Читать книгу Lion in the Night - Jack Armstrong - Страница 11

The site of the worst race riots during the sixties, Motown, the Motor City, home of the Lions and Tigers—Detroit was all these and more in 1970. Wide-spread illicit drug use, the sexual revolution, and the Vietnam War had unnerved the population. The city emergency room was often the only nocturnal safe haven for the injured, ill, and disoriented.

Ben was the surgical intern, and I was the medical intern assigned to staff the Detroit Wayne County Emergency Room. Wayne County Hospital was a 700-bed acute care hospital surrounded by a U-shaped, 2000-bed chronic psychiatric hospital. We reported for duty at 6 p.m. from Ann Arbor, home of the University of Michigan Medical School, to work a twelve-hour night shift. Bev, the head ER nurse, had warned us that tonight was a full-moon night and to expect the strange and unpredictable. Bev was a strong, wise, and practical nurse in her mid-forties who wore a slight frown or a thin smile depending on how chaotic things became and if we could control them. Her full moon superstition was shared by the entire ER staff, regardless of race, gender, or age. From her point of view, our job was to diagnose, treat, and comfort every patient who graced our doors no matter what circumstance had propelled them to us or what phase of the moon beamed down on us.

Ben, on the other hand, was a former college football player, intelligent, good natured, obsessive, and religious. He had short brown hair, a wide smile, a certainty that everything could be ordered if understood, and a total disbelief in the lunar myth. This was the first ER rotation for both Ben and me.

When I arrived in the ER at 6 p.m., the examination rooms were full of sick patients. Moans of pain, retching, and screams of distress overlaid the purring of the cardiac monitors and the soft conversations of nurses and patients. I worked ninety minutes straight before Bev, a slight frown on her pale, long face, informed me that Ben was late, and Ben was never late. Ben was punctual and neat, his small work area always orderly. I was unable to resist moving Ben’s pen or file to the other side of the desk to enjoy his studied evaluation of the small permutation and changed space—then his careful movement of things back to their original order.

After 8 p.m. Ben appeared, looking more like a trauma patient than a physician. Ben slumped into his chair, spread his large arms and hands wide, and related his vexing tale.

“I was driving along I-96, on time to arrive at 5:45. I noticed a car pulled over on the shoulder of the road, a white rag tied to the door handle, flying in the wind. A young, good-looking woman stood beside the car and waved frantically for me to stop. I pulled over, got out of my car, and walked over. It was twilight, and the sun was fading as the huge full moon rose from the horizon. She told me the engine had made a loud knocking noise, then ground to a halt. She was upset, late for work, and asked if she popped the hood, would I take a look. Just as I leaned over the engine, two big guys appeared from the other side of the car, and one hit me with a bat and knocked me to the ground. They told me not to move, took my wallet, then hopped in the car with the girl and sped away. For a while I just laid on the gravel, my head hurting too much to move. Finally, I was spotted by a passing cop who pulled over, called an ambulance, and helped me up. I refused to go to the hospital, telling the medics I was headed here anyway. The cop said I was lucky I didn’t fight back, or they might have killed me. After the medics cleared me, the cop followed me here to be sure I made it. Man, who would have thought I’d receive a good Samaritan’s penalty. As the cop drove off, he pointed at the rising moon and shook his head.”

I examined Ben, who was bruised and battered, but neurologically intact. He washed up and changed into green surgical scrubs. As Ben entered the first surgical room, he turned to Bev and said, “Well, I’m glad I’ve got my lunar curse over early!” Bev sighed and frowned but didn’t reply.

After several steady hours of routine work—chest pains, the great flux, rashes, painful pee, and twisted ankles—traffic slowed, and Bev, Ben, and I collapsed in our steel back chairs to enjoy some strong coffee. The front desk secretary broke our quiet with a yell back, “Overdose en route. Arrival two minutes.”

Bev punched my shoulder and said, “That’s you, medicine man.”

