Side Effects

by Bobby Hutchinson

  And then she did something she'd never dreamed of doing before. "I'm going to hang up now, Mother, so I can call the hospital and give them my love and best wishes."

  Her mother's outraged voice was still audible even as Alex depressed the Disconnect button.

  An instant later, she dialed St. Joe's, and the sound of Wade's excited voice made her happier than she'd been in weeks.

  "Alex? Hey, sis, we were just about to call you. Thea and I got married an hour ago." He sounded strong, and, oh, he sounded glad. There were voices in the background, and laughter, and the clink of glasses. "Half the hospital's in here right now, helping us celebrate. Mike brought champagne."

  Alex's eyes filled with tears.

  "Wade, that's wonderful, I can't tell you how pleased lam."

  "And, sis?" There was naked elation in his tone. "I stood up for the ceremony. I had to have support, but these old pins are gonna work fine again, I just know it now."

  "Oh, Wade." Tears of joy were coursing down her face, and Alex could barely speak. "I'm—I'm so very happy for you, for both of you. And tell Thea I'm delighted to finally have a sister."

  "Tell her yourself."

  There was a moment's pause, and then Thea came on the line, euphoria palpable in her voice. "We're both sorry you can't be here to celebrate with us, Alex." Her voice grew soft against the background noise. "Thanks, from the bottom of my heart. I took your advice, and you were absolutely bang on the money."

  "You told him off?" Alex was incredulous.

  "I did. And when he got over being furious, he asked me to marry him. So I took him up on it right away, before he had a chance to change his mind."

  Both women giggled.

  "I love you, Thea. Welcome to the family."

  Alex hung up. She reached down and lifted Pavarotti into her lap, terribly aware that even in this moment of absolute joy, she was alone.

  Once again, Cameron wasn't there when she needed him.

  HE FINALLY CAME HOME at 3:30 a.m., totally exhausted. There'd been a brawl at a bar, and of course by then her news about Wade and Thea had lost its first bright glitter. He dozed off while Alex was still talking, and she couldn't get back to sleep again. At daybreak she got up, all too aware that with morning came her duties as anesthetist to Hollister King.

  She drove to work with a lump of apprehension in her stomach.

  During her internship, Alex had always been aware of the peculiar intimacy of an operating room with its gowned figures hovering over the supine body of an unconscious patient like a gathering of priests in some ancient temple. She'd been aware as well of the sense of absolute unity between the medical team, a single-minded determination to do the very best possible for the patient.

  This morning, that sense of unity was noticeable only by its absence. To Alex, it seemed that she and Becky were on one side of an invisible glass wall, with Shirley and Hollister on the other. Apart from the friendly remarks between herself and Becky, there was no chitchat before the operation began, and no tangible sense of teamwork as Alex meticulously gauged the amounts of chemicals needed to render the figure on the table unconscious.

  "Do you think we could proceed anytime in the next decade, Dr. Ross?" King's voice dripped with sarcasm.

  Alex did her best to ignore him. She checked and re-checked her calculations before she finally administered the proper dosage through the infusion tubing.

  The patient was a stout young man in his midthirties named Johnnie Williams. Alex had talked with him a half hour before. Even feeling extremely ill, Johnnie seemed a gentle and likable person, although not terribly bright. He told Alex about his recent marriage, adding proudly that Laura, his new wife, insisted on being in the waiting room all during the operation, even though Doc King had laughed at the idea of her being worried.

  "He said fixing this gall bladder would be easier on me than getting a root canal." Johnnie smiled. "So I asked him why not fix my teeth while he was at it?"

  Alex laughed with him to put him at ease, but her own sense of foreboding refused to go away. She carefully studied Johnnie's chart and questioned him, confirming to her own satisfaction King's diagnosis of acute infection of the gall bladder.

  Johnnie had come to the clinic late the previous afternoon with severe right-sided abdominal pain and extreme nausea. His white blood count was elevated and he was running a low-grade fever. King had admitted him, and the abdominal X rays he'd ordered had confirmed that the gall bladder was enlarged and inflamed.

