The Soul of Perception

"Dr Tanner, you have a minute?"

He looked up, smiled. "Bill, right? And Lucille? What's up?"

They nodded, smiled: "You still giving out flu shots?"

"Yeah, I got a couple left. Y'all didn't get yours yet, I take it?"

"No sir, we sure didn't. Do you think you could get us one?"

He put his book down and went below to the fridge, opened a fresh box of pre-loaded syringes and had them read and sign a release, then he gave them their shots, had them sign a book he kept for the County Health Department.

"Dr Tanner, I've got a fresh pot of turnip greens and some corned beef on. Would you like me to bring you a plate?"

"Is that what I smell cookin'?"

Lucille smiled, blushed.

"My word but that smells fine."

"I'll go fetch you some..."

"Don't bother. I'll come over if that's alright."

They couple both seemed pleased with that and scuttled down the pier to the old cabin cruiser they called home; Tanner walked along a moment later.

"Y'all came down from Tennessee? How?" he asked when he read the hailing port on their boat's stern.

"Yessir, down the Tenn-Tom Waterway," Bill said. "Real pretty trip, too. Best thing we ever done."

Tanner ate, he laughed at their stories and listened to their heartaches, talked with the old couple for hours, then went back to his boat and fell asleep.

+++++

He went in early, talked with Macy. She was beat up physically and emotionally, was adrift after losing the baby. Tanner thought she seemed too depressed, thought he'd better tell a floor nurse to add that to her chart.

"You'll be here today, maybe tomorrow," he told her. "When you're ready I'll come and get you, take you down to the boat."

She smiled, turned away, looked out a window.

"I'll come by again in a little bit. You get some rest, okay?"

She said not a word, just drifted away into the hazy confines of her day.

+++++

The paramedics said she was a hooker, that she'd overdosed on meth and sometime during their tryst gotten into a fight with her 'john' over the quality of services rendered; the guy knocked her around a little, then shot her twice -- once in the arm, once just above her collar-bone -- when they really got into it. The 'john' was in Trauma Six, his penis hanging on by a thread, the hooker was in Trauma Three, and it was a busy night. Though it was four in the morning all twelve trauma rooms were full, several with gunshot or knife wounds, people hit by drunk drivers or wives beaten by angry husbands. Mannie Hernandez stood in the corner watching Tanner work; he had, by law, to remain with an attempted homicide victim until the docs could tell if she would live or die.

The hooker was in and out of consciousness but her vitals were good -- she was stable; Tanner held x-rays up to the light-box, looked at the bullet in the woman's neck. He wanted to pump her stomach while they waited for an O.R. to clear up, watch her fluids and vitals, but was afraid if she vomited the movement might push the bullet against her spine. He called the neurosurgeon upstairs and explained; the surgeon wanted her stomach pumped, didn't want her vomiting with a tube down her throat on the table.

He got the tray ready while nurses strapped a neck brace in place, then Tanner ran surgical tubing up her nose and threaded it past her glottis and into her esophagus, then down into her stomach. He put positive pressure on the tubing and listened with a stethoscope, made sure the tube was in her belly and not her lungs. A nurse mixed activated charcoal and saline into a wet slurry and filled a huge, syringe like pump and handed it to him. He fit the syringe to the tubing and pumped the black sludge slowly into her stomach; a nurse listened to the stuff enter the stomach and gave Tanner a thumbs up. Another nurse mixed saline and ipecac, an emetic that causes near instantaneous vomiting.

Tanner looked up, grinned at Mannie.

"Say Mannie, you wanna come over here and hold the bucket?"

"Hey, fuck you, homey. I ain't standin' next to no fuckin' volcano! No way, no fuckin' way! All them scrambled eggs and shit! Shit no, no fuckin' way!"

"Hey, you know, just thought I'd ask..." He fit the new syringe in the tubing and pumped it in, then quickly pulled the tubing out the woman's nose. As soon as the tube was clear a nurse held the woman's neck while everyone else rolled the woman on her side. An orderly stood beside the table with a fifty gallon trash can ready to go, a mask over his nose.

