the withdrawal hits, it doesn't hurt at all. It feels like gentle
death, and life too.
will see a number of things working in the OR on the third shift.
As much as cabbies or bellboys or bartenders, for sure. As much
as cops, firefighters, and various assorted nocturnal radar daredevils.
At 4am, the only heroes are the people who bring us corpses already
stone dead before they ever hit the emergency grocery-store doors.
The whole thing plays out like a movie some nights. Dramatic square-jawed
protagonists are shot down in the street and their loving family
played by James Woods and Kim Basinger sit in the waiting room pacing
back and forth. EMTs bring in some careless dick with a crotch full
of 3rd degree burns for a little background music.
am in the middle of my third bite of a microwaved plate of pork
when the "three-three-three" code comes over the anteroom
loudspeaker. When I was just getting started at this, which was
back when the president was bald and sleep hadn't been invented
yet, I used to jump right up and charge into the room like Chris
Brown in the Falkland Fucking Islands. By now I had learned to just
eat my supper. It wasn't getting any earlier and the first two minutes
was probably just going to be a bunch of screaming anyway.
nurse liked to chain-smoke unfiltered clove cigarettes in the two-by-two-foot
staff shitter, and I nodded at her as she coughed out the light
and flushed the toilet. She used to turn the fan on and clear out
the air a little, but lately she had been forgetting. She grabbed
a fishing tacklebox full of tools to cut and stab people with and
headed for triage. The actual triage nurse was just some third-year
college kid that apparently didn't make the cut for easy work-study
jobs like re-shelving library books or taking off her underpants
for Fun and Profit. Her name was Sheryl or Shirley or something
but I always called her Beverly because I couldn't remember her
Mary (my nurse), and Beverly are in the little triage cubby dealing
with something loud and histrionic while I'm washing my hands in
the staff kitchen sink. I never use the anteroom sink because it's
filthy. That's where you wash the gore off after a trip to the moon,
and when a resident finishes his rotation we toss him into it just
to break him in a little. I've seen attending physicians take a
piss into the anteroom sink when they have to go in the middle of
putting some Motorcycle Hero back together. If there's a chance
that I can get my hands genuinely clean before I go into surgery,
it's in using the kitchen sink. It's not that much of an issue anyway;
with the antibiotics we shoot people up on, I could sneeze on their
spleen and they'd be fine.
I'm getting off track. Beverly and Mary are dyking it out in triage
and I'm washing my hands when something weird happens. I blink my
eyes and all of a sudden the faucet sounds different. It's almost
like the OR is an LP and it skipped five minutes of the track and
started up somewhere completely different. I hardly notice it, but
when I look down my hands are wrinkly under the water. I turn it
off with my elbow, and walk to the door, giving it a kick with my
shoe. Mary opens the door and gives me a shitty look while she's
gloving me up.
keeps it to herself.
she said. "It's a he, I think. MVA."
does he have?" I ask, as she flips up my facemask.
walk out into the room thankful that someone decided to crank up
the AC. Most people don't know this but in sufficient quantities
blood stinks like shit. I probably learned why at some point, but
even in medicine there are some cases where knowing the answers
doesn't make you a happier, more well-adjusted person. The wretched
pile of blood and pajamas on the table in front of me looks like
a roast that someone put in the oven the night before and forgot
to turn on the heat. My eyes lose focus for a moment and I blink
to clear them.
people in the room are waiting for me to say something.
long has he been out?"
sedated him twelve minutes ago."
Mary always had a smart mouth on her.
* * *
used to know an attending who would brag to his residents that he
hadn't bought a pair of sunglasses in fifteen years. After all,
they didn't make such a thing as darkglasses, and if he wasn't in
the OR, darkness was all he ever got to see.
made it home after the faucet incident at about 8am I figure, or
roughly about the time that the sun was full up. This is an important
detail for reasons I will explain later, but for now picture me
reaching for sunglasses in my glove box that were so unused that
the dust on them had turned them from softly-tinted to almost opaque.
time or another I had bought a box to sit under my television and
record TV shows while I was out saving lives, but the only thing
I ever really liked getting on it was soft-core pornography, and
even in a bull market it doesn't make sense to spend twice as much
on your cable bill to watch Japanese schoolgirls flatten cans between
their breasts while colorful kanji characters describe whatever
strange narrative had been devised to make it all seem natural.
