Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (25 page)

Murray washed his hands all the time—all the time. If he was not on the phone, seeing a patient or destroying his pen, he would stand at the sink in the nurses' station with the water running over his hands. He could stand like that for half an hour or more; you just had to get used to the sound of splashing water when you presented a case. When he was not otherwise engaged, I know he was counting the number of hand swipes. He would move his left hand over his right, washing, for a certain number of strokes (I'm not sure how many, I think it varied with the circumstances) then he would reverse, right hand over left. He would stop and dry his hands on a paper towel, still listening to you. After a moment he would look back down at his hands, seem to notice a little speck of dirt and go back to washing again. At the end of each hand-washing session, he would carefully wipe out the sink with paper towels, wiping down the faucet and stainless-steel bowl. After this he would stand there for a minute, gazing down reverently into what must have been the only spot of cleanliness and order in that great chaotic sea of an ER. Only then would he, reluctantly, finally turn away.

Murray had been at “the Mecca” for six or seven years. “He used to be a really great guy,” everyone would say. No one could exactly pinpoint when the stress had finally gotten to him. But how could it not? Who else could come into a place like this, day after day, week after week, for all these years and not be in some way fundamentally fried? But stressed out or not, Murray did have something that was bad for any ER doctor—a volatile temper. Murray was a terror when angry. He could work himself up into a frothy rage about little things, someone spilling coffee, or not flagging an order properly. His face would become beet red, his eyes would bulge out, and after a while he would look as if his head might explode. He would yell. Rant. Weird things would set him off. For example, baby pacifiers used to enrage him. He would rip a pacifier from a little kid's mouth, and as the mother looked on horror-stricken, he would fling it into the trash can, shouting, “Never, never, never, never. Do you know—never—what those things do?” (I worked with Murray for years and never found out just what it was that pacifiers do. He never said and everyone else was too afraid to ask.) Or fevers and mothers who didn't give their child enough Tylenol. “Stupid, stupid, stupid, stupid, stupid, stupid. Do you understand me? Stupid.” He would tower over some poor woman in his best hectoring stance, a finger just millimeters from her nose. The look in his eyes would be one of transcendent, almost psychotic exasperation.

Everyone, of course, worried about Murray's sanity. But it wasn't just Murray; the sanity issue was germane to us all. We were all more or less in a perpetual state of shell shock. The pressure was everywhere—unrelenting. It crept into every facet, crack and crevice of a person's psyche. It rotted the woodwork, scarred the metal joists and broke down, without pity, the fragile scaffolding almost all of us use to hold ourselves together. Murray wasn't the only casualty. He was just the loudest.

I wasn't on the day this happened. I was doing research that involved, at the time, going through paramedic run sheets. I was sitting at the radio console. The radio went off—everyone else was busy—so I answered it. It was a bad transmission, lots of static.

“This is [inaudible] fourteen, [inaudible] do you read me?”

“Not very well but go ahead.”

Static…static…“gunshot”…static…static.

“Please repeat.”

“Twenty-two-year [inaudible] shot…” static…static…“head”…static.

“The patient is shot in the head?”

“That's an affirmative.…” Static…

“He or she is twenty-two? You're breaking up.”

Static…static…“months…” static.

“Please repeat.”

“We had a pulse but [inaudible] repeat”…static…“months…now.”

The radio transmitter clicked off.

I stuck my head out the doorway. “Hey, guys,” I announced. “You're getting a gunshot wound.”

Everyone looked around at me.

“To the head.”

Everyone groaned. Murray, who had a chart attached to a clipboard, slammed it down and said, “This is ridiculous, yes, it's ridiculous. What a ridiculous way to start the day. Ridiculous.”

The clerk hit the trauma button, and in a moment the page came though overhead on the hospital paging system.

“Dr. T., emergency room. Dr. T., emergency room.” (This was the loudspeaker euphemism used to call a trauma code—sometimes a source of confusion. One morning during rounds a patient remarked to me, “I don't know who Dr. Tea is, but I tell you he sure was busy last night.”)

