Acceptable Losses

by Irwin Shaw

  As he had promised, Dr. Levine came in the next morning with the new tube. “First,” he said, “we’ll take this gadget out.” He took hold of the slender plastic tube that was attached to the bag of nutritive powder on a steel stand above Damon’s head that led down through his nose into his stomach. “Dr. Zinfandel says it’s about time you started to eat normally.”

  Damon watched him fearfully. He was sure he would not be able to eat normally and would run the risk of starving to death. But Dr. Levine seemed confident and slid the tube out swiftly and let it dangle from the sack on the steel stand. Then he took up the new metal tube through which he would breathe and occasionally, according to the doctor, be able to make coherent sounds that might be interpreted as speech, to connect him with the rest of the human race. “This will hurt a little,” he said, “maybe a lot. But it’s over quickly and if I gave you an anesthetic, the needle would hurt more.” Then he reached in unceremoniously and deftly picked out the old, pus-encrusted tube and slid in the new one. The doctor had been right about its hurting, but he tried not to show it on his face because Sheila and Oliver were in the room, watching anxiously.

  The new curved metal tube felt peculiar in his throat. “Now …” Dr. Levine put his finger over the hole in the tube, like a flute player, “take a deep breath and then try to talk.”

  Damon took a deep breath. He realized he was frightened. Despite what the doctor had said, he was sure he could not speak. But he tried. To his surprise a sound came out. Then he said clearly, although his voice sounded metallic and strange in his ears, “Get me out of here.”

  Oliver and Sheila laughed. Sheila’s laugh was hysterically high.

  “Now try again,” Dr. Levine said.

  Damon shook his head. He had said enough for one day.

  Sheila was sitting in Dr. Zinfandel’s outer office. She had had her hair done and put on fresh clothing to replace the rumpled sweater and skirt that she had not bothered to change for days. She wanted to seem composed and firmly in control of herself for the conversation that she knew was to come. Zinfandel’s secretary said, “You can go in now.” Sheila stood, brushed the creases from her skirt, strode purposefully into the inner office, where Zinfandel was still bent over the chart on his desk of a patient who had just left the room. He looked harried and depleted. Sheila knew that he arrived at the hospital each morning at five and often was still there at eleven at night. He had mentioned a wife and two children, and Sheila pitied them, although she had never seen any signs of their existence and there were no family photographs on Zinfandel’s desk. “He is a maniac of healing,” Oliver had said, and Sheila agreed that the description fit the emaciated, loping man.

  Zinfandel looked up, smiled briefly, his eyes red-rimmed, his brain desperately crowded with a thousand uncured ailments. “Please sit down,” he said. “I’m glad we have a moment to talk to each other. You know what I have to say.”

  “Yes,” Sheila said. “And I think you’re wrong.”

  Zinfandel sighed. “I can’t take him out of Intensive Care, Mrs. Damon. Your husband is still a very sick man. His life is hanging in the balance. I do not lie or dissemble with my patients or with their families, as you well know. True, patients who have to endure long periods in the unit have a tendency to fall into a deep mental depression. But in the case of your husband it is his body we must save first. We have our professional principles, our professional experience.”

  “I appreciate all that, Doctor,” Sheila said, trying to keep her voice calm, “but I know some things, too, after living with the man for so many years. He’s at the lowest ebb of his life. He’s lost so much weight that he’s just skin and bones. He’s still losing pounds daily. He refuses to eat …”

  “The formula powder I prescribed, mixed with milk …”

  “I know all about the formula. You can prescribe it, but he takes one sip and he turns his head to the wall. I bring him delicacies … smoked salmon, caviar, soups, fruits … All he takes is pineapple juice. How long do you think he can survive on pineapple juice? He’s in a state of fatalistic lethargy. He’s looking for an excuse to die.”

  “You exaggerate, Mrs. Damon.”

