It's Nothing Personal (3 page)

“Dr. Reiner,” said Rebecca, “Dr. Hoover just
got here.
 
She said she already got
surgical consent from the patient in her office yesterday, so she just needs to
pop in and say a quick hello.
 
Is
there anything you need, or are you okay if we head back to the operating room
in about five minutes?”

Jenna was already halfway down the hallway.
 
She called back over her shoulder, “Just
make sure the patient takes out all her piercings and gets some Versed before
you come back.
 
Otherwise, I’m good,
and I’ll see you back there.
 
Thanks!”

CHAPTER 3

Jenna returned to her operating room to find
it unoccupied.
 
She found it odd
that Hillary was not scrubbed back in and standing watch over the surgical
equipment before the patient arrived.
  
A critical part of Hillary’s job
was to ensure the integrity of the sterile surgical instruments –
something that required her physical presence.

Approaching her area at the head of the operating
room bed, Jenna opened the bottom drawer of the anesthesia cart and retrieved
her stockpile of drugs.
 
Each
syringe, with the exception of Propofol, contained a clear liquid.
 
If it weren’t for the preprinted labels
Jenna had affixed to each syringe, it would be virtually impossible to
distinguish one medication from the other.
 
Ritualistically, Jenna arranged the syringes on the silver tray of the
anesthesia machine in the exact order that she intended to administer them to
her patient – Versed, Lidocaine, Fentanyl, Propofol, and Rocuronium.

At 8:15, Jenna was still the only one
present.
 
It had been well over ten
minutes since she left Rebecca in the hallway.
 
With all of her drugs laid out in the
open, she was forced to remain in the room until the patient appeared.
 
Pulling out her phone, she engaged in a
quick round of Solitaire.
 
After
several more minutes, she finally heard the sound of voices approaching the
operating room doors.
 
Jenna waited
as Rebecca maneuvered the cumbersome hospital gurney, with Michelle Hollings
onboard, into the room and lined it up next to the operating room table.
 

Overly bright and cheery, Rebecca quipped,
“Hey, Dr. Reiner.
 
Here’s our friend,
Michelle.
 
Michelle, this is the operating
room.
 
I’d introduce you to the rest
of the gang, but they don’t seem to be back yet.”
 

Rebecca’s last sentence was said with
reproach, as she cocked her head in the direction of the surgical equipment and
glanced inquisitively over at Jenna.
 
Jenna correctly interpreted Rebecca’s expression and tone, as both women
questioned Hillary’s whereabouts.
 
Outside the view of her patient, Jenna shrugged her shoulders and shook
her head disapprovingly.

“So, Michelle,” asked Jenna, “how’s that cocktail
treating you?”

Completely lucid, Michelle responded, “What cocktail?”

Michelle’s anxiety was evident as her eyes
darted from one daunting piece of surgical equipment to the next.
 
Jenna said compassionately, “Don’t worry.
 
I’ve got more.”
 

Jenna grasped the syringe of Versed and
injected its contents into Michelle’s intravenous line.
 
Not only would the Versed make Michelle
feel as though she had a few drinks, it would also cloud her memory from that
point forward.

The second dose of Versed seemed to have an
impact on Michelle.
 
Wearing a silly
smirk, she slurred, “Oh yeah, I’m feeling it now.”

Jenna guided Michelle from the hospital
gurney over to the operating room table.
 
Once the patient was positioned correctly, Jenna started her
pre-induction routine.
 
First, Jenna
secured a mask over Michelle’s face that delivered one hundred percent
oxygen.
 
She then applied the
standard monitors to Michelle – a blood pressure cuff, EKG leads, and an oxygen
saturation monitor.
 
While Jenna
went about her business, she overheard Rebecca on the phone with the charge
nurse.

With unconcealed annoyance, Rebecca asked,
“Can you find out where Hillary is, and tell her we have the patient in the
room?
 
We are about to start the
case, and there’s no scrub tech!”
 