recorder box, then, was reduced to the functionality that didn't
involve deviant performance art. It had a clock on the front of
it. A great big clock with red numbers two inches tall glowing brightly
from under the dusty, plugged-in painting of a coal mine. When I
was starting to throw together the BLT I had been thinking about,
that clock said 8:31. The extra "." was supposed to let
me know that it was the AM and not the PM, in the event, for example,
that the sun failed to shine.
little blip that curved through my shift when I stood at the faucet
was on my mind as I sliced through the bleeding tomato. When I looked
up, it was 8:32. What should have felt reassuring only made me further
wonder. My home life generally didn't include things that would
make five minutes disappear.
don't call it my social life because there's nothing social
about it. There is only work life and home life, and my home life
is a fucking playlist. It's like the rotation of a boring top ten
hits radio station or a mix-CD someone made for you the week you
graduated college and you still haven't grown out of.
1 is my drive home. This is accomplished with little difficulty
through traffic that would give rheumatoid arthritis to the white
knuckles of most of middle America. If no one cuts me off or passes
me on the right hand side with two wheels basically on the sidewalk,
I start looking around for the speed trap everyone knows about but
2 follows it up by Eating Food. Little known fact about physicians:
they eat almost the same five things over and over again for years
at a time. In a world where variety is shoved down their throats
at their job, most of my colleagues choose to enforce a comforting
monotony regarding the other things that get shoved down their throats.
3 is the Consumption of Popular Culture. Regardless of who gets
voted off the island, I spend most of my time rooting for the alligators.
4 is almost always pornography.
5 is an experimental piece called Un-Assisted Nap followed by Some
Sort of Ancillary Snacking.
6 is an extended, three-hour, instrumental version of Surfing The
Internet Until My Eyelids Feel Like Lead Aprons.
7 wraps it all together with a brief reprise of Track 4.
8 is Sleep, and Sleep brings the fucking house down.
* * *
like a Lexus to drive. I know they're Japanese, but we're not talking
about some ramped-up fuck-all Toyota like the young Hispanic kids
drive to impress their clown-car girlfriends. A Lexus conveys a
certain kind of importance that goes hand in hand with being a physician.
It says "Yeah, I paid off my school loans."
drive a Lexus LS460L which provides 380 horsepower and 387 foot
pounds of torque over the time it takes for my toe to extend all
the way to the floor. More than enough to stay ahead of the streetcar
kids who put fart-cannons on their second-hand Honda Civics. I swear
to god, if all it took was a movie for teenagers to start this awful
trend of souping up winter-rat throwaway Japanese cars, you'd think
that someone would get smart and make a movie about how slick and
cool it is for teenagers to cut off each other's fucking heads to
incrementally increase the IQ of the human race. It would work for
the same reason that the street-racing movie worked. Only the stupid
kids would do it.
I find myself behind the wheel of my love-machine on the corner
of Urban Cool and Suburban Snobbery, and I hear the honk. This isn't
a friendly honk of someone who wants to inform you that you've missed
your green light or you have a disembodied arm with a hook on it
attached to your rear door-handle. This is the Douchebag Honk. Reserved
purely for those who have long ceased to believe in the existence
of God or happiness, and choose instead to make a life out of bringing
as much additional unnecessary chaos into the world as possible.
I turn to my right and I'm face to face with the douche in question.
am unsure at first if it was him that honked, given his drawn and
turtle-headed demeanor. He is staring right at me, a broad upper
forehead tinted in wine-stain liver spots. A cheap tie pokes up
under his Adam's apple, and pins together the grimy collar of a
shirt that might have been white at some point but is now the color
of dishwater. He's about fifty, and looks like he remembers every
day of it. I decide the appropriate measure is to roll my window
down. I've found that the older I get the more likely I am to solve
problems by escalating the situation faster than others can keep
has been my experience that most traffic altercations begin with
one or more party rolling down windows, and don't get much further
than that. By the time the motor in your door rolls that puppy all
the way down, the light usually changes and you're off in separate
directions and you're telling the empty air inside your car what
an asshole you think the driver was. By some freak chance, though,
today the window goes fast enough for me to get out a single word.
of an answer, I get this same look, but this time he arches his
eyebrows and telescopes his head at me as though his jaw is on glider-hinges.
