An excerpt from All Bleeding Stops.

42nd Surgical Hospital
Phu Bai
Republic of Vietnam
August 1967

They hear them before they see them, the deep, thudding whump of the rotors pounding in their brains, booming in their chests. The choppers come at them, rising over the wall of trees, leaking oil, dripping blood, enlarging, becoming darker, louder, filling the sky with their deafening roar. They hit the ground in a whirlwind of dust and leaves, lurching, rocking, and finally settling in place. The corpsmen, crouching low, forearms thrown across their foreheads, tear through the storm of dust to offload the wounded. They rush back, hunching under the whirling blades, trotting alongside the stretchers, holding IV bags, shouting information and vital signs. They are almost at the door of the OR before disjointed fragments of their words become audible over the roar of the choppers: “Wound to the left-lower … pressure of … absent pulse … milligrams of morphine.”

***

“Lieutenant!”

Jimmy is at Barrett’s bedside, shaking him.

Ruptured bowel. Lacerated artery. Severed arm. Dead on arrival. Dead on the table. Dead in Recovery. He’s had enough. He’s not going to get up.

“Lieutenant! The choppers!”

He doesn’t move. He won’t move.

“Lieutenant Barrett! Sir, they’re here!”

Jimmy shakes him so hard his cot slides back and forth, the frame creaking and groaning. Growling curses, he rolls over, shoves Jimmy aside, and stumbles out of bed.

His patient is waiting, another teenager. Skinny Black kid, droopy Afro, eyes squeezed shut, M16 clutched to his chest.

“I’ll take that, Private.” He eases the rifle from the boy’s hands, passes it to a corpsman, then cuts away the dirty remnants of the boy’s uniform to find a gaping wound in his upper abdomen leaking blood, bile, and half-digested C-rations.

Within fifteen minutes Barrett is gowned, gloved, and inside the boy’s abdomen, searching first for the transected artery, then for the bullet and dirt and fragments of uniform that litter his peritoneum, all the while cursing the bleeding he forever struggles to control with his frenetic suctioning, clamping, and cauterizing.

They have been operating for an hour when everyone—the scrub nurse, the assistant, the anesthesiologist, even Barrett himself—knows it’s hopeless. The room falls silent, everyone waiting, everyone looking at him.

He keeps his eyes down. He won’t look at them. His hands wander aimlessly through the bloody depths of the boy’s abdomen, weaving through a sea of slimy intestines, skirting shores of stolid organs. He knows they want him to stop. He knows their nostrils are flaring at the scent of death. They think death is a thing of substance and heft, a finish line, a destination, but he has found death to be a shadowy evanescence whose existence is always a matter of conjecture, of interpretation, of perspective. As long as he keeps working, keeps cauterizing, keeps dissecting, there is hope, there is life. But when he stops, when he lays down his forceps and pulls down his mask, when he turns from the table and says the words, then and only then is the patient dead. And at that point he must live with the knowledge that although a bullet caused the boy’s wound, although shrapnel severed the boy’s artery, it is Barrett’s words that will end the boy’s life.

He straightens up and lifts his hands from the bloody abdomen. Sighing, he picks up a crumpled lap sponge and half-heartedly throws it on the field. “That’s it,” he says.

***

Every morning he walks to the OR, past glass-fronted cabinets bursting with glimmering vials of anesthetics, antibiotics, analgesics, and antiseptics. Stainless steel, polished glass, the wisdom of refractive fluids. Rows, millimeters, cubic centimeters, milligrams—all of it sneering at him, sneering at whom he supposes himself to be and what he supposes himself to do.

In the holds of tankers, in the bellies of transports, on the backs of conscripts, all the ordnance in the world has been transported to Vietnam: bazookas, flame throwers, hand grenades, shells, mortars, M60s, armor-piercing bullets, and napalm. And in the center of it all stands a hospital, an oasis of healing where Lieutenant Matthew Barrett is expected to make everything alright, to fix it all, to fold it together nicely and neatly. Edges, corners, symmetry. Smoothness, precision.

He is training himself to work in a vacuum, to ignore everything that doesn’t have to do with this abdomen, this spleen, this suture. That’s all there is. That’s all he will let himself see. He no longer operates on people; he operates on conditions, conditions that have no significance beyond that which can be measured with a thermometer, imaged on an X-ray, clamped with a hemostat.

He lives at the end of his scalpel, drawing it blindly through layers of anesthetized flesh—revealing, exposing. Through it all, Henderson’s voice booms at him: Exposure, Barrett! You must have exposure! Exposure in surgery is everything. If you can’t see it, you can’t fix it.

Transections, eviscerations, exsanguinations, amputations, decapitations, disembowelments, penetrations, disarticulations, emasculations, enucleations, incinerations—these things he has seen. But of late he chooses to see only the glimmering vials. His vision fades and darkens as he draws closer to the OR where the ultimate reality lies prepped, draped, framed, and illuminated, waiting for the surgeon to fix it all, to make sense of it all.

Exposure in surgery is everything.

Michael J. Collins is an orthopedic surgeon and author of All Bleeding Stops. He can be reached on Twitter @mjcollinsmd.

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