An excerpt from One Pocket.
I reported to Walter Reed Army Medical Center on August 25, 1969. The complex was in Bethesda, Maryland, about thirty minutes from the White House. Founded in 1909, it had cared for every president of the United States, along with members of Congress and the Supreme Court. It had 1,122 hospital beds and treated more than 750,000 patients a year.
I was assigned as a medical assistant, the Army’s catch-all term for everything from lab work to bedside care. Because I’d majored in biology at Albion College and had spent time in my father’s medical office drawing blood and developing X-rays, the Army decided I qualified. I was assigned to help manage the postoperative care of wounded soldiers returning from Vietnam, specifically those with serious head and neck injuries.
On a clear September morning, I was told a new trauma patient had come in overnight, and I’d be helping manage his dressings and general care under our reconstructive head and neck surgeon. His chart said he was twenty-one. A projectile had taken a good part of his lower jaw. He’d been stabilized at a hospital in San Diego and sent to us for reconstruction.
I found him sitting on the edge of his bed, a bandage wrapped around most of his lower face. When he lifted his head, I saw a sadness in his eyes I hadn’t seen since I’d visited my Aunt Cuffy some fifteen years before. I introduced myself and offered my hand, which he took. He waved at his own face to let me know he couldn’t speak.
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I told him I’d be helping with his care and his dressing changes. What I didn’t know yet, what nobody had told me, was that you never let your face show shock or distress when you unwrap a dressing like that. Patients watch your expression and read it as the verdict on how bad things really are.
I didn’t know that yet, so when I saw he’d lost nearly his entire lower left jaw, including part of his lip, I cringed. After an uncomfortable silence, I said, “Sorry, Jake, but I’m new to this and must admit I’ve never seen an injury like yours.” He couldn’t speak, so he just waved my comment off like he was shooing away a fly.
Jake couldn’t take food by mouth, so a feeding tube ran through his nose and into his stomach. Twice a day, I delivered his liquid diet and connected the bags to that tube. Over the following weeks, he went through several reconstructive procedures: bone grafts to rebuild his jaw and local soft-tissue flaps rotated in to reconstruct his cheek and lower lip. Somewhere in the middle of all that, I became genuinely intrigued by the reconstructive process itself.
I asked his surgeon if I could observe the last two procedures. Watching the preoperative planning (which flap, based on blood supply, tissue thickness, shape, and location) was fascinating on its own. Watching it happen in the operating room, seeing the flaps elevated, mobilized, and attached, was an experience not many people get to witness. But by far the best part was watching Jake’s recovery afterward. The reconstruction didn’t just restore his appearance and function. It lifted something in him.
It was a big day for both of us when his jaw and the floor of his mouth were finally reconstructed and his feeding tube came out. He started eating on his own, gained back some weight, and smiled more than he had when I first met him. Not one family member visited him or wrote to him the entire time (nearly a few months), but his strength and his spirit kept slowly improving anyway.
On a cold, windy morning in mid-December, I walked into the ward and saw someone had set up a small Christmas tree near the entrance. I went to check Jake’s chart, and it wasn’t in its usual slot. Looking down the ward, I saw his mattress rolled up at the foot of an empty bed. I asked the clerk where he’d gone. “His bed was empty when I came in at 5 a.m. this morning,” she said.
That was it. No goodbye. No forwarding address. I never saw Jake again.
I stood there a long moment, and it hit me that patient care was about a lot more than drugs and surgical technique. Jake’s transformation had restored something beyond his face and his ability to eat on his own; it had restored his dignity. I don’t want to overstate it. It wasn’t like a light came down from heaven and a sign appeared reading “Joseph W. Rucker Jr., MD.” But my time in that ward, and my part in Jake’s care, sent me home to sit down and write myself an honest assessment.
The bad column was long: no financial help from my family for more school, a 2.3 GPA from Albion against medical schools that wanted better than a 3.0, and a fair amount of time I’d simply wasted. The good column was shorter but held up better: The Army had already taught me that no one takes care of you if you don’t take care of yourself. I had a biology degree. I didn’t want a life of scraping by. And if a Black man in Mississippi could become a physician back in the 1920s with every door in the world shut in his face, I didn’t have much of an excuse.
So I decided to concentrate on the good column.
“The level of one’s willpower is determined by how one rebounds after hitting rock bottom.”
Joseph Rucker is a plastic and reconstructive surgeon.
