ADRENALINE: New 2013 edition

by John Benedict

  Mike walked mechanically through the back entrance of Mercy Hospital up to the second floor and keyed in the combination for the doctors’ locker room. It was empty. Good, he thought. Mike changed into scrubs and searched through his locker for several items. He retrieved a single, shiny glass ampule and a syringe. Mike fished around in his locker for a rubber tourniquet. He shut the locker door quietly.

  He went into a bathroom stall, closed and latched the door, sat down, and snugged the tourniquet around his left arm. He cracked the ampule and drew up two cc’s of Fentanyl, a powerful narcotic, one hundred times more potent than morphine. He hesitated for a moment with the needle poised above one of his distended veins. Should I? He paused, clutching at his gold crucifix, hoping for some divine inspiration, something to draw strength from. Instead, one final demon flowed into his brain. Mike remembered Bryan.

  Bryan was a five-year-old little boy with an angelic face and unruly blond hair. Mike was doing his pediatric heart rotation as a senior anesthesia resident. Children came in from all over the state for their open-heart surgery. These cases were enormously complex and carried with them mortalities approaching fifty percent for the more seriously deformed hearts. This meant half the children would die.

  Bryan had a disorder known as Tetrology of Fallot, a wicked genetic affliction where the heart is horribly malformed. The cardiac surgeon had called it a “frog heart.” Bryan was blue at birth and barely able to survive on his own, but he was too small to undergo the extensive repair surgery required. His parents were instructed to do their best to raise the boy, coax him along, get him to grow, so he would have a fifty-fifty shot at surgical cure. Talk about tough jobs. Mike did his pre-op assessment of the child the night before surgery and met the parents. Mike noticed that the five years growing time had indeed accomplished its purpose, but at a fearful price. The parents were hopelessly attached to their little boy and naturally overprotective. They asked question after detailed question about the anesthesia, as Bryan squirmed first in his mother’s lap, then his father’s. Mike did his best to answer all fully; they deserved it. He assured them the boy looked to be in good shape for anesthesia, and they would all do their best tomorrow. He mentioned that the surgeons would discuss the surgical risk involved; he couldn’t bring himself to discuss the high mortality rate with them. As Mike left the room, Bryan smiled and waved goodbye from the safety of his mother’s lap.

  Initially, everything went smoothly. Bryan went to sleep at 6:30 a.m. without a hitch, and all the complicated monitoring lines were inserted without problem. The child was placed on the heart-lung machine at 8:05 a.m. This allowed the surgeons to stop the heart temporarily so they could operate on it. The surgeons were telling jokes and laughing, a sure sign that the surgery was progressing nicely, but when they attempted to restart the reconstructed heart and come off bypass, no dice. The heart stubbornly refused to pump any blood at all. The operation was a failure. They couldn’t go back on bypass either; the heart had been stopped too long and would never tolerate another bypass run. The surgeon ordered the perfusionist to shut down the bypass machine and walked out of the room leaving the anesthesia and surgical team with his words of wisdom: “Well, you win some, you lose some.”

  “But, he’ll die. Bryan’ll die,” Mike pleaded with his attending. “We’ve got to do something. I promised his mother.”

  “You know there’s nothing we can do, Mike. I’m sorry. Turn off the ventilator. We’re done here.”

  The grief from that day had never really left him; rather it festered inside and sensitized him. For the first time, sitting in the bathroom stall with his arm throbbing from the tourniquet, Mike saw his life as it really was. He had been running from grief and fear, from the Kotzmoyers and Bryans all his adult life.

  He knew this had been largely responsible for his choice of anesthesia as a profession. He didn’t like getting to know his patients and their families and then watching them die. He took it all too personally, too hard. Anesthesia was better in this respect. Patient relationships were generally not deep to begin with, and the patients rarely died.

  Mike realized that all doctors must face this crossroads at some point in their careers. If they detach too much from their patient’s pain, they become heartless bastards with no sense of caring or empathy, no ability to heal the soul, the most important part of their patient. If they don’t detach at all, they risk being dashed on the rocks of human suffering.

  However, Mike had never before felt the full, crushing weight of responsibility for another man’s death. He believed he had killed Rakovic. The lawsuit had been the final straw. He felt like a total failure to himself, his chosen profession, and to his family.

