by Harry Kraus
The father looked at Basil. “Aren’t you going with them?”
“Sierra’s in good hands.”
Claire smiled. “She’s going to be fine. Let’s go.”
Josef and Claire pushed the stretcher down the corridor toward the scanner, with Mom, Dad, and two younger brothers trailing. Once they were in the CT suite, Claire pointed to some chairs and a magazine rack. “You can wait here by the entrance.”
Roger Jones gripped his daughter’s hand. “Can’t I go in there with her?”
The CT technician saved Claire from the confrontation. Shaking his head, he pointed to a radiation symbol on the door to the scanner. “Sorry, hospital policy. No family members can be in an area where they can be exposed to radiation.”
“We’ll be watching her through a glass window,” Claire explained.
Her mother’s hand went to her mouth. “She’ll be alone?”
“We’ll be with her, just a few feet away. And there’s a speaker so we can hear everything she says.” She watched them for a moment, understanding how hard this must be for them. “She’s going to be fine.”
Mr. Jones put his hand on his wife’s arm. “Come on, honey. Sit down.” He looked at Claire. “Take good care of our baby.” He leaned down and kissed his daughter. “We’ll be right out here, Sierra.”
“Okay,” Claire responded, wheeling the stretcher through the open door. She looked back at the parents. “We should only be a few minutes.”
Claire, Josef, and Ron, the CT technician, hoisted the patient from the stretcher to the CT table. Josef positioned the IV pole at the head of the CT table, and Claire adjusted the monitor so it would be visible from the control-room window. She looked at Sierra, whose eyes were wide with fear. “Don’t be afraid, Sierra. You will feel the bed move, but you shouldn’t feel anything else. When you hear the instructions, you’ll need to hold your breath. It won’t take very long, I promise.”
“I’m cold,” Sierra complained.
Ron responded by placing a white blanket across her. “Here.”
Claire checked the blood pressure again. It was down to sixty-five systolic. She adjusted open the IV fluids and looked at Josef. “Better run up to the blood bank. Bring me a unit of blood. If they haven’t got her typed yet, bring O negative.”
Josef nodded and jogged off.
Claire settled into a padded office chair on wheels in the control room. Beside her was Dr. Wendy Carrico, a third-year radiology resident, and in the control seat, Ron Burris typed in the patient information. Claire looked out at the cardiac monitor. Sierra’s heart rate was 150.
After the initial adjustments, the scanner was ready.
A recorded voice filled the control room and projected into the scan room. “Hold your breath. Don’t breathe.”
The CT table whirred to life and moved the patient through the large circular opening at the end of the scan table.
Twenty seconds passed. The recorded voice returned. “Breathe.”
As the images appeared on the computer screen, Claire looked at Wendy and rolled her eyes. They had shared many hours together since July first.
Wendy smiled. “What is it now?”
“Oh, you should have seen this girl’s father sizing me up. When the ward secretary brought me out to meet them, he says, ‘I thought you said you were bringing out a doctor.’”
“Chauvinists,” Wendy mumbled, and poked the technician’s ribs. “That’s why I send Ron here out to explain the scan results. I hate to keep saying, ‘I am the doctor.’”
Ron grunted and mumbled something about being outnumbered, then pointed at the image on the screen. “Wowser! Look at this liver. It looks like this girl went a few rounds with the champion and lost.”
Wendy and Claire looked carefully at the images, slowly bringing up consecutive pictures beginning at the lung bases and scanning all the way through the pelvis. Wendy put her finger on the screen. “Look here. This is at least a grade-four liver laceration. It looks like this crack goes all the way back to the cava.”
“What’s all this?” Claire pointed to an area of solid color inside the bony pelvis.
“It’s fluid, Claire. And lots of it. And in the presence of that liver lac, I’d say we have to assume it’s blood.”
“How’s the spleen?”
“Back up to the first few cuts.” Wendy rubbed her chin. “It looks fine. There’s fluid around here, but I don’t see any evidence of splenic rupture. The fluid around the spleen is probably blood from the liver.”
