Foreign Threat

by Mitchell Goldstein

  Once Mr. Springer was intubated, Sally took the stethoscope and listened to both sides of his chest. “All right,” she said. “Let’s get him hooked up to the ventilator.” She stepped back to the foot of the bed and anxiously folded both her arms around her chest. She looked up at the monitor to follow the rhythm. It looked as if he was in Vfib. Even Steve could see that. “Ok, Carmichael, start compressions.”

  “Me? Me, Dr. Jenson?”

  “Are you Carmichael?”

  “Uh… yeah, but I …”

  “Shut up, Steve, and start doing chest compressions! You’ll never learn anything standing twenty fuckin’ feet from the patient.”

  Steve realized she was right. He had barely made it in the door of the overcrowded room but reasoned that he could learn more by standing in the doorway. The fact was that he was scared shitless.

  “Carmichael, or whoever you are, you’re right. You are absolutely correct. This man does not need compressions.

  What does he need, Carmichael?”

  Steve stood over the bed in a full panic sweat. He could

  feel his pulse racing and was sure everybody in the room could hear his heartbeat.

  “Carmichael!” screamed Sally. “Don’t freak on me, boy! I can only handle one code at a time. What does this man need? Now!”

  Steve looked at the monitor and then at the vital signs. He took the back of his left hand and wiped the sweat off his forehead. As he did this, he discovered more moisture than he had anticipated. One of the nurses handed him a towel. “I think we should shock him,” whispered the petrified intern.

  “What, Steve? What did you say? Speak up. This guy is dying, and his hearing is a little shitty. He won’t care if you speak up a bit.”

  Steve was upset with the way Sally was treating him, but she was probably right. He was pussyfooting his way through his first code. Speaking of which- where was Erica? She had promised to be at his first code.

  “We need to shock the shit out of him!” yelled Steve.

  “Let’s try to leave the shit in him. The nurses would really appreciate that. Come on, Carmichael, let’s do it.”

  Steve looked over his shoulder, saw the paddles, and reached for them. He placed them on the patient’s chest. In the correct position, one paddle was in front and the other along the patient’s left side. His hands were shaking as the paddles rested on Mr. Springer’s chest. He screamed at the nurse standing near the defribulator, “Charge at 300!”

  A soft voice responded, “Charged.”

  Steve leaned into the table, ready to charge.

  “Stop!” yelled Sally. “Didn’t you forget something? You are about to make a few enemies.”

  “Oh, yeah – clear!”

  With that, all the people at the bedside moved back a step

  so they wouldn’t feel the electrical surge delivered through the paddles to the patient’s body. Steve pushed the small red buttons on the paddles, and Mr. Springer’s body jolted off the bed a few inches in a spasmodic manner.

  Steve glanced at the monitor and smiled. Everyone in the room cheered as the patient showed a normal sinus rhythm. The sweat was dripping from Steve’s face, but that didn’t matter, he had just saved Mr. Springer.

  Dr. Jenson felt much better, too. She thought that was all Mr. Springer needed.

  About twenty seconds later, one of the nurses shouted that his pressure was back down. The only IV he had was a small one, so Sally asked for a central line kit. She pushed her way to the front of the bed and evaluated the vein situation on the patient. Both of his arms had already been bruised from multiple IVs during the past week. Sally pulled the hospital gown off his broad shoulders and looked at his clavicles.

  While Dr. Jenson was assessing his subclavian vein situation, another nurse shouted, “Vfib, he’s back in Vfib!”

  Dr. Jenson looked at the monitor, and sure enough, he was back in that rhythm that would not allow the heart to adequately pump blood through the body. She checked his blood pressure: 55/20. “Shit! Start the compressions again, and Carmichael, get ready to shock him!” She was no longer in the teaching mood. There was definitely something failing Mr. Springer, and she could not determine the cause. “Someone call Dr. Douglas, NOW! And get a drip of Dopamine started at five mics.” Dr. Jenson, in the midst of a panic attack, began to place a central line.

  Steve thought, Dr. Douglas? She must be totally freaked.

  For Dr. Jenson to call in the reinforcements meant she

  was in dire need of assistance. Steve knew for a surgical resident to call for help was a sure sign of a major problem. Surgeons never felt like they needed any help, and the residents were proud of the fact that they took care of most of their problems by themselves.

  But this was not a typical problem. The patient was trying to die.

  Dr. Jenson grabbed a bottle of Betadine and splashed a bunch on the left clavicle. Then she slammed a drape over the

  area and inserted a long needle into the skin toward the clavicle.

  The patient didn’t move. His pressure was only in the fifties.

  “Someone get lab up here and draw a CBC, chemistries, and a blood gas. Then get X-ray up for a portable chest. Come on, Carmichael; shock the shit out of him! Someone give one amp of epi and then another amp of sodium bicarb. Now!” Dr. Jenson was beginning to unravel, and the others in the room noticed.

  The charge nurse leaned over to another nurse and whispered, “Find out who the attending is, and get his butt down here now!” The nurse scrambled toward the door and ran to the nurses’ station.

