For the next two days, Henry spent his spare time distributing the profits of the betting coup to the financial backers of the Red Raiders. The way the money had been bet—half of it before the game at two to one and the rest at halftime at four to one—meant that the ultimate payoff was three to one, so when Henry stopped off at The Swamp on the second afternoon and handed each of the occupants his original $500 and then $1,500 more, the recipients were more affluent than they had been in a long while.
“And no place to spend it,” the Duke said.
“Send it home,” the colonel advised.
“No,” Hawkeye said. “I got a better idea.”
“What?” Henry said.
“You keep all the money, and send us home.”
“No chance,” Henry said.
“But why, coach?” Duke wanted to know. “With the time the Hawk and me put in before they sent us to y’all, we been over here longer than anybody but you.”
“That’s right,” Hawkeye said, “and it ain’t fair.”
“Excuse me,” Trapper John said, getting up, “but I’ve heard this before and I don’t want to hear it again.”
“I’ll go with you,” Spearchucker said. “I can’t stand the sight of suffering, either.”
“Soreheads!” the Duke called after them. “Just because we get out before y’all!”
“Seriously, Henry,” Hawkeye said, “the Duke and I are scheduled to get shed of this Army in March. That’s only a little over three months away. Now, ever since we’ve been stuck out here at the tag end of nowhere we’ve watched a procession of our contemporaries come and go. Singles and doubles hitters, strike-out artists, long down the fairway or off into the woods, it didn’t matter what they were, because they all got rotated back to stateside duty four—five months before they were to get sprung.”
“That’s right,” Henry said.
“But why?” the Duke said.
“I know why,” Hawkeye said. “It’s because the Army always gets even.”
“What do you mean?” Henry said.
“I mean,” Hawkeye said, “that the Duke and I are two of the three biggest screwups over here, or four if you count Roger the Dodger …”
“I don’t count him,” Henry said. “I don’t even think of him, and if that sonofabitch comes around here again I’m gonna have him shot on sight.”
“Anyway,” Hawkeye said, “you gotta admit it. We screwed up, so now the Army, defender of democracy and symbol of justice, is gonna take it out on us.”
“No,” Henry said. “You’re wrong. You won’t believe it, but it’s not a punishment.”
“Then what is it?” the Duke said. “It feels like a punishment.”
“It’s ironic,” Henry said, “but it’s because you two, like Trapper John, came here with more than average training and experience. You’ve done a good job when the chips were down, and now we can’t afford to waste you. If you went home now you’d be of no use to anyone but your wives. Therefore, we’ve got to keep you here until your enlistments expire.”
“Ain’t that the damndest thing?” the Duke said.
“In short,” Hawkeye said, “we screwed up in the wrong area. If we had dubbed it along in the working time and never given it the goddamn college try, we’d be back at some stateside hospital, living with our wives and behaving like officers and gentlemen? Is that right?”
“Yeah,” agreed Henry with a broad grin.
“I couldn’t stand a stateside Army hospital,” the Duke said. “Too many jerks.”
The next morning the two appeared in front of Colonel Blake’s tent. When the colonel came out in answer to their calls, they announced that the Spearchucker had arranged for them both to be given $25,000 bonuses by the Philadelphia Eagles and they were leaving immediately for the City of Brotherly Love. They then departed by jeep, and were neither seen nor heard from for three days. Colonel Blake, of course, was aware that the other two occupants of The Swamp knew where they were and could have them back in two hours if a hint of heavy work arose.
Four days after they returned, the two, whose previous escapade had been ignored by Henry, appeared once again in front of their colonel’s tent. Once again he went out to meet them.
“So where do you wise bastards think you’re going this time?” he inquired.
“Paris,” replied Hawkeye.
“Yeah,” said the Duke.
“That’s very interesting,” said Henry. “What for?”
“We gotta get the Duke fixed,” explained Hawkeye. “It’s an emergency. He’s been nice to me and Trapper and Spearchucker for three days in a row, and we think he’s turnin’.”
“Well,” said Colonel Blake, “that certainly is an emergency, and we can’t have that sort of thing around here, but why don’t you just take him down to Seoul? It’s so much closer.”
