By Ben Lerman
The truth about human frailty descended on me in a windowless basement about the size of a basketball court. It had a low ceiling from which hung rows of fluorescent lamps, illuminating rows of metal tables, each supporting a dead body. In the anatomy lab, I held the scalpel as tightly as I held my breath and made the first cut. And, lo, the skin divided. It wasn’t the proximity to the dead body that made my skin crawl. It was the recognition that anything I might do to that body (and by the end of the semester my three partners and I would have dismembered, eviscerated, decapitated—no that’s too sterile, we would have shredded it to pieces) might be done to any body. My body.
Some people follow the path of least resistance to a career that suits them, while others follow the path of most resistance and wind up in the same place. A perverse masochism, a need to fly directly at whatever scared me most, led the boy who couldn’t stand the schematic drawings representing blood in a high school first aid class to a career as an emergency room doctor.
I learned, gradually, to put my squeamishness in a box, but I never succeeded in expunging it. At first the lid came off at unpredictable and inopportune moments. I got through dissection of the face, which I had thought would be the worst, only to be undone by the desiccated hand, which reminded me frighteningly of the hand of my great aunt, wasting away from cancer. A couple of years later as a surgery student, I got through a gory intestinal operation one day, only to faint onto the table as the first incision was being made the next. I was terrified that I might bungle even the limited responsibilities delegated to me as a student. My attending surgeon found my fears comical. There’s nothing you can break that I can’t fix, he would say.
By the time I was a resident I thought I had a handle on it. My anxieties were sublimated in the act of caring for the injured and the sick. That strategy worked well, not only because the work kept me busy, but because I had an almost religious faith in modern medicine. I really believed that if I did everything right, I could save anyone. Of course I was quickly relieved of my naiveté by the mounting death toll of patients under my care. I was forced to acknowledge, by degrees, that very old people might die, and yes, also people with advanced cancer, and, okay, maybe middle-aged people too, but only if they abused their bodies with tobacco and drugs and alcohol. And I finally recognized that even young people might get some horrible rare diseases that could kill them. But when it came to trauma, I stubbornly clung to my creed. A young healthy person who made it to the hospital in time, that person was just not going to die. Nothing could be broken that we couldn’t fix.
I was a second-year resident when I was flown out by helicopter to retrieve the victim of a horrific accident. A young highway worker had been impaled in the groin by one of the points of a digging machine shovel that had been driving at high speed. By the time I arrived paramedics had already inflated the Military AntiShock Trousers, which made the victim look like the Michelin Man from the waist down. The MAST hid the wound from view, but I could see that both his femurs were broken, because his feet were pointing the wrong way. I straightened them out, helped my nurse load him into the small helicopter, and strapped myself into a jump seat beside him for the ten-minute flight back to the hospital. Astonishingly, he was still awake. I put a pair of headphones on him so we could communicate above the roar of the engines. He told me he had a wife and two small children, and asked if he would live to see them. I said yes, not only because I couldn’t have said otherwise, but because I believed it.
Back in the emergency room we took off the MAST. There was a gash behind his scrotum, extending toward his rectum. I watched a senior surgeon explore the wound, inserting his gloved hand up to the wrist. A few minutes later the patient was carted off. I waited anxiously for news. A few hours later I caught sight of the surgeon as he passed through the emergency room heading out of the hospital. I rushed to catch him by the door, breathless when I blurted out my question. How had the operation gone? The surgeon looked at me as if confronted by a slightly simple child. There had been no operation. The wound had extended into the retroperitoneal space; it was inoperable. I made him spell it out, what did he mean, inoperable? Hundreds of tiny vessels, in an area impossible to reach. He had bled to death.
Twenty years it took me to learn we are made of stuff that breaks, twenty more and I am still learning to accept that it sometimes can’t be fixed. When patients ask, “Am I going to die?” the answer is “Yes.” I will do my best to put off that day, but “Yes.” We are made of matter, not light. A doctor’s shorthand for fracture is “FX,” just an “I” away from a quick fix. It isn’t that simple.