V-fib greeted him from the monitor. He had failed to get the blood pressure down fast enough. The V-tach had degenerated into V-fib as the strain on the heart had become too much. His Nipride was now useless; in fact, it was harmful. He immediately shut it off. Mike knew that in V-fib, the heart muscle doesn’t contract at all; it just sits there and quivers like a bowl full of jello. No blood was being pumped. High blood pressure had ceased to become a problem; now there was no blood pressure. Brain damage would ensue in two minutes, death in four to five minutes.
Doug Landry, the anesthesiologist on call that day, burst through the OR door. “What d’ya got Mike?” he asked, slightly out of breath. Doug glanced at the EKG monitor and said, “Oh shit! Fib!”
“Paddles!” shouted Mike, comforted by Doug’s presence. “He went into V-tach, then shortly into fib,” said Mike, nodding at the monitor.
“Yeah, I see,” Doug said. His large sinewy frame looked like it was coiled for action. Diane handed Mike the defibrillator paddles.
“400 joules, asynchronous!” Mike barked.
Diane stabbed some buttons on the defib unit and it emitted some hi-pitched electronic whines. “Set,” Diane said shrilly.
“Clear!” Mike shouted.
Mike fired the paddles, and a burst of high-energy electricity pulsed through Mr. Rakovic’s heart and body. The EKG monitor first showed electrical interference from the high dose of electricity, then quickly coalesced into more V-fib.
“Shit!” Mike said. “No good.” He had never appreciated how ugly those little spiky waves of V-fib were.
“Hit em again, Mike,” Doug said.
“OK. Recharge paddles.” The paddles took several seconds for the high amperage capacitors to charge between counter-shocks. “Better start CPR,” Mike said as he began pumping on Mr. Rakovic’s chest. His hands soon became slimed from the electrolyte gel left by the paddles on Mr. Rakovic’s chest. God, he hated chest compressions.
“Paddles are ready, Doctor!” said Diane. Her eyes were wider than before, and her mask ballooned in and out, as she gulped air.
‘Boom’ went the paddles again, and Mr. Rakovic’s body convulsed a second time. Mike stared at Mr. Rakovic’s face as it contorted, reminding him of a medieval exorcism. Mike held his breath and waited for the monitor to clear, pleading with it to show him some good news.
“Still fib!” Mike growled. He resumed chest compressions as he nodded to the circulator to recharge the paddles yet again.
“Epinephrine? Bicarb?” asked Doug.
“Doug, I don’t think he needs epi,” Mike replied quickly. Mike wondered if Doug was also feeling the pressure. His voice was too damn even, though. “His pressure went through the roof on induction. I don’t know why, but I just can’t believe he needs epi.”
“Okay,” Doug said. “The paddles are ready.” Doug’s forehead creased momentarily, then he added, “V-fib in an elective case. Unusual. Any history, Mike?”
Mike stopped compressions long enough to fire the paddles a third time. He smelled the ozone coming off the arcing paddles. The V-fib continued. Gimme a break, Mr. Rakovic!
“Shit! Charge the paddles again,” Mike said to Diane. He turned to Doug. “Yeah, prior MI, stable angina, hypertension. Doug, I think we better try Breytillium. I already gave him two doses of Lidocaine.” Sweat was now soaking through his scrub top, pants and surgical cap, and running down his face.
“Yeah, sounds like a good idea,” said Doug. “I’ll take care of it.”
Mike glanced over at Doug and cursed his calm efficiency. He knew ‘the Iceman’ was a veteran of the OR wars. Doug had worked at Mercy for twelve years. He had been on the front lines before and had always performed well. Doug reminded Mike of his mentor in residency days, Dr. Hawkins. Mike thought he could hear Dr. Hawkins now: “Retaining control and being cool are critical in these situations. Split second decisions need to be made. Panic is a luxury you can’t afford.” The advice sounded hollow.
“Any allergies, Mike?” Doug asked. “Malignant hyperthermia? Breytillium’s ready.”
“No allergies.” Mike was breathing hard now and had to space his words with short gasps. “Doesn’t look like MH—no temp. Hurry Doug. Run that shit. He’s been in fib for a while. We’re running out of time. He may never come out.”
