Die Once Live Twice (26 page)

“At the beginning of the Revolutionary War, George Washington held off the British here, until he was overwhelmed by Hessian mercenaries.”

Marion tossed her head. “Jonathan, do you think we didn’t study history in Iowa?”

Phil and Danica in the rumble seat could not hear their conversation, but Phil was busy with his hands anyway. As they climbed Washington Heights and were more exposed to the wind, Jonathan began to wish they had brought the sedan.

Suddenly a car pulled out from a farm’s driveway without looking for other traffic. Both braked fiercely and swerved, trying to avoid each other, but the other car crashed into the left front side of Jonathan’s, blowing out the front tire. Jonathan’s car slid backwards into the ditch and the rumble seat slammed against the far bank, bringing the car to a sudden halt. Marion’s head pitched forward into the windshield, breaking the glass. Blood spattered onto broken glass and covered her face. She was motionless.

Jonathan’s initial reaction was to scramble out of the car, unsure whether it would explode. His senses rapidly returned and he looked back at Marion. Horror shaped his face. He dove into the car and pulled her back into her seat, pressurizing the gash on her forehead with his hand. Spanezzi was standing outside the car. “We’re okay, Jonathan. Danica was knocked out briefly, but she is sitting on the grass. Just shaken.”

“Take your shirt off, Phil. I need a bandage. I don’t want to let go.”

Phil took off his leather coat, then his shirt, and climbed into the car next to Jonathan. “Let go,” he said and wrapped the shirt around Marion like a turban. She began to regain consciousness. “We need to lift her out of the car and lay her down. Let a real doctor take over here,” Phil smiled.

Phil gripped Marion under her armpits and told her to push off with her feet. “Ouch,” she yelped as she was lifted and dragged out of the car and laid on the grass of the ditch. “My belly hurts, Jonathan.”

The occupant of the other car, dressed in overalls, came up to Jonathan and began to apologize. Jonathan cut him off, saying, “My wife has been injured. Do you live nearby?” The man nodded and Jonathan said urgently, “Go back home and call an ambulance. Have them get here as soon as possible.”

Phil examined Marion’s head. The forehead cut was now just oozing, but the mucous membranes of her eyelids and lips were pale.
She has lost more blood than she would have from just this cut,
he thought. He moved quickly to her chest, which was not bleeding, and pressed but she felt no pain. But as he went to examine her lower abdomen, Phil saw that her skirt was blood-soaked. In a strained, tight voice, he said, “Jonathan, look.” When Jonathan saw, he reached for the car to steady himself.

Phil leaned forward to Marion and said, “Marion, you’re having a miscarriage and I have to extract the placenta or you’ll bleed to death.” Marion said nothing, but tears filled her eyes. She nodded that she understood. Phil felt that her pulse was racing and not strong, meaning her blood volume was low.

Jonathan just watched. He didn’t know what to do and wasn’t thinking clearly. Phil unbuttoned Marion’s skirt and pulled it off, then removed her underwear. “Jonathan, I need you. Hold her knees apart!” As Jonathan moved into position to do as Phil asked, Phil moved quickly to the car and pulled out the seat cushion. “Lift her pelvis, Jonathan.” Phil slid the cushion under her buttocks to elevate her pelvis.

Phil kneeled and motioned for Jonathan to spread Marion’s legs. Soon he had Marion’s blood all over his arms and legs and the ground beneath them was red with it. Jonathan watched Phil reach forcefully into Marion’s vagina and the image of him and Marion two hours earlier flashed in front of him. Marion moaned in pain, but by now she was only semi-conscious. Phil could feel that the mouth of her cervix was filled with fetal tissue and knew that if he couldn’t get the cervix to clamp shut, Marion would bleed to death. He grasped a fistful of tissue and pulled it out, throwing it on the ground. Jonathan turned sideways and vomited.

Phil forced his hand inside her vagina again and used two fingers to reach inside the cervix. When he identified the umbilical cord, he pulled on it gently and felt it give a little. The placenta was free. Pulling the cord, he retrieved the mass of the placenta and scraped it out of the cervix into the vagina. The cervical mouth was cleared and he withdrew his hand until he felt the cervix close. He pulled out the placenta, then turned to Jonathan. “It’s over. She’s safe there.” He looked at Jonathan through eyes wet with tears. No one knew better than Phil how much Marion and Jonathan had wanted a baby.