THE FUCK IS YOUR PROBLEM?" I start to shout, hoping that my
voice carries the eight or nine feet of traffic noise, but by the
time I am done, he had vanished.
word "problem" fades off into nothing, and I feel my voice
withdraw unconsciously from it. I did not remember him saying anything
else, turning away, or driving on. He's just gone. I look up and
the traffic light is green. I realize as I pull away from the intersection
that a different song is playing on the radio than the one that
had been there when we stopped. I don't yell at the interior of
my car, but I do wish I had had the chance to tell the guy to go
fuck himself. Those are satisfying words to say sometimes.
have seen a man vomit a gallon of blue toilet water and three live
fish on the eggshell-colored floor of my room at work. I have cut
out a man's gangrenous tongue while he looked up into my eyes from
the table, awake. I have seen rookie surgeons snap elderly women's
thighbones like buffalo chicken wings. This was the first time I
had seen a car and driver disappear into thin air, but it seemed
otherwise unremarkable. Peculiarity alone, it seems, had lost its
ability to move me.
hit the accelerator and the sky seemed bluer.
* * *
guy named Sid Merriweather invented sleep in the middle of summertime
about four years ago. He didn't invent the Transcranial Magnetic
Stimulation. That was discovered by a British guy named Tony Barker
in Sheffield. They used it for decades to treat things like psychosis,
homosexuality, and being poor. The journal Lancet put it
right above "bullshit gypsy snake-oil" in their study
a while, there was some evidence that people who heard voices in
their heads could benefit from TMS. Apparently the electromagnetic
pulse did a better-than-Thorazine job of shutting them the hell
up. And it helped the whacked-out insomniacs who were seeing giant
roaches and disembodied heads get some shut eye. It wasn't till
Sid Merriweather came along and put two and two together that we
found out what TMS was good for.
when applied in a carefully-calibrated manner to your frontal brain,
causes almost immediate deep and restful sleep. REM is induced after
a matter of minutes rather than hours, and you can get a 9-hour
block of restfulness that feels like you slept in on Saturday morning
on the beach in San Juan with a naked blonde for a pillow. The kicker?
You can accomplish it in only two hours.
then, there were portable MRI units that could be converted to sleep
stations for people to rent time in to get sleep when they didn't
have the time to go home and get into their own beds. It was enormously
popular among the Corporate Douchebag circuit, and for a while we
saw talk shows with rich, too-busy people that boasted of getting
only four or five hours of sleep a week.
about the same time I hit the third year of my residency in emergency
medicine (that's the year after you want to kill yourself, but before
the year where you want to kill everyone else) someone bought a
TMS bed and put it in the staff room. Suddenly we're all bright-eyed
and bushy-fucking-tailed round the clock. Go home? Nah, I'll be
back in a couple of hours for another 15-hour shift elbow-deep in
we were all more or less rested enough to care about ourselves and
our personal reputations. The mind-bending old school of medicine
fueled by months and months of sleep-deprivation and debasement
at the hands of older physicians started to crumble away. You can
imagine the sort of trouble that a boatload of otherwise cocky,
overworked, jumpy, socially-challenged kids like us got into with
a machine like this.
first bed we had didn't have cutoffs for extreme parameters. A nap
on that thing was like taking a vacation in two hours. You could
crank it up a little and get stoned on it, too. You'd be so groggy
when you woke up, and so simultaneously rested, that you felt like
you had just won the no-hangover lottery after the bender of your
young college life.
the time I finished my fifth year as chief resident there were three
beds in the hospital for staff to use, and the year I got my first
OR privileges, I bought one for my condo.
* * *
don't understand, man, Prince is the guy who basically shaped all
of music in the 1990s."
it's you that don't fucking understand," I say to Dr.
Greenstein, over the open abdomen of an elderly man who had suffered
from an acute, impacted bowel rupture. We were bringing his small
intestine out loop by loop and washing and inspecting it for ulcerations.