  Colleen had tried to reassure them that things would be OK; they’d make it through this together. She was a good wife. In fact, she was too good, and Mike couldn’t bear the thought of letting her down.

  But he couldn’t set foot back in the OR the way he was. He just couldn’t face the thought that harm might come to another innocent person through his hands. Just thinking about it made him tremble and his palms sweat. He was in no shape to deliver anesthesia; he was quivering all over. But, he couldn’t let his family down. He had only one card left to play.

  It took him two sticks to enter the vein, until red swirls of his blood mingled with the Fentanyl in the barrel of the syringe.

  He pushed the plunger.

  Within seconds the Fentanyl coursed through his entire body and brain, scorching all the fear out of him, like a mighty, fire-breathing dragon, searing his self-doubt. His breathing evened, and his pounding heart slowed. He walked out of the stall and faced the mirror above the sink. Other than pinpoint pupils, he appeared to be the old Mike Carlucci. Steady hands and all, he emerged to take on the day.

  CHAPTER TEN

  Doug finished his tuna fish sandwich, washing it down with his kiwi-strawberry Snapple. He was sitting at a desk in the center of the anesthesia on-call room, which doubled as the lunch table. The fifteen-foot square room, adjacent to the OR proper, was their home away from home. Doug felt like it was his cell, he had spent so much time imprisoned there over the years. The place could get pretty crowded if all six anesthesiologists on duty for the day ate together, but the busy OR schedule virtually guaranteed that would never happen.

  He glanced at his watch—11:45 a.m. Soon time to get back to work. He would just have time to eat some Oreos, hit the head, and proceed to the holding area to meet his noontime patient. He pulled out the OR schedule crammed in his pocket. He still had three cases to go. He hated being the late man, and this day didn’t look like any bargain. He’d be lucky to leave by seven o’clock tonight.

  Mike Carlucci breezed through the door wearing a big smile and carrying his lunch.

  “Hey Mike, have a seat,” Doug said as he pushed his briefcase aside, clearing space on the crowded desk.

  “Geez Doug, every time I come back here you’re loafing,” Mike said. He set his lunch down and pulled up a chair.

  “Yeah, right. I did two lap choleys this morning. Did you see my first one? Over three hundred pounds. Don’t talk to me about loafing. You did local standby feet all morning—a real tough one.”

  “Them’s the breaks,” said Mike as he opened his styrofoam container. The smell of fried chicken quickly filled the room.

  “I gotta go soon,” Doug said sadly. “I have Hartman at noon.” One of his favorite workday activities was to spend lunch yakking it up with Mike.

  “Is he chomping?” Mike asked as he attacked a greasy drumstick.

  “You know Hartman,” Doug replied. “When isn’t he chomping? He’s always in such a goddamned hurry.” Doug rolled his chair sideways to the file cabinet that served as a pantry, grabbed a couple of Oreos and rolled back.

  “Hey, listen. What are you guys doing next weekend?” asked Mike. “I’m pretty sure Colleen got a sitter.”

  “No good, Mike. I told you how badly I need CMEs. I lined up a course in Baltimor
e.” Again, Doug was genuinely disappointed. He enjoyed their evenings out with Mike and Colleen. In fact, they didn’t really have any other close friends.

  “Inner Harbor?” Mike asked as he swiped a napkin across his face.

  “Yeah.” Doug took a closer look at Mike. Something about his face didn’t seem right. It appeared thinner, if that was possible, and his eyes had dark circles around them.

  “How many credits?” Mike asked.

  “Twenty.”

  “Wow, decent,” Mike said. “Are you taking the kids?”

  “No, Laura’s not even going.”

  “What!” Mike set down his drumstick and looked up at Doug. “You guys fighting again?” he asked in a quieter, more serious tone.

  “No, of course not,” Doug answered quickly. “The kids have rehearsals for the Christmas pageant and surprise, surprise, Laura’s involved.”

  “Hmmm. She let you go by yourself?” Mike asked incredulously.

  “Yeah, I need those CMEs.” Doug stood up and gathered his trash. “What do you mean, anyway? She trusts me,” Doug said and chuckled but felt a slight irritation creep in nonetheless.

