Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (3 page)

“I'm sorry,” I say to the man. I don't dare touch him. Here women do not touch men.

He bows his head.

From out of the shadows comes a woman. She must have been sitting just outside the tent. The man looks up at her and says something. She, too, bows her head.

“It was Allah's will,” I say in Hausa. Who knows if they understand me.

The mother kneels beside her son and lifts him up. She holds him for a moment gazing down at him, a Madonna in chiaroscuro, face as grave, solemn and still as if she were painted by some old master. Then she bends over, and with her husband's help she slips the child onto her back and steadies him. She takes the long winding sheet of broadcloth that all Nigerian women use to wrap their children into place on their backs. She wraps him close to her for the last time. Again his head lolls back drunkenly. The husband touches the wife's hand and they look down at me. The Wind gutters the candle so I can't see well, but they seem to be blessing me, thanking me even, though they say nothing. Simon whispers something in Hausa and they look around dazed, like sleepwalkers. This is their grief. The man lifts his hand to me, a gesture of farewell, and they turn and vanish into the dark, noise-leanly, as if they were never there.

There's a beat. Simon squats down next to me. “That was a bad one,” he says.

I just sit there looking after them.

After a moment there is some rustling to the right of Simon. It is one of the other mothers, motioning to her sleeping daughter. The daughter has a rash on her face, and the mother holds her hands out toward the rash as if she is trying to sell us something valuable at a market. Staph infection, I think, then I look more closely. The rash is more like a wound and has a purplish hue, like nothing I have ever seen before. I wonder how many things I miss, mistreat, misunderstand, here in the tropics. A world of strange diseases. How many patients…

I realize I can't look again at another festering wound. I have reached my limit. “Tomorrow,” I tell Simon. “I'll look at it tomorrow.” I stumble out of the tent.

The trees, the stars, the night that had so charmed me a short time ago, now seem sinister and oppressive. I kick some IV tubing off the path. There are IV needles on the ground, used IV bags, waste everywhere. I am thinking of something I read somewhere. All grief is alike, someone had once written. Clearly, he didn't know grief; he hadn't seen it every day, day after day, the way I have. There is a taxonomy of grief; it is not one human feeling, one set of human actions. I try not to think of the grief I've seen expressed, but images come flooding back anyway. The young woman in America, one who had just lost her mother, wailing, beating on the walls, shrieking. The husband whose wife had just died in a freak auto accident. He just sat there in stunned disbelief. “But this really can't be…,” he kept murmuring. An old woman, crying after I told her that her husband of sixty-seven years was now dead. “I'm sorry,” she kept saying to me, as she cried. “Please forgive me, I know you all did your best.” She seemed more worried about me than about herself.

I have, in my memory, a whole catalogue of grief. Each entry differs as the human face differs.

And now this. African grief, Hausa grief, Islamic grief. All silence and darkness, no voice, no gesture, just a gathering up and heading out into the night. Did those parents love that boy any less than any other parents in the world? Did they suffer less? Did they see his death as I did—something absolutely unnecessary, useless, a chance encounter between two pieces of bad luck, one involving politics and the other the natural history of a disease?

I shake my head. Of course they don't see it that way. Thank God, thank God.

I find my warm Coke still out on the front steps. I sit back down and look around at the night, the darkness. All this death.

I think: You can't save everyone in the world. You must save yourself first.

I remember a snatch of a poem by—was it Auden?

But here and now,

Our oath is to the living world.

I turn the bottle opener over and over in my hand. W. H. Auden. What did he call death, “the cosmocrat”? Why is it that some poets understand death better than doctors do? I remember another set of lines:

…I have seen

the just and the unjust die in the day,

all, willing or not, and some were willing.

