Foreign Threat

by Mitchell Goldstein

  The team looked over the two other patients. The elderly man was doing well. Dr. Jenson thought he could be transferred out of the ICU, but to be safe she would run it by Dr. Douglas. Mrs. Johnson also was doing well, but Sally wanted to keep her in one more night. They finished with the notes and headed out of the ICU toward the surgical floor.

  The team bolted through the doors of the ICU. Sure enough, Jake was down the hall talking to a guy. The team continued walking the opposite direction toward the surgical floor.

  Steve began to follow the pack but then stopped in his tracks. The team started to leave without him, so Tom asked Steve if he was okay. “I’m fine. I’ll catch up with you all in a few seconds. I forgot my notes in Mr. Gordon’s room.” Steve paused until the team was out of sight and then backtracked to near the ICU doors. From afar, he studied the man who was talking with Jake.

  A lawyer didn’t seem to be the correct profession for this guy. Steve felt like they were both aliens in the hallway of a major hospital. Something didn’t fit. The guy just didn’t have that attorney look. He had the overcoat, something not seen much inside a hospital unless of course an attorney was present. But the man was too stocky, too unprofessional, too…too much like a detective, thought Steve. Maybe he was a private detective doing some work for Jake. Maybe Jake’s ex left the country, and this man was helping locate his family. The guy certainly did look like a detective, but whatever they were talking about was no business of Steve’s.

  The two men began shaking hands. A bright sparkle from the man’s ring caught Steve’s eye. Jake turned toward the ICU, and Steve quickly jumped back. He ran into the ICU to grab his notes and then chased after the rest of the team.

  Chapter 9

  Sally kept her pace at top speed while doing rounds, and Dr. Douglas never caught up. He wanted to see all the patients himself. By the time he was done visiting with one patient, Dr. Jenson and the team were on to the next patient. None of the other members of the surgery team minded since Sally was a little more pleasant to be around. The bonus of teaching the residents and students also made rounds more tolerable.

  Jake finally caught up with them as the team sat down for a bite to eat before the OR started. “Thanks for taking care of rounds,” acknowledged Jake.

  Sally just nodded her head.

  “It looks as if the only case today is removing the packs from Mr. Gordon. That shouldn’t take too long. Tom, how would you like to help out with that?”

  “I would love to, but Jake, Carmichael came in early to pre-round on all of the patients,” Tom confessed. “If it is OK with you, I think he earned the OR today.”

  “Just because he did his job you think he should get rewarded? All right, that’s fine with me. Steve, I’ll see you in the OR at 7:30 sharp. Don’t be late! I’m sure Dr. Rosberg will be there, and you will want to show him that you are an excellent and punctual intern.” Jake smiled to himself and walked off.

  Steve was not sure whether to thank Tom or flip him the bird, but going to the operating room was always better than doing the scut work on the surgery floor. Steve put half of his bagel in his mouth at one time and began to stand up.

  “Where are you off to, Carmichael?” asked Sally. “We

  haven’t gone through the patients.”

  “Yeah, I know, but if it’s okay, I would like a few extra

  minutes to review Mr. Gordon’s injuries and read about anything I don’t understand, if that’s okay with you Dr. Jenson.”

  “Fine, you little brownnoser.”

  Everyone laughed, including Sally, but she remembered all too well the first few years when she would do the exact same thing. If she didn’t know something, she would thoroughly research it so she wouldn’t look like a fool in front of the attendings when they asked her questions.

  Steve looked at the clock in the cafeteria while walking out. It was 7:15. He had ten minutes to go to the ICU to look through Mr. Gordon’s chart and still make it down to the OR by 7:25 to change into scrubs. Steve ran up the stairs to get to the ICU and walked through the doors to find that Mr. Gordon was gone. Steve looked around in disbelief.

  “Can I help you?” asked Agusta Simpson.

  “Yeah. Where the hell is Mr. Gordon?”

  “They already took him down to the OR.”

  “Shit!” exclaimed Steve. “Is his chart still up here?”

  “Sorry, they took that down with him.”

