Code Blue pft-1

by Richard L Mabry

  She saw Harshman's mask move as he opened his mouth to respond, but that response never came.

  A nurse holding a phone message slip hurried into the room. "Dr. Harshman, your OB patient, Karen Pearson, is in the emergency room. She's cramping and spotting. What do you want to do?"

  For a moment, Cathy thought Harshman hadn't heard. He picked a pair of blunt-nosed scissors offthe instrument tray beside him and began dissecting in the depths of the operative site.

  Just as Cathy was about to speak, Harshman looked up from his work. "I know you've seen her, Dr. Sewell. You know about her case. Now she's at term and she's bleeding. The baby's a breech, so I'd scheduled her for a C-section. What would you do?"

  "Is there any sign of fetal distress?"

  The nurse didn't seem to know whom to address, so she swiveled her gaze between the two surgeons. "Fetal heart tones were one fifty when she came in. They've dropped to one ten."

  Cathy didn't hesitate. "This could be an abruptio placenta or a prolapsed cord. Whatever the cause, there's definite fetal distress. She should have a stat C-section."

  Harshman nodded once, then turned to the nurse. "I can't leave this patient. Is Dr. Gaines available?"

  "He had to drive to the hospital in Bridgeport to handle an emergency there." The nurse didn't throw up her hands, but her voice conveyed the same message.

  "Cathy, how many C-sections have you done as surgeon?"

  "More than half a dozen-fewer than a dozen. And I've watched and assisted on maybe ten more."

  "Contact Dr. Steel," Harshman told the nurse. "Tell him I need him to scrub up and assist me in finishing this case. Then call Dr. Bell. He'll have to scrub with Dr. Sewell. She'll be doing an emergency C-section on Mrs. Pearson."

  Cathy bent over the hospital bed, struggling to make her voice comforting and confident at the same time. "Karen, you need an urgent C-section. The baby is in trouble. Dr. Harshman's in surgery and can't drop out. He's asked me to do it. The nurse has told you what it involves, the risks involved. Will you give me permission to do the case?"

  Karen Pearson looked up at Cathy. Despite her grimace of pain, there was serenity in her eyes. "Of course. I've been praying that you'd deliver my baby. I didn't really want it to be an emergency, but if that's what it takes, I'm okay."

  Cathy nodded to the nurse who stood at the head of Karen's bed. "As soon as the permit's signed, get her up to surgery." She looked down at Karen again. "I'll do my best for you."

  "That's all anyone can ever do," Karen said through clenched teeth. "Remember that."

  In the women's dressing room, Cathy exchanged her sweat-sodden scrub suit for a clean one. By the time she strode into the pre-op holding area, the anesthesiologist had wheeled Karen into the operating room. He turned and asked, "Epidural or general?"

  Cathy didn't hesitate. "No time for an epidural. General. I want her under the moment I'm gowned and ready."

  Marcus Bell hurried up, pulling on a surgical cap. He picked a mask out of the box above the scrub sink. "Fill me in. All I know is that you're doing an emergency C-section on one of Arthur Harshman's patients at his request, and you need me to assist."

  Cathy adjusted her own mask and began the scrubbing up process that numerous repetitions had made automatic. She explained the situation to Marcus, who, to his credit, listened without interruption or argument.

  "When was the last C-section you did?" he asked, when Cathy had finished her explanation.

  "Not quite a year ago."

  "That's about five years ahead of me. Do you recall all the details?"

  She replied with more assurance than she felt. "I know enough. Between us, we'll get through it. We have to. That woman's baby is struggling-fetal heart tones down to ninety now-and we have to get her delivered."

  This was it. Go time. Cathy looked around her. The anesthesiologist stood by at the head of the operating table. Dr. Denny, the pediatrician, sat in a corner, ready to take the baby. Marcus took his place across from Cathy, his eyes conveying no message at all. Karen lay on the operating table, her bulging belly tinted a strange orange-brown by the prep solution and outlined in a surreal square by the green draping sheet.

  "Everybody ready?" Cathy paused. "Karen, we'll take good care of you and your baby. I promise." She nodded at the anesthesiologist. "Let's go."

