by Robin Cook
Lynn quickly retraced her steps, and after a short wait, boarded one of the main elevators on her way up to five. Unfortunately it was a local, stopping at every floor to discharge or pick up people. Pressed into the back of the car, Lynn tried again with her tablet to see if Carl had been assigned a room yet, but he hadn’t. She expected it was going to happen at any moment.
Once on five, she went directly to the main desk. Like the rest of the hospital, the floor could not have been any busier. To add to the chaos, the breakfast trays were in the process of being collected. The nurses who had long since finished report were getting some patients down to surgery, welcoming others back from the PACU, attending to doctors’ orders, distributing medications, and arranging transportation to radiology and physical therapy. It was comparative bedlam.
Lynn knew many of the people who worked on the floor from her monthlong elective back in October. She looked for the head nurse, Colleen McPherson, with whom she had gotten along well, but didn’t see her. When she asked another floor nurse, she learned that Colleen was in with a hip replacement patient whom they were trying to mobilize. Instead Lynn went back behind the desk to chat with Hank Thompson, the ward clerk. In the hospital hierarchy run by the nurses, medical students were low on the totem pole, but Hank had never treated her that way. He was a student at the College of Charleston and doing his own version of a work-study program.
Like everyone else, Hank was doing six things at once. He was on the phone, with a number of people on hold. While waiting, Lynn pulled up the master list of all the patients on the fifth floor on one of the monitors. It was organized according to room number. She ran her finger down all the names, looking for Vandermeer. It wasn’t there. But there were several vacant rooms, so she thought there wasn’t going to be a problem. She was pleased. It was best for orthopedic patients to be on the fifth floor because the nurses and aides were well versed in handling the usual problems that had to be faced by post-operative orthopedic patients, like dealing with the CPM, or continuous passive motion machines, which flexed and extended joints immediately after surgery. Lynn knew that Carl would have one because Weaver used them with all his ACL cases.
When Hank finished with the people on hold, he started to punch in the numbers to make another call. Lynn grabbed his arm.
“Two seconds of your time, Hank! A patient by the name of Carl Vandermeer will be coming to the floor shortly, unless he is already here. Does the name ring a bell?”
“Not that I remember,” Hank said with a shake of his head. “Who’s the doctor?”
“Weaver.”
Hank grabbed the master OR list and scanned it. “Yeah, here it is. It was a seven-thirty case.” He looked at his watch. “Should be coming up any minute, unless there was a complication.”
“It was a straightforward case. First operation. Healthy, young guy.”
“Shouldn’t be a problem. We have several rooms vacated this morning, and they have already been serviced, so they are clean and waiting.”
Lynn nodded and absently played with a paper clip. Hank turned his attention back to the phone. It occupied 90 percent of his day every day.
Lynn knew she should probably head over to the eye clinic. The lecture would be over and patients were probably lined up to be presented and examined by the medical students. Yet she knew she wouldn’t be able to concentrate until she was certain Carl was comfortable and all was in order.
Suddenly she stood up. Feeling she couldn’t just sit there, she decided she’d go down to the second floor and at least check the OR schedule. There could have been a delay in getting started. What if Weaver had come in late for some reason? What if the OR was short of nurses? There could be millions of reasons why a case could be delayed.
Lynn took an elevator down three floors. Feeling a bit like a fish out of water, she walked into the surgical lounge. It was another one of those places medical students didn’t wander around unaccompanied. Like the rest of the hospital, it too was crowded, since the OR was in full swing. Most or all of the lounge-style chairs and couches were occupied by doctors and nurses. All were in scrubs. A TV in the corner was tuned to CNN with the volume turned way down. Most people were reading newspapers, either waiting to begin or taking a quick break in the middle of cases already under way.
Fearful of calling attention to herself and possibly being ordered to leave, Lynn didn’t hesitate. She stepped into the room far enough to see the image of the OR white board in the monitor mounted on the wall. She looked for Weaver’s name and found it in OR 12. He was doing an anterior cruciate ligament, all right, but the patient’s name was Harper Landry, not Carl Vandermeer. So obviously Carl’s case was over.