The Glamorous Life of Emergency Medicine reduced to basically washing
someone's shitpipe and checking the line for kinks. I hear some
plumbers make $60 an hour now.
is the icon of all that was wrong with music after the 1980s. Men
don't wear baby blue women's power suits with frilly white blouses
his originality. He's completely original." Greenstein
suctioned out Mr. Bowel Impaction's peritoneal cavity with a flexi-tube,
and then waved it in the air to accentuate his point. The tip of
the tube sucked bloody air.
was original about him?" I asked. Greenstein looked about to
say something but I cut him off. "Nothing is fucking original
about this guy. He's the biggest sell-out, rip-off of the late 20th
century. What, because he pretends to be girly that's supposed to
be original and edgy? David Bowie did that two decades earlier than
Prince, and everything that Bowie did right Prince did wrong."
Greenstein peered at me over his mask. One eye was made to look
telescopically tiny by the surgical loupe he wore for close-up work.
It was a look of utter irritation that indicated without a shadow
of a doubt that he wanted me to continue.
of all, Bowie doesn't sing like he has no testicles. When Bowie
did Ziggy Stardust, he was skating along the edge of the 1960s,
where all sorts of shit was happening but you could still get your
ass killed in the wrong town on the wrong day if you were a homo.
What the hell did Prince prove by dressing up like a half-mulatto,
half-Thai transvestite pimp and getting collagen injections in his
now, we had reached the near end of the colon, where the pipe meets
the pipefitting, or so it seemed. Greenstein decided not to try
to interrupt me.
nothing, that's what he proved. Prince is the face of how un-cool
it is to be a man these days. It stopped being good to be a man
right about the same time that Bowie was wondering if we could evolve
beyond the gender war in the '70s. Now anyone who is cool is a woman.
You ever wonder why women like Prince so much? It isn't because
he's four feet tall and uses the same foundation makeup they do,
it's because he's essentially a woman with a cock. Equipped with
what they need to perpetuate the species, but unthreatening, gelded,
and slightly pathetic. Kind of like you, Greenstein."
looked up from Impaction's rectum and there were two Greensteins
in front of me. Then three.
I said, "the hell."
number four motioned to my hands and I looked down. Instead of intestines,
Mr. Bowel Impaction's abdomen was full of pulsing black leeches.
must have stood there for a minute or two, but it felt like just
a second. I was never the awkward type that froze up when giving
speeches, so a little silence felt comfortable enough.
wrap this up, then," I say. "We don't want Neely getting
his hands on this one, right guys?"
was my standard pre-recorded ER banter filed under Serious Conversation.
Dr. Evan Neely was a general surgeon who hung out around the ER
during the hours when he wasn't talking someone into getting their
gallbladder electively removed. Surgeons are not so unlike dentists.
They'll see you for the cleanings, but it's the cutting, drilling,
and grinding they get paid for. You go to see one of them at their
clinics without a problem they can chop into you for, they'll pawn
you off on their residents or medical students that are probably
not being paid. No root canal needed? Go see the hygienist.
was the ghoul of our ER, and he hung around like a vulture waiting
for something to make the mistake of crawling out into the open
sun. The orthopedic surgeons were the same way, they'd sit in the
break room playing cards waiting for someone to walk into the ER
with a potential case. Every time some kid broke his collar bone
at football practice, it was like someone threw a huge wad of hundred
dollar bills on the floor and ten hungry middle-aged men with huge
German cars and hateful alcoholic wives would pounce on it in rugby-scrum-like
fashion. These men would look at you as if they were wondering how
much they could get for fixing you if a piano fell out of the sky
and crushed every bone in your body.
accident? That's a double femur fracture with extensive follow up
care, diagnostic imaging, and physical therapy, all performed by
leased subsidiary companies of the orthopedic group they worked
for. If the patient is over 65, well that's a double hip replacement.
Sorry, ma'am, it's the standard of care these days. It would
be irresponsible if we didn't do it.
took a page from their book and would try to scare the living hell
out of the patients that came in for routine or planned procedures.
He treated human organs like plastic surgeons treat beer guts. Getting
a liver biopsy? Why not have me take out your gallbladder, too?
