Foreign Threat

by Mitchell Goldstein

  He changed gears and started to go over the list of members

  of his surgical team who would be his slaves for the next two

  months. He would find out which unfortunate medical student was assigned to his service in the morning. He already knew that he was fortunate to get Sally Jenson. He could tolerate Tom Formin, someone who would require a little polishing but should do fine. His intern was Steve Carmichael. He remembered a presentation that Steve did for Grand Rounds. It was actually quite good, but that didn’t matter. The transition from a medical student to intern is tremendous. One moment, you could be the most energetic student who looked up all the obscure topics and did all the scut work without a flaw. Then you’re finishing medical school, and you’re the doctor. The doctor is supposed to have all the answers to all the problems, but the lack of sleep combined with the long hours of being degraded and slammed from all the staff could make the best medical student appear just shy of inadequate as an intern.

  While he thoughtfully analyzed his team, Jake fell into a restless sleep. Today had been the last day of pure hell, and tomorrow would be the first day of his chief residency. The advantages it promised would include power, respect, and more operating time.

  Chapter 3

  As Jake made his way to the Surgical Intensive Care Unit, Tom and Sally were finishing pre-rounds. By the time the chief resident was ready to make rounds, all the little problems of the night were identified and resolved. It was important for the residents to know everything about the patients before the chief. This way they would look as efficient as possible, and the more organized the service, the more surgery they would get to do.

  When Jake walked through the electric doors to the Intensive Care Unit, Tom and Sally gathered several pieces of paper with patient data and hurried to the first bed. “Good morning, Jake,” they greeted.

  “Yeah right,” replied Jake. “Let’s get on with it. Hey, where the hell is the intern?”

  “Steve has orientation with all the interns for the first part of the day.” Sally didn’t wait for Jake to start in on her before going over the patients. “This is Mr. Gordon who found himself in an awkward position last night as he sold his crack. It appears the buyer felt he got screwed on the price and wanted it all for the preferred rate. So he decided to blow a few holes into Mr. Gordon’s chest and abdomen to remind him the next time he is in the area that all the buyers with guns get the preferred rate.”

  “That is really too bad, but why the hell is he on my service?” demanded Jake.

  “Well, as far as I know, the operating surgeon has full responsibility for managing their patients. And since I spent eight hours operating on this lowlife, I expect you to spend the next several weeks taking good care of him. And if he dies, Jake, my boy, you’ll be back to a junior resident faster than you can say oh, shit,” spoke Dr. Rosberg.

  “Sorry, Dr. Rosberg, I had no idea you operated on him!

  And-”

  “Save it, Jake. Just don’t let him die. I missed my daughter’s birthday party for this shithead. If he dies, it really would make it that much more painful.” With that, Dr. Rosberg walked out of the ICU with a smile from ear to ear as he chuckled about Jake stuffing his oversized foot into his mouth.

  “Why didn’t you shitheads tell me he was behind me?” snapped Jake.

  “It was too late. You already had your whole leg in your mouth before we could hint anything to you,” said Tom.

  What a great way to start the chief year, thought Jake. Making a complete idiot of yourself to your staff before the year gets started. It’s one thing to jerk around your residents, but to jerk around your staff is not good etiquette. “Well what did they do to this guy last night?” he asked.

  “They did a thoracotomy on the left side and wedged out the part of his lung that had a bullet hole through it,” Sally narrated. “Then they opened his belly and repaired several holes in his small bowel. He also had his left colon penetrated with a large amount of stool in the belly, so they left a colostomy for the time being.”

  Jake thought that was quite a bit for not getting the preferred rate, but Sally was not done.

  “They also repaired his Vena Cava for a through and through injury just above the renals. And finally the best for last, they packed his liver for several penetrating injuries to the right lobe.”

  “No wonder Dr. Rosberg made such a big deal about this case! It’s miraculous the guy is alive this morning,” said Jake.

