Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (16 page)

Chances are, you think to yourself, one in a hundred. And that's assuming you have an OR team that's awake. You shake your head.

“Ready or not,” the bypass tech says as he takes over heart massage.

And it's over. Just like that.

J. T. and you take the elevator back down. The hospital is waking up now. You check your watch: 6:14. The golden hour is over.

Now for the parents. They turn out to be two ordinary people, raincoats pulled over their pajamas, who look too stunned to be grief-stricken. Your job is to “lay crepe,” that is, to prepare them for the likely death of their son while pointing out that technically the boy is still alive. One in a hundred, you think.

“If there's a miracle in the OR…,” the mother says. All families cling to that word
miracle.
They think miracles are an everyday thing in medicine, whereas you, knowing the odds, feel as if you are only leading them astray. You try to explain but quickly you see that you are not getting through. The only thing that matters to them now is the word
miracle.

So that's the story. You dig it up sometimes when you need it: the story of the sixteen-year-old kid who came in with two gunshot wounds through the left ventricle. Went to the OR with you doing open heart massage in the elevator. You are cheating when you tell it, but you are not alone. Doctors don't often tell stories about the patients they
didn't
save, or mistakes they may have made, or medical events they didn't understand. You are like that too, since, over the course of your career, you've opened a hundred chests or more, but you never tell the stories of the vast majority of them. You just tell the story of one or two you managed to save.

It's a sleepy afternoon, maybe a year later, maybe more. You are sitting writing on a chart. (Scientists have proved that ER physicians spend 50 percent of their time writing on charts. This is another thing they don't show on TV). Donna is standing above you, discharging a patient. “Now,” she says to him, pointing to the bottom of the discharge instructions. “Put your initials here.”

“I don't have initials,” the patient says to her seriously. “I only have a name.”

You put your face down into your hand so that the patient can't see you laughing. To get away, you stand up and go over to the chart rack and pick up the next player. Chest pain in someone seventeen years old. Practically no one with chest pain at the age of seventeen has any significant health problem. The only clinical skill needed is getting rid of the patient both quickly and gracefully.

The nurse had already gotten an ECG. You go into the room and ask the pasty-faced young kid there a few questions. Your first sense, strangely enough—that sixth sense you use a lot to make a diagnosis—is, “But this kid is okay. He's a nice kid.” You're not sure why that is relevant here, but the kid understands. He looks up at you, cocks his head and says, “Do you remember me?”

You have just taken down his gown to reveal a wide swath of scar from the breast bone to the axilla, the scar still a little raw. There's also the upper terminus of a healed celiotomy incision, a remnant of an abdominal exploration.

The miracle here is not whether you remember him or not. It's that he remembers you. You wonder for a moment about those end-of-life things, the light at the end of the tunnel. You imagine the patient's spirit watching a resuscitation over the medical team's shoulders as everyone frantically tries to save that body's life. How else could he ever have remembered you? But you don't say anything about that. If the kid was at all sane, he would think
you
were crazy. You just close your eyes, pass a blind hand over the trail of the scar, the palm flat on the chest, palpating for the apical impulse, as you say, “How could I ever forget?”

6

T
HE
G
OLDEN
M
OMENT

I.

O
NCE
I
WAS TRAPPED IN A BAD TRAFFIC JAM.
Up on the hill ahead was a three-car accident. One car was overturned and burning. The scene was packed with fire trucks, ambulances and patrol cars. I eased out onto the shoulder and ran a quarter mile along it beside the traffic. I was almost at the accident scene when a motorcycle cop pulled me over.

He ambled up to my car in typical cop swagger style. “What the hell…,” he said to me as he leaned down toward the window.

“Listen, Frank,” I said, “you want
me
to be
at
where I am going.”

The officer took a closer look at me. “Hey, Doc,” he said flatly. He waved a hand to dismiss me.

“How bad is this?” I asked him, but he was already walking back to his motorbike. He slapped the rear fender of my car. “They're gonna need you,” he told me over his shoulder. That was all.

