1994
This story was originally published by InterText as Mr. McKenna is Dying then was subsequently picked up by Stanford's Medworld and then eScene (whose archived site is currently in a limbo of server relocations) thanks to the kind nomination of Jason Snell and the editorial staff of InterText. The version below is my favorite.
It really does have a smell all its own. You're not sure what it is at first, or even the second or third time. You don't even realize that it's there. Eventually though, it dawns on you that that particular crisp odor comes from one thing, and one thing only. It is the smell of blood.
Today it hit me before I even got inside the room. Slapped the wall switch outside the O/R suite, strode through the doors even as they folded away before me, and there it was. Like charred orange-peels. Burnt. Or hot metal filings on the floor of a machine shop. Even the smell of the machine oil is there. It's not the same smell, but you'll recognize it if you ever chance across it. It will dawn on you then; but only after the scent has crept around your subconscious for a while, sneaking down into your hippocampus and setting off strange primitive reactions in your thalamus.
You'll remember my words then, and think, "Ah. I know exactly what he meant now."
Mr. McKenna had been out for an early morning ride on his motorcycle. Or maybe it was a late, late night ride, coming home from a party perhaps, or sneaking away from his girlfriend's place. Or perhaps he was simply out for a spin on the gray and drizzly streets, having gotten up early to have coffee with his wife and kids. You know, just to tool around the town a bit, get out on the road with the damp air wrapped around him, and marvel at the beginning of what would turn into an absolutely beautiful April day.
Then for some reason we are not privy to, Mr. McKenna drove his motorcycle right into a parked car.
At high speed.
This was not a good way for him to start his day. For that matter, it wasn't a terribly good way to start ours either, but I guess that wasn't really his fault.
The E/R attending paged Neuro down for a consult. The Neuro resident was not terribly pleased by what he saw. One pupil refused to respond to light. Blown. A wide open portal to the soul. Or in this case more like a barn door flapping in the breeze, after the horse has already run off.
I was starting to seriously reconsider the fantasies I'd been having about getting myself another motorcycle someday when I have a cash-flow.
He coded on us then, right there in the E/R. The ol' ticker just heaved once, massively, and gave up. "What's the point?" it figured, and decided to take a little breather.
We zapped it, powie. Lots of nice clean DC volts. A big bunch of amps. The heart reconsidered, and must have figured that if this was the kind of treatment it was going to receive while on break, well fuck it, it would just go back to work where no one had bothered it.
Crunch. Pop. Yes kids, that's the sound of what amounts to a really nice set of stainless steel wire-cutters parting bone. Crunch. It's a visceral sound. You'll remember that sound too. I promise.
There they are folks, the stars of the show for the moment, Mr. Heart and his two body-guards, Mr. Two-lobes and Mr. Three-lobes. They're beautiful. There's the heart, excursing away in its warm little pericardial wrapper rather like a stuck pig. The lungs are pink and healthy, mottled with black. Your lungs are mottled with black too.
You may be thinking to yourself, with a bit of righteous pride, "Nay, not mine, for I have never breathed the sweet airs of the demon tobacco, nor have I partaken of the subtle Mary-J-Wana. I have taken Dr. Koop's earnest warnings to heart, and I have seen Reefer Madness. I am a believer."
You are wrong. Your lungs look just like Mr. McKenna's. Just crap from this modern air we breathe. Its okay though, 'cause it's harmless, more or less.
Actually, I'm a bit wrong too. Your lungs don't really look like his, because his have holes in them. Blood bubbles out each time the diaphragm relaxes and Mr. McKenna exhales. There are also holes in his diaphragm. These are in addition to the expected ones that his aorta and other things pass through. As you might imagine, we are chagrinned. They are not supposed to be there, these holes.
Mr. McKenna goes on a little elevator ride up to the operating room. We have made this gaping huge hole in his chest you see, and that in itself is reason to take him there. There are other reasons too. We want to make another gaping hole in him, this time in his abdomen.
Actually, it's not really we, it's they. Surgeons. They like to cut big holes in people. I'm anesthesia. We prefer to stand around and make significant little noises at each other, crack dark jokes, and make fun of surgeons. We think we are very funny. We are right to think that.
So now Mr. McKenna has two very big holes in him in addition to all of the little ones he made inside when he drove his motorcycle into that car. The floor of the O/R is a mess. There is blood everywhere. Some of it is there because I accidentally poked a hole in one of the bags of blood that we intended to put into Mr. McKenna. That particular blood is now all over me as well. Oops.
"You shouldn't do that," says the anesthesiologist who is more or less coordinating our part of the job.
I agree with him. Folks just don't like to sit down to dine with someone who has blood all over himself. I can't imagine why.
"You," says one anesthesiologist to me, "are going to stand there and blow blood in through the pressure infuser. You are going to do this again and again, as quickly as you can."
"Yes," I say, "I am."
