The surgeon

by Wilfred Charles Heinz

  "The rent is fifteen dollars a month," Mrs. Koeppler said, "and no cooking in the room."

  "Of course not," he said. "I get all my meals at the hospital."

  After he had been there one month Pete Church called him into his office. Pete Church was a tall, pale-skinned, white-haired aristocrat with excellent facial architecture and a soft, even voice that never evidenced emotion.

  "Dr. Carter," he said, "the executive committee of this institution informs me that, due to the straitened economic circumstances in which this establishment now finds itself, it will no longer be able to supply meals to the research fellows. This involves you."

  "Yes, sir."

  "In that I now find I can't live up to my contract with you, I thought I'd tell you this myself. I'm sorry about it, and I'll be glad to help you get any position that might interest you in another university or another hospital. I'll give you the highest recommendation, but if you can afford to pay your own way, I'd like to have you stay."

  "I can swing it," he said.

  "Good. I'm glad to hear that. Meanwhile, I'll keep you in mind for the first job that opens up and that you're qualified to handle."

  "Thank you, sir," he said. "I'd appreciate that."

  He wrote to his sister. After weighing the request for two weeks she wrote back that she would increase his loan to $35 a month. This left him, when he had paid his rent, $20 a month, or $5.00 a week, on which to eat and otherwise live.

  He bought a second-hand one-burner electric grill, a coffee pot, a coffee cup, a plate, a knife, a spoon and fork. He smuggled them into his room that night, and from a wire coat hanger he fashioned a rack that would fit over the burner and hold two pieces of toast. This equipment he kept locked in the foot locker under his cot and each night, on his way home, he bought two eggs and, when he needed them, a loaf of bread or a pound of coffee.

  "Every morning I'd put the water in the coffee pot and the eggs in the water," he was to recount years later. "Then I'd put the coffee in, and when the water started to boil I'd have soft-boiled eggs. For seven months I never saw a boiled egg that didn't have a coffee-colored shell."

  At noon he would be working on pulmonary physiology in the dog lab. When the others would take off their smocks and wash for lunch he would refuse their invitations.

  "I didn't have the guts," he was to say, "to tell them I couldn't afford lunch. I'd say: 'No thanks. I want to finish this, and I'm not hungry anyway.' I got the reputation of being a real beaver."

  Once a week, at 5 o'clock in the afternoon, there would be a conference in Pete Church's consultation room, and they would serve coffee and crackers. By exerting admirable self-control he would limit himself to partaking only as much as the others, and for his one big meal, at 6:30, he would sit at a counter in a dirty, yellow-lighted, smoky, acrid-with-the-smell-of-frying-fat lunch wagon and have either Hungarian goulash or frankfurters and beans. They both cost thirty cents.

  He subsisted like this for seven months. His stomach shrank, he lost fifteen pounds and, because his diet lacked the vitamins A to C to be found in green vegetables, pimples erupted over his body.

  "Then I got an occasional job holding heads for bronchoscopies," he was to say. "Thoracic surgery was in its infancy then, and the nose-and-throat men did the bronchoscoping. I'd sit on a stool by the patient's head, and we had a stainless-steel mouth-bite, or clip. It fitted over the middle finger of your hand, and you'd bring your arm across under the patient's chin and bend your hand back and clip this over the lower mouth. You'd hold the head rigid and the mouth open that way."

  The nose-and-throat man, for whom he worked most often, wore glasses. It was a stroke of luck, for as he assisted, sitting bent over and holding the head and lower jaw, he discovered he could trace the progress of the bronchoscope, with its small light at the bottom, down through the trachea and into the bronchi, by watching the reflection in the nose-and-throat man's glasses.

  "He was getting fifty dollars for a bronchoscopy," he was to say, "and I got two dollars for holding the head. He'd do six in an afternoon, so I'd get twelve dollars, and that money looked so good to me I felt like I was stealing."

  The first big meal he bought himself he lost before he got back to his room. He was ashamed to go back immediately to the same restaurant and order again, so he went to another. In those first two days he lost every meal he ate, until his stomach and his digestive system became accustomed again to a plenitude of food.

  Two months later, when one of the interns contracted tuberculosis, he applied for the opening. He got the appointment, but the bronchoscope, as he was to say, may have saved his professional life.

  XII

  "Dr. Carter," the nurse said, "would you like to pick your forceps?"

  She was standing in the door of the instrument room. She had seen him get off the elevator and walk down the hall toward her, opening the starched and ironed white cap and turning the bottom edge up about a half-inch so that it would fit flat on his head and not have a tufted ridge along the top nor come down to his ears.

  "Sure," he said, putting on the cap and smoothing it and following her into the room. How are you?"

  "I'm fine, sir."

