My alarm shrieks. It’s 6:57. Out of bed and into yesterday’s clothes. Dizzy from alcohol and insufficient sleep, I step into the morning under-dressed. My coat lies on the couch, the December freeze ignored in my haste. I race the clock to move my car. The parking on Tunlaw goes bad at seven—cops lurk, ticket books in hand, hoping to earn the city some needed cash.
I do this every morning. The residential streets fill with cars by eight each night. A late night at work, then dinner with Angie, this is my schedule. I always park on Tunlaw. Angie went home after dinner. I stayed up late, beers and a book, puttering and procrastinating, all in an effort to delay going to bed, to stretch out my free time.
Five minutes later, back inside, no coffee, no breakfast—I don’t keep those things stocked. I assemble my backpack. Rolling my work clothes to avoid wrinkles. Reciting my mantra. Shoes, socks, underwear, pants, shirt, tie, belt. I do this every time I pack my bag. A day without underwear sucks.
I dress in riding tights and two shirts layered expertly for temperature control, my bike helmet and that awesome Gore-Tex jacket my dad bought me for Christmas, I lug my mountain bike up the stairs, out the door and into the street.
My first stop: the gym. Moderate weights, fast sets, building endurance, not size. Popping between stations—back, biceps, back, shoulders, back—super-setting. Efficient, time saving, pushing my heart-rate, working up a sweat. My hangover lingers but doesn’t disrupt. It never does. I’ve powered through this before. Forty-five minutes, and I’m done. Shaky, starving. My work day starts at 8:30.
Unlocking my bike, fully immersed in shade, the rack is glazed in frost. I steer off the sidewalk, careen down concrete stairs abutting rusted metal bleachers and ride across the ballfield—my short-cut to Massachusetts Avenue. This is the last thing I remember.
“WHA! What the hell was that?”
“Someone hit us!”
“On the sidewalk?”
We were running late, me and Jamie. They needed us at the embassy by 7:20. It was pushing eight. A dump truck crushed a hatchback under Columbia Pike—cops, ambulance, a fire truck. It took over thirty minutes to get past that shit. Mr. Rosales called us every five minutes. God was he pissed. Jamie kept handing me the phone ‘cause bringing the flower arrangements in the morning was my idea. Mr. Rosales said the night before was a better plan. I said “What could go wrong?”
Jamie jumped out of the van and then dodged to the side. “Shit! Call 911.” When I came around from my side, I saw the mess. My initial thought: “Crap, they’re going to fire me.” I’m not so proud of that. Jamie was already on the ground trying to calm the guy down, telling him to take long, deep breaths. I just worried about getting in trouble.
The guy squirmed on the driveway, tangled up with his bike. He was making this noise. It sounded like my dog’s squeak toy when he really starts gnawing on it. The front bike tire was flattened—pretzeled, my son would say—pushed part way under the van. The guy left a massive dent. Last summer when my brother got t-boned in front of his house, it caused less damage than this. Hard to believe a person could make a dent like that.
I’m not sure what happened. I made a left across two lanes of heavy traffic. I didn’t see any bike. Last year, one of the drivers hit a lady who stepped off the curb. He got fired. They said it was about his attendance, but everyone says it was the lawsuit. That’s when I got my job.
The dude was totally out of it, moaning and cussing, and he wasn’t breathing right either. All the cars on Mass Avenue stopped. A few people got out to help. I made myself useful by picking up stuff off the driveway: his glasses and phone, some random crap that broke off his bike.
When the cops arrived, they came straight to me. Lots of questions. What did I drink Thursday night? How much sleep did I get? Why was I at the embassy? Didn’t I see the bike flying down the sidewalk? I didn’t get charged, though. A cop ticketed the guy for riding on the sidewalk. Literally, he wrote out a ticket and shoved it in the pocket of his coat the ambulance crew cut off.
The police report says the ambulance arrived in seven minutes, even with all that traffic. It seemed more like fifteen. I swore the guy would die right there.
