Night Shift

So far, so good. The young man in green scrubs lounged on a gurney at one end of the dim corridor and looked at the clock at the other. 8:15. A bit more than halfway through. Kinda spooky though, seeing the suite like this. No hustle or bustle, no D&C's, no tonsillectomies. None of that daytime stuff. Nights it’s all car wrecks, gunshots, stabbings. Did a gunshot once. Helped find the exits and entries on a woman whose hubby didn't like dinner. Twenty-two. Made teeny puckered holes going in, puffy little mounds like gopher holes coming out. You have to find an entry, then see if you can find a matching exit. Did a few accidents too of course. Stuff like that doesn't just happen at night. Yeah, he'd been around, seen a few things, so he wasn't sure what he was worried about. Not real worried, just a little worried. Concerned. Maybe it was just being the only tech in the suite. But hey, no matter what the op or when, you had procedure, right? And procedure he knew. It was his proficiency on days landed him this gig. If he didn't screw it up he could take classes full-time instead of this evening routine of one or two at a time. Be an old geezer in his thirties at that rate. Might be a tight spot now and then but he'd handle it okay. And all this downtime to study! Nice. Y'know, bet some nights had nothing at all. Certainly been a snooze so far. Speaking of which, a nap wasn’t such a bad idea.

Ring-ring!

Took him a second he to realize it was the phone. You didn't hear it during the day, what with all the racket.

Ring-ring!

He sat up as Nurse Adams came out of the office down by the desk and raised the receiver to her ear. Wasn't more than a minute before she hung up and tapped the bell on the desk twice with her palm.

Two dings meant “nurse to the desk”, which meant something was up, so he slid onto his feet. A male nurse named Tony appeared next to the desk and a word from Nurse Adams sent him to the Equipment Room. Nurse Adams looked up the hall.

“Ben,” she called. “Go up to room 729 and get us a Mr. Fred Pender.”

Ben pushed his stretcher through the swinging doors of the suite. Straight ahead was the family waiting room, dark and empty. On his left he passed the closed door of the men's locker room, then pulled up by the elevators on his right. He pushed the 'Up' button and an elevator came almost immediately. During the day they’d be crowded and you couldn't always get your stretcher in but this time of day they’re empty.

"Busted stitches," he thought as he watched the floor lights go on one after another. Inpatient, so not a gunshot or accident; non-scheduled, so emergent, yet not serious enough to send a med team; instead, just an orderly to go get the guy.

"Yeah," Ben thought. "Busted stitches".

As he wheeled the stretcher into room 729 a frowsy woman held the hand of the patient in the bed. Old coat and hat with a battered purse hanging from her arm. Hat was one of those flat, disk-shaped ones with a faded fake flower stuck on the end of a wire that wobbled around with every movement of her head. She looked at Ben wide-eyed but spoke to the patient. “Here's the doc now Fred,” she said. Everything's gonna be alright now. Ain't that right doc?”

Ben smiled.

“Sure,” he crooned as he slid the stretcher against the bed. Everything's gonna be fine.”

Before he looked down at Fred Pender he caught a surprised look on the woman's face. She seemed frightened, seemed to have a graver notion of the situation than Ben’s. Mr. Pender himself looked dazed and disoriented. Pretty much what you'd expect with busted stitches: scary but no big deal. Just wheel him in and sew 'em back up.

“Nothing to it,” he announced beaming at the glazed-over face of Fred Pender.

“There,” said the woman. “Ya see?”

Ben braced the stretcher against the bed with his belly.

“All right now Mr. Pender,” he said. “Can you slide on over to the stretcher for me?”

Fred Pender flung back his blanket and tried to comply but his left leg had recently been amputated just above the knee and his bandaged stump bobbed and waved helplessly.

“Here,” said Ben. “Let me give you a hand.”

Ben helped the man onto the stretcher, covered him with a sheet, strapped him in and raised the headrest. Then he turned to the woman.

"If you wanna come with us, Mrs. Pender, I can show you the waiting room."

