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Fiction Page 22



Lawrence R. Dagstine

       Time began to blur the faces and fates of the patients, the days and nights welding together.  Every night as I looked around that emergency room I would store patients in my mind, promising myself to get back to them, but new ones kept crowding them out and the old ones vanished.  I had often wondered why the Federation transferred me to a non-profit space infirmary, but then I knew that good young surgeons and doctors in this part of the galaxy were hard to come by.
       My boss and head surgeon of the ER was well-respected among UNICEF, The Red Cross, The Galactic Salvation Army, and other non-profit organizations scattered throughout the nine systems.  He was, like myself, a child of the former earth.  Doctor Reinhold's expertise didn't just come from a knowledgeable twenty years in the profession, but in the way he handled a scalpel.  He was God.  
       Life in the infirmary¾especially the night shifts¾became a pursuit of the fine edge of exhaustion, a search for physical pain, the cleansing purge that would send the sick and incurable back to the hospital and its world of imperfect minds and bodies.  I was a newcomer there, and new to all this.  Doctor Reinhold liked to call me "Toby", short for Tobias, because as a child he had collected small wooden tobies; mugs in the form of stout old men wearing three-cornered hats.  
       The entire month was disastrous (my first month). "We go through long periods when nothing happens," said one of the nurses. "Weeks when nobody dies, nobody even bleeds around a graft; then we get a week like this and I'd like to leave the infirmary." The nurse's name was Chaney, and she had put in a good fifteen years herself.  She then patted me on the shoulder. "Get used to it."
       "Anything ever scare you about this place?" I asked her softly. "Or at least the profession?"
       She looked at me and smiled.  If another woman had been in her shoes she would have seen a very young and terribly shy man¾just out of medical practice and who looked straight ahead and talked in short direct sentences; sometimes which came out abruptly and clipped.  There was no other way to describe me.  You could not meet my sentences: they were just bare simple medical statements often presented with such honest directness.
       Nurse Chaney thought about what I said for a second. "The only thing that frightens me is the memory of my twin brothers who died of heart defects a few weeks after they were born.  And my grandfather had twin sons, uncles I never knew, who had died of what they called malnutrition way back then."
       "I'm sorry for your loss," I had said to her.  I saw how she winced at the re- collection.  I would probably have cringed at the thought of such a thing myself.
       Suddenly I heard a deep throaty voice shouting out my name from an office down the hall from the ER.  It was Reinhold.  He wanted to see me right away.
       "It's all right," Nurse Chaney said. "I'll keep you posted.  The only criticals we have are those three astronauts, and right now their conditions have stabilized."
As soon as I reached the head surgeon's office the first thing I heard out of his mouth was, "I fear that I may be one of them."
       "One what, sir?" I asked him, confused by this remark.
       "A martyr, Toby.  A friggin' martyr." He removed his glasses and put them down on his desk.  Then he used his hand to wipe the sweat from his forehead.  It was obvious he was under some kind of stress. "Many doctors like myself who retire too late end up becoming space martyrs." I just rolled my eyes at him. "A lot of times it has to do with financial burden."
       "Financial burden, sir?"
       "For more than a year now I've been all pent up," Reinhold said, sitting most decoratively in his leather chair. "I haven't made a real contribution in over twelve months, except banging out these summaries day after day.  And the heap still grows.  You'd think the Federation would help, but after your transfer they forgot about us." He stood up and walked to the far end of the room.  He pressed a button on the wall.  Walls of glass slid open to reveal a small liquor cabinet, for instant access to various kinds of whiskey.  Something you don't find everyday in a doctor's office, whether it's in space or not. "We're broke, Toby.  Bankrupt."
       "How can that be, sir?" I asked him. "We're non-profit.  We rely on donations and Federation bonus funds."
       "Yes, but the people around our way have stopped donating and the Federa-tion bonuses have gotten smaller.  If we don't get some kind of advance or financial assistance soon, the infirmary may be shut down.  That means a lot of space travelers won't get their flu shots this year, if you know what I mean."
       I had to disagree. "But you knock a lot of fees off.  I saw you contact the people from the insurance company and throw twelve unpaid bills in the wastebasket at one sitting."
       "For God's sake I'm a doctor not an accountant, Toby! I operate on people and prescribe medicine.  I don't do taxes.  What's twelve unpaid bills when you have over two hundred and fifty? And speaking of medicine, even our IV supply is low.  The patients are also starting to complain about the food.  For six months now our financial situation has caused us to serve the same vegetable with every meal."
       He reminded me a second there of something my father used to say.  It had to do with having the same vegetable for dinner every night…'You have to have an acquired taste for brussels sprouts'.  Of course the only reason I ate it on such a regular basis was to make my old man happy.  
