by Barbara Ebel
Alice scrunched her forehead like it was an off-limit topic. “Forget about him. We’re talking about Jennie Shaw and Casey Johnston. They’re getting married on Saturday. Did they skip you on the invite list? They struck me as being liberal with their invitations.”
Tom rested his hands on the patient’s leg and frowned. “Guess not. Most of my case load is up north in the next hospital, so I can understand why I wasn’t on their radar. My name didn’t roll onto some hospital list of physicians and OR folks.”
“Too bad,” Alice said.
“I don’t know why they’re getting married anyway,” the tech said. “They’ve been living together for six months. Why not keep it that way?”
“Together they turn ashes to gold. Think what they can do if they’re Mr. and Mrs.” Alice relaxed her forearm on her right breast like resting it on a table. She went to the shelf and double-checked the patient’s OR paperwork. The room silenced except for the drone of contemporary music.
Maintenance fluid dripped into Mr. Quinn’s IV and when the bag almost emptied, Viktoria grabbed a new one from the bottom drawer of her cart. She spiked it open and hung it on the pole as the OR door swung open.
A female CRNA walked in and Viktoria recognized her from the day before with Casey Johnston in the recovery room. The young woman briefly flanked the surgeon’s right shoulder, glancing at his procedure.
“Another roto rooter, Dr. Parker?”
Tom glanced up. “You bet. I only learned today that you’re getting married this weekend to a fellow CRNA.”
“Someone’s got to do it. Say, you want to come?”
“I can’t imagine you have that much flexibility with your guest list. Thanks, but I’m accounted for this weekend. Too much I need to do around the house.”
She shrugged her shoulders and stepped around the equipment and into Viktoria’s space. “Hi, I’m Jennie Shaw. You must be the anesthesia locum doc. I’m giving morning breaks if you want one.” The young woman had alert, round eyes like a puppy dog, which made Viktoria think of Buddy.
“Sure,” Viktoria said slowly. “The patient’s a sixty-five-year old undergoing a fem pop bypass procedure or a roto-rooter, as you mentioned. He’s a big smoker and drinker, but no other significant medical history besides his vascular insufficiency, that we know about anyway. I’m running him on sevoflurane, a little nitrous with oxygen, and a muscle relaxant and, so far, he only needed fentanyl and midazolam up front. I just hung this second bag of Lactated Ringers. Any questions?”
“No. I can handle it.”
“Thanks.” Viktoria glanced at Mr. Quinn’s vital signs one more time, a habit to assure her that there was no sudden change in her patient’s hemodynamics.
She stepped to the door while switching her thoughts to Buddy. Hopefully, he was faring well in the confines of her hotel suite or, better yet, she hoped the room and its furnishings were not undergoing major puppy reconstruction. In actuality, she realized, she needed to buy him a dog crate, not only for the safety of the room, but also for wise dog crate training.
“So, what kind of music do you have planned for your wedding?” Alice asked Jennie as the door closed behind Viktoria.
Viktoria walked to the main hallway where Dr. Nettle squinted his eyes through his glasses as he noticed her coming. “I see you’re out on a break. Already?”
It was too early to be the dart board for snide innuendos, so she couldn’t help herself. “Why? Is that a problem? Isn’t that what Jennie Shaw is supposed to be doing? Giving breaks?”
“Yeah, sure. I didn’t think she’d get you out first, that’s all.”
“I’m off to the doctor’s lounge in case you need me back.”
In the hallway she opened the door, and unlike the day before, there was the fresh smell of coffee. The big room had recently undergone a half facelift. The kitchen area was spanking new, but on the other side, two walls needed repainting. Three single computer desks were against one old painted wall. The middle of the room was dotted with three round tables and chairs. A long couch was to the side as well as two recliners.
A man wearing a long, wrinkled doctor’s coat looked up from the couch. He was half slumped against the armrest and tried to fake the fact that he’d been lying further spread out as Viktoria came in. “Hey,” he said.
“Good morning. I’m grabbing a cup of coffee. Can I pour you one?”
