Chapter Twenty-Nine

January

On January 4, the day I started as senior resident on Marty Shaw’s hand service, our financial situation became even more precarious. When I went out to start the old Pontiac that morning it made a terrible grinding noise, shuddered once, and was still. I tried everything, but I couldn’t get it to start. Finally I phoned Mr. Jensen at the Standard station. He grumbled that the damn thing probably died of carbon monoxide poisoning. He said with the junk heaps I drove he wasn’t sure if I was studying to be a surgeon or an undertaker.

For Patti’s sake he agreed to come and take a look. He checked under the hood, turned the key, and spat when he heard the groaning sound the car made. He told us to forget it. The car was dead. Totally and irrevocably dead. Brain dead. Flat line. Elvis had left the building.

“Thanks for the coffee and sweet roll, Mrs. C.,” he said to Patti.

Patti smiled and thanked him for coming.

“Splurge, Doc,” he told me as he climbed back in his truck. “See if you can get something with less than 150,000 miles on it this time.”

When he had gone, I siphoned the gas, removed the spare tire, and called Ernie Hausfeld at the junkyard again.

“Collins. Oh, yeah. Aren’t you the Mayo doctor?”

“Yep. That’s me.”

“You’re getting to be a regular customer, Doc.”

He didn’t have to rub it in.

“You know the routine. You drive it in, you get thirty-five. We tow it in, it’s only twenty-five.”

“It’s not going to start, Ernie. You’ll have to come and pick it up.”

“No problem. Jimmy’ll be there in half an hour. Be sure you have the title ready.”

Three hours later the tow truck pulled up in front. “Hey, Doc,” Jimmy said as he hopped out of the cab. “Nice t’see ya again.” He walked around to the back of the truck, yanked at the hitch, and slipped it under the front bumper. He leaned inside the back of the truck and pressed a button to raise the front of the car. There was a snap and the bumper fell off.

“Jesus Christ,” Jimmy said. He stood there, hands on his hip, staring with disgust at the car. Then he looked at me. “So, what kind of doctor did you say you were?”

I knew where this was coming from. How could I be a real doctor when I drove nothing but clunkers that got towed to the junkyard?

“I’m a veterinary gynecologist,” I told him.

“Figures.”

He picked up the bumper and tossed it in the back of the truck. Then he crawled under the Ponch and secured the hitch to the frame. When he was done he stood up and slapped the dirt and snow from the seat of his pants.

“You got the title, Doc?”

I handed it to him and he reached into his shirt pocket and pulled out two tens and a five. “Here,” he said. “Don’t spend it all in one place.”

 

A week later I bought an old Chevy wagon from a dairy farmer in Zumbrota. The car was another rust bucket. Someone had spray-painted it a flat gray color that made it look like a battleship. It had no muffler and the dull roar of its engine made it sound like a battleship, too.

My first stop was at Jensen’s Standard station to fill it up. Blackie, Jensen’s old Lab, shuffled over to lick my hand.

“Hey, Doc,” Mr. Jensen said, walking out from the garage and wiping his hands on an old shammy. He looked at my car and stopped smiling. “You got a license for that boat?” he asked. He waved his hand back and forth in front of his face. “Phew. Turn the damn thing off before we all choke to death.”

“So,” I said, gesturing at the car with my open hand, “what do you think? Not bad, huh?”

Jensen walked slowly around the car, eyeing it with disgust.

“You’re actually going to let your wife and those poor kids ride around in this damn thing?”

Apparently he didn’t care that I was going to ride around in this damn thing. He opened the front door and looked inside. Then he turned and spat. “Fer Chrissake you can see the street right through the floor.”

“Well, it’s—”

“You shouldn’ta paid more than five hundred for this bucket of bolts.”

“Yeah, but our other—”

“Poor Mrs. C.,” he said, shaking his head sadly. “The things you do to that woman.”

Like the mailman, the garbageman, the ladies at the grocery store, and every shopkeeper in Rochester, he loved Patti. They all did. And they all felt responsible for her. They all harbored the sneaking suspicion that her husband wasn’t quite worthy of her (a suspicion her husband also harbored).

When I finally got the car home and showed it to Patti, she put on a brave face.

“It’s, uh…nice,” she said. “But how come it looks like that?”

“Like what?”

“That gray color. It looks like a battleship, or something.”

“It’s coated with a special rust preventative,” I lied. “And, really, it’s not bad for seven hundred bucks, don’t you think?”

“It’s just that…well, it doesn’t look like a car.”

It didn’t sound like a car or drive like a car either. When I took it to work the following Monday, Jack Manning saw me pull into the parking lot and yelled, “Fleet’s in!”

