'You're going to do what? Transfer him where?'
Dr. Marcus Andrews stared down at the hospital's president, seated at his desk in his office. 'You heard me. Must I repeat it? This kid you and Allegra insisted be hired -'
'Doctor! Not kid! He's a doctor! A surgeon!' exclaimed Dr. Aaron Glassman heatedly.
Andrews leaned forward and placed both fists on the desk. 'Glassman,' he stated firmly, 'he's going to the ER whether you like it or not. This is my department. It may have been your idea to hire him; it's my idea to observe him. Determine if he's competent. See where he fits.'
'He's already done his rotations.'
'Fine. So he can do some more! He'll learn – are you against that? In the meantime we'll see if he can hold up to the strenuous atmosphere of an emergency room. If he can do that I might let him do more than suction Melendez's cases. Which, from what I hear, is all he's been allowed to do.'
Glassman gave him a withering stare. 'As long as we're having him repeat everything, shall we send him back to kindergarten?'
Melendez obstinately turned and stalked out.
Dr. Shaun Murphy shifted his weight from one foot to the other. Most of the ER personnel were rushing past him going from case to case, ignoring him. Not once had anyone requested his assistance to so much as sew up a simple laceration. He couldn't understand it. The waiting room was full; he could hear people moaning and cursing and babies crying on the other side of the wall. There was too much work; these doctors and nurses were not using their limited personnel to best advantage. Perhaps no one had told them he was a doctor. He kept glancing around, not meeting anyone's eyes while meticulously observing everything.
One nurse at the desk called out some disturbing information. 'Ten-car pileup on the interstate.'
'How many for us?'
'Two majors, one minor.'
'Plus what we've got in there,' said one of the ER doctors, a General Practitioner, indicating the waiting room. 'We're short-handed as it is.'
Shaun overheard. As they strode past, he called to them. 'I can help. Let me help.'
'Who is this?'
'New surgical resident. They sent him down here on a temporary rotation. We're supposed to let him do some minor cases; teach and observe. He needs help with patient communication.'
'Hello. I'm Dr. Shaun Murphy. I'm a surgical resident here at San Jose St. Bonaventure Hospital.' Shaun spoke in a manner almost similar to the monotone in Professor Hawking's computer. His expression was pleasant if rather blank; his lips not quite smiling.
The doctor leaned down to whisper in the nurse's ear. 'He needs help with communication, period. What's with this guy?'
'Haven't you heard?' she whispered back, seemingly unaware that Shaun could hear every word. 'He's autistic! Glassman almost forced Andrews to hire him.'
The ER doctor looked down at Shaun disdainfully. 'Wait here until we find something for you to do. We're kind of busy at the moment.'
Shaun nodded. The two left him standing in the corridor, clasping his hands and rocking on his feet.
'Not another one!' exclaimed one of the nurses, watching a gurney glide from the ambulance bay through the corridor. She glanced at the patient; a young girl with flowing dark hair. The sheet was strangely contorted by what lay beneath. It made a tent over the lower half of her body. The girl was strangely calm. 'Is this from the pileup?'
'No,' said an intern. 'It's an impalement. We need to get her in ahead of the crowd.'
'How's the waiting room?'
'Numbers diminishing. We're dealing with it. They're all minors. All the pileups are in surgery.'
Shaun, running with a peculiarly stiff gait, hurriedly followed the intern as he wheeled the gurney into the examination cubicle. The intern stood back as one of the ER doctors entered. Shaun, standing right outside the open curtain, cast a glance at the gurney as the sheet was lifted. As the case presented itself to seasoned medical personnel, Shaun could hear the intake of their breaths; this was something they didn't see very often. He turned his body, hands still clasped, and looked directly at the injury. His mind instantly mapped out the directionality of the fence rail that had completely impaled the girl's calf, midway between the knee and ankle.
The rail, triangular in shape, nearly three inches wide and from broken tip to broken tip about three feet long, had narrowly missed the Tibia, scored through the Tibialis anterior, grazed the Fibula, torn through the Fibularis longus and exited ten degrees lower than the entry wound. There was only a trickle of blood oozing out of the entry wound. Seven or eight inches of wood was imbedded in the girl's leg.
The ER doctor collected himself. After examining the leg, he made a swift decision – influenced, no doubt, by the number of cases yet to be seen, the lack of surgeons on the floor and his desire to wrap up his shift before dinner.
