Saturday Sam ran the place one day each week.  It was the only day of the week he worked. With two vacation Saturdays a year, he funded his annum on 50 days of employment per. On those infrequent times when he was asked why he only worked Saturdays, he said, “I’m usually pretty busy the other days.” Which was more than could be said about the department he worked that one day in. Until later in the night, most Saturdays were quiet most of the time. Yet the place still had to remain fully stocked and fully staffed against those black swans that might be carried through the door at any moment; and that presented a pair of nice management problems.

The first was boredom, boredom being to sharpened skills as a cement appendix is to the edge of a scalpel. Sam was not himself troubled by boredom. It’s not that he wasn’t bothered by it when it happened. It’s that he wasn’t visited by it in the first place. When the subject came up during a communal soak at Bagby Hot Springs on a morning that was not a Saturday morning, a large middle aged blonde dressed only in a smoker’s cough and a can of beer allowed that if nothing happened at her job she’d go right around the goddamn bend. “I mean, that kind of day just creeps on by, inch by inch. Makes me want to crawl out of my skin.”

“Everybody wants to kill time,” Sam observed, burning down part of the joint he held in a stainless steel hemostat and passing it on to the fellow next to him. “What did time ever do to us?”

“You seen my sagging tits, honey, you wouldn’t think that was such a good argument.” Her laughter sounded like an emphysemic cough and when she started coughing it sounded like heavy laughter.

In his first few weeks on the job, the frequent boredom among the staff had gone unnoticed by the boredom-inoculated Sam. But after a while he began to notice the listlessness, complaining and lack of engagement. Moral Hazard, thought Sam, and announced a darts tournament. Because who doesn’t like darts? he thought, before discovering that most of the staff didn’t like darts. That changed the next day when he brought a homemade Richard Nixon dart board and hung it on the staff break room wall. Inventive and largely popular, but it was the darts themselves that turned it around. He emptied a brown paper bag onto the table in the break room next to the bagels and cream cheese with salmon. It was full of 30cc syringes, 14 gauge needles, fast drying glue and fletches from an arrow-making kit. Because who doesn’t like a crafts project when things are slow?

First, attach the needle to the syringe. Then, with the tip of the needle inserted into a plastic bed pan full of water, withdraw the plunger and fill the barrel of the syringe. Don’t pull it out the whole way. Experienced shooters, it will turn out, prefer the exactly correct amount of weight so that it is light enough to aim precisely yet is heavy enough for stable flight. Then, along the length of the exposed plunger, glue three (some prefer to use four) fletches. When the glue has dried, uncap the needle and let the tournament begin.

A small but happy bit of Dick darts serendipity was the fact that when when the dart struck the dart board, the sudden stop would cause a few drops of water to eject from the needle. When the dart struck Nixon in the eye, it would make it appear that he was crying. The Nixon photo that was copied off and attached to the dart board was altered by drawing two rivulets of tiny crocodiles sliding down the cheeks of the grinning Nixon. Extra points were to be won for darting one of the tiny crocodiles.

Playing traditional tavern 501 with such a target was out of the question but a very similar game could be played by using instead of the numerals 1 through 20, the letters i-m-p-e-a-c-h and g-u-i-l-t-y, with a standard dart board’s concentric rings, all drawn with a magic marker.

Sam bought a dozen Kewpie dolls for prizes but the staff grew bored with those long before they ran out. At one morning shift change meeting, prize money was discussed but the ensuing discussion featured multiple instances of the word “professionalism.”

And so a white elephant pot luck strategy was agreed. Each week on a rotating basis one staff member supplied the prize for the day’s tournament. The prize could legally range from something out of one’s basement, anything at all that a staff member had been dying to get rid of, to something they found at at one of the junk stores in Sellwood or at a five and dime. The first dispute needing adjudication arose when a roll of toilet paper was offered as prize. This was found to be completely gross and inappropriate by several staff when it was pointed out that the end of the roll was not glued down the way an unused roll of toilet paper is and was therefore not the least bit unused. Sam pointed out that the remainder of the roll was pretty much by definition unused and therefore perfectly hygienic. It was then pointed out by much of the almost entirely female staff that men were disgusting and clueless. The tournament finally proceeded when the person who’d brought the roll agreed to bring in a fresh roll still resident inside its original store wrapping.

The often repeated story that Sam had been at Woodstock treating bad acid trips was not true. On the way to Woodstock Sam had driven onto the tail end of the massive miles-long traffic jam that lead to Woodstock and had turned around and driven back to New York, where he and his girl friend spent the week dropping acid at the Met by day and going to folk music venues in the East Village at night. Once in the break room, Cowboy Dale Evans Tuyen Tuyet Tran asked him what Woodstock had been like and he answered, “It was magical. I ought to know – I wasn’t there.”

