For the following installment in our series, the author gained extraordinary access to the inner circles of neurosurgery for an intimate and riveting portrait of a little-known profession. Making the story that much more unusual is the fact that the subject is one of an elite handful of female brain surgeons in this male-dominated field.
Dangerous Professions: Part Two
We can’t always trust our perception of danger to keep us safe. And professions that seem safe to some may be perilous to others in ways that we can’t even imagine. For example, Neurosurgery. The surgeon featured in the following story does not seem to be exposing herself to any immediate occupational hazard. She works indoors. She is in charge while working. Her patient is anesthetized. Everyone else in the room is on her team. So how could she be hurt?
And yet jeopardy comes from within.
The very nature of her work — the extraordinary psychic and emotional stress of living in the midst of chaos, emergency, and death every day, sometimes for 20 hours at a stretch, the lack of sleep, the destructively unpredictable schedule — all of these factors make her job in neurosurgery every bit as dangerous as the other occupations that will be featured in this series.
Because of this stress, as well as her desire to surround herself with less excitement, not more, we have changed the doctor’s name at her request — as well as the name of her patient and the location of the hospital. Everything else in the report is exactly as it happened while correspondent Laurence Gonzales was attending neurosurgery.
The first time I saw Helen, she was sitting up in bed, her almond eyes looking at me inquisitively. A girlish pout informed the expression of her full red lips, and her extravagant black eyebrows gave an intelligent cast to her broad forehead. Her Greek nose was fine and straight; her olive skin was clear and veiled in a soft light that cast reflections on tiny hairs, which glittered on her outstretched arm. I kept expecting her to yawn and smile and greet the morning sun out there beyond the ice crystals on the windows. It was a gorgeous day. But all she did was breathe in and out and stare at me. Her lips moved slightly as she breathed, and Dr. Anita Braun, the neurosurgeon, said, over and over, “Helen? Hello, Helen? Can you squeeze my fingers? Helen? Hello, Helen? Squeeze my fingers, Helen. Squeeze my fingers.”
Dr. Braun turned to me. “She may hear us, but she can’t respond.” It was only then that I saw the curving, horseshoe-shaped scar that circumscribed half her skull-bone removed for surgery. In the middle of the scar was a dark and ragged hole, no bigger than a nickel, where the bullet had gone in.
Helen’s hair was beginning to grow back — it was about marine-recruit length now — and I could see that she had been well cared for, clean and groomed and fed, well cared for by her boyfriend, until he hired someone to shoot her in the head. He was a drug dealer, and Helen had been planning to inform on him, because she was pregnant and needed to change her life. Now she was going to have her baby in peace — the doctors were going to keep her alive that long at least. There was no name on Helen’s chart and her whereabouts were a closely guarded secret, because the boyfriend was still after her.
As we continued rounds in the early morning hours — Dr. Braun with her entourage of surgical residents, medical students, and nurses — we passed others like Helen. “We’re going to see the train wrecks of the night,” Dr. Braun had told me on the way to the hospital. She had also told me, “Our motto is, See no evil; hear no evil; smell no evil.” At first I mistook her flip remarks for cynicism, but I didn’t understand. The truth was that Anita Braun worked at the edge of the universe. As a top neurosurgeon, she could have been making $500,000 a year fixing slipped disks. Instead, she chose to work at a county hospital in Detroit’s inner city. A neurosurgeon in private practice might actually open someone’s skull ten times in a year. Dr. Braun, getting paid a pittance by comparison, performed the same operation a dozen times in the single month I spent with her.
At first I wanted to know every story. But after a few weeks of going on rounds, I learned that there was always something more tragic than the last story I’d heard. In the pediatric ward, we visited an eight-year-old boy whose spine had been severed by a gang bullet. He was paralyzed from the neck down. “You should have seen me when I had to tell his mother that he would never walk again,” Dr. Braun said. “It was so sad. So sad.” And then she moved quickly on to the next subject. She never spent too much time in one place in quiet contemplation — it was too risky. If she was going to be able to do these people any good, she couldn’t become emotionally crippled by the horror. But my curiosity still had the best of me then, and I hung back to watch the eight-year-old boy.
