17 December
2013
1454 hrs
Dear and Patient Reader,
I have for you another story, and I will just get into it. Are you ready? Splendid!
They Always Come Back With Balloons
I stand at the bedside of a warm chunk of meat
under a sheet; a hissing ventilator, intermittent in its artificial
respirations, breathes next to it. I am
here to Solve the Puzzle. I am here to
Figure It Out. You want someone like me
to do this. I am good at it. I will Help You. It is what I do, and I do it well. You hold his fucking hand; that’s not what I
am here for. It’s what you’re here for. That’s your
fucking job.
The creature in the bed, its
brainstem too damaged to manage the task by itself, lies completely still save
for the regular rise and fall as the machine forces air into its lungs and
gravity and positive pressure force it out.
CO2
I remind myself. Carbon
Dioxide, mostly, is coming out . . .
Its head is bandaged, and though the
dressings are fresh, they are slowly being stained by a clear, yellowish
seepage that flows from a wound I have not yet seen. But I have read the chart. The fluid flows from a wound where its face
used to be.
I look at the wall above where a
headboard would be, were this not a hospital bed in the Surgical Intensive Care
Unit. I see on this wall a likeness of
what the meat once was; a fresh-faced boy taking a knee, football helmet between
his hand and the ground; emptiness behind the facemask like a grinning skull.
His uniform is clean but well-worn,
a mark of a mother who is proud of her son; she’d be damned if he
ever ran onto the field in a grass-stained uniform. I wondered, briefly, if he smelled bleach as
he put it on.
He is handsome in that picture;
surely the grabber of attention from every girl he passed in the hallway or sat
near in class. His life would never be
that way again.
Another picture on the wall; a
strong, middle-aged man starting to get heavy in the jowl; a pretty blond just
beginning to have the tiny lines around her eyes that somehow make women even
more beautiful; the boy, younger in this picture than in the last- though not
by much- standing between them. They
were dressed as if they had just come from church. The dress clothes were not dark enough to
suggest a funeral.
I sigh in time with the respirator,
just once; once is all I need. I have to
indicate on the EEG tracing where the wound to the head is, so the difference
in recorded voltage makes sense. The
less bone there is to record through, the greater the amplitude of the
waveforms.
The
creature’s nurse is at the bedside now, a bag of lactated ringers solution in
her tiny fist, ready to replace the depleted one hanging on the pole by her
head. Gravity feeds the fluids into his
arm, too. Gravity means a lot in this
place.
Susan, I say to her, I need to get to the head . . .
Oh, of course, she replied. Um . .
. gimme a sec.
I think she took the extra time to prepare for what
she knew was to come. What I read in the
chart. No matter what we see in this
world, in this place, we are ever amazed at what sights keep coming. I find I am white-knuckling the bed rail as
she peels away the Kerlix gauze. I
wonder how long it took her to wrap it however many minutes ago. I wondered if everything was a chore for her,
too.
The work can be rewarding, this work that we
do. Solving the puzzle. Fixing the
problem, most of the time, while, incidentally, saving a life. But it is
work, and nurses work harder than any other. Except maybe mothers.
I see to my right, just by my shin, a down-drain
bag full of urine. I look up at the
photos again, and I hope it got to use its penis for something other than the
latex catheter that now lives there.
Even if it was just once. Gravity pulls the urine from him and into the bag. I shake
my head, rueful of how everything is a cathexis of sorts.
A picture of a girl is glaringly absent. A young man that good-looking surely had a
girl. Maybe they broke up . . . Maybe that’s how it got here. Maybe this is what it thought it deserved for
letting What’s-Her-Name get away.
The last of the bandage was unwound, and all that
covers the . . . face . . . now are a series of overlapping 4x4 gauze squares. They are soaked through with the pale pinks
and soft yellows of a desert sunrise.
Brownish povidone iodine stains the edges where they meet his skin.
His.
