The Old Man

men in St. Vincent truck

He refused the joint. They were heading back from Prospect on Colin’s truck. He always sat on the edge of the bed, back curled forward so his hands could hold the frame and with his legs splayed for balance. It had rained earlier, and his plastic sandals weren’t much use to him against the metal. He kicked them off.

This was his third month with work. Yesterday he bought a wallet to hold his money since selling the last one some time ago. He felt worth something again to have so much. Colin and his brothers had started giving him lifts home since the second week. They were his new friends and this ride home was the highlight of his day. He knew its every inch.

He knew just where to lean. Past Git’s Supermarket there was a hard bend to the right with a pot hole. He would normally lean into the turn, but Colin had two beers tonight and would probably forget the dip. At the turn he leaned opposite as the wheel fell, dropping the weight of the car, and he kept his balance. Andrew didn’t know his brother as well and tumbled from his seat into the bed of the truck. He kept silent while the three others laughed. They teased him, “What matter wit you, boy? An’t you learn from d’old man? You don see him fall!” He had mastered these roads.

He knew the importance of details. Details mattered. He saw men with soiled clothes and recognized them. The lines of dirt on a man’s shirt shifted between begging and honest work, and he knew this. He saw it in his own sleeve slapping around his arm and he leaned his sholder forward against the wind, proud of the difference. Details mattered. His callouses were his proof.

He took the beer from Andrew. Colin was driving faster tonight and the smooth level spaces between bends and holes were shortening. He timed it to take a sip without knocking his teeth. He leaned to hand the beer back when Colin jerked the wheel. He had taken the last turn too quickly, too close to the center of the road, and swerved to avoid a car he should have seen.

He fell backwards. His bare feet lifted from the truck bed as he reached down for the lip. The beer still in his hand he didn’t think to drop it even as he balanced off the edge, half in and out of safety. Colin swerved back on course but into another hole. The dip and bounce of the bed sent him straight into the air. The truck kept moving forward while he hung there, still. He landed on the pavement flat on his back.

****************************

“Did you hear about the accident?”

“No, what happened?”

“There was an accident in Calliaqua, right by that road that forks off to our apartment. I don’t know if it was just the one car or if there was another car, but it looked pretty bad.”

“Did you see anything?”

“The cops had everything closed off and traffic was backed up all the way to Marco May’s. We didn’t get a look to see if anyone was hurt but the one car hit that concrete wall, you know, that serparates the soccer field? Anyway, it was right at five as we were coming to campus so we didn’t stop to ask any questions, but Jess saw it later and said that a bunch of people were sent to the hospital. She thinks someone died, but she’s not sure or anything. She says there was another car but it drove off.”

“Did anyone say how it happened?”

“Oh, you know, driving like fucking idiots with their brights on, too fast, and probably passing someone so they can hurry up and do nothing. I swear to God, I’m surprised there isn’t an accident every day with how dangerous they are. Serves them right. I can’t count the number of times I thought I was going to be hit head-on by one of those assholes trying to pass another car into oncoming traffic! Where am I supposed to go, buddy? The road’s only two cars wide! And it’s not like they give a damn, either. I’ve seen them just about run a Learner off the road before because they were driving too slow. I’m sorry, but with the way they drive they’re asking for it.”

“Yeah. Oh, did you hear about the truck we were behind the other day? The one with the boxes?”

“No.”

“So we’re in Georgetown coming back from the hospital and we turn onto the main road behind this flatbed full of boxes, and there’s only one string holding it to the frame and one guy sitting on top of them, like a hundred boxes, just bouncing up and down. So I said to everyone in the car, ‘Anyone placing bets that one of these boxes falls out?’ Everyone laughed but then a half-mile later I notice that the boxes started shifting, so I honked at the guy on the boxes and he looks at me like I’m crazy. Just then, two boxes fall off in front of our car and I don’t know what’s in them, so I slam on the brakes. The reggae bus behind me has been riding my bumper so he swerves into traffic to avoid hitting me. He burns the rubber on his tires and the truck in front of us stops. So we passed him and the guy in the back and the guy driving don’t say sorry or anything. The guy on the boxes shrugs his shoulders and the guy driving looks at us like we caused the fucking accident! Can you believe that?”

