by Barbara Ebel
She cleared her throat, letting him know she was there.
“Annabel, close the door.”
Her heart thumped as she stepped back to do what he asked.
“Sit down,” he said.
She inched down and waited, not looking into his eyes.
“Where were you just now?”
“I stayed with our patient as Dr. Gill woke him up and brought him to the PACU.”
“That’s what I figured.” He closed the chart and swiveled the chair to face her directly.
“It grieves me to have this talk with you. Are you even remotely aware that you left the surgical gauze in Mr. Simmons’ hernia repair last week?”
Annabel’s heart rate immediately sped up and she wrapped her hand on her knee with an iron grip. What the hell was he talking about?
“No. No, I’m not. Because I did no such thing.”
“For the brief time that I left, you and Dr. Mack finished up … you assisted him.”
Annabel shook her head. “I’m sure I didn’t do it.”
“You have been disinterested in surgery and your mind is not on the subject matter you are here to learn. You’ve focused your interest on anesthesia but you can’t be two places at once and now our patient suffered the consequences. Not to mention the personal hot water it’s going to get me in. Not only with my reputation and the department, but most likely legally as well.”
Annabel was frozen with fear. He didn’t believe her and she was in deep trouble. She felt like slithering into a tunnel to hide. Having come all this way with school and tests and preparation to become a doctor, it looked like it was all over. If she stayed here any longer, she was bound to break out crying.
“Dr. Burk, can I go now?” she asked softly.
He noticed the moisture accumulating in her eyes and didn’t want to deal with a crying medical student. “Go ahead.”
Annabel rose and left quickly while Robby wrung his hands. This cascade of events was unfortunate and he now felt worse, especially since he had developed a soft spot for her.
-----
As she dashed into the hallway, she kept in check the flow of tears that were about to cascade down her cheeks. Making matters worse, Bob was leaning against the wall as if waiting for Dr. Burk to open the door. She tried to brush past him but he stayed next to her and followed her every step.
“I thought something was going down,” he said. “Annabel, what is it?”
She shook her head as if she couldn’t talk. “Please, Bob, I’m in deep trouble,” she managed to say.
“I’m sorry. You don’t deserve this. It’s that Dr. Mack, isn’t it?”
She slowed and allowed a tear to escape. As she wiped it away with her hand, Bob’s last remark echoed in her brain.
“You may have something there.”
“What’s going on, Annabel?”
“They are blaming me for leaving a gauze in Mr. Simmons at the end of surgery last week.”
“You’re a student. We’re not doing the surgery.”
“That’s right. And now I have a sneaky suspicion that it was Marlin who incriminated me. It had to have been him who left the item in and he’s not owning up to it with Dr. Burk.”
Bob gulped. “Where are you going?”
“I don’t have a clue. What I feel like doing is going to the call room, gathering my things, and leaving for good. Call it quits.”
“Quit? No way. You’ve come too far. I’ll help you any way I can.”
She kept walking and found herself at the doors of the PACU. “No matter what they think, my heart is in the right place. I’m going to check on Mr. Simmons after he’s more awake and be the first doc to tell him that his surgery went fine. That this will all be behind him and he’ll be going home soon. It’s the least I can do.”
“I’m coming with you.”
-----
Mr. Simmons groggily stared up at the ceiling lights as the stretcher moved along the corridors from the OR to the PACU. He stretched his neck to see the anesthesia resident; on the side was that young medical student, Dr. Tilson, and steering in front was the OR nurse who he had seen before surgery. The pain in his groin was minimal and he felt lighthearted and carefree. He’d think about what an ordeal this repeat surgery was to his life later. When he had called his brother from the ER, his brother had told him he’d find him a good lawyer to call as soon as practical. He said someone had to shell out some dough for what they did to him.
After they went through the double doors, they steered him into a slot and two other nurses came over and started slapping on monitors. The blood pressure cuff squeezed his arm while someone stuck the white probe on a finger on the other hand. He heard the ‘report’ all the while. His case sounded important when they used medical terms to talk about the who, what, when, and how of his surgery. Being a landscaper and living alone, he rarely received this much attention but he wished it was under better circumstances.
“Mr. Simmons,” Dr. Gill said, “we’re going to leave you now. You’re in good hands and even though you may not remember us telling you this later on, your surgery went fine.”
Mr. Simmons nodded his head at both Dr. Gill and Dr. Tilson and then they both left. Another pretty face poked her head above him. “You’re in recovery. Are you in any pain?”
He shook his head. “Not much.”
“You let me know if you start hurting.”
“You’ll be the first to know,” he said.
“Are you cold? I can get you another blanket.”
“I’d like that.”
With a perky step, the nurse went to the cart stacked with white cotton blankets and pillows and fetched him one. She spread it over him and then peered at his vital signs. “You’re looking good.”
“Thank you,” he said.
When the nurse resumed her other duties behind the desk, he closed his eyes and nodded off for about five minutes. Another surgical admission came in and the two women scurried off to attend to the new patient just like they had done with him. He dozed again and a little while later he felt his nurse adjust the pulse oximeter again on his finger. Feeling more awake, he smiled at her.
