The Queen of Hearts(44)

“Ah,” I stuttered. What had been a relatively straightforward case had suddenly veered off into unexpected territory, placing the patient at much greater risk of complications. He might even have to have an ileostomy, or an artificial opening made along his abdomen to allow waste to exit his body.

“Dr. Colley,” said the circulating nurse on the other side of the room, oblivious to what I’d just done. “It’s Dr. Garber.” She gestured behind her, where the cord of the phone looped down from the wall onto a long counter. Dr. Garber was Melinda Garber, our team’s intern. “She says she keeps getting paged about one of the patients—something about a falling urine output—and she wants to know if somebody can go evaluate.”

“Why can’t she do it?” I snapped, aggravation momentarily eclipsing my distress. Melinda had a reputation for trying to pawn off her work onto other people. “How long have they been paging her?”

“She says she’s with the other trauma patient you guys got tonight. A head injury.”

“I know that,” I said. “So?”

I returned my attention to the unfolding disaster in front of me as the circulator murmured into the phone. Caustic bowel contents were flooding everywhere, along with what appeared to be several dozen kernels of intact corn. I shuddered, close to vomiting.

“She says he’s not stable,” the circulator said, as the medical student reared up behind me for a better look.

“Wow,” he said.

“Not stable? What does that mean?”

More murmuring. “She says she has to go,” the circulator announced, hanging up the phone. “She said she and Dr. Schreiber”—Dr. Schreiber was the midlevel resident—“are going to work on him.”

“What? Work on him? What does that mean?” I said. “Call her back.” The only part of Sanjay’s face I could see behind his mask was his eyes, but I could tell he was grimacing, although whether from Melinda’s uselessness or the fiasco in front of us, I couldn’t tell. We worked in grim silence.

“She’s not answering,” the circulator said several minutes later, at the same time as Sanjay announced, “I think we need to divert him, Dr. C.” Silently I concurred with the need to place an ostomy; without an artificial opening from the intestine to the outside of his abdomen, the patient was now at risk of a giant, festering infection if this leak continued. Shame crept up my body in a wave of heat.

The anesthesiologist popped his head over the blue curtain. “We’re having trouble ventilating here,” he said. “We sure there was no pneumo?”

He wanted to know if the lung could be collapsing. “No, there—”

“One of the ICUs is calling you, Dr. Colley,” interrupted the circulator.

“Because we’re getting a really high airway pressure here.” An alarm began to sound behind the anesthesiologist.

“Dr. Colley, look out,” said Sanjay suddenly, ignoring the anesthesiologist. “We’ve got a bleeder somewhere.”

“Suction,” I ordered, reeling. I turned to the medical student. “Break scrub and call the radiologist; ask him to review for a small pneumothorax that we might have missed when we read the films originally.” At his look of befuddlement, I added, “Pneumothorax. It’s an air leak that’s compressing the lung so it can’t expand. Every time we blow a breath into him with the ventilator, we’re making the pneumo bigger and collapsing the lung further. We think.” To the circulator, I barked, “Get a chest tube kit.”

“What do you want me to tell the ICU?”

“Tell them to handle it, or to page Melinda if it’s urgent.”

“Oh my, where is this coming from?” said Sanjay, suctioning furiously. Blood burbled up at us in a hostile spew. “We need to pack this.”

“They can’t reach Melinda, Dr. Colley. They say they need you to come now.”

“Emma.” The anesthesiologist again. “We’re starting to deoxygenate here. I’m pretty sure he’s got a tension pneumothorax.”

“Put them on speaker,” I yelled at the circulator. To Sanjay, I said, “Forget the bowel injury for now. You pack. I’m going to decompress his chest.”

The circulator held up the phone, which crackled anticlimactically for a moment. Then we could hear a panicked voice. “Dr. Colley?”

“Yes, what?” I said. I moved laterally along the patient’s body, preparing to stick a large needle in his chest wall, as the scrub nurse tore open the chest tube kit.

More crackles. “. . . the little girl. Packard.”

I stopped, my hand arrested just above the middle of my patient’s chest wall. “Hurry,” said the anesthesiologist. The loud beeping behind him began to accelerate, followed by a second, continuous alarm sound.

“What about the Packard girl?” I yelled. I plunged the needle into the left side of the chest, a few inches below the clavicle. Nothing.

“Shit! It’s not this side. Where’s the tube kit?”

“She’s coding,” said the voice on the phone.

I was reaching across my patient’s body, ready to decompress the other side of the chest as soon as the scrub nurse handed me another catheter. I froze again. “What did you say?” I said, the burning in my cheeks so extreme I thought I’d be consumed by their fire. I plunged the second needle into my patient’s chest, my hand shaking.