  Tom gave a brief update, recent vital signs, urine output,

  lab values and medications. They spoke a little more about the case while Sally finished the daily note and wrote several orders. Then they moved to the next patient.

  Rounds in the Intensive Care Unit always took a long time

  because the patients were so sick and complicated. Fortunately,

  Jake only had three people in the unit this morning. The two others he knew from last rotation. One was an eighty-three-year-old man who had come in with bowel obstruction the previous week. He had undergone surgery to find an obstructing colon cancer. Surgery went well, but because the man had surgery emergently, his heart was not evaluated fully prior to surgery. Consequently, he suffered a heart attack one day after the operation. Nevertheless, the man was doing well but needed close follow up for the next several days.

  The other patient on Jake’s service in the unit was a young woman in her early thirties with severe pancreatitis. Jake had operated on her twice in the last week. She was better this morning.

  Sally began giving a brief update, “Mrs. Johnson had a fever last night up to 101.8 degrees Fahrenheit and was given some Tylenol, and then-”

  “Was any physician contacted? Was there a fever work up conducted? How about a chest X-ray?” yelled Jake.

  “Actually, we just found out about it this morning. We were also confused why a doctor didn’t get called either.”

  Jake knew Sally was covering her tail, and besides, he didn’t mean to scream at her the first day. There would be plenty of time for that later. He looked around and yelled for the charge nurse.

  Agusta Simpson was a pleasant nurse who had worked in the ICU for the last million years. She was a rather overweight woman who walked from side to side. She knew the ICU like the back of her hand. Whether the patient was an elderly person having a myocardial infarction, a gangbanger with multiple gunshot wounds, or a young child involved in a motor vehicle accident, Agusta was the most skillful in managing patients.

  When she found out that Jake Douglas was tracking her

  down, she produced a small evil smile. “Oh, the time has finally come: we must put up with Dr. Douglas’s attitude for the next year. We will have to set that boy straight from the get-go; otherwise, this will be a very long and difficult twelve months,” promised Agusta. She strode out of the charge room to see what the commotion was all about. “Good morning, Dr. Douglas. What’s all the fuss about?”

  “Well, for starters,” yelled Jake, “no doctor was notified about Mrs. Johnson’s fever last night. If someone had been contacted, we could have started a fever workup with blood cultures, a CBC, a urine analysis, and probably a chest X-ray, not to mention we could have taken out the central line that is in place. And-”

  Agusta quickly and sternly stopped the doctor from exploding right in front of Mrs. Johnson. She raised her hand as to quiet the very dramatic Jake Douglas and walked out of the room. She turned around and motioned for him to follow.

  Jake shamefully followed her commands.

  Once out of earshot from the patient’s room, Agusta started in on him. “Well, it seems we have a problem your first morning as the big chief Jake. I’m sure this won’t be the last display of fondness expressed toward the hardworking and devoted nursing staff. But I promise you that neither I nor the other charge nurses will tolerate your abusive behavior.”

  “Yeah, but the problem here is-”

  “Shut up, Jake,” demanded Agusta. “The problem is you. Now
to explain the situation from last night, well, that is actually quite simple. The nurse’s aide got that temp on Mrs. Johnson and told me immediately. I realized the patient was under several blankets and the room temp was turned up to eighty degrees. Apparently Mrs. Johnson likes her room warm. I rechecked her temperature fifteen minutes later, and it was

  back down to 98.8 degrees.”

  Jake looked down at his shoes for a second and then started to walk backward as to leave the area.

  “Not so fast, young man,” said Agusta. “In the future, I would like to know how you want the nursing staff to deal with this problem. That way we can attempt to please the majesty as best we can.”

  “I like that attitude.” Jake smiled. “Why don’t you have your nurses call me anytime they get an abnormal temp or lab value? In fact, why don’t you just have them call me anytime they feel uncomfortable with a particular situation?”

