Consider the circumstances

Consider the circumstances

By the 7th month of surgery intern year I was comfortable in the hospital and
understood enough about running codes to be more aware of what was actually
happening. The fear of arriving first had decreased enough to let me look around.
Suddenly those bleeding broken heaps of flesh became people.

When you are learning medicine initially you are so focused on everything as a task
that all your energy goes into memorizing information as a stoic technician. You
haven’t developed the muscle memory to act without thinking. There’s no time or
availability to feel. The whole story passes by. You don’t even care much it did.
Check boxes on a 3 x 5 card is all you care about.  It is like cooking a
Thanksgiving dinner and never smelling what is coming together. In fact even after
you are done you can’t see the meal laid out or taste it. You just execute. Then one
day you hear the rooster crow and wonder if it has every morning. The sun and moon
persist and you realize how nothing needs you around to keep playing out. Maybe
being aware is just your prize. Maybe you should avail yourself to actually register
what is at stake. Considering the circumstances becomes an option.

By the 7th month I woke up into the reality that human sweat and flesh housed souls.

It was a Wednesday night. The cafeteria was filtering the usual parades of house
staff and families and I was eating stroganoff. It was one of the few things done
well at the hospital. Comfort food. I would always overeat it. Maybe it was the fear
of being hungry later but unable to gather or consume food that made me eat. Maybe I
just wanted to feel the weight of food anchoring my anxiety. Maybe I wanted to be
soothed by something that I recognized. I was tired that night, As I ate and
reviewed my written list the trauma pager went off. Thirty minutes till sign out and
“You got to be kidding me!” That page alert still stabs my heart and floods my
arteries with adrenaline. That night it did its’ job and switched off Me-ville and
switched on Go-mode. Back then Go-mode was the lower rung of expectations. The
higher rungs were still Die trying- mode and I don’t matter- mode. These higher
rungs were the suicide baits. More civilized times were coming. Go-mode was becoming
a middle rung at least.

I scooped two more bites already full.
“Eat when you can, sleep when you can,” the orientation resident had said. I raced
to the ER. Bay 2 was open and EMS was arriving.

As I arrived a man wide awake rolled in wearing still a hard hat. The room suddenly
smelled like singed hair. He was dirty but awake. He looked fine. Eyes open looking
around answering questions.

Neuro Glasgow Coma Scale: 15

I approached as the senior to run the code but there was no code. The vitals were
stable and the man was awake not complaining. I came closer and asked the
paramedics, “What’s the issue?” The tallest paramedic stopped writing and looked at
me and walked me over to the man. The smell of burnt hair grew heavy like dust. I
coughed a little at the caustic scratch in my throat.

The paramedic pulled back the white sheet.

The man had been in a bucket assessing an electricity tower. There had been some
water in the bucket from last nights rain. Suddenly there was a power surge and the
electricity had surged through his body into the bucket and the water he stood in.
The electricity continue to travel throughout his body as his hands clenched over
the wire. The power was cut and his hand relaxed. He came too on the stretcher
dazed. The voices all around him were cycling in and out. He heard his name and
answered, “What’s up?”

Neuro: Glasgow Coma Scale 14

Behind the thin sheet that covered his legs up to his waist his legs laid. The pants
he wore shredded up to his groin on the left and up to the knee on the right. All
the flesh had burned completely off his bones. His shoes remained on his feet nicely
laces, two bunny ears and neat tie. There was no blood. There was no liquid of any
kind. The entire lower half was cauterized. The arm that had held the wire was badly
swollen up to the shoulder.

The bones of his legs were stone white. The shoes tattered but not at all damaged by
burns. They appeared stuck on like someone had dressed a patio decoration for
Halloween. In fact the shoes had become glued onto the bones. The soles of the shoes
had melted into the 26 bones and 33 joints in his feet.

The whole image was incredible. The man was unaware his legs were stripped of flesh.
He was in a strange shock that seemed like every neuron was rebooting. He answered
questions and spoke normally but he was absolutely clueless that he had gone to work
or had gotten hurt. It wasn’t registering at all.

I called the attending and senior plastics fellow and general surgery chief
resident. I hadn’t a clue what we would have to do. Every organ and every muscle had
received so much wattage quickly everything would liquefy into a myoglobulin river

I placed a central line in him while the senior members of the team reviewed CT
scans and marveled at his perfectly intact chest and abdominal cavity.

While I was placing the line he talked to me.

“Hi. What are you doing? Can you move this towel? Can you scratch my nose? Have you
seen my hat?”he interrupted my suturing.

