Foreign Threat

by Mitchell Goldstein

  “You’re right. That entire situation is weird. I hate to be abrupt, but I forgot that I need to get up early in the AM, so I’ve gotta go. I hope you have a better day tomorrow. And if I were you, I would not approach your chief on this one. I mean, if he asked you not to get the tox screen, then you don’t want to piss him off by showing your insubordination. Stay good, stay safe, and watch your back.”

  Steve frowned at his screen. “Watch my back?”

  “I mean watch out for those fellow residents. You never

  know what they are up to. Hey, I need to go. See ya.”

  Steve looked at the screen to see if there were any other messages. He thought to himself, Watch my back? What the hell did she mean by that? And why was she in such a hurry to log off?

  Steve turned off his computer as he pondered those thoughts

  and got ready for bed. He made sure his alarm was set and then climbed beneath the sheets. Lying in bed, he thought about her last statement and how fast she wanted to get off. It was like she waited all night to talk to him and then signed off as quickly as she could. That was just as weird as the previous day. Steve went to sleep hoping tomorrow would be a little less weird.

  Chapter 28

  Steve yawned as he entered the locker room. He needed more sleep last night, but talking to Sweetpea had kept him up longer than he had wanted. He promised himself not to talk that late at night post-call. It didn’t matter if it was Sweetpea or the Queen of England, post-call was just not the right time to chat in the middle of the night.

  He put his backpack in his locker, grabbed his lab coat, and quickly left to get to the ICU for rounds. The locker room for all the surgery interns and residents was located in the OR, which made perfect sense as they all had to change before operating. As he dashed past the main OR desk to get up the stairs, he saw Karla crying at the desk. He wanted to joke and ask if she was scheduled to scrub with Jake again, but he decided that would not show much tact. He did wonder what was wrong but didn’t have the time to ask questions. Probably a bad night or some family issue. Steve didn’t give it a second thought as he made his way to rounds.

  He walked through the doors of the ICU, and his jaw dropped. He quickly looked at his watch to check the time. He checked the clock over the nurse’s station to confirm that he had the correct time. Both read 5:45.

  What startled Steve was the presence of Jake Douglas. “Good morning, Dr. Douglas. What a surprise to see you bright and early. Couldn’t sleep last night? Or are you just starting a new thing by rounding with your team?” Steve realized what he had said and began to turn red. “Uh, sorry, Dr. Douglas. It just slipped out.”

  Jake laughed. “I know all about having words slip out of one’s mouth. I didn’t realize, Carmichael, that you too can fit your foot in your mouth so easily. Welcome to the club.” With that, Jake gave Steve a nice slap on the back as if to congratulate him on his initiation to the whoops-I-shouldn’t-have-said-that club.

  Jake went about his business, and Steve followed suit. He visited each of the three patients in the ICU that morning to go over their labs. He reviewed the events during the night and looked for temperature spikes or any changes in their vital signs. He briefly discussed with them how they felt and if there were any problems. It was nice to have this information prior to formal rounds. However, this morning it seemed fruitless as Jake was already there, making rounds and checking everyone over himself.

  Even odder than Jake’s early appearance was that Sally had not arrived yet. She was almost always the first resident in the ICU to start looking over the patients. She was particular about the details of her patients, and even though she was not the chief resident, she still pushed herself to know everything about the patients, not to impress an attending but just to take good care of the patients. She felt it was her responsibility to manage the patients and make sure they got the appropriate medical treatment for their surgical problem.

  The rounds in the ICU were routine, with the students writing down the labs for the morning and the residents and interns going over the patients. What was not routine was to see Sally come into the ICU late for rounds without prerounding.

  Not only was she late: she looked as if she had been through a sleepless night with a drinking binge. When she finally arrived, her eyes were blood shot, and the skin below her eyelids was dark as if she had not slept for days. One could see where her mascara had bled down her cheek. Her nose was red and runny, and her eyes were swollen as if she had been crying.

  The students didn’t dare say a word, and Steve didn’t feel as if this was the time or place to inquire about her appearance. Jake, on the other hand, had no problem asking personal questions. “So what the hell happened to you?”

  Despite his lack of tact, Sally would have answered him if there wasn’t a crowd around. Instead, she put her hands to her mouth and whispered, “Later.”

  She started to whimper, and Jake decided to not be an insensitive shit. He must have realized there was something serious going on. Sally, who was usually pretty strong, would not be so upset over something small. Jake let it go and did what he rarely had done since he was a resident himself: he led rounds. “Alright, then, let’s get done with it. Carmichael, why don’t you start going over Mr. Bettles and have one of the students write the progress note so we can get this done and over with?”

  Steve did as he was told, and so did the students. Although it was unusual to have Jake around for morning rounds, he sure did pick the right morning to show up, with Sally unable to take charge. Rounds in the unit went well and quick. Soon the team headed out of the ICU and off to the surgical floors to see other patients.

