The Hooligans

by P. T. Deutermann

  I was met in the triage area, which was Cargo Hold No. 3, just behind the ship’s superstructure, by a pleasant if visibly fatigued nurse wearing major’s oak leaves on her collars. She introduced herself as Patsy Bergin, head nurse. I introduced myself and told her that I was the squadron doc for the torpedo boats in Rendova. I accompanied her and a young doc while one of their doctors did triage. I couldn’t really brief them on these patients because these were Army troops, not my boat personnel. We’d housed them in our makeshift compound for four hours until Montrose came in. I’d looked them over, but I was reluctant to offer any opinions now that they were in the hands of a “real” hospital. That was until the doc, an Army captain who was younger than I was, laid down a three-tag on one patient with two sucking chest wounds and a broken leg. I asked why. He said the three surgeons on board had told the other docs what procedures they could and could not do, and that deep thoracic was off-limits. Stabilize, yes, but to open and do chest-repair work on tattered lungs and the plumbing supplying them, and then restore oxygenated blood to the heart, was not in their bag of tricks.

  “Um,” I said. “They should be.”

  Patsy made a face and then pulled me aside. She informed me that the surgeons on board were the ones the nurses privately called “the second team” back in Nouméa. All three were straight out of their residencies. Just like me, I thought, with some irony. The first team, surgeons with twenty years or more of OR experience, were still back in Nouméa. They were considered too valuable to risk in an actual combat zone.

  “It makes sense,” she said when she saw the look on my face. “There has to be a hospital of last resort, with a medical staff capable of doing anything in the modern medical lexicon.”

  “Well, for what it’s worth,” I said, “I’m a surgeon, and I’ve repaired more lungs than I can remember. If you have some good nurse anesthetists, ether systems, and a clean OR, I believe I can fix this patient. If we move quickly.”

  She stared at me in some consternation. Then her eyes widened. “You’re the guy!” she said. “The PT-boat doctor who’s actually a fourth-year resident who’s been doing all those major procedures at Guadalcanal. You’re somewhat famous, Doctor, but I’m afraid there’s a problem.”

  “What’s his name?” I asked, as that familiar feeling swept over me.

  “His name is Colonel Henry Maddox, MC, US Army. He’s the CO of the embarked hospital, and he is…”

  “Twenty feet away and closing fast,” I muttered, looking over her shoulder.

  Oh, shit, she mouthed silently.

  Henry Maddox was a fat guy. Double chins, medium ponderous gut, arms too short for his body, and the flushed face that comes with a blood pressure problem. He was short and walked with a motion that called to mind a duck. He was looking straight at me.

  “Are you Doctor Andersen of the torpedo boat squadron?” he asked peremptorily. I said, “Yes, sir.”

  “Come with me, please. Major Bergin, we sail in two hours.”

  I followed the portly colonel up a passageway that led through the center of the ship. I was halfway tempted to emulate his strange gait but then noticed that other people in the passageway were quick to get out of his way. We finally arrived at what looked like a large lobby, beyond which double mahogany doors led into what had been the forward main dining room. There was a thin strip of very bright white light visible between the doors. They were rolling gurneys into the lobby, and nurses were tending to wounded who I assumed were waiting for surgery. To the right was a cocktail lounge which clearly hadn’t seen a cocktail for some time. He led me to a booth in one corner of the dimly lit room and indicated that I should sit down. He then squeezed into the other side of the booth, displacing the tabletop in my direction.

  “Okay,” he said. “When I was in Nouméa, we began hearing stories about a surgeon at the Guadalcanal field hospital who had not actually completed all of his surgical training. A third-year resident at Duke who was just beginning his fourth year of a surgical residency, fourth of seven, who left school and joined the Navy when the war broke out. That you?”

  “Yes, sir, it is.”

  He nodded. “Well, Doctor: what the hell were you thinking?” he asked.

  “When I went in with the First Marines, I was thinking that I’d be doing surgery as an assistant, under the supervision of the older and more experienced surgeons.”

