JosephCode Red Extraction1
Paul J. Joseph
501 Wade Drive,
Sanford, NC 27330
(919) 774-7232 (home)
(919) 353-9548 (cell)
(910) 630-7052 (work)
Code Red Extraction (3,400 words)
By
Paul J. Joseph
Code Red Extraction
“I’m not a doctor, but I play one on television.” I’ve always wanted to use that line in some kind of a joke, but I can never get it right. Everyone knows the line, but the context is illusive. Hardly anybody remembers television. I mean broadcast television, by the way. I’m talking before we had the U or netvids, and even I don’t know who was supposed to have said it or why. I think it was part of a television commercial, or whatever they called spam back then. Anyway, Ialways thought it applied to my situation somehow, so I've tried to find a way to use it as some kind of witty opening when I meet a new patient. Maybe make them smile a bit. Most of my patients need a good smile.
It’s true I’m not a doctor, by the way, at least not in the strictest sense, but the whole idea of hospitals and doctors changed a long time ago, certainly since that doctor and television line got stuck in people’s memories. Since the Universal Health Act and the foundation of Health Central, there's been a lot of money in health care, the kind of money that changes things. But, more to the point, there was less money everywhere else. I’ve heard that hospitals were big and complicated entities before Health Central, but they became more like cities since then. And, like cities, they have neighborhoods, not just having to do with specialties like pediatrics or geriatrics, but all kinds of other stuff. The hospital had to employ a lot more people suddenly because that’s where the employment money was, and it had to provide all kinds of new career opportunities to replace the ones that were diminishing elsewhere. That meant more specialties and more levels of oversight. A suturer, for example, would do all the suturing. A cutter would do all the cutting. A bone setter would set all the bones. And the doctor in charge would monitor and direct hundreds of operations, giving lists of instructions to each specialist waiting for their small part to be called for. One operation would thus employ many people, and there were more operations performed than ever before! That included my department, by the way, and operations most people had never heard of before. This arrangement was more efficient and it kept more people employed. We all know how important that is!
Of course, my department was always an unusual entity and most people still don’t know it exists, let alone what we do. We’re not very glamorous and we don’t attract attention, but we save countless lives every year. It’s a proud thing to be able to explain to my patients what their tax dollars are paying for! Again, that’s why I’m always looking for a new ice-breaker to make them smile.
I look like a doctor, at least as much as most of us do. I wear a white coat and I carry my board with all my patients' charts. I don’t typically know much about where they come from, that’s up to the people writing the instructions. Some patients come in regularly for treatment. I get to know their names and establish a certain rapport. Those are the brown codes. We all handle many of those, some for ten years or more, but it doesn’t matter which of us they see. My specialty is extractions, and I suppose I’m good at it. It’s not so much that the work is difficult. It isn’t really. I just follow instructions, but I try to put some personality into it. Do I enjoy my work? Like every profession, it has its moments, good and bad, and there are challenges as well. My last case was really interesting. They assigned me a code red extraction. Those are pretty rare.
The patient’s name was Ali. I’m sure there was more to it than that, but I wasn’t given the whole name. Ali was the abbreviation. Patient confidentiality, that sort of thing. Any time I refer to the patient in the actual report, the system fills in the complete name for anyone who needed to know. The patient waited for me in my office. He had his bracelet on and I was getting his vitals through the linkages. I could tell he was going to be difficult just by the way he was sitting. He had a defiant look. Even the best clown in the world couldn’t get a chuckle out of him. It’s always good when the patients cooperate with the treatment plan. We can do so much more for them if they cooperate, and the sour pusses rarely do.
“Hello, Ali,” I began, projecting a jovial smile. “I’m here to perform your extraction today and see to your other treatment.” I looked at his chart for other relevant information. “Has anybody told you what we’re extracting?”
I’m not sure anybody had. In fact, the term has little meaning outside our ward, or at least it has many different meanings.
“Here in this facility we do a unique and revolutionary type of surgery that saves thousands of lives every year!" I said. "It has to do with blockages, you see. You can think of these blockages as nasty little gremlins that hang on tight inside you. They may seem little or even invisible, but they cause serious damage! They’re like pegs or corks that, once removed, make things a whole lot better. And, of course, once they’re out of the way, we get a better look at what’s behind them. And that information can save the lives of people you don’t even know! Now, the funny part of this surgery is that most of it happens within your stream of consciousness, almost within your dreams. That’s why we can talk you through it and monitor things even though we don’t necessarily have to remove your scalp, for example.” I smiled with pride. “Most of our best extractions have involved virtually no surgery at all!”
