I’M not one of those people who always wanted to be a doctor. I hadn’t even considered the possibility until I took a biology class at the University of North Carolina at Chapel Hill. I sat next to an affable guy who liked to chat as he pulled his spiral notebook from his backpack and arranged three ballpoint pens on his desk, just so. As soon as the professor began talking, my classmate hunched forward in his chair, clamped his lower lip between his teeth, and scribbled at a furious rate, trying to capture every word. He was premed.
I was twenty-seven years old, and had recently returned to college after dropping out for nine years. Although I had enjoyed the freedom of doing exactly as I pleased, I had begun to feel that my life had no direction or purpose. That’s why I’d gone back to school.
The next time I saw my classmate, I mentioned that I’d been thinking about medical school. He snorted and shook his head, and held up a finger as he listed each hurdle between me and medical school. You had to have a stellar transcript. You had to do volunteer work—preferably in a hospital. You needed experience in a research lab. You had to ace the Med-Cat exam. He chuckled. You don’t just apply to medical school. I felt my face flush as I nodded along, listening to the reasons I would never get in.
A couple of days later I met with a premed adviser to find out if it was really that hard. Turned out, my classmate hadn’t exaggerated much. After the meeting I sat on the steps outside, thinking. I knew I was weak in science—before I dropped out of college I’d been an English major. My present classmates seemed younger, smarter, and better prepared, but I was pretty confident that I could outwork them.
The cold stone steps became increasingly uncomfortable. I stood and stretched. Trying to get into medical school would give me a challenge and a goal that would organize my life. I slung my book sack over my shoulder and walked down the steps. I could load up on physics, chemistry, and physiology without telling anyone I was premed. That way, I wouldn’t seem foolish or arrogant, and if I didn’t get in, I wouldn’t have to explain it to anyone.
I ran out of money quicker than I’d thought I would, so I got a job as a nursing assistant in the emergency room of a North Carolina hospital. One Saturday afternoon, the paramedics rolled their narrow gurney toward a curtained cubicle in the emergency room. I put down the bedpans I’d been restocking, and followed them. “Gunshot wound, back of the leg,” the paramedic gave his report to Julia, one of the ER nurses. One trouser leg of the mechanic’s coveralls had been slit all the way up to the belt, to expose the injury. “Blew a piece of the femur out through the front.” A shard of bone jutted out through the skin of the man’s thigh like a curved, primitive knife. The wound splayed open, its edges as sharp as if a razor had made the incision. The muscle glistened red. The man’s bare leg was skinny and pale and lay motionless against the dark fabric of his work pants. His jockey shorts were a grayish-yellow.
The man’s eyes darted over to Julia. “It hurts.” The corners of his mouth pulled downward. His face had a short stubble of dark whiskers; his hair was cropped close. He breathed deliberately and regularly: in through the nose and out through pursed lips.
“Grab the bottom sheet,” Julia told me, “like this.” She leaned forward, the stethoscope draped around her neck swinging away from her chest. Most of the nurses wore scrub pants and tops, but Julia always wore a blue scrub dress, white stockings, and white shoes.
I was new in the ER, and eager to help. I watched her closely.
Julia gathered the sheet in her hands, working more of it into her fists until they were right up against the man’s body.
Two paramedics on the other side did the same. They all waited for me to get a grip.
Julia counted to three, and we whisked him over from the paramedics’ stretcher to ours.
The guy shut his eyes tight and made a squeaky noise as he clutched his leg above the sliver of bone jutting out into the air. He opened his eyes and looked at me. I backed away. My throat and stomach tightened.
Julia touched the man’s shoulder. “Be right back.”
I hurried after her. Her brisk competence was intimidating, but she seemed willing to teach a new guy like me, and I wanted her approval. I admired the way she’d remained calm and pleasant all morning as the rescue squads brought us patient after patient, until stretchers lined our hallways. She was experienced, and could do the little extras. As she walked past a demented nursing home patient whose gown had been left awry, exposing her plastic diapers, Julia tugged it down over the lady’s knees without slowing her pace, without even seeming to notice she’d done it. And in real emergencies, she knew exactly what to do.
In the closet where we stored IV supplies, she jabbed a plastic spike into the bottom of a bag of normal saline. “Here,” she said. “Bring this to me when the fluid’s dripped all the way through the line.” She handed me the clear IV tubing. “Flush out all the air pockets.” She started back to the man with the bone sticking out from his thigh, then stopped and looked back at me. “You understand we don’t want to inject air into his veins, right?”
“No air,” I said. “Got it.”
The fluid slowly slid through the loops of the clear IV tubing. If I squeezed the bag, it would run faster. But Julia hadn’t told me to, and I didn’t want to screw something up. I was taking an Introduction to Physics class and could’ve quoted the pertinent laws of fluid dynamics, but I was afraid to squeeze a plastic bag of IV fluids. Probably better to wait the extra few minutes than run the risk of ruining the IV setup and having to start all over. I told myself to relax and enjoy the short break from the chaos in the ER. I was doing what I’d been told, and as soon as the air bubbles were out, I’d take it to Julia.
