Rita began assembling a suture tray for me. “6-0 nylon,” I told her.
“So, Doc,” my patient said when I returned, “how do you like this doctor thing?”
I replied that although it was hard work I liked this doctor thing a lot.
“Yeah,” he said wistfully, “I thought of bein’ a doc myself.”
“Really?” I said, unfolding the edges of a sterile towel. “I’m sure you would have made a very interesting doctor.”
“Fuckin’-A right,” he said. He struggled to sit up and I pushed him back down.
“Sir, you have to lie still now so I can sew up the cut on your forehead.”
He gave no sign that he heard me. “Yeah,” he went on, nodding his head and making it impossible to drape him. “I thought a lot about bein’ a doc.” He lapsed into a short silence. “Medicine’s great. You know, spending all day telling broads to take their clothes off for ya.”
I heard Mary snickering over near the crash cart.
“Well, sir, that’s not really—”
“Can you imagine,” he went on, “every day, beautiful broads, completely naked, hanging all over you.”
“You’ll feel a little pain when I put in the numbing medicine,” I said as I drew up the lidocaine. He didn’t flinch. It made me wonder if he even needed a local anesthetic.
“So, what’s it like, Doc? You know, being around all those naked women every day?”
Rita opened a suture for me and dropped it on my field. She cocked her head and looked at me innocently as if she, too, wanted to know.
“Mr. Pagulia,” I said, “it really isn’t very often we have to ask women to remove their clothes.”
He smirked. “Yeah, right, Doc.” This man knew a cover-up when he saw one.
“No, seriously, sir. I rarely ask my patients to disrobe.”
He looked up at me. “Aren’t you a real doctor?”
“Yes, sir, I am.”
“Then whaddaya mean you don’t tell ’em to take their clothes off?”
By now all work in the ER had ceased. Everyone was listening to our conversation. Rita, who was standing in the corner behind Mr. Pagulia, looked at me questioningly, gestured at her blouse, and started to unbutton the top button. I gave her a dirty look and told her to get me some more sterile towels.
“Sir,” I said, “there is no need to have women remove their clothes for most orthopedic problems.”
He wasn’t sure if I was a liar or a fool who had wasted four years of medical school. “What’s that got to do with having some broad get naked for ya?” His laughter came in great rolls that echoed around the ER. “I’d just tell ’em I can’t tell what’s wrong with their ankle until I see what their bazumbas look like.”
I finally got him to lay still so I could cover his face with the sterile drape. I tried to switch the conversation to other things but his muffled voice continued to escape from under the drape constantly harking back to naked women, breasts, and pelvic exams.
In desperation I explained that most doctors, myself included, did not spend a lot of time with unclothed women. He was obviously dismayed and disillusioned. His dreams of a career in medicine were being shattered.
We then started talking about what kind of work I did. I told him about setting fractures, repairing ligaments, and replacing joints. He seemed fairly interested.
“And yer called a ortho-peedist, huh?”
“That’s right,” I said encouragingly.
“And you spend most of your time fixing bones and shit, huh?”
“Yes, I do.”
“So you don’t get no chance to check out naked broads, huh?”
I groaned. I thought we were off this subject. “No, sir, I really don’t.”
He thought about that a moment and then gave me a look of pity.
“Well, Doc,” he said, “don’t let the bastards get you down. I’m sure if you do a good job with all this bones and shit, someday you’ll get your chance to be a gynecologist.”
Chapter Thirty-Two
June
My third year was coming to an end. In another week I would start the final year of my residency. Jack Manning had been selected chief resident for the first six months of the year, but the chief resident for the last six months had not yet been announced. There was still hope for me.
It seemed Rochester was having a special on kids with wrist fractures that summer. Every night on call I got one or two of them. Tonight it was a five-year-old kid who fell out of his bunk bed.
When the ER paged me I closed my eyes, groaned, and ran a hand across my face. Not another one! I still had one last consult to see. This was going to royally screw up my night. I told the nurses on the ortho floor that I had to see a wrist fracture, but I’d be back as soon as I could.