I stood by his bed as the nurse suctioned out the breathing tube that had been surgically implanted in his neck. He had dark Latin eyes and soft, shining black hair, and he wore Nike athletic socks that would never run a step. Each time the nurse detached him from the respirator, he started to suffocate, and a look of panic came over his gentle, handsome face; his mouth worked to gulp air as the nurse spoke soft words of encouragement.
I began to regard morning rounds as a test, to see what the world was made of. It was harsh stuff, diamond hard, but it made me clear all day, like taking a jolt of some high-tech ecstasy drug. As we walked down the hall, Dr. Braun told me about one of her patients, a woman who had a fatal form of brain cancer. No one would operate on her. Most doctors would have given her up, told her family to take her home and let her die.
But then, that’s Dr. Braun’s specialty: hopeless cases. You see, the fact is, malignant brain tumors are almost always fatal, so why bother doing surgery? The patient’s going to die anyway. On the other hand, Dr. Braun can sometimes take a comatose patient and, by carefully removing as much of the tumor as possible, give the family someone they can talk to, someone who can say goodbye, maybe even someone with a few good years left.
After the intricate and tedious operation, this particular woman survived for three more years. In fact, there was an unforeseen benefit from the operation. She had gone through a hideous divorce from a very bad husband, and when Anita Braun removed the tumor, she also inadvertently removed the part of the woman’s brain that contained her husband. “She had absolutely no memory of him, nor of the messy divorce. It was kind of a bonus for her. She was happy. She was doing fine. But then she caught on fire and burned up,” Dr. Braun told me. The woman was making coffee when her robe went up in flames. “Her mother came in and watched her burn to death.” I could see the pain in Dr. Braun’s face when she thought of the paradox of losing to fire this woman whose life she’d saved. All Dr. Braun could do was toss it off with a remark. Otherwise, if she became too involved in it, all of her pursuits would seem futile. The whole practice and all her skills would seem a grim joke, and she’d have to quit and go into a cushy private practice.
“I felt as if I were being suffocated as I watched Dr. Braun lift the seal p and peel it back and cut through facial muscles just over the patients eye socket.”
There was a man who made a study of which qualities might predict who would become a good neurosurgeon. He first went to the seminary for advice on how they chose priests, but they were of no help. Then he went to United Airlines to ask how they found good pilots. United told him, “Well, there are pilots who will get you from A to B every time and never do anything interesting, and then there are test pilots. There’s not much in between.”
“Which one are you?” I asked Dr. Braun.
“I’m a test pilot,” she said.
And she was. She took the cases that no one else would touch. Once two little girls were brought from Central America. They both seemed to be terminally ill and no one would operate on them. They did not want the blood on their hands. Besides, they wanted paying customers. Dr. Braun took them for free at the county hospital. She performed both operations. She kept a photograph of herself with one of the girls on her office bulletin board. The picture showed Dr. Braun, smiling, her arm around an eight-year-old girl whose head was all bandaged in white. The little girl was smiling, too, and her parents were smiling. Everybody was smiling.
“How did they do?” I asked.
“She lived,” Dr. Braun said, pointing to the smiling girl with pretty brown eyes. “The other one died.”
And so, as we made rounds, I began to understand what Dr. Braun thought about when she’d say something like, “Oh, this is all lightweight stuff. This is routine.” At other times, she’d hunker down inside herself and whisper something like this: “In one day there is so much drama, there’s such intensity, you have to go home and numb out. Sometimes I get home from a case, and it’s two in the morning, and I’ve been up for days, but I’m not even tired anymore — I’m beyond being tired — and I just sit up watching ‘Ben Casey’ or something moronic. It’s what I call the neverending search for boredom.”
