Luger Rounds

I am Dr. Philip Thomas, a prisoner of the intensive care unit (ICU). Victim of a hospital assassin, I am a Luger Rounds candidate. I am comatose: an unconscious state from which a person cannot be aroused even with powerful stimulation as if dead. Trapped in the intensive care unit, I appear unconscious, but the horrible truth is that I hear and feel everything. In this nightmare I am a non-person, ensnared, and dying.

Pain is my constant nemesis. With it comes merciless fear; a gripping bedfellow. Every moment brings a helpless life; racked with pain, and realizing the terror of the ICU.

I am acutely aware, my existence doses of medically caused torture. From healer to patient I am a trapped, agonizing, fearful, tormented, and slowly dying in the ICU.

Luger rounds, the term sits bitterly as a cruel phrase. An insensitive concept, tossed around by interns, stressed from the long never ending hours of their post-graduate training. This ongoing oppressive lifestyle eventually affects even the most noble of us.

Luger rounds; the phrase implies ending the life of a patient whose illness requires an overwhelming effort to maintain, while being too sick to eventually survive. The phrase was a sarcastic gag; no one really advocated this. Now irony befalls me, for I am one; a clinical disaster, a Luger rounds candidate. There is a difference, however. Unlike the casual aside, and while a bullet was not the weapon, in my case someone took the phrase to heart. My clinical case now requires such effort to keep me alive, and my chances of survival so low that I myself, once an aborted victim of murder have become a Luger rounds candidate.

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My mind drifts from the torturous prison of my life in the ICU, to dreams of the past. One moment I drift through a pleasant historically correct reminiscence, while the next I am twisting through a frightening, psychotic world created in my brain. And then my level of consciousness clears and I am aware of my tortured surroundings; sounds, voices, and most of all pain seasoned with unrelenting fear.

My mind returns to the cramped ICU room; aware once again of my condition, surroundings, and continuous pain. The morphine has cleared, the dream state resolved, but my misery goes on.

I then sense an evil presence, and fear overwhelms every aching fiber of my dying body. An ominous air fills my darkened room. My pulse rate rises as I realize his existence; I am overwhelmed by dread.

I am paralyzed, neck fixed by my tracheostomy. I can not turn to look, but somehow I know I am not alone. There is a tormentor, sitting in the dark; an assassin silent, starring, and waiting. I feel his eyes on me; penetrating and bulging like a vulture’s, their proprietor seeing me as easy prey. I hear his breathing slow and ominous. His beeper fires off. He stares straight ahead, reaches to his side, and slowly slides the switch off to silence it.

In the menacing quiet his eyes pierce me again. He is staring and willing me to crash; an assassin with a white coat covering his wicked heart. He is known to me, a killer, a trader, a colleague from my former life.

#

My lifeless body is carried over a bony shoulder at a harried pace, down a long black corridor; tossed and bumped into the walls of the narrow hall. I am helpless; unable to move or protest what seems a frightening imprisonment. No crowd is cheering this broken field run through opposing territory, the Superbowl behind me of no importance anymore. Through the end zone I am roughly deposited on the hard cold floor. Face masked fiends in bulging shoulder pads dance in victory around me. A white coated demon leads the procession. Ghoulish laughter and canon blasts punctuate the air. I try to resist as an IV is established in my left arm. A briny syringe of soup is infused to shouts of hurray. My mind is black as I am violently ripped away to a fiery pit of evil and pain.

#

“I am the assassin. I am special, brilliant; a gift to the world draped in the white coat of my profession; a physician, an urologist and destined for greatness. In my path however lies a residency; an organized insult to my importance and consequential destiny. I am in a housestaff program, slave to my department and required to be perfect. People do not know what that means. It means that to practice my chosen profession I must go without sleep, take care of undeserving patient after patient, and slip farther into insanity. Residency is every other night call, you’re “off” day ends late, and in the hospital all day and night the next. It is admission after admission, scut work, and emergency room non-sense. It is emergency’s during the night, tubes which need to be inserted, lab tests and x-rays that need to be tracked down, and most of all, it is disgusting patient after disgusting patient.”

“Luger rounds solved most of these problems brilliantly. Yes a joke; but then why just a joke? It is obvious to me when a patient will not survive. I am clinically so experienced; I can predict their eventual death. Replacing tubes, arterial lines, swan-ganz catheters, and wound debridement on a train wreck is not noble medicine, it is veterinarian slop. It is up to me, to decide and do the right thing. No one else has the leadership necessary. Mix up a syringe of decision, and use it like the Luger; sudden and sweet. With that syringe I induce a febrile death, and I have done the right thing. Undetectable and perfect; no one would disagree, if they knew what I knew. The syringe is a silent manner of death, for someone nearly dead already. It is a perfect solution to my over burdened misery, a perfect ending for an intolerable situation.”

“Narcotics are my bane now, the only thing that will temper my suffering. I am a slave to my profession and a slave to these as well. First it was simple. Take a few oxycodones from the med cart here and there. Short undeserving patients of their prescribed morphine dose. When those would not satisfy anymore, intravenous fentanyl became my drug of choice. It was easy taking ampoules from the anesthesia cart. No one suspected, especially no one suspected me.”

“I lock the call room door and remove my white coat. A rubber tourniquet is secured around my left upper arm; I will soon be flying again. I swab the forearm puncture site profusely, cleaning the site with an ironic degree of love. Slap… and the antecubital tributary is standing ready. The needle punctures the skin driving the tip to the side of the engorged vein. I deftly turn the needle tip and puncture the side of the vein. Blood return confirms its position; I release the tourniquet and slowly infuse 0.3 cc of lovely drug, fentanyl. The rush drops my head back, the buzz is immediate, and I am happy again.”

“I had suspected him, Philip Thomas my urology resident colleague, but that pink note sealed his fate. Stuck on his two-bit briefcase, his illegible handwriting shouted for action. I knew then his execution was nearing. Think of someone such as him, questioning someone like me. And then the perfection of the situation struck me, and Philip Thomas, yes with one L, confirmed his destiny.”

“That day in January was one I will remember well. I just happened to see him walking away from the resident call room, disappearing without seeing me into the lavatory. How perfect the setting, alone; the cup left just for me. No thoughts about my options. Two Chloral Hydrate capsules from my white coat pocket into his cup, and I have the perfect “Mickey”.”

“I then prepared my syringe of decision………."

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Philip Thomas is comatose, the victim of a hospital serial killer, trapped and dying in the intensive care unit. His assassin is alive and ready to finish the job.