by Barbara Ebel
“Thank you,” Kevin said watching her another second before taking the cystoscope and inserting it into the patient’s urethra.
The patient started to doze with the sedation the anesthesia resident slipped through his IV. Rachel continued to stand behind the doctor.
“Usually,” Kevin said, “how long it takes to do a TURP depends on how enlarged a man’s prostate gland is.”
“I feel bad for older men who get benign prostatic hypertrophy,” she said. “The symptoms must be terrible and limit some of their lifestyle.”
“You’re going to do fine in this room. What did you say your name was?”
“Rachel … Rachel Hendersen.”
-----
Tara sat on the stiff chair while Floyd paced across David’s ICU room waiting for staff to transport him to surgery. Annabel was going to skip her late morning class and had arrived a short time after them. “Do you mind if I join you?” she had asked.
David waved her over. “I’m so happy to see you,” he said, “but you know you didn’t have to come.” She kissed him on the lips and gripped his hand.
“I want to be here,” she said. “After your surgery, I’ll still try to get here a lot. But I know you’re going to be laid up for a long time. Maybe I can bring some books and come study here once in awhile. I can bring you something to read, too.”
“If your dad’s invention works out,” David said, “then you won’t have to study here at all.” He smiled and squeezed her hand; Annabel blinked as she didn’t know what he was referring to.
A rail-thin nurse came in. “They’re getting your chart and paperwork from the desk to take you downstairs,” she said, displaying a syringe. “This is a preop sedative ordered by anesthesia. Here you go. Enjoy the slumber.” She injected the Versed into his IV and left.
“David,” Annabel said, “what invention are you talking about?”
David’s eyelids began to sag and she heard concerned murmurs from his parents. She got up and stepped back while staff came in and began unhooking monitors.
“You all can wait out in the lounge or the OR waiting area,” his nurse said.
After quick good-byes to David, the three of them proceeded to the empty waiting room. Two pots of coffee sat on a warmer; Tara poured some decaf, stirred in a creamer, and took her cup to a couch.
“David said something back there,” Annabel said while lowering into a comfortable chair. “Has the plan for surgery somehow changed? Is my dad using some new equipment or something?”
“I guess it makes sense,” Tara stuttered, “that your dad can’t tell you everything about his care of patients. He told us of a new system he’s developed. It would eliminate David’s long stay in the ICU. It’s a wireless system for seizure monitoring. But … but … as it’s experimental, we don’t know yet.”
“He made it?”
“Yes, dear. Apparently he’s been holed up in a research lab besides trying to manage his practice. It was his creative brainstorm and long hours which may bring this to fruition.”
“I didn’t know,” Annabel said almost in a whisper.
-----
David was Danny’s first case of the new week. He’d had a good night’s sleep and had gone through the equipment in his mind over the weekend and felt optimistic about using it for the first time. Even though he’d developed it with David in mind, he hoped it would be successful and that the same thing - or a version of it - could be used again and again in future patients.
He stood next to the OR table as his favorite anesthesiologist, Dean, placed the mask over David’s face and asked him to take some big deep breaths. “See you in recovery,” Danny said.
“Night, night,” Dean said as David’s lungs filled with oxygen and he injected old-fashioned sodium thiopental in his IV. Dean still preferred its use for neurosurgical cases if there was no contraindication. When David was unconscious, Dean safely inserted the endotracheal tube and the table was moved forty-five degrees from the anesthesia equipment. The top of David’s head already had a large shaved circle for where the surgery would take place.
With Dean’s nod of approval that his patient had enough anesthesia on board, Danny finished preparing David’s head by putting it in a fixed position using a 3-pin fixation device which he bored into the skull
Danny went out to scrub but looked in the window while the nurse prepped David’s scalp with an antiseptic. He thought over David’s journey to getting here … the irony of the teen’s problem starting at a recreational event - a college basketball game – and, later, suffering a secondary impact. Now he’d have his skull opened up for a brain procedure because of seizures and it shouldn’t be the last time either.
Annabel may be involved with David the rest of her life, Danny thought, as he scrubbed thoroughly between each finger. Besides the fact that she already found fault with him, it made him carry a heavier burden than usual for the welfare of his patient.
He pushed the door open with his foot and went back in. Dean still buzzed along with padding David’s arm resting on an arm board where he had access to an IV, hanging the Foley catheter bag where he could monitor urine output, and administering the anesthetic.
After the scrub tech helped Danny get gowned and gloved and they applied all the sterile blue drapes, he got comfortable at the head of the table. He asked for a scalpel and made his incision on skin. After completing a long, rounded incised area, he folded back skin, muscles and tissues, exposing David’s skull. His heart thumped against his chest; now came the more difficult part, especially since he knew his patient. He glanced at the scrub tech who handed him a high-speed drill and he bored several small holes. With a bone saw, he cut out a flap through the holes.
Danny straightened his posture for a moment and glanced at Dean who was standing with attention. “All’s good up here,” Dean said. He nodded with appreciation and then removed the bone flap to expose David’s brain tissue.
Danny allowed himself a big sigh and Dean sat down to begin his paperwork. “I understand this is a novel case,” Dean commented.
