It’s called a stump. Dr. Balinger never thought it was a very delicate term, but it is what it is. It’s a stump.
The man’s amputated leg was bandaged below the knee.
Dr. Charles Balinger removed the gauze from the wound. It was healing. He will do well he thought. It was the best solution for advanced vascular disease in a diabetic patient. It took years for him to abandon heroic but futile measures to save diabetic limbs. Patients did better after the amputation, below the knee, not above. Huge difference.
“I’m glad you agreed to the amputation. You’ll do better.”
“It’s hard. My legs have been with me a long time.”
Balinger said, “People grow attached to their limbs.”
Mr. Walsh smiled, and then laughed.
Balinger applied a fresh bandage and discarded the old one.
“See you tomorrow.”
Balinger turned to leave the room.
“Thanks for cleaning up after yourself.”
The voice came from a young nurse.
“You’re not my mother,” Balinger replied. “And thank you for taking care of my patient.”
“I’m nobody’s mother, yet.”
Balinger noticed her soon to deliver torso.
“Ashley, when’s the baby due?”
“Two weeks. It’s my first.”
“Go home, I’ll write you a doctor’s excuse.”
“I feel like a walking Jiffy Pop, the aluminum foil’s expanding.”
“Too bad you’ll deliver before Halloween. You could wrap yourself in aluminum foil and go as Jiffy Pop.”
Balinger smiled, gave her a “thumbs up.”
Balinger was impressed that a woman could work a twelve-hour shift, despite being pregnant, anemic, and carrying thirty extra pounds.
And wear eye make-up.
A physician administrator approached, interrupting their conversation.
He smiled and said, “Dr. Ballinger, Ashley, the administration wants you two to be in charge if an Ebola patient needs to go on the dialysis machine. We’ll buy you coffee.”
Putting the two of them in a high- risk clinical endeavor with inadequate training was an administrator’s idea of a good joke.
“Not funny,” Balinger said.
The guy was offensive on a good day. His family bought him his position at the hospital. Balinger figured he came from a line of privileged men that dressed as women, and got in the lifeboats while the Titanic sank.
Balinger returned to the nurse’s station.
The charge nurse asked, “Dr. Balinger did you see this?”
She handed Balinger a one-page print out showing how to don a HAZMAT suit.
“Charles we got a one hour lecture and this hand- out to prepare us for Ebola. It’s bullshit.”
Dr. Balinger looked at the hand out. It was a cartoon of Donald Duck putting on a HAZMAT suit.
The nurse continued, “Most of the infections occur when you take the suit off, and that wasn’t discussed.”
Balinger laughed and said, “They could at least have another hand-out showing Mickey taking it off.”
“It won’t be very funny when a nurse contracts Ebola. They’ll blame the nurse if there’s a breach.”
“I’ll see we get more training,” Balinger said. “For now lets hope we don’t have to use this.”
“We don’t have real HAZMAT suits, they’re on order,” the nurse said. “We’re supposed to put on three paper gowns.”
“How well does a paper gown hold up after you spray it down with sodium hypochlorite?”
“The paper will brake apart. How does hypochlorite feel on your skin?”
“The doctors at the CDC are knuckleheads. The first major Ebola outbreak occurred in 1976. Where’s the vaccine? What were they doing?”
Balinger said, “Playing politics. If they wanted to keep Ebola in Africa they would have developed a vaccine, and vaccinated Africans.”
“There’s no money or votes in vaccinating Africans.”
Balinger said, “Now you know how the CDC works.”
“They should have let the nurse’s association manage the Ebola outbreak. The CDC guys never get near an Ebola patient except for a photo op.”
“And,” Balinger said. “They dress up like astronauts on a space walk.”
“They don’t wear three paper gowns?”
“No,” Balinger said.
“Nurses have more at stake.”
The CDC said any hospital could manage Ebola. Balinger thought the doctors at the CDC had no idea what it was like in the average American hospital.
The medical adage of “see one, do one, teach one,” didn’t apply to Ebola. But it seemed to apply to the nursing staff.
* * *
Balinger sat in his office. He was surrounded by his textbooks, diplomas, and framed pictures. There was a knock on the door.
“Come in,” he said in a voice loud enough so he wouldn’t have to get up.
The door opened. Ashley stood at the entry, still very pregnant but the bulge was lower. The baby had dropped.
Ashley didn’t look right. Her eyes reflected terror. The skin on her throat blanched red.
“Ashley, for God’s sake. You should be at home. You’re going to deliver in a few days.”
She said, “Say a prayer for me Dr. Balinger.”
“What’s the matter?”
Her hands shook, her voice tremulous.
She brushed her hair to the side of her face, and looked down.
She talked rapidly, not taking a breath.
“I did a stupid thing. I stuck myself with a needle. I put Mr. Henry on dialysis, he moved and jerked his arm, and the needle went into my finger, deep. We usually have two people put him on, one to hold his arm, and one to place his needles, but we’re short staffed, backed up…”
Balinger knew the patient and knew what this meant, but kept silent.
