From: eubanks@astro.ocis.temple.edu (Marcus Eubanks)
Subject: A Day in the Life
Date: 22 Jan 1995 23:55:11 GMT

I hope this isn't inappropriate to this group.  It's not really 
cyberpunk per se, but might perhaps have enough of a `noir' feel
to it to interest the folks who read here.  

This is a work of fiction.  Any resemblence to actual persons, living or 
deceased, is purely coincidental.


_A Day in a Life_


It really does have a smell all its own.  You're not sure what it is at
first, or even the second or third time.  You don't even realize that it's
there.  Eventually though, it dawns on you that that particular crisp odor
comes from one thing, and one thing only.  It is the smell of blood. 

Today it hit me before I even got inside the room.  Slapped the wall
switch outside the O/R suite, strode through the doors even as they
folded away before me, and there it was.  Like charred orange-peels. 
Burnt.  Or hot metal filings on the floor of a machine shop.  Even the
smell of the machine oil is there.  It's not the same smell, but you'll
recognize it if you ever chance across it.  It will dawn on you then; but
only after the scent has crept around your subconscious for a while,
sneaking down into your hippocampus and setting off strange primitive
reactions in your thalamus.  You'll remember my words, and think, "Ah.  I
know exactly what he meant now."

Mr. McKenna had been out for an early morning ride on his motorcycle.  Or
maybe it was a late, late night ride.  Coming home from a party perhaps,
or sneaking away from his girlfriend's place.  Or maybe just out for a
spin on the gray and drizzly streets, having gotten up early to have
coffee with his wife and kids.  You know, just to tool around the town a
bit, get out on the road with the damp air wrapped around him, and marvel
at the the beginning of what would turn into an absolutely beautiful April
day. 

Then for some reason we are not privy to, Mr. McKenna drove his motorcycle
right into a parked car.  At high speed.  This was not a good way for him
to start his day.  For that matter, it wasn't a terribly good way to start
our's either, but I guess that wasn't really his fault. 

The E/R attending paged Neuro down for a consult.  The Neuro resident was
not terribly pleased by what he saw.  One pupil refused to respond to
light.  Blown.  A wide open portal to the soul.  Or in this case more like
a barn door flapping in the breeze, after the horse has already run off. 
I was starting to seriously reconsider the fantasies I'd been having about
getting myself another motorcycle someday when I have a cash-flow. 

He coded on us then, right there in the E/R.  The ol' ticker just heaved
once, massively, and gave up.  "What's the point?" it figured, and decided
to take a little breather.  We zapped it, powie.  Lots of nice clean DC
volts.  A big bunch of amps.  The heart reconsidered, and must have
figured that if this was the kind of treatment it was going to receive
while on break, well fuck it, it would just go back to work where no one
had bothered it. 

Crunch.  Pop.  Yes kids, that's the sound of what amounts to a really nice
set of stainless steel wire-cutters parting bone.  Crunch.  It's a
visceral sound.  You'll remember that sound too.  I promise.

There they are folks, the stars of the show for the moment, Mr. Heart and
his two body-guards, Mr. Two-lobes and Mr. Three-lobes.  They're
beautiful.  There's the heart, excursing away in its warm little
pericardial wrapper rather like a stuck pig.  The lungs are pink and
healthy, mottled with black.  Your lungs are mottled with black too.  You
may think to yourself, with a bit of righteous pride, "Nay, not mine, for
I have never breathed the sweet airs of the demon tobacco, nor have I
partaken of the subtle Mary-J-Wana.  I have taken Dr. Koop's earnest
warnings to heart, and I have seen Reefer Madness.  I am a believer."  You
are wrong.  Your lungs look just like Mr. McKenna's.  Just crap from this
modern air we breath.  Its okay though, 'cause it's harmless, more or
less. 

Actually, I'm a bit wrong too.  Your lungs don't really look like his,
'cause his have holes in them.  Blood bubbles out each time the diaphragm
relaxes and Mr. McKenna exhales.  There are also holes in his diaphragm. 
These are in addition to the expected ones that his aorta and other things
pass through.  As you might imagine, we are chagrined.  They are not
supposed to be there, these holes. 

Mr. McKenna goes on a little elevator ride up to the O/R.  We have made
this gaping huge hole in his chest you see, and that in itself is reason
to take him there.  There are other reasons too.  We want to make another
gaping hole in him, this time in his abdomen.  Actually, it's not really
`we,' it's `they.' Surgeons.  They *like* to cut big holes in people.  I'm
anesthesia.  We prefer to stand around and make significant little noises
at each other, crack dark jokes, and make fun of surgeons.  We think we
are very funny.  We're right to think that. 

Now Mr. McKenna has two very big holes in him, in addition to all of the
little ones he made inside when he drove his motorcycle into that car. 
The floor of the O/R is a mess.  There is blood everywhere.  Some of it is
there because I accidentally poked a hole in one of the bags of blood that
we intended to put into Mr. McKenna.  That particular blood is now all
over me as well.  Oops.  "You shouldn't do that," says the
anesthesiologist who is more or less coordinating our part of the job.  I
agree with him.  Folks just don't like to sit down to dine with someone
who has blood all over himself.  I can't imagine why.  

"You," says one anesthesiologist to me, "are going to stand there and blow
blood in through the pressure infuser.  You are going to do this again and
again, as quickly as you can."

"Yes," I say, "I am."

