525,600 Minutes

Bhagirath Singh, the new first-year surgical resident, didn’t think he would ever get used to the smell of the Emergency Room—or the lack of the respect from the jaded nursing staff. All the nurses seemed to hate him. True, he sometimes had a hard time finding a patient’s vein. True, he didn’t always leave the supply room in pristine condition. True, he treated the nurses with disdain, but he was literally operating on only a few hours of sleep.  

A nurse scurried up to him. 

No rest for the wicked, he thought. Even on New Year’s Eve. 

“Dr. Singh . . .” she said, breathing heavily.

“Who’s the patient,” he cut her off. 

“78-year-old male on a spine board. Restrained driver in a high-speed motor vehicle collision. First responders found him in the car with airbags deployed. Cervical collar placed on victim by EMS after prolonged extraction. Exposed right femur, distended abdomen, multiple facial lacerations. Heart rate of 139, blood pressure 84/40.”

“Respiratory rate?”

“30.”

“GCS?”

“6.” 

“Prepare the patient for surgery,” Dr. Singh replied, beginning to wash up. Don't get emotionally invested, Bhagirath thought, remembering his father's advice. You have to look at them as cases, not people. It's the only way to survive the daily trauma of the Emergency Room.

Bhagirath Singh, Sr. had been chief of thoracic surgery at Johns Hopkins in Baltimore, but he had cut his teeth working at the trauma center at the Mayo Clinic in Minnesota. It's highly likely that Bhagirath would have become a surgeon anyway, but he really didn't have a choice.  His father had been a surgeon and his father before him.

"I think your hands are clean. Don't scrub the skin off." Nurse Anderson’s curt words jarred him back to reality.  

"I'm ready,” the intern said, gloving up. “Bring in the patient, and let's begin.” He tried to exude the confidence he did not feel. 

The nurses were skeptical of Bhagirath. Too many of his trauma patients crashed. He had left a medical sponge in one. He botched subcutaneous sutures on several patients, and he had trouble with continuous stitches, unevenly distributing the necessary tension throughout the suture strand. 

A nurse had to quickly correct a possibly lethal dosage of pain medication he ordered for a young child. Instead of thanking her, Bhagirath let loose a torrent of vitriol against her, adamant that she had misunderstood his directive.

They both knew he was lying. 

“Time of death, 12:01.” Bhagirath failed to sound calm and collected. His voice quivered and his eyes watered. Though Mr. Baumgartner was in the twilight of his life, a better doctor, a more experienced doctor, could have easily saved him. 

“We did everything we could, unfortunately, Mrs. Baumgarden—”

“Mr. Baumgartner! Please get his name right. He deserves at least that,” his widow cried. Her voice wasn’t angry, just impossibly sad. 

“Mrs. Baumgartner, our efforts were unsuccessful. Your husband passed away just after midnight.”

“No, he didn’t. He couldn’t! My granddaughter is getting married Saturday. He’s supposed to walk her down the aisle. He can’t be dead.” As the last words left her mouth she put her head in her hands and sobbed. A pretty young woman, whom Bhagirath assumed was the deceased patient’s granddaughter, tried to console the new widow. 

Bhagirath coldly walked out of the bereavement room, a room where he’d met with patients’ relatives far too frequently.  

The 4th of July always kept the Emergency Room full. Between teenagers blowing off a few of their fingers with M-80’s to well-meaning fathers trying to grill using old charcoal and too much lighter fluid, burns and flesh wounds were rife.

Six months in the Emergency Room taught Bhagirath a lot more medicine, but precious little bedside manner. In medical school, Bhagriath had been instructed in the necessity of establishing a rapport with patients and their loved ones. This, he cynically thought, was chiefly to avoid physician burnout and expensive medical malpractice claims. He recalled his father not needing any of the “softer touch.” He simply healed people. 

His grandfather had been different. Even as a young boy, Bhagriath could feel the old surgeon's innate kindness. Bhagraith’s grandfather started each patient consultation with a thoughtful observation, thorough examination, and heartfelt connection. His grandfather felt his primary directive was to listen to the patient.

