11 September 1996


Katy and Shannon arrive Saturday after I get off shift.  It's a bit after one in the morning, and they come in under the extended cover of Hurricane Fran.  I've known 'em both for better than eight years, so the conversation is a bizarre blend of in-jokes and seeming non-sequiturs.  It's made worse by the fact that Shannon is a peds 'tern now, so we banter short vignettes about patients and life in the hospital back and forth.  Katy rolls her eyes indulgently and permits us to ramble for a while.  We hang out in my living room, choosing from something like four-hundred CD's for our music.  The conversation goes everywhere.

"Well, if you think of him as your straight friend, then you really are prejudiced --" 

"But the reason you never see references to the outbreaks of malaria that happened every summer is that the folks who wrote the histories were well enough off to be able to go away during the height of the season . . . "

"Hey Marcus - any new women in your life -- ?"

"You know how different objects make different sounds when you strike them sharply?  I make this sound - "  Shannon flicks a finger against her forehead.  "Pinnnng!"  She looks at me, then grins archly at Katy.  "Marcus on the other hand, sounds like this --"  She reaches over and flicks the end of my nose.  "Buuurrrp!"

It's good to see them. 



At work, one of the nurses looks at the registration list on our almost-useful computer system.  "Joseph is back," she announces to those of us sitting back at the South nursing station.

"Aw, c'mon - he was just here yesterday," I say.  "You're kidding, right?"

In answer, she gestures eloquently at the screen.  She's not kidding.

"Crap.  Okay, I'll take him."

Joseph is one of our many, many frequent fliers.  He lives somewhere close to the hospital, and seems to have a predilection for getting incredibly, dangerously drunk.  We generally tank him up with IV fluid turned yellow by a cocktail of thiamine, folic acid and multi-vitamins, and let him sober up.  Joseph's unique trait is that he swings rapidly from being incredibly abusive to full of love for the world, serenading the entire department with pretty fair renditions of crooner's ballads from the forties and fifties.  Then he turns mean again. 

I walk into the room, accompanied by another 'tern who's spending the month with us from an outside hospital somewhere.  She doesn't have any patients at the moment, so why not?

"Hey Joseph!  What's going on?"

"Aw, ya fuckin' cocksucker, I'm dying, and no one's helping me!"

"We're here to help you, buddy.  What's happening?"

"I fuckin' toldja, I'm DYING ya sonuvabitch!" he yells. 

She looks at me, grins, then says to him, "Joseph - that's not very nice language."

He swings his head to the other side of the bed and squints at her, noticing for the first time that I'm not the only other person in the room.  He looks back at me.  "She's alo' more beu'ful 'n you are," he announces.

"She sure is.  Now what's bothering you?"

"Hey - do you like her?"

I look back at him, and my mind races for a moment.  She's got a wicked sense of humor and when she smiles it makes me weak.  I want desperately to take her out for drinks then someplace to listen to good music.

"Wudja marry her?"

I'm still in a bit of a daze.

"Hey - wudja fuck 'er?" 

The room snaps back into focus. 

"That's a personal question, Joseph."

"Fuck you, ya cocksucker," he slurs.

We walk out of the room.  "That's Joseph, ladies and gentlemen," I tell her, "how about a big round of applause?"  She grins again, and reaches for a new chart.  I pray she didn't notice that he managed to derail my train of thought completely for a moment.

So Joseph gets an EKG and continuous cardiac monitoring for the fact that he clutched dramatically at his chest at some point in his diatribe, and for his cardiac history.  He gets an IV for his rare tendency to stop breathing, on the off-chance that we might need paralytics in order to intubate him at some point.  He gets restrained to the bed because I become damned tired of him taking swings at me when I go into check on him.  He gets to sleep it off, and finally, he gets escorted off the campus by security after I discharge him. 



Katy and Shannon and I are in my living room.  For once, there's no music playing.  They're doing the New York Times cross-word together, and I'm going through stacks of papers that I've been neglecting for the past couple of weeks, separating bills here, articles for my files there, and stuff to toss into the trash on the other side.  There's a piece of paper covered both sides with my illegible hurried scrawl.  I look over it quickly, and recall immediately the night on call on which I jotted it down.


The unit is a wall of sound.  You can walk in, either at your leisure or in an incredible hurry, and never notice it.  You can stay for hours and hours, noticing no sound at all but the occasional ring of a phone, or laughter from a joke told at the nursing station, but there's this perpetual undercurrent of noise nevertheless.  It's the clicking sigh of cycling ventilators, the occasional ping of an alarm, or any of a thousand myriad things.  It's astounding how much noise it takes to create deathly silence.


