In the middle of a hot, humid and bloody afternoon Lt. Col. Henry Blake finished a bowel resection, assessed the grief in the admitting and preop wards and then stepped outside to smoke, pace back and forth and, about once every ten seconds, look hopefully to the south. From the number and nature of the casualties, and with the privileged information from Radar O’Reilly that the situation on Old Baldy would get worse before it got better, he knew that he—that all of them—were in trouble. Between his looks to the south he swore at the Army for taking two of his three best cutters to Kokura and not getting them back in time.
As he ground out his butt, drew a deep breath and made a half-hearted attempt to square his sagging shoulders, he took a last look down the valley and saw it—a cloud of dust. Henry smiled and, for the first time in twenty-four hours, relaxed because he knew that just ahead of just such a dust cloud had to be a jeep driven by Hawkeye Pierce. Seconds later Hawkeye and Trapper, in sky blue slacks and golf shirts, jumped from the jeep.
“Hail, gallant leader!” Hawkeye said, snapping off a salute.
“The organization looks busy,” observed Trapper John to Hawkeye, “so I wonder what its gallant leader is doing, just standing here and dilly-dallying in the sunshine.”
“Beats me,” Hawkeye said.
“You guys get your asses to work!” yelled Henry.
“Yes, sir,” Trapper said, saluting.
“Sure, Henry,” Hawkeye said, “but we’d appreciate it if you’d get our clubs out of the jeep and clean them.”
They ran for the preop ward where the scene informed them that they were in for the busiest day of their lives. What they were yet to learn was that they, and the entire personnel of the 4077th MASH, were in for the busiest two weeks the Double Natural had ever known. For a full two weeks the wounded would come and keep coming, and for a full two weeks every surgeon and every nurse and every corpsman, as the shifts overlapped, would work from twelve to fourteen to sixteen hours a day, every day, and sometimes some of them would work twenty out of the twenty-four.
It could have been chaos, and it almost was. They came in by helicopter and they came in by ambulance—arteries, lungs, bowels, bladders, livers, spleens, kidneys, larynxes, pharynxes, bones, stomachs. Colonel Blake, the surgeons, Ugly John, Painless Waldowski, who, when he wasn’t extracting shattered bone and wiring jaws, was passing gas to back up Ugly John, were in constant hurried communication, trying to maintain some order to the flow. Their objective was to provide each patient with the maximum preparation for and the proper timing of his surgery. This was controlled, of course, by the availability of the operating tables and the surgeons. As each new chopper brought new emergencies, plans and timing constantly had to be changed because some cases had to be moved directly from chopper to admitting ward to OR.
From one flight of choppers the Swampmen found eight new arrivals, all of whom needed maximum and immediate attention. The worst was an unconscious Negro private who was the bearer of a note from the doctor in the Battalion Aid Station. The note stated that the patient had been knocked out when a bunker had collapsed, had awakened and then had slowly subsided into unconsciousness again. This was a neuro-surgical problem, but the 4077th had no neurosurgeon because such cases were supposed to be sent to the 6073rd MASH, which had several.
Trapper John looked at the note and then at the boy. He looked in his eyes. The right pupil was dilated and fixed. His pulse was slow, his blood pressure negligible.
“I’m afraid this one has an epidural hematoma,” he said. “Duke, haven’t you been that route a little?”
“Yeah,” Duke said, “but not enough to be a pro.”
“You’re a pro now,” Trapper said.
Duke quickly examined the patient. He found indications of pressure on the brain from blood accumulating between the skull and the outer brain lining.
“Right now,” he ordered, “lug this one into the OR.” The Duke ran ahead of the stretcher. In the OR he encountered, fortunately, the boss, chief, honcho, leader and head coach of the operating room nurses, Captain Bridget McCarthy of Boston, Massachusetts.
“Quick, Knocko,” he commanded, “y’all get me gloves, knife, hammer, chisel, Gelfoam and a drain.”
Captain Bridget McCarthy was maybe thirty-five years old, five feet eight inches of solid maple, and she did not ordinarily tolerate much lip from the Swampmen or her immediate superior, Major Hot Lips Houlihan, either. This last endeared her to the Swampmen who did not call her “Knocko” for nothing, for they knew she could take out any one of them in a head-on. More than anything, however, she was also a nurse who had come specifically to be a nurse, so when Duke gave orders with fire in his eye she asked no questions and said, “Yes, sir.”