Or your appendix? It could rupture one day and kill you. Having
a hernia fixed? I can do a vasectomy while you're out! Let's just
get rid of that pesky uterus
spend the next forty minutes stuffing and pinning a pile of writhing
leeches and eels into Mr. Bowel's peritoneal cavity. I kept one
eye on the Greensteins the whole time. After all, with four of them
in the room, there was sure to be an Evil one.
* * *
machines consist of a large power generator that converts wall current
to high-voltage output, a stabilizing arm, and a cylinder shaped
like a large beer can. This cylinder contains an electrical anode
and a rotating tungsten cone inside an airtight bath of coolant
oil. This is the "tube." The tube is encased in a half
inch of lead except for the small aperture where the x-rays escape
and travel at physics-class speeds through your flesh, organs, and
bone, and strike a photosensitive crystal screen that imprints a
negative image of your anatomy on a piece of multi-layered emulsive
plastic. An entirely separate lead-lined room exists for the purpose
of containing the photoelectric ionizing radiation that occurs when
various milliamps per second course from the anode to the tungsten
cone, creating a God-like arc inside the tube. All this happens
in darkness, as most feats which harness the power of the building
blocks of the universe do.
bounce a golf ball off of the tube in our x-ray room while our third
shift radiographer scours the table beneath it with a disinfectant
so strong it comes in a glass bottle rather than a plastic one.
The room smells vaguely of feces.
you get much sleep?"
two hours, usually," Andy replies. He has a kid at home, I
know, and another on the way. A girl named Stephanie and an unborn
fetus named I Will Never Again Own a New Car.
I get one and a half, but I don't like cutting it quite that close.
If I don't get the full two hours, I just don't feel right."
ever take naps?"
he says, looking sideways at me. He stacks up x-ray films on a desk
and starts marking left and right on the corners with a black Sharpie.
a lazy motherfucker." I can always count on Andy for the truth.
"Just turn up your bed. Try maybe two and a half hours. You
won't be able to sit still after that much sleep. You'll be bouncing
off the walls."
golf ball continues to bounce off the x-ray tube.
want to tell him that I've already tried that, but I don't. I picked
this little strategy up at some conference or another in Arizona
in the middle of the winter. A study was done by some focus group
of vicious, slobbering medical office managers who had been let
out of their cages long enough to cross-breed and perfect their
torment of the rest of the working world.
discovered that when your employees, which Andy technically isn't
though he is part of my support staff, think you're ignorant or
empty-headed, they tend to work harder. They assume you'll crash
and burn if they don't step in to help you, and playing against
the guilt they'll feel if they don't is a motivating force not unlike
that of a child obeying their well-meaning but chronically helpless
parent. In other words, the way to make sure you get the last $0.01
out of every hour you pay your help is to make them feel like they're
working for their mothers.
miss a catch and my golf ball rolls under the generator. I don't
go after it. I have an entire bag of miscellaneous golf-related
shit in my locker that my patients have brought me. Someone even
gave me a putter shaped like a foot with a laser pointer attached
to it. I don't know what's more insulting, my patients assuming
I have time to play golf or the fact that they think I'm a bad enough
player to need a laser-guided putter.
* * *
some point, I realized I was in the middle of surgery on what used
to be a young woman who had been dragged on a chain behind a sport
utility vehicle over a mile and a half of gravel back-road.
think I'm hallucinating," I said, to no one in particular.
what she said," came a reply from someone in a mask and scrubs.
He gestured to the woman, whose anesthesia had sunk in enough that
she could barely manage a whimper.
you, I'm serious," I say. My face shield fogs slightly when
I breathe out. "You think I'm kidding?"
unfortunate ingénue of this evening's tragedy lets out a
"huhnnn" that is less than heroic as I scrub flecks of
gravel out of her rectus abdominis muscle, which is open to the
air given that the flesh of her torso above it was taken off as
if by a belt-sander. Cleanliness, right next to Godliness.
are the risk factors for hallucination?"
is this, continuing ed?" My colleague rolls his eyes. It's
not Greenstein, but since I just got here I don't know who it is,
exactly. "How the fuck should I know? Being a big jizzbag,
for one, probably."
surgical tech behind me snorted, and I turned to look at him. He
gaped in terror. I am covered in blood from sternum to knees, and
I'm doing my best to look pissed. Remember: whenever challenged,
the fuck did you just say?"
he mutters, suddenly very interested in the tray of surgical steel
in front of him.
are the risk factors for hallucination?" I've forgotten the
patient on the table entirely. I pick up an emesis basin full of
someone's flesh and blood and I plan on tossing it at him if he
psychoactive drug therapy, alcohol and drug withdrawal, dementia,
sleep deprivation, and head trauma
look at him for another moment and the corners of his eyes flicker.
