by Barbara Ebel
Dr. Darryl Berry handed the scrub tech his scalpel and swayed his neck like he had a cramp. Upon seeing Viktoria over the drape between the surgical field and the anesthesia work area, he stared at her for a moment.
“Your patient is doing fine,” she said.
“Did you treat her high glucose level and did you think to send off a new blood sample after we got started?”
“Yes. She’s much better. Sugar is one hundred twenty.”
His eyes didn’t blink, and he held his glance.
“Is there something else?” Viktoria asked, prompting a disapproving stare from the scrub tech and Alice Coleman.
“I’m not used to seeing an anesthesiologist or CRNA standing up so much during a case and peering over the ether screen to watch what I’m doing. Makes me wonder if you’re paying attention to anesthetic care.”
“During a case, I don’t sit much. Makes me more alert to oversee the patient, the surgical procedure, and the anesthetic. Because I’m not planted on the stool most of the time, I don’t read as many books or check my iPhone as much as other anesthesia caretakers do.”
Viktoria immediately regretted speaking her private thoughts aloud. It was not her style to chastise the few less diligent anesthesia care providers.
Dr. Berry gasped. “I harbor a love-hate relationship with anesthesia personnel and you just confirmed my thoughts about their diversions at the head of the table. And just like you were out of line, my love-hate comment can stay in this room.” He pointed his bird-like nose at the tech and then the RN. They both looked the other way like they didn’t hear a thing.
With a sigh, Viktoria turned around and tidied up the syringes on top of the anesthesia cart. She licked her dry lips under her mask and was overdue for something to drink, even if it wasn’t coffee.
In addition, she thought, she needed a bathroom break. Since Dr. Huff was running the schedule, he should have allocated one or two anesthesiologists or CRNAs to go around from OR to OR and give colleagues a morning break. Anesthesia providers couldn’t just leave a room. Someone needed to stand in for the patient’s care after a thorough report on the case.
She glanced at the double doors hoping to see someone enter and wondered about this department’s policy for short respites to use the bathroom and to grab food and drink. Ten minutes later, someone showed up at the scrub sink outside. They didn’t wash their hands, but inclined their head over their phone and became immersed in tapping their thumbs a mile a minute. He looked familiar – the male CRNA who earlier greeted the other CRNA at the patient’s bedside in the recovery room.
“You may get a break yet,” the scrub tech said nodding towards the window.
“I’m in the homestretch,” Dr. Berry said. “Hand me some dressings and I’ll wrap her wound and finish this case.”
Viktoria began easing off on the volatile anesthetic, pulled a pair of disposable gloves out from the box on the cart, and made sure any drugs she needed were drawn up. The CRNA from outside sauntered in and stood between the door and the OR table.
“Hey, Dr. Berry,” he said. “Are you finished?”
“Sure am.”
The nurse sidled closer to the head of the bed. “I’m Casey Johnston, one of the CRNAs. I can see it’s not a good time to give you a break.” Thankful for his well-timed arrival, he grinned under his mask. He had dark blue eyes, like the color of the deep northern Atlantic, and a pleasant voice, definitely radio-worthy. Viktoria figured him to be in his late twenties.
“Too true,” she said. “Now is not the appropriate time to switch Mrs. Grant’s care. I’m already reversing her anesthetic.”
“Dr. Huff has you slotted to do Dr. Berry’s next case as well. Who knows? Maybe I’ll be relieving you for lunch later or for an afternoon break.”
Dr. Berry patted the sterile white gauze he’d wrapped around Mrs. Grant’s leg and looked only at Casey. “When is Jay going to make her supervise CRNAs and oversee a couple of rooms at once? Like the anesthesia care team model your group mostly works by?”
Casey chuckled. “Ask him. Maybe it depends on whether your patient makes it to the recovery room.” He leaned his elbow on the plastic enclosure to the bellows. “Only kidding,” he said to Viktoria.
Dr. Thorsdottir untaped her patient’s eyes and turned off the sevoflurane vaporizer. The CRNA withdrew his arm and stepped away.