So it wasn't stitches after all, Ben thought as he wheeled his patient down the hall. Not that the stitches on Mr. Pender's leg couldn't have come undone, it just wouldn't have been as scary as abdominals. Plus, the stump hadn't been unwrapped so how would anyone know anything about the stitches? Whatever it was it sure had the Penders shook up. Well, Ben would find out soon enough when he got downstairs.

In the meantime he thought about what he'd have to do. If the op did turn out to be on the leg it would be Ben's job to apply the tourniquet: as far up the leg as you could get it. First you wrap some gauze, then strap on the tourniquet making sure the air valve was facing down the leg. After that, the leg would have to be prepped and Ben hoped he could do that while Mr. Pender was still conscious so he could help hold his own leg up. Otherwise, Ben would have to hold it up with one hand while scrubbing with the other. Get a pretty sore arm doing that. After the anesthesia Ben would help drape with sterile sheets: over the whole leg, under the stump. That was about it. Nothing he hadn't done before. Ben smiled at Mrs. Pender as he pressed the down button for the elevator.

As the door closed he recalled the first time he'd seen a boneman sawing off a leg, and how the body under the drapesheet rocked back and forth with the motion of the saw. Bonemen made you think again about surgery being fine and delicate, what with their hammering and sawing and banging away with chisels and drills like a bunch of carpenters. He thought too about all the arms and legs he'd carted off in heavy paper bags to be burned in the incinerator in the basement. Looking at Fred Pender he saw a man who, though nervous, was clearly not in pain. Ben didn't know what the problem was but how serious could it be? Leaving the elevator Ben turned to Mrs. Pender and nodded toward the waiting room.

“You can wait in there Ma'am. And don't worry, everything's okay.”

Ben paused at the threshold of room eight to tie on his mask and let his eyes adjust to the glare of the overhead lamp. A nurse named Margaret, employee of Doctor Reese, orthopedic surgeon, stood by the table in the middle of the room. Like Ben she wore a cap and mask, but her tied-in-the-rear gown and finely powdered rubber gloves indicated that, unlike Ben, she had scrubbed for the operation. Ben was surprised, however, to see her hands at her sides, below the level of the table. One of the first things you learn is that anything below the table is contaminated.

“Just put him on his back,” she said through her mask.

Then, in blatant disregard of procedure, she reached out to help put the patient on the table, actually touching him. As soon as they had Mr. Pender on the table Dr. Landis, Doctor Reese's customary anaesthesiologist, wheeled in his clanking cart of oxygen tanks, bottles, hoses and black balloon that expands and contracts with the patient's breathing. He plopped down on the steel swivel stool at the head of the table and began to fidget with his paraphernalia. He wasn't wearing a mask.

Ben removed the armboard from its storage spot beneath the table. An armboard is a padded board attached to the table at the patient's shoulder for him to lay his arm on. This arm is then used by the anaesthesiologist to jab his needles into. Ben asked Dr. Landis, “Which side do you want this on?”

Dr. Landis looked at Ben a few seconds before answering.

“We won't be needing an armboard,” he said.

Just then Tony rolled in a laundry basket and Ben finally got it. This was a dirty op. That's when what's inside the patient is worse than what's outside the patient. All caps, gowns and masks would be thrown into the basket before leaving the room to be sure no heinous bacteria were tracked around the suite. This was why Margaret hadn't been concerned with procedure. Her gloves were for her protection, not Fred Pender's. Tony parked the basket in one corner and walked over to the table. He looked at Ben and said, “There won't be any prep.”

This was a new one on Ben who had never heard of an operation that didn't have a prep, even a dirty one. Surgeons were soap fanatics, and Doctor Reese was just about the most finicky one of all. He always wanted everything scrubbed, scrubbed, and scrubbed again, even those gooey burns that were impossible to get clean and came away with your gloves like stringy mozzarella cheese.

Dr. Landis caught Ben's eye and, standing up, motioned toward the door. Ben followed him into the hall where the anaesthesiologist turned around and looked at Ben.

“Ben,” he said. “I can't give that man any anaesthesia because of what he's got. You and Tony and I will have to hold him down. Will you be all right?”

