“Josh, he’s a liver transplant surgeon at the medical center, and my old college roommate. He did a case tonight and was just stopping by on his way home.” Josh laughed and nodded.
“Josh . . . Joe Tector. Joe, this is Josh Careskey, one of our finest ‘ped’ surgeons.” They acknowledged each other and shook hands. Joe swayed nervously in place. “Josh, let me brag for a second. Joe is one of the new transplant surgeons at the medical center, here to increase the number of transplants, especially in kids. He’s even hoping to get an intestinal transplant program started in the state.”
“Really?” Josh asked inquisitively. “Does that actually work . . . transplanting just the intestines into a kid? They do okay with all the anti-rejection medications and stuff?”
“We’ve done a few in Florida and had great results,” Joe responded. They talked a little more and Josh went on to see some kid in the ER who needed his appendix removed. Joe hung out for a while, and then headed home.
A few months later, that brief middle-of-the-night visit would give a child a chance of surviving into adulthood. Josh had been called to see a young boy with severe abdominal pain. He took the four-year-old child to the operating room, anticipating the child was suffering from a twisted or blocked piece of intestine. Instead, he found something horrible. The entire intestinal tract had been strangulated; the blood supply had been cut off, and boy’s entire bowel was dead. We call this ‘dead gut’ or ‘dead bowel’; a small section alone can be fatal, but the entire intestinal tract was a death sentence. Josh prepared to close the child and tell the family that the young boy would certainly die in the next day or so. Then, he recalled something . . . a name . . . a chance meeting.
“Get me Dr. Tector on the phone from the med center; he’s a liver or transplant surgeon.”
Joe immediately called back while Josh was still hovering over the dead gut—the child wide open in the OR. “Resect the dead gut,” Joe said. “Put in a central line and a g-tube, then send him to me . . . let’s see what we can do.”
A few hours later, Joe was faced with the daunting task of saving this dying child. Meanwhile, Josh prepared to go out of town, leaving the young boy in Joe’s care. Twenty-four hours later, Joe obtained a donor from California and transplanted the entire intestinal tract from a brain-dead child into this young boy.
The child is now eight years old, in school, and eats the same normal junk food that any child his age enjoys. More important, he is alive.
When Josh returned a few weeks later, I congratulated him. “On what?” he asked.
“That kid you sent to Joe; he transplanted a whole intestinal tract and he’s doing great . . . what, you didn’t know?” Josh was floored but elated. He had not checked his voicemail and had no idea that the child was still alive, let alone survived the transplant. His voice cracked on the phone. “Oh my God, I’m going to cry,” he said. “It’s truly a miracle, a miracle.”
So, in 1985 two coeds shorted out my computer when they cleaned their grill. In 2002, a young boy survived what would otherwise have been a fatal complication.
We can only imagine how simple acts and twists of fate send us down one road or the other in life, but I know I have never been more grateful to have been covered in soot. There is a funny thing about time and true friendship: You can be separated by miles and years, but once you are back together, all is the same. You can pick up from where you left off and talk like you’ve never missed a day. That is, unless the reality of those missing years brings an unnecessary sense of loss instead of a sense of accomplishment for time well spent. I now understand all of those poems by Frost and Wordsworth and whoever else lamented over the passing of their youth, of quieter days.
One moment, Joe and I are young college students getting into bar fights, pushing the envelope of decency, and praying we get into medical school. The next he’s taking the liver from a brain-dead child and putting it into another, and I’m telling a son that Mom or Dad has died. I think we both look at each other and wonder, “How in the hell did we get here?” It is beyond surreal; it approaches mystical proportions. And when we sit on my back porch and watch our kids play together, look up at the immensity of a starry night, it just seems to make sense; things just seem right . . . like there’s a plan.
