I had learned to ignore everything but the job in front of me. I had been a terrible husband, a terrible father. I was rarely home, and when I was, I had no patience for anything, no energy for anything, no interest in anything.
I was standing in the ICU, at the foot of the bed of a young girl with a severe head injury. I couldn’t remember how she was injured. Car accident maybe—or was it a fall? I was watching helplessly as her temperature rose from 101 to 102 to 103. Her fever was not due to infection. It was due to severe damage to the thermoregulatory center of the brain stem.
I had packed her in ice. I had performed cool gastric lavages. I had done everything I could think of, but her temp still climbed: 104, 105. If her temperature rose much higher her chances of survival were minimal—and if she did survive, she would be a vegetable. The brain can’t take temperatures that high.
Jesus Christ, I thought, she’s only twenty. What the hell is wrong with me that I can’t stop this?
I stood there squeezing the chart as her temp rose to 106, 107.
Joe Stradlack came by, annoyed that I was spending so much time with a patient who had no hope of surviving. But he could see I was having a hard time with this.
“Mike, we did all we could. She just…Well, sometimes there’s just too much trauma.” He patted me on the shoulder, took the chart from my hand, and dropped it in the rack at the foot of the bed. “Come on,” he said gently, “we need you back in the ER.”
Joe had his bearings about him. I did not. Joe knew when to fight and how to fight and when to quit fighting. He knew just how much of himself he could afford to pour into each case. But I knew none of that. I was still used to winning every fight, and those past few weeks on the ERSS were killing me.
I suddenly realized how unprepared I was for all this. Oh, I had to have been sharp to get a residency at the Mayo Clinic. I knew my anatomy and physiology. I did well on the National Boards. I had wonderful letters of recommendation from my deans. I came very well trained for the cognitive aspects of my work, but there was no training for the emotional aspects. Letters and board scores could never prepare me to lose the struggle to save a pregnant woman and her baby, or to watch a twenty-year-old girl slowly fry her brain.
No, I was not prepared for such things, and they were beginning to rip me apart. How, I wondered, can life go on? How can my fellow residents and I continue to smile, to cut the lawn on our day off, to have children?
Of course, it would have been easier if we didn’t care, and sometimes we actually pretended we didn’t. We would try to do our job and be detached. But we didn’t go into medicine to be detached. We went into medicine because we cared. But caring kept bringing us pain and frustration and anguish.
We had been training for years to become surgeons. We had excelled in college. We had excelled in medical school. Our lives had been one success after another until we woke up one day, and there we were, surgical residents at the world-famous Mayo Clinic. It was all so perfect. But before we could congratulate ourselves, scarcely before we learned where the surgeons’ locker room was, we discovered this was a profession that, like no other, quickly and ruthlessly and uncaringly proclaimed we were not perfect. People came to us with head injuries—and we couldn’t help them. People came to us with gunshot wounds—and we couldn’t heal them. People came to us with ruptured arteries—and we couldn’t save them.
We kept confronting these terrible problems, and we kept failing, again and again and again—we, who had always succeeded, who had always known what to do, who had always been so sure of ourselves. Never before had we attempted anything so important, and never before had we failed so miserably.
Oh, sure, we tried to let conventional wisdom shield us. “Look,” we’d tell ourselves, “you did exactly the right thing, exactly what the textbooks say you should do. Just because she died doesn’t mean it was your fault.”
That’s what we’d tell ourselves, but we didn’t buy it. Medicine wasn’t about following directions in a textbook. That’s not what we were supposed to do. What we were supposed to do was save people—and so often, it seemed, we didn’t.
“You want the truth?” we’d ask ourselves ruthlessly. “Here’s the truth: a young woman came to you alive, breathing, fear in her eyes, wanting you to save her, and now she’s lying on a metal cart in the morgue with a sheet over her. There’s your truth for you.”
So we would drag ourselves into the surgical waiting room, to the frightened, anxious eyes that had been waiting for us for the last three hours. The same eyes that looked to us with pleading and hope as we rushed their daughter to the OR. They knew before we said a word. They could see it in our struggle to speak.
“I…I am so sorry to tell you that…”
And afterward we’d sit on the bench in the doctors’ locker room, and take a deep breath and slowly let it out—but we couldn’t exhale everything. We’d sit there, hands folded and heads bent, too lethargic to pull off our bloody scrubs, too tired to go to bed, too dispirited to start that IV the nurses had called for two hours ago; our minds slowly going out of focus, slowly retreating from the horrors of the past few hours.
And if we were one of the lucky ones, we’d go off duty at eight or nine, after morning rounds. We’d drive home through avenues of early-morning sunlight flashing at us through the trees, hurting our eyes, like looking into the revolving lights on an ambulance. We’d come home to our wives who needed us. We’d mumble our hellos, brush past them, and tumble into a dreamless sleep.
But more likely we did not have the day off. We had another full day ahead of us. And we had no time to think about what we did the night before. If the patient was still alive, there were other, newer challenges ahead. His lytes were off. His output was down. His wound was bleeding. These things demanded our attention, and we gave it gladly rather than try to quiet the ghosts of the night before, of all the nights before, of all the whirling maelstrom of amputated limbs and shotgun blasts and pussed-out bellies and corn-picker hands and wide-open ankle bones filthy with asphalt and dirt.
