ADRENALINE: New 2013 edition (13 page)

“Ah, let me think,” he said. “This Saturday.”

“Hey, great!” Her face lit up again. “I’m working flex then, too. See you Saturday. Maybe we’ll have more time to talk,” she said, eyes twinkling.

“Yeah, I hope so. See you.” Doug retrieved his stuff from the locker room and practically ran out to his truck with a strange mix of emotions. Yeah, I hope so? Show you the mountains? What the hell was that? However, he couldn’t deny the feeling of exhilaration he had. She was coming on to me—big time. Unbelievable!

Doug slammed his truck into reverse and pulled out of the parking space, mad that this turn of fate should befall him. He realized he had crossed a line somewhere. This was more than eye games; this was serious. He had surprised himself with his shameless ability to flirt. But then again he thought, he’d never been tempted by a woman like Jenny Stuart before. The devil had definitely pulled out all the stops this time. Could any man with a pulse resist? He jammed the shift into drive and roared away muttering to himself over and over, “What the hell are you doing?”

CHAPTER NINE

Mike Carlucci screamed. He sat up in bed, T-shirt sweat-soaked and heart pounding.

“Baby, baby, what’s wrong?” Colleen asked as she wrapped her arms around him. “You scared me.”

Mike searched the darkened bedroom. “It was here, Colleen. I felt it.” He climbed out of bed and turned on the light.

“Baby, what are you talking about? You just had a bad dream,” Colleen said soothingly. “Come back to bed.” She patted his place in bed. “It’s three in the morning.”

“Yeah, bad dream.” Mike took some deep breaths, and the pounding of his heart eased. He sat down on the side of the bed and felt Colleen snuggle up against his back. Her warmth was nice. “It was Kotzmoyer,” he said.

“Poor baby,” Colleen whispered in his ear and stroked his shoulder.

“I need a dry shirt.” Mike got up, opened his bureau drawer, and put on a new T-shirt. After all these years, he thought, shaking his head.
Kotzmoyer’s back
.

Mr. Kotzmoyer had been a patient of Mike’s as a resident who had had a heart attack. Thanks to the nightmare, Mike recalled the events vividly.

Mike was on call the night Mr. Kotzmoyer’s urine output had ceased. At the time, Mike didn’t think it was a serious problem. The nurses called incessantly through the night, usually with concerns that weren’t important and could easily keep until the morning. Mike couldn’t really think of anything to do short of encouraging fluids and ordering a diuretic, but the patient was asleep. He decided to wait until morning rounds, a scant three hours away, when he could confer with his more senior residents and see if they had any better ideas. He figured it wasn’t that important to call and wake his R3 at home. In the morning, after getting one hour of interrupted sleep, he discovered he’d made a bad decision.

His senior resident raked him over the coals unmercifully on rounds. Mike knew that medicine residents regarded anesthesia interns rotating through their service as hopelessly dull individuals who could never actually grasp the finer points of internal medicine. They were also eager to humiliate such interns in front of others to perpetuate the prejudice.

“Let me get this straight, Carlucci,” demanded Calhoun, the medicine R3, his eyes boring into Mike’s. “He had no, zippo, urine output since one a.m. and you did nothing!?”

“Well, I didn’t hear about it until three,” Mike answered softly. “I ordered some Lasix.”

“Lasix! Lasix! Did you have a clue as to this man’s volume status? You gas-passers are all alike. You just don’t get it.” Calhoun shook his head sadly.

Snickers erupted from Mike’s fellow interns on the service; all of them were internal medicine interns.

“Does anyone know what Carlucci should’ve done?” Calhoun asked.

“Of course,” chimed in Shapiro, who could always be counted on to have a knife handy for your back. “He should’ve transferred the patient to the MICU, swanned him, and depending on the results, either fluid bolus, pressors, and/or diuretics.”

“Bitch,” Mike mouthed, glaring at her.

“Right!” Calhoun said to Shapiro. He turned to Mike. “Carlucci, write the transfer orders and get this man down to the MICU stat. Line him up and page me when you get some numbers. Clear!?”

“Yes, sir!”