“Hey, sailor, want a good time?” someone else called.

But still, it ran. The main problem with it was neither the noise nor the appearance. It had a temperamental heater. For as long as we owned the Battleship I could never figure out why sometimes the heater worked and other times it didn’t.

 

A week after we bought the Battleship I was scheduled to moonlight. The temperature hadn’t climbed out of the single digits in ten days. As I sat on the edge of the bed trying to figure out how early I had to get up the next morning, I could hear the wind moaning through the fir tree outside our bedroom window.

It was easier to work backward.

I have to be in Mankato by seven, I thought. The roads should be plowed, so that means I can leave Rochester about 5:30. Rounds’ll take an hour, so that’s 4:30, plus ten minutes to drop the beeper at Bill’s. That makes it about 4:15.

I never allowed time for showering, shaving, or brushing teeth. I just hoped things would be quiet when I got to Mankato so I could shower and shave there. I set the alarm, turned out the light, and snuggled in next to Patti. But before I could settle in I remembered the weather forecast.

Shit, I thought. It’s supposed to be twenty below tonight. I’d better get up at two and start the car. I’m screwed if it won’t start in the morning.

I rolled over, turned on the light, and reset the alarm.

At two o’clock I groaned and shut off the alarm. I sat up, rubbed a hand across my face, sighed, and pulled on a pair of sweatpants. As I shuffled toward the kitchen, I could hear Mary Kate’s rattley breathing in the room next to ours. I pulled on my parka, and then stepped into the Sorrels I had left inside the back door. I didn’t bother to lace them.

I opened the door and stepped into a clear, frigid night. The wind was gusting over the rooftops and rushing through the deserted backyards. I could see the skeletal frame of our swing set, legs planted deep in the crusted snow. One of the swings, its seat covered with an inch of frozen snow, was twisting in the wind. As I crunched through the snow to the garage I could feel the hairs in my nose freeze with each breath.

I heaved up the garage door, flicked on the light, and lifted the hood. I needed to take off the air filter, but the upraised hood blocked the light, and left the engine in shadows. Largely by feel, I undid the wing nut and removed the filter. I blew on my fingers and then held them under my armpits. When a little feeling came back in them, I bent over and gave the carburetor a couple flips. Finally I came around, got in the driver’s seat, gave the accelerator two quick jabs, and turned the key. The starter groaned once, twice, and the car kicked into life. I held my breath. This was when the engine would sometimes quit on me. But the steady rumble continued.

I got out, replaced the air filter, slammed the hood, and scrambled back in the car. I scrunched down, head on my chest, hands under my thighs, waiting for the engine to warm up. Finally, after ten minutes, I gave it a couple revs and shut it off.

I pulled down the garage door and staggered back into the house. I tossed my coat on the chair next to the heat duct, kicked off my boots, and felt my way through the dark house to our bedroom.

I sat shivering on the edge of the bed as I reset the alarm for 4:15. I could hear Patti’s slow, regular breathing from the other side of the bed. I could feel the warmth coming off her. I was so cold. If I could just slowly inch right up next to her…

“Oh, God!” Patti screamed. She jumped a foot off the bed.

“Sorry, hon,” I murmured contritely.

“You’re freezing. You are absolutely freezing. You’re like an iceberg.” She was flopping around, jerking covers every which way, trying to interpose as much material between our two bodies as possible.

“I was out starting the car.”

“Naked?”

“No, but it’s twenty below out there.”

She said it felt like it was twenty below in here, and rolled away from me. I lay quietly on my side of the bed.

A minute later she relented. “All right,” she whispered, “come on.” She lifted the covers and I scooted over. She was on her back. I draped my right leg over her thighs and my right arm across her chest. I pressed as much of my flesh against hers as nature would allow. She gave a little gasp. “Oh, my God,” she said. I felt a shiver run through her.

I lay still, listening to the branches of the fir tree scrape against our window, feeling the house tremble slightly with each gust of wind. I was safe. I was warm. I was under four covers with my hand on the warm breast of the woman I loved. I was in heaven.

 

“Mr. Jenin?” I said softly. It was ten after five. I had already seen the other ten patients on our service. Mr. Jenin, who had a wrist fusion the day before, was the last one. I turned on the lights. “Mr. Jenin?” I said, a little louder.

“Huh?”

“Good morning. It’s Dr. Collins.”

“Oh. Hi, Dr. Connolly. Is anything wrong?”

“No, sir. I just wanted to see how things are going.”

He looked at the clock next to his bed. “Things?” he said hoarsely. “Going?”

I laid the chart on the chair next to his bed. He winced slightly as I peeled back the dressings from his arm. “Looks good,” I said, replacing the bandages.

