Hot Lights, Cold Steel

by Michael J. Collins

  I tried to focus on my job. I tried not to listen to the drunk who was crying and slobbering in self-pity two cubicles away from us. “All of a sudden he was juss there,” the man moaned. “He wasn’t, and then he was, and I couldn’t stop. I tried but I couldn’t. Oh, Jesus, I couldn’t. I juss wanna never happen…”

  I kept feeling for a pulse, kept glancing at the cardiac monitor looking for a rhythm. Mary, doing the chest compressions, was starting to breathe heavier, gasping a little, as she counted out each compression: “One and, two and, three and, four and, one and…”

  Still nothing. The IVs were running wide open. I couldn’t think of any more meds to give. I started wondering what the hell I was doing. Why was I poking and pushing and pumping and cutting and jabbing this innocent little boy’s body? Whom was I helping?

  I kept telling myself that as long as we kept trying, there was hope. The little boy was not officially dead until we, until I, stopped coding him. I couldn’t stop. He was just a poor kid riding his bike. He didn’t deserve to die. I could not accept what was happening.

  “One and, two and, three and…” He is not going to die.

  He is already dead.

  “Another amp of epi.” I will keep going until I have tried everything.

  You already have.

  “Why aren’t those gases back yet?” The family is depending on me.

  What you’re doing isn’t helping the family or anyone else.

  After almost an hour, when the nurses could hardly keep up with the chest compressions, when all the drugs that could be used had been used, when I could no longer pretend there was hope, I told them to stop.

  The paramedics and the techs sighed and turned away. Even the janitors and the secretaries who had been standing in the background silently drifted away. The nurses stopped for a moment to catch their breath, then methodically began the cleanup.

  We tried not to look at each other. We began to pay particular attention to the minute details of our job: Mary was carefully wiping down the side rails of the cart. Jenny, a clipboard in her hand, was doing inventory on the drugs we had used. I picked out a bloodstain on my lab coat and devoted ten minutes to scrubbing that one stain (while ignoring the other twenty).

  We became very delicate about handling the child’s body. We, who had been cutting and sticking and jabbing him for the last hour, were now careful, almost reverential with him. I lifted a hand that had been dangling from the side of the cart and placed it over his little crushed chest. Jenny took a wet washcloth and wiped the trickle of blood from the corner of his mouth, then carefully brushed the hair from his forehead. Mary gently tugged the bloody sheet from under him and replaced it with a fresh one. We did what we could to prepare him. His parents who had been clinging to each other, terror-stricken, in the waiting room, would want to see him.

  There is a rule in most hospitals that forbids anyone from removing the tubes or lines that have been inserted during resuscitative attempts. They are supposed to be removed only by the pathologist or the coroner or God-knows-who. It is a rule I have always despised, and I was not going to obey it now. I was not going to let the parents see their little boy with all those things sticking out of him.

  I pulled the ET tube, the subclavian line, and the chest tube. I asked Jenny to pull the IV. His skin was cooling, thickening. He wasn’t bleeding much anymore. He was quickly changing from a little boy to a dead body. The end of the radius was still sticking through the skin of his left forearm. I tucked the arm under the sheet.

  The nurses were wiping blood off the instruments, the cart, the floor. They whisked away the bloody debris overflowing from the garbage, all the while taking surreptitious glances at me, wondering. They knew what came next. They knew I couldn’t in all mercy delay any longer.

  I kept twisting the lap sponge in my hands. Those parents had entrusted their child to me. They were farmers or drugstore clerks or factory workers, and I was the fair-haired boy from Mayo, the one who was supposed to save their son. Instead I was about to tell them I hadn’t saved a goddamn thing. Their son was dead.

  I still have a job to do, I told myself. I will not give in. My responsibility to the dead is over, but I still have responsibilities to the living. I will not give in. I turned away from the nurses and looked up at the ceiling.

  Oh, God, I thought. Oh, God.

  I longed to let go, but I didn’t have that luxury. I didn’t get paid to let go. The others could vent their emotions, but not me. I was supposed to be there for others, not for myself. I needed to shut up and do what I could for those who were left behind.