All kinds of drugs were circulating in the seventies, but amphetamines, LSD, and PCP (angel dust) were common and difficult to manage because of extreme patient agitation. Heroin overdoses were confined to regular users, only later to reach into all classes with the explosion in pain prescriptions. Hallucinogenic drugs were especially common in young, well-educated kids looking for visions, insight, and “Hey man, something new and wild.”

The medics rolled in the gurney from the ambulance holding a raging, psychotic young woman restrained by arm and leg straps. Bev stepped up to accompany the medics to the exam room to place the cardiac monitor leads on her chest and to help the patient into her exam gown.

With a slight smile Bev said, “Give me just a minute, Dr. Armstrong, and this one is yours.” I walked to our cramped work area with one of the medics who explained to me that the woman’s roommate had related that they had shared LSD together, but the patient had taken an extra dose “to really get it on.” As he finished his brief history, a blood-curdling scream pierced the air, and the young woman appeared outside the exam room, eyes wide, mouth open, completely naked. Bev and one big medic were right behind her, arms outstretched. Just as their arms approached the wild woman she bolted down the hall, passing Ben, a medic, and me as if we were frozen ice statues. She rounded the hall corner at full sprint, passing the desk receptionist, security guard, and two medics, and raced out the ER door heading straight for the hospital lawn leading to busy I-96. Ben and I exchanged quick glances and took off after her. Ben reached the naked woman first about fifty yards from the busy expressway. He made a perfect ankle tackle, but struggled to keep her under control. She screamed, “Pigs, let me go! Ah ya, ya, ya! They’re coming after me! Look, look!” She pointed back at the hospital, then began beating Ben furiously with both fists. The moon above us was now full and bright.

Ben looked up at me and said, “I think this is a medical patient, Jack!” He lifted her up from the ground and onto my shoulder, quickly tying her ankles together with a phlebotomy tourniquet. She slowly turned her head to me, stared into my eyes and said, “Blue, the devil’s eyes are blue,” then spit on my forehead and kicked my back. The middle-aged Hispanic security guard finally arrived, draped a brown blanket over the struggling young woman, and we began our march back to the ER.

“Oh no, oh no. They’re coming for me. Help, help!” she screamed. I looked into her large, very-dilated brown eyes.

“Who is after you?” I asked.

“The panthers. The black, lean, hungry panthers. Oh, God, no, no, leave her alone!” she pleaded.

“Are they chasing you?”

“They’re chasing a small lamb and oh, oh, the lamb has turned to us and its face is my face! Save it!”

“Why are the black panthers after the lamb?”

“They want to catch her and tear her apart. Oh, no, no, they’re getting closer!”

“Imagine yourself as the lamb. Try to get inside her . . . Are you there?”

“I’m there. OK, but I’m so afraid!”

“Now roar. Roar like a lion, like you’re not afraid, but ready to fight back,” I paused while she roared into the night. “What happened?”

“They stopped! The panthers are backing away!”

“What’s your name, little lamb?”

“Sarah. Sarah Bentley. You’re a nice doctor, will you take me back to the hospital now?”

“That’s where we’re headed, Sarah Bentley. Are you a student?”

“Yeah, I’m a psych major at Wayne State. Oh, oh. . . they’re still looking at me, and their jaws are open and dripping blood. Oh, what have they killed? Help! Help me!”

“Roar, Sarah! Roar like your life depended on it.”

“Arrrrrrrrrrrrrrrrrrrr!”

“What’s happening?”

“They’re backing off. I think they might go looking for another lamb.”

“We’re almost back to the ER now. The nurse will give you a gown, and I’ll give you some medication to calm you down until the psychiatrist arrives.”

“Your voice is so calm. I think I’m getting sleepy already. I took the LSD to know what they were seeing.”

“Who was seeing?”

“The patients. The psych patients we’ve been reading about. The hallucinations of the mad.”

“Now you know.”

“Oh, God, what was I thinking? Oh, ouch. Egads!”

“What happened?”

“Electric shocks just came out of the sky and are piercing my head. Pain, pain.”

“Do you see the rock in front of you?”

“Yes, I see it. Oh, the lightning is burning my hair!”