He inched his hand along his hair, trying to make sense of it. “Why not?”
Viktoria filled two Styrofoam cups and eyed the flavored creamers. “I’m doctoring mine up. Want yours black?”
“Sure.”
She dumped in two vanilla baby containers, stirred her own, and handed him his cup.
“You must be new,” he said. “Didn’t know any new docs were in the pipeline.”
“I’m not permanent. Just passing through.”
He took a sip and nodded. “The anesthesia department, I bet. Their female is out on maternity leave. Sometimes I wish I’d chosen to pass gas.”
There was no name tag over his top pocket, so she ventured on. “What’s your specialty?”
“OB/GYN.”
“Were you on call last night?”
He flinched at the question. “Not exactly. By the way, I’m Jessy Winter.”
“Viktoria Thorsdottir,” she said, not extending her hand. His appearance made her think he had delivered a baby twelve hours ago and had yet to wash his hands. “Glad to meet you.”
Jessy stood, showing off his lanky six-foot-three frame. He tipped his hand in a salute and ambled out of the lounge with his coffee.
Viktoria settled in one of the plush recliners to enjoy the coffee and realized where she heard Dr. Winter’s name before. In the OR, someone said something about him being “noticeable.” Maybe there was some truth to that, she thought.
She plucked her iPhone out of her pocket. It was time to check if her husband had texted her about the news she told him last night.
About the dog named Buddy.
CHAPTER 6
Viktoria took a big swig of coffee and pressed her iPhone to wake up. She went to text messages and read the back and forth between her and her husband, Rick, the night before.
“New hospital first day over? How’d it go?”
“The usual, but got myself a dog. I’m naming him ‘Buddy.’”
She scrolled down and saw that he had responded at 9 a.m., a time which didn’t say much about what he was doing. Then or now, was he still lounging in bed? Was he making coffee and watching local weather? Or was he at his small insurance company’s office or working on his second business? All told, both “jobs” didn’t quite fill a normal person’s full-time job and, during the last year, she was well aware that each of them filled up less and less of his time.
“A dog?” his text said, followed by six question marks and a flutter of ridiculous dog emojis. “I could do with a dog, but what are you going to do with one?”
She half agreed with him, at least the part about her. “Can’t help it,” she responded. “The dog was abusively dumped. Maybe you can keep him some of the time.”
As she turned again to her coffee her phone dinged, so she knew the subject matter was of interest to him. “I can do that. What does he look like? How old?”
“Short of a year. He’s a Border Collie, capable of inexhaustible energy.”
“I can do stuff with him.”
I bet you can, she thought. “All right. We’re settled. What are you doing today?”
There was a long delay, so she crimped the foam cup and dropped it in a can on the way to the counter.
“Going to a customer’s house to evaluate a new claim. Roof damage from a fallen tree.”
That will fill his whole day, she sarcastically thought. “Out on break. Going back to the OR,” she responded and her phone went quiet. She retraced her steps to the counter, peeled a banana, and ate it as quick as she could. After a rest room stop, she weaved her way back to the OR.
<
br /> Viktoria walked around the bottom of the operating room table, taking in the entire surgical field and lap sponges. Evaluating the whole area gave her an idea of the patient’s blood loss. In this case, it was reasonably minimal. Dr. Parker was also making good progress, his head bent, his hands busy.
“How’s Mr. Quinn doing?” she asked Jennie.
“He’s stable as a rock. I didn’t tamper with the anesthetic at all.”
“Perfect. I appreciated the break.”
“Don’t mention it.” She rammed her hands in her scrub jacket and slipped between the equipment. “Bye, everyone. Dr. Parker, if you change your mind …”
The wrinkles around Dr. Parker’s eyes smiled, but he shook his head. Another half-liter of crystalloid dripped into her patient for the rest of the case, and the surgeon later announced he was closing Mr. Quinn’s incisions.
Viktoria injected the other one cc of narcotic which would make for a smooth awakening without pain. With the surgeon totally finished, she backed off all the other anesthetics and soon had the patient breathing on his own through the endotracheal tube. When he opened his eyes and squeezed her hand on command, she pulled out the tube.