I commuted to work with Dr. Braun, and every morning we’d get into her dusty black Honda Civic and ride downtown, stopping at McDonald’s on the way to get coffee, orange juice, and sometimes a plain biscuit. Dr. Braun liked to try to sum up neurosurgery for me, but we both knew that she never could. She’d say, “Neurosurgery is the most fun you can have with your clothes on.” Then she’d think about it and say, “No, that’s not right. Neurosurgery is… ” But it always came out sounding like something Charlie Brown would say on a greeting card. And then a summary of her world would come down out of nowhere, like the day we were driving home and her beeper went off. Dr. Braun called the hospital on the car phone that she kept on the floor under a knit cap. The sun was going down, and along the lakeshore the waves were crashing in the running sunlight. I heard her talking; then she turned to me and said, “One of my patients is D.O.A. in the hospital. Listen. I’m on hold.” She put the phone to my ear-I could hear elevator music playing. “Isn’t that great music to hear when you’re waiting for someone to tell you your patient is dead?”
Sometimes we just rode in silence. One morning there was a long period of silence, and I knew she was thinking about “Neurosurgery is… ” Finally, she said, “Nobody wants to touch the brain.” She was not being flip. She was making the observation that the brain is a holy place, a dangerous place to be, and that most doctors are afraid of it, just as most pilots are afraid of flying upside down.
I waited, as we cruised along the lakeshore, watching the waves curl and disintegrate in the winter sunlight. Then Dr. Braun said reverently, almost in a whisper, “We’re going to touch the brain today.”
There are very few arts that can make a grown man faint. But when Anita Braun first uncovered the human brain arid showed it to me, I broke out in a cold sweat, and I had to put my head between my knees.
Coming out of surgery, I always felt dangerously contaminated, as if I’d been working with plutonium. In part it was the constant threat of AIDS when we were sprayed with a patient’s blood. In part it was the smoke that seemed to hang continuously in the warm, moist air of the operating room during brain surgery, the toasty smell of flesh from the cautery knives, an odor that seemed to cling to me for days, no matter how many showers I took.
People who have never spent any time in operating rooms may speak of them as the epitome of cleanliness, but when I turn my mind back to surgery, I see the piles of bloody sponges through a curtain of blue smoke; I see the burn-blackened flesh of the scalp that is pinned back to the blue bunting with black threads and silver clamps; and I see a fragment of someone’s skull skittering across the cracked linoleum floor and disappearing underneath the silver-painted radiator in the corner.
My first time, a sense of panic overtook me as we went in. Even before we got through the amazing fortress of the skull to the actual brain, I felt as if I were being suffocated as I watched Dr. Braun lift the scalp and peel it back and cut through facial muscles just over the patient’s eye socket. Dr. Braun is a vegetarian, and I began to understand why. People are made of meat.
But my panic was rooted in a deeper sense of what was going on. To begin with, it takes time to disengage. During my first few operations, the patient’s flesh was my flesh. I could feel each scalpel stroke. I was wide awake, and they were operating on me. The danger was so palpable then — this human form was coming undone before my eyes, as if we’d pulled the keystone out of the great Building of Life.
I knew that we were creating a grave emergency with each new step we took, plunging deeper and deeper into the unknown, and yet on we went. Indeed, what nature had so wonderfully stitched together, molecule by electric molecule — this beautiful, fanciful, dimpled smoothness, this robust living tissue — was being jerked apart, and there was no hope that it would ever go back together again — not the way it was, and maybe not at all, period.
But the problem now before us demanded this sort of desperate action: It had been there for some years, though no one could have known. The woman looked and acted normal enough, until she came in one day complaining of a weakness in her right arm. Then someone took an X ray of her head, and there it was: a tumor as big as a tennis ball in the center of her brain.
Now I saw her hair in a plastic bag on a steel cart. “It’s the law,” Dr. Braun told me when I asked why they had saved it. “In case she dies. To return all the parts to her family.”
As the knife cut, blood vessels burst like grapes — and as they broke, they trickled, and the trickle of red life flickered white in the light, like a molten magic metal that was sometimes red and sometimes silver. The head — the object of this elaborate and daring ritual — was at chest height, clamped in steel points, like a sculpture on display. Beneath the head a large clear plastic bag hung down to the floor and filled with gore as the operation proceeded. The skin is an amazingly tough and resilient fabric, able to take terrible torment, but under the gleaming silver blade of the scalpel it pops submissively, parting along a neat line down to the white surface beneath: the skull. The skin is thick and its edge is white with fat, but immediately blood would ooze forth, and Dr. Braun would touch the vessels with electric forceps to cauterize the bleeding.