“Pick up the rock and hold it over your head and the shocks will bounce off.”

Sarah’s arms reached over her head holding the imaginary rock, then held steady.

“Well?”

“The shocks are bouncing off. The pain is going away.”

“We’re here now, Sarah. I’m placing you on the stretcher. Keep your arms over your head. I’ll see you soon.”

Sarah was only nineteen. She was admitted to the hospital psychiatric service for five days. The terrifying hallucinations slowly receded. The psychiatrist remarked that her lion roars could be heard in downtown Detroit. As Sarah was rolled to the elevator to the psychiatry ward, an orthopedic patient was brought back for Ben’s attention.

“You won’t believe this,” Ben stated, looking incredulously at Bev and me. “Orthopedics. What is more straightforward than bones and joints? A cast here, a brace there, it’s fractured or it’s sprained. But this next patient has two broken tibias, both fractured in the same place? How could that happen? I asked the patient to explain this as I was placing him in traction and waiting for the on-call orthopedic surgeon.”

The patient hung his head and replied. “My wife said, ‘Don’t do it. Just call the tree guy.’ But I could see the cracked limb. I could reach it with my extension ladder. As I climbed up, I noticed the full moon, just behind the limb. I went into a trance, I think. I began to dream of the first time I took my wife out on a golf course with a blanket and a bottle of wine. We were so young and everything was so new. I climbed out on the limb, the saw in one hand. Somehow I could get a better grip by sitting on the limb. The moon was so bright, my wife so young, and her skin so soft. I sawed away and the limb cracked and fell, and I fell too, straight down and landed on both feet, twenty feet down. I guess I’m lucky it was just my legs.”

Ben smiled and looked at Bev. “I guess that’s the last of the lunar crazies?”

Bev reached for the phone at that moment. She listened for a while, her whole face turning into a frown.

“Just a minute, Sir, I have the doctor here. Let me see what he thinks.” She punched the hold button. “You are not going to believe this. It could be a prank call, but the guy seems like he’s in a real panic. Will you talk to him?”

“How could it be worse then what we’ve already seen?” I asked.

Bev punched the hold button and handed the phone to me.

“This is the Doctor,” I said.

“We got trouble here, Doc,” a man replied, breathing heavily. “Real trouble. I was making love to my girlfriend. We were really going at it. Then I was done, right, so I began to pull out, but I’m stuck. Every time I try to exit I seem to get caught, and she screams bloody murder. So we’re lying here, see, and I don’t know what to do.”

“Don’t try to come out again. Give the nurse your address and we’ll send an ambulance out to bring you both in. Wrap up in a blanket and I’ll see you soon.”

Twenty minutes passed and the couple was brought back on the stretcher in the missionary position. The girl explained that they had been drinking a lot and looking at the full, radiant moon. Her boyfriend opened the window to let the moonlight in, and then they really went at it. When he was done he tried to withdraw, but each time it felt as if he was pulling her insides out.

The pelvic exam was difficult, with the boyfriend pushed to the side. The light illuminated her vagina and the man’s uncircumcised penis could be seen ensnared with the laces from her intrauterine device. Each time he moved, the captured penis tugged on the cervix, pulling the uterus forward. The cuts of the laces were tight, but eventually the man and the penis were free. The gynecology resident removed the IUD. The couple were grateful but embarrassed, and for some reason blamed the moonlight, not the IUD for their trial.

The night slowly wound down. Ben was in the surgical suite sewing up a forehead laceration of a young boy who had fallen off his new bike, which he had decided to ride in the driveway in the moonlight. Bev pushed the wheelchair occupied by a balding, middle-aged businessman in a tailored sports coat and red silk tie across from my desk. Bev’s weary face now had a permanent frown, and her left eyelid twitched rhythmically.

Bev paused the wheelchair across from me and said, “He has chest pains, Doc. He said he’s had crushing mid-sternal chest pain for an hour.”

