It's Nothing Personal

by Gorman MD, Sherry

  “Well, I thank you for being a compliant patient. I have only one last question. Do you have any loose, missing, or chipped teeth? Anything in your mouth that’s not permanent?”

  “Just my tongue ring,” said Michelle, opening her mouth and proudly displaying a silver stud.

  “That will have to come out before we take you back,” Jenna said firmly. “Any other piercings will also need to be removed.”

  “I was afraid you’d say that,” pouted Michelle. “Does that also include my piercings . . . down there?” Michelle dipped her head in the direction of her crotch.

  Jenna tried to sound unbiased. “Yeah, even the ones down there.”

  Over the course of the next few minutes, Jenna performed a quick physical exam. She peered into Michelle’s mouth and assessed her airway. Next, Jenna listened to Michelle’s heart and lungs, which sounded completely normal.

  After Jenna finished examining Michelle, she said, “Now’s the time where we have to go through the risks associated with anesthesia, and then I need to get you to sign the anesthesia consent. Even though I have to tell you all the things that could go wrong, I want to start by reassuring you that I do not anticipate any problems.”

  Michelle sat up straight, signaling Jenna to continue.

  “The most common complaints after surgery are nausea, vomiting, pain, and a sore throat. I will give you anti-nausea medication to help prevent you from feeling sick and narcotics that will hopefully allow you to wake up pain free. However, the nurses in the recovery room have more medicine, if you need it. If you get a sore throat, lozenges help, and it should resolve in a few days.”

  Jenna paused for a moment. She could see the glazed-over look in Michelle’s eyes. After giving Michelle a moment to process the information, Jenna continued.

  “It’s rare, but sometimes we can have serious complications from anesthesia. For this procedure, I have to intubate you, which means that I put a breathing tube down your throat and into your windpipe while you’re unconscious. Then I use a ventilator to help you breathe during the surgery. That was why I looked in your mouth and asked about your teeth. Those things help tell me if it should be easy or hard to get the tube in place. Based on my assessment, your airway looks very easy. However, there is a small chance that I could chip a tooth, cut your lip, or damage a vocal cord while trying to place the tube.

  “There is also a possibility that you could have an allergic reaction to any of the medicines that I give you. If I see any indication that something like that is happening, I have other medications in the room to treat you.

  “The most serious complication, and this is true for any patient, any surgery, and any type of anesthesia, is a serious and potentially life-threatening heart or lung complication.”

  With the mention of the possibility of death, Michelle Hollings clutched tightly to Bradley’s hand, but otherwise maintained her composure. From what Jenna could tell, Bradley did his best to look interested and concerned, but she also caught him checking his Blackberry several times.

  “Michelle,” Jenna asked, “do you have any questions about the anesthesia or the risks?”

  “No. I’m just ready to get on with it. I’m looking forward to my new rack,” Michelle grinned.

  “Me too,” said Bradley, a bit overly enthusiastic.

  With that, both Dr. Jenna Reiner and Michelle Hollings signed the appropriate lines on the anesthesia consent form. Jenna left the room and ran into Rebecca in the hallway.

  “Dr. Reiner,” said Rebecca, “Dr. Hoover just got here. She said she already got surgical consent from the patient in her office yesterday, so she just needs to pop in and say a quick hello. Is there anything you need, or are you okay if we head back to the operating room in about five minutes?”

  Jenna was already halfway down the hallway. She called back over her shoulder, “Just make sure the patient takes out all her piercings and gets some Versed before you come back. Otherwise, I’m good, and I’ll see you back there. Thanks!”

  CHAPTER 3

  Jenna returned to her operating room to find it unoccupied. She found it odd that Hillary was not scrubbed back in and standing watch over the surgical equipment before the patient arrived. A critical part of Hillary’s job was to ensure the integrity of the sterile surgical instruments – something that required her physical presence.

  Approaching her area at the head of the operating room bed, Jenna opened the bottom drawer of the anesthesia cart and retrieved her stockpile of drugs. Each syringe, with the exception of Propofol, contained a clear liquid. If it weren’t for the preprinted labels Jenna had affixed to each syringe, it would be virtually impossible to distinguish one medication from the other. Ritualistically, Jenna arranged the syringes on the silver tray of the anesthesia machine in the exact order that she intended to administer them to her patient – Versed, Lidocaine, Fentanyl, Propofol, and Rocuronium.