This is called "massive volume resuscitation protocol."  Mr. McKenna will,
over the course of his surgery, have over fifty-five units of blood poured
into him.  That's fifty-five of those bags that you fill up while you lie
on the table praying that the red-cross nurses are not going to blow your
vein with those godawful huge needles they stick into you.  It is rather
more blood than is in your entire body.  Maybe five times as much.  The
rest of the blood on the floor, far in excess of the twenty or thirty cc's
I spilled when I cleverly wasted that nice bag of the stuff, is coming
from Mr. McKenna.  I put it into him, and then it leaks out of various
holes in his vasculature, and spills onto the floor.  It will take
housekeeping the better part of three hours to get all of the blood off
the floor, the operating table, and various other pieces of medical
paraphenalia.  There is also blood tracked all through the hallway outside
the O/R.  This is because it sticks to my shoes, or rather to the little
blue booties that cover them, when I go to fetch more drugs or run
arterial blood gas studies.  It sticks to other folks' shoes too, and I'm
reassured by the knowledge that I'm not the sole culprit. 

The surgeons have Mr. McKenna cross-clamped.  That is to say that the
whole bottom half of his body is getting no blood.  Not that it really
matters at this point, as it was running out through various holes before
it could get too far anyhow.  It was getting *some* however.  Now it has
none.  The cells down there wonder just what the hell is going on up there
in headquarters and tough it out, doing their best to respire
anaerobically.  The cross clamp comes off, and it is discovered that there
is also a hole in his aorta.  Maybe it was there before, maybe not.  We
call injuries that result from therapy `iatrogenic.' This is a nice way to
say that the damage was caused by the folks trying to fix the patient. 

Sew sew sew.  Staple.  Crunch.  Mr. McKenna has two incredibly big holes
in him.  A good-sized cat could easily cuddle up quite comfortably in
either one. 

Some time later, he has only one very big hole, and a 25 centimeter line
of black sutures to mark where the other one was.  The problem with the
remaining opening is that every time the surgeons try to close it, Mr.
McKenna's heart get's depressed at the thought that having seen the bright
compelling lights of our O/R, it will soon be shrouded in claustrophobic
darkness again.  It rebells at this notion, and goes on a work slow-down. 
Not exactly a strike, not yet, but this recalcitrance is enough to
frustrate both surgeons and anesthesiologists. 

About twenty minutes later, his heart *does* stop.  Or rather, it doesn't
stop exactly, but sits there in V-fib and quivers like an irate child.  We
give it a taste of our amps and volts again, and it reluctantly remembers
why it started up after we did so the first time. 

One of the surgeons suggests that perhaps this exercise is becoming
futile.  "Pretend he's your dad," says another, "and do your best to save
him.  As long as the heart is going, he might pull out of it."
Unfortunately, now *both* of Mr. McKenna's pupils are blown.  The brain,
apparently, is beginning to side with the heart, and is growing tired of
the whole affair. 

Mr. McKenna's heart is still piqued by the surgeons' attempts to deprive
it of the rich light of day.  "To hell with it," reckon the surgeons, and
offer the heart a window instead.  Yes, they actually slice open a
one-liter saline bag, and commence to sewing it in place over the big
hole.  

For our part, we anesthesia types are trying to offer other incentives. 
We are infusing Mr. McKenna with mind-boggling quantities of epinephrine. 
His heart is not pleased with our offering, however.  Where your heart or
mine would be galloping like a derby thoroughbred which had just been shot
in the ass by a malicious kid with a B-B gun, this particular heart is
creeping along at about 58 beats per minute.  This would be a good pace
for a young athlete at rest, but not for Mr. McKenna, who isn't
terribly young and frankly, doesn't look like he was too athletic even
before he drove his motorcycle into the parked car. 

Mr. McKenna is dying.  In all truth, he has been dying ever since that
collision.  Now, however, he sets about it in earnest.  At two o'clock,
one of the surgeons says, "Okay, folks.  You've done a good job.  We did
our best."  Seven hours after his disagreement with that car, Mr. McKenna
is `pronounced.'

Later, when all us anesthesia-types are going over the case, writing up
the mortality report and such, one comments, "Oh wow.  I'm gonna have to
figure out the Kevorkian points for this, and decide who gets 'em."
Something snaps.  The narrow threshold which divides weeping and laughter
is crossed, and I start to giggle uncontrollably.  Kevorkian points.  I
think it's hilarious. 

He comes back after a while and starts assigning numbers to each of the
folks in the room.  Then to me.  "You," he says, "score one for an assist. 
You are the first medical student ever to be so honored."  

It sounds heartless, I guess.  Maybe it is, to some extent.  I still think
it's incredibly funny though.   

Just another day at work, I guess.  There was a heart transplant going on
across the corridor.  Right after we finished the trauma, I helped start a
kidney transplant down the hall.  I'm exhausted.  Though it was only eight
hours, it felt like a lifetime.  For Mr. McKenna, I suppose it was.  

I ask one of the anesthesiologists, before I leave, if he thinks Mr.
McKenna ever really had a chance.  

"No," he says, "not really." 

One of the others cracks, "I dunno, I figure his chances were real close
to 100% before he got on that motorcycle this morning." 


April 1994
--
Marcus Eubanks  (n3etr)         Temple Med '96         Philadelphia, PA  USA
                "A person with an inconvenient value-system."