Yep. It’s a he; somebody’s
boy. Somebody who ran a 4.4-40. Someone who made his mom laugh; made the
girls swoon . . . Someone who helped his
old man fix the car on Saturdays during the summer.
Someone who thought his problems would end with a
shotgun.
A fowling piece, is what you would call it. An older-style scatter gun, the bore
narrowing as it moved distally from the breech, effectively becoming a choke
designed specifically for killing fowl.
These guns, by design, are longer than the average shotgun, by more than
a few inches.
I look up in time to see the parents from the
photograph striding toward the bed. I
step in their direction, drawing the privacy curtain just enough to obscure the
sight of their shredded son.
I’m getting ready
to perform a test on your boy, I say. I need as little disturbance at the bedside
as possible. The fewer people around,
the more accurate the test results will be . . .
This was not a lie, and I was glad I had it to use
when family was obtrusive.
Can you help
my son? The mother asks me. It’s always the mother that asks; always the
same question that gets asked.
I already
am. Always my response. Again, it is always true.
I send them down to the cafeteria and tell them
to get a cup of coffee and wait about an hour.
They probably just came up from the cafeteria. Probably never want to see another coffee
again. Who could blame them? I take another sip of my own after they
leave.
They will go to the gift shop, if they haven’t
already. They will want to get flowers; they
always do. All they will find are fake
plants, as flowers can cause allergic reactions. Sometimes the scent alone is enough to
aggravate a patient or his roommate.
Distress is, intuitively so, anathema here.
Families’ experience of me is book-ended by two of
humanity’s worst emotions. They know why
I am there, rolling in with a two hundred-thousand dollar machine; my
appearance ominously foretold by the physician or the nurse; that I was On My Way, and what I Was To Determine once I got here.
They greet me with terror, and then I leave them an hour or so later with
the deepest of sorrows. I leave them
with that and with their hatred toward me, because that is all they can do.
This is my place on the Cosmic Wheel. I am become Death; Destroyer of Worlds.
To ease their terror they go to the gift shop,
bright and cheerful and run by a woman in a pink smock. They will see the Get Well Cards and feel a
pang of pain when they do; perhaps the mother will have a phantom sensation of
that long ago infant suckling at her breast.
That will pass; it will forever be overpowered by the memory of what she saw
after turning on the light once she came home that evening.
They will meet the mildly annoying disappointment
of the flowers and glance through the fake plants, a moue of disgust unconsciously on their faces. They will see the helium tank in the corner
behind the counter and pick out the best and brightest Mylar balloons. They always come back with balloons. This small act will somehow push back, ever-so-slightly, the terror.
To ease their sadness and their hatred as I leave
their son’s bedside, they will thank me.
Thank me for making sure their son is dead.
They’ll be back in 45 minutes. If I can get going soon enough, that should
be plenty of time. I only need 30
uninterrupted minutes to determine electrocerebral silence. Brain death.
Bet it’s not a problem, here. I feel a grimace coming on as Susan removes
the last of the 4X4’s. Jesus. How do I draw this on the tracing?
Sean or Scott, or whatever his name is, sat on
the living room couch of his home in the suburb of Sugarhouse, his dad’s
fowling piece propped between his knees. Too bad he did not have a sawed-off shotgun, I
thought.
The extra length of the barrel forced him to tilt
his head back in order to fit the muzzle snugly against the hard palate of his
mouth. This backward tilt was enough to
shear away his face, and only is face (though the wound was remarkably
profound) when he pulled the trigger.
From the mandible down, he was intact; a bit edemic in the jaw and
throat . . . the neck . . . povidone iodine staining all visible flesh
purplish-brown. But everything above the
lower jaw . . .
His maxillary region was obliterated, as was his zygomae, frontalis bone, and the first
10 cm of his hairline. They must have
found pieces of his eyes on the wall or ceiling. Everything anterior to his temples was no
more than red and wet wood chips all over the sofa at his parent’s house. They get to go home at the end of this and
clean that shit up.
