Hot Lights, Cold Steel

by Michael J. Collins

I did a quick physical exam to make sure he didn’t have any peritoneal signs and then sent him to X-ray. Fifteen minutes later he was back and, sure enough, the X-ray showed a big old dildo sitting right there in his rectum. A crowd of techs, nurses, and secretaries were gathered around the view box staring at the X-ray. I gave them a dirty look and they pretended to do other things. I went back to Mr. Spahn.

  “Yep,” I said, “it’s there all right.” I had him lie down while I did a rectal exam. I could just barely feel the tip of it. This, I thought, is nothing I want to mess with.

  I phoned the general surgeon on call. He did not seem particularly empathetic. He groaned and told me to give the patient an enema. I wasn’t too keen on that idea since I thought it would drive the dildo deeper inside, but I told the nurses to give him an enema.

  It drove the dildo deeper inside.

  I called the surgeon back. He said, “Goddamn it,” and told me he would be there in five minutes. A half hour later he came in and fished around in the kid’s rectum with a uterine tenaculum for ten or fifteen minutes. Finally he came out of the room red-faced, mumbling about “this stupid bullshit.” He told me he couldn’t get the damned thing out and I should call Rochester and ship him to Mayo.

  I didn’t like that idea, either. If we shipped the kid to Mayo, I would have to call there and identify myself as the transferring physician. Over the past year my reputation in the department had been growing, and the last thing I needed was for BJ Burke to read the transfer sheet and think Mike Collins was moonlighting in Mankato as a dildo extractor.

  I called St. Mary’s and asked for the general surgery resident on call. Thank God it was Jerry Washburn, my old partner from the ERSS.

  “Hey, Jer,” I said, “it’s Mike Collins. I’m in Mankato and I have a patient to transfer to you.”

  “Oh, no,” he groaned, “not another one.”

  I had more than my share of big-time trauma when I was moonlighting, and it seemed every time I called them I was sending them another train wreck.

  “Relax,” I said. “For once I’ve got a simple one for you.”

  “What’s that mean, the heart’s still beating for a change?”

  “No. I mean it. It’s just a guy with a foreign body.”

  “In his trachea?”

  “Well, not exactly.” I cleared my throat. “Actually it is lodged in another orifice.”

  There was a long pause at the other end. “Jesus Christ, Collins, where do you get these cases?”

  “Listen,” I told him. “This is an emergency. You’ve gotta move on this guy. He’s gotta get to the big medical center where they have specialists in rectal foreign bodies. Be a good boy and page the Emergency Dildo Extracting Service. Tell them to get an OR ready.”

  Jerry said he would get me for this. He said the state of Minnesota wasn’t big enough to hide me.

  I told him we were wasting valuable time. “Every second counts,” I said. “What if his batteries run down before we get him to you?”

  “Collins,” he said, “somewhere, somehow, I am going to find the skuzziest ortho case in the history of medicine. I’m going to wait until you are chief resident (assuming they are crazy enough to make you one) and I am going to send it to you. At three o’clock in the morning. On Christmas. When your wife is nine months pregnant. For the tenth time.”

  “Have a nice day, Doctor,” I told him.

  My first exposure to sexually aberrant practices had been in medical school. I was leafing through a textbook on forensic pathology when I came across a chapter on deviant sexual behavior. Like any red-blooded, twenty-four-year-old male I was immediately interested. We were on to something here. Intracellular accumulation of complex lipids would have to wait. I grabbed a beer and a bag of pretzels and sat down for some serious studying. I opened the chapter and immediately came across a category of behavior intriguingly labeled: “Acts Abhorrent to Nature.”

  Hmm. Sounds interesting.

  The first section in the chapter was labeled Necrophilia. Necrophilia? The ensuing discussion made no attempt to define the term, assuming any intelligent reader would know what it meant. This reader did not know, so I turned to my ever-present Stedman’s Medical Dictionary for help. “Necrophilia: the practice of engaging in sexual intercourse with a dead body.”

  I stared at the page in disbelief, my eyes bulging, my mouth gaping. “With a dead body? A dead body?” Not only had I never heard of it, I couldn’t imagine it. Maybe one person, one time, in the entire history of the world might have been sick enough to do such a thing, but I couldn’t believe there actually was a name for it. It was like having a name for albino midgets who lick purple doorknobs. I mean, come on, how many can there be?

