What is Good

The German night was black and without a moon. At four AM, a parked bread delivery truck in front of a grocery store partly blocked one lane of a two-lane road. A low wattage street light was the only illumination at the storefront and poorly visible to speeding motorcyclist Army Sergeant Whatly Good. Good had spent most of the night at a party for a departing colleague and was full of beer and bratwurst racing back to the Army Post. He rounded a sharp curve and was immediately upon the parked bread truck. The truck was slightly smaller than a US Pickup. The bike’s handle bars and front wheel stopped Good and remained embedded in the bread vehicle’s tailgate. Sergeant Good was catapulted over the truck. His body did somersaults before landing on his back and sliding fifty feet on his right side.

Michael Waxman was the temporary replacement for the chief of anesthesia at US Army General Hospital in Landstuhl, Germany. He was awakened from a sound sleep by his nightstand telephone at the Ramstein Air Force Base Bachelor Officer’s quarters, where he roomed during his Landstuhl duty.

It was the surgical watch officer. “Major Waxman, we have an emergency arriving by chopper in thirty minutes from the Ridley Army Base. The GMO (General Medical Officer) on duty out there has an Army Sergeant from a vehicular accident with a fractured right kidney. He also has a fractured right forearm. We need you to give the anesthesia as soon as he gets to Landstuhl.”

Waxman swallowed and felt his adrenalin level increase his pulse rate. “What was his last hematocrit level and does he have IVs in now?”

“The GMO is on the ball down there. Sergeant Good has two large bore IVs, a foley catheter is passing gross blood, and his hematocrit at four-forty-five was 29. A normal hematocrit for Ridley’s clinic is 48.”

***

A total of six units of blood were needed to complete the surgery. Waxman gave four units prior to his anesthetic to prevent hemorrhagic shock.

Sergeant Good required the ICU for two days. At the end of two weeks, Waxman saw Good’s name on the surgical schedule again. He called Major Kline, the urologist, before he went to do Good’s pre-op exam.

“Major Kline, is Good ready for another surgery? I mean, I know it’s on his forearm for revision of the fractures. Have you cleared him for this?”

“Dr. Waxman, this guy has rebounded quickly. However, remember we had to remove his right kidney. With only one kidney functional, I know it represents a challenge for anesthesia. Avoid giving him any agents that may affect his kidney.”

Okay, we can handle this.” Waxman hung up and started to clear his desk. He looked at a small box that the former Anesthesia Chief had left and read its attached note aloud in a whisper. “The device in this box has a special electronic circuit which may come in handy. I’ve never used it. If you get a chance, give it a try. It could save a patient from certain general anesthesia risks.” Waxman had been too busy to open it, but his curiosity was now piqued with his Sergeant Good situation.

The box was four-inch square still wrapped in postal paper. Waxman opened it. “Damn, everything’s written in German.” He looked around for a possible translator, “Anyone out there?”

“Yah,” Hilda, the cleaning lady responded to him, “Yah, Herr Doctor, you have something should I clean?”

Waxman looked at the trim middle-age woman dressed in green surgical scrubs for working in the OR. “Hilda, can you translate something from German to English for me?”

At first the effort was going nowhere with Hilda reading the German and then trying to pronounce the English medical verbiage. “Wait a minute Hilda, forget the German words and just write down each English word one at a time. I’ll help you with the spelling.”

After thirty minutes Waxman had the directions on how to use the device and it’s two wired pointy probes. Each wire extended three feet from the shiny silver box ending in a smooth metal covering to which a steel hypodermic needle with a non-cutting but sharp bevel point was to be directed to its target.” Waxman sat back. “Wow, this is simple but amazing.”

He called the orthopedic ward containing Sergeant Whatly Good. “This is Dr. Waxman, I’ll be right down to do Sergeant Good’s pre-anesthesia examination. Make sure he stays in his bed.”

Waxman entered the orthopedic ward. Only half the beds were occupied. The ward nurse pointed to Good sleeping with the head of his bed slightly elevated. He still had a bulky dressing over his prior nephrectomy site. His right arm was elevated on two pillows in a clam-shell plaster cast. The nurse nudged him awake.

“What … What … What … come on wake up, Dr. Waxman is here to do your pre-op check-up.”

Sergeant Good opened his eyes. “I remember you from when I was first admitted, Doc.”

Waxman smiled, “Good.”

Sergeant Good replied, “Yes, that’s my name, Sir.”

Waxman responded, “What?”

The Sergeant again replied, “Yes, you can call me that too. Most of my friends do.”

Waxman felt confused, “Do what?”

“Yes, call me that or Good. But please never call me Goodie.” Good looked from Waxman to the nurse and back again.

“This sounds like an Abbott and Costello routine Sergeant. I’ll just call you Sergeant.” Waxman positioned himself at Good’s right arm. “I’m going to lift your arm with the cast as high as I can and bring it to rest on the pillow next to your head. I have to examine your axilla … your armpit.”

“Nothin’ wrong with my armpit, Doc.”

“Sergeant, having only one kidney limits types of anesthetic I can give you. The best option is to just numb your arm. The technique I’m going to use is called an axillary block. I inject a long-acting novocaine-like drug into your armpit. Your arm’ll get totally numb and the anesthetic spares the kidney from any damage.”

“Holy God, Doc, a damn needle in my armpit. Can’t you do anything else?”

Waxman nodded a yes, “An alternate is to inject the same anesthetic into the right side of your neck, into what’s called the scalene nerves.”

