by Paul Hoover
“Give me that, God damn it,” he said, and grabbed the tube out of her hand. “I’m going down through the nose.” Tossing the old one aside, he took a thinner tube of red rubber, greased it with a packet of KY jelly, and pushed it down Mr. Johnson’s nose with slow, twisting motions. Dr. Ramanujan stood against the wall, her arms folded calmly over her chest; you could tell she was humiliated. The resident had seriously broken protocol, and there would be confrontations later. Meanwhile, Mr. Johnson, his chin thrust toward the ceiling, eyes closed, turned bluer and bluer. That’s why they called Dr. Blue over the loudspeaker—the patient turns blue, or cyanotic.
Dr. Rickles taped the tube to Mr. Johnson’s face. Then he attached a large rubber bulb, the Ambu bag, to the end of the tube and started squeezing with both hands. The bulb gave off an ugly wheezing sound, like water going down a bathtub.
“Hey, you!” said Dr. Rickles, looking at me.
“Me?” I said, pointing at my chest.
“Commere and squeeze this thing,” he commanded.
“Go!” said Romona, giving me a shove.
I tripped over some wiring and stumbled across the room, but soon I was squeezing the Ambu bag on the count of twelve per minute, as Rickles had instructed. The room was a blur of action. All the while, the intern, a sleepy-looking guy not much older than me, had been pushing with the heels of both hands, his arms stiff, his full weight thrown, on Mr. Johnson’s breastbone. You could see the chest sink under his pressure. This was keeping the heart going, while I was doing Mr. Johnson’s breathing. Betty Marder was busy setting up an IV. At the same time, the EKG technician strapped electrodes to the arms and legs and placed a brass cup on Mr. Johnson’s chest by means of a suction device. All these were attached to wires that ran into the crash cart. By now the whole area was littered with wiring, like the engine of a car. Rickles gave his attention to the EKG machine perched on top of the cart. Out of it ran a thin gray strip of paper with mountainous black marks that indicated the rhythm of the heart. It slid through his hands—where he read it like a stock report—and dangled to the floor, adding to the other debris of death. Rickles ordered drugs as the paper demanded. These were injected by the nurse right into the IV tubing, through a little rubber membrane.
The intern looked winded. By now he had both knees on the bed and was sweating over his task. “Need…some…help…here,” he panted.
“Let’s get the board in place,” said Rickles, pulling two pieces of equipment from the back of the cart. They looked like Rube Goldberg had made them. One was a highly polished piece of wood, about three feet long and two feet wide, with holes and metal collars on both ends. The other was a piece of stainless steel bent into an elongated U to which a plunger, made of red plastic the size of a fist, was attached. At the count of three everyone, including Ramanujan, lifted Mr. Johnson by the shoulders while Rickles slipped the board beneath him, level with his chest. Then we let him fall back, and I resumed his breathing. Rickles and the intern, working on each side, snapped the metal piece into the board’s metal collars. The “fist” was now located a few inches over Mr. Johnson’s breastbone. After a few adjustments, like lowering a piano stool, Rickles had it set right, and the intern, with far less effort, started pumping on the handle. The red fist pressed into his chest with powerful ease, then sprang up again.
The patient was apparently stabilizing; Rickles looked calmer. My hands began to ache, so I skipped a beat now and then to let the strength come back to them. Romona and Ed still watched intently, the best spectators a heart attack ever had.
A heavyset inhalation therapist burst through the doorway, mumbling apologies. He started in my direction, as if to take over.
Rickles was beside himself. “Get out of here, jerk,” he roared, sticking his index finger under the poor guy’s nose. “Get fucking out of here!” He pointed to the door like the evil baritone in an opera. As the therapist fled, humiliated, Romona gave him a withering look of disdain.
“Asshole!” hissed Rickles, as an afterthought. Then, after a pause, he said, “Shit!” I saw what he was referring to: the EKG was going crazy. The thin black stylus flew back and forth wildly, making marks on the paper like an angry two-year-old. You could hear the machine clicking desperately.
