Pat took my arm as we were walking back to our car when the evening was over.
“They seem like nice people,” she said.
“Yeah, they do. I guess we’re pretty lucky to be joining a group like this.”
When we reached our car, I turned back and stared at the house, feeling almost frightened by it.
“It’s huge, isn’t it?” I whispered.
“Yes.”
The two of us stood there, uncertain how to confront the implications of what we were seeing.
“I don’t want us to change,” Patti said, laying her head against my shoulder.
I smiled, amazed at how accurately Patti could articulate my own feelings. We drove old, junky cars. We wore old, worn-out clothes. We never took vacations. We worked like dogs. And yet we didn’t want to change. We already had everything we needed. We already had something so rare, so priceless, that we never wanted to lose it.
I slipped my arm around Patti and kissed her on the neck. “I don’t want us to change, either,” I said.
Chapter Forty
June
We drove back to Rochester the next morning. Dawn, the nursing student from next door, had stayed with the three older kids for the weekend. She was waiting at the door, suitcase in hand, when we came in. She looked glad to see us.
“They certainly are active little children,” she said on her way out.
I had only three weeks left of my residency, but I still had to take call. As chief resident I could take call from home but I had to carry a beeper and I had to stay available. The following Friday night I had been asleep for two hours when the phone rang. It was Alan Harkins from the ER at St. Mary’s.
“Sorry to wake you, Mike,” he said, “but I need your help. The paramedics are bringing in a kid from Owatonna with a compound, comminuted tib-fib fracture. He’s critical. They should be here in fifteen minutes.”
I sat up, swung my legs over the side of the bed, and took a deep breath. “Okay, Alan,” I said. “I’ll be right there.”
This was my last weekend on call. I had been hoping to make it through the night without getting called in; but I was so used to being called at night, so used to having my sleep interrupted, that I never gave it a thought. I pulled on a pair of pants and a sweatshirt and was at the hospital ten minutes later.
I had just changed into my scrubs when the ER doors crashed open and the paramedics powered through. I trotted alongside them as they wheeled the patient to Trauma One.
“Fourteen-year-old kid, run over by a tractor,” the paramedic said. “He was conscious when we got there, BP a hundred over sixty. But his right leg’s a mess—open fracture, dirt everywhere.”
A fourteen-year-old kid on a tractor at midnight? God, I thought, these farm kids work hard.
“What’s his name?” I asked.
“Johannson. Kenny Johannson.”
“Hang in there, Kenny,” I whispered to the unconscious boy.
I lifted the sheet covering the lower half of his body, and immediately the thick, fetid stink of manure mushroomed up at me. The leg was twisted obscenely to the side. The jagged end of the tibia stuck through a rent in his dirty blue jeans. A spreading pool of blood soaked the sheet underneath him.
As we lifted the boy onto the table in Trauma One, his eyes flickered open. He began to whimper softly as he searched for someone he knew. I put my hand on the side of his head and rubbed his hair gently. “Kenny, you’re in the emergency room at St. Mary’s,” I told him. “Your mom and dad are here, too. They’re in the other room.”
He rolled his head and moaned. “My leg. Oh, God, my leg! It hurts so bad.”
“I know it does, Kenny, and we are going to help you.”
“BP seventy-eight over forty,” a nurse called out. “Pulse one-sixty.”
I probed Kenny’s wound. Under the severed end of the peroneus longus there was a bloody chunk of manure wedged against the bone. I picked it up with a forceps and dropped it on the floor. When I found what was left of the anterior tibial artery I clipped it with a hemostat. His bleeding, except for a slow ooze, ceased.
In the next several minutes we did a cut-down, put in a subclavian line, and pumped him full of blood and fluid. Within half an hour we had his pressure up to one-ten over sixty. I told the charge nurse to get an OR ready. As she picked up the phone, she said when I got a chance the parents wanted to talk to me.
