Doing Harm (12 page)

“No, not really. Okay. I’m going to finish up and get the hell out of Dodge so we can get her off the table as fast as possible. Carlos, you do whatever you need to up there. Okay, man? Just let me know if there’s anything I can do.”

“Will do.”

Larry goes to work repairing the damage I’ve done. I don’t know what to say, so I start with the obvious. “Larry, I’m so sorry.”

“Not now, Steve.”

“But…”

“I said not now.” His voice is calm, but low and menacing. I’ve never heard him talk that way before.

He sews the hole in the IVC closed with sure, experienced movements, then quickly finishes taking out both the tumor-filled adrenal gland and her otherwise normal kidney, which can now no longer stay in her body because I’ve completely disrupted its blood supply. He speaks little, and then only to issue a succinct order to Luis or me as we assist him, or to ask the anesthesiologist how Mrs. Samuelson is doing. Otherwise, he doesn’t acknowledge my presence or anything that’s happened until we’re stapling the skin incision closed.

“Steve, goddammit, I told you not to try that dissection on your own,” he growls. He doesn’t look up from what he’s doing. “Why the fuck didn’t you wait for me?”

“I’m sorry. I thought I could handle it—”

“You thought wrong,” he interrupts. He shakes his head in disgust. “Jesus
fucking
Christ. Simultaneous avulsion of the right adrenal vein and renal hilum, with a corresponding tear in the IVC. Can’t say I’ve ever seen that one before. How the fuck did you manage to tear both the renal vein
and
the artery? Congratulations, Steve: You just invented a completely new surgical complication. Jesus
fucking
Christ.”

He’s quiet again until the skin of her large incision—much, much larger than it should have been, I reflect glumly—is completely closed, and we’re stepping away from the table. Luis is taping the dressing to her skin as Larry and I peel off our blood-soaked operating gowns and drop them wearily into a trash can marked red for biohazards.

“Steve…” he starts to say, but then shakes his head. “No, never mind. I can’t talk to you right now. I really can’t. I can’t even fucking look at you.” He stalks toward the door, calling over his shoulder, “I’m going to go talk to her family now and try to explain to them what the fuck happened and hope to Christ they don’t end up suing the crap out of me. Just get her settled into the SICU.”

At this point, he stops and spins around to glare into my eyes—the first time he’s looked at me full in the face since this all happened—and stab at me in the air with his index finger. “And call me immediately, I mean
fucking immediately,
if there are any more problems. Do you understand?”

“Yes.”

The OR door bangs closed after him.

I tell Luis to go finish up any work he has to do with the other patients, then head home for the day. He leaves without saying a word. I wonder what he’s thinking.

The OR nurses, Susan, the anesthesia attending, and I carefully lift Mrs. Samuelson off the operating table and onto a special bed. Her long white ponytail spills out from underneath her scrub cap and curls down around the breathing tube that sticks through her swollen, cracked lips. She’s too sick to breathe on her own. Her face is as puffy as a heavyweight fighter who’s taken a twelve-round beating, the result of all the intravenous fluid and blood we gave her during the operation.

We wheel her out of the OR and out into the hallway leading to the SICU. Her family is already there, lining the hallway on both sides, probably alerted to our imminent transit by Larry. They form a gauntlet of seven anxious, drawn faces through which we have to run to get to the SICU. They watch in shocked silence as we slowly and ponderously wheel Mrs. Samuelson down the hall in her big bed, awkwardly dragging all of her life-support monitors and intravenous lines along with us. Susan manually pushes air into Mrs. Samuelson’s lungs by squeezing a bright green plastic bag attached to her breathing tube.

In the middle of the hall, we stop briefly to let her family look at her. They close in and form a tight semicircle around the foot of the bed. One of the daughters cups a hand over her mouth and bursts into tears, wailing. With surprising tenderness, her stoic husband drapes an arm across her shoulders, and she buries her head in his chest.

Mr. Samuelson’s eyes are moist. “How long before we can be with her, Doc?” he asks quietly. I explain that the doctors and nurses in the SICU need about forty-five minutes to get her settled in. He nods. “All right, sir. We’ll wait right here.”