“Tachycardia,” said Rickles. “Everybody step back.”
When he twisted a dial on the defibrillator, a red light came on. Then he picked up the paddles; the intern, without being asked, squirted a white fluid on them that looked like runny toothpaste. This was to help conduct electricity. He placed the paddles on Mr. Johnson’s chest, each side of the heart, at a distance from each other, and looked around the bed. “Back!” he screamed at me. “Nobody touch the bed.” I backed away as far as I could, and he pushed two red buttons attached to the paddle handles. A needle on the machine swung all the way right, and Mr. Johnson’s body seemed to leap a foot off the bed, first the head and then the feet, in a kind of ripple effect. Immediately, everyone took up his old position, as if nothing had happened.
Rickles looked at the EKG again, but nothing had changed. Tachycardia, I later learned, meant the heart was totally out of control, literally collapsing upon itself. When the heart was normal, its contractions created a “sinus rhythm” on the EKG characterized by a sharp “spike” or V followed by a slurred lower-case r. These would parade confidently when everything was going right, accompanied by a small beeping sound.
“Again,” said Rickles, poised with the paddles. Everyone stepped back, and Mr. Johnson again took to the air by force of his own muscular contraction. Nothing had changed on the EKG. While we mechanically moved the blood and breath, the heart itself was giving up. Every tactic the doctor tried only created a new dilemma. Finally, the EKG stylus fluttered and stalled, and a straight black line appeared on the paper, the straightest line you’ll ever see. The moment of death spilled out of the machine and piled up on the floor. The machine hummed with eerie satisfaction in the otherwise quiet room.
6
“MY GOD,” I SAID to myself.
“Aw, shoot,” Romona said softly, in her corner of the room.
“That’s it, folks, let’s bag it,” said Rickles, tossing the paddles onto the crash cart and snapping off the EKG. “Samuels, you do the write-up, and I’ll sign it later.” The intern nodded and started to leave the room, but Rickles called after him, “Time of death, six forty-three. I’ll talk to the wife.”
Everyone but Betty Marder, the anesthesiologist, and I immediately left the room. Ed and Romona left, too, giving a sign that they’d meet me later.
Already the nurse was cleaning up the place, picking up used endotracheal tubes, pieces of paper and plastic, used syringes. It looked like a battlefield. The only casualty lay on the bed, his skin in various shades of red, blue, and gray, his open mouth revealing old yellow teeth. She took the IV. out of his arm, and a drop of blood appeared at the point of entry, at the center of an enormous bruise. A murky catheter stuck out of his penis. On the whole he looked like a battered puppet. The anesthesiologist removed the Ambu bag, but the tip of the endotracheal tube still protruded from Mr. Johnson’s face. This last task completed, she left quietly, apparently still smoldering.
Betty Marder gave me a shrug and continued cleaning the room.
“Is there anything I can do?” I asked.
“You can tell one of the aides to get her tail in here,” she said. “You’ll also have to order the death pack and take care of the belongings. I think there’s a watch and wallet,” she continued, pointing at the bedside table. “It’s your job to release them to the family, plus take him downstairs.”
“Downstairs?” I said.
“To the morgue. It’s the manager’s job—there’s no transportation around in the evenings.”
There was a wedding ring on Mr. Johnson’s finger, but Betty was having trouble getting it off. I handed her a packet of KY jelly that was lying on the crash cart. She smeared some on the finger, twisted, and in an instant the rin
g slipped off. “This goes with the belongings,” she said, handing it to me. “There’s a list inside the death pack.”
“Wonderful.” The ring was surprisingly warm to the touch. I slipped it into the pocket of my tan lab coat and went into the hall.
“You did just swell,” said Romona, “a real classy job.”
“Yeah,” said Ed, envy in his voice.
“Don’t worry, Ed,” said Romona. “You’ll get your chance real soon. You got Neuro Intensive and ENT. There’s a lot of action up there.”
“What’s this about a death pack?” I said.
