Christmas (3): A Christmas Awakening
Why do hospitals run this way? The thought crosses my mind from time to time. Any modern person would feel the same upon witnessing such scenes. How can a hospital function on such haphazard methods? “The patient looked like they were dying, so I gave it a shot” is not an excuse that flies in a contemporary hospital. To put it in perspective…
The disease that best illustrates the medical reality of the 1970s is probably cerebral hemorrhage. Treatment for cerebral hemorrhage back then went something like this: drill a hole in the head. What if there is no hemorrhage after drilling? Keep drilling until you find it. If you still cannot find it, there is nothing to be done. It was called exploratory trephination, a name that sounds more like a martial arts technique than a surgical procedure to modern ears.
The reason was simple. CT was invented in the 1970s. Commercialization came later, and it took several more years for the technology to be properly trained and studied. Most hospitals in the 1970s lacked proper CT machines or personnel capable of reading them. Of course, Stanford University Hospital had introduced CT relatively early—around the time I was graduating. But…
Most of the hospital’s professors were physicians trained in an era when the prevailing attitude was “If your head hurts, just open it up.” They did not so much as blink at any treatment method as long as there was a reason. I had seen that much already.
Anyway, this was the recovery room next to the radiology department. I was waiting with the thoracic surgery professor for my patient to regain consciousness. The professor was Norman Shumway, the surgeon who had invented and first performed heart transplantation. He had come because the patient might require emergency cardiac surgery. It had not been necessary.
Professor Shumway was reviewing the procedure note I had hastily scribbled earlier. I wondered if he could even decipher the handwriting.
“You succeeded with coronary intervention?”
“Yes.”
“That’s impressive. Saving even a patient like this. And without emergency surgery, just with catheter intervention…”
The professor clicked his tongue. “Coronary intervention. That’s the one where you shove a wire hanger into the blood vessel, right? Insert a thin wire into the artery and clear the blockage.”
I nodded. “Yes.”
“Shame you couldn’t do emergency surgery.” Professor Shumway smacked his lips. Well… the man had invented heart transplantation, after all. It was only natural he thought of cardiac surgery first. In this era, that was still the standard approach. But this patient would never have survived long enough to reach the operating table. Few things were as dangerous as open-heart surgery.
“It’s better not to operate if you can avoid it.”
“True. Still, you did excellent work. I heard there was a resident who successfully performed the first cardiac catheter procedure in this hospital, so I came to see for myself. I could hardly believe it.”
“You only do heart transplants, then?”
“That patient was lucky to end up in the emergency room where you were on duty. Looks like they’ll walk out just fine. Must be because it’s Christmas.”
Professor Shumway chuckled heartily.
Finally, after a short wait, my patient began to open their eyes with difficulty in the radiology recovery room. We walked over to the bedside.
“Where… am I?”
“You’re in the hospital.”
The patient’s face was deeply furrowed, but they looked stable. Blood pressure and ECG had returned completely to normal.
“I thought I was dead for sure. The last thing I remember is people shouting and the pain being unbearable…”
The words came out slightly slurred.
“Just rest for now.”
“I saw an angel. I was rising toward a bright place, but someone tied a string to my heart and pulled me back, asking where I was going…”
During coronary intervention, we did not use full anesthesia—only sedation—and administered oxygen instead of mechanical ventilation. They must have felt the catheter entering their heart while half-asleep. I nodded in agreement.
“It wasn’t your time yet. Still, better to have gone up than down, isn’t it?”
“Pardon?”
“Up is heaven, down is hell. Sounds like you were on the road to heaven.”
Just the kind of joke one makes in a hospital. The patient fell quiet again. I pushed the bed outward, passing through the dim radiology corridor and out of the department.
The patient’s family had been waiting anxiously. They rushed toward me at once. There were over a dozen of them. Everyone must have had a hard time on Christmas Day.
“How did the surgery go?”
“The intervention went well. Consciousness has almost returned. You should be able to see them soon.”