Mr. and Mrs. Johannson were huddled together on a couch in the far corner of the waiting room. They sprang to their feet as I entered the waiting room. Mrs. Johannson wrapped both hands around her husband’s left arm and leaned against him. She kept staring at the bloodstains on my pants.
I introduced myself and then told them that although Kenny had lost a lot of blood, his vital signs had improved and he seemed stable. “We are just about to take him to the operating room,” I said.
Before I could say more, the door to the waiting room burst open and a young man rushed in. “Dad,” he said, “I found it.”
“This is my son, Eric,” Mr. Johannson said. “He went back to the farm to look for the missing piece of Kenny’s leg.”
Eric reached into the pocket of his jacket. He handed me a clean white handkerchief in which he had wrapped a dirty, three-inch section of tibia. I doubted we could use it, but I wanted the boy to feel he had done something worthwhile. “Thanks Eric,” I said. “This could be a big help.”
“Will you be able to save Kenny’s leg?” Mr. Johannson asked.
At that moment I was more worried about saving Kenny’s life. The boy was in shock and had almost bled to death. I longed to reassure his parents, but I had learned not to make promises. “Mr. Johannson,” I said, “we’re going to do everything we can.”
“Please, Doc. Please.”
I nodded, shook his hand, squeezed Mrs. Johannson’s shoulder, and sprinted up to the OR.
They had taken Kenny to OR Ten, the largest of the operating rooms. In contrast to the ER where everyone had been barking orders, shouting for equipment, and rushing back and forth, the operating room was quiet, almost hushed. Voices were muffled. There was a greater sense of control here. We were surgeons. This was our turf.
Against the far wall the laminar-flow machine hummed faintly. The cardiac monitor issued its staccato, reassuring beeps. Two anesthesiologists were wedged shoulder to shoulder at the head of the table. They had just finished the intubation. The scrub nurse stood at the back table carefully arranging her instruments, Two circulating nurses shuttled back and forth with instrument trays from the sterilizer. In the corner, a radiology tech waited patiently next to her portable X-ray machine.
I handed the piece of tibia to the circulating nurse and asked her to sterilize it. Then I scrubbed my hands and joined the five other residents from various surgical specialties who were clustered around the shattered leg. The extent of the boy’s injuries was now apparent. Large sections of muscle, skin, and bone were missing. Parts of nerves and arteries had been torn away. Dirt, manure, and fertilizer contaminated everything.
First one, then another of the residents poked at the wound, winced or shook his head, then stepped back. No one was sure what to do. Should we try to save this leg, or should we amputate it?
They all looked at me. I was the chief resident in Orthopedic Surgery. I was the one who had to decide.
I stood in the center of the operating room with the bright lights trained on the bloody mess that was Kenny’s leg. I tried to put everything else out of my mind. It didn’t matter how much sleep I got last night. It didn’t matter what else I had planned for the rest of the day. This poor kid, barely alive, was lying unconscious on an operating table with some stranger about to decide whether to cut off his leg.
I hemmed and hawed for a few minutes. The natural impulse, of course, is to save the leg. If there is a chance in a million, take it. The kid was only fourteen years old. What did we have to lose by trying? If it didn’t work we could always amputate the leg later. Didn’
t we owe him at least that much?
I wasn’t sure. Kenny’s leg was so badly damaged that an attempt to save his leg could cost him his life.
But what about Kenny? What would he want? If we woke him up and said, “Kenny, your leg is severely injured. Should we cut it off or try to save it?” Does anyone think he would say, “Cut it off”?
For Christ’s sake, he was only fourteen years old.
The room was quiet save for the sigh of the ventilator and the steady beep of the cardiac monitor. From behind the drape at the head of the table, the anesthesiologists looked at me questioningly. The other residents stood silent, some looking at the ground, some staring at the gaping wound in front of us. No one moved. No one spoke. They all waited.