Claire picked up the phone and dialed 0. “Could you page Dr. Overby for me?”
She laid down the phone and studied the image on the screen for a few moments longer. “Can you tell if the kidneys are okay?”
Wendy pointed at two bright dots on the screen. “Yes, here’s the ureters with contrast in them. That tells you the kidneys are getting blood flow.”
The phone rang. Claire picked up. “CT. Yes. I think you’d better look at this scan. The girl has a grade-four liver lac.” Claire held the phone away from her ear and whispered to Wendy. “I think he’s upset.” She heard a loud click. Claire shook her head. “The O-man must have been hoping for a quiet night.”
Ron pointed through the window toward the cardiac monitor. “I think you better check that thing. Looks like a lead may have popped off or something.”
Claire looked at the monitor. The EKG complexes were wide and rapid. She wasn’t sure, but it certainly looked like ventricular tachycardia. She pushed past the technician and into the scan room. Sierra was blue and there was dark blood around her chest, darkening a circle on the white blanket and dripping on the floor in a crimson pool. “What’s going on?” Claire yelled a little too loudly. Panic gripped her. She looked back to the control room and yelled, “Call a code!”
She looked for an ambu bag, then, seeing none, lowered her lips to the small girl’s face and gave her four quick breaths. She felt for a pulse. Nothing. “Wendy!”
Overhead, the operator’s voice began sounding the code. “Code blue, CT scanner one. Code blue, CT scanner one.”
The door from the waiting room flew open as Claire started chest compressions. Dr. Overby bounded in, sweat glistening from his forehead. “What happened, Claire?”
“I’m not sure. After the scan, I walked in and found all this blood.”
The chief resident pulled away the blanket so he could see. “The central line is disconnected from the IV tubing.” He looked at the position of the IV pole at the head of the table. “You can’t put the IV pole up there and expect the tubing to stretch this far! Weren’t you watching?”
Wendy grabbed the IV pole and pushed it around the table so it would reach. She hooked it back to the central line.
Roger Jones was standing in the doorway, his eyes frozen on Claire. Behind him, his wife was sobbing. “No, no, no.”
Ron gently put his hand on Mr. Jones’s shoulder. “Come on, we’d better let the doctors work.”
Claire was relieved to see the door close again. She wasn’t sure she could stand to hear Mrs. Jones’s agony.
“She’s probably had an air embolism, from sucking air back into the disconnected IV,” the O-man explained. “We need to put her back on the stretcher so we can tip her head down and put her on her side.”
He scooped her in his arms and lifted her to the waiting stretcher. The members of the code team arrived as Claire resumed chest compressions.
Dr. Overby put a syringe on the central line and pulled back the plunger. Bubbles of air filled the syringe. “Bingo,” he said. “Let’s roll her on her left side. We’ve got to see if we can float the air lock out of her pulmonary outflow track.” He tried the maneuver again. This time, he only withdrew dark blood.
“Get me an endotracheal tube,” he barked.
Josef arrived with blood. The O-man slipped a tube in Sierra’s trachea. Claire continued chest compressions. They gave blood. More blood. Lidocaine. Bicarbonate. Calcium. Multiple defibrillations.
Minutes passed. Dr. Overby paged urgently for Dr. Walter Andrews, the pediatric surgery attending on call. Dr. Andrews arrived twelve minutes later and listened to the summary given by the chief resident.
They transfused more blood and continued CPR. For a full hour they worked, even inserting a transvenous pacing wire to try and capture the heart, to force it to beat normally again.
Dr. Andrews surveyed the scene with compassionate eyes. He pulled off a pair of disposable gloves and wiped the sweat from his brow. “You’ve done all you can, Overby.”
Sierra Jones was dead on her seventh birthday.
“Let’s call it.” The O-man looked at his watch. “Time of death: 10:05 P.M.”
Ron handed the chief resident a hard copy of the CT scan. He sighed and looked at the team. “Thanks.”
Claire couldn’t hold back the tears.
The chief resident put his hand on her shoulder. “She lost a lot of blood from the liver, Claire. Even without the air embolism, I doubt she’d have ever made it through surgery.”