Each surgery followed the same pattern: Once the thick scalp had been pulled back from the bone, electric knives were used to denude the skull of the thin membrane that covered it. The first time I saw clouds of smoke rising from a human skull and watched the two blue-shrouded surgeon’s heads (Dr. Braun and her chief resident) bobbing as they worked — the headlights they wore dancing in the smoke and making odd reflections on the silver-red blood pouring down the drape below the patient’s head — I could not help thinking of primitive rituals of human sacrifice, and I understood that we were about to enter into the heart of darkness, armed with little more than our wits and fire and a few metal implements.
We were in an alien world. A foreign language was spoken. “What’s her crit? Give me 20 of Decadron. Cushing retractor.” Sometimes after surgery I’d find going back into the world difficult. Surgery was a strange dream, a kind of madness. Constant noises hurt our ears: high-pitched screeching sounds, the hiss and hum of fans and the roar of machinery, both near and distant, and the intermittent bells, whistles, tones, and sirens, all underlaid with the throbbing heartbeat and breathing of the mechanisms that kept the patient alive as we worked. Usually a beat-up old radio played music somewhere in a far corner.
Now a nurse wheeled a black tank of compressed air into view beside the patient, rolling it out on a black dolly with dirty rubber tires. It looked as if we were preparing to weld. On the far side of the patient, a wall of wires, tubes, and monitors hid the anesthesiologist, who was back there chemically manipulating the patient’s life functions. Now and then I could see the dark eyes, the Indian-brown skin, the red cosmetic dot in the center of her forehead, as she peered over the blue drapes and looked out at the theater of surgery from behind her mask.
“Who was the first person to operate on a meningioma?” Dr. Braun asked as she worked quickly and carefully. Neither of her residents knew the answer. “Durand in 1895,” Dr. Braun told them. As the senior neurosurgeon, it was her job to teach as she worked. “It’s amazing how many neurosurgeons,” she had told me, “don’t even know gross anatomy.” More than once I’d seen her send residents back to their textbooks because they could not identify major landmarks within the brain.
The tank of air was hooked to a pneumatic drill, and a drill bit was inserted — a large one. The helical silver screw skated for a moment on the white surface, then bit and caught and began spewing out curlicues of bone, like holy-candle wax. It took all of Dr. Braun’s strength to keep the drill biting. I couldn’t help wondering what it sounded like inside the secret vault of that woman’s head when they applied the screaming silver drill to her skull. (Could she hear? Once two residents were making jokes during surgery, and Dr. Braun stopped them, saying, “You know, they say that even anesthetized patients can hear what we say. Have a little respect.”)
The chief resident, using something that looked like a basting bulb, splashed salt water on the drill bit to keep it cool. It was a bizarre baptism of holy water and steel. The white bone that was being screwed up out of the growing skull hole mixed with water and blood and ran like semen down the blue surgical drapes into the long, clear plastic bag. One of the residents kicked a bloody sponge down between my feet. As the growling drill gnawed into the patient’s head, I saw the brown eyes of the anesthesiologist peer out at me for a moment, then disappear once again. A Mozart chorus played from a speaker somewhere.
Blood, like fine silver, tarnishes to a black metallic sheen if it’s left in the open air. Blood is the life force; it can also be the kiss of death. One morning Dr. Braun forgot to put on her goggles, and only remembered when she hit an artery. The spray of blood caught us all in its shower, but it hit Dr. Braun directly — in the eye. She leapt from the operating room and ran to wash out her eye. A couple of weeks later, she said to me, walking down the hall, “I still haven’t gotten myself tested for HIV [the AIDS virus].”
Now Dr. Braun withdrew the drill, and the scrimshaw of her art showed clearly: a nickel-sized hole, beneath which we could see the dura mater covering a living human brain. “Do you know what ‘dura mater’ means?” Dr. Braun asked. “It means tough mother.’ And this is one tough mother.”
The bone was not only tough, it was alive. It bled. It was also surprisingly thick. I found it difficult to believe that anything could crack my skull without also killing me. The chief resident was drilling the second hole now, and it took all his strength, too. He got up on his toes and leaned down with elbows out and an expression of fierce concentration on his face.