As she glanced at the doors closing behind him, she mumbled something in Danish. Under her breath.
-----
Alice Coleman reached up and turned on the recovery room EKG machine above the stretcher and it came alive with electronic beeps. She lowered her arms aside her plump breasts, slid a pen off her top pocket, and waited for Dr. Thorsdottir’s report.
For the second time, Helen opened her eyes after her surgery and tried to make sense of her situation.
“Helen,” Viktoria said, “you did fine. You’re in the recovery room.”
“That’s not funny.”
“Seriously, your surgery is finished.”
Helen fought to keep her eyes open, glanced around in the curtained cubicle, and accepted her whereabouts. “Dr. Berry should get a medal for getting me through another weed whacking.”
“You can slumber off again,” Alice said. “Dr. Thorsdottir will finish giving me report.”
“Ask radiology to slip in and grab a chest X-ray on Mrs. Grant,” Viktoria said after her full report. “They just need to confirm my central line placement and lack of complications.”
Alice nodded and Viktoria stepped away to sign off on her paperwork. She passed Casey sitting idly behind the desk or taking a break which should have been hers.
Jay Huff ambled in, bouncing with authority, and positioned himself midway in front of Viktoria and Casey. Dr. Viktoria, how’d it go?”
“How did Mrs. Grant do or how did I do?”
“She seems no worse for wear,” he said throwing his glance over his shoulder. “And you, well, you can take a quick lunch before your next patient … the usual deal, thirty minutes. Casey will set your room up and check out your drugs and I’ll do the preanesthetic assessment on the patient. However, you need to stop by Jeff Appleton’s office. He’s the Director of Surgical Services. His office is down the hallway from the OR.”
“What is Dr. Berry’s next case?”
“A cholecystectomy on a forty-two-year-old female.”
Viktoria nodded. She signed the intraoperative record and went into the anesthesia office, a room with counters facing one and a half walls and a full couch on one side. Two rolling chairs were available, bookshelves with mostly paperwork, and a plastic tray for the anesthesia records. Besides the electronic record, each intraoperative case with anesthesia start and end times went into it for reimbursement purposes. She dropped in Helen Grant’s sheet.
Foremost, she needed to hit the restroom before hunting down the Surgical Services Director, so she deviated into where she had changed and stored her things in a locker earlier in the day. As opposed to many hospitals, especially newer ones, the female locker room was the same for all female OR staff whether a person was a doctor, nurse, or tech.
A woman in scrubs crouched over her sneaker and was tying a knot while she was in full conversation with a nurse next to her. “I couldn’t care less about the wedding. It’s the reception that’ll be worth our while. Jennie never does anything half-assed.”
The adjacent nurse glimpsed at Viktoria and shut her locker. “I hope she doesn’t invite any last-minute strays,” she said softly.
The other woman planted her sneaker on the floor, stood up straight, and turned her back to the entrance. Viktoria turned into the bathroom area. When she left, the two women exited the locker room in front of her without holding the door open.
Dr. Thorsdottir walked the quiet corridor outside the OR and found the Director’s office only three doors down. She rapped on the door and heard a firm, pleasant “Come in.”
A man immediately stood up from behind his de
sk. He was around Viktoria’s age; tall and fit like a winter athlete who modeling ski clothes. Although his mouth registered a smile, his light brown eyes conveyed most of his social friendliness. He wore dark pants and a blue-pressed shirt with an open-top button.
“You must be Dr. Thorsdottir. I hope I’m pronouncing your name correctly. Please have a seat.”
Viktoria stood between two dark red chairs. She lowered herself into the right one as a stack of booklets littered the one to her left. “I settle for most attempts at my last name, but that was almost spot on.”
“Glad to hear it.”
She eyed a copper name plate on the edge of the desk; Jeffrey Appleton, RN, MS, Director of Surgical Services. A laptop computer stood open nearby and stacks of paperwork and binders dotted the rest of the desk.
