by JJ Gould
Sean Clarke, the CRNA, number three in the pecking order, leaned over the patient to get her attention. “You ready, Midge?” he crooned. “How’s that Elvis song go—‘Love Me Tender’? Can you sing me a little?”
The patient smiled. Sean was a looker and a favorite among the patients. He must have found out she was an Elvis fan. “Love me…” murmured the patient.
“Aaannd… she’s out.”
Good thing too. The clock on the wall said 6:58 a.m., and if the gossip Janet had heard about Dr. Hall was right…
Bang!
The double doors to the OR blew open, and a tall and imposing figure stormed in. The girl at the nurse station—Jennifer, Jessica?—jumped. Janet was pretty sure this was her first week. Her desk was along the wall so she would be ready to call out for help or support if the doctor needed anything. She didn’t have much to do, but her schooling put her above Janet and the other scrub tech in the pecking order, even though she looked like she could still be in high school.
“Is she out?” Hall shouted at Sean Johnson.
“Yes, just now.”
“And so is the doctor,” said Ann Johnson. No sooner had Dr. Hall barked his question than he stormed out of the operating suite.
“What the…?” Sean asked. Eight sets of eyes—the only part that could be seen beneath scrubs, masks, and goggles—looked at each other.
“Shoulda known.” Ann’s voice was dry. “When I saw Devon LaCroix’s stuff here but no Devon, I knew he’d freak.”
“Who’s Devon LaCroix?” Janet hadn’t heard the name or seen it on the staff list.
“He’s a sales rep for Panco. Mainly hips and knees,” Sean said.
“Ohh, Devon is way more than hips and knees.” Ann’s eyes twinkled.
“He’s a cutie?”
“Oh, honey. He’s ex-marine. Was a medic. He’s got that charm and swagger and…”
The swinging door burst open again, and two blue-clad figures entered the suite—the taller Dr. Hall and an energetic figure with… yes, a definite swagger.
“All right, Big Five. It’s showtime!”
That was not the thing for a rep to say before a surgery, but it did not faze the doctor. In fact, it seemed to comfort him. Dr. Hall was a nervous sort. His eyes darted around at each of the utensils on the tray, a tic in one eyelid. “Are we ready?”
The way he said it made Janet uneasy, like he wasn’t sure if he was ready.
Sean gave the vitals.
“Sc-Scalpel,” Dr. Hall said.
Janet handed him the scalpel then shot a glance at him. The guy looked like a nervous wreck.
Tentatively, he made his first incision. “Right here?” The way he said it made it sound like a question.
The PA, a heavyset guy named Morrison, seemed alarmed. Technically, he was number two, the one who could handle any procedure and step in if needed. That day, he looked a little ill.
The next six hours were horrific. With each incision, the doctor became more and more tentative, often pausing to stare at seemingly nothing. Sean, the anesthetist, looked worried. The longer patients stayed under anesthesia, the more problems arose in post recovery. Janet had seen this hip replacement done in as little as fifty-five minutes by other surgeons. The suite was booked for three procedures that day. One for sure would have to be cancelled.
Morrison, the PA, looked pale. He was sweating. After three hours in, unbelievably, the original hip bone had yet to be removed. Suddenly, Morrison collapsed.
“Hey there, big fella!” Devon was the first to react, stepping in from behind. He grabbed Morrison around the waist before he fell completely and pulled him off to a bench along the wall. Technically, the sales rep was to be confined and away from the patient, behind his table of sets which included every imaginable joint, plate, screw, and accessory, all sanitized and ready to go.
“Musta been somethin’ I ate.” Morrison looked glassy-eyed and out of it.
Janet felt a little panicky herself, like she was watching a car wreck in slow motion. She looked at the patient with a pang of remorse. Sorry, lady. Then she looked at Dr. Hall. Oh shit.
The doctor was losing it, and everyone in the OR could see it. He wasn’t focused on Morrison or the patient—his eyes were locked on a point in the middle distance, staring at nothing.