“I’m bolusing now,” Doug said as he injected a large quantity, “and here goes the drip.”
Mike clung to Doug’s steady voice like a lifeline. Mike realized that he was in danger of losing control. He could see it in the trembling of his own hands and hear it in the huskiness of his own voice. He wondered if Doug noticed. Deal with it, Mike. Deal with it.
Hawkin’s words floated back to him again. “It’s just like being in combat. Soldiers can train and drill all they want, but they never really knew how they’ll react until the bullets are real and start to shriek by their heads. Will they turn tail and run, or fight back?” Leave me alone, Hawkins!
Mike looked around the room. He felt they were all staring at him; he could read the expressions in their eyes: “It’s your fault! You screwed up!”
“Try it now, Mike,” Doug said, jolting him back to reality.
Mike grasped the paddles tightly to prevent them from slipping from his slick hands and applied them to Mr. Rakovic’s hairy chest for the fourth time. He pushed the red trigger buttons on each paddle simultaneously to release the pent-up electricity. All 280 pounds of Mr. Rakovic’s body heaved off the OR table again and crashed down, sending ripples through the fat of his protuberant abdomen. Mike now smelled an acrid, ammoniacal odor and realized it was coming from the singed hairs on Mr. Rakovic’s chest. He frantically wiped the burning sweat out of his eyes so he could see the monitor. The V-fib continued stubbornly and had begun to degrade into fine fibrillations. “Damn you!” Mike yelled at the monitor.
“I’ll give you some bicarb,” Doug said. Out of the corner of his eye, Mike thought he could see Doug shaking his head slightly.
The next fifteen minutes were a blur to Mike. More chest compressions, more emergency last line drugs, many more countershocks were tried. Nothing worked. Mr. Rakovic continued to deteriorate, his pupils widening until at last they became fixed and dilated. His skin was a gruesome, dusky purple-gray. He was dead. Doug finally called the code after fifty-three minutes and gently persuaded Mike to stop chest compressions. Dr. Sanders walked out of the room without saying a word.
Mike was numb as he stared at the corpse in front of him. One portion of his brain, however, continued to function all too well. It kept replaying his initial encounter with Mr. Rakovic in the holding area. He could see Mr. Rakovic in vivid color and hear him plainly, as the rest of the OR faded to silent gray. They had joked about the Phillies’ pitching staff. They wondered whether Barry Bonds would break Big Mac’s homerun record. God, he wanted this to stop, to get his laughing, living face out of his mind. But he couldn’t. His mind was a demonic film projector playing it over and over. He felt very sick to his stomach and had an overwhelming need to get out of the room and get out of the hospital with all its stinking smells. Just go, anywhere but here.
God, this was what he hated about anesthesia. One minute you’re having a casual conversation with a living, breathing, laughing, for God’s sakes, human being and the next you’re pumping on his chest. He becomes subhuman before your eyes as his face turns all purple and mottled. He cursed his decision to ever become an anesthesiologist. What in God’s name was I thinking? Frail human beings were not meant to hold someone’s life in their hands. The responsibility was just too awesome.
“Mike. Hey, Mike. You OK?” Doug put his hand on Mike’s slumped shoulders. Mike came out of his trance enough to nod his head. Several tears rolled down his cheeks. “Mike, there’s nothing else you could’ve done,” Doug continued. “We were all here too. He must’ve had a massive MI on induction. Not your fault. Some of those guys just don’t turn around no matter what you do. Don’t blame yourself. We tried everything.”
“Yeah, I know Doug. But I just can’t get his face out of my mind. We were talking, joking just an hour ago. Now he’s dead.”
“C’mon, let’s get out of here.” Doug led Mike out of OR#2. “I know you might not be up to this, but Mike, you’ve got to talk to the family. Did he have any relatives here with him?”
Mike didn’t answer immediately. As the adrenaline haze faded, he struggled to regain control. He felt completely drained with an enormous sense of loss, but coaxed sanity back into place. “Yeah, he came in with his wife. Nice lady.” Mike paused, feeling his vision blur again, this time with tears. “What do you say, Doug?”
“Listen, I’ll go with you. Just tell her what happened. Everything was going fine. He went to sleep and then bam, out of the blue, he had a massive heart attack. Nothing in the world was going to save him. We worked on him for almost an hour and tried everything. Tell her we’re really sorry.”
