Emergency! (21 page)

The next ER was in a well-heeled Long Island suburb. It was a busy place, but not like the city. The clientele included mink-coated dames with tennis elbows and injuries from riding their horses, along with older Wall Streeter types with failing hearts and livers. I lasted eighteen months. I was not as diplomatic as I could have been, and the nights were not getting any easier to do. Especially when there are children at home that won't let you sleep.

The hospital reorganized to accommodate health care reform. The leaner-meaner budget included a significant cut in ER expenditures for salaries and improvements in the physical plant. I saw the writing on the wall and updated my résumé.

I answered an ad in
The New York Times
, for a director of a medical department in a major Fortune 500 corporation. When I accepted the job, I had no idea of what I would be doing as an occupational medicine physician, but at this point I was willing to chance it. The salary was less than I had been making, but the lifestyle improvement is so significant that it makes it worth the change and more. I take care of the employees and executives. It's not challenging medicine,
but I am home at 5
P.M.
, and no weekends. I'm sleeping through the night for the first time in ten years, and I love it!

I'll call you soon so we can make plans to get together.

Sincerely,

Campion

CAMPION E. QUINN, M.D.
      

Rockville Center, New York

A
s the ambulance-bay doors slammed open, Frank announced his arrival by shouting at the nurse, “Fuck you, cunt,” punctuated at the end with the
phthoo
of phlegm being hocked at someone. I looked up from the patient I was treating and saw Frank rolling into the department, being held down on a gurney by two nurses, two policemen, and two paramedics. And they were struggling. Another nurse went to get the leather restraints.

“Let me go, you fucking cocksuckers!”

I excused myself from the bedside of the prim seventy-three-year-old Blue Hair. She had come in at midnight with the always dreaded complaint of “weak and dizzy for three months”—a syndrome that meant either her daughter wasn't paying enough attention to her or she was about to have a heart attack, and it was impossible to know which. Frank's language was not commonly heard in her living room. As I departed to deal with Frank, she was grinding her teeth quietly, eyelids fluttering, squeezing her complimentary copy of
Watchtower
with arthritic hands.

As Frank rolled in, he passed a four-year-old with a broken wrist waiting quietly in a chair next to his mother. Frank reared up on the gurney, made a monster face, and roared at him. The boy began to cry. Frank began to laugh.

“Fuck you fuck you fuck you,” he shouted at the ceiling as he was rolled into his cubicle. Seven of us held him and applied the restraints that would pin his arms and legs to the gurney. He struggled and snarled and spit and snapped. We then stood back out of range to admire our handiwork.

“I'm going to sue you motherfuckers. I want your fucking names. I want everybody's name. I know my fucking rights,” Then to one of the nurses: “What are you looking at, bitch? Huh? I'd like to fuck you in the ass.” I stepped out of the cubicle to talk with the paramedics.

“What fine citizen did you angels of mercy bring to us tonight?”

“Frank here was out drinking and bullying people down at the Rebel Lounge bar and apparently used the word “nigger” once too often in addressing another patron. They got into a fight and Frank got a knife in the back.”

“Sorry it wasn't a gun.”

“Well, we thought about stopping the ambulance and throwing him off the bridge, but we knew you were looking forward to seeing him.”

“Where's the wound?”

“Down low, right side, back. Vitals are stable. Probably didn't get much.”

“Too bad. Why is he in custody.”

“He beat up one of the cops. He's on parole.”

“What a surprise. Apparently his rehabilitation didn't take.”

“Maybe next time.”

“Our tax dollars at work.”

I knew that he would need a CAT scan of his abdomen to see if the knife had cut into his kidney, ureter, or bowel. He would need to lie still for the scan and he would need an IV. I went back in to explain this to Frank. The room held that special odor created by bacteria growing in the warm sweat of the underarm for long periods of time. Frank was six feet, shirtless, and muscled. He had a goatee that tried
to compensate for sparseness with length. On his left upper arm a tattoo read
WHITE MAKES RIGHT
in a crescent atop a swastika. On the other arm, two voluptuous women performed cunnilingus. He was deep in conversation with the security guard as I entered: “Your wife's home fucking a nigger right now, faggot.” My presence in the room interrupted their little chat. His attention turned to me.

“Who the fuck are you, pussy?”

I felt the surge of adrenaline and the anger well up in my face. I stayed calm. “Frank, you have a stab wound in your back and we need to be sure it didn't cut anything life threatening. I need to start an IV and take some X rays of your stomach.”

“Fuck you, cunt. You ain't doing shit to me. You touch me and I'll sue your fucking ass.”

Jacked up on speed and booze, he felt pretty brave. But tomorrow morning, if he turned up sick or dead, lawyers would dance in licking their chops: “Our client's judgment was affected by the stress of his injury. You should have known that and treated him anyway.” At trial, the lawyer would have him bathed, shaved, sheared, and suited, looking sad about his dead kidney and with all his illegitimate ragtag children assembled for the first time ever in a familylike pose in the front row of the courtroom.

I hated Frank and the parade of people like him who increasingly inflict themselves on the Emergency Department, demanding we clean up after their latest self-indulgent mess.

“Frank, for your own safety, you need to let us get this test done.”

“Make me, shitball,” he taunted. He was beaming at me, very pleased with himself. He bucked his hips up off the gurney. “Come here, baby. Come here and suck my cock.” At this time he managed to get his right foot loose and kicked one of the nurses hard in the chest. Security and two other nurses jumped in and restrained the leg. The kicked nurse was sore but OK.