  Steve looked at the clock. 7:20. He turned around and ran down to the OR. He quickly changed into his scrubs and hurried to the pre-operative area. He looked around to locate Mr. Gordon. It shouldn’t be tough with the guy on a ventilator, thought Steve. But as he looked over the pre-operative area, there was no sign of a vent or Mr. Gordon. Steve heard a soft voice from behind the nurses’ desk.

  “Can I help you find someone?”

  “Mr. Gordon. Do you know if he came down already?”

  “Yes, they did, but he was on a ventilator. They take those patients directly to the room. He is in…” The nurse studied her sheet of paper in front of her. “Um…it looks like operating room four.”

  “Thanks.” Steve quickly headed to OR 4. As he left the pre-op area, he glanced at the clock again. 7:24.

  Steve put on a facemask and hat and walked into the room. He looked up and nearly fainted. In the corner was not only Jake Douglas, but also Dr. Rosberg. Dr. Rosberg was flipping through the pages of the chart.

  Great! thought Steve dryly. Now what, just grab the chart from Dr. Rosberg and say excuse me, but I need to look through that thing too? No, that didn’t sound right.

  “Good morning, Dr. Carmichael,” greeted the senior doctor. “Welcome aboard. I heard you earned the right to scrub in the OR today. That a boy! I know you’ll do as good of a job as a resident as you did while you were a medical student.”

  Steve was not certain what else to say, but before he could think about it, words came out of his mouth. “Thank you, sir. I’m looking forward to the challenge.”

  Dr. Rosberg got up and put the chart down. “Jake, don’t get started until I get back. I need to talk to scheduling for a minute, and then I’ll be ready to go.”

  While anesthesia put Mr. Gordon to sleep, Steve finally had a chance to glance through the chart. Just as he was in the middle of a paragraph, Jake tapped him on the shoulder.

  “Come on, let’s go and scrub.”

  Steve hesitantly put the chart down and followed Jake to the sink. While washing, Jake apologized for the boring case. “This is all I got for you today, but I’m sure there will be other more exciting cases soon. All we have to do is remove the packs and irrigate. It shouldn’t take too long.”

  A scrub nurse poked her head through the door, “Come on, guys, we’re ready.”

  Steve followed Jake into the room. After the patient was draped, Jake asked for the scissors.

  “Don’t you want to wait for Dr. Rosberg?” inquired Steve.

  “Nah, we’re just wasting OR time waiting here. This should be simple. Just remove the liver packs, and irrigate.”

  “Yeah, I know, but Rosberg stated specifically to wait for him,” pleaded Steve.

  Jake looked up at Steve and stared at him. “If you don’t think you can handle a little blood, doctor, then you better leave!”

  Jake grabbed the scissors and cut the suture holding the patient’s skin together, exposing the whole belly. “All we’ve got to do is remove a few packs, irrigate, and get out.” Jake poured saline over the packs to make them easier to remove. Slowly and very carefully, he pulled the first pack out. “See? Not a problem. I wonder how many packs they left in this guy.”

  Steve looked up at Jake and could not believe his ears. “Didn’t you read his operative note from the trauma?” he asked.

  “Nah, I didn’t have time. Rosberg had the chart, then it was time to scrub in, and here we are. We just have a few more packs left.”

  Steve was shocked. Here was a chief resident who spent years of training be
fore entering the private sector, and only a year away, he didn’t find the time to review old op notes. Shit, thought Steve. I’m just an intern just a few days, and I know better than that! “Six,” he answered.

  “What? What do you mean six?” asked Jake.

  “Six. There were six packs placed at his surgery.”

  “Oh, that’s good to know,” said Jake. He continued to work.

  Steve shook his head in disbelief but made certain not to make it too noticeable.

  Jake poured more saline in the abdomen to loosen the packs.

  Next, three packs were removed fairly quickly. Not a problem. But then Jake stopped and studied the situation. Two more packs were left, but they appeared to be deep and behind the liver. Jake took a deep breath and began to pull the next pack. A little red fluid was building up next to the liver, but that could be saline mixed with old blood.

  The OR was incredibly quiet as the fifth pack came out.