The ER staff and cops are natural allies. Only people from the ER
know
what cops know. Only cops and ER doctors and nurses know about
provocation
—that special in-your-face quality people in the street can have. It's the intuitive ability, perhaps the only talent these guys have ever displayed in their lives, to worm their way into your hidden store of hatred. Often it is hatred that you never knew you had and would otherwise never have suspected was there. It's invisible, even to the people who have a vested interest in finding it—ex-wives, lawyers, teenagers. Only a mean drunk in the middle of the night knows it's there and knows how to make you burn because of it.

Not long ago we had a patient come in with a gunshot wound to the abdomen. The bullet had entered the epigastric area, the midpoint of the belly, and exited out the right flank, well away from the spinal cord. A fixable injury. But it didn't take us long to figure out why the man had been shot.

The nurse asked him: “How old are you?”

“Look, don't waste my time asking a bunch of stupid questions,” the guy said.

We were searching his pants for his driver's license and came up with over $9,000 in hundred-dollar bills stashed in his coat pocket.

“Do you have any health problems?” the nurse asked.

“No, I don't have any goddamn health problems.”

The surgical residents started to arrive. The first surgeon to walk in was the second-year resident. He looked at the guy and said, “Who shot you?”

“That's none of your business,” the patient growled.

“Do you have any health problems? Take any medicines?”

“What the hell is this with all these questions? I just told somebody about my general state of health, and I told somebody about all the fucking medication I take. I'm not going to sit here answering the same fucking questions over and over.”

“Sir, there are going to be a lot of us taking care of you. We're all going to be working hard to make sure you are okay, so you have to answer us.”

“Bullshit, that's total bullshit. There is no reason why you have to ask me a bunch of stupid questions.”

The surgery resident persisted. “When was the last time you ate?” (Anesthesia always wants to know.)

The patient exploded. “What the fuck difference does it make about the last time I ate? You're here to fix me, not ask me a bunch of stupid questions. So fix me, goddamn it, and don't fuck around.”

“Listen,” I said into his ear. “We're trying to save your goddamn life.”

“You just do your
job
and fix me. That's all you have to do.”

“Hey, guy,” one of the security guards said. He had been standing watching all this from the doorway. “Take it easy.”

The patient looked him over. “Oh, so you are the tough guy. You are the big man. You think you can take me on, big boy. You can just kiss my ass.”

That's when Sheldon, one of the beat cops, came in. He walked over to where the patient lay and looked down on him. “What happened?” he asked the patient.

The patient looked at him. “What the fuck does it look like happened?” He stretched out his arms. “I've fucking been shot.”

Sheldon scanned the room. He must have figured out the scene pretty quickly: an asshole patient surrounded by a bunch of stony-faced, seething health care professionals.

“Well,” Sheldon said, patting his shoulder. “It looks like it couldn't have happened to a nicer guy.”

The next night we took care of another solid citizen. This time Sheldon had brought him in, an eighteen-year-old kid picked up for selling cocaine. Sometime during the thrash of an arrest, he had eaten the evidence. Sheldon had brought him in for us to lavage the guy out and work the rest of our ER magic.

“You need the stomach contents for evidence?” I asked him.

“No,” Sheldon said. “We're not doing anything with this.” He looked at me, genuinely concerned. “I just want to make sure the kid's okay.”

I looked at him quizzically.

“I know him,” Sheldon said. “He's a good kid, basically. Just really stupid.”

Sheldon was one of the nicest cops I had ever met. He was a tall, immaculately bald black man, broad-shouldered, narrow-hipped. He had a big man's presence and ease. Sheldon never had to menace; he could take control of a situation just by walking into the room. He never lost his temper; never succumbed to provocation like the rest of us.

Sheldon's usual partner was Dino Dupuchio, short and excitable. He played small, yappy terrier to Sheldon's Saint Bernard. A gentleman, though. When he was on night shift rotation, every night about three
A.M.
he would bring us donuts from DonutLand and then sit around with us showing us pictures of his kids.

