Harvest Season

By John Hargraves.

He was tall, tanned, lean and in his sixties.  His wife drove him up from their farm just north of Binghamton. He had become weak, short of breath and could not keep up with his chores. It was harvest season and time could not be wasted. Yet he walked unaided into the hospital and climbed onto the gurney.

My pager went off that Sunday evening. I was on my 36 hour shift at the VA. Unable to discern his ailment, I called for backup assistance. His heart was beating fast, urine output was low and he was frightened. Attending physicians were scarce on weekends. The farmer’s wife decided to head back, confident that he was in good hands. The combine they hired was coming the next morning for the corn.

This intern was in luck. Two cardiology fellows were available and interested in my conundrum. Making little urine was likely from dehydration or heart failure. The treatment would be either pushing fluids or giving diuretics. An incorrect choice would make things worse. The fellows would clarify the decision with a Swan-Ganz catheter. It would be inserted into the right jugular vein, threaded through the right side of the heart and floated into a pulmonary arteriole to obtain a pulmonary wedge pressure. If low, we’d turn up the IV and run more fluid to open up his kidneys. If high, we’d get rid of excess fluid with drugs and reduce the workload on his heart. I explained it all and he signed the informed consent. His mind was on the corn. 

The fellows arrived late that night and took charge. His neck was swabbed with iodine and draped. “You’re gonna feel a prick” one said, as the line was inserted. He arrested as the catheter entered and irritated the walls of his heart. The junior fellow grabbed the paddles as I began CPR. My gloved hands were bathed in the warm crimson fluid that pooled around his neck from the withdrawn catheter. “All clear!” Zap! He was back with a beating heart, awake and screaming. I sighed, fighting my human instincts to decline further participation in what might transpire. Reassured, he calmed down as the fellows prepared to reinsert the Swan-Ganz. We never did get the wedge pressure. The second killing finished him. The fellows packed up and told me to be sure to ask for the autopsy permission.  My forearms were steeped in blood after the second CPR as I gazed at the reaper’s still Face.

Around 2 am the hospital operator was able to reach his wife.  Hearing myself, I felt the shame warm and haunt me. The harvest was in.