While the drill was being passed back and forth between the two surgeons, making its siren sound and its dental smell, I caught sight of a man reflected in the glass of a cabinet where surgical supplies are kept: He wore clear plastic goggles (to protect his eyes from flying bone chips and spraying blood), a blue surgical mask, a green hair net, and swamp-green scrubs. His eyes were wide with amazement at what he was seeing; the skin of his face was pale with shock. It took me a moment to realize that I was looking at myself.
Finally, all six holes were drilled, and the air was thick with the smell of burned flesh and bone, as Dr. Braun called for the geelee saw guide. “Do you know what this is used for?” she asked. “It’s a French safecracker’s tool,” she said, waving the thin strip of springy steel at us.
Dr. Braun inserted the saw guide into one of the holes to pass it between the skull and the dura so that it came out the next hole. Blood flowed from each hole as she worked. Meanwhile, the chief resident worked at a steel cart, fitting a cutting bit onto the pneumatic-drill head. The phone rang, and a nurse held it to his ear so that he could prescribe medication for one of his patients without contaminating his hands.
Taking turns, they cut from hole to hole with the pneumatic saw blade. “Like cutting plywood,” Dr. Braun had told me. Only it was nothing like cutting plywood. Bone is alive, and beneath all the blue drapes was a human being, ensconced in the form of a towering sarcophagus. A steel platform on which all the surgical tools were laid out was suspended above the patient, and a scrub nurse stood on a riser above us to reach them and pass them one by one to Dr. Braun. “Surgery is all ritual,” she told me one day.
Now the whistling saw was spuming forth its white froth of spermy bone, giving off a smell of sea wrack, rotten weed, and burning flesh, as Mozart played along. (“We play rock ‘n’ roll when we’re closing,” Dr. Braun said. “It makes it go faster.”) As the buzz saw rounded the corner to the last hole, the bit slowed down and the music stopped as the skull fell open. With four hands, they lifted the teacup saucer of bone and splashed it into a stainless-steel bowl of water, a move that made me think of the sacraments. It was difficult not to, with the vestments, the incense, the ritual nature of surgery, and even the music.
Now through the semi-translucence of the bloody dura, I could see a dark and forbidding blue-gray shade, like building storm clouds, the matter of thought itself, beating and rising with the tide of life, which lay unraveled now in bloody streamers.
Dr. Braun plucked the membrane with a stainless-steel pick as fine as a sewing needle, and then cut it with the tip of a scalpel — the slightest touch of the blade parted the tissue. Then, guiding the instrument carefully, she slit the dura all around and peeled it back to reveal the naked brain.
“No one wants to touch the brain,” she had told me more than once. “The general surgeon will do almost anything, but no one wants to touch the brain. It’s too mysterious.” What she meant was that it was too risky. There is no wiring diagram for the human brain. Sometimes they can take enormous pieces of it out, and the person remains completely normal afterward. Other times they can nick a blood vessel and render a patient unable to speak.
Moreover, it takes a lot of blood up there to keep things going. That tidal surge of blood collects at the top of the head-the sagittal sinus-which is not so much a blood vessel as it is a virtual canyon of blood. From there it flows back out of the brain and recirculates. When doing brain surgery — going in with the drills and saws and then puncturing the dura — it is crucial not to start the sinus bleeding, because then it’s like the dam has burst. There’s no way to stop it, and it comes roaring out until there is no more. Once I saw it nicked ever so slightly, and we were awash in blood. One morning a chief resident came out as we were going in. He was shaken and pale: “I’ve begun to think I should do neurosurgery wearing rubber boots,” he told us.
And yet, just when I thought I had heard or seen the strangest thing of all, nature had another surprise in store for me: One day after surgery, Dr. Braun asked me, “Did you see how the brain started looking all red and angry at the end there?” I said I had. She explained that sometimes the brain will take the abuse of trauma, and sometimes it will not. Now and then when they open someone’s head, the irritated brain simply swells up, overflowing the boundaries of the skull, and continues swelling right out of the patient’s head.
“What do you do then?” I asked.
