PAYDAY | Daniel Boron-Brenner

It is late for us. The night is waning, and daylight fast approaching. The department has been ministering to the city for hours yet, so that when the man comes barreling through the bay doors we are ready for him. 

He tumbled at work today, from the basket of a scissor lift 30 feet in the air. He was slinging electrical wire outside when a wind picked up and pushed him over the guardrail. He fell from the basket, all the way down, first onto his knees and then his thighs and then striking his head. His face is covered in cuts and bruises, but his femurs obviously took the brunt of the impact. They are exposed, bone the color of tea shattered in multiple places. He is lucid and a little snowed, cresting alternating waves of pain and fear, as well as the morphine judiciously administered by the medics.

The team moves smoothly. I call out orders as hands glide over him. Some place IV’s, others take his blood pressure. The resident at his head looks into his eyes with an otoscope, seeing his pupils constrict smoothly and drop away to little black dots with the light. We call out to each other, back and forth, ensuring that vital organs—his heart, his brain—are intact.

 He takes it all in stride. More doctors come in. The trauma team, in one’s and two’s, with the trauma surgeon himself blearily walking in last. As they do their own evaluation, I walk up to him and place my hand on his chest. I tell him my name, tell him we will take care of him.

 He looks up at me. His eyes are blue.

 “OK,” he says.

Back at my computer. I assign the trauma surgeon’s name to the patient’s chart, the patient’s name unknown and now a deliberately anonymous jumble of state names and Greek letters. I know our patient is 37 years old. I may find out later he is a family man with concerned parents who will soon stop by. Maybe I will meet his kids and update them on their father’s condition. I may never know anything about him. 

People filter back to the department. I ponder the man in our bay for a few more moments, then get back to work. There are other people to see; the sun is rising soon. I end the shift with an older woman, a little hungover from a lifetime of cocaine and alcohol, telling me about her arm pain and how her belly feels hard tonight. Orders have already been placed, the train is about to leave the station, and I just nod my head at the things she tells me while pressing and prodding her shoulder. I think she’ll go home. I hope I will leave soon too. 

Eventually the relief comes in. Its 7 am. They’re bundled up against the winter morning, and as they take off their outerwear, I wearily pass them first the shift phone and then the patients to go with it. It wasn’t a bad night, just busy. Some patients were sick, like the man that fell, but most were routine. There are always the ones coming in on nights like this, seeking solace from the cold. Or the people who drank too much and stumbled, or got into fights, or crashed their car. Routine issues for a Saturday night in our little corner of the world. 

I thank the residents as I leave, ask if anyone has any questions, and then I’m out the door. The wind is bracing, diamond sharp as it hits my nostrils and cheeks, but there is also something enlivening about the air, penetrating as it is in its depth and longing. I jump into the car, turn on the heat, brace my hands against the dash as it warms. “Hung Fire,” a Christmas song, begins to play. I put on sunglasses and watch through polarized lenses as the night folds into the day. There are people out now, an early morning hospital crowd, who step on crisp, oblivious feet around what remains of the evening. I nudge my car out and seeing it’s clear, rapidly leave the parking lot behind. Like an octopus discharging its ink, I am propelled on this jettisoned life. At least a facet of it and only, honestly, for now. 

The world goes gliding by. There is a false sobriety to the morning after a shift. I don’t feel intoxicated, just more lucid than I should have any right to be. I think over last night’s patients. Faces. Names. Their chief complaints. Sometimes it’s obvious what ails them. A new pain in the chest as coronaries tighten and tombstones bloom all over the ECG. A gunshot to the arm. Maybe a baby that needs to be born, hurtling herself out (and hopefully into your embrace) just as you are prepping for delivery.

Sometimes it isn’t. Sometimes you meet someone and they tell you something, and you see a whole constellation of pain behind their eyes. You swim through their history, and as you swim your arm glances against a part of something large and dark in the water. Just touching the tip of whatever massive thing has passed you by. 

The car pilots itself home. I turn up my street, then down the driveway. I stop the car and sigh, a wave of exhaustion coming over me. I walk inside, putting down first my bag and then my coat, and finally taking off my shoes. My kids are up, and come running towards me. I take one of them in my arms and then all of them and I feel my heart open. My wife comes over. I give her a kiss. We are both tired. 

Soon I am in a t-shirt and sweats, plodding around the kitchen as my family prepares for the day. I pour myself a small glass of whiskey, the ER doctor’s breakfast. I don’t drink much, honestly, but I am tired and the liquor helps keep me asleep. My children run up to me and ask me about the night.

“How was it?” they cry.

“Oh fine,” I say. “Fine.”

I head upstairs after they go to school. I put my head on the pillow and close my eyes and it all just fades away.

I sleep. I dream, of great heights and of a conspiracy of missteps. I fall and in my falling I startle awake. I look around me. I am alone.

I finally wake up for real a few hours later. I log back in to finish a few charts and check my email. While I’m finishing up work, an email comes through: deposit received. Lo and behold, a bi-monthly payment has sailed my way. 

Sometimes the money is worth it. A day here or there can be rote, even mundane. Most hum along at a brisk clip. A few are hair-raising but not all of them, and on those days when it is hitting the fan, I have a capable team to back me up. They are good people, the men and women to whom I am bound. They understand the work, and comprehend the sacrifice. But the sleeplessness, nights and days alike, may do me in. And the uncertainty. That strange dance, cat on a hot tin roof. If you’re not jazzed by the shift itself, then you stay awake, wondering if you did the right thing. 

What did Hemingway say?

“I love sleep. My life has the tendency to fall apart when I’m awake, you know?”

I finish up the charts and am about to log off when I see a message from our chair. Someone in the group is sick. They’ve given permission for us to be made aware. The message is short. Metastatic cancer, recently discovered. They’re undergoing treatment. Someone has started a GoFundMe page for their wife and kids.

I know them. They’re a year younger than me. I sit in a kind of benumbed silence, hands folded in my lap. I wonder how he’s feeling right now. I wonder if his kids know. I picture his face, often smiling, never complaining. I look into his eyes. They’re blue too.

There’s never any escape from the job. 

I call down to my wife, working in the first-floor office. 

“Hey babe,” I say. “Lunch on me today?”

Daniel Boron-Brenner is a practicing emergency medicine and palliative medicine physician in Philadelphia. Boron-Brenner's work is inspired by a multitude of experiences and sources, especially the ongoing adventure of training (and now working) as a doctor while also raising a family of three boys with his wife, Cris. He enjoys reading (especially anything by Michael Ondaatje, Zachary Mason or Dwight Garner), eating his way through the Philadelphia area and traveling. Ask him about the last eclipse he saw.

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