BAPTISM UNDER FIRE

Back in the days, you know those days, when time was irrelevant, nights merged into days and once in a while you saw the sun. The rest of the time was underneath fluorescent lights and walking past those germ repellent UV lights caressing the corridors. All you heard was “Paging Dr. So and So,” and visiting little children would laugh when they made up stuff amongst themselves for the garbled overhead announcements. The corridors were clean without any mechanistic large devices that regurgitated medicines upon a directive from the screen above, nor were there large covered shelves with clean laundry awaiting immediacy due to a spill. There were housekeepers that were quick on the call and nurses who mostly tended to the call-light overhead the patient-room door. The nursing floors were mostly empty save for the Ward Secretary who answered the calls and triaged them to appropriate personnel. The nurses were busy doing what they were trained to do, provide nursing care and not spending time documenting every hiss of the opening and closing door.

During those Shangri-La moments there were pulses of great chaos too. The Emergency Room was always filled with wounds, diseases and sudden illnesses. Coughs and Colds rarely wasted their time visiting.

On such a Thursday evening, when the shifts were changing and bodies moving from work to leisure and shoulders relaxing to shed the burden, I found myself on the side of a very sick lady. I was the medical resident and this one had arrived with severe abdominal pain. She was pale with fear, her eyes were wide open in pain and her body writhing without relief from the calamity within.

There are moments that are not quite ripe in memory. My next recollection is walking beside the gurney with the chief surgical resident on the other side and three nurses holding various equipments that proclaimed life had not escaped the host. The anesthesiology resident was astride the patient’s head as he ventilated her through an endo-tracheal tube and everyone’s eyes were glued to the monitor for the rapid blips that signified a beating heart. The next thing I remembered was my right hand inside her belly clamping the pulsating aorta. The surgical resident had determined that she might not make it to the Operating Room where we were headed in a frenzy, so rather than wait, he did what he had to do and needless to say, my gloved hands were there feeling the weakening pulsations of the aorta. Her posterior penetrating gastric ulcer had eroded into her aorta. The rest of everything was a blur. I remember seeing the UV light on the wall and then I remember standing in the operating Room for a long, long time. 

The attending physicians and the rest of the elite crew arrived and brows were mopped off the sweat, The smell of blood and guts was everywhere, the fading and strengthening heart monitor and the arterial pulse pressures, the pints of blood dripping furiously down the tubing, IV saline rushing through wide-bore angio-catheters into the subclavian vein like open faucets and the race to save a life was on. The clocks seemed frozen in time. The long arm stayed at the 12 O’clock while the short arm circumnavigated its face. One moment it was ten o’clock at night and then one o’clock in the morning and the next time I looked up it was six o’clock in the morning. I had a morning “Intake Conference” to present before the medical department an hour later. I did. I don’t exactly know what I said or how the audience received it. Sleep came with difficulty that night as time replayed itself in a frenzy. What was, what could have been and what should have been.

A few weeks later, on call for the night, I walked into the Emergency Room and found myself face to face with a young 19-year old girl. She was sweating and throwing up at the same time. She looked tired, worried, and fretful. After an evaluation and the appropriate tests an hour later, I determined that she was pregnant. A happy occasion, I thought, as I approached her with the news. She sobbed hysterically into a convulsive heap. Fortunately the nurse was there to handle the raw emotions. After tending to a few other easy patients, I took the shortcut and walked from the Emergency Room to the Resident quarters, which were across the doctors parking lot. The moon was out and everything was a silvery bright. From the corner of my eye, I saw a flash and turned quickly to see what that was. I saw a tall, rather large man brandishing a shotgun in his arms. He approached me from the side and said in the most menacing voice one can hear, “Doc, my girlfriend ain’t pregnant! You hear me. She ain’t pregnant! Now you go and do what you have to do, or I’ll make sure of a few things.” What do you do in a circumstance like that? I said, “Okay” as best as I could muster the air out of my lungs and through the vocal cords, and walked slowly back to the emergency room with him following at a short distance behind. I remember my insides shaking, actually convulsing, feeling that any moment a flash of light would be it. I walked as best as I could although my knees were buckling from fear. The muscles had absolutely no power and the bones felt heavy. I made it to the automatic sliding door and as I stepped in and felt the door close behind me, a sigh of relief escaped. I remember not looking back. I remember going to security and reporting the incident. I remember walking into the corridor past the emergency room and collapsing against the wall. I remember hearing some commotion in the emergency room and then all was silence. No reports, no police, no nothing. And then, “Hey, had a tough ER call?” from a fellow intern. "Just ducky." I thought.

On the Tuesday before Halloween, I was scrubbed holding a retractor while the surgeon attempted to pull the diseased gallbladder out. His hands were steady but he had a voice that would make you shiver and sweat. “Pull here,” he would say and after showing what he wanted with the retractor, he expected you to follow and then imagine what he was thinking for his next move. If you didn’t, then the invectives flew. Somewhere during that surgery, I saw the oozing blood in the surgical field turn a darker shade of red. Mind you, I was a lowly intern. So in the bravest of brave tones, I said, “That blood looks dark.”

“Shut up. Who asked your opinion?” Moments later the patient’s heart rate rose and the dinging from the monitor portended bad tidings. The anesthesiologist’s eyes grew wide, the surgeon’s hands showed a little tremor and they all anticipated what was next to happen. And it did. The patient had a cardiac arrest. I remember being pushed aside to the walls of the operating room and there, I stood and watched the bizarre pantomime. Everyone worked in unison. Not a motion was wasted. After an hour of this and that, the monitor blips came back in full vigor; the surgical pads in the stainless steel bowl became colorfully red again. Finally I remember walking into the recovery room as the patient opened her eyes. All was well with the world but for those frightful moments when she was asleep.

These moments are a few from the many that make a doctor arrive at his chosen destination of caring for the sick, the infirm, the unhealthy. There is more to it than meets the eye of an insurer or a bureaucrat isolated in the trepidations of a large governmental building. Learning medicine comes after you have given a bit of yourself. You as a physician realize, there is more to life than medicine, that people other than doctors are oblivious to the red oxygenated pulsating blood from the aorta, the convulsive moment of life and death, of humanity’s trigger from fear and apprehension, of anger and pain, of betrayal, of humility and finally of real purpose. 

The world that steadfastly conspires to denigrate this noble of profession, should consider otherwise. The trials and tribulations that precede becoming a doctor and then being one for life exacts a toll on them. Give these few dedicated men and women, what they deserve, a little respect.