On the surgical field in front of me was a leg. That’s all that could be seen. The draping was deliberately arranged to exclude everything else. Everything else was superfluous. In hiding the rest of the body, the rest of reality, we were trying to convince ourselves, as surgeons always do, that we had defined and isolated the problem to the mangled hunk of skin and bone on the sterile, blue surgical sheet in front of us. It was so much cleaner, so much easier, that way.
But what of life’s unseen tendrils that spread slowly from this leg, extending under the drapes, out of the room, and into the unpredictable world we tried so tenaciously to exclude? What of Kenny’s basketball games, and high school dances? What of the walks in the woods, and the sensuous intermingling of legs on his first night of sex? Did we really think by hanging sterile blue sheets in a room on the second floor of a hospital we were no longer required to think of those things, too?
This was not some abstract problem of surgical technique or diagnosis. This was not even a dispassionate analysis of the viability of muscle tissue or the regenerative ability of nerves. This was deciding whether to amputate a kid’s leg. This required an understanding that an amputation means more than just severing bone, muscle, and tendon. This required an understanding of what a scalpel can and can’t do.
I knew there was an easy out. I could say it was the kid’s decision, not mine. I could step back, hold up my hands, and say, “Don’t blame me. I just did what Kenny wanted.”
Or was it?
No, I realized, that’s not what Kenny, or his parents, wanted. What they wanted was a compassionate, highly trained surgeon who would do what he thought was in the best interest of this little boy. And I knew what was in the best interest of this little boy. I knew damn well. I just didn’t want to do it.
Go ahead, I told myself. Be the hero. Fix the kid’s leg. You’ll be four hundred miles away six months from now when Kenny and his family realize they should have had an amputation. Someone else will have to do the dirty work then. But the family will always remember you as the hero, the surgeon who saved Kenny’s leg.
I looked at the mutilated pile of skin and bone that up until two hours ago had been a miracle of functioning flesh. Now it was only a mass of dark meat lying on a blue surgical sheet slowly oozing its life away.
I picked up a scalpel and began the amputation.
It was 4:30 A.M. by the time we wheeled Kenny into the recovery room. His vitals were stable. It looked as though he would make it. His parents, his brother, and some aunts and uncles stood up when I came into the waiting room. I told them Kenny had made it through surgery and although he was still in critical condition we thought he would pull through.
“What about his leg?” the father asked.
I looked at them, struggling to find words. My hesitation confirmed their worst fears. “I’m afraid the injuries to Kenny’s leg were just too severe,” I began. “There was no way…” When I told them I had to amputate the leg, Kenny’s mother’s hand flew to her mouth. His father’s shoulders sagged and he hung his head.
“But,” I said, “there is an excellent chance that he will walk quite normally with a prosthesis.” I said a few more things about Kenny needing a lot of support during the next few weeks, but they didn’t seem to hear much after the part about the amputation. I could see the disappointment, the accusation in their eyes. Why hadn’t I saved Kenny’s leg? Why had I failed them?
When I finished talking to the family I went back to the doctors’ locker room. It was 4:50. I considered lying down on the couch until rounds at 7:30, but decided instead to go home. The thought of two hours in my own bed was too good to pass up. I was going to leave my scrubs on, but saw there was blood spattered all over my pants and shoes, so I changed and then headed home.
A light, sleety rain was falling as I walked through the empty parking lot to my car. I stood for a moment, key in the door, lifting my face and letting the soft rain wash over me. Swirls of sleet drifted past the light above me. It felt good just to be out there. It felt good to rediscover that life isn’t all pain and suffering. I was glad I decided to go home, and to leave all those other things behind—at least for a while.
I closed my eyes, enfolded in the soothing caress of the rain. A few seconds later I swayed against the side of the car. My eyes snapped open. Home, I thought. I need to go home.
I turned and looked back at the brilliantly lit emergency room entrance. An ambulance was parked there, its doors open. It was empty, but an air of tension lingered in the air. A seat belt dangled from the driver’s side. From the radio receiver in the front seat I could hear garbled voices, urgent transmissions about other emergencies in other places. In the back of the ambulance I could see a blood pressure cuff swinging back and forth from a silver hook on the wall. The floor was littered with empty syringes and vials, a plastic airway, and ten or twenty bloody 4×4s.