'We can do this here.'
The nurses draped and wiped down the area with Betadine. They prepared injections of topical anesthetic and stood by, waiting.
Shaun spoke from the open end of the curtained cubicle.
The doctor palpated the entire site and, satisfied, made a small incision at the entry and exit wounds.
'X-ray,' Shaun repeated, a little louder.
The GP looked up, annoyed. 'Look, we don't have time to deal with or teach you anything today. Come back tomorrow when we don't have a horde to look after.'
Shaun had always had difficulty with the intricacies of human interaction. He still had much to learn about such things as obscure meanings in language; ambiguous intentions; body language; sarcasm. However, almost as a saving grace, he had been endowed with an inborn intelligence; undefined and unnamed senses that had helped him through the trials of medical school and his internship. He instinctively knew when he was being brushed aside and when and how to assert himself.
'She needs an x-ray,' Shaun firmly stated. He entered the cubicle and looked down at the wound. 'I'm very sorry, this may hurt a little,' he told the girl. She winced as he gently manipulated the two ends of the wood.
'There's an abnormality. There's a break in the center, right in the center.'
'I know that,' said the GP. This stuff's fragile; it broke in two.'
'I don't think so.'
'You know what I think? I think you should go back to the Home or wherever you came from and stop playing Doctor! Go outside, find a bench and sit down. Stop bothering me.'
Shaun obeyed. He fidgeted on his seat as the doctor extracted the rail pieces; first the top piece, then the bottom. He cleaned the wounds, deep dark holes, and ordered a series of injections for infection. Despite Shaun's ongoing pleas, the girl was released to her family within hours, hobbling on crutches.
Six months later, Shaun was back on the surgery floor, still doing scut work and suction for Dr. Melendez. He never complained; it wasn't in his unique nature to rail against the injustice of being a fully qualified surgeon with skills far surpassing his superiors, relegated to such duties as standing holding a tube in a gaping wound or running for labs or picking up organs for transplant. Also, wherever he went he had a chaperone – the young female doctor he had met on the first day.
Dr. Claire Browne had become a friend of sorts; she was the only one who tried hard to understand the way Shaun's unique mind worked and how to communicate with him. Dr. Glassman was invaluable in his suggestions on how to reach Shaun. Claire learned that he would not respond directly to a question if he could help it. For some reason he didn't like questions. If one reworded the question to a statement, one might get an answer from him.
'I know you don't like scut any more than the rest of us do, Shaun,' she said one day at lunch. 'We've all had to do it. You seem to get more than your share.'
'Yes, I do. I don't like it.'
'Maybe a case will come along – maybe one like the boy you helped at the airport – that will change things for you.'
'Yes, demonstrate what you're capable of. I know you've been hiding your light under a bushel,' she teased before she thought.
'I bought a bedside lamp at the furniture store. Thirty-nine dollars. There's no bushel of anything.'
Claire smiled. 'A case will come in that will make them take notice of you, Shaun. Wait and see.'
'I'm Dr. Melendez. Your doctor referred your daughter to me for surgery. He thinks there is a massive infection in an old injury.' Dr. Melendez looked at the girl's chart. 'You hurt yourself last April?'
The girl nodded.
'What's your name?'
'I'm the girl's father, Doctor. My name's Robson. Dianne's fourteen. She's been up every night, unable to go to school – her leg is swollen and red and she can't bear weight on it. It gets worse each day.'
The older man told Dr. Melendez the story. His daughter had spent the night with a friend who had horses. The next morning they went riding. Dianne's horse became hard to handle; kicking and fighting the reins; then took off running. A split rail fence encompassed the field; the horse ran too close to it and a fractured rail was rammed through her lower leg, breaking off of the fence as she flew past. Diane thought she had merely scratched the leg until she looked down. Her friend came to her rescue and led the horse back to the stable. There she slid her friend out of the saddle and supported her as they made their way back to the house. The girl called 911 and Diane was brought to San Jose St. Bonaventure's emergency room where she received treatment.
'And the fence rail was wooden?'
The doctor looked at the leg. Even the lightest palpation brought a gasp of pain from the girl.
'The entry and exit wounds have granulated and closed over. It's a closed infection. I see why he referred you to me for surgery. Any idea what kind of wood that rail was made from?'
Mr. Robson handed him a small piece of wood. 'This is a sliver that came from the place where she got hurt.'
The doctor took the sample to the light. He rubbed it with his fingers.
