Travels with Dr. Sam

A doctor’s story of love, life and loss

“Are you the surgeon?” she asked.

It was my final month of medical residency. I had been called in by the surgical service to medically clear a patient for surgery the next morning. A quick review of the chart had revealed a 25-year-old healthy young man scheduled for reconstructive plastic surgery. I had walked into the room to evaluate the patient when the woman who had been sitting by his bed asked me the question.

“No, ma’am. I am a senior medical resident. I’m here to clear him for surgery.”

“Oh,” was all she said, not making any effort to hide her disappointment.

I turned to look at the patient, a tall and athletic man who sat in the bed with his back turned towards me, looking out the window. The view through the grime-covered glass was spectacular. The downtown L.A. skyline was silhouetted against the setting sun, and the lights of the teeming city below looked like an upside-down tropical night sky. The hospital, set in an Art-Deco building, had been featured in many television shows and movies. But unlike the spic-and-span glass-and-steel interiors on television, the inside of the building was run down and falling apart. The elevators shook, the floors creaked, and cracks zigzagged across the ceilings and walls, in response to the restive earth’s movements below the sprawling city.

The hospital catered to the poorest of the poor. It was the last refuge for those left behind. Like the plaster on the ceilings and walls, the hospital was filled with broken men and women. In a city swarming with millionaires and celebrities, it was tucked away in a corner, hidden from tourists, the glittering malls, theme parks, hotels, and mansions just a few miles away.

The patient turned around and looked at me. I suppressed a gasp as I saw the hideous scar that distorted the right half of his face. From the chart, I knew that he had suffered from a self-inflicted gunshot wound. He had survived, but the bullet had caused the right side of his face and skull to cave in. He must have been very handsome at one time but now looked like a character out of a Hollywood B-movie.

“How are you doing?” I asked.

He sat passively as I listened to his heart and lungs.

“You’re in good shape. Cleared for surgery.”

He just nodded and turned back to the window. The woman had by now gotten out of the chair and had been nervously pacing around the room.

“Will the surgeon be here soon?” she asked.

I didn’t know if the surgeon would be coming that evening. I knew that the surgical resident had already seen the patient and written his notes and orders. Usually, the attending physician or surgeon never came by in the afternoon or evening.

“You are?” I asked.

“His mother.”

She was quite young and pretty but looked tired, and I had presumed her to be a friend or sister. She wore a pair of faded jeans, a cotton shirt, and flip-flops. Her dull blond hair was tied at the back of her head with a band, and strands of loose hair hung around her face. She had no makeup or lipstick on.

“I signed all the papers and I spoke to the resident, but I want to talk to the surgeon.”

I said that I would inform the surgery resident of her request.

I went back to the nurses’ station and began writing my notes. Out of the corner of my eye, I saw her step out of the room and look around. Upon spotting me, she walked across. She stood in front of the desk and waited, drumming her fingers absentmindedly on the countertop. I looked up.

“Yes, ma’am. How can I help you?”

“Will he be alright?”

“Yes, he will be. He is young and healthy.”

“No, I mean will the surgery work? Will he look like he did before?”

I averted her gaze. I knew that no amount of skillful surgery could undo the damage that had been done.

“He should look very good.”

“Thank you, doctor. I feel better now.”

She smiled and walked back into the room.

I felt guilty. Maybe I should have told her the truth. Maybe I should not have gotten her hopes up.

Back at home that night, I looked at my infant son. He was fast asleep in his crib, stuffed between the queen bed and the wall of our tiny bedroom. I stood by his bed and admired his perfectly formed features. I picked up his little hand and gently felt his pudgy fingers. I bent down and kissed him on the cheek. Before he was born, my wife had been stricken with fear that we would have a congenitally deformed child. Her fear was irrational, but perpetuated by an unusual set of circumstances. In a span of a few years, we had heard or known of several friends and family members who had kids with Down’s syndrome, autism, and congenital malformations. I looked down at my son and was thankful that we were blessed. Of course, at that time, I had no idea about the terrible twos or teenage angst that was going to come later in life.

I had all but forgotten about the patient when, a couple of days later, I got paged by the surgical service. It was at the beginning of a 36-hour shift that we had to endure every four days. I was glad that this would be one of my last shifts and I would be done with it forever. Little did I know at that time that this was just the beginning of many sleepless nights to come in the future. Just one of many more nights that my wife would have to sleep on our bed alone.

“Oh, it’s you again? Remember the young guy you cleared for facial reconstructive surgery three days ago?”

“Yeah.”

“Can you come and see him?”

“Why?”

“Well, he didn’t do so well. He’s in the ICU.”

“What happened? He was healthy.”

“The bloody wound got infected. He’s in septic shock.”

I went over to the ICU, passing through the dimly lit, dull, and dreary corridors reeking of illness and death. Human misery seemed to be pouring out of every pore of the crumbling building. Family or friends, of the few patients that had any, huddled in corners whispering or sobbing.

I saw him lying in his bed, his mother sitting by his side. She looked haggard and had aged considerably in the three days since I had last seen her. She was wringing her hands; her untidy hair now hung haphazardly. His face was covered with dressings, only the endotracheal tube poking out through them. He had IVs running into both arms. I looked at his chart before going in to see him.

She looked up at me as I walked in. I nodded at her and began my examination.

“Why him?” she asked.

I paused, not quite sure how to answer.

“Of all the people in the world, why does it have to be him?”

I kept quiet. I wanted to tell her that he would make it out and everything would be alright again, but I just couldn’t. He was in septic shock and respiratory failure. DIC had set in, and his chances of making it through were slim.

“The surgeon said it was rare to have these complications. Why then did he have to have them? Why?”

I had no answer. I put a hand on her shoulder. She started crying.

“He was such a beautiful boy, my only child. And I raised him all alone.”

She wiped away the tears with the back of her hand and rubbed her nose, which had turned a bright red.

“He always wanted to be an actor. He would have made such a good actor.”

I had other patients to see. Similar tragedies were unfolding all across the hospital and all across the world. I left then, but I came back and checked on him throughout the night.

“Why did he want to kill himself? He had always been so happy?” she asked at midnight.

“I just want to take him home,” she said at 2 a.m.

He passed away at 5 a.m. I rushed in with all the other interns and residents when the code was called. She had stopped crying. Her hands were balled into fists.

“It’s not fair,” she hissed, as I was leaving with all the others.

I got home after five that evening. I rushed past my wife into our bedroom. He was fast asleep on his back, his arms and legs curled up, chuckling in his dream. I picked him up and held him close.