Ben had held a man down before. Right across the hall. The man had been gagging and choking and spouting phlegm from the little red hole at the bottom of his neck because Dr. Katzenberry was stuffing a bronchoscope down his throat. It had been unpleasant but Ben had managed.

“I'll manage,” he said.

“Fine,” said Dr. Landis patting Ben on the shoulder. “Fine.”

Ben followed him back into the room where they found Doctor Reese waiting for them. Ben was one of the few orderlies Doctor Reese would even allow in his room. Ben had never contaminated anything or anyone, never washed a patient with benzoin instead of Phisohex, never applied a tourniquet upside down or on the wrong limb. The surgeon was gloved and gowned but as heedless of procedure as everyone else. His eyes slid over his mask from Dr. Landis to Ben, then back to Dr. Landis.

“Okay Tom?” came the muffled question.

Tom Landis sat down and barely nodded.

Ben saw that Fred Pender's bandage was gone. The skin on the swollen stump shone reddish purple. Doctor Reese glanced over his shoulder at Tony and Margaret, then stepped up to the table right across from Ben.

“Well,” he said. “I guess we'd better get started.”

Tom Landis stood up at the head of the table and Tony moved around to the foot. The surgeon reached back toward Margaret and when he turned back again he had a scalpel in his hand.

Fred Pender shuddered suddenly and whimpered. Ben saw his wide eyes staring at the gleaming blade.

“Jesus Christ!” thought Ben.

Then Tom Landis pinned the patient's chest and shoulders to the table and Tony grabbed his ankle. Margaret appeared across from Ben as Doctor Reese slid down to the stump. She pinned Fred Pender's one arm to his side, so Ben pinned the other.

Fred Pender's body tensed and he uttered a long, low moan. His stump danced frantically in the air. Doctor Reese tucked it under one arm and cut a deep gash the entire length of it. Fred Pender screamed and fought violently to get free. Methodically the surgeon made a second gash, then a third and a fourth. Fred Pender shrieked over and over again. Halfway through one shriek he would abruptly begin another. He bucked and squirmed with all his might but was held fast by his captors.

Ben was mesmerized by the four parallel streaks in Fred Pender's jumping thigh. None of them were bleeding. There was no blood anywhere. All Ben could see beneath the purple skin was a grayish green bubbling ooze that gurgled contentedly when cut and reeked a godawful stench. Ben began to gag. Fred Pender subsided.

“He's passed out,” said Tom Landis to Doctor Reese.

“For how long?”

“Can't say.”

“We're not getting anywhere with this. We'll have to go higher.”

Tom Landis nodded and Doctor Reese looked at Ben.

“You gonna be okay?” he asked, his mask bobbing up and down with the words.

“Yeah,” Ben said. “I'm okay.”

“All right then. Let's go.”

Doctor Reese bent down and slowly slashed Fred Pender from the middle of his groin to his hip. Fred Pender stiffened and arched his back. As Ben watched Mr. Pender's flailing stump he could feel the arm he had pinned twitching, struggling to get free. Mr. Pender gasped, four times, staccato, taking in more air each time. Then he screamed the longest and loudest scream Ben had ever heard before passing out again.

Ben looked up at Doctor Reese who was splashing clear hydrogen peroxide from a brown bottle onto some white lap rags. In normal ops lap rags are used to sop up the blood. When the rags were thoroughly soaked Doctor Reese poked them with his fingers into the gashes he'd made in Fred Pender. Fred Pender groaned and rolled his head from side to side. Doctor Reese finished with the lap rags and stepped back from the table. His shoulders sagged and he glanced at Tom Landis. Then, to Margaret, he said, “Better get us a bed from Recovery.”

Margaret made a “come in” sign at the door behind Ben.

Turning, Ben saw Nurse Adams' window-framed head nod once and disappear. Immediately the door opened into the room and a Recovery Room bed was pushed in. Ben rolled it alongside the table, then watched as Tony and Margaret wrapped Fred Pender's stump and abdomen with clean white gauze. They didn't bother to suture his wounds or even remove the lap rags, the edges of which were sticking up out of the gashes. When they had finished, everyone but Doctor Reese helped lay Fred Pender on the bed.