Mr. Quinn gasped a big breath and then settled back down. Viktoria logged in his last vital signs and her last remarks about extubation. With the OR staff and an orderly, they all moved him to a stretcher.
Viktoria placed her iPad on the mattress, turned around, and opened the drug drawer. She needed to return the two-cc unused vial of fentanyl into the drug dispenser machine.
Her heart skipped a beat. She was sure she had slipped the vial in the empty compartment next to the vasodilators and vasopressors. But that space was empty.
Staff began to move the stretcher and someone held open the doors. “Dr. Thorsdottir,” Alice said, “we’re waiting on you.”
Viktoria’s eyes scanned each drug compartment and, as panic set in, she opened the top drawer and glanced carefully there as well. Seeing nothing resembling a fentanyl vial on the top of the cart, she peered into the sharps’ container.
Shit, she thought. This is a “first.”—A schedule II narcotic signed out to her patient, under her name, and she couldn’t account for it.
-----
Mr. Quinn opened his eyes back up in the recovery room and spoke softly after Viktoria gave the nurse a report. “I’m counting on Dr. Parker to make my leg good as new. Maybe even better.”
“He’s all finished,” Viktoria said, “so time will tell.”
The man forced his eyes open wider and grinned. “You’re pulling my leg. My surgery is over?”
“Yes, sir.”
“That man is a magician.”
Viktoria patted him on the shoulder and raced back to the OR. She checked the anesthesia drawers from top to bottom, poked around in the sharps’ container, and moved every item on top. The ventilator, inhalational agents, and monitor set-up machine had two drawers as well, and she rummaged through both.
She grimaced and admonished herself over her apparent mistake. Especially in a new place, not accounting for a narcotic would be a scar on her personal and professional record. She headed to the anesthesia scheduler for the day, Phillip Nettle.
The round man barreled out of the anesthesia office with his hands in the air. “We have to wait until a room comes down,” he told the OR nurse scheduler, “before Dr. Berry adds on a case and opens another room.”
Viktoria waited until he had his say.
“And what do you want?” he snapped. “You have another case to follow in your room.”
“Dr. Nettle, I have a narcotic discrepancy from the last case. A two-cc vial of fentanyl is missing.”
“Didn’t you give it to the patient?”
“No.”
“Well, that messes things up, doesn’t it? I better go talk to Jay. He’s supervising today. I’ll have to pull Jennie from breaks. She can start your case until we clear this up.”
“Great,” said the nursing staff scheduler. She leaned into Viktoria. “I’m kidding, but if you lost it, you could have recorded that you gave it, and we wouldn’t be having this conversation or causing a case to be delayed.” The woman walked away, shaking her head.
Viktoria narrowed her eyes at how despicable it was to think or mention such a thing. Dr. Nettle had taken off, so she stood in front of the white board like a child in a principal’s office.
The two anesthesiologists came scurrying down the hallway with their heads bent. “Dr. Thorsdottir,” Jay Huff said, “I understand you’ve lost fentanyl! I’m calling the lab. Go procure a specimen cup from them and provide them with a urine sample. We’re drug testing you.”
-----
Dr. Thorsdottir tried to handle her emotions as she marched into the lab on the top floor of the hospital. Being defensive over their request for a urinalysis would serve no purpose. It was very possible that someone in her situation could have injected the vial of fentanyl into their own bloodstream instead of the patient. After all, a minor percentage of people chose to practice anesthesia because of the availability of the most precious, pure, potent narcotics on the planet.
She spotted a woman with salt and pepper hair who gave her eye contact as if waiting on a ship to arrive. “I’m Evie,” she said, reaching a thin hand to the overhead shelf and pulling down a plastic, sterile wrapped cup.
“How often do you hand these out?” Viktoria asked, outing the cup in her hand.
“To hospital employees? Not very often. However, we send down random drug screening requests at least once a month to the anesthesia department. I’m the director here. I run a tight ship as far as keeping tabs on people, in case they’re abusing in this hospital, no matter what the department.” The woman pointed to the back of the lab. “There’s a rest room back there.”