Chapter Six
Stay for Breakfast, Mr. Brown
I liked him immediately when I first met him. I can’t explain why. There was just something very peaceful, honest, and humble in his demeanor. He was covered with paint and drywall dust that matched his grey hair. Dressed in work clothes, it was obvious that he was a laborer, probably in construction. He told me that he had retired from Allison or Cummings Engine—I can’t recall which, or maybe it was Chrysler. He had a cut on his hand that needed sutures. We carried on with small talk as I anesthetized his hand and cleaned his wound. I slowly placed the sutures so as to have more time to talk with him. There was something about him. He calmed my spirit. He told me that he did home repair, drywall, and painting to help pay the bills and so he could buy nice things for his grandchildren. It just so happened I needed my garage painted and some drywall repair. He gave me his card and we set a time for him to come out and give a bid on the project. The quote was ridiculously fair; my wife liked him and he was hired on the spot. Since we were leaving on vacation, we gave him a key to the garage, completely trusting that this man whom we hardly knew would take good care of our home.
When we returned, the garage was nicer than my house; I wanted to move the couch and TV out there but my wife drew the line there. After that, we told him not to take any jobs for the near future since he was going to be working at our home for a while. He painted the kids’ rooms, the hallways, and the wood trim. He was slow and meticulous, a rare breed of handyman who took excessive pride in his work, paid attention to detail, sharpened all edges, and straightened all lines. We shared sodas on the back porch. He would talk with reverence about his wife, his children, and especially his daughter who was due to have twins. He smiled so broadly when he spoke about his family and the pending birth of his grandchildren that it moved air. He seemed able to fix anything from a door hinge to simple electrical wiring to a broken window. I imagine that as a father he could have fixed broken hearts, hurt feelings, and injured pride with the same degree of skill. He got a kick out of my young sons, and they seemed to take to him. My oldest son Max would sit with him and tell in detail just how he wanted his room painted. He liked Mr. Brown, who even let him help out a bit. He soon became a fixture around the house, and if he had only eaten a bagel that morning, he might be alive today.
All of us walk through life with ‘what if’ stories. And I know I’ve been harping on this theme, but it’s essential to my search for answers. So, what if we had been there five minutes early, or two minutes late? What if I had been driving with him, or had been eating lunch with her that day? What if I had been sitting there, or walking the same way back to the office? What if? I think ‘what if’ stories are not so much near misses: they are celestial slaps upside the head from God. They are the Friday-at-noon civil defense alarms of life that jolt us back to reality. For others, unfortunately, they are tragedies that leave us asking why them, not me; why him, not her? I don’t believe in fate per se. I think there are just so many of us moving around so quickly that it is inevitable that on occasion we collide with each other, with nature, or just with ourselves at times. God gives us the rule book: a mind, heart, and soul; the rest is up to us.
‘What if’ questions are the source of so much despair in the ER, and the cause of so much grief in our daily lives, that we should wear a Pavlovian shock collar to jolt us every time those two words pop in our heads. What if I had only insisted he come to the ER for his chest pain, what if I stuck to my guns and took away the keys—what if, what if, and what if?
When I was in fourth grade my family and I were driving back from Chicago on I-65 in northern Indiana just outside of Monticello. Dad and Mom were in the front seat. My g
randma sat in the middle seat, while my sisters played with their Barbie dolls in the back seat. I lay in the back of our white Ford ranch wagon, tucked in amongst the luggage. It was raining very hard, and for a while, thick greasy rain coated the windshield, and then it suddenly stopped. The sky was dark with an undulating deep green canopy of clouds, and the air was very still. I stared out the window, noticing how one patch of sky a few hundred yards off to the side of the car was churning about. It was so odd and beautiful at the same time, just one patch on still sky. The next moment, a monster in the form of a giant tornado dropped from the sky perhaps 300 yards from the side of our car. I screamed and pointed at our soon-to-be executioner; my family erupted in panic and the car shook from the deafening roar. We were the last car to make it past Monticello on
I-65. The tornado devastated the town, and if I recall correctly, numerous people were killed. “What if we had left the hotel thirty seconds later?” I ask myself each time I recall this episode. The answer: we might just have well been hit by a truck at the toll road. We ruminate and we ponder on these near misses ad nauseam, and the reality is we will never really know, or should know.
