by Aram Kim
Buzz, buzz, buzz, buzz, buzz, buzz…
I have been stuck in this windowless excuse for a library entering research data for a whole Friday afternoon and evening. I look to the bottom right corner of the computer screen to see that it is 2:13 AM – a lot later than I imagined. Look at all these piles of patient files I have gone through!
Buzz, buzz, buzz, buzz, buzz, buzz…
I stretch my hands to reach for the pager, but it slides away from me with each vibration. I stand up, stretch my back, and snatch the pager as a cat would a black mouse. It’s probably not Doctor King or Poe at this time. Most likely a trauma code.
“ATL1 TB1 ETA 15m1”
I am so damn right. It’s all about pimping the page demographics. Wait… what else could it be besides a trauma code at 2am? I’m not thinking straight. I am hungry. I decide to call the computer quits, pack up, and walk out of my building towards the ER.
Drip, drop, drip….
It’s raining. The air is humid as it always is on a North Carolina summer night, but it’s surprisingly nice outside. The humid warm air feels soft and warm on my skin after being in the air conditioned building for so long.
Splat, splat, splat, splat…
My slick, black Danskos on slick, black rain on slick, black asphalt. This code has to be a MVA (Motor Vehicle Accident). I am 90% sure. I actually don’t know what that means because when that person comes through the door, he is not going to show up with 90% MVA and 10% some-other-trauma-diagnosis-on-rainy-night. He’s going to be either MVA or not. Percentages are impersonal like that. Same thing with cancer patients. They are either going to have complete remission or they are not.
Buzz, buzz, buzz, buzz, buzz, buzz…
“ATL1 TB1 ETA 10m”
The trauma codes are usually paged twice. Most of the time, the message is exactly the same except for the ETA (Estimated Time of Arrival). The trauma personnel told me the second page is to keep the trauma team updated as the patient is en route. However, I have my own explanation. Occam be damned. I secretly believe that the second page is an apologetic whisper for that poor trauma surgery resident who suffers from chronic sleep deprivation – alluring him to leave the stupor of on-call room and greet the next customer at the ER door with a tired smile. I never say stupid stuff like this except in my head because I know my mentors would put me into a Zen coma of tying knots. I forget which resident is on call tonight. Poor guy. Wonder how much sleep he got last night.
The electrical door opens as I approach the ER. I nod my head at the nice security guy whose name I forget. Hence the nod instead of “How are ya, Ted or Bob?” I feel bad. I glance at his name tag. His name is John. John, John, John, John, John.
I pop the little blue handicapped figure on the little round plate next to the door that says, “Press Here.” Another set of doors open for me. I imagine I am a little mouse in a labyrinth of a hospital. All day long, I have been pressing buttons for my morsels of cheese. Right now, my cheese is the trauma code. This code is my reward for working so hard tonight. I feel bad for the person who is coming in. He’s probably in really bad shape. I have to learn from this though. It’s difficult to look at hurt people, but it’s the right thing to do. Face the pain and fear. Learn to do something about it.
The ER is quiet. Few regulars in different rooms, and no one seems particularly rushed. The nurses are chatting up the trauma code.
MVA it is.
For the next few minutes, the sleepy looking people straggle in. Rhyne is the lucky trauma resident. Five feet six inches of caffeine junky. I smile. She smiles. Her eyes betrays her desire to look sharp and awake; I can clearly see sleep deprivation-induced ptosis. Conjunctival mucosa is definitely dry with mild injection. I wonder how many surgery residents use stimulants at our hospital. Oops, not supposed to think about stuff like that. Think happy thoughts. Think happy thoughts. Think happy thoughts. William Osler. Harvey Cushing. What was Cushing syndrome again? Moon face, buffalo hump. Excess steroids? Let’s see Addison’s is no steroids, so… Oh, Rhyne is getting ready. I should, too.
I dress myself in a yellow gown and put gloves on, too. We lean against the wall in ER hallway next to the trauma bay with our arms folded in. The attending walks in – Dr. Pruell. He looks like crap, too, except he looks good looking crappy. That’s the difference twenty years makes. De facto tiredness that doesn’t faze him. Just too cool. I greet him.
“Good evening, Doctor Pruell. It’s MVA.”
He nods. He puts his gear on and leans against the wall next to us. Dr. Pruell is probably thinking about his children. Rhyne is thinking about… I don’t know. What do mid-thirties surgical residents think at 2:23am in the morning? Oh, she might be wondering how long this case is going to take. She’s probably hearing the tempting call of on-call room bed. Poor Rhyne.
We wait. The trauma bay is clean and ready for our patient. Three generations of medicine people crazy about spending countless nights with hurt strangers. I know what drives me, but what drives Rhyne and Dr. Pruell? Money? Value? Obsession? Faith?