“Lop off as much as we have to and close ‘em up,” she said.
“And then what happens?”
“And then they die.”
I found it difficult to accept that there was nothing more, no secret answer, no maneuver, no last incantation that would save the day. But it was just a measure of how primitive our methods are. And it was a reminder, lest we forget, of how costly mistakes can be, whether they are nature’s mistakes or our own.
As soon as the brain was exposed, Dr. Braun called for the laser. “Is everyone wearing goggles?” She held the laser gun poised over the patient’s beating brain. Dr. Braun took up a wooden tongue depressor, pointed the laser gun at it, and fired. A whisp of smoke curled into the air. A neat black hole appeared in the wooden spatula. “I guess it’s turned on,” she said with a laugh.
As the laser reduced the tumor to ashes, the ‘two surgeons chatted about doctors who had set patients on fire. One surgeon got the nickname “Torch” because he set several patients on fire with a laser. I wanted to say, “Shh! The patient might hear you.”
The tumor began to glow from within. I don’t think I’d ever seen anything as strange as that. The tumor was a fatty, convoluted, angry red blob-like a special effect in a bad horror film, only it was real, and it was inside someone’s brain. There is no limit to the great imagination: One day we went into a lady’s brain and found a fungus ball, a mushroom-shaped growth the size of a bonsai tree right in the center of her head. It’s no wonder people believe in voodoo, hexes, and the presence of the devil. How else to explain such a gleeful, malicious, and devious trick of nature that would cause a mushroom to grow in a brain?
Now the glistening fatty blob, which was the size of a baseball, was being reduced to brown ash from the shimmering caustic laser light inside it-our cancer within the cancer-fighting fire with fire. The chief resident wanted to crank up the laser and blaze away, commando-style, but Dr. Braun took it slowly, inch by smoking inch. The field was flowing with bright hot lava. The anesthesiologist started a unit of blood.
By the time of that particular operation, I had been at it for a while, and I’d become somewhat inured to the vicissitudes of surgery, the blood and smoke, the smells and sounds. I found myself yawning there, exhausted from weeks of work, and somewhat hungry, because it was afternoon, and we’d been there since seven. That was nothing for Dr. Braun — she could go 14 hours.
Early that morning, during prep, she had stopped in the staff room for a cup of coffee, and I watched as she poured the plastic cup full of milk and added a teaspoon of coffee. I had wondered why she did that, until I watched her operate and realized that she didn’t get to go to the bathroom between seven in the morning and seven at night. Sometimes when I would go home to have dinner (or even wimp out and go to bed), Dr. Braun would call me at eleven o’clock or midnight and I’d hear her cackle madly on the other end of the line and say with a kind of goading, prideful levity: “I’m still in the O.R., Laurence. You want to come down and watch some more?”
I began to realize that they took pleasure in the pain of exhaustion, these surgeons. And I began to understand the paradox of what might seem — to the casual observer-their callous attitude, as compared to the actual depth of their passion and compassion. For no matter what they said, no matter what jokes they made or what hard remarks, they always did it while they were saving someone’s life. I’ve seen the same attitude among fighter pilots, who say “It’s not your day,” when they mean “This will kill you.” A surgeon would no more say “I love this patient” than a fighter pilot would say “I’m afraid of dying in a crash,” although both of those statements would certainly be the truth.
There’s a certain class of people who don’t even show up for work unless someone has already hit the panic button, and Dr. Braun is definitely one of them.
One day while I was at the hospital, a construction worker who had fallen off a building and then had a piece of heavy equipment fall on top of him was brought in. Everyone was called in, because that poor man had something wrong with every part of him. His head was smashed. His left leg was crushed. His left lung had filled with blood. His heart was bruised, and at first they were concerned that he might have torn major blood vessels off of it. (“Have you ever seen an emergency chest crack?” Dr. Braun asked. “Oh, you’ve got to see them crack his chest if they decide to do that.”) She was called in because of the head injuries, and when she first laid eyes on him, she said, “Ooh, God, that’s yucky.”