Jonathan was thinking clearly again. “Phil, she feels clammy. Her pulse is weak. At least 150. What type blood are you?” Just in the last ten years was the ABO blood typing system defined by Karl Landsteiner, now working at Rockefeller Institute. Jonathan, Marion, and Phil had all volunteered for one of his experiments to learn their blood type.

“I’m O,” Phil answered.

“That’s what I remembered. Marion is O, too. We need to transfuse her.”

Jonathan went back to his crumpled car and reached into a compartment behind his seat for his medical bag. Out of it he pulled two glass syringes, two needles, a rubber tube, and a glass bottle of iodine. “Sure glad these didn’t break,” he said to no one.

Phil looked around for Danica and saw her by the road. She had flagged down a car in case they needed transportation. By now four cars were stopped, with people all gawking at the scene unfolding in front of them. Danica was telling them to not interfere. “They are both doctors,” she explained.

Phil called Danica over to come help them. He explained they were going to transfuse blood from him to Marion and she needed to be their nurse. “This rubber tube is a tourniquet. It will be tightened on my arm to distend a vein to insert a needle. Then wrap it around Marion’s arm to distend a vein for Jonathan to put a needle into her. You’ll stay with Marion while Jonathan is drawing blood from me.”

Phil lay down next to Marion and Jonathan knelt between them. Jonathan poured iodine over Phil’s arm, told Danica to do the same for Marion, then inserted a needle into Phil’s vein. Phil covered the open needle with his finger to stop the bleeding while Jonathan turned to Marion with a second needle. Finding a vein in Marion was hard because her low blood pressure collapsed the vein walls. Jonathan stuck her once, twice, and then a third time in the antecubital fossa of the left elbow until he succeeded. He began the transfusion by withdrawing 20 ccs of blood from Phil into the syringe. He detached the syringe from Phil, swiveled to connect the syringe to Marion’s needle, and pushed the blood into her. As he released the syringe, he said, “Danica, put your finger over the needle so the blood doesn’t back out. See what Phil is doing?”

Back and forth he went twenty times, withdrawing blood from Phil and then transfusing it into Marion. With a pint of Phil’s blood in her, her pulse dropped to 120 and her inner eyelids pinked. Jonathan gave a sigh of relief and removed the needles from both their arms. Danica put pressure on Marion’s vein while Phil did the same on his. Leaning back on his knees, Jonathan gripped Phil’s hand. “Thank you, my friend. Thank you. I lost my son today. I could not have lived with my sorrow if Marion had died, too.”

“The ambulance is here,” Danica called out. Phil squeezed Jonathan’s hand, his eyes filled with sorrow for his best friend. “We need to get her to my hospital,” he said, sitting up. “I have to do a D&C. Any remaining tissue in her uterus has to be removed or it will necrose and cause infection.” He looked at Jonathan’s shirt which was covered with blood. “And you need to change that shirt.”

The ambulance driver and the two doctors lifted Marion onto a stretcher. Four men from the roadside crowd lifted the stretcher and carried it to the ambulance. “We need to go to the Ruptured and Crippled Hospital,” Jonathan said.

“I can’t do that, sir. I got to go to the closest one.” Jonathan pulled out his wallet and counted out one hundred dollars. He knew that was four months’ pay for the driver. The bribe, and assurance he wouldn’t get in trouble, convinced the driver to agree. With Jonathan and Phil in the back of the ambulance with Marion, and Danica riding up front, the July 4th celebration was officially being moved to Phil’s hospital.

“One second, driver!” Jonathan yelled up front. He climbed out the rear of the ambulance and slid back down into the ditch. Jonathan scooped up the tissue from the grass that Phil had evacuated. He laid it in his cap, crossed himself, doubled his cap closed and returned to the ambulance. “Marion and I will want to bury our son,” he explained. Phil nodded and crossed himself, too.

The next morning Jonathan was asleep in the chair next to Marion’s bed. Phil shook his shoulder and Jonathan looked up. “Is Marion stable?” Phil asked.

“Yes. Her pulse hovers around 100. She’s sleeping after five milligrams of morphine. There is no vaginal bleeding.”

Marion waved weakly. “I’m awake, Phil. Come here.” Marion gave him a hug. “You know, your nickname is no longer Deezi.”

“Why is that?” Phil smiled.

“Well, I have your blood in me and I can’t be a
dipshit
.” The men laughed loudly. “But you have a new one.”

