17 comments/ 13378 views/ 2 favorites The Soul of Perception By: Adrian Leverkuhn ©2009AdrianLeverkuhn Once upon a time there was a doctor. A surgical resident in a big city hospital, he seemed to care about people, always had a smile ready or a hand out for anyone who needed him. Some people thought he was a doormat, that he couldn't say no to people and that everyone took advantage of him as a result. These people called the doctor a 'Patsy' -- an easy mark -- and perhaps they laughed at him behind his back from time to time. Perhaps there are some who think so little of people like this because they have forgotten that if only occasionally true goodness walks among us from time to time. This is a little story about goodness, and the price some pay as a result... +++++ Doug Tanner rubbed the corner of his right eye, picked dried flakes of 'sleep' from his skin, then with thumb and forefinger rubbed the tiredness from his bleary eyes. He looked at his watch: 2220 hours. An hour -- he'd had an hour of sleep -- in the last two days! His mouth tasted coppery, cruddy; the air smelled like stale coffee, body odor and cheap after-shave lotion. He was hungry but he hated the idea of food, the very idea he needed food. There were times he resented his own human frailty, and this was one of them. The pager in his lab-coat buzzed and he picked it out of the rubbish of gum wrappers and throat lozenges, looked at the code on the little green display and groaned. "Crud, not again..." Then, from a speaker in the ceiling: "Dr Tanner, Dr Tanner, stat to ER, Trauma Two. Dr Tanner stat to trauma Two." "Hey, Tanner, sounds like they're playing your song again," a resident sitting in the room said. "Go get 'em, Tiger!" He didn't know her name, and for some reason he couldn't have cared less. He grumbled something nine-tenths obscene under his breath and pulled himself from the sticky vinyl sofa; he yawned and rubbed at his eyes absent-mindedly while he stumbled out of the 'Residents and Interns Only' break room. He followed the red stripe on the floor to the ER and waded into Trauma Two, a small room set up for emergency surgery and advanced life-support. A couple of other residents had arrived before him and were sorting out the mess. "Tanner! Gun shot, through and through right lobe. Need you to get a chest-tube in, now!" Doug Tanner was wide-awake now. He gloved-up, moved to a tray set-up by the patient, a black kid on the table -- wide-eyed, terrified, bloody foam coming from his nose; a nurse opened the kit while Tanner palpated the kid's thorax, then Tanner made an incision between ribs on the kid's left side and thrust the hemostat and surgical tubing into the kids chest. Frothy blood came out the end of the tubing at first, then a steady stream of deep red fluid jetted onto the floor. An anesthesiologist was intubating the kid, the chief thoracic resident hovered over his sternum, her scalpel poised and waiting for the go-ahead from the 'gas-passer'; another resident was swabbing the kid's sweaty, mud-caked skin with saline and Betadine. There wasn't enough time to get the kid upstairs to an O.R. This was Tanner's second year as a general surgery resident, his third six-month rotation through the ER. He couldn't remember ever having done anything else in his life. He could barely remember his parents anymore -- they seemed like abstract constructs in an anatomy class. Girlfriends: who had time? Jenny so-and-so, a waitress one night, and Macy last summer -- they had come and gone, had fallen into the general blur of life at the hospital, just another blur on the past-passing landscape. Everything he had once thought important, girls, cars, even maybe getting married someday -- all these things belonged to a past that was so far away it wasn't recognizable anymore. Everything he ever wanted to do was gone now, his memory wiped clean by drunk drivers and irate husbands. 'Everything... but this goddamned ER,' he told himself from time to time... An orderly rushed into the room: "Can one of you break free? We've got a big bleed in five!" The Chief looked up at the orderly, then at Tanner. "Go!" she said when she made eye contact. "Right." Tanner walked down the hall and ducked into another room and shuddered to a halt: "What the hell?!" he said in wide-eyed astonishment. "He got his arm caught," a paramedic began explaining, "in this machine, they grind hamburger in..." Tanner looked at the mess: male, forties, calm... sitting up on a fire department gurney, his right arm -- almost up to the elbow -- had been pulled into a large metal meat-grinder; there was a fireman holding the machine up to keep it from pulling the man's mangled arm from his body. Paramedics had applied a tourniquet at the scene and started an IV; every time they released it on the ride-in massive blood loss resumed. Tanner walked to the man's side. 