Wednesday, July 3, 4:15 p.m.
Mitt entered the surgical lounge with the intention of heading directly into the locker room, but then he caught a glimpse of Andrea sitting near the communal coffeepot, using her phone. Pleased to run into her, he immediately changed directions and walked over. She acknowledged him with a nod and a smile but continued her conversation. Mitt could tell it was a personal call, so he took the chair directly opposite hers. While he waited, he took out his own phone to check for any messages and, pleased that there weren’t any, turned off Do Not Disturb mode. A moment later Andrea concluded her call and pocketed her phone. They exchanged a knowing glance. She was back to her fashionista mode, wearing her white coat over an arresting blue dress. As usual she looked a lot more put together than Mitt felt.
“I guess we both missed Journal Club,” Andrea said with a sly smile and a glance at her watch to be certain it wouldn’t be worth heading up to the fifteenth floor. After morning rounds they’d both admitted that with everything else going on the last thing they wanted to do was attend Journal Club, especially since they hadn’t had an opportunity to read any of the designated articles.
“I’d completely forgotten about Journal Club,” Mitt admitted. “How on earth did you remember? Was seeing me a reminder?”
Andrea’s smile morphed into an actual laugh as she hunched her shoulders in a shrug. “Maybe so. Who’s to know?”
“How was your day of surgery?”
“So-so,” Andrea said, holding her hand aloft, palm down, and letting it flutter.
“Don’t tell me you had a bad outcome.”
“Nothing that serious,” Andrea said. “The last case was a Whipple procedure, and I was holding a retractor for almost the entire interminable operation, and like you described with your aneurysm case, for too much of it all I got to see was Dr. Rodriguez’s back. In that sense it was miserable. On the good side, my first two cases were fine, and I did get to do more suturing on all three cases. But enough about me, what about you? How were your cases, and how did you get along with Dr. Singleton?”
“Dr. Singleton is a delight,” Mitt said. “How did you find Dr. Rodriguez?”
“Fine,” Andrea said. “He’s obviously more than competent, but I did get a little spoiled with Dr. Singleton. He’s so much more personable.”
“I know exactly what you mean,” Mitt said, succumbing to a kind of psychogenic blackout. Andrea’s comment had made him revisit Dr. Singleton’s concern about his hallucination in the operating room, which brought back the hallucination itself in shocking detail. Right there in the front of his mind and momentarily blocking out his view of Andrea and the surgical lounge was the taunting blond girl, viciously gesturing toward him with some kind of surgical instrument as she’d done earlier. Behind her and threatening to push past was the bloodied horde of surgerized, tortured souls.
“Mitt, are you all right?” Andrea questioned with a touch of urgency.
Mitt looked down at his knee as he became aware that Andrea had reached out and grasped his leg, awakening him from his disturbing but fleeting trance.
“Yeah, of course,” Mitt responded with a slight shake of his head to clear his mind. “I’m sorry. I just drifted off there for a second.”
“What were you thinking about? You suddenly had this dazed expression.”
“I was just agreeing with what you said about Dr. Singleton,” Mitt said, hunching his shoulders as if to say it was as simple as that. At the same time, he again wrestled with the idea of telling Andrea about his hallucinatory experiences, especially this most recent one, but just as he had on the previous occasion and with Dr. Singleton, he hesitated. Despite the fact that he thought of her as a true, close personal friend and fellow resident going through the same emotionally traumatic experience, he had no idea how she’d take such strange information. The question was whether her loyalty would ultimately be to him or the residency program if she thought he was losing it. As he’d reasoned previously, he wasn’t even sure how he’d respond if the situation were the other way around.
“What’s with these sudden pauses?” Andrea questioned. “You’re acting a bit weird, like you are having a premature senior moment.” She looked at him askance, brows knitted. “Are you sure you’re okay?”
“I’m fine. Really, I’m fine.”
“Okay, I’ll accept that, I suppose.” She rolled her eyes. “Let’s move on! You haven’t mentioned anything about your cases today. Did everything go okay in that department? You didn’t have any more strange deaths that I didn’t hear about, did you?”