We continue down the hall, struggling with Mrs. Samuelson’s bed, which handles like a monstrously heavy shopping cart with broken wheels, until we finally pass through a set of automatic double doors into the SICU. The SICU is a large, circular room ringed by multiple glass-walled cubicles, each of which houses a critically ill patient. The cubicles line the outer wall of the room, forming a continuous circle broken only by two doors: the main entrance, through which we just passed, and a smaller, nondescript, employees-only door tucked between two of the patient cubicles on the far side of the room, exactly opposite the main entrance and accessible only with our coded University Hospital badges. Most of us refer to it simply as the back door. In the center of the room, from which all of the patient cubicles are visible, like the hub of a wheel, is a nurses’ station with computer workstations, cardiac monitors, desks, and wheeled chairs.

We pause in front of the security guard and unit secretary seated at the nurses’ station facing the front door.

“Which bed?” I ask wearily. “We’re coming from OR two.” The unit secretary directs us to an empty cubicle. Susan and I secure the bed in it as several nurses appear seemingly from nowhere. They quickly gather around Mrs. Samuelson, checking her vital signs and heart rhythm while hooking her up to a ventilator, chatting amiably about happy hours at local bars. They never miss a beat, expertly calling out vital signs and running diagnostics on the life-support machines even as they compare margarita specials.

I give a report to a harried-looking SICU doctor and then double back through the main doors and out into the hallway. There, I practically stumble over Mrs. Samuelson’s family, who are clustered just outside.

Dammit.

I forgot they were there. I should have snuck out through the back door.

Mrs. Samuelson’s family looks at me expectantly, silently pleading for more news, any news, I can offer.

Where do I begin?

What do I tell them?

The truth? That I single-handedly almost killed one of the most important people in their lives? Ripped the biggest vein in her body to shreds because I thought I knew what I was doing? Turned an otherwise fairly routine surgical procedure into a complete disaster?

“I’m so sorry,” I manage to stammer. “Things were going well, but it was a really big tumor and then, well, we ran into some trouble…” I pause, groping for the right words.

Mr. Samuelson steps forward and clears his throat. “We understand, Doc.” His tone is surprisingly paternal, like
he’s
the one trying to make
me
feel better. “Don’t beat yourself up too much. The other doc, your boss, already told us everything. Things happen. We understand. You folks are doing everything you can, and we appreciate it. We surely do. We’re just so glad she’s in such good hands. Other hospitals, she might not have made it. But here, well, you folks are the best. We’re sure you folks are going to get her through this, with the Lord’s help.”

The rest of the family nods in agreement. “God is good,” one of them murmurs. Even the daughter who had been wailing a few minutes ago out in the hallway is bobbing her head up and down emphatically, her cheeks flushed and wet. Her red eyes, glistening with hope and misplaced trust, are fixed on me. She sucks in her breath in short bursts as she chokes back her sobs.

“She’s strong. She’ll make it,” I say. I have no idea if that’s true or not. I don’t know if she really is
strong
—whatever the hell
that
means—and she most certainly might not make it. She might die. She might die tonight, for all I know. But I can’t think of anything else to say, and I’ve learned that it’s usually the kind of stuff that families always want to hear from doctors in situations like this one.

She’s strong. She’s a fighter. She’s going to make it.

Mr. Samuelson smiles. He actually smiles.

“Yes. You’ve got that right, Doc. She’s a strong woman. She surely is. She always has been. She’s fought herself out of tighter spots than this one. Hasn’t she, girls?”

All three daughters smile and murmur their agreement, wiping the tears from their eyes.

Suddenly, all I want to do is get away from these people as quickly as I possibly can. I smile weakly, shake hands with Mr. Samuelson, each of the daughters—the one with the tear-soaked cheeks keeps repeating, “Thank you, thank you so much, Doctor, thank you”—and the sons-in-law, and walk away.

That’s when it hits me.

My stomach flips over, and a wall of saliva inundates the inside of my mouth. I grit my teeth and manage to dart around a corner where Mrs. Samuelson’s family can’t see me before stumbling into a bathroom. I lurch into the stall nearest the door just in time.

I drop to my knees and clutch the sides of the toilet, emptying the contents of my stomach into the bowl, heaving again and again; and suddenly I’m not a thirtysomething surgeon anymore at one of the best hospitals in the world, but a clueless eighteen-year-old kid again, squatting on the cold, indifferent tile of my college-dorm bathroom, regretting one too many plastic party cups full of foamy, frat-party beer.

