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This story is from the Anamnesis episode called Scar Tissue and starts at 29:09 in the podcast. It's from Hannah Brooks, MD, a recently retired surgeon and cancer geneticist based in New York.
I remember the taxi driver. I was on trauma surgery rotation at Jacobi Medical Center in the Bronx. It was 1990 and headlines screamed that taxi drivers, in particular the more vulnerable drivers of gypsy cabs, were being robbed at gunpoint. These cabs, unlike the familiar yellow medallion taxis, were generally the only ones to be found in the Bronx. Drivers desperate for work, and customers desperate for any ride that would turn up. In short, there were gypsies out at all hours, cruising for prospective fares, despite the dangers.
As the junior surgical resident on call that night, I was first to the emergency room, sent by my chief to scope the situation. The wiry brown-skinned taxi driver, who appeared to be in his late 30s, had been shot through the head during a robbery. His bloody turban lay on the floor under a silver mail stand. In its stead, thick layers of gauze compressed with an Ace wrap encased his head.
I was surprised to find him sitting up on a stretcher when I arrived, awake and appearing, at least at first glance, oriented. He spoke haltingly to the heavyset blonde nurse who moved quietly and efficiently around the curtain booth, discarding torn gauze packs and used syringes, and replacing IV bags. He turned his attention to me, repeating what he had just said to the nurse, as if trying to convince or remind himself that he had been shot. He asked for his family, his kids.
I introduced myself and helped him lean back as I supported his arm. I adjusted the backrest of his stretcher to perform a brief physical, then lifted and locked the side rail. I grabbed his chart and scratched out a few notes. Within minutes, the neurosurgery fellow arrived, followed by the rest of my team.
We're Talking to a Dead Man
"Where's the el gato de cabeza?" quipped the chief resident, trying to lighten things up with his usual morbid humor.
"The CT scan? Over in rads," I replied, the team already heading in that direction before I'd finished answering.
"It's not an operative case," the fellow stated bluntly as he stepped on a pedal that scrolled the black and white images on the rotating lightbox. We studied the serial x-ray sections of our taxi driver's skull and brain.
"See here?" he pointed. "The bullet crossed the midline. A bi-hemispheric penetrating brain injury has the highest morbidity and mortality of all. The brain will swell and then, well, the damage is done. It's just a matter of time. He's basically non-salvageable. It's textbook." He paused and took a deep breath. "We're talking to a dead man."
I started trembling. It was hard to fathom. He was talking. He was awake. I felt overwhelmed by what I had just heard. Strangely, crying seemed the only appropriate response. But there was no place, no time. Besides, as one of only three women among 60 surgeons in training, I'd be judged and pilloried for it. I collected myself and returned to the main ER.
On the next stretcher was a burly workman in a rumpled hospital gown and oil-stained jeans. Moaning. I scanned his clipboard, motor vehicle accident, vital signs stable, closed fracture left tibia.
"I'm going to get a cast on your leg," I said, as I extended the slit in his jeans from below the knee up to his thigh with my utility scissors. I prepared to set his broken leg.
As I went to collect my supplies, my mind strayed to the taxi driver a few bays over. I thought about how young he was. I thought about how difficult it must have been to seek refuge in this country. How he must have struggled as a new immigrant, as my own mother had, stuck with poorly paying and often dangerous jobs. I thought about his turban lying on the floor, and how as a religious man, the taxi driver had probably been living an honest and simple life that tried to honor the sacred. I would probably have found commonality with him.
A Life Reduced to a Few Film Images
I organized my supplies and cleaned the workman's LED. My mind drifted to the dark room and the CT scan, to the fellow's pronouncements. I thought about the enormity of what he'd said, how the end of a life had been reduced to a few film images, in lines from a textbook. I thought about how all of it -- the poor taxi driver's life and the lives of the wife and children he had asked for -- was irrevocably and eternally changed. Unable to repress my tears any longer, I let them spill, hoping my glasses and face mask would cover my sin.
I forced my gaze at my gloved hands and on the cotton batting and warming plaster as I shaped the cast, trying to focus on the patient before me. His moaning stopped. I glanced up for a second to find him staring at me. His face was a question. His dark eyes still. Cast done, I went to order the follow-up films, passing the taxi driver on my way to radiology. Now he was quiet. Now, he was on a ventilator, his face swollen and pale.
Over the course of that night, I passed the taxi driver about five or six times, alone on his thin cold stretcher, while I attended to people with abdominal pain, broken fingers, and a motorcyclist who'd ambled away from a 50-mile-an-hour accident with nothing but some road rash and an achy shoulder. By the early morning hours, it was just as the fellow had predicted. The taxi driver was unresponsive, dying. I didn't notice if his wife or kids had made it. I wondered for a second if his kids were too young to be allowed in.
My pager beeped: rule out appendicitis, peds ER. In peds, I found a little girl in a pink flannel nightgown sitting up on her stretcher, cheerfully bobbing her kinky red curls side-to-side while she popped orange and green M&Ms into her mouth.
I had her lie flat, distracting her with silly cat stories. I called her "Miss Little Pink Gown" while I pressed on her belly, then quickly released it, searching for signs of rebound tenderness.
"Does it hurt when I let go?" I asked, scrutinizing her face. The little girl shook her head.
"Show me where it bothers you." She swirled her hand over her middle.
I turned to the little girl's mother. We would keep her for observation. The next team would re-examine her. I went back to the adult ER to complete my last few notes.
Later that morning, I called the day resident to follow up on Little Pink Gown. She'd been taken to the operating room, he told me, and did indeed have early appendicitis, adding that I hadn't missed anything, that it was anything but a textbook case. I felt my heart rise again. I was glad to hear it was caught early. Glad she'd be okay. I sat for a few moments and thought about my 2-year-old daughter at home. I wondered about the taxi driver's children, waiting for a father who would never return.
It's Not a Sin to Cry
On my way out of the ER, I recognized the transplant coordinator and social worker, their expressions somber and earnest standing at the trauma bay. They were speaking to a wide-eyed young woman in a long dark tunic. A black scarf framed her frozen face. She gripped the guardrail of the stretcher on which the taxi driver lay, the regular "click" and "whoosh" of the ventilator the only sounds emanating from his direction.
I headed for the elevators. The post-op checks were waiting. The doors parted and the transplant team brushed past me. I got on and rode up to the floors, contemplating the taxi driver during the moment in silence. I pulled out my pocket manual of general surgery and located the small laminated card I carried between its pages.
"God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference."
From time to time, I think about the taxi driver and the important lesson I took away from my experience that night. I often tell my medical students and residents that it will be hard, sometimes close to impossible, to hold on to your humanity, especially when the system of training and of practice is stacked against you. But you must try. You must always remember that you are a healer.
"Just take 30 seconds," I tell them. "Put yourself on the other side of the desk."
I want them to know it's okay to feel, that to be a good doctor is to be a humanist, that it is not a sin to cry.
Check out other stories from the Scar Tissue episode, including "I Can't Do This Again" and "When the Patient Becomes the Healer."
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