Forty years ago, I was the chief surgical resident on a surgery unit in a prestigious university hospital. As first assistant, on a chest case that morning, I prepped, draped and positioned, on the operating table, a forty-two year old female patient for a major lung resection. She had a huge tumor in her left lung. The operation, proposed by the attending clinical professor, was a heroic attempt to remove the lung and the tumor before it took her life.

I developed a rapport with this young woman when I did her admission history and physical exam. In the three-day interval of preoperative evaluation and workup, prior to surgical intervention, we had become close friends, and this is unusual, as resident doctors don’t generally develop personal relationships with patients. Nevertheless, we connected for some unknown reason, and became good friends. I met her three teen-aged children and her quietly apprehensive husband. The entire family and the patient put themselves in our hands in our desperate attempt to save her life.

The operation began without incident and things were going well and after entering the chest cavity, the senior surgeon began the lung dissection when she suddenly suffered a cardiac arrest. Her heart just stopped beating; for no apparent reason. It just stopped. We had done only minimal dissection and disturbed little of her cardiac anatomy. Her heart just stopped beating. Immediately her blood pressure fell to zero and blood flow to her vital organs ceased as her heart stopped pumping on its own.

In itself, cardiac arrest during a chest operation does not cause panic, for during a lung operation, if cardiac arrest occurs, the heart is squeezed manually to maintain blood flow and blood pressure until the cause of the cardiac arrest is determined and corrected. Blood flow to the vital organs, the brain, the kidneys and the heart itself is maintained by the manual open cardiac massage performed at the table. Usually normal cardiac function resumes when the cause of the arrest is corrected. As the first assistant standing directly across from the professor, I had immediate access to her now quietly lifeless heart, right at my fingertips.

I began rhythmically squeezing her heart with my right hand to maintain her vital signs and blood flow until we could right whatever was wrong. The anesthesiologist immediately switched off the anesthetic gases and administered pure oxygen via the tube in her trachea.

But, why had her heart stopped beating? We hadn’t a clue. It just stopped. We went through the standard checklist. Lab tests, blood gases, etc.—all within normal limits. We could find no apparent cause for this suddenly catastrophic cardiac arrest. Her heart remained lifeless and unresponsive to the cardiac stimulant drugs the anesthesiologist immediately administered intravenously, as I continued to massage the lifeless organ, maintaining blood flow to her vital kidneys, heart and brain. We tried shocking her heart with the sterile defibrillator paddles placed directly on the heart. Once. Twice. No go. No response.

Her heart remained unresponsive to the electrical shocks. I continued to massage and pump blood through the persistently lifeless heart. We tried injecting cardio-tonic drugs directly into the heart itself; again, with no result. Repeated shocks with the defibrillator paddles had no effect. I continued to massage the flaccid heart during these machinations.

She suddenly opened her eyes. With no anesthesia and breathing pure oxygen, she awoke on the operating table, her chest wide open and a tube in her windpipe. She looked directly into my eyes as I continued to massage her heart with my right hand. Our faces could not have been more than two feet apart.

I lamely tried to explain. “You have a breathing tube in your windpipe through your larynx; your voice box, and this is why you can’t talk while the tube is in your throat and we’re breathing for you. Everything is under control for right now. You have had a cardiac arrest. I am massaging your heart to temporarily maintain blood pressure and flow until we can correct things and get your heart restarted. Do you understand me? Blink once for yes if you understand.”

She blinked once.

“Are you having pain? Blink once for yes and twice for no.”

She blinked twice. Good. No pain.

“Close your eyes and try to rest. We have things under control.”

She blinked twice. She was apprehensive; justifiably so and continued to stare intently, directly into my eyes, terror stricken. I tried to look busy and break eye contact but my gaze returned repeatedly to lock onto her frightened, widely staring, frightened eyes.

We continued investigating the cause of the arrest. The professor used every means available and every drug he knew that might help get her heart started again. Nothing worked. We shocked and re-shocked the unresponsive heart. We repeated the cardiac stimulants both intravenously and directly into the cardiac chambers. Nearly two hours had gone by. I continued cardiac massage, switching from right hand to left hand periodically, as the impending cramped and muscle weaknesses of my arm and hand dictated. I refused multiple offers to spell me at the table as I massaged her heart. I could not break eye contact. I could not quit massaging her heart. She continued to watch me, apprehensively staring intently at my every move as we desperately tried to restart her heart.