“His beans will probably shut down and kill him, thanks to you,” Calhoun graciously informed Mike.

Mike was bone-tired after less than an hour of sleep and depressed over the prospect of another long day, but Calhoun’s dire prediction energized him. Rather than wait for the transport aide, he pushed Mr. Kotzmoyer’s hospital bed by himself down to the MICU. He felt sick all over; his screw-up might seriously endanger another man’s life.

Hours later, the situation worsened. Despite the application of hi-tech medicine of the day, Mr. Kotzmoyer’s condition deteriorated. His kidneys did indeed shut down, and each drop of urine was considered a treasure. Sitting in the MICU nurses’ station poring over Kotzmoyer’s chart and the latest lab printouts, Calhoun was calling the shots now and appeared deeply worried. Mike sat next to him, feeling as bad as Kotzmoyer looked.

“Like trying to get pee from a stone,” Calhoun said. “Nothing’s working. Dopamine’s on, wedge is good, got megadose Lasix and Bumex. What else is there?”

“How about Dobutamine?” suggested Mike.

“Are you crazy?” answered Calhoun. However, Mike noticed he couldn’t give him any good reason not to try it.

Just then the monitor watcher shrieked out, “V-tach! I got V-tach! It’s Kotzmoyer!”

Mike and Calhoun raced into the room ahead of several ICU nurses. They arrived in time to see Kotzmoyer’s eyes roll upward
into his head as he lost consciousness. Mike glanced at the arterial line trace to check for any blood pressure. There was none.

“Paddles!” screamed Calhoun. He was never very calm at codes, and this one proved no exception. “Call the code, damn it!”

Mike went to the head of the bed, hooked up the Ambu bag, and began ventilating Kotzmoyer with the mask. Thankfully, this was before the days of pulse oximetry, so they didn’t know how low their patient’s oxygen saturation really was.

The nurse rolled in the crash cart. Calhoun applied the paddles and fired. The V-tach broke into an irregular sinus rhythm. Mike noticed pressure waves reappearing on the art line trace as BP was restored.

Kotzmoyer opened his eyes and let out a groan. Amazingly, he spoke. “Where am I? What’s going on?”

“You’re in the intensive care unit, Jack. Your heart’s giving us some trouble,” Mike responded, not really knowing what to say. Calhoun couldn’t be bothered.

“Oh, I see—”

The rhythm degenerated into V-tach again and Kotzmoyer went out in mid-sentence.

“Shit! Have to hit him again!” roared Calhoun. “Get that Lido drip running STAT!”

This time it took two shocks. Kotzmoyer regained consciousness again. “Tell Helen, I love her. The boys, too.”

“Hang on, Jack,” Mike implored him. “You’re gonna be OK. Hang on.” Mike’s eyes began to blur with tears.

This time didn’t last long. V-tach again. A third set of electroshocks barely restored proper rhythm. Mike sensed where things were heading. Mr. Kotzmoyer, the Lazarus man, awoke yet again.

“Helen—”

Mike couldn’t stand it; he was being driven insane. He felt as if Death itself was in the room and playing games with the mortals, jerking the marionette strings, taunting them with the inevitable. He cursed the monster over and over.

Mr. Kotzmoyer died shortly thereafter, this time succumbing to V-tach, which no longer responded. Mike wept softly, while Calhoun stormed out of the room in disgust.

The memory of Kotzmoyer always affected Mike, but he hadn’t thought of it in years. Mike could never shake his feelings of responsibility and grief over Kotzmoyer’s death. Even after his attending pulled him aside and told him that nothing they could have done earlier or later would have altered Kotzmoyer’s fate, he still didn’t feel absolved of his guilt. He could also never forget the look in Kotzmoyer’s eyes as he had stared at him from beyond the grave. Mike climbed back into bed.

“Feel better?” Colleen asked.

“Yeah,” he lied. “Night.”

“Night.” She turned over, kissed him on the forehead and rolled back. Soon he could tell from her rhythmic breathing that she was asleep. He stared up at the ceiling, knowing that the odds of himself sleeping were slim.