       "Well, think of it this way," Reinhold said, sitting back down with a small glass of bourbon in his hand. "At least you're a bright young surgeon with a future ahead of you.  You can put this place down on your resume when you leave here.  You can get back to work now if you want.  Nurse Chaney probably needs you."
       I realized during my first month at the infirmary that there was more drama to be found there than at most hospitals on earth, because at any given moment there could be twenty-four patients crowded in one department, only three or four feet apart from each other.  Each patient is in intense pain, demanding sympathy and attention, but due to lack of funds there are only three doctors and three RNs working each shift.  So even though I am here to create miracles, there is a lot of running around.  As for someone like Chaney, it takes a special breed of nurse to cope with the extraordinary physical and emotional demands of recovery.  With patients struggling to climb out of their beds or yank vital tubes and wires from their bodies, the atmosphere is at times that of a battlefield hospital; and right away Nurse Chaney's position becomes like Florence Nightingales'.  The care dispensed is professional and caring, but rationed out by a small, overworked staff.
       Shortly before midnight a space miner was admitted with a severe case of anchylosa appendicitis, which is often contributed to inhaling raw space minerals.  Inhalation of these minerals will cause the vermiform appendix to suddenly burst, thus giving the patient sharp cutting stomach pains and sometimes even sending him or her into shock.  An appendectomy was to be performed right away, and I was called into surgery to carry it out.  I had been working overtime for countless days now, so I was overtired.  I drank a cup of black coffee and, with no tension showing, went to the wash basin to prepare myself.  As I cleaned my hands and arms and nails, I looked through the glass wall and saw the miner lying on the table, with the anesthesiologist putting him under. "This is who I am," I remembered saying to myself, putting on a pair of latex gloves and a surgical mask.
       A second later I went inside and did what I was supposed to.
       For the first few minutes of the procedure the patient had lost a lot of vital bodily fluid, so there was a slight chance we could still possibly lose him.  I wasn't nervous.  I stayed calm, just as Doctor Reinhold would do in one of these situations.  Just like the future of this infirmary, life was caught in the balance…he was holding on by a thread.
       The procedure went well of course, and the man would be on his way to a speedy recovery within no time, but there had been a depression buried within me and it was roused with another appendicitis case, one from three years ago where the outcome wasn't as successful.  It was my first, and only to this date, loss.  A lot of people don't understand how it feels when a family member loses a loved one, but it's just as bad when a doctor loses his patient.  The feeling is equally the same, a feeling of utter failure on their part.
       At a quarter to two a young woman's heart, maybe mid-thirties, was still beating, but barely.  The infirmary received a call that she was only five minutes away and that a sporadic ventilator was doing the breathing for her, drugs keeping her pressure at a satisfactory level.  The triage had said that turbulence through the asteroid belt was so bad that the stretcher had to be placed on top of the oxygen filter, the respirator leaned against two other tanks, and the intravenous bottles hung like clothes on a washline.  The gravity in a pressurized craft interfered with the intravenous drip and the triage had to hold the bottles in his hand and force fluids into her arm.  When the space ambulance approached the infirmary's docking bay, Nurse Chaney was horrified to learn that the woman was her cousin.
       I felt sorry for Chaney.  Here was a woman, known to be at odds with sickness and fatality (she had lost her twin brothers, remember?), who spent most of her life helping others to survive, and now she was going to lose yet another fond relative.  I had to do something.  I ran to Doctor Reinhold's office since he was an experienced heart surgeon¾twenty years practice.  But the poor old doctor was slumped over his desk with a bottle of whiskey in his hand.  Unprofessional, and the kind of thing which would have your license taken away in a jiffy.  The stress of the infirmary's finances must have driven him to the point of shallow drunkenness.  I soon realized that I was the only available doctor in the ER, and that it was up to me to save this woman's life.
       The sporadic ventilator breathing for the woman was coming apart and the triage held it together with his hands.  Oxygen tanks were banging about, bottles broke and sloshed liquids as she was wheeled up the ramp.  The woman's thoracic cavity was filling with fluid; her heart was skipping beats.  Chaney helped pull the gurney.  She grabbed my arm on the way, begging and crying, "Please, Tobias, you must help her.  You must save her life!"
       "I'll do my best," I said.  I couldn't promise her. "I imagine Reinhold must have broken six laws.  But we'll worry about that later." Chaney went directly to the chapel, where she prayed almost continuously for an hour.  I went and prepared for heart surgery.
       "When she came around¾briefly," said the triage, exchanging an IV drip with the one he had not yet finished, "we told her about her condition.  She referred to her `sick heart' with a cute look on her face.  But I could see her anguish, doc."
       "We'll do something about that," I said. "Right away.  But I need you stay with me right now.  Put aside all your other calls till I'm finished with this patient."