  Agusta crossed her hands around her stocky body and rolled back and forth on the balls of her feet. She smiled. Then she clarified Jake’s statement. “You mean you would want the nurses to contact you with any situation they feel uncomfortable with at any time. Is that right Dr. Douglas?”

  “That’s perfect,” replied Jake.

  “Then you want the nurses to contact you as they did the night before last? Is that perfect Dr. Douglas?” As Jake struggled for a rebuttal, Augusta smiled, turned around, and proudly walked back to her office.

  Tom and Sally tried their best to hold back their laughter as the team walked out of the ICU. Just as the automatic doors were swinging open, two very nervous medical students entered. They asked frantically where Dr. Douglas’s team was as they gazed around the unit looking for a group of people that resembled a surgical team.

  Sally grabbed one by the arm and whispered, “Are you

  Mike and Roger?”

  The boy with a rather large earring in his left ear answered yes.

  “Boy, are you two in trouble, not to mention you picked the wrong day to be late. Dr. Douglas has already had a difficult morning. Just do as he says and apologize profusely that you guys were late. And stress to him you will never ever be late again on this rotation.” Sally put her long, thin arms around each boy and added, “Good luck!”

  Sally walked quickly to catch up with Jake as he dashed to the general care floor where the rest of the surgical patients were located. “JAKE!” she shouted as she raced up to him. “The medical students are here. It appears they went to the wrong ICU and started rounds with the medical ICU service instead of starting with us. Is that right, guys?” she asked with a wink to Mike.

  Jake was still so pissed with Agusta that he didn’t notice the nonverbal communication.

  “Ahh, yes. We are so sorry, Dr. Douglas. It was really stupid. It won’t ever happen again, Dr. Douglas. Not while we are on your service, sir.”

  Sally thought, What a sweet kiss ass. He will make an excellent surgeon some day.

  Jake looked at them both like he was going to explode. “Which one of you is the fourth year?” he demanded.

  “Well, actually, sir,” Mike stuttered, “we both are third year students. They must have made a mistake, but if you like, I can run up to the office to see if one of us can be exchanged for a fourth year student.”

  “That’s fine,” mumbled Jake. “Just hang out with Dr. Jenson. She will show you both what your duties are on this service. She also will fill you in on all the little secrets that you need to know to survive this rotation, just like the ones she gave you a few minutes ago.” Jake smiled cleverly and continued his trek to the second floor nurses station. The entire crew followed close behind.

  The rounds on the general care floor went quickly and without too many problems. Jake and the rest of his service hurried to the cafeteria to get a bite of breakfast before surgery. They all sat down at the same table. It was uncomfortably quiet for the first few minutes, but then Tom began to make small talk.

  Soon after the ice was broken, Jake gave orders for the day.

  “Tom, why don’t you scrub with me today, and Sally you take the medical students this morning? Show them all they need to know about taking care of the patients and looking up their labs. And Sally, don’t forget to schedule that ICU patient for the OR today so we can take out his liver packs.” With that, Jake and Tom went to the operating room.

  Sally and the students stayed at the cafeteria for a few more minutes. After Jake left, there was a feeling of relief. Sally told the students about the events of the morning and gave them more hints on how to survive the rotation with Doctor Jake Douglas.

  Chapter 4

  Steve looked around and saw a few familiar faces, but he didn’t recognize the majority of people. There were two guys from his medical school class that he knew were going into Urology, and there was one girl going into Ortho, but other than that, he didn’t see anyone else he knew. Sitting back, he wondered how Deagan was getting along. Deagan started his internship two days earlier. Steve would have to e-mail him later.

  The room became quiet, and a large figure in a white coat walked to the front of the room. As he faced the crowd, Steve recognized him as Dr. Musso, the chairman of the Surgery Department.

