The Beauty in Breaking

by Michele Harper

  Because the incident happened at the end of my shift, I could go right home, something I badly needed to do. When I got to my apartment, I took a naproxen and went to bed with the conviction that I would not dream about what had just taken place.

  And now, almost two years later, I was faced with another yellow alert, another reminder of how little power we physicians actually have. Despite my efforts, I couldn’t stop thinking about the physician who’d been assaulted by this patient I was about to see. I had tremendous respect for this doctor I’d never met, for the restraint it must have taken for her, after being violated, to calmly put down her scalpel and walk away. I would like to think I would have done the same. I suppose I had, with my inebriated patient—doing just enough to ensure my safety, and then leaving. After all, it was about survival, not retribution. She was lucky she hadn’t accidentally killed her assailant when he groped her. But if that had been her reflexive response when under attack, she would have been in the right. It infuriated me that in the world of medicine, a female health care provider could be attacked without consequence, without any means of redress. It was as if patients were permitted such assaults. Why was it that the woman must quietly walk away while the aggressor is allowed to return to the emergency department at any time with the expectation of being serviced?

  I stood there in the staff lounge wishing it were easier to be human, wishing we could shed our binary views around gender and power, views that have never served humanity well. I longed for our society to move closer to a harmony where the yellow alerts would fade away so that when I clicked on a patient’s history, I would see just another gray computer screen.

  It turned out there was coffee in the break room. I touched the side of the pot to find it was still hot. I poured some into my cup and added cream and sugar to the grainy brown brew, thin and watery and likely at least five hours old. In any other circumstances, it would have been unpalatable, but toward the end of a night shift, it was ambrosial. I inhaled—caffeine and a hint of motor oil—and took the first sacred sip.

  Now I was prepared for the patient I had no choice but to see.

  It was true that I didn’t know him at all, so was it fair to judge? I had to admit that there might have been extenuating circumstances to explain this patient’s degeneracy—after all, I knew nothing more than what had come up in the notes. Maybe he had been abused as a child. It is not uncommon for boys who are abused to become abusers themselves. It is never a justification, of course, but it is an eventuality that deserves compassion. (For all I knew, he had gotten therapy since the assault and was now a fund-raiser for the Rape, Abuse, and Incest National Network. It was a long shot, but it was possible.) It still felt appropriate to make the patient wait, but I knew that there would eventually be other patients to see after him, and it wouldn’t be right to delay their care.

  I had squandered six minutes, and there was still only one patient in the ER. I grabbed the male nurse who’d been assigned to the patient, Mike, and we headed over to his room.

  On the way, Mike grunted under his breath, “I can’t believe this guy is allowed to come back here. It’s shameful.”

  I half-smiled at him in solidarity.

  The curtain to the room was ajar, revealing a wiry white man lying uncomfortably on the stretcher. His full head of dark hair made him look much younger than he was: His chart said fifty-one. There was no sheet on the bed and no blanket. The man was tall, and naked except for the thin white hospital gown embellished with navy blue geometric shapes. He seemed not to notice or care that as he lay on the stretcher, writhing from side to side, his gown splayed open revealing his bare backside. Mike stood on one side of the room, and I stood next to him and leaned against the supply cart; I needed this bracing as well as the distance. Mike and I stared at the patient as he flopped around like a fish on a hook.

  I sighed. Making sure to convey that I was a distant authority figure, I said, “Mr. Samuels, I’m Dr. Harper. What brings you in today?” showing a little less enthusiasm than I might have displayed when asking if he had a paper clip I could borrow.

  “The pain, the pain,” he moaned. “It happened again!”

  “And what might that be, sir?”

  “The hernia,” he whispered in anguish.

  I recalled the triage note in the record. “Hernia? You didn’t come in for a hemorrhoid?”

  “Well, I don’t know what it is. There’s something swollen in my groin. It just started today, and I can’t take it.”