  In a few moments, Karen was under. The clock had started to run. Cathy had less than ten minutes to get the baby.

  "Fetal heart rate?" she asked.

  "Holding at a hundred."

  Cathy had a decision to make. Did she have time to make a low "bikini" incision across Karen's abdomen or should she save precious minutes by using the long vertical incision employed years ago? Cosmetic result or safety for the baby? Plastic surgery could minimize scars. If she were on that table, she'd say, "Hurry. Save my baby."

  She reached out her hand. The scrub nurse slapped a scalpel into it. "Vertical incision." Cathy fixed Marcus with a look that she hoped carried the authority she didn't feel."Get a sponge in one hand, cautery in the other, keep up with the bleeding."

  "But -"

  Cathy's eyes dropped to the operative field. "Marcus, I have a reason for everything I do, but I don't have time to explain. I'm the surgeon. Help me. That's what assistants do." he plunged the scalpel into the taut flesh of Karen's abdomen. As layer after layer yielded to her dissection, SCathy wondered if her words had offended Marcus. She was surprised to realize that she didn't care. Her priority right now was to do what was best for Karen Pearson and her baby. She'd worry about her relationship with Marcus and all the other doctors on the stafflater. If practicing good medicine and putting the patient first got her ridden out of Dainger on a rail, so be it.

  "Down to the uterus. Let's get a self-retaining retractor in."

  As he had since her initial exchange with him, Marcus complied without comment. To his credit, he'd been an excellent assistant, anticipating her moves and working in smooth tandem with her.

  "I'll make a low fundal incision, then extend it with scissors. The presentation's a footling breech. I know how to do the extraction, but I'll need a second set of hands to do it."

  She sent a look at Marcus. He nodded once.

  "Fetal heart rate has dropped to eighty-five."

  "Here we go," Cathy responded.

  Cathy let reflexes, muscle memory, and hours of midnight study take over. In seconds, the uterus was open, the amniotic sac incised, and she reached for the baby. "Dr. Denny, are you ready?"

  The pediatrician moved closer to the table. "All set."

  The information flashed through Cathy's mind like the words on an electric sign. The largest part of a baby is the head. For a C-section, make the incision big enough to deliver the head and there's no problem with the rest. In this case, the baby's legs would come out first, the head last. She'd have to guess at the incision size. Halfway through the extraction, Cathy saw that her incision hadn't been large enough. "Scissors." She held out her hand, palm up, and felt the firm slap of the instrument.

  "Do you-?"

  Her eyes never left the operative field. "Marcus, I know what I'm doing."

  "Fetal heart rate is eighty."

  The words spurred Cathy on. She dropped the scissors and slid her hand down along the baby's head. Words memorized by rote now were turned into action. Hand onto the face, finger in the mouth. Turn a bit. "A little more traction on the legs please."

  There! The baby was free. And there it was-a prolapsed umbilical cord, a kink that cut offthe blood supply from mother to child. Cathy clamped and cut the cord and handed the baby offto the pediatrician.

  As she worked to complete the procedure, her ears waited for that most wonderful of sounds, the cry of a newborn. There was the gurgle of the suction bulb as Dr. Denny cleared the baby's mouth and nose. A moment of silence, then more suctioning. She was aware of murmuring between the pediatrician and the nurse assisting him. As Cathy was about to turn back toward the bassinet, she heard it. Faint
at first, then stronger. The insistent cry that signaled a healthy set of lungs.

  "Nice work, Doctor. It's a boy."

  Cathy stood beside Karen Pearson's recovery room bed and watched the woman's eyelids twitch, then open slowly.

  "You and your son are doing fine," Cathy said.

  Karen reached out her hand, wincing as tension on the needle in her wrist pricked her. "Thank you, Dr. Sewell. See, God brought us both through it just fine."

  "I- Thank you, Karen. Now, you get some rest. I need to go help another doctor."

  Cathy shucked out of her surgical gown and hurried to report to Harshman. She paused just inside the door and said, "Mrs. Pearson's doing fine. Footling breech with a cord prolapse. The FHT had dropped to eighty by the time we got the baby out. Healthy little boy."