“Yes,” Danny said. “And let’s pray that it works.” He reached over to the instrument tray and picked up a network of electrodes which looked like little white, round sticky pads on sheets of cellophane. “These are electrodes which have been whittled down to 100 micrometers in diameter.” He smiled under his mask. “Versus 10 millimeters.”
“Nice,” Dean said, holding a pen between his fingers.
Danny laid the grid back down and suctioned the bloody oozing around the edges of the moist cortex. For the next hour, he worked on electrode placement as if precisely setting up the pieces of a chess game on an open brain instead of a board.
Dean lowered the amount of anesthetic flowing from the vaporizer as the present part of the case was less stimulating. He stood and stretched his legs. “I understand this is the premier college basketball player who had those two head injuries. Have you been taking care of him all along?”
“I have, along with Penny Banks. He’s also dating my daughter. If it had been more serious than college dating, I would have considered it a conflict of interest to be caring for him. I couldn’t turn my back on him, however; I was even at the basketball game for the first head injury.”
“That’s a tough one, Danny. But, knowing you, your patient has benefited from your involvement. And I hope your daughter knows what an excellent father she has.”
“That’s to be seen. Maybe when hell freezes over.” Danny reached for the next equipment and held it up for Dean to see. “This is the tiny microchip and antenna which I’ll implant right here. So, the electric signals from the epilepsy will be captured and processed under the skin in this miniaturized station.”
“And then what?” Dean asked.
“Via wireless power transfer from the outside, this internal device is powered.”
“Electromagnetically?”
Danny nodded affirmatively. “Inside here, the system can process a lo
t of data and then transfer it to an external unit.”
“Why not let a mobile phone pick up the data?”
Danny laughed. “One step at a time, one step at a time,” he said while implanting the last pieces of the process. He stopped to suction several times and was finally satisfied as he looked down at the living, breathing brain with attached paraphernalia. It made him think of the movie Matrix.
“Thank you for not turning the radio too loud during this … you can crank it up now.”
As he heard the country music, Danny asked the scrub tech for David’s bone flap, put it back in place with some soft wires, then placed a temporary drain for excess fluid.
Finished, he hummed a Blake Shelton song as he left the OR knowing David would wake up just fine under Dean’s care.
Chapter 22
Danny shed his OR shoe covers, mask and hat and walked straight to the waiting area where Tara and Floyd were more than anxious. To his surprise, Annabel was there, too. Wearing a school T-shirt, blue jeans, and sneakers, she looked more relaxed than her boyfriend’s parents.
Except for the overhead television on a low volume, there were no other distractions in the room. Danny motioned for them to stay seated while Floyd asked how David was doing.
“He’s on his way to recovery and he did just fine.”
“Thank goodness,” Tara said.
“After some time in recovery, he’ll go back upstairs. We’ll keep you posted when he can leave the ICU and, hopefully in these next few days, I’ll send him home. We’ll have a chat about that when the time comes.”
“Are you happy with the equipment you used, doc?” Floyd asked.
“So far,” Danny said.
Annabel lowered her head. There wasn’t much she could say in front of the Bells about her father’s work on a new system or that he’d developed it.
“Any more questions? Otherwise I better get going as I have another case.”
The Bells shook their heads. “No, and thank you so much,” Floyd said.
“You’re welcome,” Danny said. “Annabel, I hope you had a nice weekend. Call the house later if you’d like. We have some news.”
“Okay,” she said. “Thanks.”
-----
Rachel followed Robert around another Monday morning in the cysto room studying every aspect of how to set up for the day. When they were as prepared as possible, he opened up his newspaper in the supply room and took out the crossword page; he folded it into a neat section, smoothed it out on the counter, and took out a pencil from the drawer.
“Good morning,” Dr. Mcbride said, walking in and placing down a small duffel bag. “Rachel, you’re a nice break from only Robert being here.”
“You won’t have me to look at much longer,” Robert mused. “But then again, you’re not a permanent fixture either.”
“So true,” he said. “A real job waits. West coast, here I come.”
“Aren’t you dating someone?” Robert asked. “Is she going with you?”
“It’s nothing serious. Her job is here and she’s not the adventurous type. Once I get out there, a long-distance relationship isn’t going to work so I expect it’ll sizzle out.”
Rachel lost some hope when she heard the bad news that he had a girlfriend but the good news came just as fast. She smiled to herself because hat cinched it. She’d be the bait plus the trap.
“Moving and experiencing new places is good for the soul,” Rachel said. “I look at it as a learning experience. After all, you have to start all over.”
“So true,” Kevin said. “Add a new job and work environment, and you have a big challenge.”
“I hear them bringing the patient in,” Robert said, looking up from his paper. “So what’s the word for a fictitious name?”
“A pseudonym?” Kevin asked.
“Maybe, but how do you spell it?”
“P-s-e-u-d-o-n-y-m,” Rachel said.
Robert got up and grabbed a spinal tray. “You two are a team,” he said. “Come on Rachel. Let’s get this patient ready for surgery.”
