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Notes from a Healer

Sunday Morning Requiem

A summer Sunday morning: bright, clear, warm. I’m outside, repairing the lattice-work on my front porch. The excavators destroyed a panel with their backhoe when they dug down deep to replace the sewer drainage pipe. After enduring several frustrating days with four children in the house, I’m thankful that our sewage system works again.

My children are camped outside as well. While the girls play together on the front porch, the boys watch me work. I measure a board and proceed to cut along the pencil line with my hand-held circular saw. My boys cover their ears with their hands as the blade’s teeth tear through the wood.

I hold the board in place and reach for a hammer. Suddenly I hear a shout behind me in the street. A young boy breathlessly calls my name. “Can you come down to church?” he pants. “Some kid fell down and hit his head.”

I can see the brownstone church from where I’m kneeling, less than a block away. I lay the board down, instructing my twelve-year-old to keep an eye on his younger brother and sisters. I start down the driveway, then remember the circular saw. Quickly I retrace my steps and unplug it. “Don’t touch the tools!” I shout, as I trot after the young boy down the street and over the grassy knoll.

I push through a small circle of children outside the brick church school building and bound up the stairs to the youth room. There, lying on the sofa flat on his back, is an adolescent boy. A man bends down over him, applying cool wet paper towels to the boy’s chest. My ears pick up strained, irregular breath sounds, coupled with garbled gurgling noises from the boy’s throat.

“What happened?” I ask, tilting the boy’s chin back slightly with my fingers.

“We were playing up here during the church service,” my young guide’s voice pipes up. “He screamed and grabbed his head, and then he fell over.”

“Did he hurt his head before he fell?”

“No, we were just running around.”

The adolescent’s face is pale. My chin lift maneuver did nothing to improve his breathing pattern. “Let’s turn him on his side,” I say, directing the man to help me roll the boy’s body as a unit: head, neck, torso. When I peel back one of his eyelids, the dilated pupil does not respond to the light.

“Someone call 9-1-1!” I shout, steadying the boy’s back.

“They’ve already been called—the ambulance should be here shortly.”

A policeman rushes into the room, carrying a large aluminum case. He pulls out an oxygen tank fitted with a mask and pressure-delivery device. “What happened?” he asks.

I tell him what I’ve learned, and then I say: “I think something’s going on inside his head. His pupils are dilated, and he’s not responsive.”

The policeman positions the mask over the boy’s face and delivers a short burst of pressurized oxygen. The boy’s chest does not rise.

“He may have aspirated; his breathing is irregular,” I tell him.

The ambulance crew arrives. I tell them the story while they prepare to transport the boy. “Where are you headed?” I ask them.

“To the school yard down the street. We’ve radioed for Life Star helicopter support.”

I follow the team out of the building, pushing through the gathering crowd. Someone calls my name. I turn my head to find the eyes of the boy’s mother staring intently into my own.

“What’s wrong with him?” she asks. She knows that I work in the medical profession.

“Not sure. He complained of a bad headache, then collapsed. Was he hit in the head recently?”

“Last week. He jumped a pasture fence trying to get away from a goat and fell onto his head. We took him down to the emergency room, but they said he was fine.”

I hop into the back of the ambulance, and we ride down the street to the school. As we drive out onto the grassy playing field, I can hear the helicopter hovering above the baseball diamond. It kicks up quite a bit of dust before dropping gently down to the earth.

Members of the transport team open the back doors of the ambulance and pull out the stretcher. One paramedic balances a cardiac monitor on the boy’s chest. I grasp one corner of the litter as we race across the field toward the helicopter.

Suddenly the tracing on the oscilloscope of the cardiac monitor flat-lines. Immediately we drop the stretcher to the grassy field and apply defibrillator paddles to the boy’s chest. Someone shouts “Clear!”—I see the torso jump. A rhythm pattern appears, then falters again.

“Go, go, go!” a technician shouts, motioning with an outstretched arm toward the chopper. We hoist the stretcher onboard, the crew climbs in and the chopper lifts off. I turn my head, hold my arm up across my face and cough in the dust.

Turning around, I find myself once again face to face with the boy’s parents as they stand together at the edge of the field. All sorts of people are milling about behind them. Some look up to the sky, shielding their eyes with their hands. Others stare quietly in my direction.

“What are his chances?” the father asks me.

I open my mouth to speak, but the words don’t form in my mind.

“He’s only thirteen,” his mother says, “much too young to die.”

The whirring blades of the helicopter gradually die away in the distance. Like the muffled sounds of a child’s failing heart, they leave only a thundering silence inside my own head.

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine. Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care. His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. "Sunday Morning Requiem" is an excerpt from Mr. Maurer's newest book, Village Voices.

Published: June 1, 2007