  I don’t know what I said to the parents. I scarcely remember the conversation. I believe they took it well, whatever that means. I remained quite composed. I wonder if they thought I was a cold fish.

  I spent the next two hours treating the patients who had been waiting with their earaches, stomach pains, and wrist fractures. It was a small emergency room so everyone knew what had happened. They were apologetic, as if recognizing that their problems paled in comparison to what they had just witnessed.

  They had been listening through the drawn curtain as the drama unfolded. They heard us wage our frantic, and ultimately futile, fight; and doubtless they, too, suffered when they heard the log nurse declare flatly, “8:27 P.M. Resuscitation halted.”

  I must have looked more distraught than I realized. All the patients tried to encourage me. I can’t recall if I was embarrassed by their efforts or if I welcomed them. Perhaps I resented them.

  I left the drunk, the one who had killed the little boy, until last. He had gashed his cheek when he fell getting out of his car. Two stern-faced Mankato policemen were standing next to his cart, waiting to take him away as soon as I finished. As I stood over him, preparing to suture his laceration, I tried hard to hate him. I wanted an object at which I could direct my wrath.

  “Oh, Doctor, what have I done?” he said to me. “I’m sorry. I’m so sorry.”

  He was so remorseful, so devastated, that I couldn’t find it in me to hate him. The two Mankato cops, however, didn’t have that problem. “Thanks, Doc,” one of them said when I put in the last stitch. “Now this bastard is going to jail and I hope he rots there.” The prospect of his rotting in jail seemed to please them. It did nothing for me. Why do we always think our pain will be less if we can make others suffer more?

  At length I caught up with the rest of the work in the ER. Then I started to fill out the ER record and the accident report. I was about halfway through when I realized I couldn’t remember all his injuries. Was his facial laceration four inches or six? Was it his third finger or his fourth that was dislocated?

  The body was in the hospital morgue awaiting transport to the coroner’s office. I had never been to the morgue before. Jenny had to tell me where it was. I went down to the basement, to the end of a long corridor. I pushed open the door and startled an owlish-looking man who must have been a pathologist. He wore thick, dark-rimmed glasses that made his eyes look huge.

  “106.8 centimeters,” he was saying.

  The little boy’s body was lying naked on a metallic table in the center of the room. The man was obviously performing the postmortem. He held a Dictaphone in his left hand, a tape measure in his right.

  I introduced myself. We said a few words and then went about our business. I examined the boy and scribbled a few notes on the index card I carried in my shirt pocket. Lying pale and naked on that table, he didn’t look like a little boy anymore. He looked like a dead body.

  The pathologist adjusted his glasses and went on with his dictation. “Severe cranial contusion involving the right temporoparietal region…”

  This was too much for me. Yeah, life had to go on, and, yeah, autopsy reports had to be dictated—but right there? Right then? Did we have to be in such a hurry to reduce him from a child to a report? It was hideous.

  I wanted to scream at the pathologist: Is that all you have to say? That he was 106.8 centimeters long and
had cranial contusions? That’s a summing up? He was trying to reduce this little child to impersonal facts dribbled dispassionately into a Dictaphone. I wanted to choke him. What the hell do you know? This little boy cannot be summed up so tidily. His height and the summation of his injuries don’t begin to describe him.

  I was approaching the end of my Basic Science rotation, the end of my junior residency, and I was beginning to understand that there was more to that little boy, more to all of us, than can be measured with a ruler or weighed with a scale—a lot more.

  If not, I thought, everything I do is pointless.

  Chapter Twenty-Five

  June

  June had been a gift. After a cold, rainy Memorial Day weekend, a succession of warm, sunny days stretched lazily to the end of June. But June was drawing to a close, and with it, our six months of Basic Science.

  Basic Science had been great. I loved the practical training: the vascular repairs we did on dogs, and the course on internal fixation of fractures. I had spent hours in self-directed study of almost every aspect of orthopedics. But I didn’t spend a lot of time on the esoteric stuff: the biomechanics and histology. I had grown tired of lectures and formulae and pompous academics with inflated egos. I loved orthopedics. I loved taking care of patients. Now that Basic Science was ending, I couldn’t wait to put on my scrubs and be a surgeon again.