I trudged down to the ER, picked up the chart, and went back to examine my patient who was sitting in his father’s lap, sniffling quietly. The boy was wearing Donald Duck pajamas and holding a well-worn stuffed animal that looked like Goofy. His left wrist was bent back about forty-five degrees.
Well, I thought, you don’t need to be an orthopod to make this diagnosis.
I hadn’t even ordered an X-ray yet, but I had already decided what was wrong, what needed to be done, and how long it would take. I was becoming very good at this sort of thing. I was becoming quite proficient at reducing fractures, repairing ligaments, injecting shoulders, and scoping knees—but something was wrong. Despite my growing competence, my work wasn’t fun anymore. It was as if I had become a factory worker, mindlessly performing the work in front of me, but taking no enjoyment from it, anxious only to get it done.
But I was impatient with my self-analysis, impatient with being distracted from the job at hand. What difference does it make? I thought. I’ve got work to do.
I introduced myself to the father and then tried to talk to his son. I leaned over and asked him what happened but he wouldn’t answer me. He wouldn’t even look at me. He turned his head away, clutched his stuffed animal, and shrunk deeper in his father’s arms. Fine. I gave up and called X-ray. I wasn’t about to waste any more time.
Five minutes later the tech appeared. She squatted down next to the boy and stuck out her lower lip. “Oh, Danny,” she said. “Did you hurt your arm, sweetheart?”
The kid looked at her and his eyes welled up with tears. He nodded his head. “I fell out of my bed.”
“Oh, you poor little thing.” She put her hand on his cheek. “Well I’m going to take a picture of your arm and then this nice doctor is going to fix it for you, okay?”
“Mmm-kay.”
“Would you like me to take a picture of Goofy, too?”
He looked at her in amazement. Did she really mean it?
The tech continued to squat next to him, smiling encouragingly.
Danny nodded his head and handed Goofy to her.
I stood in the corner, wondering why the child would talk to an X-ray tech when he wouldn’t talk to his doctor. As the tech continued talking to the boy I grew impatient. Was she going to keep jabbering to him all night long? I had a job to do, and we were wasting time. Finally the tech set up her portable machine and took the wrist films. Then she laid Goofy on a cassette and took a film of him, too.
While I waited for the X-rays to be developed, I made arrangements to take the kid to the OR. I called Bonnie Wilk, the anesthesia resident on call, and told her I would like to do it in the cast room just off the main OR. Then I called the cast tech, John “Ski” Kowalski, and asked him to meet me in the cast room in fifteen minutes.
The X-rays showed a badly displaced fracture of the distal radius and ulna. But the little kid wasn’t interested in the X-rays of his wrist. He was staring at the X-ray of his stuffed animal. A faint gray silhouette of Goofy was outlined against the black of the film. While the X-ray tech and the boy took turns pointing at things on Goofy’s X-ray, I explained to the parents that the bones would have to be reduced, and that the least painful way to do t
his was under a general anesthetic.
“I don’t think I will have to make an incision,” I said. “I can usually manipulate the bones back in position, then put on a cast. Danny can probably go home tonight, but let’s see how things go.”
We got the kid up to the cast room and then had to wait fifteen minutes for anesthesia to show up.
“Sorry,” Bonnie said. “We were just finishing a C-section.”
I looked at my watch and nodded impatiently. Yeah, right.
It had been a long day and I wanted to get to that last consult. And besides, when we were done, I’d have to talk to the parents again. That would take another couple minutes. I made a note to myself to be sure I remembered their name this time. The last time I fixed a fracture like this, I did a perfect job, but when I went out to talk to the parents I couldn’t remember their name or their child’s name, either. It had made for a very awkward conversation.
Ski, quiet and competent as usual, wheeled the cast cart over and started selecting the plaster rolls we would need. When Bonnie finally got the kid asleep she nodded to me and said I could go ahead.
“Okay, Ski,” I said. “You know the drill.”
