A five-year-old youngster fighting for his life on the operating table was my first solo case. He accused me of ruining everything when he discovered me in a hospital parking lot twenty years later.
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I was 33 years old and a new attending in cardiothoracic surgery when it all started. I never imagined that the boy I assisted would most bizarrely reemerge in my life.
Five years old.
Car collision.
I worked in the dreadful realm of hearts, lungs, and large vessels—life or death—rather than general surgery.
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I still recall how it felt to pretend not to feel like a fraud while strolling through the hospital hallways late at night wearing my white coat over scrubs.
My pager screamed to life just as I was beginning to unwind on one of my first single nights on call.
trauma team. Five years old. Car collision. potential damage to the heart.
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potential damage to the heart.
I felt sick to my stomach from that alone. My heart was beating more quickly than my feet as I ran to the trauma bay. I was struck by the scene’s strange turmoil as soon as I pushed through the swinging doors.
There was a frenzy of movement all around a small corpse that was crumpled on the gurney. Nurses moved with frenzied precision, emergency medical technicians shouted vital signs, and machines screamed statistics that I didn’t like at all.
Under all those wires and tubes, he appeared so tiny, like a toddler posing as a patient.
That was sufficient.
to make me feel nauseous.
From the left eyebrow to the cheek, the unfortunate child’s face was deeply slashed. His hair was crusted with blood. With every beep of the monitor, his weak breaths rattled as his chest rose quickly.
The ER staff member said, “Hypotensive. Muffled heart sounds. Distended neck veins,” as we locked eyes.
“Pericardial tamponade.” Blood was accumulating in the sac surrounding his heart, silently strangling it as it was squeezed with each beat.
I tried to ignore my natural panic, shouting that this was someone’s baby, and instead concentrated on the data.
“Pericardial tamponade.”
The worst was verified by a hastily obtained echo. He was dwindling.
I said, “We’re going to the OR,” and I’m not sure how I managed to sound calm.
Now it was just me. There was no surgeon to supervise me, and I had no one to check my clamps again or to help me if I hesitated.
I would be responsible if this child perished. The universe shrank to the size of his chest in the operation room (OR).
The strangest detail that comes to me is his eyelashes. Gently feathering across pale skin, it was long and dark. He was only a youngster.
He was dwindling.
His heart was surrounded by a pool of blood when his chest was opened. After I hastily evacuated it, I found that a tiny rip in the right ventricle was the cause. Even worse, the ascending aorta was brutally injured.
He had absorbed the full power of a high-speed accident, which can cause internal body injury.
I couldn’t believe how quickly my hands were moving. Clamp, suture, start the bypass, and fix. Vital signs were continuously taken by the anesthesiologist. I made an effort not to panic.
I made an effort not to panic.
There were a couple terrible times when the EKG shrieked and his pressure dropped. I believed that losing a child that I was unable to save would be my first loss. But he did not give up! We did the same!
We weaned him off the bypass a few hours later. His heart beat once more, not flawlessly, but powerfully enough. His facial gash had been cleansed and repaired by the trauma team. He was alive, but the scar would never go away.
Anesthesia said, “Stable,” at last.
I have never heard a more wonderful term!
But he did not give up!
After we transferred him to the pediatric intensive care unit (ICU), I became aware of how trembling my hands were after removing my gloves. Two gray-faced, terrified adults in their early thirties waited outside the unit.
The man paced. The woman stared at the doors while sitting motionless with her fists clasped tight in her lap.
I inquired, “Family of the crash victim?”
I froze as they both turned to face me.
I was taken aback by the woman’s visage, which was older but clearly recognizable.
The man paced.
The lovely brown eyes and freckles were familiar. High school returned in a rush. That was my first love, Emily!
Before I could stop myself, I blurted out, “Emily?”
Stunned, she blinked, then squinted.
“Mark? From Lincoln High?”
The man, who I would find out was named Jason, glanced between us. “You two know each other?”
I blurted out, “We… went to school together,” before reverting to my doctor persona. “I was your son’s surgeon.”
“Emily?”
Emily gripped my arm as if it were the only solid object in the room as her breath caught.
“Is he… is he going to make it?”
I explained everything to her in clear, medical terms. As I stated, “tear in his aorta,” her face twisted, and her hands covered her mouth as I suggested a potential scar, but I was watching her the entire time.
She sobbed with relief as she fell into Jason’s arms when I informed her that he was stable.
Whispering, “He’s alive,” she said. “He’s alive.”
The world had stopped as I watched them embrace. As I stood there, a stranger in someone else’s life, I had an unexplained, weird ache.
“He’s alive.”
