Penthouse Retrospective

by Laurence Gonzales Originally Published: November, 1990

Neurosurgery | 30 Years Ago This Month

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.

Presumably people define "danger" somewhat differently, but Neurosurgery does not seem like such a stretch to include to us. Apparently it did 30 years ago.

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