  Steve shocked Mr. Springer repeatedly, but he didn’t respond. Dr. Jenson finally secured the central line, despite being interrupted several times for the shocks that Steve delivered.

  Dr. Rosberg burst into the room. “What the hell is going on in here? Jenson! Why didn’t you call me when this happened? Shit, it looks worse than a fuckin’ MASH unit. Did anyone get a blood gas?”

  Dr. Jenson, as upset as she was, filled Dr. Rosberg in on

  the details as best as she could remember. Steve could sense both a feeling of remorse and relief that Dr. Jenson expressed while talking to Dr. Rosberg.

  After almost two hours of coding Mr. Springer, Dr. Rosberg checked the patient’s pupils. He turned from the bed and walked past Dr. Jenson. “Next time you decide to kill one of my patients, inform me first.” He walked solemnly out of the room.

  Dr. Jenson was even more determined to save Mr. Springer, but after several more minutes, she too checked Mr. Springer’s pupils. Fixed and dilated. Over the last few hours, there had not been enough blood pumped to his brain. Not enough oxygen

  had been delivered to his brain cells.

  Dr. Jenson turned and quietly glanced at the clock. “Shit,” she whispered. “Time of death is 4:32 PM.” She took Mr. Springer’s hand and said, “Sorry.” She roamed the room quietly for a few minutes and then sat down to put her head in her hands.

  As Steve sat with Sally, he thought about his perception of

  the code and death of Mr. Springer. What the code meant to Steve versus Sally was clearly different.

  Steve sat with Dr. Jenson for five minutes before she said, “Alright, Carmichael, now you’ve seen surgery at its worst. There are a few other patients on the floor that need scut work done. Why don’t you find Tom? He will orient you to our patients and what needs to be done. I guess you won’t have to

  worry about writing a progress note on Mr. Springer.”

  Steve stood up, patted Sally on the back, and repeated his condolences.

  Later while walking down the hallway with Dr. Formin, Steve saw Jake and Sally talking. She was crying again, and he was comforting her with a hug. Steve never thought surgery residents needed hugs, but then he never saw a resident so upset before, nor had he ever witnessed a patient dying right before his eyes. Steve was impressed that both residents were able to express their feelings so openly, but he knew that they were surgeons and that it would be short lived. By
tomorrow, both Jake and Sally would be just as demanding, just as egotistical, and just as condescending as they had been before.

  Chapter 7

  It was pitch dark out as Steve drove home. It was not the beginning of a beautiful sunset or a romantic twilight. It was just late at night. He, of course, had been forewarned about the long hours spent training to be a surgeon, but he thought it would somehow be different for him. When he left for orientation this morning, it had been dark as well. This would be something to which he could adjust, but the real problem would be the lack of sleep that accompanied such long hours of training. He’d had his chance to select a different specialty, but surgery was what appealed to him the most. So for the next several years, at least until he became a chief resident, residents above him would dictate his life; his days would be painfully long.

  As he turned up the driveway and shut off the engine, Steve had to admit it was a wonderful night. No clouds in the sky and all the stars one could ever imagine. The temperature was still warm, and he heard some neighborhood dogs barking to each other. He was happy that he decided to rent a duplex in a family neighborhood. He had felt it was time to move away from college apartments. While in both college and medical school, he lived where all the action was, but now he needed a place to hang out quietly after long call nights. He needed a place to be able to study without a loud party blasting his eardrums until the wee hours. He needed a place to call home and not share it with three other guys who had girls gallivanting around the place, left dirty clothes on the stairs, or ignored three-day-old pizza laying on the kitchen table.

  The duplex he had found was in a very quiet area and near most of the hospitals that he would have to work, specifically the University Hospital. The family below him was very pleasant and kept to themselves. They had two small children, both boys, and one golden retriever. Steve thought the father worked nights and the mother stayed home, but he was not sure. They owned the complex, and Steve could tell they were good managers as everything appeared clean and well kept. Whenever he had a problem, the husband would be up the next day to fix it. In fact, when he first moved in, the stairs up to his front door squeaked. The next day, they were fixed.

  Tonight the stairs were quiet as ever. He looked through the front door window and noticed everything was pretty much how he had left it that morning. He bought an automatic light switch so when he came home on nights like this he would not have to walk in to a dark house. He put his key into the lock and was glad that the owners installed a new deadbolt since the previous occupants had run off with one of the second set of keys to the old lock. The landlord tried to assure Steve that they were fine people and would never bother him, but Steve felt more secure knowing that he held the only keys to his home.

  As he swung the door open, he heard this clatter coming from the living room. He stopped in the doorway and stood still. Sudden the scurry of feet hitting the hardwood floor sounded. One second later, a big yellow lab raced around the corner and almost flattened Steve. “Down boy, down boy! That’s a good dog. How was your day, Pudge?” Steve called his dog Pudge because the dog never stopped eating. From the very beginning as a pup, Pudge always chowed on anything and everything. He had earned the name Pudge.

  It was nice to have Pudge greet Steve after his first day of residency, especially since there was no one else to do the chore. After letting the dog out, Steve opened the fridge and pulled out yesterday’s meatloaf and warmed it in the microwave. Steve was not a gourmet chef, but he knew how to cook the basics. In college, he always did the majority of the

  cooking. It never bothered him. In fact, he rather enjoyed it.

