10

The business of doing major surgery on poor-risk patients can be trying and heartbreaking at any time, and when it is done regularly it can have an increasingly deleterious effect upon those who are doing it. It was therefore inevitable that The Deluge should have its after-effects, not only on the patients who survived but also on the surgeons who con­tributed to that survival. The first of the Swampmen to give outward evidence of what they had all been through was Hawkeye Pierce, and the first man to get caught in the fall-out was the anesthesiologist—Ugly John.

A good anesthesiologist is essential to any important surgi­cal effort. Without one, the greatest surgeon in the world is helpless. With one, relatively untalented surgeons can look good. If the man at the head of the table understands the surgical problem and the surgeon’s needs, if he understands the physiology and pharmacology of carrying a patient through a hazardous procedure, if he can have the patient under deep and controlled anesthesia when it is needed and awake or nearly so at the end of the operation, he is an anesthesiologist and a boon to all mankind. If all he can do is keep the patient uncon­scious, he is just a gas-passer. There were more gas-passers than anesthesiologists in Korea, but in Captain Ugly John Black, limpid-eyed, dark-haired, and the handsomest man in the outfit, the 4077th had an anesthesiologist.

Ugly John probably worked harder than anyone else in the unit. Theoretically his responsibilities consisted only of supervising the anesthesia service. Actually, as the only one formal­ly trained in anesthesiology, he was morally if not militarily bound to be available at all times. Too often this involved day after day of twenty-four hour duty, with only an occasional catnap. During busy periods like The Deluge the surgeons were constantly aware of his almost perpetual state of exhaus­tion and his greater than average effort. Nevertheless, when they had a tough one, they either wanted Ugly John to give the anesthesia or they wanted him to be around to check on it. Just his presence, or the knowledge that he was sacked out around the corner in the preop ward, was emotional balm to the man at the knife.

One of the most consistent customers of the 4077th MASH was the Commonwealth Division, consisting of British, Cana­dian, Australian, New Zealand and other assorted British Empire troops a few miles to the west. Captain Black had an intense, burning, complete, unremitting hatred for all the medical officers in the Commonwealth Division. His reason was very simple: they gave half a grain of morphine and a cup of tea to every wounded soldier. If the soldier was incapable of swallowing the tea, he still got the half grain of morphine. As a result of this treatment, it was frequently necessary to wait for the morphine to wear off before a patient’s condition could be assessed. If early surgery seemed reasonable or mandatory, Ugly John, in the process of getting the patient to sleep, often caught the tea in his lap. Frequently the patient had holes in his stomach or small bowel. In this situation, Ugly did not catch the tea in his lap. The surgeon would aspirate it from the abdominal cavity where it had leaked through the holes. The surgeons of the 4077th had the largest series of tea peritonitis cases in recorded medical history.

When leisure came his way, Ugly’s first duty was to repair his intratracheal tubes. These are tubes placed in a patient’s windpipe through the mouth and attached to a machine, controlled by the anesthesiologist, which delivers oxygen and anesthetic agents in the concentrations desired. Inside the windpipe the tubes are held in place by small balloons which are inflated after their introduction.

The balloons on Ugly’s intratracheal tubes, like all balloons, kept blowing out. The supply of new tubes was limited or nonexistent, for reasons never quite clear, so it was up to Captain Black to keep them in constant repair. There was only one source of new balloons.

Every week or ten days the PX received a shipment of the various things PX’s receive shipments of. This always caused a line to form, and the line always included most of the nurses. At the head of the line, however, would be Ugly John Black. As the PX opened for business, Ugly John would step up and announce in a loud, clear, purposeful voice: “I’ll take sixty rubber contraceptive devices. I hope to hell they’re better than the last batch. They all leaked.” Then he’d turn around and look austerely at the interested throng, few of who knew what he did with sixty such items a week.

When not working or blending intratracheal tubes and contraceptives into efficient units, Ugly was known to have a drink or two. In these situations, he usually wound up in The Swamp and vented his spleen upon the entire medical profes­sion of the British Empire.

“Those lousy bastards!” he would yell. “There isn’t a god­damned one of them would shake hands with his grandmother. He’d rather knock her on her ass with half a grain of morphine and then drown her with a cup of tea.”

Such a man was bound to be held in high esteem by the Swampmen and was considered a warm and welcome friend. Actually, the incident involving Hawkeye and Ugly John was a minor one—at least, as it concerned them—but it was the first sign of things to come.

In The Swamp, every problem case ever done at the 4077th was discussed, dissected and analyzed from every possible angle and in every conceivable detail. The Deluge had left much for discussion, and two nights after its end the Swamp-men were thus engaged when the door opened and a corpsman stuck his head in.

“Hey, Hawkeye,” he said, “they want you in the OR.”

“I’m not on duty. Tell them to go fry their asses.”

“The Colonel says to get your ass over there.”

“OK.”

Over in the OR, two of the night shift had the typical difficult war surgical problem with major wounds of chest, abdomen and extremities. The abdominal wounds alone made it a bad risk, and there was little margin for error. They needed help and advice. Hawkeye scrubbed up and was briefed by Ugly John.

“So how much blood,” Hawkeye wanted to know, “did they give him before they started operating?”

“One pint,” said Ugly.

“For Chrissake, John, why in hell do you let these cowboys start a case like this on one pint?”

“Well,” Ugly started to say, “they …”

“Look, goddamit,” Hawkeye went on. “You know as well as I do he should have had another hour and at least three pints before they brought him in here. What the hell’s the matter with you, anyway?”

“I can’t do everything around here,” Ugly said. “I’m just the goddamned anesthesiologist.”

“That doesn’t stop you from thinking, does it?”

“The surgeons said he was ready,” Ugly said. “These guys have been doing OK, so I haven’t been arguing with them …”

“Then don’t argue with me,” Hawkeye said.

“So you’re right,” Ugly said, “but I’ll tell you this. You’re getting pretty hard to live with, Pierce.”

“And that kid on the table may be pretty hard for someone to live without,” Hawkeye said.

Then he got into the case and took it over. He concluded it as quickly as possible. He used every trick he’d learned in ten months of war surgery, and then he called in Dago Red to put in a fix.

“Please, Red,” he said, “bring him in.”

Too much is too much. Despite all efforts and fixes, the boy died an hour after surgery.

Father Mulcahy led Captain Pierce to Father Mulcahy’s tent, gave him a cigarette and a canteen half full of Scotch and water. Lying on Red’s sack, Hawkeye dragged on the butt, swallowed the drink and said, “Red, my curve’s hanging, and I lost the hop on my fast ball.”

“Speak English, Hawk. Maybe I can help you.”

“Listen to Losing Preacher Mulcahy,” Hawkeye said. “You’d like to get me snapping the mackerel, wouldn’t you?”