Publication Acknowledgement: This fictional short story was published in Secrets from the Black Bag (Royal College of General Practitioners Publications; London, December, 2005).
I’ve always involved myself in the lives of my patients and their families. Familiarity with context helps me to provide better treatment and nourishes such mental processes as intuition. My intuition once saved a farmer’s wife but let me down as the life of her neighbor slipped away. I should have known. All the signs were there. I hate guns.
One Sunday afternoon before Christmas, a call came to meet the ambulance at a nearby farm. Blast these Sundays and holidays! They make people crazy. Second shooting in two weeks. In the first, one young man had been told mistakenly—not by me, thank God—that he had a particularly nasty stomach cancer. He didn’t want to be a burden to his wife, so he jammed a shotgun under his jaw and pulled the trigger. The men use guns, and they are mostly successful. The post-mortem showed no sign of cancer. How much should the family be told? The local medical community was still grappling with that one when I was called out to Mr. McLean.
I’d never met the man despite my involvement with his lovely wife and daughters, so I can’t blame myself for missing his signals. Mr. McLean was one of those healthy farmers who kept away from the doctor. I knew the type and suspected the reasons for his action. Wool prices, his children’s schooling, and the drought had dragged him into a corner of his land he preferred to avoid, letting go all but one of his men, whose families had depended on his for generations. He watched the land parch and his wife’s face pinch.
I stuffed plasma, oxygen, and the ruddy lot into the car and raced through the streets and into the surrounding farmland. Somewhere a siren wailed. I broke just about every traffic law, swerving around slow-moving tourists in every permutation of vehicle, self-propelled or otherwise. The town’s population had swelled like a sponge, absorbing holidaymakers on a seaside sojourn.
Now, attitudes towards firearms are cavalier in rural New Zealand and Australia—as in most country areas, I suspect. A while back, I stopped going hunting every year. I must be one of the few people around here who is anti-gun, simply because I know that if anything happens, I’ll be the one they call, like that Sunday morning when a farmer climbed through a fence and pulled his rifle after him by the muzzle. He survived a shot in the stomach, but it meant resuscitating the chap in a panic, putting in a drip, getting the ambulance and going with him for the three-hour drive to the hospital. My wife was not impressed, as she had planned a family picnic to celebrate our son’s birthday and ordered me not to miss it.
Firearms and impulsive behavior can be a lethal combination. There are all sorts of impulsive behaviors. Shopping is one, but it’s not dangerous. Some husbands might argue that point. Arson is another, in certain circumstances. Certain suicidal gestures fall into this category, making a definite argument for gun control. We had a young chap once who tried to commit suicide with a shotgun, but it didn’t go off, to his great relief. By some stroke of luck there was no bullet in the breach. He then swerved off in his car, got pulled up by the cops for dangerous, drunken driving, yelled at and abused them, and got carted off to casualty. He stayed in a hospital bed overnight and a prison cell next afternoon. He returned to work Monday.
These thoughts of guns and desperate men filled my mind as I turned off the main road toward the McLean place. I jumped out of the car and raced to the farmer’s side. He’d chosen a tree behind the barn, not visible from the house, but overlooking the fingers of headlands reaching into the sea. Some locals felt trapped by all this beauty. It was fine for tourists to wax lyrical, but they could leave. They didn’t have to watch their dreams wane like a fading moon, because of market forces and changing times. The ambulance arrived just after I did. I scowled at the driver. He left me alone with Mr. McLean, who had put a twenty-two rifle between his eyes and pulled the trigger—and lived. Death was inevitable, and we both knew it. The bullet lodged between the lobes of his brain, but hadn’t knocked him out.
I will always remember his eyes. By the time I got there, he couldn’t speak. He just looked at me, pleading with his eyes to save him. Clifford Beers said the delusion that drove him to a death-loving depression vanished as soon as he leapt out of a window.1 Mr. McLean obviously felt the same, released by the commission of his horrific act.
There was nothing I could do.
“How can I help?” I cried.
Mr. McLean just looked at me, speaking with those eyes.
I cradled him in my arms. “I wish I could do something, Mr. McLean,” I said, voice cracking. I wanted to intubate him because his respiration was going down, but something stopped me. I just sat there, holding him.
I recall one afternoon when my good colleague, Thucydides Hare, shared with me his admiration for Louisa May Alcott and her ability to control her feelings while volunteering as a nurse in a Civil War army hospital.2 He reported that once the arrival of eighty ambulances awakened her in the grey hospital dawn. The sight of those hopelessly wounded men led her to admonish herself that she had come to work not to weep or wonder; so she corked up her feelings and returned to the path of duty, something she found very difficult. I could relate to that. One young soldier worried about a gunshot wound through the cheek and what on earth Miss Josephine Skinner would say. Louisa May controlled her risibles and assured him that Miss Josephine would admire his scar if she were a sensible girl. Thinking of my colleague’s story about Louisa May, I wonder, what would Harey have done in my current situation? He’s better at controlling his risibles than I, who couldn’t hide my emotions from patients.
Mr. McLean’s eyes stick in my mind. They shouldn’t, but they do. Those eyes were pleading, “Help me. I’ve done it, but I don’t really want to go.”
I just sat there, holding him.
Mr. McLean seemed quite a decent chap. I regretted that this act formed the sole basis of our relationship. The dying process took about half an hour for the poor man. Thirty slow minutes in which I was powerless. Thirty short minutes out of a lifetime that will go with me to my grave. I laid him down gently. Would being uninvolved have made me better able to comfort Mr. McLean? Would being distant from my patients make me a better doctor? All I know is that Mr. McLean’s eyes will haunt me forever. I couldn’t save him, and God knows I wanted to.
- Beers, Clifford Whittingham, “A mind that found itself,” Medicine in Literature and Art, ed. Ann G. Carmichael and Richard M. Ratzan, Könemann, Köln, 1991, pp. 247-51.
- Alcott, Louisa May, Hospital Sketches, Applewood, Bedford, nd, reprint, originally published Boston: J Redpath, 1863.
SUSAN WOLDENBERG BUTLER was born in Lafayette, Louisiana. She has published fiction and non-fiction in the U.S., U.K. and Australia, including Secrets from the Black Bag (Royal College of General Practitioners Publications), which is on the recommended reading lists of the Association of Course Organizers in the U.K. and General Practice Training in Tasmania. Black Bag Moon, her second book of doctor stories, is under consideration with a U.K. publisher. She lives with her epidemiologist husband, Colin, in Tasmania and Canberra, Australia. In 1989, Colin and Susan founded Benevolent Organization for Development, Health & Insight (BODHI) (www.bodhi.net.au), a non-profit organization that works in the areas of health, education and micro-credit in developing countries. For more information about Susan, please visit her website: www.susanbutler.com.au.