At 11:29pm, four minutes after the helicopter landed, we
knew she was going to die.
She had what most people think of as the “flesh-eating
bacteria” infecting her right leg. The tired-sounding surgeon at the community
hospital, three hours away, paused for effect after he recited her lab values
and vital signs, hearing the incredulity in our silence.
I called the next of kin while my superiors began
coordinating the operating room personnel, because even though we knew there
was no hope, there is always hope.
The phone rang four, five, six times: the community surgeon had told us the
family was on their way to our hospital by car, racing against time and the
helicopter, but they were very elderly, possibly driving without cell phones. I
hoped that I could hang up the phone, say that I tried, and wait for their
arrival, when legions of people more experienced and competent than I could explain
to them that the only way we would save their daughter’s life was by sawing off
her right leg at the hip socket.
The helicopter landed and we went to examine her. She was
intubated, sedated, massively obese and edematous from the liters of fluid they
had pumped into her. Upon removing the sodden dressing from her right leg,
which was filleted down to the spectacularly dusky and engorged muscles from
the thigh to the ankle, we put our gloved hands on the exposed muscle and felt
the ominous popping, like palpable fireworks. It was the operating room or
death, but more likely, the operating room then
death. Everyone began to move simultaneously and in various directions,
like cars at a busy roundabout; I dialed the family’s phone number again,
wedging the portable ICU phone between my ear and shoulder as I unlocked the
bed and began wheeling her towards the elevator. Nurses unplugged various IV
pumps, draping the cords methodically and storing portable monitors
unceremoniously between her feet, where I could keep my eyes on her heartbeat
and blood pressure as we traversed the long limbo between the ICU and the
operating room.
A voice answered the phone on the fourth ring. It sounded
shockingly calm. I gulped once, twice, introduced myself as Doctor So-and-So,
gulped again, and asked with whom I was speaking. It was her
80-something-year-old mother.
I’m afraid we are taking
her emergently to the operating room right now, I said gently.
Long pause. I still had both hands on the bed rails, helping
the nurses steer the bed down the interminable hallway, and I briefly wondered
if I had accidentally hung up the phone by shifting my shoulder the wrong way.
So you think you can
save her?
She’s very sick. The
only chance she has is if we remove the infection completely, which will most
likely mean that we will have to disarticulate her hip. I explained that
this meant that the entire right leg would be removed from where the hip
attaches to its socket on the pelvis. The mother emitted a muffled, horrified
cry, as if she had a crumpled tissue handy for quickly stifling her sobs.
I’m very sorry. We are
going to do everything we can.
I know you will. I
trust you.
I nearly dropped the phone. Had she spontaneously begun
speaking in Elvish, I might have been less flummoxed. I had just told a
complete stranger that I was about to remove her 59-year-old daughter’s leg—a
daughter who had been in perfectly good health 24 hours earlier—and her
response was to reassure me that she
knew we were making the right decision. What had I ever done to earn such
profound trust? Obtain a degree that allows me to introduce myself as Doctor So-and-So?
Be fortunate enough to have worked at a prestigious, well-known, highly
reputable hospital? Use medical lingo that sounds impressive?
The authority that people grant you for being a physician is
something for which nobody can really prepare you, something that I will never
believe I deserve. Families, lives, entire worlds can be torn asunder and put
back together at the word of one human being in a white coat. Such power is
awe-inspiring, humbling, and terrifying. I accept and respect the trust that
complete strangers place in me and in my colleagues, but I also fear it. I fear
how natural it feels to comply with the convincing edicts of an authority
figure, who you believe has your best interests at heart. I fear how trusting
we are as a species, how enticing it is to succumb to someone else’s plan when
you are suffering and afraid. I fear how easily we could be controlled.
_____________________________________________________________
It is not just the suffering of illness or the fear of
impending death that makes people vulnerable to manipulation. Complacence,
apathy, and the urge to conform to widely held values system are everyday
driving forces that passively enable manipulation. People actively seek a
knowledgeable and capable individual who will tell them what to do during times
of duress; during times of quiescence, not
resisting is simply easier.
Today, I was riding the bus from the office at twilight. In
New England, the sun sets by 4:30 p.m. at this time of the year; as the bus
rounded a corner heading East, the moon was suddenly straight ahead. It was the
largest, fullest, brightest moon I had ever seen in person. Looming above the
spire of the Prudential Center, which was sparkling with the first lights of
evening, the moon gleamed bright white against the deep purple sky. There were
no clouds, no wind.
The sight was so strikingly beautiful that I looked around
the crowded bus to see who else had noticed it. Everyone was bundled up in
puffy black winter coats, knit scarves around necks and heavy-duty winter boots
on feet. Every single head was bent, the dull glow of cell phone screens
staining every face.
The bus turned a corner and the moon disappeared behind a
block of tall buildings. No one else had seen the moon.
We are blinded by the mundane, seduced by the routine of our
lives. Someone goes on a TV show and talks about climate change and how human
beings are destroying the Earth, and someone else goes on a different TV show
and says that this is all a vicious rumor propagated by China. Which is easier:
attempting to see the truth for yourself and understand the science that
irrevocably proves that humans are actively wreaking havoc on the environment,
or choosing to believe a person on a TV show? And if you choose to believe the
person who shouts that climate change is a lie concocted by enemies of the
United States, doesn’t that make you feel better about driving your
gas-guzzling SUV to work and dumping hundreds of tons of non-biodegradables on
landfills? Why disrupt your routine in the name of truth? If someone in a
newspaper insists that unarmed Black men being shot when fleeing from the
police did something to deserve it,
might that validate your own prejudices against non-whites, justifying your
urge to cross the street when you see a Black man in a hoodie walking towards
you?