My pager then went off once again. I turned to face Emily again.
“I’m really glad I was here tonight,” I said.
For a moment, we were 17 again, kissing beneath the bleachers, as she gazed up. Then, still crying, she nodded. “Thank you. Whatever happens next — thank you.”
That was all. For years, I kept her thank-you note close at hand like a lucky coin.
That was all.
Ethan, her kid, survived. After weeks in the intensive care unit, he was moved to the step-down unit before being sent home. During the follow-up, I saw him a couple of times. He shared Emily’s obstinate chin and eyes. Unmissable and indelible, the scar across his face turned into a lightning bolt.
After that, he stopped attending appointments. That’s usually good news in my world. When people are healthy, they disappear. Life goes on.
I did as well.
Life goes on.
Twenty years went by. I became the surgeon who people specifically asked for. I dealt with the most repulsive cases—those where death was imminent. In order to think like me, residents scrubbed in. The notoriety made me proud.
I also engaged in the typical middle-aged activities. I tried again, failed more subtly the second time, got married, got divorced, and tried again. I’ve always desired children, but timing is crucial, and I’ve never been successful.
Twenty years went by.
I enjoyed my job, though. That was sufficient until one typical morning, following a grueling overnight shift, life unexpectedly brought me full circle. After working a nonstop shift, I had just changed into my street clothes and signed out.
I was walking toward the parking lot in a zombie-like daze. I navigated the typical tangle of vehicles, cacophony, and frenzied activity that plagues every hospital’s entrance.
I became aware of the car at that point.
I enjoyed my job, though.
The drop-off zone was incorrectly oriented, and the caution lights were blinking. The passenger door remained ajar. My own car was parked foolishly a few feet distant, protruding too far out and partially blocking the lane.
Fantastic. Being that person was just what I needed.
As I sped up, searching for my keys, a voice cut like a razor through the atmosphere.
“YOU!”
Startled, I turned!
“YOU!”
A man in his early twenties was sprinting in my direction! Anger was flushing his face. With crazy eyes, he gestured to me with a trembling finger.
“You ruined my whole life! I hate you! Do you hear me? I [expletive] HATE YOU!”
The words were a slap in the face! I froze. The scar was then visible to me.
That flash of pale lightning that cut from his eyebrow to his cheek. The visions of the boy on the table, chest open, clinging to life, smashed into each other, and my mind whirled. Then this angry man yelling as if I had killed someone.
The words were a slap in the face!
He gestured at my car before I could even absorb it.
“Move your [expletive] car! I can’t get my mom to the ER because of you!”
I ignored him. A woman was slumped in the passenger seat. Unmoving, she pressed her head against the window. Her skin appeared gray, even from a distance.
I asked, already running to my car, “What’s going on with her?”
With a gasp, “Chest pain,” “It started in the house — her arm went numb — then she collapsed. I called 911. They said 20 minutes. I couldn’t wait.”
I ignored him.
I nearly missed a curb as I wrenched open my car door and reversed without looking. I gestured him inside.
I said, “Pull up to the doors!” “I’ll get help!”
His tires squealed as he accelerated. I was already running back inside and calling for a crew and a gurney. We had her on a stretcher in a matter of seconds. Beside her, I felt her pulse, which was barely perceptible and thready.
Her face remained pale, and her breathing was shallow.
Arm numbness, collapse, and chest discomfort.
All the alarms in my head went off at once!
“I’ll get help!”
She was hurried into the trauma bay by us. The EKG was a complete jumble. My concern of aortic dissection was validated by lab results. a rupture in the artery supplying the body as a whole. She would bleed out in a matter of minutes if it burst!
“Vascular’s tied up. Cardiac, too,” someone remarked.
“Mark. Can you take this?” my chief asked, turning to face me.
I didn’t think twice.
“Yes,” I said. “Prep the OR!”
“Prep the OR!”
Something was bothering me as we wheeled her upstairs. I hadn’t really looked at her face yet. I hadn’t considered what my subconscious already knew since I was too preoccupied with protecting her life.
The world slowed down as I approached the table in the operating room. Even through the oxygen mask, I could see her freckles, her gray-tinged brown hair, and the shape of her cheek.
Emily was the one. Once more.
dying while lying on my table.
Emily was the one.
My initial love. The same mother who had just cried out that I had destroyed it, the mother of the boy whose life I had once spared. I blinked vigorously.
“Mark?” inquired the scrub nurse. “You good?”
I gave one nod. “Let’s start.”
Aortic dissection surgery is gruesome. There are no second chances for you. To replace the damaged part, you open the chest, clamp the aorta, put them on bypass, and stitch in a graft.