Dr. Thorsdottir nodded. With the sparsity of bathroom breaks, it was easy to produce a sample and Viktoria soon placed the container on the bench.
“Thanks, I think,” said the woman.
Viktoria stopped right between Dr. Huff and Dr. Nettle when she returned. “I’m not having an unexplained narcotic mishap go on my record. Your CRNA, Jennie Shaw, gave me a break this morning. She was alone with my case and had access to all the drugs.”
“That is, if you left the fentanyl there like you said you did,” Jay said.
“Let her finish,” Phillip said.
Viktoria sucked in a small breath between her teeth, calming her anger. “If you drug tested me, then it’s your duty to drug test her as well.”
“Jennie?!” Jay exclaimed. “She’s as naive and American apple pie as they get. And I don’t know about the drug culture where you come from.”
“Do you ever curb your mouth or is it always spilling froth inaccuracies?”
Jay’s forehead wrinkled up like a Shar-Pei, and he pranced on his sneakers. His colleague put his hand on him, thinking he may step forward and clout her.
“I tell you what, Jay,” Dr. Nettle said, “she has a point. Since I’m running the schedule today, I’ll be the unpopular one with the nurse anesthetists and I’ll ask her to also provide a urine sample. Dr. Thorsdottir, go back and take over the case she started for you and send her out here. I hate to tell you, however, I don’t think we’ll have the manpower to give you a lunch break.”
“I couldn’t care less,” she said. “Patients come first.”
-----
Viktoria weaved into her next case where country music was now the chosen genre. Dr. Parker was only beginning his case, a lumpectomy of a woman’s breast.
“You made it back quick,” Jennie said. “I heard they chose you to fulfill the department’s minimum monthly quota for drug sampling. That’ll make the rest of us happy. We won’t be bothered.”
“Not quite.”
Jennie’s eyes squinted. “What does that mean?”
Viktoria didn’t want to question or confront Jennie about the missing vial. If the young woman had needed the vial that badly, more than like
ly she used it on herself and the testing wouldn’t lie. “Report to Dr. Huff or Dr. Nettle after you give me report, and who did this patient’s preop assessment?”
“Dr. Nettle, who was also here on induction. The patient’s only in her thirties, and they found a suspicious mass on a mammogram which proved positive for cancer on biopsy. She wanted a lumpectomy and not a mastectomy. She has a clean bill of health other than that.”
Viktoria nodded and noticed which anesthetics were turned on. “What did you check out of the drug cart for the case?”
“Two ccs of fentanyl and midazolam. I’ve given both.”
“On induction when Dr. Nettle was here?”
“Gosh, do you want me to bring you up to speed by writing a book?”
“Go. The two docs are waiting on you.”
-----
Since Dr. Thorsdottir had acted ambiguous, Jennie’s curiosity piqued as she turned the corner looking for Dr. Nettle. She found him in the anesthesia office which was close to the scheduling board. His eyes were widened like the rest of him as he plowed a knife down the middle of a hamburger.
“Lunch time?” she asked.
“It’s about time. I didn’t eat breakfast.”
She doubted that. “The outlander anesthesiologist said you wanted to see me.”
“Now, now. Interesting word choice for her. Yes, consider yourself the lucky winner of the drug screen lotto for this month and report upstairs.”
“What? That doctor just went up there.”
Phillip abandoned salting his French fries, and contorted his face. “How the hell? News and gossip travels through these walls faster than a nerve impulse.”
“Seriously? How come you and Dr. Huff are making two people get screened this month?”
“Like you said, she’s an outlander, so she doesn’t count for our group.”
She tried to think of an excuse not to go, but his expression turned serious.
“Okay, Dr. Nettle. I’m on my way.” She swiped a fry from his plate and hustled away.
Jennie rode the elevator, fixated at the blinking yellow light as it passed each floor. With a ding, her ride stopped, and she crossed into the hallway and entered the lab.