       The triage threw his partner the keys to the space ambulance and nodded.
       Three hours after she had been admitted into the operating room, Chaney's cousin was ready for recovery.  I had saved her, and seeing that it was my first open heart surgery, I was even more proud of myself than before with the emergency appendectomy.  I had reconstructed her heart, her existence for a time dependent upon the most advanced technology.  The triage supervised her transfer from the table to the rolling stretcher, and it was important to stay with her a while longer.  A tube was down her throat, its connection taped across her mouth for the ventilator that would breathe for her until the lungs rallied¾if they could.  During the transfer, I would take turns with the triage squeezing the black oxygen bag to feed her oxygen.
       Doctor Reinhold had stumbled out between surgeries and hovered as the triage hooked her up to the various monitoring machines.  I just happened to be in recovery at the time checking on my appendectomy patient and moved down to the woman's bed. "She'll be all right if a cardiologist takes proper care of her," said Reinhold. "Let me through."
       I blocked his way. "Not this time, Reinhold.  I know times are rough for the infirmary, but you have committed a massive assault on this medical institution and the patients within it.  And don't bother passing the buck to me either."
       Reinhold pushed me aside and said, not wholly in jest, "Your shift is over.  Go back to the space station, Toby."
       I just muttered, "My shift may be over, but your career is over." But in reality a good doctor is on call twenty-four hours a day (or depending on how many hours there are in your spacial location).  Hospitals are in need of great surgeons all the time.
       After a six-hour sleep at the station I flew back quickly to the infirmary, where I wanted to follow the woman's progress through the most critical day of her life.  Chaney was a wreck.  She was back on duty and had not slept a wink.  Shortly after 11:00AM, I was having coffee in the lounge when Chaney hurried in with her cousin's chart.  The woman's potassium level had plunged.  And so, without a second thought, she was given some right away.
       In the hours after heart surgery, five dangers are often watched for: heart block, lung malfunction, arrhythmia, bleeding around the heart, and then there's bleeding around the graft.  An abnormal rhythm can send the heart into fibrillation and death, and a fatal drop in blood pressure and fluid trapped inside the pericardium often accompanies bleeding around the heart.  It can only be corrected by emergency surgery.
       When there was a period of almost an hour without a page or summons from Reinhold, Chaney and myself relaxed with a couple of other nurses on duty.  We just happened to be talking about Reinhold¾his skills as a doctor, his failures as one¾a continuing topic of conversation among the staff.  
       "I can't thank you enough," said Chaney, stopping in the middle of the floor to give me a hug. "You saved her life.  I watched her grow up you know.  I don't know what I would have done if something ever happened to her."
       "Be thankful the transfer and surgery were successful, but I want you to know that the next 72 hours are going to be critical." I didn't want to get her hopes up.  In the medical profession a patient's health can change when you least suspect it.  Take my appendectomy patient for example: I thought all was well with him until his stitches opened up the following day.  He had to be sewn back up right away.    
       "I know," she said, a tear running down her cheek. "I know.  Heart problems seem to run in the family." She began to chuckle, but it wasn't the happy kind. "I sometimes wish every illness in the galaxy were curable."
       I looked at her and said, "I do too, but even with the technology available to us in this day and age, it is still impossible to beat death.  It comes to all of us at one time or another.  God meant it that way." And I couldn't believe I had once looked up to Reinhold as God.  I was partially ashamed of myself.
       "I'm about to head to the nurse's station," said Chaney, "and I was wondering what will happen to Reinhold?"
       "The Federation will probably take away his license," I said. "He'll probably stand before a board, but because of his twenty years in the practice, he'll be reinstated in five, or at least eligible.  But I think he'll take this opportunity to mark his retirement.  The man is washed up." I looked around the emergency room and grinned. "So this is what it's like to be a full-time resident at a hospital in space.  The work that you put in, the undaunted effort.  I'm glad I chose this as my place in life.  I picked the right career¾helping people.  I'm sure going to miss this infirmary when they shut it down."
       "As will I," said Chaney. "As will I."
       Well, anyway, seventy-two hours after surgery, Chaney's cousin was sitting up, sipping on a ginger ale, brushing her hair, and tearing into a pile of get-well cards.  The bluish cast to her skin was gone, the sadness had slipped from her eyes, and though she was still pale, she was able to breathe on her own and there was a general aliveness about her that had not been there when she was first wheeled in.  I listened to her heart and she accepted my stethoscope without protest.  "You must be sick, my dear, you're so quiet," I said, nodding encouragingly at Chaney on the opposite side.  
       "And what is your prognosis for today, Doctor Tobias?" asked Chaney.  She just happened to be smiling at the same time she asked me that.  So I smiled back.
       "It'll be a few months before those hissing noises go away," I said, "but I do believe she's going to be fine."