We called the internal medicine cardiologist into the operating room for his consultation, suggestions and opinions. He could offer nothing more than we had done. Another cardiothoracic surgeon was queried. He too, was of no help and offered only his commiseration. She continued to stare into my eyes as I continued to pump her inert, motionless heart, temporarily maintaining her circulation to her brain and heart. She could hear us talking and discussing the situation. She sensed our frustration and inability to rectify her cardiac arrest. She began to realize how hopeless the crisis had become. I’m sure she was now completely aware of everything that was occurring and the potential consequence.

We’d been at the operating table for more than three hours. My right hand and forearm had begun to cramp badly and I’d switched to the left hand and then again back to the right to maintain a rhythmic pumping action. Several others at the table insisted they spell me, but I couldn’t break the eye contact with her. I wouldn’t quit. I couldn’t quit.

She too, was getting tired. She couldn’t speak and she was now less attentive to our frustration and our mounting sense of futility. Her eyes began to wander and her eyelids began to droop. I continued the cardiac massage. Leaning closer, I whispered, “We’re doing everything we can. We’ve tried everything. Your heart refuses to start. We’re not giving up, though, but things do not look good. I have sent word to your family about the problem and they are aware.”

I sounded ineffectual. And I was. And we both knew it. Still, I felt she should be aware of the desperate nature of her condition and be appraised of our efforts and our refusal to give up. But she could sense our anguish and the now pervasive hopelessness at the operating table and in the entire operating theater. The senior surgeon, who is always the final arbiter, finally said, “It’s time to quit. We’ve done everything. We can do no more. Stop the massage.” The anesthesiologist nodded in affirmation. She understood. She looked deeply into my eyes, blinked once for yes, and then wearily closed her eyes. Peacefully. She gave me permission. Permission to quit, closing her eyes for the last time.

“No. No. We can’t quit. We can’t. I won’t. No. NO!” I was adamant.

They had to forcefully pull me away from the operating table. Tears were streaming down my face. I turned and stumbled from the operating room, still in my bloody gown and gloves. I remember little of the next hour or so. They found me in the chapel an hour later, still in my blood stained gown and gloves. I could barely speak and was numb with grief. The tears had ceased.

Surgeons can’t let themselves get too close to their patients, emotionally. Good judgment calls for objective assessments of the patient’s problems and impartial decisions. Personal attachments only confuse and obscure what is best for the individual patient. Emotional attachments to a patient may deleteriously influence surgical decisions and appropriate treatment. But sometimes… Sometimes, emotional involvement is unavoidable. She gave me permission. I think she did. I‘m sure she did. God help me, I hope she did.

“Here we are. You first, young lady.”
“Thanks. Chivalry isn’t dead after all.”
At the ornately carved mahogany stained door, one of the men pushes a button and they wait. The door opens a crack and they are greeted by a liveried black doorman. Short, wiry with pomaded hair and reeking of aftershave lotion, he is the proverbial milk chocolate color of mixed race parents. Bowing and smiling courteously, he swings the door wide and proffers, “Good afternoon, ladies and gentlemen. Welcome to The Club.” He looks like Sammy Davis Junior in his tuxedo and black tie. “I’m Oliver and I’m here to serve as well as meet and greet.”
“Go right in Miss. I know you. And, Mr. Andrews; good to see you again. And you sir?” he said, turning to me.
“He’s my guest Oliver. I can vouch for him. He’s from Guardian on the fifteenth floor. I do business with them. He’s Okay and is good to go.”
“If you say so, Mr. Andrews. Wait here, please sir. You’ll have to be vetted by Mr. Carter.”
I stroll down the foyer surveying the artwork on the walls as I wait. “Pretty fancy place you have here Oliver. Several of these paintings are originals. You must do a good business,” I remark.
“We manage. Yes, we manage, sir. We try hard to serve you and yours.”
As Andrews proceeds to the lounge area, he whispers under his breath so that Oliver can’t hear, “See you inside after you’ve been vetted by Carter. By the way, once more, what’s your name again?”
“I’m Squires. Karl Squires. I’m with Guardian Associates.”
“Got it. You’re gonna’ like The Club.”