“Fucking idiots.”

****************************

“What hospital rotation do you have today?”

“Pathology, it’s our last one.”

“Oh, I heard somebody died last night in a car accident. I think they autopsy those people. Maybe you’ll get to do it.”

“Hope so. I’ll let you know when we get back.” I grab the keys off the doorway nail. Since our last exams, St. Vincent has looked so beautiful. Everyday has been bright blues and greens with orange at night and it has taken me longer and longer to leave our house on the hill. No one had our view. I walk to the car slowly, staring at all the ships, annoying my roommates who are sweating already. It’s so hot here.

We drive down the hill, riding the brakes. Any faster, any momentum at all, and the brakes won’t catch again. We have to always inch, slowly grinding away the brakes that already fail us. The longest sight line is less than 60 yards and most are less than 40. Coming down to the main road on rises, dips, lefts and rights with the honk of my horn the only thing saving my life, traveling ahead of me as a warning, has become mundane. The roads are all so narrow, maybe the width of two cars plus a foot, and it has made us experts at depth perception. We know down to the inch what width of our tire we can hang into the gutters. We don’t think twice about pulling in the sideview mirrors when passing. We don’t hold our breath anymore and cringe, because there’s just no point.

The polution is terrible on the roads with every other truck belching blue smoke, burning. There are no sidewalks and pedestrains share the cramped space. Nobody flinches anymore, not even when a car clips a purse. It’s expected. In the city, close to the hospital we play a game of spotting “crazies” to keep things interesting. There’s Travelcrazy, the man that walks around with wheeled luggage, his penis out of his skivees. There’s Angrycrazy, the man that walks up to any white tourist and starts screaming about his money and where is it. There’s Dancingcrazy with his bright red shorts and single flipflop who is never far from the speaker store. And our favorite, BoyScoutcrazy, with his black boots studded with pins and his revealing green shorts. His red sash is covered with badges and authority as he stands in the streets directing traffic. As a police officer chases him away we wonder where he found such a complete uniform and we take guesses at his Eagle Scout project.

“Spreading crazy,” someone answers.

Autopsy shed

Dr. Wilson takes the five of us from his office to the Path lab. We leave the hospital, down an alley towards the back. Behind Cato Hospital is the Georgetown cemetary. It can be seen from every floor of the hospital, inspiring confidence. There’s nothing here but a shed and of course this is it. It’s small, maybe 20′ by 25′. The body is on the table. Tina says she might pass out and that we should catch her if she does. We each grab a mask and start buttoning up our white coats as his assistant unzips the body.

He’s not gentle and this always bothers people the first time. It takes a while to get used to the dead as dead. As he pushes and pulls the man free, I see his sunken cheeks and grey hair. He doesn’t have a stitch of fat on him; every muscle is obvious. His right forearm is completely broken and even I cringe as the assistant grabs his hand and wrenches the arm backwards, trying to take off his shirt. His pants and underwear join the heap on the floor.

We crowd around, looking for injuries. Besides a cut lip and a broken arm, we can’t find anything. The assistant slides a block underneath his shoulder blades, forcing his chest to jut out towards the ceiling. His head doesn’t fall back immediately, but slowly because he’s cold and his neck muscles are still contracted. It almost looks likes he’s trying to keep it up. I look around to see if anyone else saw it, but they’re all looking at Dr. Wilson. Dr. Wilson picks up his scalpel and in two quick cuts, one up and one down, splays him open. Across the room you can see each mask pulled taught between our noses and jaws. We hadn’t prepared ourselves.

****************************

autopsy painting

Wow that was fast. I think I’m going to be sick. What is he doing? Why is he hacking away at the chest? “Now, I am looking for cracks in the ribs. As a pathologist, you have to establish cause of death. The lack of obvious external injury should have you thinking of other causes such as internal hemorrhage, asphxiation, or brain damage. I am separating the pectoralis from the chest wall and inspecting each rib to rule out lung puncture and tension pneumothorax.” We never dissected like this. Anatomy lab would have been over in two days. God, it smells. Oh no. Please don’t go to the intestines. Please stay up at the chest. “Before sawing open the rib cage, we will inspect the bowel. Here is the duodenum. I’m pulling on the first part and you can see that the remainder is retroperitoneal, so I’m going to tie this off and cut it. Now we can easily pull the intestines out be cutting through the mesentery and checking for hemorrhages.” Thank God for the A/C. “As you can see, the small intestine is quite long. Here, see this hemorrhage?”