“Even though you’re only ‘passing through,’ I wanted to welcome you to our two-hundred thirty-seven bed hospital. We’re not exactly a tiny community hospital, but we’re not a huge regional center either. However, from these small towns around the south-eastern area of Lake Erie, we pull in a lot of patients.”
“Since you’re a full-time person on the business side of running an OR, thank you for the welcome. I am so far removed from the operational side of an operating room.”
“For sure. Anymore, in your field, there are a dozen models of how the departments are run and get paid. The anesthesia group here is not independent. The hospital employs them. We pay everyone’s salaries. In your case, my department’s budget has paid the locum tenens agency to find you and to pay you. The bottom line is to let you know that my door is open in case the stipulations of your four-week stint here do not meet what you were promised. Such as a forty-hour week etc.”
“Appreciate that.” She inched to the end of her chair, ready to spring up, but Jeffrey leaned back more comfortably into his.
“Jay Huff and the other anesthesiologists have been working like dogs. That’s why they begged for help. The only female anesthesiologist in the group went out on maternity leave two weeks ago, and they puffed out their chests and said they could handle the extra work load and call. I think they all wanted a little extra cash in their pockets.”
“There’s something to be said about keeping sane nine-to-five work days. Or seven-to-three as the case may be.”
“I would be ecstatic to put in forty hours in four days and then have a three-day weekend, but that’ll never happen.”
“Well, it was nice meeting you,” she said and rose.
He came around the desk and stepped behind her as she left. “I detect an accent, not from the Lake Erie region, but we knew that. However, you don’t sound like a typical Long Islander from New York, which is listed as your residence on your paperwork. Where you from originally?” He stopped in the doorway and let the question hang in the air.
She turned and faced him. “I’m originally from Iceland. I’m an Icelander.”
-----
Viktoria flicked her hand as a good-bye, and scurried away before Jeffrey Appleton bombarded her with questions about her origins. He still stood open-mouthed, and only when she reached the staircase, did she hear his door close.
Now she was in a time jam. Half her allotted “lunchtime” was over, and she still needed to eat, let alone find the cafeteria. She took the stairs and, in the main lobby, she saw the coffee shop. Grabbing something there would be her best option, so she bought a yogurt, banana, and a hot, strong Americano. Like a stray dog, she gobbled down her small lunch, and finished the coffee on the elevator back to the OR. She deviated to the recovery room first and went on a hunt for Helen Grant’s X-ray to confirm her central line placement. It proved fine and there was no pneumothorax. Viktoria had not “dropped” the patient’s lung.
She raced out and contemplated her next patient as she headed to the preop area to see her—a female for a gallbladder removal. Chances were that her forty-two-year-old patient, if statistics were correct, would be female, fat, and forty.
Viktoria read Dr. Huff’s preop assessment first and then swung open the drapes. “Tina Parker?”
“That’s me,” replied a woman of more than average girth. For someone about to undergo a surgical procedure, she carried a happy disposition like she’d just eaten a piece of chocolate cake. Which made Viktoria realize her NPO status, or nothing per mouth status, would be her most important question.
“I will be doing your anesthesia today. I’m Dr. Thorsdottir.”
“Oh, okay, I guess. After you give me a bunch of drugs, I’ll never remember that when I wake up.”
“Not to worry. Most people don’t remember my name even if they don’t go under anesthesia.”
“That makes me feel better.”
“That’s the intent of your surgery today, Mrs. Parker. And when did you last eat or drink?”
“Yesterday. Not a blasted thing today.”
“Perfect. I have Dr. Huff’s notes about you. Nothing else you want to tell me about your medical background?”
“We covered it.”
“He told you the risks and benefits of your anesthetic?”
“Yes, ma’am.”
Viktoria checked Tina’s IV. “I’ll give you sedation when they wheel you back to the OR. And someone is here to take you home today?”
“Oh yes. He went downstairs to eat. Without me!”