This is called "massive volume resuscitation protocol." Mr. McKenna will, over the course of his surgery, have more than fifty-five units of blood poured into him. That's fifty-five of those bags that you fill up while you lie on the table praying that the red-cross nurses are not going to blow your vein with those godawful huge needles they stick into you. It is rather more blood than is in your entire body - maybe five times as much.
The rest of the blood on the floor, far in excess of the twenty or thirty cc's I spilled when I cleverly wasted that nice bag of the stuff, is coming from Mr. McKenna. I put it into him, and then it leaks out of various holes in his vasculature, and spills onto the floor. It will take housekeeping the better part of three hours to get all of the blood off the floor, the operating table, and various other pieces of medical paraphernalia. There is also blood tracked all through the hallway outside the O/R. This is because it sticks to my shoes, or rather to the little blue booties that cover them, when I go to fetch more drugs or run arterial blood gas studies. It sticks to other folks' shoes too, and I'm reassured by the knowledge that I'm not the sole culprit.
The surgeons have Mr. McKenna cross-clamped. That is to say that the whole bottom half of his body is getting no blood. Not that it really matters at this point, as it was running out through various holes before it could get too far anyhow. It was getting some however. Now it has none.
The cells down there wonder just what the hell is going on up there in headquarters and tough it out, doing their best to respire anaerobically.
When the cross clamp comes off, it is discovered that there is also a hole in his aorta. Maybe it was there before, maybe not. We call injuries that result from therapy "iatrogenic." This is a nice way of saying that the damage was caused by the folks trying to fix the patient.
Sew sew sew. Staple. Crunch. Mr. McKenna has two incredibly big holes in him. A good-sized cat could easily cuddle up quite comfortably in either one.
Some time later, he has only one very big hole, and a twenty-five centimeter line of black sutures to mark where the other one was. The problem with the remaining opening is that every time the surgeons try to close it, Mr. McKenna's heart get's depressed with the thought that having seen the bright compelling lights of our O/R, it will soon be shrouded once again in claustrophobic darkness. It rebels at this notion, and goes on a work slow-down. Not exactly a strike, not yet, but this recalcitrance is enough to frustrate surgeons and anesthesiologists alike.
About twenty minutes later, his heart actually does stop. Or rather, it doesn't stop exactly, but sits there in v-fib and quivers like an irate child. We give it a taste of our amps and volts again, and it reluctantly remembers why it started up after we did so the first time.
One of the surgeons suggests that perhaps this exercise is becoming futile.
"Pretend he's your dad," says another, "and do your best. As long as the heart is going, he might pull out of it."
Unfortunately, now both of Mr. McKenna's pupils are blown. The brain is apparently beginning to side with the heart, and is growing tired of the whole affair.
Mr. McKenna's heart is still piqued by the surgeons' attempts to deprive it of the rich light of day. "To hell with it," reckon the surgeons, and offer the heart a window instead. Yes, they actually slice open a one-liter saline bag, and commence to sewing it in place over the big hole.
For our part, we anesthesia types are trying to offer other incentives. We are infusing Mr. McKenna with mind-boggling quantities of epinephrine. His heart is not pleased with our offering, however. Where your heart or mine would be galloping like a derby thoroughbred which had just been shot in the ass by a malicious kid with a B-B gun, this particular heart is creeping along at about 58 beats per minute. This would be a good pace for a young athlete at rest, but its not for Mr. McKenna, who isn't terribly young and frankly, doesn't look like he was too athletic even before he drove his motorcycle into that parked car.
Mr. McKenna is dying. In all truth, he has been dying ever since the collision. Now, however, he sets about it in earnest.
At two o'clock, one of the surgeons says, "Okay, folks. You've done a good job. We did our best."
Seven hours after his disagreement with that car, Mr. McKenna is 'pronounced.'
Later, when all us anesthesia-types are going over the case, writing up the mortality report and such, one comments, "Oh wow. I'm gonna have to figure out the Kevorkian points for this, and decide who gets 'em."
Something snaps. The narrow threshold which divides weeping and laughter is crossed, and I start to giggle uncontrollably. Kevorkian points. I think it's hilarious.
He comes back after a while and starts assigning numbers to each of the folks in the room. Then to me.
"You," he says, "score one for an assist. You are the first medical student ever to be so honored."
It sounds heartless, and maybe it is, to some extent. I still think it's incredibly funny though.
Just another day at work, I guess. There was a heart transplant going on across the corridor. Right after we finished the trauma, I helped start a kidney transplant down the hall.
I'm exhausted. Though it was only eight hours, it felt like a lifetime. For Mr. McKenna, I suppose it was.
I ask one of the anesthesiologists, before I leave, if he thinks Mr. McKenna ever really had a chance.
"No," he says, "not really."
"I dunno," says one of the others, "I figure his chances were real close to one-hundred percent before he got on that motorcycle this morning."
This piece is non-fiction. I honestly don't remember what his name was any more, which is probably a good thing. The dialogue, details and such are exactly as I remembered them, and the draft was essentially written about an hour after I got home from work that day in a letter to my folks. This scene was filtered through the eyes of a second-year medical student, naive indeed vis the workings of medicine, trauma and death.