I look down and notice my hands are wet. Stupidly I look up at the sky, but there is only the canopy of leaves. Then I realize I am crying, real tears. The funny thing is, I think, as I wipe the tears out of my eyes, I don't feel sad. In fact I really don't feel anything. And that, it occurs to me, is the problem. I never feel anything anymore. The death of a child—I shrug it off. A bad car crash where people come in dying or dead—nothing; it feels like nothing to me. It's not as if I don't care. I'm sure I do care or I wouldn't be here. But I'm not sure anymore what caring really feels like. It doesn't exist for me as an emotion. In fact, I think, as I turn the bottle cap over and over again, nothing exists for me as an emotion anymore. I try to remember the last time I felt sad or upset, worried or lonely or confused or even happy. The only emotion that seems to have remained a friend is anger. I still know how it is to be angry. All the other emotions just get in the way of being a doctor, of working in the ER, of working in Nigeria.

I can no longer feel things, I think, because I couldn't survive if I did. I can't mourn everyone who needs mourning; I can't grieve at every death. I can't feel outraged at a rape or at a child abused. I can't afford these feelings. What could I do with them except to pile them higher and higher? But what have I become? An automaton? A person who shrugs off the death of a child and all the other tragedies?

And with these thoughts it feels as if I have redeemed another feeling, but not the one I could ever have expected. I am flooded, suddenly, not with sorrow for that child or those parents or the woman in the bed next to the policeman's son, I am flooded by a kind of wistfulness about myself. Here I sit, as detached as ever, another tragedy under my belt. My youth is gone, spent haunting hospital corridors at all hours of the night, and now my middle age is spent in some washed-out back corner of a country where I have come to make some decisions about my life and have ended up, once again, awestruck by the suffering God can inflict.

Just as suddenly as that feeling of wistfulness came, I feel laughter rising up. I'm feeling sorry for myself, I think, smiling as I wipe the tears out of my eyes. The first true feeling I have had in a long time and what would that be? Self-pity, of course. I look out on the night. Everything is as still as death, as still as that child. I put my face down into my hands and draw a deep breath. I would rather feel anything else in the world, self-pity—anything—than feel the death of that child.

As I sit there, images from the ER come flooding back. I see them all, the crazy patients, the nurses, the cops, the paramedics. I hear the banshee wail of the ambulance in the night. Another trauma, another disaster. What I miss most, I realize, is the feel of the instruments, the snap you make with the latex sleeve when you put on a pair of sterile gloves. I miss peeling open the suture package and wrapping the suture around the index and middle finger of my left hand. Putting my hands over the hands of the residents and trying to make them make the right moves for suturing, for starting central lines.

I remember the last evening that I worked, the last ER shift before I left. It was a quiet night. I was reading a magazine in the nurses' station when the deadpan voice of Mark, the security guard, came crackling over the intercom:

“Attention, triage,” he said wearily. “There's a full arrest in the parking lot.”

A full arrest in the parking lot, I think, shaking my head. And I realize, as I wipe more tears out of my eyes, I am smiling.

Could I miss the ER? Could that really be home for me?

I stop myself. I am in Africa. A child has just died. What does the ER have to do with this? But I don't stop thinking about it. I can't. Do I miss it? I don't know, I can't tell. What would it take to have feelings again?

I think of hair transplants and that beautiful office, those professional nurses, the sober patients worried about nothing more than their hair. Kenny G playing softly in the background. What a nice life that could be. As I think of this, though, I can feel the tethering, the sense of being anchored and drawn down, back down, again and again, to those dark places, the places where children die and monsters are born. Probably, I can never go completely back to the surface again, where the bright sunlight is, where most people live. I remain entwined by the memories of days and nights in the ER, and those memories would never let me go, not even if I were drowning.

An owl flies overhead and beyond, down to the tents. The first tent is lit from within; the nurses are making their rounds. The light is amber through the canvas of the tent, the color of old gold. I have emptied my mind out—there is nothing left for me to think. I stand up, dust my pants off and lock up the pharmacy again. My candle has gone out, so I make my way back slowly down the path shuffling in the dark. It must be midnight, I think. Late, late. A few hours from now, not long at all, the world will begin to fill with light and from every minaret and mosque rooftop the crackling sound of some old loudspeaker will echo and reecho the
muezzin,
the Muslim call to prayer.

