by Steve Low
Three of us sat and waited for Green. I felt light headed, my stomach knotted. Tutorials always wound me up. This one, quite close to the exam, was bound to be testing.
“I hope he doesn’t ask about the liver,” Boy Wonder said. “I know nothing about the liver.” He lay back on a chair, one foot resting up on the table in front of him.
The lying bastard, I thought. The Wonder Boy would know it all, inside and out.
The Handwringer was living up to his name, pacing up and down by the windows, wringing his hands. His face was pinched, his mouth a tiny chink on an ashen skull.
Green came in. “How are you guys?” he announced cheerily. “Got all the answers doc?” he said to Boy Wonder. He sat down behind a large table. “Who’s in the hot seat first? Looks like it’s you David.”
The questions came. The Handwringer agonised. He shifted in his chair, buttock to buttock. He wiped his forehead with the back of his hand. He leaned back, arms folded, his shoes drumming the carpet. His answers though, were solid.
Green sat back, when it was over. “O.K. guys, what’s he doing wrong? Gregory, any ideas?”
Still reclining back, the Boy Wonder smiled. “It’s his body language. He’s like a cat on hot bricks.”
“Worse than that,” Green laughed. “He’s like a New Zealand opener, about to face the West Indian pace attack. You’ve got to sit still David. Lean forward, put your hands in your lap and look the examiner in the eye. Your answers are fine. With a decent presentation, you’ll bolt in. Right Gerry-o, it’s you.”
Taking note of the advice, I took up the desired body position, fixing my gaze on Green’s mouth. Green asked me a very general question, about the management of a patient with burns. I started off confidently enough, describing history taking, physical exam, the rule of nines, and fluid resuscitation utilising the Parkland formula. Then I dried up – my mind had seized.
“You’ve gotten too bogged down in fluid resuscitation,” Green said. “You must cover the whole topic. Try and think laterally, across the breadth of the question. You failed to mention which investigations you would do. Sure fluid therapy is a cornerstone in the management, but don’t forget basic things like patient cooling, topical antisepsis, systemic antibiotics and surgical debridement - early or late etcetera. And for God’s sake, don’t forget to mention the airway. It should be one of the first things you do. Look for signs of inhalational injury. Elective intubation is right in vogue at the moment.”
I was relieved to quit the chair. I had really stiffed the question. I watched dazed as Boy Wonder trounced Green’s question about management of an asthmatic patient in respiratory failure. At first, Green seemed to lap it up. His face seemed to say, ‘This is one of my boys – my alter ego’. Then the Boy Wonder began to advocate high levels of PEEP and Green frowned.
“Come on Gregory, the patient’s asthmatic. The lungs are already stretched up with dynamic hyperinflation. If you put on more PEEP, he’ll have trouble emptying his lungs.”
“So what,” the Boy argued. “I’d increase the expiratory time on the ventilator. Besides, the increased end expiratory volume, will stretch his respiratory muscles and put them on a better part of the compliance curve. ”I was astonished to see Green jump to his feet.
“That’s bullshit Gregory,” he thundered. He pointed a finger, right at Boy Wonder’s face. “You’re too big for you’re boots mate,” he continued. His hand was shaking. “You better watch it, or you’ll go down the gurgler.” He scooped up his briefcase and headed for the door.
Boy Wonder’s oval mouth hung open Blood rushed to the roots of his curling hair. He turned to us.
“What? . . . What’s gotten into him? Is he alright?”
“I’ve never seen him react like that before,” the Handwringer said.
I laughed. “You irritated him to hell. You’ll just have to hope you don’t get him in the vivas. He’s an examiner, don’t you know.”
“But, you know what he’s like. He just doesn’t react like that normally.” Boy Wonder shook his head, as he stuffed some papers into a folder.
We left the room silently. I too was perplexed. It certainly had been out of character. Was Green that churned up about hyperPEEP? I walked across to the lifts and pressed the down button.
My conscription to a monitoring role in the second hyperPEEP experiment had turned out to be something of a blessing. I had relieved the professor during the afternoon, to keep an eye on the prone pigs. Unintentionally, Boatwood had provided something of a sanctuary in which a couple hungry for love could blossom. The adjoining office at the back of the laboratory had sufficient separation from the adjacent vivisection, to allow for romantic love. A wooden table scoured by graffiti, a pink and grey filing cabinet, a bookcase of weathered tomes and dark stained floorboards – those were our prop. The sterile interior injected a violent freneticism. We simply devoured each other. We were all over the office – upright, supine, sitting – eroticised by circumstance. Afterwards, emerging shattered from the office, into the gleaming laboratory, Melanie had faltered in the face of the acid-lung montage.
“This is in your face,” She nervously laughed, turning her back on the spectacle. “I don’t know whether I agree with using animals for research purposes. It’s kind of like cynical exploitation.”
“Yeah it is a bit ugly,” I said. “But what else could we do instead – to make drugs and techniques safe for people?”
Hours later, forced by my monitoring role to sit in one spot, I could at last reflect positively on a period of productive study. Physically spent, I leaned back on a rickety chair, my eyelids beginning to weigh down heavily.
Footsteps approaching down the corridor surprised me. I glanced up at the electric clock. It was ten-thirty. Niall wasn’t due to take over until midnight. I watched the door as the sound got closer. I felt slightly apprehensive. The handle turned. The door edged open. Gibbs stood there, blinking as though dazzled by the bright light.
“What are you doing here?” he barked.
I was baffled by the question. It was the sort of thing that I might be asking him. However I spelt it out for him.
“More lambs to the slaughter,” Gibbs said, with the familiar flash of teeth. I pointed out that the animals under study were pigs. “You know what I mean,” Gibbs growled. He disappeared out into the back office, reappearing moments later with a bundle of papers. He stumped about amongst the ventilators, peering at the displays. “Bit of a cock up last time,” he said, in more friendly tones – as if pleased by the poor outcome. I said nothing. Had Boatwood spoken to Gibbs? Perhaps Baerwald had said something. Gibbs picked up the clipboard, holding the four o’clock results. I watched the short man peruse the numbers.
“The hyperPEEP group is oxygenating much better than the controls.” I volunteered to my senior.
“Sure,” Gibbs said. “But it’s a question of what will happen side effects wise. Pneumothorax has already tarnished Boatwood’s figures. And with that pressure for three days say, you’re bound to get some structural lung damage. Capillary fracture principally. Then they will leak and compound your original problem.”
“Yes, but in the short term, hyperPEEP could keep someone alive, while the primary problem is corrected with some other therapy - antibiotic treatment of pneumonia, for example.”
“We already use ordinary PEEP for that purpose,” Gibbs said. “It’s a question of degree. Boatwood’s gone right over the top. He will get complications. He already has.” Gibbs started heading for the door. “You here all night?” he asked, stopping short of the exit.
“No, it’s Niall after midnight,” I said
Gibbs bared his teeth again. “He’s keen, that boy,” he said. Then he was gone.
Niall’s gangly frame, finally manoeuvred through the door at midnight. I was busy, drawing the sixteen hour samples.
“Great results,” Niall said, peering over my shoulder. “No sign of pneumothorax?”
“No, the airway pressures have hardl
y changed at all.” I gestured to a pressure dial. “Makes you wonder what happened last time.”
Niall seemed unaffected by the late hour. He frisked about amongst the piglets, his stethoscope darting from chest to chest.
I packed up my books sleepily. I looked wistfully at the door leading into the back office, where Melanie and I had been lovers a few hours before. I felt the chill of loneliness. Life seemed to have no other meaning . . . only Melanie East.
Chapter 6