  “Well, I’m glad she does, ’cause I sure don’t,” Mike said and laughed easily.

  “What the hell are you talking about?” Doug asked, grinning.

  “I see the way you can’t keep your eyes off them pretty young thangs.”

  “Cut me a break!” Doug said. “You don’t know what you’re talking about.”

  “Must be that midlife crisis they talk about,” Mike said. “They say that’s what happens when you get older.”

  “You don’t have to worry about getting old eating that stuff.” Doug pointed to the drumstick. “Haven’t you heard, fat’s bad for you?”

  “Do I look fat?” Carlucci asked, patting his trim belly proudly. “You wish you were in such good shape.”

  “You Italians just don’t get it.” The old give and take felt good. He hadn’t seen Mike so cheerful in weeks. But then Doug got an odd sensation that Mike’s good humor didn’t quite fit with his haggard appearance.

  “You’re just jealous.”

  Doug glanced at his watch. “Shit, I really gotta go. Who’s relieving you, anyway?”

  “No one,” Mike answered, awkwardly suppressing a grin.

  “When’s your next case?” Doug asked in mock alarm, as he stood up. He already knew the answer.

  “One o’clock,” Mike replied.

  “An hour and fifteen minutes for lunch!”

  “I deserve it.”

  “Unbelievable!” Doug managed to get in before the two broke down into laughter. “Well, some of us have work to do,” Doug said and headed out the door. Over his shoulder he called back, “I gotta grind out three more cases.”

  Doug was relieved after his conversation with Mike; he had been very worried about how Mike was holding up. Things seemed back to normal, and Doug was thankful. He dismissed his earlier thought about Mike’s tired appearance; maybe he had just had a rough night with the kids. The two men had become very tight in the six years they had worked together. They shared similar philosophies on many things from work to family, and Doug felt he could read Mike pretty well. Mike was just too happy for anything to be seriously wrong.

  “Geez, Doug, it’s seven-thirty,” said Mike, as he and Doug entered the locker room. “Sorry to keep you here so late.” Mike didn’t need to change clothes since he was on call and staying the night, but was in the habit of seeing Doug out. Tonight, he wanted to make it quick though. He had other things to attend to.

  “No problem, Mike,” replied Doug, as he stripped off his scrubs. “When it’s busy, it’s busy. Nothing you can do.” Doug sat down on the wooden bench and rubbed his eyes and forehead. “I just hope tomorrow stays sane. Saturdays really suck.”

  “Yeah, I hope so for both our sakes,” said Mike. “So far, there’s only a hip on for Clark. Shouldn’t be too bad.”

  “Right,” said Doug as he put on his jeans. “He doesn’t fool around too long on anything.”

  “Laura and you doing anything tonight?” asked Mike. He tried to put his key in the lock but his hand shook so badly it wouldn’t go in. Mike quickly checked on Doug to see if he noticed. Doug was busy lacing his boots.

  “Naw, are you kidding?” Doug asked. “I’m beat after you slaved me all day. How many more years we gotta do this?”

  “Twenty to twenty-five, I reckon,” said Mike. He took a step sideways to block Doug’s view of his hands.

  “Is that all. Sounds like a prison sentence.” Doug pulled his turtleneck shirt over his head. “We might try to watch a video after we get the kids to bed, if I can stay awake.”

  “Yeah, I know what you mean,” said Mike. With one hand steadying the other, he managed to get the key in and open his locker. “You should see Colleen. She loves watching movies and all, but I swear she’s never made it more than ten minutes into one. I get hooked and watch the whole damn thing.”

  Doug smiled at him, and Mike tried hard to smile back. Mike felt the closeness between them and was tempted to tell Doug his secret. They could talk about anything. He remembered telling Doug about Colleen’s miscarriage last year. Doug had confided in him about how broken up he was over his father’s death.

  Certainly, it would feel good to unburden himself. But a part of him wondered how Doug would react. Doug was so cool; he might not understand what it meant to be afraid. He knew he couldn’t tell him yet. Maybe he’d tell Doug after he got through the trial and stopped using. Doug was good at keeping secrets. Maybe someday, they’d laugh about it together.

