My White Elephant

Beginning a sixty year journey......

At the start of my medical career I lived, of necessity, with my parents in their suburban home in which I had been raised.  In those early 1960’s we were a one car family, and my transportation was a motorcycle.  Given that the community hospital emergency room where I served as an orderly was only five miles distant, this worked well even with the frequent South Texas coastal rainstorms.  One Sunday morning I kick-started my Suzuki and was about to head down the driveway when my mother came out frantically waving for me to hold up.  She told me that Sam Boiler’s (not his real name) wife from down and across our street had called wanting me to come over, as Sam was suddenly in a bad way. 

Even I, with my minimal experience and training, was not surprised.  Sam Boiler was the prototypical political operator.  He had headed the Harris County Republican Party apparatus for years.  Sam worked irregular long hours without clearly defined weekends, smoked endless cigars, drank with whoever he needed to cajole, and ate his short frame into the big and tall sizes.  His job was more taxing than one might guess.  In those days, being a Republican in South Texas was not dissimilar in public opinion to being a Communist.  While the Reds might want to rape America, the Radical Republicans had raped the South after the Civil War with Reconstruction, and to many in South Texas the war of Northern Aggression was only yesterday. 

Even so, we were a more civil people.  Racism still required me to sit in the front of the bus whenever I might have met Ruby, our next-door neighbor’s maid, on her way home.  She had patiently explained my place forward of hers when I first tried to join her on the bus at age seven or eight.  But even that daily apartheid was conducted with mutual silent consent.  Our local grocery—oddly, a Weingarten’s--had three restrooms for men, women, and “coloreds”, and two water fountains, again subject to race.  Prejudice against Republicans was almost as virulent, but not so open in daily life.  Sam and his family had always been safe.  Demonstrations were core components of political campaigns, but they were on behalf of a party or candidate, not against a person or belief.  Public slurs and foul language or violent behavior were largely absent in a kind of social shunning.  That same public lived within an echo chamber defined by personal interactions with friends, family, business associates, and acquaintances, based on the limited information everyone shared equally from the local newspapers and the one hour of news stories on the three TV networks then existing. 

Sam Boiler’s professional life had consisted of boldly travelling through all such echo chambers to try and recruit new Republicans.  He had admittedly difficult successes.  The South, especially Texas, was full of Blue Dog Democrats—basically staunchly conservative in social and fiscal outlook but refusing to consider they might really be dreaded Republicans.  Sam had done mighty work on that in our county.  But he had been ridden hard and put away wet too often.

I rode my Suzuki down the street and parked on the sidewalk in front of Sam’s house.  Mrs. Boiler and their two adult daughters hustled me through the front door down a hallway just like my parents’ home, to Sam in his bedroom.  Sam was only a third of the way between five and six feet tall, and nearly as wide.  With a very soft mattress and his great bulk he was truly lying “in” his bed.  Stertorous, irregular breathing, unresponsiveness, and his purplish lips showed me he was in dire straits.  Bloody froth bubbled from his mouth.  As I got onto the bed next to him, his breathing ceased with a grunt.  I couldn’t find a pulse in his bull neck or his huge chest.  Using what training I had, I began CPR.  Pumping on his chest just above and to the left of his bulging belly, I found that every breath I tried to blow into his mouth gave me a mouthful of the bloody fluid flooding his lungs.  Pump, pump, pump, pump, pump, pump, pump, blow, spit.  After a few cycles of this I realized that pumping on his chest while in this bed was useless.  The mattress was so soft and Sam so large that my straight-arm efforts were frustrated by the bed’s rebound.  Stepping off the bed, I then rolled his three hundred-plus pounds off onto the floor with a great thud that shook the entire room.  The roll was perfect; he landed flat on his back with my hand cushioning his head.  On this hard surface my chest pressings were at last effective, even if my breaths into his mouth could not overcome the sodden lungs. What next to do beyond trying to resuscitate him did not register in the moment.

My attention was diverted from Sam by my mother, who was there with Sam’s family and a newly arrived police officer.  Our small community was famous for its useful and effective police department—they could be and were anywhere in town within three minutes of being called.  No “911” in those times—you had to have the police department’s number at hand and shoo whoever was on your party line phone off to call them directly.  Since paramedics didn’t exist then, and the fire department only came for actual fires, calling the police for any other unusual event was the norm.  What took my attention away from struggling with Sam was my mother’s question to the police officer— “Is he doing it right?”.  Sam was not only a neighbor and a friend of my parents, but in their age group, and what my mother was witnessing probably slapped her hard with her own potential mortality.  Also, she had little knowledge of either my duties or capabilities at this early stage of my progress in the medical profession, and cardiopulmonary resuscitation (CPR) was still minimally known to the public at large.