Doctor Reese was gone.

Tony and Margaret wheeled Fred Pender to Recovery and Tom Landis rolled away his cart. Ben tossed his cap and mask into the laundry basket and went into the hall where Nurse Adams was waiting for him.

“You okay?” she asked.

“Oh sure. What the hell was that anyway?”

“Gas gangrene.”

“Damn. Why is it called gas gangrene?”

“Did you see how it sorta bubbled? Like it was carbonated?”

“Oh yeah…”

Nurse Adams grinned.

“Well, you better go change your clothes. That was a dirty op you know.”

“Right.”

Ben pushed through the swinging doors only to stop dead in his tracks. Mrs. Pender was in the hallway, between Ben and the locker room. She'd removed her coat but still wore the silly hat. She saw Ben before he could react.

“Doctor,” she cried rushing up to him. “Is he alright?”

Ben felt his face flush and he tried to edge around her.

“Actually,” he mumbled. “I'm not a doctor, I'm just an orderly. Doctor Reese should be out to see you shortly.”

Mrs. Pender caught Ben's arm as he made a break for it.

“But he's OK, right?”

“I'm sorry, ma'am,” Ben said. “I can't really say. Gotta be a doctor to do that.”

He could feel Mrs. Pender's eyes on the back of his head as he scurried away.

The narrow dressing room was furnished with a small table flanked by two chairs against one wall and a row of lockers against the other. The only light came from the tiny adjoining lavatory just beyond the chair furthest from the door. Ben sat in that chair in the dark pondering the situation. What a way to break in. It'd been tough sledding but he'd managed. He didn't suppose ops could get much rougher than that one but he'd handled himself well, and for Doctor Reese no less. That was the good news. The bad news was the Penders. He felt sorry for Mr. Pender but all that gangrene and no anesthesia and whatnot, that was just the hand fate dealt him, that shit happens. Not so with the missus. Ben felt bad about that one. Might be fun to be taken for a surgeon, but don't go telling folks things are all hunky dory when you don't know squat. Live and learn, eh?

Just then the door opened and Tony stepped into the room. He dropped into the other chair and shoved the door closed with his foot. After a moment he said, “Mind of I turn on the light?”

“Help yourself.”

Ben saw that Tony was worked up, but Tony was always pissed about something. Tony was not one of Ben's favorites, too much chip on the shoulder, too critical of everything and everyone. Tony was trying to get into med school and Ben kind of hoped he wouldn't make it. Just didn't seem like he'd be a good doctor. Tony glanced at Ben.

“So what did you think of that?” he asked.

“Of what? The operation?”

“No. The brass band marching down the hallway.”

“Well, I guess it was pretty rough.”

Tony snorted.

“More like disgusting,” he said as he stood up and dialed the combination on his lock.

Ben examined the table edge's dark, parabolic scars of cigarettes past.

“Yeah,” he said. “Thought I was gonna upchuck for a minute there.”

More snorting from Tony.

“I wasn't talking about the gangrene,” he said.

Ben looked away, stared at the opposite wall.

“I'm talking about Reese,” said Tony, lowly and distinctly.

Now Ben stared at Tony's back.

“And why is that?” he asked.

Tony stopped fiddling with his locker and faced Ben.

“Do you know what that was?”

“Sure, gas gangrene.”

That stopped Tony, but not for long. “What else do you know about it?”

“Nothing I guess. Just the name.”

Tony sat down and looked at his feet. Then he turned to Ben.

“Gas gangrene,” he said, “is caused by a bug called Claustridium. It's always in your body but it's anaerobic which means it thrives only in the absence of oxygen. So as long as the blood, which supplies the body with oxygen, is flowing, Claustridium is harmless. But when the blood supply is cut off long enough gas gangrene sets in. With me so far?”

Ben nodded.

“Now, as you know, limb ops get a tourniquet, and a tourniquet cuts off the flow of blood. So if the patient's on the table too long…”

“Wait a second,” said Ben. “Are you saying Mr. Pender caught gas gangrene here in the OR? From the tourniquet?”