I go on like that for a long time, intermittently puking and panting. Minutes, hours … I’ve no idea how long I’m there, retching and miserable on the floor in front of the toilet. Somewhere in the middle of it all my pager goes off, and I think I simultaneously hear a voice on the hospital’s overhead public announcement system, as if through a tunnel, but I could not care less. My known universe has shrunk to the size of that porcelain bowl.

When I’m finally done, I flush the toilet and push myself up, using the sides of the stall for purchase. My stomach muscles, atrophied by years of an exercise-free lifestyle, scream as I inch my way up to a stand. My legs are trembling, but I manage to let go of the sides of the stall without falling. I try to swallow the vile taste lingering in my mouth, but I can’t; the back of my throat is raw from the stomach acids that washed up along with my lunch. I stagger to the sink and turn on the water, dousing my head, letting the cool stream rush over my face and into my mouth. It’s late now, and the rest of the bathroom has, mercifully, remained empty.

Oh, God. This sucks. This really, really sucks.

My pager goes off again. Somehow, the shrill chirp sounds more incessant this time. I’d forgotten it had gone off earlier.

I pull it off my belt and read the text message.

… 911 … Mr. Bernard coding … 911 … Mr. Bernard coding … 911.

Simultaneously, I hear the disembodied, dispassionate voice of the hospital’s overhead announcement system call, very clearly now. “Code Blue, Johnson Building, twelfth floor. Code Blue, Johnson Building, twelfth floor.”

Code Blue.

Cardiac arrest.

Johnson 12 is Mr. Bernard’s floor.

You have GOT to be kidding me.

I run to Mr. Bernard’s room on shaky legs.

*   *   *

It’s a total flail.

The second one of the day.

Mr. Bernard’s room is on the other side of University Hospital and, because of my late start and crappy physical condition, by the time I get there, the code team has already been working on him for a while.

People are running around the room, shouting. It’s the controlled chaos of a code, with nurses, medical technicians, and doctors weaving around one another like a crazy, hyped-up square dance. And in the middle of it all, the center around which this medical maelstrom is directed, is Mr. Bernard, lying on his bed, motionless and completely naked.

At the head of the bed is an anesthesia resident, rhythmically squeezing air into Mr. Bernard’s lungs with a big green balloon attached to a plastic breathing tube that snakes through his mouth and down to his lungs. The balloon is called an Ambu bag. Each time the resident squeezes the Ambu bag, it makes a wheezing sound—
weeha
—as it blows oxygen through the tube and into his lungs, exactly like a giant bellows.

At the center of the bed, GG is working on Mr. Bernard’s lifeless body, doing chest compressions, pushing down on his sternum with grim diligence. Mr. Bernard’s torso bounces down and up—
down, up, down, up
—as GG pushes and releases, pushes and releases. Meanwhile, from the top of the bed, the anesthesia resident isn’t even trying to conceal the fact that he’s staring straight down GG’s scrub top. In the middle of a fucking code.

An intern at the foot of the bed, a member of the code team, calls, “Hold compressions!” and GG and the anesthesia resident stop and back away. The medical resident squints at a portable cardiac monitor set up on a chair next to him. I can’t see the screen from where I’m standing.

A second intern from the code team is clutching a pair of defibrillation paddles—for some strange reason, the old-fashioned kind that you hold in your hands rather than the newer ones that you simply stick on the patient’s chest with adhesive labels. He yells, “One, I’m clear! Two, you’re clear! Three, everybody clear!” with the eagerness of someone who’s obviously never gotten to defibrillate someone before. After everyone else backs away, the resident steps forward and, with a flourish, slaps the paddles on Mr. Bernard’s chest and depresses the buttons. Mr. Bernard’s body convulses weakly. It’s never as much as you see in the movies or on TV, but his lackluster response to the 200 J of electricity pouring into his body is discouraging.

“No rhythm, continue CPR,” the intern at the foot of the bed calls. Defibrillator Resident backs away, paddles in hands. The anesthesia resident starts squeezing the Ambu bag again—
weeha, weeha, weeha.
GG steps forward and starts pushing on Mr. Bernard’s chest—
down, up, down, up.