  “See? Not a problem. You just have to take your time and be patient. This way, when Rosberg comes back all the dirty work will be done, and all he’ll need to do is put on gloves and gown, peek in, and say okay. Then he can turn around, leave the OR, and bill the big bucks.” Jake laughed to himself as he looked at the last pack.

  Steve was not as content. He didn’t have much time to look over the chart, but what he did read through was concerning. The trauma team had encountered a difficult time to stop the bleeding from what they thought might be hepatic veins behind the liver. These were incredibly difficult to reach unless you were doing a liver transplant. But that was not the plan today.

  As Jake began to pull the last pack from behind the liver, Steve took a small step back and squinted, as if waiting for a disaster to occur. At last he couldn’t take it any longer, “Uh, Jake, don’t you think we should wait for Dr. Rosberg for this last one? I mean you did most of the work, but he could be here for this last pack. That way he wouldn’t feel guilty about charging the patient, and-”

  “Rosberg feel guilty? This is an attending we’re talking about. There are no guilt feelings in their conscious. And besides, he…OH SHIT!” screamed Jake. “GET ME SUCTION! SUCK, SUCK!”

  Steve couldn’t believe his eyes. He had never seen the abdomen fill with that much blood so quickly.

  “PACKS! Get me packs now, damn it! Shit, where is all that blood coming from?” Jake’s voice was filled with panic.

  Steve tried to help. “The op note said that there was a lot of bleeding from the hepatic veins, and that is when they-”

  “Hepatic veins? They never told me about fuckin’ hepatic

  veins! Shit, we’ll never get to those.” Jake quickly started to freak out and lose it.

  “WHAT THE HELL IS GOING ON HERE?” shouted Rosberg as he burst into the OR. “Douglas, what the hell are you doing? Do you not understand the English language? What did you not understand about DON’T GET STARTED UNTIL I GET BACK?! Is there any blood available? Send for it, NOW, DAMN IT!! Get me a gown! Jake, you stupid shit, pack that belly, NOW!” Dr. Rosberg quickly gowned up.

  The rest of the room was silent as could be.

  Then anesthesia yelled, “We’ve got a drop in blood pressure. We need some time to catch up. Let’s get two bags of LR while we’re waiting for the blood. How come the blood is not in the room? How long before the blood is available?”

  Great, thought Steve. Not only did he earn this bullshit operating room experience, but also he was going to witness several grown adults freaking out.

  “Carmichael, move down!” Dr. Rosberg shouted as he

  stepped toward the table.

  Steve thought for a second that he could earn major brownie points by telling Rosberg about the op note, number of packs, and the source of bleeding, but then he would have to answer to Jake for the next several months. Steve still had to respect the hierarchy of authority.

  “Jake, how come you have an intern scrubbed on this trauma case?” Dr. Rosberg demanded.

  “Well, he earned the privilege to be in the OR and-”

  “That’s exactly right, you moron. It is a privilege to be here in the OR. I’m not sure YOU have earned that privilege!”

  Dr. Rosberg packed the wound with about ten packs and put pressure on them as they lay over the liver. He turned toward the head of the bed and asked, “How are you guys up there? Are we caught up yet?”

  “We need the blood up here before the packs come out, and let’s get some fresh frozen up before we let the dike out,” replied Dr. Lee, head of anesthesia.

  “Fine. Someone call Dr. Jenson and get her butt down here, NOW! Steve, it’s nothing personally, but I’ll need some experience for the remainder of the case. Don’t you worry, young man. The next appendectomy I have, you will be the first person I call. Besides, you learned just about everything you could learn from this case, especially not to be a stupid asshole while in surgery. Speaking of appys, I think the intern lecture today is on appendectomies. Why don’t you listen carefully today so the next appy that comes in can be yours?”

  Steve felt awkward with the situation but took his cue. “Thank you, sir. I guess I’ll see you later. Good luck.” He had a feeling of relief as he exited the OR.

  He couldn’t believe how careless Jake was with patients.