I bent the elbow to ninety degrees. While Ski held the arm I applied traction to the hand, stretching the fracture. Then, while continuing to apply traction with the right hand, I increased the deformity just enough to let me wedge my left thumb under the edge of the fracture. Then I levered the dorsal edge of the distal fragment over the dorsal edge of the proximal fragment, and finally pushed the whole thing volarly. I could hear a little crunch as the bones slipped back into place.
I knew the reduction was perfect. I told myself that I had done my job. All right, I thought, so far so good. Now let’s get the cast on and get junior here to the recovery room.
“Keep the elbow at ninety,” I told Ski, “and be sure the wrist is in volar flexion while I put the cast on.”
Ski nodded and held the arm in perfect position. As I began wrapping cast padding around the boy’s arm, I noticed a blue tattoo under the edge of Ski’s scrub shirt.
“Hey, Ski,” I said, pointing to the tattoo, “what does twenty-eight mean?”
Ski, embarrassed, pulled his sleeve down to cover the tattoo. “That was my regiment,” he said quietly. “The Twenty-eighth Infantry. I was a corpsman.”
“Where were you stationed?” I asked.
He shrugged. “Here and there,” he said. “In Nam, mostly.”
In Nam. The war had long since ended; but even then, if you wanted to open some wounds, start talking about Viet Nam. Ski knew that. That’s probably why he never mentioned it.
I had been ambivalent about the war in Viet Nam. Like most middleclass white kids I supported it at first. The U.S. was doing what it was supposed to do: stopping the spread of evil. My dad’s generation had to stop Hitler, mine had to stop Ho Chi Minh; otherwise, LBJ told us, the communists would conquer all of Asia—and then set their sights on us.
But there remained the question of precisely who was going to stop this communist juggernaut. It wasn’t middle-class white kids. We were given student deferments. We went to college and drank beer while the kids from the vocational high schools and the ghetto high schools were hauled off to some godforsaken jungle on the other side of the world.
Meanwhile guys like me stood on the sidelines with a beer in one hand and a red, white, and blue pom-pom in the other giving the old college cheer: “Go GIs! Beat Commies!” If a few soldiers had to die, well, that was the price of freedom. Implicit, of course, was the understanding that this price would be paid by others, not by us.
I wondered if I could get Ski to talk about those days.
“So what was it like, Ski?” I asked as I dipped the first plaster roll in the bucket. “Being in Viet Nam, I mean.”
Ski looked at me before he answered. “It was a hellhole, Doc,” he began. “It was hot and dirty and oppressive and full of people who didn’t want to be there. Everyone had a chip on his shoulder. I was lucky, though, I was a corpsman. I actually liked that part.
“I lived through a pretty shitty time in Nam. Corpsmen are sent where the action is, so I saw a lot of guys burned up and blown apart and shot to shit. Every day I was surrounded by it.”
I finished applying the first roll of plaster, then began working on the second one.
“Yeah,” Ski said quietly, “it was a shitty time. I saw so many terrible things over there. I spent every day bandaging and splinting and cauterizing. It became mechanical after a while. I could do it without thinking about it. I didn’t want to think about it. I just wanted to get it done, serve out my hitch, and go home.”
“Yes,” I murmured, “I know what you mean.”
“But I was wrong, Doc,” he said as he expertly shifted his hands away from the plaster as I rolled it. “I had forgotten about those poor grunts who were getting shot to shit for no reason. It’s bad enough to get shot or killed for noble purposes, but we didn’t know what the hell we were fighting for. Everyone in Nam hated us and everyone at home was embarrassed by us or ashamed of us.
“Nam started to get to me. I drank a lot and smoked a lot of dope, and I probably would have wound up in the guardhouse or rehab if I hadn’t finally realized that what those guys needed from me was not just bandaging and splinting and cauterizing. They needed to know that someone cared—not just cared about their leg or their burn or their fitness to return to duty, but cared about them. It wasn’t just about bandaging wounds—any more than what we did here tonight was about realigning bones.” He slipped those last few words in casually, but I knew they were meant for me.
“Right,” I said, nodding affirmatively. But while pretending to agree with him, I wondered what he was talking about. What does he mean it isn’t about realigning bones?
