an Excerpt from “Thirteen Months a year”
Riegel took a break waiting for the OR to get cleaned up for his next case, sitting by the phone at the desk on 5200. I asked, “Were you here during the Watts Riots?”
“I was a brand new intern, fresh from Yale.”
“What was it like?”
“D Day. The jail ward filled up the first day. Prisoners were chained down everywhere. In a crisis people drive by a dozen hospitals to come here.”
“What happened?”
“A lot of the rioters were drunk. They got into fights, ran over each other with cars or got low back strains carrying too much loot. I got a gal with her belly blown away by a shotgun, like she’d swallowed a hand grenade, exposing the severed end of her aorta—an empty belly, no guts, no kidneys, no bladder.”
“What did you do?”
“I gave her morphine and shut off her IV’s.”
“How’d you handle so many patients?”
“We worked until it was over. Nobody went home. Interns did major cases. Med students did surgery.”
“Med students?”
“Nobody else available. They did Achilles Tendon repairs. Some jokester told the rioters the best way to break a store window was to heel-kick it, so we got hundreds of Achilles injuries. Plate glass comes down like a guillotine.”
“Is that what made you choose neurosurgery?”
“I like action, but not that much. I was born to crack heads.”
“I think I’m destined for internal medicine, maybe oncology.”
“Why oncology? Everybody dies.”
I laughed. “As opposed to your specialty?”
At midnight, I discovered that one of our patients hadn’t returned from radiology. A hit-and-run driver had clipped her while she was out walking her dog. Her only complaint was neck pain. I’d put her in a protective collar and sent her for films.
I stepped out of the stairwell into the X-ray holding area. Two-dozen patients lay on gurneys. A few sat in wheelchairs. My patient lay on a gurney near the registration desk. Her face was pale and the undersides of her arms had the purplish color of livor mortis—dead for three hours.
I approached the chief technician, who was lifting a pile of x-ray cassettes. “Excuse me. What took so long to do the films on the old lady over there? You clocked her in five hours ago.”
Squinting towards my patient, he said, “Her—oh, yeah. Couldn’t get her positioned. Limp as a dishrag. We’ll get back to her. I’m sorry, but you know we’re short-handed.”
“Don’t worry about it. I’ll take her upstairs and, uh, bring her back later.” A death in the radiology department would shut it down, making matters worse for everybody else, and doing my patient no good.
“Thanks, doc,” he grunted and staggered away.
I wrote a death note, post-dating it by ten minutes, the amount of time it would take to get back to the floor. Leaving her face uncovered, I took her back to 5400 to bag her and send her to the morgue.
At five AM I was sleeping in the call-room. A nurse shook me awake. “Gunderson has gone sour,” she said.
“Where’s Riegel?”
“Sleeping upstairs in an empty OR.”
I squinted in the glare of the hallway and snapped up my smock. My patient had tripped over a curb and sustained a scalp laceration. Drunk but lucid, admission hardly seemed needed. Now he was comatose, and his left pupil was dilated. “Does everybody crash? He looked fine a few hours ago.”
“Don’t count on saving any lives here,” she said.
I gave a dose of Decadron and phoned the OR supervisor. She got Riegel. “One of our drunks has blown a pupil.”
“Acute sub-dural. Set up for burr holes.” I shaved the patient’s head and smeared on Betadine, treating him where he lay—-crude, but effective. Riegel used a bit and brace to drill a hole above the left ear. He cut through the inner table of the skull and removed a circular bone plug, revealing bulging dura mater. “Voila!”
“How’d you know that it’s a sub-dural?”
“A pickled brain shrinks, stretching the bridging veins. They tear with the slightest trauma.” He sliced through the fibrous covering of the brain, and dark blood spurted onto the surgical towels. The patient’s respirations improved, but he never awakened. He died of pneumonia one week later.