  At 8:15, Jenna was still the only one present. It had been well over ten minutes since she left Rebecca in the hallway. With all of her drugs laid out in the open, she was forced to remain in the room until the patient appeared. Pulling out her phone, she engaged in a quick round of Solitaire. After several more minutes, she finally heard the sound of voices approaching the operating room doors. Jenna waited as Rebecca maneuvered the cumbersome hospital gurney, with Michelle Hollings onboard, into the room and lined it up next to the operating room table.

  Overly bright and cheery, Rebecca quipped, “Hey, Dr. Reiner. Here’s our friend, Michelle. Michelle, this is the operating room. I’d introduce you to the rest of the gang, but they don’t seem to be back yet.”

  Rebecca’s last sentence was said with reproach, as she cocked her head in the direction of the surgical equipment and glanced inquisitively over at Jenna. Jenna correctly interpreted Rebecca’s expression and tone, as both women questioned Hillary’s whereabouts. Outside the view of her patient, Jenna shrugged her shoulders and shook her head disapprovingly.

  “So, Michelle,” asked Jenna, “how’s that cocktail treating you?”

  Completely lucid, Michelle responded, “What cocktail?”

  Michelle’s anxiety was evident as her eyes darted from one daunting piece of surgical equipment to the next. Jenna said compassionately, “Don’t worry. I’ve got more.”

  Jenna grasped the syringe of Versed and injected its contents into Michelle’s intravenous line. Not only would the Versed make Michelle feel as though she had a few drinks, it would also cloud her memory from that point forward.

  The second dose of Versed seemed to have an impact on Michelle. Wearing a silly smirk, she slurred, “Oh yeah, I’m feeling it now.”

  Jenna guided Michelle from the hospital gurney over to the operating room table. Once the patient was positioned correctly, Jenna started her pre-induction routine. First, Jenna secured a mask over Michelle’s face that delivered one hundred percent oxygen. She then applied the standard monitors to Michelle – a blood pressure cuff, EKG leads, and an oxygen saturation monitor. While Jenna went about her business, she overheard Rebecca on the phone with the charge nurse.

  With unconcealed annoyance, Rebecca asked, “Can you find out where Hillary is, and tell her we have the patient in the room? We are about to start the case, and there’s no scrub tech!”

  Jenna stopped eavesdropping and returned her focus to her patient.

  “Okay, Michelle, we’re ready to go off to sleep. I’m giving you the good stuff. You’re going to get really sleepy, really fast.”

  In rapid succession, Jenna injected Lidocaine, Fentanyl, and Propofol. Jenna pushed the Propofol into Michelle’s intravenous line. The milky white fluid travelled down the IV tubing from the injection port and disappeared into Michelle’s bloodstream. At that point, Jenna warned Michelle, “This last medicine that you are getting might burn a little bit at your IV site, but it makes you fall asleep quickly. I’m rubbing your arm as you drift off, which helps some with the discomfort. I promise, we are all going to take very good
care of you, and we’ll see you in a few hours.”

  Thirty seconds later, Michelle’s eyes flickered and then drifted shut as the rest of her body went limp under the effect of the drugs. Jenna then held a mask securely over Michelle’s mouth and nose, squeezing oxygen into her lungs from a bag on the anesthesia machine. After Jenna witnessed Michelle’s chest rise and fall from the artificial breaths, she injected the Rocuronium. Within thirty seconds, the paralytic took effect and each hand-delivered breath entered Michelle’s lungs with increasing ease. Once Michelle Hollings was completely unconscious and paralyzed, Jenna tilted her patient’s head back and placed the metal blade of the laryngoscope into her mouth. The light at the tip of the instrument lit up Michelle’s throat. Jenna peered in and slid an endotracheal tube past Michelle’s vocal cords, into her windpipe.

