We sat in the residents’ lounge, our ordered food in front of us. 7:30 p.m. Last call night of my surgery rotation, thank God. I thought the day would never come. We had just scrubbed out of the last OR case, the last of a long procession, one gallbladder, followed by an appendix, followed by another gallblader, then a lung. A breast, here and there. The breast cases were the hardest really. Sometimes, the patient looked just like your mother. At least with the lung cancer patients, you could make yourself feel better by saying, “Well, 50 pack year history, what’d he expect?”
The intern and I put our feet up, eating our Chinese food and watching the last of Felicity on the TV screen. Neither of us wanted to be there that night. We felt alone when the sun faded into dusk, and we thought of lights turning on in houses around the city, families sitting down together, the TV shows and dinners and phone calls carrying out the comfortable routines of the week. The intern’s pager went off. We both stared at it, then stared at each other. “Some old white guy with back pain in the ER. You don’t have to come if you don’t want to.”
The thing is, the description can never really match the patient accurately, no matter how hard you search for the right words. We found the patient in Radiology, the techs attempting to get a CT scan on him. A heavy, not so old looking, white as snow male, was writhing on the scanner, so much so that he was about to fall off. Screaming, not able to find a comfortable position no matter how much he turned this way and that way, no matter if he curled up like a baby, no matter if he lay on his stomach or back. His face and scan told the truth: a ruptured aortic aneurysm. He was bleeding out.
“Stop screwing around! We need to get this patient to the OR!” screamed the surgery senior resident. We rushed the patient to the OR and got him on the table, all sterile technique forgotten. The scrub nurse threw the package containing the foley catheter in my direction. I have never put a foley into an awake, conscious, screaming patient, and I fumbled around with the catheter a bit, hesitating…maybe I’d wait until the anesthesiologist had him under. “You can’t even put the Goddamn foley in!” The Surgery senior yanked back the foreskin and shoved the foley in, ignoring the patient’s recoil. I winced. The intern and I, in the midst of all the commotion and yelling and shoving, exchanged glances. As the twilight of anesthesia began to settle around the patient, he was cut open, from sternum to pubic bone. With frantic efforts, the senior and attending attempted to contain the bleeding, yet their hands and eyes constantly drowned in red, welling, welling, as they fished out clots and threw them aside. “He’s dropping his pressures…” warned the anesthesiologist.
He coded and was brought back three times to a thready pulse before the attending and the senior gave up. I looked around the room. The floor was a sea of blood with gloves, torn packages, and thrown instruments floating about. There was a heavy, palpable air of defeat in the room. A patient had died on the table. The attending and senior tossed their gloves into the garbage, and walked out of the room to talk to the patient’s wife. “Who took this patient to CT?” “Who the hell was following this patient, letting him walk aroudn with a freaking aneurysm that size??” We all still needed somebody to blame. There had to be an explanation why modern medicine had failed this man whose wife was still sitting downstairs in the ER, turning his eyeglasses over and over in her hands.
My intern was practicing his suturing – they had let him close. Neat railroad tracks on the surface. Underneath, organs and omentum hastily shoved back in, fascia more or less shut with a few stitches here and there. I put on some gloves, and together we began the process of cleaning the patient. We wiped off the Betadine, and the blood that had seeped onto his skin. We took the tape off of his month and eyes. We ran a wet towel through his greying, scant hair. His eyes were slightly open, watching us clean him. He was still warm.
Once dead, he seemed alone and forgotten. The staff went about clearing the room and taking care of necessary paperwork. The surgeons were gone. It was me and the intern, with a man who, according to his wife, had just played golf with their son yesterday. How do I clean the arms that had held his wife, wipe the lips that had kissed his children? It was all I had to offer him…after all, I couldn’t even put the foley in.