Bang, clang, shwoooo-clang, phoomp…
The ambulance crew flies through the door with the patient on a gurney. Had it not been for the straps, the patient surely would have fallen off the gurney; the crew was in a hurry to get to the bay. The patient’s eyes are open and wanders over to me and other people in the hallway. He has a neck collar on. His arms are moving.
OUCH! I feel a chilling sensation through my spine even before I recognize what I see. Bone. Bonessssss. More than one. I see several phalanges and metacarpals on his right hand. The hair on my neck stands up erect, but I maintain a serious poker face. Someone calls for orthopedics resident on call. I wonder how much sleep that resident got last night.
“Patient is a 38 year-old African-American male who was traveling on a motorcycle… GCS of 15...”
One of the EMT’s blurts out the relevant facts in rapid succession. The busted hand and motorcycle story fits. He wasn’t wearing gloves, eh? Rhyne, Doctor Pruell, and the rest of ER staff rush into the trauma bay after the patient and EMT’s. It’s an orchestrated chaos. Doctor Pruell is conducting, and the team moves in a fluid manner. There is little waste in motion or time. Beautiful as can be.
People are shouting out medical findings at the speed of light. Another trauma resident, Jack jumps into the bay. This patient is a human funbag. They poke him every which way possible. They shine light in his eyes, cut his clothes off, get IV started, and insert a folley catheter. Jack shouts to the patient that he will insert his finger into the patient’s rectum to check for blood. The patient does not hear Jack first because he is in a lot of pain and second because Rhyne just asked him to open his mouth and say “Ahhhh.” In front of my eyes, Jack performs the fastest digital rectal exam I have ever seen. The patient cringes. I cringe.
“Patient’s assigned name is Zebra.”
The record nurse yells out the trauma patient’s pre-assigned name. These names are predetermined names in alphabetical succession so we know what to call the patient even before the trauma patients’ identities are known. Mr. Zebra is the last patient on this set of names. I wonder what the next trauma patient’s name would be. Abracadabra? Angel? Doctor Pruell is staring at me. I think he just asked me why one of the legs was shorter. I respond with a slight delay.
“Doctor Pruell, I think… I think he, uh, I think the leg is broken. I’ll get the femur traction kit right away.”
I sound like an idiot. Why didn’t I say he has a broken femur? Femur, femur, femur, femur. I unravel a cardboard box that contains a simple yellow sheet of plastic that folds into an open box which allows a strap to pull on the broken leg. We apply the traction kit to his leg. Even with the utmost care, it still hurt him like hell. We pull. He cries. God knows I hate people in pain. Wait. That’s not what I meant. I hate to see people in pain.
The X-ray technician comes in. I step behind the closest person wearing a lead vest to save my thyroid and testes. Everybody stops moving around as if their own bones are to be X-rayed. After the films are taken, Mr. Zebra is again molested by prodding fingers and by interrogative questions.
Beep….. Beep….. Beep….
The monitor is online. It shows Mr. Zebra’s blood pressure, oxygen pulse, heart rate, and few other numbers I don’t understand. ABC’s (airway, breathing, and circulation) looks good. From what I can understand, Mr. Zebra seems very stable.
The X-ray is on the LCD screen. I step closer to hear Dr. Pruell, Rhyne and Jack talk about the fractures. I see little white clouds floating on a black sky. The little white clouds are broken femur pieces belonging to Mr. Zebra. That sucks. Comminuted fracture. He’s going to need screws to set them in place. He is going to need surgery for his leg as well as his hand.
I wonder if he has kids. Just as I look to for a wedding band, the resident grabs the ring-cutter and works the wedding band over the bare bones. Mangled. Like its owner. I wonder if this is going to really change Mr. Zebra’s life. The orthopedic resident comes in. Tall, white guy. I haven’t seen him before. Brian’s name tag tells me his name is Brian. Brian the Bone Doctor.
Brian preps the cast material. I stand watch. The trauma team decides the patient is stable. One by one the room empties. The trauma surgery team back to sleep. The ER staff back to homeless patients and a pair of anxious parents of a febrile, crying baby. I hope the baby has something benign.
The ortho resident picks Mr. Zebra’s hand up to his face and stares as he would a fine piece of tangible art.
“Mr. Zebra, we’re going to need to do surgery on your hand. OK?”
I look closely at Brian. Judging from the little hedgehog on his chin, I know he didn’t have time to groom himself. Less groom, more sleep. Still, his eyes are sharp, and I am sure he’s really good at what he does. He moves over to the leg and glances at the X-ray on the LCD screen. Brian immediately knows that it’s going to be a long night. He’s not happy about it. He’s looking at Mr. Zebra. I sense a bit of edge in his eyes and in his voice.