I use the red felt-tipped pen to draw the
anterior aspect of his head. Each page
of the EEG paper has a bird’s-eye view of the top of a head, replete with a
diagram of the electrode placement according to the International 10-20 system
that is used universally. Just in front
of electrodes F3 and F4 I draw a concavity indicating he had no forehead. I could see into his sinuses and saw where
birdshot pellets had scratched the dura mater
and yet (miraculously? Mercilessly?)
managed to not penetrate the relatively fibrous external meningeal layer.
His brain, seemingly, is undamaged by the
violence of hot lead forced out with a gas-expansion rate of 17,000 feet-per-second. His potential brain death would be
anoxic in nature; that brain of his damaged not by a hundred projectiles, but
by exsanguination and subsequent oxygen-deprivation. He could have just slit his wrists in a hot
bath and saved his folks the money they spent to repaint the walls . . . replace
the carpet . . . buy a new sofa . . .
I am forced to find a new location for the
Iso-Ground electrode, for the center of the forehead, the standard place for
it, was gone. I jury-rig the other
anterior leads. This is not an
inconvenience; this slab of warm meat is somebody’s loved one. I’ve already met two of them.
The record shows
Burst-Suppression. Not quite brain dead,
and yet still very bad, prognosis-wise.
He will be ruled electrocerebrally silent within the next 24 hours.
How is he? A voice hitting my
shoulders microseconds before my eardrums.
I turn around. Dr. -------, the
best cardio-thoracic surgeon I have ever met.
He’s also on the transplant team.
He needs some organs. He wants to
know if he can harvest Scott’s. Or
Sean’s- whatever.
Not quite, I say neutrally. Maybe tonight or early tomorrow. I sense barely disguised disappointment
in his reaction, which was a seemingly understanding nod. I thought this behavior ghoulish when I first
encountered it years ago. Now I understand
it. A heart here, lungs there, a liver
over there . . . Kidneys; corneae . . .
how many lives can be improved and outright saved by . . . What’s-His-Name's pieces?
The surgeon turns
on his heel and moves away from us. He
does so silently with his Adidas clothed in the blue paper shoe covers so ubiquitous
in hospitals.
He has to
wait. We all have to wait. No one’s wait carries more weight than that
of the parent’s that will break the rules and stay here after visiting hours. No one will tell them they must leave.
Mary in 410, one
floor up, is waiting for those lungs.
She has been in a coma for weeks, a patient in the hospital for nearly a
year. The wait, I hope, will be worth
it.
I hear the soft,
onomatopoeic bomp-bompbomp of Mylar
balloons on the other side of the partially drawn curtains. I see the silhouettes of heartbroken people
on its obverse and the horrible, amorphous dark from the too-many balloons; the
parents mere shadows that radiate no heat, belying the creatures that block out
the sun to create them.
Susan is wrapping
the last Kerlix on . . . the patient’s head.
I am wrapping a towel around the used electrodes, unattached now. Susan has to change the wet bedding. She spent the last half-hour irrigating the
wound with sterile saline squeezed gently from a bulb syringe. She will do the change in a bit. She puts a fresh towel under the kid’s
head. The pink stain is too disturbing
to bear.
All done, I say, drawing the curtain open.
This is the only comfort I get from the
job: I don’t give bad news. That will come
later in my life. I don’t have to tell
them to go Make Arrangements. I don’t
have to tell them that by sunset tomorrow their child will be parted-out like
an old Pontiac. That the balloons have weeks longer in terms of life-expectancy . . .
I leave that for the
attending physician.
He’ll be along shortly . . . I tell them.
The dad reaches out
with a meaty paw.
My wife and I want to thank you for helping our boy, He says. Thank
you . . .
The
above event happened to me back in 1987.
Names have been changed, as always, to protect the guilty.
I thank you again, Dear and Patient Reader, and
I’ll see you very soon, I’m sure.
The Cunning Fennec Fox
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