Juicing Out — An Excerpt

A surgeon must make the most difficult cut of his life—or die trying. A steep descent into the ordered but claustrophobic mind of a surgeon as time runs out on his most significant patient…

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Sam Vogel is a brain surgeon, one of the best. He’d better be, because on this night he’s going to be taken to the very brink of his skills and endurance. And before it’s over, he’ll know exactly what sort of stuff he’s made of. Literally.

˃˃˃ A far surpassing tale of surgical suspense that will leave you breathless. And pale.

This is one of those stories that pretty much wrote itself. The idea came to me in my exhaustion one night. It sat in my brain, worming its way around like a parasite of some sort until I had to write it down after a few weeks. I’m glad I did. I think it’s pretty good and I’m betting you’ll think so too. Fair warning though, it’s intense. Jesus Mother Mary intense. 

And it’s a novella, about 16,000 words. Which is to say several hours of awesome reading. Perfect for the commuter: planes, trains, or automobiles.

An excerpt from JUICING OUT
by Edison McDaniels, MD

The sound was piercing, high pitched, and shrill, but quick and elusive the way a chirp is at once there and not. Irritating too, the midlife equivalent of that old elementary school trick of dragging one’s fingernails across a chalkboard. That chirp was a curiously instantaneous sound, lasting, I came to think of it as defining, an instant. And that instant came again (chirp), and again (chirp), and again (chirp). I timed it later—not because I wanted to but because I had no choice—and found it to be exactly thirty seconds. Oh sure, sometimes it seemed shorter, like maybe only fifteen or even ten seconds had elapsed since the last chirp, but then I would watch the second hand of my timex jerk forward and when the counting was done the interval would be those same goddamn thirty seconds. No sir, that lousy smoke detector was never off by so much as a tick. 

I guess maybe it was my sanity that was off.

But that all came later. Just then, at o’dark thirty on that lousy morning, all I knew was that that little birdie of a smoke detector was driving me nutso. I had been up for the better part of two days and I should have been sleeping. My body needed it and I certainly wanted it. A half hour before I hadn’t even bothered to undress. My butt hit that mattress and I fell back like some sort of boneless waif. I was probably asleep before my head even hit the pillow. But some sounds are designed to be heard no matter what, even through a dead sleep—especially through a dead sleep as it turned out—and that smoke detecting little birdie chirp was chief among them. Once it started up, no power on earth seemed capable of canceling it.

If I’d have had a shotgun I’d have blown that goddamn birdie off the ceiling and out of my life. But I didn’t and so began the trouble.

 

Six hours before, I had just finished my third crani and seventh operation in thirty-six hours. I crack heads for a living, as in brain surgery, not bouncing. It was already going on eight in the evening and I was looking forward to mashed potatoes and a chicken-fried steak at the Hungry Peddler followed by some quality time with my pillow. My week of call had less than twelve hours left. Better yet, I had a week of vacation to follow, though I hadn’t planned much aside from driving over to Minneapolis to see my daughter and her family. I had left that idea open though, maybe I would show up and maybe I wouldn’t, so they weren’t expecting me at any particular time. 

My third crani had been a teenager named Junious Flagg. He should have been in school but was out joy-riding with his buddies instead. He arrived smelling of whiskey and I later heard the cops found two empty bottles of Night Train on the floorboards. I guessed he’d had his head out the window, maybe in his cheap whiskey stupor he’d actually been trying to climb out I imagined, when his buddy spun out on the shoulder of the road and Junious took a stop sign to the face. He’d come in seizing, his lips and fingers hypoxic blue and arms and legs flailing like some version of the horizontal funky chicken. One side of his face was hard to look at, a red pulpy mess. But the far bigger problem for him was the clot I saw pressing his brain inward on the CT. We went to surgery on the spot, without bothering to pass go or collect $200. Two hours later, after removing a fair portion of his skull and sucking out the clot along with several good sized pieces of wood, I gave his brain only a fair chance of ever allowing him to wake up. His face was at least covered with skin again, though if he lived he wasn’t going to be impressed with his new look. I was getting him tucked into the ICU when another call came.

