The Fix-It Man

　　Gregory D. Williams, MD

　　Mesa, Ariz

　　My father herded my three sleepy-eyed younger siblings toward the backseat of our blue Olds 98. I followed him to the car, carrying a cooler with one hand and opening the right rear door with the other. "Thank you," he said. "You're a gentleman and a scholar and a man of great learning." We both grinned. He had been feeding me that line since I'd entered high school. It had grown from clever to corny, but we still enjoyed sharing it. "I'll load the ice chest. Why don't you check with your mom and see if she's ready to go?"

　　It was August 1970. We were embarking on our annual summer excursion to southern California to escape the Phoenix heat for a week. I was only 16 but nearly a 10-year veteran of many overland journeys to the Pacific. On those first trips, when my dad's hair was thicker and mine shorter, he would have carried me in my pajamas to the rear bed of a station wagon for our predawn departure. But as we pulled out of the driveway on this morning, I buckled in directly behind him, my wiry frame clothed in cut-offs, a T-shirt, tube socks, and tennis shoes. We traveled north on Interstate 17 for several miles before turning west. My mother sat up front in the passenger seat adjusting the air conditioner vents on the dash. As soon as the sun cleared the horizon, the UV rays pierced the right side of her face and she opened the vacation with a familiar refrain: "This is the last summer I'm going to spend in this heat." My sister lip-synched the words from the backseat, then buried her face in a pillow. My two younger brothers dozed open-mouthed between us.

　　I stared out the window and wondered what it would be this trip: alternator belt, vapor lock, air conditioner freezing over. Despite my father's best efforts, mechanical trouble seemed to lie in wait, coiled by the highway, striking without warning, crippling our car in the middle of the desert. Still, I wasn't too worried. The breakdowns all ended the same way: Dad sliding behind the steering wheel and saying, "Looks like I fixed it." He prided himself on being prepared and it was a trait he passed on to me. But I don't think he learned that as an anesthesiologist. I think it was his nature and it served him well, at home or at work. He had meticulously readied the car for our voyage. Tire pressure, oil level, coolant level, and transmission fluid—they all checked out. Flares, jumper cables, motor oil, antifreeze, extra water, belts, and hoses—just in case. He packed Craftsman tools, an electrician's repair set, and a roll of tape. He seemed to carry two of everything, including a backup to his backup plan.

　　We stopped in the small town of Wickenburg just long enough for breakfast, then picked up Interstate 10 where it began on the other side of town. We raced against the Earth's rotation to pass through the Sonoran Desert before the sun reached its apex. From behind my father, I leaned into his reflection in the rear view mirror and studied his concentration. He kept both hands on the wheel, eyes darting behind prescription sunglasses to the instrument panel, the road ahead, and the rear and side view mirrors in a constant cycle of monitoring. I learned later that he employed similar actions every day at work. For 10 years he had scanned the ECG, checked the blood pressure, and observed the surgical field. What better cross-training for systematic alertness?

　　We reached a cruising equilibrium halfway into our journey. My mom occupied herself with needlepoint. My sister read a book. It had been at least a half-hour since either of my brothers had griped, "You're not the boss of me," and they were beginning to doze again. I stared across the 50-foot-wide median dividing the highway. Patches of yellow grass and sun-scorched creosote dotted the hard brown earth. Two crows contested the remnants of a meal. Across the road, saguaros raised their arms to the cloudless blue sky. Every couple of miles, families in station wagons or sedans, returning to the valley of the sun, flew across my field of vision. The air conditioner droned as we chased our shadow westward.

　　"What is she . . . ? Oh my God, someone's hurt!" The alarm in my mother's voice tightened my gaze. A young woman wearing a yellow sundress was running back and forth in ten-yard gallops along the median, parallel to the highway. She was pulling at her black hair, eyes wide, mouth open. We sped past a figure lying still on the ground. "Oh, dear God, Ray, it's a boy! We have to stop!" My dad steered the Olds across the median, turned east, and parked along the shoulder past a U-Haul truck. A Cadillac with a dented hood and grill was cocked at an angle across the inside lane a few yards behind us. "Stay here" was all he said. He hurried back across the road to the boy and knelt beside him. My father's hands raced across the motionless figure. He leaned over and pressed his mouth against the boy's mouth. Once, then twice, the child's chest rose. He straightened and performed stiff arm compressions against the boy's chest. It was the basic CPR he had shown me when I was in fourth grade. Others were stopping. They rushed from their cars to the boy and back again. I lowered my window. Frenzied pleas penetrated the heat: "Phone . . . rest stop . . . ambulance." Another man joined my father. He pushed on the boy's chest while my father resumed the breathing. The boy's mother continued her panicked vigil up and down the barren median, screaming with each exhalation as if she was on fire. My dad and the other man continued, minute after minute. Breathing. Compressing. Breathing. Compressing. I wanted to help, but what could I do?