It was Devon who reacted first. He started in with his patter, slow and soothing, the tone more important than the words. “Hey, Big Five, piece of cake. You just gotta grab that saw and whack the bone through right about there.” He pointed with a laser pointer. “Just like eighth-grade shop class. Easy peasy.”
Woodenly, Dr. Hall followed instructions, LaCroix talking him through what he must have seen done thousands of times.
“She looks like an eight centimeter, Doc. Perfect! Got the right size right there, third drawer down.” Again LaCroix pointed with the laser pointer.
It reminded Janet of those airliner movies where the air traffic controller talked the panicked passenger into landing the jumbo jet. Four and a half hours into the operation, Dr. Hall was still fumbling with the artificial hip joint, awkwardly trying to seat the joint in place with a four-thousand-dollar stainless-steel hammer. He swung and hit it off center with a cracking sound. Janet could see where the femur had split off a six-inch wedge of bone, now white and bloody.
“Shit!” Hall said.
The doctor was really freaking out, and again, Devon stepped into the void with a patter of words. “Happens all the time, my man. Three times last week alone. That’s what I’ve got plates and screws for. Slather some bone cement on it, and she’s bulletproof, better than before. Fourth tray down. Get ’er done with three number-four plates and about twenty-four screws, depends on how tough the bone is… the bone cement is right there… like a walk in the park with a beauty queen.”
“You do it.” The tone of the surgeon was like that of a spoiled boy who wanted to go home.
The surgery team stopped and stared. Morrison looked up weakly from a nearby bench.
Dr. Hall stared defiantly at LaCroix. “You heard me, you cocky son of a bitch. You know everything. You point from back there like you are God’s gift. You do it.”
His hands were shaking badly. Everyone could see it. Devon looked at Sean the anesthetist. Sean in turn looked at the monitor over the patient's head. The vital signs had been artificially slowed down far too long for a simple surgery like this.
LaCroix exhaled long and deep. “All right, Big Five. Been a rough morning all around, so let’s just do this.” He stepped out of the room.
The rest of the team stood frozen in place, all eyes staring at Hall, whose hands were shaking so badly he had to fold his arms. The nurse at the station by the door had her hand poised by the phone but seemed paralyzed. The only one who seemed relaxed was LaCroix, who had come back in, scrubbed and ready.
“Hey, Big Five, why don’t you help out your number two, huh?”
Stiffly, awkwardly, Hall stepped over and perched next to Morrison, seemingly oblivious to the room around him.
“Well, how’s this for a clambake, huh?” Devon stepped up to the incision, completely confident and in charge.
Calmly and smoothly, making a little patter and gentle banter with the team, his hands steady, his movements quick and certain, LaCroix landed the plane, just like in the movies. No muss, no fuss, not a bump or squeal of the tires. He expertly set the plates, squeezed in the cement, attached the screws, and tapped the joint home.
“Nothing but the needle and thread now, girls, like sewing a 4-H apron,” Devon said, and Janet could see the experience of a medic at work, fast and nimble, clean and quick. Dr. Hall stood stock-still, catatonic, as the sales rep finished up the surgery. Devon nodded to Sean. “Bring her up, buddy.”
And then with a final shuddering sigh, Dr. Hall walked out of the OR, followed by LaCroix, who was helping along the pale PA. The surgery team avoided eye contact with each other. Janet immediately reported herself sick for the rest of th
e day and went to find a bar near the mall.
They hadn’t planned it, but there was Ann Johnson, too, sitting at a booth in the back, face white with shock. “You sick too?”
Janet said nothing until she’d gulped the entire contents of a Long Island iced tea and ordered another one. “Holy shit.”
Chapter 10 - Claire
“Whaddaya think, kiddo?” Claire hoisted the baby up on a hip and continued her inspection of the house.
When they decided to move to Sioux Falls, both Stan and Claire had been skeptical of a long-term proposition. “Money like that, though?” Claire said. “You’d be crazy not to take it.”
Stan agreed. “What about you? With this salary, we won’t both need to work. What do you want to do?”
“I’ve got an idea,” she’d said.