'Why isn't he in shock?' he asked himself. "How'ya doin', doc," the man said. He still had his white butcher's coat on. "Sorry about this." "Can you feel anything?" Tanner asked while he bent over to examine the "hamburger" that had come out the spout on one end of the machine. "No, not really... it hurt like a son-of-a-bitch while it was happening, but not much since." "Nerves are completely severed," Tanner mumbled. "Nurse, get me some saline, and let's get some light down here." Someone handed him an opened bottle of saline and he slowly poured half of the liter bottle over the wounded pulp; Tanner pulled a lamp closer, looked at the mangled mess. "And start some ringers," he added. "You gonna have to amputate?" the butcher asked stoically while he watched Tanner probing the mess. Tanner kept looking at the mangled remnants while he poured saline over the tissue, looked at hidden structure with the metal probe in his gloved hand. Every now and then he made little clucking noises with his tongue and his head moved from side to side but other than that he seemed completely absorbed with the problem at hand... "Does this machine come apart? There?" Tanner asked the butcher as he pointed at the main body of the grinder. "No, not the chute," the butcher said, "that's solid aluminum, doc." Tanner moved, looked down into the machine's feed chute, from the uninjured side of the man's arm. "What about those blades in there? Do they reverse?" "No, doc. The gears just turn one way." Tanner studied the machine for a moment, then stood up: "Nurse, call someone in maintenance and have 'em bring down a metric socket set and some vice-grips." "What?" the nurse said. "What did -- you want...what?" Tanner turned to the nurse. "Metric socket set and vice grips, and Stat!" "What are you gonna do, doc?" the butcher asked again. "Amputate?" Tanner looked at the man; his eyes were full of fear. "What's your name?" "Jake. Jake Bushman. Sorry I can't shake hands." "Well Jake, I'm going to disassemble this grinder and remove whatever is keeping those gears from going into reverse. Then we're going to turn the gears slowly -- in reverse -- then we'll pull your arm out the way it went in, try not to mess up any more tissue than we have to. Once we get that done we'll take you up to an operating room. We'll try to reassemble the structure, repair the veins, and see if we can't save this hand." "You gotta shittin' me!" one of the paramedics said. Tanner looked up, scowled at the paramedic: "Nope. Piece of cake." "Fuck! I thought for sure I was gonna lose my arm!" Jake said. "No guarantees, Jake. But we're gonna give it our best shot. Okay?" He turned to a nurse, ordered some blood chemistries and a couple of surgical trays, then pulled up a stool and began looking at the machine. A janitor walked into the room with a toolbox, looked at the butcher and the surgeon, then at the gleaming machine and the pulpy mess of arm hanging from the spout, then passed out and fell to the floor like a sack of potatoes. +++++ Tanner left the hospital a little before noon the next day; he got in his ancient BMW and drove out of the physician's lot and headed down to the marina, parked and walked out to his boat. While he walked down the pier he looked at his feet, tried to ignore the world around him. When he got near his slip he stumbled to a stop, looked at the suitcase on the deck by the cockpit; he saw Macy sitting in the shaded cockpit and sighed. "Ah, the ghost of girlfriends past," he mumbled as he took a few more steps. "It must be Christmas already." They'd broken up last summer, a spectacularly uneventful parting of the ways. Still, she'd been nice... "Hey Doug," the girl said when she saw him. She seemed upset, not like the Macy he remembered. "Hey yourself." He climbed on-board and ducked into the cockpit and unlocked the companionway, lifted the boards and walked below. He went to the breaker panel and flipped on the air-conditioning, checked a battery monitor and flipped a switch to cycle the bilge pump, then walked to the little fridge in the galley and pulled out a Coke. "Want something?" he called up. "Whatever you're having." That was vintage Macy, alright. She must have been a telepath! Never ask for anything, never want anything, but she resented the hell out of you when you didn't give her what she wanted. He grabbed another Coke and walked up the steps into the cockpit. "To what do I owe this honor," Tanner said as he popped the top and took a sip. "I'm