Part of me believes that Mr. Brown died because he didn’t eat a bagel. He was not quite finished with the paint job in my son’s room; there was a bit of trim molding to touch up, but he had to get to Missouri or Illinois or somewhere to do some painting for a relative; who, in turn, was going to repair his personal home computer. He thus had all of his paint supplies, mineral spirits, and turpentine in the back of the van. He asked cautiously if he could get paid, even though he had only a small amount of work left to do.
“Of course,” I said, having no doubt he would finish the job at a later date, no doubt whatsoever. I paid him about $500; he stopped at my bank, cashed the check, and hopped onto I-70 heading toward Illinois. He slowed down for a traffic jam on the interstate and was promptly hit from behind by a huge semi-truck that had failed to notice the slowed-down traffic. The van exploded and Mr. Brown died instantly: He was burned beyond recognition.
What if Mr. Brown had eaten the bagel or accepted the cup of coffee that I had offered him that morning? The truck most certainly would have been in front of him, and perhaps then this accident would not have happened. Or, perhaps the truck would have run into a family of six coming back from Chicago, killing them instantly, including two little girls playing with Barbies in the back seat. I have no doubt that Mr. Brown would not have wanted to change places with that family; he certainly would have preferred that God take him instead.
Though we hardly knew him, Sheryl and I went to his funeral, where we met his family. We learned he was a decorated Vietnam veteran and a good, honest churchgoing man, who loved his family dearly. My oldest son Max wrote Mr. Brown a note telling him how much he liked his new room. If you visit our house, you will notice a small amount of wood trim that has not yet been painted. The lines are simple and straight. It is an honest piece of wood, a noon alarm, a reminder of how thankful I am to be on this earth, and also how thankful I am to have known this gentle man even for a short time.
But I have figured out the answer to some ‘what if’ questions, though. What if we never learned from our near misses, our noontime civil defense alarms? What if we failed to appreciate a gentle moment, the smile of a child, or the feeling of fresh air upon our faces? What if we failed to tell our friends and family how much we love them? Well, that would be a real tragedy.
Chapter Seven
“There’s a Cockroach in My Ear”
Now, before you think it’s funny, trust me, it isn’t. Anyone who has ever had a cockroach or any other bug in their ear can tell you it is horrifically painful. Picture that little insect with its sharp, hairy claws, replete with hooks and nails to allow it to climb up vertical surfaces, scraping and ripping at your eardrum. Now you get the picture. There you are, asleep on your couch without a care in the world, and the little vermin climbs up your shirt, across your hair, and sees a nice little tunnel to snuggle in. Next thing you know you feel like someone has driven an ice pick into your ear. So when the woman came into the ER with the chief complaint of a cockroach in her ear, I rushed backed to her room, ready to alleviate her discomfort. Instead of finding an ear full of insect, I found a can full of worms.
“Quick, get it out!” she yelled, grabbing at her ear. “It’s a cockroach, it crawled in my ear.” I grabbed the otoscope from the wall along with a set of alligator forceps. “Calm down, slow your breathing…I’ll get it out.” I laid her back on the bed and turned her head to the side, adjusted the light, and prepared to come face to face with the vile bag of segmented, antennae-bearing, bacteria-laden, kingdom animalia, phylum insecta. To my surprise, all I saw was the pearly white luminescence of a pristine eardrum glistening on the end of a completely clear ear canal. There was not even a small ball of wax present.
“Uhhhhh, it’s this ear, right?” I asked, backing away from her head briefly.
“Yes, yes!” she screamed. “Get it out…get it out.”
I slowly approached her ear again, looking around to see if maybe it had crawled out prior to my exam. I looked around her scalp to see if maybe I missed shingles or something else. I slowly pulled her ear back and again looked deep into her ear canal. Again, I was met with nothing but a perfect, non-inflamed, completely benign, normal, everyday, good old working eardrum. “Ma’am, I’ve got good news; there is nothing there. I bet it already crawled out.” I figured that she would be completely comforted by this fact, but I was wrong.