“What were you doing this late at night in the rain driving on a motorcycle?”
“Were you drinking?”
“What were you doing?”
“I lowsided. Too wet.”
“No shit, man.”
Mr. Zebra is tired now. He wants to rest. He really wishes he wasn’t here now. He wishes he was home. I wonder if he has insurance. Brian starts wrapping Mr. Zebra’s leg.
“So… what kind of motorcycle do you ride?”
“What kind of motorcycle do you ride?”
“It don’t matter.”
The nurse in charge of paperwork is called out of the bay. I look up. It’s a battlefield for sure. Cabinets are left open. There’s stuff lying around everywhere on the counters. I look down. Blood and plastic wraps litter the floor. The dirty clothes bin is overflowing with yellow gowns with blood stains.
Brian, Mr. Zebra, and me. Hey, great! White, Black, Yellow. What is that? The German flag. I think.
“Was it a crouch-rocket? It bet it was nice.”
“Why you wanna know?”
Yeah, why do you want to know? Why are you fixating on this, bud? Do you ride a motorcycle yourself? Wait, no sane orthopedic resident rides motorcycles. Why is he grilling this guy about the motorcycle? That’s the least of Mr. Zebra’s concerns right now. His bones are sticking out for crying out loud!
“Is your motorcycle OK?”
“Why you wanna know, man? It don’t concern you, man.”
Wait, Brian doesn’t care about the motorcycle. He’s just pissed at Mr. Zebra.
“Well, I wouldn’t want you to have a broken motorcycle. That would be just awful. I wouldn’t want you to lose money on it and stuff.”
Oh, now that was just too obvious. Come on, Brian! You know damn sure that this accident put him back at least 50 grand IF he has insurance. We may bankrupt him for this admission. That’s bullshit about you caring about his motorcycle and money. I know it. You know it.
You are only pissed because you don’t want to stay up and put Mr. Zebra bones and tissues back together. Brian wants so badly to call Mr. Zebra an idiot for riding in the rain at 1AM. Brian probably believes that Mr. Zebra deserves a Darwin award for the state that he’s in. The worst part is that it’s not that he doesn’t want to say it; he cannot say it. There is no use in scolding the patient at this point. Sort of like how you don’t tell a end-stage lung cancer patient “if only you hadn’t smoked so much.” The milk is spilt. There is no need to yell at the spilter now.
My hands are sweaty. My body feels weird. This is really uncomfortable. I see their mouths moving, but I don’t understand. I try.
“……………………..Just leave me alone, man.”
Brian, leave him alone. Just do your job. I’m sorry you’re tired. He’s tired, too. We don’t need to make him suffer any more than he already does. He’s paid dearly for his decision. I feel compelled to say or do something.
Aram, just shut up and pretend like you are cool with everything.
I hear Pete, my mentor in my head; he’s right. I speak too much of my mind at times. My throat feels tight. I am a mannequin. Brian knows he screwed up. Mr. Zebra is more unhappy about Brian than about the accident and his broken bones and possibly his broken life. I know saying something to Brian wouldn’t help because I’ll force him to defend himself more. I also don’t care for any excuse he maybe have for himself.
Mr. Zebra, did you expect this to happen at the hospital? Do you think that Brian is treating you this way because you are black? Would you have preferred a black resident? Is this disparity? Is this racism? Mr. Zebra, it’s funny. I’ve lived in the U.S. for more than a decade now as a foreigner and as a minority, but I do not remember being treated as you have been here by Brian. I am sorry that you are in so much pain, and I am sorry that things are the way they are.
“Hey, you’re going to need surgery for your leg, too.”
“Did you hear me? I said you’re going to need surgery for your leg, too.”
“Why do I need surgery on the leg? The cast is good enough.”
“Your bones are broken in such a way that you need screws. Otherwise, your leg will not heal right.”
“My cousin had a cast for his leg. He didn’t need surgery.”
“I don’t know what your cousin had, but your legs are broken in multiple pieces… we need to put screws in…”
“I don’t need it.”
Brian, I think what Mr. Zebra means is he doesn’t want surgery from you. At best, he thinks you are a punk and at worst, a racist. If I were Mr. Zebra, I would probably choose to walk crooked than have you fix me. On the worst hour of my life, you judged me and gave me a hard time for a decision I already regret more than anything else in my life. I probably would’ve punched you in the face if my hands weren’t so mangled. Or I would’ve punched your face with my other hand if it wasn’t for the morphine-induced haze. I wouldn’t care if I have to go to court for it.