And that idea was the purpose of this house visit. The realtor hovered near the entrance, with no interest in actually going inside. “It’s got good bones!” he called. “A real fixer-upper!”
Claire was doing some math in her head and ignoring his vapid comments. Sioux Falls was a growing city, usually in the top ten for economic growth nationwide. The house was on South Phillips, and its former owner had let it slip into decay. The front yard was a forest of overgrown trees and shrubs, the antithesis of a place with curb appeal.
Half a block to the north, there was a definite uptick in the look and maintenance of the homes.
And despite the realtor’s hackneyed comment, the house did have good bones. It was a two-and-a-half-story Craftsman, probably mid-1920s with what looked a major upgrade in the ’50s where the attic had been converted to a large dormered room with leaded glass and wood floors. The house had clearly been a beauty back in the day. If the town continued growing, the nicer neighborhood would easily migrate south and encompass this block too.
“Why are they selling?” Claire asked over her shoulder.
“Estate sale.” The realtor, his arms folded across his chest, gingerly stepped into the doorway. He looked warily at the dingy interior. “The three kids live on both coasts and have no plans on coming back. They want it to have a good owner. A young family like yours.”
Claire rolled her eyes. Time to start digging. “Well, let’s do a little looking around and see what we can find.”
Ninety minutes later, the realtor looked haggard and defeated.
“Termite tracks, horizontal foundation crack, bat droppings in the attic…” Claire ticked down the list. “An eighty-amp service, forty-year-old furnace. Looks like the air conditioner is an old swamp cooler. That thing should be in a museum somewhere.”
“It has such potential, though.” He sounded like he didn’t believe his own words.
Claire’s narrowed eyes glinted steel. “Well, that potential is going to have to come out of their end, not mine.” She shot him an offer.
He didn’t blanch. He must have been showing the house for a while. “I’ll talk to the family and let you know.”
Chapter 11 - Sean Clark
The nurse anesthetist, Sean Clark, was coming out of OR when he got the page. “Sean Clark to Central Four, Sean Clark to Central 4.” He got about four pages a day, usually routine stuff or a phone call, but Central 4 was for post-op conferences with families. He felt a tremor in his gut. Uh-oh.
Normally, the surgeon or the PA handled the post-op stuff. When an anesthetist was called down to meet a family, it was either because the surgeon was busy in another surgery—rare—or because they and everybody of higher rank were avoiding the family and kicking the shit downhill.
Oh-uh.
The older of the two men looked confused, frightened, and out of place. He had a striped work shirt that said Earl on the patch and calloused hands with the grime worn in. “You know anything about my Midge?” He looked about to cry. “She had surgery this morning but hasn’t seemed like herself. It’s like she don’t know me.” He whispered the last part as if afraid of saying it out loud.
The younger man was equally upset. “It’s okay, Uncle Earl. This can happen. Sometimes people react differently to anesthesia… Aunt Midge is just a little slower than some at recovery.” Turning to Sean, he became more professional. “Her name is Martha Elaine Sanderson. Midge is what everyone calls her. Fifty-eight. Left hip replacement. The surgery was this morning. I just got here myself. Were there any complications?”
Oh shit.
“Yes, there was a fragmentation of the femur, and some extra plates were required. Not ideal, but she should be okay.”
“Can we talk to the surgeon?” The younger man checked a pad of paper. “Let me see… Dr. Hall?”
“Dr. Hall is away with other patients. I’m not sure when he will be able to visit with you.”
The younger man was trying to soothe his uncle and threw out an icebreaker. “Hall? He any relation to the Hall Clinic Halls?”
Sean nodded nervously. “Yes. Fifth generation.”
“Oh! See, Uncle Earl? I’m sure Aunt Midge was in the best of hands.” He smiled encouragingly to both Sean and the older man.
Earl sniffed hopefully. “Y-You think so, Bill?”
