By and Bye

A man was put in prison in 2000 some­thing, I don’t know why, didn’t ask.
He was trans­ferred to my sur­gi­cal ser­vice. It goes like this:
I get a page say­ing to call the trans­fer cen­ter at the hos­pi­tal. It’s an ER 45 miles away. The doc­tor there has a patient who has a bowel obstruc­tion – imag­ine a kink in a hose, an impor­tant hose – and no sur­geon. He wants to trans­fer to the near­est sur­geon, me. I say yes.

My patient is 55 year old, HIV positive,a pris­oner with a her­nia (a hole in the mus­cu­lar wall of his abdomen, acquired through a pre­vi­ous med­ical dis­as­ter.) It has been that way for years, but he is in prison and the can­taloupe shaped mass pro­trud­ing from him has not warranted…anything. Until now, because the bowel going into the her­nia is now obstructed.

(Bowel obstruc­tion: we are built like donuts with a long tube run­ning through the mid­dle of us. This tube starts at the mouth. You know where it ends. If the tube, which makes the “hole” of the donut, gets twisted, it is a mechan­i­cal prob­lem and you will be look­ing for a human mechanic, like me. I know. It’s a weird job. Should prob­a­bly be on “Dirty Jobs” sometime.)

Jim is my patient. He is rail thin start­ing at his nose and never end­ing. He looks like a rag that has been wrung out twice and thrown down. He is pleas­ant and kind to me. The pain of hav­ing the intestines twisted is unique. You can imag­ine it if you try.

When I exam­ined him, besides the gen­eral issue of com­plete dehy­dra­tion, insti­tu­tion­al­ized neglect and fear, it was clear that the cantaloupe-sized mass on his abdom­i­nal wall was the prob­lem. It is not brain surgery, gen­eral surgery. He was in pain, so I gave him drugs, which helped. I imag­ined him bathing at the prison which is not a place one wants to look one’s best; but the shame of it fell down on me like the shower cur­tain they don’t have. Day in and out and in and out. I thought of my brother…

I took Jim to surgery shortly after meet­ing him. The liq­uid in his bow­els had backed up to his mouth and when we put him under anes­the­sia, that liq­uid went straight in to his lungs. He imme­di­ately became very sick and the bac­te­ria in that fluid caused his blood to stop clot­ting. This is not some­thing sur­geons like, unco­op­er­a­tive blood. It needs to clot, espe­cially in a HIV pos­i­tive patient. It is scary to work in that crim­son, unclot­ting and liv­ing bath. I worked as fast as I could, remov­ing the thinned out skin that barely stretched over the mass, free­ing the bowel up, plac­ing a patch over the hole in his abdom­i­nal and mov­ing skin around to close him. My assis­tant got stuck with a nee­dle. The risk for him to acquire the AIDS virus is less than 0.03%. It feels like a thou­sand per­cent. We will know for sure in six months. Six.

Jim was sick for days and then he slowly got bet­ter. Every­day I would come in to his room and even though he was inca­pac­i­tated com­pletely, a guard sat by his bed­side not keep­ing vigil. She, or he, just watched, and kept her dis­tance, and made sure the shack­les were secure to the frame of the bed. No one was going any­where, and again, I thought of my brother.
He may be, some­day, in need of some­one, some­thing. He sits in a Texas prison, by his own doing, by the undo­ing of his dam­aged mind. I am, today, my brother’s doc­tor. I am his doc­tor through Jim. For my beloved and lost brother, I give, Jim. He is all sewn up and right as rain. He was proud of his new flat abdom­i­nal wall. I kept him an extra day beyond what he needed…for the TV and the win­dow. I will make the prison bring him back to my office for appoint­ments for as long as nec­es­sary and then some so he can look out the win­dow of the dri­ving car, so he can feel my hands on him with­out threat; so he can be touched.