‘Another call’ turned out to be a major trauma alert to the ER. One of those all hands events, choreographed chaos. The patient hit the door, another young man, and was whisked straight to the trauma bay. He wore international orange and was awake and talking, though what he was saying was anybody’s guess. His speech was thick and mostly unintelligible, like he had marbles in his mouth. That wasn’t the most of it though. Wrapped around his head was a thick and bloody bandage of a sort I hadn’t seen in all my twenty years of practicing neurosurgery. It looked for all the world like an adult diaper.
It was. I confirmed this a short time later in the OR. Just then though, I was trying to figure what had happened and what needed doing to save his life. The rapid beep-beep-beep of the heart monitor filled the room. Somebody hollered “100/60” and I saw a nurse pull a pair of shears from her smock and start cutting his clothes off. It was done fast and was followed quickly by an intern sticking a finger where the sun doesn’t shine. “Good tone, no blood,” she said to nobody in particular, then went to work sliding a catheter up the shaft of his manhood.
The patient didn’t particularly appear to like this, but then again he probably didn’t like much of what happened over the next several minutes. A lab tech stuck a needle in his arm and blood dribbled from it onto the floor. An IV was started. His arms and legs flailed and at one point he kicked one of the orderlies holding him down. I stepped in and shined a light in his eyes, which were both reactive, and he squenched them closed in the next instant. He opened them again, seemed to gaze at me with a sort of distant, languid look.
“You got what you need, Sam?” somebody asked me.
“What’d you say happened here?”
“Don’t know for sure. He was out in the woods, deer hunting by the looks of him, and was found on the wrong side of a ridge by his buddies.”
“A deer stand diver?” Every year we saw a dozen or more folks who’d fallen out of a deer stand, maybe because it had rotted in the off season, or they had fallen asleep with boredom, or, and this was the grand winner in terms of numbers, because they had mixed guns and alcohol. One year I had a guy who had dropped his shotgun over the side in his beer stupor. It blew the top of his head to smithereens when he peered over the edge just in time to see it striking the ground.
“Not so far as we know.”
“The diaper?” I asked.
“His buddies carried him out. Drove him to the local ER I hear. I guess they used what they had.”
I thought about asking if they were hunting in diapers, but I let it go. “His head?”
“Nobody knows,” he looked at me, asked again, “You got what you need?”
“Yeah, sure. He’s combative and we need a look under that diaper.”
“We’ll get him over to CT as soon as he’s tubed.”
He was tubed, paralyzed, and in the scanner inside of five minutes. I stood with the other docs looking at the monitor as the machine scanned through that diaper. His head was a small ball in the middle of the wad. As the pictures revealed themselves, there was a collective “holy shit,” followed by several loud whistles. To a person they turned to me.
“Anybody think he looks like a deer?” I asked.
Somebody chuckled. The trauma surgeon, Joe Gap was his name, said, “Somebody must’ve thought he did.”
The scan showed several large bullet fragments in the back of his head. His skull had been fractured by the impact and pieces of bone and lead were laced throughout his occipital lobes. Something large and metallic was stuck near the bony prominence at the back of his head. There was no way it hadn’t lacerated the transverse sinus, the big mofo as far as veins in the head go. I looked through the leaded glass at the man laying in the CT scanner, at that stupid looking wrap on his head. Did he look paler than he had in the ER? I had a pretty good idea there must have been a shitload of blood spilled in those woods. Jesus Mother Mary, I thought, and was suddenly glad I hadn’t opted to unwrap that diaper before scanning him. I was shocked they’d gotten him this far alive. This guy owed his life—or the last hour of it anyway—to whichever of those hunters had a problem holding his bowels so severe he’d opted to wear an adult diaper into the woods. I couldn’t believe he hadn’t bled to death out in those woods. I couldn’t believe he’d arrived here talking. Most of all though, I couldn’t see how he was gonna leave here in anything but a body bag. “Shit,” I said, “tell the OR we’re coming. And tell the blood bank I need a half dozen units of O neg. And tell ‘em be quick about it.” I turned to Joe. “Can you give me a hand?”
He nodded, “but just remember, I ain’t no brain surgeon.”
