A Half-Step Ahead
Tales From the ER

He was one I remember as a marginal friend -- he was not, however, marginally friendly, but a fellow whom I got to know only so well.

He was a journalist, and as is true of that genre, was somewhat liberal in outlook.

He prided himself on his candor, but like so many candid people he was much more open about the frailties of others than his own.

As with many journalists he also prided himself on his honesty, but seemed blind to the fact that none of us have more than part of the truth about any proposition.

For instance, his children were my patients and he frequently came into the office with complaints about physicians in general, or about the behavior of some specific physician for which he seemed to hold me personally accountable.

But then the checks that he mailed in when billed "bounced" more than once.

He intrudes on my present mind-set because once he complained of the movie Mash as being flawed by being funny.

Most will remember Mash because, though a story about a medical unit in the Korean War, the TV series that resulted endured for a much longer span than did the war itself.

My writer friend took exception to this because the shows were unfailingly funny and he felt that looking after desperately injured people was no laughing matter.

What he missed, to my notion, was that the wounded were always dealt with promptly and conscientiously, if not always successfully.

The humor came from the comments of the caretakers about one another, and they never postponed treatment to crack wise -- that always came later.

The closest thing to this in my own experience as a physician was my limited, though somewhat widespread, duty in various Emergency Rooms.

It is singular that most of the truly humorous health care episodes that I recall took place in emergency units.

One wonders if this has to do with the spontaneity of life there compared to the more regimented phases of hospital operation.

Most hospital procedures are like intricate ballets -- they may appear to be spontaneous events, but everyone's parts are carefully choreographed.

Emergency work requires a more ad-lib response, and this brings suspense as well as the anxiety that always attends the care of the ailing.

There is certainly nothing humorous in suffering and duress, but it does seem that frequently, after emergent needs are managed, that someone says something very funny.

One night a woman presented herself, angry and bleeding.

She had a neat but egregious slash that started on the back of one upper arm, ran across her back and ended on the back of the other arm.

It was nigh a yard long and deep as well, extending into the underlying muscle.

I say "neat" because it showed almost surgical precision, and, indeed, it had been done, according to the victim, by a straight razor with keenness comparable to a scalpel.

It took a awhile to repair due to its extent and the fact that the underlying tissues had to be approximated as well as the skin.

When I finished I was cleaning the patient's back when I noted for the first time a well-healed scar, about two inches below the laceration I had just repaired, and paralleling it for its entire length.

I said to the patient:  "It looks like you've been cut about the same way before".

She shook her head and replied:  "Yep -- same man -- I can't quite outrun him!"

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April 15, 1996

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