by Barbara Ebel
He looked down at his shoes. “She’s in grammar school. Poor girl. This may sound cruel, but the greedy ex-wife has lost her cash cow.”
“No, not cruel. Who is going to see to his remains?”
“I heard the ex-wife is stepping up to take care of things. After all, he’s the father of her daughter.”
Jeffrey opened his eyes wide, smiled, and stepped to his desk. “I didn’t forget.” He picked up a paper plate with a cellophane-wrapped piece of Saturday’s wedding cake and handed it to her.
“How sweet,” she said, taking a serious look. “Thank you.” The top of the cake was iced with thick butter cream frosting and between the vanilla layers was a raspberry filling.
“Believe me, it tastes as good as it looks.”
“I better go store this in the refrigerator in the doctor’s lounge. I’ll enjoy it later. Thanks again.”
She rounded the corner into the hallway, but he suddenly remembered one more thing and followed her. “Viktoria, we started talking on Saturday about another issue. You said something about a ‘loophole,’ but we never finished the discussion.”
“So true. Unfortunately, I better hurry. I don’t know yet what cases I’m doing this morning.”
“I have a better idea. How about meeting for coffee or a casual dinner after work today? I am anxious to hear what you have to say.”
“Perfect. It may be better to tell you away from here anyway.”
“Okay, we’ll correlate later.”
Viktoria slipped away and slid her cake into the refrigerator in the doctor’s lounge. Although she thought Jeffrey Appleton was handsome, smart, and considerate, the appointment with him would be strictly business.
CHAPTER 22
Viktoria changed into scrubs while the nurses for the beginning and end of the shift had so much to talk about, the chatter never ceased. Not everyone had attended the CRNAs wedding and not everyone had been around Friday night for the discovery of Dr. Winter’s suicide. The nurses and employees in the “know” for either event prided themselves with gossiping about the details.
As she slipped on her clogs, someone mentioned her name. “Dr. Thorsdottir over there found the body. I’m glad it wasn’t me. The hospital doesn’t pay me enough to discover dead doctors.”
Viktoria grimaced. “What happened is a real shame for everyone,” she said. “May he rest in peace.” The discussion quieted down and the woman respected Viktoria’s comment.
Dr. Thorsdottir pushed open the locker room door and hurried to the front schedule on the wall. Dr. Nettle held a hinge of his glasses with two fingers, and with the other hand, rubbed a lens with a cloth.
“Looks like a mighty busy Monday morning,” she said.
“No kidding. I can’t decide what to do with you. Want to do your own cases or supervise?”
She wondered why all of a sudden she had a say in the matter. Maybe because it was her second week? “If I supervise, I may be of more use to you since the schedule is jammed full.”
He hooked his glasses behind his ears and nodded. “That’s what I was thinking. Cover rooms three and four to start. I’m putting Casey Johnston and Bobby Wright in those rooms.”
“Casey Johnston? Really? He’s here and not off on a honeymoon?”
Phillip swiped the air like he was swatting a bug. “Are you kidding? Casey and Jennie live together and take well-deserved, expensive trips when their vacation time comes up. Their wedding was their big bang for the time being. If I know him, he’s going to bask in the glory of having everyone talk about the Hollywood drama wedding they pulled off.”
“Even so, there must be days’ worth of cleaning up to do.”
“You don’t understand them. They’d rather work in anesthesia for their substantial CRNA salaries and pay the catering clean-up services to do that. They are a smart business couple.”
Viktoria grabbed a printed schedule and parted the curtain in the preop holding area for her OR Room 3 patient. Ashley Turner was a sixty-six-year-old woman for a portacath insertion. Her patient shivered under a sheet while a nurse hustled in past her and began covering the patient with a warm blanket.
“I’m Dr. Thorsdottir, the anesthesiologist.” She pulled the white blanket up on her side. “Now your teeth won’t chatter!”
