Triage

SHORT STORIES

From Plaintiffs and Pontiffs

TRIAGE

I'm pretty sure my liver is failing. It could also be my appendix, my spleen, my pancreas, or one of my kidneys. What does it feel like when an adrenaline gland fails? Is that even possible? You never see it on the TV shows—a doctor says, “This man is running out of adrenaline,” and the attending nurse replies, “My God, does he have any family to notify?” Never happens, and now I'm wondering why not. Anyway, I took all of the same health classes in high school as everyone else, I know there are digestive systems in there, respiratory, exocrine (I think), definitely a reproductive—but they never tell you exactly where your organs are. Mine could be anywhere. That's an exaggeration—I've got a pretty good handle on where my reproductive system is. It's the other ones, mostly.
    So I don't know what's wrong, I just know that something really is, and I'm guessing it's my liver—I've done some extensive partying in my day, so it's a fair guess. The pain explodes in sharp waves, and twice I've thrown up. By some kind of miracle I was able to climb into my truck and drive the few miles to the hospital, and here I am.
    I'm pretty sure there was an episode of Modern Marvels dedicated entirely to the hospital in my town. The whole thing's made of marble, I think, twenty stories tall. It was the inspiration for St. Paul's Cathedral. Everyone around could start dying at the same time and there'd still be half the rooms vacant. I have no idea where we got the money to build it. They've been spending less on the schools lately, maybe that was enough. I park by the emergency room, throw up one more time in some bushes, and hobble my way through the entrance.
    It's a little cold in here, don't you think? Like they're refrigerating all the people waiting so they don't spoil as quickly. There are a lot of people in the lobby, all ahead of me—I try not to think of that as I go up to the reception desk.
    All the employees look exasperated, like they've done all that should be expected of them and now it's all just forced charity for the ungrateful miscreants of the world. But they're all sitting in chairs, so I don't feel too sorry for them. One of them hands me a form, and says I'll have to fill it out and turn it back in before anyone will see me. It comes with a clipboard and a pen, which I take back to a chair.

Patient Admission Form

Date ____ Name ____ Social Security____ Phone ____ Address ____ Birth Date____ Sex ____ Spouse ____ Major Complaint ____ Employer ____ Primary Insurance ____

I understand and agree that (regarding my insurance status), I am ultimately responsible for the balance of my account for any professional services.

Patient's Signature ____

Let's get started

Date ____ April 28th, 2016.

Name _____ My name is Jude Fawley. And there's a person literally dying next to me. They looked fine when I first sat down next to them—a teenage girl and her mother—but now the girl is coughing up an absurd amount of blood and phlegm, and I'm within the blast radius. What the hell is wrong with her? Malaria? I'm going to catch an exotic disease in this place. But I'm committed. The pain in my abdomen is intolerable. If I leave now, I will just die. So I shift to the far side of my seat and continue to write.

Social Security _____ I'm really bad with numbers, even the ones that identify me. I've had this number for thirty-two years, and I've had thousands of dollars taken out of my paychecks for whatever it represents, but I can't for the life of me decide whether the fifth number is a three or a seven. Both look right when I write them down, but then I cross it out and write the other, and that looks acceptable too. Does it really matter what the number is? What do they use it for? As far as I'm aware, it's just so I can get money when I'm retired, if there's any of it left by then. I've heard there might not be. Which is frustrating—if nothing will be left, what, then, have I been paying for? This isn't a retirement form, though, so that's all irrelevant. It's a three. I'm pretty confident now.

Phone _____ I stumble once more on the whole number thing. I didn't even have a phone until about six months ago, when my sister gave me one of her 'old' iPhones. She's the complete opposite of me, she's done well with her life. As a reward, whenever the newest phones come out she gets to buy one right away. She took pity on my state, and so it was a birthday gift. Her real reasons are probably much less altruistic than that—she likes to call me up at least once a week to yell at me for not taking care of dad, and she couldn't do that back when I didn't have a phone. I pull it out and search everywhere on it for my number—I click 'Settings', since all the important things are usually there, but no. I go through all my contacts, but I'm not one of them. Eventually I just end up calling my sister. I ask her for my number, she takes the opportunity to yell at me about dad, I tell her I'm in the emergency room, she tells me my number, I hang up.