“Why, Colonel,” replied Hawkeye, “you can’t be serious. Just two days ago you gave the enlisted men a lecture on how they should not get it in Seoul because there is so much neisserian infection. What applies to enlisted men must certainly apply to officers, and we do not wish to set a bad example. We hear that there is not too much of it in Paris, so that’s where we are going.”
With that they jumped into their jeep and disappeared for what turned out to be another three days. This time their colonel realized that, for the good of the organization it for no other reason, he would have to curtail the extracurricular excursions of his two transients. At the same time he realized that, as the two sweated out the termination of their enlistments and grew more itchy by the day, he needed some means of keeping them busier and thus happier in their home away from home. He might have prayed for an increase in battle casualties, but he was too fine a human being for that, so he prayed for any other answer, and the next morning it appeared in two parts, named Captains Emerson Pinkham and Leverett Russell.
Captains Pinkham and Russell were replacements for two of Henry’s surgeons who, having been nursed along to the point of being able to accept major responsibility, had unaccountably but not unexpectedly been whisked away. Henry greeted them, oriented them and then invited them to meet him and various members of his staff late that afternoon for cocktails at the so-called Officers’ Club.
It was a pleasant, but in some ways disturbing, social occasion and confrontation. Trapper John, Spearchucker, Ugly John and the others who were not on duty found Captains Pinkham and Russell highly presentable. They were intelligent, polite, seemed to possess normal senses of humor and on the subject of surgery talked impressively. This last should not have surprised nor disturbed the veterans, for the surgical world changes rapidly and almost all surgical residents talk well, but the veterans had been so far removed from the mainstream of their profession for so long that, as the recruits expounded on new approaches and new techniques, at least several of the listeners wondered if, when they did get home, they would have to start all over again,
“Well,” Henry said, as he, Trapper John and Spearchucker headed toward the mess hall at the party’s end, “they seem all right. Good men.”
“I think so,” Spearchucker said, “for Ivy League types.”
“I guess so,” Trapper John said, “but we’ll see what the Hawk and the Duke think, if they ever get back.”
“Oh, they’ll be back,” Henry said, “and that gives me an idea.”
Two days later, when Hawkeye and the Duke returned, Henry read them the Old Familiar. While the strains of that were still sounding in their ears, he launched into his project for the preservation of what remained of the sanity of Hawkeye and the Duke and the perpetuation of the efficiency of his organization..
“Now, while you two clowns were gone,” he told them, “we picked up two new men. Their names are Emerson Pinkham and Leverett Russell.”
“Sound like Ivy League types,” Duke said.
“That’s right,” Henry said. “They are, but they’re good men. They’re intelligent, they’ve had excellent training and they’re abreast of certain new concepts of surgery that you and I have never even heard about.”
“Good,” Hawkeye said. “Then let them do all the work.”
“No, goddammit,” Henry said, the red rising to his hairline again. “Not for one minute. That’s been the trouble with this organization. When we’ve been busy there hasn’t been time to teach the new men the kind of hurry-up, short-cut or call-it-what-you-will surgery that you have to do in a place like this. When we’ve had time you people have goofed off, which is my fault, and as a result anybody who learned anything here just picked it up by accident. Well, that’s gonna stop, and it’s gonna stop right now. These new men are going to be taught everything they can be taught, and you two are gonna teach them!”
“Yes, sir,” Duke said.
“OK,” Hawkeye said. “I guess you’re right.”
At lunch that day, Henry introduced Hawkeye and Duke to Captains Emerson Pinkham and Leverett Russell, and the two veterans invited the two recruits to join them, Trapper John and Spearchucker at The Swamp for cocktails at four o’clock. At four o’clock the two appeared and were served libations. As before, they shaped up well in all the requisite areas. Since their arrival they had observed a number of operations and had performed two themselves, and this, of course, quite naturally invited a comparison between the methods being employed at the MASH and the techniques taught in the high-level stateside training hospitals.
“I think I can speak for Lev as well as myself,” Captain Pinkham said at one point, “when I say that we are not, for a moment, regretting our presence here. There’s a job to be done, and some men are giving their lives so, at the very least, we can give our time and our talents, such as they may be. At the same time, any surgeon, aware of everything that’s going on in his field back home, has to regret it when he’s sent to a place like this where about all he ever gets to do is meatball surgery. No offense, of course.”
Hawkeye looked at Duke, Duke looked at Hawkeye, Trapper John and Spearchucker looked at their colleagues. The term was one that was used often in The Swamp, but now it had just been used by someone else, and a recruit.