The right temporal area was quickly shaved and scrubbed, and Duke incised down to the bone. He had no desire to go through the skull with a hammer and chisel, but he also had no choice. The appropriate drills for making burr holes were at the 6073rd with the neurosurgeons, so he did the best he could. With luck, or skill born of need, he cracked a jagged hole in the skull in less than a minute. As he broke through, blood flowed out in a torrent. The torrent quickly diminished to a dribble and then Duke exercised highly commendable surgical wisdom. The wise surgeon, particularly when out of his field, knows when to quit, so Duke refrained from looking for hemorrhage beneath the dura mater. He settled for the drainage of the epidural hemorrhage, and the pressure on the brain was relieved. He stuffed Gelfoam down toward the bleeding site, put in a rubber drain, closed the skin with silk sutures, and the soldier began to stir and moan. As his breathing improved and his pulse picked up, the Duke spake the words that, if they ever name a medical school after him, may be carved in stone over the entrance to the administration building:
“He might make it, even if all I really did was hit him in the head with an axe.”
As Duke went, then, to the postop ward to write orders on his patient, Captain Bridget McCarthy went to the other end of the operating tent to find out what the excitement was. The excitement was the patient who’d arrived on the same chopper with the epidural hematoma. Hawkeye had looked at him quickly, found him to be in shock, semiconscious but not, it seemed, in immediate danger. His clothes were saturated with mud, as was his hair, and there was a muddy, bloody bandage around his neck.
“Get that bandage off so I can see what the hell’s underneath,” Hawkeye told a corpsman, and he went on to the patient on the next stretcher.
The corpsman removed the bandage. The patient turned his head to the left. Blood shot two feet into the air from the hole in his right neck where a mortar fragment had entered. The soldier yelled.
“Mama, Mama!” he yelled. “Oh, Mama, I’m dying!”
It looked like a gushing well, and a fascinated group gathered to watch. As the well crested and the blood descended, it fell on the face of the soldier and into his mouth. He coughed, spraying his rapt audience with blood.
Hawkeye ran over. In haste, and instinctively, he stuck his right index finger down the hole, blocking off the severed common carotid artery. He had stopped the flow of blood, but he had also tied up his right hand, and he wondered: “What the hell do I do now?”
“Bring him to the OR right on this stretcher,” he yelled. “I can’t take my finger out. Find Ugly John and get his ass in here!”
As Knocko McCarthy followed Hawkeye into the OR, she had no chance to ask questions. Hawkeye was still sounding off orders.
“Start somebody cutting off his clothes … Tell the lab to come in with a couple of low titre O, and type and cross match him for five or six more … Get somebody to do two cutdowns and start the blood … Come to think of it, get somebody to start rounding up donors, and send some cowboys to Seoul for all the goddam blood they can get … And get that Christly gas passer in here!”
“I’m here,” Ugly John said.
“Good,” Hawkeye said. “I guess you’d better get him asleep and a tube in him if you can. His common carotid is cut, and I can’t do anything with the son of a bitch jumping all over the place. We haven’t got time for any of the preoperative pretties.”
“Mama, Mama!” the patient was yelling. “I’m dying.”
“Hold still,” Hawkeye said, “or I’ll guarantee it.”
Ugly John did a cutdown and got into a vein. He got some blood started, as well as Pentothal and curare, and inserted his intratracheal tube. It was still a toss-up. Although the patient had survived the induction of anesthesia, Hawkeye still had to get the carotid clamped off, and as soon as possible.
“Get help,” he ordered Knocko McCarthy. “I gotta keep a finger on this or we lose him, and I can’t expose it and get it clamped with one hand.”
He tried though. Grabbing a scalpel with his left hand, he enlarged the wound around the bare, dirty right index finger which had to stay in the neck. Next he tried to slide a Kelly clamp down his finger into the wound and clamp the artery, but it didn’t work. Then he got a retractor and, managing to hold it in the wound with his left hand, he improved the exposure. He was still in desperate need of help.