  Jake fell behind when Tom Formin finally showed up and began to pick up the slack. He motioned to the others to follow. As they did, Jake and Sally slowed down to talk in private.

  Steve was curious what was wrong. He tried to put the pieces of the puzzle together. First Karla and now Sally, upset and in tears. This couldn’t be a coincidence. Steve never saw the two of them together for lunch or snacks and didn’t believe they were close friends, so it was very strange that they were both upset this morning.

  He slowed down to hear the conversation. At first, all he

  could make out was Sally crying as she tried to talk to Jake. He continued to listen carefully and was able to pick up a few thoughts.

  “Did you hear the awful news? I just can’t believe it,” exclaimed Sally.

  “What? I didn’t hear a thing.”

  “The OR called A.J. this morning because he was unusually late. His wife answered the phone and was totally hysterical. She had heard the alarm clock go off, but A.J. never turned it off. She just figured that he was sound asleep. So she rolled over him to turn the alarm off and he…” Sally whimpered a little and then cleared her throat as if to become stronger. “That’s when she discovered his body was stiff as a board.” Sally cried for a few seconds before finishing the story. “Apparently he had a heart attack during the night. Never felt a thing, he just went in his sleep.”

  Jake was shocked. “Shit! I just did a case with him the other night. Not once did he let us know that he was having any trouble. I can’t believe that guy could have died! He was in great shape, not to mention that he was so young. I don’t think he was past his mid-fifties. Well, at least he went in his sleep. That is definitely the way we all should die. I’m really sorry to hear about that, Sally. If you need to take the day off…”

  Steve hurried ahead. He had heard enough. It made him sick to his stomach. That certainly explained all the tears in the OR this morning. He couldn’t believe it either. A.J. was in great physical shape and never really complained about anything. Steve recalled a 36-year-old patient from his medicine rotation that needed cardiac bypass surgery, but that guy had terrible genes with lots of heart trouble in his family history, so he was doomed to have heart problems too. Maybe that was the trouble with A.J. He could have had high cholesterol or a family history of heart conditions
. Steve wondered if that was why he was always working out and in such great shape. Either way, it was a terrible event that shook the entire OR Department and staff.

  Steve caught up with the rest of his team by the time they reached the surgical floor. By the time they began reviewing the chart of the first patient, Jake had caught up with them as well. Sally was not with him.

  They finished rounds in record time, and the students along with Steve and Tom Formin headed to the cafeteria for breakfast. Jake went on to the OR to check on the cases. He spoke a few minutes with Tom and then left. The others got their food and coffee and sat down. They started with small talk, but then one of the students asked where Jake and Sally were.

  Tom had been on call last and was still too sleepy to pick up on anything, so Steve stepped up to inform them of the current events. “I don’t know if this is supposed to be made public yet, but I’m sure it will get out sooner than later. Last night A.J., the anesthesiologist, died in his sleep. It has kind of freaked everyone out here. I guess Sally took it really hard, so Jake offered her the day off.”

  Tom had a total look of surprise and disbelief written on his face. He knew A.J. well, and they even had gone boating several times to enjoy a shared love of water skiing. “I can’t believe it,” Tom said. “That guy was in great shape. I never heard him complain at all about any angina or other problems.” He sat back, shaking his head in denial.

  Steve answered some other questions from the group as best he could. By the time he was finished, Jake walked solemnly up to the table. “I don’t know if you guys have heard, but A.J. died last night unexpectedly. That has really set the OR and Anesthesia Departments into a tailspin. And because of that, the OR manager has decided to cancel all elective surgery cases.

  What that means for you slugs is that we will have a sweet day.”

  Jake continued, “Tom, since you didn’t get much sleep last night and you’re post-call, why don’t you take the day off? We will see you in the ICU for rounds in the A.M. Steve, I’ll have you take care of the floor with the boys here.” He waved at the two medical students. “At about three or four o’clock, make afternoon rounds. You can do that on your own since there won’t be any fresh OR patients. If you have any questions, just contact me on my pager. I already sent Sally home because she was so distraught about the events of last night. Any questions?”

  Steve chimed in, “What if new patients come in from the ER?”

  “That shouldn’t be an issue today because the other surgery service is taking call tonight.”

  Steve nodded. “Okay.”

  Tom scooted his chair backward and took off without further questions. Jake walked off too without adding anything else. Steve stayed with the students at a table, discussing morning rounds and delegating what needed to be done.

  The three of them split up to get everything done. Steve told the others to check in with him when the work was done. If everything looked okay, he planned to send them home early. He could make evening rounds by himself.

  The day went without a hitch. The students got their work done by two o’clock. They reported to Steve to discuss what they had done and any other issues that needed to be covered. As promised, Steve let them have the afternoon off. He took the opportunity to hit the medical library for some quiet reading. He didn’t feel right about signing out the patients so early since usually they wouldn’t sign out patients until eight or nine at night.