I hadn’t even clocked-in yet, I just walked in the door when the call came in. A bike courier and a car they said. The courier lost. That means we eat the cost. Those guys never have insurance. Jason drove while I rode crew. He loves driving in traffic. He acts like it’s a movie. Sometimes I cringe.
Pulling up, Jason mumbled “Christ, look at this shit.” I could tell the guy was fucked when I saw the dent. I’m always shocked by people who bike through the city. It’s like they want to get killed or something. A thirty-pound bike, a two-thousand-pound SUV. And then they sue everyone involved. This guy will, if he lives.
The crowd backed away as we assembled our gear, all of them. No medical personnel stopped to help. That’s unusual, especially in this part of town. This route is thick with doctors, I guess they had better places to be. We were solo, and this was a mess.
Assessing the patient, we suspected multiple blunt traumas—surely a collapsed lung, possibly a spine injury, likely head trauma, maybe some broken bones. His sweaty, pale complexion suggested he lost a lot of blood. Internal bleeding, not a drop of blood on the outside. This seemed strange given the violence of the crash.
The driver hovered close after the cops were done with him. He looked like he had questions, but he never asked any. Jason and I ignored him. No good letting a guilty driver distract us. The cops talked with the guy in charge of the embassy like they were old friends.
We hooked up fluids to offset the blood-loss. The only other field treatment was a quick needle decompression to relieve the pressure in his chest. That worked, he began to breathe easier. Not well, but easier. As we completed the final assessment before transport, one of the cops came close, gathering the clothes we cut off. While we collared and boarded the patient, a cop wrote out a ticket. I have no idea what he planned to do with it, it’s not like he could hand it to the guy.
When bike crash calls come in, I’m always a bit nervous, I never know what to expect. Most are minor, maybe a broken arm, scrapes, lots of cussing. But some are terrible, as bad as we get. Once I responded to a lady who got run over by a Metro bus. This one was bad like that. Not as gory, but bad. I haven’t heard yet if it was fatal.
“Holy Shit!” Instant mayhem. Nothing was going on, nothing. We were eating breakfast, crowded around a four-top, extra chairs stolen from neighboring tables, from people sitting alone. Dr. Marlow droning about pneumonia. Pulmonary rotation. It’s the worst. One dried out geezer after the next. Asthma, emphysema, COPD, it’s a pathetic crowd.
Pagers erupted simultaneously, at least three of them within earshot. Marlow told Rob and me to ditch our food and get down to Trauma. A few minutes later, the torrent arrived. The patient, a Level 1, lashed out at the paramedics. “I’m not a fucking courier.” He was pale, almost white, and wild-eyed like a trapped animal. Breathing hard like he ran here. “I already told you, I have insurance.”
The guy was young, maybe thirty, and crazy fit. Writhing and barely clothed. Muscular. His shoulders and chest muscles were ripped like a swimmer. For a guy about to die, he was pretty hot. Rob saw me checking him out and said “Forget about him, he’s an asshole.”
Rob and I hooked up a few weeks ago. We just started on Pulmonary. After our first long shift together, eighteen hours, we all went out for mid-afternoon beers. It didn’t take much effort to get trashed, I was so strung-out from working overnight.
From the start, I flirted with Rob. I wasn’t really interested, I just wanted him to be. Most of us have been in rotation together from the beginning, but Rob just arrived. He’s further along than the rest of us. Back then, his sarcastic jokes still seemed funny. He kept calling me “his exotic creature.” I guess his lines worked. A little after sunset, he walked me to my place. Jesus, what a mistake. I can’t keep dodging him forever.
Dr. Liu pointed out the asymmetrical rise of the patient’s chest as he breathed. “Among other injuries, he suffers a pneumothorax. Plus, internal hemorrhaging, the lung cavity is full of blood, he’s drowning. We’ll set up a drain and prep him for surgery.”