Every second counts.
“Let’s start.”
We discovered a big, furious tear when we opened her chest.
I worked quickly because adrenaline overcame my exhaustion. I needed her, not simply wanted her to live.
Her blood pressure dropped during a terrible moment! I gave commands with greater force than I intended! As we steadied her, inch by inch, the OR fell silent. Her heart stabilized and blood flow was restored after we implanted the graft a few hours later.
“Stable,” said anesthetic.
That term once more.
That term once more.
We shut down. For a moment, I stood there and gazed at her face, which was suddenly calm due to the sedative. She was still living.
After removing my gloves, I set out to locate her son.
Eyes bloodshot, he was pacing the intensive care unit hallway. He stopped dead in his tracks when he saw me.
“How is she?” he said in a raspy voice.
“She’s alive,” I acknowledged. “Surgery went well. She’s in critical condition but stable.”
His legs folded like paper when he fell into a chair.
“Thank God,” he muttered. “Thank God, thank God…”
I took a seat beside him.
She was still living.
He said, “I’m sorry,” following a protracted pause. “About before. What I said. I lost it.”
I reassured him, “It’s okay. You were scared,” “You thought you were going to lose her.”
He gave a nod. For the first time, he gave me a serious look.
He said, “Do I know you?” “I mean… from before?”
“Your name’s Ethan, right?”
He gave a blink. “Yeah.”
“Do you remember being here when you were five?”
He gave a blink.
He stroked his cheek and said, “Sort of. It’s all flashes. Beeping machines, my mom crying, this scar.” “I know I was in a crash. That I almost died. I know a surgeon saved my life.”
“That was me,” I muttered.
He raised his eyebrows. “What?!”
“I was the attending that night. I opened your chest. It was one of my first solo surgeries.”
Stunned, he gazed at me.
“What?!”
“My mom always said we got lucky. That the right doctor was there.”
“She didn’t tell you we went to high school together?”
His gaze expanded. “Wait… Are you that Mark? Her Mark?”
“Guilty,” I admitted.
His laughter was dry.
“She never told me that part,” he remarked. “Just said there was a good surgeon. We owed him everything.”
He remained silent for a while.
His laughter was dry.
He finally added, “I spent years hating this,” as he touched the scar. “Kids called me names. My dad left, and Mom never dated again. I blamed the crash and the scar. Sometimes I blamed the surgeons too. Like… if I hadn’t survived, none of the bad stuff would’ve happened.”
Saying “I’m sorry,”
He gave a nod.
He swallowed and said, “But today? When I thought I was going to lose her?” “I would’ve gone through everything again. Every surgery and every insult, just to keep her here.”
He took a swallow.
When I said, “That’s what love does,” “Makes all the pain worth it.”
He got up and gave me a hug! Close.
“Thank you,” he muttered. “For back then. For today. For everything.”
I gave him a hug in return.
“You’re welcome,” I replied. “You and your mom — you’re fighters.”
I gave him a hug in return.
Emily spent some time in the intensive care unit. Every day, I checked in with her. I was standing next to her bed as she woke up from her nap.
“Hey, Em,” I said.
She smiled weakly at me. “Either I’m officially dead,” she murmured, “or God has a very twisted sense of humor.”
I said, “You’re alive,” “Very much so.”
“Ethan told me what happened. That you were his surgeon… and now mine.”
I gave a nod.
“Very much so.”
She extended her arm and grasped my hand.
“You didn’t have to save me,” she declared.
The answer was, “Of course I did,” “You collapsed near my hospital again. What else was I going to do?”
She winced after laughing. She remarked, “Don’t make me laugh,” “It hurts to breathe.”
“You’ve always been dramatic.”
“And you’ve always been stubborn.”
“It hurts to breathe.”
The monitors beeped while we sat there for a while.
“Mark,” she said.
“Yeah?”
“When I’m better… would you want to grab coffee sometime? Somewhere that doesn’t smell like disinfectant?”
I grinned. “I’d like that.”
She gave my hand a squeeze. “Don’t disappear this time.”
“I won’t.”
“I’d like that.”
Three weeks later, she returned home. “Stationary bikes are the devil. Plus, the new cardiologist said I must avoid coffee. He’s a monster,” she texted me the following morning.
I said, “When you’re cleared, first round’s on me.”
Ethan occasionally joins us. We are seated in that small downtown coffee shop. At times, we simply discuss literature, music, or Ethan’s current goals in life.
Ethan occasionally joins us.
And what if I were told once more that I destroyed his life?
I would address him directly and say:
“If wanting you to be alive is ‘ruining’ it, then yeah. I guess I’m guilty.”
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