  He looked at the dozen forceps lying in the slots of the wooden rack on the counter, each about sixteen inches long, slender and delicate, designed to be passed down through the bronchoscope and with the scissor-like handles at one end activating the small jaws at the other. If it should actually be a piece of soft hamburger meat, he was thinking, he would need the biopsy forceps with the flat spoons on the end, but if it turned out to be a sliver of bone or a piece of gristle he might get it more easily with a pair with tonglike jaws.

  "I haven't the vaguest idea what Dr. Stanczyk is doing," he heard one of the two nurses in the back of the room saying, "but that orderly was down here again for another pint of O-Negative."

  "I know," the other said. "The Red Cross dug up two donors."

  "I'll need those flat, foreign-body forceps," he said, pointing, "and that one there with the smaller tongs."

  "Yes, sir," the nurse said.

  "Thanks," he said.

  "Excuse me, Doctor," the nurse said, "but what is Dr. Stanczyk doing?"

  "I don't know," he said. "I haven't looked in."

  "I just wondered," she said.

  When he walked out into the hall he saw Jim Branson, big and blond and in his scrub suit, standing by the door of the emergency O.R. He was talking with the young intern named Darrow, and when they saw him coming they stopped talking and waited for him to say something.

  "How's our eminent thoracic resident?" he said.

  "Tired," Branson said. "Do you know Paul Darrow here?"

  "Sure," he said, nodding to Darrow. "We were just talking upstairs."

  "That's right," Darrow said.

  "Have you seen Benjamin Davies?" Branson said.

  "Yes."

  "How is he now?"

  "I put him back on the morphine."

  "Did you see his wife and daughter?"

  "Yes. I told them what to expect. I also told Mrs. Kirk's husband."

  "You've had a great morning already, Doctor," Branson said.

  "You look like you had a great night."

  "I did. I'm really bushed."

  "What happened?"

  "A lot of things. I don't want to bore you with most of it, but I almost called you about 2 a.m."

  "Oh?"

  "We got a guy, twenty-five years old, and his girl friend out of a car accident. They were coming home from a party right after midnight, and for some reason hit a fire hydrant. The girl wasn't bad—concussion, broken nose, and simple fracture in her right shoulder—but the boy friend was in shock, and when I examined him I could feel his fourth and fifth ribs moving here in front. You know how you can feel the broken ends click under your fingertips?"

  "Yes."

  "He probably hit the steering wheel."

  "Undoubtedly."

  "When he came in, his
blood pressure was good—130 over 70. When I looked at the X-rays to check the rib fractures I saw his heart shadow was enlarged."

  Cardiac tamponade, he was thinking, listening, and I wonder if he spotted it right away.

  "This scared me," Branson was saying, "and when I took his blood pressure again it was now 110 over 90 in less than an hour."

  It was cardiac tamponade all right, he was thinking and meaning that he was sure now that there had been bleeding within the pericardial sac that contains the heart. Because the blood was compressing it, the heart couldn't fill normally.

  "Were the jugular veins more prominent?" he said, knowing that they would be distended due to the blood's inability to flow easily back into the heart.

  "Definitely," Branson said.

  "So what was your diagnosis?"

  "Cardiac tamponade."

  "Good."

  "So I didn't know whether to call you 01 not. I still don't know whether I did the right thing to tackle it myself."

  "I can answer that. How's the patient?"

  "He's fine," Bronson said, smiling. "In fact he pulled out of it great."

  "Then you did the right thing. Congratulations."

  "Thanks," Bronson said, enjoying it now. "Anyway, when I opened him and got in there the sac was so full of blood it was distended like a balloon. So . . ."

  The left ventricle, he was thinking, listening to Bronson, thirty-one and a winner, forgetting his fatigue now and feeling like he might cure the world. One of those splintered ribs stabbed into the left ventricle.

  ". . . with the blood gushing it took me a little while to locate the source. When I finally found that it was a stab wound from a jagged rib that had penetrated the left ventricle I got my finger on it and closed it with two stitches and . . ."

  And it is a great feeling, he was thinking, and the shame of it is that, as you get older, you experience it less and less.

  ". . . and after that," Bronson said, "we were just coasting home."

  "So you see, Dr. Darrow," he said to the intern, who had been just standing there but following all this and nodding his head, "Dr. Bronson made an excellent decision for two reasons. I got my sleep, and he got an important win."

  "I see," Darrow said.

  "What Dr. Bronson and I know, however, is that the decision of whether or not to call the attending surgeon in the middle of the night sometimes isn't an easy one."

  "I'll say," Bronson said. "If you call the attending out of bed or even away from a dinner party and it turns out to be something you could have handled yourself, you feel like a damn fool."

  "In other words," he said, "it sometimes requires more courage to admit you're in doubt and to call the attending surgeon than to proceed on your own."

  "I understand," Darrow said, nodding.

  "But Dr. Carter doesn't seem to mind coming in," Bronson said, "no matter when you call him."

  I'm glad I give that impression, he thought, but I hope he doesn't start buttering me and I wish they'd get Mrs. Brower down here and I wish I could get to Mr. Scheller. If it's actually in his vena cava and I do that graft I'll feel as good as Bronson.