“Do you feel this?” I asked, running a finger along the side of his hand.

“Uh-huh.”

“Can you move your fingers, like this?”

He did.

“Good. Have you had much pain since surgery?”

“Yes, but the medicine helps.”

I talked to him about the physical therapy he would have later that day, apologized for waking him so early, and told him Dr. Chapin would be by to see him later that day.

It was still dark when I pulled up in front of Bill’s house. It seemed every other weekend Bill, Frank, or Jack was stuck holding my beeper for me. They must have taken pity on me since they never refused. Bill had agreed to do it this time. I told him I would leave my beeper in his mailbox rather than wake him up.

God, it’s cold, I thought as I trotted up the sidewalk to Bill’s front door. I wonder if beepers can freeze?

I laid the beeper in the bottom of the mailbox. I also left a note thanking Bill and listing all the patients.

It must be 5:30 by now, I thought. I walked around to the front of the car so I could read my watch in the headlights. 5:36 A.M. Well, I’d have to hurry.

 

As I pulled away from Bill Chapin’s house, the announcer on KROC said it was nineteen below. I prayed this would be one of the days when the Battleship’s heater would work.

Highway 14 was deserted at that hour and I kept the Battleship cruising along at seventy. The car had no dashboard light, and since it was still dark, I occasionally had to turn on the overhead light to see how fast I was going.

The wind was streaming in through the holes in the floor. At seventy miles an hour and the temperature near twenty below, the windchill had to be approaching a couple hundred below. There was a four-day-old copy of the Post-Bulletin on the seat next to me. I spread it across my lap and started fiddling with the heater. I turned it off and on. I pounded my fist on the dashboard. I jiggled the control knob. But, after fifteen minutes, as I passed Mantorville, I realized there would be no heat on this trip.

I had another seventy-five miles to go. My legs were shaking and I was starting to lose feeling in my feet. In desperation I looked into the backseat. Next to the car seat I saw Mooey, Mary Kate’s brown-and-white, stuffed cow. The car swerved onto the shoulder as I stretched behind me and grabbed the cow.

Poor Mooey. There would be no coming back from this mission. I wedged her into the largest hole in the floor. Immediately the cold draft up my pant leg diminished noticeably. “’Tis a far, far better thing you do than you have ever done before,” I recited.

Mooey seemed unimpressed.

When I finally got to Mankato I had a hard time getting out of the car. My knees and ankles were stiff like an old man’s. I stumbled into the ER and waved a hand at the nurses. Thank God the place was empty.

“Gonna shower,” I said, my teeth chattering.

After ten minutes in the shower I was finally warm enough to get out and shave. When I pushed my shaving cream dispenser, it made a guttural, groaning noise. A small wad of snow plopped from the nozzle. It was frozen solid. I tossed it back into my shaving kit and shaved with soap instead.

It was a wonderful day to be at Mankato. The high temperature was forecast to be around ten below. It was just too cold to go out, so the ER was empty for most of the day. The hospital paid me by the hour, so whether I saw a hundred people or three I made the same.

I spent most of the afternoon in the doctors’ lounge watching the Canadiens play the Bruins. Every couple hours I went out and started the Battleship. I had parked it against the wall outside the ER. Around four o’clock I turned off the hockey game, went to the call room, and took a nap. An hour later the nurses called to say we had a patient, a Mankato cop with frostbitten ears. He had spent the last hour at Mt. Kato, Mankato’s one and only ski hill, looking for a missing skier who turned up later in one of the local bars.

“There’s not a lot we can do for this,” I told the cop as I lathered ointment on the tips of his ears. “Just be sure you keep them covered so they don’t get damaged any further.”

When he had gone, I went to the cafeteria and had dinner. I sat alone in the corner, a plateful of pork roast, corn, mashed potatoes, and gravy in front of me. For once I was conscious of being alone. Around me, in groups of twos and threes, nurses and techs were talking and laughing. I worked away at my meal, listening to them talk about bridal showers and car problems and TV shows.

One of the nurses at the table next to me saw me laugh at a story she was telling. She flashed me a smile, letting me know that she didn’t mind my listening. But I was embarrassed all the same. I finished my meal and wandered back to the call room. I lay down, took out Campbell’s Operative Orthopaedics, and started to read about ankle arthrodeses. I was sound asleep at eight o’clock, the book lying on my chest, when the phone rang.

“We need you,” Connie said. “An ambulance just called. They’re on their way in with a guy in full arrest.”

I grabbed my coat and sprinted down to the ER. Over the loudspeaker came the call, “Emergency room! Emergency room! Emergency room!”