“Mr. Simmons, you’ve done fantastic and I just called for them to come get you and transport you to your room. Someone is on their way. You must be a long-distance runner to have a blood pressure like that.” She took the cuff off his arm, the oximeter off his finger, and the EKG leads off of his chest.
“No. Running would be a waste of time because I’m mostly outside working.”
“I hope you stop to smell the roses though.”
“I do. Sometimes putting them in is my business.” His sunken cheeks registered a smile. He looked up the aisle towards the middle of the room and pointed a wrinkled finger. “I think they’re having trouble over there.”
“Yes, I better go help her.” The nurse rushed over to her colleague, knowing the other patient had a history of obstructive sleep apnea.
Mr. Simmons started to feel somewhat different. It wasn’t pain, but he couldn’t put his finger on it. Maybe it was anxiety. Yes, that’s what it must be, he thought. Anxiety about getting the whole mess behind him. But the uneasiness ramped up and his heart ticked faster as he became more afraid. That was because his whole body seemed to get heavier and, for some reason, breathing became more difficult. His eyes focused on one spot as the fluorescent lights beamed down on him, practically smirking. Absolute fear enveloped him and although the words did not come out, his brain screamed … “Help me!”
Chapter 16
Annabel and Bob pushed through the PACU doors and continued talking.
“I think all I’m trying to do is get my composure back,” she said. “I guess I can’t leave in the middle of a call anyway.” She turned to him, her eyes not as shiny any more. “But I want you to know that I do appreciate your help.”
“It’s not a problem. We’re all in this together. I bet we’ll remember these weeks for the rest of our lives.”<
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“My dad says he still thinks about his med school rotations.” Someone brushed passed them and rushed to a stretcher halfway down the room.
“That’s one of the attending anesthesiologists,” Annabel said.
They followed to where the commotion was, then stood back and watched the nurses and doctor attend to another team’s patient. The anesthesiologist saw them and said, “Obstructive sleep apnea.”
The patient’s oxygen saturation began another slow decline. One of the nurses brought over a cart while the doctor stood at the head of the bed and positioned the patient’s head yet again. He applied a mask and ambu bag, injected some medications, and intubated the patient with a tube that the nurse handed him. After listening to breath sounds, respiratory therapy showed up. An orderly finally came to transport Mr. Simmons to his room.
“What vent settings do you want?” asked the respiratory therapist.
The anesthesiologist rattled off some numbers while Annabel and Bob still lingered in the same spot, watching and learning from the experienced doctor and nurses.
The orderly, a bulky man in scrubs, walked back from Mr. Simmons. “Did you all say the guy in Slot 8 was going to the morgue?” he asked in a deep voice.
The nurse taking care of Mr. Simmons rolled her eyes. “No. Mr. Simmons over there is going to Room 319. His papers are in his chart on the stretcher.”
“But he looks dead to me,” he said.
Annabel and Bob glanced at each other and then followed the nurse and the orderly to the back of the room. They all surrounded the stretcher. Annabel grasped Mr. Simmons’ forearm but it made no purposeful movement. The nurse called the anesthesiologist and as he hurried over, she slapped all the monitors back on that she’d removed for his transport.
Directions came fast. Before Bob knew it, he was the one doing chest compressions. The respiratory therapist finished with the other patient, came over with all his equipment and they manually breathed for Mr. Simmons with oxygen and a new mask. As the doctor felt his non-pulsating carotid artery, he drew up resuscitative drugs.
Rather than a rhythmic heart tracing on the monitor overhead, they saw a solid straight line across the screen. Annabel signaled to Bob that she could take over; he nodded and let her slip into his spot. It was the first time for her to do CPR and, as she did compressions, she knew that - two hours ago - her and her patient’s situation had been near rock bottom … now it qualified as residing in the flames of hell. She pumped as strongly as she could.
“Whoa! You can ease up a little on the superman CPR,” the anesthesiologist said to her. He watched and waited for results from the ACLS they did for almost twelve minutes but no cardiac activity began, no movement occurred, and Mr. Simmons remained dead. He put his hand up. “I’m calling it. Unfortunately, that’s enough.”
Annabel backed off and rubbed her hands together; even her shoulders were fatigued. She glanced at Bob and then towards the doors as Robby ran in and headed straight for them with a look of fear.
“I’m sorry,” the anesthesiologist said to Robby. “I just terminated resuscitation.”
“What on earth?” Robby said, his voice barely loud enough to carry over the stretcher.
The students didn’t notice him at first, but Marlin Mack had followed his chief resident into the room. He stopped next to Robby, surmised the situation, and bore his stare into Annabel.
“This is a career breaker,” Marlin said with a vehement tone. “A healthy patient with an inguinal hernia … turned into an infected glossypiboma patient due to student negligence … turned into a dead patient.”
Annabel rubbed her hands harder while she automatically took several steps backward. It felt like an arrow had pierced her chest, like he was calling her a murderer.
“Come on, Annabel.” Bob lightly touched her upper arm. “We’re not needed. Let me take you out of here.”
She relented without a word. They slipped out of the OR area and automatically went to the office and shut the door.