“Look, Ug,” he said to Ugly John who was busy enough with the anesthesia and the new blood, “grab a Kelly, and from where you are I think you can ride it down my finger, grab, and we’ll have this mother under control.”
Ugly did as told. Reaching the bottom of the wound, he opened the clamp as wide as he could. Sensing that he was around something substantial, he closed the clamp vigorously, asserting, “I got it! I got it!”
He had clamped the end of Hawkeye’s finger. Hawkeye, by reflex, removed his finger—and the blood flew. When it did Hawkeye went back in, but this time with his left index finger, and now, with luck, he was able to get a clamp on the artery.
“I’m OK for now,” he told Knocko McCarthy and one of the surgeons from the other shift who came running up with her, “but get the Professor.”
Most of the surgeons had some locally acquired experience in the care of arterial injuries, but they were still beginners. Therefore the Army had sent a Professor of Vascular Surgery from Walter Reed Hospital in Washington to give lessons throughout Korea. Fortune had placed him, at this time, at the Double Natural, and he bailed the patient, and Hawkeye, out.
Trapper John, meanwhile, had delved into a chest and Duke was now occupied with several feet of small bowel which were no longer useful to the owner. Hawkeye returned to the preop ward where Colonel Blake had taken charge.
“What’s the score now?” Hawkeye asked.
“A major case on every table and ten more that are bad and about thirty that can wait till things quiet down.”
“Who’s ready?”
“That one over there,” said Henry, pointing.
That one turned out to be a very black Negro who was one of Ethiopia’s contributions to the UN forces. Hawkeye repaired the damage to the liver and bowel there just in time to assist Trapper John who had gone into another chest. From Trapper he went to help Duke remove the right kidney and a section of colon belonging to a Corporal Ian MacGregor.
“What type we got here?” Hawkeye asked the Duke.
“Don’t y’all know you’re operating on a member of Princess Patricia’s Canadian Light Infantry?” the Duke said.
“Finest kind,” Hawkeye said.
That was the way they played it, day after day. As soon as someone finished a case he had to assist elsewhere until another case of his own was brought in. Then, briefed by Colonel Blake, he’d step in and do his best. When the last of the serious cases was allotted, the surgeons, as they became free, would start working on the minor things—debridement of extremity wounds, some with fractures, some requiring an amputation of a finger, a toe, a foot or a leg, but minor as compared with what had gone before. Meanwhile they, and everyone else, would listen for, and dread, the sound of the six o’clock chopper.
The six o’clock chopper, either morning or evening, was always unwelcome because the very fact that the pilot was risking the trip in half-daylight meant that the soldiers lying in the pods were seriously wounded. So twice each day, at dawn and at dusk, as six o’clock approached, everyone—surgeons, nurses, lab technicians, corpsmen, cooks and mostly Lt. Col. Henry Blake—would listen, and during the time of the Great Deluge, they would hear, not one six o’clock chopper but three or four.
“What the hell is going on up there, anyway?” Colonel Blake asked no one in particular one 6:00 p.m., the roar of the choppers filling the postop ward, where the colonel was assessing results with the Swampmen.
“The Chinks,” Trapper John said, “are obviously holding a Gold Star Mothers membership drive.”
“And it’s up to us,” Hawkeyc said, “to stamp out that organization, so let’s get to it.”
“Right,” Duke said. “We can fix ’em just as fast as they can shoot ’em.”
“Right, hell,” Henry said. “You guys can’t go on like this forever. You haven’t had any sleep.”
“Right,” Duke said.
“How the hell do you feel?” Henry said.
“Better than the patients,” Duke said.
“Then what the hell are you doing, standing around here?” Henry said.
The new group Was truly international. Hawkeye drew a Turk, and repaired his lacerated colon. Duke took off the right leg of a Puerto Rican kid, portions of whose femur, shattered by a mortar up on Pork Chop Hill, had punctured the chest of his fox hole buddy, who was now on the next table under Trapper’s knife. When Trapper finished there, he closed the ruptured diaphragm of a Chinese prisoner of war, while Duke assisted the Professor of Vascular Surgery who was trying to save the left leg of a Netherlands private by fashioning an arterial graft out of a segment of vein from the other leg, and Hawkeye, with Pete Rizzo assisting him, went into the belly of an Australian.