“Here’s Mr. Carter now. Mr. Carter this is Mr. Squires, an associate of Mr. Andrews. He’s with Guardian on the fifteenth floor,” says Oliver officiously.
Carter is black. Really black — the dark chocolate black of a Caribbean heritage with a lilting accent to match. He sports a huge diamond stud in his left earlobe and a cat’s eye pinkie ring on his right hand. Black Belgian shoes complement his tailored ecru Italian silk suit. His frown is intimidating, but his manner is suave and smoothly oleaginous; he feigns obsequiousness and subservience but he emanates a threatening, ominous ambiance. A bulge beneath his left shoulder suggests a weapon.
“So nice to have you join us. How did you hear of our organization?”
“Oh, the word is circulating in the building about your rather unusual relaxation spa.”
“I know your company, Guardian. Welcome to our premises. Can I see some identification?”
“Here’s my card. Will a driver’s license do?”
“Your business card is enough if you’re a friend of Mr. Andrews and work here in the building. How long have you been with Guardian?”
“Seven years. I got transferred to Mobile, seven months ago, from Atlanta.”
“Your card looks Okay. Go right in. I’ll have a visitor’s pass printed up for you today.”

Kurt entered the lounge cautiously. The pungent odor of marijuana was pervasive. The smoke, in the dimly lit room made it as hard to see as a foggy morning in a delta bayou. Through the haze he could make out at least a dozen overstuffed chairs and couches occupied by people using bongs or smoking hand rolled joints. Several were using ornate Turkish water pipes as they lazed back in the comfortable recliners. Most appeared sleepy, tranquil and dreamy.
By golly, the tipster was right. This is a dream house. It’s not a crack house, I thought to myself. Right here in downtown Mobile. In an executive office building top floor penthouse at that. They all seem to be high rollers too; whales, executives or top businessmen; many from right here in the building – no one would believe this set up – it’s perfect for them and right under our DEA noses.

“What’s your pleasure, Mr. Squires?” said Carter as he approached me. “There’s a self-service bar with liquor on the far wall. Here at the smoker’s kiosk we have lots of choices. Let me recommend some of this Turkish Black or the Mexican Gold. This south of the border product is absolutely high end stuff. Some munchies are on the table.”
“Thanks for your help and advice. I’ll try the Mexican. Put it in a bong for me, will you?”
“As you wish. Most of us here just help ourselves but since you’re new, I’ll assist.
By the way, the dues are paid monthly – cash only. You’ll be billed in addition for whatever you use. No credit cards. Cash only. We will give you an ID number. We don’t use names here for reasons you are well aware of I imagine. Just sign for what you use here on the register in the kiosk. ”
“I got the idea. Pass that bong over and I’ll take it from there.”
Easing down in a leather recliner, I took a hit from the bong and waited.
Whoa, this stuff is tough. Made me dizzy already. Not used to the pot the high rollers use. It shouldn’t be too much longer I mused dreamily. They’d be here in short order.
I could see Andrews and the young secretary on a corner loveseat, heads together, amorously whispering to one another as they shared a smoldering Turkish water pipe.

In just minutes, Carter strode over and sat down next to me. His brow was wrinkled and he looked troubled. As he leaned forward his coat gaped open. I could see the huge menacing automatic pistol in his shoulder holster.
“I’m concerned about you. You say your name is Kurt Squires. Right?”
“That’s right.”
“Then why the initials AKM on your briefcase?”
“Uh. Well… I use this briefcase at times. The owner’s name is uh… Adrian Martin. Adrian Kurt Martin. My name is Squires. Kurt Squires, but I use Adrian’s briefcase now and then. I work with him.”
“Sure you do mister. But I don’t think you belong here. I just talked to the Guardian home office people in Atlanta. They tell me you’ve only been with them for ten days.”
“No. That’s not right. I’ve been with them for seven years. There’s been a mistake.”
I can’t verify you or your story. I want you outa’ here right now. Don’t ever come back and I wouldn’t recommend you speak to anyone about our club facilities. Oliver can be ugly if he has to be. He’s a black belt and he’s been known to hurt people. Let’s go. Out. Now!”
“Okay. Hold on a minute. I have to use the facilities first and then I’ll go.”
Acquiescing, Carter nodded toward the men’s room in the far corner. “Over there.”
“Use the john. I’ll wait for you at the door. Go do your business.” He obviously wasn’t fooling.
Entering the men’s room, I slipped into a stall. Flipping open my cell phone, I dialed the waiting Swat team’s number.
“Better hit ‘em now, Ed. I’m in the men’s room. They’re on to me. I blew my cover; forgot my assumed undercover name. They tumbled to I’m not who I said I was. Come in blazing. Better make it quick. I’m worried about this Carter guy. He’s packin’.”

