Intensive Care
John Crawford
I quit my job because of M*A*S*H.
I’d taken a job as Patient Care Technician, which is somewhere between an Orderly and a Nurse’s Aid. I was tired of doing the normal retail jobs, and I figured working in the Intensive Care Unit at a hospital was about as far from being a register jockey as I was going to get. A year and a half later, I’d done so many chest compressions on so many people that doctors running the codes didn’t call for compressions anymore. They just looked at me and nodded.
It always started the same way: I would hear the PA system’s automated female voice, somehow managing to convey the tone of urgency hidden under a forced calm, “Code blue! Code blue!”I’d taken a job as Patient Care Technician, which is somewhere between an Orderly and a Nurse’s Aid. I was tired of doing the normal retail jobs, and I figured working in the Intensive Care Unit at a hospital was about as far from being a register jockey as I was going to get. A year and a half later, I’d done so many chest compressions on so many people that doctors running the codes didn’t call for compressions anymore. They just looked at me and nodded.
Then it would state the area of the hospital where this was all happening. During the day shift, because of all the visitors, the nurses and techs and other necessary personnel perfect a sort of power walk that they believe is going to keep things on the quiet side. Although I expect seeing a bunch of people in scrubs power walking down a hallway would not go unnoticed. Overnight, on my shift, no such pretense was necessary, and occasional observers would see blurs of scrubs flying through the hallways to get to the dying patient. It really is just as dramatic as it is on television, until you hear the people running with you making jokes.
Just another day at the office, chatting around the old water cooler.
By the time I would get to the room, it would always be full of people, until someone, usually my charge nurse Marlena, would kick most of them out.
“If anyone is here who doesn’t need to be here, get out!”
Marlena could clear a room faster than anyone I’ve ever met, and I have nothing but pity for anyone who ever tried to challenge her. She was a short, stocky woman with a significant limp that tried unsuccessfully to slow her down. Her parents had been hard working immigrants from Mexico, and she was as tough as a person could be in a pair of flowery scrubs. Whenever there was a code in our unit, she would tell any other tech who showed up to leave, because I was there. More than once I ended up doing compressions for nearly an hour, because she didn’t trust the techs from the other parts of the hospital.
So the room would clear out, except for the on-call doctor, Marlena, the patient’s nurse, a couple of others who stayed to help, and a respiratory therapist. And me, one knee up on the bed for leverage, doing chest compressions.
This part is nothing like it is on television. On television, you never see the rib plates folding under that pale, grayish skin. You can’t feel the tiny shock wave that travels up your arm when a rib breaks under the pressure. You don’t hear that muted crack under the skin, and you don’t notice how your hands push in a little more than before. This, they tell you in CPR class, is an acceptable side effect, and will happen more often on thin people. When the code ends on television, either everyone is relieved and works out their own problems, or we get to see how hard the doctor takes his patient’s death. They never get called back into the room, because the patient crashed again. You never see the twenty one year old tech go outside to the dank, isolated employee smoking area, and he never chain smokes for half an hour because he knows he has to go back upstairs after this and take the body to the morgue.
The credits never roll in real life.
What happens instead is that people get used to it. It turns out to be like any other job. At first, it’s all new and unnerving, but eventually you get the hang of it and it’s just work, like anything else. Eventually, you get so that after you witness a man forcefully remove his own catheter –which is much worse than when women do it-, or you wrestle a delusional patient with a head wound back into bed and get them restrained, you don’t need to go outside to smoke. Instead, you remember that it’s lunch time, so you go downstairs to the all night snack bar and get some chicken strips. When someone codes half an hour before your shift is over, and everyone grumbles about wanting to go home, you join in.
This where I was until one night, my first night off in four days, I was sitting in my quiet little one bedroom apartment watching television. When all your friends work days, and even the bars close at two, you spend a lot of time at home, by yourself. So I’d gotten pretty familiar with the late night programming schedule. From midnight to one, The Cosby Show would be on one channel. Then, one episode of Cheers, or maybe something like Night Court, depending on my mood. After that, I had thirty minutes to kill before M*A*S*H came on, and that was when I’d make dinner. That night I went to Whataburger, which took forever, and by the time I got back the theme song was playing already. So I threw the bag of food on the coffee table and ran into the kitchen to get a beer before it was over.
M*A*S*H is a show about an army hospital unit set in the Korean War. The title is actually an acronym that stands for mobile army surgical hospital. I had taken a renewed interest in it since starting at the hospital.
It turned out to be the episode where a TV journalist comes to visit and interviews the surgeons and nurses about what it’s like there. This is one of the greatest episodes of M*A*S*H ever, and I hadn’t seen it since I was a kid, so I was in a pretty good mood. I was blissfully alone in a quiet apartment, watching one of televisions’ best shows, having a big, greasy, half pound double burger and what would probably become three or four beers provided by a Mr. George Killian, by way of Coors. What more could I ask? Then, actor William Christopher showed up on screen as Father Mulcahy and said this:
When the doctors cut into a patient,
and it’s cold, you know, the way it is now,
today . . . steam rises from the body.