  Johnnie was now unconscious, covered with a sterile green sheet through which a window had been cut to expose the surgical site. Alex checked his eyes, then ran a finger along his eyelashes. There was no response. "He's under," she announced.

  She felt her own heartbeat accelerate as Shirley slapped a scalpel into King's waiting palm. The elderly doctor looked puffy and flushed this morning, although his hands seemed steadier than they'd been during the cesar-ean section the week before. Maybe he was better early in the morning. Alex fervently hoped so.

  With a flourish, King made the incision in Johnnie's abdomen, extending it from the sternal notch along the rib cage to a lateral point. Just as before, the doctor seemed to feel the need to hurry; within seconds, and with less caution than Alex felt advisable, he'd isolated the gall bladder, and Shirley slapped another scalpel into his palm so he could cut it free.

  So far so good. Alex glanced down at Johnnie's face and checked his vital signs, which were fine. At a muffled gasp from Becky, however, her head jerked up again just in time to see that somehow King had dropped the scalpel into the opening in the abdomen.

  He cursed and reached for it, and simultaneously rich, red blood welled from the incision and spilled in rivulets across the green sheet covering the patient's stomach and legs.

  It was obvious that the scalpel had somehow sliced the liver and that King needed to locate the cut and repair it with due haste, but as Alex and the two nurses watched in horror, King began to fumble, muttering under his breath, demanding clamps and then throwing them to the floor.

  "Blood pressure's dropping, 90 over 60. Heart rate 20." Alex flew into action, starting a large bore intravenous to elevate the blood pressure with intravenous solution.

  The patient was bleeding out. "80 over 50, heart rate 40. Get him cross matched, and I want four units of O negative, stat." She quickly grabbed Ringer's Lactate to hang on the initial IV line.

  If only one of the pharmacological agents would work—but she knew all too well that no drugs helped hy-povolemia, diminished blood volume.

  King's head wobbled and his hands trembled, and precious minutes passed while he groped around ineffectually, trying to find the site of the bleeding.

  "Blood pressure's dropping, 60, palpable," Alex warned again, and almost before the last word was out of her mouth, the heart monitor warned that Johnnie's heartbeat was irregular.

  "He's going to arrest, Holhster." Alex's voice was loud, even though her throat felt constricted. Her entire body was icy cold. "The patient is in hypovolemic shock."

  Events seemed to slow, until to Alex everything was happening in the terrible slow motion of a nightmare.

  "Do something, Hollister, for God's sake," she pleaded. "He's in r-fib. He's bleeding out—"

  "Stop hollering at me and help me here, Doctor Ross." King's voice was panicked. There was blood everywhere. "Get those paddles ready, Becky," he bellowed.

  Becky snatched the defibrillator paddles and shoved them into King's hands, even though the bleeding was continuing unabated and they all knew the paddles were useless if the patient bled to death.

  Alex plunged her gloved hand into the incision, desperately trying to find the exact source of the bleeding. She groped and groped again, but there was no way of telling where it originated.

  The beeping of the heart monitor changed abruptly, giving the flat, uninterrupted wail that signaled cardiac arrest, and in a loud, agitated voice, King began giving orders to use the defibrillator pa
ddles, but of course it was no use.

  Blood still seeped from the abdominal incision but it was evident to everyone except perhaps Hollister King that Johnnie Williams was dead.

  SOWLY, BECKY unhooked the monitors, and for a moment they simply stood around the table and stared down at the body. Alex felt stunned, as if she'd been struck on the head by a heavy object.

  She'd seen patients die before, far too many of them over the years, but never had she been involved in such a clumsy and utterly appalling foul-up as this. She looked over at Becky, and then at Shirley, and in their eyes she saw a reflection of her own horror.

  To her amazement, King was the first to recover.

  "That was most unfortunate, but these things happen. No point standing around. Let's get this incision closed."

  Shirley handed him the materials and he went to work, seemingly quite calm now, his hands steady.