The DEA team broke in. A flash-bang smoke grenade bounced into the lounge and exploded, astonishing and bewildering the stunned smokers. The black clad, swat team, guns waving, bellowing and shouting, burst into the lounge. The startled and confused patrons could only stare dazedly, like the proverbial deer in the headlights. Carter, taken completely by surprise had no opportunity to use his weapon.
The leader of the DEA team yanked the men’s bathroom door open and called, “you in there Adrian?”
“I’m here. That you Ed?”
“Yeah, it’s me. You okay?”
“Sure thing. Just a little confused. Had to smoke some of that Mexican Gold.”
“Adrian, you’re too old to be hitting a bong or smoking that high end stuff.”
“You’re damned right about being too old. I forgot my undercover name.”
Dangerous, when you blow your own cover, you know.
It just may be time to retire.

There! Wait, over there–to starboard. There in the distance was the wake of a ship. A carrier. Must be her, my carrier, my home base and hopefully, there would be Mother standing on her fantail waiting to bring me in. I dropped down to sea level, leaned up the gasoline mixture and throttled the engine down to conserve fuel. I was concerned about running out of gas and having to ditch in the black, threatening ocean. The needle was near empty. They would never find me in the dark if I ditched in the ocean at night.

I followed the wake of the carrier until I was only a mile from her stern. Breaking radio silence, I called for help. Breaking radio silence was a real no-no; there were enemy submarines in the vicinity. “This is Red Fox leader. I’m desperately low on fuel, have a damaged aircraft and will need some deck illumination for a night landing. This is an emergency. I request a priority landing as I don’t have the fuel to proceed into a standard landing pattern.” The sun had already set and no moon was visible behind the cloud cover.

No reply. Nothing. Was my radio working? Didn’t they hear me? Why no reply? Again I attempted to raise the carrier. “Red Fox leader attempting a landing with a damaged aircraft low on fuel. Please give me thirty seconds of deck light that I might make an emergency landing.”

And again, no reply. Silence. I thought to myself, under no circumstances am I going to ditch in the ocean. They’ll never be able to find me in the dark. I’d rather crash on deck than ditch and drown in the sea. I continued my approach toward the fantail of the carrier as I began the landing checklist in my head. Wheels down. Flaps down. Hook down, Canopy back. Seat restraints loosened for quick exit. Throttle back. The plane began to flutter and waver just maintaining enough speed to prevent a stall. The engine began to miss and cough. I was running on fumes.

As I approached the stern, there was Mother, the landing officer with his paddles, frantically waving me off a landing. The landing officer is responsible for deciding if a landing aircraft is “in the groove”, and is capable of landing safely. A fiery crash on deck can jeopardize the entire ship and its crew and it is Mother’s responsibility to allow only safe landings. He waved off any plane that might crash and burn if it threatened the safety of the ship. It was drummed into us in flight school that one never questions or disobeys Mother’s orders; in this case, a “wave off “of an attempted landing. Never sass yo’ Momma.

Waved off landing, I was not sure if I had enough fuel to do a turn around; I gunned the throttle and banked to port, avoiding the carrier’s bridge island as I again lined up with the wake of the carrier. It was black as the inside of a burned out gun barrel. On the radio, I announced, once more, “I’m coming in momma, wave off or no. I will not ditch in the sea. I can’t swim. I have enough fuel for one more try and I’m going to land or crash on deck, one way or another.”

The engine began missing and sputtering as I throttled down. Wheels down, Flaps down, Hook down, Canopy back, Restraints loosened, I approached the carrier’s stern. There was Mother, again waving his landing paddles frantically, trying to wave me off. As I cleared the stern, just ten feet off the deck, the engine sputtered and quit. The Avenger flies like a brick when she loses power and I dropped heavily to the deck. My plane bounced once as I missed the first and second restraining cables. My tail hook caught the third wire, jerking to a stop just in front of the barrier at the end of the flight deck.

Perspiration beaded my forehead and face as I pulled off my helmet, goggles, oxygen mask and throat radio as I stood up in the cockpit. I thought to myself, Thank you Lord. I’m down. I’ll probably get a court martial for disobeying Mother’s wave offs and orders not to land. Yet, just possibly they’ll give me a commendation for a difficult night landing and saving this pilot and this aircraft. Not likely, but just maybe.

At that moment, a man in a yellow garrison cap bearing the rising sun red ball of the Japanese Navy, scurried from under the wing, looked up smiling toothily and said,

“Ah so, American Pilot, you make a very good night landing.”