pregnant," she said. She was looking him in the eye, daring him to say something smart. "Oh? Really?" He met her eyes. "Don't worry," she said; she looked down at her hands. "You're not the father." "Great, but I'm missing something." She seemed to be hovering over plains of a great despair. "I mean why are you here? Why me?" "I lost my job. I need a place to stay." Jake looked at her, lifted his hands and shrugged. "And... what? You suddenly remembered good ole Doug and decided to come on over, move in?" She smiled unevenly, laughed a little: "Yeah, something like that." Then she looked at him again, more closely this time. "I didn't know what else to do, Doug. I had to move out of my apartment last night." He nodded. "What about the father?" "Nada. Threw me out when I told him." "Sounds like a nice guy. Real father-of-the-year material." "You have to go back in soon?" "Nope; got 48 off." "Think we could go out?" "Out?" "Sailing?" Tanner sighed, looked at the sky, thought about his berth down below and how much he wanted to sleep. "Hadn't been planning on it," he said, but what the hell. Looked like a nice breeze out there and maybe he could figure out what it was she wanted from him. "Please," she said. "I used to love going out, with you..." "Well, why don't you put your stuff up forward, give me a hand with the lines..." +++++ He raised sail and the boat slipped out the cut from Dinner Key, pointed toward Key Biscayne across the shallow, blue bay, downtown Miami off the port beam. It was warm, in the hi-60s, a typical mid-December day. There was no one out on the bay mid-week; it was like they had the whole ocean to themselves. The boat knifed gently through the water, the wind little more than a breeze. Macy took the wheel and Tanner went below for more Cokes and to make some sandwiches. They ate in silence; Macy seemed to bask in the sun for a while, then she curled up in the cockpit and fell into a restless, twitching sleep. Every now and then she moaned. Tanner watched her, jibed the boat slowly and pointed the boat south, toward Homestead; he set the auto-pilot and put his feet up, regarded the girl while she slept. A gust passed through the sails, the boat heeled a little and dipped through a wave. "Penny for your thoughts," he heard her say. "Why me?" he said. "Because you are who you are," she said openly. "I know you... you'd help." "Why's that? Because I'm the biggest sucker you know?" She shook her head. "You're not a sucker, Doug..." He looked at her, looked at her tiny belly. "How far along?" She shrugged. "Macy? Have you seen an O.B. yet? She laughed. "Maybe." She turned her face into the building afternoon wind, her hair streamed past her shoulders. "No foolin', Macy! You been gettin' check-ups or not?" She shrugged. "I can't afford it." "What... what happened? I thought you were pretty high on the seniority list." "Not high enough. They let about three hundred of us go." She'd been a flight attendant with a major carrier for years but everything seemed to be falling apart this year; the only real growth industry in Dade County seemed to gunshot wounds and drug overdoses. "I'm sorry," he said. "I didn't mean to pry; I know it's been a bitch all over. But don't you have Cobra, or some kind of policy?" She nodded. "Yeah, but the premium's are pretty steep, the co-pays... there's just not enough to go around." He nodded. "It's been tough for a lot of folks." he said. The ER was awash with these new, cruel realities -- he sutured-up the grim truth of this reality day in and day out. He looked at her a long time, tried to think of what to say, or how to, then: "So right, feel free to stay aboard if you want. 'Til you get your feet back under you." He looked at her, looked at her gentle smile. Maybe that was all he wanted out of life, he told himself; to see people smile, see them get a fair shake every now and then. "You see, I told you." "What?" "You're... you know... you're the most decent human being I know, Doug." He laughed, blushed, looked away. "Right, that's me. The very soul of perception..." "Why do you always put yourself down?" "Habit," he said. +++++ Tanner eased into the slip just as the last of the sun's light faded away, as the sky slipped from purples and oranges into sinking waves of cobalt, then on down to the hazy amber-black of an urban sky. There were no stars out, there never were, not here under layers of bright city haze. Tanner chopped the throttle, jumped onto the pier and made fast lines, hopped back aboard with power cords and hooked them up. He squared away all the "stuff" that went along with sailing, went below and switched the ships systems back to shore power. "Man, you got some sun