“No, no deaths. My cases went okay. Well, that’s not exactly true. There was a problem with the first one. After a vein stripping on a nearly four-hundred-pound woman that went reasonably well, other than not being able to use a planned epidural, the patient wouldn’t start breathing on her own. And then while she was in the PACU, somehow her electrolytes got totally out of whack and she started having extra heartbeats. As far as I know, she’s still on a ventilator six or seven hours after her surgery. Since I did her admission history and physical, I know she had no history of pulmonary disease, and her lungs were perfectly clear last night and presumably this morning. Weird, for sure. Dr. Singleton did say that there are some patients who just go south and there’s nothing to be done. He actually used that specific phrase. Unfortunately for all concerned, the patient is now in the ICU, meaning I have two cases in there.”
“That’s not good.”
“Tell me about it!” Mitt said, rolling his own eyes.
“What about the other two cases you had? Are they okay?”
“Yes. They seem to be doing fine, fingers crossed.” Mitt held up his intertwined fingers for emphasis.
“What were they? Were they the kinds of cases that can have a rocky postop course like my Whipple procedure? I think she’s going to be a challenge for me for the next few days, but I hope she doesn’t cause you any trouble tonight. It’s amazing how much the digestive system is rearranged during a Whipple.”
“I don’t think my two cases are going to be a problem, at least I hope not. They were pretty standard general surgical cases: a breast biopsy with a lymph node dissection and a thyroidectomy for a cancerous nodule. From my perspective in terms of learning surgery, the first procedure was okay, but the second one was a joy, better than any anatomy lesson by a long shot. In fact…”
All of a sudden the memory of the girl and ugly crowd again flashed into Mitt’s mind like a psychic thunderstorm. Only with significant mental effort and another even more obvious shake of his head was he able to dispel it this time.
“In fact, what?” Andrea questioned. She leaned forward, staring into Mitt’s eyes with a questioning expression. “Am I losing you again? What is it with you? Are you okay? Come on, something is bothering you, I can tell.”
“No, no! I’m fine! Really, I’m okay,” Mitt assured her, but he could see she wasn’t convinced. “All right, to be honest, I am still tired, maybe even a bit more so. And I’m definitely still on the anxious side with all these deaths. And to top it all off, I haven’t eaten anything all day. So, after I force myself to descend a floor to the ICU, our least favorite place in the hospital, to look in on both Elena Aguilar and Bianca Perez, I plan to take myself directly to the cafeteria for an early dinner. How about joining me? Are you game?”
“Hell no!” Andrea said but with a smile. “After I check all my postops including today’s, I’m getting the hell out of this hospital. I was just on the phone with a friend. We’re going to have an early but real dinner in a real restaurant. But finish your thought. You were talking about your thyroidectomy, and you started a sentence with ‘in fact’…in fact what?”
“Good for you to get yourself out of this hospital for a few hours,” Mitt said. “That’s a healthy idea, and I’ll try to do the same tomorrow. What I was going to say was…in fact, my thyroidectomy case was a superb anatomy lesson in a living, breathing human being. And that’s by far the best type of anatomy lesson.
“The attending surgeon’s name was Dr. Taylor Smith, and he was excellent. I got the definite sense he loves teaching. I hope I get to scrub with him often, and I hope you do, too. The only thing mildly unusual about the whole experience was the attending’s rather curious name. I’ve never met another male ‘Taylor,’ whereas his family name is one of the most common. Anyway, the combination caught my attention.”
“What are you talking about?” Andrea said with an exaggerated questioning expression. “Taylor is a fairly common name for both men and women. I know several.”
“Regardless,” Mitt said with a wave of dismissal. “The commonality of the name isn’t important. The point I’d like to emphasize is that this Dr. Taylor Smith is a born teacher. I learned more during this thyroidectomy today than in all my other surgeries put together. You’re going to love him if you get to work with him. Believe me!” Mitt heaved himself out of the rather low chair and got to his feet. As he did so, he experienced a fleeting touch of dizziness, which he attributed to low blood sugar. With that thought in mind, he noticed a bowl of individually wrapped peanut butter crackers over Andrea’s shoulder by the coffeepot and was momentarily tempted, but then he thought he could hold out another half hour or so for a real meal.
“Thanks for the heads-up about Dr. Smith,” Andrea said, getting to her feet as well. “I’ll look forward to scrubbing in with him. Before you go, let’s talk about tomorrow morning. What time do you want me to show up? My guess is it’s up to us, since there are no formal rounds.”
“Good question,” Mitt said. “I hadn’t given it any thought, to be truthful.” He’d had a premonition that the night ahead was not going to be pleasant, but he didn’t know how bad or at what point during the night it might be bad—late in the evening or early in the morning or both. But he did know that the worse the night turned out to be, the earlier he’d want to be relieved.
