The Queen of Hearts(43)

So I eased myself onto the uncomfortably firm bed in my call room, and of course my pager went off a few minutes after I finally fell into a desperate, hard-edged sleep. A dull heaviness encased me as I awoke, as if my metabolism had slowed to a tenth of its normal speed. I jumped up and was forced to bend forward at the waist as a wave of nauseating dizziness pulsed through me.

I panted for a moment, head between my knees. Was I sick? Or was this some physical manifestation of stress? Maybe I was too old for this. I’d always prided myself on my toughness, especially since I work in a field so completely dominated by men. My phone beeped a reminder, and I forced myself upright. Another level-one trauma en route. I started down the hall, staring at the maroon carpet under my feet.

From years of painstakingly patching up people who’d been squashed, shot, stabbed, and mangled, I’d developed a healthy degree of safety consciousness. Everyone who knew me also knew my nonnegotiable rules: no alcohol or cell phone usage if driving, no guns, no climbing on roofs, and of course, you didn’t set foot in my car without a seat belt. (Although my safety measures didn’t quite approach the level of paranoia manifested by one of my med school professors, a guy named Cyril Herring, who insisted on wearing a ridiculously conspicuous NASCAR-type helmet everywhere he drove.) I also privately believed alcohol should be off-limits for anyone who exhibited poor impulse control, although I hadn’t quite worked out how to implement that one.

As I regarded the scene in the ER, I reflected that maybe Dr. Herring had been onto something. Head injuries are the bane of trauma surgeons: most often these patients aren’t fixable. Our brains contain one hundred billion neurons, but exactly how they function is still something of a mystery. Especially when they’ve been flung into a dashboard at forty-five miles per hour.

The other injury I detest in trauma patients is a bunch of broken bones. I couldn’t do anything for broken bones, and the people who could—orthopedic surgeons—intimidated me. A race of overgrown, jocular, self-appointed surgical overlords, they lumber around the hospital confident in the belief that nothing trumps a fracture. As an illustration of this, the orthopedic surgeon standing in the ER right now had once stormed up to me in the TICU, commanding me to book an operating room for him stat so he could fix our mutual patient’s femur fracture. I declined to call the OR for him, which prompted a condescending lecture about the time-critical nature of restoring a pulseless extremity. I listened without interrupting and then politely informed him (a) I was the trauma surgeon, not the nurse, and (b) perhaps the patient’s leg was pulseless because he had died several hours ago, a fact that had escaped this doctor but not the family of the patient, who were watching this exchange with open mouths. I was right, of course, but despite this, none of the ortho guys here seemed to like me.

So this patient had a nonoperable head injury and a broken leg and some spine fractures and was going to be absolutely uninteresting from a management standpoint, but he was my responsibility because he had multiple body systems involved. Neurosurgeons and orthopedists don’t manage patients who have other injuries. I nodded to our midlevel resident and intern to take over the workup, and I headed for the door.

Before I could get ten feet outside the ER, my pager informed me the EMTs were five minutes out with another one. I resigned myself to yet another night without sleep.

This one was more palatable: another guy, another drunken car crash, but at least he had chest and abdominal injuries instead of a head injury. I wasn’t particularly fired up about going back to the OR, but it would have the benefit of keeping me awake. And it would make the time pass quickly until morning. Sanjay, along with our med student, barreled off to scrub; I limped along behind them, battling another surge of nausea and fatigue. I straightened my shoulders and told myself not to be a wimp.

But I felt even worse when I got to the OR. One of the scrub techs, a vapid, tattooed woman named Darla, cut off her droning chatter midword as I entered the room. She might as well have worn a sign around her neck: I WAS COMPLAINING ABOUT YOU, DR. COLLEY. I waved a tired hand at her.

The circulating nurse mistook this for permission to resume their conversation. Ignoring them both, I buttressed my leaden body against the solidity of the OR table, trying to breathe deeply enough to stave off the urge to crumple up in the fetal position.

Some of Darla’s giggly words filtered out to me: “. . . foxy and nice . . . Sherry says . . . just divorced . . .”

“Can we get it quiet in here?” I said, my tone harsher than I intended.

All conversation ceased.

Trembling, I considered my options. I could let Sanjay and the medical student do the case, but it was too early in the year for that: the medical student, eager though he was, was only one step up from the average fool on the street when it came to surgical ability. I trusted Sanjay as much as I trusted anyone who wasn’t me, but that wasn’t saying a lot: it’s widely acknowledged that I have control issues.

But I should have. I should have. I should have let Sanjay take over. Something was wrong with me—fatigue, or sickness, or stress—and only a few minutes into the case, I made a mistake. A big mistake, a stupid, completely avoidable mistake: I wasn’t careful enough as we cut open the lining of the abdomen, and I sliced a hole, a very big one, in the patient’s small intestine. At this hour of the night, one might hope for a relatively empty GI tract, but unfortunately this was not the case here. Not only had this man gotten all liquored up before wrecking his car, but at some point in the evening, he’d apparently ingested a meal gigantic enough to power an entire NFL team, which was now enthusiastically coursing its way out of the unexpected opening in the bowel. I stared, horrified, for a second before Sanjay grabbed the loop of bowel and elevated it, calling for the scrub nurse to give him some irrigation.