Just an afterthought; forgo the flowers. Send a donation to an obscure charity.

I wrote to Boo several weeks ago. My best friend on the mainland.

His wife replied with a short note. And there it was… In lieu of…

I searched the papers. No notice. Nothing in the newsletter.

Nothing on the networks, the internet or cable. Google – nada.

Yet, there it was. Surprise.

Abstain from the accustomed. No flowers.

Strange. Too soon. It wasn’t his time.

A favorite of mine. Loved and esteemed. And now, just no flowers.

An error? Maybe. Not likely, though. Possibly a mistake? Improbable.

A lie? Couldn’t be. No reason to prevaricate.

A joke. That would be sick. No one would do that; I hope.

How to check? Not many of us left to confirm or deny.

Should I call and ask? Better not. Don’t want to open a wound again. Nothing maudlin.

There’s something missing now. An empty space.

A hollow, dreary void now exists where there was none before.

I’ll not send flowers. Just the check.

Seems pointless.

]]> http://www.reillymaginn.com/2009/04/04/in-lieu-of-flowers/feed/ 2 http://www.reillymaginn.com/2008/12/31/good-times/ http://www.reillymaginn.com/2008/12/31/good-times/#comments Wed, 31 Dec 2008 15:50:31 +0000 Reilly http://www.reillymaginn.com/?p=99

            “Jesus Ed, why didn’t you come in sooner?  That sore behind your ear is almost certainly a malignant melanoma.  You’ve got nodules in your neck and that trouble breathing, you’re having, is a bad sign.  The darned thing has probably spread.  I want to get a chest X-ray right now.”

            “Come on doc.  You sound like you’re hanging crepe.  Can’t be that serious now can it.  Sounds like you’ve got a Porsche payment coming up and need the dough.”

            “Damn it Ed.  Stop jacking around.  I’m not kidding.  Those lumps in your neck could very well be metastases and there’s little question the lesion behind your ear is a melanoma and a bad one.”

            “Okay, Anders.  It was just a little gallows humor.  You’re not kidding about how serious it is and how it may have spread are you?”

            “I wish I was kidding Ed.  I’m not.  Let’s get the film right now and let me look at it, okay?”

            When they looked at the X-ray a few minutes later there was dead silence.  Both lung fields were covered with small nodules.  Even Ed, a layman, could see his doctor was not joking.  Frowning, Dr. Anders said, “This is really serious Ed.  We need a biopsy of the lesion and from one of the nodes in your neck.  They can be done under local anesthesia tomorrow.  I’ll do a frozen section on the tissue and have a diagnosis this afternoon.

            The results were as the doctor predicted.  A viciously malignant melanoma that was already widespread.

            “Sit down here Ed.  I’m not going to pull any punches with you.  You’ve got a really bad cancer and it’s widespread.  It’s beyond surgical removal, radiation therapy and even chemotherapy is out.  You had better get your affairs in order.  You don’t have long.  I’m really sorry to be this blunt but as your doctor and your friend I feel you need to know just how serious this is.”

            “How long have I got?

            “No telling.  That’s Hollywood stuff when they say you’ve got two months or two years.  No one can predict what’s going to happen and how soon.”

            “Gimme’ a ball park estimate.”

            “Hell, it could be this afternoon if you have lesions in your brain or it could be three months from now.  I’m not kidding when I say I can’t give you a time.”

            “Anders, I walked in here this morning with a sore behind my ear and you’ve just given me a death sentence.  Can this be real?”

            “Fraid so, big guy.  I wouldn’t be this frank and in such short order if you weren’t my best friend.  We’ve been sailing together for nearly thirty years.  I was Commodore last year at the yacht club and you’re Commodore this year.  I count you as a colleague as well as a true friend.  Your wife Marie and my Annie have been close since we met.  You have to tell Marie about this and soon.”

            “I understand what you’re saying doc.  I gotta’ think this thing through and figure out how I’m going to tell her.  Certainly not tonight.  They are giving me a roast and a plaque at the yacht club dinner tonight.  I’ll get to it in a day or two.  No need to spoil the occasion tonight.”

            “Okay but don’t put it off too long.”

            “Don’t worry.  I’ll “git ‘er done” and in due time.  Thanks for nothing you big galoot.”

             “Go on and get outa’ here and enjoy the dinner tonight.  See ya’ this evening at the yacht club roast.  I’m around if you need me or want me to help with breaking the news to Marie. Okay?”