“I don’t think I can stay here,” Annabel said. Her nervousness reflected in her voice, she looked at him imploringly.
Bob scrunched his forehead and tried to think what he would do in her shoes. “I tell you what, I know your patients and their histories. Give me your list, I’ll check on them and get updates for you to present on evening rounds if you want to do them. Go to the call room and take a break. Rest or cry or do whatever. Keep me posted by texting me. If you don’t want to do rounds later, I’ll cover for you.”
Annabel blurted, “I believed in fairytales when I enrolled in medical school but I’ve been brought to my knees fast.”
“Maybe Cinderella needs a kiss,” he said sympathetically, trying a little humor.
She took a deep breath. “Thanks for everything. I’m taking you up on it. The call room, that is. I’ll text you as to what I’m going to do.” She put her head down and hurried away as fast as she could.
-----
Dumbfounded and staring at Mr. Simmons’ face which carried an expression of fear, Robby felt like his tongue was plastered to the roof of his mouth and he couldn’t speak. He walked to the desk with the anesthesiologist where he found himself relying on the other doctor to help with paperwork and details; he could barely think straight.
When the PACU simmered down to a normal pace - even the patient with obstructive sleep apnea was extubated again and discharged to a monitored bed for observation overnight - Robby snapped out of his initial stupefaction.
“If everyone was focused on the other patient,” he said, “and no one witnessed anything amiss with Mr. Simmons beforehand, this puts us in a further dilemma besides the horrific outcome of his death.”
The anesthesiologist nodded. “Let’s look at the meds he received here.”
They both scoured the two main pages of notes during his stay. “The last thing Dr. Gill gave him in the OR was 10 mg of IM ketorolac,” the anesthesiologist said. “That seemed to have held his pain mostly in control so that all they gave him in here was a single small dose of meperidine.”
“Then it appears he would not have had any respiratory depression from narcotics.”
Mr. Simmons’ nurse was standing at the counter. “That’s true,” she said. “And his oxygen saturation the whole time was fine. I’m totally shocked at what happened. There was no reason; his recovery went along smoothly.”
The two doctors looked at each other. “It’s going to be up to an autopsy then,” Robby said. “I’d put a pulmonary embolus or heart attack at the top of the list. Although he didn’t have heart risk factors, he may have been a patient who inherited bad DNA, signaling an early age for a sudden heart attack.”
“Possibly,” the other physician said. “But I’ll worry for you, Robby. Because no matter what the direct cause of his death was, the trail for it was set up by the sequence of events leading him to this surgery.”
“I know. If only that gauze hadn’t been left in.”
He wished he had never left the OR last week before the closure of Mr. Simmons’ simple inguinal hernia repair.
-----
Robby completed one more short surgery with Dr. Wallace and Da’wan. Then, grateful that his pager was quiet the rest of the afternoon, he went to his own office. After he left a message, Mr. Simmons’ brother called back saying he was on his way from out of state and ‘wanted answers.’
Robby went through his stack of mail which continued to grow by the day. Much of it was from physician recruiters trying to match new available doctors with specific groups and geographic locations. But getting involved with a particular practice was still his second choice. Now, more than ever, he wanted a sabbatical year off from this work in the states that was making him feel like he was being choked by a watchful legal eye.
As he jostled the pile around, he saw an envelope from Global M.D.s. When he opened it, a faint ray of optimism gave him hope. The cover letter was warm and welcoming, they were interested in him, and could he come
to their office in Tallahassee for an interview?
He looked at their potential dates and his calendar, and knew he could swing it if one of the other chief residents covered for him. Robby picked up the phone, finalized a meeting, and then called his fiancé. Even though she didn’t like his idea, maybe she would change her mind, especially if he wined and dined her for the weekend.
“Faye,” he said, “if you can break away, I’d like to take you to Florida for a short weekend. It’ll be for business and pleasure.”
In the middle of a pulmonary consult, Faye put her pen down and eyed her nails which were overdue for a manicure. Robby’s invite took her by surprise and she grinned; a get-away together was sorely needed.
“It sounds wonderful. I already can’t wait.”
-----
Annabel paced the narrow space between the bunk beds. It crossed her mind that her situation could be worse than she thought; that the surgery department might make recommendations to the school that she be thrown out of medical training. She had no idea if there was a precedent for that or if it had ever happened. Surely, extreme bad behavior would warrant such a thing. Too bad she couldn’t share this situation with her father but she had already complained to him enough.
At the moment, the only ally she felt she had was Bob. Yet, above all, she wished that Robby had the clarity to see what was really going on. She wanted to fault him; if ever she became a chief resident, she now knew there was a lot more to it than direct patient care. But wasn’t that the way with many supervisory jobs?
She wished she could go back to being a youngster playing with her sisters when her parents were still married. And spending time with her grandparents when they would all go fishing on the Caney Fork River. It was her grandfather most of all who had taught her the beauty of nature and living things. She felt more sorrow wash over her and, as she climbed up to the top bunk, she wished for the rest of the call day to be over.
When a knock sounded at the door several hours later, Annabel opened her eyes. Bob flipped on the light switch and walked in.