“My neck! Oh no, stay away from my neck, it’s still sore from my accident!”

Waxman continued palpating Good’s armpit, “I can feel your armpit nerves right around your main armpit artery. It’ll be an easy procedure, especially with this new device I have.”

“New what…what kind of device, Sir?”

“A nerve stimulator attached to the needle that goes into your armpit. It should be quick and very effective at locating the nerves that need to be numbed.”

“Should be? Doc, I don’t want to be an experiment here. Are you sure it’s the best way?”

“Yes, Sergeant. If you damage the other kidney, you could die or be on a dialysis machine the rest of your life. I need you to sign a special consent form because this is a new method.”

Sergeant Good was silent and then spoke in a low voice looking at both the nurse and Waxman, “Can I think about it and tell you tomorrow, Sir?”

Waxman brought Good’s arm back down to the pillows, “Of course, but I won’t see you again until we’re in the operating room.”

Waxman walked with the nurse to the chart station and wrote pre-op orders, “I’m giving him a sedative for the night which won’t affect his kidney. Do not give him any pain medication or other sedation in the morning. I need him free of depressants to legally sign the consent form in the OR.”

The nurse smiled, “I understand, Dr. Waxman.

***

Sergeant Good was first on Waxman’s anesthesia case load. The OR staff was divided into the surgical team in sterile gown and gloves and the circulating team going about their preparatory chores. He greeted Good when he arrived in the OR. When Good was attached to his blood pressure, temperature, and pulse monitors Waxman inserted a large bore IV catheter in Good’s left forearm.

“The needle for the anesthetic is much thinner than what I just used for your IV, Sergeant.” Waxman motioned the circulating nurse over to the OR table with the consent form. “Let me explain again about the armpit nerve block and add one other thing I missed yesterday.”

“I knew there’d be a catch, Doc.”

“No, Sergeant. I wanted to inform you that with this nerve block device the anesthetic lasts for three days because I can leave a catheter in your armpit and give you daily novocaine-like stuff. You’ll be totally free of pain from your arm surgery for 72-hours.”

“I’m glad of that Doc. One thing I have to tell you, my kidney surgeon said you saved my life when I first came in. So I guess I owe you.”

“Owe me what?”

“Yes, Doc?”

“Yes, what?”

“Yes, I owe you. I mean I can trust you by doing the right thing and protect my one remaining kidney, like you said.”

“Good.” Waxman responded.

“What?” Sergeant Good replied.

The OR staff began to laugh. Waxman spoke, “Just tell what you think you owe me.”

“Well, Sir, I owe it to you to give me the safest anesthesia even if it’s an experiment. I’ll sign the consent form Sir, if you provide the right answer to a very important question.”

“What?”

“What, Sir?”

“Sergeant Good, we have to stop this play with your name. What is your question?” The room had suddenly become quiet. Only the beeping of the EKG monitor could be heard.

“Okay, Sir, if I get this armpit needle thing will I still be able to have sex again?” Good stared at Waxman’s masked face.

Waxman looked around the OR. All eyes were upon him. Some were holding their breath. How am I to answer this? The EKG beeps seemed to increase in loudness. If I don’t give the right answer, the entire hospital and the entire US Army will know. It could blight my reputation and career.

He put his hand on Good’s shoulder, “Sergeant, my anesthetic today will only numb your arm.”

“You sure it won’t affect my sex life, Doc?”

“The anesthetic will be long gone by the time you’re ready for an active sex life, Sergeant.”

“Doc, I mean I love a wild romp in the hay, you know.”

“Sergeant Good, I don’t know what kind of sex you’ll be able to go back to, but YES you will be able to have sex again.”

The silence was broken. There were some giggles and laughs and then all present applauded Waxman’s response. He looked around and smiled under his mask. My lifetime moment of glory has arrived. The US Army Medical Corps will forever remember about why Sergeant Whatly Good signed his anesthesia consent form.

***

When Waxman returned to his Delaware home, he related some of his Landstuhl exploits to his wife Barbara, but not about the nerve stimulator until one day she had to sign for delivery of a Postal package.

“This is for you dear. It’s from Germany.”

Waxman opened the box and smiled from ear-to-ear. “My God, the Chief of Anesthesia at Landstuhl, the one I replaced for a while, sent me my own regional nerve-finder device.”

“What?” she asked.

Waxman couldn’t hold back the laughter her question triggered. “What? What is Good. And Good is What.” He related the entire name-game scenario with Army Sergeant Whatly Good.

 

Two years later, Waxman received a letter from Fort Dix, New Jersey from Sergeant Good. He read it aloud to Barbara, “Dear Dr. Waxman, It took me over a year to fully recover from my motorcycle accident. I’m extremely grateful to all the Landstuhl Army Hospital people for their help. I’ll never forget that new anesthesia thing you did and what you said in the operating room. My wife and I are now the proud parents of twin boys.”

It was signed: “Thanks a lot, Whatly Good, Staff Sergeant, US Army, Fort Dix, New Jersey.”

Barbara smiled, “So now you can tell everyone you were a hero in the Army. I can hardly wait to see the medal for what you did.”

Waxman hugged her, “It is said that everyone will have their one moment of glory in their lifetime. Mine was in the OR in 1985 in Landstuhl, Germany—treating an Army patient.”

Barbara kissed him, “Oh no dear, you’ll always be a hero to me and the children.”