That night their suspect, in addition to swallowing crack, had also smoked some “wet”—a combination of PCP and marijuana. (“Nice mix of drugs,” Donna said, “the marijuana sort of takes the edge off the psychosis.”) He lay limp and “unresponsive” on the cart, eyelids fluttering, playing possum, while we got everything started to hose him down.

“We got to get that cocaine out of you, dear,” I told him. “We're going to have to put a big tube down your throat.”

He lay inert, eyelids still fluttering.

Donna opened up the lavage kit, got out the Ewald tube—a tube with a diameter a little smaller than a garden hose—and said to Sheldon, “What's his name?”

“Benny.”

“Benny. You are going to feel something sliding down your nose.”

Donna got the tube about three inches into his nostril when Benny woke up a madman. He reached up and pulled the tube out of his nose and then swung at Donna, sending her back against the wall. He took off toward the end of the bed at top speed, but his right wrist stayed tethered by handcuffs to the frame of the bed. Sheldon was on him in a second. He swung him back up on the bed while the rest of us grabbed at various body parts trying to hold the kid down. Even with Sheldon there it took five of us.

“Come on, Benny,” Sheldon kept saying. “Now let's be reasonable here.”

Bill put Benny's head in an “ER headlock.” An elbow is placed on the patient's carotid, the forearm across the mandible, the other hand levered down on the first arm's wrist, providing extra torque. If the patient continues to misbehave, then a little more pressure is applied with the elbow.

Under Bill's arm, Benny was screaming something, maybe the same thing, over and over.

“What's he saying?” I asked Bill.

Bill lifted his arm up and we all stopped to listen.

“Let me go
,” Benny shouted.
“You're messing up my hair.”

Sheldon put his head down close to Benny's ear and said, “Come on, Benny, you made us do this. If you had behaved responsibly, we wouldn't be in this position.”

Benny stopped fighting and now stared out beyond us, lost to us. Just another addled addict.

Sheldon leaned over him and began singing,

Night and day

You are the one…

here in the old familiar…

Sheldon looked up at us. “Cole Porter,” he said. “Always settles them down.”

“Keep singing,” Donna said.

It took a minute, but finally Benny put his head back down on the bed and appeared to be sleeping comfortably.

Donna picked up the Ewald tube and waved it at Sheldon. “Care to accompany me while I put this tube down?”

“Of course,” Sheldon said, getting a good grip on Benny's face. Donna looked at Sheldon standing there, a man's face torqued between his two bear-like palms. “Keep this up and I'm never letting you come to my party again.”

II.

I once rode in the zone car around District Five, our hospital district. It was a Friday night.

“Let's have no end-of-shift arrests tonight,” one of the two officers said. “I was doing paperwork until ten A.M. this morning.”

“Deal.”

The scenery we drove through was aging urban: run-down gas stations, ratty quick-stop stores guarded by iron grillwork, shuttered quondam factories, empty lots, Dollar Dave's Easy Auto—no credit, no problem—DonutLand donut shop, a strip joint, a twenty-four-hour Laundromat, Uneeda Car Repair. I recognized the homeless guy pushing a grocery cart up the hill: Anthony Gouchette. I had seen him a hundred times.

It was a quiet evening.

If I had waited a week, I would have been there this particular night. I can imagine myself sitting in the backseat, invisible, seeing it all. Two officers, experienced guys, were roaming the streets. They had just stopped at McDonald's and now were coming up Berwin Avenue. It had been a rare summer day, now deeply shadowed, nearly night. Saturday evening traffic ran the long way up the hill, cars braking once they saw the shadow of the dark cherry top of the police car behind them. The officer behind the wheel eased the car out into the middle lane, behind a white Toyota Corolla. The Toyota slowed.

“Left brake light out,” the officer driving said.

“I, personally, can live with that,” his partner countered.

“I, on the other hand, want do some fishing.”

“Then you call base.”

“No, you call. I called last time.”

The officer behind the wheel turned the light on. The Toyota throbbed red, blue, red, blue.

They went through a green light at Maxwell; the car pulled over just beyond it, stopping in front of Dave's Easy Auto. The first officer took his flashlight, undid his seat belt and adjusted his holster. He opened the door to step out.