Authors: Mark A. Jacobson
T
HE PULMONARY FELLOW AND
medical assistant transferred Larry to a recliner chair and proceeded to ignore him as they sorted through boxes of bottles and syringes. Herb, now gowned and masked too, entered the bronchoscopy suite. Larry grabbed the armrests and pushed himself back into the chair. His lips were trembling.
Like a caged rabbit, Herb thought. A tide of empathy rose. He fought it off and diverted his gaze. Maintaining cool objectivity was essential, he believed, for performing this procedure with minimal risk to the patient's safety as well as to his own mental health.
“There's nothing to be scared about, Mr. Winton.”
Herb balked. He couldn't pretend the consequences of his being late were potentially disastrous. He had to be completely present, whatever the cost to his equilibrium.
He placed his hands on Larry's shoulders and looked into his eyes.
“You'll get through this just fine,” he vowed. “I promise.”
Saying those words stirred up memories he couldn't suppress.
In seventh grade, during a field trip to Manhattan, Herb's class traipsed across Madison Square Park to see the statues of famous Americans. Herb lingered too long in front of the Civil War admiral who had famously yelled, “Damn the torpedoes, full speed ahead.” On realizing his classmates were gone, he jogged in widening circles around the park until finally giving up. He trudged in search of a subway station and soon faced a massive stretch of identical, fifteen-story red-brick apartment buildings. Just beyond was the East River. He turned around and saw six rough-looking teenagers blocking his path.
“Whatchya doin' here, chink?” shouted the gang's apparent leader. “This ain't Chinatown.”
“I'm lost,” Herb confessed. “How do I get to the Long Island Rail Road?”
“What! Peter Cooper Village ain't good enough for you, chink? You wanta go to the suburbs?”
Herb retreated. He didn't notice one of the boys creep behind him and crouch down. Falling backwards, Herb's head slammed on the sidewalk. The leader lifted him by the collar and slugged him, splitting his lower lip.
“Get outta here you little shit,” he yelled as they ran away.
Too stunned to sit up, Herb lay patting his scalp and lip gashes in a feeble attempt to stanch the bleeding. Eventually, there were sirens. Herb was taken by ambulance to a hospital, propped up in a wheelchair, and rolled to an exam room where a pale, freckled, middle-aged man clad in green scrubs knelt down and looked into Herb's eyes.
“I'm going make you numb, lad,” he said in an Irish accent, “Clean your cuts and sew them shut. Are you brave enough to lie still for that?”
Herb submitted willingly. No white adult had ever made such direct eye contact with him, not even a schoolteacher. That alone sufficed to convince him the man must be well-intentioned.
“You'll get through it just fine,” the doctor promised.
Herb's faith wavered when an anesthetic injected into the wounds burned hard enough to make him shed tears, but the warm, rinsing liquids that followed restored his trust, as did the doctor's chipper apology, “Sorry, lad,” each time Herb felt a dull yank from sutures piercing and pulling his skin together. He had been given a pain pill that kicked in as the last thread was tied. The throbbing ceased, and true numbness cameâa neutral buzz, constant, predictable, bearable.
Herb was asleep when his mother arrived. She bundled him into a taxi and brought him home. He spent the rest of the night buffeting between dreadful dreams and conscious pain. At some point during this fugue state, his father appeared, demanding information. Herb's mouth was too swollen to make intelligible words.
His father returned at six in the morning. He made Herb get dressed and eat cereal. Though moving his lips was excruciating, Herb didn't complain. He didn't have to be told this was his own fault for not paying attention. His father drove them to a police station in lower Manhattan. They went from
office to office through mustard-colored hallways reeking of stale tobacco smoke. Fluttering fluorescent lights made Herb dizzy. He found a bathroom and vomited.
His father insisted a criminal report be filed. Flash bulbs lacerated Herb's headache as photographs were taken for evidence. The presiding officer was good-natured. Too good-natured. As his father filled out forms, the man grinned. Other policemen were smirking or outright laughing. Herb was incredulous his father couldn't see he was the butt of their joke. Then he realized his father actually had noticed and was refusing to acknowledge the fact. Herb began to despise him.