today!" he said when Macy eased below. "You're gonna burn, there, on your shoulders." She reached up, felt her skin: "Youch!" "I'll get some aloe..." he went to the fridge and got out a pump bottle. "Sit you down; let's get some goop on that..." She sat, he rubbed. He remembered the way she felt now, while he touched her, like his skin on hers unlocked some vital store of memory. He thought of her, of the months they'd spent together, and he had to admit the memory was good. He rubbed her shoulders, the tops of her arms, then up her neck... he felt the downy hair on her neck and remembered the way it used to smell when they made love. "You're still in love with me, Doug, aren't you?" he heard her say as he slipped away in shades of gray. He heard her words, shook himself back into the present, stood and put the aloe away. "You hungry?" he asked. "Actually, I'm not sure. I feel, maybe, well yes..." "Me too." He slipped into the aft cabin, grabbed his shower things and walked up to the shower building. He enjoyed this marina despite its size; once upon a time it had been a Pan Am flying boat terminal; now it was a huge marina full of live-aboards, overflowing with herds of South American pilots and families with kids and retired people off to see the world -- and taking a time out. He showered, walked back to the boat, saw a mother and her crying daughter waiting by the boat. The little girl was crying... "High Amy," he said to the freckle-faced girl as he got closer, "what's wrong?" "Oh Doug, she picked up another splinter, a real biggie, playing a while ago," Mary Ann, the girl's mother, said. The little girl looked at him stoically and held up her hand. He bent over and squinted in the darkness. "Youch! That's a biggie alright." Tanner said. "Well! Let's see if we can't fix you up." He jumped below, heard Macy barfing in the forward head while he got his bag out; he walked forward and knocked on the door: "Morning sickness?" "Oh boy oh boy am I gonna chop off the next dick I come across!" -- she said before she retched again, followed by a deep moan... "I swear to God I'll never touch another fucking penis as long as I live..." "Uh, right... I'll be back in a second, got a splinter to remove..." "Right..." More retching sounds followed. He shook his head and went to the panel, turned on the cockpit lights and went back up into the cockpit. "Is Macy back?" Mary Ann asked. The marina was like any other small town -- news traveled fast. Her husband was a pilot for AirTran and gone all the time... "Lost her job and her apartment," he said while he opened the cockpit table and laid his tools out. "Okay Amy, let's see that honker!" The girl held her hand out and put it on the table and he bent over and looked at it. "Well, doesn't look as bad as I thought. You want to be a brave girl and tough it out or do you want me to use some Novocain?" "Is that a needle thingy?" a wide-eyed Amy replied. "Yep. But that's a real big splinter, Amy. If it was in my hand I'd want the shot." "Okay then. If it's what you'd do." Not too long ago Mary Ann had told him her little girl had a crush on him. He got to work, cleaned up the wound and bandaged it, gave her a tetanus shot and sent them on their way; he went below, found Macy on the v-berth up front lying in a pool of sweat. "You're burning up, kiddo," he said. He returned to the galley, got his bag and a cool washcloth and went back forward, put it on her forehead. "You hurt anywhere?" "Here," she said, pointing to her lower left quadrant, "and here," now at her mid-groin. "How bad?" he asked as he reached down and palpated gently. "Bad!" she moaned when he touched her. "Okay. If you think you can walk we'd better go to the ER; if not I'll call an ambulance." "What? Why?" "Not sure," he lied. "Better check out some things and make sure the baby's okay." He was concerned she might have an ectopic pregnancy; he needed to keep her calm. "Can you walk?" "I don't think so," she said. "I don't think I can move." "Right." Tanner walked back to the chart table and got his phone, called 911, gave the operator directions to the boat, went back and took her blood pressure, wiped more sweat from her face. He heard the ambulance a few minutes later, went topside when he heard the paramedics getting close, helped them load her in the ambulance and rode with her to the ER. He called a social worker while they worked her up; he wanted to get Macy set-up with Medicaid before the bills got out of hand. He went back to check on her but they had already taken her upstairs. Then he remembered he didn't have a ride back to the marina. He looked at his watch; three in the morning. "Great!" he said. "Hey, doc! How's