LIFE IN AN EGGCUP by John Gamel
David Johansen was never my patient, but I remember him well. His story remains legend to every doctor and nurse and medical student who worked at Stanford Hospital during his two-year admission, which began with a three-month stay in the ICU, followed by nine months in the TCU and almost a year on rehab. He was in bad shape. His motorbike had run headlong into a parked car, catapulting him into the middle of a busy street. Speed–of both the chemical and kinetic variety–was involved. Roy Cohen, Stanford’s Chairman of Surgery at the time, described David’s internal injuries as “too numerous to count.” No one knows how many vehicles ran over him before traffic finally ground to a halt, but the first California patrolman to arrive at the scene reported that the truck trailer whose rear wheel rested on David’s right knee was loaded with six junked cars.
By the time they got the poor fellow to the ER his right leg was coal black, swollen to the size of a log. Six weeks later he awoke from a coma to discover that his leg and speech and control of bowel and bladder were gone forever. A rehab worker taught him to type with two fingers. The day before his discharge to a nursing home for what would in all likelihood be a lifelong habitation, he typed “A Farewell Note to My Stanford Family,” a rambling, poetic commentary on his life among us. Most memorable was the following excerpt: “In that wreck I lost four things: my leg, my voice, my bike, and my girl. The one I miss the most is my bike.”
David was the exception. In the house of surgery, amputation inhabits the darkest room. Doctors are meant to heal, take away sickness, but the joy of victory is lost when this taking away carries with it an arm or a leg. Surrendering a nonessential organ–a ruptured spleen, an infected appendix, a stone-laden gallbladder–brings little grief. Even the loss of a cancerous kidney or lung strikes a happy bargain with death. The patient who awakens from surgery without an arm or a leg, however, will never be the same, inside or out. Even when chronic infection has reduced a limb to a festering, cumbersome mess, amputation brings with it a devastating sense of loss, so much so that many Vietnam veterans limped about on crutches for years before surrendering their withered legs to the surgeon’s knife. During my orthopedics rotation, the chairman advised his residents to start their patients on antidepressants two weeks before an elective amputation, hoping to blunt the depression that often followed–a depression sometimes so severe it led to suicide.
* * *
I never suffered an amputation, but I did have a near miss, as attested to by an ugly, bone-deep scar on my right heel, the stigma of a broken hip when I was five years old. The general practitioner who wrapped a plaster cast from my armpits to the soles of my feet did his best, but his best was too tight. The medical term is pressure necrosis. If the wrong bacteria had infected the dead flesh on my heel, the resulting gangrene could have cost me a foot, perhaps a leg. Still, all things considered, I have nothing to complain about. Or do I? This has always bothered me: my father was six-foot-two, yet I never made it to five-eleven, thanks to an early growth spurt that petered out when I was only twelve. And another thing: my legs are too short. Were they proportional to my trunk, I would be the same height as my father. Did that broken bone stunt my growth?
That’s what happened to Jerry Silverberg, the chief neurosurgery resident during my internship at Santa Clara Medical Center in 1971–72. A drunk ran over him when he was seven years old, shattering the bones of his lower legs. Jerry showed me the scars, jagged black lines running down his shins, where fragments of bone had been driven into the asphalt. Though his father was over six feet tall, Jerry stopped growing at five-eight, and every inch of this disparity was a bitter pill. Fate gave him many gifts, including charm and genius and–according to no less an authority than Jake Hanberry, Stanford’s Chairman of Neurosurgery at the time–the best hands in the business. But Jerry’s sense of humor was vicious, and when he lost his temper everyone in shouting range headed for the hills. A handsome enough fellow, but without those stubby legs–what an Adonis! The man was pissed off. I don’t blame him. He later became Chairman of Neurosurgery himself, yet his reign was marred by an enduring bitterness that renewed itself every time he looked up at a taller man.
* * *
In the darkest corner of amputation’s dark room there lives an obscure operation, a procedure rarely performed but nonetheless horrific, an unspeakable mutilation of the human body. The name– hemicorporectomy–tells its own story: hemi is Latin for “half,” corpor is Latin for “body,” and ectomy is Latin for “excision.” The surgeon, hoping to cure a pernicious cancer, severs the spine just above the pelvis and removes the pelvis with all its contents and appendages–the colon, rectum, bladder, hips, legs, external and internal genitalia–then wraps the remaining organs in an enormous skin flap. A mutilation known in medical vernacular as Eggcup Surgery, since any victim who survives the surgery must spend his or her life perched in a padded receptacle that resembles nothing in the world so much as a giant eggcup.
