The Blood of Strangers: Stories from Emergency Medicine

First Chapter

I took the young one. He lay soaked in sweat, with a blue-red hole in his neck. "I can't move my feet," he yelled, over and over. "I can't move my feet."

The volume of his shouts was like a physical force in the small space. We hung blood immediately -- deep red, the icy drops tumbling into him as he grew quiet, and his face settled into the mottled blue mask I'd seen so often in that room.

On the X ray clipped to the board, the bullet appeared magniÞed, white against the grays of his chest, just under his heart. As we ran to the operating room, the gurney humming like a shopping cart down the hall to the elevator, I heard the nurse on the phone behind me. "They're coming up right now," she said. "Get the room ready."

In the elevator, the slow minute of quiet, he looked up at me, and I felt his hand on mine. "Please," he said, like a small child beginning to cry, "I don't want to die. Don't let me die."

"You're not going to die," I replied, thinking he might very well. "We'll take care of you."

The bullet had clipped his aorta, torn through one lung, through the diaphragm, and into his belly. He lay on his side, his chest split open, while the surgeons struggled and cursed. With both hands I held his beating heart out of the way so the surgeons could see. His chest was like a misshapen bowl, dark and rich, Þlling again and again.

"Jesus Christ, this guy is making us work," Rosa, the surgery resident, said, scooping out handfuls of clotting blood which slid off the surgical drapes onto the þoor. Sweat beaded up on her nose above the mask, then fell, drop by drop, into the wound.

There was so much blood they couldn't see what they were doing, putting in dozens of misplaced stitches until some began to stick, and the bleeding slowed to an ooze. He was cold by then, despite the anesthesiologist's best efforts and the heat turned all the way up in the room, his blood full of acid and losing its ability to clot.

"OK," Dr. Blake, the attending surgeon, said, "We've got to stop and just hope he doesn't break loose."

It was a long night in the ICU, transfusing him with unit after unit of blood and plasma. Toward morning he was no longer recognizable, swollen from the þuid, bruised, but miraculously alive. When I came to see him, before sunrise, I found a police ofÞcer sitting in a chair reading a magazine. The policeman yawned when he saw me, put down his magazine, and came out to talk.

"He's a bad one," he said, gesturing to the monstrously distorted Þgure. "We think he killed at least two convenience store clerks last year."

"Really?"

The cop nodded. "Killed them both, after he'd got the money." He made a shooting motion with thumb and foreÞnger. "Right through the head. We've been after him for a year."

I vaguely remembered the crime -- front-page news, "Convenience Store Clerks Shot Dead by Unknown Assailant" - and I looked at my patient as if for the Þrst time. He didn't move at all, letting the machines do their work.

I learned the full story from the other wounded man. He was not my patient, but that morning I went to see him anyway. Ray Solano, lying down the hall, had been extraordinarily lucky.

He was wide awake, off the ventilator, and he looked up with a start when I came into the room. He'd been hit once in the chest, but somehow the bullet had followed a rib around and out the back without hitting any vital structures. He would be leaving the ICU shortly.

"Mr. Solano," I said. "I'm sorry to bother you so early. How are you feeling?"

"Alive," he replied, shaking his head, extending his hand. We shook, even though I'd done nothing for him.

"What happened?" The man looked at me, and I realized that he was going to cry.

"I knew he was going to do something as soon as he came into the store. He asked me for a job, and I told him I wasn't hiring." Mr. Solano looked up at the ceiling and took a deep breath. "Then he asked where my safe was, and I saw that he had a gun in his hand. I told him it was in the back, and then he just shot me. Right away, without asking anything else. I knew that he was going to shoot me again." He looked away, crying in earnest now, and I stopped asking questions, apologized, left his room.

The nurse Þlled me in. "He knew he was going to get shot again," she said, whispering. "That guy" -- she gestured down the hall -- "dragged him to the back, where the safe was, and told him to open it, and he went for the gun."

I imagined that struggle: middle-aged Ray Solano, already wounded, wrestling a much younger man, somehow turning the gun on his attacker and pulling the trigger, then staggering to the telephone. "There was blood all over the place," the cop had said, "like someone dragged it down the hall with a mop."

That night I saw my patient on TV. It was the lead story on the local news. A clip of the crime scene with ambulances, and then the smoky, black-and-white surveillance tapes of the previous murders: an overweight, unrecognizable Þgure standing in front of a cash register, his hand outstretched as if pointing at the men, then, very deliberately, two faint þashes, puffs of smoke, into their faces. They dropped like stones, the whole scene strange, distorted by the small wide-angle lens of the camera, like looking into a jar of water.

Over the next few days my patient began to wake up and was taken off the ventilator. I went to see him each morning, and he began to turn his head toward me, open his eyes. He started to look human again as the þuid eased out of him, his thick black hair þowing to the curve of his brown shoulders. He began to speak, to ask the nurse for ice, and within two days it was as if a light had come on; he was alert, back in the world.

"Thank you, sir," he said, intelligent, as I stood above him. "Thank you for saving my life."

"I didn't save your life," I replied. "The surgeons saved your life."

"That was you in the elevator, wasn't it?"

"Yes."

"I remember you."

Then later, quietly: "Do you think I'll be able to walk again?"

"I don't know. It's too early to tell."

He was unfailingly polite. He thanked me whenever I came into the room, speaking in a curiously childlike voice. I found myself drawn there, doing things for him: adjusting his pillows, bringing him a glass of water. There was an aura about him that fascinated me, a presence that the nurses also commented on. He seemed guiltless, unburdened by the act; his relief on learning that his victim was alive and would leave the hospital was real. It meant one less murder charge to face. The evidence of the others was not overwhelming, and he knew it. As did the police.

