"Is everything squared away?" asked Dr. Harshberg. "Yes, sir. He's getting his head scan. The neurologist is involved. I've spoken with the wife. I've given the nurse a couple of Valium to relax!" I knew that he didn't care to know the details.
"Good work, Rastus. While you were gone trying to decide what to do with Mr. Sullstein's brain, we've been trying to decide what to do with Mr. Jacobs' shitlands. It's quite a challenge. We don't know what's intestine and what's tumor. Look here. His abdominal wall is full of tumors. We just put a hole in his bowel. Rastus, this man had more shit pouring into his abdomen than I had ever seen. Cutter did a good job sewing it back together."
"More irrigation?" Dr. Ungaman hesitated to ask.
"Cutter, his belly is full of shit. IRRIGATE IT, SON. IRRIGATE IT. It's polluted with shit and you know the solution to pollution." "The solution to pollution is dilution!" recited Cutter. "Inger, warm saline to me," he continued while waiting for the water. "Frankly, we can't do much more for him. We relieved one of his many obstructions. I think I'm going to call it quits. I'll talk to his family and inform them of what we did. You go ahead and close the belly with Cutter. This was a long and tough day, boys. Thank you."
"Doctor Harshberg, are you going to examine Mr. Sullstein on your way out? I believe he should be back by now," I asked him, feeling a lot of guilt about what I had told Mrs. Sullstein.
"No, Rastus. I don't need to see him. I fixed his leg. I can't fix his brain." "I understand." I bent forward and looked at Mr. Jacobs' belly. He was in a mess beyond description. Dr. Harshberg was ready to leave. "Sir, how aggressive do you want me to be in supporting Mr. Jacobs?"
"I don't know. What does Cutter want to do?"
"Well, I suppose we can maintain his blood pressure. He's probably going to bleed a lot. He'll need to be transfused. He's going to be tough to manage," answered Dr. Ungaman.
"There's a lot I can do for him. What's appropriate?" I asked again.
"Discuss it with Cutter. Whatever he's comfortable with, I'm comfortable with. See you in the morning. Keep an eye on Doctor Gastein. Shit, he's sleeping again. GOOD MORNING, VIETNAM! IT'S DOUGHNUT TIME," yelled Dr. Harshberg as he left the room.
The poor anesthesiologist jumped off his chair.
"Vicryl suture to Doctor Baldi. Let's close this mess. This is so depressing. Ron, let's hear some country goodies," exclaimed Cutter.
"Right away, Doctor Ungaman. What would we do without country music!" replied Ron as he walked to the music box and turned it on.
Originally from the southwest, Ron knew almost every country music song. And with his long hair and wide mustaches which protruded from both sides of his facemask, he could have made a great country singer. "How aggressive do you want me to be with his care?"
"If I could make money out of loving you, I would have made a million or two..." sang Dr. Ungaman. He tried to evade the subject by singing with the radio.
"Cutter?" I stopped sewing the belly and looked at him. He stopped singing. He hesitated to answer. He was the chief resident. I insisted on hearing his plans for Mr. Jacobs.
"What? What do you want from me?" he asked.
"What? What? Look at him. He's fuckin' butchered. Let's stop it here. This man needs suffer no longer. Doctor Harshberg doesn't and wouldn't care. We'll tell him that he crashed on us. That would be it. Ron, shut off this stupid music," I started to raise my voice.
"I don't know. I just don't know what we did for him tonight. He's sick," he mumbled without looking at me.
"So? Let's pull the plug right now, right here," I replied upset. The anesthesiologist and the two nurses froze.
"If you're looking for answers, don't look at me. I'm here to learn how to operate. I did my work. You're in charge of his care now. Do what you think is right," he finally answered ignoring my request to let go of Mr. Jacobs. "Finish up closing him. I'm taking off. Meet me in the intensive care unit at five in the morning. You'll be there all night anyhow. I'll grab you some coffee. Keep the patients alive," he walked out of the room without debating further. He looked exhausted. The excitement of all the cutting he had done had drained all of his energy.