She couldn’t respond. She was numb. Her patient had died because she hadn’t been paying attention.
“Here,” he said, handing her a tissue. “Wipe your tears. We have to face the parents.”
She walked out behind Dr. Overby, who followed closely behind Dr. Andrews.
They found the family huddled together in the corner of the waiting room. They stood as they saw Claire approaching. “Well?” the father said.
Dr. Andrews grasped Roger Jones’s hand. “I’m Dr. Andrews, a pediatric surgeon.”
Celia stood beside her husband, her face ashen, her eyes swollen. “How’s Sierra?”
Dr. Andrews shook his head without speaking.
“I’m sorry,” Dr. Overby responded. “We did everything we could to save her.”
“No!” Mr. Jones yelled. He pointed at Claire. “You said she was going to be fine! You went in there with her. She was alive. What have you done to Sierra?”
Celia grabbed her husband’s arm. He shook it free.
Dr. Overby frowned and introduced his massive frame between the agitated father and Claire. “Mr. Jones, your daughter’s liver was badly damaged. A drunk driver took the life of your child, not Dr. McCall.”
Claire backed away. “I’m so sorry. So sorry.” She pivoted and rushed from the room, her hand to her mouth. She found her way to her call room without thinking. There, she sunk to her knees and dissolved into tears.
Chapter Nineteen
Claire washed her face, pushed the event aside, and completed the night with mechanical numbness. She managed to steal away to a call room at three A.M., but images of a purple birthday bicycle with a handlebar basket and bell prevented any hope of sound slumber.
In the morning, Claire’s duties shifted. She walked with Beatrice in silence, looking for the O-man, their chief resident. They found him in the ER teaching a battle-weary group of medical students. She handed her beeper to him with a ceremonial salute. He patted her shoulder and held her gaze for a brief moment. “You’ve had a strong start, Claire. I’ve liked working with you.”
She nodded. She felt like crying. She’d fought in the trenches side by side with this man, and in spite of his sometimes humiliating tactics, she’d learned more from him in a month than she had during a year in medical school. She wanted to grab his white coat and hang on, to stay with him another month, listening to his stupid rules, and watching him step in and rescue patient after patient. She didn’t want to choke on her words now. “Thanks, Dr. Overby,” was all she could say.
She turned and walked away, listening as the O-man said good-bye to Beatrice. As the doors to the ER closed behind her, she heard him joking about first blood.
She padded on heavy feet to the Cardiothoracic Intensive Care Unit, the CT ICU, where she was scheduled to meet her new team. She looked at her watch. It was almost six in the morning.
She was joined by fellow intern, Martin Holcroft, MD, PhD, a Harvard Medical School graduate. Martin was softspoken and geeky with a reputation for methodical slowness in completing his scut list. Scut, the grunt work on any hospital service, consisted of minor procedures like drawing blood or inserting IVs or running down the myriad of labs and necessary X rays for rounds. Scut work was usually handled by the medical students, which gave rise to the designation which most of them despised: “Scut monkeys.”
Martin had on a white shirt and tie beneath his white coat. His pockets were filled with necessary accessories. Pens, a stethoscope, and several clinical manuals crowded his pockets. Claire had adopted more streamlined apparel. One pen, one stethoscope, and a pack of cheese crackers were the only necessities she carried.
Martin wiped his hand through his stringy brown hair before offering it to Claire. “Hi.” He smiled, revealing a small gap between his front teeth. “I heard I’d be working with you this month.”
She took his hand. “Hi, Martin. What service did you come from?”
“Plastic surgery at the VA.” He frowned. “I haven’t even seen the inside of an OR yet. How about you?”
“I was on the trauma service here at the university. I got to do a few cases, nothing too major.”
They looked up as Robert Rosenthal approached. Robert was the cardiothoracic surgery fellow on the service. He was Dr. Rosenthal to the interns, as he had already completed his general surgery residency and was now in his second year of his CT fellowship.
Dr. Rosenthal looked at the intern duo and tugged on the lapels of his heavily starched lab coat. “Morning,” he said. He held out his hand to Claire.