  He was curled in the fetal position, his knees bent to his chest. As he spoke, he buried his face in his hands.

  “Okay,” I said. “Let’s take a look at this hernia. Lie on your back.”

  He tried to relax his legs and attempted to pry them apart. Mike and I regarded him coolly. We didn’t move as we waited for him to adjust and calm himself. When he was more still, I walked toward him. His fists were clenched around waves of pain, and his toes twitched with the throbbing. I began to raise his gown and told him to straighten his legs. His arms started to flex up and move toward me. I quickly dropped the edge of his gown and leaned back.

  “Put your arms down,” I commanded. “Keep your arms down by your sides. Stay still. Straighten your legs.”

  His thighs were tense as I tapped the side of his right leg. “Okay, open up.”

  His legs stayed clamped.

  I didn’t attempt to hide my annoyance. “Sir, would you like to be examined or not?” I continued, already knowing the answer. “The only way I can do that is if you show me the area that is bothering you.”

  I could sense Mike rolling his eyes, but I was too close to the patient to do anything more than grimace.

  The patient lifted his gown and spread his legs enough to reveal a large, firm swelling extending from his right groin to his left scrotum, which was stretched to the size of an eggplant. The skin was so taut that it glistened. Still cautious, but focused, I reached out to palpate his scrotum; I couldn’t identify any anatomic landmark. I tried to follow what I imagined might be a thick cordlike swelling down the inguinal canal, but all I could really discern was a balloon of exquisitely tender human flesh. What should I push back into place and where? What was intestine and what was testicle? Was there a perforation or dead bowel? An infection?

  I turned to Mike, who had already started to grab supplies. Our faces softened. This was a surgical emergency. Yes, the man was likely an awful human being, but his pain was real.

  “Sir, we will need to put in an IV and check some blood work. We will also need to perform a CAT scan to see what exactly is going on with your hernia. You are right that there is a serious problem here. I have to find out if it’s infected and how it is stuck. I will also call a surgeon because you will certainly need an operation to fix this. While all this is going on, we’ll make sure you’re comfortable. We’ll give you pain medication right away.”

  He looked up at me and nodded. “Thank you, ma’am. Thank you, Doctor.”

  His eyes were a tremulous, pale gray. I didn’t remember the name of the female physician he had assaulted, only that it had sounded Indian. Was she dark-skinned like me? I wondered if Mr. Samuels saw her when he looked at me.

  I tore off my gloves and started to enter the orders into the computer. I asked the clerk to page Surgery so I could give them a heads-up. As I waited for the call back, I stared into my coffee, remembering how slowly I had stirred in the half-and-half as Mr. Samuels’s legs had twisted in pain, how painstakingly I had added the sugar, almost grain by grain, as his intestines pushed against his testicles and his scrotum ballooned. To the patient, those six minutes of procrastination on my part must have felt like an eternity. While he certainly deserved to pay for his past violent behavior, it wasn’t for me to decide when or how. In my mind, this wasn’t the time.

  The surgeon, Dr. Castellano, was just leaving a patient’s room on the floor. She sai
d she would swing by to take a look, as the shift might change by the time Mr. Samuels’s test results came back. Five minutes later, she was in and out of the patient’s room.

  “Yeah, Dr. Harper, pretty impressive. Please give a call once the labs and CT are done. If I haven’t heard from you before my shift is over, I’ll let Dr. Ritter—she’s the day doc—know to expect your call.”

  Fate had delivered this man into the care of three female doctors that evening, each of whom had calmly gazed at his excruciatingly swollen genitals. Women were the ones to inspect him, to touch him, and, ultimately, to slice open his flesh to save his life. Was any of this irony lost on him? From that experience, did he learn how it felt to be vulnerable? I wondered if it might expand his definition of gender, what it meant to be female or male. I wanted to believe that he would never grab a woman again, and I took another moment to stand there trying to convince myself that this could be true. Probably not, but maybe.