“No offense,” Hawkeye said. “Have another drink.”
As it happened, the Double Natural was moderately busy at this time, and Henry had paired Captains Pinkham and Russell with Captains Pierce and Forrest on the night shift. On this very first night, in fact, there was even a six o’clock chopper, so after they had bolted down a quick meal, the two veterans escorted the two recruits over to view the passengers.
The chopper had brought two 4077th MASH Specials: both had belly and extremity wounds, and one had a minor chest wound. Hawkeye and Duke stood back while Captains Pinkham and Russell made their examinations, then informed the recruits that they would be ready and willing to assist when the patients had been prepared and moved into the OR. After that the two Swampmen retired to the lab where, a few minutes later, Captain Bridget McCarthy found them avidly engaged in questioning Radar O’Reilly who had recently been in communication with Jupiter,
“All right, you two!” Captain McCarthy ordered. “Get out of here!”
“What’s your maladjustment tonight, Knocko?” asked Hawkeye.
“Listen,” she said. “Your two Cub Scouts want to operate on those patients right away, and they’re not ready to be operated on.”
“Now just a minute, ma’am,” Duke said. “Just where did y’all …”
“Attend medical school?” Knocko asked. “Right here.”
“Yes, ma’am,” Duke said. “We’ll go help.” In the preoperative ward the two graduates of the ivory tower surgical training programs were showing their inexperience. The two cases that confronted them were well within the ability of the Double Natural, or any other MASH, to handle. Both patients were in moderate shock, but had no continuing blood loss. Both required preoperative resuscitation by a process well known even to the corpsmen and Korean helpers.
Captain Pinkham had the boy with the minor but significant chest wound. When Hawkeye and Duke wandered in, he was fussing around the patient, rapping on the chest and listening to it with a stethoscope. He was behaving, in other words, like a doctor and not a meatball surgeon, so Hawkeye took a look at the X-ray, assessed the situation and spoke.
“Doctor,” he said, “this guy obviously has holes in his bowel and his femur is broken. It’s not a bad fracture, but he’s probably dropped a pint here. There’s at least a pint in his belly and maybe a pint in his chest. Agreed?”
“Agreed,” Captain Pinkham said.
From there Hawkeye went on to explain that the patient also had a pneumothorax, meaning that there was air in his pleural, or chest, cavity because his lung was leaking air and had collapsed. In addition, he suggested, the shock from the blood loss was probably augmented by contamination of the peritoneum, or abdominal, cavity by bowel contents.
“So what he needs,” he said, “before you lug him in there and hit him with the Pentothal and curare and put a tube in his trachea, is expansion of his lung, two or three pints of blood and an antibiotic to minimize the peritoneal infection.”
“I see,” Captain Pinkham said, beginning to see a little light, “but we’ll still have to open his chest as well as his belly.”
“No, we won’t,” said Hawkeye. “The chest wound doesn’t amount to a damn. Stick a Foley catheter between his second and third ribs and hook it to underwater drainage, and his lung will re-expand. If he were going to do any interesting bleeding from his lung, he’d probably have done it by now. We can tap it after we get the air out and his general condition improves. Right now we just want to get this kid out of shock and into the OR in shape to have his belly cut and his thigh debrided.”
Two corpsmen brought what at the Double Nature passed for an adequate closed thoracotomy kit. It contained the bare essentials for insertion of a tube in a chest, and after Hawkeye had watched Captain Pinkham fiddle around with it for awhile, he spoke again.
“Look,” he said. “All that’s great, but there will be times when you won’t have the time to do it right. Lemme show you how to do it wrong.”
Hawkeye donned a pair of gloves, accepted a syringe of Novocain from a corpsman, infiltrated the skin and the space between the ribs and shoved the needle into the pleural cavity. Pulling back on the plunger he got air, knew he was in the right place, noted the angle of the needle, withdrew it, took a scalpel, incised the skin for one-half inch and plunged the scalpel into the pleural cavity. Bubbles of air appeared at the incision. Then he grasped the tip of a Foley catheter with a Kelly clamp and shoved the tube through the hole. A nurse attached the other end to the drainage bottle on the floor, a corpsman blew up the balloon on the catheter and now bubbles began to rise to the surface of the water in the bottle. Hawkeye dropped to his knees on the sand floor and, as he began to suck on the rubber tube attached to the shorter of the two tubes in the bottle, the upward flow of bubbles increased as the lung was, indeed, expanding.