  I had gained a tremendous amount of experience during those six months. I had done so much moonlighting, had seen so many fractures and dislocations and lacerations and infections, had done so many repairs and reductions and castings, that instead of feeling inferior to my peers, as I had for the first two years, I actually felt that now I had seen more and done more than they had.

  The trees were swaying gently in the breeze as we sat in the second-floor classroom of the Medical Sciences Building one last time. I was looking out the window watching two cardinals flirt with each other in the elm tree just outside the window.

  At the end of the row Dr. Wong waited impatiently. “Dr. Collins, the exam is finished. Pass your test to me.” I folded my biomechanics final exam booklet and passed it down to him. When he had collected all the exams he turned to the class and said, “All of you are to remain seated. Dr. Burke wants to talk to you.”

  “Aw, Christ,” Bill Chapin muttered, pushing back in his chair. “What does that Irish asshole want now?”

  “Hey, watch the ethnic slurs,” I said.

  “Yeah,” Jack said, “don’t forget Collins is an Irish asshole, too.”

  Bill, Frank, Jack, and I had a tee time at Maple Valley at one o’clock. We weren’t happy about waiting. BJ stormed in ten minutes later. He wasn’t happy either. He said we hadn’t applied ourselves. He said we treated Basic Science like a vacation. He said medical students knew more biomechanics than we did.

  “Do you think that’s funny, Chapman?” He took pleasure in calling Bill the wrong name.

  “No, sir.”

  “Then why are you laughing?”

  “I wasn’t laughing, sir. It’s just that most medical students can’t even spell biomechanics.”

  I winced. Bill never learned. Why didn’t he just take his medicine, shut up, and let BJ move on to harassing other people? Instead Bill always baited him and invited more disaster.

  “Chapman,” BJ said, leafing through the papers in front of him until he found the one he wanted, “your scores in histopathology and biomechanics are pitiful. A medical student with scores like this would never even get a residency. Did you study at all, or did you spend the whole six months goofing off?”

  “I—”

  “If you want to stay in this program, Chapman, you better shape up.”

  “Yes, sir,” he said. He put his right hand behind his back and stuck up his middle finger.

  “As for the rest of you,” BJ said, “your days as junior residents are over. Tomorrow you will begin your senior residency. You will have junior residents working under you. You will be given a tremendous amount of responsibility, and I expect professional behavior from every one of you. This is the Mayo Clinic and every patient is to be given the best care of anyplace on this planet.”

  He bent his head and peered at us over the top of his glasses. “I will be keeping a close eye on this group,” he said, “a very close eye.” He picked up his papers and left the room.

  “Keep a close eye on my ass,” Bill muttered.

  After BJ’s pep talk, the four of us piled into Jack’s Buick. We couldn’t get everyone’s clubs in the trunk so Frank and I, in the backseat, held Frank’s clubs across our laps. We were running late, but Bill insisted we stop for a bucket of Kentucky Fried Chicken and a couple cases of Grain Belt.

  “We’ll stick ’em in the back of our carts,” he said.

  We made it to Maple Valley with four minutes to spare. Artie, the owner, was waiting for us. “I was getting worried,” he said. “You guys are never late for a tee time.”

  “One has one’s priorities,” Jack told him.

  “We’d have been here sooner, but we got delayed by some lunatic who wanted to talk about force couples and vectors,” Bill said.

  “Well, you’re on the tee, fellas,” Artie said as he took our money. “And you better get a move on. We got another foursome going off right behind you.”

  “Naked cheerleaders?” Jack asked.

  “You guys watch too many movies. This is Minnesota. People here don’t even get naked when they take a bath.”

  On the first tee Bill broke open the Grain Belt and handed us each a can.

  “Gentlemen,” he said, raising his beer, “our revels now are ended. Tomorrow we reenter the world of surgery. But first we’ll have one last adventure. This afternoon, here at beautiful Maple Valley Country Club, we will be competing for”—he paused, eyeing each of us seriously—“the Golf Championship of the Western Hemisphere.”

