Names have been changed.
If not for my wife Karen, an ER nurse, I’d probably still imagine the ER as a riveting drama, as in emergency room. About half the time it’s anything but emergency. (It’s not a room either; Karen supervises an emergency department, with sixteen rooms.) The changing dynamics of healthcare send people to the ER with perhaps an upset stomach, the flu, a bad cold, back troubles. Used to be, you’d go to your doctor or clinic for these things, and there’s a tired edge in her voice when Karen describes her day as mostly clinic business. It’s not what she does best. Imagine feeling relieved or gratified when real trauma comes in: car wreck victims with lacerated limbs; an out-of-control diabetic; the broken foot, crushed by a pipe out at the drilling rig. But sometimes trouble isn’t satisfied until it sends someone like Dr. Brooks through the ER.
Brooks died today. He was forty-five.
He was scheduled to work at three at the emergency department where Karen works. At two-thirty, his wife Becky called in. “Ed will be late,” she said. Just after leaving for work he’d called her on his cell-phone to say the gallbladder pain was back. He was close by St. Joe’s, he’d said, so he would stop there.
A short time later when Karen answered the phone, it was an ER doc from St. Joe’s: “I need to talk to Dr. Cooper,” he said, “—about Dr. Brooks.”
“Cooper’s over in radiology right now,” Karen said. “So how is Brooks anyway?”
The doctor hesitated. “He’s dead.”
Karen laughed. She got the joke—black humor is the armor you put on in the ER. And she said, “no, really Doc, how is Brooks?”
“He’s dead.”
***
Everyone called him Brooks. Only Becky called him Ed. And who knew that his first name was Horace? He’d kept that much secret. Horace Edward Brooks always had a ready supply of jokes. He was forever asking Karen the dosages for medications—“What’s the normal dose for Pediazole?” The part of his brain that would store that sort of detail was filled instead with What has four legs and an arm?—a rottweiler.
Brooks lacked the self-importance that makes some professionals tiresome. Before medical school he worked as a coal miner in West Virginia where he grew up. He was plain-looking, on the short end of medium height, and without particularly distinguishing features. His blank face was a mask, however, for behind it was always lurking a deadpan “How many straight waiters in Key West does it take to change a light bulb?”—He can do it by himself. Brooks’s irreverence served as balm in the ER. When some great hulking character with a cold strolled back to occupy room three, coughing in the nurse’s face and pleading for a pain shot, Brooks’s muttered “Land-whale alert, room three” took the edge off.
While suturing the hand of a builder who’d had a run-in with a table-saw, Brooks asked him, “So what do you do on your days off?” And soon they were trading quail-hunting stories. Outside of work he didn’t let on that he was a doctor—”Aw, it changes everything. All of a sudden you’re somebody—it’s a damn nuisance.” He carried a flat plastic change purse, the slotted kind you don’t see anymore, that you squeeze to open—”it’s all the money Becky let’s me carry.” (He said it with a straight face, and meant it, this guy who’d bought his wife a Lexus for Christmas.)
Karen remembers being surprised when Brooks came in with Christmas presents for the staff—R.N.s, L.P.N.s, aides—everyone in the unit. It was only coffee mugs, peanut brittle—small stuff—but it was unexpected, he didn’t have to do it. And everyone had kidded Brooks about the time, some months back, when he’d ducked back into the house to grab his sunglasses, leaving two-year-old Taylor in the idling pickup, and she’d dropped the thing into gear and plowed into the back wall of the garage. But that was Brooks, and these things happen.
Sometimes, when they had worked a patient who wasn’t responding, Brooks would get an impish look, and swing his arms in a small arc at his sides and say, “Well, anyone got any ideas?” There was no discrepancy between this Brooks and the one who forty-five minutes earlier had leaned close, probing the man’s abdomen and chest, and asked, “Where does it hurt, Mr. Reid, here or here?” When you’ve done all there is to do, someone’s got to break the spell, to acknowledge the limitations of the work. (Medicine, especially in the ER, is an art not a science. I’ve learned that much from Karen.)
***
When the pain hit him this afternoon and Brooks went to St. Joe’s, he found a spot for his pickup out in the parking lot and walked in to the unit. Only to collapse in their lobby of a massive heart attack—an M.I., in ER terms.
Three nurses and two doctors, people who knew Brooks as a friend, worked him for over an hour—epinephrine, defibrillation, the whole deal—well past the point of reasonable hope. Afterward, these five stood in the hallway, momentarily unsure of what to do with themselves—let alone with Brooks’s wife, Becky, who was headed toward them. Becky was just one glass door away from learning something new, when a woman stepped out of another room, saying, “How long we gotta wait in here? We been here half an hour an’ Ronnie’s got bad back pain. An’ y’all just standin’ around like ya can’t be bothered. This is a real emergency—he’s been like this for two months. How long y’all plan to keep us waiting?”
***
They have a saying in the ER, Shit don’t die, referring to the overall survivability enjoyed by a goodly chunk of their clientele. They traipse into the unit, often with a retinue of siblings, in-laws, neighbors, spouses, and such, for whom an ER visit is a dramatic event, even better than the two to three hours of Sally Jessy or Oprah that it replaces. The ER staff knows most of these folks by name, the regulars—”Oh, Mattie, what is it this time?”
“Aw, I just haven’t been myself for a while. Got this cough that won’t quit. And while you’re at it, could you look at Ricky’s ear?”
Often the complaint is a vague stomach ailment, constipation, sore throat, a cough, or some other simple matter of maybe two to three week’s duration that demands attention now. It may be near midnight on a Sunday, only eight hours from when the clinic opens, but here they are instead. Although the symptoms may be real—frequently a result of personal neglect, poor nutrition, too many years of cigarettes—overall, these patients’ health and stamina is enviable, enabling them to return again and again. Terminology varies from one ER to another: such patients are frequent fliers, and a common diagnosis is TSTL, too stupid to live. The other day a woman rushed in the door and called frantically, “Hurry—he’s burned, he’s burned bad!” and nurses dropped everything to run out to her husband in the car with his severe . . . sunburn. Sunburn that he’d got by laying in the yard half the day in a drunken stupor, wearing only shorts.
Then there are those limber drunks who manage to crawl from their wrecked vehicles. They are cut up and banged up but no more than that, while the forty-three-year-old mother whose car they hit is dead, and her sixteen-year-old son in critical condition. Shit don’t die.
It’s a statement of prickly irony—a dull, numbing affront—that haunts the mind when you hear that Brooks is dead. He seemed to be in his prime. And just last year they lost Michael, a nurse, not yet forty; cancer subtracted him from the ER staff. Cancer announces itself—you can see it coming—and you could see Michael leaving. But Brooks is the one guy, the colleague, the brother, you don’t expect to do without. He seemed to be in his prime. Of the handful of doctors who staff the ER, Brooks was the prize in the Crackerjacks box, personable and unassuming—maybe too much so. Like today, when he found a parking space at St. Joe’s and then walked on in. Maybe he’d have stood a chance if he’d stopped at the door rather than parking in the lot. Others do. But that wasn’t his way.
***
Today was like any other sunny spring afternoon, until Karen came home with red etched into her face. She trembled out the words, “Brooks died, Brooks is gone.” I held her, stung by the inescapable offense: Shit don’t die, but Brooks did.
Karen put it differently. She said, “It’s not fair.”
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