  “And?”

  “Guadalcanal was chaos from about the third day,” I said. “There was a big sea fight around Savo Island, where we lost four allied cruisers. Then the landing support ships were withdrawn because of a carrier battle, where we’d lost a carrier. They took with them half of our supplies: ammo, food, fuel, medical. When the Japs saw that, they hit us hard. We had a big surge in casualties.”

  “Go on,” he said. I wondered if he knew anything about the medical aid conditions during the battle for Guadalcanal, situated as he had been among the stately palms of Nouméa, a thousand miles from Guadalcanal.

  “We were immediately overwhelmed at the PHS,” I continued. “We had Marine casualties and also Navy wounded. All the amphibs and cargo ships had done a bunk. The senior Navy doctor told me to take a table and do what I could, so I did. Over the next few weeks I found myself doing stuff that I had only assisted with at school. Not just once, either. After the tenth time that I did a bowel resection, removed a ruined lung, spliced up a couple hundred blood vessels, they turned me loose. I kept a log, by the way.”

  He nodded, and then stared into the middle distance for a moment.

  “I have orders to find you if I can and to see to it that you’re returned to Nouméa, where they plan to open a board of inquiry on how you ‘got loose,’ as you so quaintly put it. Where is that log?”

  “In my seabag over on Bau island. But a board of inquiry? Everything I did I had permission to do. Orders to do it. Reluctantly, at first, but then enthusiastically.”

  “Between you and me, Doctor, I think that somehow what you have been doing out here got back to BuMed in Falls Church. Imagine the bureaucratic outrage.”

  “How’s about imagining all the men I saved instead?”

  “Fair point,” he admitted. Then a messenger knocked on the lounge’s entrance and delivered a message to the colonel. “Okay,” he said to me. “Our departure has been delayed until sunrise due to some new calamity over on New Georgia. Would you please go retrieve your log and your seabag, and then return aboard? I’d like you to go out with us to our hideout station, and then I’ll have time to review this matter and not be rushed about it.”

  “What about my MTB crews?”

  “I’ll send one of our doctors to your squadron while you’re with us. He’ll be qualified to do what any squadron doc can do; if surgery is required, the patient will be sent to us, won’t he.”

  I took a deep breath. This threat of an inquiry was bullshit, but now I thought that the portly colonel thought so, too. He might even turn into an ally once he saw my log, or so I hoped. If some Washington medical bureaucrat was going to come after me, I’d need all the allies I could get.

  I came back aboard at around ten that night. There’d been only three boats in, so I didn’t get a chance to clear my departure with Bluto, who was out on a mission with a makee-learn boat skipper. I told Higgins, but didn’t mention the board of inquiry—one less thing for him to worry about. He’d been with me practically the whole time and I knew he’d brood about it. I was assigned to a cabin on the top deck. The doctors got the top deck cabins, usually two to a cabin, along with the ship’s captain and Colonel Maddox, who had their own private quarters. The cabins below the main deck were all reserved for patients. The nurses were quartered in the afterpart of the superstructure, separate from all the male doctors and ship’s officers. I was taken to my assigned berth by a hospitalman third class. I asked him if he had been given any instructions for me. “Not that I know of, Doctor.” The cabin was air-conditioned, as was pretty much the entire ship. I decided to ju
st get a good night’s sleep and let events unfold.

  I awoke the next morning when my roommate came in off the night shift at 6:15. He looked exhausted. The ship had been kept in port because of a surge in casualties over on New Georgia and the night had been very busy. He introduced himself as Tim Forrest, and said he was a dermatologist.

  “So now you’re a burns expert,” I said.

  He gave me a tired grin. “Exactly,” he said. “And you?’

  “Linc Andersen,” I said. “Surgeon. Went in with the First Marines at Guadalcanal, and I am painfully aware of what ‘very busy’ means.”