Within three minutes all the ER nurses, the respiratory tech, the lab tech, and a pharmacist were waiting with me. I calmly checked the crash cart and waited for the ambulance. I had run enough codes by this time that they were becoming almost routine.

The ambulance roared into the bay with full sirens going. The driver hopped out and swung open the back doors. The paramedics were doing CPR on an obese, cyanotic-appearing man. I followed them as they wheeled the patient in.

“Fifty-one-year-old guy,” the paramedic gasped between chest compressions, “chest pain for two hours…collapsed at home…his son, a high school kid, started CPR right away…we were there in eight minutes…never got a pulse.”

We cut off his shirt, slapped on the cardiac leads, and started an IV. I gave him some bicarb, then epi, then more bicarb. He was in V-fib so I shocked him. I went up to his head and intubated him, went down to his groin and drew a femoral artery blood gas.

During the first few furious minutes when I was trying to do ten things at once, I looked up and saw the anguished face of a high school kid with a letter jacket standing at the foot of the cart watching the feverish activity, watching his father’s cyanotic face and sightless eyes. A few seconds later someone whipped the curtain closed, and I never saw the kid again. He was the son, though. He had to be. I could see the resemblance.

I put in a central line and gave some more drugs. I tried the defibrillator again. It didn’t work, any of it. After another half hour I called the code. The man was dead.

As I sat quietly at the desk, filling out the death certificate, and the ER record, I remembered the kid’s eyes: the anguish and fear and confusion. How incredibly fast it must have come upon him. He sees his father clutch his chest and fall to the ground. There is a moment of confusion and panic. What is it? What has happened? Then the terrible realization that it must be a heart attack. His father needs CPR. Can he do it?

Oh, God, he thinks, why didn’t I pay more attention to this stuff in health class?

He begins, clumsily. Is this the way? Is this how you do it? Then the desperate, plunging chest compressions, the awkward attempts at mouth-to-mouth, the intense longing for the ambulance to get there. Oh, God, where are they? He pushes the hair from his face and goes on. He sees his father’s face growing purple, feels his lips growing cold. As he struggles on, he hears his mother’s anguished sobs behind him.

Finally the paramedics arrive and he is pushed aside. He doesn’t know if he did the right thing. Has he helped his father? Or has he killed him? He backs farther away, wedging himself into a corner, staring as the paramedics wage their desperate battle. Soon his father is spirited away in an ambulance. He and his mother follow in their car.

At the hospital, strangers are cutting off his father’s clothes. They are sticking tubes in him, shocking him with paddles. He stands at the foot of his father’s cart watching it all. He can hardly bear to watch, but he can’t tear himself away. Finally someone closes the drape and he can see no more.

A few minutes later a doctor in a white coat comes out to tell his mother that her husband is dead. The doctor never speaks to him. No one does. When he thinks of his father all he can see is the bloated, purple face with that tube sticking out of it.

 

Two hours later, when the code was over and the death certificate filled out, when the janitors had mopped the floor and the nurses had restocked the crash cart, when the PM shift had gone home and the coroner had come to claim the body, I was still slouched in a chair at the desk. I kept going over the code in my mind, asking myself what I could have done differently. I couldn’t think of a single thing. I ran a perfect code. But I kept seeing the look in the eyes of the kid with the letter jacket, and the fact that I ran a perfect code did nothing for me.

Death, suffering, failure. They were the enemy, but they didn’t play by the rules. Sometimes, even when I did everything right, they still won. I couldn’t give up the childish notion that things ought to be fair. When I ran a perfect code, when I did everything right, the patient ought to live. What more could be asked of me? What more could I give? Day in and day out I did the best I could, the best anyone could—and so often it wasn’t enough.

 

It had been four hours since I had started my car. I knew I should go out and start it. I grabbed my lab coat from the back of the chair and told Connie I’d be back in a couple minutes. She told me there was a guy in Three with an infected elbow.

“Get an X-ray, a CBC, and a sed rate,” I said as I left.

The ER doors slid open. As I stepped outside, every bit of warmth was sucked out of me. I groaned through gritted teeth and wrapped my lab coat around me as I opened the door of the Battleship and plopped down. I turned the key and the engine roared into life. Thank God. Within two minutes I was shivering uncontrollably. My head and shoulders were hunched forward, my arms clutched to my chest, my thighs squeezed together. My breath was condensing into a frozen mist on the inside of the windshield.

After five minutes, just as I was ready to shut off the engine, I noticed a trickle of warmth coming from the heater.

Why now? I wondered. I drove ninety miles and the damned thing never threw out a single bit of heat. Now, after sitting out in the cold for fourteen hours it decides to work. I revved the engine a couple times, shut it down, and trotted back inside.

Some questions, I realized, are never going to be answered.