ADRENALINE: New 2013 edition (8 page)

“Me either,” said Ken.

“Thank God, it’s a general,” said Sandy McCoombs, the scrub nurse as she noisily made last-minute rearrangements of her instruments.

“Yeah, she’s some piece of work,” muttered Ken as he proceeded with the anesthetic. He knew the intravenous Diprivan would wear off in about five minutes, and in order to keep Dorothy anesthetized, he would need to quickly administer a gaseous anesthetic agent. He dialed in the Forane vaporizer to two percent. To provide muscle relaxation, he also administered Atracurium intravenously, which would temporarily paralyze his patient.

“What’s wrong with you today, Ken?” asked Babs, good-naturedly. “Cat got your tongue?”

“I’m out of it today, Babs. Ryan was up half the night with croup. After we finally got him settled, I was too keyed up to sleep.”

“How old is he now?”

“Ten months.” Ken scanned his monitors—everything looked good—sat down, and started to fill out his anesthetic record.

“They’re so cute, then,” Babs said. “Well, if I see you nodding off, I’ll bonk you one.”

Ken looked up. “Yeah, you do that,” he said. He broke off eye contact again and busied himself with his record, hopefully signaling an end to the conversation.

The surgeon, Dr. Bruce Watkins, came through the door, his hands dripping wet and held high. “Hi, Babs, Sandy.” They proceeded to gown and glove him. “Morning, Ken.”

“Hi, Dr. Watkins.” Ken still didn’t feel comfortable calling the older surgeons by their first names, even though he had worked with them for three years now.

“What do you think of my patient, Mrs. Lubriani?” Watkins asked.

“She sure can talk a blue streak,” Ken said. Looks like everyone’s in a talkative mood this morning, he thought glumly.

“Ah, you noticed. Any trouble putting her to sleep? She’s got a slew of medical problems.”

“No, not really. Once you take her brain out of the picture, she’s really quite healthy.”

“You’re probably right, Ken. I’m not sure how diseased her gallbag’s gonna be, but she’s been hounding me for six months now to take it out.”

“I can imagine.” Ken didn’t want to be rude, but he hoped Watkins would pick up on his disinterested tone soon.

“She’s got the symptoms down pat—she was a nurse you know—but her papida scan doesn’t show much.”

“Well, we’ll see,” Ken said. “She’s awful big, though.”

“You know what they say: female, fat, and forty—think gallbladder,” Watkins said and cracked up at his own wit.

Ken yawned under his mask.

Dorothy regained consciousness slowly. She felt very peaceful and relaxed. She wasn’t quite sure where she was but didn’t let that concern her. She was probably home in bed making a late morning of it. She
could
open her eyes if she wanted. Naw, just savor the floating sensation. Bits of a faraway conversation drifted by her ears. She chose to ignore them. Then one word, a name, penetrated her stupor—Dr. Watkins—her surgeon. That’s right! This was the special day she had waited so many months for. She was supposed to have her gallbladder out today. She also heard her name and the beeping of some monitor.

Oh, of course, silly. You’ve already had your surgery and you’re in the recovery room. I remember seeing that nice Dr. Danowski and drifting off to sleep. Wow! That was fast. And no pain. Isn’t modern medicine wonderful? I knew laparoscopic procedures were less painful, but this is fantastic!

Dorothy Lubriani figured it was time to wake up and perhaps see about some additional pain medicine, just in case. She tried to open her eyes and found she couldn’t.

That’s strange. She noticed that she wasn’t breathing normally. In fact, the air was being pushed into her lungs instead of her sucking it in. Very strange.

Fear began to creep into her sodden brain. What was going on? Was something wrong? Since she couldn’t see anything, she focused on listening.

“—female, fat, and forty—think gallbladder.”

That’s Dr. Watkins, she thought. Hey, who’s fat!?

Dorothy had had enough of this little game. It was time to stop playing possum—time to get up and go. Only when she tried, she found she couldn’t move a muscle.