“Much appreciated,” Mrs. Turner said. “I haven’t had anything to eat or drink since last night, and yes, I am starving. Look at this shriveled up skinny body. It’s you anesthesiologists that won’t let me eat. I’m a frequent flier because there’s always something wrong with me and surgeons are frequently taking a stab at me.”
“Oh no, that’s no fun. Well, getting your cancer port in will help a lot so the chemotherapy can be given without your being stuck for blood and IVs all the time.”
“That’s what I was told.”
“Which side is he doing today and which side is your breast cancer?”
“Breast problem is the left and port’s going in on the right.”
“And can you tell me your other medical problems?” She clutched the pen out of her lab coat.
“Arthritis, a bad knee, a new hip, neck pain, glaucoma, high blood pressure, and breast cancer. And my doctor diagnosed me last year with irresistible bowels.”
Viktoria’s pen slipped from her fingers. She never heard that one before and the humor of it was endearing. “I hope your doctor meant irritable bowel syndrome.”
“Oh, yes, I guess that’s it.”
Viktoria gathered the rest of the information she needed. “This should not take too long. We’ll give you a general anesthetic through a mask and you should do fine. A nurse anesthetist will be in the room with you the whole time and I will be in and out.”
“Thanks, doc.”
After explaining more to Ashley, she parted the drapes and found Casey approaching. “Morning, newlywed. Congrats again and I appreciated being an accepted guest. It was fun.”
“It was. Jennie is psyched. Everyone seemed to have a great time, and she loved being the bride.”
“You two make a beautiful couple.”
“So, what’s the story with our patient and I’ll go get some drugs checked out.”
“Breast cancer for a portacath. Appropriately, NPO, and we’ll watch her for hypertension. Port will be on the right. For you Monday morning comic relief, she has a new GI problem called ‘irresistible bowels.’ And I was thinking a general anesthetic with an LMA.”
“Sounds like a plan. Yes, an interesting GI problem,” he said with a smile.
Casey introduced himself to his patient and Viktoria went to see the orthopedic patient, Kenny Abrams, who proved to be a relatively healthy sixty-eight-year-old with arthritis and stomach ulcers. He was well versed with his surgeon’s explanation of an anterior hip surgery approach.
It was time to get her second Monday morning rolling at Masonville General Hospital. The second week of doing locum tenens in a new place was usually a more settled atmosphere, but nothing quite usual had been the norm yet for the urban OR. For a second, her mind jumped to later in the day. It would be fun to meet Jeffrey Appleton outside work again, both for the work-related topic they needed to discuss, and the enjoyable social interaction they seemed to have.
-----
Ashley Turner’s eyes closed after the propofol went into her IV and circulated through her bloodstream and into her brain. Viktoria handed Casey the supraglottic airway device, the LMA or laryngeal mask airway, and he inserted it into his patient’s hypopharynx, covering the supraglottic structures and allowing the isolation of her trachea. Viktoria cranked on the sevoflurane inhalational anesthetic and the nursing staff prepped Ashley’s right chest wall for the surgeon.
“Your wedding was magnificent,” Viktoria said. “Was Jennie the main planner?”
“She was, and if she was not sure about something, she left the decisive vote for me. Like prime rib versus roast beef, stuff like that.”
“You seem to be a very compatible couple. That’s rare. It
was probably about time you two got married.”
“Sure thing.” He taped Mrs. Turner’s eyes closed and readjusted her beeping pulse oximeter.
“Someone told me that you’re a low-income housing landlord too. That must take a lot of time.”
“I have hired help, fine workers for me, and they end up with spin-off secondary businesses.”
“How’s that?”
“For example, when folks get evicted or leave without notice, and don’t pay any past due rent, the guys clear out the furniture and stuff that’s been left behind. They can either keep it themselves or put it in the second-hand thrift store that they started. It’s only for limited hours. This all helps me because the loot they get is part of my deal to pay them. I shouldn’t tell you all this,” he said lowering his voice, “because it’s all off the books. I don’t pay them much of a ‘salary’ but, as you can appreciate, I pay them by other means.”