While they moved my patient down the hall and up the elevator two floors to surgery, I made my way back to the ER. I always try to at least meet the next of kin before operating, especially when the next time I talk with them might be with a priest beside me.
His significant other was in the waiting room I was told, but I found her outside smoking a cigarette. It was cold outside, but you couldn’t smoke in the hospital and there was probably nothing she needed more in that instant than a cigarette. That’s a truism I’ve discovered over the years. I watched her through the glass for a moment. She stood beside a pole (in the spring or summer I thought she’d have been leaning against that pole, but not in the dead of winter; that pole would have burned her bare skin). She held a cell phone in the same hand as the cigarette, but she wasn’t using it just then. I saw she wasn’t wearing a sweater and had her shoulders hunched against the cold. She seemed alone in her misery.
I stepped forward and the doors slid apart. I said “excuse me” and she turned around. She was maybe thirty pounds overweight, the couch potato zone I thought, still a few pounds shy of true obesity with its diabetes, heart disease, and back problems. She had an unflattering ruddy complexion though; not the picture of health. She had the look: she’d been crying and there were rings around her eyes of a sort almost exclusively reserved for those who don’t know if a funeral or a hug is in their future. A wad of kleenex was balled in her off hand. She looked decidedly blue collar in a slightly frayed white maid’s uniform. A name tag pinned over her left breast, above her heart I guessed, said Howard Johnson’s on the top line and Josie in large letters below it. I held my hand out, I like to touch folks (I read somewhere how it makes the interaction more heartfelt for them), and she stuck the kleenex in her pocket after a moment of hesitation and took my hand in hers.
“Is he…” Her voice had a smoker’s phlegmy rattle.
“No,” I said quickly, maybe too quickly I thought afterwards, on the way up to the operating room. “But it doesn’t look good.”
“He gonna make it. Has to, that’s all. Has to.”
Saying it doesn’t make it so I thought but didn’t say. “Why don’t we go inside.”
She took a last drag on the cigarette and stubbed it out under her shoe on the icy sidewalk.
When we were seated in the privacy room, I said, “My name’s Sam. I’m a neurosurgeon.” I paused. Nobody is ever happy to see a neurosurgeon and the realization can come as quite a shock. “He’s hurt real bad.”
“Neurasurgeon. That a brain surgeon, right?” Her eyes loomed large before me, but they never actually looked at me. Like she was afraid to make eye contact. Or maybe she was just overwhelmed. Maybe she was used to taking her cues and getting her words from others. Mostly men I thought. I thought too how those eyes had a hard edge to them. One of them had a tinge of blue beneath it, like an old bruise.
“Yes ma’am. Just now I’ll be taking him into surgery, the back of his head…” I indicated my own head with my hand, “…it’s busted up pretty bad.”
“What you think, Dr. Sam? Does most people what have a busted up head make it? Or does they go to ground?”
I had never heard that term before and there must have been a quizzical look on my face.
“That how my grammie used tuh say it. You think he’ll go to ground, Dr. Sam?”
“Actually, it’s Dr. Vogel, Sam’s my first name. May I call you Josie?” I didn’t wait for an answer, there wasn’t time. “And I don’t know if he’s going to ground.” But there’s a damn good chance of it, I might have added but didn’t.
“He cain’t go to ground. Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I know he love me.” She almost looked at me then, and I thought Who gave you that shiner Josie? Did Bobby—your ain’t no bad guy man—do that?
“I ain’t never had no one to love me before. I know something about bad guys and he ain’t one.”
I thought she probably did know something about bad guys. Looking at her, I thought maybe she could write a book about bad guys. I said, “I’ll do my best.” But don’t expect too much, cause that’s a big ol’ bullet somebody put in Bobby’s head, bad guy or no.
She bucked up then, and nodded at me. She looked in that moment like she had seen life at its worst and this wasn’t it. She looked like she had faith in me.
A few minutes later, I was standing in the operating room looking down on Bobby. I knew there was gonna be a bloodletting like nobody’s business as soon as I unwrapped that diaper. Normally, I’d have called my partner to assist me on something like this, but there wasn’t time. Joe was right in that he wasn’t a brain surgeon, but he was a damn good trauma surgeon and wouldn’t faint when things turned to stool.
They turned to stool in a hurry.
Click Follow to receive emails when this author adds content on Bublish