Regaining self-control, Herb said, “You need to be relaxed for this. I'm going to give you a medication that'll help. I'll be surprised if you remember the experience afterwards. Ready?”
Larry nodded meekly. He watched Herb attach a syringe to his intravenous tubing and the fellow adjust dials on an ominous black box connected to a two foot length of cable.
“You'll be getting sleepy soon.”
Alarmed by a burning sensation in his arm, Larry tensed. Pleasure suddenly bloomed in the back of his head. The fatigue, fear, and relentless labor of breathing dissipated.
Herb was speaking rapidly. Larry was unable to comprehend. Was it a foreign language? Latin? As the ceiling lights dimmed, Herb's face was bathed by the glow emanating from the bronchoscope dials.
Now everything made sense to Larry. He remembered a priest, a regular on Haight Street, who wore a black Nehru jacket over his clerical collar. The man chatted with street people about hustling and drugs, but he didn't proselytize. Instead, he helped them find housing, food, or a place to detox. He had never approached Larry until seeing him short of breath. When asked if he needed assistance, Larry declined. The priest gave him a card with the address of a local parish church. Once a half-block walk became the limit of his endurance, Larry reconsidered his options. He hoped Catholics had a different perspective on sin than Baptists.
The Sunday before he was admitted to City Hospital, Larry took a bus from Haight Street to Saint Ignatius. The street priest was at the pulpit, wrapped in a white robe, giving a sermon about purgatory. The term was vaguely familiar to Larry. He supposed it had something to do with suffering for your sins. The priest explained that individuals whose lives never strayed from virtue went straight to heaven while those who had never hesitated in being selfish went straight to hell. Purgatory was a waiting room for people who had made any effort to atone for their misdeeds.
“Mr. Winton,” said Herb. “You're going to feel a tube go down your throat. Take in a long, slow breath.”
Larry did his best to cooperate. He understood what was happening. This doctor was Saint Peter. He had come to see Larry and decide whether to send him to heaven or hell. Fair enough, thought Larry, and he relaxed.
A
FTER DROPPING OFF
A
LLISON
at school, Herb returned to his office. He found a note from Kevin taped to the door, asking him to attend noon conference. The case to be discussed would be Larry Winton. Herb knew Kevin's team had just admitted fourteen patients to the wards in addition to Winton in the ICU, which meant Kevin would have already been awake for twenty-eight consecutive hours when the conference began. He wondered why Flagler, the elderly head of infectious diseases, said the residents were getting soft.
Herb sat at his desk dictating reports and letters for the rest of the morning. His office, part of an interior suite, had white walls and floors. Hospital wards fanned out in all directions, allowing Herb to see patients, teach, and conduct research with maximal efficiency. He didn't mind working in a windowless hive. There was more than enough drama here to distract him. Seven years into this job, Herb was absolutely certain it would never become boring.
In the conference room, a chief resident sat on either side of Flagler who motioned Herb to join them at the “pontificators' table.” Kevin stood at a blackboard that spanned the entire east wall. Chalk in hand, he made notes while his medical student summarized the case. Kevin wrote acronyms, distilling the salient features of Larry Winton's history, physical exam findings, and laboratory results into an even briefer synopsis. He asked Herb to comment on the chest x-ray. Herb pointed out the obvious. Both lung fields were solid white throughout.
Kevin continued to make notes as the discussion proceeded. Larry Winton's
clinical
diagnosis was severe pneumonia. The
differential
diagnosis Kevin scribbled on the board, a list of all plausible causes of his pneumonia in the order of their probability, numbered twenty by the end of the hour
when people began leaving. Yet the process was hardly finished. It had been easy enough to achieve consensus in eliminating common causes. It was the obscure autoimmune, allergic, and infectious diseases that generated controversy. Kevin gained energy with each comment he wrote for or against a rare illness. He drew arrows connecting candidate diagnoses to tests which could confirm or exclude the condition and medications that could treat it. Since some tests could help nail down or rule out more than one diagnosis and some drugs could treat more than one disease, his arrows branched and crossed forming a web.
