The Queen of Hearts(35)
We scrubbed quickly, watching through the OR window as the nurses flew around the room opening various instrument kits. Just as we were about to start, the trauma pagers blared again. Dr. Kalena, Clancy, and Ethan departed.
I braced for a long and uncomfortable slog. For the first hour, I held a delicate retractor while the two men grafted and ligated, my arms locked in an increasingly uncomfortable position until I could no longer control their shaking. The vascular surgeon, a genial British fellow named Markey, peered out over his loupes as my tired forearm muscles started vibrating enough to shake the entire surgical field, and said, “Have a little stretch, dear. I remember those days of endless retractor holding. Dr. X will have to make this up to you later.” Even in the midst of this hushed life-or-death drama, I could tell X was grinning under his mask.
“Yes, sir, he will,” I replied. “I’m so sorry to distract you.”
“Not at all. Dr. X can take your place for a moment.”
I had not yet released my hand when the anesthesiologist let out a muffled curse from behind the patient’s head. “Sorry, boys. We’ve got some rhythm issues,” he said.
“What’s going on?” Dr. Markey asked.
“Runs of V-tach. We’re waiting on repeat electrolytes— Oh shit.” A nonstop beeping sound began. “He’s in V-fib,” the anesthesiologist called. “Shock him.”
The nurses sprang into action, ordering everyone to stand clear. Dr. Markey said sharply to the anesthesiologist, “What’s the last hemoglobin?”
“Waiting on it now. How much have we lost in the last ten minutes?”
“Third shock delivered,” said the circulator, as the patient’s body jerked on the table.
“Five hundred CCs,” Markey replied, backing away from the table with his hands up as if surrendering.
“Resuming CPR,” announced the scrub nurse. The surgeons jumped back up to the table, everyone craning their heads to see the monitor, which demonstrated an ominous series of jagged green peaks and valleys. The anesthesiologist called out, “Giving epi now, one milligram,” at the exact moment that the monitor changed back into a recognizable sinus rhythm. With no one holding pressure on the myriad little open arteries in the neck, the vasoconstriction of the epinephrine caused a Vesuvius of blood to erupt, a high-force hail of magma pulsing out in all directions. Dr. X and Dr. Markey were instantly drenched, even behind their eye shields. The circulator bounded over to sponge off their faces.
“Motherfuckingshitsonofabitch,” swore Dr. X. Then, to Dr. Markey: “Can you ligate anything?”
“I’m afraid I can’t see shit,” replied Dr. Markey in his posh British voice. “Suction! Here!”
“Aaaah!” cried the scrub nurse, who was blasted in the face while leaning over with a Yankauer tip. Dr. Markey snatched the tube from her and attempted to suction as much blood as possible from the field. Inspired, I rolled up a small surgical cloth and carefully placed it at the inferior aspect of the open wound, compressing as firmly as possible everything beneath it. This slowed the battalion of geysers in Lima’s neck, dulling them down to burbling red fountains. “Oh, well-done,” breathed Dr. Markey. We peered into the bloodbath. There were oozing little vessels everywhere, and one or two larger ones, on which Dr. Markey and X immediately set to work.
“Dr. Markey?” I asked timidly, looking at the white face of the young father. “Will he make it?”
X’s pager chirped, a reminder beep for a message we’d all missed during the explosion.
“It’s from Dr. Kalena,” the circulator read. “She says they’ve got the new one—Edict Trauma. Twenty-six-year-old pregnant female, gunshot wound to the head.”
—
“Last but not least, this is hospital day two for Edict Trauma, a twenty-six-year-old female at eighteen weeks gestation, status post-GSW to the left temporal lobe,” Ethan droned the next morning, by now immune to sentiment even though he was talking about a pregnant person who’d been shot in the head. We’d just finished rounding on Lima Trauma, who had somehow survived surgery and hung on through the night. “She’s day-one status post craniotomy with clot evacuation.”
“You can skip the rest of the history, Speedy, since we just spent all night with her,” X allowed. He hadn’t shaved, and he sported blond stubble that lent him a rakish look. “Vitals?”
Ethan vomited a cascade of numbers. “Pulse of 84, BP 105/65, temperature 98.2. She remains on the vent, with 96 percent O2 saturation on AC 10, PEEP of 5, Fi02 50 percent.”
“We need to replace her line,” said X, reading something on his sign-off sheet and frowning. “A femoral line from the ER is not the most sterile access.”
“Yes, sir, you did mention that yesterday,” Ethan mumbled.
“Val?” X was still looking at his notes. “Page me when the family gets back so I can discuss her prognosis. We’ll do it first thing after rounds. Respiratory was concerned that her endotracheal tube might be developing a cuff leak, so we’ll change that out. Ethan, you have a case with Hollister, so, Zadie, you stay with me and we’ll get it done. Let’s try to get out at a decent time today, team; I have important plans tonight.”
“Yes, Dr. X,” Val said.
I smiled to myself. X had finally bowed to the inevitable and agreed to do “something romantic” with me tonight. This was good. It was doubtless unhealthy to conduct nearly one hundred percent of a relationship at work. I made him solemnly vow to forgo our usual lustful frenzy—um, physical contact—and have a sit-down dinner, complete with intellectual conversation, candles, and music of some non-Rage genre. X had complained briefly about this last request (“What am I supposed to play, Enya?”) but capitulated, although he did insist on takeout instead of a restaurant.