cervical spines and a CT scan of his head, we’re going up to the OR. Someone alert them. Lydia, you’ll assist, so go scrub as soon as you can. Tell them we’re going to explore this fellow’s abdomen.”
“Do you want antibiotics?” she asked.
Will glanced up at her and pumped his fist just enough for her to see.
“Way to go,” he said. “Order whatever you think would be best.”
“Julie, two grams of Mefoxin IV, please,” Lydia said.
In minutes, the broad-spectrum antibiotic was in, and the anesthesiologist had placed a breathing tube down John Doe’s trachea. Next he inserted a third intravenous line via a “blind stick” into the internal jugular vein.
“Temp’s seventy-two,” a nurse announced. “BP is still in the twenties.”
Will glanced down at the man’s abdomen, which was more distended than even a short while ago.
“Let’s get him over to X-ray right now,” he said. “We’re running out of time.”
This was medicine the way it was meant to be, Will thought, vigorously scrubbing his hands with a hexachlorophene-impregnated brush. A patient in big trouble, a surgeon and his team prepared to act. No forms to fill out; no panel to go through.
He wished things with Maxine had worked out differently and that he didn’t spend so much of what little free time he had alone. He wished he had the kids more and the money and time for a memorable vacation with them. He longed to spend more time in the gym. But one thing he never wanted to change was the rush of this moment, focusing years of training and experience into the awesome responsibilities of being a surgeon.
Using his knee, he shoved the lever to the right, shutting off the water. Then, hands up, palms facing in, he backed into the OR, accepted a towel from the nurse, and dried his hands. Finally, he slipped into a sterile gown, allowed it to be tied, and thrust his hands into a pair of size 71?2 gloves. Time for battle.
John Doe was stretched out on the table, covered with drapes that exposed only his abdomen, swabbed in russet antiseptic. Will could see and feel that the area had become even more distended. Just before he had entered the operating suite, he had received the blood-alcohol report-negative. That result, coupled with the negative head CT, strongly suggested overwhelming infection or massive blood loss into the abdomen as the cause of the profound shock and coma.
“Ready, Ramon?” he asked the anesthesiologist, who peered over the drape separating his work space from Will’s and nodded. “Ready, everyone? Lydia? Okay, number-ten blade, please, Jennifer.”
One by one Will sliced through three of the four layers of John Doe’s abdomen.
“Suction ready,” he called out just as the fourth layer, the thin peritoneal membrane, parted beneath his blade. Under pressure, volumes of foul-smelling brown liquid spewed out of the abdominal cavity, a good deal of it overwhelming the suction and flowing down onto the floor. Will stepped back just in time to keep from irreparably soiling his trademark OR footwear-red Converse Chuck Taylor high-top sneakers.
“Whew!” the circulating nurse exclaimed. “Deodorizer?”
“Why not. And a pile of lap sponges, Jen, and more suction.”
The circulator placed two drops of deodorizer on every person’s mask. One by one, Will inspected each organ-large and small bowel, kidneys, pancreas, liver, spleen, stomach, and gallbladder, even though the source of the problem was already quite apparent. Scar tissue from chronic inflammation caused by gallstones had shut off the blood supply to the large intestine, causing a foot-long section of it to become gangrenous and finally to split, spilling feces into John Doe’s abdominal cavity. Septic shock was the result.
“Lydia?” he asked. “Where to from here?”
The resident’s eyes were red from the onslaught of the fetid spillage. Will suspected that at least a corner of her brain was imagining life as a plastic surgeon-bowel contents versus Botox. No contest.
“Isolate the diseased intestine, staple it off with a GIA stapler,” she said, “then control bleeding, irrigate the abdominal cavity clear with warm saline, and then go after the gallbladder first.”
“The artery we need to tie off to get the gallbladder out?”
“Cystic.”
“Excellent. Go ahead and locate it. You sure you want to go into plastics?” Will could tell from her eyes that she was missing the glint in his. “Don’t bother answering that,” he said.
He guided her through the removal of the gallbladder and then did the colon removal and colostomy himself. If by a miracle Mr. Doe survived this ordeal, the colostomy could be reversed some time in the future. With heavy bacterial contamination, it was best to leave the skin incision packed with dressings rather than to suture it closed. The scar would be impressive, but that, too, could be revised down the line. At the moment, it was life versus death, with death holding most of the high cards.
Finally, it was done. A procedure fraught with potentially fatal pitfalls had just been completed quickly and virtually without a hitch, and every person working in OR 3 at that moment felt part of it.
“Great job, Will,” the anesthesiologist called out as he lowered the drape. “You can take out my gangrenous intestine anytime.”
Several nurses and Lydia echoed the praise.
John Doe still remained teetering on the edge of death and was facing a multitude of potentially lethal complications if he managed to survive the hours immediately post-op. But Will felt exhilarated. The hundreds of decisions he had dealt with, instinctively or after deliberation, were holding up.
He helped transfer the man to a recovery-room bed and watched approvingly as the nurses reconnected the myriad of fluid and monitoring lines.
Maxine, the exhausting hours at work, the alimony and support payments, the periods of loneliness, the truncated time with the twins, the pressures from managed care-as long as practicing medicine could deliver as it had tonight, he would somehow find the strength to deal with the rest.
CHAPTER 3
At five in the morning Serenity Lane was dark and still. Posed in front of the vast picture window over the kitchen counter, Cyrill Davenport carefully fork-split a Thomas’ English muffin and set the toaster oven for precisely two-point-five. Davenport was nothing if not precise-obsessive, he knew some at the company called him, but he didn’t care. He was the president and chairman of the board of the Unity Comprehensive Health HMO, and they weren’t. He could see little through the darkness beyond the window but had no trouble envisioning his yard-nearly two rolling acres of grass, gardens, walkways, majestic boulders, and ten varieties of mature trees. Not bad for someone who had to wheedle a scholarship just to attend a small state school. Now the student center at that school bore his name-his and Gloria’s.
It had been a mistake to include her name on the building, he thought now. He unwrapped a soft pat of custom-prepared butter, sliced it precisely in two, and spread each piece in concentric circles beginning at the center of the muffin halves. If he had donated a detox to the school, Gloria’s name should definitely have been on it-but otherwise, most resoundingly not. The Cyrill Davenport Student Center-that’s how it should have been. He poured eight ounces of the chilled orange juice he had squeezed the previous evening into a Waterford goblet and sipped it down as he finished the muffin. No matter, he acknowledged. Gloria gave great parties, kept a magnificent house, and handled the help impeccably. So what if she was too sloshed most of the time to be much of a wife?
Davenport pulled on his overcoat and set his dishes in the sink. This day was to be a most significant one for Unity Comprehensive Health. Depson-Hayes, one of the largest electronics-manufacturing corporations in the Northeast, was on the verge of shifting its total coverage package to Unity. By mid-morning, the announcement would be made, and the seven different HMOs that had been covering the D-H employees-including several who had been pressuring Unity to join in their merger-would be shit out of luck.
It had taken statistics and promises-a boatload of each-to convince the health people at D-H that care would not suffer despite a striking reduction in the premiums they and their employees would have to pay. Now it would be up to Davenport’s lieutenants to see to it that Unity’s hospitals and physicians made good on those promises. Davenport knew he was asking the impossible, but this was one instance, like horseshoes and hand grenades, where close would be good enough. There could be problems and complaints from the D-H policyholders, even serious ones-just not too many of them. Fortunately, although he would never broadcast the fact, both the state
