ADRENALINE: New 2013 edition (5 page)

She eyed the door, as if calculating the distance, and then edged a few steps to her left toward it. Marshall didn’t pursue her, but was content to study her, aware vaguely of the heaviness of his breathing. She was such a small thing, and so young. Not much older than his daughter. He knew he could easily overpower her. He debated his course of action for a moment, but something about her eyes got to him. She had the look of a cornered animal; he thought she might scream at any moment. He realized he was going about this all wrong—this was virgin territory after all. Time for a new tack, he thought.

With effort, Marshall manufactured a gentle smile and slowed his breathing. “Look, Miss McCarthy. I’m sorry about the—ah, hug. It’s just my Old World upbringing.” He searched her delicate face and dazzling, light-green eyes. He thought he could see the panic recede a notch. He retreated behind the oak desk that consumed half the room and settled down in the leather chair, its wooden frame groaning beneath the load. The casters on his chair squealed as he rolled closer to the desk. He shuffled some papers, cleared his throat, and said, “Have a seat.” He gestured to the only other chair in the room.

“I’d prefer to stand,” she said, her face trying to manage defiance, but her voice wavering and barely audible.

“As you wish,” he said. “The reason I called you in early for this meeting is so we could discuss several things. You’ve been
a student here six months now and it’s come to my attention that you’ve had some problems.” He looked up at her. She remained standing, staring at the newly carpeted floor. He cleared his throat again and continued. “The Department of Anesthesia is like a big family. The school of Nurse Anesthesia is part of that family. Your problems are our problems and vice versa.” He maintained his smile, trying hard to add warmth to it.

After slipping on his reading glasses, Marshall opened a folder on his desk and began leafing through papers slowly as if performing a distasteful task. “Hmmm, let’s see here,” he said sadly. “Failure to intubate the trachea, unrecognized esophageal intubation.” He paused and looked over his glasses at her. She didn’t meet his gaze. He continued, “Poor manual dexterity, technical skills below average, D on the pharmacology final.” He leaned back in his chair, shook his head wearily and sighed. “Karen, Karen—your evaluations say it all. What
am
I going to do with you?”

“B-but sir, I’m improving, sir.” She clasped her hands and began to wring them. “M-most of those were early on. It’s been a rough year, sir.” She looked up and made her first direct eye contact with him. Her eyes were pleading.

“Ah, yes. A rough year, indeed.” Marshall sat forward in his chair suddenly, elbows landing on the desk, and fixed her with a hard stare. His tone changed abruptly from concerned professor to Gestapo interrogator. “You neglected to mention on your application that you had a baby!” He slammed his fists on the desk and the phone handset rattled in its cradle. A hint of a smile surfaced on his face, but he quickly suppressed it.

She let out a muffled cry of surprise and tears began to roll down her flushed cheeks. “How did . . . ? Who told . . . ?” Her lithe body trembled, and she swayed back and forth slightly.

Much better, he thought. Now we’re getting somewhere. His plan was paying off. Marshall reflected back to his first meeting with Karen. He had known early on that she had lied on her
application about the out-of-wedlock baby. He was well connected and had his sources. Normally, this would have doomed any chance of admission to the rigidly Catholic Mercy Hospital. But he had intervened on her behalf; he had chosen not to reveal her secret to the committee. He said he saw real promise in her, and in this, he had been quite honest. “It would be such a shame if the hospital found out about the baby. Why, they’d have no choice but to expel you.” Marshall turned both palms upward in a helpless gesture as he let this sink in.

“I need this job,” she said meekly. “My baby—”

“I know you do, Karen. I know you do.” His soothing voice continued, “I understand perfectly. I want to help you.” Hope flickered across her face. Marshall felt a stab of remorse as she gazed at him imploringly with her doe eyes. He broke eye contact, but like a moth to light, his gaze soon returned to her breasts. His hands had taken a preliminary measure of them moments earlier and had discovered they were much larger than her baggy scrub suit had let on. This excited him immensely and served to obliterate his hesitation. Nothing would deny him now. “Remember what I said about the department being family? Well, family members help each other, don’t they? But help is a two-way street, isn’t it Karen?”