After the spinal block numbness set in and the patient was also groggy, the anesthesiologist sat down and Kevin began. This time, Rachel kept switching out the empty overhead bags used for the TURP irrigation for new ones.
The patient’s prostate was extremely enlarged so Kevin kept chipping away at removing tissue. He stood straight for a moment and took a deep breath as Rachel stood behind his shoulder. “Do you know the risks of all this irrigation fluid to the patient?” he asked her.
“I heard about the paper you co-authored with attending staff so I looked it up,” she said, her breath wafting over his neck when he sat down, her body slightly resting against him. “Patients can have their intravascular fluid volume diluted resulting in decreased sodium or hyponatremia. Am I correct about that?”
After adjusting the cystoscope in the man’s penis, he glanced around and her aqua eyes were right there, staring straight into his. “Yes … good,” he stumbled. “And especially since you’ll be in this room, learn what hyponatremia can cause.”
“Please do teach me what I don’t know. If not now, in the doctor’s lounge or somewhere. Even if I have to move out west this year due to a sick relative, I would still plan on working in a GU room. It seems interesting so far,” she said. She paused, then said softly, “Plus, I believe the field attracts doctors who are the cream of the crop.”
The anesthesiologist raised his eyebrows and gave the patient another milligram of midazolam.
Robert walked out of the adjacent room. “Okay, what’s a seedy fruit of the rose family?”
“How many letters?” Rachel asked.
“Ten.”
“Blackberry,” Kevin said.
Rachel and Robert looked at each other and Rachel shrugged her shoulders. “See? The cream of the crop.”
As Dr. Mcbride finished the procedure, Robert waved Rachel into the supply room. “Get him set up with the Foley catheter and bag. You can put the kit on the instrument tray.” He pointed to the glass cabinets full of supplies.
Rachel grabbed what was needed, walked back in, and opened the kit; now the patient was less sedated and more interested in what was going on.
Kevin took the catheter and began inserting it. “Sir,” he said, also glancing at Rachel for her ears as well, “I’m inserting a catheter to remove urine and blood - or clots - in the bladder. It’s only normal that they occur after the procedure I just did. You’re going to your own room and, when your urine is free of any significant bleeding, I’ll remove the catheter. Your symptoms and BPH will have been taken care of and you can then be discharged.”
“Thanks,” he said. “You’re all welcome to visit me in my room. Just bring one of those crossword puzzles with you.”
“It would be our pleasure,” Rachel said. “I’ll bring you something not too difficult so you have a more pleasurable post-op course.”
Kevin watched their interaction; this woman went beyond the call of duty in her job. He liked that. Besides that, she was easy on the eyes. Very easy.
-----
Sara heard the upstairs door open and Mary and Casey both came down. “Nice to have you down here for a change,” she said.
“We’d be in your face too often if we came as much as we wanted,” Mary said, plucking a cookie off a kitchen plate.
“I had a craving for chocolate chip cookies,” Sara said. “And store-bought ones just don’t cut it.”
“I’ll say,” Mary said. She went to the refrigerator and poured some milk while Dakota nuzzled her for a greeting.
Casey went over to Julia and hoisted her up into the air while she squealed.
“Hey, everybody,” Nancy said, emerging from her bedroom with a dangling headset around her neck and grabbing a cookie.
“Maybe it’s my imagination,” Sara said, “but you seem to be getting bigger by the day.”
Mary rubbed her belly. “I’m not that big … yet. But sometimes I feel that
way.”
“Julia,” Casey said. “See, Auntie Mary has two babies growing inside her. You’re going to have special cousins to play with. After they are born, you can show them things, even help them to learn how to walk. Won’t that be fun?”
“I have a baby puppy all my own,” she said.
“Yes, you’ve told me.”
“Her name is Snoopy.”
“What do you think we should name your cousins?”
“Stupid.”
Casey gulped and Sara frowned. “Julia, that’s not nice,” she said. “Don’t say nasty things like that, especially about your family.”
Julia scowled at Sara. “You’re not my mother.”
“Okay, that’s enough, young lady. I’m taking you to your room where you can be by yourself until we put you to bed.”
When Sara returned, all four of them huddled around the kitchen counter.
“She’s become an absolute handful,” Sara said softly.
“And she’s only two,” Mary said sympathetically. “And her behavior seems to be getting worse.”
“Makes me think I’d never want to have kids,” Nancy said.
“That’s quite a thing to think at your age, too,” Casey said, shaking his head. “But I can tell you that you girls weren’t anything like Julia.”
“Thank God,” Sara said. “I didn’t know I had such fine children.” She beamed at Nancy and put her arm around her shoulder, pulling her in for a hug as the phone rang.
“Casey, you can get it,” Sara said. “Maybe it’s Danny again. He’s still delayed at the hospital.”
He stretched to the wall phone and answered; it was Annabel.
“Yo,” Casey said, “how’s school?”
“It’s okay,” Annabel responded. “The year will be finished soon and I’m looking at job prospects for the summer.”
“Good for you. What do you want to do?”
“I don’t know. Waitress maybe. But I have to shadow Dad a little bit for the extracurricular activities they like to see on a med school application.”