This is how we ended up with Donald Trump.
_____________________________________________________________
Everyone—the media, pundits, commentators, politicians,
family members, etc.—seems fond of saying that, in retrospect, we should have
seen this coming. And perhaps we should have. After years of vicious rumor-mongering
and the systematic construction of a narrative that portrayed Hillary Rodham
Clinton as a perfidious, shrill, unfeminine, unpatriotic, nefarious crook—a
narrative that was aided and abetted by the purported “liberal media”--it was
simply easier for people to conclude that they shouldn’t vote for her, rather
than try to understand why Donald Trump could
not be allowed to win the election, for the sake of humanity. If every
major news outlet is telling you that Mrs. Clinton’s emails probably contained
something shady, do you choose to interrupt the flow of your daily routine by
taking the time to research the veracity of these speculations, or do you
parrot the buzzwords (“Scandal!” “Political insider!” “Benghazi!”) that you
keep hearing as evidence that there’s something inherently and profoundly wrong
with electing Mrs. Clinton?
I know what that something is. I understand now. The “it”
that we all should have seen coming is actually this: the election of President
Barack Obama challenged the white male power structure, the structure that
human civilization has fought to maintain for centuries throughout the world. The
people who voted for Donald Trump—white, non-white, male, and
female--understand their role in a society dominated by a white, wealthy man.
The fact that this white, wealthy man cares nothing about the working class,
women’s rights, or “cleaning up the inner cities” is seemingly immaterial;
these people know where they fit into a wealthy white man’s world, and, for
better or for worse, wherever they fit into that world seems preferable to an
uncertain position in a non-white man or woman’s world.
And the people who didn’t
vote for Trump, but who are now attempting to grovel at his altar, are
staring at their phones, refusing to see the moon. These people will not be
rewarded for their conciliatory pleas to “give him a chance”. They will not be
spared from the carnage of whatever terrible international conflict awaits us
simply because they implored people to “wait and see what happens”. Strangers place their trust in physicians
like myself because, for centuries, the profession has demanded a standard of
ethics to which we all must strictly adhere lest we be stripped of our
privileges; Trump’s well-documented behavior over the years adheres to no such
standard whatsoever. In fact, the words that have come out of his own mouth and the numerous
destructive and immoral decisions he has already made in the four weeks since
he was elected are more than enough to reject him entirely as an authority
figure. Blindly placing your trust in such a person is irresponsible and
cowardly. No one could make the excuse for you that you are suffering or in
pain or terrified, like the patients who blindly trust doctors to make the
right decision on their behalf. You are simply being complacent and apathetic.
You are being lured into the trap of relentless optimism that seems to plague
modern American society.
For what its worth, I reject your apathy. I reject your
dogged optimism. When complete strangers trust me with their bodies and lives,
and the bodies and lives of their most treasured loved ones, I choose to take
this as seriously as Trump is choosing to be flippant about dodging the daily
intelligence briefings that are offered to him in order to enable him to make
the decisions that will keep all of us safe. It is your refusal and to see what
is in front of you, in plain sight, looming overhead in the night sky and
shining brighter than day, that will make it possible for an egomaniacal,
malicious amateur to control you. Because it’s easier to be controlled by the
soothing narrative that Trump is going to miraculously transform the second he
gets inaugurated into a competent, conscientious, unifying leader who will
elevate the working class and restore some long-forgotten illusion of our
former glory than it is to face the reality: that this is the end of America as
we know it.
_____________________________________________________________
She did die, as we knew she would. Not right away. It
actually took her six-and-a-half months to die.
We removed the entire right leg, leaving a gaping mess of
tissue where the right hip should have been attached to her pelvis. Eventually,
she woke up, the breathing tube was transferred from her mouth to a hole in her
neck, a feeding tube was placed, and she was set on the slow journey towards
some semblance of recovery. We knew she would never recover, though. It was the
listless optimism of her family that compelled us to keep putting the
antibiotics on and off, keep doing more surgeries, and keep devising ideas as
to how a critically ill woman could someday live outside the hospital with half
her lower body missing, unable to even sit up in a wheelchair.
I remember one time, towards the end, when she looked me
straight in the eyes. Hair face was huge, flabby, and swollen, but her eyes
were always wide with what I can only describe as abject horror. She could not
yet speak around the tracheostomy tube in her neck. Sparse gray hairs had
spouted on her chin. Countless machines and monitors beeped and hummed around
her. We had just found out that she had cancer, of which a rare complication
had led to the devastation of her right leg. She knew about it, as did her
family, but their optimism prevailed even in the face of inevitability.
We had all assumed that she was delirious and had permanent
brain damage from the many cardiac arrests she suffered throughout her long
stay in the ICU, so I had never had an actual conversation with her. But this
time, she stared me down and very clearly mouthed, come here.
I came close to her, held her hand, addressed her by her
first name, and asked her what I could do for her.
Her eyes widened, and she mouthed, watermelon.
Of course, the only food she was able to have was a
liquefied nutritional compound pumped into her gastrointestinal tract through a
tube. Eating anything by mouth was not an option, which I attempted to explain
to her as clearly and compassionately as I could.
She shook her head, grimaced slightly, and mouthed again: watermelon.
Weeks later, when I read her obituary, I understood.
She had known.