it going?" Tanner turned, saw one of Miami's finest, a good-natured cop everyone called Mannie. "Hey yourself. What are you doing down here? Krispy Kreme not open yet?" "Ha-ha! I don't eat them hi-dollar donuts, Pachuco!" "Yeah? Looks like you're eatin' 'em somewhere, Mannie! Whoa, dude, you're packing on the pounds!" Mannie Hernandez looked down. "Yeah, I know," he said quietly. "Something wrong?" "Yeah, everything." "You on duty?" "Overtime. Came in with a big MVA, a DUI homicide. Headed back to the station." "Good, you can give me a ride home?" "Yeah, sure, no problem," the cop said. "Thanks. Now, what the fuck's wrong?" "Oh, man, it's my old lady..." They stopped off for a couple dozen donuts on the way... +++++ He spent the morning with Macy, and the other half of his day cleaning the boat; he had finally put his feet up in the cockpit and opened up a book, had just started reading when an old couple walked up... The Soul of Perception "Dr Tanner, you have a minute?" He looked up, smiled. "Bill, right? And Lucille? What's up?" They nodded, smiled: "You still giving out flu shots?" "Yeah, I got a couple left. Y'all didn't get yours yet, I take it?" "No sir, we sure didn't. Do you think you could get us one?" He put his book down and went below to the fridge, opened a fresh box of pre-loaded syringes and had them read and sign a release, then he gave them their shots, had them sign a book he kept for the County Health Department. "Dr Tanner, I've got a fresh pot of turnip greens and some corned beef on. Would you like me to bring you a plate?" "Is that what I smell cookin'?" Lucille smiled, blushed. "My word but that smells fine." "I'll go fetch you some..." "Don't bother. I'll come over if that's alright." They couple both seemed pleased with that and scuttled down the pier to the old cabin cruiser they called home; Tanner walked along a moment later. "Y'all came down from Tennessee? How?" he asked when he read the hailing port on their boat's stern. "Yessir, down the Tenn-Tom Waterway," Bill said. "Real pretty trip, too. Best thing we ever done." Tanner ate, he laughed at their stories and listened to their heartaches, talked with the old couple for hours, then went back to his boat and fell asleep. +++++ He went in early, talked with Macy. She was beat up physically and emotionally, was adrift after losing the baby. Tanner thought she seemed too depressed, thought he'd better tell a floor nurse to add that to her chart. "You'll be here today, maybe tomorrow," he told her. "When you're ready I'll come and get you, take you down to the boat." She smiled, turned away, looked out a window. "I'll come by again in a little bit. You get some rest, okay?" She said not a word, just drifted away into the hazy confines of her day. +++++ The paramedics said she was a hooker, that she'd overdosed on meth and sometime during their tryst gotten into a fight with her 'john' over the quality of services rendered; the guy knocked her around a little, then shot her twice -- once in the arm, once just above her collar-bone -- when they really got into it. The 'john' was in Trauma Six, his penis hanging on by a thread, the hooker was in Trauma Three, and it was a busy night. Though it was four in the morning all twelve trauma rooms were full, several with gunshot or knife wounds, people hit by drunk drivers or wives beaten by angry husbands. Mannie Hernandez stood in the corner watching Tanner work; he had, by law, to remain with an attempted homicide victim until the docs could tell if she would live or die. The hooker was in and out of consciousness but her vitals were good -- she was stable; Tanner held x-rays up to the light-box, looked at the bullet in the woman's neck. He wanted to pump her stomach while they waited for an O.R. to clear up, watch her fluids and vitals, but was afraid if she vomited the movement might push the bullet against her spine. He called the neurosurgeon upstairs and explained; the surgeon wanted her stomach pumped, didn't want her vomiting with a tube down her throat on the table. He got the tray ready while nurses strapped a neck brace in place, then Tanner ran surgical tubing up her nose and threaded it past her glottis and into her esophagus, then down into her stomach. He put positive pressure on the tubing and listened with a stethoscope, made sure the tube was in her belly and not her lungs. A nurse mixed activated charcoal and saline into a wet slurry and filled a huge, syringe like pump and handed it to him. He fit the syringe to the tubing and pumped the black sludge slowly into her stomach; a nurse listened to the stuff enter the stomach and gave Tanner a thumbs up. Another nurse mixed saline