by Barbara Ebel
“Whoa,” Dr. Richie said. “Good head lift. I’m pulling it. You’ll be on your own but we’ll be right here.”
She nodded, ready to breathe on her own.
Dr. Richie pulled the air out of the cuff, held the tube, and drew back. Annabel coughed several times and then stopped. After taking a big breath, she said, “That was too damn close, you all.”
“We’re so sorry,” Bob said.
“It could have been worse,” Wilbur said, “but I have a lot to tell you.”
“You need some rest,” Robby said. “And there’s no way we’re letting you go home. You’re staying overnight.”
Annabel looked up at the ceiling and, when she looked back at them, managed a small smile. “Well, like Bob whispered when I was paralyzed, its one damn thing after another!”
Her relief was so great, she closed her eyes with gratitude for her colleagues who had pulled her back from death’s door.
-----
Annabel looked around at the familiarity of the hospital room; it felt odd to be on the receiving end of care. They brought her lunch and she ate half of the entrée but finished the whole cup of ice cream that came with it. Her mouth felt dry as sandpaper and she kept replenishing the glass of water from the pitcher on her table.
As soon as the kitchen staff removed her tray, Annabel used her phone to call her dad’s cell. She wasn’t sure if he’d still be in surgery, but she got him at the office and told him everything that happened that morning. Alarmed and worried, he said what she expected. “I knew one of us should have been there with you.”
“It’s okay, Dad,” she said. “And Dr. Burk is coming by later and I will text you with the lymph node results. Tell Mom, Casey, and Mary that I’m fine and not to worry.”
She hung up and knew there would be a lot of concern from her family that evening at their dinner table. Maybe even some from her sister Nancy.
Before Robby had left the PACU earlier, he promised her he would stay after the team’s afternoon rounds and come check on her separately. He wanted her to rest and be monitored; he had, on purpose, not yet told her the results of her surgery. One thing he had said made her grin the most … besides coming to see her as her doctor, he would ‘visit’ with her. In the meantime, Bob had lent her his surgery book for the afternoon and – aside from closing her eyes intermittently - she managed to get through two major chapters. Despite setbacks, maybe she still had a shot at passing the final exam.
Trying as hard as she could, however, Annabel’s thoughts kept wandering back to the PACU when she felt the air being sucked out of her and she was helpless to talk or move. That encounter at the brink of death was not an experience to forget so easily and she shuddered to think it would be a memory she would carry with her the rest of her life.
Close to 6 p.m., and after another meal tray had come and gone, Robby strolled into her room. He carried an envelope and a small vase of pink and white carnations. “From the whole team,” he said. “Luckily we have a decent hospital gift shop.” He smiled as he put it down.
“You all are so sweet. Thank you,” she said. She opened the large card with cartoon characters cheering her on after surgery. The team and Dr. Pittman, Wilbur, and Dr. Richie had all signed. Bob had written “Quit being so ODTAA!”
“What a fun group. Thanks again,” she said. “I have so much to tell you but, first, I’m ready for the surgery news.”
“The samples I sent to the pathologist all came back negative,” he beamed. “Lymph nodes are clear and we did nice clean wide margins. I have already talked to your dermatologist. She’s happy with the results. You and I will do a follow-up clinic appointment, and she wants to see you in a month.”
Annabel entwined her fingers and clasped her hands together tightly. “Thank you.” She gave him a big smile. “I am so relieved.”
“I bet you are. You deserve to be.”
“Do you mind if I take a minute to text my dad? I promised him and I’m sure my family is waiting to hear the news.”
“Please, go right ahead.”
She took her cell and typed: Make a toast. I’m in the clear. Love you all.
Annabel placed the phone next to her but it dinged soon enough with her father’s response. Wonderful news. We’re ecstatic for you! Have a good overnight and we love you, too.
“My family is a trip and they needed to know,” she said, looking back at Robby.
He nodded. “Do you mind if I sit down?”
“You must. I’m bursting to tell you something. I realized it as my body was seizing with fear and heading into preliminary skeletal muscle relaxation, paralysis, or whatever you want to call it.”
“I have big news, too. After the FDA confirmed to us this morning that there’s nothing wrong with vecuronium and rocuronium and then you got into trouble, we brainstormed the problem.”
“But you must hear me out,” Annabel said, her voice taking on more excitement. She flexed her knees and turned to her side. The head of the bed was up and she leaned against the pillow. “I realized that those drugs weren’t the problem. And because of my time at the head of the table with Wilbur, he had given me insight into the reversal of those muscle relaxants. Dr. Burk, I believe the problem lies with the reversal agent. I mean, why would the relaxant’s mechanism of action be reversed efficiently but then come back to cause re-paralysis?”
Robby’s eyes widened and his mouth fell open. “Annabel Tilson, you’re a card, aren’t you?”
“Sorry,” he said, realizing she looked bewildered. “It’s an old expression. So you figured that out on your own without the FDA’s information. That’s what I was going to tell you.”
She smiled and his milk chocolate eyes beamed at her, making her heart do a somersault. Afraid she might blush, she lowered her eyes.