I wonder how many minutes go by.
what I thought," I say. I hand him the emesis basin and head
for the door, pulling off my mask as I go. Blood sloshes onto the
floor, but I ignore it and him.
are you going?"
need a nap," I say over my shoulder, to no one. As I hit the
door I look up to see another door. I open this one into an identical
hallway with another door at the end. And another, and another.
* * *
I was just calling from North Union Hospital. This is Sandy. We're
calling to make sure everything's okay with our favorite doctor!
Call us back when you get a minute, I've got a few messages for
think I turned the phone off, I don't really remember. I have some
vague vision of putting the key in my condo door and hearing it
grind loudly as I turned it, but after that all I felt was soft
I've been unconscious for hours. The inside of my mouth feels like
indoor/outdoor carpeting, and I've urinated on myself while I slept.
I've not missed a day of work in seven years, twelve if you count
residency. I thought they'd be a lot angrier than they sound. Sandy
make the call to the hospital and tell them I'll be in tonight.
that's fine. Dr. Greenstein covered for you. He did leave a message
that you should try the office bed next time, whatever that means."
know what it means."
feeling okay?" she asks.
been more than helpful."
all his lack of good taste in music, Greenstein did a good job of
jumping from one lily pad to another.
nerve cell in your body consists of a long cable with a synapse
at each end. The cable part of the cell is made up of fatty membranes
that conduct electricity in the form of tiny, single-electron currents
called action potentials that occur between sodium and potassium.
When the current reaches the end of the cable, it jumps to the next
strand by secreting a chemical that helps the current flicker across
the gap. These chemicals have familiar names like serotonin, dopamine,
epinephrine, and acetylcholine. When these currents jump to muscle
fibers, you get a contraction. When they jump to a gland, you get
secretion. When they jump to your brain cells, you get a boner,
and so forth.
all you are, you clever bipedal meat-Gods. Just electricity sizzling
down cables made of fat and squirting across a little space between.
This is another of the things that knowing doesn't an otherwise
blissfully ignorant life improve.
Tony Barker has this thought well in hand when he positions the
first TMS patient's pre-frontal brain directly between the poles
of an MRI electromagnet. Barker is doing this in the '80s, so he's
very progressive that way, but he is not so far removed from the
old days that he flatly dismisses the gains made by psychiatrists
in the '50s and '60s when they plugged people right into the wall
current and put a rubber block between their teeth so they didn't
snap them off. MRIs are safe, though. It's just a little current
change. Hardly noticeable. The first two letters of MRI stand for
Magnetic Resonance, and that's exactly what TMS does. It causes
the electrons on a molecular level to resonate. Instead of blowing
the fuse entirely, the TMS just flips the breaker on and off, on
and off, thousands of times per second.
Dr. Sid Merriweather did was discover the frequency, the note played
across what amounted to a seventy-thousand-dollar electric guitar
string, that reset the right sequence of synapses. Do Not Pass Go,
Go directly to Stage-4 REM sleep.
* * *
were a few pieces of ferrite dust on the magnet's face, but not
enough to throw off the cycle."
is it, do you think?" I asked the repairman on the phone. I
dislike people being in my apartment when I am not, but this could
not be avoided.
may want to just try another bed if you have access to one."
bit of diagnostic wisdom is becoming tiresome. It may be a while
still before I go all the way over the high side, but I can feel
it coming. Mary, prescient soul that she is, has started hiding
my car keys.
the hell are they?" I ask her.
she walks away, the pocket over her left tit jangles.