and ipecac, an emetic that causes near instantaneous vomiting. Tanner looked up, grinned at Mannie. "Say Mannie, you wanna come over here and hold the bucket?" "Hey, fuck you, homey. I ain't standin' next to no fuckin' volcano! No way, no fuckin' way! All them scrambled eggs and shit! Shit no, no fuckin' way!" "Hey, you know, just thought I'd ask..." He fit the new syringe in the tubing and pumped it in, then quickly pulled the tubing out the woman's nose. As soon as the tube was clear a nurse held the woman's neck while everyone else rolled the woman on her side. An orderly stood beside the table with a fifty gallon trash can ready to go, a mask over his nose. "Oh, crap," the orderly said seconds later, "here it comes!" The woman's eyes opened momentarily, just before the deluge; she managed to say "what the fuck!" before she let loose. She convulsed violently then settled down, kept barfing into the can, moaning between upheavals. "Hey, Mannie!" one of the nurses said. "How'd you know she had scrambled eggs for dinner?" "Fuck you, man! Just fuck you!" Everyone laughed, everyone but Tanner. He ran his fingers through the woman's hair, leaned over and whispered something in her ear. She moaned, smiled a little before she closed her eyes. He continued rubbing her head until he was sure she was asleep. +++++ He got off after thirty hours on, went upstairs to Macy's room. "Howya' doin'?" Tanner asked when he walked in her room. She seemed brighter today, not quite as down. "Better, Doug. Thanks." "Yeah. Say, the chemistries look good; they wanna cut you loose. Feel like taking a ride?" "Doug. I mean it. Thanks. You saved my life." "Bah! Nonsense!" "I was gonna go get a hotel room. I would have been alone. The nurses said I'd have bled to death." "Macy? You ever think that some things happen for a reason?" "Maybe. I don't know." "You don't huh? Imagine that." They laughed. "So, I brought you some things. Why don't you get dressed? I'll come back in a minute..." ... He drove slowly, let her get used to the sun and the air and the greenness of life. The sky was bluebirds, not a single cloud anywhere, the air cool and fresh. The world smelled of mangos and freshly mown grass, girls on roller-skates and dudes on skateboards crowded the sidewalk by the beach, Frisbees flew across the sand and out over the silvery-blue water beyond -- sailboats crowded the cut from the marina out to the bay. He watched her, thought about what she'd been through, about the hopes and dreams she might have had, about the nightmare that had come calling instead. He helped her from the car, walked arm-in-arm with her down the pier. There were fresh flowers 'from all of us here in the marina' and Lucille stood by as they passed, followed them and handed Tanner a huge pot of greens and corn bread. She was pale and light and he had to admit it now: he had never really stopped loving her. He fed her and put her in his berth in the aft cabin, drew the little curtains and crawled in next to her and held her through the night. He held her when she cried, he held her while she slept. He brushed the hair from her face, kissed her eyelashes as gently as a breeze. She looked at him, held him in her eyes. She smiled. "See," she said, "I told you so. You still love me." "You were right." "I know." It was her turn now. She held him, held on to him as tightly as she could. +++++ Tanner went in early the morning -- it was an off day but a third year resident had called in with the flu. When the Chief was short she knew who to call. Tanner never said no. Sundays were slow days. They didn't usually get bad until evening rolled 'round, but even so most Sundays were easy. And so this Sunday was. Medicine was busy, lots of flu presenting, and psychiatry was too. Paramedics came by with a teenage-girl strapped down to the gurney a little after noon; she'd slit her wrists -- "the way they do it on TV" she told him, and he repaired a tendon and sutured her wrists while she went on and on about how life wasn't worth living because her boyfriend had dumped her... "Just curious," he asked her at one point, "what would make life worth living?" She mentioned something about a new cell-phone or a Mercedes like her mom's and Tanner smiled as he looked at her, while he steri-stripped the margins of the wounds and covered them with four-by-fours. A resident from psychiatry came by, and when out of the room asked what he thought about the girl: "Looks like a pretty classic cry for help," Tanner said, "except her feet are filthy, there's a load of dirt under her fingernails, and she's malnourished. She acts like little miss rich-kid but I'd lay odds she's alone and on the street, maybe