Address _____ This one's kind of sad, at least for me. So I bought a house just a few months before the market crashed. Bad timing. I've had the opportunity to talk about it with numerous financial advisers since then, and that's what they all say: “That's just bad timing.” And I tell them all in response: “That's not really advice.” The house was worth three hundred thousand dollars when I bought it. Admittedly, I didn't put much down. I got a bad interest rate, I had to pay mortgage insurance, all of that. Market crashed and I lost my job shortly afterward. I didn't just go bankrupt and lose my house, I went bankrupt twice, got divorced, and lost my house. After the first bankruptcy, I did what all formerly respectable people do—overextended the generosity of all my friends and family, got heavy into drugs, got a lot of tattoos, played too many video games. I've been trying harder lately, but the scars remain. Whatever's happening to me right now in my stomach is quite the scar. And now I live in an apartment. The address is short enough for me to remember, thankfully.

Birth Date ____ I don't like the way this question is worded. I wrote 'Every year', and then realized that the joke doesn't work. So I had to cross it out, which is embarrassing, almost as embarrassing as the three attempts at my social security number above.

I'm surprised this form doesn't ask for my ethnicity. Most forms want to know that, for whatever reason. If it did, though, I'm not sure I could put white. I've just turned yellow, and I'm very concerned about it. Jaundice? Jaundice. Only a few questions into my form, I return to one of the receptionists.
    “I really think something's wrong with me,” I say.
    “That makes sense,” the 'over-worked' lady replies.
    “Well, I need help.”
    “Give me your form and someone will see you shortly.”
    “I'm not done with it.”
    “You have to fill it out first, obviously.”
    Back in my seat, the malaria is gone. At least its source, I should say—the malaria's probably everywhere by now. But the girl, she's been replaced by a guy with a nail through his hand. For some reason he hasn't removed it himself. Three inches of of it are sticking out of his right hand, and yet he's filling out a form of his own. Instead of trying to write left-handed, he's got the pen cradled between thumb and nail, and he's trying to write that way. Morbid sight. I'm feeling faint, and this image isn't helping me.
    I rush through the rest of the form, since my life literally depends on it.

Sex ____ Yes please, amiright?

Spouse ____ Fucked that up. Refer to previous answer.

Major Complaint ____ Dying from the inside out. But it's more than that, right? It's everything. My former friends don't answer when I call them from the phone I never wanted—that's hard to deal with. The job I had didn't pay enough for me to afford my rent, even if I worked an extra twenty hours a week and saved all of it, so I gave up—I'll be evicted in two months, I've made the calculations. My shoes are too tight—for a while I didn't even own shoes, but I signed up for this public outreach program, since I was that desperate. I'll never beg for food on a street corner, I'll just go hungry, but shoes I just couldn't go without. And these blessed people, they gathered us poor people together in a high school gymnasium and gave us all Air Jordans while photographers took pictures for the local newspaper. I think they actually expected us to play a game of basketball afterward, me and a bunch of drunk homeless people. That's worse than Sea World—at least they feed the whales. I wasn't afraid to let them down, and leave at the first opportunity I found. Anyway, they neglected to figure out our sizes first—mine are several sizes too small. I wear them anyway. It took me a month to get over the vague yet intense claustrophobia they caused me, and I still have nightmares about it. Nightmares about shoes. But I walk a lot of places, so it was better than the alternative. Are those major complaints? Your question is vague, hospital. And I can keep going.

Employer ____ Is this form meant to be so damn depressing? And who cares where I work(ed)? Who cares who my wife was? She affected my health, yes, but that was all psychological. I'd never go to a doctor for something psychological. In most circumstances, I'd never go to a doctor at all. That's why I was never able to justify paying for health insurance (among other reasons). So what if it's 'required by law'? I can't afford it. I'd rather just ignore it. But it's the next question, so now I'm thinking about it.

Primary Insurance ____ NA

I'm sweating profusely. All my liquids are on the outside. I've caught myself, several times now, compulsively repeating the Pledge of Allegiance, and I have no idea why. The guy with the nail through his hand, he's already completed his paperwork, even though he started after me. That's how lost I am, beaten by a man that nailed himself. At the entrance, paramedic-types are bringing some person in one part at a time—they'll probably take precedence over me. Whatever.

I understand and agree that (regarding my insurance status), I am ultimately responsible for the balance of my account for any professional services.

Patient's Signature ____ Jude Fawley, I sign. What else am I supposed to do? Die? I can't just resign myself to death. I'll sign whatever I have to. Want my soul? I'll sign it over. Just give me a pen and paper.