Ali seemed unimpressed and, aside from my speech about the preliminaries, I didn’t have much other good news for him. Still, I tried to keep a smile and a positive attitude.
“As you know, you have full coverage for the procedure,” I tried again. “But there are certain stipulations we have to follow to make sure we’re using all our resources most efficiently. I’ll make that more clear as we go along.” I smiled, but the man didn’t smile back. The idea was to deliver the good news first. Bad news is usually easier to take if it’s surrounded by good news. Of course, if the best news I could come up with was that he was covered for the cost of the procedure, I guess I couldn’t really expect much in terms of a good mood. I leaned forward and held his chart out so he could see.
“I’m not sure to what degree the procedure was explained to you. Your case is a bit more . . . urgent, I’m afraid. Do you understand what has to be done?”
Again, Ali only glared at me. I’ve gotten used to that. He wasn’t mad at me, after all, but the situation. He might not have been given the details, but he must have known the news would be bad.
“We’ll be doing a series of extractions this week, but some of them are critical. Has anyone explained our color code?”
This time I barely waited for an answer.
“If I were given a code green extraction, that would mean that whatever we needed to take out wouldn’t represent an immediate threat and we could wait a while. If yours was a code green we’d start planning the procedure today and begin working at it regularly over a long period of time. They usually plan a generous time-frame with a code green.”
“Who is ‘they?’” Ali asked. “Who are you talking about?”
I smiled. “So you can talk!” No laughter. Hey, I tried. “Ali, these orders come down from administration. That’s all handled by people who have a unique insight into your case.”
His face turned sour again. He obviously didn’t trust doctors, which was most likely why he ended up in my ward. I’m not like most of the doctors people encounter. I’m more of a people person. It’s my job to put a different face on the treatment plan.
“If I were given a code yellow or code amber extraction, that would usually mean it was serious enough to need to be addressed today and completed within a few days.”
I knew he heard me, but I don’t think he was listening.
“But a code red extraction is serious and very life threatening. Code red extractions have to be excised immediately.”
He looked at me with cold eyes. He probably didn’t understand how serious the situation was. Many people are very stubborn about this sort of thing. They hold onto those blockages as if their very lives depend on them. Some of them willingly risk death to avoid the procedure. I never really understood that, but it's quite common, especially in this patient class.
“We have to begin now,” I went on. “Don’t worry, the instructions I follow are quite explicit. Really, these are very simple procedures. Again, the more you cooperate the easier it will be.”
The man hated me but, again, not me personally. I looked at the first set of instructions. “They’re asking me to go after the small one first.” I held up his chart. “Now, during the procedure, one of the hospital administrators will be guiding you through the extraction. Listen to what he says and do what you can to cooperate. He’ll be directing your stream of consciousness. He’ll get you prepped while I set up the first procedure.”
I didn’t get to hear the conversation, but there generally wasn’t much to hear. I knew Ali was going to be a difficult patient. He wouldn’t be likely to care about his treatment plan, much less the pressure we’d be put under to perform the procedure within guidelines. The steps were easy, but most of them depended on his willingness to cooperate. I started out with category A, as per instructions. This procedure required the use of electro-shock therapy using a mild electrical current. It didn’t take long to set up the electrodes. I shaved a portion of his scalp and applied conductant jelly, all the while humming a pleasant tune. Even category A techniques can cause the patient some discomfort, but I’d hoped that a small extraction like this would be minimal. That would, of course, depend on how well he cooperated with the treatment.
“Do you understand what the doctor explained to you?” I asked.
I think the patient might have tried to spit at me had his mouth-guard not been in place.
“Electro-shock therapy has come a long way from what you might imagine. It’s certainly nothing like it’s depicted in the old vids. It’s very therapeutic in this case. As you know, we have to direct your stream of consciousness. Sometimes these things we have to extract hold on very tight, so much so that everything around them holds tight, too. With electro-shock we disrupt this pattern, hopefully making it possible to pull the target out during the momentary confusion. I’m hoping a low-level treatment will do it. The supervising doctor is in contact with you and he’ll be controlling the procedure. If we can get this first one out now, the rest will probably go much easier and we can finish with time to spare.”
