by Barbara Ebel
“Yesterday at lunch. Since then, it’s been one thing after another. This baby is going to be hungrier than me when it gets here.” Another contraction seized her and Viktoria glanced at the fetal heart monitor. At the peak of Wilma’s uterine contraction, the fetus showed a transient decrease in its heart rate, a result of hypoxia.
She hustled back to the OR and checked again that all was in order. Soon staff pushed the stretcher with Mrs. Lancet into the room and Jessy Winter followed them to the sink where he put on a bonnet and mask and began to scrub.
Some anesthesiologists did quite a bit of OB anesthesia, some did few cases, and some did none in their practice. Viktoria was not intimidated by the area of specialty and felt like she was proficient enough. She tilted the patient to her side for aorto-caval decompression, put the oxygen mask over the patient’s face, and did a rapid sequence induction.
With the endotracheal tube placed correctly, they draped the sheets across the top of the bed by the patient’s shoulders. Viktoria tweaked the anesthetic to the correct dosage … enough for the mother and yet not too much to decrease her blood pressure and have an effect on the baby.
The nurse quickly scrubbed Wilma’s enlarged abdomen as Dr. Winter came in. His eyes appeared heavy. He stayed quiet, managing the uterus after his initial incision, and managed to bring a full-term baby out and suction out it’s tiny mouth.
The nurse declared the time of birth and Viktoria made a note of it as well. The robust baby cried and was whisked to the incubator. A satisfactory, successful result, Viktoria thought.
“Were you on call last night?” Viktoria asked Dr. Winter. She assumed so since he was available and there so early in the morning.
“No. I’m going over to the office, however, when I’m finished here.”
The tech glanced at Viktoria and then paid attention to her instruments.
Dr. Winter’s sutures had something to be desired as he closed the patient up. Viktoria walked to the end of the table and estimated blood loss to be heftier than the normal one thousand ccs for such an operation. She tended again to the head of the table and soon had Wilma Lancet’s endotracheal tube out.
Wilma’s first question was, “Where’s my baby?”
In the OB recovery room, Dr. Winter wrote his note and addressed the nurse while Viktoria plugged her initial postop note into her iPad.
“In case you need me for the next few minutes,” he said to her, “I’ll be upstairs.” He looked back at her as he left. “Thanks.”
Viktoria patted Wilma on the arm. “By the way, congratulations.”
She nodded at the recovery room nurse on her way out. “I thought he was going to the office.”
The nurse twisted her mouth. “He’s probably going to change his clothes. He wasn’t on call last night, but he was here nevertheless.”
Dr. Thorsdottir’s curiosity piqued. He was like some loner obstetrician/gynecologist hanging around in the bowels of the hospital when there was life to be had outside of birthing babies.
“Why was he here?”
She leaned in and delivered a whisper. “He’s going through a divorce which may or may not be final. Word is his wife threw him out of the house.” She shrugged her shoulders and Viktoria responded with a flick of her head.
Viktoria took off for the main OR as she tried to wrap her head around Jessy Winter. That was a strange one she hadn’t heard of, or seen before, in her assignments—a physician living in a hospital call room. Or stretching it further, he was like a homeless person. She couldn’t fathom what he was going through.
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Viktoria placed the paperwork for the case in the anesthesia record bin, a synopsis version of the full case recorded on her designated iPad app.
“How did the emergency C-section go?” Dr. Huff asked, stepping behind her into the anesthesia office.
“No problems. Baby came out fine.”
“How did Dr. Winter fare?”
“He got the job done.”
“Hmm. That’s the best we can all say these days.” He stood against the end of the counter and picked up Wilma Lancet’s charge slip. After glancing at it, he placed the paper outside the box and rested his hand on top of it. “Go take a break,” he said.
Viktoria peeked at her watch. “It’s eleven. I’ll skip a morning break if you let me simply take my lunch break.”
“That’s a deal. The hospital chef often puts hot Reuben sandwiches in the doctor’s lounge on Wednesday. First come, first served. Don’t say I didn’t do you a favor.”