  I was still shaking my head in amazement that night after our softball game. We were standing at the bar in O’Dea’s pub on West Division Street, ten or fifteen young, mostly Irish Catholic guys from the West Side of Chicago. None of us very, if at all, experienced sexually.

  “Honest to God, you guys,” I said. “It means someone who goes around screwing dead bodies.”

  There was a chorus of disbelief. “Aw, bullshit,” they all replied. “Don’t you doctors have anything better to do than sit around and make up stories about perverts?”

  “No, I swear. It’s right there in the dictionary: ‘sexual intercourse with a corpse.’”

  “Is this what our young people are being taught in school?” said another. “No wonder our country is going to the dogs. Oh, by the way,” he went on innocently, “if you screw a dead dog is that bestiality or necrophilia?”

  “It’s true love,” said another.

  It was too fantastic, too unimaginable—and therefore, perfectly ripe for humor. Our shortstop pushed back his chair and began limping across the floor, pretending to drag a corpse behind him. “You guys make me sick,” he said. “Why can’t you leave us alone?

  “Just say ‘no,’ if you want me to stop, sweetie,” he said tenderly to his imaginary corpse.

  By that point I realized I never should have mentioned the subject.

  But my enlightenment in matters of perversion was not at an end. The next section in my forensic path book was entitled pedophilia. Pedophilia? I mused. What the hell is that? I thought back to my high school Latin. Pes, pedis—feet.

  Feet? I thought in astonishment. What do they do with feet? I thought I must be the biggest babe in the woods in the history of North America.

  After reading about sex with corpses I was ready to believe anything. I tried to picture some unshaven man in a dirty trench coat performing all kinds of fantastic acts with his feet.

  It was getting to be too much for me. Maybe this medical school thing wasn’t such a good idea after all. Corpses, feet. What the hell was next, sex with fish? Sex with dead fish? Sex with dead fishes’ feet?

  In dismay I turned again to Stedman’s Dictionary. I don’t know if I was relieved or appalled when I learned that pedophilia was not sex with feet, but sex with children. At least I’d heard of the latter.

  I finally got Mr. Spahn shipped off to Rochester. He objected to being sent in an ambulance, but I wasn’t taking the chance of his colon perforating if he stopped at home and tried to get it out with a coat hanger.

  I saw Jerry Washburn at breakfast a few days later. “So, Jer, whatever happened to that guy with the dildo? Did you get it out okay?”

  “The dedicated general surgeons at the Mayo Clinic performed yet another medical miracle. We gently and lovingly removed the young man’s device. It was then sterilized, disinfected, and returned to its rightful owner none the worse for wear.”

  “Good. Now I know who to call if I get another one.”

  He put down his forkful of scrambled eggs and leaned across the table. “Don’t do me any favors, okay?”

  Chapter Twenty

  November

  I was the junior resident on call at St. Mary’s when they brought Ben in. There wasn’t much anyone could have done for him. He was prob
ably dead before they loaded him in the back of the pickup. At least that’s what I kept telling myself.

  And I kept thinking foolish things. I kept feeling guilty that while his arm was getting torn off I was lying on a couch in the residents’ lounge reading Louis L’Amour. Why? What possible reason did I have to feel guilty?

  I don’t know, maybe it wasn’t guilt. Maybe it was frustration that we couldn’t help him, that our best wasn’t good enough. Or maybe it was resentment that life isn’t all smiles, and surgeons aren’t always successful, and sometimes the bad guys win.

  He was only sixteen. I learned later that he and his three brothers had been bringing in the corn on their father’s farm near Kasson when the sleeve of Ben’s blue jean jacket got caught in the power take-off. He must have turned and brushed against it. One second he was fine, the next he was yanked sideways, flipped over the power take-off, and slammed headfirst to the ground. His body wedged under the wheels of the tractor, and as the power take-off kept spinning, his left arm was tensioned terribly, then torn from its socket with a sucking, popping sound. Blood began spurting from the gaping wound at his shoulder.

