good point.”
Harvey Goldberg fidgeted, wishing he had asked Fairweather’s question.
Susan revived from the depths of her daydream as a result of me verbal exchange between Bellows and Cartwright.
“Does anybody have any idea why this horrible thing has happened to this patient?” asked Susan.
“What horrible thing?” asked Bellows nervously while he mentally checked the I.V., the respirator, and the monitor. “Oh, you mean the fact that she never woke up. Well ...” Bellows paused. “That reminds me.
Cartwright, while you’re calling consults, have neurology get their asses up here and do another EEG on this patient. If it is still flat, maybe we can get the kidneys.”
“Kidneys?” questioned Susan with horror, trying not to think about what such a statement meant for Nancy Greenly.
“Look,” said Bellows putting his hands on the railing with his arms extended. “If her squash is gone, I mean wiped out, then we might as well get the kidneys for someone else, provided of course, we can talk the family into it.”
“But she might wake up,” protested Susan with color rising in her cheeks, her eyes flashing,
“Some of them wake up,” shrugged Bellows, “but most don’t when they have a flat EEG. Let’s face it; it means the brain is infarcted, dead, and there is no way to bring it back. You can’t do a brain transplant although there are some cases where it might be very useful.” Bellows looked teasingly at Cartwright, who caught the innuendo and laughed.
“Doesn’t anyone know why this patient’s brain didn’t get the oxygen it needed during surgery?” asked Susan, going back to her previous question in a desperate attempt to avoid even the thought of taking the kidneys out of Nancy Greenly.
“No,” said Bellows plainly and looking directly at Susan. “It was a clean case. They’ve gone over every inch of the anesthesia procedure. It happened to be one of the most compulsive of all the anesthesiology residents and he’s sucked the case dry. I mean, he’s been merciless on himself. But there’s been no explanation. It could have been some sort of stroke, I guess. Maybe she had some condition which made her susceptible to having a stroke. I don’t know. In any case, oxygen was apparently kept from the brain long enough so that too many of the brain cells died. It so happens that the cells of the cerebrum are very sensitive to low levels of oxygen. So they die first when the oxygen falls below a critical level and the result is what we have here”—Bellows made a gesture with his hand, palm up, over Nancy Greenly—“a vegetable. The heart beats because it doesn’t depend on the brain. But everything else must be done for the patient. We have to breathe her with the respirator there.” Bellows motioned toward the hissing machine to the right of Nancy’s head. “We have to maintain the critical balance of fluids and electrolytes as we were doing a few moments ago. We have to feed her, regulate the temperature ...” Bellows paused after he said the word temperature. The concept keyed off his memory. “Cartwright, order a portable chest X-ray today. I almost forgot about the temp elevation you mentioned a little while ago.” Bellows looked at Susan. That’s now most of these brainstem patients depart from this life, pneumonia ... their only friend. Sometimes I wonder what the shit I’m doing when I treat the pneumonia. But in medicine we don’t ask questions like that. We treat the pneumonia because we have the antibiotics.”
At that moment the page system came to life as it had been doing intermittently. This time it paged “Dr. Wheeler, Dr. Susan Wheeler, 938
please.” Paul Carpin nudged Susan and informed her about the page.
Susan looked up at Bellows quite surprised.
“That was for me?” asked Susan in disbelief. “It said ‘Doctor Wheeler.’
”
“I gave the nurses on the floor a list of your names to put on the charts in order to divide up the patients among you. You’ll be paged for all the blood work and other fascinating scut.”
“It’s going to be strange getting used to being called Doctor,” said Susan looking around for the nearest phone.
“You’d better get used to it because that’s the way you’ll be paged. It’s not meant to flatter you. The idea is to make it easier on the patients.
You shouldn’t hide the fact that you’re students, but don’t advertise it either. Some of the patients wouldn’t let you touch them if they thought you were med students; they’d yell and scream they were being used as guinea pigs. Anyway go answer the page, Dr. Wheeler, and then catch up with us. After we finish here we’ll be up in the conference room on ten.”
Susan walked over to the main desk and dialed 938. Bellows watched her cross the room. He couldn’t help but notice that under the white coat lurked a sensuous figure. Bellows was being attracted to Susan Wheeler by quantum leaps.
Monday, February 23, 11:40 A.M.
It gave Susan a feeling of unreality to answer a page for “Dr. Wheeler.”
She felt transparent as if she were an actress playing the role of a doctor. She had on the white coat and the scene was melodramatic and appropriate. Yet on the inside she just didn’t feel like the part, and there was the thought that she would be exposed at any moment as a charlatan.
At the other end of the phone line, the nurse was matter-of-fact and to the point.
“We need an I.V. started on a pre-op. The case has been delayed and anesthesia wants some fluid in him.”
“When would you like me to start it?” asked Susan twisting the phone cord.
“NOW!” answered the nurse before hanging up.
The other members of Susan’s group had moved on to another patient and were again huddled about the desk, straining to see the chart Bellows had pulled from the rack and had in front of him. No one looked up as Susan traversed the half-light of the ICU. She reached the door and her left hand wrapped around the upturned stainless steel handle.
Turning her head slowly to the right she chanced another glance at the immobile and lifeless-appearing Nancy Greenly. Once again Susan’s mind stumbled through a painful identification. She left the ICU with difficulty but also with a sense of relief.
The sense of relief was short-lived. Hurrying along the crowded corridor, Susan began to prepare herself for the next mini-hurdle. Susan had never started an I.V. before. She had drawn blood from several patients, including her lab partner, but she never had started an I.V.
Intellectually she knew what was required and she knew that she could do it After all, it only involved punching a razor-sharp needle through some thin skin and impaling a vein without going all the way through the vessel. The difficulties arose from the fact that frequently the vein was only the size of thin spaghetti with a corresponding smaller lumen. In addition, sometimes the vein could not be seen from the surface of the skin and had to be attacked blindly with only the help of the sense of touch.
With these difficulties in mind Susan knew that even something as mundane as starting an I.V. was going to be a challenge of sorts. Her biggest concern was that it was going to be very apparent that she was new at the game, and perhaps the patient might rebel and demand a real doctor. Besides, she was in no frame of mind to have to put up with any exasperated ridicule from any of those bitchy nurses.
When Susan arrived at Beard 5, the scene was unchanged. The bustle of activity was as hectic as ever. Terry Linquivist gave a fleeting look at Susan before disappearing into the treatment room. One of the other nurses, whose cap had a bright orange stripe and whose name tag read
“Sarah Sterns,” responded to Susan’s arrival by handing her the I.V. tray and a bottle of I.V. fluid.
“The name’s Berman. He’s in 503,” said Sarah Sterns., “Don’t worry about the rate. I’ll be down there in a few minutes to regulate it.”
Susan nodded and headed for 503. En route she examined the I.V. tray.
There were all sorts of needles: scalp needles, long-dwelling catheters, CVP lines, and traditional disposable needles. There were packets of alcohol sponges, a few lengths of flat rubber tubing to be used as the tourniquets, and a flashlight. Eyeing the flashlight, Susan wondered how many times she would repeat the scene of trudging off in the middle of the night to start an I.V.