Lynn’s eyes scanned around the room for a familiar face, somebody, anybody she might know however vaguely from either her orthopedic elective or from third-year surgery. But she didn’t recognize anyone. With sudden resolve she went into the women’s changing room.
Getting some scrubs, she changed quickly, using an empty locker for her clothes. After tucking her moderately long hair into a cap and grabbing a surgical mask, she checked herself in the mirror. The almost-white surgical hat emphasized her olive complexion, and without the benefit of her thick hair to frame her face, she thought her youthful, angled features and slightly upturned nose made her appear younger than she was. Combined with her height, she worried she was going to stand out like a sore thumb as a first-year medical student who didn’t belong. More to conceal her identity than to be aseptic, she put on the mask.
Satisfied, she returned to the lounge. Without hesitating, for fear she would lose her nerve, as Lynn generally followed rules, she walked out of the lounge and pushed her way through the double doors into the OR suite. She had been there before on numerous occasions during her monthlong orthopedic elective and even a few times during third-year surgery, but always accompanied. She had even assisted Weaver as well as a few other surgeons to get a close-up idea of orthopedic surgery. To her, orthopedic surgery was a lot different from what Karen had suggested. It wasn’t eye surgery, to be sure, but with newer tools it was considerably more precise than it had been.
Lynn half expected that she would be challenged, but she wasn’t. She kept moving at a good clip with the belief that any hesitation on her part would be a tip-off that she was an interloper. Her destination was the PACU, and she headed directly for it. She pushed through the second set of double swinging doors as if she belonged, but then stopped a few feet inside the room.
For most people, Lynn included, the PACU was a busy, alien world of high tech, which made students feel incompetent. The patients were on elevated beds with side rails. Most of the beds were occupied. There were no dividers between the beds. Each seemingly sleeping patient had at least one nurse, many with a nursing assistant as well. Fresh bandages covered varying areas of the patients’ bodies. Clusters of intravenous containers that appeared like plastic fruit hung on the tops of metal poles. The lines snaked down to run mostly into exposed arms, although a few were central lines going into the neck. Monitors were clustered on the wall over the head of each bed, with various electronic blips tracing lines across their screens. Plastic bags hung under the beds for drainage and urine. Several of the patients had ventilators for assisted respiration. The sounds in the room were a mixture of the electronic beeping, the cycling of respirators, muted voices of the nurses, and a low hum of powerful HVAC motors keeping the air in the room clean and cool.
Right behind Lynn, a gurney came crashing through the swinging doors, bringing in a fresh post-op patient and making Lynn jump out of the way. An OR nurse was pulling at the front. In the back was an anesthetist pushing while making sure that the patient’s breathing was not being compromised. A nurse from behind the central desk came around to help guide the gurney alongside an empty bed.
As the patient was efficiently moved from the gurney onto the bed, Lynn took a quick loop around the
room, trying not to be conspicuous. None of the staff seemed to notice her. Carl was not there. She would have recognized him immediately. There were two people who had had knee surgery with CPM machines to keep their knees constantly flexing and extending. Neither was Carl.
Confused and not knowing exactly what to do, Lynn wandered over to the counter facing the central desk. She assumed she would soon be challenged, but felt it no longer made a difference. If Carl was not in the PACU or on the fifth floor, then where the hell was he? And why was he not on the orthopedic floor? There were beds available, according to Hank. Of course maybe Carl had been finished so soon that it was before the beds on five were ready. Hank had said that they had been vacated just that morning. Lynn felt that had to be the explanation. Yet the ongoing mystery was starting to upset her, fanning the subliminal tension she had felt upon awakening that morning, the same tension that had made her laugh so hard at Ronald’s off-color joke about the angel.
“Can I help you?” a voice questioned.
Lynn turned to face a PACU nurse almost as tall as she. The nurse was gowned over her scrubs. She regarded Lynn with a questioning, steady gaze.