And the doctor will . . . warm himself
over the open wound. Could anyone
look on that and not feel changed?
I sat back against the cool leather of the couch and stared at the screen. I didn’t know why that hit me so hard, exactly. I’d seen episodes before where people died and things were sad and everything and had never been bothered by it. I’d seen Hawkeye, a surgeon on the show, do CPR, and instead of hoping the patient lived, I pointed out that he was doing it wrong, his rhythm was off. But that stayed in my head for the next two days, rattling around as I enjoyed my time off.
Then it was time to go back to work. It was a quiet night for a while, until about one in the morning, when Marlena told me to get room number three ready for a new patient. As I got up from my chair, I heard her tell Sandy, a bushy blonde haired nurse who spoke softly and looked at everyone with eyes that always seemed to understand, that she was getting a new patient.
“She’s an over dose, they think aspirin and a few other things.”
“Family with her?”
“Family’s out of town, they can’t get ahold of ‘em. They gave her charcoal, but they don’t know if it’s too late or not.”
That was all I heard, because that’s when I started thinking to myself I should make sure a comfortable chair is in that room, because I’ll be in there babysitting in case she wakes up.
I went into the room, sliding the door open. The rooms in this unit didn’t have regular doors, but huge sliding glass doors that opened up all the way for easier access. This made it possible for us to bring in the patient on his or her bed, line them with our bed, and lift them up and over. I just finished laying the blue cotton pad on the bed –designed to protect the sheets in case of incontinence- when I heard the general noise of people from the ER getting off the elevator and pushing the stretcher. Marlena directed them to room three and I put some gloves on and twisted my neck a little to pop it, out of habit.
They wheeled the stretcher in and I saw for the first time that it was a young teenage girl, maybe fourteen. I heard the snippets of the nurse from ER giving report to Sandy while the rest of us moved the girl onto the unit bed and hooked her up to the monitor.
“Police found her in her home. . . empty bottles on the floor next to her. . . couldn’t find any numbers. . . fourteen years old. . . aspirin, sleeping pills. . .”
After everything was situated, the ER people took their stretcher and went back downstairs, Marlena told me that I would indeed be sitting in here, just in case. I knew that for an aspirin over dose, charcoal is sent into the stomach via a nasogastric tube, because the chemicals in aspirin will bind to that instead of getting in the blood stream. If this is done too late, however, the liver bleeds out. So I was in there either waiting for her to wake up or bleed to death internally.
Much as I hate to admit it, this normally would not have bothered me very much. I’d done it before, with varying outcomes, so I was familiar with the end process. But this time, Father Mulcahy was delivering his monologue in my head with that high pitched, earnest voice of his. I tried to ignore it, reading a book I’d brought in with me. It didn’t last. I sighed and put the book down in my lap, turning to look at the patient.
Fourteen years old. This girl was too young to be here. She wasn’t a patient; she was just a kid, a baby. This wasn’t work, this was a living person fading away right next to me, and I was just reading a book like I was waiting for a fucking bus. I looked at her, so small in that hospital bed, tubes coming from her nose and arms going into small IV machines. She wasn’t ending a long and painful battle with cancer; she wasn’t paying the price for a life of heavy smoking and drinking. She was just a girl, all alone and feeling God knows what.
She was unconscious, intubated, and if anything was left in her mind, she was dealing with it all on her own.
So I did the only thing I could think to do. I held her hand lightly and turned on the TV, talking to her softly about what was on. We watched the two episodes of M*A*S*H that came on at two, and after that I channel surfed with the bedside remote, talking to her the entire time. Until about five, when she crashed.
In the span of about ten seconds, I went from holding her hand to pushing down on her chest, making her heart pump while nurses flew around us, setting up the crash cart and yelling for things. The translucent blue mask pushed her eyebrows together, making her look like a child having a nightmare. I felt one of her ribs go, the small crack vibrating through my wrist the way thunder rattles windows. For the first time in over a year I felt scared and desperate about what was happening. I found myself pleading with a God I didn’t even believe in to do something, even though I knew it was too late.
Fifteen minutes later I was outside, smoking cigarette after cigarette and looking up at the sky. It was still dark; sunrise wouldn’t be for an hour or so, and the stars were shining. I sat on an old wooden bench and stared up at them while all the things I’d seen and done in this building came rushing back to me. All the people I’d seen die as I kneeled over them, all the bodies I’d taken to the morgue or helped the funeral home people move out. All those empty, blank faces staring up at nothing came back, and I knew why Mulcahy’s words had stuck. I wasn’t used to it anymore, and I wouldn’t be again.
I had looked, and I had been changed.
