Critical Condition

by Peter Clement

  His two charges asked a few questions about what to expect next, then uneasily returned to the cribbage game they'd elected to play, the better to keep their minds occupied with the count and away from nightmare scenarios.

  "I'll call back in an hour for another update," Richard added, hoping the prospect of not having to endure the full six hours without news would help relax them. Instead it only increased the frequency with which they kept sneaking anxious glances at the clock.

  He moved his own nervous pacing outside onto the sidewalk of Thirty-sixth Street. Facades of the houses adjoined to his formed a three-story wall along the length of the block. The stones of each dwelling tinted a different color held and gave back the heat of the day. Warmth radiated across Richard's shoulders as he paused to lean against the deep brick-red front that distinguished his home from the rest.

  The humid mid-June air enveloped him like extra clothing until his shirt grew sticky against his skin. He moved then, heading toward Lexington, hoping that something along the way would distract him from the curse of all doctors— knowing too well what could go wrong. But at the corner he could see the sprawling shape of New York City Hospital towering over the other buildings. By counting down from the top, he identified the OR floor. There being only a single set of lights burning at this hour, he found himself looking straight at the windows behind which Hamlin was at work on Kathleen. He retreated back to his house, craving a cigarette as badly as he'd ever wanted one since quitting one and a half years ago. But he didn't yield. Giving them up had been part of a pledge he'd made, after having drunk, smoked, and grieved himself into a heart attack, almost leaving Chet an orphan.

  He grabbed a fistful of carrot sticks from the fridge and crunched down on them.

  At two o'clock he was back using the phone.

  "They've raised the tonsils of the cerebellum, a rear part of the brain lying over the pons, and exposed the area they're after," he explained minutes later; the two teenagers listened attentively but with puzzled looks. "It means they can see the part of the brain stem they're after. It's swollen and has an underlying brown discoloration where the hemorrhage is. They're ready to cut into it as we speak."

  What Richard didn't say was that this would be the moment of truth. If Hamlin opened the cavity of the angioma and set off a bleed he couldn't bring under control, Kathleen was lost.

  Peering through his operating microscope, Hamlin carefully slit the cavernous sac containing the tangle of vessels that had bled and peeled back its edges using microretractors. Fresh blood surged out the opening, immediately flooding his surgical field and making it impossible to see anything.

  "Suction!"

  The resident opposite him, looking through the eyepiece on her side of the microscope, touched the tip of a tiny silver catheter to the welling red pool. With the sound a straw makes at the bottom of a milkshake, the fresh blood receded, enough to reveal lumps of old clots the color of liver, and a jet of crimson that pulsed up from deep within the cavity.

  "Quickly, visualize the site of the bleed," said Hamlin, picking up his own microsuction. Together he and the resident removed more bits of gelatinous clot mixed with fresh blood, burrowing ever deeper into the small cavity. Their progress was slowed by the delicacy of the surrounding structures and the fact that the opening they were working in was no more than four millimeters, or a quarter-inch across.

  "How are the patient's vitals?" he kept asking.

  "Stable so far," the anesthetist assured each time.

  As they got farther in, they came across the first of the abnormal vessels. It bled as soon as they lifted a piece of clot off it.

  "I've got 'er," said Hamlin, zapping it with the point of his bipolar coagulator, a device resembling a minuscule soldering stick but which electrocutes blood in a vessel, instantly frying it to a solid. The bleeding stopped, but the culprit they were after kept pulsing bright red from below.

  "Keep going," said Hamlin.

  The two doctors worked furiously, setting off more bleeds and coagulating them as they went. Finally they lifted off a piece of clot and uncovered a ball of vessels the size of a raspberry. Hamlin spotted the crimson rivulet that they were looking for; it was coming from one of the lower vascular loops.

  "Got you," he said, touching his coagulator to it.

  They spent the next two hours coagulating and cutting away all the feeder arteries and shrinking down the central structure, until nothing but a shriveled husk of its former self remained, and this Hamlin removed in its entirety.