Everyone began to migrate to the trauma room. I sat alone at the radio console for a few minutes and then shrugged, what the hell, and got up to follow them, to look over their shoulder. I was young and a trauma was still exciting, the “real reason” I went into emergency medicine.

Who else walked back there that summer evening? There was Sheila, of course, the knitter of afghans, otherwise so unobtrusive as to exist as a redheaded blur in my memory. There was Sudesh, one of my fellow residents. Sudesh wanted to move to Florida after his residency and specialize in emergencies of the rich and famous. There was manic Ted, a nurse who would teach students how to place a nasogastric tube by putting it down himself. And of course there was Donna, trauma nurse queen, wit tart as lemons. It was Donna who had commented to me and to Murray's back after he had said something inexplicable, turned, and walked away, “Do you think that if I go home and put a metal colander on my head I could communicate with the planet that man is coming from?”

“What else did they tell you?” Sudesh asked me.

“I couldn't get any information. They were breaking up so bad.”

“Great,” Murray said. He was walking in front of us, looking like he always did, head down, slope-shouldered, sack-butted. “Absolutely—I can't believe it—great. Great, great,
great.”

By now the “Dr. T.” call was echoing throughout the hospital. The trauma team would have heard it. They were probably busy doing nothing, maybe watching TV in the surgical lounge since it had been quiet so far today. The “scout” medical student would be on his way down to see if this was a “real” trauma. Anesthesia was, as always, busy being busy. (If they were doing a case, they didn't have to come down and they were always doing a case.) The on-call pharmacist was also to come down to help mix drugs and such. The pharmacist at this hospital was always the most reliable about getting to the code. He or she actually ran down the hallways and would even take the stairway if it was faster. But when he or she got there it was—so what? What was a pharmacist to do about a sucking chest wound? Public relations also weighed in very early, just checking to see if whoever the paramedics dragged through the door was in some way newsworthy (small child? high school athlete? interesting story? somebody white?).

For the people in the ER though, the first responders, this was “heads up” time. It starts the moment after an ambulance calls in a trauma and it extends until the doors slide open and the patient is revealed. No matter what the paramedics told you on the radio or, in this case, tried to tell you, you never really know what is going to roll through your door until it actually does. That's when the victim of a gunshot wound to the chest turns out to be someone who was shot with a twenty-two and the bullet bounced off his clothing. Or a simple facial burn from a mishap with the oven turns out to be someone whose face has melted down to a third-degree burn so severe it exposed cartilage. It might take twenty minutes for the paramedics to cut a drunk driver out of his crashed and burned motor vehicle, but he turns out to be fine, ready for discharge in no time, while the person he hit, someone in a Volvo, no less, who is up and walking at the scene, turns out to have a dissecting aortic aneurysm and dies on the operating table. There is just no telling.

I stood to the side that day, not a player. Murray could be very peculiar about who participated in
his
code. I knew all the moves, though. Sudesh stood at the head of the bed checking the intubation equipment: the plastic endotracheal tube, a syringe, a wire stylet, a little lubricant; the stuff that saves lives. After this, he turned on the suction, and when it wouldn't work started poking at the plastic tubing, looking puzzled. Murray stood off to the side, arms folded, head bent, chin resting on his chest. He was mumbling; I couldn't hear what he was saying, and it was probably just as well.

That was when, apropos of nothing that I could see, Sudesh turned to Donna and said, “You know, this is not a real life.”

“You're right,” she replied. “This is not a real life. This is a test. If this had been a real life, you would have been instructed where to go and what to do.”

Sudesh turned away, shaking his head wearily. Ted laughed. (This was his third double shift in a row.) Sheila rolled her eyes. I can remember everyone in the room that day, or were they at another resuscitation? Was Sudesh on the night before and Sheila on day shift and had she already left? And Donna? Why do I remember Donna when I didn't work with her until years later? As I think back, what I remember, more than anyone I knew or anything that happened, is the pervasive sense of exhaustion, of being up for hours and hours, days and days, weeks, months. Exhaustion was like dust, settling over everything. You felt as if you had to swim through the day; the drag coefficient of even the littlest gesture made you ponderously slow. You even thought slowly. The whole world seemed darker than you ever remembered it—and the memory of the real light had almost vanished. And with the exhaustion came the phantoms of emotions, monstrous feelings, panic, terror, paranoia. Sudesh, standing by the bed, looked punch drunk, bedazzled by the suction equipment. This was his eighth twelve-hour shift in a row.