  “Chapman,” Frank said, going into his BJ Burke imitation, “your swing and your short game are pitiful. Medical students know more about golf than you do. Did you play golf at all this quarter or did you spend the entire six months looking at the pictures in your biomechanics book?”

  “Wales,” Bill said, “I am going to give you a stroke a hole and will still beat you to a bloody pulp.”

  And he did. Bill cruised in with a seventy-eight. He was one under on the front nine: three birdies and two bogeys. However, the cooler of beer and the bucket of chicken caught up with him on the back nine. He claimed the chicken made his fingers greasy. He limped in with a forty-three—still enough to beat me by four strokes.

  When the round was over, when the last chicken bone had been buried in the last sand trap, when the last beer can had been tossed in the back of the cart, Jack said we couldn’t just go home.

  “One last beer,” he said. “Tomorrow we put away our notebooks, pick up our beepers, and become surgeons again. Tonight we’ll have one last beer together.”

  We squeezed into his car and headed back to town. Jack parked a half block down from Tinkler’s, leaving the front right wheel of the Buick up on the curb.

  “Well,” he said when we were inside, “it’s been a hell of a six months.”

  Jack was right. It had been a hell of a six months. I had (barely) mastered the Right Hand Rule, had learned to recognize Ewing’s sarcoma under a microscope, had memorized the modulus of elasticity of stainless steel, and had written a paper on femoral shaft fractures. But more important, on my own, I had studied every aspect of orthopedic surgery I could get my hands on. I read about ankle fractures and hip replacements, ligament repairs and knee fusions, foot amputations and tendon transfers. For the first time I felt if not like a real orthopedic surgeon, then like a real orthopedic resident—and I was ready to go back to work and prove it.

  But it hadn’t been all work. During those six months I had also managed to get my handicap down to a twelve, and to spend countless hours reading Hemingway, Yeats, Woolf, Flann O’Brien, Neil Gunn, Shakespeare, Wordsworth, Matthew
Arnold, and, I’m not ashamed to admit it, Louis L’Amour. Frank Wales was the guy who got us hooked on Louis. There were so many Louis L’Amour paperbacks in the ortho call room at St. Mary’s that we had begun referring to Louis as the Patron Saint of Orthopods.

  Besides golf and reading, I also had moonlighted enough times to actually open a savings account. And, in between everything else, Patti and I had managed to conceive another child.

  “What is this, Birth-O-Rama?” Jack asked when he heard the news. “There is a way to prevent that, you know.”

  “There is?” I said. “I guess I should have paid more attention on my OB/GYN rotation in med school.”

  Sharon, one of Tinkler’s younger, more well-endowed waitresses, had just brought us another pitcher of beer. Bill was making her listen to the story of his round of golf. “So there I am on the eighteenth hole,” he was saying. “My caddy, a broken-down booze hound named BJ Burke—” He turned to her. “Ever heard of him?”

  Sharon, who was studying her fingernails, shook her head. “Ah, no,” she said. “No, I haven’t.”

  “Well, never mind. He’s some bum from the state mental hospital who caddied for me. Anyway, I’m about 180 out and the idiot hands me a nine-iron. A nine-iron! Can you believe it?”

  Sharon shrugged. “Sounds dreadful.”

  “Damn right it was. But I took that nine-iron, closed it down a little, and nailed that sucker. Hit it stiff. Six inches from the pin.”

  “How nice,” Sharon said, glancing at her watch.

  “Yeah,” Bill said, puffing out his chest. “Yeah, I was thinking of quitting this doctor gig and going on the pro tour.”

  “A couple more beers,” Jack said to Sharon, “and he may run for pope.”

  “Shut up, Manning,” Bill said. “Any guy who just finished six months of Basic Science and still can’t break a hundred should be ashamed of himself. You’re a disgrace to this residency.”

  Jack hung his head and put a hand over his eyes. “I’m ashamed,” he said. “I feel so cheap, so dirty.”