I looked at the white and black clock. It was two thirty in the morning already. The anesthesiologist put his Reader's Digest in his pocket. We got Mr. Jacobs off the operating table and transferred him to his intensive care unit bed. We wheeled him out of the operating room. He ended up in Room 2220, five rooms away from Mr. Sullstein. Dr. Gastein gave a full report about the case to the intensive care unit nurse, Silvia. Silvia, a short Hispanic, was one of the best nurses around. She had nursed several of my patients in the past.
I sat at the desk in front of Room 2220. I looked at Mr. Jacobs. With a tube down his throat, he was hooked to the ventilator which was breathing for him. Another tube inserted through his nose was draining all of his stomach juices. A dozen lines were connected to his body: blood units, antibiotics, intravenous fluids, medications, and monitoring lines. Two drains were shoved into his abdomen to drain the shit mixed with tumors from inside his belly. He looked very different than when I first saw him down in the emergency room just a few hours ago. I stared at Silvia. She was busy marking all the lines. She was having a hard time going through all of them. She looked stressed. I was stressed too, trying to decide what to do with Mr. Jacobs. The big mess was done. I was left to clean it up. It was too much for me to handle at this early morning hour. I walked to Silvia seeking help.
"I suppose the anesthesiologist told you all about the case."
"He did. So Harshberg and Ungaman dumped the patient on you. I have no respect for Harshberg. I've seen him chew out his residents in the intensive care unit before," said an excited Silvia.
"Well, Silvia, sometimes it's hard for doctors to decide what to do. This man was sick. He needed help. He came to the surgeons. What do you expect them to do? If he would have sought the help of medical doctors, it would have been different. Or maybe he needed the help of a rabbi. I think he needed a rabbi to hold his hand tonight. But see, his family brought him to the surgeons. Doctor Harshberg intends well. He tried what he thought was best for this patient," I said in his defense.
"Doctor Baldi, I respect you. I know what position you're in. What are you going to do?" She paused. I stood at his bedside and thought for a few minutes.
"I'm waiting for your orders. Are you going to do the right thing?"
"What's the right thing, Silvia? Doctor Harshberg said to do what was kosher with Doctor Ungaman. He said to do the right thing. You said to do the right thing. What's the right thing, damn it?" I tried to hide my frustration.
"Did they teach you anything at Stanford?"
"Honesty towards myself. Compassion towards my patients. But this is the real world, Silvia. It's not medical school where I can turn to someone else for answers. I have to find the answer and live with it. I have to do the right thing. Help me."
"If this were your father, Doctor Baldi, what would you do?"
"I would find him a rabbi. I would bring my family here right now. I would not do anything aggressive at this point. I would give him a sweet drip of morphine and let him join his father and grandfather," I softly said. "Doctor Baldi, his pressure is dropping. Do you want me to start a drip to bring it back up?"
Silvia was pushing me. I looked at Mr. Jacobs. I looked at the monitor. His systolic blood pressure had drifted into the eighties.
"So, Doctor Baldi. Do you want to treat his low blood pressure?" she asked again.
I looked at her. She looked me in the eyes. Her Hispanic face was sweet and gentle.
I looked down at the floor. I took off my glasses. I rubbed my eyes.
"No, Silvia. You know what to do."
"Is this a verbal order?" she asked.
I lifted up my head. Put my glasses back on. I looked Silvia in the eyes. I hesitated for a moment.
"Yes, it is."
"Can I give you a verbal order, Doctor Baldi?"
"I beg your pardon?" I asked.
"I don't see a rabbi around here. Please hold the hand of your patient and pray for him. I'll go mix the morphine drip."
Nurses never gave doctors orders. Yet I listened to Silvia. She had the courage to do what three doctors didn't dare to do, let this man die in peace. I grabbed his right hand and gently placed my left hand on his sweaty forehead. I bent my head and whispered in his ear that it was all right for him to go. Silvia returned with the morphine.
"I have to check on the other patients. Titrate the drip to his comfort. Hopefully he'll slip away over the next few hours. Thank you, Silvia."
I turned around. I started walking away. I was already thinking about the consequences of what I had just done. I knew that I could easily lose my job.
"Doctor Baldi..." I heard Silvia's voice from behind me. "You're a good man," she said.
I looked back. She had already hung the morphine drip, the juice of a peaceful death.
|Chapter Five||Chapter Seven|
Copyright © 1996 Maher Abbas, M.D. All rights reserved