“That wasn’t the cause of death, right?”

“No, it’s much too small. This probably happened at the time of injury but didn’t contribute to his death. You see tears like this due to shearing forces from a fall or other blunt trauma. Now look here. Can you see this inguinal hernia? His scrotum contains some small intestine and watch as I pull it free…there. This bowel is not strangulated and you can see that the scrotal skin has stretched to accept it. He likely had this hernia for some time.” I can’t believe he’s dissecting with a saw. Isn’t he afraid he’ll cut something important? “Now that we’ve freed the colon I’m just going to cut around…the…rectum…there. His entire bowel is now free.” So, he doesn’t have a rectum now. He is rectum-less. This is too much. Ugh. “Now as I cut open the baldder…” Muah ha ha ha ha! “…sometimes that happens. It’s just a little urine. Was anyone hit?”

“I was.”

“You buttoned up your coat. Smart man.” He had to have done that on purpose. There’s no way he didn’t know that was going to happen. I’m standing back here from now on. “You can see that the bladder surface is trabeculated. This happens with obstruction and increased pressure. At his age you expect prostatic hyperplasia, but we should make sure to look for signs of obstruction in his kidneys as well. See this? All you have to do is cut open the prostate and you find a little stone in his urethra. Roni, can you hand me the saw?”

“Tina, are you okay?”

“Yeah, I’m alright. Thanks for asking.”

“Dr. Wilson, the family’s here to identify the body.”

“Is a police officer here?”

“No.”

“Tell them to come back in an hour. Honestly, I told them to be here at one o’clock. It’s two-thirty. I’m so tired of waiting for people to get their act together. The families are never on time. Okay, now with the ribcage gone we have a good view of the lungs and heart.”

“He was a smoker?”

“I don’t think so. His beard isn’t stained and neither are his fingers. You see a lot of this blue mottling of the lungs because of all the polution, especially in the lungs of pedestrians. Roni, can you grab me the laddle?” Oh my God that’s a lot of blood. I can’t believe how much blood there is hiding under the lungs. His lungs look so sick. They just squish as the laddle pushes them out of the way and fills again. I think I’m going to vomit. “One liter. Now you can see as we get most of the fluid out of the way we get to the clots that have congealed and settled at the bottom. Looks like red cranberry sauce, no?” I can’t take it.

“Tina, you okay?”

“Yeah, I just need a minute.”

“One and a half liters of blood on each side. Okay, now we’ll take out the mediastinum and the foregut and, Roni, can you get started on the skull?” Breath. Stand under the A/C. Keep it together, Tina. You can do this. This can’t take much longer. Just push it out of your head. This is your last day. “Now…you can separate the pharynx and larynx…from the floor of the mouth…there…” What is that in his hand? Is that a tongue? Oh my God that’s his tongue. “…and you can run the blade against the spine as you pull…and everything comes right out!” I don’t know if that was the most amazing or horrible thing I’ve ever seen. He just pulled the man’s tongue out from his CHEST and took the heart, aorta, IVC, lungs, liver, pancreas, stomach and esophagus with it. All in one piece. Everything is backwards. That was amazing.

What is that?!

“Can everyone see this? See this here? The posterior surface of his aorta is torn horizontally and you can see the massive amount of hemorrhage around it. This was the likely cause of death.”

“That’s horrible. Would he have even known? That much blood that fast you’d think he’d immediately pass out and stop breathing. Right?”

“Maybe; maybe not. You can’t know if the tear was immediately this size or if it expanded with the hemorrhage.”

****************************

 

“Well that was an amazing last day! Twenty-one hospital visits with a bullet!”

“I can’t believe that guy’s organs. They were perfect. No sign of any real disease. Even his aorta was pristine. Did you see a single fatty streak?”

“Nope. And his heart was fine. His liver was fine. Other than his lungs, that guy should have lived to one hundred. I wish we had seen that sort of thing at the end of anatomy; would have been a great review.”

