You are an emergency room doctor. A 24-year-old man had gone to bed the night before feeling just fine. He woke up with a swollen arm and came to the ER. It’s hours later, and now you must tell him he probably has lymphoma, blood cancer that could take his life. It’s hard enough to break the news to an elderly person. The assignment is a horrible one when the patient is so young.
“The arrows life throws at us are unpredictable. Most are just a nuisance, but this one is a body slam. Death at a young age is a very real possibility,” Dr. Patrick Crocker writes in his new memoir, Letters From the Pit (self-published; available on Amazon). The anecdote illustrates how Crocker’s empathy constantly interrupted the physician’s need—for sanity’s sake—to maintain some distance, but not too much, from the daily toll of human suffering. Crocker’s book, too, is anything but cold and clinical.
For almost three decades, Dr. Crocker was emergency medicine chief at Austin’s Brackenridge Hospital, or “Brack,” as the 130-year-old safety net hospital was known before it closed, and at the Dell Children’s Medical Center. Now retired with his wife Marcia at their ranch near Medina, Crocker was a man of Austin. An ER director is expected to wear a shirt, tie, white coat, and his best shoes. Crocker hated the white coat. Just months after his appointment as Brack’s ER chief, he lost the tie, dropped the white coat, and slipped on a pair of Birkenstocks. (Though when he met with patients, he wore scrubs.) Come summer, he pared down to t-shirt, shorts, and sandals. Competence brings certain freedoms, especially in Austin, the capital of slackers, where no one much cares what you wear as long as you do your job.
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There are, perhaps surprisingly, moments of humor. In one eye-popping case [warning: graphic content ahead!], Crocker used blunt forceps to remove a tube of Prell shampoo from a patient’s rectum. The distressed man’s story: He was in the shower washing his hair and soap got in his eyes. The Prell fell to the floor, coming to rest in a standing position. The man slipped and fell, and the Prell tube went you know where.
“Puhlease!” writes Crocker.
Foreign bodies stuck in rectums and vaginas are not unusual in emergency rooms. Crocker has seen carrots, cucumbers, and plastic balls, among other unlikely objects. He takes all of this in stride; he doesn’t care what people do with their spare time.
In a similar case [warning: extremely graphic content ahead!], a patient was being X-rayed for removal of a vibrator from his rectum. A second object was spotted on the X-ray: a chicken bone in the man’s penis. The operating room surgeon went on to extract that, as well as the vibrator.
When the patient recovered, he angrily summoned Dr. Crocker and threatened to sue him. He was, shall we say, rigid with rage. “I gave you permission to remove the vibrator, but I did not say you could remove the chicken bone from my dick! Do you know how hard that bone was to get in there?”
Writes Crocker, drolly: “I can only imagine.”
More typically, there were moments when Crocker and his staff came face to face with the worst sorts of tragedies. One early spring morning in Central Texas, the cool and sunny weather and fields of green splashed with Indian paintbrush and bluebonnets were accompanied by the first pediatric drowning of the year. It happened to a five-year-old boy at a swimming pool not far from Dell Children’s. The ER team’s efforts were exhaustive, including placement of an endotracheal tube to clear an airway, and the insertion of an IV carrying a double dose of adrenaline, a drug that speeds the flow of blood to muscles and stimulates the heart’s output. With extreme efforts, the child was resuscitated, and his heart stabilized. But the child was declared dead the next day when examination showed no brain activity.
Reflecting on this heartbreaking episode, Crocker offers advice to parents, especially the ones you have seen in poolside lounge chairs, engrossed in their smartphones and paying scant attention to kids in the pool.
“It’s a widely believed myth that the lifeguard has the time to save a drowning person,” writes Crocker. “It’s another myth that a typical drowning includes a scream for help, splashing wildly, a kid obviously in distress. The grim truth is most drownings are silent. The child simply slips below the surface, inhales the water he was enjoying seconds before, and never raises his head again.”
And then there are the moments when tragedy is averted and genuine life lessons are learned. One day, a 35-year-old man arrived on a gurney, cursing the staff loudly, spitting on the floor. “He’s clearly a dyed-in-the-wool jerk,” Crocker observes. Tests showed the man was undergoing a heart attack of a kind so serious it is called a “widow maker.” His heart stopped, and he turned blue. Surrounded by the medical staff, Crocker shocked the man with a defibrillator. When the once-nasty patient awakened, he was surprisingly calm and polite.
“He says he went to heaven and stood before God,” Crocker writes. “He explains all that he saw. First were the bright lights often reported with near-death experiences. He says he could hear church organ music. After a sensation of rushing upwards he says he stood directly before God. God told him he needed to change his life. No more drugs, no more being an asshole. He was being granted a second chance.”
Perhaps because he has always been able to look beyond the blood and gore and adrenaline that mark life in the ER and see in full the lives stretched out before him, Crocker survived a career that often leads physicians to depression, substance abuse, and early burnouts. In fact, he did more than survive—he came out the other side of this sometimes harrowing profession wiser and stronger for the experience.
I’ve often wondered whether physicians—who witness death as an ordinary part of their day—experience the same fear and foreboding as ordinary mortals. Crocker leaves no doubt that he is one of us.
“I think about my own mortality. Average lifespan of the U.S. male is 78.6 years. I count maybe nineteen more spring times for me. A distressingly small number. I try 85 years, as I am healthy, active, and lack bad habits. Twenty-five more springs. Still a distressingly small number. I love the sunrise, so I decide to count sunrises. Twenty-five years times 365 days per year and I get 9,125 more sunrises. This sounds a bit better. I think of yet a better number. The number of times I can be with my wife and daughter and tell them I love them. Limitless.”
That’s as good a gift as any of us have. There’s no warranty on life, but people like Crocker can help make it better.