Dazedly, Ed Macon stumbled out of his doctor’s office.  He was in shock.  The whole morning seemed surreal.  He was going to die and very shortly.  And he had to tell his wife of forty-four years of the results of the tests as well as its inevitability.  Unbelievable.  What the hell happened to my life?

            Ed and Marie had been married more than four decades.  No children.  It was their decision.  It was just the two of them through the years.  And their love had not faded or dulled.  Indeed, it had increased as the two melded into a single unit, each supporting and strengthening the other.  They remained lovers as well as husband and wife.

            The dinner, the jocularity and the good times that evening were unmatched.  The club members roasted Ed with good naturedly tinged humor.  The food, the wine and the conversations were unequaled that night.  Ed and Marie cuddled and kissed on their way home like newly weds and made love that night as never before.  At dawn, Ed arose without disturbing Marie and went to his desk.  Taking a sheet of stationary and his pen, he made his way out to the deck overlooking the bay as the sun rose.  Silently he contemplated the unruffled water and the blank sheet of paper as the sun rose over the bay.  Finally he began to write.

         Marie, I’ve been given some very bad news by Doctor Anders.  This sore behind my ear is a malignant lesion that is now widespread and beyond any cure or even treatment.  My days here on earth with you are essentially over.  I refuse to become a vegetable in a hospital ICU and will not subject you to the agonizing decision making about when to “pull the plug”.  I’m going sailing this morning on GOOD TIMES and will not return.  I only hope it will be termed an accident. An accident judgment will preclude problems with my insurance.  The investments and the life insurance settlement will sustain you after I’m gone.  I know full well this is the coward’s way out but I feel it’s best for both of us.  I love you with all my heart and I don’t want you to agonize over a dying man.

         Your loving and adoring husband.

            He signed the letter, sealed it and placed it on the kitchen table.  Slipping out the kitchen door he drove slowly to the yacht club where their small sailboat was tied up.  Casting off the mooring lines he ghosted out into the channel and thence into Mobile Bay.  Raising the sails, he cut the motor and relaxing, leaned back on the cockpit coaming.  Ed began to reminisce about the good times he and Marie had experienced aboard their small sailboat, GOOD TIMES.  Leaving the bay, he headed out into the Gulf of Mexico.  The sky was cobalt blue and cloudless as the sun rose.  The gentle following sea was smooth and the north wind quietly drove the boat south into the Gulf.

Better tie down this tiller so she holds her course south into the Gulf; don’t need anyone questioning how I got so far south.  We may get to Mexico before they find Good Times.

Guess it’s about time for my” two step” off the transom.  I’m out of the sight of land and any curious onlookers.  Kind of scary, I must admit.  Hope they think it was just an accident.  Maybe a shot of some Dutch courage would help.  I think there’s a nearly full bottle of Wild Turkey in the galley locker.  And indeed there was.  Retrieving the whiskey, Ed poured himself a generous shot.  Downing it in a single gulp, he poured another.  And another.  Wow, that’s strong stuff.  Feel a little dizzy.  Maybe too much too quickly.  Better put my head down and rest for a minute.  GOOD TIMES can handle herself for a bit.  One more for good luck.  He fell fast asleep almost immediately.  The whiskey, taken in such large quantities and in such a short time put him into a near comatose state.  He was virtually stuporous for the next five hours. 

The north breeze began to back in an hour and when he awoke, four hours later, the wind had shifted one-hundred and eighty degrees from north to the south.  The sailboat had gradually turned and was now heading right back into Mobile Bay.

            Ed awoke slowly and groggily.  Where in the devil am I?  Well I’ll be damned.  That’s the Sand Point lighthouse to port.  I’m heading back into Mobile Bay.  The wind must have backed and GOOD TIMES just swung around and is taking me home.  Guess I owe the “Big Guy” upstairs for this.  Think he just wasn’t going to let me do my two step off the transom.  Besides, they couldn’t bury me in the church cemetery if they found out what I did.  A couple of Hail Mary’s and Our Fathers are in order.  Might as well head back to the club and tie up.  Boy, have I got a headache.

            Securing GOOD TIMES in her slip, Ed drove home.  Oh shit.  I forgot all about the note on the kitchen table.  Marie is really going to be pissed when she reads it.  Jesus, she can be a shrew when she’s aggravated.  I’ll just have to try a couple of mea culpas and explain. 

