COLUMN: The Longest Zipper

From Tim Zeigler's "Turn Your Head and Cough," Fall '94 The five hours of sleep I had since leaving the hospital this morning did little to ease this mental hangover. I can not wipe the scowl from my face. Any amount of activity around me is only a fleeting distraction from my brooding over what I saw while on-call last night. As a medical student, I am spending a month working with the trauma surgery team here at HUP. It is the third week of taking call every other day -- spending 28 hours straight in the hospital followed by about 20 hours off. During the off-hours you try to catch up on all the life scut and basic bodily functions that you have ignored for a while -- piss, shower, nap, pay some bills, whatever. During that long shift in the hospital you are usually pretty busy seeing sick little campers, the most brutalized of the banged-up. Last night was a true shitter, a new low. Too much death for one evening, too many ultimate demonstrations of how easily one person can dispatch another with a blade or bullet. The cynic within that curses mankind as a hopelessly self-serving, self-destructive, wretched species had ample evidence on his side. Bright red pools of proof spilled onto the floors, soaking the covers of my shoes. Blood was everywhere except in the patients. The cynic's argument fell from the unzippered mouth of the plastic body bags... Nothing else takes that long to zipper. The unmistakable sound drones on forever, punctuated only by brief pauses to round a corner or tuck a cooling limb inside the bag. Last night a total of five patients received a "trauma alert", a fast-paced procedure intended to evaluate, stabilize, and identify any surgical emergencies in a critically injured patient. All five of our players were the victims of violence. Two of them never made it to the operating room -- immediate discharge to the morgue. The first fatality was the victim of a single gunshot wound to the chest. The crew bringing him to the hospital sent word that the patient had lost all vital signs during transport -- he had no spontaneous heartbeat or respiration and no blood pressure. Moments later he was wheeled before us, the medics standing over the gurney to continue CPR. After confirming the absence of any spontaneous pulse, the defibrillator paddles were placed on his chest to check for any electrical activity from his heart. Flatline -- game over. No amount of intervention (by us, anyway) would bring him back. A single, small caliber entrance wound over his left chest told us that Death had won this one, had won it before the game ever started. He had barely invited us to play. It was later, around 1 a.m. when the real ass-kicker arrived. Two patients were en route to the hospital. Both had received gunshot wounds to the chest and both were in very unstable condition. The team of nurses, surgeons, and anesthesiologists was fully assembled when the first patient was brought to us. The cold pallor of his skin told us that he was running out of blood to lose. Severely agitated, he struggled with us since he could not reach inside to what was killing him. The intensity of the activity in the trauma bay suddenly increased, signalling the arrival of the second patient. The first one deteriorates rapidly before our eyes, his pulse dropping to nothing as the heart itself becomes starved for oxygen. His chest is opened, his heart massaged by the hand of the surgeon to continue some amount of blood flow. But his heart is empty as he has lost too much blood, lost it faster than we can give it back. He is gone. Full attention is turned to the second patient, also in critical condition. He is struggling frantically against the pain of all our interventions to save his life. Needles are placed to put blood back into his vessels. Tubes are inserted into his chest to drain the blood that is collapsing his lungs. Immediately after he is sufficiently stabilized, he is taken to surgery for exploration and repair of his injuries. He will survive, but it will be quite a while before he is very happy about it. In the morning I am pretty despondent about the events during the sleepless night. I go home, sleeping for several hours and awakening in the late afternoon. I am hungry and unable to recall when I last ate anything... lunch yesterday? I walk out in search of a pizza. My thoughts cycle on what senseless, ruthless idiots we are. I am unable to think about the ones that lived, only the dead ones... Why were they shot? How the fuck could anyone just point the gun and pull the trigger? If humans can do this to each other, I no longer want to be human. I'll submit my resignation tomorrow, but to whom? People suck. Life sucks because people suck . Over and over in my mind, I find no redemption, no real reason to continue to care. I'll just feed my face and go back to bed. Maybe a stray piece of the Shoemaker-Levy comet will turn the earth into a cosmic greasespot before I wake. I don't care. I won't care. As I walk along, a mother and her two children approach on the sidewalk from the opposite direction. Scowl firmly affixed, I am plodding past when the young boy , perhaps four or five years old, floors me with a completely genuine and cheerful, "Hello!". I am reeling, off- balance and trying to recover. "Ah...Hiya!" I sputter back at him in a well-meaning but feeble effort to equal his enthusiasm, if not his innocence. And then I am laughing at myself, realizing that my distance from caring has instantly evaporated. I am busted, caught, snagged. Despite all my bilious venom, I am pulled instantly back into the ballgame by the friendly gesture of a five year-old. "Okay, okay. You got me. Uncle. I give in," I mutter towards the sky. If I need any better reason to keep trying, then I am only slightly less of a bastard than the ones squeezing the triggers. I am still laughing, less ruefully than before. I nearly lose to the small smile trying to break out on my face. I'll get some food, vent to some friends on the phone, and go back to bed. Tomorrow, I'll go to work again. Thanks, kid. I hope I never see ya' when I'm working. If I do, I'll do my damnedest -- count on it. Tim Zeigler is a medical student from Williamsport, Pennsylvania. Turn Your Head and Cough appears alternate Wednesdays.