“I hope so,” Lynn said. “I’m looking for Dr. Weaver’s first case. A man named Carl Vandermeer.”
“And who are you?” The woman’s voice wasn’t challenging or truculent, just authoritative.
“I’m Lynn Peirce, a medical student. I did a rotation in orthopedics and scrubbed with Dr. Weaver.” It was the first thought that came to her mind. It wasn’t a real explanation, but it sounded good.
The nurse eyed Lynn for a moment, then went behind the desk. “The name is not familiar to me,” she said. She took a quick look at the PACU log and found it. “He was Gloria’s case,” she said to Lynn, and then called loudly across the room. “Gloria! What was the dispensation of the Vandermeer case?”
“The neuro consult guys took him to the neuro ICU,” Gloria called back.
Lynn reached out and grabbed onto the edge of the desk to help support herself. The neuro ICU! What the hell did that mean? As she turned and fled from the PACU, she tried not to think. The problem was that she had a pretty good idea of what it meant for Carl to be in the neuro ICU.
4.
Monday, April 6, 11:05 A.M.
Lynn was in a hurry. It was a way to avoid thinking. Without bothering to change back to her street clothes, she went directly to the main elevators, where a number of people were waiting. To avoid the possibility of getting into a conversation, she avoided any eye contact, keeping her attention glued to the floor indicators above the elevator doors. Nervously she continuously pressed the up button. None of the cars appeared to be moving up or down.
“That’s not going to get the elevator here any faster,” a woman said. Lynn closed her eyes, hoping that by not responding she would be spared having to try to be pleasant while her mind was in turmoil. There was nothing about Carl being in the neuro ICU that could be good news, and it was difficult not to imagine the worst.
“You are a fourth-year med student, if I’m not mistaken,” the voice said, undeterred by Lynn’s silence.
Reluctantly Lynn turned to face the woman. As soon as she did, she recognized her as one of the surgical attendings. She was wearing a long white lab coat over scrubs. Lynn assumed she was between cases and heading up to the surgery floor to check on a patient.
Lynn tried to smile in an attempt to be sociable. Her pulse was throbbing in her temples. She wondered if her face was red or pale. It had to be one extreme or the other, as she was experiencing an adrenaline rush. She was aware she was hyperventilating. She nodded. “I am,” she said distractedly. What the hell could be holding up the elevators? Still none had moved from the various floors where they had been when she first hit the button.
“Lynn Peirce,” the surgeon said, bending forward and reading Lynn’s ID hanging from a lanyard around her neck. “Actually, I remember you from your third-year surgery rotation. I’m Dr. Patricia Scott.”
“I remember you for sure,” Lynn managed. “Your lectures were terrific, especially your slides.” Lynn forced another half smile at the tall, elegant woman before returning her attention to the elevator floor indicator. She hoped her anxiousness wasn’t too apparent. She didn’t want to explain herself.
“Thank you. You must have been paying attention. I remember you did extremely well. I understand you got your residency notification a couple of weeks ago. Considering how well you did in your surgery rotation, I hope you gave surgery some consideration.”
“Orthopedics, actually,” Lynn said.
“Indeed! That’s terrific. We need more women in all the surgical fields, particularly orthopedics, where we are not very well represented. Where will you be going for your training?”
“I’m staying here,” Lynn said.
“Wonderful,” Dr. Scott said sincerely. “That’s super. I’ll look forward to having you scrub with me during your first year of general surgery.”
“I’m sure I will enjoy that, Dr. Scott,” Lynn said, hoping she didn’t appear as preoccupied and stressed as she felt. Finally one of the elevators that had seemingly been parked on the first floor began to ascend.
“You can call me Patricia now that you will be part of the house staff. And, for the record, my office is always open if you need any advice. It wasn’t that long ago I went through the training gauntlet, and unfortunately surgery is still anachronistically considered by some to be a men’s club.”
“I appreciate your thoughtfulness,” Lynn said.
