by Pamela Grim
You already know how cops get there: that point where everyone, even the innocent, seems to bristle with provocation. You've known about that place theoretically, but you've never been there yourself. Not until today. The fact is, you want to tear that shirt off the guy's back and cram it down his throat.
You look over at the woman, who weighs in somewhere around three hundred pounds. You dread the parting of her massive thighs, and of all those future thighs waiting for you. You grumble a few questions at her and then get ready to do the pelvic exam. That's when you discover that there is…no stool.
You always use a certain stool during pelvic exams. There is only one in the ER like it; it has wheels on it. You had sat on it all morning, but now—and you look all over the room for it—it's gone.
You stalk out of the room into the hallway. There Carol, the charge nurse for the day, is stocking the IV cart.
“Where's my stool?” you shout at her.
“What stool?” she says, not even looking up.
“My pelvic stool.”
“Your pelvic stool?”
“Yes,” you shout and something in the tenor in your voice finally makes her look up. “For pelvic exams, for Christ's sake. What do you think?”
Carol points. “Why don't you use the chair?”
You cannot believe how stupid she is. “That chair has no wheels.” You look around, irritated beyond belief. “I need my stool.”
Carol stands there a moment, hands on her hips. She just looks at you. “Doctor,” she says finally, “get a grip.”
Carol, whom you have known for a million years, has just called you Doctor, a clear early-warning sign that you are being inappropriate. But you can't see that, of course. All you see is a hallway lit with white, hot light, no shadows anywhere, just the brilliant fire of your anger. You turn and storm into the nurses' station. You kick a chair violently out of your way and announce to your startled co-workers, “Goddamn it, I'm not going to do one more pelvic exam until somebody finds my goddamn stool.”
Nobody says anything. The room is silent, so you go on.
“This is ridiculous. I shouldn't have to put up with this.” As you say this, actually shout this, you dimly realize you are gasping for breath. At this point you lift the clipboard you hold in your hand and fling it across the room, where it strikes the wall. When it hits, you hear again that sonic boom of gunfire and you start shaking, just like on the day six months ago when that man pointed a gun at you. In retrospect you realize that things can really happen that way: you get shot at one day and six months later, out of seeming nowhere, you realize that you, too, are as mortal as any of your patients.
After that, it's all over. Everything that happens after this, none of it good, you could have seen reflected in the eyes of the people in the nurses' station that day. All of them knew that—nothing personal—you were losing it. They knew you couldn't take it anymore. They had from where they were sitting a perfect view of your future, the steady road downhill. The only one who couldn't see it at all was you.
You still have that recurrent dream, the one you had the night that patient went wild. There really isn't any action in it; it's mostly a feeling, this terrible feeling of foreboding and of darkness. With the feeling is the image of an old man, that old man, the heroin addict who stood next to the cop that morning. He is just standing there, looking at you. He has one hand raised up toward you.…
That's basically it, that's the dream.…The hand is raised before you, palm flat, as if motioning you to stop. There is actually a visual paradox in this dream; you know that the hand is dead and rotted away, but you can see it is also intact in front of you. Associated with this somehow is something about a room that's all white, and sometimes in the background of the dream there is someone singing a few bars of music. It sounds like the chorus of a pop tune with a single phrase sung again and again. The phrase is “Get over it.” When you hear this, you awake to the sound of sobbing. It always takes a minute, maybe more, before you realize that the person who is sobbing is you.
10
MURRAY
IT HAPPENED SO LONG AGO, I have only a skeleton memory of the story. (I was a young doctor when it happened and was still transfixed by trauma's drama.) To be told, the story has to pick up bits and pieces from other, more recent catastrophes, ones that happened yesterday, for instance. I've had to people it with doctors and nurses I know now, since the only person I remember for sure from the place where this happened was Sheila, the knitting nurse. I remember her only because, unlike the rest of us, who worked off job-related stress by smoking, drinking coffee and picking at our sores, Sheila knitted afghans.
And I remember Murray, the doctor on for the day.