‘Another call’ turned out to be a major trauma alert to the ER. One of those all hands events, choreographed chaos. The patient hit the door, another young man, and was whisked straight to the trauma bay. He wore international orange and was awake and talking, though what he was saying was anybody’s guess. His speech was thick and mostly unintelligible, like he had marbles in his mouth. That wasn’t the most of it though. Wrapped around his head was a thick and bloody bandage of a sort I hadn’t seen in all my twenty years of practicing neurosurgery. It looked for all the world like an adult diaper.

It was. I confirmed this a short time later in the OR. Just then though, I was trying to figure what had happened and what needed doing to save his life. The rapid beep-beep-beep of the heart monitor filled the room. Somebody hollered “100/60” and I saw a nurse pull a pair of shears from her smock and start cutting his clothes off. It was done fast and was followed quickly by an intern sticking a finger where the sun doesn’t shine. “Good tone, no blood,” she said to nobody in particular, then went to work sliding a catheter up the shaft of his manhood.

The patient didn’t particularly appear to like this, but then again he probably didn’t like much of what happened over the next several minutes. A lab tech stuck a needle in his arm and blood dribbled from it onto the floor. An IV was started. His arms and legs flailed and at one point he kicked one of the orderlies holding him down. I stepped in and shined a light in his eyes, which were both reactive, and he squenched them closed in the next instant. He opened them again, seemed to gaze at me with a sort of distant, languid look.

“You got what you need, Sam?” somebody asked me.

“What’d you say happened here?”

“Don’t know for sure. He was out in the woods, deer hunting by the looks of him, and was found on the wrong side of a ridge by his buddies.”

“A deer stand diver?” Every year we saw a dozen or more folks who’d fallen out of a deer stand, maybe because it had rotted in the off season, or they had fallen asleep with boredom, or, and this was the grand winner in terms of numbers, because they had mixed guns and alcohol. One year I had a guy who had dropped his shotgun over the side in his beer stupor. It blew the top of his head to smithereens when he peered over the edge just in time to see it striking the ground.

“Not so far as we know.”

“The diaper?” I asked.

“His buddies carried him out. Drove him to the local ER I hear. I guess they used what they had.”

I thought about asking if they were hunting in diapers, but I let it go. “His head?”

“Nobody knows,” he looked at me, asked again, “You got what you need?”

“Yeah, sure. He’s combative and we need a look under that diaper.”

“We’ll get him over to CT as soon as he’s tubed.”

He was tubed, paralyzed, and in the scanner inside of five minutes. I stood with the other docs looking at the monitor as the machine scanned through that diaper. His head was a small ball in the middle of the wad. As the pictures revealed themselves, there was a collective “holy shit,” followed by several loud whistles. To a person they turned to me.

“Anybody think he looks like a deer?” I asked.

Somebody chuckled. The trauma surgeon, Joe Gap was his name, said, “Somebody must’ve thought he did.”

The scan showed several large bullet fragments in the back of his head. His skull had been fractured by the impact and pieces of bone and lead were laced throughout his occipital lobes. Something large and metallic was stuck near the bony prominence at the back of his head. There was no way it hadn’t lacerated the transverse sinus, the big mofo as far as veins in the head go. I looked through the leaded glass at the man laying in the CT scanner, at that stupid looking wrap on his head. Did he look paler than he had in the ER? I had a pretty good idea there must have been a shitload of blood spilled in those woods. Jesus Mother Mary, I thought, and was suddenly glad I hadn’t opted to unwrap that diaper before scanning him. I was shocked they’d gotten him this far alive. This guy owed his life—or the last hour of it anyway—to whichever of those hunters had a problem holding his bowels so severe he’d opted to wear an adult diaper into the woods. I couldn’t believe he hadn’t bled to death out in those woods. I couldn’t believe he’d arrived here talking. Most of all though, I couldn’t see how he was gonna leave here in anything but a body bag. “Shit,” I said, “tell the OR we’re coming. And tell the blood bank I need a half dozen units of O neg. And tell ’em be quick about it.” I turned to Joe. “Can you give me a hand?”

He nodded, “but just remember, I ain’t no brain surgeon.”

 

While they moved my patient down the hall and up the elevator two floors to surgery, I made my way back to the ER. I always try to at least meet the next of kin before operating, especially when the next time I talk with them might be with a priest beside me.