a runaway. I'd call Social Services right off the bat." The resident nodded and made notes, walked away. A little later they rolled the girl down to psychiatry; she waved at Tanner when she saw him and he smiled, waved at her. "Gunshot wound inbound," came the crackling voice from the speaker overhead. "Paramedics about five minutes out." Tanner was the senior resident on the floor. Two first-years surgical residents and a gaggle of interns hovered expectantly, watching and waiting for him to say something. An emergency medicine doc was hustling down from the cafeteria. The older resident, Doris Tayloe, a woman who'd graduated from med school on her 48th birthday, looked ready to go: "Right. Doris, go get some trays set up and ready to go, would you? Take a couple of interns with you, and tell 'em to tuck in their goddamn scrubs! And trust your nurses!" He was tired of finding loose hairs on his sterile field; heads would roll soon if he saw another sloppy intern walking around with their scrubs not tucked-in! He got on the phone, called the doctor advising the paramedics in the field: "What do they have?" he wanted to know. "Six year old African-American male, at least two gunshot wounds, one in the gut, one looks like it got the femoral artery. They've got trousers on the kid." "Right, have you notified vascular?" "Yeah. Collins is finishing up a chest, he'll be down as soon as he can. I called your chief, too. She's on the way in." "Right. Thanks." "Okay, they're turning in now. Seeya..." Tanner hung up the phone, walked down to Trauma One and filled in the team. Everything looked ready. He saw the ambulance screech to a stop and back in to the loading bay, two patrol cars roared in and pulled raggedly into spaces marked Police Only. Mannie Hernandez jumped out of one, another he didn't recognize followed. Orderlies got the ambulance doors and firemen helped pull the gurney out; one of the paramedics was bagging the kid, another held IVs overhead as they rolled him into the ER: "Go to One!" Tanner called out; he saw the emergency medicine doc running down the corridor. "Thank goodness for small favors," he said as he followed the gurney into the room. Orderlies and nurses began cutting away the kid's clothes; Tanner saw the boy's eyes roll back in his head and moved to the kid's gut. "It's a fucking mess in there," he heard one of the paramedics say. "Must have been a .357 or something, maybe a 41 mag.; there's a big fucking exit wound where his right kidney used to be..." Tanner started calling orders, supervised the residents and nurses, let them do their jobs while he did his. "Okay, I can palpate the aorta; it feels intact -- good pressure -- the renal might be okay too -- Doris, let's roll him... I wanna have a look at that exit wound before we take the cuffs off his legs -- Fuck, what a mess! -- Somebody call for a gas-passer -- the renal is intact but I can feel bullet fragments all over the fucking place -- goddamn hollow-points!" He heard in the periphery of his mind Mannie out in the hall, a hysterical woman screaming, probably the kid's mother, probably taking all Mannie's strength to keep her out of here, then -- "get a cut-down and lets get those cuffs off, I'm gonna go in and clamp off the femoral..." "But it'll be retracted..." one of the interns commented. "No shit, Sherlock!" the emergency medicine doc said angrily. "Get the fuck out of here and go read a comic book!" Tanner palpated the inner thigh, thought he felt something and made an incision from the scrotum down his thigh about eight inches. There wasn't much fat, not much muscle, either; he stuck his finger into the shattered tissue, felt the artery, felt it pulsing lightly. "It's just... still mostly intact... oh, no! Clamp!" he shouted. He felt the clamp slap in his left hand and guided it down to the deteriorating artery; he got it on the first try. "Got it! Shit, there's bone frags everywhere -- better call ortho, somebody!" Tanner stood, looked at the monitors: the kid was holding his own but the screaming in the corridor was getting out of control. "Mannie! Bring her in!" "You sure, man!" "Let her go!" A black woman, maybe thirty, thirty five, thundered into the room; she shuddered to a stop when she saw the boy. She started wailing. "Ma'am, I need you to be quiet, and listen, alright?!" The woman struggled to control herself. "Ma'am! Listen to me!" She calmed noticeably when she looked at Tanner, as if she took comfort from his strength. "Awright, doctor, I'm listenin'." "We've got a lot of the bleeding under control. The boy's stable right now. Do you believe in God?" "Yessir, doctor, I sure do." "Alright. I want you to go out with