I believe in the sanctity of the workplace and all that high-minded
bullshit, but there's only so much a professional can take."
sends me a look that pretends she has no idea what I'm talking about.
grab a random chart off of the wall, and head into the adjacent
lung has to come out."
ten year old boy on the bed looks up at me in terror. He and his
mother look at each other over the cast on his leg and then back
me for just a moment," I say. "Mary!"
medical assistant that I was firmly against hiring from the start
looks up from a handful of used needles. I grab the front of his
white coat and shove him into the nearest room. I hear the sound
of either him crying or broken glass. The hallway overhead fluorescents
start to pulse with my heartbeat.
I bellow down the hall, "the Doctor needs you!"
rounds the corner in a pretty flourish of professional cleanliness.
Only I know that she has not taken her scrubs home to wash them
in over two weeks. Her filthiness is mildly arousing.
wonder about those armpits of yours," I say. She gives me a
smile that says I am one charming dog.
there something you need?"
need my lung. Where did he go?"
did she go?"
I say, putting an arm around her shoulder. We walk toward room ten
and on the way she walks me straight into a wall. "I was just
in room ten, and my lung was definitely not in there."
again," she suggests, helpfully.
lung will have to come ou
open the door in front of her. Sitting at a card table, are three
large greyhounds counting a stack of money. They peer up at me with
lively, suspicious eyes. The one on the far left gives me a look
like I might owe him a favor.
me," I say, closing the door quickly.
arches her eyebrows and her hair seems to straighten and re-curl
in front of my eyes.
you do something different with your hair?"
the door at the end of the hall," Mary motions with a seven-inch
going to have to have a talk about your bedside manner," I
tell her as I proceed to the door at the end of the hall. The medical
assistant springs on me like a trapdoor spider.
doctor, I have Dr. Neely on the phone for you
HIM TO GO FUCK HIMSELF," I scream at him, buffeting him about
the head and neck with a clipboard. The escalation principle once
again steers me clear of time-consuming negotiation.
* * *
have no idea what happened to the carcass on my operating table,
but at some point it's clearly going to require a bucket and a mop.
I have a vague sense-memory of cracking his/her ribcage with the
spreaders and feeling the little joints along the spine where the
ribs attach give way.
we have a patent airway?"
feel a moment of relief that they're not talking to me.
I say. The third-year resident looks up at me for a second and I
can see his synapses firing behind his eyes. For a moment I envy
him. He has no idea how wild this kegger can get.
nothing. Let's get the spine exposed. So, let's review," I
tell the room.
I don't think now is the time"
would you prefer? Later with popcorn and a greatest-hits reel? It's
doesn't matter what you fucking think. Review. Now."
is a forty-seven-year-old male brought in after a motor vehicle
accident involving a rollover. Lacerations about the midsection
indicate that he was wearing a seatbelt that either failed or was
improperly positioned. The impact crushed the third lumbar vertebral
body, causing a comminuted fracture that is putting pressure on
the nerve roots and causing a possible cerebrospinal fluid leak.
Anterior-entry emergency decompression with fusion at L2-L3, and
L3-L4 was indicated. Primary incision was made at 1:43am."
only why the hell are we cracking his ribs? L3 is way down here
room looked at me. Kids, the whole fucking pack of them. I felt
like a math teacher.
you did that," one said.
it, never mind that now. Can we see the spine?"
have the anterior surface of the vertebral body of L3 in sight,
though it is behind this layer of muscle and fascia. We stopped
here because we didn't know how to proceed."
I say, leaning forward, "you need a little bit of elbow grease,
pull up hard on the muscle fibers that run the length of the man's
spine, and I bite through them with my teeth.
I spit a mouthful of blood on the floor, "that's not so hard,
see the door open and someone's ass disappearing into it. Retching
sounds follow him.
all you gotta do is take that one link out of the chain."
reach in and find the third lumbar vertebra, which feels like a
plastic child's toy that has been slammed in a storm door. It crunches
a little under my fingers. I reach around the muscle layers and
grab it in my hand. The accompanying tissue makes it about the size
of a tennis ball.
someone should call Dr. Greenstein
Greenstein," I say. "What are you going to do when I'm
not here anymore and there's no senior attending to run to? Who
are you going to call? Call the receptionists, maybe? They have
more sense than you."
going to need some help in here
do you imagine is next, you goddamned geniuses?"
