The Blood of Strangers: Stories from Emergency Medicineby Frank Huyler
Reminiscent of Chekhov's stories, The Blood of Strangers is a visceral portrayal of a physician's encounters with the highly charged world of an emergency room. In this collection of spare and elegant stories, Dr. Frank Huyler reveals a side of medicine where small moments--the intricacy of suturing a facial wound, the bath a patient receives from her husband and daughter--interweave with the lives and deaths of the desperately sick and injured.
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THE UNKNOWN ASSAILANT
ONE WAS MIDDLE-AGED, BALDING, THE OTHER YOUNG, OVERWEIGHT, and both men screamed as they rolled in on the gurneys. We had no warning on the radio at all. The paramedics were urgent, moving quickly and breathing hard. Multiple gunshot wounds, they said, with unstable vital signs. They didn't have time to call it in; it was too close, they were too busy.
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 immediatelydeep 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 magnified, 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, andinto 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, filling 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 floor. 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 fluid, bruised, but miraculously alive. When I came to see him, before sunrise, I found a police officer 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 figure. "We think he killed at least two convenience store clerks last year."
The cop nodded. "Killed them both, after he'd got the money." He made a shooting motion with thumb and forefinger. "Right through the head. We've been after him for a year."
I vaguely remembered the crimefront-page news, CONVENIENCE STORE CLERKS SHOT DEAD BY UNKNOWN ASSAILANTand I looked at my patient as if for the first 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 filled 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 stow 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 figure standing in front of a cash register, his hand outstretched as if pointing at the men, then, very deliberately, two faint flashes, 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 fluid eased out of him, his thick black hair flowing 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?"
"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.
I HAD A 1972 MERCURY STATION WAGON WITH A CYLINDER gone, and at the end of that summer, when I left Boston for medical school in North Carolina, it pumped smoke all down the eastern seaboard, filling the rearview mirror with a blue haze. I felt like a slow rocket, sticking to the Naugahyde, sweat on my face, windows down, the back full of boxes and clothes.
It was one hundred degrees in New York, and on the Verrazano Narrows bridge, in a traffic jam, the needle rose off the top of the temperature gauge. On either side, the tenements, with men in undershirts at open windows, smoking cigarettes, still, looking down at the cars below. I turned on the heater full blast to cool the engine, and it must have been one hundred and twenty in the car. The world shimmered for a bit until at last the line began to move, and the sweet air came in through the windows, and I had chills.
I rented a small house at the edge of the college town, and I didn't own anythingan old car, a cat, a guitar, clothes, a few posters. The heavy, wet heat of the South, days in the dean's office, registering, writing my name, sitting still for the camera. In the evenings I made pasta and took it out with a beer to the porch, watching the thunderheads gather as my cat Tim rummaged in the dense undergrowth of the hill. After dark he brought home his mice and birds, like little wet clumps of cloth, and once he left a string of exact, bloody tracks across the linoleum floor of the kitchen to the couch in the living room. I was alone, I left them there for days, and when I finally cleaned them up the blood was dry, like powder.
The evening thunderstorms in Chapel Hill that summer seemed vast, beautiful, all deep bass and rain, and I lay in the dark listening to them. I would doze on the bed, then wake to more rain, and lightning, and water streaming out of the gutters off the roof. Then Tim would bang on the screen door with his paw until I got up to let him in, and he'd jump on the bed damp, purring, smelling like grass.
On the first day of anatomy, we stood in silence, staring at the bundle of greasy plastic on the gurney. My partner already had a black leather bag, a present from his family, with his name on the handle. He was small and dark, with brown hair and eyes, and he looked gentle. We wore new white lab coats, our hands did not yet smell of formalin, and I was trembling just a little, the fine hair on my arms rising in the air-conditioned cold of the room.
We introduced ourselves. "I'm Tony," he said. "It's nice to meet you." And the instructor unwrapped the body.
Our cadaver was sixty-two years old, and after a while, when we had gotten used to it, we cut around his tattoos and saved them, like a little pile of photographs which we left by his intact head. Mother. A red rose, and a woman's silhouette. The United States Navy.
When we reached it, the cancer in his lung felt like sand under the blade. I felt it in my hands long after the lesson was over. Foreign, gray like fog or gravel, there in the apex. It was strong and frightening, because even as we reduced him to pieces I knew that he was real, that he had stories to tell, that he had looked out at the sea from the decks of ships. I could feel it when I chose to. Mostly I chose not to. Mostly it was anatomy.
Three weeks later we carried his leg to the sink and washed the green stool out of the attached portion of his rectum. For the first time, it was too much, and I had to step outside, onto the high balcony. It was hot and still, and I held the railing, looking out over the pine forests that stretched for miles into the distance at the edge of town, knowing that I should go back inside. But I stood there anyway, emptying myself, until someone opened the door behind me.
"Are you OK?"
"I'm all right, Tony, thanks. I'll be there in a minute."
Meet the Author
Frank Huyler is an emergency physician in Albuquerque, New Mexico. He is a graduate of Williams College and the University of North Carolina at Chapel Hill, and his poetry has appeared in such periodicals as The Atlantic Monthly, The Georgia Review, and Poetry, among others.
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I read this book in one short sitting. Dr. Huyler presents his emergency room stories with a clarity that is remarkable. Even though the 28 stories are short (the book has only 160 total pages), they are packed with emotion. 'Sunday Morning' is particularly touching -- sad, but heartwarming at the same time.
If you liked 'Chicken Soup for the Soul', you'll love this one for sure; but my own experience working at the ER has taught me that poetry doesn't mesh very well with blood, pain and imminent death situations. I'm glad Dr. Huyler found a way to channel his stress in a positive way, but his somewhat empty prose leaves me quite cold. If you're looking for some good, interesting and serious tales about hospital medicine I recommend you 'Extreme remedies' by John Hejinian. In this, his one and only work of fiction, Dr. Hejinian writes a story that reflects the unadorned reality of this exciting but scary world, and even when the novel was first published more than 20 years ago, it's still actual.
This was a wonderful little book that touched on the many realities of emergency medicine...the triumphs, the failures, the bizarre things that can happen to human bodies and the unbelievable things that patients tell us. Anyone contemplating a career in medicine should read this for a realistic view of what they will be up against. It should be required reading in nursing and pre-med schools (and would be one of the most enjoyable of required readings).
i was given this book as a gift, by my best friend, who is now a doctor. he said 'here, this is what i do all day.' needless to say, i am quite impressed, and have adeeper understanding of his life and the lives of doctors. very recomended