Indeed, I had never seen anything like it. I stood over him in the angiogram room, where they were taking X rays. The man’s face had blown up and distorted until it was unrecognizable except as purple meat. Bubbles of mucus and sputtering blood percolated out of his nose and mouth around the tape and tubes-shunts and silver clips and clamps and colored lines, red and yellow and green. There must have been a dozen people around him, experts from every field, and while one of Dr. Braun’s people was drilling a hole in the man’s head, others were running metal probes into his arteries and still others were connecting him to a variety of devices such as I had never seen before. Every few moments someone would shout a warning that they were going to shoot an X ray, and we’d all scurry behind a screen to avoid being irradiated. There was much gaiety and joking about deformed babies.
When they had moved the patient to a trauma-unit bed, I stood by him for a long time, waiting for him to die. I wanted to write down what I felt when he died. His family was across the hall, and the trauma surgeon had set his chances of living at two in ten, which Dr. Braun said was optimistic. He was a big man with reddish-blond hair, and his jeans were still on him — what was left of them after the paramedics and surgeons had cut them away to get at the flesh beneath. A nurse brought in his construction boots in a plastic bag. They were filled with blood. Dr. Braun’s intracranial pressure monitor was screwed into his head like a piece of plumbing, and an optical lead from it fed a digital instrument that read the pressure in his brain. His brain was swelling because of the hard blow he’d taken in the fall. — That alone could kill him. If his other vital signs stabilized, Dr. Braun could put him in a drug-induced coma, which would reduce the swelling until his brain could settle down.
More wires and tubes ran into and out of the fallen construction worker than I have ever seen — he was more a device now than a human being — and yet when the trauma surgeon pulled back his eyelid (so badly swollen that it took two fingers to open it) there was a small hazel iris in there and a dark pupil: life.
‘“Listen, I’m on hold.” She gave me the phone — I heard elevator music playing. “Isn’t that great music to hear when you’re waiting for someone to tell you your patient is dead?”’
I couldn’t help thinking about him on this Friday morning, kissing his wife and children good-bye and going off to work with his lunch pail, thinking about what a great weekend he was going to have. By afternoon, here he was: beside an old Carrier air conditioner by a dirty window overlooking a ventilation shaft in the county hospital. And suddenly I didn’t want him to die. I didn’t want to see it.
I watched across the aisle as a grandmother stroked the head of an 18-year-old boy who had come in with multiple gunshot wounds and was now in a coma. The nurse told me, “He is technically dead, but his family won’t give consent. His head is rotting, and his feet are rotting. It’s terrible.” A surgical resident shook his head, saying, “Yeah, isn’t it terrible when they start to decompose on you before they’re dead?”
The construction worker did not die in the night, and by morning, things were looking up. When Dr. Braun and I came in at eight, we saw the trauma team marching in a phalanx down the hall, and we stopped to watch. They were young men and women in green scrubs, and their hair was all in disarray, and they were covered with sweat and blood. They looked like athletes — or more properly, like gladiators — and they were smiling. They had made it through the night with a man that no one thought would live. Of course, they were exhausted, but they looked happy. I thought, Now, here’s a new TV series: “Trauma Team!”
Dr. Braun paused briefly at her office door to watch. “Look at them,” she told me with a laugh. “Look at them. They love it.”
We stopped by to see the lady Dr. Braun had operated on the previous day, the one with the tumor the size of a tennis ball. She was sitting up in bed, a youthful, pretty woman with an open smile. I was amazed at how well she looked. There was no sign that she had undergone a traumatic experience, except for the bandages on the back of her head.
“How do you feel?” Dr. Braun asked. “Fine,” she said.
As we walked away, I asked how the woman would do.
“She’ll be completely cured,” Dr. Braun said.
We walked up the stairs and down the hall to stop by to see Helen, the pregnant woman who had been shot in the head. She was sitting up, too, or someone had propped her up, her vacant eyes staring out the dirty window at the little park across the street. Her mouth was working, and bubbles of saliva grew and popped and grew again. “Look at that,” Dr. Braun said, explaining that sometimes coma patients move their mouths like that before they start to come out of it. “She might wake up. Good morning, Helen.”
In case you have forgotten and neurosurgery has tickled your brain, our first Legacy reprint on dangerous professions would be here.