Doctor, the spinal cord
give a pull with all my strength and out comes the offending little
tennis ball with a crunching slurp. I see blood spicules hover in
the air like droplets from a garden hose against a summer sun. The
carcass on the table jerks like an electric love doll, and my residents'
faces light up.
that is fucking medicine!"
feel jubilant claps on the back, there are shrieking cheers, someone
is lifting me up in triumph. They grasp my shoulders and arms and
I try to tell them that it's not allowed in a sterile environment,
but what the hell? Let them have their moment of victory. Let them
celebrate their hero. Let them carry me away.
all associates, cleanup on aisle 4, please.
* * *
gone fruity," he says. I forget for a moment who he is. Oh.
Right. My physician. "You've been sleeping for real, haven't
have," I say.
the fuck are you thinking? You've read the studies, we've all read
wonder briefly if this guy ever read the one about how it's not
okay to be a douche to your patients. I didn't read it either, but
I remember seeing it on the syllabus.
thought I was losing my mind at first."
are losing your mind. You can't real-sleep forever, man,
it'll ruin you."
do you mean why? You know why. The Morvan Principle. There's
a physiological cutoff of relative hours of REM sleep necessary
per hour of wakefulness."
seem to be doing okay so far."
stared at me for a moment, and his forehead wobbled slightly.
much are you real-sleeping?"
hours at a time, sometimes ten."
still equals only about an hour and a half of sleep, maybe two on
the outside, and anything can wake you up and ruin it in a hurry."
must have shrugged.
just not enough. Not for a regular 16-hour workday, and I bet you're
doing more than that, aren't you?"
putting your patients at risk, and yourself. Most importantly, you're
putting the hospital at risk, and that we cannot have."
the hell did they do it in the old days?" I ask.
the old days, malpractice insurance wasn't 25% of their income,
it was 60%. That's how. You're headed for trouble if you don't treat
Whoever reached into a little cheap half-stack filing cabinet under
his desk and took out a Xeroxed copy of a copy of some old graph.
are here on this curve," he said, pointing just before the
spot where it sloped, spiraled, and ultimately nose-dived toward
Certain Doom. "If you continue to ignore the Morvan ratio,
you'll start getting visual anomalies, heart function irregularities
Your hand is shaking."
it isn't," I said, as it twittered against my leg.
you taken administrative leave yet?"
going in later this afternoon. I have to relieve Greenstein."
Dr. Downer replied dourly. "You can't. And I can't let you."
what's the answer?" I ask. "My bed doesn't work for me,
and I've tried two others in the break room and neither of them
not your bed, man, it's you. Pre-frontal lobotomy. It's your
cerebral cortex that won't accept the TMS. We need to alter it."
know I'm fucking goofy now because I think I just heard him say
not get carried away here," I say. Suddenly the sweat on my
armpits notifies me that I am, in fact, nervous about this whole
need surgery." He folded his hands over his chest.
hell I do. I'm not your fucking meal ticket, cutie," I say,
as I pull my shirt on.
I wobble toward the exit, a Kodiak bear in a lab coat carrying a
clip-board enters the door and blocks it entirely. I try to rush
him, but he sprouts six additional lab-coated arms and hits me with
some incapacitating medication that feels like my face hitting a
linoleum floor. I take a bow. Unconsciousness follows like the hiss
of air after a tire-puncture.
* * *
am cognizant enough of the dream about Beverly hula-hoop-ing naked
on my front lawn on a sunny day to be pissed off when it ends, and
I see instead a ring of magpie-like masked faces staring at me in
a room that with too much oxygen and no shadows.
pig motherfuckers," I say, "I have a fucking sprinkler
him up a little," I hear someone say.
the hell did I just tell you to do?"
hear the clanking of surgical steel against sheet metal. I can almost
see the prissy attending tossing down his hemostat in anger. I can
feel myself doing it. Am I doing it?
and when you're done, go outside and find someone else that can
do your job because you're never coming back in here."
relax for a moment realizing that at least in this dream I'm not
the resident again. I do feel something happen. Just something.
I am in no pain, but that is always a shaky place to find oneself.
I try to focus, but their voices recede. The attending, which might
be me, leans back a little and yawns. His hands are full of steel
me, I'm tired."