Murray was an attending that year, the last year of my residency. I was in training at “the Mecca,” an elite institution—specializing in liver transplants and functional bowel syndrome-improbably located in the midst of one of the biggest ghettos in America. Upstairs from the ER, great Nobel Prize-winning research was carried out and complex, extremely expensive surgery was performed. Downstairs in the ER, though, we practiced medicine in a war zone.
That summer the streets were on fire in the inner city; the police nominally patrolled the streets during daylight, the gangs ruled the night. This meant that, in addition to the usual domestic type of violence you have in any ER, we saw terrible things: machete slashings, butcher-knife dismemberings, Uzi slayings, cop-versus-bad-guy shootouts, four- or five-year-old kids riddled with bullets and clearly too dead to even think about trying to resuscitate. Bosnia had nothing on this swath of ghetto except maybe a few more land mines and a few less Uzis.
That summer we saw the first wave of the crack epidemic coming through, watched the early stages of destruction of a generation from our unique vantage point. Sometimes we saw crack addicts with acute symptoms: a myocardial infarction in an otherwise healthy thirty-four-year-old man; exacerbation of psychotic symptoms in a schizophrenic. Mostly, though, we saw the crack-heads when they were at the end of the line—badly addicted, broke, strung out. They would come crawling into the ER desperate, begging—please, please, please, help me. And we could give them a sandwich and a couple of telephone numbers to call in the morning.
But far worse than any crackhead were the guys on PCP—phencyclidine—an animal tranquilizer. We would not see these guys later, when they'd hit bottom. We would see them when they were still high. The police would bring someone in, usually chained down because the patient had gone on a rampage. A man high on PCP knows no fear, feels no pain, has the strength of ten and the sensibility of a raging elephant. He can upend a hospital gurney, break out of five-point leather restraints, overcome a herd of large security guys and escape into the night with the kind of grace otherwise only seen in the majorly psychotic. Someone with a bad PCP high is psychotic, hallucinating madly, in a state of aggressive terror. One guy, very high, saw a large dog attacking his mother, so he killed the dog. Only there was no large dog. He had been hallucinating. But his mother was there—he had killed her. The police brought him in, under arrest, of course, because he had a cut on his hand. He kept telling the officers: “Call my mother. She'll bail me out. Call my mother.” One of the officers kept saying in return, “We can't call your mother. You killed your mother.”
“Come on,” the guy would say in reply. “That's not funny.”
There were, back then, the Latin Kings, the Vice Lords, the Disciples, the Spanish Cobras and of course, the legendary El Rukins, among many others. These were the gangs that ruled the Chicago streets. Each gang had a gesture, a symbol. Two fists raised up with forearms crossed, that was the Popes. Their colors were blue and black. Two fingers outstretched and the hand held in a let's-pretend-gun position, that was the Villa Lobos. Their colors: green and black. Colors were always a big thing, a way to mark out territory. That year, though, the cops were cracking down; things had to be really low key. Gangbangers, who used to wear in-your-face bright blue or green jack
ets, now wore regular T-shirts (Snoop Doggy Dog and his “Doggy Style” tour was a favorite imprint) along with their regulation low-slung jeans. Colors would be there unobtrusively, visible only to a special kind of eye: a wrist band, a sweatshirt hood, shoelaces. My very first night in the ER we got three shooting victims (two died) from a drive-by shooting at a local takeout place—Popeyes. Each victim was wearing green shoelaces on his right sneaker only. They were the Insane Deuces taken out by the even more insane El Rukins.
Murray was on the night a sixteen-year-old kid came in all shot up, two bullets in his belly and two in each leg. Just as everyone began to work on him, starting IVs, attaching the monitor leads, the El Rukin who shot the kid to begin with came into the trauma room, shot the boy twice in the head and then disappeared into the night. The police never found him. The kid died, of course, and everyone else was pretty shaken. None more than Murray, though. He talked obsessively about it, reliving every second, over and over and over. The man with the gun, the boy on the table, the expressions on the nurses' faces. All in all, those two minutes just pushed Murray that much farther over the edge.
