We knew it was probably going to be pretty hopeless, but we started doing everything anyway. The chief intubated him, Peter started pumping his chest, and Terry and I tried to get lines [IVs] into him. I somehow got one in his right arm, which was a miracle in itself, and we started pushing bicarb [sodium bicarbonate, to reverse the buildup of acid in the blood] and epi [epinephrine, in an attempt to get the heart to start beating again], but nothing happened. Then the surgeons came by and offered to crack the kid’s chest for us [perform an emergency thoracotomy, an operation in which the chest is opened so that the heart can be directly massaged]. Hey, when five surgeons walk up to you with scalpels in their hands and say they’d like to crack a patient’s chest, it’s hard to say no. So the kid got his chest cracked and they found that he had a bronchopleural fistula. [The impact of the van had caused the left main stem bronchus, the main windpipe to the left lung, to tear in half. Oxygen that was being forced into the boy’s windpipe was ending up in the pleural space outside the lung, causing an ever-worsening tension pneumothorax.] It was about then that we realized that this code was pretty much over.
I walked out of the trauma area, and the boy’s mother was standing there less than ten feet away. She was literally being held up by one of the nurses. She said, “Doctor, how is he? Is he going to be okay?” I didn’t see any way out; I was too upset to come up with a lie. So that’s when I, wearing my Bozo wig; my Bozo makeup; my Bozo shoes; and my Bozo suit, which was now covered with blood, told the woman that her son had died.
She went crazy. She started crying and she fell down on the floor. I felt like a total idiot standing there dressed like that, and there was nothing I could do to change anything. One of the hospital administrators, the guy we call the administrator-in-charge-of-patients-dying because he always seems to show up when this kind of thing happens, came, and he, the nurse, and I lifted the mother up off the floor. The administrator led the woman out of the ER. I don’t know where they went, but before seeing the next patient, I changed my clothes and took off the stupid makeup. I don’t think I’ll wear that costume again. The bloodstains kind of take all the fun out of it. And next year, if I’m on call on Halloween again, I don’t think I’m going to dress up.
Tuesday, November 5, 1985, 10:00 P.M.
I’m feeling much better today. Sure, a weekend off, that’s just what I needed. It gave Carole and me two whole days to fight about whether we should get married. It was a whole lot of fun. At least she didn’t make me wear my Bozo costume while we argued.
I really don’t know what to do about this. I don’t want to get married during my internship. Can you imagine that? Falling asleep standing up right in the middle of the ceremony. And then the wedding night! Yes, the wedding night must be a memorable event for the intern’s spouse. Eight continuous hours of snoring. Seriously, being married is hard enough when you lead a relatively normal life. I don’t think it’d be possible for us to survive if we got married while I was doing this. But Carole thinks we should do it. She says if we got married, she’d be able to take better care of me for the rest of the year. I think I’ll eventually wind up marrying Carole. We get along very well and we basically want the same things out of life. I just can’t do it yet. I think I’ll be able to think a little more clearly after this is over, but that’s not for seven months yet. Well, what can I do? I’ll just try to hold her off as long as possible.
And then, after that fabulous weekend, I got to be on call again last night in the Jonas Bronck emergency room. And what a night it was! We were five hours behind the whole time. We had two security guards stationed at the doors to protect us. Every five minutes, another angry customer would appear and want to know why his or her precious little child who had been sneezing for three days hadn’t been seen yet. And what interesting patients I had to take care of! I got this four-day-old who, through some sort of screwup in our world-renowned Social Service Department, wound up getting discharged from the nursery with his psychotic mother who also happened to be a crackhead. Usually when a baby’s born to a crackhead mother, Social Services picks up their hot line and gets a BCW hold slapped on the kid so that the baby can be kept in the hospital while the BCW figures out what to do with him. We usually have to keep them longer than three days anyway because the kids usually have withdrawal symptoms and need to be treated. But somehow Social Services missed the boat and sent him home early.
When the nursery’s social worker realized the kid had been discharged, she called the cops and had them find the kid and bring him back. The cops did a great job: They went out and scooped up the baby, the mother, and, lucky for us, the father and brought them all in. Of course, they didn’t mention to them what was going on. So not only did we have two psychotic crackheads roaming around the ER, we also had two psychotic crackheads who were paranoid and had no idea what was going on, which is a wonderful combination.