“Tune in tomorrow, whiny guys,” Ted said, “for another episode of
Days of Our Lives.”

Murray turned on everyone.
“Would you all be quiet!”
he shouted. Then he glared at me, but he said nothing.

From outside in the ambulance bay we could hear the backup buzzer. The paramedics would be rolling in any second.

“All right, all right,
all right.
Let's go, let's go,
let's go,”
Murray shouted at everyone, even though there was really nothing anyone could do.

Four paramedics swept in, one doing chest compressions, one holding an IV aloft, another bagging the patient and the last wheeling the cart. They all looked terrified. The victim's head was swathed in bloody Kerlix. Blue sweat pants, T-shirt. Man? Woman? The belly was massively distended.

“Twenty-two-year-old shot in the head, we think times two. She had a pulse when we got there, but we lost it. It was a big-time bloody mess in the field.”

“Breathing?” Sudesh asked.

“Agonal, at best. I'm not sure.”

“Wait a minute, wait a minute.” It was Murray. He had moved over and now stood in front of the hospital gurney, blocking the paramedics' way. He raised his hand.
“What's this?”
he shouted, pointing at the swollen belly. He glared down at the lead paramedic as if whatever it could be was all his fault.

The paramedic took a deep breath. “She's pregnant.”

“Pregnant!”
Murray shouted. “Pregnant!
What do you mean pregnant!”
He stood nose to nose with the paramedic, waving his hands.

One of the other paramedics, the one holding the IV bag, leaned forward and said directly to Murray, enunciating each word carefully, “She's—going—to—have—a—baby—In two weeks. She's term. And she doesn't have a pulse.”

Murray turned back and shouted,
“Would you all be quiet!”
again. He turned to Donna, “We need anesthesia down here; we need OB; we need pediatrics—neonatal, we need…” He stopped, apparently having run out of things to need. He turned back to the patient and stood for a moment staring at the abdomen. Everyone stood silently watching as Murray leaned forward and put his hands on the belly. He looked as if he needed to touch it to believe it. Only then did he step aside so that the paramedics could get through.

“
Come on, come on, come on. What the hell, what the hell are you waiting for?
”

The paramedics looked wrung out. Sweat was dripping from the forehead of the paramedic doing chest compressions. “She's lost a bunch of blood. We've got two IVs in her, but we can't keep up, she's still bleeding like stink. We tried tubing her but the scene wasn't secure; nobody knew what was going on, just who had the gun or what. The family was making a big scene, so we had to just run with what we had.”

“Did you get a blood pressure at all?” Sudesh asked.

“Nada. But that's not to say…”

Everyone shifted around to help move the patient off the gurney. All I could really see now was her sweat pants and cheap white sneakers covered in blood. Sheila leaned over and started attacking the sweat pants with her trauma scissors before they had even moved the patient off the cart.

“Hold CPR. Hold CPR,” Murray shouted. “Hold CPR. We need to roll…She needs…Side, side. She needs a side.…We need to turn…” In a panic nobody knew what he meant. (It's a simple thing; you want to position a pregnant woman so that the fetus and uterus don't cut off the blood supply to the lower body.) Finally Drew, another resident (didn't I know him from some other time and other place?), pulled the patient's arm, rolling her to the side of the cart. But with this it became almost impossible to do CPR. There was a clumsy minute while everyone tried to figure out what to do. Imagine the chaos of desperation, a room full of people all scrambling to try to save a life but having to contend with reality: not enough room, not quite sure where to stand, a falling IV pole, IV lines everywhere, monitor leads, head bleeding (and you are aware, as you fumble, that each drop of blood on the floor is bringing the patient just that much closer to the end of the line). There seemed to be no way to brace the patient properly. Finally someone wedged a few towels under the backboard and the medical student was told to crawl up there and get started with chest compressions. He did so, his face white as a sheet. The woman's Kerlix-bound head lolled to the side; blood was everywhere.