The businessman looked up from the wheelchair and said, “Look, Doc, I don’t want to be here. What are you, just an intern? Jesus Christ, I told those damn medics to take me to my private hospital, but ‘Oh no,’ they said, ‘You’re having a heart attack, and we’re taking you to the closest ER, Wayne County. Time is really important.’ So here I am.” His face was as white as the moon, and perspiration was apparent on his upper lip.

“What were you doing when the chest pain began?” I asked, noting the contrast between his Harris Tweed jacket and his dirt-stained hands.

He looked embarrassed and hesitated for a moment, but like most men whose lives are in the balance, decided to tell the truth.

“I woke up at 4 a.m. and couldn’t go back to sleep. The moon was huge and shining through our bedroom window. I figured I might as well dress for work. I work for GM in Rochester. After I dressed, I looked out the window again, and the moonlight had illuminated the whole backyard, particularly the part I had been raking last night, but didn’t finish. I’d left the wheelbarrow half full of leaves and those damn walnuts. So I thought, well, might as well finish the job. I loaded up the wheelbarrow and was pushing it up the hill to dump it in the mulch pile when it felt like a vise had grabbed my chest and was clamping shut. I became short of breath and broke out in a sweat. I made it back inside, and yelled to my wife to call the rescue squad. As we drove off in the squad car, you could see the whole yard lit up by the moon. Strange.”

As the man said “strange,” his voice trailed off. After a moment he began to tremble, then shake, and finally his arms and legs began to twitch in tonic clonic movements. Suspecting he was developing ventricular tachycardia during the acute ischemic stage of his heart attack, I leaned across the narrow work desk and hit him firmly in the sternum. An external cardiac thump had been known to cardiovert ventricular tachycardia. After a brief pause, the seizure stopped, he regained consciousness, and said, “Damn, Doc, that really hurt. Why’d you do that?”

Bev nodded at the cardiac room and rolled the stretcher quickly back. Rapidly we undressed him, slid the gown on, and placed the cardiac monitor leads. I slipped an intravenous catheter into his arm and Bev drew up the IV lidocaine. As we checked the monitor, his cardiac rhythm switched from rapid sinus tachycardia to ventricular fibrillation, a serious cardiac arrhythmia that cannot support blood pressure or life. His tonic clonic seizures resumed.

Bev wheeled the defibrillator to the bedside. I pushed the IV lidocaine through the new IV as Bev cranked up the voltage on the defibrillator.

“Ready to go, Doc,” Bev said.

I placed the defibrillator pads on his chest, applied the paddles, and pressed the discharge switches. The defibrillator shocked the patient’s chest, and he rose abruptly from the stretcher.

Ben had entered the room to help, as did two additional nurses. Ten eyes focused on the cardiac monitor. The seizures slowed, then stopped. The monitor displayed the normal rhythm and echoed the reassuring regular beeps.

“We need to get to the Coronary Care Unit quickly!” said Bev.

As we wheeled the stretcher through the exam room door leading to the elevator, the patient resumed groggy consciousness.

“Damn, my chest really hurts!” He focused on me, paused, then said, “I’m going to look for you, buddy, when this is over.”

We wheeled him quickly through the ER, into the elevator, then into the Coronary Care Unit where expert hands took over.

Ben, Bev, and I sat quietly in our small, now-cluttered work area. Three untouched steaming cups of coffee and three large chocolate donuts rested in front of us. Ben’s warm smile was gone, his hair was rumpled, and his hands rested in his lap. Bev no longer smiled or frowned, and her left eye twitched constantly. My insides were empty, spent. Bev looked up first to Ben, then to me, and said, “Just walked outside. It’s dawn. The sun is rising. The moon has set. We should be OK now.”

Ben and I both sighed, but neither of us corrected her.

Ten days later, at the night shift start, Bev poked her alert face around the corner, both eyes arched but not twitching, and said, “Someone here to see you, Doc.”

A well dressed, balding, middle-aged businessman appeared around the corner, a serious expression on his face. Had he at last returned to even the score? A wide smile broke out on his face, and his hand extended to mine.

“Thank you, Doc, for a really good punch. I’m going home today!”