“I won’t give you my opinion about your methods. Must be profitable for you.”
“Sure. There are a variety of buildings and rental options outside of town, but not all of my places are in the south.”
Viktoria nodded as the surgeon came in, gowned and gloved, and asked for a scalpel. He gazed at Dr. Thorsdottir for her okay to proceed. “She’s ready for you, sir.”
Casey turned around and grabbed his syringe of fentanyl, which was drawn up as two ccs. He pulled off the cap, approached the stopcock, and made a motion to push the narcotic.
Viktoria put her hand out quickly and stopped him. She hadn’t even planned to, but the syringe ended in her hand. “Maybe Mrs. Turner didn’t tell you, but she requested no narcotics as she thought a lortab postsurgery would suffice her better. This isn’t a significantly painful procedure, and she gets terribly nauseated with narcotics. I told her we would try our best.” She glanced back at Ashley’s vital signs and there appeared to be no signs of increased pain. She put her hand out, Casey handed her the cap, and she plugged it over the syringe.
“But I checked it out for her.”
“No problem. We’ll waste it.” She turned around, and with her back to Casey, she pretended to unscrew the needle and dump the two cc’s in the sharp’s container as well as the entire syringe. The full fentanyl syringe she slipped straight into her scrub jacket pocket. Her heart pattered rapidly against her chest. She had never done anything devious like that before in anesthesia.
“Oh,” Casey said. “I’ll note down the wastage in the medical record. Good thing I didn’t check her out a five-cc vial instead of the two ccs.” He bit his lip and frowned. “Such a waste,” he mumbled.
“Yes, well, a five-cc vial would have been overkill.”
“Dr. Thorsdottir, I believe you have made innuendos to me before like that. I wonder if you give your patients the amount of narcotics they need, versus what you think looks better on your medical record, or something like that.”
“How about giving patients what they require versus what the anesthetist wants to give them? Or give the patient what the anesthetist is not actually giving them when they should be?”
“What the hell is that supposed to mean?”
Viktoria shrugged and studied his narrowed eyes. “Things are going along smoothly here, so I must step out and start my case next door with Bobby Wright.” She peered at the surgical site where the surgeon had made a clear, straight two-inch incision along the patient’s chest, and then headed for the door.
“Good morning.” Viktoria squeezed to the head of the bed in the next room where the CRNA was waiting for her. Kenny Abrams smiled from under the oxygen mask Bobby held over his face. “I’m ready for this new hip,” he said. “Put me under, doc.”
“We’ll take good care of you,” Viktoria said as she scanned the monitors and Bobby began pushing the propofol. Soon the sixty-eight-year old was intubated, positioned, and ready for his hip prep and draping.
“I cannot believe all the goings-on over the weekend around here,” Bobby said.
“Yes, that was some wedding.”
“Not so much that, but your finding Dr. Winter upstairs. I tell you, Dr. Thorsdottir, there were people who despised and talked negatively about his recent lifestyle hanging around in the hospital, but he was going through a lot and somebody should have spotted his deep despair and gotten him to therapy or something.”
“You’re spot on, Bobby. He had a serious work-home conflict and that catalyst for physician burnout is often overlooked because of the other major reasons—tremendous workloads, inefficiencies in the health care system, and lack of autonomy. He talked to me a little bit, and I wish I had been more proactive in getting him help.”
“During your first week here, did he open up to you?”
“Yes, somewhat.”
“He must have spotted your openness to listen. Around here, I think there’s a lot of negative talk and derogatory action towards people undergoing difficult times.”
“That’s too bad, Bobby. So, if you need to justifiably complain about something, my office is open.”
“Ha, ha. Where is it?”
“At least for fifteen minutes today, it’s going to be in the doctor’s lounge. I have a piece of Saturday’s wedding cake in there that someone was kind enough to bring me. See? Someone cared enough to think about me to do that.”