“Crude, ain’t it?” said Hawkeye.
“Yes,” said Captain Pinkham.
“How long did it take?”
“Not long,” admitted Captain Pinkham, who couldn’t help noticing that the patient’s breathing had already improved.
Duke, meanwhile, watched Captain Russell apply his surgical resident’s approach to the other soldier who, waiting for blood, was still in shock. Captain Russell, afraid that he’d miss something, was examining the patient centimeter by centimeter, fore and aft, while the corpsmen waited impatiently to start the transfusion.
“Excuse me,” Duke said after a while, “but all you’re doin’ now is holdin’ up progress. Why don’t y’all let these folks get to work?”
“But don’t you think …” Captain Russell started to say.
“What I think,” Duke said to the corpsmen, “is that we better start the blood.”
Having taken the recruits that far, the two veterans headed for the game in the Painless Polish Poker and Dental Clinic to pass the two hours until the patients would be ready for surgery. When they figured that the patients had been sufficiently transfused and adequately resuscitated, they headed back to the OR, scrubbed and joined their junior partners.
Duke and Captain Russell had a boy whose small bowel was somewhat perforated, requiring removal of two different areas and closure of several individual holes. This sort of work is done ritualistically in most surgical training programs, because it is basic to belly surgery and should never be learned incorrectly, and as a result, the surgical residents in their third and fourth years of training, particularly in good teaching hospitals, may still be at the ritualistic stage. Captain Russell surely was.
Duke having determined that all they had to do was fix the small bowel and that time, up to a point, was not going to be a factor, decided to sweat it out. For two hours he stood there amusing himself by mildly insulting Knocko McCarthy, who wouldn’t hurt him while he was scrubbed, and assisting in wonder as Captain Russell performed a small bowel resection as performed by the residents in a large university hospital.
“Do y’all mind if I do this one?” he asked, as Captain Russell finally advanced on the second area needing repair. “I lost twenty bucks in that poker game, and I’ll never get even at this rate.”
He didn’t wait for an answer. In twenty minutes he removed the damaged segment of bowel and sewed the two ends together.
“Y’all probably noticed,” he explained to Captain Russell as they were closing, “that when clamping and cutting the mesentery, I wasn’t quite as dainty as y’all were. Y’all will recall that I didn’t do the anastomosis with three layers of interrupted silk, like y’all did. I used an inner layer of continuous catgut and interrupted silk in the serosa. Where y’all put twelve sutures on the anterior side of yours, I put four. Y’all observed that the lumen in my anastomosis is as big as yours, I’ve got mucosa to mucosa, submucosa more or less to submucosa, muscularis pretty much to muscularis and serosa to serosa, and there ain’t any place where it’s gonna leak. It took y’all two hours, and it took me twenty minutes. Your way is fine, but y’all can’t get away with it around here. Y’all will kill people with it, because a lot of these kids who can stand two hours of surgery can’t stand six hours of it.”
“But …” Captain Russell started to say.
“That’s right,” Duke said, “and if I’m really in a hurry I’ll ride with just the continuous catgut through all the layers.”
So it went, for several weeks. The recruits, being polite, listened and, being intelligent, learned. They had both, however, been born and bred, as well as formally educated, to be fastidious, so the shucking of old habits did not come easily. Captain Pinkham, in particular, still tended to get bogged down in detail. He would become completely absorbed in repairing damage to a hand and ignore or sublimate the obvious fact that the patient could die of his abdominal wounds. Once, in fact, on a busy night while Hawkeye was occupied elsewhere, he spent six hours on a case that should not have taken more than two hours and managed to miss a hole in the upper part of the stomach. The patient almost died, early, from too much surgery and, later, from the missed hole. Hawkeye took that one back to the table and, two days later, with the patient well on the way to recovery, he was able to make this the case in point.