“What?” She threw in a laugh. “Did you stay up all night to help prepare them?”
“No. I mean because I’m letting you go to lunch right now.”
“I’ll save my firstborn for you.” She turned. It wasn’t a wise idea to taunt the scheduler who could dump on you, but she didn’t care. Her lunch break comes with the territory and the timing was also to his benefit.
Viktoria wished there were other, closer options for lunch, and she didn’t want to waste minutes going to the cafeteria. All told, however, the close-by hot sandwiches sounded pretty good. The downside was, more than likely, she’d run into more negative personalities.
Dealing with negative health care workers in the current work environment, she sighed, was like trying to swipe Icelandic midges away from her face while she was tending to the care of horses. The flying, pesky insect was so representative of her country of origin, that they named a whole lake after them. And although they wouldn’t bite or sting, they would swarm her face in droves. Like many of the folks in Masonville, and the majority of the people working in Masonville General Hospital, they were totally annoying.
She sauntered over to the doctor’s lounge and opened the door. The smell of corned beef on rye wafted over to her nostrils, making her grateful for the early lunch break. Two doctors were sitting together at a table and Jessy Winter was making a lunch plate, already changed into clothes for the office.
Viktoria poured an iced tea first before approaching the hot food. “Grabbing food before seeing patients?”
“Yes, some things never change,” Jessy said. Remember being in medical school? When you never knew when your next meal would be? So, you’d eat grub whenever the opportunity arose? Had we all consulted magic crystal balls to foresee our futures, we would have learned that when we became attending doctors, our lifestyles would not change.”
“That’s one reason why the choice of our specialties is so important.”
“You really think that makes a difference? We get screwed no matter what we go into.”
“I sense you are now referring to more than snatching food.”
“I suppose so.” Jessy leaned his head to the side of the sandwich platter and wiggled out the thickest packed rye bread he spotted. He placed it next to the potato chips piled on his plate and turned to her.
Jessy stood so much taller than her five-foot seven frame, but he seemed to shrink with disappointment.
“Dr. Winter, can I can lend you a listening ear?”
Viktoria avoided eye contact, selected a sandwich, and let him think it over. “I’m sitting over there,” she added, pointing to the table farthest from the two other doctors.
Jessy poured a coffee and sluggishly pulled out the chair across from her.
“Obstetrics must often be demanding,” she said. “I bet the most solitude and undisturbed meals come from being a radiologist, but that may be my own misconception. Certainly, they work hard and are experts in their field just like the rest of us.”
Viktoria didn’t expect Jessy to tell her his problems, but perhaps with a little rapport he’d open up. Not everyone has people in their lives to confide in, she thought. But since she was a stranger, maybe she was just what he needed.
“Do you have kids?” he asked.
“No. I don’t have the pleasure or perhaps the disappointment. Do you?”
“A girl. She’s in grammar school.”
“How nice. Is she topp
ling the average height record like her dad?”
A shimmer of a smile crossed his lips, which warmed Viktoria’s heart.
“Yeah. Her school is trying to sprout a girls’ basketball team. My daughter signed up.”
“Is she any good?”
“Don’t know.”
Viktoria leaned back and enticed more information with her eyes.
“I don’t live at home with her anymore. My wife asked me to leave, she’s filed for a divorce, but that’s common knowledge around here even for you, the ‘outlander.’”
“‘Outlander?’”
“That’s what your department is calling you.”
“Why is that? Because I’m originally from Iceland?”
“I heard about that too. But it’s not only because of your country of origin, it’s also because you’re from Longgg Island, and not from around here.”
“AHH. And my gypsy, locum tenens lifestyle.” She contracted her eyebrows. “Doesn’t matter. I also don’t possess the correct hair texture, the correct posture, the most tolerable accent, the best fingertips, the most alluring kneecaps, or the most precise width to my forehead.”
“You forgot the fact that you wear your drawstring tie outside your scrubs. Almost all the women around here tuck it in.”