  “Hey, space cadet,” Doug said interrupting his thoughts. “I said, have you heard the weather?”

  “No,” Mike replied.

  Doug zipped up his Woolrich down parka and closed his locker door. “It’s supposed to drop down to ten degrees tonight. Big windchill, too.”

  “Shit, why so cold this early in December?” Mike asked. Just go, Doug.

  “Some jetstream bullshit, arctic air mass and all that,” Doug replied. “Well, I’m outta here, Mike. I’ll be at home, but try not to call me, OK?”

  Mike forced a grin. “Don’t worry, pal. You know me.”

  Doug headed for the door, but then turned and said, “It’s good to see your old cheerful self back, Mike. I was a little worried about you earlier in the week.”

  “Yeah, yeah, me too. Don’t worry, Doug. I got it under control.” Mike paused and flashed Doug another fake smile. “See? Happy. Now go on. Get out of here before I put you back to work.” Mike motioned toward the door.

  “All right, all right. See ya.”

  As soon as Doug left, Mike dropped all smiles. Mike was irritated with Doug. He was a good friend, but sometimes he was a little too perfect. Well, that wasn’t entirely true. Mr. Cool was having his own set of problems at home. He didn’t admit to it, but Mike knew. When the couples had gone out recently, he had seen the tension between Doug and Laura. Besides, Doug had never gone to a meeting before without her. What was that all about?

  Mike knew Doug had always had a wandering eye, but his affliction seemed to be worsening. Mike didn’t get it. Laura was as pretty as they came and nice to boot. She’d do anything for you—not the typical, bitchy Doctor’s wife. No, he didn’t understand Doug’s behavior. Doug even seemed touchy when he brought it up.

  The hospital PA system barked to life, startling him. “Doctor Campbell, call the emergency room, two-one-six-four, STAT.” Oh shit, Mike thought. They’re stat paging the vascular surgeon to the ER. That can’t be good news.

  His fears were returning with a vengeance. He still had several cases to go that he knew of. And Friday nights, all bets were off. Anything could come screaming up from the ER: ruptured aneurysms, trauma, pediatric emergencies or obstetrical nightmares. He knew it was time for a re-dose if he was going to make it through the next twelve hours of call.

  His heart began to pound and the trembling intensified just thinking ab
out it. How the hell am I going to make it twenty-five years? Don’t think about it. One day at a time and all that shit. You know, desperate times call for desperate measures.

  He retrieved the necessary supplies from his locker and proceeded to one of the bathroom stalls.

  Doug made it all the way out to his truck, before he realized he’d forgotten the schedule book.

  “Damn it!” he said, as he flung his bag into the truck. He couldn’t decide whether to get it or forget about it until tomorrow. “Feels like ten below!” He didn’t relish another trek back to the hospital, but he’d promised Laura he would bring the book home tonight, so they could plan the family’s summer vacation.

  “Damn it! I’ll never get out of here,” he said, as he began retracing his steps to the hospital. The wind did its best to punish him for his forgetfulness.

  Mike closed the door to the bathroom stall. A small part of his brain noted how quickly he had progressed from moral dilemma stage, to figuring out when it would be time for his next dose. Was it really possible to become drug dependent that fast? Could someone sink so low in a period of hours?

  The remainder of his brain quickly overwhelmed these concerns, flooding him with images of panic and naked fear. He felt powerless to resist. A man’s gotta do what a man’s gotta do. He repeated this mantra over and over while he drew up the Fentanyl and performed the venipuncture on himself. Mike pushed the plunger for the second time that day, this time with considerably less reluctance. He took a deep breath, sat back and waited for the Fentanyl to kick in and deliver him from his fear.

  He didn’t have to wait long. He was still amazed by the rapidity of it all. He likened it to the crashing surf of a swiftly incoming tide; his fear was a small sandcastle, obliterated in an instant by the rushing torrent. The tourniquet dropped from his arm to the floor as he sat entranced by the pounding waves.

  Doug was walking fast and still shivering as he entered the locker room. He had to go through the locker room to get to the on-call room where the schedule book was kept. He noticed that Mike’s locker door was ajar, but didn’t think much of it.