“Ha! Ha! Ha!” he screamed at me. I was starting to get grumpy.

“Hold him down and start an IV and let's give him ten milligrams of Pavulon. Tell CAT scan to get ready. If he doesn't want to hold still for the scan, we can help him hold still.”

Pavulon is a fascinating drug. It is most often used in surgery to
completely relax the patient's body after he is put to sleep. It works by paralyzing all voluntary muscles. An awake person, when given this drug, cannot move a muscle, cannot breathe, open his eyes, swallow—nothing. Yet his brain is fine. He can think, hear, and feel everything. He is a totally alert prisoner in his own paralyzed body. His heart beats normally. A tube must be slipped into his airway and hooked to a ventilator to breathe for him. From the outside, he looks peacefully asleep. Inside, he is awake, helpless, and completely vulnerable.

Frank struggled against the IV, but without luck. The drug was injected and within a few moments the struggling and swearing slowed, then stopped. I slipped a tube into his airway and connected it to the ventilator. He looked peacefully asleep. But I knew better. I pulled up a chair next to his head so I could speak gently into his ear.

I knew what I was about to do was politically incorrect. Frank no doubt had a mean mom, a drunken dad, and a cranky cellmate in prison. Therefore, his current “acting out” should be excused ad infinitum. But I was tired of him bullying the rest of us with his self-indulgent appetites. I wanted to frighten him. I wanted him to squirm.

“Frank, you've been a very unpleasant person tonight. You've been rude and vulgar and nasty and noisy. No one wants to put up with it. We are sick and tired of it. I don't see any way to avoid it. I'm going to have to castrate you. If anyone asks, we'll just explain that your balls and pecker were cut off in the fight. Who would disagree? I don't think you have many friends left here, Frank.

“We thought about just sending you down to the Patient Shredder and having you turned into fertilizer, but we were afraid it would kill the grass. So say good-bye to your genitals, Frank. No more hard-ons for you. But what a prize you'll make back in prison. You'll look almost like a woman. They'll be lining up to hump you in the butt. You'll be known as Frances instead of Frank. Frances the nutless wonder.”

I stood up and put on two pairs of rubber gloves. With the big trauma scissors, I cut off his pants, then his underpants. His small penis lay slumped to the left. I picked up his testicles in my left hand
and put the scissors close to his left ear and snipped them in the air. “Ready, Frances? It will only hurt for a while. Oh, and Frances, please try and hold still.” I hefted his testicles in my left hand and air-snipped the scissors a few times. “Actually, Frances, I don't think these scissors will work. Let me go get the saw.”

I left the cubicle, having finished torturing Frank, and asked the tech to insert a Foley catheter in Frank's penis to check for blood before he went to the CAT scan. I hoped that the sensation of the tube being inserted would fool Frank into thinking he had been turned into a Frances. Soon after, Frank left for the CAT scan, catheter in place. Who knows what he thought.

The scan was negative. When Frank came back from the scanner, I whispered to him that he was going upstairs to a bed. “I'll be up to finish the job in a little while, Frances. Don't fall asleep.” Frank was hospitalized overnight for observation. The Pavulon wore off and he was discharged back into police custody, to be rapidly recycled through prison and then unleashed yet again onto the community to continue his mission of misery.

I felt some guilt. I was sure that what I had done did not fall within the guidelines of the Hippocratic oath. But then again, Hippocrates probably didn't know Frank. I also had some fear of getting caught and ending up on the front page:
DOCTOR TORTURES PARALYZED CITIZEN
!

I felt some sadness. I went into medicine out of my affection for people and my hope to do them some good. My punishing Frank seemed like a betrayal of myself. But then I realized that Frank is the disease. The calm and reassurance I was able to create for old Blue Hair was wiped away in moments by Frank's savagery. She retreated then even further into her loneliness. Everywhere, people's lives are being poisoned by this new breed of savages who are forever protected by their “rights” and shepherded by packs of grubby lawyers braying and sniffing for money. When will it ever end?

RHODA GOODMAN, M.D.

Washington, D.C.
       

F
our-thirty
A.M.
, the darkest hour, too late to be called night, too early to be called morning. The hour when dreams become reality and reality is dreamlike.

Inside the ER, I'm on duty. My eyes blink with lids of thick sandpaper. The whites now are pink as I rub to clear my vision. Hundreds of night shifts and yet there's still no getting used to this blurry feeling. The nurses know this. The smart ones take the night shift for a few years, then go on to days as soon as an opening appears. Night shifts wear on a person slowly, relentlessly, almost seductively, rubbing away the protective armor of rational thought, exposing the primitive self. Like fasting or meditating or doing drugs, the night shift is to be taken seriously.

The hospital sleeps fitfully, narcotically, restlessly. Inside, stark fluorescent lights hidden behind white opalescent plastic panels create the illusion of day. Outside, the wet blacktop holds pools of rainwater reflecting the scarlet lamp from the ambulance now gliding softly into the parking lot. The splash of tires on wet pavement breaks the silence. The red light casts a pulsating glow off the walls as the vehicle backs under the overhang of the Emergency Department. The radio crackles with static. The doors slip open with a pneumatic hiss. Warm antiseptic air rushes out to meet the cold, damp night. The ambulance doors open, revealing a gurney inside holding a blanketed figure, strapped down, face up, silent, motionless. The mouth opens and releases a pained groan.