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Anonymity gives certain license and I have a hankering to tell a story. Years ago, one very cold raining winter night, I was walking toward the emergency room when an old pickup truck raced up and stopped. Out of the doors came a father and son. In their arms was a cold dead 15 year old boy. Seems the two boys had been driving down an old country road when they hit a flooded stream. The truck flipped and only one of the boys got out. The first boy tried to get his submerged friend but could not. He ran down the road to a house and in his panic, he called his father. The elderly couple who lived in the house could not help him. The boy ran back to the truck and tried and tried to rescue his friend. The father came from 15 miles away and, after 35 minutes under water, the two of them were able to get the drowned young man out of the vehicle. In their dazed confusion they brought the body to the hospital as they didn't know what to do.

There's a saying in emergency rooms, especially northern emergency rooms, that no one is dead until they are warm and dead. Cold water drowning is a survivable phenomena. I threw this dead cold boy over my shoulder and raced into the ER and we started to work. I wasn't too far out of training from a place where 15 doctors would have helped attend this boy. But in this small town I was the only doctor there with any expertise... not even an emergency staff physician. I intubated the boy, inserted a peritoneal catheter and we started CPR and warm peritoneal dialysis. After 45 minutes there was a heart rate of 4 and another MD walked through the ER and asked what was going on. After hearing the story he told me I was silly to waste my time and the hospital resources ... just pronounce him and be done ... and he left. We pressed on. By 2 hours we had a heart rate of 35, blown unresponsive pupils, and a totally unresponsive boy. By the third hour, he showed some movement, his temp was coming up, and he had weakly responsive pupils. We moved to the ICU where he then developed evidence of widespread damage to blood cells (hemolysis) and had no kidney function. We transfused him with the only blood available. The other MD came through again, on his way home ... saw the progress and offered to go talk to the family of the boy... a well connected family in the area ... fine I said. The boy then rapidly developed a lung condition that caused the lungs to become very stiff and hard to ventilate. We were up to maximum pressures and 100% oxygen and were loosing him. While this was occurring he developed evidence of a sudden blooding clotting disorder (DIC). On into the 12th hour with no help and no way of getting him to a larger hospital. The other MD comes in for an update as he arrived for the day... it's now 7:30 AM and I haven't left the boy's bedside for 12 hours. He had posturing movements that indicate severe brain damage... but.... we heard a drip drip drip... his kidneys had started working. The lung stiffness started to decrease..... and his pupils became more reactive. It was 8:30AM and the other MD, an Ob-Gyn doctor we'll call Dr H, came in again and could see the elation. Dr H said he'd go update the family. By 12 noon, the boy was breathing spontaneously and the lung pressures were all the way back to normal and he responded to commands. I went out and talked to the family for the second time... they thanked me... and Dr H. I thought that was strange but thought little else about it. Finally, by 4PM the boy was completely stable and I was able to feel comfortable enough to go home for a breather. If I live another 100 years I'll never care for a patient as perfectly as I did that night. I was all alone and did every task flawlessly... intubation, dialysis, Swan-Ganz... each condition managed. It was my finest hour as a doctor... no help, all alone, and I measured up. I walked out of the hospital and went straight home, sat down in my chair and opened the afternoon paper. On the front page was a picture of Dr H and the family of the drowned boy. The headline read "Dr H and hospital staff save drowned boy." I went numb. I stared in disbelief. Dr H, an intolerable boaster, had gone out and taken credit for my work. There was nothing I could do. If I screamed foul... I'd look terrible myself. The nurses knew what happened. The boy's mother came to understand. Dr H came up to me a day or two later and apologized for the "misunderstanding" and he didn't know how the paper could have misunderstood him like that. The 15 yo boy... walked out of the hospital five days later and the town at large celebrated Dr H. Dr H left the area a year or two later under "troubled" circumstances.

Today at church, 20 years later, I overheard a lady recall the glorious night when Dr H saved Scott *****. I laughed and laughed and home I came. On the TV was the movie "The Man Who Shot Liberty Valance". I enjoyed every minute. If you don't know the plot I won't tell you. I'll just say this. Life evens out. I've gotten credit for being a great doctor many many times when it wasn't deserved.

But no one can take this from me... one cold winter night I was perfect when there was no one to take my place. I've come to appreciate that I can now occasionally think back and silently enjoy my night of perfection unblemished and unsullied by the world at large. There are still two nurses around who were there that night. They will occasionally indicate remembrance. But for them and Scott's mother ... my night of perfection is mine alone. It makes me smile and I wish a night of perfection for everyone... a moment we can look back on and say "on one day I was perfect."

And so I laughed and laughed when the train conductor said, at the end of the movie, "nothing's too good for the man who shot Liberty Valance"

ps- the worst thing about the whole episode... I worried for years that Scott would grow up and become an ax murderer or some other terrible thing... and wreck my perfect night! He's now a practicing veterinarian.
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