Robby tapped the mattress with his hand. “There’s a brand new reversal drug that anesthesia has been using since it came on the market a month or two ago. It’s called Legammadex. It’s only indicated to use with the two muscle relaxants we’ve been talking about. Wilbur used it on you and, by digging in the records, we found out it was used on the other folks who had bad outcomes.”
“The name sounds familiar,” Annabel said. “So what happens now?”
“There has been lots of communication between the anesthesia chairman, the FDA and the drug manufacturer today. They’re recalling Legammadex and it will be given stat priority to find out why this has happened. And why has the re-paralysis happened to some and not every patient who received it?”
“Yeah,” Annabel said. “Like yours truly.”
“Speaking of which … that must have been horrific. I’m sorry you had to go through that.”
“It was scary, like I was being plucked up into heaven. And even though Bob was absorbed in his surgery book at first, it’s a good thing you posted him as a sentry by my bed. It could have been a lot worse if my teammates and the PACU nurses weren’t watching me closely.”
Chapter 27
Two days later, Annabel made her way past the coffee stand and stopped abruptly. Bob had been such a dear friend for the whole rotation that she couldn’t resist buying him more espresso beans; he had driven her home from the hospital yesterday after her discharge and had called her last night to check on her.
On top of everything else, she had studied intently the entire afternoon. If she passed, she would go on to her next rotation that she found out would be psychiatry. Anesthesia was still on her radar but that would have to be as an elective some time later.
Upstairs, before she checked on her patients, she found Bob at the nurse’s station looking over his own patients’ charts. His blonde hair with its tapered sides, which had been growing out of shape during the rotation, had been cut and redefined since yesterday. He looked crisp and clean in his short white jacket and seemed to enjoy the interest a young nurse was showering on him.
He sat down to write a progress note as Annabel peered over the counter. “Good morning, Bob,”
she said.
“Annabel! How are you feeling?”
“Except for the PTSD from being paralyzed awake and almost going to heaven, I’ll survive.” But then she smiled. “Don’t worry, I’ll get over it. And thanks again for all your help.” She pulled out the box and handed it to him. “A present.”
“I swear I’ve made you a junkie over these things,” he said. “So I’m glad you bought them for me.”
“Say,” she said, “did you get psychiatry next, like me?”
“I did. Awesome. We can rotate and learn about head cases together. And not the physical aspect like your dad works on, but the mental and emotional facet.”
“Yes,” she beamed. “I’ll count on it … that is, if I pass this one first.”
“I think we’re all worried. Even Da’wan. So hang in there and you’ll do fine.”
She leaned closer and lowered her voice. “But I have to worry about the clinical evaluation from Dr. Pittman and Dr. Burk, too. I mean, there were all sorts of problems with me along the way.”
“Annabel, I can’t speak for what Dr. Burk is going to do but you’ve apparently been instrumental with this anesthesia drug problem. I don’t think you have anything to worry about.”
“I hope not,” she said.
“By the way,” Dr. Burk is here and went to his office. He told me that if I saw you, to send you his way.”
“Okay, thanks. I’ll see my patients and head over.”
-----
As Annabel made her way past the OR lounge heading to see Robby, she had to stop for a man weaving a cart with a stack of boxes and his briefcase stashed below. He wore a shirt and tie, and she noticed his name tag was from a drug company. The head nurse walked over to him.
“I have leftover donuts from this morning’s meeting up in administration,” the man said. “You all want them?”
“Sure,” she said. “My hungry nurses, docs, and orderlies always live up to the motto ‘bring them to the OR. We’ll eat anything.’” She smiled at Annabel. “Help yourself, too, Dr. Tilson.”
“You already did help me,” Annabel said, smiling in return; just in the nick of time before the final exam, she finally knew the tenth OR saying.
She skipped taking a donut and when she arrived at Robby’s office, the door was closed. After knocking once, he opened it a little bit. “I wasn’t sure if it was you,” he said. “Come in.”
Wondering why he had called her, Annabel didn’t know if she should ease herself into a chair or continue to stand.
Robby gestured for her to sit as he did the same. “I’m making out my students’ and residents’ clinical evaluations,” he said. “Hence the reason I’m in early and secluded in here. Evaluations always need to be in the department’s office before the students take their test. And since that’s in two days, I can’t procrastinate anymore.”
Annabel nodded and held his gaze. She knew she would miss seeing him and the probability of bumping into him after this rotation were slim, especially since her elective anesthesia rotation wasn’t set up yet. This may also be the last time they spoke alone. She sighed. It was too bad she wasn’t totally enamored with surgery; otherwise she would increase the chances of running into him at CME meetings, or in surgery lounges, or even in the same practice.
Robby still held the folder in his hands that he came to the door with; he placed it on his lap. “You all were an interesting team,” he continued. “Even Dr. Mack and Dr. Wallace are leaving for a pediatric surgery rotation. I’ll be getting a whole new group.” He rubbed his hands together and leaned forward.
“Anyway, you went through an ordeal two days ago and I called you in here nice and early to make sure you are not feeling any ill effects. Dr. Pittman and I want to be sure you are up to these last two days of clinical duty.”
