One was middle-aged, balding, the other young, overweight, and both men screamed as they rolled in on the gurneys. We had no warning on the radio at all. The paramedics were urgent, moving quickly and breathing hard. Multiple gunshot wounds, they said, with unstable vital signs. They didn’t have time to call it in; it was too close, they were too busy.

I took the young one. He lay soaked in sweat, with a blue-red hole in his neck. “I can’t move my feet,” he yelled, over and over. “I can’t move my feet.”

The volume of his shouts was...

I had a 1972 mercury station wagon with a cylinder gone, and at the end of that summer, when I left Boston for medical school in North Carolina, it pumped smoke all down the eastern seaboard, filling the rearview mirror with a blue haze. I felt like a slow rocket, sticking to the Naugahyde, sweat on my face, windows down, the back full of boxes and clothes.

It was one hundred degrees in New York, and on the Verrazano Narrows bridge, in a traffic jam, the needle rose off the top of the temperature gauge. On either side, the tenements,...

I couldn’t believe William was alive. He was like someone out of the past, weary behind the barbed wire, blinking at the Allied soldiers at the gates. He was in his early forties, and all he did as he lay on the hospital bed was chew pieces of ice. After a while I came to identify that sound—the crunch of teeth on ice—with him. He was calm, alert, and he wanted only one thing now. This was why he was here, back home after all the years in Atlanta.

“Is there anything I can do for you?” I...

She was angry, and wouldn’t look at me, staring instead out the window at the parking lot. It was hot already, in the late summer morning, and sparrows gathered at the feeder just outside her room.

“I want Pete,” she said, as she watched them. Pete was a medical student who had recently rotated off the service. I was his replacement, a fact Mrs. Smith digested with visible regret.

“Mrs. Smith,” I said, “I really think you should let us give you the blood thinner.” She stared out the window. “Mrs. Smith?”

“The Lord knows more than you,” she said...

In the middle of our third year, I found him leaning against the wall by the nurses’ station. Tony, my first-year anatomy partner. It was well past midnight, both of us were on call, and he looked distraught, unshaven, in wrinkled scrubs and the stained short white coat we all wore. That afternoon one of the attendings had told him she was going to fail him for the month, that he would have to repeat his rotation.

“I keep falling asleep when she lectures to us in the conference room,” he said, shaking his head. “I can’t stay awake. She...

He was in so deep a coma that I didn’t bother using local anesthetic when I sutured the wound in his face. It was Sunday afternoon in the ICU, and I had been called in from home to close the man’s lacerations. The night before, on a dark road, he had gone through the windshield.

It was really a job for a plastic surgeon. The wound extended from the top of his scalp deep into the tissues around his eye, then down his cheek into his mouth. I knew why they had called me, the intern. The man was not...

He was in his sixties and lay gasping for breath as I walked into his room. I introduced myself, and he nodded, with effort. The nurse attached him to the cardiac monitor, fitted the oxygen cannula to his nose, started the IV.

“When did the pain start?” Early this morning. It had woken him up.

“Do you have any heart problems ?” No.

“Do you have any other medical problems, like diabetes or high blood pressure?” He shook his head.

“Describe the pain for me. Is it sharp, or dull?” Dull, vague, in his chest, going up into his neck...

“He’s here again,” the nurse said, pointing to the cubicle. “He’s a hard one.”

A thin man sat on the gurney at the heart station. He was shirtless and alert, like a sparrow, interested in the proceedings. A tech was attaching him to the cardiac monitor.

“Mr. Santana,” I said, introducing myself, “what can I do for you?”

“I’m having chest pain,” he replied. “And”—before I could ask—“it’s a ten out of ten.”

His silk shirt lay neatly folded on a chair. He wore a heavy silver necklace, dark with inlaid turquoise, and polished hand-woven cowboy boots, their...

We had a few minutes of calm, waiting in our gowns and gloves, our heavy lead aprons, as the radio filled the trauma room. A pickup truck, high-speed rollover, two coming in. Teenagers.

The black boy, who came in first, was dead. He lay unmoving, eyes half-open, with a clear plastic tube sticking out of his mouth, the paramedics still squeezing air into it through a blue rubber bag.

“He’s in asystole,” the paramedic said, meaning his heart was not beating. As I turned away, I noticed his hair, cascading to his shoulders, dark and shining, each strand braided and...

