Monday, February 9, 2009
A Play With No Acts
The scene: In scrub clothes, a surgeon is addressing elected representatives. Stage left, curtained off and visible only to the audience, a patient lies gravely ill, attended by two nurses. The surgeon clears his throat a couple of times, taps on the microphone. The assemblage continues to talk amongst themselves, or move aimlessly in and out of the room. Some are sleeping, others flipping through press releases.
Surgeon: "Ladies and gentlemen, please. I have urgent business. [Taps again, clears throat.] Pursuant to articles eleven through nine hundred thirty one, I stand before you again to profess the immediate need of, and to obtain permission for operating on Patient X, who, we now know, has free perforation of a diverticulum of the sigmoid colon, with generalized peritonitis. I cannot overemphasize the importance of immediate intervention. The patient could die, and will surely do so if we don't proceed. As required, I seek your permission, and, with respect, I need it now."
A Senator, leaning to a colleague: "What did he just say? Perferdiversigmo? What the fuck is that? It's free?"
The colleague: "Damned if I know. I'm hungry. Are you hungry? I'm really hungry. Is the dining room still open? Are you hungry? I'm starving."
Surgeon: "If you will all have a look at this Xray you'll see what we call "free air" ...."
Another senator: "Sir, I rise to point out that all air is free."
Surgeon: "Senator, it's a matter of terminology here... See, what I'm saying is..."
Senator: "Well, that's just silly. If you look at my chart, you'll see the amount of air available in the last eight years, and you'll notice it's no less than now. I've always been for air. Always."
Surgeon: "Sir, I think that's a little off point. What I'm trying to say is that stool is leaking and infection is spreading throughout..."
Senator: "Who do you think you are, doctor? First of all, shame on you for saying "stool." And "leaking." You nasty man. And all that urgency stuff. It's scare tactics, just scare tactics."
Another Senator: "From what I hear, when you operate it just makes things worse. My naturopath says high fiber."
Stage left, more people enter and look worriedly at the patient.
Another: "Chiropractors are really great. Got one works on my grand kids, none of them has diculums."
Another: "Homey-pathy. That's the stuff. I use a homey-path. Water has memory. Did you know that? Memory. More'n I can say for my staff. Har har."
Still another: "When I had that tickleitis thing they gave me antibiotics, and it worked just fine."
Surgeon: "We're giving antibiotics, maximum doses, and sometimes that's enough. But this isn't that kind of case. We need to operate, because there's a hole in his bowel. If we don't address that, he'll die. I've seen many, many.... Here's the data. His white count..."
Senator: "That's just scare tactics. I thought you were against scare tactics. That's just scare tactics. Aren't you against that? Scare tactics, I mean."
Surgeon: "It's not scare tactics when it's true, Senator. Go look at him. The man is sick as hell. Anyone can see it."
Stage left, someone grabs a phone off the wall and starts gesturing excitedly.
Senator: "Well, you listen to me, sonny boy. I don't need to look at him. Don't go telling me what I should be looking at. Shameful. I may not be a doctor, but I watch "House." Good show, by the way. They try all sorts of stuff. Never works the first time, take 'em off this, give 'em that. Those doctors do everything, surgery, xray thingies, bust into homes, don't ask permission. That House guy. Real American. Rush Limbaugh kind of American, way he talks, pills and everything. Har. Sorry, Rush."
Surgeon: "Excuse me, Senator. That show bears no relation to medical reality. We have..."
Senator: "Dockie, it looks real enough to me. Plenty real. Popular show where I come from. More damn popular than you are, I'm here to say. By the way, what about alternatives? Have you tried Head-On? I've seen commercials for it, and it looks damn good. Easy. I move that Head-On be tried first."
Stage left, an emergency cart is wheeled into the area.
Clerk: "It has been moved and seconded..."
The vote proceeds, and the motion fails with 41 yes votes, all from the same side of the aisle. Stage left, a person enters with more Xrays and papers.
Surgeon: "People, listen to me. This is a very serious situation. I've just been told the patient has a positive blood culture and is going into septic shock. There's only one..."