But I’m not Mr. Zebra. I’m a medical student. Just here to learn. Shut up and watch, Aram. You have to watch. Learn from Brian. Learn from Mr. Zebra. I am sure Brian is a great guy. I would not have thought Brian to be the way he is now if he and I were out drinking at a bar together, but he certainly did his best to make me second guess him. More importantly, he lost his chance to become Mr. Zebra’s confidant, and Mr. Zebra is alone in this hospital.
Brian knows it himself, too. He has become quiet in the last minute. He’s thinking. Maybe he’s thinking about his medical student days when he slept 8 hours a day and thought about ideals as I do now. Are you hating yourself for being mean? Were you just tired and cranky?
“Well, it is my professional opinion that you need surgery on your legs. I am going to go ahead and get ready for the operating room and call my attending. You think about it and let me know when I come back.”
Brian struts out of the bay and leaves the heavy air and his guilt behind. Now it’s just black and yellow. What is that, a bumble bee? He’s looking at me. I look at him. He doesn’t say anything initially, but I know he wants me to stand up for him. He needs someone he can trust. I am not that person. I try anyway.
“Are you cold? Do you need more blanket?”
“I’m fine, man, but let me ask you something.”
“Do you think I need surgery for the leg? You see, my cousin had a broken leg once, but he didn’t need no surgery, man. I don’t want to get surgery.”
“Well, I’m only a medical student. I don’t know anything.”
“Yeah, yeah, but what do you think?”
“You see that X-ray on the computer? Your leg bone is shattered. I agree with Brian about the surgery.”
I bite my tongue. Damn it! I sided with Brian. Stupid, stupid, stupid! Why did I do that?
“I don’t know, man. I don’t think I need it.”
I so want to come clean and tell him straight that Brian was an asshole. I don’t.
“Hey, I think you’re always entitled to a second opinion. But it might be hard to get a second opinion right now. You want me to go grab a nurse and see if she can page another bone doc for you?”
“Just let me know.”
I’m sorry, Mr. Zebra. It’s crap, I know. Wish I could help you more.
He sounds more composed now.
“Korea. The one without nuclear weapons.”
“Hey, you said, you’re a medical student, right?”
“What you wanna do?”
“Probably surgery. I like kids, so maybe pediatrics. I don’t know yet.”
“I probably don’t need to tell you this, but don’t be like that white guy. Fucking asshole.”
I don’t reply except with a hint of a smile.
“I’d like to talk to a nurse. Can you please go ahead tell somebody?”
“Sure thing, Mister….”
“James. Call me James.”
“Alright, James. I’ll go get that nurse and then come back and say goodbye before I head home.”
James closes his eyes. The monitor is still beeping in rhythm with his heart. Regular rate and rhythm. He’s going to be fine. I leave the bay under the pretense of looking for a nurse, but I know too well that I deceive myself. I am enjoying the escape from the heaviness of the room just like Brian did earlier. I tell a nurse behind one of the counters and tell her that Mr. Zebra wants another orthopedic doctor. She looks at me with a where-am-I-going-to-find-another-orthopedic-surgeon-at- 3am-on-a-Saturday-morning look. Just as she was about to ask why, she halts and realizes why the patient might be asking that. She probably knows what happened in that room.
“Thanks, kid. The attending orthopod is going to see him later anyways.”
“Thank you, Ma’am.”
The monitor is still beeping. I decide not to wake him up; the ortho attending will wake him up shortly anyway. He can use the sleep. Just like everyone else in the hospital. Just like Brian. Just like Rhyne. Doctor Pruell. As do I. I should go home and sleep.
Splat, splat, splat…
I walk out into the drizzling black rain to my car. The image of James’ bare bones follow me into the rain, and it gives me spine chill again. I think about my old 600cc Honda crouch-rocket. I am glad it was stolen instead of destroyed – along with my hands and legs. Then I judge and hate Brian for having worked 100 hours last week and being tired and cranky tonight in front of James. What a bastard. No matter how tired I am, I am never going to torture my patients like that. Never ever. I bathe in my self-righteousness.
“ATL1 TB2 ETA 25m”
Another trauma code. I consider for a split second if I want to stay for this code, but I remember how awful it was in the room with James and Brian. If I have to see Brian again tonight, I don’t know if I can look into his eyes. He would probably figure out that I am judging him, too.
For Brian’s sake, I hope the new code is for a white person who doesn’t need an ortho consult. For my sake, I hope that I figure out a way to get enough sleep when I am a resident myself. If I fail to do that, I hope I just shut up and do my job for James’ sake. It’s only right.
Ok, I go home. This headache is killing me.
1) ATL1: Adult Trauma Level One; TB2: Trauma Bay One; ETA 15m: Estimated Time of Arrival in 15 Minutes.