The face of death: case history, literary histories.

Abstract

THE FACE OF DEATH: CASE HISTORY, UTERARY HISTORIES RICHARD E. PESCHEL* and ENID RHODES PESCHELi The Tunnel Our hospital is divided, basically, into two buildings: die antiquated one, still in use, was constructed about 1900; and the odier, more modern , was built in die 1950s. Some of the integral parts of the hospital— for example, the Emergency Room (the ER) and die morgue—are located in die old building; whereas other essential sections—including die Intensive Care Unit (the ICU) and the Coronary Care Unit (the CCU)—are situated in the new building. The buildings are linked by an underground tunnel. Because of diis haphazard arrangement, patients often have to be transported through the tunnel from die old building to die new one: diat is, many patients brought in on an emergency basis—someone widi a suspected heart attack, for instance—must be admitted dirough die ER in die old building and then conveyed on a stretcher to the new building, via the tunnel. This tunnel is like no odier. It is long (approximately one-and-a-half city blocks from end to end) and narrow: about two stretchers wide. Its gray cement floor looks worn, as though scarred widi die weight of all the feet and wheels diat have hurried over its sunless surface. Yellowish, rectangular tiles line the walls. Their jaundiced appearance recalls die pollution-tainted tiles of tunnels that wend dieir ways beneath rivers. But here there are no cars or honking horns or smiling faces in vehicles; no policemen standing guard along die walls; no toll-takers, eidier. No visible toll-takers, at any rate. Yeteither before or after diis tunnel, a toll is certainly taken, of that you can be sure. The traffic through this subterranean passageway, you have surmised correcdy, is exceedingly strange. Though it is assuredly physical, a com- * Assistant professor of therapeutic radiology, Yale University School of Medicine, New Haven, Connecticut. t Editor, Medicine and Literature. Address: 1 1 Manor Drive, North Haven, Connecticut 06473.© 1983 by die authors. 0031-5982/83/2603-0390$01.00 394 I Richard E. Peschel andEnidRhodes Peschel · The Face ofDeath bination of bodies and equipment, it is also almost eerily ethereal. One might expect to see ghosts or phantoms curling through die corridor. The ambience in this roadway underneath die ground, this lower roadway—this via inferna, as the ancients might say—is heavy, congested, and oppressive. You have a hard time breadiing, even if you are healdiy and not in distress, like the patient on die stretcher. The only sound you hear is the droning of die ventilation fan. You wonder if it is really working, the air of this place is so stale. There are no windows, but it is bright. Fluorescent filaments fling down light from above and make you squint. Except for one curve, the tunnel is straight. Ifyou stare directly ahead, you think that you are caught in an almost endless tube. The interns in our hospital hate this tunnel, curse it, dread it, and must travel through it time and time again. They loathe it for good reason. When an intern "on call" in the new building is assigned a new patient who is considered critically ill (e.g., someone being sent to the ICU or die CCU), diat intern has to go through die tunnel, pick up his patient in the ER, and accompany him to the new building—through die tunnel. Thus, the intern has to make this terrible trip twice: once widiout his patient, and once with him. Because the patient is probably gravely ill, he is hooked up to all sorts of life-sustaining and life-monitoring equipment: a cardiac monitor and intravenous poles, for example, and perhaps some other emergency gear. There is also a defibrillator, in case the patient has a cardiac arrest. The incessant nightmare of every intern in our hospital is diat his patient's heart will stop or that his patient will stop breathing in that tunnel. For die intern knows that when he is in there, he himself is the only medical person on whom he can call for help. In that tunnel, an intern is so isolated, in fact...