White Hot Light

Twenty-Five Years in Emergency Medicine

Frank Huyler

• Publisher: Harper Perennial
• Year: 2020
• Print ISBN:
  9780062937339
• eBook ISBN:
  9780062937353
• Topic: Medicine
• Subtopic: Social Science Biographies

FINALIST FOR THE JAN MICHALSKI PRIZE FOR LITERATURE

Another "pitch-perfect book of short essays" ( New York Times Book Review) from the acclaimed author of Blood of Strangers, this one exploring the contemporary practice of medicine from the perspective of a doctor with 25 years of experience in the ER.

In the late 1990s, a young physician in Albuquerque, New Mexico, published a stunning memoir of his experiences in the highly charged world of the ER. Presented in a series of powerful, poetic vignettes,  The Blood of Strangers became an instant classic.

Now, over two decades later, Dr. Frank Huyler delivers another dispatch from the trenches—this time from the perspective of middle age. In portraits visceral, haunting, sometimes surreal, Huyler reveals the gritty reality of medicine practiced on the razor's edge between life and death.

From the doomed, like the Iraq vet with a brain full of shrapnel, to the self-destructive, like the young woman who inserts a sewing needle into her heart, to the transcendent, like the homeless Navajo artist whose sketches charm the nurses, Huyler assembles a profound mosaic of human suffering and grace, complemented by episodes from his personal life: the hail that fell the night his wife gave birth, his drive through a snowstorm to see his father in a Colorado ER, the beautiful wedding of his childhood friend with terminal cancer. Melding hard-earned wisdom with a poet's crystalline vision, Huyler evokes the awesome burden of responsibility, the exhaustion, the relief of a costume disco nurse party, and those rare occasions when the confluence of luck and science yield, in the author's words, "moments of breathtaking greatness." 

White Hot Light offers an unforgettable portrait of a field that illuminates society at its most vulnerable, and its most elemental.

I

I don’t think we are ready to die, any of us, not without being escorted.

J. M. COETZEE

The Boy

WHEN THEY BROUGHT HIM IN, HE WAS ALMOST ALIVE. HE was a handsome boy, in his early teens, and I saw this first because he was nearly unmarked. He was brown and slim, and we stripped him immediately, and he lay still under the lights.

The gunshot wound itself wasn’t bleeding, and it stared at us from his chest. A little blue circle, an open eye.

I thought of my son. I thought of him immediately.

The young surgery attending was there early, thin and lean and hungry, well trained and arrogant and fast, and he has economy and grace and he looks through me as if he doesn’t know who I am. I don’t care. I’m indifferent to him. But he is sharp and hard and quick and sometimes that is what you need.

He tried to save the boy.

“When did you lose pulses?” he said to the paramedic.

“On the way in,” she answered.

So he acted, right then, without waiting for anything or anyone. There was beauty in his ruthlessness.

* * *

He stepped forward, poured iodine on the skin, put on a pair of sterile gloves, took the blade in his right hand, and opened the boy’s left chest with a single astonishing stroke from his sternum to the bedsheet. Flesh parts to a scalpel effortlessly, like the wave of a hand.

“Open the thoracotomy tray,” he said, over his shoulder, as the others arrived.

I was standing behind him. I could see exactly what he was doing, because the light was bright, and lit up the tissues.

The wound was bloodless. It should have come alive with little points from the capillaries, but it was clean and dry, and so I knew.

He took the scissors and inserted one of the blades between the ribs down low, by the bedsheet. Then he lifted his hand up to the sternum again, and there was the lung, pale and gray, with a few yellow beads of fat clinging to it.

By then the tray was ready. He put in the rib spreader and turned the crank, and the boy’s rib cage opened like a flower.

Dark blood poured from his chest to the floor.

* * *

When I was young, and still a student, I once went to my advisor’s lab. He was doing basic research on cardiac arrest, trying to find ways to keep the brain alive for a few more minutes.

Ambition is so vulnerable to the passage of time. We remember it, we can even still feel it, but there was no solution that could be injected into the vessels that would preserve brain function, no technique that would revolutionize CPR or raise the dead with their memories intact. Instead, there were dozens of dogs.

The dogs were from shelters, and they were young, because older dogs could skew the data. He didn’t know their ages exactly, but if you know about dogs, you can guess, and be close enough.

The dogs were brought out from their cages on a leash, and led to the room. They were afraid, and trembling, as if they were at the vet’s.

Starting an IV in a dog is no different than starting an IV in a human being. His graduate assistant would start an IV, and inject a sedative.

It took a few minutes. They held the dog on the table, as it grew unsteady and finally lay down, and then they gave it Pentothal that put it out forever. They intubated the dog, taping the long tube to the dog’s nose, and attached the cardiac monitors, and then they flipped it on its back and shaved its chest and performed a thoracotomy.

When the dog’s chest was open, they would cross-clamp the aorta, stopping blood flow to the brain. Then the measurements would begin.

My advisor was not changing their fates. They were from shelters, and would have been euthanized in any case. But I could see that it troubled him anyway, as he soothed them on the table, and spoke gently. He seemed human then, for a few moments, before they were asleep, and humbled by what he was about to do.

* * *

The surgeon worked on, scooping warm handfuls of clot out of the boy’s chest and onto the sheets.

The others were there, crowding around me, straining also to see, and the entire focus of the room settled on the beam from the surgical light overhead. The boy receded, as we looked into the field.