Cowboy considered this. “You talk like Zen guys my country. Bald hippie American Zen guy!” She walked back to her desk chuckling.

This Saturday morning, boredom didn’t stand a chance. They’d barely finished the shift change meeting and begun the bagels when Finalist #1 was wheeled through the ambulance dock door, snoring loudly. The triage nurse, Dick dart still in hand, listened to the story and pointed the paramedics to the first of the empty patient rooms. Moments later Cowboy Dale Evans Tuyen Tuyet Tran’s younger brother Nguyen was wheeled in, causing Cowboy to momentarily abandon her post to stand beside him, weeping quietly, while the triage nurse sent him off to a second room.

When Sam heard the radio report of an incoming possible geriatric trauma-induced pneumothorax, he had one of the trauma rooms readied and it was all hands on deck. He had just located two of Mr. Elmo P. Gersten’s ribs that weren’t broken, inserted a chest tube between them and sent for the portable X ray when he saw his possible cervical spine injury being wheeled in. He walked up to the stretcher. “You guys are aware, aren’t you, that the tri-county area is home to many fine medical facilities besides this one?”

George smiled.  “We go to the best, avoid the rest.”

The body of Finalist #2 was strapped tightly onto the gurney. Her head was immobilized on three sides by orange vinyl bags of sand and gussied up with generous lengths of gauze tied to the side rails to keep her head from raising up. Sam smiled down at her. “Good morning, my dear. My name’s Sam. I’m going to look after you this morning.”

Finalist #2 looked at him as if she were surprised to find him without a mop and bucket. “I was told,” she said frostily, “that I was being taken to see a doctor.”

“That would be me,” said Sam.

“I doubt that very much,” she said and stared at the ceiling.

“Well then, let’s see if we can’t scare up a real doctor for you. Follow me, won’t you?” He led them into the exam room, turned to the nurse who’d joined them and mouthed the words “You’re up!” A moment later she was back in a lab coat and the pair of black rimmed theater glasses kept in a drawer at the nursing station for occasions such as this one.

“Maam, this is Carolina Parker, one of our top notch clinicians.”

Finalist #2 looked up into the smiling face of a young woman beautiful enough to play a doctor on TV and said, “And where did our top notch clinician go to medical school?”

Sam leaned down next to her ear and said, “She is modest to a fault and would never dream of bragging about going to Harvard Med.”

“Well it’s about time I was taken to a competent person,” Finalist #2 said in Carolina Parker’s direction. “The men around here are a little slow” and she moved her eyes back and forth to indicate the little pest, the rude policeman and the janitor posing as a physician.

“We must love them anyway for trying to do their best,” said Carolina.

Finalist #2 considered this. “Yes, I suppose we must.”

And this was Sam’s answer to his second management problem, the problem of skills erosion during slow times: he created a small cadre of young talented home made doctors and set them upon the ill and battered who walked or were wheeled into the department. Sam’s theory was that a medical school was the worst possible place to get new doctors because medical schools are full of untested young kids. Sure, some of them are bright and can think on their feet. But why not train up only those people who are bright and can think on their feet? Much better, thought Sam, to start with already established talent and work from there.

Sam came to this theory – or rather had this theory delivered directly to him – when he was a resident working in a cardiac care unit. He spent most of one 12 hour shift caring for a middle aged lady in heart failure, in particular right side heart failure. Sam owned a 1960 Ford Falcon named Nelly Belle and driving home that night Nelly Belle collapsed and passed out.

Sam managed to get her onto the side of the road, walked to a pay phone and called a tow truck. The tow driver said “Let’s have a listen” and popped the hood. Sam tried to start her but she just coughed and wheezed and eventually the driver signaled him to stop. The driver told him that there was a small hole in the diaphragm of his car’s vacuum accelerator pump.

Sam was initially skeptical. He could tell this just just by listening? Yeah, it was pretty obvious, and he explained to Sam in clear and intuitive detail what a vacuum accelerator pump is, why his car needed one and why when the one it had lost its vacuum the engine would sound a particular way when trying and failing to start.

On the taxi ride home that night, Sam pondered the difference between treating pump failure in persons and in cars. In fact the pondering began as an instinctive ego defense against the very uncomfortable idea taking form in his mind that he and the tow truck driver were working at a very similar cognitive level. It was true that a big difference exists between medicating and monitoring a human in heart failure and simply swapping out a defective pump for a new one. But all the doctor stuff that Sam needed to do and a car mechanic didn’t, was down not to superior knowledge on Sam’s part but to superior applied technology available to the mechanic.