  Alex gaped at him, astounded at his callousness, his refusal to take responsibility for what had just happened. She knew if she didn't get out of the room, she'd say exactly what she thought—that Hollister King was guilty of criminal negligence, that he ought never to operate on anyone again.

  She burst through the doors of the operating theater and stood with her back against the wall, breathing in deep, ragged gulps, trying to regain some semblance of control. She thought of Johnnie Williams's new wife, waiting nervously somewhere nearby. What in God's name would Hollister King tell that poor woman?

  She stood up straight and looked through the double windows into the operating room.

  King was talking earnestly to the nurses, and Shirley was nodding in agreement. Alex stumbled over to the sinks and stripped off her bloody gloves, tossing them into the trash. She turned on the water and scrubbed her arms, but the blood seemed to cling, refusing to be washed away.

  Behind her, the hinged doors from the operating room burst open, and King came out. Alex flinched at the sight of him. Blood was spattered on the lenses of his glasses and all over his face. His gown was drenched with it. He looked as if he'd participated in a slaughter.

  But he did, her mind screamed. We all did.

  He was solemn-faced, composed. "As soon as I wash up, I have to speak to next of kin, so I won't be through here for a while, Alexandra. Would you tell Ruthie to apologize to the patients who are waiting over at the clinic and ask my afternoon appointments to reschedule?"

  All in a day's work. Alex was certain she was going to vomit. She swallowed hard against the bile in her throat. "I'd like a word with you, Hollister."

  "No time at the moment," he snapped.

  "Then I'll come to your office at the end of the day, about six." Her voice was tight and thin, and she didn't wait for a response. She turned her back on him and headed off to have a shower.

  ALEX TAPPED ON Hollister King's office door at 6:00 p.m.

  "Come in, come in. Well, Alexandra, it's been a long, hard day, and I still have house calls. What is this about? Can we make it brief?"

  He was sitting behind his desk smoking a cigar. As always, he was impeccably tailored, his white-on-white striped shirt bandbox fresh, his glasses sparkling in the gleam of the overhead light.

  Not a trace of blood anywhere, Alex thought wearily. He'd washed it all away, and from the looks of him, he'd also put it out of his mind.

  "I'd like to talk to you about what happened this morning in the operating room." She didn't wait for an invitation to sit—she stiD felt ill, and she slid into one of the large oak armchairs. Every muscle in her body ached, and her head was pounding. Getting through the day had taken a major effort.

  He puffed, and a cloud of smoke wafted toward her. She nearly gagged.

  "Regrettable," he said with a shake of his head and a somber look. "A most regrettable accident. I feel terrible about it. But as I explained to Mrs. Williams, we doctors aren't God. There wasn't the slightest hint of any cardiac dysfunction. I did an EKG and it was normal. There was no way to guess that his heart would give out during the operation."

  Alex was flabbergasted. She looked him straight in the eye. "You know as well as I do that Mr. Williams's heart wouldn't have failed if he hadn't been hemorrhaging. You dropped a scalpel, Hollister. You nicked the liver. The patient bled out—he didn't die from a heart attack. The autopsy will confirm it."

  "We all make mistakes, Alexandra. You of an people should know that." He glared at her, his bushy eyebrows drawn into a single severe line across his forehead. The light caught the lenses of his glasses so that she couldn't see his eyes. "Before you point the finger of blame at me, you should remember that you're no more exempt than I am from errors in judgment. I distinctly remember a situation recently in which a young woman was miscarrying and you didn't even bother to examine her. She, too, could easily have died."

  Alex was speechless for a moment. "You can't think of comparing that situation to this, Hollister. That was an accident scene. The girl was brought into hospital immediately and treated."

  "I treated her. It was only because of me there were no serious repercussions from your carelessness."

  Alex stared at him, and her outrage and anger overcame her. The man's ego was monstrous. She'd hoped to be as diplomatic as possible, but now she didn't give a damn about diplomacy. Her voice was firm, her words harsh and honest. "In my opinion, Hollister, you shouldn't be operating on anyone any longer. I've watched you twice now in surgery, and it's clear to me you're no longer capable."