“I appreciate your concern. I only have to work at getting rid of the potent memory of it, otherwise I’m absolutely fine. This has been a tremendous learning experience and every day counts.”
“Good. Perfect. And since we’re on call today, you’ll probably get to scrub one more time.” He got up and, as he did, the folder on his knees fell to the floor. She frowned, wishing she could sit across from him longer. If only he didn’t look so good.
Annabel hesitated. Robby made no attempt to bend over, so she stooped down and picked up the file.
With two long steps, he was at the doorway. “I must see Dr. Pittman before rounds. You can just put that on my desk. Dr. Pittman is going to countersign what I have in there. You can take your time, Dr. Tilson, but please lock the door when you leave.”
She gave him a look of confused consternation but he disappeared out the door, closing it as he went. Looking down, the folder had a magic marker inscription ‘Surgery Department: Personal and Confidential.’
As she walked to the desk with it, she shrugged her shoulders. It dawned on her that he had left her there on purpose … because of the folder? She laid it down but peeked inside.
Clinical Evaluation of Marlin Mack, M.D., third year resident on Dr. Burk’s and Dr. Pittman’s surgery rotation.
Annabel sat down in Robby’s chair and read:
It is with profound displeasure that I write this clinical evaluation. Never before in my supervision of medical trainees below me, have I had to deal with what I believe is untrustworthy and disparaging behavior.
Dr. Mack has on numerous occasions during this rotation treated a medical student unfairly and with bias. It appears that he brings his own prejudices (from his own background?) to the workplace and has disrupted, camouflaged, or outright erred in the normal flow of clinical duties.
To protect the innocent, I will keep names and examples of his actions off the record but I am willing to be queried by the department or by future professionals asking for recommendations.
In essence, I feel that Dr. Mack has not upheld the classical Hippocratic Oath which we are all bound by. He dismisses the fact that he has special obligations to other human beings … of mind and body … as well as illness. He fails to recognize or deliberately fails to execute medicine and the obligations it assumes with fellow professionals - those being warmth, sympathy and understanding which sometimes must outweigh the surgeon’s knife or the chemist’s drug.
In my opinion, having been privy to his behavior, I believe he dismisses our sacred concept of medical ethics.
It is my recommendation to the department to consider putting Dr. Mack on some type of probation, if not suspension, from our surgery department’s program.
Respectfully submitted,
Robby Burk, M.D., Chief Resident
(Approved by Jacob Pittman, M.D., Attending Staff)
For a few seconds, Annabel put her hands over her mouth in disbelief. Then slowly a grin spread across her face. Robby’s evaluation didn’t pull any punches; she loved it like she loved him. Wait a minute, she thought … loved him? No, it couldn’t be. She had a schoolgirl’s crush on him, that’s all. But, for sure, her admiration for him had just escalated. It took balls to write something so potent.
She thought about Marlin. Robby had documented what he knew and saw and, in the least, it would probably slow down Marlin’s underhanded and unscrupulous behavior in the future.
Annabel flipped closed the cover, put the file squarely on his desk, and went to the door. Glancing around for the last time, she mumbled good-bye to his private space then locked the door behind her.
-----
All the students considered themselves lucky to be on call Wednesday because the next day they’d get home early and have time to cram before their final exam on Friday. Annabel paid extra attention on morning and evening rounds for whatever last minute teaching her upper-level docs would divulge. She did scrub one more time but tried her best not to make eye contact with the chief resident of her dreams.
The following morning, she even felt a kinship to her patients and was sad to say good-bye and good luck to them with the next surgical team. At home, she changed in
to sweats, took a short run along the river, and buckled down to review all major points of surgery that a student at her level should know.
She walked into the department’s conference room Friday with heightened anticipation. How difficult did they make the test? She wiped her hands on her cargo pants; she was more nervous than she thought.
Students piled in. She saw Da’wan already sitting at a desk; of course, he must have been here first, she thought. Bob and Ginny appeared and she waved them over.
“I’m so sorry,” she said quietly to them. “I forgot to tell you all the last OR saying we were missing. I fortunately heard it in the hallway two days ago.”
Bob put his arm around Annabel and Ginny like they were huddling in during a football game. “Tell us,” he said.
“Bring it to the OR,” she replied. “We’ll eat anything.”
They all smiled and Bob patted her on the back. “Thanks,” they all said.
“And good luck,” Annabel remarked as she took a seat across from Da’wan and the proctor passed out their exams.
-----
Annabel sat on a bench on Saturday morning in a tiny neighborhood garden overlooking the river. Glorious sunshine caused the water to sparkle as if slivers of ice floated on the current. She had thought about going to Eden Park for a few hours but decided against it. The thought of what happened there with those two guys trying to lure her into a threesome was too fresh in her mind and she wouldn’t want to bump into them again.
She glanced down at her cell phone beside her. Nah, she thought. She wanted to formally get her first rotation behind her before jumping onto Findar again. The surgery results would be posted early Monday morning; she would take either a deep breath and go on to her next rotation or … well, she didn’t know what would happen if she failed.