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The Scalpel and the Soul – Dr Allan Hamilton

The decision was made to take Thomas to the operating room and cover him with his father's skin. At 8:30 A.M., we removed all the dead graft tissue covering Thomas. Painstakingly, over the next eight hours, we quilted his father's skin onto him. To me, the grafts looked lifeless and gray. I had little confidence. All I could think about was all the waste. Thomas's young life. His father's. Long parts of our own lifetimes.

B dinnertime, we had finished. Fresh bandages in place, Thomas's comatose body was wheeled back into its slot in Mummy World. His vital signs seemed stable enough. We knew he'd survived considerable surgery, but we had doubts about his physiologic reserves. I went into the call room and fell asleep instantly. I had been on the move for more than forty-eight hours straight.

Only seconds seemed to pass before I woke up angry and disoriented. A nurse was knocking loudly on the call room door. I looked at my watch. I'd been asleep for over two hours. The nurse was hammering, and it suddenly flashed into my mind that Thomas was probably dying. Maybe his heart had already stopped. Maybe she was calling me to help supervise CPR. I steeled myself to be able to call it off. Let him slip away.  We'd done everything possible. It was time to let go.

I opened the door. The nurse was stammering. "It's Thomas ….he's …he's trying …to talk!"

That simply wasn't possible. Thomas must be having problems with his ventilator. She'd misinterpreted his respiratory efforts as an attempt to talk. Hadn't he been in a coma for nearly a month?

I went right to the ICU. Not only was Thomas trying to speak, he was moving all of his limbs-something he'd never done before. He was fighting his bandages and constraints. It must have been extremely painful, as many of the fractures hadn't yet healed. But the efforts were unmistakable. He was trying to pull the endotracheal tube out of his windpipe. Of course, his hands were wrapped in dressings and tied down. There was no way he could bend his arm enough to reach it.

I slipped my hands inside the plastic-encased arm ports and reached around his throat to undo the knot. There's a small balloon at the end of the tube that helps hold it securely in place at the top of the trachea and below the larynx. I got the tie undone and deflated the balloon. I could hear Thomas trying to move air around the deflated tube. So daring more than hoping, I pulled the tube out of his mouth.

He coughed violently a couple of times. Suddenly he spoke. His voice was perfectly clear.

"What happened to my father?" were the first words out of his mouth.

Of course, no one had said a word to Thomas about his father. How could we? He'd been unconscious the entire time! The nurses looked at me. It was my responsibility to answer. After all, I'd been the one who removed the boy's endotracheal tube.

I decided to lie. "Nothing has happened to your father, Thomas. He's just fine" I said.

Thomas looked at me in confusion. "Are you sure?" The boy was completely lucid.

"Yes. I'm sure. He's fine. He'll be glad to hear you're getting better."

Today I deeply regret that lie. I should have told him the truth right away. But I was a young resident. I didn't know better. I thought I was being kind. Thomas knew something was wrong.

"My dad's just standing there at the end of my bed.  Why doesn't he say something?" There was the hammer blow.

For a hazy instant, I blanked out what had actually happened. The father's death. The harvest of skin. Then reality returned. Thomas must be seeing someone through the plastic, a distorted silhouette that reminded him of his dad. I looked around. No one was here. Just the drapes and the lights beyond.

"Thomas," I asked, choking back tears in disbelief, "where do you see your father?"

"He's standing right there" he answered, staring at the empty foot of the bed. "Hi, Dad!" he called out, and he feebly attempted to wave.

One of the nurses choked back a sob.

"Thomas, your dad's passed away," I admitted. "He died three days ago. He had a heart attack."

I could see the shock registering within, even beneath so many layers of bandages. Then I heard him whisper something. I leaned over.

"That must be his ghost then that's waving back at me”  he said softly.