            Turning into the drive he could see Marie’s car in the garage.  Damn, she’s home already.  Here goes, he thought, as he opened the front door.  “Marie.  You home already?”  No answer.  In the living room he saw her lying on the couch.  Apparently asleep.  His note was on her bosom, still moist with tears.  It was then he saw the empty bottle of Seconal sleeping pills on the floor.  Picking up the letter he could see she had written a comment at the bottom.

            Ed, we’ve been married for forty-four years and we’ve been a darned good team together.  I’m not going to go it alone. You’re not going without me.  Wait up.  I’m coming with you.  I love you with all my heart.

            She wasn’t breathing.

I had a terrible motorcycle crash last year; in a coma for twelve weeks. I’m a surgical resident and I ended up in my own hospital, tended to by my own professor and mentor. I’m sure I got special care. He just wouldn’t give up on me. He took me back to the operating room six times in the first few weeks, to stop bleeding, they say. I woke up twelve weeks later missing my left eye, my right hand, my left lower leg and parts of my liver and left lung, as well as a kidney. I was told they had to remove those organs because of continued bleeding. Nonetheless, I’m still here and relatively functional. They said I was nearly brain dead and my recovery after three months of coma was astonishing. It certainly surprised the professor, I’m told. He just couldn’t believe it, they say.

Coming out of a coma is like coming up from a deep ocean scuba dive. It’s all dark and then you can see some light above you. You start ascending and the light gets brighter and you begin to hear voices. One can’t make out what they’re saying, at first, but things get clearer and then one day you break through the film above you and burst into the sunlit world again. At least that’s how it was for me. It seems my mind and mental abilities were not seriously impaired, for I recovered my memory of events before the accident with no trouble. Interestingly, my sense of smell, hearing and taste were not diminished and my recall of distant occurrences was not impaired.

My pot holed, rutted, twisting road to recovery was accomplished with the constant harassment of the skillful physical terrorists; I call them terrorists. In reality the physical therapists probably saved my life after all those operations. Like the professor, they never gave up on me. I must admit, I developed a real dislike for a couple of them during the long rehabilitation penance year. I paid my dues though, and I can now walk, think, see, and use my hook with some dexterity. I’m grateful to them for their persistence and perseverance. Together with the professor, the hospital team and the rehab unit physical therapists I’m here today. They saved my life. I’m grateful.

But wait. There’s more to the story. Last week I was sitting in the back booth of the pub across from the hospital, nursing a beer. I’m still not too social after the trauma and the long recovery period.

A pair of surgical residents slid in the booth next to mine without noticing me. They were buzzing with excitement about the day’s occurrences.

“He’s been indicted and charged with malfeasance, ethics violations and malpractice.”

“You’re kidding. The professor? The head of the transplant unit?”

“No I’m not kidding. I hear he has it coming. You should hear what he did.”

“What?”

“It seems he had a comatose patient that he thought was going to be pronounced brain dead. He removed a whole bunch of organs, for transplant, from the patient before he was certified dead. And to everyone’s surprise the patient woke up weeks later and recovered, weeks later.”

“I can’t believe it. He did all that?”

“He did. But you haven’t heard the worst yet. The donor was one of us.”

“What do you mean one of us?”

“It was a surgery resident on the professor’s own transplant service. You remember him. The guy that had that horrific motorcycle accident last year.. The prof. took six different organs and transplanted them into six different recipients. That’s how he made his name in the field of transplantation. Six transplants to six donors. All unrelated. And they all are still functioning. It got him a Nobel Prize.”

“What a story. It’s almost unbelievable, isn’t it.”

Sitting in the next booth, I was stunned. No. I was astounded. He used me as the donor for this surgical tour d’ force. In addition, the professor used my organs to make a name for himself. He betrayed me and the whole cadre’ of transplant physicians. What a bastard. I was furious and I wanted payback. I left the pub in a rage, hurriedly gimping along with my cane on my prosthetic leg.

The walk home is long and I’m a bit slow so it gave me time to mull over what I’d heard and what I might do about it. I began to think about the results of the professor’s actions. A woman with a new kidney is free from the tyranny of the hemodialysis machine. A yellow jaundiced child is now enjoying a normal life with a normally functioning liver. A blind girl can now see again. A cripple is walking again and a boy has forsaken his iron hook for a functional right hand. A child, gasping for breath because of lung disease, is now breathing normally. God only knows they must be the most grateful group of patients you’ll ever see. And me? What about me? I can walk and I can use my hook. I can see and my liver and lung functions are adequate. I only need my one kidney. I’m getting along Okay, I guess. I’m grateful to the wonderful care I got at the University hospital and for the wonderful group of therapists in the rehabilitation unit. I’m grateful to be alive. And let’s face it. I’m alive because the professor took care of me. Sure he had an ulterior motive but I’m still here, aren’t I.