Lying there in bed, his head canted back at an odd angle, kussmaulling away under his one-hundred percent O2 non-rebreather mask.  His eyes are already coated with thick gray-tinged film. 

"I just want him to be comfortable," she tells me.

"Comfortable --?  Good Christ," I think, "he's about as comfortable as a mollusk on a warm sea-bed; and with better than a hundred milligrams of morphine an hour pouring into him, just as aware."

This is our state of the art care for the patient nearly-dead of cancer.  The heart of the mechanism is already destroyed, consumed from within by malignancy.  All of the elegant beauty is gone now; the dancing laughter, the dry wit, the savvy business acumen --  All that remains is the relatively crass lizard hindbrain, rousing itself intermittently to make a half-hearted attempt at continuance. 


Still, for our part, we reckon that the patient still has a pulse and spontaneous respirations, labored though they may be, and are content to attribute life. 


I remember that I spent that night with a poem by Gerard Manley Hopkins running through my mind. 


Not, I'll not, carrion comfort, despair, not feast on thee;

Not untwist -- slack they may be -- these last strands of man

In me ór, most weary, cry I can no more.  I can;

Can something, hope, wish day come, not choose not to be.


Things might have been catching up on me, I think.



Shannon and Katy are sitting up here in the back room on my second floor while I'm writing.  Shannon is cranking through a science-fiction novel from my shelves at a furious pace, and Kate is looking at a comic-book.  There is intermittent conversation coupled with companionable silence. 

Last night, we went up to Royal's place and pretty much polished off his Chartreuse while making conversation over the view of the city.  Scheid managed to get away from the Trauma ICU for a small part of the evening to join us.

"What's that building with the sorta Roman-looking colonnades on the top of it over there?" Katy asked.

I looked over at Mike, and we started laughing simultaneously. 

"That's where me and Scheid work, kiddo.  Where I took you and Shannon for a tour of the E/R earlier today."

"Wow.  It's huge."

"Yep - sorta dominates the North Side skyline, don't it?"



I walk into the room after signing the chart in all the myriad places that require my chop.  The note on the triage-sheet says, "head hurts."  He was here about fourteen hours ago with the same complaint.

"What brings you in to see us this afternoon?"

"I was wondering if maybe you could give me twenty or thirty percocets so I can sleep."

"Ah.  I see."

I make several phone calls.  One is to the surgeon who the gentleman tells me is his primary doctor.  He relates that he has only seen the patient once, and that he believes the gentleman to be dangerously insane.  Another is to the clinic at another hospital where he was seen a few hours ago.

"Listen, I'm not going to give you any percocets."

"But my face hurts.  The doctor who I saw when I was here before told me that if it hurt I could come back here, and someone would give me percocets."

"How about that."  I flip through the chart from his last visit.  "You know, that guy's here right now.  I'm going to ask him about it, okay?"

"Oh, you don't need to do that.  He told me you would give me percocets."

I shake my head.  The various calls to assorted providers has eaten up way too much of my time.  He asks if he can go outside to have a cigarette while I make calls.  I tell him no, so he goes into one of our bathrooms and smokes there, which makes me realize that I'm an idiot.  He repeatedly comes out of the examination room and looms over the nursing station while I'm on the phone to tell me "just one more thing, doc . . ."  He is six feet, four inches tall.  He is morbidly obese.  He looks like he could become rather dangerous fairly rapidly.

I'm loosing patience. 

Back in his room I tell him, "Mr. Jenkins, I'm not going to give you percocets.  No one in this emergency department is going to give you percocetts today, tomorrow or next week.  I promise."

"You're tough, doc.  We're you in the Marines?"


"I'll bet you were.  You know, I'll bet I could tell you a lot about yourself . . . "

"No.  Try telling yourself this:  `he is not going to give me any percocets.'"

He looks bewildered, and tries again.  "But doc, my regular doctor is out of town for the next month, and I don't have anyplace else -"

"I just talked to the person who you said is your regular doctor.  He has no plans on going anywhere anytime soon.  Sign here.  You are now discharged.  You may leave.  Do not forget your cigarettes.  Good-bye."

He is almost out the door when a thought strikes him.  "Hey doc - can you give me a cab-voucher?"

"Where are you going?"

"Back over to Mercy Hospital."

"How did you get here?"

"Uh -- "

"No.  Goodbye, Mr. Jenkins."



Shannon & Kate are gone, having taken off to go camping somewhere in central Pennsylvania for the rest of thier vacation.  I'm on over-night tonight, which means that when I get home at eight a.m. tomorrow, I have the rest of the day to be worthless to my heart's content. 

Perchance to relax - read a science-fiction novel or something.  I've got to find myself a new apartment, so I might chase down some leads around North Side.  Maybe I'll even look at something which pertains to medicine.