Watershed

To Maria and Alexandra, who stood by me. SATURDAY.The bow of the approaching runabout lifted as it accelerated, and he lost eye-to-eye contact with the skipper. The Friday before. Bastille Day. One more reason to celebrate the easy end-of-week schedule in his E-rooms. The usual collection of injuries caused by negligence, bad luck, and, all too often, alcohol-fueled bravado. Small fry after 30 years of practice at level I trauma centers. Nothing like the commotion a couple of days ago—a fellow of the knife-and-gun club shot in the pelvis. He’d almost exsanguinated by the time the chopper’s rhythmic thumping and acrid exhaust announced his rooftop arrival. A flurry of activity followed, keeping the teams in high gear for hours. Fortunately, no drama this Friday. Ahead, a call-free weekend with excellent weather. For the “guys and dolls” on weekend call, “perfect outdoor weather” usually translated into staying on your feet around the clock. For him, it meant ideal conditions for a lakeside party tomorrow and a group bike ride the following day. After the usual “stay safe” and “see you Monday,” it was time to get on his bike. He valued the daily jaunts to and from work as “free employer-sponsored workouts,” essential exercise between intense weekend group rides. Tomorrow’s party meant one less training ride—more reason to push harder on the way home today. As he vigorously pedaled, he pictured himself waterskiing the next day. Savoring the muscle fatigue from his efforts, he was blissfully unaware that this would be his last ride. Saturday. In the water, waiting for the towboat to retrieve him, he mused that waterskiing was far from his favorite pastime—and it interrupted his training for the long-anticipated multiday bicycling challenge later in the summer. But even waterskiing was a welcome break from the party tedium of eating, drinking, gossiping, and sunbathing. No risk of rupturing a cruciate ligament—unlike last winter’s downhill crash that instantly annulled an entire outdoor season. The bow of the approaching runabout suddenly rose, obstructing his line of sight. No more reassuring eye-to-eye contact with the skipper. As the boat continued straight toward him, he shouted. A blunt thud, boat against shoulder. Feverish efforts to push away, overwhelmed by the water’s drag on skis and life jacket. He slid along the hull toward the stern, drawn to the propeller by the vortex of the powerful engine. Sucked into the rotating propeller, the stainless steel blades sliced the left inner thigh, cleaved through the perineum, crushed the pelvis, fractured the right femur, diced the quad and the sciatic, stripped hamstrings and glutes, all that within milliseconds. So quickly he didn’t feel any pain, just an overwhelming sense of doom. The passengers froze, paralyzed by a scene straight from “Jaws,” immobile until he yelled, “Get me out!” As they pulled him on board, he murmured, “The leg is toast.” The first wave of excruciating pain hits when they heave him over the gunwale. A taste of what lay ahead. Every movement, each change of position, triggers waves of agonizing pain—onto the deck, to the dock, into the ambulance, onto the ER table. Each time, he pleads, “Get the helicopter,” a plea he repeats again and again, trying to stave off unconsciousness, his voice dwindling. On the opposite shore, uncertainty and impatience set in among the party guests. Where are they? What takes so long? One too many on board? Out of gas? Dinner is getting cold. Finally, the boat approaches. “Why are you so late? Where is my husband?” “Something happened.” “What?” “His leg got injured. They took him to the local hospital.” Okay, just the leg. Can’t be too bad, with all the biking and skiing he’s used to getting hurt. The disembarking passengers avert their eyes. Her phone rings. “Are you Mrs. X? We would like to transfer your husband to the University Hospital. Shall we wait for you to see him before transport?” “No, no—just transfer and I’ll see him there.” How bad can it be? Probably just wants to be treated by his buddies. Saturday, late afternoon. University Hospital. Transfer from outside hospital. Boating accident: male, bleeding, hypotensive, not intubated. Request to set up trauma OR. Rapid infusion system on standby. Prepare for massive transfusion. Meanwhile, in the rural ER, futile attempts to place peripheral intravenous lines. More success with shooting a noncontributing chest X-ray. BP 68/44, HR 80, Sao2 98% on room air. Just stay awake—don’t give them a reason to intubate. A wavering voice asks for consent to place a central line. “No, please, just get the helicopter.” Everything’s hazy, circulation to the retina must be dicey. He wouldn’t recognize anyone in this rural place anyway. Just stay awake. Flashes of central line placements gone awry and botched intubations in patients with Philadelphia collars rush through his mind. No central line. Get me to my hospital! It’s only 46 miles away, 50 min by car, where’s the goddamn helicopter? An eternity. Then violent pain brought him back from near-oblivion as he is transferred to the helicopter gurney. Clenching his jaw, groaning, somehow he made it through that interminable flight. Another transfer. Now, finally, the familiar ER—but from an unfamiliar perspective. The routine assault by the trauma team now experienced from the novel, receiving side: lines, rectal exam, basic questions and up to the trauma OR. Two hours after the accident. An hour at the community hospital, wasted? Finally, he was in what was “his” OR just yesterday. A familiar voice murmurs, “Hang in mate, we got you” followed by a barely audible, “Sorry, mate, but we’ll have to take your leg off.” “Go ahead. Just knock me out.” Oblivion, at last. This was the curtain call for his life as a practicing physician and the overture to a long, painful transition—from acute patient to lifelong cripple. A week later. After days of delirium, the fog finally clearing, he found himself incapable of any movement without help. Others had to feed him, dialyze him, brush his teeth, care for his colostomy, turn him, scratch him, reposition him. Bouts of violent somatic pain competed with excruciating phantom spasms. He came to learn that he was considered lucky, that he had escaped, by less than an inch, lakeside exsanguination, complete incontinence, and genital nullification. Not to mention the expected consequences of extensive wounds and open comminuted fractures flushed with a cocktail of wildlife from agricultural runoff-laced lake water. Even considering this “luck”—the skill and daring of surgeons, the dedication of nurses, and the competence of his immune system—the prognosis was dire. The gluteus was gone together with his leg and whatever was left of the femur was too short for a conventional prosthetic. Plans of hiking the Amalfi coast, biking Vietnam, diving the Great Barrier Reef, even walking the Seven Hills of Rome, vanished beyond the event horizon. Mutilated, in constant pain, bedridden, stripped of profession and self-esteem, what was there left to live for? “You have been always on the lookout for ways to challenge yourself. Now Fate has offered you the greatest challenge of your life, even though it’s not the one you would have chosen.” He hears Maria say. After a brief pause, she continues softly, “Together let’s prove worthy of your sufferings.” A faint glimmer of light stirred in the surrounding darkness.