Henry Rojelio, Day One

All she said was, "Doctor, he's turning blue." She spoke the words softly, quickly into my ear. I turned to look, expecting a grin. All I got, though, was backside, hurrying away to the exam bay, like a game of tag.

I've relived it a million times. It wasn't a game, it was a play. A stage whisper blurted by a vanishing actress. She knew her audience. She told me the patient was cyanotic -- cyan-colored, like ice -- but the delivery had its own message: I may be new here, but I'm not panicked. I've done this before; I'll do it again. On TV she would have stood up straight and tall in the center of the ER and ceremonially announced just short of a shout, "Doctor! The patient is acro-cyanotic. Come stat!" Writers love the word stat. Clinicians only use it when they're pissed off. Stat is Latin for "hurry the fuck up."

Anyway, that's how it started. Henry, Day One.

She got exactly the response she wanted. On cue, I thought, Bullshit. I probably snorted. Robin Benoit was a nurse. I knew well the common doctorly chauvinisms about nurses as diagnosticians.

In all the retelling, the reliving of the opening -- for the other doctors, the family, my closest friends, my parents, the police, the lawyers, and over and over for myself -- I have always admitted that I hesitated, though only for a few seconds.

Don't misunderstand me. I would never let a patient lie there starving for oxygen for even a millisecond, no matter whose ego is on the line. But I did not believe thirteen-year-old Henry Rojelio really could have been blue. Not ten minutes earlier he and I had had been talking about baseball and his crooked penis. He was not that physically sick.

Nor did my hesitation make one whit of difference. The record will support that. Five seconds was not long enough to have mattered. But the issue has never laid down and died.

Professional machismo looks lousy in the hindsight of self-recrimination.

I was on the phone. I ended the call, abruptly, then sat there with a vacuum-tube stare long enough to show that I wasn't impressed and certainly wasn't panicked either. This from the rules I'd learned early on: Never run. For punctuation I took a last gulp from my can of Squirt and made a point of finding my stethoscope. "Where's my fucking stethoscope?" I remember saying out loud. I was annoyed. Whether the patient's cyanosis is real or imaginary, it's a pain in the ass for all concerned. I patted all my pockets, then found it looped over my shoulders. All this may have added five seconds to the downtime. That could not have been critical. I sauntered after Robin. I didn't -- I wouldn't -- believe her. Five seconds.

Though new to me, Henry had been a regular in the Glory ER. His chart -- which I had dutifully read over -- was into its fourth volume. At his worst he was only a moderately bad asthmatic. When I listened to his chest on admission he was not all that tight, and he was getting over-aggressive treatment as it was. True "blue" was not possible.

I pushed open the door, smiling, stupidly optimistic that a doctorly presence would right the misdiagnosis and end the scurrilous rumors. It had worked before.

He was, however, lying oddly flat and straight, unconscious and limp, and by-God blue all right. And starting to turn a mottled gray, which is worse than blue, because it's what comes next.

I thought to turn around, not to run away, but to find the Resident-Who-Knew-What-to-Do. For almost all of my time tending patients, there had been somebody at least one year further along in training standing behind me, sheltering both the patient and me. Certainly I'd signed on in little Glory to be The Doctor, but I had hoped to avoid conflagration at least until the locals had come to trust me. I knew I was a good doctor despite anything they might have heard. They'd told me it was a quiet little ER in a quiet little town, and no one would bother me. Turns out, though, sickness is pervasive.

I was, I confess, paralyzed. Though not as long as they tried to imply. A second can seem so long. Panic, however ephemeral, looks bad. All my brain parts were going off at once, chattering and bickering. "Hurry, think, hurry, think, hurry, think." Robin, bless her heart, spoke, coaching me. "Is he breathing?"

I put the back of my hand an inch under the boy's nose, hoping for a tiny current or hint of warmth. Nothing was moving. Of course he wasn't breathing; that's why he was so goddamn blue. He was, though, a known malingerer. It said so in his chart. Maybe he was holding his breath. I'd heard mothers swear their children would hold their breath long enough to turn blue, but I'd never seen it. I didn't really believe it possible, but at that moment I was willing to believe in the Tooth Fairy if she could help. I dug a knuckle into his sternum, hard, and twisted it. It's one of the accepted bits of medical sadism we use to weed out fakers and wake up drunks. Henry, however, lay still.

He was dying or maybe already dead. He needed me to breathe for him. I looked for the bag. Every ER room in the world is supposed to have a breathing bag and mask in plain sight, ready to go, no glass to break in case of emergency. It's usually hanging on the wall by the oxygen outlet ...