“The heart’s empty,” he said, and stopped the massage, and pulled a few more fistfuls of blood out of the boy’s chest until the interior was empty and pink and still. The heart lay there before us, the lung, the pleural membrane, and it all looked clean and beautiful.

Then he surprised me.

“Let’s have a minute of silence,” he said, and bowed his head.

It’s new, that moment of silence. It’s a modern ritual. The younger surgeons do it, even as the older surgeons walk away.

So everyone stopped. The nurses, the trauma team, the X-ray tech who stood waiting in the corner, her services unrequired.

For a moment everyone stood quietly under the lights, looking at the boy’s body, and no one knew the story then, no one knew anything, but suddenly it was reverent, and everyone could feel it.

A minute can pass slowly. A minute is more than enough.

“OK,” he said finally, lifting the flaccid heart and pointing with his finger. “The bullet went in the ventricle here. And then it continued through the vena cava. It’s an unsurvivable injury.”

So the attention changed, and it became the wound again, and then he stepped aside and let the residents in.

One by one they took their turn, feeling the slack heart, and the hole, and the vena cava, because such chances are rare, to be so close, when everything is warm and the anatomy is so perfectly clear, young and new and as crisp as the morning. In that moment, the dogs came back to me.

When they were done, I did the same, reflexively, without thinking. I hadn’t been a resident in more than twenty years. But I forgot all of that, forgot that I wasn’t young anymore, forgot myself entirely. I just saw the wound, and felt the same cold curiosity, and was drawn in also.

I held his heart in my hand just like the others, and felt for the path the bullet had taken, just like the others. But it is an impossible intimacy, and you can’t escape it entirely, and I didn’t escape it at all. I saw his face beneath me—his face, that handsome boy—and suddenly it came to me with a terrible vengeance. I did think of my son again, and of a stranger, a man my age, doing this to his body for no good reason on this earth.

He was a child, I thought later, driving home. Have I learned anything?

Hail

A FETAL MONITOR SOUNDS LIKE SURF IN THE DISTANCE. Strapped to the woman, it crashes and hisses, because the microphone is sensitive. Every movement is a roar, and every drawn sheet is a waterfall.

But all of that is noise. It’s the center you listen for, the delicate wish wish of the child’s heart. It comes and goes in its faintness, like a hummingbird, and often the straps must be adjusted to find it again.

The mother’s heart beats also. But it’s deeper, and slower, and you can hear the difference.

The mother’s heart is noise as well, her clenched hands and her gasping and sweat—all of that is wind in the trees. You put your palm flat. The muscle gathers beneath your hand, and turns to stone.

That is when you listen most closely. The child’s heart can’t slow down too much, or for too long. It must be steady, and rise and fall with modesty, as if it is untroubled, and ready for the life ahead.

I listened all day, and then night fell. Headlights came on in the streets through the window.

In the dark, the monitor sounds musical and rhythmic, like a chant, like driving a long distance alone at night when you’re tired, listening to static on the radio, watching the center line flick by. It doesn’t soothe you or comfort you. It keeps you awake, and keeps you looking forward. You think about your own life also, the path you are on, and the path of the woman beside you, and how you’ve joined elemental patterns and must follow them into the dark without the slightest understanding of how they possessed you, realizing only that they were with you all along.

Childbirth is terrifying for men. Pain at its most blinding sweeps the fears aside. But the fears are terrible also, and you endure them also, thinking about the hopes and the dreams, and the room waiting in the house, and the face on the ultrasound screen that seemed so alive and so ghostly at the same time, as the hand drifted up in the fluid beside it, and you saw the fingers curl.

That night they turned the volume just low enough to hear without straining. It receded into the background, steady and endless.

I was lying beside her on a cot, I was looking at the ceiling, I wasn’t sleeping, and I was not used to being part of the world in this way.

At times she would sleep as well, at times lie awake and gasp. At times the nurse would come by; at times the doors would close and open roughly in the hall; at times someone would laugh at the desk, because there were others around us.

Beside me, her pain continued, in cycles, in gasping waves, faster, then slowing again. She didn’t cry out, or turn to me, or turn away from me. I was a fixture in the room, but not a witness. Only a small part of me was a witness, and that’s what I remember.

Then the anesthesiologist arrived, and the lights went on. Time for a little mercy, the wave of the wand.

“How are you doing, sweetie? Having some pain?” she asked.

“Yes,” my wife replied, softly.

So I watched as my wife sat upright, with her hands on the pillow on the table. Her back was lit up in the spotlight. I could see the tips of her spine, and the spaces between them open as she bent forward, and bowed her head, and the anesthesiologist painted a perfect brown circle of iodine in the center of her back.

The anesthesiologist was steady. Her movements were deft and unhurried and exact, and I saw her experience in them, and they comforted me. She advanced the needle, and spoke in the voice of a mother.

Then I saw the flash of spinal fluid into the syringe, clear as glass, like the purest and lightest of oils. It’s not quite water, and you can feel the difference in your gloved finger as it drips from the needle and gathers poised to drip again.

The final details escape me now. The procedure is the idea of a procedure to me now, the imperfect memory of lights and needles and a white tray on the table, and the blue drape, and then the anesthesiologist was done, and the catheter was in the epidural space, and the lidocaine was flowing as another contraction began.

Lidocaine is grace. It allows thought to return, and reduces the blinding light to a dull gleam.

I thanked the anesthe...

Table of contents

• Cover
• Title Page
• Dedication
• Contents
• I
• II
• Acknowledgments
• About the Author
• Also by Frank Huyler
• Copyright
• About the Publisher