“Exactly," said Tony. On Reese's table as a matter of fact.”

Ben stared.

“How did it happen?” he asked. “Was there a problem? Was the tourniquet put on wrong or anything?”

“How the hell do I know? I wasn't there.”

“Then what's the problem? Chances are it wasn't Doctor Reese's fault at all.”

“Who said it was? Could have been any number of things. No two patients are alike, shit happens. It could have been a lot of things that weren't Reese's fault, but that's not the point.”

“So what is the point?”

“The point is, that man's operation was three days ago. He's had gangrene for three days. If they had gotten him down here sooner, when it just got started, they could have stopped it. As it was, there was no chance at all.”

Ben looked away, studied some grunge on the floor. Finally, he said, quietly, “What took them so long?”

Tony looked at Ben.

“They didn't know!” he said. “They didn't know."

A moment passed before he added, "No one checked.”

“Checked?” said Ben.

"Yeah. You have to look for it. Patient doesn't feel anything, no fever, no telltale vitals. Just the purple skin. So someone has to go look. Gotta remove the bandage and look."

Ben ran a hand through his hair.

“And who's supposed to do that?” he asked.

Tony shrugged.

“Someone. Someone is supposed to do it. The floor nurses, Margaret, maybe even Dr. God himself. Does it matter? Whose patient is it? Where do you figure the buck stops? It was up to Reese to see that it was done and it wasn't.”

Ben looked down at his feet and Tony stared at his locker. After a minute, Ben said, “When did they find out?”

“This evening, when he went into shock.”

“Shock?” Ben murmured, remembering how the Penders had looked so worried.

“Text book,” Tony muttered. “Three days, shock, then lights out.”

Ben looked up.

“Are you saying that once the patient goes into shock he's a goner?”

“Yep.”

“But then, what was this op for? What's the peroxide for?”

Tony sneered and jumped to his feet. Once there, however, he seemed to discover there was nowhere to go, turned around in a circle, and sat back down. “What a joke,” he said. “According to Reese he was trying to oxygenate the stump. Can you believe that? Jesus Christ, you saw that thing. How effective do you think a little peroxide is going to be? Everything's already gone! There's nothing left, no muscle, no blood vessels, no nothing. Kaput. All the way up to his navel. But that's all BS anyway. Reese knew the guy was a goner before you even wheeled him in.”

“So then why?” Ben asked.

Tony looked at Ben for a moment.

“Where do you think Reese is right now?” he finally asked. But before Ben could answer he said, “I'll tell you where he is. He's with the widow, some middle-aged frump with curlers in her hair. A couple hours ago she was home watching soaps, maybe even one of those hospital ones, and now Reese is telling her, hey, these things happen. I'm so sorry. Act of God, one in a thousand chance, no one knows why. We did everything we could, we fought it to the end.”

With a grunt Tony stood up and resumed fiddling with his locker. Watching him change his scrubs Ben said, “Hat”.

Tony looked over his shoulder at Ben.

“What?”

“Not curlers. A hat. She's wearing a hat.”

Tony turned back to his locker.

“Oh, well, that makes all the difference.”

A few seconds later Ben asked, “Why couldn't they give him any anesthesia?”

“Good question. The gas passer refused to take the chance the poor slob would croak from the drugs. He was willing to hold the man down, but not to take the heat.”

Tony slammed his locker shut, spun the lock, took one look at Ben and left. Ben stared at the closed door and squinted. Suddenly the overhead light was too bright. Ben wished it was dim again, like it was when Tony first came in. Of course, he could get up and turn the light off, but somehow he wasn't able to. He didn't like Tony, didn't trust him. With a heavy sigh Ben stood up.

Back in the suite the hall lights were on and Nurse Adams was sitting at the desk writing. Ben walked up and leaned against the desk.

“Say,” he said. “What did you call that stuff again?”

Nurse Adams looked up.

“Gas gangrene,” she smiled.

“That's some wicked stuff.”

“Sure is.”