"Oh, crap," the orderly said seconds later, "here it comes!"

The woman's eyes opened momentarily, just before the deluge; she managed to say "what the fuck!" before she let loose. She convulsed violently then settled down, kept barfing into the can, moaning between upheavals.

"Hey, Mannie!" one of the nurses said. "How'd you know she had scrambled eggs for dinner?"

"Fuck you, man! Just fuck you!"

Everyone laughed, everyone but Tanner. He ran his fingers through the woman's hair, leaned over and whispered something in her ear. She moaned, smiled a little before she closed her eyes. He continued rubbing her head until he was sure she was asleep.

+++++

He got off after thirty hours on, went upstairs to Macy's room.

"Howya' doin'?" Tanner asked when he walked in her room. She seemed brighter today, not quite as down.

"Better, Doug. Thanks."

"Yeah. Say, the chemistries look good; they wanna cut you loose. Feel like taking a ride?"

"Doug. I mean it. Thanks. You saved my life."

"Bah! Nonsense!"

"I was gonna go get a hotel room. I would have been alone. The nurses said I'd have bled to death."

"Macy? You ever think that some things happen for a reason?"

"Maybe. I don't know."

"You don't huh? Imagine that."

They laughed.

"So, I brought you some things. Why don't you get dressed? I'll come back in a minute..."

... He drove slowly, let her get used to the sun and the air and the greenness of life. The sky was bluebirds, not a single cloud anywhere, the air cool and fresh. The world smelled of mangos and freshly mown grass, girls on roller-skates and dudes on skateboards crowded the sidewalk by the beach, Frisbees flew across the sand and out over the silvery-blue water beyond -- sailboats crowded the cut from the marina out to the bay.

He watched her, thought about what she'd been through, about the hopes and dreams she might have had, about the nightmare that had come calling instead. He helped her from the car, walked arm-in-arm with her down the pier. There were fresh flowers 'from all of us here in the marina' and Lucille stood by as they passed, followed them and handed Tanner a huge pot of greens and corn bread.

She was pale and light and he had to admit it now: he had never really stopped loving her. He fed her and put her in his berth in the aft cabin, drew the little curtains and crawled in next to her and held her through the night. He held her when she cried, he held her while she slept. He brushed the hair from her face, kissed her eyelashes as gently as a breeze. She looked at him, held him in her eyes. She smiled.

"See," she said, "I told you so. You still love me."

"You were right."

"I know."

It was her turn now. She held him, held on to him as tightly as she could.

+++++

Tanner went in early the morning -- it was an off day but a third year resident had called in with the flu. When the Chief was short she knew who to call. Tanner never said no.

Sundays were slow days. They didn't usually get bad until evening rolled 'round, but even so most Sundays were easy. And so this Sunday was. Medicine was busy, lots of flu presenting, and psychiatry was too. Paramedics came by with a teenage-girl strapped down to the gurney a little after noon; she'd slit her wrists -- "the way they do it on TV" she told him, and he repaired a tendon and sutured her wrists while she went on and on about how life wasn't worth living because her boyfriend had dumped her...

"Just curious," he asked her at one point, "what would make life worth living?"

She mentioned something about a new cell-phone or a Mercedes like her mom's and Tanner smiled as he looked at her, while he steri-stripped the margins of the wounds and covered them with four-by-fours. A resident from psychiatry came by, and when out of the room asked what he thought about the girl:

"Looks like a pretty classic cry for help," Tanner said, "except her feet are filthy, there's a load of dirt under her fingernails, and she's malnourished. She acts like little miss rich-kid but I'd lay odds she's alone and on the street, maybe a runaway. I'd call Social Services right off the bat." The resident nodded and made notes, walked away. A little later they rolled the girl down to psychiatry; she waved at Tanner when she saw him and he smiled, waved at her.

"Gunshot wound inbound," came the crackling voice from the speaker overhead. "Paramedics about five minutes out."