“Dammit,” he said, after about a half hour of it, “we just need more hands.”
“I know,” Pete Rizzo said, “but I only got two.”
“Knocko!”
“Yes, sir?” Captain Bridget McCarthy answered.
“Put on a pair of gloves and help us for a few minutes, will you?”
“Can’t, Hawk,” Captain Bridget McCarthy said. “I’ve just got too much to do already.”
“Then find somebody else.”
“Yes, sir.”
Ten minutes later, Hawkeye was aware of the help— gowned, capped, masked and gloved—at his left. Without looking up he reached over and put the new assistant’s hands on a retractor.
“Pull,” he said.
“How, Hawk?” he heard Father Mulcahy say. “This is a little out of my line.”
For days, now, and for nights, too, Dago Red had been doing his part. All day and all night he had been going from patient to patient—black, white, yellow—friend and foe. Some of them didn’t know who he was, but they all knew the side he was on. A confident patient does better in surgery, and so does a confident surgeon, and Dago Red had the right words for both.
“Just pull,” Hawkeye was saying now. “Right there, and toward you. More. Good. And when we get out of this you can put in the first sterile fix in the history of surgery.”
And still they came. Bellies, chests, necks, arteries, arms, legs, eyes, testicles, kidneys, spinal cords, all shot to hell. Win or lose. Life and death. At the beginning of it, all of the surgeons, and particularly the Swampmen, had experienced a great transformation. During periods of only sporadic employment they often drank far too much and complained far too much, but with the coming of The Deluge they had become useful people again, a fulfilled, effective fighting unit and not just a bunch of semi-employed stew bums stranded in the middle of nowhere. This was fine, as far as it went, but it was going too far. By the end of the second week they were all wan, red-eyed, dog-tired and short of temper, and it was obvious to all of them that their reflexes had been dulled and that their judgment had sometimes become questionable.
“This can’t go on,” Lt. Col. Henry Blake was saying at five forty-five one afternoon, for the fiftieth or sixtieth time within the last three or four days. “Goddam it and to hell, but this just can’t go on.”
Henry was standing, with the Swampmen, just outside the door of the postop ward. Once again, somehow, they had managed to take care of all the major cases, and the debridements and fractures and amputations were now being handled by others. They had ostensibly stepped out for a smoke, but each knew that they were all there to post a watch to the north and hope against hope against the appearance of the six o’clock choppers.
“It’s gotta end sometime,” Henry was saying. “It’s gotta end sometime.”
“All actions and all wars,” Trapper John said, “eventually do.”
“Oh, hell, Mclntyre,” Henry said, “what good is that? When? That’s the question. When?”
“I don’t know,” Trapper said.
“But who the hell does know?” Henry said. “I call three times a day, but those people in Seoul don’t know a damn thing more than we do. Who the hell does know?”
“I don’t know,” Hawkeye said, “but maybe Radar …”
“O’Reilly, sir,” Radar O’Reilly said, at the colonel’s elbow.
“Goddam it, O’Reilly,” Henry said, “don’t do that!”
“Sir?”
“What the hell are you doing out here, anyway?”
“I thought you called for me, sir,” Radar said.
“Look, O’Reilly … ,” the colonel started to say.
“Look, Henry,” Hawkeye said, “maybe I’m going off my nut …”
“Maybe we all are,” Henry said.
“Then maybe Radar can help us.”
“We are crazy,” Henry said, shaking his head. “We’re absolutely mad.”
“Look, Radar,” Hawkeye said. “What we . ..”’
“Let me handle this, Pierce,” Henry said. “O’Reilly?”
“Sir?”
“Now don’t lie to me …”
“Why, sir! You know that I never …”
“Never mind that, O’Reilly,” Henry said. “I don’t want to listen to any of that, but I want to know something.”
“What, sir?”
“Goddam it,” Henry said, turning to the others. “I haven’t really gone out of my mind, have I?”
“No you haven’t, Henry,” Trapper said. “Go ahead.”
“Yeah, go ahead,” Duke said.
“Look, O’Reilly,” Henry said, looking right at Radar. “What do you hear?”
