Futility

***

Had it all planned—the suit, reservations at Cascadia, oysters on the half shell and a bottle of champagne. And instead I stand her up, drink myself into a stupor, and pound on her door after Joe's closes down for the night.

I'd be pissed, too. Am pissed, on second thought. Piss drunk.

This is the definition of futility: do the same thing again and again, expect different results. This time, though, I screwed it up before it even began.

***

You save people, and they die anyway. Sooner or later. Usually, though, it's too soon.

One of the soldiers in a neighboring unit had found it on patrol, heard it whining from inside a bombed out shell of a building. Took a machine gun and four guys for backup to go investigate. Found a mid-sized dog with shrapnel in one leg and the stench of deep-set infection.

"I couldn't leave it there," he had said, carting the pathetic animal into his clinic.

"I'm a surgeon, not a vet."

But I didn't say no. Looked up veterinary anesthesia and antibiotic dosing online, shaved the front leg to start an IV, and the back leg to see how bad things really were. One below-the-knee amputation, two abscess debridements, and three weeks of penicillin later and the dog was walking awkwardly on three legs.

***

Hit and run, SUV versus eight-year old pedestrian. Kid was a mess: splenic laceration, two broken ribs, open tib-fib fracture. What the hell took the parents so damn long to bring him in? Three hours since the accident, they thought.

Well now I think I'm gonna have to amputate your kid's leg. There was ground glass and dirt in the wound, the distal pulses and nerve function are compromised, and the only thing staving off compartment syndrome is the gaping hole in his shin where bone had punctured skin.

The x-ray showed multiple old fractures, a still-healing spiral fracture of the humerus. I allowed myself a brief fantasy of the dead-beat abusive parents getting mowed under a car instead of their kid. Seen a lot of gruesome things in the war, but this casual cruelty made my blood sing.

"Karev, go get consent."

He looked like he wanted to argue, but took a clipboard and left the room after a small hesitation. Looked about as disgusted with the thought of talking to the parents as I felt.

***

I saw her fear in back of Joe's, flinching back from me. Felt like a blow to the gut. She deserved better than me, better than to be pressed up against a brick wall in an alley with a crazy drunk assaulting her, kissing her like there's no tomorrow. Or yesterday, same drunk, this time working on a nice case of alcoholic pancreatitis. She should've kicked me out, or at least let me pass out wet in the shower stall.

Instead I woke up on a couch with the morning light like knives slashing at my face, room spinning when I moved to sit up, wearing what had to be Callie's ratty sweatpants. Found my still-wet clothes wadded up in the kitchen sink when I went looking for caffeine, and Cristina's birth control pills and a two-year old prescription for post-surgical oxycodone when I scoured the bathroom for Tylenol.

My cell phone wasn't working. Guess it drowned. No note, anywhere. No food in the fridge. Surgical textbooks under the coffee table instead of magazines.

***

He became the camp mascot in no time. The guys named him Jeep after his favorite place to sleep. Made a killing off the young pups homesick for their own dogs or kids or wives, begging table scraps and constant attention. Followed me around the outpatient tent, thumping his tail while I cleaned wounds and wrapped the minor gore and healing wounds in fresh white gauze.

***

Half hour wait we couldn't afford for the pediatric anesthesiologist to get his ass to the OR. Started broad-spectrum antibiotics by drip in the meantime, plus normal saline with glucose. Exploratory laparotomy, emergent splenectomy with ligation of the splenic artery. After that his hematocrit stopped dropping and his pressure stabilized. Everything else in there looked good, thank god.

Next the leg—a lost cause. Below the knee amputation, no more walking the dog, no more little league baseball.

Made a good recovery, though. Good kid, high spirits. Went home after a week, afebrile, nothing but oral antibiotics and a clinic appointment with orthopedics in two months to talk about prostheses.

Couldn't get social services to go after the parents. Not enough evidence, they said. Not their policy to break up families.

"What do you need? A body?"

That shut her up, but didn't get anything done.

***

She wasn't quite ignoring me. Not quite. We saw each other at Joe's, sometimes—she sipping at a beer, me downing whiskey. Even played darts, once, in an uncomfortable silence.

I tried to apologize, but that hard look came over her face.

"I may be used to disappointment, Dr. Hunt. Doesn't mean I like it."

Didn't know what to say to that, so I said nothing.

***

Jeep died with the rest of the unit two months later.

***

I was on call when the kid came back in five weeks after discharge. More broken bones, but that wasn't the worst of it by far. Basilar skull fracture, imminent herniation, apnea.

Before we even had him on the vent, I told security to hold the mother and called CPS and the police.

Paged Shepard. CT wasn't promising, EEG was even worse. Brain dead. Eight years old and brain dead, and I had known he wasn't safe going home. Had known, had reported my suspicions, followed all the damn protocol, even tried for an appeal.

I set the fractures and sutured the lacerations, knowing full well it was useless. He stayed on life support two days, with serial electroencephalograms showing no activity, vent weans showing no spontaneous respirations. On the third day, I turned off the machines. The mother had the gall to cry over the tiny body and ask me why I didn't save her little boy. The father was still in police custody.

***

The hand on my arm startled me, and I spilled whiskey on the counter and my sleeve. Turned, and saw her, with all that gorgeous unruly hair loose around her face.

"I heard what happened. I'm sorry."

She took the stool next to mine, and waved over Joe.

"Tequila."

"Sure thing."

He came back a minute later with a shot glass and a wedge of lime, interrupting the silence that was stretching between us.

She licked the salt off the back of her hand, downed the shot in one go, and sucked on the lime wedge without so much as a flicker of distaste. Turned to me, looking angry and beautiful.

"You're not the only one with history, not the only one who's ever been hurt, you know. I lost an ovary and every shred of dignity I ever had to a man who left me at the altar and left the city in the same day." After a moment she muttered, as if this was the greater embarrassment, "I lost my eyebrows to his witch of a mother."

I was speechless. The most I'd ever learned about her, about her past, and she tells me in a crowded bar after barely acknowledging me for a month.

She waves Joe back over, who comes with two more tequila shots.

"No, thanks, Joe," I say, when he sets the second one down on the bar.

"They're both for me."

She downed one more, and I wonder why she's trying to get drunk tonight.

"Cristina—"

"Don't. I'm talking now," she said, then fell silent for a moment. "You think you have the patent on broody and tortured. Well we're all dark and twisty inside, and we all screw things up, even we we're doing the best we can. So get over yourself."

"You're right."

"Of course I'm right," she eyed me suspiciously, waiting for an argument. When none came she finished the last tequila shot, and waved Joe back over.

"What can I do for you, gorgeous?"

She snorted, nearly falling off her barstool.

"He's paying for these," she told Joe, who looked to me for confirmation. I nodded, placed a steady hand on Cristina's shoulders.

"You're paying for these," she told me. Her breath smelled like tequila, and I could see the slightest bit of nystagmus in her gaze. "You're paying for these, and then you're taking me home with you."

"Okay."

"No arguing."

"Okay!"

Left fifty for Joe. Wound an arm around her small frame, and guided her out the door, through the light rain, to my car.

My jeep.

Maybe it isn't all so useless. Maybe we try and try again because we don't know what else to do, and we have to do something.

Maybe I suck as a philosopher. But she's there next to me, running her hand down my arm, smiling at me drunkenly. And for her I think I'll keep on trying.

***

February 3, 2009