“Uh-oh.”

“It is Speezi.”

“Which means...?”

“Well Phil, since I won’t be having a baby...” Her voice was shaking. “I was excited about having that special person. And since you saved my life by your skill and blood—well, now you’re my new special person.
Speezi
means
really special person
.”

No one spoke while Marion cried. Jonathan wiped the tears from her cheeks. Phil took her hand. “You know, Marion, I didn’t think about what I was doing. I didn’t need to. It was for you.”

“I can’t believe how lucky we were that I had transfusion syringes in my emergency bag,” Jonathan said. “I read just last week how many lives were being saved in the war by transfusions of patients in shock. I added the syringes and needles to my bag. War teaches doctors more medicine than a lifetime of peacetime practice,” he lamented.

“Then
thank God
for this war,” Marion said. “And thank you both for being so smart.” She took her husband’s hand. “Jonathan, you have work to do. You have to get me pregnant again!”

Chapter Twenty-seven

O
ver the next year, Jonathan and Marion’s wounds, internal and external, healed slowly. Neither gave up on having children, although when Jonathan celebrated his fiftieth birthday, he worried that he had married too late to fully enjoy children, if they were to come. Marion laughed at this, telling him that she had never met a man so young and so willing to prove it every night.

The relentlessness of disease kept them both busy, and although there was good news from the war front, Marion always said that she was glad Jonathan did not have to fight. “I can’t imagine worrying about you being in battle. I’m worried enough about little Jimmy.”

“Not so little anymore. He’s old enough to take care of himself, I guess,” Jonathan replied, although he too was worried. His brother’s son had enlisted in the Army in 1917, right out of high school, passing up a football scholarship to Notre Dame. In the first attack by Germans against his unit, Jimmy had been seriously wounded in the leg during a heroic charge on a nest of snipers. A transfusion had saved his life too, and a subsequent operation had been largely successful. They were looking forward to seeing him after he recuperated, and eager to see how Julianna was coping now that she had been diagnosed with diabetes. “Anyway, I’m glad I don’t have to fight over there, too,” Jonathan said with a laugh. “I have enough battles to fight here.” But when the soldiers began returning home in 1918, he stopped laughing.

Jonathan would remember September and October 1918 as the two worst months of his medical career. He was summoned to Philadelphia from the Rockefeller Institute because the city was facing a flu crisis unlike any seen before. Never had he confronted a foe so relentless in killing people. Worse yet, it was a foe that was safe from counterattack, because the body did not recognize it as a disease. Even worse, the people who should have been protecting America against it were doing nothing.

Although first reports of the flu had come in March and April, newspapers had underplayed the symptoms and the spread of the disease and suggested homeopathic treatments—castor oils, camphor, and a variety of other useless remedies. Jonathan and a close-knit group of Hopkins-trained scientists along the northeast coast knew better than to accept the rest of the country’s interpretations of this contagious fever. Welch had begun holding sessions with his colleagues as early as May to try to determine its cause.

The disease took a course unlike anything any of them had ever witnessed. The symptoms started innocently enough. Chills with fever, a sore throat and then, without warning, the flu took a horrendous turn. A massive headache and fever spikes would trigger delirium and nose bleeds. Patients felt as if their ribs would be torn apart by raging spells of dry coughing. As symptoms progressed, they would drift into delirium-induced psychotic episodes. When they thought the disease had tortured them to its full extent, their skin turned dark blue, nearly black. The sacs and the lungs that should have held air were filled with fluid. Patients literally drowned in pus, gasping for every possible molecule of air until they finally succumbed. Death was a mercy.

This flu was raging internationally, fueled by the war. Although many thought it had originated in Kansas, it had been tagged the Spanish Influenza during the war when it exploded among the troops in Europe. Welch and Flexner predicted that the epidemic in war-torn France during the late summer of 1918 would soon be repeated in the United States. A massive epidemic was brewing because the general public could be exposed at any moment.

When Jonathan learned that Philadelphia was planning a Liberty Loan parade on September 28, he raged at city officials about the need to avoid public gatherings. But they were under pressure from Washington to disregard any fears and go ahead with the parade in the interest of the war effort. Jonathan fought to no avail. The parade went on as planned, thanks in part to the continued manipulation of the truth. Unfortunately, Philadelphia was not unique in its separation of state and medicine, a situation in which medicine always lost. Medicine still had no cultural authority to influence government decisions.