Jenna stopped eavesdropping and returned her
focus to her patient.
 

“Okay, Michelle, we’re ready to go off to
sleep.
 
I’m giving you the good
stuff.
 
You’re going to get really
sleepy, really fast.”
 

In rapid succession, Jenna injected Lidocaine,
Fentanyl, and Propofol.
 
Jenna
pushed the Propofol into Michelle’s intravenous line.
 
The milky white fluid travelled down the
IV tubing from the injection port and disappeared into Michelle’s
bloodstream.
 
At that point, Jenna
warned Michelle, “This last medicine that you are getting might burn a little
bit at your IV site, but it makes you fall asleep quickly.
 
I’m rubbing your arm as you drift off,
which helps some with the discomfort.
 
I promise, we are all going to take very good care of you, and we’ll see
you in a few hours.”
 

Thirty seconds later, Michelle’s eyes flickered
and then drifted shut as the rest of her body went limp under the effect of the
drugs.
 
Jenna then held a mask
securely over Michelle’s mouth and nose, squeezing oxygen into her lungs from a
bag on the anesthesia machine.
 
After Jenna witnessed Michelle’s chest rise and fall from the artificial
breaths, she injected the Rocuronium.
 
Within thirty seconds, the paralytic took effect and each hand-delivered
breath entered Michelle’s lungs with increasing ease.
 
Once Michelle Hollings was completely
unconscious and paralyzed, Jenna tilted her patient’s head back and placed the
metal blade of the laryngoscope into her mouth.
 
The light at the tip of the instrument
lit up Michelle’s throat.
 
Jenna
peered in and slid an endotracheal tube past Michelle’s vocal cords, into her
windpipe.

Jenna was taping the breathing tube in place
when she glanced up and noticed Dr. Lisa Hoover standing by the doors.
 
Reaching over to the anesthesia
ventilator, Jenna attached the breathing circuit to the endotracheal tube, and
turned on the machine.
 
The bellows
on the ventilator rhythmically squished down like an accordion and then
stretched out again.
 
With each
descent, Michelle Hollings’ chest rose as her lungs were inflated with a
mixture of oxygen and anesthesia gases.

Jenna smiled at her colleague and announced,
“She’s all yours.”

“Thanks, Jenna.”
 
The surgeon then turned her attention
toward Rebecca and asked curtly, “Do we have a scrub tech for this case, or am
I flying solo?”

As if on cue, Hillary appeared.
 
Her arms were wet up to the elbows from
scrubbing them at the surgical sink in the hallway.
 
In order to avoid contaminating herself,
Hillary held her arms up in the air and away from her body as she backed into
the doorway, careful to avoid touching anything.
 
Hillary walked over to the surgical
table and dressed herself in a sterile surgical gown and a pair of gloves.
 

“Sorry I’m late.
 
No one told me you guys were in the
room.”
 

Rebecca shot Hillary a cold, critical stare
and shook her head in disgust.
 
No
one else in the room acknowledged Hillary’s apology and, for several minutes,
it was painfully silent.

The hush was soon broken by the sound of Dr.
Hoover’s iPod playing her collection of modern rock over the operating room
speakers.
 
Dr. Hoover left the room
to scrub, returning with the same ceremonial entrance that Hillary had
performed a few minutes prior.
 
Hillary helped the surgeon gown and glove.
 

Rebecca was ready to prep Michelle Hollings’
chest for surgery, but before she did, one unpleasant task remained.
 

The nurse asked, somewhat embarrassed, “Dr.
Hoover, the patient has a piercing in her pubic region.
 
She said she could not get it out on her
own.
 
Do you want me to remove it?”

Rebecca had already parted Michelle’s
legs.
 
Dr. Hoover came over and took
a look.
 
“Yeah, that needs to come
out.”

“I was afraid you’d say that,” Rebecca
responded, sounding defeated.

Jenna walked down to the foot of the bed and
peeked at Michelle’s piercing.
 
A
silver stud with little bulbs on each end was embedded in her clitoris.
 