“W-what do you want?” she asked, although he could see from her anguished expression she understood.

“Nothing you haven’t done before, I assure you,” he said and stood up from his chair. The panicked look returned to her face.

“I can’t,” she said, and then bolted for the door. She grabbed the knob with both hands, yanking it hard. When she realized it was locked, she froze, still facing the door. Her shoulders collapsed and soon began to bob up and down as fresh tears came.

Marshall closed the gap between them. Being so close to her again, seeing her tightly curled, strawberry hair peek out from the surgical cap, breathing in her clean, young woman smell, he found it hard to concentrate. He reached out and took off her surgical cap. Her hair seemed to expand as if spring-loaded and tumbled
down to just below her shoulders. He was amazed that it had all fit into her cap. He turned her gently to face him. Her limbs moved waxily as she released the doorknob; she wore a blank, resigned expression. She looked past him toward the shelves of books and journals, but appeared to focus on nothing. Marshall put his arms around her, drew her close to him and ran his fingers through her coppery mane. He towered over her, his chin resting on the top of her head.

“There, there now, Karen. No need for tears.” He selected a kindly, fatherly tone as he continued to stroke her hair. “I’m not the uncaring ogre that you imagine me to be. I don’t want to have to throw you and your baby out on the street all because of some bad grades and a little lie.”

All she could manage in response were muted sobs.

Marshall caressed her body and nuzzled her. “Don’t make me do that, Karen,” he said in a husky voice. “I want to help you. I need you to help me.” He slid his hand under her scrub top. He felt her shudder, but she offered no resistance. “And call me Daddy.”

The twenty-five-year-old memory, one of his favorites, still held considerable power and never failed to excite him. His heart was thumping rapidly and his breathing was uneven as he put the photographs back and locked up. Poor Karen, he thought. Such a pity.

CHAPTER FOUR

At 5:30 a.m. Wednesday morning, Doug’s clock radio alarm did its best electronic impression of a screech owl. God, he hated that noise. Doug had already been awake for ten minutes and was resting comfortably waiting for the alarm. He had the uncanny ability to know what time it was anytime at night. After twelve years of getting called at all hours, he could gauge the time by how fatigued he felt. He liked to get seven hours of sleep, but his brain had carefully cataloged the different feelings of one hour of sleep, two hours, three hours, and so on up to seven. He actually enjoyed waking shortly before his alarm, so he could savor the relaxation of his bed, rather than be oblivious to it in sleep.

He got up, shut off the alarm, and headed for the shower. He rarely utilized the snooze button, regarding this as a moral weakness. His morning routine was timed down to the minute. Surgeons did not tolerate late starts.

Doug’s mind wandered back to last night’s meeting as the hot water pulsed across his body. He had set the adjustable shower
massage head to hard pulse; his seven-year-old son, Steven, called this setting “bombs.” It helped him wake up and relieved some of his morning stiffness.

Would the hospital really get rid of us?
He would’ve thought it impossible a couple years ago, but now in the era of health care reform and managed care all bets were off. Surely, even if Pinnacle came in, they would offer positions to some of them. He began to mentally dissect his own group, Keystone Anesthesia.

He smiled when he thought of the large differences between the members of his group. Just as in every walk of life, some people are particularly well suited to their jobs and some are not. Doug was often amazed by how much effort some patients would expend to select a surgeon, only to leave the choice of the anesthesiologist to potluck. He knew that in many operations the two are equally important in determining the outcome of the procedure.