Dr. Liu jabbed a scalpel between T7 and T8 but got hung up on the patient’s thick oblique muscles. He changed his angle and pushed through. The scalpel came out with a splash of blood, and Dr. Liu jammed in a clear plastic tube to direct the flow of blood. This was the most blood I’ve seen on this rotation. During surgery, they control things. Inserting the chest tube looked like turning on a hose. “Darwinism in action,” Rob said, maybe louder than he wanted. A couple of other residents looked at me and rolled their eyes. Dr. Liu stared at Rob. Only Rob would compete with a guy on the operating table.
Surgery really shook me. Dr. Liu called for a splenectomy. My mind wandered to my brother, twenty-two years old, living in Manhattan. I imagined him spread out in the O.R. having internal organs removed. Near the end of the operation, I got to assist in surgery, and I stapled the patient shut. Rob watched. Dr. Liu isn’t going to let that Darwin comment drop.
An officer called me at work. He said Chris got hit by a car, I should go to George Washington Hospital to see him. It sounded minor, so I kept working on my report. Peter already called twice to see if I finished. Every Friday morning starts the same way. Me late, undercaffeinated, trying to get caught up. Peter arrives, agitated, pushing for the numbers.
“Oh, I gotta go, Peter. Chris’s in the hospital.” I milked the drama of the situation so Peter felt sorry for me. “I’ll be back in an hour or two.” I walked to GW by the way of Starbucks. I got one for Chris, too.
I met Chris at a bar of course. My coworker Maggie had plans to meet friends for happy hour, a dive bar on K Street. Debbie and I came late. We both went home to change. It was really noisy. Loud music, people shouting to be heard. Deafening. It smelled like a frat house basement, or one of those empty bars we go to in Baltimore for a laugh.
We arrived right at that point when happy hour morphs into the nighttime crowd. Early partiers like Debbie and me just arriving, and the hardcore happy hour drinkers who decided to make a night of it. Maggie and her friends seemed pretty buzzed. I can’t really say drunk, because they were still conversant, but they were boisterous, and comfortable with the volume of the bar. Chris hit on me from the second we walked in. He backed me against a wall and spewed a confident banter of charm and jokes. It was almost like he was performing. Or I suppose he was. I fell for it, though. We started dating that night.
I walked into the hospital cold but carefree, excited to be out of work, maybe for the day. Curious to see what Chris broke, if anything. Maybe his arm or wrist. He broke his wrist a year ago. He hit a tree on his mountain bike, but we weren’t dating then.
The receptionist at the window asked who I was there to see. I told her Chris, and she told me to wait on the couch. Five minutes later a lady came out of the back. She wore a white collar like a priest. I stood to talk with her. “Your friend’s in surgery, we expect him to be in there for several hours.” This caught me off guard, my knees buckled a little, I sat back down.
I knocked Chris’s coffee over as I set mine on the end table. The liquid glugged out of the little sipping hole for three or four seconds, soaking the magazines before I turned it upright.
“But the cop said.. I mean… he didn’t say it was serious.”
“He has a lacerated spleen. They’re removing it now. He’s lost a lot of blood, maybe a serious head injury.”
A toddler behind me talked with her grandparents about her mommy and the baby. A guy with bed-head hunched over and rocked. He looked like he might throw up. I watched the coffee-spill slipping over the edge, staining the white linoleum floor. “Is he going to die?”
“Oh,” said the lady, “Let’s not think about that now.”
Angie called at noon. It took her forever to find my number. Chris didn’t have his phone with him. Or at least it didn’t make it to the hospital. I got there as they finished up surgery. They inflated Chris’s lung and decided his spleen was salvageable. They didn’t remove it. They CAT scanned his whole body though. His brain functioned properly, and his bones were intact. I was thinking we dodged a bullet.