On another night I would have been inside as the patient was wheeled in. I could see the ERSS chief barking orders, the junior resident wiping back the hair from his forehead as he tried to get an IV started. Someone else was prepping the chest for the subclavian line. Techs were scurrying back and forth with blood tests and X-rays.
Not tonight, I thought. Tonight it’s their show, not mine. I’m going home.
I opened the car door, dropped into the driver’s seat, and headed west on Second St. I knew the heater would never warm up in the five minutes it took to drive home so I scrunched down in the front seat, shivering slightly. At least the wipers were working. In the rearview mirror a faint gray was spreading across the dark sky as night dripped slowly into day.
What a life, I thought. What a crazy life. Going home at five o’clock in the morning excited because I have a chance to sleep in my own bed for two hours.
As the car splashed on I began thinking how much my life had changed in the last few years. I thought about all the guys I had grown up with. I still got together with them every Christmas when I was home. They were the same old guys. They partied and laughed. They shot pool at O’Dea’s, went to Sox games, played sixteen-inch softball, and closed Callahan’s on Saturday night. Yes, they, too, were getting married, finding jobs, starting families; and yes, they, too, put in some long hours. But at least their lives had some balance. At least they didn’t have to worry that every mistake they made would kill or cripple someone.
I remembered all the times, so very long ago it seemed, when I was one of those guys—single, roaming the bars on the West Side, shooting pool and singing Irish songs, closing one pub and going to another until the last bartender at the last bar served us the very last beer. (“Time now! Time, gents! For the love o’ Jaysus, it’s half three. Have yez no homes to go to? I mean it, lads. This is the last one. Get ye home.”) God, it seemed like another life, another person. Was that really me?
I liked the person I was ten years ago. But I wasn’t sure I liked this new person, this surgeon, I had become. Who was he? I had never gotten to know him. I hadn’t the time. Time was a tool I used to accomplish other, bigger things. I had learned to manage my time so efficiently, to be so perfectly pragmatic and utilitarian. Introspection was an irrelevance, and I had no time for irrelevance.
Perhaps because it was so late and I was sill
y from lack of sleep, I began to wonder what it would be like to meet my old self. I was approaching the point where Second St. leaves the city and becomes a country road. Under the last streetlight I imagined I saw someone. It was myself, my younger self, standing in the rain, his Notre Dame letter jacket hunched up around his neck. His thumb was out, and he was trying to hitch a ride. I stopped to pick him up. I knew him and he knew me. He got in the backseat, slammed the door, and shook the rain from his wet hair.
“Thanks,” he said, trying not to be too obvious, as he looked me over. He seemed rather deferential at first, almost as if he were in awe of me—perhaps because it was hard for him to imagine himself being so different and yet so much the same. He felt at a disadvantage. I knew everything about him but he knew nothing about me. He stared at me, wondering how such a profound change could come about. He couldn’t tell yet if he was pleased with this change or not. He asked me what I did.
“I’m a doctor.”
He looked at me in amazement. He thought I was kidding. The possibility of becoming a doctor had never entered his mind. He leaned forward and put his hand on the front seat. I could smell the beer on his breath.
“Really. A doctor, huh?”
“Yeah.”
“What kind of doctor?”
“An orthopedic surgeon.” I only say “orthopedic surgeon” when I’m trying to impress someone. Otherwise I just call myself an orthopod.
“Orthopedic,” he said. “That’s a bone doctor, right?”
“Yeah. Bones and joints.”
“Jeez.” He was quiet for a minute, then asked, “So, are you married?”
“Yeah.”
“You are?” He seemed even more surprised and delighted. He wanted to know everything about Patti—what she looked like, how we met, where she was from. When I told him we had four kids he stared at me in amazement.
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