　　Suddenly he stopped, placed his hand along the child's neck, paused, and rose. He walked over to the boy's mother and with the aid of another man guided her back to the shade of the U-Haul. He stayed with her for a few minutes, then yielded her care to others. An elderly man in sunglasses sat erect at the wheel of the Cadillac. His wife sat next to him with her arm across his chest. My father approached the open door, placed a hand on the man's shoulder, and spoke briefly.

　　Through the heat shimmer rising off the highway, Dad trudged back to our car. Dried blood stained his mouth and shirt. He sat down in the driver's seat and stared straight ahead. He gripped the steering wheel to steady his hands. "There was nothing I could do," he began. "I thought I felt a pulse once, but he was like a bag of bones. If he had just looked before he crossed the highway." In tight-lipped silence we listened from the backseat as my dad explained, through quivering starts and stops, what he had learned from the mother and the elderly man. The 10-year-old boy had left his wristwatch at the rest stop. His mother made a U-turn across the median and parked along the far side. The boy bounced out of the cab, rounded the front of the truck, and darted across the highway. The Cadillac had hit him at about 70 miles per hour.

　　At some point we left the scene and pretended to be on vacation. I don't remember where we stayed or what we did, only that the air was thick and salty when we arrived at the motel. My parents shared one room and we kids split the double beds next door. Sleep didn't come easy for me that night. In the silence and near darkness of the room, I replayed the accident over and over onto the dimpled ceiling. I pictured the boy darting across the highway, smiling and confident one second, then lying 20 yards away, twisted and jelly-limbed the next. I watched my father, my hero, working valiantly to try and save the boy's life. And I saw myself, a mere spectator, confined to the car and my limitations.

　　Sleep evaded my parents as well. Through the thin wall that separated our rooms and our emotions, I heard my father sobbing. I assumed he was crying because a boy the same age as one of his own had died, because he understood the mother's loss, because the whole thing was preventable. I had never heard him cry before, and it saddened me to know he was hurting, but it also comforted me to know I wasn't alone. I never asked him about his feelings. At first I was too embarrassed, and I didn't want to embarrass him. In a few weeks my young mind moved on to other things. Years later I followed the genetic pull to medical school and then an anesthesiology residency. During my training and subsequent practice in a community hospital, I confirmed the value of being prepared and having a backup plan. Like most anesthesiologists when faced with a surgical emergency, I adhered to guidelines, initiated algorithms, and borrowed from experience to help steer the patient away from danger.

　　Yet the art and science of medicine has limits. A few times in the operating room I peered through the window of those limits at death's inevitability, as powerless to intervene as a 16-year-old confined to the backseat of a car in the middle of the desert. But in 1970 my limitations were relative to what I had yet to learn. After my medical training they were for the most part absolute. The decision trees I adopted branched with lifesaving options, including one final, seldom-rehearsed limb available to all physicians: let go, relinquish hope, accept death's tenacious hold. Coupled to a physician's obligation to provide medical care to the best of his or her ability is the burden to decide when nothing more can be done. I was fortunate. The few times I had to make that decision were within the security of a well-equipped and well-staffed hospital. There I found solace in technology and a consensus of educated opinions. Now I see a more complete picture of my father's grief that August day.

　　When the Cadillac slammed into the boy, it also struck my father. It hurled him beyond his capabilities, far out into death's desert with only his bare hands and a medical degree, where even backup plans are of no use and things can't be fixed. It's a place where gusts of helplessness sting like blowing sand, where the last green vestiges of hope wither under reality's glare, and sense never grows from senselessness. It's a stark landscape that defies preparation, especially when faced alone．