“How long did he have it, do you know?”

Nurse Adams stopped smiling.

“Yeah,” she said. “I know.”

Ben shook his head.

“Man,” he said. “The stuff some folks put up with. I saw this woman once, room 12 I think, had this big knob sticking out of her belly, right at the navel. Looked like a shrunken head. The setup nurse told me it was an umbilical hernia and the woman had had it for eighteen years. Imagine not going to the doctor with something the size of a softball sticking out of your stomach. And another time I had to prep this old guy, a real string bean, had a staph infection in his crotch, ate his business clean away. Wouldn't go to the doctor. Now this guy. Let that gangrene go so long it ate up his leg and most of his gut.”

Nurse Adams laughed.

“Wasn't like that all,” she said. “Gangrene's quick, only took three days, and the patient didn't even know it was there since you can't feel it.”

Ben whistled softly.

“Boy,” he said. “Three days, huh?”

Nurse Adams nodded.

“And you don't feel a thing?”

“Nope.”

“Damn,” said Ben looking up at the clock. “Hey, break time.”

The clock on the cafeteria wall was sneaking up on 10:15. Less than two hours had elapsed. Ben blew on his coffee and studied the matronly woman in white who ran the place at night. Surely she was someone's grandmother. She sat on a stool under the dimmed lights by the cash register and gazed at her hands in her lap. Ben sat by a wall that was all glass. He watched the raindrops splashing against the window and then sliding downward. Peering out into the gloom he could make out some trees swaying in the wind. Normally when he was inside looking out at a storm he'd feel cozy and secure, but not tonight. Tony had told him true. Five people, no six, Nurse Adams shared in this too, six people had tortured a man tonight. And for what? To keep Reese from getting sued? To help Reese convince himself, well, convince himself of what?

Reese had had time to think about what he had planned. Fred Pender went into shock, his condition probably discovered by the floor nurse who probably called the on-site resident who diagnosed the problem easily enough. No need to undo the bandage on the stump. The guy's in shock, you lift his gown, you see the purple abdomen, you pretty much get the picture. So the resident then called Reese. In the time between then and when Reese called Margaret he decided to do what he did. Why? Some foggy idea of having to do something? How long did he think about it before he called Margaret with his instructions? Call Landis, call the OR, set it up. Then he'd have rushed out to his car and driven to the hospital. How long did that take? What did he think about during that drive? What the hell else could he have possibly thought about? Yet he didn't change his plan. He arrived, changed clothes, scrubbed in - no wait, did not scrub in - and still he didn't change his plan. When he got into the room and finally saw Fred Pender, when Ben was in the hall with Landis, what did he think then? When he saw the stump was completely gone, when he saw the purple abdomen, why didn't he change the plan then? He could not possibly have thought that anything could help Fred Pender. No, the conclusion was inescapable. Dr. Reese cut Fred Pender to ribbons without anesthetizing him for some reason other than to cure him. What did it matter if it was some personal, psychological reason or a cynical attempt to avoid monetary or professional consequence? What did it matter if it was a mixture of motives? There simply could not be a motive that was not venal or self-serving or morally unacceptable. Period.

Ben stared at his reflection in the glass, a reflection warped by the streams of water on the other side. Yeah, he had helped hold the victim down. Of course, Ben was the only one who didn't know beforehand that it was all a sham. But he knew now. What should he do? Go find the widow, tell her the truth? Report Reese and Landis and Margaret and Tony and Nurse Adams to the administration? Did the damned administration really need to have it spelled out? Cause of death would have to be listed as gas gangrene. There was no way Reese could wriggle out of that. The administration would get the picture clear enough, they didn't need Ben to tell them anything. That left just the widow. Ben Willis, crusading orderly. That would be the end of this job, for sure. And maybe the widow didn't need Ben's help anyway. Sure, she'd smell a rat alright. For three days all she hears is everything is fine, everything is OK, then all of a sudden Fred's dead? No, Ben thought, this was life, this was how the world worked, grab a helmet. He stood up and looked out the window at the storm. Then he shook his head and thought, “man, night shift's a bitch”.