If that ER was a pressure cooker, then the pressure had gotten to Murray. He was a tall, thin and very nervous man, perpetually possessed by the largest number of facial tics, twitches, verbal mannerisms and idiosyncratic gestures I have ever seen in one person. These were endlessly repeated; he was like an autistic adult. Murray never said no. He said “No, no, no, no, no. Absolutely not, no, never. I mean it, no. You can tell him no, no, no. That's my last word, no.” Or, “I'm just going to tell you once, I only want to say this once, once, do you understand me? Just one time.” He would go in to see a patient and half the time come back out, head down, muttering, “This is senseless, senseless. I'm right here thinking about this and I can't believe how senseless it is.” He would turn to anyone standing near him, a resident, a unit clerk, another patient. “Senseless,” he would tell them. And he would be right; sometimes it was senseless in the extreme: babies with colds for a week brought in by belligerent grandmothers at three in the morning; tanked-to-the-gills, smashed-into-pieces drunk drivers; maced police suspects; I'm-here-for-a-pregnancy-test patients; my-doctor-told-me-to-come-in-right-away-and-that-you-should-give-me-some-Demerol patients; grown men whimpering like babies over sore throats; patients who said, just as you were leaving the room, “Oh, by the way, Doc—I had sex with a hooker last night and so I need an HIV test.” (Bonus points if you could guess the name of the hooker.) After a while most of the rest of us had gotten used to just how senseless it could be, but Murray never did. He remained terminally amazed.
Murray's first chore of the morning was to go to each of the phones he might use during the day and wipe off the receiver with alcohol swabs. He would then wash down his desk area with a special kind of super disinfectant. (This was his desk area. No one else could sit there for the duration of the shift.) Then he would take out a new pen—he always had a fresh one at the start of the shift. During the course of the next few hours, he would proceed to destroy this pen. He would gnaw on the cap until it was frayed into plastic bits, and if he was upset about something, he would bend the pen back and forth in his hands so that, when he went to write with it, the end of it would veer off at a crazy angle.
Murray washed his hands all the time—all the time. If he was not on the phone, seeing a patient or destroying his pen, he would stand at the sink in the nurses' station with the water running over his hands. He could stand like that for half an hour or more; you just had to get used to the sound of splashing water when you presented a case. When he was not otherwise engaged, I know he was counting the number of hand swipes. He would move his left hand over his right, washing, for a certain number of strokes (I'm not sure how many, I think it varied with the circumstances) then he would reverse, right hand over left. He would stop and dry his hands on a paper towel, still listening to you. After a moment he would look back down at his hands, seem to notice a little speck of dirt and go back to washing again. At the end of each hand-washing session, he would carefully wipe out the sink with paper towels, wiping down the faucet and stainless-steel bowl. After this he would stand there for a minute, gazing down reverently into what must have been the only spot of cleanliness and order in that great chaotic sea of an ER. Only then would he, reluctantly, finally turn away.
Murray had been at “the Mecca” for six or seven years. “He used to be a really great guy,” everyone would say. No one could exactly pinpoint when the stress had finally gotten to him. But how could it not? Who else could come into a place like this, day after day, week after week, for all these years and not be in some way fundamentally fried? But stressed out or not, Murray did have something that was bad for any ER doctor—a volatile temper. Murray was a terror when angry. He could work himself up into a frothy rage about little things, someone spilling coffee, or not flagging an order properly. His face would become beet red, his eyes would bulge out, and after a while he would look as if his head might explode. He would yell. Rant. Weird things would set him off. For example, baby pacifiers used to enrage him. He would rip a pacifier from a little kid's mouth, and as the mother looked on horror-stricken, he would fling it into the trash can, shouting, “Never, never, never, never. Do you know—never—what those things do?” (I worked with Murray for years and never found out just what it was that pacifiers do. He never said and everyone else was too afraid to ask.) Or fevers and mothers who didn't give their child enough Tylenol. “Stupid, stupid, stupid, stupid, stupid, stupid. Do you understand me? Stupid.” He would tower over some poor woman in his best hectoring stance, a finger just millimeters from her nose. The look in his eyes would be one of transcendent, almost psychotic exasperation.