Herb left after two hours and worked in his office until four-thirty. On his way out of the hospital, he walked by the conference room. Kevin was still there, holding a stub of chalk, erasing and re-writing in the few empty interstices remaining on the blackboard. Herb was about to insist Kevin go home and sleep when his pager sounded. A moment later so did Kevin's. Both displayed the ICU phone number, followed by 9-1-1. They looked at each other, said “Winton” simultaneously, and ran to the unit.
L
ARRY AWOKE FROM A
nightmare. He had been kidnapped by his high school football team, hog-tied, and taken to the Trinity River. The boys were screaming “Die, homo, die!” as the quarterback dunked his head. Larry fought fiercely, thrashing to get his mouth above water for the half-second it took to get another small breath.
He opened his eyes to see he was in the glass cubicle, not Texas. But his frantic struggle to get more oxygen hadn't ended. He grasped the bed rails and rocked backward to maximize inhalation then forward to expel every bit of air. Kevin was sitting next to him, extracting blood from the arterial catheter in his wrist. Dark purple liquid pulsed into the syringe, a familiar sight to Larry from his days of shooting speed, though something about it was wrong. Whenever a shooter's point hit a vein, blood of this same purple hue would seep slowly into the syringe. It wouldn't pulse like this. And if he hit an artery by mistake, the backflow would pulse like this, but the color was always bright red.
Kevin looked dejectedly at the syringe. He signaled to the pulmonary fellow waiting at the nurse's station. She carried a toolbox into Larry's room and removed trays filled with hollow plastic tubes and chrome instruments. Larry was terrified again. Were they going to cut a hole in his neck?
Kevin was talking about a machine that pumped oxygen into the lungs. Larry couldn't concentrate on what he was saying. Kevin moved on to another issue.
“Mr. Winton, is there a family member I can contact?”
“Don'tâ¦bother,” he answered between breaths.
A technician wheeled in a mechanical ventilator.
“As soon as the tube is in place,” said Kevin, no longer able to hide his anxiety, “we'll turn the machine on. Then your lungs will get enough oxygen. OK?”
Larry was listening now.
“You'll have an uncontrollable urge to cough the tube out. We have to put you to sleep so the machine can do the work of breathing for you. It can't help you if you're fighting it. You understand?”
“Doc...will I â¦wake up? Or is thisâ¦just...easy way out?”
“No! Not at all! We're buying time. We still don't have all the bronchoscopy results. Once we know what's causing your pneumonia, we can start treating it with the right drug.”
“OKâ¦I'll beâ¦good soldier.”
As the fellow sprayed numbing medicine into Larry's throat, Herb entered.
Praise God, Larry thought, Saint Peter's back in charge.
Now the fellow was holding a short length of clear plastic piping, half an inch in diameter and covered with lubricating jelly, in front of Larry's face. She instructed him to swallow as she thrust the tube into his left nostril. He retched. She forced the tube farther until it jammed into the back of his throat. He retched again.
Larry saw Herb wince.
“One more swallow,” she coaxed.
He tried to comply.
“Now inhale.”
Larry obeyed and felt the tube slide down his throat. He coughed violently.
“We're in!” she yelled triumphantly.
“Inflate the cuff,” Herb calmly decreed.
Kevin attached an empty syringe to a side port on the tube. He pushed the plunger down, expanding a balloon-like sheath at the tube's other end, which sealed off Larry's windpipe. Kevin secured the tube to his nose and cheeks with strips of fabric tape. Herb pressed the ventilator power switch on.
A rush of air inflated Larry's lungs. His terror was submerged in a wave of self-disgust. His body, once an object of desire, had been diminished to flesh of medical interest only. It repelled him. He wanted to be rid of it.
Kevin stroked his hand. Larry remembered being touched this way long before he had ever been penetrated or sucked for someone else's gratification. A protective touch.
His mother had done that when he was a little boy and had measles. In a darkened bedroom on a steamy summer afternoon, Larry had been fitful. He couldn't sleep, couldn't find a comfortable position to rest. Sensing his frustration, his mother gently swept away the wet strands of hair stuck to his forehead.
As the intravenous anesthetic arrived in his brain, Larry began to cry. His craving to be sheltered vanished.