When Chris was two, he ate some snail poison I left out on the patio the night before. He was limp, listless, and violently ill. That was the last time he went to the hospital for something serious. He’s had plenty of injuries, especially lately on his mountain bike, but they always patched him up and sent him away. Chris told me those stories like a comedy routine, making stitches and broken bones seem fun. That time when he was a baby, I thought I killed him.
Angie cried nonstop. I comforted her as much as I could. She’s hard to like, everything’s about her, even with Chris in surgery. She talked nonstop—I kept hoping one of her friends would show up. She needed constant reassurance. I wanted to concentrate. Meditate, maybe pray.
Ten years ago, my wife… Chris’s mother died. A six-year spiral with various cancers. It started with lymphoma, and as we treated that, she developed lung and stomach cancer. I spent days in the hospital watching her die. My day waiting for info about Chris brought those same feelings flooding back.
Chris handled his mother’s death poorly. He drank heavily since college started, but things really escalated after she died. After his second DUI, I checked him into rehab. He never stopped drinking, but he picked up his exercise thing which straightened him out. People who prioritize exercise like Chris don’t get drunk.
After a couple of hours, an Asian doctor came through the swinging doors with a young woman doctor close behind. She looked European. Not American-European, but actually from Europe. Maybe from Spain or Romania or something. “He came through surgery well, Mr. Carter. Your son is very fit. That always helps.”
“So, he’s going to be OK?” Angie perked up when I said this.
“He lost four units of blood, and his organs and brain sustained serious trauma. Let’s see how tonight goes. He’s in the ICU. You can see him now, but I doubt he’ll be lucid before morning.” The younger doctor looked unsure, awkward, upset. She kept glancing at Angie for some reason, maybe reassurance from a peer. Angie stopped crying and smiled a little. The room seemed to brighten.
That was the roughest day in at least a year. I spent nine hours in surgery on three different patients. They were all Level 1. Two people hit by cars and one gun shot. The gun shot was the easiest, and that one included a shattered rib and a collapsed lung. I usually see three or four serious pedestrian injuries a week. Two in a day is unusual. And Johnson had one too. Drivers are in a hurry. The pedestrians, especially the young ones, have a sense of entitlement. They don’t know how much damage a car can do.
After my shift, I wrote up a report about that cocky resident, Rob. He tries so hard to impress the other residents that it becomes distracting to everyone in the O.R. I know his type. He’ll finish up his residency and move on to dermatology or an orthopedic practice. Something steady and lucrative, low risk. He would never last in the E.R. Too much work, not enough reward.
Ilana shows promise though. More than the rest of them. The other trauma surgeons agree, she’s the one we’ll invest in. I let her get into that bike crash even though it was a fairly touchy operation. I’m not sure she was ready, but she needs to learn. Trial by fire is the best way. She did fine by the way.
“Oh, Friday. That was a terrible night.”
We were short from the start. Then Jessica went home sick. People running around, trying to keep up with the emergencies. They pulled some of the residents to help out. Those kids are just clueless. It’s hard to believe they’ll be in charge a few years from now.
The pace never let up all day, and here I was on a double, I switched with Jeanette. We had two pedestrian accidents and a shooting. And of course, the bike crash in IC4. They were all in bad shape. The trauma team was already in surgery when I came in.
My feet and back hurt from all the standing, I didn’t even get to break for dinner. Just before shift change, the biker flat-lined. Liu’s team responded, and they kept at it for more than thirty minutes. No one can say they didn’t try.
Later, after shift change, that pretty Israeli girl was crying in the patient lounge, maybe too hard. Sometimes it overwhelms you, especially the young ones. That asshole frat-boy tried to calm her down. You could tell she’d had enough of him. When you spend your life around death, you learn that some people want comfort, some just want to cry. I saw the father and the girlfriend in the waiting room talking with Dr. Liu. I think the father is going to be OK. But that girl, I don’t know.
Mostly I wanted that shift to end. Some days are cursed, everything goes bad. You just want to go home and sleep it off. Start fresh again tomorrow.