  “Pleased to meet you,” he said. “We desperately need more surgeons.” Then he shed his bloody gowns and headed for the shower. When he came out, wrapped in a towel, he sat down in one of the cabin chairs. “You that guy from Duke? Starting fourth-year surgical resident who’s been doing major surgery out here on his own for the past year?”

  “I am,” I said, unsure of where this was going.

  “Brother, you’re famous down in Nouméa,” he said. “There was a rumor going around the hospital here that you were aboard. Honored to meet you, Doctor.”

  “Don’t get too close,” I said. “Colonel Maddox says there are rumblings in Washington that I’m some sort of bad guy.”

  “Screw that,” he said. “There’s a war on. Nouméa is infested with old-time docs and administrators. Chickenshit rules. That’s why I volunteered for Montrose.”

  “Can I trust Maddox?” I asked him. “I’m going to show him my log sometime today.”

  “Porky Pig?” he said with a grin. “Yes, I think you can. He’s a surgeon, thoracic, and he’s good at it. He puts on this ‘I’m a tyrant, so be afraid’ persona, but he’s been more than good to the medical staff. The ones that are afraid of him should be, but only because they aren’t up to his standards.”

  “Wow,” I said. “America at war, and already the bureaucrats are clawing their way back into the action.”

  “Linc,” he said. “If I may call you Linc. Can I see that log? I mean, the young docs back in Nouméa can’t believe what they’re hearing about you.”

  “Sure,” I said. “But only if you can show me where the drinkable-coffeepot lives in this showboat.”

  We got dressed, he in fresh medical whites and I in working khakis. He took me forward to a small dining room where there was not only coffee but actual food. A steady parade of docs and ship’s company officers came through. Nobody stayed very long. There were portholes and I could see that it was full daylight outside. Normally Montrose would have left Rendova around midnight in order to get well to seaward of the increasingly nasty fight on New Georgia. The ship’s company naval officers looked worried. We were only twenty miles from Rendova. This was still Jap bomber country.

  My roommate perused my log during breakfast. He whistled softly when he was finished.

  “What was your mortality rate?” he asked.

  “Too high, at first, but it got better as time went on. It was nothing compared to the mortality rate of the guys we didn’t or couldn’t get to.”

  He nodded at that. I described our operating conditions. He could only shake his head at what I was telling him.

  “Man!’” he said. “I had no idea. All we ever saw were the ones that made it to Nouméa. You show this to Colonel Maddox. He’ll take care of you.”

  He headed back to the cabin for much needed sleep. I gave myself an unofficial tour of the ship, with a mug of coffee in hand. I finally got below to the main operating area after several false starts and went through the swinging doors. They’d done an ingenious job of it. The expansive space that had been the main dining room was now subdivided by curtained enclosures, twenty feet on a side, which contained the operating tables and rolling cabinets filled with surgical instruments. There was a wide central aisle right down the middle which had several nurse’s stations and even more equipment, especially sterilization machines. The entire space was air-conditioned and well lighted. Surgery, I thought. On a production-line basis.

  There wasn’t much going on, so I backed out into the welcoming arms of an orderly, dressed in whites. He told me Colonel Maddox wanted to see me. Ten minutes later I was in Maddox’s cabin, which was one of the first-class suites from the old days. I handed over my log. He pointed to a coffee stand, which had a small plate of real donuts. I hadn’t seen a donut since leaving Duke. The silver tray was vibrating slightly as the old girl did her best to make tracks out into the open sea and away from prowling Jap bombers. I ate one donut and then took its brother and a mug of coffee to a large, upholstered chair near one of the portholes. Bright sunlight was streaming in, and in the distance I could see one of our escorting destroyers bouncing happily through the choppy seas. In silhouette her five-inch gun mounts, all pointed skyward, looked like spines on the back of some ancient but dangerous beast.

  It took the captain twenty minutes to go through my log. When he was finished, he, too, gave a low whistle. “This is pretty amazing, Doctor Andersen,” he said. “I’m a chest cutter, so I know most of these procedures. How in the hell did you manage all this?”