We were learning that all the training and all the caring in the world were not going to solve every problem. This wasn’t medical school. We weren’t going to ace every exam. Silver-haired professors weren’t going to pat us on the head and marvel at our intellectual acumen. We weren’t going to win every battle.
“Sometimes there’s just too much trauma,” Joe said.
There certainly had been for me.
Chapter Eight
November
On a blustery Saturday morning, with three inches of new snow on the ground, I sat in the ER of St. Mary’s Hospital for one last morning report. Jerry was still up in surgery where they had taken a guy with a ruptured bowel about 4:00 A.M. Mac was slumped in a chair in the corner. Rollie and I were relatively fresh, having had the night off. Joe Stradlack thanked us, said we did a good job, and then began to orient the new guys.
When morning report was over, Rollie, Mac, and I shook hands. They said for a dumb orthopod I did all right. I thanked them and wished them good luck taking care of rectal abscesses and fat people’s gallbladders for the rest of their lives.
I asked them to say good-bye to Jerry for me, and I headed to the docs’ lounge to begin my next assignment: six weeks in pediatric orthopedics. Jake Burg, my new senior resident, knew I had just come off the ERSS. I think he felt sorry for me. After we finished rounds he told me to take the rest of the weekend off.
Jack Manning, who had started on Dr. Hale’s service that morning, gave me a ride to Methodist Hospital for the Saturday morning conference. On ERSS we were never given time off for conferences, so I hadn’t been to one since September. The conference was on complications of carpal navicular fractures. I was just settling into my chair when Dr. Burke called on me.
“Dr. Collins, how nice of you to join us. Explain the high incidence of nonunion and osteonecrosis associated with navicular fractures.”
I explained that navicular fractures
were often accompanied by disruption of the vascular supply to a portion of the bone.
“Which portion of the bone?”
“The distal portion.”
“What is the name of the vessel that is disrupted?”
“I believe it’s a branch of the—”
“You believe?”
“It’s a branch of the radial artery. It enters the navicular at the—”
“I didn’t ask you where it entered. I asked you the name of it.”
“Tell him it’s the anal artery,” Frank Wales whispered from behind me.
“I’m sorry, Dr. Burke. I can’t recall the name.”
“Don’t apologize to me,” he answered. “It’s your poor patient you should apologize to.”
I mumbled, “Yes, sir,” and started to sit back down.
“When was the last time you attended this conference, Dr. Collins?”
I stood back up. “It’s been a few weeks, sir, but I’ve been—”
“I don’t care where you’ve been. Attendance at this conference is mandatory.”
“But I thought when we were on—”
“Mandatory.”
I realized I should cut my losses and shut up. “Yes, sir,” I said.
“Mandatory, that is, for those who wish to remain in this residency program.”
“Yes, sir.”
I stood in silence while he stared at me from over the top of his reading glasses. “Sit down, Dr. Collins,” he said finally. “Dr. Manning, do you know the name of the vessel that supplies the navicular?”
As I plopped back in my chair, Frank touched me on the shoulder. “I think he likes you,” he whispered.
By 11:30 I was home. Although he lived on the opposite side of town, Jack had given me a ride.
“Look what I found, Patti,” he called as we pulled into the driveway. “He doesn’t look like much but he’s housebroken—sort of.”
The sun had come out and last night’s snow was already starting to melt. Patti was standing at the curb, next to our car, an old green Dodge that hadn’t started in four days. She was wearing a cream-colored, Irish cardigan sweater that fell to either side of her very swollen belly. Eileen stood next to her, both hands wrapped around Patti’s right leg. Mr. Jensen from the Standard station was there, too. He looked up, nodded in my direction, and then stuck his head back under the hood.
Jack told Patti she was looking good. “I like that beach ball look,” he said.
“Ha-ha, very funny,” she said, sticking out her tongue at him.
Jack backed out of the driveway, waved, and said to call him if we needed a ride anywhere. When he was gone, I went over to Pat and gave her a kiss. She looked worried.
Mr. Jensen straightened up and slammed the hood. “Mornin’, Doc,” he said.
“Hi, Mr. Jensen. So, what do you think?” I asked, pointing at our car.
He didn’t waste any time. “Engine’s blown,” he said. “Cost you two grand, maybe more, to fix it.”
Two grand? We only paid seven hundred for it.
Jensen saw the look on my face. “Forget it. It ain’t worth fixin’.”
Patti and I stood there saying nothing.
“Sorry, Doc,” Jensen said. As he was getting into his truck, he turned to me and said, “I gave Mrs. C. the number of a guy I know owns a junkyard. He might give you thirty or forty bucks for it.”
I smiled weakly. I wondered if he was trying to be funny. When he left, Patti and I turned to each other.
“Now what?” she said.
“How much money do you have?” I asked.
She dug in her pockets. “Six dollars.”
I put my arm around her. “We’ve got three hundred in the bank, plus whatever we get from the junkyard…”
She looked at me. “Do you really think we’ll only get thirty dollars for it?”
