“Good,” Hawkeye said. “Then let them do all the work.”
“No, goddammit,” Henry said, the red rising to his hairline again. “Not for one minute. That’s been the trouble with this organization. When we’ve been busy there hasn’t been time to teach the new men the kind of hurry-up, short-cut or call-it-what-you-will surgery that you have to do in a place like this. When we’ve had time you people have goofed off, which is my fault, and as a result anybody who learned anything here just picked it up by accident. Well, that’s gonna stop, and it’s gonna stop right now. These new men are going to be taught everything they can be taught, and you two are gonna teach them!”
“Yes, sir,” Duke said.
“OK,” Hawkeye said. “I guess you’re right.”
At lunch that day, Henry introduced Hawkeye and Duke to Captains Emerson Pinkham and Leverett Russell, and the two veterans invited the two recruits to join them, Trapper John and Spearchucker at The Swamp for cocktails at four o’clock. At four o’clock the two appeared and were served libations. As before, they shaped up well in all the requisite areas. Since their arrival they had observed a number of operations and had performed two themselves, and this, of course, quite naturally invited a comparison between the methods being employed at the MASH and the techniques taught in the high-level stateside training hospitals.
“I think I can speak for Lev as well as myself,” Captain Pinkham said at one point, “when I say that we are not, for a moment, regretting our presence here. There’s a job to be done, and some men are giving their lives so, at the very least, we can give our time and our talents, such as they may be. At the same time, any surgeon, aware of everything that’s going on in his field back home, has to regret it when he’s sent to a place like this where about all he ever gets to do is meatball surgery. No offense, of course.”
Hawkeye looked at Duke, Duke looked at Hawkeye, Trapper John and Spearchucker looked at their colleagues. The term was one that was used often in The Swamp, but now it had just been used by someone else, and a recruit.
“No offense,” Hawkeye said. “Have another drink.”
As it happened, the Double Natural was moderately busy at this time, and Henry had paired Captains Pinkham and Russell with Captains Pierce and Forrest on the night shift. On this very first night, in fact, there was even a six o’clock chopper, so after they had bolted down a quick meal, the two veterans escorted the two recruits over to view the passengers.
The chopper had brought two 4077th MASH Specials: both had belly and extremity wounds, and one had a minor chest wound. Hawkeye and Duke stood back while Captains Pinkham and Russell made their examinations, then informed the recruits that they would be ready and willing to assist when the patients had been prepared and moved into the OR. After that the two Swampmen retired to the lab where, a few minutes later, Captain Bridget McCarthy found them avidly engaged in questioning Radar O’Reilly who had recently been in communication with Jupiter,
“All right, you two!” Captain McCarthy ordered. “Get out of here!”
“What’s your maladjustment tonight, Knocko?” asked Hawkeye.
“Listen,” she said. “Your two Cub Scouts want to operate on those patients right away, and they’re not ready to be operated on.”
“Now just a minute, ma’am,” Duke said. “Just where did y’all …”
“Attend medical school?” Knocko asked. “Right here.”
“Yes, ma’am,” Duke said. “We’ll go help.” In the preoperative ward the two graduates of the ivory tower surgical training programs were showing their inexperience. The two cases that confronted them were well within the ability of the Double Natural, or any other MASH, to handle. Both patients were in moderate shock, but had no continuing blood loss. Both required preoperative resuscitation by a process well known even to the corpsmen and Korean helpers.
Captain Pinkham had the boy with the minor but significant chest wound. When Hawkeye and Duke wandered in, he was fussing around the patient, rapping on the chest and listening to it with a stethoscope. He was behaving, in other words, like a doctor and not a meatball surgeon, so Hawkeye took a look at the X-ray, assessed the situation and spoke.
“Doctor,” he said, “this guy obviously has holes in his bowel and his femur is broken. It’s not a bad fracture, but he’s probably dropped a pint here. There’s at least a pint in his belly and maybe a pint in his chest. Agreed?”
“Agreed,” Captain Pinkham said.
From there Hawkeye went on to explain that the patient also had a pneumothorax, meaning that there was air in his pleural, or chest, cavity because his lung was leaking air and had collapsed. In addition, he suggested, the shock from the blood loss was probably augmented by contamination of the peritoneum, or abdominal, cavity by bowel contents.
“So what he needs,” he said, “before you lug him in there and hit him with the Pentothal and curare and put a tube in his trachea, is expansion of his lung, two or three pints of blood and an antibiotic to minimize the peritoneal infection.”
“I see,” Captain Pinkham said, beginning to see a little light, “but we’ll still have to open his chest as well as his belly.”
“No, we won’t,” said Hawkeye. “The chest wound doesn’t amount to a damn. Stick a Foley catheter between his second and third ribs and hook it to underwater drainage, and his lung will re-expand. If he were going to do any interesting bleeding from his lung, he’d probably have done it by now. We can tap it after we get the air out and his general condition improves. Right now we just want to get this kid out of shock and into the OR in shape to have his belly cut and his thigh debrided.”
Two corpsmen brought what at the Double Nature passed for an adequate closed thoracotomy kit. It contained the bare essentials for insertion of a tube in a chest, and after Hawkeye had watched Captain Pinkham fiddle around with it for awhile, he spoke again.
“Look,” he said. “All that’s great, but there will be times when you won’t have the time to do it right. Lemme show you how to do it wrong.”
Hawkeye donned a pair of gloves, accepted a syringe of Novocain from a corpsman, infiltrated the skin and the space between the ribs and shoved the needle into the pleural cavity. Pulling back on the plunger he got air, knew he was in the right place, noted the angle of the needle, withdrew it, took a scalpel, incised the skin for one-half inch and plunged the scalpel into the pleural cavity. Bubbles of air appeared at the incision. Then he grasped the tip of a Foley catheter with a Kelly clamp and shoved the tube through the hole. A nurse attached the other end to the drainage bottle on the floor, a corpsman blew up the balloon on the catheter and now bubbles began to rise to the surface of the water in the bottle. Hawkeye dropped to his knees on the sand floor and, as he began to suck on the rubber tube attached to the shorter of the two tubes in the bottle, the upward flow of bubbles increased as the lung was, indeed, expanding.
“Crude, ain’t it?” said Hawkeye.
“Yes,” said Captain Pinkham.
“How long did it take?”
“Not long,” admitted Captain Pinkham, who couldn’t help noticing that the patient’s breathing had already improved.
Duke, meanwhile, watched Captain Russell apply his surgical resident’s approach to the other soldier who, waiting for blood, was still in shock. Captain Russell, afraid that he’d miss something, was examining the patient centimeter by centimeter, fore and aft, while the corpsmen waited impatiently to start the transfusion.
“Excuse me,” Duke said after a while, “but all you’re doin’ now is holdin’ up progress. Why don’t y’all let these folks get to work?”
“But don’t you think …” Captain Russell started to say.
“What I think,” Duke said to the corpsmen, “is that we better start the blood.”