Chapter Six

October

Not every patient we cared for on ERSS had major trauma. Vern was a forty-year-old guy with a bushy red mustache and a fishhook up his nose. He had been fishing on Lake Pepin when his brother’s cast snagged him. The hook had embedded itself somewhere deep inside the nose. The eye of the hook, with a small monofilament knot still attached to it, glittered in the entrance to the left nostril.

Joe Stradlack thought this would be an excellent case for a junior resident to tackle. “If you do a good job,” he said, “we may let you lance a rectal abscess sometime.”

A rectal abscess. Oh, gee, could I?

I numbed up Vern’s nose, but after that everything seemed to conspire against me: the mustache, the lighting, the exposure, the bleeding. I shaved away part of the mustache, but still couldn’t see the tip of the hook. My plan was to use a small wire-cutter to snip the shaft, then I would try to wiggle the hook free. If I could spread the nostril a little wider I might be able to see better.

I had an idea. I turned to one of the nurses. “Get me a pediatric vaginal speculum.”

“Bull shit!” Vern bellowed from under the drapes.

“Vern, relax. It’s been cleaned and sterilized. It’s perfectly fine.”

“I don’t care what it is. You’re not sticking one of those things in my nose.”

So, did he want to go through the rest of his life with a fishhook up his nose?

“Fine,” I said. I turned back to the nurse. “Get me the nostril dilator.”

She stared at me uncomprehendingly. “There’s no such—”

“You know. The chromium-handled, fishhook-extracting nostril dilator?” I did everything but wink at her.

“Oh,” she said. “Oh, yes, the nostril dilator.”

She opened the gyne cart and handed me an instrument.

Fifteen minutes later I had irrigated away enough blood and had dilated the nostril enough to snip the shaft of the hook. Now I just had to tease the barbed point out of the tissue. It was not going well. Vern was having a hard time holding still. Perhaps the fact that he had a vaginal speculum and half a hardware store stuffed up his nose was part of the problem.

“How buch logger is diss gudda take, Doc?”

“Hang in there, Vern. I just about have it.”

“Dat’s what you said tweddy bidutes ago.”

“Have you ever tried to take a fishhook out of someone’s nose?”

Finally, I slid a small, curved-needle holder deep into the nostril. I grasped the hook and pushed it through the tissue and out the skin of the nose. I reached around and pulled the hook out.

Vern let out a hideous scream and leaped off the cart. “Ow! Fuckin-A! Oh, my nose! Jesus Christ! Fer da love a’ Cry-yi!” The vaginal speculum was still dangling from his nose. I must have hit a small artery because bright red blood was gushing from both inside and outside Vern’s nose.

“Vern, would you please—”

“I’m outta here,” he said. “I’m the fuck outta here.”

“Vern, we’re all done. I just want to—”

“Fuckin’ right you’re all done.” He ripped the sterile drape off his chest and started walking to the door.

“You can’t leave. You’ve still got the—”

He reached up and grabbed the bloody speculum and yanked it out of his nose. He stared at the speculum, his eyes narrowing. “It is,” he said. “It is one of those things.” He gave me a look of disgust, threw the speculum in the corner, and stomped out the door just as Joe Stradlack came back.

“Collins,” he said, “what the hell’s going on here?”

“Mr. Merven’s not very happy. Apparently he has more pressing business elsewhere. I got the fishhook out, though.” I held it up for him.

“Took you long enough,” he said, looking at his watch.

I shrugged my shoulders and began peeling off my gloves. “So, does this mean I’m not going to get to lance any rectal abscesses?”

 

Twelve hours later I was assisting one of the senior residents on an appendectomy. Halfway through the case we were told there was an emergency in the ER. The senior resident let me close while he headed down to help. I finished up, brought the patient to the recovery room, and wrote the post-op orders. Then I spoke with her parents, letting them know everything had gone well. I took a minute to splash a little water on my face and then went back to the ER.

The place was packed. There must have been fifteen people crowded around a cart working on a young woman. I asked Amy Watkins, one of the nurses, what was going on.

“She ruptured an artery or something. No one knows,” Amy said. “She was in full arrest when she got here.”

“How long have they been working on her?”

“Long time,” she said. “The paramedics started CPR on the scene and we have been doing it for almost half an hour now.”

That meant her chances were poor. I glanced over at her. She was a young woman, about my age. Her gray face was partially obscured by the ET tube and the Ambu bag they were using to breathe for her.

“Who are all these people?” I asked, nodding at the crowd.

“Well, besides ERSS and the code team they have the Neonatal team here, too.”

“Neo? What are they doing here?”

“She’s forty weeks pregnant.”