  “Good morning, people,” he announced. “I would like to welcome all of you to our surgery training program here at the University Hospital. I assure you that you will discover the challenges of internship during the next twelve months. But I also know that everyone sitting in this room will deal with these difficult issues with great maturity. I know this because I selected each and every one of you to be a part of this training program. I wish you all the best. Dr. Goldman is the Residency Coordinator. He will fill you in on several other issues to be discussed today. If you have any questions about the year, your schedule, or problems that arise during the coming months, please feel free to contact him. Good luck!”

  Steve leaned over to the guy next to him and said, “Short but sweet, huh?”

  “Yeah, no lie. Not like I was expecting a big hug or anything, but a few words of wisdom or encouragement would have been nice. Hey, my name is Dennis Burrows. What’s

  yours?”

  “Hi, Dennis. I’m Steve Carmichael. I’m one of the surgery interns tracking for general surgery. How about you?”

  “That’s great! I’m going in general surgery too. Maybe we will have a few rotations together.”

  A calm and quiet voice began speaking in front. Dr. Goldman had arrived and started to inform the group of the expectations of the year and of other pertinent information that the interns needed to know.

  Dr. Goldman spoke for about two hours. All his words seemed important, but it was difficult to stay awake for the entire time. At the end of the presentation, Steve and Dennis went to lunch at a small bar and café a few blocks from the hospital. As they sat down, Steve glanced at the T.V. up on the wall.

  A CNN reporter informed, “There is no new information regarding the whereabouts of Phil Wells. There is great speculation that he was injured during the latest attack this week. The importance of this remains unclear, and the authorities are still not giving out too much information. Reporting live for CNN news, I’m Alan Paridy.”

  A new voice said, “Thank you, Alan. Today the world trade market continues…”

  “Isn’t it weird that those attacks are getting closer to us?” questioned Dennis.

  “Yeah, but that would never happen,” Steve replied. “The security at all of those government buildings is so strict that the president probably has a difficult time getting into the White House.”

  They both laughed.

  A few other familiar faces from orientation came into the bar, and Steve motioned them to sit with him and Dennis. The group of people introduced themselves and then took turns criticizing the orientation thus far. It continued throughout

  lunch and on the way back to the orientation room.

  Upon returning to the lecture hall, Dr. Goldman distributed W-2 forms for the interns to
fill out, the first item in a ton of documents to be completed. After the paperwork was finished, Dr. Goldman took center stage again. “Well, that is about it. If any of you have any questions that your chief can’t help you out with or you are having some other problems, please feel free to contact me. You can get a hold of me either by paging me or making an appointment through my office. When we are done here, please report to your service. Good luck, people.”

  With those delightful words of bullshit, Dr. Goldman was gone. Steve and Dennis remained in their seats and looked over one another’s schedule.

  “Quite frankly, I’m not in a hurry to do scut work for Jake Douglas. I think I’ll just stay here for another two to three hours. Do you think anyone will notice?” Steve asked jokingly.

  “I heard Dr. Douglas is a complete dick,” replied Dennis. “I’m glad I don’t have him this year.”

  Eventually they both felt it was time to start their internship. They exchanged phone numbers and went their own way.

  Steve stopped at the elevator and looked out the large glass windows. Dressed in his finest suit and a perfectly ironed white lab coat, it would appear to any patient walking by that he was an exceptional young doctor, one who could help a child overcome appendicitis or relieve a man with terrible diverticulitis through a colon resection or find a safe way for an elderly diabetic to revascularize a leg that had been in pain

  for more than six months.

  The truth of the matter was that Steve really didn’t feel comfortable with any of those scenarios. It was true that he completed four years of medical school, not to mention two of those years spent on clinical rotations, but during those rotations, he was never totally responsible for the patients. He was involved with their care and management, but he didn’t have to take all the phone calls about their problems after hours. He sat by the residents as they answered their pages and heard them order certain medications. He had stood in the corner once while an older man had a cardiac arrest; the residents did CPR and revived him, but Steve had never had to take on that responsibility.