  “I want him moved from that damned Intensive Care Unit, where he’s surrounded by dying people, by the machines and paraphernalia of death, put him back in his own room, make any move, any, any change. He’s like a wild animal in captivity there, like those animals who refuse to eat behind bars and prefer to lie down and die.”

  “It’s impossible to move him,” Zinfandel said crisply. “He needs the machines, the respirator, the oxygen, the monitors … his heart, his pulse, his blood pressure … his red blood count, which continues to be dangerously low. There may be an emergency at any time. He needs moment-by-moment attention. The ICU is the only place where we can guarantee it. You must understand, Mrs. Damon, we are responsible for his life …”

  “So am I,” Sheila said. “And he’s giving up on it where he is now.”

  “I understand your fears,” Zinfandel said gently. “Yours is a subjective viewpoint. We can’t permit ourselves that luxury. We have to make our decisions on an objective basis. Please trust us.”

  “I don’t,” Sheila said. She stood up and strode from the office.

  When Oliver came into the ICU waiting room that evening after work, which he did every evening, he could see that Sheila was much more troubled than when he had left her the night before. “What is it?” he asked.

  “I have to talk to you.” Sheila looked around her. There were two other visitors in the room and the chief doctor in overall direction of the unit was whispering intently to one of them in a corner. “I don’t want to talk here. Let’s go out and get a cup of coffee.”

  “Is he worse?” Oliver asked anxiously.

  “He’s worse every day,” Sheila said and didn’t say anything more until they were seated at a table in the small cafe near the hospital where they sometimes took their meals and which was frequented by the nurses on their breaks from duty. There was a group of three nurses now near the entrance, and Sheila led Oliver to a table at the rear, where they were alone.

  “What’s going on?” Oliver asked. His face had been troubled ever since the shooting, but it was intensified now. To Sheila he looked like a small boy who had been lost in a crowd by his mother and was trying to keep from crying while he searched the faces around him for her.

  “Something peculiar,” Sheila said. “And I don’t know just what it is.” Then she told him about the conversation with Zinfandel. “If Roger is losing ground every day,” she said, “it only makes sense to try to do something else. But the doctors’re stonewalling me. They pretend to listen, but they don’t. Have you any ideas?”

  Oliver’s face twitched uncomfortably and he made some incomprehensive noises deep in his throat. “Well,” he said at last, “I didn’t want to worry you, but …”

  “But what?”

  “This is only a guess …” He stopped again.

  “Go on, Oliver,” Sheila said impatiently. “Don’t beat around the bush.”

  “They’re spreading the responsibility.”

  “Who’s spreading the responsibility. What responsibility?” Sheila had difficulty keeping her voice down.

  “All of them. The doctors. Sheila, I was told this in the deepest confidence.”

  “Stop talking in riddles, Oliver; for Christ’s sake.”

  “Well, you know that pretty blond nurse, Penny?”

  “Yes.”

  “I’ve had a meal or two with her.” He was blushing. “She’s highly intelligent, aside from being most attrac—”

  “No descriptions,” Sheila said brutally. “Go on.”

  “You remember, Roger wrote you once asking you to get hold of a lawyer?”

  “Of course, I remember.”

  “Well, somebody read it before they gave it to you. Or one of them—the doctors, I mean—did. He told the others, I guess. They think it’s because you and Roger are
going to sue Rogarth, the hospital, everybody, for malpractice. Millions of dollars.”

  “Roger never would sue anybody in his life. Every time he’s read in the papers about one of those suits, he’s raged; he’s told me again and again it’s ruining the practice of medicine in America.”

  “You know that,” Oliver said. “I know that. They don’t. At least according to Penny they don’t. They’re scared witless. There’s one more thing she told me—Penny.”

  “What’s that?”

  Oliver jerked his head around to make sure nobody had come in quietly behind him. “When they brought him into the ICU after the operation, one of the doctors on duty said, ‘Another one of Rogarth’s hatchet jobs.’”

  “Oh, God,” Sheila said. Then accusingly, “Your own brother told you he was one of the best in the country.”