  I’d update the surgeons with the details of his CT, which would confirm his strangulated hernia, so they could better plan his case for the OR to remove the dead bowel and close up the deficit in his fascia that had allowed the breach so that now his body was busted like his character.

  If Mr. Samuels were ever to evolve, it would be due to experiences like this one, where people who didn’t have to care for him chose to do so anyway, regardless of his past actions. And, yes, people who commit the type of violence that Mr. Samuels did should be held accountable by the appropriate people, in the appropriate ways. Still, his life lessons were for him alone to choose to learn from or disregard as he decided.

  If I were to evolve, I would have to regard his brokenness genuinely and my own tenderly, and then make the next best decision. My choosing to care about his welfare, my decision to hold in my heart the best intention for another human being no matter who that person is or what they have done, that day in the ER, despite my disgust at his previous behavior and the possible moral decay that had led him to it, was a social action.

  Two more patients flashed on the board, a sore throat and eye discharge, but they would wait just a little while longer while I finished with Mr. Samuels.

  FIVE

  Dominic: Body of Evidence

  “Just make him do it!” A voice rang out, followed by the sound of metal grating on metal.

  I leaned past my computer screen toward the triage area to see a young man in handcuffs chafing at the bony prominences of his reddened wrists. Fading charcoal gray lines of graphic tattoos on his left forearm were almost indecipherable against his dark skin.

  “I didn’t do nothing!” the prisoner shouted.

  “That’s enough out of you!” a police officer commanded.

  “Listen, we have to take your vital signs. Put on this gown.” The voice was from Carl, the charge nurse assigned to head the nursing team for the shift.

  “I ain’t doin’ nuthin’. I don’t want to be here. I don’t want to put on that gown. I’m not doin’ nuthin’.” The young man looked away—away from the charge nurse who tried to stare at him straight in the face, away from the officer who looked only at the nurse, away from the audience comprising the full ER occupants, who were intently watching the show.

  His white shirt, made brighter still by the contrast of his chocolate skin, quivered with every shallow exhale. His dark jeans were clean and fit perfectly, as if he had just been wearing them on a Diesel runway. His white trainers weren’t new, but they were certainly well cared for—bright, clean, polished. He couldn’t have been more than five foot nine and looked thin and frail under his fashionable attire.

  The four officers who brought him in seemed like overkill—like rolling in military tanks to secure a small-town demonstration. At the same time, I can’t claim with absolute certainty that the show of force wasn’t indicated: I’ve seen a 125-pound man on PCP evince Herculean strength that required everyone in the emergency department to subdue him with injectable tranquilizers and physical restraints. I always felt bad watching a patient being wrestled to the floor, knowing that he could be injured, knowing that, heaven forbid, he could be killed, even though we were doing it for his protection and ours. Even when everyone has the best of intentions, things can go terribly wrong. Yes, the patient had chosen to take the PCP, necessitating that the authorities be called and he be brought to the ER, thereby involving us in the danger of his personal decisions. Although, in so many ways, we in the ER pay the price for a patient’s choices, it never feels okay when there is a complication. Because the stakes are so high, the moment we decide we have to go hands-on, the critical action is always contained in the question before: Is this truly necessary?

  “You’re gonna have to make him do it,” one police officer said to Carl. “He has to be examined, so you’re just gonna have to make him comply.”

  I shifted my chair to keep one ear and one eye on the commotion, eavesdropping as I clicked away at my computer. This section of the ER was circular, with the doctor’s station in the middle, so it was possible to keep an eye on most rooms. The situation didn’t appear to be defusing, so I knew I needed to wrap up my work and head to triage.

  “What’s his name?” Carl asked.

  “Dominic,” the same officer replied.

  “Dominic, you’re gonna have to put on this gown and let us examine you,” Carl said firmly.