2

S
UDDEN
D
EATH

What to Do When Someone Dies

I
T'S FIVE A.M. WHEN YOU GET THE CALL
. Ambulance 18. “We've got a full arrest from Lake Village Nursing Home.” Everyone groans and you groan too. “Eighty-two-year-old female, severe short o' breath. Doc, she arrested, stopped breathing, just as we got here. She had a pulse but now we've got nothing…”

You can hear the banshee wail of the siren in the background.

“We've intubated her, and have a line established, normal saline and all. We'll be there in two.”

You hit the transmit button. “I assume the patient is
not
DNR.” Do Not Resuscitate.

“That's an affirmative, the nursing home says she's a full code.”

A full code means the whole enchilada, chest compressions, intubation, the pharmaceutical resurrection cocktail.

You shake your head while Pam M., the nurse in charge tonight, raises a hand and says, “We know you have a choice when choosing your emergency department and we want to thank you for choosing Hope General Memorial Hospital.” She drops her hand and walks away in disgust. Pam is rarely cynical like this, but Julie, who is standing to Pam's right, is the embodiment of peevishness. She throws a clipboard down on the desk. “Why do they even
bother
to do this? It's so stupid. Like we are going to bring back an eighty-nine-year-old full arrest. Get
real
.”

“Eighty-two,” you say, but you know she's right; everyone in the ER knows she's right. You glance at your watch and think, this shouldn't take long.

One of your classmates decided he wasn't cut out to be a doctor when, one night during his first week of internship, as he performed CPR on a patient, he found himself hoping that the patient would just die because he was too tired to take care of her if she lived. You, too, have had this thought more than once—the irony is that you never took it to mean you shouldn't be a doctor. You have always felt that death can sometimes be a release for everyone involved, not excluding yourself. Tonight, for example, you are hoping for something easy: a quick death.

There's an old saw: “It is the duty of a doctor to prolong life. It is not a doctor's duty to prolong the act of dying.” You believe in it.

Everyone shuffles off to the code room. Pam, as charge nurse, commands the crash cart while you fiddle around trying to get suction to work. The sense of utter fatigue, that five
A.M.
slump that occurs at the end of every night shift, steals over you. You feel as if you are doing everything underwater—as if exhaustion has exaggerated the drag coefficient of air so that every movement, even breathing, has become a major effort. You abandon the suction equipment, fold your arms and sag against the cabinet, looking around, seeing nothing.

The ambulance doesn't take long to get here—you hear the backup signal, then the doors bang open. The paramedics, panting and sweating, sweep into the code room. One is doing chest compressions, the other is ventilating the patient. Firefighters maneuver the gurney.

“I told you guys to stay out of trouble,” you grumble at Jack, one of the EMTs.

“Trouble loves us,” he responds brightly. He's counting out chest compressions Lawrence Welk style, “and a-one and a-two and…”

Everyone moves to take over from the paramedics, transferring the monitoring leads, switching off on CPR. The respiratory tech takes over the Ambu bag. Julie climbs up to replace Jack for chest compressions. “This is so stupid,” she observes once more.

You look down at the patient and then close your eyes tight. Full code! you wonder to yourself. How could anyone think this patient should be full code? There is barely anything human left to her. She couldn't have weighed more than sixty pounds, each bird-like limb bent, arms to chest, knees to belly—the fetal position except she's been fossilized there. The paramedics had a hard time just doing CPR because they can't get her to lie flat on her back. As you lean over her you smell that distinct odor, the odor of old age and of nursing homes, that curdled milk and rotting blood smell with overtones of decayed feces. You know the rest too, without even looking. The peg tube in the stomach, maybe a colostomy, an indwelling Foley catheter draining silt, and, always, massive decubitus ulcers. (Decubitus: from the Latin
decumbo,
to lie down.) These are pressure sores, great potholes eroded through the skin—sometimes even down to bone. They occur when someone lies in one position in a urine-soaked bed for months or years. As this woman probably has.

From the Latin…actually, from the Greek. It was Eos, you think, Goddess of Dawn, that fell in love with a mortal. She went to Zeus to ask for eternal life for her lover but forgot to ask for eternal youth. Eos realized what she had done when her lover's hair turned gray. She left him and he went on alone to age and age and age into all eternity. Eventually he shriveled up and became so small he turned into a grasshopper.