Mike swerved into the doctor’s parking lot, tires spitting gravel, about an hour earlier than he normally arrived. His hands trembled a bit as he fumbled with the plastic card at the gate. What little sleep he’d gotten seemed to have been riddled with more ghastly dreams. Mr. Rakovic continued to haunt him, as he had all week.

Last night his dreams had centered on his early encounters with the Angel of Death. He was replaying the highlights again now, as he trudged toward the hospital, his boots crunching on the frozen ground. The parking lot was a ghost town. It was still dark outside, although troubled clouds could be made out in the pre-dawn eastern sky. The bitter cold and rude wind failed to make significant inroads to his consciousness.

He remembered his first encounter clearly. He had been a third-year med student at the University of Virginia, new to the clinical part of his education. His first rotation was cardiology,
which he thought was fascinating, but which also brought home the life-or-death nature of medicine. After all, what signified man’s mortal frailty better than the heart. He’d been at lunch when his red code beeper went off.

“Code Blue! Nurses’ Station, 4 East, STAT!”

He left his lunch and sprinted to the fourth floor nurses’ station. They directed him to room 408; it was familiar to him because it was one of his patient’s rooms, Mr. Nagle. He could barely stick his head in the door, because it was jammed with residents, med students, and nurses, all engaged in frenetic activity. No attendings were in sight; they rarely made appearances on the wards.

Mr. Nagle apparently had suffered a cardiac arrest. He was lying on his back on the floor, wedged between his bed and the wall, vomitus smeared all over his face and hospital gown. Mike was shocked at the almost comic nature of the resuscitation effort, or “code,” as it was called. It seemed to be nine parts chaos and one part medicine. Residents at the bedside shouted out demands for equipment or meds as they pumped on Mr. Nagle’s chest, inserted tubes, and stabbed him repeatedly with needles of frightening size. Their demands were relayed to the nurses in the hallway, who frantically searched their carts for the desired items; drawers were ripped open and slammed shut.

Luckily, as a third-year med student, Mike had very little actual responsibility for his patients other than knowing their histories, medications, and latest lab values for presentation on rounds. He watched with rapt attention as the code unfolded, inwardly cheering his team like a spectator at a football game; craning his neck to get a better view of the big plays. He was overcome with emotion when Mr. Nagle’s heart rhythm was restored and it was clear he was going to make it. Touchdown in sudden death overtime. Mike felt noble about his pursuit of medicine that day.

Aside from being his first encounter with actual life-and-death medicine, what Mike remembered most about the resuscitation
were two things. One was the nurse giving CPR to Mr. Nagle. Her name was Colleen. He found out later she had discovered the patient unconscious in bed and called the code. By a twist of fate, Mr. Nagle’s erratic heartbeat had led to the start of a relationship between Mike and Colleen that eventually blossomed into marriage. They still told the story of how they met at a code and how Mr. Nagle survived in spite of them.

The second thing that Mike recalled was the distinct feeling that Death had been cheated that day, and wasn’t particularly happy about it. He had sensed the presence of the creature and could’ve sworn it whispered to him, “I’ll be back.” He believed the creature had paid him a visit last night.

Mike walked mechanically through the back entrance of Mercy Hospital up to the second floor and keyed in the combination for the doctors’ locker room. It was empty. Good, he thought. Mike changed into scrubs and searched through his locker for several items. He retrieved a single, shiny glass ampule and a syringe. Mike fished around in his locker for a rubber tourniquet. He shut the locker door quietly.

He went into a bathroom stall, closed and latched the door, sat down, and snugged the tourniquet around his left arm. He cracked the ampule and drew up two cc’s of Fentanyl, a powerful narcotic, one hundred times more potent than morphine. He hesitated for a moment with the needle poised above one of his distended veins.
Should I?
He paused, clutching at his gold crucifix, hoping for some divine inspiration, something to draw strength from. Instead, one final demon flowed into his brain. Mike remembered Bryan.

Bryan was a five-year-old little boy with an angelic face and unruly blond hair. Mike was doing his pediatric heart rotation as a senior anesthesia resident. Children came in from all over the state for their open-heart surgery. These cases were enormously complex and carried with them mortalities approaching fifty percent
for the more seriously deformed hearts. This meant half the children would die.