  “I ain’t doin’ nuthin’. These cops are lying. I didn’t do nuthin’ and I don’t want to be examined. I don’t want to be here,” he exclaimed as drops of spittle flew from his mouth.

  As if suddenly resigned, his face became a mask of calm, but that flying spittle told another story.

  “Someone, please get the doctor,” an exasperated charge nurse entreated.

  Hearing this, Lauren, the second-year resident who was my charge for that day, took five hurried steps over to the melee. Lauren’s steps were always hurried and overconfident. She was pale white, of average height, with a narrow nose and a frame as slender as her fine mousy blond hair, which fell limply in a taut ponytail at the nape of her neck. She would have been entirely nondescript if not for the salience of her habitual condescension. She, like me, had heard the drama unfold. I was the only attending physician on in my section and just wanted three precious minutes to finish up with the last five cases before delving into this quagmire.

  I could practically hear Lauren put her hands on her hips as she asked, “What’s going on here? I’m Dr. Morgan. What seems to be the issue, officers? Carl?”

  I took a deep breath, knowing that she would not be the one to resolve this situation. I just needed 170 more seconds to wrap up my work so I could smooth things over in triage. I also knew that I had to give Lauren a chance to at least attempt effective mediation. She was, after all, my trainee, and thus my obligation for the next nine hours, forty-seven minutes, and thirty-two seconds.

  I took a deep breath for another reason: I wanted so badly, when I entered the triage area, to see black officers and a white prisoner, or at least one black officer and a nonblack prisoner—anything other than the stereotypical white cop/black prisoner scenario. But I had already surveyed the scene, so I already knew—I made myself take another breath—that in triage was the configuration of characters I least wanted to see.

  We are not yet at a time in America when the attributed or perceived actions of a brown or black or queer or Muslim “wrongdoer” are considered singular. Instead, such accused are seen as emblematic of an entire demographic, one labeled guilty before charged. And yet, the overwhelming majority of spree killers from the most notable mass shootings in U.S. history are male and white. The crimes of each of these assailants are repeatedly viewed as individual acts indicative of one sad, tormented man’s mental state and not of his entire gender and certainly not of his race. This privilege of individual self-determination is purposefully not extended to all. Strangely but not coincidentally, these massacres do no
t lead to large-scale examinations of the state of “maleness” or “whiteness” in America—both topics that Americans most desperately need to examine.

  It could not be delayed any longer. I stood up and removed my gray fleece and put on my long white coat. At that time in my career, I always had my white coat with me. In truth, I used it more to hold a collection of medical references and my favorite pen light, which had pupil measurements on its side, than to show everyone that I was a doctor. In fact, I almost never wore it. I found it cumbersome to run around an ER wearing a long coat with full pockets. And indeed, it became a liability in the department: just another item I had to protect from blood, vomit, and bedbugs. But apart from what I could stash in its pockets, there were times when it was a useful costume. Sometimes I had to explain to a family member that her courageous mother had just passed away, or ask another if his father’s end-of-life wishes included cardiopulmonary resuscitation. The coat was my garment of choice for such conversations. It was a uniform that signaled expertise, authority, confidence. And now here was another scenario in which I had found it came in handy.

  As I approached, Lauren was looking directly at the patient and saying, “Sir, you are going to have to do what we say. You did something that is dangerous and life threatening. Now you are under arrest. You must get in this gown, and then we will examine you.” No invitation, no question. Simply her interpretation of the events and a directive to comply.

  No one moved.

  Suited up, I approached the stalemate. I looked at the patient’s face. He was turned away, looking at nothing in the far corner of the room. His chin was tilted upward, his jaw tight, his brow glistening with the first signs of perspiration. His breathing was rapid and shallow.

  I clasped my hands in front of my chest. “Hello, sir,” I said softly. He lowered his head to look at me. I was anywhere from twelve to four inches shorter than everyone else in the area. He and I were at least ten shades darker than everyone else in the triage room. “Sir, what’s your name?”