To Bhagriath, he felt this was a waste of time since patients were often hysterical and poor sources for their ailments. He was learning that nurses actually knew more than he had previously though, and grudgingly, he found himself listening to them more frequently. 

Even the most stoic of emergency room surgeons remember their first trauma case involving a child. Bhagraith remembered Mrs. Baumgartner, but few other patients; however, his first 4th of July would be one he would never forget.  

The boy's name was Reginald Hayes, but as far as Bhagraith knew, his friends might have called him Reggie. He was 13 years old with a face full of braces. He had defied his mother, climbing the tall pine tree just behind his house. 

The family’s holiday party was in full swing when they first heard Reggie’s screams. It wasn’t more than twenty minutes after his fall that Reginald found his way to Bhagraith’s operating table. An x-ray would be needed to confirm his initial diagnosis, but Bhagraith felt that Reggie would never walk again. 

There is little doubt that the skills he had honed over the previous six months saved the young boy's life, but for the first time in his surgical career, Bhagraith understood his grandfather's heart. The memory of meeting with Reggie’s grief stricken parents was one that Bhagraith would carry with him the rest of his days.

“How is he,” Reggie’s mother pleaded to Bhagraith, as if he were a deity that could deftly reassemble a spine. The parents were always wide eyed, asking questions that any god would be pained to answer with surety, let alone a doctor. Bhagraith had learned from the nurses to alleviate what fears he could at first, all the while ensuring he made eye contact with all concerned parties.  

“Mr. and Mrs. Hayes, Reggie has been stabilized,” he said, reaching out and touching the father’s shoulder as the father dissolved into grateful tears. He waited a beat until family members hugged and comforted each other. He managed an authentic, but small smile, knowing that what he would say next would change all of their lives forever. 

“Thank you, doctor,” the mother said, hugging him without restraint. He startled at her touch, feeling as if he received her thanks disingenuously. 

“Unfortunately,” Bhagraith said, knowing this one word would stun the small group. It did, yet he continued. “Reggie’s fall precipitated a shock to his spinal cord. At this point, your son suffers from complete paralysis from the waist down. With treatment, we can hope that—”

The mother’s inhumane wail sent a shiver up Bhagraith’s own spine. As the group coalesced around her into silent pain, the father stood staring at the doctor, waiting for something more. Certainly there was a pill, a procedure—a plan for his son? It was the 21st century. Doctors should be able to cure anything.

Bhagraith looked back in silence at the father. Surely the father knew when he ran to his broken son at the foot of the tree. Bhagraith had seen that look of despair in his own father’s eyes when he disowned him, after Bhagraith announced he would not marry the woman his family had arranged for him to wed. 

The only person Bhagirath still communicated with from his estranged family was his grandfather. That night in the quiet of a supply closet, he called his Dada for comfort and to cry.

Eyes still red, Bhagraith finally left the closet, practically running over Nurse Anderson. No words were spoken between them, but Nurse Anderson’s expression made it clear she knew he had done all he could for Reggie. 

Bhagraith was not supposed to work Thanksgiving Day, but when a colleague asked if he was busy, he honestly was not.  His family didn’t celebrate the holiday, and even if they did, he would not have been invited. His 12-hour shift had been remarkably uneventful.  No fried turkey incidents or carving knife accidents.  

All was well until it wasn’t.

Bhagraith’s family was by every reasonable definition dysfunctional; however, differences were dealt with by silence, not violence. Such was not the case with the patient arriving in an ambulance with lights flashing and sirens wailing. This poor soul had said the wrong thing at dinner and had a knife in his chest to show for his unwelcome political opinion.  

“We have an unresponsive 26-year-old male with a puncture wound to the right lung. The patient was injured by a relative in the home. The wound has been packed with gauze. Pressure applied during transport. He remains hypotensive due to blood loss. Vital signs are BP 82/50, pulse is irregular, respirations 24. No other significant findings. Nothing on the head, neck, abdomen, or other extremities. Patient has a history of drug abuse and alcohol consumption.”