  Jenna was taping the breathing tube in place when she glanced up and noticed Dr. Lisa Hoover standing by the doors. Reaching over to the anesthesia ventilator, Jenna attached the breathing circuit to the endotracheal tube, and turned on the machine. The bellows on the ventilator rhythmically squished down like an accordion and then stretched out again. With each descent, Michelle Hollings’ chest rose as her lungs were inflated with a mixture of oxygen and anesthesia gases.

  Jenna smiled at her colleague and announced, “She’s all yours.”

  “Thanks, Jenna.” The surgeon then turned her attention toward Rebecca and asked curtly, “Do we have a scrub tech for this case, or am I flying solo?”

  As if on cue, Hillary appeared. Her arms were wet up to the elbows from scrubbing them at the surgical sink in the hallway. In order to avoid contaminating herself, Hillary held her arms up in the air and away from her body as she backed into the doorway, careful to avoid touching anything. Hillary walked over to the surgical table and dressed herself in a sterile surgical gown and a pair of gloves.

  “Sorry I’m late. No one told me you guys were in the room.”

  Rebecca shot Hillary a cold, critical stare and shook her head in disgust. No one else in the room acknowledged Hillary’s apology and, for several minutes, it was painfully silent.

  The hush was soon broken by the sound of Dr. Hoover’s iPod playing her collection of modern rock over the operating room speakers. Dr. Hoover left the room to scrub, returning with the same ceremonial entrance that Hillary had performed a few minutes prior. Hillary helped the surgeon gown and glove.

  Rebecca was ready to prep Michelle Hollings’ chest for surgery, but before she did, one unpleasant task remained.

  The nurse asked, somewhat embarrassed, “Dr. Hoover, the patient has a piercing in her pubic region. She said she could not get it out on her own. Do you want me to remove it?”

  Rebecca had already parted Michelle’s legs. Dr. Hoover came over and took a look. “Yeah, that needs to come out.”

  “I was afraid you’d say that,” Rebecca responded, sounding defeated.

  Jenna walked down to the foot of the bed and peeked at Michelle’s piercing. A silver stud with little bulbs on each end was embedded in her clitoris. Jenna laughed and left Rebecca to her ‘duty.’

  Hillary unexpectedly piped in to the conversation. “I’ve got one, too.”

  Jenna replied, “I don’t mean any offense, but why would you do that to yourself? Doesn’t it hurt?”

  Hillary shrugged and answered matter-of-factly, “It’s just another way to express yourself. I just know that some people think they’re cool. Once they heal, they don’t hurt at all. I guess it’s all about individual choice.”

  “I guess,” was all that Jenna could articulate for a reply.

  With the piercing removed and the chest prepped and draped, Dr. Hoover prepared to start the procedure. Before the surgeon made her first incision, Rebecca grabbed the patient’s chart and turned off the music.

  “Time out,” said Rebecca. Everyone paused and gave the nurse their full attention. “This is Michelle Hollings, twenty-two-year-old female, no major medical problems, no drug allergies. She is in the supine position and is here today for a bilateral breast augmentation. Implants are in the room. Preop antibiotics are running. No beta-blockers were ordered or administered. Compression stockings are on and functional. Warming blanket is in place. All in agreement?”

  Following a series of mumbled “yeses” and “yeps,” Rebecca turned the music back on. Dr. Hoover and Hillary moved to the right side of the patient’s chest, and the surgeon ran the blade of her scalpel over the lower part of Michelle Hollings’ breast.

  In response to the incision, Michelle Hollings’ blood pressure and heart rate increased. Quickly, Jenna increased the concentration of anesthetic gas being delivered. She then logged back into the Accudose machine and checked out 10 milligrams of Morphine. Like Fentanyl, Morphine is a powerful narcotic, but lasts much longer. Based on Michelle’s lack of response to the first dose of Versed she received in preop, Jenna assumed that the girl was probably not naïve when it came to drugs. Consequently, Jenna did not hesitate to inject the entire dose of the narcotic. After several minutes, Michelle’s heart rate and blood pressure remained elevated, so Jenna administered another 5 milligram dose of Morphine. Finally, the drugs took effect.

  “Looks like we have a party girl on our hands,” Jenna declared.

  “Oh yeah?” asked the surgeon. “Is she sucking up the goods?”