“I’m Claire McCall.”
He nodded and held his hand out to Martin.
“Martin Holcroft.”
Dr. Rosenthal pointed to an empty bed in the eight-bed CT ICU. “Let’s sit down for a minute to go over the rules.”
Martin and Claire sat on the bed. Rosenthal stood and seemed to be sizing them up.
Claire thought his jacket looked too starched. She wondered if he could sit even if he wanted to.
“We have two CT attendings. Dr. Lewis and Dr. Blanton. They are easy to please if you follow their rules. We will do morning rounds at six, starting here in the ICU. You will be on every other night.” He looked at a notepad in his hand. “Claire, you’ve been assigned odd-night calls. All call is in house and you are expected to be inside the ICU for the night following any day we’ve done open-heart cases in the OR. We do open-heart cases on Monday, Tuesday, Thursday, and Friday. Wednesday is our clinic day. Scrub attire is permitted only in the OR. Dr. Lewis is particularly persnickety about this. If you are on rounds with Dr. Lewis, you’d better wear a white lab coat and a tie.” He paused and looked at Claire. “Uh, in your case, you should wear a dress.”
Claire looked down at her scrubs. “Uh oh.”
Rosenthal made a clicking noise with his cheek. “Make sure you change by the time we round with Dr. Lewis after today’s cases.”
Claire winced. “This is all I have here. I just came off the trauma service. This is what we wore all the time.”
“Well, this isn’t trauma, it’s hearts, and here, the attendings want you to look the part of well-dressed professionals.” He looked at Claire for a moment longer and made a few more clicking sounds. “Can you get home and back in thirty minutes?”
“I think so.”
“Good. After rounds, get home and get changed. If the interns aren’t properly attired, it’s my back that gets riding by the attendings.”
Rosenthal lifted his hand and gestured toward the occupied beds in the unit. “These are our post-op open-heart patients. This is the pinnacle. Everything you’ve seen in general surgery up until now was just a warm-up. The CT surgeons actually cut and modify the human heart. Every open-heart case we do is actually an artificial suspension of life. We still the heart, and pump the patient’s blood with a cardiopulmonary bypass machine. If you get your floor work done efficiently, you are welcome to come into the operating theatre and observe. But don’
t be hanging out in the OR if your scut list isn’t complete.”
Claire glanced sideways at Martin. She hoped he wasn’t as slow as she’d heard. She wanted desperately to get in the OR where the action was.
“Questions?”
The interns shook their heads silently.
“There will be three students on this service, but, unfortunately, since this is August, it’s the very beginning of the year for them, so they won’t have had any practical experience. They are in an orientation until ten this morning. When they show up, you can divide up the patients on the service and assign them to the medical students. Since they are new, they’re going to need a lot of help with case presentations. Work with them. Buff them up as much as you can. When they look good, the attendings think the interns are teaching them, and they like that. If the students look good, you look good. And if you look good, I look good. Got it?”
Claire nodded numbly. The only thing more worthless than an intern on her first day was a third-year medical student on her first day.
Dr. Rosenthal smoothed the front of his jacket. “Then let’s have at it.”
After rounds, Claire made a beeline for her house to grab a dress. While she was there, she listened to her phone messages.
Her mom had called. Clay had a court date for a DUI. Her mom wanted Claire to pray that the judge would be lenient and let him keep his license. The last thing she needed was to have to run him to work, in addition to caring for Wally. Claire shook her head. After watching Sierra Jones die, the last thing Claire felt like praying for was leniency for a drunk driver. Let Clay take his medicine like everyone else.
John called. Just wanted to hear her voice. Claire shook her head. How many times had she told him she was taking odd-night call? He should know she wouldn’t be home.
Brett called. He hadn’t seen her for a few days and was just wanting to see how she was doing. That was sweet.
She opened her closet and sighed. She hardly ever wore dresses. She had a few party dresses, but they weren’t exactly the professional look that the CT surgeons wanted. She settled on a navy skirt and a white blouse and made a promise to herself that she would go shopping.