“Now I’ll offer you some thoughts,” he told the much relieved Captain Pinkham. “This is certainly meatball surgery we do around here, but I think you can see now that meatball surgery is a specialty in itself. We are not concerned with the ultimate reconstruction of the patient. We are concerned only with getting the kid out of here alive enough for someone else to reconstruct him. Up to a point we are concerned with fingers, hands, arms and legs, but sometimes we deliberately sacrifice a leg in order to save a life, if the other wounds are more important. In fact, now and then we may lose a leg because, if we spent an extra hour trying to save it, another guy in the preop ward could die from being operated on too late.”
“That’s hard to accept at first,” he said, “but tell me something, doctor. Do you play golf?”
“I do,” Captain Pinkham said, “but I haven’t been getting much in lately.”
“Then let me put it this way,” Hawkeye said. “Our general attitude around here is that we want to play par surgery on this course. Par is a live patient. We’re not sweet swingers, and if we’ve gotta kick it in with our knees to get a par that’s how we do it.”
“I can’t argue against that,” Captain Pinkham said.
“Good,” Hawkeye said. “Come on up to The Swamp for a drink.”
Colonel Blake, of course, was enormously pleased. He had not only hit upon a project that was at least partially intriguing Captains Forrest and Pierce during their final months, but also Captains Pinkham and Russell were obviously benefitting. He had established a kind of teaching hospital. Then Captain Pinkham came to see Colonel Blake and Colonel Blake came to see Captain Pierce.
“Have a drink, Henry,” Hawkeye said.
“Yeah,” the Duke said. “Join us.”
“No, thanks,” Henry said. “How’s it going?”
“Good,” the Duke said. “Can we go home now?”
“No,” Henry said. “What I want to know is how Pinkham’s been doing lately.”
“Good,” Hawkeye said, “although the last couple of days I’ve had the feeling that I’m starting to bore him.”
“He’s got a problem,” Henry said.
“We all have,” Hawkeye said.
“Not like his,” Henry said.
“What’s wrong with him?” the Duke said.
“His wife,” Henry said.
“Too bad,” Hawkeye said, “but he married the broad. You didn’t, so why is he bothering you?”
“Yeah,” the Duke said.
“Ever since he landed here,” Henry said, “he’s been getting letters from his wife saying she can’t live with his parents and their kid is sick, she thinks, but the doctor doesn’t, and why doesn’t he come home and take her off the hook? The damn fool woman seems to think the guy can break it off over here any time he wants to.”
The two Swampmen were silent. Henry looked from one to the other.
“Come on, you guys,” he said. “You always got ideas. What the hell am I going to do? I didn’t think I was sent over here to run a kindergarten.”
“If I was y’all,” said Duke, “I wouldn’t do a goddamn thing.”
“Sure,” Henry said. “That’s the obvious answer, but I have a hospital to run and you know how hard replacements are to get, and I have to make the ones we get as useful as I can. This guy was just starting to shape up, but this week he got four letters, all saying the same thing but each one worse than the one before. She’ll drive him nuts.”
“I don’t know,” Hawkeye said.
“Me neither,” Duke said.
“Thanks a lot,” Henry said, as he departed.
The next day Captain Pinkham received another and more desperate letter from his wife. This time he didn’t tell anyone about it, but at 2:00 a.m. it was obvious to Hawkeye, who was watching him closely, that Captain Pinkham was trying to concentrate but that he was failing. Between cases he gave the Duke the word and they took Captain Pinkham to The Swamp, gave him a beer and asked: “What’s the trouble? Anything we can do?”
Captain Pinkham showed them the letter. After reading it, they took him to his tent, gave him a sleeping pill and said: “Sleep and don’t worry about the work.”
The next day Captain Pinkham awakened still impaled on the horns of the kind of trouble only hardnoses can survive, and Captain Pinkham was no hardnose. Two days later, fortunately for all, salvation came. It came to Colonel Blake, via the Red Cross and the Army, in the form of orders to send Captain Pinkham home on emergency leave. His wife had folded and been placed in a private fool farm.
The two Swampmen found that they missed Captain Pinkham, who had proved himself willing to try, so they were particularly nice to Captain Russell, who missed his buddy even more. Between themselves the two made noises about how they would handle that kind of grief if it ever came their way, but they both had the same doubts. They thanked their good fortune for wives who didn’t bug them from 9,000 miles away, and they sat down and wrote identical letters:
Darling,
I love you. I need you, I hope you love me and need
me. If so, you can have me in two weeks by following
these simple instructions:
(1) Go crazy.
(2) Notify the Red Cross.