Senator: "Oh, well, listen to the hoidy-toidy doctor, going all med school on us. Positive. Culture. Shock. Elitist, anyone? Doctor, I may not have gone to medical school but I know about culture, and I WILL be heard."
Another senator: "What, exactly, do you propose to do in this operation?"
Surgeon: "I'm glad you asked, sir, because that's the real issue. We'll be putting him to sleep, opening his abdomen, washing out his belly with liters [A senator snorts: liters? What's wrong with quarts? This is America!] of fluids, removing part of the colon. Almost certainly we'll need to give him a temporary colostomy...."
Senator: "Whoa, whoa, whoa. Putting him to sleep? What's wrong with hypnosis? Or that acupuncture?"
Surgeon: "Senator, I really think...."
Senator: "Wait just a minute, sonny. Acupuncture works. I saw a Youtube... Fifty needles, or I'm saying no to the operation."
Surgeon: "Well, after he's asleep I suppose we could..."
Senator: "And I don't like the idea of a colostomy. No colostomy. I knew a guy...."
Surgeon: "Senator, it's pretty dangerous not to do one if the patient is in shock...."
Senator: "Don't like 'em, wouldn't have one. Not doing one today. They stink. Ronald Reagan never had one. No colostomy."
Stage left, a medical student faints.
Another Senator rises: "Ladies and gentlemen, I think we need to listen to the doctor. He's an expert. None of us has gone to medical school, none of us knows how to operate. I've talked to the surgeon, and he seems to know what he's doing. Other surgeons agree with him. The patient trusts him, and wants to go ahead. So does his wife, and some kid that was in there. Let's just...."
Another: "Oh no you don't. I got me elected here, my people don't much like all this surgery stuff. Lots of prayin' folks in my district, prayin' and singin' and asking the Lord for help. That's what we... Besides, the doc already did an operation today. People get all perforated, what we need is cutting back on surgery. Pretty soon they'll be operating on everyone. Telling us all we have to have one. Communists."
Surgeon: "If I may, Senators, this really is critical. It's real. We won't have a do-over. My patient will die..."
Another Senator: "Sorry, mister fancy doctor and your fifty nine senators, you aren't steamrolling us. This isn't bipartisan what you're doing. Not bipartisan. We get our say, you said we would. You say the guy is sick, gonna die. Well, maybe yes and maybe no. But just because you're a doctor [making air-quotes], with all that knowledge [double air-quotes]... We got us forty one votes over here, and until we get forty one percent of the operation, you're getting zilch. That's the way it works. We get our votes, textbooks or not. "
Surgeon: "But this patient is one hundred percent sick. You can't divvy up the cure. Only some things will work. If I may, sir, your ideas have been tried. They didn't work. Not enough saline. Wrong antibiotics, wrong operation. It's all been tried. There are papers..."
Senator: "Doctor, doctor, doctor. If God had wanted experts making decisions, he wouldn't have invented Congress. And he sure as hell wouldn't have invented filibusters. But here we are, you knife-happy know-it-all. Let's have another vote."
Slow fade to black....
The curtain rises. We see the patient surrounded by doctors and nurses, students, pharmacists. A woman weeping. Tilted head down, the gurney is in the shock position. Several IVs are running wide open. One doctor is holding defibrillator paddles. The surgeon enters and speaks:
Surgeon: "Okay, well, we just got permission to proceed. We can make six tenths of an incision, wash him out, but with no more than two quarts of saline..."
Surgeon: "Don't ask. And if we resect, we have to anastomose. But we can do a loop colostomy, just not over a rod."
Assistant: "But isn't that..."
Surgeon: "I tried. It's the best I could get. And stop all the other antibiotics, hang a million units of penicillin. Only penicillin."
Surgeon: "I know, I know..." [sighs heavily, turns away, rubbing Head-On onto his forehead.]
Anesthesiologist: "Guys. I don't think it matters anymore." Squirts goo on the paddles, rubs them together. "CLEAR!!"
Before the lights go up, from backstage the sound of an electrical zap, heels pounding the end of the gurney, and, again,