Tanner was the senior resident on the floor. Two first-years surgical residents and a gaggle of interns hovered expectantly, watching and waiting for him to say something. An emergency medicine doc was hustling down from the cafeteria. The older resident, Doris Tayloe, a woman who'd graduated from med school on her 48th birthday, looked ready to go:

"Right. Doris, go get some trays set up and ready to go, would you? Take a couple of interns with you, and tell 'em to tuck in their goddamn scrubs! And trust your nurses!" He was tired of finding loose hairs on his sterile field; heads would roll soon if he saw another sloppy intern walking around with their scrubs not tucked-in!

He got on the phone, called the doctor advising the paramedics in the field: "What do they have?" he wanted to know.

"Six year old African-American male, at least two gunshot wounds, one in the gut, one looks like it got the femoral artery. They've got trousers on the kid."

"Right, have you notified vascular?"

"Yeah. Collins is finishing up a chest, he'll be down as soon as he can. I called your chief, too. She's on the way in."

"Right. Thanks."

"Okay, they're turning in now. Seeya..."

Tanner hung up the phone, walked down to Trauma One and filled in the team. Everything looked ready.

He saw the ambulance screech to a stop and back in to the loading bay, two patrol cars roared in and pulled raggedly into spaces marked Police Only. Mannie Hernandez jumped out of one, another he didn't recognize followed.

Orderlies got the ambulance doors and firemen helped pull the gurney out; one of the paramedics was bagging the kid, another held IVs overhead as they rolled him into the ER:

"Go to One!" Tanner called out; he saw the emergency medicine doc running down the corridor. "Thank goodness for small favors," he said as he followed the gurney into the room.

Orderlies and nurses began cutting away the kid's clothes; Tanner saw the boy's eyes roll back in his head and moved to the kid's gut. "It's a fucking mess in there," he heard one of the paramedics say. "Must have been a .357 or something, maybe a 41 mag.; there's a big fucking exit wound where his right kidney used to be..."

Tanner started calling orders, supervised the residents and nurses, let them do their jobs while he did his. "Okay, I can palpate the aorta; it feels intact -- good pressure -- the renal might be okay too -- Doris, let's roll him... I wanna have a look at that exit wound before we take the cuffs off his legs -- Fuck, what a mess! -- Somebody call for a gas-passer -- the renal is intact but I can feel bullet fragments all over the fucking place -- goddamn hollow-points!"

He heard in the periphery of his mind Mannie out in the hall, a hysterical woman screaming, probably the kid's mother, probably taking all Mannie's strength to keep her out of here, then -- "get a cut-down and lets get those cuffs off, I'm gonna go in and clamp off the femoral..."

"But it'll be retracted..." one of the interns commented.

"No shit, Sherlock!" the emergency medicine doc said angrily. "Get the fuck out of here and go read a comic book!"

Tanner palpated the inner thigh, thought he felt something and made an incision from the scrotum down his thigh about eight inches. There wasn't much fat, not much muscle, either; he stuck his finger into the shattered tissue, felt the artery, felt it pulsing lightly. "It's just... still mostly intact... oh, no! Clamp!" he shouted. He felt the clamp slap in his left hand and guided it down to the deteriorating artery; he got it on the first try. "Got it! Shit, there's bone frags everywhere -- better call ortho, somebody!"

Tanner stood, looked at the monitors: the kid was holding his own but the screaming in the corridor was getting out of control.

"Mannie! Bring her in!"

"You sure, man!"

"Let her go!"

A black woman, maybe thirty, thirty five, thundered into the room; she shuddered to a stop when she saw the boy. She started wailing.

"Ma'am, I need you to be quiet, and listen, alright?!"

The woman struggled to control herself.

"Ma'am! Listen to me!" She calmed noticeably when she looked at Tanner, as if she took comfort from his strength.

"Awright, doctor, I'm listenin'."

"We've got a lot of the bleeding under control. The boy's stable right now. Do you believe in God?"

"Yessir, doctor, I sure do."

"Alright. I want you to go out with Officer Hernandez there and get down on your knees somewhere and start prayin'! You here me? You stop prayin' when I come out and tell you too. You hear me!"