  "I assisted Dr. Carter a couple of months ago," Bronson was saying to Darrow, "on a case I was glad I wasn't handling alone at 3 o'clock in the morning."

  "What one was that?" he said to Bronson.

  "That pulmonary artery," Bronson said, and then to Darrow: "The tie had slipped off the pulmonary artery, with the heart already exposed and the blood concealing the opening. You know?"

  Well at least he's picking a good one, he thought. I liked that recovery myself.

  "So it was impossible to locate the source," Bronson was saying. "You couldn't see a thing, so Dr. Carter grabbed the heart with both hands and stopped it to arrest the bleeding. Dr. Robinson emptied the field with the tonsil sucker and put the clamp on the opening. Then Dr. Carter massaged the heart for about ten seconds to revive it, and the whole thing didn't take more than half a minute."

  "I'd like to have seen that," Darrow said, nodding.

  "It was great," Bronson said to Darrow. "You get a whole new concept, because although a patient is technically declared dead when the heart stops, life continues until the oxygen in the body is used up by the cells. You know?"

  "I know."

  "Here's my patient now," he said.

  The orderly had pushed the bed off the elevator, and now he was pushing it toward them. The nurse-anesthetist named Jasperson was walking behind the orderly, and Mrs. Brower was lying flat on the bed, the sheet over her and only her head showing.

  "How are you now?" he said to her.

  "I was just saying," she said, looking up at him with that small-girl look they acquire with fear, "that I'll never eat another hamburger again. I never will."

  "Of course you will," he said. "This is nothing. You won't feel a thing, and it will be all over in a few minutes."

  "I never will," she was saying. Darrow was holding the door open and Bronson and the nurse-anesthetist named Jasperson were helping the orderly maneuver the bed into the room.

  "Now we just want you to slide over onto this table," Jasperson said to her. "Sheet and all."

  They had positioned the bed next to the operating table, and Bronson had lowered the table to the level of the mattress on the bed.

  "I just feel so foolish, Doctor," Mrs. Brower was saying, on the table and her left arm out along the arm board. "I know you're not going to find anything down there and I'll feel so foolish."

  "We'd all be fools if we didn't look. You'll be glad we did this."

  "Now all you're going to feel," Jasperson said, "is a little pin-stick. It won't hurt, and that's all you'll feel."

  "My heart is beating like mad," Mrs. Brower said. "It feels like it's going to burst."

  "You're going to be all right," Jasperson said.

  She had found the ante-cubital vein in front of the elbow on the arm board. When she inserted the needle Mrs. Brower winced just once.

  "You see," Jasperson said, starting the Pentothal. "That wasn't bad. Now just keep your eyes open."

  "She's giving you a cocktail," he said to Mrs. Brower. "What you're getting is a frozen daiquiri."

  "Just keep your eyes open," Jasperson said, watching her.

  "Do you feel sleepy?" he said.

  "Yes," Mrs. Brower said, her eyelids fluttering and then closing. "I feel . . ."

  He took the rolled white mask out of the pocket of his smock and took off his smock and tossed it on a stool. He shook out the mask and tied the bottom strings around his neck. He brought the mask up over his mouth and nose and knotted the top strings above his cap.

  Branson and Darrow and the nurse were adjusting the Emerson chest respirator, the semi-clear plastic shell with sponge-rubber flanges on its edges that fits over the front of the chest like a breastplate. From its top a hose, the size and composition of a vacuum-cleaner hose, runs to a suction pump, and it would breathe for Mrs. Brower.

  Mrs. Brower would be unable to breathe on her own because of the curare Jasperson would introduce into her vein to paralyze her skeletal muscles and her diaphragm. It is a derivative of the natural drug with which the Amazon Indians poisoned the heads of their arrows, and so the automatic respirator would replace, with its even, alternating rhythm, her muscular function.

  "How's she doing?" he said. He had put on the green operating gown, untied and hanging loose in back, and he was pulling on the thin brown latex gloves.

  "Fine," Jasperson said.

  "Shall I tie that for you, Doctor?" Darrow said, referring to the gown.

  "Yes, please," he said, "although this will only take a couple of minutes."

  How many bronchoscopies he had done in twenty years he would never know, but by now they must have numbered four thousand. Almost daily, and sometimes three or four times a day, he had looked into lungs, searching for disease, into the bronchi or the esophagus looking for chicken bones, pennies, nickels, dimes, peanuts, dental bridges, o
r the small gold crucifix that the baby pulled off the chain around her neck and swallowed.

  "We're all set here, Doctor," Bronson said.

  "Good."

  He walked over to the stool at the head of the table and moved it up with his left foot and sat down. Mrs. Brower's head was level with the lower half of his chest.

  And she's too far down the table, he thought. I'll wait until they get the table up before I show them, and then maybe they'll remember it. Bronson has seen me do enough of them so he should know it, if he weren't so tired.