His significant other was in the waiting room I was told, but I found her outside smoking a cigarette. It was cold outside, but you couldn’t smoke in the hospital and there was probably nothing she needed more in that instant than a cigarette. That’s a truism I’ve discovered over the years. I watched her through the glass for a moment. She stood beside a pole (in the spring or summer I thought she’d have been leaning against that pole, but not in the dead of winter; that pole would have burned her bare skin). She held a cell phone in the same hand as the cigarette, but she wasn’t using it just then. I saw she wasn’t wearing a sweater and had her shoulders hunched against the cold. She seemed alone in her misery.

I stepped forward and the doors slid apart. I said “excuse me” and she turned around. She was maybe thirty pounds overweight, the couch potato zone I thought, still a few pounds shy of true obesity with its diabetes, heart disease, and back problems. She had an unflattering ruddy complexion though; not the picture of health. She had the look: she’d been crying and there were rings around her eyes of a sort almost exclusively reserved for those who don’t know if a funeral or a hug is in their future. A wad of kleenex was balled in her off hand. She looked decidedly blue collar in a slightly frayed white maid’s uniform. A name tag pinned over her left breast, above her heart I guessed, said Howard Johnson’s on the top line and Josie in large letters below it. I held my hand out, I like to touch folks (I read somewhere how it makes the interaction more heartfelt for them), and she stuck the kleenex in her pocket after a moment of hesitation and took my hand in hers. 

“Is he…” Her voice had a smoker’s phlegmy rattle.

“No,” I said quickly, maybe too quickly I thought afterwards, on the way up to the operating room. “But it doesn’t look good.”

“He gonna make it. Has to, that’s all. Has to.”

Saying it doesn’t make it so I thought but didn’t say. “Why don’t we go inside.”

She took a last drag on the cigarette and stubbed it out under her shoe on the icy sidewalk.

When we were seated in the privacy room, I said, “My name’s Sam. I’m a neurosurgeon.” I paused. Nobody is ever happy to see a neurosurgeon and the realization can come as quite a shock. “He’s hurt real bad.”

“Neurasurgeon. That a brain surgeon, right?” Her eyes loomed large before me, but they never actually looked at me. Like she was afraid to make eye contact. Or maybe she was just overwhelmed. Maybe she was used to taking her cues and getting her words from others. Mostly men I thought. I thought too how those eyes had a hard edge to them. One of them had a tinge of blue beneath it, like an old bruise.

“Yes ma’am. Just now I’ll be taking him into surgery, the back of his head…” I indicated my own head with my hand, “…it’s busted up pretty bad.”

“What you think, Dr. Sam? Does most people what have a busted up head make it? Or does they go to ground?”

I had never heard that term before and there must have been a quizzical look on my face.

“That how my grammie used tuh say it. You think he’ll go to ground, Dr. Sam?”

“Actually, it’s Dr. Vogel, Sam’s my first name. May I call you Josie?” I didn’t wait for an answer, there wasn’t time. “And I don’t know if he’s going to ground.” But there’s a damn good chance of it, I might have added but didn’t.

“He cain’t go to ground. Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I know he love me.” She almost looked at me then, and I thought Who gave you that shiner Josie? Did Bobby—your ain’t no bad guy man—do that? 

“I ain’t never had no one to love me before. I know something about bad guys and he ain’t one.”

I thought she probably did know something about bad guys. Looking at her, I thought maybe she could write a book about bad guys. I said, “I’ll do my best.” But don’t expect too much, cause that’s a big ol’ bullet somebody put in Bobby’s head, bad guy or no.

She bucked up then, and nodded at me. She looked in that moment like she had seen life at its worst and this wasn’t it. She looked like she had faith in me.

 

A few minutes later, I was standing in the operating room looking down on Bobby. I knew there was gonna be a bloodletting like nobody’s business as soon as I unwrapped that diaper. Normally, I’d have called my partner to assist me on something like this, but there wasn’t time. Joe was right in that he wasn’t a brain surgeon, but he was a damn good trauma surgeon and wouldn’t faint when things turned to stool.

They turned to stool in a hurry.