I let her sleep it off in the hall stretcher. She was blind drunk, and she stank, her light brown hair coiled on her neck, her blue eyes half-open to the ceiling. She lay still, but every so often something happened: a twisting movement, a jerk on the gurney, one arm flailing into the air. Her lips trembled, and as I passed I could hear her muttering, fast and low, nonsensical.

She wore stained overalls and a bandanna. When the nurse took off her shoes her feet were black, crusted, and smelled so badly that we wrapped them in plastic...

I was walking past x ray on my way back to the emergency room. The door to one of the X-ray suites was open, and, glancing inside I saw a surgery resident I knew peering anxiously at a patient’s monitor. Even from the door I could see what it said: blood pressure 60/40. Heart rate 130.

“What’s up?” I asked. The surgery resident turned.

“He’s an MVA from the trauma room. We had to intubate him because he was so combative, but the CAT scan of his head and belly were normal. He’s only got leg fractures—but his pressure...

The pagers went off harshly, early in the morning, and we stumbled out of our beds, waking up on the stairs as we went down to the ER. Gunshot wound to the head. A young woman.

She was there already, alive, trying to sit up on the gurney. She even spoke a few words: “I’m cold,” and, a little later, “Where am I?”

She could move her arms and legs, but it was a terrible wound. A tiny hole, a splinter of bone just above her right ear, and I had to work my glove through the clot, rubbery and...

“Why don’t we plan on withdrawing support tonight,” the attending said, to settle the matter. “We’ll give his sister time to get here.” The sister was already driving, the family said, south from Colorado. She understood the urgency. The rest of the family had gathered for days, shuffling in to talk to him as he lay there on the ventilator. The guards were sick of them, bored, reading magazines in his room. It was protocol; all prisoners needed to be watched.

During the last few days of his life Mr. Garcia was watched all the time: by his family, by...

His pager took both numbers and voices. It was a little black card on his hip, with a green diode and a screen. It weighed almost nothing, and could vibrate or ring. He wore it all the time. The world entered him through it.

“Whatcha got, slick?” he would say into the phone, and we’d tell him, and he would get into his truck and come in. His voice was the army and west Texas, a cracker from a rough town, sly, amused, full of dark things—surgery, for example, and the blues.

Dr. Blake was the head of the...

“I don’t think any of us here seriously expect this man to survive,” the attending said every morning when we reached room 6. We expected the remark. The intern would begin the presentation, and it was always the same.

“This is ICU day 28 for Mr. Johnson, a twenty-six-year-old cowboy with pneumonia, sepsis, respiratory failure, renal failure, and anemia . . .” A detailed analysis of each problem, in descending order of severity, then ensued. He was growing steadily worse. The ventilator had been at maximum settings for weeks, supplying the man’s ruined lungs with just enough oxygen to

“This...

Maria would not stop bleeding. It defined her now. She lay there, and it just went on, it wouldn’t even slow down. Nothing we did, nothing we could think of, had any effect. She was a leaking vessel, day and night, and she was alert, watching as she filled up the bed.

A ritual developed. Every few hours I called the blood bank, and, expecting my call, they approved another transfusion for Maria. By the end of the week none of her own blood was left in her body. She was full of the blood of strangers.

The distance between...

The morgue at the university of New Mexico is a stone building, squat, determined-looking, with a glass foyer. It keeps strictly daylight hours. There are usually a few police cars out front, cops standing around smoking and talking. You pass them, enter the unlocked door, then speak into an intercom: “I have an appointment. . .I’m here to see . . .” and they buzz you in.

After a few visits the receptionist recognized my voice. “It’s Frank Huyler,” I’d say, standing in the heat of the foyer, and he would hit the button that opened the door. The receptionist...

The man came by air, south from the Colorado border. He was alert, asking for morphine and his wife. They wheeled him directly from the helipad, under the roar of the blades, down the hall to the tub room.

The tub room is always first. It’s two hundred gallons, stainless steel, 98.6 degrees, antiseptic, with wisps of steam rising, and a block and tackle above it. After a while, everyone lying in the rooms beyond comes to fear it. They keep the morphine in a locked chest nearby, in dozens of cold vials, and refill the chest every week.

Over...

“You have to come and see this,” the nurse said breathlessly, interrupting rounds. “It’s the grossest thing I ever saw.”

It was early on Sunday morning, and the trauma team had been shuffling around the surgical ICU for an hour, trying to impose some order on the carnage of the night before. It was a blur for me by then, a stream of wounds and bodies. There had been only two surgery residents and me, and we had been going for twenty-four hours straight, trying not to miss something big. I felt jumpy, distant from the world, and the bright...

