Goliath
It is two o’clock in the morning and the emergency room is unusually quiet. A chest pain in search of a diagnosis occupies Bed 1 and a low back pain is waiting in Bed 4. My gut feeling is esophageal reflux or maybe anxiety in #1 and a need for a work excuse plus or minus a script for Tylenol with codeine in #4. I don’t think I’ve grown especially cynical in my middle age, but in the early morning hours a person gets to be a pretty good judge of human nature. In the emergency room, instinct is as valuable as knowledge. Bed 1’s EKG looks better than my own. Bed 4 seems pacified by a pain injection. While cardiac enzymes and other labs are cooking for Bed 1 and X-rays are being processed for Bed 4, the nurses and I make small talk while sipping bitter coffee. We always enjoy a few minutes of peace and quiet, more commonly known as the calm before the storm. And as if right on schedule, the ER is assaulted not by a cloudburst but a human earthquake. Two paramedics along with the hospital security guard struggle with a large man strapped to a stretcher who is flailing and thrashing about so violently that not only are the restraints in danger of being torn off but very possibly the heads of the attendants as well. My first thoughts are drug abuse, seizure, or possibly both. My next thought is that if I don’t do something quickly, someone is going to get hurt. And I don’t mean the patient. This guy is gigantic like some freak of nature. He is easily the largest human being I have ever seen face to face. He is the equivalent of two men. Weighing at least 400 pounds, his arms alone are each the size of a child’s entire body. Like Greek columns, they are decorated with intricate carvings and markings. Yet his inscriptions and garnishments are not mythical beasts and heroes but rather tattoos of daggers, barbed wire, and a skull. He will not remain still long enough for me to inspect these engravings more closely and read the story of his life scrolled on his skin. Besides, I’m beginning to fear for my own. His head appears almost comically small for his gargantuan body. His perfectly round face is framed by short curly brown hair and a ragged beard. His eyes are closed but a small trickle of drool bubbles from the right corner of his mouth. His face seems to depict a grimace. His massive limbs hang over the hospital cart like tentacles, blindly groping at the air. I simultaneously examine him and avoid his arms and legs. The man is so large that he seems to be wearing the hospital cart strapped to him as if it were a backpack. If he flips it over, I doubt we’ll ever turn him right side up. The entire staff approaches this creature with the caution normally reserved for contagious and life-threatening bacteria and viruses. They sense what I already know. In truth, he is even more dangerous than his appearance suggests. "Jesus, this guy is huge mongous," Stephanie, our ER clerk, announces the obvious to everyone. She sometimes speaks English as if it were a second language for her. Our Goliath is unable to provide any medical history in his present condition. If he has a voice, it is hidden deep within his massive body. Treatment will be tricky, even dangerous, without knowledge of his current medications, drug allergies, and previous illnesses, but I can’t wait for answers. "Does anyone know anything about this guy?" I ask everyone around me. Almost on cue, an apprehensive woman approaches the commotion. She is careful to keep her distance from the vortex created by the agitated behemoth and those of us caring for him. Intuition tells me it is Goliath’s wife or more likely his girlfriend. She is little more than one-quarter the size of her man. They are an anatomically incongruous couple. Her pale blond hair is limp and slowly being overtaken by dark brown roots. Her face appears haggard. The woman looks fortyish but dresses as if she were half that age. She wears a low cut, black top that might actually be a sports bra. Peeking just above the garment is a small tattoo that seemingly floats on the center of her chest. I realize that I’m gawking at the tattoo like some kind of voyeur, but it suddenly becomes essential that I learn what it is. Goliath’s life, her future, and possibly my own well-being depend on deciphering that small symbol. I squint hard and discover that her skin is indelibly marked with a little heart pierced not by one, but two tiny arrows. It is as if her body is a map, and this small tattoo marks the spot of its treasure. If only all love was so easily identifiable and permanent, there would be much less suffering in the world and much less business in the ER. "He’s going to be okay, isn’t he?" she asks of no one in particular. Her voice sounds tired. She looks at Goliath with an expression of concern and then maybe disappointment. She touches his arm and for an instant I imagine his seismic activity quelled. Immediately, his shaking resumes and the force of it disconnects them. "Yes, I think so," is all I can stammer. "We need some more information." "He’s been drinking . . . again," she says without remorse. "When he gets depressed, he drinks heavily and has a seizure. Like this. They’re hard to stop." I learned he had quit taking his anticonvulsant medication six months ago even though he still had an entire bottle of pills at home. Now Goliath’s bulging veins greedily accepted our medicine, but it might as well have been water. He received more intravenous drugs in the emergency room than I have ever prescribed for a convulsion but still he quaked. This was no mere seizure. Seizures are not communicable, but I felt myself trembling. Goliath looked like a man possessed. Despite enough medication to stop a charging rhino in its tracks, he continued to shake violently. "He may need general anesthesia," I thought out loud, "but lets try some Haldol first." Within twenty minutes of the injection, I convinced myself that our juggernaut was settling down. The floor was no longer vibrating. Another dose of Haldol was administered, and soon Goliath was sound asleep. His harsh snoring reverberated like a growl of a beast. No one dared disturb him. His vital signs were stable and all his tests, including a CT scan of the head, turned out normal except for a blood alcohol level confirming his reverence for spirits. It occurred to me that Goliath’s woman had vanished. I could understand that she might be upset or tired and perhaps went home to rest. I wondered if she might just be frightened that we would send this wild man home before she was ready to deal with him again. "Where did this guy’s wife go?" I asked Stephanie. "I need to speak to her. I’m admitting him to the ICU, and I don’t even know his name." "Wife?" she looked puzzled. "He’s not married. Do you mean the thin blond woman that was here earlier? She’s his mother." The look on my face surely betrayed my embarrassment. Of course, it had to be his mother. Who else would wear their love so openly for everyone to see? Who would tolerate behavior so adolescent, dangerous, and disconcerting? Who would always be there to take him home? I wanted to say something to this woman before her sleeping child was transported to the ICU. I wished to reassure her, console her, or maybe advise her about the future. Perhaps that is why she disappeared without a trace. Too often wounded by words and promises, she did not desire my counsel or commiseration. When I returned to work the following day, I learned that Goliath had already left the hospital against medical advice. And when you think about it, who in their right mind was going to stop him? "I’m amazed that guy was even able to wake up in less than 24 hours considering his alcohol level and all the drugs we gave him on top of that," an experienced nurse pointed out. "Doesn’t it make you angry that we spend so much time, effort, and money on some people, and they just throw it away?" "You can’t help people who don’t want to be helped," I replied. "But that doesn’t mean you don’t try anyway. I’m betting he’ll be back." "Well then, let’s go save the world," the nurse mocked me. "You’ve got an otitis media in Room 2." I quickly forgot about seizures, tattoos, and rescuing the world. I sipped my coffee and savored the rich taste and smell of a new day’s fresh brew. I eagerly entered the small exam room and greeted a mother who was cradling her crying infant. Immediately, I felt warmed by the power of a mother’s love.
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