  "Good. We're almost through here. Dr. Steel's done a fine job assisting," Harshman said.

  Cathy was thinking that he was too polite to add, "Better than you did."

  Instead, Harshman said, "I must admit that I was a bit hesitant to send you offto do that emergency C-section. Glad you got through it."

  "Thank you. Would you like me to tell Dr. Gladstone that everything is going well here?"

  "Yes, please do. I'll be out in about fifteen minutes to talk with him."

  She was halfway through the door when she heard his last words. They stopped her in her tracks.

  "Good job, Cathy."

  The anesthesiologist had said his good-byes and headed for home. Dr. Denny stopped by long enough to change into his street clothes and offer his congratulations on a successful C-section. Now Cathy and Marcus sat in the deserted surgeons' lounge, side by side on the sagging sofa. Their feet rested on a coffee table littered with the detritus left by previous occupants: discarded surgical masks and caps, pink message slips with cryptic scribbling, and pads of hospital progress notes. Cathy sipped from a cup of vile-tasting coffee. She hadn't wanted it, but Marcus had presented it like a peace offering.

  "Thanks for the coffee," Cathy said.

  Marcus nodded. "You're welcome."

  Marcus was obviously walking on eggshells, so Cathy decided to try easing the tension. "I appreciate your scrubbing with me. I couldn't have done it without you."

  "Happy to help, although there wasn't much choice. The case needed to be done stat, and I was probably the most logical candidate to scrub in."

  A thought crossed her mind. "Are you angry that Harshman didn't ask you to do it?"

  The wait before his answer told Cathy what she needed to know. Marcus blew on his coffee, tasted it, and made a face. "I don't really know. I guess my first thought was that I was more qualified to do it than you are. But, as it turned out, I was wrong."

  "You didn't pay any attention to those letters about my qualifications, did you?" She felt the anger boiling up. Maybe it was time to get all this out in the open. "You know, you're just like the other men on the committee. You had your mind made up before that meeting that I would have the same privileges as every GP who's practiced in Dainger since the hospital opened. Never mind that I'm a residencytrained, board-certified family practitioner with undeniable qualifications and excellent recommendations. It was a foregone conclusion that, because I'm a woman, because I grew up here in the shadow of my father-a real doctor-there was no way I could ever be as capable as you men." She put the Styrofoam cup onto the table with enough force to slosh coffee onto everything, wishing it were a china mug so she could slam it down.

  Marcus tossed his half-full cup into the trash. "No, no. I know you're qualified. It's just that I have to remain neutral in these things. If I take a side, I automatically end up with half the doctors on the staffmad at me."

  Cathy rose and bent down until she was almost noseto-nose with Marcus. "And that's why you didn't want me to speak up at the credentials meeting. And why you didn't vote. You were unwilling to risk making someone on the committee mad. This way, the only person you disappointed was me. And you figured you could make that up by taking me out to dinner. Is that my price? A nice dinner? I'm insulted. Even Judas got more than that!"

  Marcus was still talking when Cathy turned and stalked into the women's dressing room. She tried to slam the door behind her, but the automatic closer thwarted her efforts, easing it closed with a soft whoosh. Oh, well. She figured this wouldn't be the last time she had some strong words for Dr. Marcus Bell. Next time, she'd make her exit a bit more emphatic.

  12

  You look different today. New hairstyle?" the remark was so out of character for Josh that it took Cathy by surprise.

  "No, same style I've had since I started med school. Low maintenance and plain."

  "Maybe it's the makeup. You look different."

  Cathy settled more comfortably in the chair. "I guess it's because I feel different. Let me tell you what happened a couple of days ago."

  When she'd finished relating her experiences in surgery, Josh leaned back, crossed his legs, and clasped his hands together in front of his knee. "How are you sleeping?"

  "I've been so worn out recently that I'm asleep as soon as my head hits the pillow."

  "Any more run-ins with that black SUV?"

  Cathy shrugged her shoulders. "No. The sheriff' s looking into it, and I'm careful."