  While the meatloaf was warming, Steve sat at the dinner

  table and began making a list of the things he needed to get

  accomplished that night. He always made lists to help him stay organized. Tonight the list was short, but his late start time was a problem. He had to go over the orientation material, make a list of the patients on the surgery service and read about their problems, read at least ten pages of his surgery text, and then talk to his best friend. He had never actually met this lady before in person, but he knew her well from chatting on the internet.

  She entered his life about three months before med school ended, about the same time he found out where he was going to complete his surgery residency. It was strange at first, talking to a stranger, but they were like best friends after just a few encounters. Steve was usually very cautious, so when she first entered his cyber world, he was reluctant to converse with her. However, she coaxed him into chatting with her, and eventually they developed a private chatroom so no one would snoop on their conversations. This made Steve feel more comfortable with the conversation, but then he went through a phase where he thought she might actually be a he. He stopped talking with her for about a month after that. She never sent a picture of herself but assured Steve that she was, in reality, a woman. She referred to herself as Sweetpea. Tonight, though, Sweetpea might have to take second fiddle to all the things Steve needed to get through before morning. They had talked almost every day since he had gotten over the gender doubts, only missing a day talking to each other for really special occasions. But Steve had to get through his orientation material and learn about his patients. He had also promised himself that he would read a little every day from his surgery text so that he could learn as much as possible before his surgery inservice exam, a yearly test surgery residents had to take.

  After letting Pudge back in, he made a pot of coffee and took his meatloaf to the living room. His TV was up on a meticulously organized entertainment center. On one shelf, he had a few art sculptures, and on another, he had several hard cover books that were neatly sitting upright against each other.

  Steve sat down with his plate of food and turned on the TV to listen to the news. He took a drink of coffee and began to go through his packets of material from orientation.

  After twenty minutes going through boring orientation materials, Steve had enough. He made a file with a manila folder and titled it “Surgical Orientation.” He carried the heavy folder into his second bedroom, which was converted into a small office. A two-level file cabinet stood next to his large oak desk. He sat down and found a place for the orientation file in the file cabinet.

  A framed picture of his family sat on the file cabinet. Steve gazed fondly at his father, mother, and two sisters posing in front of a fountain at a family wedding. It had been too long since he had spoken to any of them. He made a mental note to call his mother in a day or two.

  On his desk were neatly organized papers describing his medical school graduation and information on his medical boards. To the right on his desk laid a beautiful laptop computer. It was a gift from his parents for graduating from medical school. His desk, like the rest of his office and living quarters, was quite organized.

  It was not as though Dr. Carmichael was some obsessed neat freak, but he was brought up in an organized home, and the pattern stuck. When he first left his parent’s home, he couldn’t wait to get to a place where he didn’t have to make his bed every day, but as soon as he moved into the college dormitories, he found himself making his bed every morning out of habit. It was one of several habits he had planned to break once on his own, but they were so engrained in his everyday life that they could not be broken.

  After filing his orientation material, Steve turned around to a matching bookshelf and pulled out a surgery text. He grabbed several index cards and wrote the names of a patient on each card. He put down their primary diagnoses, their medications, allergies, their past medical history including operations, and any relevant social or family history. Steve reviewed all of the different problems the patients had. Those he didn’t recognize, he looked up in his text. He continued until his eyelids were heavy and about to close. Finally, he gathered the cards together neatly and placed a clip on them.

  The time was 11:25 PM. He still wanted to chat with his friend online, so he organized ever
ything for the morning, got ready for bed, and turned on his computer.

  Steve and Sweetpea met in a private chatroom. They tried to connect together around eight every night, but Steve had warned her that he was about to begin a new job that would have some terrible hours. She asked him what was so demanding that they would not be able to talk to each other every day. Steve was reluctant to tell her about being a doctor and a surgeon, but just before school ended, he told her that he was a med student about to graduate. She took it much differently than Steve imagined. She was just every bit as excited as Steve was. He figured that was probably why they were such goods friends. They talked a lot about medicine and Steve’s career in surgery. He confessed right before his internship was about to start that he had fearful thoughts on the surgery training experience. Sweetpea talked him through it and made him feel like he could accomplish anything.

  As much as they talked about Steve and his plans, he still didn’t know exactly what she did. He asked several times, but she always evaded the question and managed to get them on to a different topic, yapping about the Bahamas or skiing in Colorado. Nonetheless, Steve wanted to fill her in on the details of his first day, so he signed online and went to their chatroom.

  She was waiting for him. “Hi, Steve. You must be really tired. I mean, it is almost midnight. Don’t those residents you work with have any heart? You’re just an intern in his first week.”

  Steve replied, “You would think they would give us a little break, but there is so much to learn about how to take care of patients. The more senior residents feel that the sooner they teach us how to handle all the everyday pidly stuff, the sooner they can do other things like enjoy surgery and not have to worry about taking care of the patient because that’s the job of the intern. In other words, the better the intern is, the more surgery the senior residents can do.”