  “I’m sorry,” Oliver said apologetically. “If he made a mistake, it was an honest one. If my brother said Rogarth was one of the best in the country, that was what he’d heard. Maybe Rogarth was once. Maybe never,” Oliver said, shrugging. “Reputations. There’re writers Roger wouldn’t touch with a ten-foot pole who’ve been getting great reviews for twenty years. As for doctors—it’s a closed corporation. To put it mildly, they’re not in the habit of rapping each other. And there’s one other thing Penny told me. With the log of the operation when he was sent to the ICU, there were three letters on the top page.” He hesitated. “I don’t know if I should tell you this, Sheila.”

  “What three letters?” Her tone was fierce.

  “CYA,” Oliver said.

  Sheila frowned. “What does that mean?”

  “Penny says it means ‘cover your ass.’” Oliver sighed, as though he had delivered himself of an enormous burden. “They knew there’d been a big mistake and everyone was being warned to close ranks, they had to hide it.”

  Sheila closed her eyes, then covered them with her hands. When she took her hands down, her face was stony. “The pigs,” she said quietly. “The cynical pigs.”

  “You won’t say anything about this, will you?” Oliver asked anxiously. “If they trace it to Penny, they’ll kick her out in two minutes.”

  “Don’t worry about Penny. I’ll handle it my own way. Roger will be out of that goddamn place tomorrow. Why didn’t you tell me this sooner?”

  “What good would it have done? They’re afraid now. How would it help Roger if they also were furious?”

  “Oliver,” Sheila said, “I can’t go back to the hospital tonight. I don’t know what I’d do or say. I’d like you to take me out to a nice restaurant, full of healthy people, who’re enjoying a good meal and not plotting against anybody and buy me a couple of drinks and a fine bottle of wine. Unless you have a date with the pretty Penny.”

  Oliver blushed again. “We just happened to be going down in the elevator together,” he said, flustered, “and she was coming off her shift and it was dinnertime and—”

  “Don’t apologize,” Sheila said. She smiled. “Just because Roger’s in the hospital doesn’t mean a man can’t look at a pretty girl once in a while. Just go up and if Roger’s awake, which isn’t likely, tell him you insisted I take a night off with you because the hospital was getting me down. He’ll understand. There’s a saloon down the block. I’ll be waiting at the bar for you. Don’t be shocked if I’m drunk by the time you get there.”

  When Zinfandel made his usual visit at six the next morning, Sheila was there, sitting grimly in the little easy chair near the window. Zinfandel, as always on his morning rounds, was cheerful and lively. He looked at the nurse’s chart at the foot of the bed, touched Damon’s bare toes, which were no longer black, and asked the patient how he felt.

  Damon, who by now hated the man whose presence at dawn every morning announced the beginning of another endless painful day, said, “Lousy.”

  Zinfandel smiled, as though this show of spirit demonstrated that Damon was on the road to recovery. “Your toes are still icy,” he said, making it sound that he considered the fact a sign of bad faith on Damon’s part.

  “Sometimes they freeze,” Damon said. “Sometimes—like now—they feel as though they’re on fire.”

  “It may be a touch of gout,” Zinfandel said.

  “For Christ’s sake, I haven’t had a drop of booze for more than a month,” Damon said.

  “One thing can have nothing to do with the other. I’ll have somebody take some blood this morning and we’ll run some tests.”

  Damon groaned. “Do you think you can find someone who actually knows where the veins in the human body can be found? The plumbers you’ve been sending in here have been stabbing me ten times in a row to get two drops of blood.”

  “Your veins—” Zinfandel said sadly. “I don’t have to tell you again about your veins.” He hung the chart back on the foot of the bed after making a notation on it and turned to go out.

  Sheila, who had not greeted the doctor or said a word while he was in the room, stood up. “I’d like a word with you,” she said. “Outside.” She followed him to the corridor.

  “I hope it won’t take too long,” Zinfandel said. “I’m behind schedule as it is.”

