Richard Hooker - MASH - A Novel About Three Army Doctors

From one flight of choppers the Swampmen found eight new arrivals, all of whom needed maximum and immediate attention. The worst was an unconscious Negro private who was the bearer of a note from the doctor in the Battalion Aid Station. The note stated that the patient had been knocked out when a bunker had collapsed, had awakened and then had slowly subsided into unconsciousness again. This was a neuro-surgical problem, but the 4077th had no neurosurgeon be­cause such cases were supposed to be sent to the 6073rd MASH, which had several.

Trapper John looked at the note and then at the boy. He looked in his eyes. The right pupil was dilated and fixed. His pulse was slow, his blood pressure negligible.

“I’m afraid this one has an epidural hematoma,” he said. “Duke, haven’t you been that route a little?”

“Yeah,” Duke said, “but not enough to be a pro.”

“You’re a pro now,” Trapper said.

Duke quickly examined the patient. He found indications of pressure on the brain from blood accumulating between the skull and the outer brain lining.

“Right now,” he ordered, “lug this one into the OR.” The Duke ran ahead of the stretcher. In the OR he encountered, fortunately, the boss, chief, honcho, leader and head coach of the operating room nurses, Captain Bridget McCarthy of Boston, Massachusetts.

“Quick, Knocko,” he commanded, “y’all get me gloves, knife, hammer, chisel, Gelfoam and a drain.”

Captain Bridget McCarthy was maybe thirty-five years old, five feet eight inches of solid maple, and she did not ordinarily tolerate much lip from the Swampmen or her immediate superior, Major Hot Lips Houlihan, either. This last endeared her to the Swampmen who did not call her “Knocko” for nothing, for they knew she could take out any one of them in a head-on. More than anything, however, she was also a nurse who had come specifically to be a nurse, so when Duke gave orders with fire in his eye she asked no questions and said, “Yes, sir.”

The right temporal area was quickly shaved and scrubbed, and Duke incised down to the bone. He had no desire to go through the skull with a hammer and chisel, but he also had no choice. The appropriate drills for making burr holes were at the 6073rd with the neurosurgeons, so he did the best he could. With luck, or skill born of need, he cracked a jagged hole in the skull in less than a minute. As he broke through, blood flowed out in a torrent. The torrent quickly diminished to a dribble and then Duke exercised highly commendable surgical wisdom. The wise surgeon, particularly when out of his field, knows when to quit, so Duke refrained from looking for hemorrhage beneath the dura mater. He settled for the drainage of the epidural hemorrhage, and the pressure on the brain was relieved. He stuffed Gelfoam down toward the bleeding site, put in a rubber drain, closed the skin with silk sutures, and the soldier began to stir and moan. As his breathing improved and his pulse picked up, the Duke spake the words that, if they ever name a medical school after him, may be carved in stone over the entrance to the administra­tion building:

“He might make it, even if all I really did was hit him in the head with an axe.”

As Duke went, then, to the postop ward to write orders on his patient, Captain Bridget McCarthy went to the other end of the operating tent to find out what the excitement was. The excitement was the patient who’d arrived on the same chop­per with the epidural hematoma. Hawkeye had looked at him quickly, found him to be in shock, semiconscious but not, it seemed, in immediate danger. His clothes were saturated with mud, as was his hair, and there was a muddy, bloody bandage around his neck.

“Get that bandage off so I can see what the hell’s under­neath,” Hawkeye told a corpsman, and he went on to the patient on the next stretcher.

The corpsman removed the bandage. The patient turned his head to the left. Blood shot two feet into the air from the hole in his right neck where a mortar fragment had entered. The soldier yelled.

“Mama, Mama!” he yelled. “Oh, Mama, I’m dying!”

It looked like a gushing well, and a fascinated group gathered to watch. As the well crested and the blood descend­ed, it fell on the face of the soldier and into his mouth. He coughed, spraying his rapt audience with blood.

Hawkeye ran over. In haste, and instinctively, he stuck his right index finger down the hole, blocking off the severed common carotid artery. He had stopped the flow of blood, but he had also tied up his right hand, and he wondered: “What the hell do I do now?”

“Bring him to the OR right on this stretcher,” he yelled. “I can’t take my finger out. Find Ugly John and get his ass in here!”

As Knocko McCarthy followed Hawkeye into the OR, she had no chance to ask questions. Hawkeye was still sounding off orders.

“Start somebody cutting off his clothes … Tell the lab to come in with a couple of low titre O, and type and cross match him for five or six more … Get somebody to do two cutdowns and start the blood … Come to think of it, get somebody to start rounding up donors, and send some cow­boys to Seoul for all the goddam blood they can get … And get that Christly gas passer in here!”

“I’m here,” Ugly John said.

“Good,” Hawkeye said. “I guess you’d better get him asleep and a tube in him if you can. His common carotid is cut, and I can’t do anything with the son of a bitch jumping all over the place. We haven’t got time for any of the preoperative pretties.”

“Mama, Mama!” the patient was yelling. “I’m dying.”

“Hold still,” Hawkeye said, “or I’ll guarantee it.”

Ugly John did a cutdown and got into a vein. He got some blood started, as well as Pentothal and curare, and inserted his intratracheal tube. It was still a toss-up. Although the patient had survived the induction of anesthesia, Hawkeye still had to get the carotid clamped off, and as soon as possible.

“Get help,” he ordered Knocko McCarthy. “I gotta keep a finger on this or we lose him, and I can’t expose it and get it clamped with one hand.”

He tried though. Grabbing a scalpel with his left hand, he enlarged the wound around the bare, dirty right index finger which had to stay in the neck. Next he tried to slide a Kelly clamp down his finger into the wound and clamp the artery, but it didn’t work. Then he got a retractor and, managing to hold it in the wound with his left hand, he improved the exposure. He was still in desperate need of help.

“Look, Ug,” he said to Ugly John who was busy enough with the anesthesia and the new blood, “grab a Kelly, and from where you are I think you can ride it down my finger, grab, and we’ll have this mother under control.”

Ugly did as told. Reaching the bottom of the wound, he opened the clamp as wide as he could. Sensing that he was around something substantial, he closed the clamp vigorously, asserting, “I got it! I got it!”

He had clamped the end of Hawkeye’s finger. Hawkeye, by reflex, removed his finger—and the blood flew. When it did Hawkeye went back in, but this time with his left index finger, and now, with luck, he was able to get a clamp on the artery.

“I’m OK for now,” he told Knocko McCarthy and one of the surgeons from the other shift who came running up with her, “but get the Professor.”

Most of the surgeons had some locally acquired experience in the care of arterial injuries, but they were still beginners. Therefore the Army had sent a Professor of Vascular Surgery from Walter Reed Hospital in Washington to give lessons throughout Korea. Fortune had placed him, at this time, at the Double Natural, and he bailed the patient, and Hawkeye, out.

Trapper John, meanwhile, had delved into a chest and Duke was now occupied with several feet of small bowel which were no longer useful to the owner. Hawkeye returned to the preop ward where Colonel Blake had taken charge.