I put on a pair of gloves. We had just moved him off the gurney and onto the OR table, his skin felt cold and clammy, when the assault began. “Pressure’s dropping,” one of the anesthesiology folks said. I glanced over his direction and saw six people, each doing their damnedest to keep this guy breathing. “We don’t have any blood yet?” I asked. We turned the guy up on his side and propped him there with a pillow. I positioned an orderly at the man’s back. “You don’t move,” I said. “Pretend you’re a seatbelt.”

“No blood yet,” one of the gas passers on the anesthesia side of the table answered, “even O neg takes some time.”

I turned to Joe, who turned to the circulating nurse, a young beauty named Alyssa. “Get on the goddamn phone and tell them send whatever they got. Tell them he ain’t picky.” By he he meant Bobby of course.

I looked down at the diaper and saw a new flush of red seeping out from somewhere near what had to be the back of his head. The rapid beep-beep-beep of the monitor suddenly hiccoughed, Bobby’s heart had dropped a beat or two under the strain, then became steady again. “How long?” I asked Alyssa, who was standing on the other side of the room and must have read my lips. No way she could have heard me in that confusion.

“Maybe ten minutes.”

Joe mouthed a reply back. “He’ll be dead in five.”

It was Shock 101, first year med school stuff. Bobby was losing blood, the so-called effective circulating volume. I thought he had arrived to the ER having already lost a good bit of the red stuff, maybe a quart. It couldn’t have been much more than that. He had been confused, maybe a little pale. But he had been awake and his heart rate, although fast, hadn’t been skipping beats. He’d been in Class I shock when he hit the door, which by definition in a guy his size worked out to a quart of blood, about 15% of his effective circulating volume if I had my figures right.

He was damn sure beyond that now. The tracing on the monitor showed Bobby’s heart was doing periodic back flips, meaning it was having trouble keeping up with demand. The folks at the top of the table were trying hard, breaking a sweat and dancing like there was no tomorrow. They were giving him salt water in the absence of blood—which meant they were giving him volume but no life saving red blood cells, a trick that would buy a few minutes tops. Pretty soon Bobby would start bleeding water and before too long he wouldn’t even bleed that. 

I had seen that once before, bleeding water. A little baby I worked on as a resident in training. That poor kid had been shot as well—his father had blasted away the top of his head with a shotgun—and we couldn’t begin to stop the bloodletting in that case. “Looking pretty thin down here,” I hollered when the stuff coming out his wounds was no more than pink salt water. That baby’s heart stopped, started, stopped and started a dozen times before it finally gave up the ghost and we pronounced him. I could have read a newspaper through the watery stuff coming out his veins by then.

Bobby’s heart wouldn’t last that long. He had probably lost a quart and a half of blood, maybe even two full quarts, by then. Half a gallon of milk. He might survive losing a third quart—though he’d probably have a stroke and speak gibberish for the rest of his miserable life—but he damn sure wouldn’t live to shoot another deer if he lost a fourth, which would bring him up to the magic and lethal number of forty percent blood loss. Everybody goes to ground at that number.

He looked pale. Like instead of a bullet to the brain he’d taken a vampire to the neck. His blood pressure was ninety over thirty one moment and sixty over fuck the next. If he had been awake and not anesthetized, he’d have passed out. He would have fainted and never awakened. Yes sir, he looked like a forty percenter to me.

Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I thought Bobby’s days of doing her were just about over.

I stole a glance at the scrub tech. She was frantically trying to get the instruments laid out and ready. I glanced at the table, saw a scalpel and a mess of hemostats, scissors, clamps, and sponges. I thought it probably wouldn’t be enough. I thought it had to be enough. Jesus Mother Mary. You wait any longer, I told myself, you’ll be operating on a cadaver.

“I can’t wait,” I said. “Help me with this, Joe.”

Together we unwrapped the diaper and the crown of his head came into view. He was mostly bald, middle-aged or better I thought. I hadn’t asked his age in the confusion, not that it mattered much now. His age would be on his tombstone after all. No confusion about that.

The skin at the back of his head was torn and bruised. I saw that much. Then Joe pulled the diaper off the hole in Bobby’s skull and the damn burst wide. A sea of dark blue, almost black, blood. For an  instant, it poured out like somebody had diverted Niagara freakin’ Falls into that broken head…

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One thought on “Juicing Out — An Excerpt

  1. This excerpt reads great. I couldn’t stop reading, even though I had no time. I already bought the book last July. I hope to find time to read it, soon.

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