“Don’t worry,” she said. “I’ll order it for you.” She went over to a drawer, took out a yellow form about the size of a traveler’s check, and stamped it with Mr. Johnson’s charge plate. Then she went to the back of the station where the pneumatic tube system was breathing and hissing, picked up one of the clear plastic tubes with leather and rubber to cushion each end, inserted the form, opened a roaring valve, and sent the tube slithering through the pipes down to Central Supply.
“That man’s been through hell,” said Ruth, referring to Mr. Johnson. “Cancer of the spine.” At the end of the hall, Barbara, Mrs. Johnson, and Dr. Rickles made a sad-looking trio.
“Better call the Reaper,” Romona said to Ruth.
“Already done it,” she said, “but that man can smell it on his own.”
“Speak of the devil,” said Romona.
Around the corner came a thin elderly man in a cheap brown suit. He, too, was carrying a clipboard, but he held it like a scroll.
“I understand you have an expiration,” he said to Romona.
“That’s right. William Johnson in 621.”
“Has the family been notified?”
“See for yourself,” she said, pointing down the hall.
“Very good. How about the belongings?”
“We’re waiting for the pack right now,” said Romona.
“And who are these young men? I don’t believe I’ve had the pleasure.”
“Norm Cane, Jim Holder and Ed Grabowski. Jim is in charge of the unit.”
“Well, that’s nice, young man,” he said, offering a limp hand that smelled of cigarettes. “Just remember, death is an important event, and we must be judicious in dealing with the family.” He put a finger over his lips when he said the word family, as if it was sacred. His name tag said “Normal Cane, Administration.”
“I’ll remember,” I promised.
“Things to do,” he said, waving his clipboard and turning in the direction of the doctor and Mrs. Johnson. His silver hair, mixed with dirty blond, was shiny under the ceiling lights. Robert Sage, who’d been walking up and down, gave him a little wave as they passed in the hall.
When he was out of range, Romona said, “Now you see why we call him the Reaper. He’s the evening administrator, but there’s nothing to do but release a body now and then. He spends all his time hanging around the corpse’s family, pretending he’s somebody important.”
“What a bizarre character,” I said.
“I kind of liked the guy,” protested Ed.
A red light started flashing near the nursing station. Ruth got up and opened the silver doors of the dumbwaiter, and there was the death pack wrapped in plastic.
“You take it,” she said, handing it to me. “These things give me the creeps.”
“Actually, it’s a scam,” said Romona. “There’s only a couple of sheets in there, some safety pins, an ID tag for the big toe. That and the valuables list. And we charge the insurance company seventy-five bucks.”
I opened up the pack, and she was right. It was like opening a present and finding only empty boxes, one inside the other. There was only one thing she hadn’t described, a large pad of some kind with gauze strings attached.
We took everything into the room, where Betty and the nurse’s aide were giving Mr. Johnson a bath. They had him turned on his side, just like a living patient, but his limbs and mouth gave him away. On the whole, he looked much better. The catheter and endotracheal tube were gone, and his hair was combed. Much of the equipment was back on the cart, properly washed.
“What’s this thing?” I said, holding up the mysterious gauzy object.
The nursing aide thought this was very funny.
“It’s a diaper,” said Betty Marder without a trace of humor.
“Come on,” I said, “what is it really?”
“It’s a diaper, honest to God. We put them on the expirations so they don’t shit on themselves.”
I didn’t believe it.
“It’s true,” said Romona.
“It’s the anal sphincter,” said Ed with seeming expertise. “We get them like that all the time, like they was babies.”
“Huh?” said the nurse.
“Never mind,” I said. “Here’s everything you need.”
We watched while the body was dressed. The ritual was overpowering: the ablutions, diapering, binding, and wrapping. There were no preservative powders or eucalyptus leaves, of course, only a couple of worn-out sheets with “Chicago Laundry Company” stamped in ink on a corner.
