group’s performance. Actually Susan was not concerned with this aspect as were the others. Susan was more distressed about the sudden and unexpected response and change in attitude of Johnston and, to a lesser extent, Bellows. One minute they were jovial and friendly; the next minute they were angry, almost vengeful, simply because of an unexpected turn of events. Susan rekindled her preconceptions regarding the surgical personality. Perhaps such generalizations were appropriate.
After changing back to their street clothes, they all had a cup of coffee in the surgical lounge. It was surprisingly good coffee, thought Susan, trying to overcome the oppressive haze of cigarette smoke which hung like Los Angeles smog from the ceiling to a level about five feet from the floor. Susan was mindless of the people in the lounge until her eyes met the stare of a pasty white-skinned man hovering in the corner near the sink. It was Walters. Susan looked away and then back again, thinking that the man was not really watching her. But he was. His beady eyes burned through the cigarette haze. Walters’s omnipresent cigarette hung by some partially dried saliva holding the extreme tip in the corner of his lips. A trail of smoke snaked upward from the ash. For some unknown reason he reminded Susan of the hunchback of Notre Dame, only without a hunchback: a ghoulish figure out of place yet obviously at home in the shadows of the Memorial surgical area. Susan tried to look away but her eyes were involuntarily drawn toward the uncomfortable stare of Walters. Susan was glad when Bellows motioned to leave and they drained their cups. The exit was near to the sink, and as the group left the room, Susan had the feeling she was walking down Walters’s line of vision. Walters coughed and the phlegm rattled.
“Terrible day, eh, Miss,” said Walters as Susan passed.
Susan didn’t respond. She was glad to be rid of the staring eyes. It had added to her nascent dislike of the surgical environment of the Memorial.
The group moved en masse into the ICU. As the oversized ICU door closed, the outside world faded and disappeared. A surrealistic alien environment emerged out of the gloom as the students’ eyes adjusted to the lower level of illumination. The usual sounds like voices and footsteps were muted by the sound-absorbing baffling in the ceiling. Mechanical and electronic noises dominated, particularly the rhythmical beep of the cardiac monitors and the to-and-fro hiss of the respirators. The patients were in separate alcoves, in high beds with the side rails pulled up. There was the usual profusion of intravenous bottles and lines hanging above them, connected to impaled blood vessels by sharp needles. Some of the patients were lost in layer upon layer of mummylike bandages. A few of the patients were awake and their darting eyes betrayed their fear and the fine line that divided them from acute insanity.
Susan surveyed the room. Her eyes caught the fluorescent blips racing across the front of the oscilloscope screens. She realized how little information she could garner from the instruments in her present state of ignorance. And the I.V. bottles themselves with their complicated labels signifying the ionic content of the contained fluid. In an instant, Susan and the other students felt the sickening feeling of incompetence; it was as if the entire first two years of medical school had meant nothing.
Feeling a modicum of safety in numbers, the five students moved even closer together and walked in unison to one of the center desks. They were following Bellows like a group of puppies.
“Mark,” called one of the ICU nurses. Her name was June Shergood.
She had thick luxurious blonde hair and intelligent eyes that looked through rather thick glasses. She definitely was attractive and Susan’s’
keen eye could detect a certain change in Bellows’s demeanor. “Wilson has been having a few runs of PVCs, and I told Daniel that we should hang a lido-came drip.” She walked over to the desk. “But good old Daniel couldn’t seem to make up his mind, or ... something.” She extended an EKG tracing in front of Bellows. “Just look at these PVCs.”
Bellows looked down at the tracing.
“No, not there, you ninny,” continued Miss Shergood, “those are his usual PACs. Here, right here.” She pointed for Bellows and then looked up at him expectantly.
“Looks like he needs a lidocaine drip,” said Bellows with a smile.
“You bet your ass,” returned Shergood. “I mixed it up so I could give about 2 mg per minute in 500 D5W. Actually it’s all hooked up and I’ll run over and start it. And when you write the order include the fact mat I gave him a bolus of 50 mg when I first saw the runs of PVCs. Also maybe you should say something to Cartwright. I mean, this is about the fourth time he couldn’t make up his mind about a simple order. I don’t want any codes in here we can avoid.”
Miss Shergood bounced over to one of the patients before Bellows could respond to her comments. Deftly and with assurance she sorted out the twisted I.V. lines to determine which line came from which bottle. She started the lidocaine drip, timing the rate of the drops falling into the plastic chamber below the bottle. This rapid exchange between the nurse and Bellows did little to buoy the already nonexistent confidence of the students. The obvious competence of the nurse made them feel even less capable. It also surprised them. The directness and seeming aggressiveness of the nurse was a far cry from their rather traditional concept of the professional nurse- physician relationship under which they all still labored.
Bellows pulled out a large hospital chart from the rack and placed it on the desk. Then he sat down. Susan noticed the name on the chart N.
Greenly. The students crowded around Bellows.
“One of the most important aspects of surgical care, any patient care really, is fluid balance,” said Bellows, opening the chart, “and this is a good case to prove the point.”
The door to the ICU swung open, allowing a bit of light and hospital sounds to spill into the room. With it came Daniel Cartwright, one of the interns on Beard 5. He was a small man, about five seven. His white outfit was rumpled and blood-spattered. He sported a moustache but his beard was not very thick and each hair was individually discernible from its origin to its tip. On the crown of his head he was going bald rather rapidly. Cartwright was a friendly sort and he came up to the group directly.
“Hi, Mark,” said Cartwright making a gesture of greeting with his left hand. “We finished early on the gastrectomy so I thought I’d tag along with you if I may.”
Bellows introduced Cartwright to the group and then asked him to give a capsule summary on Nancy Greenly.
“Nancy Greenly,” began Cartwright in a mechanical fashion, “twenty-three-year-old female, entered the Memorial approximately one week ago for a D&C. Past medical history entirely benign and noncontributory.
Routine pre-op workup normal, including negative pregnancy test. During surgery she suffered an anesthetic complication and she has been comatose and unresponsive since that time. EEG two days ago was essentially flat. Current status is stable: weight holding; urine output good; BP, pulse, electrolytes, etcetera, all OK. There was a slight temperature elevation yesterday afternoon but breath sounds are normal. All in all, she seems to be holding her own.”
“Holding her own with a good deal of help from us,” corrected Bellows.
“Twenty-three?” asked Susan suddenly while glancing around at the alcoves. Her face reflected a tinge of anxiety. The soft light of the ICU
hid this from the others. Susan Wheeler was twenty-three years old.
“Twenty-three or twenty-four, that doesn’t make much difference,”
said Bellows as he tried to think of the best way to present the fluid balance problem.
It made a difference to Susan.
“Where is she,” asked Susan, not sure if she really wanted to be told.
“In the corner on the left,” said Bellows without looking up from the input-output sheet in the chart. “What we need to check is the exact amount of fluid the patient has put out versus the exact amount that has been given. Of course this is static data and we are more interested in the dynamic state. But we can get a pretty good idea. Now let’s see, she put out 1650 cc of urine ...”
Susan was not listening at this point. Her eyes fought to discern the motionless figure in the bed in the corner. From where she was standing, she could make out only a blotch of dark hair, a pale face, and a tube issuing from the area of the mouth. The tube was connected to a large square machine next to the bed that hissed to and fro, breathing for the patient. The patient’s body was covered by a white sheet; the arms were uncovered and