“Here’s my offer,” Andrea said. “If you are willing to hand off the baton as late as nine a.m., I’ll do your histories and physicals. That way you won’t have to come in to do them.”
“That’s very generous,” Mitt said. “But I don’t think it’s fair to burden you with my responsibilities just because I lucked out having the day off. As I said, I literally live around the corner. I don’t mind coming in. But nine a.m. is fine.”
“Are you sure?”
“No, I’m not sure. If it’s a bad night, I’ll kick myself for saying nine. But there’s no way to know, so let’s say nine.”
“Okay,” Andrea said. “Fair enough! I’m not going to fight you, that’s for sure.” She moved toward Mitt, offering first one cheek, then the other, in her usual warmhearted fashion.
After the gesture, Mitt glanced around the surgical lounge, feeling self-conscious. He couldn’t help it, but public displays of affection made him feel uncomfortable. He was relieved to see that no one paid them the slightest heed. Besides, there weren’t that many people in the surgical lounge at that moment.
Together they walked out to the elevator lobby as Andrea described in enthusiastic detail the restaurant she would soon visit. An up elevator came before a down, and Mitt waved to her as she boarded. “Good luck tonight,” she called out as the door began to close.
“Enjoy your dinner date,” Mitt responded, still waving. For a brief moment standing in the elevator lobby with Andrea gone, he experienced a strange sense of loneliness, as though he was being abandoned. He couldn’t explain his feeling, especially with several other people around him waiting for a down elevator. A moment later he was able to board and the feeling vanished. In its place was the more understandable and worrisome concern about his upcoming visit to the ICU.
Minutes later, Mitt pushed into the ICU and immediately felt a sense of déjà vu. He experienced the exact same anxiety over the threat of potential clinical catastrophe as he had that morning, although maybe it was a little more intense now that he had two patients. As he penetrated deeper, it got worse, and Mitt paused to decide if he should head immediately to 10 South and check on Perez or if he should stop and find out Aguilar’s location. Coming abreast of the bank of monitors made the decision for him.
Several of the people using the monitors nodded a greeting to him, and he nodded back, feeling a bit more welcome. Again, without sitting down, he typed in Elena Aguilar and was immediately rewarded with her location, 8 North.
Leaving the central desk, he made a snap decision to check on Perez first since he knew where that specific room was located and it happened to be physically closer to where he currently was. As he approached 10 South, he began to formulate what he’d like to see if it were up to him, namely that the woman was off the ventilator and conscious. He knew it was wishful thinking, but he indulged himself anyway. Since it was already after four in the afternoon, he knew the chances of Gabriela Martinez still being the nurse on duty were slim, so he planned on again admitting his newbie resident status up front.
Coming to the door of 10 South, he stopped short. Not only was Gabriela Martinez not there, but the patient wasn’t Bianca Perez. In the bed was an elderly Black man with white hair and a short white beard who was sitting up and sipping a cup of ice water. A second later, a nurse popped out of the connecting nurses’ station. Like everyone else in the ICU, she was dressed in surgical scrubs. She, too, was Black and didn’t look much older than Mitt’s twenty-three years, if that.
“What’s up?” the nurse questioned with a friendly smile. “Have you come for Mr. Henderson? He’s ready to go.”
“No,” Mitt said. Instinctively he leaned to the side to make absolutely certain he was in the correct room. He was. “I’m a first-year surgical resident,” he quickly added while trying not to believe what his mind was telling him. “I was coming to check on Bianca Perez, who was in here this morning. Has she been sent back to her regular assigned room?”
Without so much as a slight hesitation, the nurse approached Mitt, latched onto his right arm above the elbow, and drew him a couple of steps away from the room’s doorway and out of earshot of her current patient.
“Bianca Perez passed away this morning,” the nurse said quietly. “She had a cardiac arrest and was a DNR.”
For Mitt the information was like a slap in the face, and he recoiled. “No,” he said as if he had the power to alter reality, but then quickly added: “When did this happen?”
“Ten a.m. or thereabouts. You can find it on the record if need be.”
“Okay, yes, of course,” Mitt said. “Thank you for letting me know.”
“You’re welcome,” the nurse said. She raised her eyebrows as if asking if Mitt had any more questions.