“OK. Help me, Doug.” He would’ve rather stuck nails in his eyes than face Mrs. Rakovic at that moment.
The two men walked through the electronic entrance doors toward the OR waiting room. Mike swallowed hard and entered the small windowless room. Doug was right beside him. Mike searched the faces until he found Mrs. Rakovic. It wasn’t hard. As soon as she saw him, she immediately leapt out of the chair with a quickness that belied her bulk. Her frantic gestures revealed the depth of her hysteria. Mike walked over and she collapsed into his arms. “Tell me is not so!” she wailed in her thick, Slavic accent. “Tell me Doctor Sanders made mistake. Not my Joey!” She cried convulsively.
“I’m so sorry, Mrs. Rakovic,” Mike said, blinking fast. “He had a massive heart attack. We tried everything.” He felt her tears burn into his shoulder and then felt his own tears stream down his face. “I’m sorry.” Her wracking sobs shook them both.
CHAPTER TWO
Doug Landry juggled his cup of coffee and his heavy notebook as he fished out his keys. The sign posted on the Radiology classroom door read, “Keystone Anesthesia Corporate Meeting, Tuesday, December 10th - 7:00 p.m.” Doug walked in, flipped on the lights, and surveyed the small room. He resented for a minute that the anesthesia department didn’t even rate their own meeting room anymore. The hospital was always looking to cut costs these days. Where would it end? he wondered.
The classroom was windowless and had a long table in the center with about ten chairs gathered round. A beat-up lectern sat in front of a huge chalkboard, which all but covered one wall. Two other walls were devoted to the radiology library with countless textbooks and journals interspersed with life-sized anatomic models. On either side of the door could be seen framed photos of the graduating classes of X-ray tech classes all the way back to 1969 when Mercy opened its doors.
Doug sat down in his usual seat and chuckled; they always sat in the same seats in these meetings. Pecking order didn’t just apply to birds. Bryan Marshall, the chief of the department, occupied the head of the table. Doug and the younger members of the group sat on Marshall’s left, while Joe Raskin and the old guard sat on Marshall’s right. Mike Carlucci generally sat to Doug’s immediate left. Doug sipped his coffee and wondered how Mike was holding up after his hellish case yesterday. He knew Mike was high-strung; hopefully, he could shake it off.
The door opened and Mike walked in balancing a box of pizza in one hand and a six-pack of Coke in the other. “Hi, Doug,” Mike said as he laid his cargo down on the table. “Shit, it’s cold out there! I brought some pizza. I’m tired of starving at these damn meetings and eating when I get home at ten o’clock.”
“Great idea,” Doug said, the smell of fresh pizza already filling the room. “What kind—no, wait, let me guess. Pepperoni, right?”
“Yup.”
“You Italians. So predictable,” Doug said, smiling.
“Hey, you don’t like it—more for me.” Mike removed his ski cap, took his coat off, and slung it over the chair to Doug’s left. He helped himself to his own slice and popped the top on a Coke. “So, what do you think this emergency meeting is all about? Have you seen the agenda?”
“No, I haven’t,” Doug replied. “I’m not sure what it’s about, Mike. I know Marshall’s been agitated all day. He and Raskin have had lots of hush-hush conferences in the hallway today.”
“Not just today, Doug. All last week. I swear something’s up.” Mike ran his fingers through his prematurely graying black hair in a futile attempt to straighten out the mess left by the cap.
“Probably just some B-S about our contract with the hospital,” Doug continued. “I think it’s coming up for renewal.”
“Do you think it’s about my, uh, case?” Mike asked, his thin face darkened by a heavy five o’clock shadow, turning very serious.
“I don’t think so, Mike. You just said this has been brewing for a week. Marshall likes to call these emergency meetings to rile everyone up.” Although Doug was worried that Marshall might bring up Mike’s case. It would be just his style to rub Mike’s nose in it.
“Yeah, I guess so, and to demonstrate his power over your life. Colleen and I were going to take the kids to Chuck-E-Cheese tonight. She wasn’t too happy about me bagging out at the last minute.”