I worked every weekend in the ER and was in class Monday through Friday. The job made up for what scholarships and loans didn’t pay, and gave me the chance to meet people who could write letters of recommendation for me. I was still nervous around doctors because I’d never known any, other than the pediatrician my mom took me to when I was a child. His waiting room smelled like alcohol, and had a small merry-go-round with four wooden horses, their carnival paint chipped and scarred. It didn’t spin. Every time I got a shot, my doctor handed me a stick of Juicy Fruit gum for the ride home.
The fluid in the IV line continued its slow progress. I knew the guy was hurting and needed the IV, but I couldn’t take it to Julia until the fluid had flowed all the way to the end of the tubing. Finally, the last air pocket sputtered out. I ran my thumb down the little white plastic wheel that turned the IV off and hustled it over to Julia.
The guy was making louder squeaky noises in his throat—a tight sound that was more than a whimper, less than a scream.
“Big stick,” Julia warned the man in a bored monotone, as she slipped the catheter into a vein at the crease of his elbow. She moved calmly as if his arm were one of the rubber models for practicing IV skills. “Gimme that,” she said, holding out her hand.
I held out the bag of fluid, still staring at the end of the bone sticking out of the man’s leg. It looked like a feather carved from ivory and then polished perfectly smooth, the edge tapering to an impossible thinness.
“I need the end of the tubing.” She kept her thumb buried in the crease of his arm, pressing down on the vein to keep blood from running out onto the floor.
“Oh, yeah.” I felt stupid as I snatched at the dangling end of the tangled IV tubing. “Here.” I knew my rushing was making me clumsy, but I hadn’t seen enough medical emergencies to be able to work efficiently.
“You’ll need to untangle it,” Julia told me. She looked up at the man’s face. “We’ll get you some pain medicine in just a minute, sir,” she said. She took a deep breath and quietly let it out. “As soon as we get your IV running.” She looked down at the floor.
“Thanks,” he said.
I felt my face flush as I fumbled with the IV tubing. Finally it was straight, and I handed it to her.
“Thank you,” she said, as she twisted the IV tubing onto the needle. She taped the plastic needle to the guy’s arm, in a deliberate way, first one tab of tape, then the other. “I’ll be right back with one of the doctors,” she told him.
I stood beside the stretcher. I should be doing something more to help.
Julia came back with Kyle, one of the interns, strolling behind her in green scrubs and deck shoes without socks. Kyle had a deep tan and sun-bleached hair.
He stood at the end of the stretcher and folded his arms.
“Damn,” he said, with a subtle note of amusement in his voice. He looked over at me, raised his pale eyebrows, and grinned. He stared at the bone, shaking his head. “Does he have a pulse?” he asked, all business now. He leaned over and gently placed two fingers on the top of the man’s foot. I knew that, just like at the wrist, you can feel a pulse on the top of the foot, as well as on the inner part of the ankle. “Dorsalis pedis is intact.” He pulled a pen out of his coat pocket and made a small “X” on the top of the guy’s foot. “Lucky.” He felt to the side of the ankle. “Posterior tibial’s good, too.” He marked that spot with his pen as well. He straightened and looked across the man to Julia. “What’s his name?”
“Randal,” the man answered. “Randal Meyers.”
“Randy,” Kyle said, “you’re a lucky man.”
Lucky? I looked from the bone to Kyle’s face.
He frowned at the man and pointed at his foot. “I didn’t really expect to find any pulses.”
“I need—something—for the pain,” the man stammered, between quick little breaths, “’cause it’s getting—bad.”
Kyle shrugged with one shoulder, and turned to Julia. “You can give him some morphine.”
She left to get the medicine.
Kyle reached out his hand and brushed the side of the man’s foot. “Sir,” he said loudly, “can you feel this?”
“Yes,” the man said.
Kyle brushed the other side of his foot. “What about this?”
“Yes, yes, yes. Am I going to get something for the pain?”
“Just a minute.” Kyle’s voice had an edge of irritation. “You could’ve trashed your nerves. I need to check them.”
“I’ve got the morphine right here, sir,” Julia said, as she returned and slipped the needle of a syringe into a port on the IV tubing. She eased in the plunger.
As the medicine began to take effect, the man relaxed his grip on his leg. He grunted, a subtle sound of gratitude and relief, then took a deep breath and slowly let it out.
I took a deep breath, too. I’d been a full-time firefighter for five years, after dropping out of college the first go-round, so I’d gotten used to emergencies, but not medical ones. We went on a few medical calls, but mostly we put out house fires. Early on, an old-timer had told me, “When you get to the fire, don’t look at it. Concentrate on what you’re supposed to be doing.” Good advice. A fire that’s burning out of control can be enthralling, and you find yourself staring at the flames dancing from the windows and bursting through the roof. It’s scary and awesome. There’s beauty in fire, even as it burns someone’s home down to the foundation. As a firefighter, I learned to focus my attention on the task immediately in front of me. But I’d never seen a man with a sliver of bone slicing its way up out of his leg, and the distraction—coupled with my worrying about the man’s pain—had made me clumsy at the only thing I’d been asked to do to help him. If I was going to become a doctor, I’d have to learn how to deal with this kind of stuff.