"Yessir," she said. "Thank you, doctor." She had somewhere to focus her strength now, and backed quietly from the room.

In the quiet, Tanner hoped, things would go smoothly, things would start looking good...

+++++

The man was huge. His bald head just barely cleared the automatic sliding doors when they opened for him, and he must have weighed three hundred and fifty pounds. His black skin glistened with sweat; he was wearing ragged denim overalls and old work-boots caked with dried mud, and nothing else: his bare chest appeared to be solid muscle, his arms too. He was looking for his step-son; the kid had taken twenty dollars from his wallet and that had been the last straw... Something inside had snapped...

He saw his wife standing in a little room, a cop standing between him and her. He took out the pistol in his overalls and aimed, shot the cop. The noise was overwhelming; people screamed, interns ran behind counters, the cop fell over, slid down the doorway, blood coming from his mouth and nose.

The woman turned, saw her husband and ran into the trauma room, tried to hide from him.

The man walked into the room, saw his wife hiding behind a doctor... or was he trying to shield her, protect her... he couldn't tell... it didn't matter...

He fired once, then again and again.

Nurses and doctors flattened against the wall, tried to get out of the line of fire, then another gunshot, this time from behind the man, then another. Brain was exposed on the left side of the man's head as he fell to the ground, his eyes lifeless.

Doug Tanner lay on the floor, he saw a cop across the room on the floor, blood pooling under her head; he tried to move, to help her -- but he couldn't. The world grew light and distant, and he felt himself falling into cold light.

+++++

He woke up, recognized an ICU nurse and wanted to ask her what she was doing in the ER. He tried to talk but couldn't, tried to swallow but simply could not. He felt a wave of panic wash over, knew he was the patient but had no idea how he'd gotten here. Then the nurse was overhead, looking down at him...

"Doug? Doug, you were shot, in the ER. Neck wound. There's a drain in now; that's why you can't talk..."

He heard her talking, heard her say something about his mouth and tape and everything was going to be fine... and then he felt himself drifting off again...

++++++

He felt his head lifting, heard a motor whirring away under the bed, opened his eyes, saw doctors looking at his neck and talking. The room was dark, but he could tell the curtains were drawn and faint sunlight was seeping through.

"Oh, hey Doug. You awake enough to talk?" one of the doctors said.

"Yeah," he croaked. It hurt like hell.

"Good! The vocal cords are fine! I think we can take out the drain, Bill." He ignored them...

...because he saw Macy behind them; she looked anxious and moved close when the doctors left a moment later. He watched as she started crying, began shaking uncontrollably. He reached up and took her hand. "How are you doing," he asked her.

"How am I doing? Me? Oh, Doug!" He felt her head on his chest, smelled her hair, felt her body shake as tears convulsed her...

"Hey, Pachuco!"

"Mannie?"

He felt Macy stand, saw her turn and look at the cop as he walked in.

"Hey, amigo, brought you some donuts..."

"Right!" He looked at Mannie, then at Macy: "Try and save me at least one, will you Macy. That man is a donut fiend. He'll snatch 'em right off your plate..."

Everyone laughed, even if it did hurt a little.

+++++

So yes, once upon a time there was a doctor... I met the man I've called Doug; he lived at a marina where I stayed once, just a few months before what happened - happened. I've filled in the blanks, rounded out the details in the soft pastels of conjecture that so often make-up a little story like this -- but maybe you should let the facts tell the real story. Surgical residents in the United States will treat, on average, more than twenty gunshot wounds during the course of their training; in Europe the average is statistically insignificant, less than one, anyway. Physicians, nurses, paramedics are wounded or killed in American emergency rooms every year, year after year. Cops, too. Not all these stories have happy endings.

"Doug" and "Macy" got married not long after these events, and they had a kid, a little girl. He finished his residency, practices vascular surgery in Texas and remains a friend. They still live on the boat, plan on taking off and seeing the world some day. I hope you run across him someday.

©2009AL5.5.09