He was still wearing the hard hat also fused to his scalp.

“Hi. I’m just getting some extra IVs for fluids for you,” I would nonchalantly
reply. “My god,” I thought. The mask I wore made me light headed for the first time
in 7 months. The nurse helping me remained methodical and I told her I was ok and
would clean up after myself like my mom taught me. She was a southern mother and
nodded approvingly and disrobed.

The team had decided not to show him his legs or tell him what happened. He seemed
to have fugax. “Certain diseases are truly merciful,” I thought.

His wife raced in as I was finishing and cleaning up my needles and caps.

“I’ll be back Jerry,” I called over my shoulder leaving to talk to the wife.

“Right on,” he reply.

I disrobed from the sterile gown and washed my hands and walked to meet the wife.

I introduced myself and she held back tears. Her hands were full of tissues. Some
used. All crumpled.

“Did you come alone?” I asked.

“I…. I couldn’t drive,” she replied.

I looked down at the floor. Then I raised my head and said, “It’s impossible to
describe. Your husband  was working in a bucket. It had a little water in it which
when the electricity surged it conducted up into his body over and over. It has
basically cooked every organ and burned off the flesh on both his legs.”

She looked over my shoulder and saw the white sheet and sneakers peering out from
under the sheet. I saw her eyes and forehead relax then puzzle. She was thinking he
looked fine. She was noticing the sheet a little lower as it fell off the pelvis on
the left and the right thigh. She was adding. Then she furrowed and her lower jaw
fell open.

“Listen to me,” I redirected her “The burn was so bad his bones are completely
stripped clean.”

She gasped and placed her hand on her mouth. The tears dove like huge missiles.

“He won’t have legs?”she asked.

“Ma’am. He won’t survive this. The team is planning a hemocorporectomy,” I managed.

The wife looked puzzled. I explained the strange word.

“You are cutting him in half? He won’t have genitals? Wha…. Why?” She said

“Ma’am, he has lost everything from below the waist. We will also need to take his
entire right arm,” I said.

I must’ve sounded like a mad woman.

“Ma’am, the team is coming to talk to you. I think you need to spend your time
talking to him.” I was whispering now. “Whatever you want to talk about that you
want to share with him whatever you two do alone together privately when you …
Talk. Talk like that now. He doesn’t know at all what has happened. He is in shock
and also likely some kind of brain damage because of the high voltage.” I grabbed
her forearm. I was maybe a little too intense. I couldn’t help it. Suddenly
electricity was surging in me. ” Don’t look under the sheet. It’s not something you
need to ever see. Please. Go talk to him but about nice things. I know.. I know you
won’t talk to him again once they take him to surgery. I know he won’t wake up,” I
begged her.

She stared at me in utter disbelief.

“Ma’am, do you understand?” I repeated.

“We have to try,” she managed.

“Go talk to him as if you won’t again,” I begged and begged.

She left me and I sat to type my procedure note and sign out. I was ending a shift.
It was to me the end of a shift.

I could hear her greet him.

“Hi baby,” she said.

“Oh Sarah! What’s for dinner babe?”he asked.

“You always think with your stomach Jerry,” she said touching his hair. “Baby
remember how we said we would go for a trip soon to San Diego and rent that boat?
Remember how we said we would go?”

“Oh yeah! It’ll be fun babe,” he responded.

“I booked it all. I can’t wait,” she said crying.

“Remember that restaurant? You and your coupons!” He said lost in some memory of
steak and lobster buy one get one free.

They talked like this for 20 minutes. I joined the team to look at films and try to
care about their plans. I secretly hoped I would never have to cut a man in half. I
gave my sign out to the other intern and was glad to leave. I didn’t want to try or
fail or tell the wife later how we tried but failed. Acidosis would set in and
nothing would work. I hated my nihilism. I wanted to be a surgeon who cuts. I wanted
to go to Die trying- mode.

I heard they wheeled him off to surgery still joking with his wife. I heard the
surgery was swift with massive amputations and a left arm fasciotomy. The other
intern had much to do. I realized I was jealous of the procedures I missed. Training
makes you hungry for procedures. I heard he left the OR but within an hour he
totally disintegrated into an acidotic storm. Surgery training makes you forget that
your shift ending is no end point like death.

I hear the wife never looked under the sheets. The life saved was hers to not have
to see that imagery or know that truth.

I wonder if we should’ve just let the two watch a movie together or fall asleep
together. I wonder why that wasn’t an option. We should’ve consider that option.

He died trying at least.


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