The younger man was freckled, open faced, sandy haired, and athletic. He looked like he could be a tennis instructor or gym teacher. He nodded again. “You bet, Unc! And I’m sure when I come back down day after tomorrow, she’ll be right as rain.” He turned to shake Sean’s hand. “I’ve got to head back up to the Cities tonight, but I’ll come down Wednesday to see the doc then. In the meantime, I’ll have my receptionist send down for the charts. Oh, here.” The tennis pro fished into his pocket for a card. “Maybe I can talk you into the nickel tour when I come back. I always was curious how you run things down here.”
The card said: William C. Sanderson, MD, Doctor of Orthopedic Surgery ABOS/AAOS/AANA.
Sean’s heart skipped a beat. Oh shit.
Chapter 12 - Stan
Stan Martin had the papers signed on the radio station building, a ten-year lease on a fifteen-hundred-square-foot office underneath a dentist and behind an insurance agent. Since it was hidden in a mostly residential area sharing a parking lot with an apartment building, Stan doubted anyone would expect a radio station. The lease paperwork had been signed by Emilio Gonzales, whose English was normally excellent but if needed could become clouded and heavily accented. When asked about his business, Gonzales enthusiastically praised God in a torrent of Spanish, pumping the real estate agent’s hand enthusiastically.
She nodded awkwardly. “I see.”
The agent scanned the paperwork as if looking for clues. The location had the proper zoning. The station would have between five and ten employees and between one and five customers daily. Her face cleared as she spotted the cashier’s check in the full amount clipped to the contract. One year paid in advance.
She smiled brightly, carefully said, “Buenos dias,” and left with the check.
Welcome to America.
Once gone, Stan shook Emilio’s hand. “Thanks.”
“You got it, pal.” Gonzales’s accent was now completely gone. “We done now?”
Stan nodded. “Yep.”
“Adios.” Sounding more Texan than Mexican, Gonzales turned and left, his job done.
Now for the remodel.
Chapter 13 - Janet Brecht
Later on, Janet and the other members of the surgical team would call it the “Get-our-story-straight meeting,” although that was certainly not what the two attorneys and the two doctors Hall called it. The meeting had taken place in the office of Dr. Harrison Benjamin Hall IV, a large expanse of wood, leather, cut glass, and collector’s volumes behind more beveled glass. In the middle, next to a fireplace, sat the members of the surgical team on deep, plush, dangerous carpet, looking up and across the table at the doctors Hall and two lawyers, Everett Meyer—a jovial attorney with a smooth rich voice and the eyes of a shark—and an attractive woman in a charcoal business suit with the same shark eyes.
Cozy.
“We
ll, well, we might as well start.” Meyer, who was running the meeting, chuckled mirthlessly after five minutes of strained introductions.
“This—this practice of law, this practice of medicine that we are called to…” Meyer paused, searching for the right words as if setting his trap carefully. “It seems so simple when we are young, so clear-cut. Every situation seems to have been studied and explained either in a book of law or”—he gestured to the books behind glass—“in a book of medicine.” He steepled his fingers and puffed out a ponderous sigh. “Yet it is not simple or straightforward, nor is it black and white.”
The woman next to him was scribbling furiously on a legal pad, the scratching of her pencil the loudest sound in the room.
“Without muddying the waters with either medical or legal jargon, let us revisit the tragic circumstances that surround the unfortunate Martha Elaine Sanderson.” Meyer looked over his glasses at the papers in front of him. “It seems that the operation to replace Mrs. Sanderson’s left hip was going smoothly until the femur split, causing the need for more plates and screws to be added. This rare occurrence caused some need for additional time under anesthesia while the correct medical hardware was selected and attached, and then the hip replacement was continued. Dr. Hall the Fifth”—Meyer gestured to a pale and glassy-eyed Hall—“commends your excellent teamwork in pulling together in this difficult surgery. Certainly, the family is upset, and although anesthesia is itself a practice—one that with continued practice has become most reliable—it, too, is not foolproof. And, Nurse Clark, as the person in charge of the anesthesia and the one ultimately responsible, I want to assure you that the full legal team of Hall Clinics stands by to protect you in any legal or other inquiries. I can’t imagine what the burden would be financially and professionally on a nurse who would have to face scrutiny alone without expert legal consultation.”