Ruth was a small british woman with close-cropped blond hair and a tiny white triangular scar that lifted the corner of her upper lip just enough to make her look secretly amused. She was the new attending neurosurgeon, already in her early forties, though you wouldn’t know it to look at her, with her smooth fair skin, her quick exact movements.

Usually she was calm and polite, but you could never tell what would set her off. Her face would grow still, she would step up close, white-lipped, and empty her flat gray eyes into yours. It didn’t matter if...

I’m hard on him, I don’t give him any time to plan. I have him on the gurney, and his eyes are flicking back and forth. He wants escape, to rise and flee, but he can’t. So he starts to cry, and I go right through his tears, purposeful, head down.

“You need it, Mr. Hyde. We’re going to put it in whether you like it or not.”

“I want my wife!” he cries. “I want my wife.”

He is alert from the car; he remembers the crash exactly.

“Can’t you do something else? Isn’t there another way?” I say...

The young woman was drunk, her jaw was shattered, and as she screamed the air around her head filled with a fine blood mist that beaded up on my goggles and mask. Another car crash, another steering wheel to the chin, but even from the first we knew it wasn’t that bad.

“Bobby,” she screamed. “Bobby.” Bobby was her boyfriend. He lay in the next room, drunk also, with a face full of glass, but just as lucky. As she opened her mouth to scream again, deaf to us, we saw the jagged fracture, the splinter of white bone sticking...

She was so beautiful she caught me. I entered the room looking down at her chart, so when I raised my eyes I had no warning, no time to prepare myself. She was fifteen, and I was exactly twice her age. But I couldn’t help it. She was oracular, the kind that leaps from the crowd. And she was used to it, I could tell, but she was shy anyway, and smiled a small embarrassed smile when she saw me.

A young man stood next to the examination table. He was older, in his early twenties, and he looked rough....

The little girl was running around the room, screeching happily, and when she saw me she hid under the bed. I could see her peering at me from between the legs of the gurney as I stood with her chart in my hand. Her father shook his head, grinned, and looked at his wife. “I told you there’s nothing wrong with her.”

I looked down at the chart. On it the triage nurse had written, in bold black letters, “Two-year-old acting weird.”

“I’m Dr. Huyler,” I said. “What can I do for you?”

“Nothing,” the man said, and

“She’s not...

She lay there and wouldn’t talk to me, staring at the ceiling with her pale blue eyes. I felt myself getting angry. “I can’t talk,” she mouthed, as if to a lip-reader.

I knew she was lying. “You can talk,” I said. “Why don’t you tell me what’s wrong?”

She mouthed some more, and I started, despite myself, to hate her. I am complex, she said. I am so complicated, so interesting. Look, you see—I can’t talk at all. She was sixty years old, and lay still on the gurney, full of trickery. So I moved closer, pressed my...

The nurse came up to me. “The guy in four wants antibiotics for his sore throat. Can I give him something?”

I glanced at his chart. He had a cold, that was all, and it was busy. “I haven’t even seen him yet,” I said.

The nurse rolled her eyes. “He’s just going to keep bugging me.”

The ER was full, it was the middle of the night, and I was feeling sorry for myself. Yesterday they had slept.

The waiting room was full of children. Coughs, runny noses, fevers, keeping their parents up until they’d had enough. I’d seen...

The man looked familiar, but I couldn’t place him. He sat on the side of the bed, monitor wires leading from his thin brown chest to the screen. Chest pain, the nurse said, with a cardiac history.

I introduced myself, and we shook hands. “It’s terrible,” he said, “this pressure in my chest. It started two hours ago, and it’s getting worse. It feels exactly like a heart attack.”

“You’ve had a heart attack?”

“I’ve had three, four if you count this one. And heart surgery lots of times.” His white shirt lay folded on a chair, and next to...

Sometimes when I catch a glimpse of myself in a mirror, or reflected in a glass door, I understand why they’re surprised when I enter the room. Their eyes widen. They often ask me.

“I’m older than I look,” I say, which is true. They’re usually about ten years off when they guess.

“Is that the doctor? Really?” This from the twenty-year-old nursing assistants, the X-ray techs who don’t know me yet. They smile and shake their heads.

I mind and I don’t mind. When they see a kid in front of them, they don’t want it or expect it....