I struggle to turn the form in, return to my seat, and resume dying. Great, great, great. Pain isn't real. These things that seem like they're swallowing me whole, they're not real. I retreat to that deep corner of my mind where I'm safe from all the hurricanes. I've been here before. I've had a hard life, I don't think it's immodest to say. So I've been here before, I know what to do. Retreat to my corner. These pains, these phantoms, they'll haunt me but that's all they'll do. Ghosts aren't real. My God.
    Time goes by.
    I barely notice, but it seems that maybe it's my turn to be healed. A professional-looking man is standing in front of me. He's got close-cropped hair, a perfectly shaved face, starched, white clothes, great teeth, a confident demeanor. A good man. He's saying, “Are you sure, Mr. Fawley, that you don't have health insurance?” He's saying it very loud, baring my shame to the world that is the lobby of this enormous emergency room.
    A popular uprising forms against me, seemingly out of nowhere. A man a couple rows over stands up. His left arm is gangrenous to the elbow, but that's besides the point. He addresses everyone in the room, he says, “I won't stand idly by as these freeloaders take advantage of what my money has paid for. Whatever happened to good old-fashioned triage? Care should only be provided to the valuable members of society, those that contribute something. People that work from nine to five every week and put money into their 401(k) every paycheck. This man needs to learn a little something about personal responsibility. I've been watching him for a while now—he's got one of the newest phones, he's got tattoos, he's got nice shoes. Nice shoes! He's been spending his money on all of these luxuries, instead of being responsible like the rest of us who paid our insurance like decent human beings. I refuse to let my money go toward this waste of human life.”
    Triage. My delirious mind fastens on that word. I'm nothing for numbers, but I'm avid for history. Not the dates and all that, that shit doesn't matter. The people, though—the concepts, the tragedies, the miracles. Those things I love. Triage comes from the French word trier, meaning to separate, sift, or select. It's a method for being efficient with medical resources. Injured people are divided into three groups—those that are beyond repair and will likely die, regardless; those that will likely live, regardless; and those that will likely live if they get help and die if they don't. For the first group, nothing. The second group, nothing. Everything goes to the third group. After the Napoleonic Wars, followed by the wonderful Western Front, France had to get really good at losing. And that they did—triage helped. Americans did some triage too, like during the polio outbreaks in the 40's. Polio paralyzes the lungs, which kills people pretty quickly, so they had to put people in iron lungs. But there were only so many iron lungs, so they mostly let the kids use them, since kids were about ten percent more likely to survive. That was the deciding factor.
    So what this guy is saying, I think, is that we can only save so many people, or something like that. And that I'm beyond repair. It's probably more of the second. Not that I'm too sick or anything, and not that we don't have the resources—just that I'm beyond repair in a greater sense. I only perceive the insult clearly for a second, and then I'm submerged again in pain.
    My doctor is on the verge of violating his Hippocratic Oath, but, in his defense, he stands his ground for at least a moment. He says, “We don't deny service, here at the ER. And he will be billed in full for the services provided, so there's nothing to worry about.”
    But the other man has a more powerful spite, a more powerful argument. “He won't ever pay it. Just look at him. And when he doesn't pay, guess who does. We do. That's not how the world should work.”
    Other people stand up, they join him. Many of them are in dire health for various reasons, but it's worth the effort for them. Their bodies are insured, after all, and their maladies are covered, so they can afford a few extravagances. “Send him home!” they yell. “Get him out of here!”
    I'm grabbed by the shoulders, hauled out of my seat. I'm dragged along the ground. Someone steals my fancy shoes, like I'm already a corpse. I'm jarred from the safe place in the corner of my mind, and exposed to the severest elements of my pain and humanity. I open my eyes. I see that the person holding my left arm and dragging me just as vehemently as the rest of the crowd is none other Jesus Christ, of blessed memory.
    As he drags me away from my salvation, at least he offers me an explanation I can accept. “If I had to die for their sins, Jude, then so should you. I was a better person than you'll ever be.” He says other things, something like, 'had there been health insurance back when I was talking to the apostles, I would have told them there's no excuse not to have it'. He also says something about how he should have been more clear about homosexuals. You have to really read between the lines he says, but it's all there.
    It's the first thing he says, though, that really hits me. If he had to die for their sins, so should I. There's an overwhelming logic to that statement. I'm almost comforted as I die, out on the sidewalk, the sun glaring down at me with all its radiant fury.