While my hands were running over the surface of the cast, smoothing the finish, my mind was twisting and turning away from the truth Ski had thrust in front of me. Of course it’s about realigning bones. Isn’t that what the father brought the kid here for? Isn’t that my job?
I am a dumb shit, I realized finally. Of course that isn’t my job. I have been missing the boat.
Ski had identified exactly what had been bothering me. I had been failing to see the big picture. I had been developing into an adept technician, learning to repair tendons and reduce bones, but I had forgotten what brought me to medicine in the first place. It wasn’t reducing fractures and replacing hips. Those were the means, and I had let them become the ends.
I was stunned, lost, bewildered. I stood there mindlessly rubbing my hands up and down the now-hard cast. Ski covered for me. He motioned to the tech to shoot the post-reduction films. He must have wondered what happened to Captain Efficiency who stood there rubbing a dry cast instead of rushing the tech to get the films done. I stepped back and stood there dumbly, while Ski positioned the arm for the X-ray.
I had let my work become automatic, forgetting the essence of what a doctor is called to do. I had let pragmatism take me too far, take me to where I had lost sight of my calling. I was wrapped up in the technical aspects of what I was doing while ignoring the fact that my vocation wasn’t approximating collagen bundles or correcting angulations, it was helping people—living, breathing, hurting people. How could I have forgotten that? Why, even the X-ray tech knew it intuitively, knew enough to show an injured little kid that someone cared about him—and all I could think of was hurrying him up, straightening his arm, and getting on to the next order of business.
The films were back in five minutes. Ski snapped them up on the view box. “Very nice reduction, Doc—as usual.” Why had I never noticed the irony in his voice before?
“You can wake him up, Bonnie,” I said quietly to the anesthesiologist.
When the boy started to awaken, we wheeled him to the recovery room. While I waited for him to come to, I took Goofy and wrapped a small bit of plaster around his arm, then fashioned a little sling out of Kerlex and tied it aroun
d his neck.
“Don’t be afraid, Danny,” I said as his eyelids fluttered open and he looked about in panic. “We’re all done. Your arm is all fixed. And look, we fixed Goofy, too.”
He reached with his good arm and I handed Goofy to him.
“Would you like me to get your mom and dad?” I asked him.
“I want my mommy,” he answered, his lip quivering.
“You’re all fixed, kiddo,” I repeated. “We’re going to let you and Goofy go home in just a little while.”
I picked up the chart and looked at his name: Oestmann, Daniel. 1451 Cottonwood Avenue, Byron, Minnesota. I wiped the dried plaster from my forearm, picked up the X-rays, and went out to talk to the parents.
“Hi, Mr. and Mrs. Oestmann,” I said. “Danny is fine. Everything went well. His fracture is back in place. He should be able to go home with you tonight.”
“Did you have to open it?” his father asked.
“No, sir. I was able to push it back into place without opening it.”
His parents beamed. When had I stopped noticing things like that? When had I become so impatient to impart my news, deliver my instructions, and be off?
“Please,” I said, gesturing at the couch behind them, “sit down.”
I sat with the Oestmanns for fifteen minutes. They told me they had two other children, ten and twelve.
“So Danny’s your baby, huh?” I asked Mrs. Oestmann.
“You got that right, Doc,” Mr. Oestmann interrupted. “Nancy thinks the earth revolves around him.”
“Oh, I do not,” Mrs. Oestmann said with a shy smile.
I told them what to watch for, gave them instructions about getting a follow-up X-ray with us in the clinic next week, and asked them to call if they had any concerns. Then I said I was going to see if the recovery-room nurses would let them come back and be with Danny.
They got to their feet and shook my hand. “Thanks, Doc,” Mr. Oestmann said. “Thank you so much.” I said good night to them and headed back to the recovery room.
I was about to enter my final year of training, but I had learned a valuable lesson that night. When I finished talking to the nurses I headed back to the cast room. There was someone there I needed to thank.
Hot Lights, Cold Steel Page 22