“You’re lucky. Locals like other locals around here and don’t adapt to newcomers very well.” He checked the nurse prepping Mr. Abrams hip, who was talking shop with the surgeon.
Viktoria nodded. “That’s not an impression I failed to notice last week.”
“Perhaps you’re going to beat the normal record of hostility to newcomers which can last for months around here.”
“I’ll be gone, Bobby, so I don’t plan to find out.”
-----
Since the patient’s case for a portacath insertion would not take that long, Viktoria swung by the preop holding area to see her next patient and then poured herself a cup of coffee in the lounge. She swung open the refrigerator door, brought out a creamer, and eyed the wedding cake. Too early to eat, she thought, but it was tempting her.
She poured a vanilla creamer in the dark brew and debated to sit down as Everett Benson waltzed in.
“So, did you go to the wedding?” he asked.
“Yes, thank you for encouraging me. It gave this out-of-towner something to do.”
“Awesome. You deserved an outing after what you went through Friday night.”
“And how was your call on Saturday?”
“Not so bad.” Everett grabbed a small orange juice bottle from the refrigerator, plucked a pastry off a tray, and motioned to a table. He was wide-shouldered with long arms and started chugging down his juice in several gulps.
Viktoria sat and crossed her legs. “Everett, every once in a while, I consider permanent placement, so I often compare the salaries of anesthesiologists in different areas. Do you mind if I ask what the docs in this group make?”
“No, not at all. We don’t do big cases here, as you are aware. No hearts and no transplants or significant trauma, and our call schedule and hours are not terrible. You may be aware that the hospital pays our salaries, and we’re all the same at two hundred thousand a year. Except for our President, of course, Jay Huff. He makes two-twenty. That is because he goes to a lot more meetings to represent the group and has more business with the hospital to attend to. In essence, you could say he puts in work after hours. Me, I hate a lot of boring business meetings.”
“You’re the youngest in the group. Seems to me that in the beginning of our crazy careers, after finally becoming a doctor, we must get used to being an independent practitioner, and also catch up on extracurricular activities that we put off during med school and residency. The desire to be politically and business minded often comes later. Enjoy these years after working so hard to achieve them.”
“So true. Right now, the extra twenty thousand dollars a year that Jay Huff makes isn’t the least bit attractive to
me.”
Viktoria smiled. Everett had his head in the right place. Maybe the president of his group was a lot greedier than being satisfied with the extra stipend the hospital afforded him. She stuck her hand in her pocket. There was something else she needed to attend to.
CHAPTER 23
An 80s song collection piped through the room as Evie walked down the middle of the laboratory aisle towards Viktoria. “You again?” she commented. “Is the department wanting another urinalysis drug screening, even though you and Jennie Shaw came up crystal clear last week?”
“No, not quite. Would you mind running the contents of a syringe through the mass spectrometer?”
The woman adjusted her white collar as she watched Viktoria take a syringe from her pocket—the fentanyl syringe she had plucked from Casey’s hands. “Looking for purity of a drug?”
“Or lack thereof,” Viktoria said.
The woman sneered from one side of her mouth, and extended her skinny hand. “Put it here.”
“Appreciate it.”
“Are you going to give me any data about the sample?”
Viktoria flinched. “Would you mind keeping the specimen off the grid until we see what we’re dealing with?”
She hesitated. “All right. For the time being.”
“I’m Dr. Thorsdottir with anesthesia, in case you’ve forgotten my name. Don’t call me. I’ll be back.”
“Not today you won’t. Check with me tomorrow.”
“Sure, I understand. Oh, by the way, Miss Shaw is no longer Shaw. She married Casey Johnston over the weekend.”
“I heard about that wedding. Besides our Dr. Winter call room fiasco, a blurb with pictures of the wedding ceremony showed up in the newspaper today. I’m not begrudging that sweet, smart young couple but, by comparison to the apparent estate they have, the hospital must not pay me enough.”
“You run a wonderful lab here and most likely have your priorities in order. Not everyone does, you know.”