The Patient

The patient’s wife teetered behind his gurney, brown eyes fluttering back into her skull. I dug my nails into her gaunt arm, startling her awake. I met her terrified eyes and said, knowing he could die any minute, that a long road of surgeries and rehab would fix him. Then the patient hollered in a bloodied voice, “Wait! Wait! Can we stop and talk about this?”

The EMTs stopped dead in their tracks and stared at the patient on the inclined gurney, one open-mouthed, the other squinting. We darted to each side of him as the EMTs moved. His blue eyes appeared alert despite the blood in them and the purple ringing them. 

Dark blood caked most of the craters and folds of his pockmarked, sagging face. The left ulna lay in a jagged line within its blackened skin, the right ulna broke through with a dull white tip of bone. Both thighs were purple and swollen to the point of nearly bursting, thanks to multiple femur fractures. Only God or a CT scan could tell how many lacerated organs hid under the cracked sternum.

The wife repeated through her bony hands, “Oh my God, oh my God,” in a voice equal parts fear and wonder.

“You’re extremely lucky,” I said.

“What?” the patient shouted.

Add perforated eardrums to the chart. I raised my voice. “We’ll do a CT scan and then proceed.”

He stared at my ID badge. “But Dr. Kolo….”

“Kolodiewiecgze. Dr. K.”

“Dr. K,” he said. His eyes were alarmed but analytical. “How much treatment is really necessary?”

“Oh my — what?” the wife drawled.

“You said there’d be a lot of surgeries and rehab. I should shop around. But first, what’s a need and what’s a want?”

The wife said, “You ain’t a doctor.”

I added, “We can’t decide without the CT scan.”

“Really? You can’t watch me and see what acts up?”

“Listen to the doctor,” his wife groaned, pinching her hooked nose.

“Okay, okay, but how much we talkin’ for fixin’ my legs?”

“No idea,” I said.

“Ballpark?”

I decided to humor him since he wasn’t actively dying. He would wait in an exam room for hours anyway, unless he suddenly went south.

“Thirty, thirty-five thousand?”

“Per leg?”

“Yes.”

“How many surgeries?”

I studied his swollen legs, a patchwork of purple and blinding white skin. “Maybe three or four on each?”

The patient whistled through blood stuck to his throat. “Definitely a want.”

“You can’t not get your legs fixed,” his wife said.

“How ‘bout my arms?”

“Uh, probably around fifteen to twenty thousand per arm, a couple surgeries on each.”

The wife looked at the ceiling, gripped her protruding hip bones, and droned, “So. This is what we’re doing.”

That pulled me back. “Your limbs will never work properly if you don’t have them repaired. But I’m more worried about internal bleeding. Let’s get that CT.”

He blurted, “You know what? I feel good enough to go home and see how I do. I’ll need some painkillers, of course.” He glanced at his limbs and added, “And casts. Or splints? Which is cheaper?”

“Listen to the doctor!” his wife shouted, tight fists pulsing on either side of her head.

“Hear me out, Maggie. What’s the cost of operating a motorized wheelchair over the next fifty years?” He flashed crooked teeth coated with blood. “Not $360K!” His smile dimmed as he looked to the side and pondered. “I’ve read about some cool robotics for disabled people.”

I assured him that even with the surgeries he would be fully disabled and in chronic pain.

Maggie’s eyes lunged at him, but then they darkened and looked down. He murmured, “Better not throw money away. We’ll never pay it off, and for what?”

She opened her mouth to reply but stopped and chewed her lower lip while staring into space.

I asked, “Did I mention you could die?”

“Oh, I’ll go to the ER if anything happens.”

“You’re here now.”

“But I don’t need it now.”

“You’re choosing to risk your life at worst and to have impaired function in four limbs at best.”

His face clouded, then brightened. “Have you seen those sprinters with the metal legs? That might be the ticket!”

“Those are for amputees.”

“It’s still gotta cost less, they’ve been sawin’ off legs forever. The legs are just metal, hell, I bet I could source ‘em myself. Titanium’s overkill, you ask me.”

“Is she,” I stabbed a finger at Maggie, “willing to feed you and wipe your ass?”

She glared and crossed her arms. “‘Course I’ll take care of ‘em.”

I screamed at the EMTs, my oath and the idea of a malpractice suit palpitating my heart, to take him back for a CT.

He laughed and said, “You’re looking at it the wrong way, Dr. K. They’re gonna want people to test robotic arms and exoskeletons and what-not, they’ll probably give it to a poor guy like me for free. A free upgrade. Have you seen those sprinters run? You gotta look ahead, Dr. K.”

I looked ahead to the EMTs for support. They stared back as though watching the wreck that brought us together.

The choices of the day, the next day, the day after that, and so on until retirement or death, settled in my stomach like sludge. Maggie looked at me with gratitude, and somehow that soothed it.

“I’ll write a script for Fentanyl. We’ll get some splints. Shouldn’t be more than five grand.”

“I’ll just see my family doctor tomorrow.”

“Let me guess. No ambulance ride home.”

The patient chuckled, and even Maggie grinned. The humorless EMTs shuffled to the gurney.

“What’s your name?” I asked.

“Luke.”

I trailed behind Maggie, Luke, and the EMTs on their way to the ER’s front desk. I thought about what I would have for lunch in a couple hours.