  "No longer capable? Is that so?" King's face grew purple. "Well, as far as I'm concerned, madam, your opinion is less than worthless around here." With short, vicious movements he stubbed out bis cigar in an ornate silver ashtray. "I've been operating since you were in di-apers, and I'll continue to do so long after you get tired of playing country doctor and run back to the city where you belong. You're only here because your father used his influence to get you the job. I told the board at the time you were hired that you wouldn't last."

  Alex's voice rose. "I hate to disappoint you, but I'm staying, Hollister. I'll be around a long while, and from here on, I will no longer administer anesthetic for any surgical procedure you decide to perform. I intend to notify the administrator of that decision immediately."

  King's voice, too, was out of control. He lumbered to his feet, leaning his palms on the desk and looming over her, his voice and his expression menacing. "We'll just see about that, madam. Being able to administer anesthesia was one of the requirements of your employment here. If you refuse to fulfill the terms of your employment, we'll simply have to get ourselves another doctor, won't we?"

  He was utterly furious, and Alex herself was angrier than she could ever remember being. She gave him back glare for glare, but inside her, a tiny voice reminded her that this dreadful fighting wasn't accomplishing anything.

  With an immense effort, Alex lowered her voice and tried for a reasonable approach. "Look, Hollister, I feel rotten having to say these things to you. I know this is hard for you, but for the sake of your patients, you have to face facts. During that cesarean the other day you became aphasic. You couldn't remember the names of the instruments, and you endangered a mother and child. And this—this disaster this morning—Hollister, you dropped a scalpel, and then you became confused. When the bleeding began, you wasted precious seconds, time that young man didn't have to waste. I can't sit back and pretend this was an unavoidable accident. I believe you were negligent in your duties as a physician, and I'd be just as negligent if I didn't draw it to your attention now."

  She drew in a deep breath and said quietly, "Unless you voluntarily stop performing surgery, I feel I have no choice but to write a letter to the College of Physicians and Surgeons, telling them exactly what happened this morning. I will also speak to Harry Perkins, of course."

  He let out a derisive snort. "Go right ahead. It's your word against mine. Harry Perkins and I go back a long way. As far as the college goes, I'll simply tell them the truth, that from the moment you arrived here you've don
e your best to undermine me to the community at large."

  Alex gasped, and he blustered on. "You're an ambitious woman, and you'd rather I wasn't standing in your way. There's a great deal of money to be made in a community like this, and policemen don't get rich, isn't that a fact?"

  Furious and disgusted, Alex still refused to let him bully her into another outburst. Instead, she quietly listed the sequence of events that would follow, praying that he'd back down. "You know there'll be an investigation as soon as I lodge a complaint, Hollister. Becky and Shirley will both have to give statements. There'll be an independent autopsy."

  "My nurses will fully support me." There was complete confidence in his tone. "They'll swear I did everything in my power to save that young man's life, because, of course, I did. The autopsy will undoubtedly indicate that there was a heart defect that didn't manifest on the tests, and you show me a doctor who hasn't dropped an instrument at one time or another. I warn you, you'll come out of this looking both vindictive and dangerously ambitious, Doctor Ross. This will not benefit your career, believe me."

  Alex got to her feet. Her knees felt shaky, and the nausea was rising again in her throat. "You leave me no choice in this matter, Hollister." She walked to the door. "I'm taking action to see that nothing of this sort has a chance to happen again."

  CHAPTER EIGHTEEN

  "ALEX OPENED THE DOOR and walked out, King's raised voice following her into the hallway. "You're going to be sorry you ever started this, madam. Remember, you're the newcomer in this town, not me. The people here are all my friends. You'll find that out the hard way, Alexandra."

  She shut the door softly, cutting off his voice. She was trembling violently. She wondered if she could make it down the hall to her own office without having her knees give away. She knew she was doing the right thing, but it felt awful.

  And the trouble was, much of what King said was absolutely true; she knew the college would be very careful about taking disciplinary action.