  "Anybody see any bleeding?" he said, inspecting the now-empty capsule that he'd cleaned out as he irrigated it with a mix of normal saline and antibiotic solution. All the other residents around the table strained to see the video monitors where they'd been following the procedure.

  "None."

  "Looks clean."

  "I think we're done."

  "What a great job, Dr. Hamlin," said the sole female who had assisted him during the procedure. "You were fantastic."

  Others joined in.

  "Yes."

  "Absolutely."

  "Bravo."

  "Okay, one last touch," said Hamlin, enjoying the accolades and eyeing his lady protegee. An attractive blonde in her late twenties, her name was Rachael Jorgenson, and beneath all her surgical garb she had a body he'd been impressed with from her first day on his service. Entertaining thoughts of inviting her back to his office to discuss her future, he picked up a small syringe he'd kept sequestered to one side of his tray. From it he slowly infused a few cc's of clear fluid into the still-open cavity.

  "What's that?" she said, still standing across the operating table from him.

  "Ringer's," he lied, referring to a colorless physiological solution intended for intravenous use that normally mimics the electrolyte and sugar composition of blood. "A little bath of the stuff at the site of surgery minimizes the swelling of brain tissue afterward. At least that's what a group out West are claiming. It's apparently got to do with osmotic pressure, the way a poultice of salt and water draws off the edema of inflammation. I do it on all my cases now."

  As with most necessary deceptions, he'd kept the cover-up simple and credible. Each new batch of residents, the nurses, and anyone else who happened to be in on his cases always bought it.

  Flush with success over both the magnificent job he'd done on Sullivan and what he'd once more pulled off under everyone's noses with no one the wiser, he eyed Rachael. "Step over here to my side of the table and into the driver's seat, Rachael," said Hamlin, standing aside and offering her his place at the operating microscope. "Tonight, or this morning rather, the job of closing falls entirely to you." Groans of disappointment came from the rest of the group, "closing" being an honor coveted by all.

  "Why, thank you, Dr. Hamlin." She moved into position, looked through the binocular eyepiece, and, using tiny silk sutures, proceeded to sew up the opening they'd made in the covering dura. As he leaned closer to inspect her work, she nestled into him.

  Well, well, he thought. As pedagogical affairs went, this felt most promising.

  Chapter 4

  Friday Morning, June 15

  Her mind cleared.

  Voices came and went.

  She recognized Lisa.

  Chet, too.

  Where was Richard?

  All the voices reassured her that she would be all right.

  They must be lying.

  She wasn't all right.

  She couldn't even see.

  And one voice frightened her, yet she couldn't remember why. "We have to keep you sedated, Dr. Sullivan," he had said. "Don't worry, the operation went fine. Just relax."

  She wanted to scream at that particular piece of advice. But she was too drowsy to even open her eyes, let alone move any other muscle in her body. How had she gotten this way? She knew there was a good reason but couldn't recall what it was. Her mind clouded over.

  She dreamed she was buried alive, submerged in quicksand, and
pinned in a straitjacket. She awoke to the sensation she'd been imprisoned in cement that had hardened around her as she slept. Was she sleeping or awake now? She wanted to turn over— and panicked at her inability to move. Then the alarms on her monitors went off, loud as car horns it seemed, and frightened her even more. She heard the nurses running to her, the swish of the curtains as they swept them aside, and their chatter that sounded like shouting.

  "When was her last dose of midazolam?"

  "Two hours ago."

  "Christ, she's going through this stuff like candy. Maybe Hamlin should change it to something more long acting, or she'll be addicted soon."

  Why were they yelling? Had she done something wrong? She didn't want any more injections. And did they mean that Hamlin was trying to addict her to that medazzle stuff?

  Oh, Richard, where are you? I need you.

  "You're going to advise his maestro on what medications he should use?" intervened another voice, still awfully loud. "Good luck, sister!"