Mitt spun around and headed toward the north-facing ICU patient rooms. As he walked, skirting various hustling people and passing a multitude of rooms, each with a very sick patient and at least one nurse, he felt numb, like he was in a nightmare and couldn’t wake up. What he was having to face was yet another patient death, meaning that all four of the initial cases that had been assigned to him had died: first Suárez, then Thompson and Silva, and now Perez. Can that have happened by chance? Mitt silently wondered. Knowing something about statistics, he was well aware the odds were very small indeed, and when he added in the fact that Elena Aguilar was doing poorly, it seemed almost beyond statistical probability.
Mitt turned the corner and started along the north-facing ICU rooms. As he got closer to 8 North, he found himself purposefully slowing, as if by doing so he could influence reality. But it didn’t work. The moment he reached the door and looked in #8, his hopes of a positive clinical turnaround were dashed—Elena Aguilar was still on the ventilator and obviously not breathing on her own. Her eyes were taped shut. And she was completely motionless save for the slight rise and fall of her chest with each mechanical respiration. The assigned nurse was busy on the right side of the bed, adjusting the flow from a cluster of intravenous containers hanging from the IV pole.
“Can I help you?” the nurse asked, catching sight of Mitt standing frozen in the doorway.
Mitt went through the same explanation he’d given to Perez’s nurse that morning to emphasize his status as a three-day-old surgical resident. He then asked how the patient was doing since her arrival in the ICU.
“She’s been reasonably stable, yet that’s not much to write home about,” the nurse said with a series of nods as if agreeing with herself. Mitt tried to see the woman’s name tag, but it was partially covered up by a surgical gown she was wearing backward over her scrubs. The ICU was kept at a lower temperature than the rest of the hospital, and Mitt had noticed most of the nurses wore a variety of such cover-ups over their scrubs. “Her pupils, although reactive, are sluggish in my book, but that hasn’t changed,” the nurse continued. “Of particular importance, she had some premature beats a few minutes ago. The second it happened, I let the Cardiology fellow know. Other than that, she’s been stable in terms of BP and oxygen saturation. I’d been told that the O2 had dropped in the PACU, but down here it’s been fine provided the ventilator volume and pressure are maintained.”
“Has the Cardiology fellow come to see her?”
“No, but he said he’d be by shortly. He did up her beta-blocker and told me to call him back if there are any more PVCs.”
“I see,” Mitt said. He recognized that he didn’t even know enough about the ventilator to ask any pertinent questions. “What about the electrolytes? Up in the PACU, I’d been told by the nurse they’d gotten out of whack and had to be adjusted.”
“Yeah, we heard about that,” the nurse said. “So, we ran electrolytes the minute she got here. They came back reasonable, maybe a tad low on potassium, but otherwise within normal limits. We also did a chest X-ray, and it was clear.”
“I’m on call tonight, so I’ll be around,” Mitt said, silently gritting his teeth. The last thing he wanted was to be called to the ICU, yet he felt responsible for Elena, especially since he didn’t have a good feeling about the woman’s near future.
“What’s your name again?” the nurse asked. She tried to make out Mitt’s name on his ID tag but couldn’t.
“Fuller,” Mitt said, purposefully leaving out the doctor title. “Michael Fuller.”
“Okay, I got it, Dr. Fuller. I’ll give you a shout if there’s any marked change. Because she’s making absolutely no attempts to fight the ventilator, I’m not feeling optimistic there’s going to be a lot of change. The only thing that seems to keep changing is this damn IV.” She’d been watching the drip chamber as she’d been talking to Mitt, and now she went back to adjusting the IV. “If you want to call me at any time until I leave at eleven, just dial ICU bed 8 North,” she said over her shoulder. “I’ll pick up if I can. If I can’t, leave a message, and I’ll call you right back.”
“Okay, will do,” Mitt said. He liked that. It meant he had the option of checking on Elena without having to come into the intensive care unit, and that sounded like music to his ears. Turning on his heels, he hurried back toward the relative safety of the hospital proper. Thinking of the news he’d just gotten, he realized the ICU was certainly living up to his worst fears, with Bianca Perez dead and Elena Aguilar hanging onto the edge of the precipice with just the tips of her fingers.
Reaching the elevator lobby, he knew he had to think about something other than death and statistics. Luckily his gnawing hunger provided a distraction, and he started wondering exactly what he was going to have for his upcoming dinner.