“I kept wishing I had gloves on. I wanted to touch his organs so bad, see what they felt like before they were pickled with formaldehyde. And when he cut the organs into sections like a loaf of bread? That was awesome! I wish I could see that again.”

“Anybody catch his name? I think I want to write this up for our last assignment and all I got was ‘eighty-four years old.’”

“Nope. Did you, Sam?”

“What’s it matter? Just make up a name. Anyone else want a root beer before we head home?”

****************************

driving at night

“Stop the car COLIN STOP!” Colin slammed on the brakes and the bed pitched forward sending Andrew crashing into the back of the cabin.

“Andrew, shit you alright?” He didn’t stop to answer. The old man was lying on the ground 30 yards back, his arms laying on his chest and his chin in the air. He jumped over the side of the truck and turned running. His feet were barely making contact as he closed the gap. The old man’s eyes followed him as he slid to his knees. He could barely speak.

“What’s huh huh wrong huh huh huh can you huh breathe?” The old man couldn’t. His eyes were wide and terrified and fixed on Andrew. They were pleading with him. He tried to grab onto Andrew’s shirt but couldn’t. He needed to get closer. The muscles of his neck jutted out from the skin as he lifted his head to Andrew’s. Nothing came. His lips moved but fell short of sound. All he could do was make the shape of “help.” Andrew was terrified. The old man tried again but appeared to give up. His eyes stayed fixed, his mouth still spelled “help,” but his neck relaxed.

His head cracked against the pavement.

Andrew turned to the car. “HELP!” He tried to think. “HELP!” He couldn’t see anything wrong. He didn’t know what he could fix, what he could stop from happening or make happen. He kept looking at the old man’s eyes, asking them to move when they wouldn’t. He didn’t understand. The old man had fallen but not far. It shouldn’t be this bad. The old man never fell. He shook him.

“He’s dead!” yelled one of the men from the truck. They had all stayed behind.

Help me!”

“Get back here, fool! He’s dead and we have to get!” The car they had swerved to miss had crashed into a wall. The doors had opened and two people had stumbled out. Across the street men were coming out from the bar to watch. They were yelling at the truck full of men and coming closer. Numb, Andrew stood up and looked the men from the bar straight in the eyes. They saw him; he knew it. He looked down at the old man. He was dead. “NOW Andrew!”

He turned away running, as fast as he had come, as fast as his legs would carry him. He jumped for the bed and the other men pulled him in. He fell onto his back and laid there. Chin in the air and arms at his sides, his chest heaving away to catch every breath, he hoped there was nothing he could have done.

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14 Responses to The Old Man

  1. jarrad says:

    Beautifully done Topher. It always seems so easy to forget how seperated the medical field is from the patients’ lives. It’s easy to start seeing patients as just another set of symptoms wrapped up in an organic form, when in truth, they are people, afraid, hard working and worried that they didn’t do everything they should have done. It’s good to keep in mind that all of our patients are their own people, with their own stories and lives. I like the way you bring the two together.

  2. Agreed. I’d say more but Jarrad’s basically said it all. Another brilliant post.

  3. […] on autopilot. I can think of only one time where I ever challenged myself, and that was with The Old Man. I still think it’s the best thing I’ve ever written, and it kills me that it sits […]

  4. Adrian says:

    Yeah, this was basically brilliant. You showed the sometimes insensitive nature of medicine without being bitter, I think. This just shows us why we aren’t more invested in the patient’s life – it would be too hard to ‘dismantle’ them.
    Great writing, as usual.

  5. […] or not, i don’t know…… The Old Man the rumors were true […]

  6. […] I was hungry for some new kind of challenge. Immediately after, I gave everything I had left to The Old Man, which I consider to be the best thing that I have ever written and the only thing I ever did […]

  7. Boothby says:

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  9. Chartier says:

    Not in my neighborhood, Mister!

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  11. Katherine says:

    Beautiful.

  12. […] Topher tells the story of the people and students of St. Vincent as they are drawn together in the death and autopsy of The Old Man. […]

  13. […] Topher tells the story of the people and students of St. Vincent as they are drawn together in the death and autopsy of The Old Man. […]

  14. […] Topher tells the story of the people and students of St. Vincent as they are drawn together in the death and autopsy of The Old Man. […]

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