They’re going to ask me to testify at the hearing. I don’t think so..

Thankful? Appreciative? Indebted? Yes, all of the above and most of all I’m grateful.

            Now what, I thought as I strode down the hall to the swinging doors of the emergency room.  Another stat and it probably is nothing more than a sore throat or a hangnail.

            “In here, quick,” shouted Caldwell, our warhorse emergency room nurse.  She’d been an  ER nurse for ages and nothing fazed her; she’d seen it all.  But this time there was panic in her voice.

            “Doc, he’s been stabbed in the chest.  He’s going into shock.  The blood is bright red, arterial and it was spurting when he came through the door.  Now it’s only dribbling and we’re losing him.  Hurry.”

            His eyes were rolling back and he was collapsing in her arms. 

            “Get him on the gurney.  Looks like they might have got him in the heart,” I said as I gave him a quick once over.

            “Call the OR and tell them we’re coming.  Emergency thoracotomy.  Get some blood to the lab for a six unit cross match.  Come on, move girl or we’ll lose him.  Have Cynthia get the elevator for me now,” I shouted as I wheeled the gurney into the hall.

            They were finishing a belly case in the OR as I burst through the door with the stretcher.

            “Call anesthesia and break out the chest instruments in the big room,” I yelled.  “He’s been stabbed in the chest and I think they got his heart.  Get him on the table, left side up while I scrub.”

            The well oiled OR team didn’t miss a beat.  They dropped the clean up duties from the previous case, wheeled him in the trauma OR and prepped him for a left chest incision.  My “sterile” scrub was a splash of soapy water and I was back in the OR, gowning and gloving. 

            “Spray the betadine and give me an eye hole sheet.  No time for a full drape,” as I grabbed the scalpel from the back table and made a sweeping incision beneath his left fourth rib. 

 As I the chest cavity blood cascaded onto the floor.

            There.  There it is, I thought, as I exposed the heart.  Just a slight nick in the pericardium now only dribbling minute amounts of un-clotted blood.  I split the pericardial lining around the heart with the scissors and we could see a rent in the heart muscle pumping now only diminutive jets of bright  red arterial blood.  I put my index finger over the hole and the bleeding ceased.

            “Pour the blood to him John,” I said to the anesthesiologist.  “Give him all six units as fast as you can.  I know there are at least six units on the floor and in my shoes right now.”

            “OK, team, easy on now.  I’ve got the bleeding stopped.  Let’s give him a few minutes to stabilize while we get better organized.  Let’s all of us take a breather.”

            The crew visibly relaxed as the tension in the room eased.

            “Doctor M.  Can I speak to you for a minute?” whispered the circulating nurse hesitantly.

            “Sure Cindy.  Before you do see if you can clean up this bloody mess I spilled on the floor.  It’s all over me, the floor and it’s in my shoes.”

            “In a minute, doctor M.  I think this takes priority.”

            “Go ahead, now what?”

            “Your wife called when you burst through the door.  I took the call.  She said she was in labor.  I told her you couldn’t come to the phone right then.  She said her water broke and wanted you to come get her.  I explained that you were busy and told her to get a cab and come here to the hospital.  What else was there for me to do?”

            “Oh my.  Forgot all about her being so close to delivery.  Go on.”

            “Well, she did as I asked.  She’s now down on the OB floor and she’s OK.  I’m afraid she delivered in the cab.  You’re a new father.  She’s fine they tell me, and asking for you.  It was a boy and all the fingers and toes are in the right place they tell me.  I had to wait till now to tell you.  You were too busy to listen.”

            “Golly.  Thanks for grabbing the ball and running with it Cindy.  Now get me some three O cardiovascular silk so I can fix this hole in this man’s heart.”

              “Is he OK, John?”

            “His blood pressure is coming up and his pulse is coming down.  Go ahead and finish what you’re doing.  Looks like he’ll make it.  And by the way, congratulations, dad.”

            We finished the case.  The patient survived with no complications. 

            My wife did fine after her single handed taxi cab delivery. 

            And my son?  Oh yeah, he’s OK too.