  Jenna replied, “4 milligrams of Versed, 250 micrograms of Fentanyl, and 15 milligrams of Morphine. Yeah, I’d say she’s a fun date.”

  The remaining two hours of the case passed uneventfully. At the conclusion of the surgery, Jenna turned off the anesthesia gases, gave Michelle medicine to reverse the effects of the muscle relaxant, got her breathing on her own, and removed the endotracheal tube. Jenna then transported Michelle and her new, very large breasts, to the recovery room. Once there, Jenna gave report to the recovery room nurse. When she informed the nurse of the amount of narcotic and Versed she had given to Michelle, the nurse whistled softly and whispered, “For a breast augmentation, on such a tiny, little thing? Wow!”

  “Amazing what partying can do for your metabolism,” Jenna remarked and then walked away.

  Jenna was headed to the preop holding area when she felt the vibration of her pager on her hip. Unclipping it from her waistband, she squinted to read the tiny print.

  “To all Doctors: Blizzard Warning in Effect. All remaining elective surgeries at all facilities cancelled for today. Only call doctors need to remain in-house.”

  Having been confined in the windowless operating room all morning, Jenna had no idea the weather had gotten so bad. She strolled into the hallway and glimpsed out the window. The snow was falling at a relentless pace – big, wet flakes coming down in droves. On the streets below, people were battling the wind and drifts just to cross the street. Cars were already becoming nearly entombed.

  Immediately, Jenna worried about her daughter. Mia was in fifth grade. If the hospital deemed things bad enough to cancel cases and forfeit revenue, then certainly the schools would be closing soon, too.

  Reaching into her breast pocket, Jenna pulled out her phone and quickly texted her husband.

  “Hey, Tom. Can you get Mia from school? I’m leaving now, but you’re closer. See you guys soon. Love, Jenna. P.S. A nice bottle of red and a warm fire sounds great, if you’re ‘up’ for it.”

  Not thirty seconds later, Tom texted back.

  “Definitely UP for that. Already picked Mia up. School closed an hour ago. Drive safe – roads are awful. Love you!!”

  Jenna smiled as she headed toward the elevator, thinking to herself the day was not turning out too badly after all.

  CHAPTER 4

  June 5, 2010

  Hillary and her parents had been sitting at the kitchen table for hours, discussing the mess she had created. Harold Martin struggled to comprehend the amount of devastation that his daughter had caused. His stomach balled up when he thought about the degree of trouble Hillary faced. Infuriated and exhausted, Harold clutched Hi
llary’s arm and began to yell at her. The ringing of the phone, however, immediately silenced him. Hillary shook her arm free from her father’s grasp and stomped over to the telephone. Her mother and father watched her trembling hands pick up the receiver.

  There was no reason for Hillary to check caller ID. She had been dodging phone calls and meetings with Detective Morris for over a week. Her moment of truth had come.

  “Hello,” Hillary answered, barely more than a whisper, as she turned away from her parents.

  “Is this Hillary Martin?” asked the deep, authoritative and, by now, recognizable voice on the other end.

  Her parents sat motionless as they strained to catch every word of Hillary’s end of the conversation.

  Hillary could barely force the words from her mouth.

  “Yeah, this is Hillary.”

  “Hillary, this is Detective Morris. I need to set up a time to meet with you down at the station. We need to question you regarding allegations of drug tampering and diversion that occurred while you were employed at St. Augustine Hospital. It seems like we’ve had our fair share of difficulty connecting. If you are available today, I’d like to meet with you at three o’clock. Would that work for you?”

  Tears of self-pity and fear slowly slid down Hillary’s cheeks. “Yes sir, I will see you there.”

  Detective Morris had played nice cop with Hillary Martin for over a week now. During that time, she had repeatedly lied to him, eluded his phone calls, and failed to show up for scheduled meetings. Today he was not taking any chances.

  Pointedly, Detective Morris asked, “Do you have a ride down to the station? If not, we will send a car to pick you up.”

  Hillary understood this was his way of telling her that this was her last chance to come in voluntarily. Not appreciating being backed into a corner, Hillary made no attempt to disguise her irritation. “My parents will give me a ride. We’ll be there at three.”

  “Do you have an attorney, or do we need to arrange to have someone represent you?”