“Stupid me.” Viktoria smiled enough that Dr. Winter caught a flash of her white teeth.
CHAPTER 10
More anesthesia personnel were in the office than Dr. Thorsdottir had previously met. With a flurry of case turnovers, they congregated on the couch and chairs, eating take-out food and celebrating a birthday. A tall chocolate cake with decadent wafers decorated the middle of the table and slices of it dotted paper plates in peoples’ hands. Dr. Huff kept his spot in the doorway with one eye on the scheduling board.
“Your hot sandwich recommendation was spot on,” Viktoria said in passing.
“Glad you enjoyed it. Help yourself to cake. It’s Susan’s birthday, one of the CRNA’s. You and she will be doing the triple A that’s in the preop area. Came up from the ER. The abdominal aortic aneurysm has not ruptured yet and the patient is stable, but the vascular doc is not taking any chances and wants to do him right away.”
“Dr. Parker?”
“Yes, that’s right, you worked with him already.”
Viktoria nodded and stepped over to slip a piece of cake on a plate.
“Just don’t dilly-dally,” Jay said.
“Who needs the calories anyway,” Viktoria commented and aborted the plan. “Introduce me to Susan.”
Dr. Huff pointed to the older woman sitting in the middle spot on the couch. “This is Susan Rust. You two will be working on the next case together.”
“Happy birthday. Finish your cake, Susan, and I’ll go see the patient and set up as much as I can.” Viktoria turned and, in the preop area, met Mr. Sutherland, a sixty-nine-year old bald man with a sparse mustache. He wore a look of fear.
Along with lugging over the chart, Viktoria went out of her way to drag a plastic chair next to his stretcher and sat down. “I’m the anesthesiologist, Dr. Thorsdottir.”
“Under better circumstances, I would say ‘it’s nice to meet you.’”
“Mr. Sutherland, you are in good hands. Dr. Parker will fix your troublesome blood vessel while you are under a general anesthetic and before you know it, you will wake up in the ICU. I usually keep my patients on the ventilator for a while after this procedure.”
A fluid bag hung from the pole at the top of his stretcher, and she traced the tubing to his IV. Surprisingly enough, someone in the department had already placed a large bore catheter in his forearm as well as an A-line into his radial artery for continuous blood pressure monitoring.
“Do you have anyone with you today?” She leaned in closer giving him undivided attention.
“My wife is in the waiting room. She’s more scared than I am.”
“She must care a lot about you.”
“Two more years, and we’ll be married for fifty years.”
“When you go home after your surgery, maybe you’ll plan an anniversary cruise.”
His taut scrunched-up face relaxed. “That’s a damn smart idea.”
“I see another anesthesiologist talked to you and left a preop note. Looks like your main medical history is high blood pressure and you smoke.” Along with being a male and over sixty years old, Viktoria knew he carried the main risk factors to land him in his current situation.
“That’s true. The surgeon said this aneurysm is in my aorta. Isn’t that above the heart?”
“It heads that way from your heart but loops down behind your chest and abdominal contents and becomes the chief blood supply for a person’s abdomen, pelvis, and legs. An area of it can enlarge or balloon out and it becomes more disconcerting depending on the size. In essence, it can rupture. Luckily, Mr. Sutherland, you came in before that happened.”
“I’ll get this over then. Will you be with me the whole time?”
“Perhaps not the entire case, but if not, another doc and a nurse will take over.”
Viktoria explained more about the anesthesia and, at last, she gave him some sedation. Susan Rust appeared, greeted the patient, and they both went back to the OR before Mr. Sutherland’s stretcher wheeled into the room.
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Peering over the drapes, Viktoria was impressed by Dr. Tom Parker’s skill with an abdominal aortic aneurysm. His assistant facing him from the other side of the table was his wife, an RN he had met along his career path. Before and after they married, she tied a noose around his neck that was so tight, the only other assistants that helped him were male. She made sure of it; she also worked in his office.