  No wonder Sally thought the guy Jake was speaking with this morning was a lawyer. Jake seemed to find himself in these situations a lot, per the last poll from junior and senior residents. From their analysis, Dr. Douglas not only needed a lawyer but a small firm to take care of his legal matters. He had the divorce, his kids, his stupid ass mistakes in the OR, and his financial difficulties, to name a few.

  Steve was thinking about Jake when he almost bumped into Sally.

  “What the hell happened?” she demanded. “It was supposed

  to be a simple procedure, remove a few packs, irrigate and get out. How the hell did you guys get into so much trouble so quickly?”

  Oh no, not her too. “Just remove the packs and irrigate” seems to be the resident thing to do, thought Steve. “Jake removed the final pack, and the hepatic veins showed themselves.”

  “Great!” said Sally, rolling her eyes. “Now the floor work will be delayed by an hour.”

  “An hour!” laughed Steve. “If you guys are out in one hour, I’ll do your scut work for a week.”

  “Scut work? That’s your job anyway. How about you wash my car for a month if we’re done in less than an hour?” dealt Sally.

  “Fine, that sounds like a good…” Before he went on, he had to rethink what he was betting on and the possibilities. “In less than an hour is a deal, except the man needs to come out of surgery alive and stay alive for at least a month.”

  Sally considered the bet as she continued toward OR four. She shook her head violently from side to side. “No, absolutely not. There is not a bookie in town who would take that risk.”

  They both giggled. Steve departed the operating room as Sally continued in.

  The lecture series was put on by attendings and their chief residents once a week. The lectures were usually presented by chiefs, but Jake had other plans today. When Steve got to the lecture hall, only a few interns and students were there. He looked for Dennis but couldn’t find him, Mike, or Roger. Steve picked a seat in an empty row.

  Finally, a familiar face joined him. “Hey, great OR experience so far this morning,” Dennis said. “The whole hospital already knows about it. I think they e-mailed most of the personnel just to forewarn the good human beings, as well as the assholes, to stay away from Jake the flake.”

  “You could say that I now know what to do when your attending says wait for him,” said Steve. He and Dennis compared notes on their mornings before the lecture began. As they were talking, Dr. Jones approached the podium.

  Dr. Jones was known as the chief resident who was the

  epitome of a surgeon jerk. He made Jake Douglas look like an angel. “Good morning, lowlifes. It has come to my attention that some of yo
u green interns went to either very prissy med schools or just skipped out on all the essentials to making a good surgery intern. But for you wimps who didn’t put IVs in while you were students, you need to face this horrible event so that you won’t bother me anymore with the bullshit phone call that you can’t get an IV.”

  Dennis leaned over to Steve to whisper, “I heard the intern on last night couldn’t put an IV in for the life of her. Jones got so pissed he made her go home.”

  “What? No way.”

  “Yeah way. She has to make the call up later. But he got

  so pissed he told his team that he was going to bore us with the art of placing IVs instead of teaching us the art of performing appendectomies.”

  “Just my luck,” said Steve. “Today Dr. Rosberg felt bad for kicking me out of the OR, so he said the next appy that comes in I’ll be able to do.”

  “That’s great! Maybe you’ll be the first intern to do an appy this year.”

  “That is great, except I was planning to learn how to take out an appendix today in the lecture. I guess I’ll have to show up to these lectures for the next few weeks, at least until they

  discuss the appendectomy.”

  Dr. Jones explained the art of putting in IVs, the pearls or tricks to make certain they were placed correcting in the first attempt, and the complications of IVs. After going over everything in painful detail, Dr. Jones made the participants practice on each other. Steve and Dennis got IVs into each other very quickly and were instructed to leave after passing the practical exam.

  The exam was controversial, at least in Steve’s mind, but it

  was very simple: place an IV in Dr. Jones. The controversy existed because there were a few residents who would rather fail on purpose in order to make a mistake or two on Dr. Jones, just to cause him pain. Since Steve and Dennis did such an outstanding job on each other, Dr. Jones elected to dismiss them without placing an IV into his thin vessels.

  Steve walked out grinning with Dennis. “Hey, hope to see you at the next appy lecture.”