Emergency

By Harvey Silverman

I had become a doctor, sort of. Graduation had at last occurred thus producing an MD after my name but with virtually no actual experience I hardly felt like a physician. I began my year as an intern with a combination of excitement, anticipation, anxiety, fear and insecurity. The uncomfortable emotions were only slightly mitigated by a serendipitous combination of good fortune, choice, and circumstance which had resulted in an internship in the Massachusetts community in which I had grown up and in which my folks still lived.

Within just a few months anxiety and insecurity had been gradually replaced with a sense of confidence and comfort, walks down hospital corridors which once would have found me figuratively slouched and close to the wall now were undertaken with a bold stride down the center of the corridor as if I had an important destination. The nurses who had at first seemed somehow annoyed by my presence now treated me with at least a veneer of respect. Some attending physicians who might have been initially brusque had imperceptibly become senior colleagues.

When it became my turn to spend a month as the emergency room intern I welcomed the duty. For that month I would have no night call rather that the every third night I had to that point spent at the hospital. That alone was reward enough, but the opportunity to be the first doc to see a patient before any senior house staff or attending physician would allow me to perform as a genuine practitioner rather than the lowest man on the pole to whom the most mundane tasks were invariably assigned.

The ER nurses were friendly and welcoming; they all had many years of experience and knowledge and they kindly and patiently allowed me to act as a physician while they taught me tricks and skills that were never a part of any medical school curriculum. When very ill or difficult patients presented there was help, senior staff or attendings, always nearby and accessible.

Fifty years later my memory of that month, indeed of the entire year, is for the most part an indistinct and foggy blur but there are two patients from that time in the ER who remain clear in my memory.

* * *

His name was a common and mainstream one but never used. He was known by his nickname, appropriate for his character and reputation. He was an intimidating and threatening sort who I first encountered years earlier in eighth grade; I and my friends generally hoped to avoid him but one day standing in the line for lunch he was just ahead. For some reason water pistols were momentarily popular and I had brought a small one with me to school and took it from my pocket to show my friends.

He saw it and coldly and ever so matter-of-factly said, "Give that to me."

Which I immediately did. He looked at it, placed it in his pocket and turned away. Of course I never saw that toy again.

Four years later I was playing high school football and as usual relegated to the bench. He was on the team, naturally a starter, tough and strong and nasty. I had little interaction with him which suited me quite well.

One day in practice Coach had the team form two lines for a certain one-on-one drill in which one player would line up opposite another and at the signal both go forward and each try to overcome the other. Naturally while waiting one would count the players ahead and see with whom one would be matched up.

I counted and saw it was he. He was of course much better than I but I immediately became excited. Somehow I thought if I could get the better of him this time, just this once, that would count as justice, as retribution, yes, even a sort of revenge.

As I slowly moved toward the front of the line, the sound of pads smashing against one another and the grunts and exhortations merely a background noise, I focused on the task I had assigned to myself and became even more determined, more certain that this time, this one time, I would come out on top. Now I was there, at the front of the line, my concentration acute and my confidence complete.

I got down into my three point stance across from him, our helmets inches apart. I was more focused, I thought, than at any time in my life. There was no doubt that I would best him. At the earliest sound of Coach's whistle I fired out forward with all my strength, my form perfect, certain I had been first off the ball.

He punched me in the face.

He said nothing, I said nothing, Coach said nothing. I walked back to the end of the line, thinking that he really was pretty good to have been able to do what he had done. We wore those 1960s style helmets with the single protective face bar across the front but somehow he had been able to get his fist past that to strike just below my eye.

When I got home after practice I had an obvious black eye which naturally prompted my mom's concern and a question as to what happened.

"Nothing."

It was an ordinary day so far for me in the ER. I picked up the chart of the next patient to be seen; a construction worker who while at the job site had something blown into his eye by the wind. That was a straightforward enough case and as I walked toward the room I looked at the patient's name.

Wow. His name. I wondered if it were he. It was certainly a common name but the age was right. I walked into the room and there, lying on his back on the examination table, his eyes closed, was my bete noir.

I introduced myself as Dr. Silverman, and neither of us gave any hint of recognition of the other. Standing at the head of the exam table I everted his upper lid, a simple maneuver the protective ER nurses had previously taught me but one which to the lay person appears to require deft skill. Sure enough, under the lid just where it should have been was a small foreign body which I easily removed with a swab.

His symptoms were immediately gone. A quick examination revealed no other eye injury or complication. I wrote a brief note on his chart, handed it to the nurse who would review with him his instructions, and wordlessly walked out.

Balance had been restored. A more profound justice had been rendered. I have never seen him since and have no clue as to his fate after that day.

* * *

Interning in my home town had in reality made little difference to that point. The physical, intellectual, and emotional demands of the position left neither time nor energy to visit familiar places and I had not even seen my folks and had hardly spoken with them.

A few days later all was going smoothly in the ER when an ambulance quickly pulled up and the attendants ran in with the patient, a pedestrian who had been struck by a car. There were no signs of life and a "Code Blue" was announced over the hospital's communication system.

By then I had participated in a number of resuscitations but those had all involved hospitalized patients with medical problems. An acute trauma case such as this was a new challenge and my body immediately squeezed out extra adrenalin as I hurried to the patient.

Fortunately it happened that at the time a couple of senior house staff were already in the ER for one reason or another and they immediately took charge of the patient while more doctors, nurses, therapists, technicians and the like, hearing the Code Blue, quickly arrived. I was trying to make myself somewhat useful but there was nothing for me to do with so many staff already there. I for the first time glanced at the patient's face. A brief glimpse.

She was a middle aged average sized female with blonde hair. The large amount of blood from a scalp laceration and the general traumatic results obscured her features somewhat and it had only been a quick glance but she appeared familiar.

Was that my mom?

I immediately felt my heart skip and then race. I could not bring myself to look at her more closely or at all for fear of what I would see. I slowly moved away toward a wall and then quietly walked out of the room and headed to the basement and the on-call rooms we used when covering the hospital at night. Weak, lightheaded, a bit nauseated I went into the first one. In the middle of the day it was unoccupied. I picked up the phone, got an outside line and forced myself to remain as calm as I could. I dialed my folks' home. The phone rang. And rang.

Finally. "Hello."

"Oh, hi mom, I had a couple of minutes free and just called to say hi." I had never done that before while working and my mom wondered if everything was okay. I assured her things were fine, can't a guy call his mom, and I had to get back to the ER.

"Bye."

I sat on the bed for a few minutes, regaining my self-control, and then walked back upstairs to the ER. The resuscitation attempt was over. The patient was dead. Her body had already been removed.

Originally appeared in Slab.