"That bastard might get off," one said, shaking his head. "It's a fucked-up world."

"Hello, Dr. Huyler," he said every morning, smiling at me, dark-eyed, his hair unkempt and thick against the pillows. There was knowledge there, and I was glad, even as weak as he was, that he meant me no harm, that I was not Mr. Solano, alone in the store and unready.

Each day I helped him get better.

x x x x x x x

0520218639|2|Through the Dark, Softly

I couldn't believe William was alive. He was like someone out of the past, weary behind the barbed wire, blinking at the Allied soldiers at the gates. He was in his early forties, and all he did as he lay on the hospital bed was chew pieces of ice. After a while I came to identify that sound--the crunch of teeth on ice--with him. He was calm, alert, and he wanted only one thing now. This was why he was here, back home after all the years in Atlanta.

"Is there anything I can do for you?" I asked, after I shook his hand on the day we met. I was still a medical student then. I wouldn't be as open now.

"Yes," he said. "You can give me two hundred milligrams of morphine all at once."

In the silence that followed he smiled. "It's a joke," he said weakly, turning his head to look out the window.

It was springtime, with the dogwoods in bloom on the immaculate hospital grounds, and I often found him looking out at the gardens beyond the parking lot. Cars came and went, sun þooded the windows, nurses entered his room smelling of fresh air, and he lay quietly, watching all that life pour by and continue. In the late afternoon thunderheads gathered, and he looked forward, he said, to watching them.

His family didn't know what to make of him, what to do or say, but they came to see him anyway: his father and mother, in their mid-sixties, from a small town nearby, and his sister, strained, cheerful, who always wore ofÞce clothes. They sat by his bed, all three of them, and made small talk. Parties they'd been to. A wedding. The MacGregors selling their house and moving to Florida, who knew why. A card from the congregation, prayers from the neighbors across the street. "Oh, yes," he said. "I used to cut their lawn when I was a kid. That was nice of them."

Later, after they'd gone, he talked to me. Neither of us had much else to do that month. "My mother and father haven't really accepted that I'm dying," he said. "I just don't know what to say to them. They'll always remember it. I have to be so careful."

But it was impossible not to believe he was dying. His parents and I had discussed it. They wanted to know how long. "I really don't know," I said. "It could be a few weeks or it could be a few days. I'm sorry."

His father had started to cry then, and had tried to hide his tears from me. "My husband is an upstanding man," his wife said, after he left the room. "He's gone to church every Sunday his whole life. He prays for his son every night. He just doesn't understand why this is happening."

Later, his sister took me aside. "Mom and Dad don't really know why William left home for Atlanta," she said. "They couldn't understand why he wanted to drive a limousine in Atlanta instead of going to college. I couldn't tell them." She paused, looked away. "Or maybe underneath it they did know. I guess it doesn't really matter now." Then, after a silence: "Yesterday my mom said he looked exactly like Christ on the cross. It's true, don't you think?"

One afternoon, as I went into his room, a thunderstorm was raging outside, the kind of thunder you feel deep inside you, with lightning white through the window, wind whipping the tops of trees by the parking lot, and then the rain, a gray curtain sweeping over the cars until the window hummed with it, the gutters overhead like fountains.

"It's great, don't you think?" he said, turning to me, smiling, lost in the moment. "It's beautiful." A few people ran across the parking lot for the safety of their cars, and headlights came on along the far road. In a few minutes it was over, the sun shining again on the drying pools that littered the sidewalks and black asphalt.

"You know," he said, "when I was in Atlanta I saw this slide show by this famous performance artist. I forget his name. Anyway, he covered a parking lot with broken glass. It was at night, and he had all these þuorescent lights up, so they reþected off the glass. Do you know what I'm talking about?" I shook my head. "Well, he crawled across the parking lot. He was naked, and he crawled across a parking lot covered with glass. And then he had photographers take pictures of him. When he stood up he was covered with blood, only it looked black under the þuorescent lights. Do you know what he called the piece?" I shook my head again. "'Through the Dark, Softly.' That was the name he gave it." He laughed.

"I was always sorry I never went to college," he said, after a little while. "But now I don't think that guy knew what he was talking about."

A few days later he decided to stop eating. No food, just water, morphine, and ice chips. What's the point, he said. It was the Friday before Memorial Day weekend, and I had three days off. I told him I'd see him when I got back.

He looked up at me. "Be careful driving, Frank," he said. "There are lots of accidents on Memorial Day weekend. I wouldn't want anything to happen. You have your whole future ahead of you."

I shook his hand, I thanked him, and just before I left I took him in my arms and lifted him to a more comfortable position on the pillows. He was too weak, too light, to move on his own, and I could pick him up without effort.

"You should probably wash your hands," he said when I was done, and I did, at the sink in the room, letting the surgical soap and hot water cover my hands and wrists, my bare forearms and elbows. The water felt good there.

As I walked to the door he stopped me again. "If I don't see you when you get back," he said, "thanks for everything you've done."

"I'll see you again, don't worry."

"No offense," he replied, "but I hope you don't."

And Tuesday morning, as I opened the door to his room, I could feel it. I knew what I would Þnd. There was a Þgure on the bed. Beyond, through the window, the poplar trees dipped and swayed, full of sunlight and wind. As the door closed the Þgure sat up and turned toward me: a young man, his face handsome and full, with dark brown eyes, startled, as if woken suddenly from sleep.

"I'm sorry," I said, as I stood there staring at him. "I must have the wrong room."