Chapter Twenty-Two

March

I moonlighted every chance I got during my Basic Science rotation. I hoped to pay off all our bills and even put away a little for the future. I moonlighted so often that I could almost do the ninety-mile drive in my sleep. Sometimes I think I did.

Although I moonlighted because I needed the money, I was starting to realize how much valuable experience I gained while moonlighting. I reduced fractures, drained infections, repaired tendon lacerations. Even the nonorthopedic things I did, things like caring for heart attacks and treating ear infections, honed my diagnostic skills and made me a better surgeon.

Some weekends at St. Joe’s could be relatively quiet, but this weekend I was earning every cent they paid me. I had been working for thirty-four hours and had just two more to go. I had gotten three hours of sleep Friday night and managed another hour the next afternoon. But Saturday night had been a nonstop succession of the ill, the injured, and the intoxicated.

The guy with the chest pain had finally been admitted to the CCU. The college kid with the broken hand from the bar fight had been casted and sent home. I was just finishing the prescription for the baby with the ear infection.

“Give him one teaspoonful three times a day,” I said, handing the mother the prescription. “We’ve given him his first dose here, so you can wait ’til morning to fill the prescription.” The mother nodded, folded the prescription, and put it in her purse.

“Did you ever have an ear infection when you were a kid?” I asked her.

“No,” she said, shaking her head wearily, “never did.”

“Me neither. But every adult who ever had one says it is the most painful thing they can ever remember.”

We both looked at the baby who, thank God, had finally fallen asleep. Being careful not to wake him, I ran my index finger up and down his chubby, little forearm, feeling the baby-soft skin.

“The ampicillin will fight the infection,” I said, gazing at the sleeping infant, “but it doesn’t do much for the pain. Be sure to give him some Tylenol if he seems to need it.”

She nodded in understanding and gave me a quiet smile of thanks. She lifted the baby to her shoulder and in a moment they were gone.

I was just about to go to bed when Johnny called back to say Helen Youngberg was here again. Helen was a thirty-seven-year-old woman with multiple sclerosis. She was a regular at St. Joe’s ER. Her parents brought her in at least once a week with one problem or another. Although Helen’s MS was worsening, she ignored her neurologist’s advice to stay in a wheelchair; consequently, she fell a lot.

Helen had suffered the ravages of MS for fifteen years. She could barely walk, and because of optic neuritis she could barely see. Connie Fritz, one of the ER nurses, had known Helen for years. Connie told me she thought Helen was deteriorating mentally as well.

When her husband had left her five years before, Helen moved in with her parents who were in their seventies. Her ex-husband remarried, moved to Seattle, and had nothing to do with Helen. “As soon as the going got rough the son of a bitch took off,” her father had told me.

Helen’s parents were tough old Swedes. They never complained, but it was becoming obvious they were having a hard time caring for Helen. Helen, however, adamantly refused to consider a nursing home or long-term care facility. She kept insisting she was fine at home.

Johnny pushed Helen, who was in a wheelchair, back to us. Helen was holding her wrist. Her parents, heads hanging, shuffled slowly behind.

“She fell again, Doc,” her father said. “We’ve told her a thousand times to call us if she has to go to the bathroom but she got up by herself. Looks like she broke her arm.”

“Hi, Helen,” I said. She didn’t answer. Even though I had seen her several times before, Helen appeared not to recognize me. Her wrist was swollen and angulated. “I’m afraid your wrist is broken,” I told her. “We’ll get some X-rays, and then I’ll try to put the bones back in position.”

She was back from X-ray in fifteen minutes. The films confirmed a displaced fracture of the distal radius. I explained to Helen and her parents that I would have to reduce and cast the fracture. I scrubbed her wrist, then injected some local anesthetic into the fracture area. This would help but it never eliminated all the pain. Helen gasped as I mashed the bone back in position.

When I finished applying the cast I told Connie to get some post-reduction films. While we were waiting, Helen’s father asked if he could talk to me. We stepped into the empty waiting room. “Doc,” he said, “do you think you could keep Helen here for a day or two?” He rubbed a hand across his forehead. “I can’t bring her home. My poor wife is wore out trying to look after her.”

A wrist fracture is not sufficient grounds to admit a patient to the hospital. But I couldn’t bring myself to tell him that. The poor man looked terrible. He was seventy going on a hundred. I knew I could admit her if I made up some bullshit about neurovascular compromise or something.

“Let me see what I can do,” I told him.

I went back to Connie and told her we were going to admit Helen.

“For a wrist fracture? They’ll never let you admit her for that.”

“Yes, they will. Tell the supervisor she is being admitted for observation of her neurovascular status. She may need surgery.”

Connie looked at me like I was nuts. I put my hand on her forearm. “Connie,” I said, “we can’t send her home.” I pointed at Helen’s parents who were slumped against each other in chairs along the far wall. “Look at them. They’ve done what they can. It’s time to find another solution.” Connie nodded. She called the nursing supervisor to make arrangements for the admission.

The front desk was quiet except for the occasional, disinterested voice coming across the police radio. I signed a couple charts, then dictated a history and physical. There was no sense going to bed since Helen would be back from X-ray in a few minutes. I thought I’d take a quick break. I slipped on my lab coat, waved to Johnny at the front desk, pushed open the door, and stepped into the night.

I hopped over the snowbank at the edge of the sidewalk and walked thirty or forty steps until I was away from the bright lights over the door to the emergency room. It was quiet out there. I leaned against a tree and looked to the west where the moon, almost full, was just setting. The Minnesota River was several blocks away, and although I couldn’t see it, on a quiet night like that one I could hear the faint, sibilant rush of its waters.

It was cold, so I clutched my thin, white lab coat a little tighter about me. I felt guilty that I had lied to get Helen admitted—and yet I felt it was the right thing to do. Helen could hardly walk, could hardly see, and was growing demented. She needed more than her parents could provide. I didn’t blame Helen for trying to hang on to every possible thread of normality. I knew she thought if she went to a nursing home she would never come out. But I felt sorry for her parents, too. They were seventy years old and trying to do the impossible.

I looked back at the hospital, thinking how far away it seemed, and how far removed I was from the mortal lessons being played out within its walls. But as I basked in my invulnerability, I began to feel vaguely troubled. There was something about Helen that struck a chord in me, something more than the usual empathy a doctor feels for his patient.

I didn’t know why. One could hardly have picked two more different people. I was a young, healthy, active man. She was a sick, decaying woman. But despite our differences, I could understand her frustration and anger at what was happening to her.

As I stood there watching the long shadows of the moon stretch across the open field next to the hospital it occurred to me that maybe Helen and I had more in common than it seemed. Wasn’t I held just as firmly in the inexorable grasp of mortality? I didn’t want to admit it, but maybe that’s why I felt Helen’s situation so keenly. Maybe I found her story tragic merely because it was a distillation of my own. Maybe my empathy for her was just a disguised grieving for myself.

Behind me a faint smudge of gray streaked the sky behind the leafless trees. It would be dawn soon. I massaged the back of my neck, pushed away from the tree, and brushed the dirt from the sleeve of my lab coat. I took one last, lingering look into the night and headed back to the ER.