“Romona, Ed, and I watched them put on the diaper, and it did look like a baby’s. Then they tied the ankles and wrists together with gauze, in order to make the handling of the corpse more manageable. The wrists crossed over the chest, palms down, like old statues of saints. One ankle rested on top of the other. The ID tag, which had been stamped with his name and patient number, was tied to a big toe. Finally, they wrapped him in his cut-rate shroud, which was laid out under the corpse like a diamond. When all the ends were wrapped tightly and secured with safety pins, Mr. Johnson looked like a handmade cigarette. Using safety pins, they attached two more name tags to the outside of the shroud. Now the job was done.
“Aren’t you forgetting something?” said Romona.
“What?” said the nurse.
“What if the wife wants to see him? He’s all covered up.”
“No problem,” she said, neatly unwrapping only the head, so the face peered out of its bunting, serene and distant.
“How’s that?” she said, stepping back to inspect her work.
“Beautiful,” said Ed.
“Let’s get the things together,” Romona said, “then we’ll see the wife.” There was an atmosphere of preparation and care, as if a party were being planned. She opened his locker, which was set into the wall, and pulled out the clothes. They were old sturdy things: black tie shoes that would never wear out, a white dress shirt that was a little frayed at the collar, and a blue suit styled in a forgotten fashion. The jacket was surprisingly heavy, as if there was sand in the lining, and the seat of the pants was shiny. We lay the clothes on a neighboring bed.
“How do we know if this stuff is his?” I said.
“It’s his, all right,” said the aide. “Don’t you worry about that.” She reached into the bedside table and pulled out a watch and wallet.
“Let me see that,” said Romona. She started to go through the limp old wallet, which smelled of sweat and age. There was a five-dollar bill and three ones, and a faded photograph, now very much wrinkled, of Mr. Johnson and an attractive brunette. It must have been the forties, since he was wearing an army uniform. It wasn’t clear to me if the woman was Mrs. Johnson, but it might have been. She was standing up very straight and smiling into the camera brightly. There was an orchid pinned to her dress that opened toward her face.
“Sad, isn’t it?” said Romona, holding it for me to see. Ed, meanwhile, was efficiently listing everything on the bed. One blue suit, one white shirt, two black shoes, eight dollars in cash, two packs of Camels, a toothpick, a pair of white socks. Everything had to be listed, even the lint in his pockets. The hospital wanted proof in case the family claimed something was missing.
“That’s about it,” said Ed.
We put everything in a large brown paper bag and attached another name tag to it. Romona attached one copy of the valuables list to the to
p of the bag. “All done,” she said.
Outside was a patient who’d been ousted from the room in the commotion. “Can I come in now?” he said. “My wife’s supposed to call.” He looked to be in his fifties, and was wearing a bathrobe from home with little blue anchors on it.
“Not yet,” Romona said. “It’ll be about an hour.”
“I guess he died, didn’t he?” said the roommate.
“I really can’t say,” Romona said, closing the door behind us.
“Too bad,” said the man. “He was a nice fellow. White Sox fan, like me.”
There wasn’t much we could say to that.
“You come back in about an hour,” Romona repeated.
“Fine, fine,” He turned back toward the lounge, where another patient was waiting for him, looking up expectantly. They shook their heads back and forth, as if to say, “Now, isn’t that something.”
Barbara, Norm Cane, and the wife approached. Ed handed the bag to me. He and Romona stepped to the side.
“I understand you have something for me,” the wife said tensely.
“Yes, ma’am,” I said, holding up the bag. “There’s a list of belongings we’d like you to sign.”
She eyed the bag as if it contained a trick of some kind.
I started to read from the list. “There’s one blue suit, two black shoes, two packs of Camels…”
“Never mind all that. Where do I sign?” She seemed enormously tired, and signed the form jerkily, as if she might not finish. I studied her face to see if she was the one in the photo; but if she was, age and worry had disguised her.
“I’ll take these things for you,” Barbara said, picking up the bag. They started toward the patient lounge, but Cane said, “Wait a minute. We have to make sure of the money. How much was there, young man?”
“Eight dollars,” I said.
“Does that sound about right, Mrs. Johnson?”
“I really don’t know,” she said. “Bill never carried much money.”