Doug could picture Colleen taking that call. She was such a sweetie, but Doug knew she hounded Mike relentlessly about spending time with their two little girls. “Sounds like you’re in the doghouse now, buddy,” Doug said, and proceeded to make howling noises. Mike smiled tiredly but said nothing. Normally, Doug knew, Mike would’ve joined the dog team, but not tonight.
“Let’s just hope Kim gets here on time,” Mike said.
“Yeah, remember last time?” Doug asked, matching Mike’s serious tone as he busied himself with the pizza.
“Marshall ripped her a new one,” Mike said. “She was only ten minutes late.” Mike paused to sip his Coke, a thoughtful look coming over his face. “Why does he have it in for Kim so bad?” Mike glanced at his watch and eyed the door nervously, then added, “Marshall usually has a soft spot for attractive women.”
Doug lowered his voice a notch and said, “Mike, it’s like this. Marshall hates Kim and everything she represents.”
“What do you mean?” Mike’s bony hands tapped out some rhythm on the table.
“Marshall’s from the old school when it comes to doctors, nurses, and women in medicine. It killed him to take Kim in as a partner last year. He believes only men have the necessary devotion to make reliable partners. Haven’t you ever heard him rattle off one of his favorite sayings? ‘Men don’t get pregnant’ or ‘Women are ruled by their emotions.’”
“Yeah, I guess I have.”
“There’s two other things that really stick in his craw. You know that Kim will call off when one of her kids is sick. Marshall can’t stand that. As far as he’s concerned, dedication to Keystone is Job One; kids and family take a backseat—way back.” Doug finished his slice and washed it down with more coffee. The cold coffee almost made him gag, but he forced it down, figuring he needed the caffeine to make it through the meeting.
“What else?” Mike asked. “You said two things.”
“Well—and this is probably the main reason he hates her—her husband’s a fricking doctor. He’s an internist with Lombard Associates, the busiest practice in Central Pennsylvania.”
“I know that. Why is that such a problem?” Mike made little popping sounds with his empty Coke can as he repeatedly dented it.
“Marshall likes his docs to be sole breadwinners with families. The reason is simple. These suckers are much more likely to be loyal to him because they’re dependent on him for their livelihood.”
“Oh, you mean like me?” Mike asked and smiled ruefully. His hands became still for a moment.
“Yeah, just like you. And me. You’re not going to gripe about working seventy hours a week. You need the money. So do I. Kim does gripe about the hours.”
“OK, I get it,” Mike said quickly. “Maybe we should change the subject be
fore he gets here.”
“Fine, but you asked me.” Doug didn’t add that Marshall also liked his doctors in debt and encouraged this with low interest corporate loans. Doug knew Mike had recently made use of this and bought a huge new house and was in big-time debt.
Bryan Marshall moved to the lectern, glanced at his watch, and gruffly called the meeting to order at precisely 7:00 p.m. Even though he had been in the states for thirty years, he still retained traces of his South African acquired British accent. Doug could see he was in a foul mood. Where was Kim? he thought anxiously. He glanced around the table at the other members of their group.
Marshall cleared his throat, and Doug refocused on him. He was a large man, just shy of sixty, with a generous potbelly somehow supported by thin spindly legs. He had a thick mane of white hair that was disheveled at the moment thanks to the surgical cap he had worn all day. His massive head rested uncomfortably on his shoulders with only a hint of neck showing, as if the weight of his head compressed his neck. His coarse facial features appeared slightly swollen and inflamed due to the deep ruddiness of his complexion. Tortuous blood vessels snaked across his temples and neck adding to the impression that his head contained too much pressure.
Doug watched him scan the room and saw his scowl deepen. He was clearly annoyed, and this amused Doug. After spending twenty-eight years as chief of the department, Doug knew that Bryan Marshall was unaccustomed to being delayed by anyone.
“Well, it seems Dr. Burrows hasn’t seen fit to arrive yet,” Marshall said. He practically spat out the word “doctor.” Doug knew Marshall was capable of thickening his accent at will, a technique he often employed to telegraph his authority and command respect. Tonight, it sounded like he had just stepped off the boat from Johannesburg. “No matter. We have a lot to cover and I’d like to commence.”
Doug turned to Mike and rolled his eyes in anticipation of yet another long meeting. There had been too many in the past month.
ADRENALINE: New 2013 edition Page 2
