Part II

He rolled into the trauma bay at 0200 in agony, mouth agape, face pallid, eyes bloodshot. They rushed him through the double doors, medics on both ends of the gurney, one clamping down to control the bleeding. In my ten years, I had seen plenty of blood—but this was too much. He wasn’t half full; at the rate he was bleeding, he was a far cry from half empty.

The medics gave the report while Dr. Shepherd listened: entry wound, yes. Exit wound, no. The bullet had entered his belly at close range, liked what it saw, redecorated the place, and had shown no signs of wanting to leave. An IV line was initially acquired on the field. Fluids were pushed. The patient was calm and alert. But when they tried to administer morphine, he flipped.

“Yanked the line right out,” said the medic. “After that, we couldn’t do anything.”

The man needed an emergent surgery, likely laparotomy. For that, he needed to remain still.

We tried to get an IV, but he thrashed with such force to hold us at bay, gnashing his teeth, flailing his arms.

“No, pain, no, pain!” he exclaimed, over and over, as if it were some ethereal blessing, some mantra.

I raised my voice. “Sir, you need to stay still.”

“No! Pain! 24!” The man wrenched his arms and wrapped them in a self-embrace.

I saw the track marks and tattoos. The faded ink crawling up his arms, occasionally broken by pockmarks and pop holes. I assumed the worst, my mind wrapping its dendrites around the “A” word

Addict.

“Sir, we can’t help you if you keep moving.

“No, pain. 24 d—”

“Sir, we’ll give you pain meds, but we don’t dose dilaudid that high.”

The man trembled, then his arms went limp. “No pain,” he pleaded, “24 days.”

By this point, we had fentanyl at the bedside, and were ready to administer intramuscular haldol to sedate him. I raised an eyebrow at Dr. Shepherd, waiting for the okay.

Dr. Shepherd held up his hand. Quietly, he walked to the patient, knelt forward, mouthed something into his ear, out of our hearing.

The man calmed. We got the line.

“Hold the fentanyl. Only Haldol.”

The patient was stabilized and sent to the OR.

***

He didn’t make it, we found out the next morning. The blood loss was too great, and his body couldn’t compensate for the shock, no matter how many RBCs they infused.

Later, when asked what he whispered that had calmed the man down, Dr. Shepherd said this:

No dilaudid, no morphine, no fentanyl. No opiates, I promise.

“You administered him nothing for his pain?” probed the M&M panel in the coming week.

No dilaudid, no morphine, no fentanyl.

“So, in other words, you provided him nothing?” queried the malpractice letter in later months.

No opiates, I promise.

The patient died on his own terms, liberated from his demons; free. That’s not something you can give with a needle