Michael Palmer - Oath of Office

But what caught Lou’s eye wasn’t just watching the pro at work. It was the youthful, freckle-faced cook directly to the chef’s right. The young man’s dark brown eyes were fixated on the slicing end of the razor-sharp knife. His right hand was just six inches or so from the carrot pieces that were flipping out from the blade like poker chips. Once, then again, it looked to Lou as if the young man-twenty-two if that-was going to make a move to snatch one of the newly minted coins from the cutting board.

Lou tensed.

The chef, lost in concentration, remained fixed on his gleaming blade, which never came up off the cutting board more than a millimeter or so farther than it had to.

Another flinch from the boy-this time involving not only his hand, but his shoulder as well.

The kid was going to go for it.

Lou felt certain of it.

Pushing back from the counter, he rose from his stool.

No one seemed aware of the drama that was playing out-least of all the husky chef himself.

To Lou’s left, Dennis was lost in the glory of his perfect burger.

One more slight tic by the boy, and Lou had seen enough.

But it was too late.

The kid seemed to be lost in some sort of hypnotic fugue state, timing his moves like a striking rattlesnake. His latex-gloved hand shot out toward a particular, perfect orange disk.

“Nooooo!” Lou cried out, toppling his tall stool backwards, and diving, arms outstretched, across the counter.

The heavy ten-inch blade snapped down on the boy’s extended thumb with unimaginable force.

Bone cracked like a sniper’s shot.

The boy’s shriek filled the enormous dining room, accompanied moments later by the screams from dozens of others.

Then there were more, unrelenting shrieks.

From the vegetable cutting board in the kitchen came a geyser of blood.

“Oh, Jesus! My thumb! My thumb!”

In an instant, blood was everywhere, spurting into the air from within the tattered rubber glove and cascading across the wooden chopping board onto the floor.

Lou vaulted over the counter and past the waitress, whose expression gave no indication that the startling event had even registered. He slammed into the chaos of the kitchen through a swinging door with an eye-level porthole as a crush of customers and staff closed in behind him.

“It’s Joey!” someone cried out. “Joey’s cut his finger off!”

Lou’s powers of observation were immediately heightened. Seconds passed as minutes. The world around him began moving in slow motion. His tone became firmer, but his speech slowed. What might have been dozens of factors were analyzed and synthesized at once.

Crunch mode.

“I’m a trauma specialist from Eisenhower Memorial,” he heard himself announce calmly. “Please give me room. Give me some room. Someone call nine-one-one and tell me when you’ve done it. One of you bring over some rubber gloves. The rest of you, back away, please.”

Incredibly, the boy was still on his feet, staring down at his hand with what appeared to be little comprehension. Blood had sprayed across his white apron like a macabre piece of spin art. The blade had crunched through the bone just above the metacarpo-phalangeal joint-the knuckle separating the digit from the hand. It had been a vicious cut, requiring almost unimaginably intense force.

The bone had been splintered more than sheared in two. Some soft tissue remained intact at the base-a piece of good fortune that would enable optimum anatomical alignment in preparing the boy for transport. Still, as things stood, two bloody tendons and a bridge of skin were all that kept the digit from dropping into the stack of blood-soaked carrots.

If this were a single finger other than the thumb, it seemed quite possible the hand surgeon would opt simply to complete the amputation. But this was the thumb-the digit that, because it could be pressed against the pads of the other four fingers on the hand, created the opposition that, in essence, separated primates from other animals. Writing, grasping, fine motor skills. For life to go on as it was for this youth, meticulous reimplantation was critical.

And preserving anatomical relationships and circulation had to be Lou’s mission. But first, there was the matter of the kid himself.

Lou grabbed a towel and laid it over the boy’s hand. Instantly, the white cloth became soaked in crimson.

“Joey, is that your name?” Lou asked, supporting him by the shoulders.

“Joey,” the kid managed. He began shrieking again and raised his hand to eye level. Heavy drops of blood fell from beneath the towel.

“He just stuck his hand in there!” the chef cried out, the heavy, blood-covered blade still in his hand. “I never saw him. Jesus, Joey, what in the hell were you thinking?”

Joey’s fair, freckled complexion was ashen-one of the early changes of shock.

“All right, Joey,” Lou said, “I’m going to lower you down.”

“Here you go, Doc,” someone said.

A box of disposable rubber gloves appeared on the high bench where the accident had occurred. From his earliest days in the hospital, Lou had to battle against the intense urge to dive right in and help whenever there was an open, bleeding wound. Then articles began appearing in the literature reporting the surprisingly large percent of HIV-positive patients found in sequential testing in both inner city and suburban emergency wards. And finally, conversion to positive happened to a fellow moonlighter who didn’t follow protocol, in a small, affluent community hospital, fifty miles outside of D.C.

“Please, no one come near the blood without having gloves on,” he said, donning a pair and quickly backing it up with another. “One of you roll an apron under his neck and someone else get his legs elevated with something under his knees and ankles. The higher, the better. If there’s a blanket around, put it over him. And I need towels. Lots of towels.”

He brought his mouth next to Joey’s ear.

“Joey, my name is Dr. Louis Welcome. Call me Lou. Hang in there with me and we’ll get you fixed up. Okay?” He took a clean towel and slid it in as a replacement for the blood-soaked one. “Do you have any allergies to medications?… Any past surgery…?”

He craned his neck back until he made eye contact with his father. Then he pulled his car keys from his pants pocket.

“Ask that guy over there in the green plaid shirt to get my medical bag from the trunk of my car,” he ordered the chef nearest to his left. “Then get me a large bowl of ice water and some dishwashing soap. Dove, Palmolive. Anything you have is okay.” The circle of people gathered around them began to close in. “You’ve got to back up!” Lou said firmly, applying gentle pressure. “Give us more room.”

Blood flowed from the wound in thick spurts. Hemostasis? Ice? Cleansing?

He evaluated the pluses and minuses of each maneuver.

Stop bleeding.… Get alignment.… Sterilize.… Protect any microscopic arteries that might still be intact.…

Lou made decisions while talking to the boy almost continuously. A single rolled apron had been placed under Joey’s neck, and stacks of towels were now elevating his legs from the knees down.

Lou rested the damaged hand palm down on a clean towel, gently adjusting the thumb into an anatomically correct position.

“Okay, Joey … listen to me now.… Everything is going to be just fine.… I’m going to help.…”

“Help me,” Joey answered back meekly. “Please help me.”

“Someone give me a scissors, please.”

Lou pulled one of the towels from the pile and cut off a long three-inch strip. Next, he wrapped the strip twice around the middle of Joey’s forearm and tied it off. The bleeding began to slow. To add torque, Lou slipped a wooden cook spoon under the strip and turned it until the bleeding began to slow even more. He made note of the time, 12:50. There may have been as much as two hours of wiggle room to keep the tourniquet on before there was tissue damage, but he had no desire to cut things that close.