  “I want Mr. Damon moved to a private room,” Sheila said. “Today.”

  “Impossible. I’ve already explained that—”

  “If he isn’t moved,” Sheila said flatly, “I’m going to our lawyer and I’m getting a court writ to get him out of here and I’m putting him in another hospital.” She could see the little flicker in the doctor’s pale eyes at the word lawyer.

  “I’ll see what I can do,” Zinfandel said.

  “You will not see what you can do. You will have him moved by three o’clock this afternoon.”

  “Mrs. Damon,” Zinfandel said, “you keep forcing me to act in a way that runs counter to all my training and principles. You dictate treatment, you listen to nurses’ gossip and confront me with impossible demands. Now you threaten a lawsuit …”

  “Three o’clock this afternoon,” Sheila said, and went back into the room, where Damon was trying to fall back to sleep.

  That morning Damon hallucinated for the last time.

  For a reason that was not explained to him, he was allowed to wander around the ship at will. The ship itself had changed. It was no longer a dingy cargo vessel, but a white-painted ship crowded with passengers. Everybody was busy packing and saying good-bye, because the ship was due shortly to put into port. Without being told, Damon understood that the port was Seattle. Damon also understood that although everybody else was going ashore, he was not to disembark.

  With great blasts of the ship’s horn, the ship was tied up. The nurses, whom he had grown to recognize one from the other and for whom he now realized he had developed a hopeless affection, passed him, no longer clad in white but dressed in charming traveling clothes of all colors, their hair newly done, their young faces carefully made up, their high heels clicking on the decks as they waved cordially at him and departed. Only one nurse stopped to say good-bye to him. It was the prettiest of them all, the one they called Penny. Tears streamed from her deep blue blond-lashed eyes down the angelic face.

  “Why are you crying?” he asked sympathetically.

  “I’m in love with Oliver Gabrielsen,” she said, “and he’s in love with me and he’s married.”

  “Ah, Penny,” he said, “you were born for weeping. You will always weep.”

  “I know,” she said, sobbing. She kissed him, her lips damp and soft, and carrying her bag, went down the gangplank.

  The bull-necked doctor, now dressed in a zippered wind-jacket, with “University of Virginia” lettered on it, stopped in front of Damon. “Well, good-bye, old son,” the doctor said kindly. “Is there anything I can bring back for you from ashore?”

  Damon thought for a moment. “Bring me a Coca-Cola,” he said. “With ice.”

  “It shall be done,” the doctor said, and shook his hand, his grip like steel. Then he, too, went down the gangplank
and Damon had the enormous ship all to himself.

  That afternoon Damon was removed to the private room. Damon didn’t ask Sheila how or why it was done and she did not tell him. The room had a private shower and toilet and using a walker because he could not stand without its support, Damon got to the toilet and sat on it, with a feeling that approached ecstasy. After he had finished on the toilet he heaved himself up, using the walker and looked at himself in the mirror. He had been shaved by the hospital barber before leaving the ICU and the lines of his face were starkly defined. Staring back at him from the mirror was a face he hardly recognized, a face greenish dull white in color, the skin stretched like mottled parchment over sharp bones, the eyes in deep hollows and devoid of all light. They are the eyes of a dead man, Damon thought, then clumsily moving the walker cautiously inches at a time ahead of him, clumped back into the room, where Sheila and the nurse helped him back into the bed, lifting his legs because he didn’t have the strength to do it himself.

  He was pleased to see that there was no clock in the room.

  “I brought the Times,” Sheila said. “Do you want to look at it?”

  Damon nodded. He held the paper in front of him. The date was meaningless to him. The headlines made no sense to him. The language might just as well have been Sanskrit. He let the paper fall on the bedcover. He began to cough violently. The nurse attached the tube and put it down into his lungs through the open hole of the tracheotomy tube low on his throat and switched on the compressed air to drain his lungs. He had become accustomed to the treatment, but this was the first time he realized how painful it was.