  “It was a matter of necessity,” I said. “The conditions weren’t very good, nothing like what you have here. Hot, not very clean tents, constant rain, continuous gunfire all around us, generators that were running on questionable fuel … Our one and only autoclave broke down on the first day, so the Marines kept two fifty-five-gallon drums outside the tent filled with boiling water. The hospitalmen would dump our used instruments into one of them for ten minutes, and then into the second one for another ten minutes. Then they’d fish ’em out, set the trays, and bring ’em back in. We’d change gowns twice a day, if there were clean ones available.”

  “But how did you know what to do?” he asked. “Like an aorta repair? That takes a lot of training.”

  “I probably didn’t do it correctly,” I said. “But I could improvise. Sew in a tube upstream of the damage and then terminate it below the damage. Clamp off the damaged area, resection, sew it back up, and then release the clamps. Left the tube in place. The real surgeons down in Nouméa could deal with that later. His aorta was no longer leaking. That was the important thing.”

  He just stared at me.

  “I don’t want you to think that I think I’m a fully qualified, board-examined general surgeon,” I said. “You used the word procedure. To me, a procedure is something you do in a well-run hospital with a full support staff. I’ve been doing battlefield trauma surgery. If I knew the general outlines of the procedure, I did it. If I didn’t, I had my chief hospitalman read it to me from the manual. Like with a descending aorta repair.”

  He nodded. I went on. He was the first senior surgeon I’d been able to talk to practically since I’d come out with the Marines.

  “You make an aorta repair sound like a once-in-a-lifetime procedure. Problem was that I had fifteen more patients, lying on litters on the floor of the tent, with even worse damage. I did what made sense to me at the time. All the other surgeons were elbow deep in gore of their own. I wasn’t the only one there doing stuff way outside my training envelope.”

  “Damn,” he whispered. “Just damn.”

  “You think you’ve been swamped aboard this ship?” I said. “We were swamped five hundred yards from the front lines. We surely didn’t save them all. But we tried our hearts out, and I’m proud of what I did do. If your board of inquiry wants to question what I did, bring it on.”

  He closed the log and sighed. “Having seen this I’m pretty sure I can take care of that,” he said. “The board, I mean. You know, or maybe you don’t, that any time a military mission gets its own bureau, the pissants are gonna surface, sooner or later. You ever hear the story of the Pearl Harbor anesthesia incident?”

  I shook my head.

  “The Brits, who’ve been at war since September of ’39, told us there’s a story circulating in medical circles there. The sum and substance of it is that our own surg
eons killed more men than the Japs did at Pearl. All because of a new wonder anesthetic called thiopentone. The story’s anecdotal, but the deal was that this stuff caused cardiac arrest and respiratory paralysis if misused, especially in patients who were in shock, which was pretty much everybody that day. Did you know that in England, anesthesia is performed exclusively by medical doctors, trained in that as a full-fledged specialty?”

  Again, I shook my head. All of our anesthetists were enlisted personnel. “We used ether drip,” I said. “But it was our enlisted hospitalmen doing it.”

  “As it was here,” Maddox said. “Until we got the nurses on board. The only thing we use thiopentone for here is, well, when we have to let a patient go peacefully to his Maker.”

  Battlefield euthanasia, I thought. The unmentionable fact of life in combat medicine. “What would you have me do?” I asked.

  “Join a surgical team,” he replied. “Hell, after looking at this, lead one of my surgical teams. The New Georgia campaign isn’t going very well at all and we’re getting horrible casualties. I’m the only thoracic guy on board; the rest are mostly post-residency docs. You’d be a Godsend, and you’re being wasted with that MTB squadron.”

  “Now, wait a minute,” I protested. “Twenty-four hours ago, I was going to be sent back to Nouméa to face a board of inquiry,” I said. “You let me operate here, you might be facing the same thing. Sir.”