“Jesus,” I murmured.

Joe Stradlack was standing at the foot of the cart running the code. The patient had three or four lines going in her. A team of anesthesiologists at her head was bagging her. Rollie Whitfield was doing chest compressions.

Suddenly Joe turned and looked into the crowd at the foot of the cart. “Is Neo here?” he asked.

“Yes,” one of the residents answered. She looked awfully young.

“Who are you?”

“Mary Whithers, Neonatal ICU.”

“What are the baby’s chances?” Joe asked her. He knew damn well what the baby’s chances were. I think he just wanted to see what sort of resident he was dealing with, whether he could trust her with what was to come.

“Well,” she answered falteringly, “even under the best of circumstances CPR will not adequately oxygenate the fetus.”

“So?”

“So the sooner you can deliver it the better—at least as far as the fetus is concerned.”

Joe nodded and turned back to the woman in front of him.

Oh, God, I thought. I know what he must be thinking. CPR had by then been going on for over half an hour. The woman had no rhythm. Joe had to make a decision. If he continued CPR, the baby had no chance. If he stopped CPR and took the child by C-section, the mother had no chance.

He hesitated just a moment, then grabbed a small cup of betadine, splashed it on the abdomen, and picked up a scalpel. He slashed once, twice, three times, spread apart the gaping wound with his hands, reached in, and pulled out a perfectly formed, full-term baby. He cut and clamped the cord, then handed the child to Mary Whithers.

Now everything changed. Now instead of being the anonymous observer in the back of the crowd, Mary was the center of attention. Everyone stopped and watched to see what she could do. Nurses, surgeons, anesthesiologists, and techs all stared at the child she now held in her hands.

The child, a girl, was still warm and slippery. Mary set her down, slipped an ET tube down her throat, and had one of the nurses begin bagging her.

“Does anyone else know how to do neonatal CPR?” she shouted. One of the anesthesiologists said he knew, so she let him take over the chest compressions. Joe did a cut-down on the child’s arm and got a large-bore IV going. Mary very calmly and systematically began giving resuscitation orders. She tried everything; she gave every possible drug, but the baby didn’t respond. Finally, in desperation, Mary tried intracardiac epinephrine.

Even when it became obvious that there was nothing else to do, she couldn’t bring herself to stop. This baby was not a premie. She was a fullterm, perfectly developed baby, the kind you see on the cover of baby magazines. This was supposed to be the beginning of her life, not the end.

After another ten minutes Joe Stradlack finally laid a hand on her shoulder. “Good job, Mary,” he said. “There was nothing we could do. We got them too late.”

Mary looked at him, too beaten to speak. She hung her head and let her hands dangle limply at her side.

As everyone started to drift away, I glanced at the still, gray figure of the mother lying on the gurney. The overhead lights were still trained on her. Someone had tossed a sheet over the lower half of her body. The ET tube dangled limply from the side of her mouth. Then I saw that one of the nurses had brought the baby over and laid her next to her mother. The two of them lay there side by side. I tore my eyes away. I couldn’t look anymore.

What the hell kind of world is this? I thought.

I looked at the tray littered with used syringes, needles, vials of meds, bloodstained 4×4s, scalpels, and hemostats: the paraphernalia of futility.

In the corner of the room Mary Whithers was standing by herself trying not to cry.

I thought Joe gestured to me to follow him. I don’t know, maybe he didn’t. I wouldn’t have followed him if I had known where he was going. This was the part I couldn’t handle, the human part. Joe had to go tell a young husband we had failed. His wife and his baby were dead.

Joe took the husband’s hand, and struggled to find words. “I…I’m so sorry to tell you that…”

He said we were sorry. We were heartbroken. We had tried everything. We would have done anything. Everything that could be done had been done. And then the man thanked us. He shook our hands, even mine—I, who had done nothing. This was too much. I wasn’t ready to be thanked. I wanted to punch myself, or the world, or someone. Mothers and babies shouldn’t die!

I let the man shake my hand, and then I walked out of the ER. I leaned against the wall rubbing my left hand over my right, overwhelmed by what had just happened. It was quarter to seven. The halls were full of clean, fresh, young doctors and nurses, reporting for duty. They had been sleeping all night, had gotten up, showered, and come into work. For them it was the beginning of a new day. For me it was still one long yesterday.

I had a few minutes before morning report. I thought I’d better go check on that girl whose appendix we had taken out. Numbly, I waited for the elevator. When I got in, Jack Manning, showered, shaved, and bright-eyed, was standing there. He smiled and said hello. He could see I had been on call.

“Hey, bud,” he said. “How was your night?”