Doug cringed when he thought of two members of his own group. Omar Ayash was in his late fifties and had a bad habit of falling asleep in the OR while administering anesthesia. Sometimes he would nod off for a few seconds, and the circulating nurse would have to shake him to rouse him. He had been written up numerous times, and his personnel file was replete with incriminating reports, but somehow they couldn’t get rid of him. The hospital didn’t want to get entangled with disciplining a physician and felt the responsibility lay with the anesthesia group. Keystone was loath to fire him, as he had already threatened lawsuits for age and nationality discrimination. Doug couldn’t wait for him to retire.

Then there was Joe Raskin, a strange mix of a man. He was in his mid-fifties and aging poorly. He was barely 5’ 7” and unable to convince anyone that the 260 pounds packed on his frame belonged there. He was dark complected and sported a thick, unkempt black beard generously streaked with gray. His beard was so heavy that Doug figured Raskin needed to trim the upper portion if he wanted to see. He had intense, dark brown eyes and a broad nose smeared over the center of his face.

Doug reflected that Raskin was one of those guys that every place is obliged to have: a great talker. He could sure talk the talk, but stumbled when walking the walk. Raskin’s story was actually tragic; he had fallen into one of the common pitfalls of anesthesia practice. Doug recalled bits of one of their earliest conversations twelve years ago, when they had first met.

“Where did you train?” Doug asked.

“Mass General,” replied Raskin, his voice caressing the name in reverence.

Doug couldn’t help but be impressed. It was one of the premier anesthesia training centers. “When did you finish?”

“Sixty-nine.”

“Was Mercy even open then?” Doug asked.

“Yeah, sure. It opened in sixty-eight. Bryan Marshall started the department. I came six months later.”

“But why Mercy? It couldn’t have been much more than a clinic back then. You probably could’ve gone anywhere.”

“You got that right, Doug.” Raskin paused and seemed to recall memories, possibly of his forgotten youth. “I was hot shit back then. They didn’t come any better trained. I coulda written my own ticket.”

“Yeah, but why Mercy?” Doug persisted. “Why not Penn or Columbia or Cornell?”

“I was hot shit.”

Raskin never did answer the question, but Doug finally figured it out over the years: laziness. Raskin had opted for the easy life when he took the job at the shiny new Our Lady of Mercy hospital. It was a nice posh job in a sleepy community hospital, complete with nurse anesthetists (CRNAs) to do the work. He couldn’t pass it up.

Therein lay the trap. Raskin’s job consisted of supervising the CRNAs. This was supposed to mean an intimate involvement in the cases, helping with the critical induction and emergence phases, and
troubleshooting any problems. Probably Raskin started out that way, but eventually the money and his laziness must’ve gotten in the way.

Raskin worked during the heydays of anesthesia. He and his early partners (Omar Ayash joined in 1972) made a fortune supervising thousands of cases. They ran three or four rooms with low-paid CRNAs, and billed the fledgling insurance companies full freight decades before the days of cost-containment and the powerful HMOs.

Somehow, Raskin’s supervision evolved until it looked like what it did now. Raskin no longer bothered to set foot in any of the ORs. He spent most of the day on the phone to his various brokers keeping tabs on his several million dollars in pension, profit-sharing, and personal accounts. He walked up and down the corridors of the OR complex rubbing his hands together, and signaled the “girls,” as he referred to the CRNAs, to proceed. He gave them a peculiar hand sign, a cross between a military salute and a traffic cop gesture, through the window in the OR doors.

The essential drawback to this technique, Doug figured, besides having the CRNAs make fun of Raskin behind his back, was that his skills, his actual hands on procedures, deteriorated badly.

This might have been okay; Raskin might have been able to slide by until his retirement except for several gigantic unforeseen changes that swept over the anesthesia field in the late 1980’s. First, CRNA salaries skyrocketed, doubling or even tripling in a five-year period. Second, the supply of well-trained anesthesiology residents was at an all-time high. Third, because of the advances in surgery and anesthesia, many more complicated procedures were being done on older and sicker patients. What this all translated into was that many anesthesia groups were leaning toward more physicians and fewer CRNAs to run their departments. This meant less supervision and more personally administered anesthetics by the physicians themselves.