Ten minutes later I was on the phone to Ernie Hausfeld, owner of the Mantorville Junkyard.
“Collins? Oh, yeah. Old man Jensen said you might call. He says you’re a doctor at the Mayo, huh?”
“Yes, that’s right.”
“Then how come you’re driving a junker?”
Oh, yeah, I forgot. Doctors always drive Porsches and BMWs. “My Lamborghini’s in the shop,” I told him, “so I’ve been driving my butler’s car. I thought I’d get him a new one.”
“Very funny, Doc. Well, here’s the deal: if you can drive the car here, I’ll give you thirty-five dollars for it. If we have to tow it in, you get twenty-five.”
Twenty-five dollars, that’s it?
I sighed. “The engine’s blown, Ernie. You’ll have to come and get it.”
“All right. Have the title ready. Someone’ll be there in an hour.”
Three hours later a tow truck pulled up in front of the house. A young guy with a dirty blue Twins cap got out and looked at our address. I walked out to meet him. He glanced at the paper in his right hand. “Doc Connolly?” he asked.
“Collins,” I said, holding out my hand.
He stuck the paper back in his pocket and shook hands with me. “I’m Jimmy. I drive for Ernie.” He looked at the Dodge. “This your car?”
I nodded. “Yup. That’s it.”
“So the old girl’s headed for the last roundup, huh?”
“Yeah. I hate to see her go. She always ran great—until the last few days.”
“You got anything in the trunk or glove compartment?”
“Nope.” The spare tire was bald but it held air, so I had rolled it into the garage on the odd chance that it would fit whatever “new” car we got.
Jimmy backed up the tow truck, and hooked the winch under the front bumper. He pressed a button on the side of his truck, and the front of the car rose off the ground.
“I just need the title,” he said, “and we’re all set.”
I handed it to him. He, in turn, counted out five dirty five-dollar bills and gave them to me.
“Pleasure doing business with you, Doc.”
Patti came out and watched as Jimmy drove away with our car.
“Want to come down to the BMW dealership with me to pick out our new Beemer?” I asked.
She wasn’t laughing. “Mike, what are we going to do?”
“I looked at some ads in the Post-Bulletin. I think we can get something decent for six or seven hundred dollars.”
“Where are we going to get six or seven hundred dollars?”
“I thought I’d get a job as a male stripper.”
“Yuk.” She grimaced. “Who would hire you? Nursing homes for blind, senile old ladies?”
If you want to stay grounded, get married. Still, there was no need to rub it in.
I told Patti I didn’t have a plan. I said we’d just have to wait for our next paycheck, which was two weeks away.
“How much money do we need?”
“Well, three, four hundred bucks, I guess. Plus the three hundred we have in the bank.”
I turned and started walking back toward the house, but Patti stood where she was.
“Aren’t you forgetting something?” she asked.
“Like…?”
“Like there won’t be any money left for food.”
“I’ll bring stuff home from the hospital when I’m on call.”
“I’m not living on apples and prune sweet rolls for a month,” she said.
“If you treat me right I just might bring home a little lutefisk casserole.”
She grabbed Eileen’s hand and stormed by me.
“I don’t want lutefisk casserole,” she said. “I want meat. And vegetables. And potatoes.”
“Damned Irish girls,” I called after her. “I should have married an Indian woman. She could have lived off roots and berries and grubs for a month.”
“And I should have married a lawyer. At least there’d be food on the table.”
Patti had been under a lot of stress or she never would have said such a terrible thing.
Chapter Nine
No
vember
As autumn drew to a close we were starting to settle in. I was enjoying my stint on pediatric orthopedics. Patti, meanwhile, had met all the neighbors. She was a regular customer at Mr. Jensen’s Standard station. She had made friends with Dan the Butcher at Barlow’s grocery store, and Tim the Mailman, and Zack the Garbageman. I was constantly running into people who said, “You must be Patti’s husband.”
We had gotten a new car, a ’72 Pontiac I bought from a guy out near the airport. It had no shocks, the brakes squeaked, and it was badly rusted, but it started easily enough. For six hundred dollars I wasn’t going to get anything better.
“Why does the front seat wobble like that?” Patti asked when she first got in.
I had forgotten to tell her the bolts for the front seat had rusted out.
“It’s so you can rock the babies while I’m driving,” I said.
She gave me one of her looks. “Did you have to pay extra for it?”
“Aw, come on, hon. What did you think we were going to get for six hundred bucks?”
She relented a little. “Well, the tires don’t look so bad. But are you sure it’s safe to drive Eileen in this thing?”
“Unless she can find a better set of parents, she’s stuck with us—and our car.”
I was getting more comfortable with orthopedics. I still felt behind all the other residents, but at least I was learning the language. Now that I was off ERSS, call was a little more tolerable. I was on call every third or fourth night. When I was on call I had to stay in the hospital, and was responsible for taking care of orthopedic problems in the ER, seeing consults, and answering pages from the nurses on the ortho floor. I would rarely sleep for more than two or three hours. But at least I was home with Patti and Eileen most nights.
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