  The other boys stared, first at their brother’s body and then at his arm, caught in the power take-off, spinning round and round, spraying blood everywhere, making a rapid phlap-phlap-phlap-phlap noise as it hit the ground with each revolution.

  Evan, the youngest, was the first to reach Ben. He stopped short of the body, as though afraid to approach it. “Ben?” he said tentatively. His two older brothers pushed Evan aside and knelt down next to Ben.

  Norman turned him over. “Oh, Jesus, Ben,” he said, leaning forward to touch his cheek. Ben’s eyes were closed. The top of his head was swollen. He wasn’t moving.

  Donald scrambled to his feet, leaned over, and shut down the tractor. Ben’s arm made one last phlap sound as it hit the ground. Then it dangled obscenely from the greasy metal coupling. Blood was pumping steadily from the gaping hole in Ben’s shoulder. Norman tried to smother it with his hand, but the blood leaked through his fingers.

  “Shit,” Donald said, watching the blood pour from Ben’s arm socket. “He’s gonna bleed to death if we don’t get him to a hospital.”

  He and Norman lifted Ben and carried him to the pickup. They set him down in the dirt while they dropped the tailgate, clambered onto the bed, and heaved the four bales of hay over the side. In the distance the boys could see their father’s tractor moving silently up and back through the north field a half mile away.

  “Evan!” Donald shouted. “Go tell Dad what happened. Tell him we’re going to take Ben to St. Mary’s.”

  Evan was still standing next to the spot where Ben had been thrown. He was staring at the dark spot in the dirt at his feet. He looked first at one brother, then the other. He seemed not to have heard.

  “Evan, goddamn it, go tell Dad!”

  Evan jerked suddenly and began running toward the north field. “Dad! Dad!” He was screaming and waving his arms as he ran. Norman and Donald lifted the body of their brother into the back of the pickup.

  “You stay with Ben.” Donald said. “I’ll drive.” He vaulted over the side and sprinted back to the power take-off. He pulled tentatively on the mangled arm entwined around the dirty shaft. It wouldn’t come free. He pulled again, more forcefully this time, but it still wouldn’t come loose. Finally, he took his jackknife and cut away the sleeve. He carried the arm back to the pickup and laid it on the seat next to him. Norman meanwhile had hooked his right arm over the side of the truck. With his left arm he lifted Ben’s head and cradled it in his lap.

  “Oh, Jesus, Ben,” he kept repeating.

  Donald rammed the truck into gear and it lurched forward, spraying gravel and manure from the rear wheels. Norman was flung first backward, then forward as the truck shot out of the farmyard.

  The ER had no clue they were coming. Donald pulled right up to the ambulance entrance. He ran in, holding Ben’s bloody arm in his left hand, and started yelling that he needed help, that his brother was “hurt bad.”

  John Stevenson, who was on ortho trauma call, Joe Stradlack from the ERSS, and Jeannie Popp, the head ER nurse, saw him waving the bloody arm. They ran out to the truck where Norman, tears running silently down his cheeks, was still sitting in the back of the pickup, stroking Ben’s hair. They loaded Ben onto a gurney and wheeled him into Trauma One.

  I was up in the call room when my beeper went off. “Dr. Collins, please call the ER, 5591, 5591, 5591. Please call the ER, STAT, 5591.”

  They don’t say stat in the ER unless they mean it, so I immediately picked up the phone. “Code in Trauma One,” I was told. “Kid with a power take-off injury.”

  I threw my book aside and sprinted down the stairs. I got there just as Joe finished putting in the subclavian line. I glanced at the monitor over the bed and saw the patient had no rhythm. Then I saw he had no arm.

  The nurses were squeezing O-negative blood into him as fast as they could. John Stevenson was fishing around in the bloody stump of the axilla with a hemostat looking for something to clamp, but by then the kid didn’t have much blood left anyway.

  We went to work. We pumped him full of blood, shot him full of drugs, flailed away with CPR, clamped and cauterized various unrecognizable strands of vessels in the stump. All the while his skin kept growing colder, and doughier, and bluer. John and I kept looking at Joe out of the corner of our eyes, wondering, waiting, thanking God it was his call, not ours. Finally, when we had done everything we could think of, twice, Joe slowly straightened up and tossed a bloody wad of 4×4s on the kid’s chest.