Emergency Room surgeons are used to treating catastrophic injuries. The good doctors are unfazed by any amount of blood, phlegm, and other bodily secretions. They don’t waste time worrying if they can save a life; they simply do what the body needs to have done to survive. 

No one who saw this patient believed he would live. Not the paramedics who performed the Herculean task of getting him stabilized and to the Emergency Room. Not the triage nurse who articulated the vitals to Bhagraith. Not the anesthesiologist who wondered if the patient could handle any more drugs in his body. Not anyone, but Bhagraith. 

At that moment, he finally understood his father’s last piece of advice. Bhagraith Sr. wanted his son to know a great trauma surgeon acts—he doesn’t react. On the operating table,  Bhagraith did what needed to be done for the body to survive. 

With great relief, he delivered good news to the family. After interning in the Emergency Room for almost a year, Bhagraith finally felt what he was: a lifesaver.  

For New Year’s Eve, Bhagriath helped decorate the nursing station with tiny top hats and silver champagne glasses. He had spent the better part of his day off putting gift bags together for the nursing staff, especially Nurse Anderson who had taught him more than most of his medical school professors. Bhagriath ordered pizza for everyone in the quiet hours before the onslaught of post-midnight patients, those partygoers who were too inebriated to get home in one piece. 

The previous year he hadn’t even noticed the decorations. Now, Bhargraith found himself staring at the clock waiting for midnight, not for the traditional reason. At the official end of his shift, he would be a junior resident. It was just a small step on his journey to being a full fledged surgeon, but he inherently knew paying his dues in the Emergency Room was an important step as well.

Still a few hours away from the new year, Bhagraith allowed himself a moment to laugh with the nurses. He knew a few boxes of cold pizza couldn’t repay them for all they had done for him over the past year, but he also knew nurses were just as much lifesavers as the doctors and EMS and custodians. All in the Emergency Room worked to ensure that patients were given every opportunity to survive. 

An Uber driver skidded to a stop next to the curb in front of the Emergency Room’s doors. A frantic driver jumped out and grabbed Bhagriath by the arm.

“Doc! There’s a lady in my car,” he shouted in obvious distress. “She’s very pregnant and about to have a baby. Please Doc, you gotta help. She’s all alone.”

Bhagraith wasted no time, alerting the orderlies to bring the woman inside.  Most times pregnant women are rushed to labor and delivery, but this young woman was dilated to nine centimeters. The baby was about to crown.  

Nurse Anderson, working in perfect harmony with Bhagraith, helped prepare a room for delivery before slipping out to call the young woman’s family.  Bhagraith knew all the necessary steps to delivering a baby, but this would be his first actual delivery. Very few fortunate things happen in the Emergency Room, especially at night and on New Year’s Eve. 

Tonight would be the exception.  

At just after midnight, 12:01 a.m. to be exact, Bhagraith delivered a healthy baby boy.  Both mother and child were doing exceptionally well. For a change, Bhagraith couldn’t wait to give the good news to the family.  

As an official junior resident, Bhagraith entered the waiting room; nothing could have prepared him for what he was about to see. In the room of  delighted family members, towards the back was an elderly woman whom Bhagraith recognized immediately.  

“Mrs. Baumgartner, is that you?” he said, astonished at the coincidence.

“Yes! And you, doctor, just delivered my great-grandson.” 

Bhagraith broke down in tears. He had carried the picture of this grieving woman in his heart for a year, after the death of her beloved husband, and the juxtaposition of the emotions caught him off guard, overwhelming him.

Then with a tenderness only a great-grandmother can show, Mrs. Baumgartner embraced Bhagraith. 

“He’s a beautiful boy,” Bhagraith said, wiping his tears. “Does he have a name yet?”

“His name is Miles,” Mrs. Baumgartner replied, “Named after my late husband. Thank you for giving my family a life back.”