Excerpt from “MASH” by Richard Hooker ~~Meatball surgeon~~

picture-MASH-HookerCaptain Pinkham had the boy with the minor but significant chest wound. When Hawkeye and Duke wandered in, he was fussing around the patient, rapping on the chest and listening to it with a stethoscope. He was behaving, in other words, like a doctor and not a meatball surgeon, so Hawkeye took a look at the X-rays, assessed the situation and spoke.
“Doctor,” he said, “this guy obviously has holes in his bowel and his femur is broken. It’s not a bad fracture, but he’s probably dropped a pint here. There’s at least a pint in his belly and maybe a pint in his chest. Agreed?”
“Agreed,” Captain Pinkham said.
From there Hawkeye went on to explain that the patient also had a pneumothorax, meaning that there was air in his pleural, or chest, cavity because his lung was leaking air and had collapsed. In addition, he suggested, the shock from the blood loss was probably augmented by contamination of the peritoneum, or abdominal, cavity by bowel contents.
“So what he needs,” he said, “before you lug him in there and hit him with the Pentothal and curare and put a tube in his trachea, is expansion of his lung, two or three pints of blood and an antibiotic to minimize the peritoneal infection.”
“I see,” Captain Pinkham said, beginning to see a little light, “but we’ll still have to open his chest as well as his belly.”
“No, we won’t,” said Hawkeye. “The chest wound doesn’t amount to a damn. Stick a Foley catheter between his second and third ribs and hook it to underwater drainage, and his lung will re-expand. If he were going to do any interesting bleeding from his lung, he’d probably have done it by now. We can tap it after we get the air out and his general condition improves. Right now we just want to get this kid out of shock and into the OR in shape to have his belly cut and his thigh debrided.”
Two corpsmen brought what at the Double Natural passed for an adequate closed thoracotomy kit. It contained the bare essentials for insertion of a tube in a chest, and after Hawkeye had watched Captain Pinkham fiddle around with it for a while, he spoke again.
“Look,” he said, “All that’s great, but there will be times when you won’t have the time to do it right. Lemme show you how to do it wrong.”
Hawkeye donned a pair of gloves, accepted a syringe of Novocain from a corpsman, infiltrated the skin and the space between the ribs and shoved the needle into the pleural cavity. Pulling back on the plunger he got air, knew he was in the right place, noted the angle of the needle, withdrew it, took a scalpel, incised the skin for one-half inch and plunged the scalpel into the pleural cavity. Bubbles of air appeared at the incision. Then he grasped the tip of a Foley catheter with a Kelly clamp and shoved the tube through the hole. A nurse attached the other end to the drainage bottle on the floor, a corpsman blew up the balloon on the catheter and now bubbles began to rise to the surface of the water in the bottle. Hawkeye dropped to his knees on the sand floor and, as he began to suck on the rubber tube attached to the shorter of the two tubes in the bottle, the upward flow of bubbles increased as the lung was, indeed, expanding.
“Crude, ain’t it?” said Hawkeye.
“Yes,” said Captain Pinkham.
“How long did it take?”
“Not long,” admitted Captain Pinkham, who couldn’t help noticing that the patient’s breathing had already improved.

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2 Comments

Filed under Fiction, Literature

2 responses to “Excerpt from “MASH” by Richard Hooker ~~Meatball surgeon~~

  1. Richard Hooker was born in New Jersey, USA on 1 February 1924, and died on 4 November 1997, aged 73 years. “MASH” was published in 1968. Hooker had been a surgeon at the 8055th Mobile Army Surgical Hospital during the Korean War.

  2. Alexander

    That’s great !- I love the bit “show you how to do it wrong”

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