“Mr. Henry has HIV, Hepatitis B, and Hepatitis C,” she said.
Tears inched, then streamed down her face. She tried to talk, gasping for breath.
Balinger stood, walked towards her, put his arm on her shoulder, and led her to one of two chairs located in front of his desk. He sat in the other chair and held her hand.
“It will be ok,” he said.
Ashley composed herself and said, “They never should have gone to the blunt needles. We should have stayed with the ones that cap themselves.”
Balinger said, “They thought the blunt needles were safer.”
“They’re cheap,” she said. “We knew how to protect ourselves with the old needles. No one cared about us.”
“Ashley, you’ve been vaccinated for Hepatitis B, right?”
“Of course, and I made antibodies.”
“You can forget about Hepatitis B, and it’s very unlikely to get HIV from
a needle stick,” Balinger said. “About one in a thousand.”
“I know,” she said. “But I’ll take the medication anyway. The AZT will
make me sick, but I won’t risk not taking it. It’s the hepatitis C, it’s more contagious.”
“Make sure you get your blood drawn now and again in two weeks to see if you contracted anything. If you can prove it’s work related you’ll get benefits, if not the hospital won’t help you.”
“If I turn HIV positive, will they think I fooled around when I was nine months pregnant?”
Balinger regretted his comment. It seemed clinical rather than comforting. Right now his goal was to comfort. When emotions were high things sometimes came out wrong.
“Are HIV drugs safe for a newborn? Can I nurse the baby?”
Balinger didn’t know the answers.
He said, “I feel bad you’re going through this. I’ve stuck myself before. I know the feeling, it’s awful.”
“If I convert, I’ll be contagious. Who’ll take care of my baby? I’ll have to be careful when I hold him. I won’t be able to kiss him.”
“There is treatment if you contract hepatitis C.”
“Yeah, a liver transplant.”
“No, there are treatments now.”
Ashley gritted her teeth and said, “He was a dirty man, who lived a dirty life, whose dirty blood entered me and my baby.”
“Ashley, I understand.”
“I get stuck with a needle because I did my duty.”
Dr. Balinger said, “Hospital work is dangerous. Especially where we are; in the trenches.”
“If we had a nurse’s union we’d have capped needles.”
“Be careful, Ashley. If the administration hears you talk about a union, the pimps will fire you on the spot.”
She looked at the picture of her baby in utero. It was gray and white, and showed the curled up fetus sucking its thumb. Its eyes were open.
“Nurse’s lives shouldn’t be at risk, or their babies.”
“Ashley, I will help you.”
“Thank you. Do what you can. But I think I need your prayers.”
“You have them.”
“I have to get back to my patients.”
Ashley walked back to the wards.
I called the lab and told them to do a rapid assay on Ashley’s blood sample. It should be back in a couple of hous. I could at least shorten her excruciating waiting time.
Balinger thought of the hospital executives, safe in their cocoon of high self-regard, oblivious to what Ashley was dealing with, something that could change everything.
He spied the sharps container that contained the used needles. The coiled tubes and bloody needles resembled fanged, venomous snakes.
Balinger knew the angst Ashley would experience. The two weeks would seem like years. Not knowing if you contracted a disease that could alter your life, and those of the ones you love, and for whom you provided.
He returned to his office and sat at his desk.
Balinger looked at a framed picture displayed in the center of his office. It was the scene of the Twin Towers burning, soon to accordion down. People were running away, panicked. In the opposite direction an orderly convoy of shiny red fire trucks not yet covered in ash, and white New York police cars headed for the inferno. They were unquestioning first responders. Balinger displayed the picture to remind him of duty and sacrifice.
Something to live up to.
It won’t be the doctors but rather the nurses who would be the first responders to Ebola or any other contagion that hit the hospitals, the country. They were as vulnerable, and brave, as the trained policemen and firemen and just as likely to be victims.
He viewed them in the same light.
And so he added another picture to display next to the burning Twin Towers. It was that of a nurse dressed in the traditional uniform of the 1940’s. She wore a starched white nurses uniform, blue wool cape with a red lining, and a Grace Hospital Nurse’s cap.
She was leaving for the veteran’s hospital, which in the early 1940’s was too busy.
Before the war the nurse routinely administered to patients with polio and tuberculosis and other diseases for which at that time there was no cure and could infect her as well.
During the war she held horribly injured young soldiers. Read to them and wrote letters for them.
Fifty years later, on a trip to the Holy Land, the nurse, and her World War Two war hero husband were murdered by radical terrorists.
The nurse was his mother in-law.
He displayed her picture on the wall next to that of the Twin Tower first responder heroes.
To Balinger it represented the professionalism, sacrifice, inchoate, and often overlooked bravery of all nurses.
He called the lab. Ashley’s blood tests were negative.
She was disease free. He put a page into her. He told the operators it was stat. She answered. She cried when he told her the good news.
* * *
The CDC calls it “Ebola Hemorrhagic Fever.”
The Africans call it “The Nurse Killer.”