  "Let's review. You came here because you were depressed- understandably so, given what you'd experienced, although you didn't seem to realize it. Actually, you thought you were on the road to full-blown paranoia. You were afraid you might be showing signs of the same schizophrenia your mother developed. How do you feel now?"

  "Better, I guess."

  "You're relieved because, instead of being mentally ill, your life is actually in danger?"

  "I know. It's crazy." Cathy laughed at her poor choice of words. "You know what I mean. Anyway, this is something I can fight, and I've made up my mind to do just that. And I have some help."

  "The boyfriend turned lawyer?" The smile Josh flashed was a rare sight and one Cathy had learned to appreciate.

  "Actually, the boyfriend turned lawyer seems to be turning into a boyfriend again. At least, I think so. Right now I want to stand on my own two feet, but it's nice to know someone has my back."

  Josh shifted in his chair. "So, do you think we're about done here?"

  Cathy shook her head. "I'd like to come back for a few more visits, but maybe we can stretch them out. I've still got some issues I'd like to talk out with you."

  "Good enough. Let's do it."

  For the rest of the session, Cathy poured out her thoughts as fast as they entered her mind, in a true stream-ofconsciousness catharsis. No stopping for a drink of water. No sweat running down between her shoulder blades. No racing of the pulse. Maybe she had gotten a handle on her problems.

  Soon, Josh stood and stuck out his hand. "I'll see you in a couple of weeks. Call me earlier if you think it's necessary. But I think you'll be fine."

  First a smile, and now this. Quite a red-letter day. She shook the hand Josh offered. "I appreciate all you've done."

  Cathy stopped at the secretary's desk to arrange her next appointment. As she was about to leave, she said, "When I shook hands with Dr. Samuels, I couldn't help noticing the calluses on his hands. Unusual for a doctor, isn't it? How did he get those?"

  "Oh," the secretary said, "that's from his hobby. He's a carpenter. He spends a lot of time repairing things that are broken-and building new ones."

  Cathy envied Will as he sat next to her at the conference table arranging his notes, scribbling an occasional addendum in the margins. No sign of nervousness. Of course, he wouldn't be. This was his office. And he was a lawyer. Depositions were as common for him as cutting hair was for a barber. But she'd never been through one, and she was as nervous as she'd ever been in her life.

  The door opened, and the stenographer entered. She took her seat before a strange-looking machine, added a fresh stick of gum to the wad already in her mouth, and stared at the wall with a blank expression.

 
; Will leaned in and whispered in Cathy's ear. "Remember. Pause before you answer. That gives me time to stop you. If you have any questions, you can whisper them to me."

  "What if you object to something they ask?"

  "My objections will simply be to get them on the record. There's no judge here to rule on them. But anytime I object, you clam up. Okay?"

  Cathy nodded. Her mouth felt as dry as the sands of West Texas. She poured a glass of water and sipped from it, but it didn't seem to help much.

  "Sorry to keep you waiting." Sam Lawton, Nix's lawyer, ambled into the room. He took a seat at the head of the table, nodded to Will and Cathy, and asked, "Is the court reporter ready?"

  "Yes, Judge."

  Will responded to Cathy's quizzical look with a whispered explanation. "Even though he was voted out years ago, Lawton's like most judges. He wants that title for life. Don't let it throw you. "

  Lawton's gray hair spilled over the collar of a wrinkled dress shirt. He wore a blue suit that was five years out of style, accented by a slightly askew red polka-dot tie. Smeared reading glasses perched on the end of his nose. He reminded Cathy of a fine home gone to seed. But Will had warned her that, despite his age and appearance, Lawton's mind was sharp, his legal skills honed by years on the bench.

  "Dr. Sewell, let's get started." Lawton's disarming smile was akin to what the snake must have displayed as he approached Eve.

  Cathy placed her left hand on the Bible held by the court reporter, raised her right, and was sworn in.

  "Now, Dr. Sewell, tell us about your medical training."

  Cathy detailed her education, her residency training, and her postgraduate courses.

  Lawton nodded in satisfaction, as though he'd just proven something important. She remembered Will's warnings. Don't try to read the man's expression. This was part fact-finding, part mind game.