Viktoria nodded and peeled away to go back to OR 7. Sure enough, Casey had set up her work area for the case. She scanned through the machines, equipment, and laid-out syringes. Controlled substances had been checked out as well. He’d drawn up a five-cc syringe labeled with midazolam, for sedation, and a five-cc syringe labeled as fentanyl, a narcotic. There was a second unopened vial of fentanyl lying beside it. That was overkill, she thought. For a straightforward cholecystectomy, the probability of her opening the second vial was slim.
The double doors pushed open and in came the stretcher with Tina Parker, who glanced around and made small talk with Alice Coleman and the tech. Viktoria sighed. At least her second patient was cheery compared to most of the people who had come across her path since she arrived at the Masonville, Pennsylvania hospital.
However, there was one other person who qualified as cheerful—Jeffrey Appleton.
CHAPTER 3
Viktoria should have guessed it. Aside from again being slow doing a case, Dr. Berry was far from adept at laparoscopy. The scope was a narrow tube with a camera, and he had the hardest time inserting it through the incision he made, which delayed him from seeing Tina Parker’s gallbladder on the screen.
Since Dr. Berry and his assistant were not stimulating his patient like some critical, painful surgical case, Viktoria kept her anesthetic on the “light” side. The two women in the room expertly listened to Dr. Berry’s gripes as they discussed their jobs before working in an OR.
“Did I ever tell you that I’m an ex-barista?” Alice asked.
“Less challenging than what you’re doing now,” the tech said. “Where’d you work?”
“The coffee shop on Hospital Road. Half the people working here stop in there. I figured I heard so much hospital talk, I might as well go into nursing.”
“That was a mindless, uninteresting job,” Dr. Berry chimed in. “Now you have responsibility.”
“However, I carry the inside secrets of the most major mainstream coffee franchise.”
“Like what?” the tech asked.
“I bet you think that a Venti hot drink carries three shots of espresso.”
“Why would we think that?” the surgeon asked.
“Because there are three cup sizes; a Tall, a Grande, and a Venti. So, you’d think that a Tall comes with one shot of espresso, a Grande with two, and a Venti with three. But if you order a Venti, it comes with only the same two shots as the Grande.”
“Rip off,” the tech said.
“Yeah. The few folks in-the-know would order a Venti and ask for an extra shot of espresso, but then they’d be charged for it.”
�
��Double rip off,” the tech said.
“You can get your java buzz another way, however. Three shots of espresso are included in a Venti iced drink.”
“What?” Dr. Berry said, holding the scope handle stationery.
“You heard me,” Alice said. “Order a Venti iced mocha on the way home tonight and you’ll stay awake for a midnight movie.”
“I’m on call, so maybe I’ll run over there whenever, between cases.”
Viktoria noted another set of her patient’s vital signs. It would be no sweat off her back if he disappeared for coffee between his cases.
One of the doors inched open and Casey stepped in. Alongside the surgeon, he viewed the screen to watch Dr. Berry try to define the gallbladder with his instruments. “One more gallbladder bites the dust,” Casey said and laughed at his own joke.
He kept his smile and stepped into Viktoria’s space between the OR table, the anesthesia machine, and her drug and equipment cart. “Ready for an afternoon break or should I go on to the next room?”
“Depends on if you’ll return.”
“Don’t give up your only chance now,” he said eyeing her cart.
“I’ll take it. Mrs. Parker is a forty-two-year old with a recent history of right upper abdominal pain and nausea. Dr. Berry’s doing a laparoscopic cholecystectomy, and she does have gallstones. No other significant medical history, and she’s only allergic to sulfa drugs. I’m running her on isoflurane and very little diprivan as an infusion. She took three ccs of fentanyl in the beginning and a little midazolam. Vitals are stable, and she’s all yours while I’m gone. By the way, thanks for setting up my room while I ate lunch.”
“No trouble.”
Viktoria slipped past him and slipped off her OR jacket.
“Hey, Casey,” Alice said. “I just told our clueless surgeon and tech the difference between coffee cup sizes at the local coffee shop. Want to hear about it?”
