by Barbara Ebel
She changed into dark blue scrubs in the nurse’s locker room and looked in the long mirror. Trying on both a blue and a white OR hat, she decided to wear the white one and scattered a little hair alongside her face from underneath it. She put on some mauve lipstick and touched up her mascara. Now her eyes looked their best and she smiled while tightening the bow on her pants.
Having looked at the OR schedule, she already knew that Dr. Kevin Mcbride would be in the cysto room the entire morning. Over the weekend, especially on Sunday while Julia had come for visitation and had taken a nap, she had learned all she could about him from the internet; it was amazing what a person could dig up online.
She walked over to the nurse’s lounge and inquired about Robert, the person she was told would show her the ropes of her new position. With shift change occurring, the room was busy with nurses giving reports and checking in. Lots of coffee was being consumed and hands were dipping into boxed donuts. “Does anyone know where I can find Robert from the cysto room?” she asked a group at a table.
“Right there,” a male orderly said, pointing at someone leaving through the door.
“Thanks,” Rachel said and hurried after him. “Robert, wait up,” she said.
He turned around. “Come on, you must be Rachel. Glad to meet you. Let’s get you broken in so I can leave for greener pastures.” She figured him to be in his mid-fifties and he walked with a limp. She wondered how many more green pastures did he have left.
The main cysto room wasn’t that large. There were glass cabinets, counter space, steel rolling tables and the main table for patients. Besides the overhead fluorescent lights, there were lamps that moved and could focus on areas of the patient. A doorway which stayed open had a supply room and counter space as well, basically where Robert hung out with his paperwork or his crossword puzzle when not directly involved with the patient or the docs.
“Basically, we’ll have Dr. Mcbride today,” Robert said, “and an anesthesiologist, too. Actually both of them are senior residents. Watch what I get, what I give them, pay attention, and you’ll be fine.”
In a half hour, an orderly rolled a stretcher in with a male patient. With Rachel at his side, Robert verified the name and paperwork in the chart. “You’re having a transurethral resection of the prostate or TURP, correct?” Robert asked.
“Unfortunately, yes,” the patient said.
After they got him situated on the table, Robert placed a spinal tray on a rolling table for the bubbly anesthesiologist who talked to the man the whole time. After prepping his back with a sterile solution, applying local anesthetic under his skin, and easily placing the spinal needle with further medication, the patient began getting numb from the waist down while Robert positioned him in the lithotomy position.
Dr. Kevin Mcbride entered the room and greeted the patient first while Rachel stayed near the supply room door watching him carefully. She was forty-two years old and she figured him to be late thirties, perhaps thirty-eight or -nine. He had dark features, darker than what she’d expect from the Irish heritage he must have with a name like Mcbride. His eyebrows and hair were black as coal; his eyes were deep blue and he had a sloping tip to his nose. With very white teeth and a flurry of wrinkle lines around his eyes, his smile radiated happiness. So far, so good, she thought. Good looking, but not the most handsome man she’d come across or been involved with.
Kevin turned from the patient. “Good morning, Robert.”
“Good morning,” Robert said. “This is Rachel. I’m showing her the ropes. She’s a tech who is going to be my replacement. I’m asking for a change of pace. Maybe they can teach an old dog a new trick.”
Rachel stayed where she stood but focused solidly on the doctor’s gaze.
“Nice to meet you,” Kevin said.
“My pleasure,” she said, her voice as smooth as velvet. “I’m a fast learner but let me know if there is anything I can make better. You’ve been doing this, I am sure, for years and years so you’re apt to find a newcomer’s mistakes.”
“Actually,” Robert said, “Dr. Mcbride is a senior resident.”
“Yes, I had a past life as a CPA,” Kevin said.
“Really?” she crooned. “You didn’t happen to be part of the Janney and Mcbride CPA Associates, did you?”
The doctor nodded with a smile and Rachel followed up immediately. “They were the most respected and dedicated certified public accountants in the state of Tennessee. That’s my opinion anyway, especially before they changed hands to Janney and Forrester CPA Associates. Now it makes sense because that must have been when you left.”
“To go to medical school,” he said, proudly.
“Well, I hope you don’t mind my saying that you had a fine career then and a fine career ahead of you now. I wish you lots of luck.”
“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 lot 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.”