When the clamp came off Mr. Sutherland’s aorta, the tension mounted up as the blood flow to the patient’s lower extremity was reestablished. “How’s he doing?” Tom asked.
“His blood pressure, and his urine output, is starting to stabilize. I thought he would need a dopamine infusion, but we’re good right now.”
Dr. Parker nodded, took a minute to stand still, and let that sink in. He glanced at Viktoria. “So, where have they put you up in this mediocre town?”
His wife’s eyes glowered at her. Tom was oblivious as he continued to pause and Viktoria could swear steam rose out of the woman’s head.
“The Stay Long Hotel. Just a joint up the way.”
“Sorry,” he said.
“It’s not so bad,” Susan chimed in. “They’re renovating it.”
“So true. I have everything I could possibly want.”
Susan sat on the small circular stool. Viktoria thought she was a fine CRNA, probably close to retirement. She noticed the woman was slow to respond, but preferred her knowledgeable experience to new nurses fresh out of school.
Dr. Huff walked in and stood by the ventilator. “It’s three o’clock, so I’m springing Susan to go home. Casey is one of the late nurses, so he’s coming in to finish the case. You can go too, Dr. Thorsdottir, unless you simply want to finish this up.”
The case was almost finished, yet they still had to transport the patient to the unit. She hated to leave the dog that long and of course, had an arrangement for three o’clock as her cut-off. Yet, switching off both caretakers made her uncomfortable. She also remembered Mr. Sutherland’s being scared to death over his case.
“Heck,” she said, “he has a big anniversary coming up. I can’t desert him yet.”
“That means you’re staying?”
“Sure does. I’ll go take a bathroom break if you stay for a few minutes and, also, Casey can come in and take report from Susan.”
Tom Parker’s wife patted her husband’s right hand, attempting to refocus his attention on his sutures. His mouth was agape under his mask, impressed by the dedication Viktoria showed toward his patient.
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Viktoria marched out of the bathroom, poured a half cup of iced tea in the doctor’s lounge, and gulped it down in a hurry. All the while she thought a
bout her case. Mr. Sutherland’s postop pain management in the initial period in the ICU was her responsibility. He would be on the ventilator, but as he began to awaken from such a painful and important operation, she wanted him to be as comfortable as possible. What she gives him at the end of the case could go a lot further than the surgeon’s standing orders for him later in the unit.
Plus, to tolerate the ventilator better, she would not reverse his muscle relaxant. The term ‘muscle relaxant’ was a misnomer in a way, because anesthetic muscle relaxants or neuromuscular blocking agents paralyze patients’ skeletal muscles, making the surgical process easier for surgeons since patients won’t move. In delicate surgeries, non-movement was essential.
Viktoria went straight to the drug dispensing machine. She typed in Mr. Sutherland’s name and then selected a 2-cc ampule of 100 MCG of sufentanil. The vial contained the ‘big gun’ narcotic, almost ten times more potent than its parent drug, fentanyl, that they used all the time. Not only that, but the damn liquid was five-hundred times more potent than morphine!
When Viktoria was the anesthesiologist in charge of open-heart surgeries, she would check out the five cc vials. Having one’s sternum sawed down the middle to crack a chest was one of the most horrendous tactics she watched in surgery and, obviously, one she never wanted a patient to feel at all. There was no bigger heavy hitter than sufentanil.
She cupped the vial in her hand, and in Room 5 she slunk between the machines, and stepped over the cords on the floor.
“Everything is under control,” Jay said, “and Susan left.”
“Thanks for the break,” Viktoria said. She handed the sufentanil vial to Casey and she and Jay looked at the monitor. “Yes, his blood pressure has behaved and I’ll make sure it stays that way.”
Casey turned around to the anesthesia cart and slapped a sufentanil label on a 2-cc syringe.
Jay slipped out between both of them and made his departure. Viktoria drained the Foley catheter bag into a measuring container. “Another three hundred ccs,” she said.
Casey logged the number into their iPad. He wiggled the sufentanil syringe in the air. “Want him to get this now?”