going to have to remain in the waiting room.”
“Follow my finger with your eyes, please, Dylan.” Dr. McQuillen drops his penlight into the pocket of his white coat and takes out a tuning fork, rapping it on the table as he brings it up. “Hear this?”
“Yes.”
“Louder when I do this?” He presses the handle to Dylan’s forehead, then moves the head back to near Dylan’s ear. “Or this?”
“That,” Dylan says.
Dylan’s in his underwear and a gown that’s open down the back. Swinging his feet off the edge of the table he looks like a child who’s somehow gotten himself into a boxing match, with McQuillen and me as his cornermen. I’m using wet gauze and scissors to untangle the blood clots on the back of his scalp.
“Can you see that spot over there? Focus on it,” McQuillen says. “What’s fourteen times fourteen?”
“Uh—”
McQuillen pulls Dylan’s broken nose away from his face, twists it, and lets it snap back into place.
“Ag, fuck!” Dylan says. While his mouth is still open, McQuillen slots his tooth back into his jaw, which he then holds shut. *
Dylan hums in pain.
“Stay closed now for a few minutes. Let it set.” McQuillen puts the earpieces of his stethoscope in. “Shh. I need to be able to hear.” He runs the stethoscope across Dylan’s back, then listens to Dylan’s chest and abdomen while using his other hand to feel for liver and spleen abnormalities. Turns the head of the stethoscope side-on to use as a reflex hammer up and down Dylan’s arms and legs.
It’s fun to watch. It’s the kind of routine that makes you wonder if you’ll ever be that expert at anything.
McQuillen prods Dylan’s spine and kidneys. “You’re going to need stitches in two or three places, and you’re going to need to stay here so we can watch you. Otherwise, you’ve gotten very lucky.” He pinches one of Dylan’s triceps, * causing Dylan to squeal.
“What about the CT scan?” I say.
“What about it?” McQuillen says.
“Are you going to give him one?”
“I see no reason to. His jaw is intact, as are both zygomas—at least to an extent that would rule out surgical intervention. There’s no evidence of a LeFort or a suborbital. We’ve checked him for anosmia. He’s not visibly leaking CSF, which means he’s unlikely to require brain surgery. And as for hematomas, this one has a pretty hard head.” To Dylan he says “What hurts most right now?”
“My nose,” Dylan says through his teeth.
“See? We’ll need to check for renal injury, but I have a perfectlygood microscope. There are a lot of things you can tell about a patient without irradiating him, you know. In the nineteenth century, gynecologists operated blind.”
“I think the standard of care may have changed since then.”
McQuillen smiles. “Nobody likes a smart-ass, Doctor.”
“That’s right, Lionel,” Dylan says.
“As for you,” McQuillen says, “keep smoking meth. You won’t be a smart-ass for long. First you’ll be stupid. Then you’ll be dead.”
“I’m not smoking it.”
“You will be. Then you’ll be injecting it. I’ll give you some clean hypodermics before you go. No need for you to get hep C while you’re killing yourself with methamphetamine. I’m seventy-eight. I would appreciate it if you outlived me.”
Dylan rolls his eyes.
“What about C-spine injury?” I say.
“Not worried about it,” McQuillen says, in a condensation of a much longer discussion we then have.
“You’re at least going to do plain films.”
“I’d be treating you instead of the patient. Were you never in a scrap like this when you were young?”
“Not exactly.”
“That doesn’t surprise me. People barely act like physical beings now. Do you know what percentage of severe head injuries will cause a subarachnoid?”
“No.”
“Five to ten.
Severe
head injuries. And a fast-moving subdural will show signs in the next two hours. A slow-moving one isn’t going to show up on
“Follow my finger with your eyes, please, Dylan.” Dr. McQuillen drops his penlight into the pocket of his white coat and takes out a tuning fork, rapping it on the table as he brings it up. “Hear this?”
“Yes.”
“Louder when I do this?” He presses the handle to Dylan’s forehead, then moves the head back to near Dylan’s ear. “Or this?”
“That,” Dylan says.
Dylan’s in his underwear and a gown that’s open down the back. Swinging his feet off the edge of the table he looks like a child who’s somehow gotten himself into a boxing match, with McQuillen and me as his cornermen. I’m using wet gauze and scissors to untangle the blood clots on the back of his scalp.
“Can you see that spot over there? Focus on it,” McQuillen says. “What’s fourteen times fourteen?”
“Uh—”
McQuillen pulls Dylan’s broken nose away from his face, twists it, and lets it snap back into place.
“Ag, fuck!” Dylan says. While his mouth is still open, McQuillen slots his tooth back into his jaw, which he then holds shut. *
Dylan hums in pain.
“Stay closed now for a few minutes. Let it set.” McQuillen puts the earpieces of his stethoscope in. “Shh. I need to be able to hear.” He runs the stethoscope across Dylan’s back, then listens to Dylan’s chest and abdomen while using his other hand to feel for liver and spleen abnormalities. Turns the head of the stethoscope side-on to use as a reflex hammer up and down Dylan’s arms and legs.
It’s fun to watch. It’s the kind of routine that makes you wonder if you’ll ever be that expert at anything.
McQuillen prods Dylan’s spine and kidneys. “You’re going to need stitches in two or three places, and you’re going to need to stay here so we can watch you. Otherwise, you’ve gotten very lucky.” He pinches one of Dylan’s triceps, * causing Dylan to squeal.
“What about the CT scan?” I say.
“What about it?” McQuillen says.
“Are you going to give him one?”
“I see no reason to. His jaw is intact, as are both zygomas—at least to an extent that would rule out surgical intervention. There’s no evidence of a LeFort or a suborbital. We’ve checked him for anosmia. He’s not visibly leaking CSF, which means he’s unlikely to require brain surgery. And as for hematomas, this one has a pretty hard head.” To Dylan he says “What hurts most right now?”
“My nose,” Dylan says through his teeth.
“See? We’ll need to check for renal injury, but I have a perfectlygood microscope. There are a lot of things you can tell about a patient without irradiating him, you know. In the nineteenth century, gynecologists operated blind.”
“I think the standard of care may have changed since then.”
McQuillen smiles. “Nobody likes a smart-ass, Doctor.”
“That’s right, Lionel,” Dylan says.
“As for you,” McQuillen says, “keep smoking meth. You won’t be a smart-ass for long. First you’ll be stupid. Then you’ll be dead.”
“I’m not smoking it.”
“You will be. Then you’ll be injecting it. I’ll give you some clean hypodermics before you go. No need for you to get hep C while you’re killing yourself with methamphetamine. I’m seventy-eight. I would appreciate it if you outlived me.”
Dylan rolls his eyes.
“What about C-spine injury?” I say.
“Not worried about it,” McQuillen says, in a condensation of a much longer discussion we then have.
“You’re at least going to do plain films.”
“I’d be treating you instead of the patient. Were you never in a scrap like this when you were young?”
“Not exactly.”
“That doesn’t surprise me. People barely act like physical beings now. Do you know what percentage of severe head injuries will cause a subarachnoid?”
“No.”
“Five to ten.
Severe
head injuries. And a fast-moving subdural will show signs in the next two hours. A slow-moving one isn’t going to show up on
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