“Oh, thank you so much…”
A chorus of murmurs followed. They were relieved it was a success, asked what had happened, expressed gratitude that the patient had not died after all. It was a Christmas miracle. They wondered why this had occurred. I nodded slowly. They would need time to process everything.
“We’re still determining the cause. Given the age, I suspected infective endocarditis, but further testing is needed.”
As soon as I finished speaking, the man who appeared to be the patient’s father rushed forward and grasped my hand.
“I can’t thank you enough. I was worried the emergency room would be packed because it’s Christmas…”
“It was simply my duty.”
“Thank you.”
“Now that everyone has greeted them, I’ll take the patient up to the ward. They need rest, so please keep things quiet—”
I pushed the bed forward.
***
“The condition doesn’t look good.”
This was Kristin Silver, the second-year rehabilitation medicine resident on duty for Christmas. She was studying the patient’s medical records and test results with a grave expression. I waited anxiously for her assessment.
“Ah. Is it that bad?”
“Rehabilitation will be necessary.”
It was an absurd answer. If a patient came to me, an internal medicine doctor, asking for help and I replied, “Ah, medication will be necessary,” how ridiculous would that sound? I scratched my head.
“What kind of rehabilitation?”
“General functional decline. Partial aphasia and muscle weakness, likely central in origin. It could be transient delirium, but I’m inclined to think it’s a focal neurological lesion.”
When she saw my worried expression, Kristin shook her head slightly.
“Ah.”
“Don’t worry too much. In patients under thirty, even severe brain lesions like cerebral infarction often recover function in the majority of cases. There’s still a chance these symptoms are temporary…”
Meaning the prognosis was not that poor. Relatively speaking, of course. I let out a sigh of relief.
Come to think of it, I had completely forgotten because of the emergency patient. The time I had planned to leave work had long since passed.
“What do you estimate the likelihood of cerebral infarction to be? If it’s endocarditis, the coagulation status—”
Kristin cut me off. “Write up the records and go home. You pulled an all-nighter on Christmas Day because of this patient, didn’t you? I just started my shift.”
“Ah.”
“It’s well past time for you to leave. Other internal medicine doctors should be arriving soon. Finish up and head home.”
Now that she mentioned it, I had been at the hospital for nearly thirty-six hours. It really was time to go… I bowed to her.
“Thank you.”
I could leave with peace of mind. On the other hand, my family would be waiting at home. I had said I was coming but never showed up. I would be quite late.
***
A house in the suburbs of Palo Alto. The fireplace held only glowing embers, the Christmas tree stood decorated, and a golden retriever and a cat gazed at the oddly shaped tree that had recently appeared in the living room. The Christmas Eve and Christmas Day parties had passed. Only the lingering warmth and decorations remained.
The Parks family stared at the front door. The hour their son was supposed to arrive had long since passed. Had another patient come in?
“Do you think he’ll come?”
“Who knows.”
The puppy lying on the floor perked its ears as if in agreement and lifted its head. Something must have happened. Being busy with hospital work was nothing new. It was unavoidable.
Then the dog suddenly turned its head at the sound of someone approaching. Was he finally here?
The doorbell rang moments later. They moved toward the door to open it.
“Hello.”
The family blinked in surprise. It was someone they had never seen before. A young woman with an elegant, cat-like gait and refined clothing smiled at them. She raised her hand in greeting to each family member in turn, then to the dog, and finally to the cat beneath it.
“Who are you?”
“Liselotte. Liselotte Weismann. I’m a friend of your son, and I’ve brought brownies.”
“Ah…? Come in.”
“Thank you.”
She stepped inside slowly. Liselotte placed the brownies on the table, hung up her coat, and soon settled onto the sofa beside the puppy that had approached her.
“I thought he would already be here.”
Liselotte tilted her head. The person she had come to see was nowhere to be found.
“So did I.”
“Perhaps he was delayed at the hospital? There may have been many patients on Christmas Day.”
Liselotte smiled faintly as she gazed out the window. He would arrive soon enough, anyway.