  "I'm not about to advise Hamlin of anything," said the one who'd mentioned addiction. "That curvy resident he's always making rounds with these days is the one I'll speak with. Let her convince him. Looks to me like she's already got his ear, among other parts of his anatomy. Lord, the way that young woman is always brushing up against him."

  Her companion gave a laugh that pierced the air like a shriek.

  Get away from me! Kathleen imagined that she was surrounded by witches. They must have cast a spell on her, or injected ink into her mind, since everything in her head was black mush. Was it day or night? She still couldn't open her eyes, despite knowing it was important she do so, that there awaited something for her to take care of out there where the shadows were. Again she'd no idea what.

  Time passed. She realized she could perceive changes from light to darkness, even through her closed lids. And if someone loomed over her, she could tell that, too, as their shape caused her to see a darker gray.

  A shadow crossed in front of her. "Can you hear me, Dr. Sullivan?" asked the voice she instinctively feared. Her ears amplified his words to the point they hurt her eardrums. She also found herself acutely aware of his smell— a mix of half-camouflaged body odors covered by a bracing flowery scent.

  She struggled to look at him, and managed to raise her lids a slit. The lights in the room seared like a lash, and she shrank back behind her sole defense— darkness.

  "I think you can understand," he said, this time in a whisper so close to her ear that she felt he had slipped into her skull.

  He'd been there before, she vaguely recollected. And done something bad to her brain. "The medication I've given you has mixed you up, given you troubling hallucinations. Forget them, for your own good. You'll get better faster if you put them out of your mind. You must not let those bad dreams get you excited and interfere with your getting well, understand? Otherwise I can't risk allowing you to see Richard or taking you off the drugs."

  I want you out of my head! She was bursting to scream again.

  Kathleen floated out of sleep, only to instantly recognize the smell of that awful man while feeling him poking and prodding her. Leave me alone, you stinking pig! she yelled, but once more no sound came.

  After enduring his tapping her ankles and knees, then repeatedly stroking the bottoms of her feet with something sharp that sent her legs shooting into spasm, she heard him say, "So what do you think, Rachael?"

  "That it's time to lower her sedation?" replied a woman's voice.

  "Normally, yes. But in this case, since Dr. Sullivan already exhibited symptoms of acute paranoia after her first stroke, and the accompanying anxiety caused a rise in blood pressure that probably precipitated the second bleed, we can't afford to reduce her dose, can we?"

  "I guess not."

  "Guess? You'd be certain if you'd seen her, going on about me putting something in her brain. Of course Dr. Steele didn't help matters any, getting her all worked up and feeding her delusions by encouraging her to communicate them by blinking her eyes."

  "You're kidding."

  "A serious instance of a physician letting his personal feelings interfere with professional judgment. We don't dare let her regain consciousness again until we're sure we can wean her away from such upsetting ideas."

  No, thought Kathleen. He was lying. She remembered now. He and the rat-faced man did inject something into her brain. And he was blaming Richard for making her worse. She tried so hard to protest that the alarms started to sound again.

  "Look at her vitals take off," the woman said.

  "If anything," Hamlin added, "we better up her sedation." Moments later, Kathleen felt a warning swirl and plummeted, free fall, into a silent black void. Saturday, June 16, 9:10 a.m.

  "I still can't let you see her, Richard. I'm keeping my ban on all visitors. Even when I show up her pressure goes off the charts."

  "But, Tony, I can calm Kathleen down, I know it." He'd intercepted the neurosurgeon outside the doors to ICU. The man's resident, a Dr. Rachael Jorgenson according to her name tag, moved a discrete distance down the hallway. "By all means keep the other visitors away. Well-meaning as they are, there have been far too many, and I certainly agree you should protect her from them." Because the comings and goings of doctors are recorded in ICU, the nurses had dutifully logged in Kathleen's chart the names of his colleagues who'd stopped by to inquire about how she was doing. On one level the list was personally gratifying. He particularly noted the physicians outside of his department who had taken the trouble to try and see her. Paul Edwards, chief of gynecology, Francesca Downs from cardiology, even Adele Blaine who ran her own rehabilitation institute on the upper East Side paid a visit. While he dealt with these people regularly in ER, he couldn't say they were friends. Their reaching beyond the professional to make a personal gesture moved him deeply. But no way was Kathleen ready for such onslaughts of thoughtfulness. "I swear, Tony, I'll put out the word myself that no one else is to bother her. And when I'm at her side, I'll keep my mouth shut, not make so much as a peep, and just hold her hand."