Jenna laughed and left Rebecca to her ‘duty.’

Hillary unexpectedly piped in to the
conversation.
 
“I’ve got one, too.”

Jenna replied, “I don’t mean any offense,
but why would you do that to yourself?
 
Doesn’t it hurt?”

Hillary shrugged and answered
matter-of-factly, “It’s just another way to express yourself.
 
I just know that some people think
they’re cool.
 
Once they heal, they
don’t hurt at all.
 
I guess it’s all
about individual choice.”

“I guess,” was all that Jenna could
articulate for a reply.
 

With the piercing removed and the chest
prepped and draped, Dr. Hoover prepared to start the procedure.
 
Before the surgeon made her first
incision, Rebecca grabbed the patient’s chart and turned off the music.

“Time out,” said Rebecca.
 
Everyone paused and gave the nurse their
full attention.
 
“This is Michelle
Hollings, twenty-two-year-old female, no major medical problems, no drug
allergies.
 
She is in the supine
position and is here today for a bilateral breast augmentation.
 
Implants are in the room.
 
Preop antibiotics are running.
 
No beta-blockers were ordered or
administered.
 
Compression stockings
are on and functional.
 
Warming
blanket is in place.
 
All in
agreement?”

Following a series of mumbled “yeses” and
“yeps,” Rebecca turned the music back on.
 
Dr. Hoover and Hillary moved to the right side of the patient’s chest,
and the surgeon ran the blade of her scalpel over the lower part of Michelle
Hollings’ breast.
 

In response to the incision, Michelle
Hollings’ blood pressure and heart rate increased.
 
Quickly, Jenna increased the
concentration of anesthetic gas being delivered.
 
She then logged back into the Accudose
machine and checked out 10 milligrams of Morphine.
 
Like Fentanyl, Morphine is a powerful
narcotic, but lasts much longer.
 
Based
on Michelle’s lack of response to the first dose of Versed she received in
preop, Jenna assumed that the girl was probably not naïve when it came to
drugs.
 
Consequently, Jenna did not
hesitate to inject the entire dose of the narcotic.
 
After several minutes, Michelle’s heart
rate and blood pressure remained elevated, so Jenna administered another 5 milligram
dose of Morphine.
 
Finally, the
drugs took effect.

“Looks like we have a party girl on our
hands,” Jenna declared.

“Oh yeah?” asked the surgeon.
 
“Is she sucking up the goods?”

Jenna replied, “4 milligrams of Versed, 250 micrograms
of Fentanyl, and 15 milligrams of Morphine.
 
Yeah, I’d say she’s a fun date.”
 

The remaining two hours of the case passed
uneventfully.
 
At the conclusion of
the surgery, Jenna turned off the anesthesia gases, gave Michelle medicine to
reverse the effects of the muscle relaxant, got her breathing on her own, and
removed the endotracheal tube.
 
Jenna then transported Michelle and her new, very large breasts, to the
recovery room.
 
Once there, Jenna
gave report to the recovery room nurse.
 
When she informed the nurse of the amount of narcotic and Versed she had
given to Michelle, the nurse whistled softly and whispered, “For a breast
augmentation, on such a tiny, little thing?
 
Wow!”

“Amazing what partying can do for your
metabolism,” Jenna remarked and then walked away.

Jenna was headed to the preop holding area
when she felt the vibration of her pager on her hip.
 
Unclipping it from her waistband, she
squinted to read the tiny print.

“To all Doctors: Blizzard Warning in
Effect.
 
All remaining elective
surgeries at all facilities cancelled for today.
 
Only call doctors need to remain in-house.”

Having been confined in the windowless operating
room all morning, Jenna had no idea the weather had gotten so bad.
 
She strolled into the hallway and
glimpsed out the window.
 
The snow
was falling at a relentless pace – big, wet flakes coming down in
droves.
 
On the streets below,
people were battling the wind and drifts just to cross the street.
 
Cars were already becoming nearly
entombed.