham, England, Duke and Hawkeye did two vein grafts to bridge the arterial gaps blown out by gook artillery. When the shift was over, they started for The Swamp, tired, excited, and troubled. They had just done two operations on two legs belonging to young men, to each of whom a leg was important, and they were walking away knowing that, in all probability, they would never learn the fate of the legs.

  At The Swamp, their two colleagues were waiting for them, bottle open. By 11:00 a.m. they had gone over for the third time plans, which each secretly suspected would never materialize, for meeting in the States as soon as possible after Spearchucker and Trapper John gained their releases.

  "Look," Trapper John said finally, "aren't you guys going to say goodbye to Henry?"

  "Naturally," Duke said. "We take kindly to the man."

  "Well, why don't you do it now?"

  "Yes, father," Hawkeye said.

  At 11:15 a.m. Duke and Hawkeye, still in their soiled fatigues but wearing scrubbed and serious looks, arrived at the office of Colonel Henry Blake. Hawkeye approached Henry's sergeant, threw his shoulders back and stated, "Captain Pierce and Captain Forrest request permission to speak to Colonel Blake."

  The sergeant, who had known them for eight months as Duke and Hawkeye, was shaken.

  "What kind of bullshit is this?" he wanted to know. "Don't screw up now, for Chrissake."