  “That’s it,” he said.

  The code nurse asked, “Are you calling the code, Doctor?”

  I wanted to shout, “What the hell do you think he’s doing?” but Joe just said quietly, “Yes, I’m calling the code.”

  As usual, I had no time to think about what had just happened. For the next eight hours there were lacerations to sew up, consults to see, fractures to set. At 4:00 A.M. I wrapped the last bit of plaster around the leg of the seventeen-year-old girl in the car crash, wrote out her prescription, and dutifully recited the fracture care instructions to her parents.

  I took the elevator to the sixth floor and walked down the silent corridor to the call room. I shouldered the door open. It banged against the opposite wall and slowly swung shut behind me. The wooden chair scraped across the marble floor as I pulled it from under the desk. I dropped into the chair and closed my eyes. It was quiet up here, away from the patients and machines. It was nice to sit with my mind turned off for a while. I slumped back in the chair, thankful for the silence. Somewhere down the hall, a door opened and closed. I heard the steady click of footsteps approaching and then gradually fading in the distance.

  My shaving kit was sitting on the desk where I had left it twenty-one hours before. The room was immaculate. The cleaning ladies had come around in the morning after everyone left for surgery or rounds. At that time of day, the rooms were always a mess. Newspapers, call schedules, notes, and lists littered the floor. Wet towels lay in a heap in the corner of the bathroom, or hung limply from the back of a chair. The rooms often were dirtier than they had to be, almost as though the residents, tired of feeling abused, tired of cleaning up other people’s messes, had decided to abuse someone else, to create a mess for someone else to clean up.

  I had never seen the cleaning ladies. I had never been in the call room when they were around. There was just too much to do. While we stitched up wounds, assisted at surgery, or set fractures, the cleaning ladies swept floors, changed sheets, and washed the sink and shower. They scooped up the disordered pile of books and arranged them tidily with Charnley’s Closed Treatment of Common Fractures, two old anatomy books, and the aged copy of Campbell’s Operative Orthopedics neatly stacked on their sides propping up a long row of well-worn Louis L’Amour paperbacks.

  The sheets and gray woolen blanket were tucked tight and crisp under the mattress. The doo
rs, the walls, the desk, the square metal ends of the bed, all rose and intersected at their perfect right angles. Everything was so symmetric, so defined. Sometimes, coming back to this room late at night, the cleanliness, the order, and the symmetry would comfort me. But not tonight. Tonight the incongruity of it all overwhelmed me.

  Everything inside me seemed to have been beaten away. I wasn’t tired. I wasn’t depressed. I wasn’t sad, or outraged, or horrified. I was just empty. I kept seeing the gaping hole where Ben’s shoulder should have been. I kept feeling guilty that Ben’s death was another step on my learning curve, another item on my résumé. I needed things like that to become a surgeon. They brought me a step closer to my goal.

  The whole thing made me sick. I wondered if any goal could be worth all this. It wasn’t that I minded the work. In some ways the mind-numbing drudgery was my salvation. It was a crutch, a shield. I got tied up in it and it insulated me, protected me. It used me, but I used it, too; and I had drifted into a comfortable marriage with it. I immersed myself in work in order to distort and disguise what I did.

  That was not a human being my scalpel was slicing through. It was a knee. No, not a knee but a meniscus. No, not a meniscus but a target, a single unit of focus upon which my attention could be riveted. It was like one of those sequences of pictures from outer space where first we saw the North American continent wedged between two vast oceans, then we zoomed down to New England, then to Vermont, then finally to the little town of Mapleton where, in the backyard of that Victorian house on Elmwood Avenue there was a dark red picnic table upon which a baked potato lay steaming. The larger context was irrelevant. The locus of the potato was inconsequential. At that precise moment there was nothing outside the framework of the lens.

  A young boy slipped and got his arm caught in a power take-off. He came to the ER with a gaping hole where his arm used to be. How much easier it was to focus on some specific thing: his hypovolemia, his lytes, where we would take the vein graft, what kind of ex-fix to use. We are not meant to see sixteen-year-old kids die. We are not meant to see arms ripped out of sockets.