Seeing her doubt expressed was only momentarily distracting as I spit out more of the bloody phlegm from Sam’s lungs.  The police officer looked back at her and gave a pronounced shrug indicating he had no idea of what to do.  Meanwhile Sam was not responding in any way to my efforts, and I was tiring.  Pumping a massive fluid-filled bellows sixty to eighty times a minute with an ineffective forced blowing into lung balloons that will not inflate or deflate was using up even my young energies.  My Ben Casey hospital whites were not only splattered with blood but getting soaked with my perspiration.  I was not capable of declaring Sam gone, especially in front of his family and my mother.  Soon I would not be capable of continuing my efforts, and there was no one else to take over.  Nor, seeing close up what I was doing, would any of them want to.

That’s when the ambulance arrived.  While it would relieve me of my efforts and unwanted responsibilities, I knew it would not help Sam.  In the first years of the 1960’s most small cities had no ambulance service.  Ours was volunteer.  They were literally a rotation amongst the local funeral homes, who would send a hearse to a location when called and transport a person in desperate condition or injury to our local community general hospital.  Occasionally, but not routinely, they might have a bottle of oxygen to use.  But no other capacities.  The driver and the attendant, both dressed in funereal suit and tie, rolled their drop-down stretcher into the bedroom, and after some maneuvering, they, the police officer, and I rolled/lifted Sam onto the stretcher with much of him overflowing beyond it.  Sam of course had not been breathing and had no natural or artificial circulation during these efforts.  No means of taking vital signs, of finding or monitoring his heartbeat, existed.  He was an oversized load slammed into the back of the hearse as it wheeled away at the speed limit without sirens to the hospital.  I knew, since I worked in that hospital emergency room, that the lone emergency room R.N. and the orderly I was supposed to be relieving would try to start an I.V. and watch Sam until his private physician arrived.  There were no dedicated emergency room physicians.  You called your doctor first, who told you to go to the ER, and often you and your doctor would arrive there simultaneously with that physician evaluating and dictating your care.  With spontaneous arrivals at the ER, the R.N. would call either the known private doctor for that person or another who was “on call” for such cases on a rotating basis amongst the hospital’s entire medical staff.  From my prior experience as a volunteer hospital emergency room orderly, a Medi-Stat, I knew that it wouldn’t matter if the doctor was there on Sam’s arrival.  I was fairly sure that the EKG machine would be hooked up (cardiac monitors did not yet exist), show no activity, and with the length of time that had passed as well as the obstacle of Sam’s massive bulk, his time of death would be recorded as DIER.  This meant “died in the emergency room”, as the hospital could not bill as much for someone who was DOA— “dead on arrival”.

All that passed through my mind as I gave minimal and empty reassurances to Sam’s wife and daughters—after all I was far younger than them.  My mother elected to stay with them for a while.  I went back home and changed into another set of Ben Casey whites, fired up my motorcycle, and finally made it to the hospital for my abbreviated shift.  True to my expectations, Sam Boiler was in a side room of the ER, fully covered in a sheet.  His next ride in the same hearse would await the doctor contacting his family I had just left.  I hadn’t the ability to prepare them for his almost certain death, but as was often the case in those times, most families were familiar with death of loved ones in the home. I had seen in their faces their stricken certainty of Sam’s end. 

Being a full-time student, I missed Sam’s funeral several days later.  A week or so afterwards Sam’s family called my parents and invited us all over for a few minutes.  They were wonderfully grateful for my failed efforts at saving Sam and wanted, despite my reluctance, to give me some memento gift from Sam’s vast collection of political gewgaws.  Something visible, substantial, durable, and lasting, as were their feelings for Sam and their gratitude to me.  Something bulky, like Sam.  Something representing the strength of Sam’s beliefs.  They gave me his alabaster white elephant.

This weighty object, shiny, solid, cracked through many areas but still unyielding, has accompanied me throughout my life and career.  My white elephant daily reminds me that, despite any expectations of failure in life, I must not fail to try.  After all, the practice of medicine is always a softening and delaying of the inevitable facing us all.  Those were the lessons I learned from Sam and my white elephant at that earliest stage of what would become my obligatory career.  I was a volunteer Medi-Stat, emergency room orderly, newly licensed motorcycle owner, fourteen years of age that day. Since then, I have ridden my white elephant a long way through many decades of medical practice, and despite retirement have a way yet to ride.