The cognitive playing field was even more level, Sam realized, when it came to the subject of diagnosis, which is what had caused his pondering in the first place. The differential diagnosis of acute onset chest pain, for instance, is a long list of ailments. It’s the doctor’s job to tell the impending heart attack from the indigestion. The differential diagnosis of engine failure is a similarly lengthy and tricky list. By the end of the taxi ride Sam had concluded that the issue wasn’t whether a human system was more complex than an automotive one. It was, but that wasn’t what interested him. What interested him was the realization that there was a much narrower cognitive skills gap between experienced mechanics and experienced doctors than there was between medical students and experienced doctors.

As his residence went on he made a list of jobs requiring the sort of people smart and detail oriented enough – cabinet makers, plumbers, welders, electricians, mothers who raised children and ran a household at the same time, many retired people – to make good clinicians. He calculated that six months of solid hands on experience and direct guidance would do the trick. He had none of those occupations to work with but he had something even better – a department full of experienced nurses.

Carolina Parker held the hand of Finalist #2 while she felt the back of her neck, listened to Two-forty Morty explain what had happened and began ordering X rays and tests. Sam walked out to attend to his other patients and as he passed an orderly on the way in and the phlebotomist coming to do the blood work he told them, “I’m declaring the over and under on her blood alcohol at .20, in case you’d care to tell the others.”

“You covering?” asked the orderly.

“Absolutely.”

“Way too high for over and under” said the phlebotomist, “so I’ll go 25 bucks under and because I respect you as a healer I’ll let you pay me a little every week.”

George drifted into the hallway while Two-forty Morty went up front to do the paperwork and billing information ritual with Cowboy Dale Evans Tuyen Tuyet Tran. The place looked like Saturday night. Four ambulances in the dock, staff and equipment coming in and out of four exam rooms and at the end of the hall four gurneys waiting to get spiffed up for the next customer and on one of them, little Cathy Remy, curled up and snoring peacefully.

George, newly homeless and for all he knew wardrobeless too, found the charge nurse and was told to fish around in the exam rooms until he found a few pairs of scrubs to wear until he could get himself sorted out. “Don’t worry. I bring ‘em back next week all washed and folded.”

“Why on earth would you bother to do that?”

The first three exam rooms contained an elderly gentleman with a chest tube, IVs and wires everywhere, Finalist #1 being attended by a bored LPN, Finalist #2 getting the royal treatment, and drawers with scrubs of size tiny. In room four he found 3 sets of scrubs that were close enough to big enough, and Cowboy Dale Evans’ younger brother Nguyen sitting up in bed with his legs dangling over the side and a pressure bandage wrapped around his head.

“Hey! My favorite war criminal! Fuck’re you doing here?”

George walked up and poked around the bandage. “For all you know, they so busy out there, they send me in to put in your sutures. So what up? Somebody finally clobber you for messin’ up a simple mop job?”

“If I told, you don’t believe it. Listen, you seen my sister?”

“Not yet.”

“She was crying when they bring me in. Could you look in on her, let her know I’m not gonna die or whatever?”

“I’m all over it, boss.”

In front, Happy Hal and Two-forty Morty were finishing up with Cowboy Dale Evans when George with his armload of scrubs pulled up a chair. “How you doin’, little cowgirl?”

Cowboy Dale Evans’ eyes were bloodshot and the tears had turned her mascara to sludge. She put her head in her hands, let out a loud sigh and said “I hope I’m dead!”

George smiled. “I wish I were dead,” he corrected her gently.

She looked up at him in surprise. “What, you too? Hey, what’s going on around here, anyway?”

“Rough morning?”

“Sure. I got a line of new patients stretching out the window. Somebody cuts up my brother. My mother’s coming down now, all freaked up. She knows nobody understand Vietnamese so she’ll probably start yelling in French.”

“Just saw your brother. No big deal. Couple stitches maybe.”

“Tell that to my mother. You and Morty go outside and wait for her, OK? Tell her go back home.”

George and Morty walked down the hall through the swarm of RNs, LPNs, phlebotomists, X-ray techs and orderlies, all moving quickly, doing several things at once many of them, and yet looking – in a way that he understood himself but would have a hard time explaining to anyone else – satisfied.

As Sam walked quickly by, reading a print out of lab results, George said to him, “Happy as a pig in shit.”

“A decidedly unkosher observation,” said Sam in the tone of someone not in the least bored.