'I don't recognize this as wood. Looks too fibrous.'
'Dianne's friend said her dad got it from a ranch auction – he said it was chemically treated redwood.'
'Don't worry,' said Melendez. 'This is a straightforward surgery. We'll fix that leg right up.'
In the operating room early the following morning, Shaun stood poised to assist with the suction tube. Dr. Melendez made the incision, an eight-inch line from the top of the tibia to below the exit wound. This would encompass the gaping holes and make a much less visible scar.
'Watch for suppuration, Doctor Melendez.'
'Counting on you to stay ahead of me and suction it, Murphy. Once we clean it out we'll flush it and sew it back up.'
'I don't-' Shaun started to say. He was interrupted by the intercom.
'Emergency, Dr. Melendez. Dr. Andrews needs you as second on a liver transplant. They're running out of time.'
'How much time". He asked while Shaun assiduously suctioned the mas of infection
'Cutting it damn close.'
'There were complica-'
'Don't bother me with details. I'll scrub out.' He turned his attention to Shaun. 'I'll have an attending here shortly to fill in. Keep suctioning.'
After Melendez left, Shaun continued to obediently clean the wound for several minutes. Something caught his eye. 'What do you see, Doctor?'
'An anomaly. I see an anomaly'
'We better wait for your attending.'
'How long has it been since Dr. Melendez left?'
The nurse sighed. 'Nearly fifteen minutes.'
'Doctor Murphy –'
'This girl's leg is not just infected. Cleaning it won't help. There is an anomaly. There is a foreign object. Unless that is removed this girl will lose her leg. The infection is spreading. The infection is spreading. I am not operating on a body cavity. This is muscle tissue. Tissue spreader!'
The nurse capitulated. The anesthesiologist muttered, 'Hope you know what you're doing, man.'
'I do. I saw this case in the ER six months ago. There was a doctor…who made a mistake. Light.'
The nurse brought the light down. With the tissues spread and the wound bed clear, Dr. Murphy saw the problem.
'Oh my God, what is that? What is that in her leg? It looks like spinach!'
'Not spinach. Spinach is a vegetable. This is wood. This is two inches of wood in her leg. It's worked its way into the muscle.'
For the next two hours Sean Murphy carefully dissected the damaged muscles of the leg, removing bits of wood, softened and delicate after six months in living tissue. Some portions of muscle were no longer viable and had to be removed. One entire muscle was found to be contaminated by a mass of the soft, fibrous wood and Sean had no choice but to remove it.
'Her other muscles will bulk up and replace the one I'm taking. There will be no loss of strength. She may feel a twinge from the nerve damage. It might hurt a bit. But this is better than losing her leg.'
Only when he was satisfied that the leg was completely clear did he close the wound, layer by layer. The stitches down the long incision were perfectly even, as though a sewing machine had laid them down.
'Nice work, Doctor,' said the nurse admiringly.
'Not even a blip on her blood pressure or heart rate.' The anesthesiologist clapped him on the back. He accepted the human contact as he had long ago learned to do. Maybe deep inside he felt pride but it was so effectively buried it did not show on his face.
When Drs. Melendez and Glassman learned of what Shaun had done, they congratulated him – Glassman warmly, Melendez rather coldly.
'Sorry your attending didn't show up,' said Melendez. 'You seem to have – handled the situation well on your own.'
'I don't think you could have gotten any better compliment from him than that,' Dr. Glassman said, smiling at his protégé after Melendez moved off to another patient.
'She might have a slight limp but she will walk,' said Shaun.
'What I want to know is, who is the doctor from the ER that refused to x-ray the leg? Impalement always require an x-ray. Will you tell me his name, Shaun?'
'We need to have a medical audit meeting. This doctor made a grievous error nearly costing a young lady her leg. He will be called in front of the committee to explain his actions. Depending on the case he will be reprimanded. Although this was a good outcome – thanks to you – he might even lose his hospital privileges. You'd have to attend, of course, in essence, testify against him.
'He didn't take an x-ray.'
'Tell the committee that.'
'He said the wood broke in the middle. It did break. Twice. There were three pieces. There were three pieces, not two like he thought. I said the wound will infect. She will lose her leg.'
'She damn near did. You need to tell them what you saw, Shaun. Feel up to it?'
For a brief instant, Shaun looked his mentor straight in the eye.
'Yes, sir. I do.'