Officer Hernandez there and get down on your knees somewhere and start prayin'! You here me? You stop prayin' when I come out and tell you too. You hear me!" "Yessir," she said. "Thank you, doctor." She had somewhere to focus her strength now, and backed quietly from the room. In the quiet, Tanner hoped, things would go smoothly, things would start looking good... +++++ The man was huge. His bald head just barely cleared the automatic sliding doors when they opened for him, and he must have weighed three hundred and fifty pounds. His black skin glistened with sweat; he was wearing ragged denim overalls and old work-boots caked with dried mud, and nothing else: his bare chest appeared to be solid muscle, his arms too. He was looking for his step-son; the kid had taken twenty dollars from his wallet and that had been the last straw... Something inside had snapped... He saw his wife standing in a little room, a cop standing between him and her. He took out the pistol in his overalls and aimed, shot the cop. The noise was overwhelming; people screamed, interns ran behind counters, the cop fell over, slid down the doorway, blood coming from his mouth and nose. The woman turned, saw her husband and ran into the trauma room, tried to hide from him. The man walked into the room, saw his wife hiding behind a doctor... or was he trying to shield her, protect her... he couldn't tell... it didn't matter... He fired once, then again and again. Nurses and doctors flattened against the wall, tried to get out of the line of fire, then another gunshot, this time from behind the man, then another. Brain was exposed on the left side of the man's head as he fell to the ground, his eyes lifeless. Doug Tanner lay on the floor, he saw a cop across the room on the floor, blood pooling under her head; he tried to move, to help her -- but he couldn't. The world grew light and distant, and he felt himself falling into cold light. +++++ He woke up, recognized an ICU nurse and wanted to ask her what she was doing in the ER. He tried to talk but couldn't, tried to swallow but simply could not. He felt a wave of panic wash over, knew he was the patient but had no idea how he'd gotten here. Then the nurse was overhead, looking down at him... "Doug? Doug, you were shot, in the ER. Neck wound. There's a drain in now; that's why you can't talk..." He heard her talking, heard her say something about his mouth and tape and everything was going to be fine... and then he felt himself drifting off again... ++++++ He felt his head lifting, heard a motor whirring away under the bed, opened his eyes, saw doctors looking at his neck and talking. The room was dark, but he could tell the curtains were drawn and faint sunlight was seeping through. "Oh, hey Doug. You awake enough to talk?" one of the doctors said. "Yeah," he croaked. It hurt like hell. "Good! The vocal cords are fine! I think we can take out the drain, Bill." He ignored them... ...because he saw Macy behind them; she looked anxious and moved close when the doctors left a moment later. He watched as she started crying, began shaking uncontrollably. He reached up and took her hand. "How are you doing," he asked her. "How am I doing? Me? Oh, Doug!" He felt her head on his chest, smelled her hair, felt her body shake as tears convulsed her... "Hey, Pachuco!" "Mannie?" He felt Macy stand, saw her turn and look at the cop as he walked in. "Hey, amigo, brought you some donuts..." "Right!" He looked at Mannie, then at Macy: "Try and save me at least one, will you Macy. That man is a donut fiend. He'll snatch 'em right off your plate..." Everyone laughed, even if it did hurt a little. +++++ So yes, once upon a time there was a doctor... I met the man I've called Doug; he lived at a marina where I stayed once, just a few months before what happened - happened. I've filled in the blanks, rounded out the details in the soft pastels of conjecture that so often make-up a little story like this -- but maybe you should let the facts tell the real story. Surgical residents in the United States will treat, on average, more than twenty gunshot wounds during the course of their training; in Europe the average is statistically insignificant, less than one, anyway. Physicians, nurses, paramedics are wounded or killed in American emergency rooms every year, year after year. Cops, too. Not all these stories have happy endings. "Doug" and "Macy" got married not long after these events, and they had a kid, a little girl. He finished his residency, practices vascular surgery in Texas and remains a friend. They still live on the boat, plan on taking off and seeing the world some day. I hope you run across him someday. ©2009AL5.5.09