Cook County Hospital was the biggest hospital in America, and at one point after it was built in 1916 had three thousand beds. There were twenty-five operating rooms on the eighth floor, which was the length of a city block.
The back of the ward on the sixth floor of Cook County Hospital had the sickly-sweet smell of gangrene mixed with Dakin’s solution.
It was early spring and the Frosties were coming in—homeless people who had frozen their feet in the brutal Chicago winter and were now being admitted because the problem had become life-threatening. The medical student ran ahead and pulled off the dressings so the residents could inspect the blackened, necrotic appendages and watch them demarcate, the natural process of forming a line between healthy and dead tissue that would determine at what level they had to amputate. For now, they had to decide who needed to go to surgery right away, and who needed more time on IV antibiotics.
“We are TOPS! Dontcha love it, Brad?” said Tom, the third-year junior resident, to his surgery intern.
“Tough On Pus Surgeons,” said Brad. “I gotta love it. You’re letting me do the next amputation, right?”
“Hey buddy, it’s all yours. Right after we take out this old boozer’s pancreas.”
Their sickest patient, Henry Dapper, was in a bed up front near the nurse’s station. He was so sick and had so many lines going into his veins and orifices that rather than transfer him to a gurney, they were set to take him, still in his bed, up to the eighth floor, right into the operating room.
The team gradually made their way through the sixty-bed ward, starting with the Frosties in the back; at the front, they arrived at Mr. Dapper. They couldn’t start from the front because the patients would “Hey Doc!” them on their return trip, remembering a symptom they had forgotten to share or begging for an increase in pain meds.
Mr. Dapper was their last patient on morning rounds. His chart formed three volumes and his diagnoses filled a full page. An intractable alcoholic with acute on chronic end-stage pancreatitis, he had been in and out of the hospital for years. A 5 percent alcohol and saline solution dripped into his central intravenous line. He had no veins in his arms or legs, just scars from his old heroin days, but an IV was essential. Without the alcohol drip, he was certain to go into delirium tremens.
“Hey, doc! I be painin’…you got somethin’ stronger than this shit they be givin’ me? C’mon man.”
Tom asked the nurse to give the man a small shot of morphine. He was so debilitated that a little too much could kill him. This dose wasn’t for the pain, though, but as a pre-op sedative. Dapper winced as she plunged the injection needle into the front of a thigh.
“Brad, finish here and meet us up in the OR. We should be done in a couple of hours. We’re gonna take our man’s pancreas out,” said Tom. He made a comical bow to Dapper who watched him curiously. Then he took the head of the bed and a med student took the foot, and they began wheeling the sick man toward the elevator.
As the morphine absorbed into his circulation, a big happy smile came to Dapper’s lips, and he said: “Oooh, yeah, that’s what I’m talkin’ ‘bout.”
“I can take care of those gangrene dressings for you, Dr. Rosedale,” said the nurse. “Why don’t you go on and take care of your other business?”
“You’re an angel, thank you,” Brad said, and strode to the stairwell to bound down six flights. Tomorrow morning he would bring the nurses a fresh box of donuts like he did every week. It was amazing how little things like that made life easier. He thought about Dapper, guzzling cheap rum and vomiting blood until his blood count was so low he had to be admitted. He thought of the Frosties; some would purposely sit on the sidewalk in sub-zero weather with no shoes on, not caring if they lost a foot or a leg, so long as they could get admitted to the county hospital where a bed and warm meals awaited them.
All the self-destruction, the pain, where does it come from? I became a doctor to help people, and they don’t want my help. The thing they most need is to be saved from themselves. Why don’t they care? The thoughts resounded in his brain, unsettling him.
He crossed a street and entered Karl Meyer Hall. He could smell the gangrene on himself as he went through the resident’s cafeteria line for a late breakfast. When he sat down with his tray, the shapely and lovely dental student he had met last week sat next to him. “Heya Brad, how are you?”
I hope she can’t smell the dead feet on me. “Okay, how are things?” he said, already with a mouthful of food.
