“Wracks we want you to come in at night at the ER because that is when the action happens.  Be sure to be here Friday or Saturday night on the Graveyard.  Every week we have a gunshot or a bludgeoning event.  We need the extra hands to tie sutures,” said Dr. Saber. “I will be here,” said the Wracks

“We have a stat on a fight victim coming in,” said the dispatcher.  “Wracks, bring him in and work him up. Then call me.” Said Dr. Saber.  The Paramedics brought the patient into the double doors of the ER.  The ER had double electric doors in case a murderer wanted to finalize an act not perfected.  We could lock them out.  The patient was of average height and average build Caucasian male.  He wore sweats and had no obvious odors diagnostic of metabolic conditions.  Upon neurological exam, I find the pupils fixed and dilated. The breathing is intermittent but not agonal.  There is no obvious bleeding from the nose, eyes or ear canals upon fundoscopic observation.  The patient is unconscious and does not respond to pain from needle prick or skin pull.  “Dr. Saber, I think we have a subarachnoid hemorrhage with antecedents of trauma to the face. “  Dr. Saber runs to console, grabs the phone and calls upstairs.  “Wait with him!” Dr. Saber commands.

They say it in hushed tones. N-surg.  It happens in the penthouse.  A nurse brings Wracks the key and puts it in his hands.  They want you upstairs.  Don’t forget to put the key in the basket when you enter.  The Wracks goes blindly unwitting to what is going to befall.  The elevator goes up and up, and the door opens.

     “Dr. Saber said you have good hands,” said the brain surgeon. “I want you to assist me in neurosurgery tonight.”  “I will teach you how.”   The patient was already upstairs.   The brain surgeon is a smallish man impeccably dressed in a suit and tie. His hair is wavy and reddish and has a curl to it and his eyes are gun metal gray just like his brother.  He gestures to me and says, scrub in and I will meet you at the stadium. Don’t stop and get anything to eat. The Wracks enters the surgical suite and the anesthesiologist has a water filled blanket on the patient, his head is scrubbed and affixed by metal hold fasts.  

“I will teach you brain surgery,” said the brain surgeon.  “First, the conditions.”   “Cool your patient to 90 degrees Fahrenheit with a water blanket.  This will slow the heart and make the neurons less irritable.”  “Then infuse urea to establish hyper osmotic equilibrium to prevent brain swelling. The urea extravasates in four hours.  Switch to mannitol post operative.  Now infuse solumedrol to prevent inflammation. There is an immediate naturistic effect and a long-term hormonal effect. When the patient is readied by the anesthesiologist then we will begin.  Anesthesiology must be light or the patient will stop breathing.  The patient will be conscious.  No matter what the patient says keep going. Learn to focus and block out everything but the job at hand.”

   The patients head was shaved and the brain surgeon looked at the x-rays.  Visualize in your mind where the lesion is from the x-rays.  Take the x-rays here before surgery.  Do not rely on anyone.  Do not let anyone but licensed surgeons into the room.”  “Now we will unearth the calvarium.” Said the brain surgeon. 

     The bone saw whirs at a high frightening screech.  The saw is a small stainless steel orb that glints under the klieg lights and comes from a sterilized package.   “Hold open the operating theatre for me,” he said.  “Do not let go.”  “The patient might move!”  The saw whirred with a horrible whine and the frequency dulled as the blade cut the bone.  Smoke arose from the cut and I started to vomit.  “Dr. Saber said you were good.”   “Are you good?”  “I am good.” says the Wracks and his senses came back.  He pulled of the top of the patient’s skull and snipped the tentorial ligaments with a small scissors.  “This is the durra mater and underneath the subarachnoid membrane. “  Under the durra mater, a skin like membrane stretched over the top of the brain was a mass of congealed blood.  The patient started to speak in a childish voice a language I could not discern. “Do not listen,” he said.  The brain then starts to swell like a loaf of bread rising in an oven.  It pushed out two inches high.   “This is a bad one,” said the brain surgeon.  “We will have to do a total lobectomy.”     “I Want you to hold the suck and turn the fulgurate on when I tell you to.”  The Wracks holds the suck stable.  The surgeon literally sucks brain matter through a stylet into a huge plastic receptacle.  The osterized brain matter is bright pink like Jell-O.   The neurons are a light grey and the supporting structure of glial cells and myelin is alabaster white.  The brain surgeon hit a capillary and the blood spurts two feet high like a small geyser.  He clips it with the forceps and says “burn it.” The Wracks presses the trigger of the fulgurates.  The smell of burnt brain permeates the whole operating area.  The Wracks starts to black out.  “I am going Doctor,” says the Wracks The brain surgeon commands, “Hold the suck.”   “I am going Dr,” says the Wracks.   The brain surgeon commands “Hold the suck.”   The Wracks slowly starts to come back. Slowly, surely the Wracks comes back to consciousness.  “Now we can continue.” He said.  Small hemorrhages would occur as he aspirated brain tissue.  The Wracks holds the suck and triggers the burner as he commands “Our father who art in heaven.”  And they continued.  “Hallowed be thy name.”  And they continue.  “Thy kingdom come. Thy will be done.”   “There” said the brain surgeon.   “The bleeding and swelling have stopped and the patient still breathes.”  He put the top of the skull back on the patient and secured it with staples.  Then he sutured the scalp back into place.   The clock says two A.M and I am spent.  “You can go now.” Said the brain surgeon.  “I am done here.”

      The elevator from the top slowly descends to moral reality and the Wracks walks back into the ER.   “Did he make it?” said Dr. Saber “He made it.” Says the Wracks.  “Good “said Dr. Saber.  “We have a gunshot wound to the abdomen in room 3 and I want you to wait there until the police arrive.”   “o.K.,” says the Wracks.

      They said the patient was alive on a respirator until he was transferred to another hospital.  The Wracks lost track of him.  Some say he died some say he slipped away.  Some say the event never happened.  He might be a billionaire of a dot com.   The Wracks never saw the brain surgeon again. He flies around the United States and operates on peoples’ heads. He looks like an inbred Englishman.  Instead, he does brain surgery with an African American who hated to do colostomies.   There was always action in the south, in the city, downtown, late at night during the summer externships at the citadel with a pretty name of a clinic when the Wracks was a medical student.

“Where were you,” said Dr. Saber.   We need suturing for a head wound in room two.  The Wracks went back to work for nothing in the days before the darkness during youth when achieving was so important and nothing else mattered.  He has to pay to learn the craft in a closed shop populated by eccentrics., If they don’t invite you to apply, don’t even bother and waste your life.