Everyone, of course, worried about Murray's sanity. But it wasn't just Murray; the sanity issue was germane to us all. We were all more or less in a perpetual state of shell shock. The pressure was everywhere—unrelenting. It crept into every facet, crack and crevice of a person's psyche. It rotted the woodwork, scarred the metal joists and broke down, without pity, the fragile scaffolding almost all of us use to hold ourselves together. Murray wasn't the only casualty. He was just the loudest.
I wasn't on the day this happened. I was doing research that involved, at the time, going through paramedic run sheets. I was sitting at the radio console. The radio went off—everyone else was busy—so I answered it. It was a bad transmission, lots of static.
“This is [inaudible] fourteen, [inaudible] do you read me?”
“Not very well but go ahead.”
Static…static…“gunshot”…static…static.
“Please repeat.”
“Twenty-two-year [inaudible] shot…” static…static…“head”…static.
“The patient is shot in the head?”
“That's an affirmative.…” Static…
“He or she is twenty-two? You're breaking up.”
Static…static…“months…” static.
“Please repeat.”
“We had a pulse but [inaudible] repeat”…static…“months…now.”
The radio transmitter clicked off.
I stuck my head out the doorway. “Hey, guys,” I announced. “You're getting a gunshot wound.”
Everyone looked around at me.
“To the head.”
Everyone groaned. Murray, who had a chart attached to a clipboard, slammed it down and said, “This is ridiculous, yes, it's ridiculous. What a ridiculous way to start the day. Ridiculous.”
The clerk hit the trauma button, and in a moment the page came though overhead on the hospital paging system.
“Dr. T., emergency room. Dr. T., emergency room.” (This was the loudspeaker euphemism used to call a trauma code—sometimes a source of confusion. One morning during rounds a patient remarked to me, “I don't know who Dr. Tea is, but I tell you he sure was busy last night.”)
Everyone began to migrate to the trauma room. I sat alone at the radio console for a few m
inutes and then shrugged, what the hell, and got up to follow them, to look over their shoulder. I was young and a trauma was still exciting, the “real reason” I went into emergency medicine.
Who else walked back there that summer evening? There was Sheila, of course, the knitter of afghans, otherwise so unobtrusive as to exist as a redheaded blur in my memory. There was Sudesh, one of my fellow residents. Sudesh wanted to move to Florida after his residency and specialize in emergencies of the rich and famous. There was manic Ted, a nurse who would teach students how to place a nasogastric tube by putting it down himself. And of course there was Donna, trauma nurse queen, wit tart as lemons. It was Donna who had commented to me and to Murray's back after he had said something inexplicable, turned, and walked away, “Do you think that if I go home and put a metal colander on my head I could communicate with the planet that man is coming from?”
“What else did they tell you?” Sudesh asked me.
“I couldn't get any information. They were breaking up so bad.”
“Great,” Murray said. He was walking in front of us, looking like he always did, head down, slope-shouldered, sack-butted. “Absolutely—I can't believe it—great. Great, great, great.”
By now the “Dr. T.” call was echoing throughout the hospital. The trauma team would have heard it. They were probably busy doing nothing, maybe watching TV in the surgical lounge since it had been quiet so far today. The “scout” medical student would be on his way down to see if this was a “real” trauma. Anesthesia was, as always, busy being busy. (If they were doing a case, they didn't have to come down and they were always doing a case.) The on-call pharmacist was also to come down to help mix drugs and such. The pharmacist at this hospital was always the most reliable about getting to the code. He or she actually ran down the hallways and would even take the stairway if it was faster. But when he or she got there it was—so what? What was a pharmacist to do about a sucking chest wound? Public relations also weighed in very early, just checking to see if whoever the paramedics dragged through the door was in some way newsworthy (small child? high school athlete? interesting story? somebody white?).