I never met a patient who underwent hemicorporectomy, but everyone at Stanford Hospital during my era came to know George W., who not only ended up in an eggcup but did so by his own volition. His story began much like Jerry Silverberg’s, with a car that ran over him when he was a child, but the accident left George with something worse than short legs. George’s legs were spastic, drawn up behind his back in a state of rigid disfigurement so profound he could neither lie on his back nor sit in a chair, but had to spend his life chest-down on a gurney. By the time he was thirty, his twisted legs were hard as wood and covered with sores. Not that this handicap kept George confined to his room. Thanks to a special gurney whose wheels his powerful hands spun like windmills, he scooted himself down every corridor of Stanford Hospital. In the cafeteria they moved tables to create an aisle wide enough for his gurney, and here he made friends with everyone he met.
At first it seemed strange–talking to a man who lay chest-down on a gurney, resting his chin on one hand and gesturing with the other while his twisted legs formed a lump under the sheet. Yet day by day, George became less a disfigured patient and more an ordinary person, no different, in any substantial way, from those who sat with him. Well-educated, with a mellow bass voice so much like Paul Harvey’s every new acquaintance commented on the resemblance, he knew current events down to the last detail, and could entertain a table of interns and nurses throughout the lunch hour. And there was something more–an open face, iron-grey hair and eyebrows, a warm smile and a gentle, measured tempo to his speech that brought peace wherever he went. His one idiosyncrasy was an aversion to conflict or any hint of violence. Several times during the Nixon/Watergate hearings–they seemed to go on forever, one venomous debate after another–I saw George abruptly wheel himself away from a table when Nixon supporters and detractors began shouting at each other.
Finally, after a three-month hospital admission, George got bad news from Doctor Chase, the Chairman of Plastic Surgery. Osteomyelitis had rotted George’s left leg into an irreparable state; surgery was the only option. Worse yet, the infection had spread so far up the femur a standard amputation would have left behind a festering core of antibiotic-resistant bacteria in the marrow of the remaining hip bone, and thus, for any hope of cure, Doctor Chase would have to perform a disarticulation–excision of the lower leg and the entire femur, leaving only the smooth curve of the pelvis itself. George consented. What else could he do? He disappeared from the halls of Stanford Hospital for almost a week.
The next time I saw George, he was parked on his gurney beside the Pharmacy counter, chatting with an intern and two nurses. The lump formed under the sheet by the twisted leg was half its former size.
“Good grief, George,” the intern said as I approached, “you been doing speed or something?”
Indeed, George was more animated than I had ever seen him. Propped on both elbows, his face aglow, he talked with boisterous energy, insisting that he felt no pain. (Nonsense, of course–it had taken 120 stitches to close the wound.) The surgery had gone splendidly. So splendidly, in fact, George had hatched a scheme: by hook or crook he would persuade Doctor Chase to disarticulate his other hip.
“Jesus, George,” the intern said, “that’s a nasty piece of surgery.” The intern and I and the two nurses nodded in agreement. We felt embarrassed. George was obviously manic, irrational. Perhaps those decades of illness had finally taken their toll on his mind. The intern said, “Maybe you could just get a regular amputation.” The nurses and I murmured our assent.
“Not in a million years,” George insisted. His face darkened, his brow furrowed. “Doctor Powell says they could never sit me in a wheelchair with a stump like that twisted up behind me. If I ever want to get off my gurney, they’ve got to take out the whole thing.” Powell was the Chief of Rehab Medicine. “That goddamn leg has done nothing but get in my way for 22 years. I’ve had enough.”
At first Doctor Chase wouldn’t consider disarticulating a leg that posed no threat to the patient’s life, but George hassled the poor man for months, until finally Chase sent him off to a psychiatrist, promising they would schedule surgery if George proved to be of sound mind. The Psychiatry Department had a lot of experience in such matters, since they had examined candidates for the transgender surgery Stanford so famously pioneered. After three sessions, the therapist declared George officially sane.
