Sandbags
In 1983, I was in my final year of medical school and I knew nothing. Fourth year medical students spent most of their time in the hospital, where they were called clinical clerks: the lowliest members of the medical team, the ones whose badge was yellow instead of white and didn’t say doctor. I tried not to get in the way, to learn some things, and to accept the shit jobs with grace.
I was assigned to one of Toronto’s venerable teaching hospitals, which at that time didn’t have any of the new wings it has acquired since. It was old, with walls repainted a thousand times rather than washed, I think — a color of green that makes everyone look sicker, which must have been reserved especially for hospital hallways. I imagined the halls getting narrower over the years from the thickness of paint.
On the surgical ward, the head nurse wore one of those folded white nurse caps that now you only see in movies. She once added a prescription for chlorophyll to the orders for every male patient on the ward because she had caught one of them masturbating and chlorophyll, purportedly, had the power to make sure that never happened again on her ward. The whole place smelled like chewing gum.
I was assigned to the residents of the cardiovascular surgery team — all young men with ambition, their gaze narrowly focused on the future. They wanted to be in the operating room as much as possible and to do as little else as could be arranged. Their intern, Paul, handled everything that freed them to operate: seeing the newly admitted patients to take a history, ordering the tests that the anesthetists required, troubleshooting if the level of sodium in someone’s blood was too high or oxygen was too low. Paul was one year out from medical school and vastly more competent than me — I couldn’t imagine how I could acquire those skills in such a short time. I tagged along and tried to mimic a professional attitude.
Harry Hartman had been a patient on the cardiovascular surgery ward for a while already when I started my rotation with the service. He had bad arterial disease in his legs. He couldn’t walk 50 feet without having to stop because of pain from muscles that were not getting enough oxygen. Tests had identified the problem and the operation that he needed. “Smoking” said Paul, “diabetes.” I nodded gravely, faking comprehension.
On the day that I am remembering, the team was doing rounds as evening settled. Paul knew every patient and what the residents wanted to know about them — who he was “crossing and typing” in case they needed a transfusion in the operating room, what he was doing to “move the meat,” which means hastening the discharge of patients who were recovering from their surgery and using up a bed that the surgeons want for someone new. Rounds were interrupted by a nurse, walking quicker than nurses usually do and urgently telling the team “you need to go to 11B. The post-op is bleeding.”
“The post-op” was Harry and “bleeding” was a dramatic understatement. Streams of bright red blood pumped out of Harry’s thigh in pulses as if shot from a water pistol. Paul stopped the geyser by pushing the heel of his right hand against the site of the bleed before I was able to register exactly what was going on. He gave the nurse some instructions about increasing the flow of fluid from the intravenous bag that was hanging beside the bed and asked for Harry’s vital signs, which she had measured before being asked. In a few minutes, the scene was calm again and the bleeding was stopped as long as Paul applied pressure, but would resume as soon as he pulled his hand back. The source of the bleed was Harry’s femoral artery. There was a hole at the place where it had been cut and then stitched back together during his operation. The stitches had obviously failed. The femoral artery is large because it feeds blood to all of the smaller arteries in leg and the pressure within it is great. Harry’s “bleeder” was not going to stop until someone stitched it up again. He had to go back to the operating room.
“Listen,” Paul said to me, “this is going to take a while. They aren’t ready for him in the OR. There isn’t even going to be an OR free for a few hours. You’re going to need to keep this under control while we wait. Push here while I go get something that will stop the bleeding for now.” I took over his post at the side of Harry’s bed and Paul disappeared. He came back in a few minutes with four little sandbags that looked like they were kept for just a situation like this. They were loosely filled so you could fit them where they had to go, and each one seemed to weigh a couple of pounds. Like everything else in the hospital they were old. If someone told me they had been in a cupboard since the Second World War, I would have believed it.
Paul indicated to me to pull my hand away and replaced it with a sandbag. Then he put a second one on top and then piled on a third. “That should do it but you are going to have to stay here to make sure they stay in place and they keep working. I’ll be back when we are ready to bring him up.”
It took only a couple of minutes after Paul left for it to become clear that the sandbags weren’t stopping the bleeding. I added a fourth sandbag to the tower, which made the pile unsteady but didn’t stop the expanding red seepage from its base. I pulled off the sandbags and put the heel of my palm back on Harry’s thigh.
That was when our eyes met for the first time. In fact, it is when I first learned the name of the man whose thigh was pressing. “I’m Harry.”
“Hi Harry.”
I put my other hand over the first and adjusted the pressure, trying to make sure I was not pressing too hard.
“Am I hurting you?”
“It’s fine,” Harry paused, “I prefer it to the alternative.” I smiled.
For a person who had been through what Harry had, he looked good. He was calm and the blood loss hadn’t made him confused or sleepy.
“I don’t know how long this is going to be,” I said as if informing him, although he had heard what Paul said, same as me.
“I know.”
“They’ll fix you up when you go back to the operating room.”
“They’ll try.” Harry was matter-of-fact. “They already tried once and this happened.” He gestured towards the spurts of blood on the wall beside the bed. “I expect I’ll lose the leg, but first they’ll try to fix it.”
I could see that Harry knew more about his options than I did, so I stopped trying to reassure him. “Do you have family?”
Harry was keeping eye contact. He looked like he was up for a conversation. “Yeah. They won’t be visiting. I haven’t seen them… for a while.”
“You live on your own?”
“I have a room in a house on Euclid.”
“What do you do for a living?”
“Dole.”
I was so green and my experiences so privileged that I had no idea what that meant. Harry was giving me lots to look up and read about. “You have kids who are grown?” Harry looked to be about sixty.
“Yeah, but it’s been years.”
I must have looked quizzical but I didn’t ask a question. My curiosity lacked courage at that stage.
Harry answered the unasked question. “Making amends is Step Five. I’m on Step Two.”
Countless patients over the years since my conversation with Harry have taught me about the twelve steps of Alcoholics Anonymous. I couldn’t comprehend at the time all that he was sharing with me: that he struggled with addiction but was trying to do something about it, that his actions had pushed his family away but he hoped to set that right if he could someday, and that he was stuck on Step Two, which is admitting that there is higher power that could help.
I took a closer look at Harry’s face. There were old scars on his cheek and forehead. His skin was weathered and his smile revealed a space between his front teeth and others that had grown at angles. He looked like an old hockey player.
“You ever go to the Royal York?” he asked.
“I’ve just walked through the lobby.” It was a fancy old hotel, well beyond my means.
“I used to work there. Right out front. Bellhop. You would have seen me in the lobby.” He was obviously proud.
“You must have stories.”
“Jesus yeah. Pardon my French.”
I just waited. Harry didn’t pause long. He began to tell stories that he had probably told a hundred times before about celebrities and gangsters that he assumed I would recognize by name, hookers, the “suits” who ran the hotel, and drunken escapades. Harry talked me through the hours until an operating room came free, my Scheherazade. I was his audience, asking the odd question but mostly listening, my hands getting numb from doing the only useful thing that was available to me.
Almost forty years later, I see my night with Harry foreshadowed a career in medicine. This is what we do. We sit or stand in scenes that should be more disturbing than they feel — blood on the walls and sheets — making intimate connections with strangers, using whatever blunt tools are available to buy time, waiting for a better solution, knowing that the stakes are high, the solution is often elusive, and that just being there may be the best medicine we have to offer.