“That was just five milligrams.” Julia looked from Mr. Meyers’s face to Kyle’s.
“Okay,” he said. “Repeat it if he needs it. But don’t snow him.” Kyle looked around the ER. “Anyone here who can sign an op permit?” He pointed to the leg. “They’ll have to take this to the OR.”
“Yeah, I know, but he just got here.” Julia glanced toward the entrance to the ER. “Someone’ll probably show up soon.”
“Wait a minute.” Kyle said. “He’ll need to sign an op permit before he gets any morphine.”
“He’s already gotten it.” Julia pulled the needle from the port in the IV line. “But don’t worry, someone’ll sign for him.” She looked up at the man’s face. “Mr. Meyers, is anyone coming to wait with you?”
“My brother,” he said, as he eased his shoulders down until they rested on the stretcher. “My brother should be here soon.” Mr. Meyers lifted his head off the pillow and looked down at his leg. “How bad is it?”
“Pretty bad,” Kyle said. “But you’re neurovascularly intact.” He pointed to the leg. “Your arteries and nerves seem okay.” He grinned. “Like I said, you’re really lucky.”
“Can I have something else for the pain?” His voice was less strained.
“Don’t give him any more.” Kyle frowned at Julia. “At least till I talk with ortho. They’ll need to talk to him before we snow him too far.”
“Are you okay?” Julia asked.
“I’m still hurting.” He slowly lowered his head to the pillow and closed his eyes. “But not quite as bad.”
“Would it feel better,” I asked, “with a pillow under it?”
“No!” The man held up one hand, fingers spread wide. “Please. Don’t move me.”
“Okay,” I said, stepping back. “I won’t.” I sure didn’t want to hurt him, and I didn’t want to piss off the nurses and doctors. I glanced at Kyle and Julia to see if my suggestion had irritated them. From what I’d seen, docs and nurses had a pecking order that was stricter than the fire department’s. Once, at a fire scene, I’d made a suggestion which, in retrospect, was probably pretty arrogant since I was still a rookie at the time. “Fuck you, boy,” one of the officers had said. “We don’t pay you to think.” He pointed to the canvas hose I held. “You just hump that hose.” No one in the ER had been that blunt, but I didn’t want to push my luck.
I looked at Mr. Meyers, his eyes closed, head tilted back into the pillow of the stretcher. His breathing was slower and deeper, but not natural. It was too regular, like he was aware of it. Mr. Meyers was still in pain.
“Foreshortened and externally rotated,” Kyle said.
“Huh?” Was he talking to me? Since we wore scrubs just like the nurses and docs, the docs would sometimes forget that we were just nursing assistants, and explain stuff to us. It was as if the visual cues of our dress blurred the distinctions in our roles and status. I was flattered. Kyle seemed so far above me: his job was learning medicine and treating patients; my job was pushing stretchers, changing the sheets, and rinsing out bedpans. Kyle was what I hoped to become.
“Foreshortened and externally rotated,” Kyle repeated. “See how his foot’s pointing off to the side, and how that leg looks shorter than the other?”
I looked carefully from the patient’s right foot to the left, then back.
Mr. Meyers grunted. Still hurting.
Kyle didn’t seem to notice. “Little old ladies get the same thing when they break their hips. The muscles in the thigh pull the leg up and out to the side.” He wrote something on the chart. “I’ll give him a gram of Ancef, and some Gentamycin.” The IV antibiotics would decrease the chance of an infection. Kyle walked toward the nurses’ station.
I envied his casual confidence, but I wondered how he could seem so oblivious to the man’s pain. I moved up to the head of the stretcher. “I hope you feel better soon,” I said, having nothing else to offer.
Mr. Meyers opened his eyes to look at me and said, “Thanks.” He closed his eyes again.
I backed away from the stretcher. Kyle had known exactly what to do: he’d given him morphine, antibiotics, checked the arteries and nerves, even marked the pulses so other people could check, too. He’d addressed every problem.
But damn, he’d seemed so callous. I wondered if he’d been like that before he started, or if medical school and internship had done it to him. And if med school could change people that much, did I really want to go? My Quaker parents had stressed the importance of caring about other people, which I thought required gentleness and a soft voice and an open heart.
A tech from the operating room came down to get the man with the bone angling out of his thigh. I helped push the stretcher down the hallway to the elevator. When the doors opened, the elevator floor was an inch lower than the hallway. I pulled back on the stretcher to decrease the jolting as the wheels bumped down across the threshold. Mr. Meyers winced, but didn’t grunt or whimper. On the second floor, we eased out into the hallway with hardly a bump. He let out a deep breath, as we rolled him to the operating room. Signs on the double doors said, in large red lettering, NO ADMITTANCE.
“Thanks,” the tech said. “I can take it from here.” As he wheeled my guy through the doors, I longed for a more important role to play. Watching the doors swing shut, I knew that I wanted to be a doctor.