The next chapter in George’s story came from Freddie Tinsdale, a classmate of mine and an intern on the plastic surgery team that performed the second operation. The procedure went without a hitch. George woke from anesthesia cheerful as a new mother, refused his morphine, violated his post-op diet by mooching a slice of apple pie from his roommate, and the next morning wheeled himself down to rehab on his old gurney, where his smooth, legless pelvis would be fitted for a special seat. That evening Tinsdale discovered George giving himself a bed bath. The nursing aides were meant to do that, but George had persuaded rehab to install parallel bars above his bed, and now, unencumbered by those useless legs, one ape-strong arm could support the weight of his body. Tinsdale pulled back the bed curtain to discover the naked upper half of a dangling man soaping his armpit.
On the fourth post-op day, an even stranger thing happened. Tinsdale always choked up when he told this part of the story. About four in the afternoon, the charge nurse on George’s ward paged the plastics team, so Tinsdale, along with his resident and medical student, wandered up to find out what was going on. Nothing much, the nurse said, just . . . well . . . somehow, George had disappeared. After lunch he had propelled himself down to rehab on his gurney, eager to try out his new custom-made wheelchair, but the clerk on the rehab ward swore George had finished his therapy hours before. Calls all over the hospital–to the cafeteria, the ER, the ICU, the Admitting Desk, another to rehab–had turned up no sign of George.
How peculiar: a legless man had gone missing. The nurse sat at the ward desk, staring up at the intern and resident and medical student. They stood in a circle staring down at her. The hallway was silent except for the overhead speaker, which sounded almost constantly, since this was the era before radio-pagers: “Doctor Vinney, STAT to SICU . . . Orderly with a wheelchair, Ward East 1A . . . Blood bank tech, call extension 511 . . .”
Then, suddenly, all eyes were on the overhead speaker. “My god,” the nurse shouted, “That’s . . . It’s . . . Yes!” The plastics team ran down three flights of stairs, into the basement where two page operators sat huddled in a cubicle. The team crowded around the doorway. There was George, microphone in hand, perched in his new eggcup, mounted in his new wheelchair. A set of earphones embraced his head. He plugged his earphones into the telephone switchboard. The voice was unmistakable: “Doctor Coursey, they’ve got a walk-in at the ENT clinic, and he’s been waiting almost an hour.” Finally George noticed the doctors standing in the doorway and looked up. His face burst into an ecstatic smile.
“My first job,” he shouted, tears streaming down his cheeks. “I’ve been on the payroll almost three hours!”
It could have been a disaster, since the skin flap covering the right side of George’s pelvis was held in place by 120 four-day-old stitches, every stitch bearing the weight of his torso. The plastics resident went after the switchboard manager, but she insisted it wasn’t her fault.
“How was I to know?” she said. “He’d been pestering me for weeks, rolling down here every day on his gurney, and I kept telling him I’d hire him soon as he could get in a wheelchair. Then he disappears for a few days. Next thing I know here he’s bragging about his new wheelchair and asking when he can go to work. Didn’t say a thing about his surgery. One of the girls was out on maternity leave, the backup broke her ankle at Tahoe over the weekend. It only took me a few minutes to show him how to work the board.”
George was retired on the spot. Three weeks later Doctor Chase signed the release for him to go back to work. It was George’s first job, and might very well have been his last; he was still at it five years later when I finished my fellowship at Walter Reed and went back to Stanford for a visit. His voice was distinctive, a deep, soothing bass that put his listeners at ease. And he was a smart man, knew every nurse and doctor in the building, knew their routines, their hiding places. He was kind, dedicated, thoughtful. A good man altogether.
* * *
I’ve continued to struggle with the problem of my short legs, a problem that has little to do with legs, but nothing helps. I’m still mad as hell, and so is Jerry Silverberg. This late in life there’s not much hope for either of us.
George lives in an eggcup. Every morning he dangles first by one arm, then the other, bathing his half body as it hangs suspended over the tub, then swings himself around his apartment on overhead horizontal bars and settles into his padded wheelchair. For decades he cherished a fantasy–not the fantasy of walking on his own two legs but the simple triumph of bathing himself and earning his bread.
I envy the man. I don’t envy his eggcup, but I would give anything to own what’s in his heart.
John Gamel’s essays have appeared in Boulevard, The Antioch Review, and The Kenyon Review. He is Professor Emeritus of Ophthalmology at the University of Louisville School of Medicine.