All this mental activity happened in milliseconds. I didn't stand pondering and uncertain while the bearded man lay there. From the time I opened the back of the ambulance to the time he was pronounced DOA, less than thirty seconds elapsed. But it seemed much longer, and it affected me for hours. I did have one thing to be thankful about. My training had advanced far enough so that I would not be popping back in to feel for a pulse.
The central, cutting question remained: why should I be allowed to make such a decision? I felt somehow an accomplice of evil, an agent in this man's death. It's true that if I hadn't done so, someone else would have pronounced him dead; I was not necessary to the drama. That’s easy enough to say if you're not involved, but I couldn't dismiss the matter so quickly. I had made the decision without which the bearded man would not have been technically dead at this moment. We'd have had him all wired up by now, and we would have been pushing on his chest, breathing for him, keeping him legally alive. So I felt that, because I had cut off this possibility, I was the one responsible for his being dead.
Had I been too hasty in calling him DOA, in taking the easy way out? As soon as I said it, all the medical doors clanged shut. Had the decision gone the other way, in favor of an attempted resuscitation, my first move would have been to insert an endotracheal tube so that we could breathe for him. I had always found this a very difficult task. Maybe I had pronounced him DOA partly to save myself the trouble. Or maybe it was because I knew all the beds up in ICU were full, and figured that even if we did manage to resuscitate him, he'd only be another vegetable anyway. I now think these are questions without answers, but at the time they were driving me crazy. In that state, I walked out into the hallway to face the wife and child. The wife was tall and thin, almost gaunt, with dark, deep-set eyes. She wore sandals and some sort of floor-length granny dress. Up against its ample folds, really wrapped in it, was a little girl of about seven.
The situation was right out of a prime-time television program—"The Interns" or "The Young Doctors" — ingredients for either a dramatic or a terribly sentimental confrontation. The reality, again, was nothing Ben Casey would have recognized. Facing the dreadfully concerned and frightened wife and child was neither dramatic nor sentimental, only one more hurdle for me to jump. Perhaps an omniscient third party would have read more into it. I was hardly that. I knew what had happened in the room behind the curtains, but I had no idea what these people were thinking, what they needed to hear. Worst of all, I was hopelessly swamped in my own crazy thoughts about death and responsibility, about what might have been. I wanted to beg them to hear my lectures on the Krebs cycle or some other medical elegancy. How poorly medical school had prepared me for this. "Just get the concepts, Peters. The rest will come." The rest — death — you learned about by trial and error, and finally, gratefully, you did fall back on the comfortable stock phrases of television.
"I'm very sorry. We did all we could, but your husband has passed away," I said softly. The banal words rolled out, seeming good enough, really quite satisfactory under the circumstances. Perhaps I had a future in television. The only bothersome part was that business about doing all we could; we hadn't done anything. What I said, however, was only a stupid self-serving hypocrisy. It would pass. Wife and child simply stood there, frozen, as I turned and walked away.
Thank God no other patient was waiting to be seen. I signed the sheet of paper making it official that I was the reason the bearded fellow was dead, and then I went quickly into the doctors' room, slamming the door behind me. In the process I jarred off the wall a picture a drug firm had given us of a bunch of Incas opening up some poor devil's skull; but the Playboy calendar opposite only rustled a little in protest, and Miss December hardly seemed disturbed. I sank into an enormous old leather chair. It was a large room, with blank walls except for the Inca picture and Miss December. A low, crowded bookcase stood at one end, and a small bed and a lamp at the other. The chair I sat in faced the pale green wall that was supporting Miss December. I longed for my mind to become as empty as that room, and as placid.
Miss December helped; in fact, she had me mesmerized. What did Playboy have against body hair? Aside from the required abundance on top of her head, Miss December was as smooth as a piece of marble — no hair around her breasts, under her arms, or on her legs, and apparently none between her legs, either, although that was difficult to tell for sure because of the artfully draped Christmas stocking. Maybe Playboy was misjudging a good part of its market. I didn't think pubic hair was so bad. In fact, remembering the night before, I decided that Joyce Kanishiro's pubic hair was one of her most appealing features. No offense meant — if s just that she had very pretty pubic hair, and a lot of it. When she was naked, you saw it no matter what position she was in. I thought it would be hard to put Joyce on a Playboy calendar.
Miss December, Joyce, and the esthetics of body hair couldn't drive the bearded man entirely out of my mind. It certainly wasn't the first time death had confronted me in the ER. In fact, on my very first day on ER service, when I trembled to see even a patient with mild asthma, an ambulance had pulled in, its siren trailing off, and disgorged a twenty-year-old boy on whom the ambulance crew had been performing artificial respiration and cardiac compression. I had stood on the landing virtually wringing my hands and hoping that someone would call a doctor. This was ludicrous. I was the person they had been racing to, running red lights, risking life and limb.
I had looked down at the boy and seen that his left eye was evulsed. Its distorted pupil looked off into nowhere. What on earth could I do with that eye? Actually, I didn't have long to think about it, because the boy wasn't breathing and his heart had stopped. The crew rapidly informed me that he had not made the slightest movement since they picked him up, in response to a call from a neighbor. As they rolled him onto the examining table, I glimpsed a wound in the back of his head. I tried to get a better look at it, but my view was blocked by little pieces of brain oozing out of a hole about an inch in diameter, and I suddenly realized that he had been shot, that a bullet had gone through the left eye and out the back of the head. The nurses and ambulance crew stood by, panting from their efforts, while I went through my routine. It was sheer nonsense to fuss with my stethoscope — nothing would make any difference — but for lack of another strategy I put it on his chest. All I heard were my own thoughts, wondering what to do next. The intern is always expected to do several things, yet this boy was so dead he was practically cold.