“Listen, you idiot; there is a cockroach in my ear…where did you go to medical school? How hard is it for you to see that there is a cockroach in my ear? You are not looking in the right place, dammit. Get me someone else who knows what they are doing.”
I maintained my cool and avoided the trap of getting angry at my patient. “Ma’am, let me look again. Perhaps I missed something, but it’s not like it can hide from me in there. The ear is like looking into a thimble; either something is in there or it’s not…but let me check again.” I slowly looked into her ear, spending a good deal of time so as not to appear rushed, and rattled off the anatomy: “The canal looks great, no rash, no lesions…good-looking ear drum, no fluid, pearly white…that’s good…great light, great…nope…nope…looks really good, ma’am. Great news, I think it probably crawled out.”
“You may be the worse doctor I have ever met…how you cannot see the cockroach in my ear is beyond me. I want to talk to your boss now! You’re a moron.”
That’s when I said it…it couldn’t be helped. “Ma’am, lay back and let me look again.” I turned her head and looked into her other ear.
“What the hell are you looking there? It’s the other ear, you idiot,” she responded.
“Ma’am, I’m just making sure it didn’t crawl through to the other side,” I said with a big, sarcastic smile on my face. With that she jumped out of the bed and stormed out of the ER. A few days later I received a copy of the patient complaint from hospital administration called in by the patient. It described me as being condescending and incompetent, and not taking this patient’s concern seriously.
My dear friend Joe always tells me, “If you never say it, you don’t have to apologize for it.” I truly believe that God has a sense of humor. If he didn’t, why would he have created the anteater, the dung beetle, reality TV, and the ‘thigh-master’? I think we are occasionally thrown curve balls in our life just to see how we will respond. I am sure God would have preferred that I put my arm around this woman and do everything in my power to turn her anger into comfort, her oppositional behavior into love. I am certain that he would have wanted me to embrace the golden rule, love thy neighbor and that whole do unto other mantra. And if I had to do it all over again, I would have taken that path…no, come to think of it…who am I kidding? I would have said the same thing…the letter of apology was worth it.
Chapter Eight
A Christmas Story
I grew up
on the east side of Indianapolis. We were the only Jewish family on that side of town, and it was far from a welcoming experience. I knew at a very early age that I was different, and the neighborhood kids let me know it from the outset. In the late 1960s and early 1970s, our city was less than culturally diverse. While we were still feeling the pains and the turmoil around the deaths of Martin, Malcolm, Bobby, and Jack, we still did not welcome a sense of cultural diversity into our small corner of the world. I recalled being called “Christ killer”, “Jew boy”, “kike”, and other anti-Semitic slurs from children my same age, who were only at fault for being born in an era of ethnic bigotry.
I remember with great clarity the first time I met an African-American child in my school, a product of busing to integrate our school system and bring a sense of community balance. I recall two young Vietnamese refugees who somehow found their way to our grade school, exposing us to the realities of war and bringing the realization that there was a whole world of non-English speaking people out there. And I remember thinking that, with each of these new foreign faces, somehow they would take the pressure off of me, but it never happened.
Christmas would roll around and my parents would beg me not to tell the other children that Santa was not real, which was like asking a precocious kid like me not to touch the chocolate cake. Besides, I had to teach a lesson to all those who called me names and teased me about not eating the ham sandwiches and pigs in a blanket at lunch.
“Your mom and dad hide your presents in the closet, in the trunk of the car, or under their beds, and then bring them out when you’re asleep . . . you idiots!”
“You’re just jealous because Santa Claus doesn’t come to your house ’cause you’re a Jew.” This was usually accompanied by profound crying, a quick run home, and a choreographed “you killed Jesus” on their return.
The Patient in Room Nine Says He's God Page 5