The elevator’s doors opened. The car was jam-packed. Dr. Scott gestured for Lynn to precede her, and both had to literally squeeze in to allow the doors to close. Lynn was briefly tempted to ask Dr. Scott what it meant for a patient to go to the neuro ICU directly from the PACU, but she didn’t. The trouble was, she could guess. It had to have been some kind of anesthesia problem or disaster. Yet she still maintained a certain amount of hope it could have been something less worrisome. Could a nerve in Carl’s leg have been damaged with the bone drill? As bad as that might be, it was better than other possibilities she was trying to avoid imagining.
By the time they got up to the sixth floor, where neurology and neurosurgery were located, the elevator had emptied considerably. Lynn thanked Patricia Scott before getting off. She walked quickly. She knew where the neuro ICU was located. She’d been there on a few occasions during her neurology rotation and again during her stint on neurosurgery.
Most visitors to the floor were expected to check in at the main nurses’ station. But Lynn decided on the spur of the moment to act the same way she had down in the PACU: as if she belonged. Without hesitation she pushed into the ICU directly.
The neuro ICU appeared superficially similar to the PACU in terms of its prominent high-tech equipment, but here patients stayed much longer, sometimes weeks, even months on occasion. There were separate cubicles defined by glass walls, and not all the patients were sporting bandages. There was also less frantic activity from constant arrival and departure. Instead, a kind of heavy silence reigned, broken only by the distant beeping of monitors and the rhythms of the ventilators. A central circular desk was positioned to afford a view into each of the sixteen individual bays. All were occupied. At least half had nurses in direct attendance.
As Lynn glanced around the room she saw that each cubicle had an ID slot with the patient’s name printed in bold letters. Almost at once she zeroed in on VANDERMEER, cubicle 8. Slowly she advanced. Carl was supine. She could not see his face. As she had expected, there was a CPM apparatus constantly flexing and extending his operated leg. Seeing it gave her a modicum of premature hope that everything was as it should be, but it didn’t last long.
Two people were in attendance. An ICU nurse was on Carl’s right, checking the blood pressure by hand, even though there was a BP readout on the monitor. On Carl’s left was a resident physic
ian dressed all in white. He was using a penlight and shining it alternately into each of Carl’s eyes. It didn’t take Lynn long to recognize that Carl was unconscious. She could also see that he was evidencing some low-amplitude myoclonic jerks with his free leg. His free arm and wrist were flexed across his body. The other arm with the IV was secured to the bed rail.
Coming up to the foot of the bed, Lynn looked at the monitor. Blood pressure was normal. The same with pulse and the ECG, as far as she could tell, but she was no expert with ECGs. She could see that oxygen saturation was down a little but still reasonable at more than 97 percent. Carl seemed to be breathing normally. She forced herself to glance at his face, which she could now plainly see. His color wasn’t bad, maybe a little pale. The worst part was that it was definitely Carl and not someone else.
As the resident straightened up he noticed Lynn. Slipping his penlight into his jacket pocket, he asked, “Are you from radiology?” Then without waiting for an answer, he added, “We are going to need an MRI or a CT scan ASAP.” Lynn could read his name tag: Dr. Charles Stuart, neurology. He was a slight man with thinning hair, small features, and rimless glasses.
“I’m not from radiology,” Lynn managed. Seeing Carl unconscious and possibly seizing was almost too much to bear. “I’m a medical student,” she added. She reached out and grasped the railing at the foot of the bed to steady herself. As she had in the PACU, she felt suddenly light-headed. A hospital was a place of tragedy as well as hope, but this was turning out to be all tragedy. “What is going on?” she asked as casually as she could.
“It’s not looking good,” Charles said. “It seems that we are dealing with a delayed return to consciousness after reportedly uneventful anesthesia for a routine ACL repair. So far it is a mystery as to why.”
“So he hasn’t awakened?” Lynn asked, not knowing what else to say, yet feeling as if she had to say something to warrant standing there.