Immediately, the phone number of the OR appeared on his pager. He called. “Dr. Tom wants you to go to the ward and get the amputation right away and bring him up.”
Mr. Dapper had died on the table. There were complications as soon as they started excising his pancreas, and he went into cardiac arrest. If they didn’t bring the next case immediately, they would lose the OR to another service that had a patient prepped and ready.
Poor Mr. Dapper. He had trained a lot of medical students and residents with his numerous medical problems. Now he would train a pathology resident who would autopsy the extensive damage wreaked on the man’s internal organs from many years of self-destructive behavior.
Brad got to do the below-the-knee amputation, which took under thirty minutes and produced a nicely shaped stump that would fit well into a prosthetic limb once it healed and matured. The stinky, blackened foot and ankle were taken away on a tray to be bagged and transferred to pathology. The amputation specimen would prduce more paperwork and be added to the pile of human body parts waiting for incineration. Brad was pushing himself hard to help his surgical team and be TOPS with Tom so they could impress their chief resident. His internship ended on the last day of June, and in Brad’s file, the chief wrote that he was the best intern he had ever had.
And all Brad did that year was try to help people hell-bent on destroying themselves.
* * *
Chicago was a glittering city of polar opposites, an incongruous melting pot of diversity where somehow everything that needed to be done got done. He loved the city, the energy, the way the tall buildings downtown looked from the El on a ride around the loop. There was even a little slice of Lake Michigan’s beach at Oak Street; in the summer, it reminded him of childhood trips to Long Beach.
The second post-graduate year brought what he wanted: nonstop orthopedic trauma and surgery. From the moment he hit the hospital at seven a.m. for intake rounds, to the moment he would head for the parking lot ten or twelve hours later, or thirty-six hours if he was on call, it was a constant stream of fractures, dislocations, gunshot wounds, tendon lacerations, and other musculoskeletal misfortunes. His rounds were much better than the general surgery rotation, where people seemed to go downhill for a variety of reasons. On the orthopedic service, even when they had put themselves in harm’s way, they could usually be fixed.
At the end of the year, he showed enough proficiency that the senior residents let him do some advanced surgeries with a medical student assisting. They kept it quiet from the director; fortunately, their boss was so buried in administrative work or supervising the Trauma clinic that the secret was safe.
“Looks good!” said the orthopedic chief resident, standing in the doorway of the OR, holding the film up against the bright overhead lamp. After Brad had fixed the ankle fracture fragments with screws and plates, they were so well aligned that the fracture lines were barely visible. “I like how you always get that plate bent just right to maintain the normal flare of the fibula. Are you measuring it with a goniometer, or what?”
eyeballing. He knew better than to say that. “I bend the plate then hold it up in front of the x-ray of the normal side and keep bending it until it matches.”
“Hey buddy, you’re good. Close up that incision and meet me in the lounge. Gleason’s here.”
Matt Gleason was their reconstructive spine surgery attending. Brad had watched him expose an entire thoracic spine and insert Harrington rods in less than three hours. The patient was a fourteen-year-old girl with severe scoliosis and a big rib hump. The problem with Gleason was that he wouldn’t let the residents operate; they had to assist him. But he was so good, they would fight for a chance to scrub in and hold a retractor.
Gleason had a big private practice, and rumor had it that he made over a million dollars a year doing spine surgeries. It wasn’t exactly a rumor. He told it to the Chief Resident who was asking about joining him in practice when he finished his training. Ever since that day, the Chief had walked, talked, and dreamed about becoming a rich spine surgeon.
After Brad wrote the post-op orders for the ankle fracture and checked that the patient could wiggle her toes, he went up to the lounge, but Gleason and the Chief were already scrubbing for a decompressive laminectomy for a spinal stenosis patient.
Surgery was over for the day, and the fracture clinic would start soon. It would be frantically busy and Brad needed to save his legs, so he got into an elevator and told the attendant to take him to the main floor.
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