I checked his chart again to make sure we had contact and that his physiological responses were being accurately recorded. I could make out some of the conversation between Ali and the doctor. I could tell from the tone that he wasn’t being very helpful. My copy of his chart monitored the extraction. It wasn’t coming. I didn’t want to interrupt, but I felt I had to.
“Ali,” I said over his objections. “Ali, please try to concentrate. The doctor needs to get a good image. This procedure normally works over a longer time frame, but we don’t have that luxury. It would be really good if we could get this little one over with now. If we have to go to category B, we can’t come back again. It’s not covered, you see. We’re only allowed to use category A once.”
I knew he wouldn’t listen, and he didn’t. The doctor ordered me to step up the voltage a few times, but he still couldn’t budge it. It wasn’t moving. But it was worse than I feared. I forgot that hydrotherapy was still not available in our facility. There weren’t many other category B options. And, with a code red extraction being so time critical, the doctor didn’t have much choice but to order a more invasive procedure. The one he chose was brand new and experimental. Honestly, I never thought I’d get to administer it. Ali’s chart now indicated the use of skeletal therapy.
This did require some explanation and it would take some time to set up. The apparatus was large and would appear in the room in stages.
I faced Ali with a sober expression. Jokes wouldn’t help him now. “I’m afraid the electro-shock therapy didn’t work. As I said, we normally like to stick with category A treatments as long as possible, but we have to see some progress relatively soon in a time sensitive procedure like this.” I shook my head. “We’re no closer to dislodging even the smallest extraction target and I’m afraid we’re going to have to get more invasive if we hope to get any of them out in time.”
I looked at Ali. In truth, I felt sorry for him. He was a sick man and he was only getting sicker. The electrodes had left burn marks, like they usually did, and his hair had been scorched. Extractions took a toll on these patients, and many of them got worse before they got better.
“This treatment may be more beneficial in that we can probably go for all three extractions at once,” I said with a hint of cheer. “But, as I said, it's an invasive procedure. You could perhaps appeal the doctor’s decision if it were less than a code red extraction. As it is now, this treatment is the only thing covered under your plan.”
As if on cue, the first part of the apparatus was delivered. The unit was large, taller than a cook stove and twice as long. It accommodated the right side of his body, fitting next to the gurney he lay on. Because the nature of the treatment was so delicate, I overrode the patient’s musculature to better position his hands and feet. Each finger joint was nestled into a separate clamping mechanism, measured specifically for this patient. The same was true for all the bones in his feet. Larger sections accommodated the more substantial bones in the arms and legs. A chest unit was added on top to fit each rib, and a bottom piece lined up every vertebrae.
“The ancients used trephination as a kind of medicine,” I explained. “The practice required them to literally drill holes in the skull to let out what they perceived to be evil spirits that made their patients ill.” I smiled. “Don’t worry, we’ll not be extracting evil spirits today, but, as it turns out, the ancients might have been on to something. They just took it in a different direction. You see, when any bone is broken, a certain chemical and psychological reaction takes place that stimulates all the glands. It can have that same disruptive affect that electro-shock or hydrotherapy can have on your stream of consciousness, but to a much greater degree. It’s our hope that through this stimulation we can release all our extraction targets. Your nervous system is holding onto them very tightly, but by throwing your nerves completely out of balance we might be able to shift your perceptions enough to loosen them without doing much other damage. Again, the doctor will be guiding you through the process.”
The patient’s chart showed green. I turned the crank on the device, setting the mechanism at the ready. The tiny iron hammers and rods that rose from the clamps looked quite impressive, as if the patient was in the center of a great grand piano. And then the performance began.
The first attempts were not successful. Three small hammers struck the finger joints in his right hand, then three others hit his left. His vital signs rose significantly, but the extraction targets remained fixed. Clunk, clunk, clunk, three more bones, these in his wrist, then two more in his left foot. The device was quite complete in its scope and could continue delivering proper stimulation as long as the man still had bones. One of the targets began to move finally, but not fast enough. Now both his legs were shattered at the femur, tibia and fibula. At last, the first extraction was beginning!
“My cell works out of New York State!” he shouted. “Our target is the George Washington Bridge!”
The unit stopped briefly. Extraction one was being processed.
“We’re planning to spill nuclear material onto the traffic from above so that it will be carried all throughout the city! We have several operatives working as cab drivers!”
The second extraction went from red to green as it was processed.
And then the third and final one began to move. Name after name flowed from his lips into the recording device while our equipment monitored his physiological responses for traces of lies. When the doctors were convinced all of the information had been successfully extracted, the treatment could stop.