“Nothing, sir.”
“Nothing!” Henry said. “What the hell do you mean, nothing?”
“I don’t hear anything, sir.”
“Well, what does that mean?”
“I believe it means, sir,” Radar said, “that the action has subsided in the north.”
“Good!” Duke said.
“Look, O’Reilly,” Henry said. “Are you telling the truth?”
“Why, sir! You know that I never …”
“Stop that, O’Reilly!”
“Yes, sir.”
“Radar,” Hawkeye said. “Tell us something else.”
“Yes, sir?”
“Do you hear the six o’clock choppers?”
“No, sir.”
“You sure?”
“Yes, sir.”
“Well, how the hell are you going to hear them, anyway, standing here?” Henry said, and he pointed toward the north. “You should be listening out there.”
“Yes, sir,” Radar said.
Radar started to walk slowly toward the north then, and they followed him. They formed a small procession, Radar in the lead, his ears at the right-angle red alert, his head turning on his long, thin neck in the familiar sweeping action. They walked across the bare ground the fifty yards to the barbed wire, beyond which lay the mine field, and they stopped.
“Well?” Henry said.
“Nothing, sir.”
“Keep trying.”
“Yes, sir.”
To the north the valley was blanketed in shadow now, the hills to the left dark, but the sunset colors still bathing the tops of the hills to the east. They stood behind O’Reilly, where they could watch him and the sky at the same time, and they maintained absolute silence. As they watched, the last of the colors left the eastern hills, the dusk mounted in the valley and only the sky held light.
“O’Reilly,” Henry said, “it’s six o’clock.” “Nothing, sir.” “It’s six-oh-five.” “Nothing, sir.”
“O’Reilly,” the colonel said, at about six-fifteen, “I can’t see my watch any more.”
“Nothing, sir.”
“Glory be!” the Duke said.
“Good work, O’Reilly,” the colonel said. “Dismissed.”
“Thank you, sir.”
“And by the way, Radar,” Hawkeye said, “stop by The Swamp tomorrow for a bottle of Scotch.”
“Thank you, sir,” Radar said. “That’s very kind of you, sir, but you were thinking of two.”
“OK,” said Hawkeye. “You’re right, and you’ve got two.”
“Thank you, sir.”
“We’re all crazy,” Henry said.
There was no jubilation. They were all too tired. In fact, they were exhausted, completely spent, and the Swampmen hit their sacks. When 6:00 a.m. came and went, and there were no choppers, they slept on, and at 8:00 a.m., when Radar O’Reilly, accompanied by an associate lab technician, entered The Swamp, he could have made any of the three the victim of his desperate need, not for two fifths of Scotch, but for a pint of A-negative blood, quantities of which were on order from Seoul but had not arrived.
“Captain Forrest?” he said, shaking the Duke. “Sir?”
“Not now, honey,” the Duke mumbled. “Gobacksleep.”
Gently, Radar straightened Duke’s right arm. Deftly, he injected Novocaine over a vein. Duke stirred but did not awaken, and while the assistant tightened the sleeve of Duke’s T-shirt to serve as a tourniquet, Radar skillfully inserted a No. 17 needle into the vein and joyfully extracted a pint.
“Where’d you get it?” Colonel Blake asked, after Radar had hurriedly cross-matched it and proudly presented it to his chief. “Twenty minutes ago you said there wasn’t any.”
“I found a donor, sir,” said Radar.
“Good boy,” said the colonel.
Two hours later the colonel himself was a visitor to The Swamp. By now Hawkeye was in the middle of Muscongus Bay between Wreck Island and Franklin Light. He and his father, Big Benjy Pierce, were hauling lobster traps.
“Finest kind,” Hawkeye was saying.
“C’mon, Pierce,” Henry was saying, shaking him, “C’mon. Wake up!”
“What’s wrong, Pop?”
“Pop, hell!” Henry said. “It’s me.”
“Who?” Hawkeye said.
“Listen, Pierce,” Henry said. “There’s a Korean kid in preop with a hot appendix. Who’s going to take it out?”
“You are,” Trapper John said, rolling over in his sack.
“Why me?” Henry said.
“Because,” Trapper mumbled, “although you are a leader of men, there are no men left.”