That’s weird, Ken wondered to himself. His patient’s heart rate had just shot up from the 70’s to over 120, and her blood pressure had increased to 190/110. Normally, heart rate and BP jumped on incision, but they hadn’t touched the patient yet. Watkins was still BS-ing with the nurses, and they were in slow gear hooking up all the video equipment necessary for laparoscopic surgery.

She seems light. Ken quickly dialed the Forane to three percent, a very high setting he rarely used, while he reviewed his anesthetic. He knew he had given her plenty of Fentanyl and already had the Forane on a hefty amount. She can’t be light on three percent Forane on top of the Fentanyl and Diprivan. Maybe she really does have a bona fide medical problem after all—untreated hypertension. If so, the only way to bring down the pressure and pulse was with an antihypertensive. Ken drew up some Labetalol and gave it, hoping to control the pressure before incision.

“Okay to go, Ken?” Watkins asked as he grasped the scalpel in his gloved hand.

“Uh, yeah, sure,” Ken replied, feeling uneasy. He knew Watkins wouldn’t really wait for an answer. The question was more of a formality designed to denote incision time, rather than actually ask permission. Ken drew up more Labetalol and watched his monitors closely.

“Okay to go, Ken?”

Whoa—wait just a minute here! What’s going on? Why can’t I move?

Dorothy’s questions were all answered when she felt the searing pain just below her umbilicus as the scalpel blade bit in.

She screamed, but no noise came forth. Her mouth didn’t even twitch.

Stop! Stop! You can’t do this! I’m awake, damn it!
She thrashed as hard as she could, but she might as well have been a statue. The pain intensified. Tears came to her eyes.

C’mon, Dorothy. Fly right. Ken wanted to stabilize his case and veg out a little. He wasn’t in the mood to tackle any big diagnostic dilemmas or emergencies this morning. He gave several more large doses of Labetalol before he got the pressure under control.

He sat down and started to draw up his drugs for the next case, but uneasiness still tugged at the edges of his mind. Ken had been doing anesthesia long enough to know that many patients didn’t follow the textbooks. However, he also knew it was generally not a good idea to ignore his sixth sense. More often than not, there was something he had overlooked. He reviewed his anesthetic once again. Nothing amiss. She just runs high, that’s all.

Oh, sweet Jesus! Don’t let them do this!
The pain was becoming unbearable.
Please, dear God, just let me die. Help me! Help me!
Dorothy continued to sob.

God, it’s only 8:30, thought Ken.
I’m wasted already. Gonna be a long day
. Ken yawned for the hundredth time. His mind drifted and he imagined himself sitting in his easy chair at home
watching TV with his wife, Lynn. The baby was asleep upstairs and all was so peaceful.

In his daydream, his black Labrador came over to him and pawed at his arm. “Leave me alone, Trooper,” he mumbled. Ken snapped awake at the sound of his own voice. Something was wrong!

He sat bolt upright and shook his head to clear it. He scanned his monitors once again and went through a mental checklist, forcing himself to look carefully at each one.

Was she getting enough oxygen?

O2 Sat - 99%

FiO2 - 0.52

Yes
. Oxygen saturation was excellent and inspired oxygen concentration was a normal 52%.

Was the tube in?

EtCO2 - 35 mmHg

FiCO2 - 0 mmHg

Again, yes. He had normal readouts showing the presence of carbon dioxide in the exhaled gases and no rebreathing of CO2.

BP-170/95

P-76

All still OK, except for a mildly elevated BP. He couldn’t find anything wrong with any of the other monitors. Ken was baffled.

He turned to examine his patient. One of the casualties of the hi-tech explosion in anesthesia, he knew, was that recent grads focused almost wholly on their computer screens instead of their patients. For the most part, this worked out well. After all, modern advances in monitoring had largely accounted for the increases in anesthetic safety. But Ken also understood there was a danger to this approach.