if someone had made a mistake in assigning this crisis to me. A gunshot wound to the head?
Though I’d been given a preview of the demands placed on residents at SFGH—the only Level I trauma hospital in the Bay Area and one of the busiest in the nation—little in my academic training had prepared me for the war zone atmosphere of trauma services. Fear gripped me as I ran down the stairs and then through the corridor leading to the emergency room.
Alfredo, get hold of yourself, I thought. But there was nothing of myself to hold on to! The faster I tried to fly down the hall, the more my breathing accelerated, the slower my footsteps fell. My head felt disembodied, as though floating in the air above me. Sweating heavily, my heart pumping wildly, I struggled for balance, certain that I was about to collapse on the floor—right here in the hallways of this magnificent building and institution.
From outside the hospital on that gloomy summer night came the sounds of police sirens, honking horns, and distant voices echoing down dark streets. No music, no order—only chaos. A feeling of powerlessness washed over me as I approached the emergency room. Who was I attempting to fool? Why not admit my fear, turn around, and dash off in a different direction? Other questions countered these thoughts. Was I ready to give up? Was I going to let terror of the unknown win this battle without a fight? Or could I accept my fear as a familiar foe—as I had for most of my thirty-one years—and struggle even harder to find a way back onto solid ground?
The answer was clear. I composed myself, pushed through the staff door into the emergency room, and strode to Trauma Zone I, Bay 2, where the members of the trauma team were finishing up their evaluation of the patient. As I moved toward the partitioned space where the patient lay with feet toward me, I saw that he was a young African-American man, in his late teens or early twenties. On further approach, I observed that the yellow transport table underneath him—used by paramedics to bring in highly injured patients—was drenched with blood and gray matter.
A wave of nausea and dread hit me hard. The room began to spin. But I moved closer to assess the damage, fighting the feeling that I was descending into quicksand. When I reached his immobile body on the transport table, I slowly knelt down next to his head—where I could see that part of his skull was missing. Peering more closely, I was jolted by an unforgettable and shocking sight: a tunnel through his head with a bright white light glaring at the end of it.
My God, I thought, how can this be? Then my answer came. The light was from the X-ray box secured on the counter on the other side of the patient! The light at the end of the tunnel was no metaphor for a patient whose life hangs in the balance, but in fact this patient’s real condition—defined by an actual tunnel in his head through which a bright white light blazed from a source outside of him.
Rocked off balance again, my knees buckling, I felt for the floor to steady myself, seeking a semblance of terra firma. But to my surprise, I found my grounding force not in the physical support under me but in an arsenal of memories that suddenly surfaced. A memory I had once tried to forget overshadowed the rest: an image of me at the bottom of a dark abyss, battling death, holding fast to the sight of my own light at the end of a tunnel, in need of a miracle.
That image arrested my freefall, and in a surge of faith, I recalled the years of my education and the life lessons that had prepared me to face other crises. Memories arose to remind me of the courageous doctors and caregivers who had inspired me to choose medicine. Courage, I remembered, was not an absence of fear but a refusal to give up, especially in the face of great fear. Within seconds, I found my footing and my voice. With the past guiding me, I was able to take command of the situation and provide direction to the members of the trauma team so that we could fight for our patient—whose life was steadily bleeding from him on the table in front of us.
More than a decade has passed since my first night on call at San Francisco General Hospital, although I frequently think back to that profound experience and reflect on what it taught me about the power of memory. The simple awareness that came to me then, and which I carry with me every day, is that I have been that patient myself, on the same yellow table, literally and figuratively.
And if not for those who refused to give up on me, I wouldn’t be alive today. That’s why I can never give up on any patient without engaging in the same kind of battle that saved my life. It’s also why I never forget how blessed I am to be here and why, whenever I prepare to step foot in the operating room, I pause to remember other times and places when I’ve stood on the threshold of uncertainty. My ritual, as I lather my hands and vigorously scrub up and down my arms, is to use the time to supercharge myself with the extra volt of energy needed to benefit a patient; to concentrate, meditate, and appreciate the gift that is life. In order to walk toward the operating table with certitude that I will make the best possible decisions in this life-or-death setting, I need the confidence that comes from everything I’ve learned about our miraculous human capacity to defy the worst odds.
Yet, as I regularly tell my students, there’s a fine line between confidence and arrogance! When walking that line in the OR, it’s also important to place my feet on solid ground, firm in the knowledge that I can’t control everything, and in the reality that I am only human. This was another lesson I learned on that night in June 1999, staring at the light at the end of the tunnel through the brain of a critically injured patient at San Francisco General Hospital.
In the final hours of his life, my patient was a reminder of the universal lesson that we human beings are more alike and more connected to one another than we tend to acknowledge. Take away the boundaries of language, culture, ethnicity, and background, go below different skin colors, and you’ll find that under the bone casing of our skulls, we each have a brain that is fundamentally the same as the brain of every other human being in the world. The most beautiful organ in the human body, our brain is the storehouse of our individual identities, our unique thoughts and feelings—yet its gray matter shines the same in everyone. Peel away the dura, the velvet-smooth covering of the brain, and we discover that we all have similar treasure chests of memories, similar capacities to stargaze at the night sky, and similar human aspirations to “live well and prosper”—as the great Star Trek saying goes.
My dying patient—I still recall the stark beauty of his emerald green eyes against his dark brown skin—would never be able to tell me about his life’s journey, but I tried to imagine what his hopes and dreams had been. Somewhere outside the hospital, I knew, he had family, friends, and loved ones who were waiting desperately for news, fearing the worst.
In those days, we didn’t refer to unidentified patients as John Doe or Jane Doe; instead, we assigned them the first name “Trauma” and the last name of whatever letter of the alphabet was available. My patient that night was assigned the name “Trauma Zulu.” Though I never learned anything else about him, I’ve always felt a connection to Trauma Zulu. His memory gives me courage every time an emergency call comes in, and his story, which will for the most part remain untold, is one of the reasons I chose to write this book—as a means of paying tribute to him and to all my patients, who are not only among my best teachers and true heroes but who have given my story its purpose.
In early 2005, I placed a rose on the grave of one of the people I was never able to thank for saving my life and helping me make my way to terra firma. On that occasion, I made a promise to myself that whenever I told my story, I would pay homage to him. I could never have become Dr. Q without co-workers like him and without my family members, friends, colleagues, staff, mentors, students, patients, and loved ones. Each one of them is woven into the fabric of who I am. And this story wouldn’t be worth telling if not for my wife, Anna, and my three children, Gabriella, David, and Olivia—who have inspired me to take this journey of hope and imagination with you now.
PART ONE Stargazing
APRIL 14, 1989. NEAR THE PORT OF STOCKTON, CALIFORNIA.