  Steve rarely had time to just sit and read while at the hospital, so he took full advantage of this unfortunate event. As he settled in with a stack of books, he thought about A.J. and how he was just with him the other night doing the case with Jake. Steve had seen a number of people die since he had been an intern, but to lose someone you knew was a different feeling. Besides that, A.J. seemed so young and healthy. Steve wondered if A.J. had been having angina or if his cholesterol was elevated and not treated. He was searching for some logical explanation as to why A.J. had died so young.

  Between wondering about A.J. and his death and trying to study, the free time flew by. Steve looked up at the time and found it was almost five o’clock. He felt that this would be a reasonable time to make rounds and leave. Rounds went flawlessly with no one for Steve to answer to. He wished it could be that easy every time. After rounds, he signed off his patients and left. It was a very strange day indeed.

  Chapter 29

  An unusual few days followed as everyone in surgery and anesthesiology were trying to get back on track. Life in the OR was solemn, but everybody did the best they could to get over the tragic sudden death of A.J. People greeted each other with a slight smile and nod of their heads. The nurses and scrub techs went through the motions of the day, but they really weren’t there. Everyone was thinking about A.J., or thinking about their own lives: their children, their parents, their grandparents or their friends. The tragedy affected so many people that dealt with death and dying on a daily basis but now had an unfortunate chance to experience it firsthand.

  Sally returned to the team after taking an extra day off to collect her thoughts. She looked well rested, but she didn’t really speak unless spoken to. She didn’t offer any smiles or hellos. She just saw her patients and reported to Jake. At breakfast in the cafeteria, when Sally would usually delegate the day’s responsibilities, Jake stepped in and assigned duties to the students and interns. For the early days surrounding A.J.’s death, Sally and Tom would exclusively go to the OR, and no one questioned it.

  Steve worked with the students on the floor, and if he had extra free time, he used it to his advantage for studying. All in all, things were slowly getting back to normal. A.J.’s wife decided to have his funeral the third day after his death. This seemed somewhat quick, but no one asked any questions. Steve didn’t attend because he didn’t really know A.J. that well, but Sally and Tom attended because they had worked with him longer.

  The OR was shut down except for emergencies on the day

  of his funeral. Steve and the students covered the service

  again, but the number of patients had been getting smaller. It was no big deal for the three of them to take care of all the work.

  Steve was not sure if Jake was going to return to the hospital that night, but they were on call together. Although the chief residents were not required to spend the night in the hospital while on call, most of them did. In fact, Jake was the only chief on the staff who would take a chance and go home. If anything serious came in, he would rush into the hospital.

  The night started off quietly for the surgery team on call. The mood seemed subdued, especially in the operating rooms. Steve had to see two patients with abdominal pains in the Emergency Room. He discussed these cases with Jake, and to no surprise, Jake elected to admit the patients and observe them. He would rarely operate on a possible appy or belly pain unless their white count was sky high or they had free air in their abdomen, which was usually a sign that there was a perforation somewhere in the abdomen. It was a quiet night until about midnight when a trauma code was announced over the loud speakers and over the pagers of the entire surgery call team, including Steve’s.

  When a trauma code was called, the complete surgery team on call would have to show up in the ER to help run the code and stabilize the patient. If necessary, they would take the patient up to the OR to complete surgery. For this reason, the OR team had to be on call from the hospital. An entire OR crew had to be ready to go at any time.

  Unfortunately for Jake, when a trauma code was called and he was the chief resident on call, he would have to speed into the hospital in order to help out. This usually was not a bother for the OR crew unless Jake was having a beer or some other tasty beverage because he would need to spend a few minutes trying to sober up before heading into the hospital. This might translate in to the chief resident showing up late to the code or, worse yet, showing up drunk. Although Jake was irresponsible a great deal of the time, he rarely showed up to the hospital intoxicated.


  Steve rushed to the ER, imagining several dramatic scenarios. He was sure to include a scenario that involved working by himself with no one else there to help run the code or the trauma. He was beginning to feel rather confident with what he could handle by himself, but he was not ready to handle a trauma by himself. The first thing he did when he made his way to the ER was to search for the chief resident.

  Jake was nowhere to be found.

  Steve saw the pre-trauma commotion. The nurses were trying to get the IV tubing situated and organizing the airway management equipment, including an endotracheal tube. Someone else was getting the paperwork together, including the orders and flow sheet for the trauma.

  Steve continued to look for Jake. As the estimated time of arrival for the ambulance drew closer, the chief resident was nowhere to be found. Steve knew the ER doctor would be able to manage the trauma, but if a chest tube needed placement, he would be in a bind. Steve wondered if an ER doc would be able to help with a deep peritoneal lavage if that became necessary. The intern had seen all these procedures performed in the past but never had to tackle this alone.

  A few short months ago, Steve would have panicked know-

  ing he might be on this trauma alone, but he knew a third or fourth year surgery resident would be around soon. Even if no one showed up, Steve felt he could do any of the procedures necessary to stabilize the patient. Just then, everyone heard the ambulance rig pull up. Steve grabbed a face shield and gloves

  and then ran outside.