  Hamlin shook his head, the white mane adding to his authority. "The vascular ends of all those arteries I sealed off are still fragile. They'll give way unless she remains completely quiet."

  "She must be terrified."

  "Not with what I'm giving her."

  "Christ, Tony, I know I screwed up big-time—"

  "Yes, you did. And by the way, so you're forewarned, I just learned one of the nurses reported you to Gordon Ingram."

  "What!"

  "Sorry. It wasn't my intention."

  "But—"

  "Look, do as you're told, and I'll have a word with him," said Hamlin, turning to walk away.

  "Jesus, Tony, the last thing I need is to have Ingram on my back right now."

  "I told you I'll speak with him. With any luck I should be able to make him back off. Of course it will have to wait until Monday morning, and you've got to behave."

  Damn it to hell! thought Richard, shuddering at the prospect of being subjected to an inquisition by the most pugnacious ethicist and quality assurance expert that New York City Hospital ever had. But the man was sure to give him a fair hearing, he reassured himself. After all, Ingram championed excellence as ruthlessly as he ferreted out shoddy care. And, Richard remembered, the fact that he had saved Ingram's life wouldn't hurt his case any. Saturday Evening, 6:30 p.m.

  Ever since Doctor Francesca Downs read her first Wonder Woman comic she wanted a secret life, especially one that involved a trusted sidekick. But that was twenty-five years ago. As time passed, other dreams developed. The fascination she felt at dissecting frogs lured her into biology, then medicine, and finally to the rarefied world of cardiac surgery, where she had neither time for a life, secret or otherwise, nor a sidekick. Until two years ago. That's when she'd fallen in with the "sensational six," as they teasingly called themselves. But now, standing in the center of her walk-in closet and about to dress for tonight's dinner
with her coconspirators, she realized that her once-happy childhood fantasy, sidekicks and all, had become a nightmare. After pulling on the plain black dress she'd chosen, she padded into her bedroom and stared through the dusk at the lights of the greatest city in the world. In the distance she could even make out Times Square where thirty stories of dazzling neon necklaced the famous intersection with a crossed, thousand-watt strand of glitter. Her thoughts drifted to when all six of them had first got together at the place that had become their permanent meeting spot. A heavy rain had been pelting against the full-length windows at Lauzon's, a French restaurant with a private dining room overlooking Eighth Avenue. Droplets cascading down the glass rendered the gaudy points of color outside as insubstantial as a shower of champagne bubbles. The cut off setting proved a fitting bower for hatching a scheme so ripe with promise it blurred the prospect of consequences and made the risk seem remotely vague enough to be acceptable. The decisions they made that evening were the real intoxicants, so loaded were they with possible accomplishment. Together the six of them toasted each other, raising tall crystal flutes in celebration of their daring. As the pale golden fluid effervesced merrily in the light, Francesca believed she had finally arrived in the winner's circle.

  She had even allowed herself a moment of feeling glamorous that night, having caught sight of her reflection in one of the full-length, smoky mirrors adorning the walls. Its flattering softness gave her white complexion and blond hair a golden glow that the harsh lights of the hospital never did, and she liked how her red cocktail dress showed off her breasts and hips the way no scrubs or lab coat ever could. That dress was hanging in her closet now. She had so few opportunities to wear it that whiffs of stuffiness wafted off the material. Whenever she did put it on, that scent, she figured, served as warning to anyone who came near that she didn't get out much and therefore probably had something wrong with her.