therapeutic dose of anesthetic:
5 cc's of.25% Marcaine. Then he capped off the catheter.
'That's all there is to that,' Jeffrey said as he put a sterile bandage over the puncture site. 'But I want you to stay on your side for a while.'
'But I don't feel anything,' Patty complained.
'That's the idea,' Jeffrey said with a smile.
'You're sure it's working?'
'Just wait until your next contraction,' Jeffrey said with confidence.
Jeffrey conferred with the LPN to let her know how frequently he wanted
Patty's blood pressure taken. Then he helped her put the labor monitor back in place. He remained in the labor room through Patty's next contraction, using the time to complete his habitually meticulous anesthesia record.
Patty felt reassured. The discomfort she had been experiencing was much improved, and she thanked Jeffrey effusively.
After telling Monica Carver and the LPN where he would be, Jeffrey went into one of the darkened empty labor rooms to lie down. He was feeling better, but certainly not normal. Closing his eyes for what he thought would be just a few minutes and soothed by the sound of rain against the window, he surprised himself by falling fast asleep. He was dimly aware of the door being opened and closed several times as different people checked on him, but no one disturbed him until Monica came in and gently shook his shoulder.
'We've got a problem,' Monica said.
Jeffrey swung his legs over the side of the bed and rubbed his eyes.
'What's wrong?'
'Simarian has decided to do a Caesarean on Patty Owen.'
'So soon?' Jeffrey asked. He glanced at his watch. He blinked several times. The room seemed dimmer than before. Checking his watch, he was surprised to see that he'd been asleep for an hour and a half.
'The baby is an occiput posterior and hasn't been progressing,' Monica explained. 'But the main problem is that the baby's heart has been slow to return to a normal rate after each contraction.'
'Time to do a Caesarean,' Jeffrey agreed as he got unsteadily to his feet.
He waited a beat until his mild dizziness cleared.
'Are you all right?' Monica questioned.
'Just fine,' Jeffrey said. He sat down on a chair to slip on his OR shoes.
'What's the time frame?'
'Simarian will be here in twenty minutes or so,' Monica said, studying
Jeffrey's face.
'Is something wrong?' Jeffrey asked. He ran his fingers through his hair in fear it was standing on end.
.'You look pale,' Monica said. 'Maybe it's the lack of light in here.'
Outside it was raining even harder.
'How's Patty doing?' Jeffrey asked, heading for the bathroom.
'She's apprehensive,' Monica said from the door. 'Painwise, she's fine, but you might consider giving her some kind of tranquilizer just to keep her calm.'
Jeffrey nodded as he turned on the light in the bathroom. He wasn't wild about the idea of giving Patty a tranquilizer, but given the circumstances, he'd consider it. 'Make sure she's on oxygen,' he told Monica. 'I'll be out in a second.'
'She's on oxygen,' Monica called over her shoulder as she left the room.
Jeffrey examined himself in the mirror. He did look pale. Then he noticed something else. His pupils were so contracted, they looked like twin pencil points. They were as small as he'd ever seen them. No wonder he'd had trouble seeing his watch in the other room.
Jeffrey splashed his face with cold water, then dried it roughly. At least that woke him up. He looked at his pupils again. They were still miotic. He took a deep breath and promised himself that as soon as he got through this delivery, he would make tracks for home and put himself to bed. After ad- justing his hair with his fingernails, he headed for labor room fifteen.
Monica had been right. Patty was embarrassed, scared, and nervous about the upcoming Caesarean. She was taking the failure of the labor personally.
Tears came to her eyes when she again voiced anger at her husband's absence. Jeffrey felt sorry for her and made a big effort at reassuring her that everything would be fine and that she certainly wasn't at fault. He also gave her 5 mg of diazepam IV, which he thought would have minimal effect if any on the unborn child. It had a rapid calming effect on Patty.
'I'll be asleep during the Caesarean?' Patty asked.
'You'll be very comfortable,' Jeffrey replied, skirting the question. 'One of the big benefits of continuous epidural anesthesia is that I can extend it now that we need a higher level, without disturbing Patty junior.'
'It's a boy,' Patty said. 'His name is Mark.' She smiled weakly. Her lids had become a little droopy. The tranquilizer was clearly taking effect.
, The transfer from the delivery area to the OR suite was accomplished without incident. Jeffrey kept Patty on oxygen by mask during the short trip.
The OR had been advised as to the decision to do a Caesarean. By the time
Patty was transferred, the room was almost set up for the procedure. The scrub nurse, already scrubbed, was busy laying out the instruments. The circulating nurse helped guide the gurney into the room and transfer Patty to the OR table. Patty still had the fetal monitor on, which was left in place for the time being.
Jeffrey wasn't as familiar with the evening personnel, and he hadn't met the circulating nurse before. Her name tag read: Sheila Dodenhoff.
'I'm going to need some.5% Marcaine,' Jeffrey told Sheila as he changed
Patty from portable bottle oxygen to oxygen delivered through his Narcomed
III anesthesia machine. He then reapplied the blood pressure cuff to
Patty's left arm.
'Coming up,' Sheila said cheerfully.
Jeffrey worked quickly but deliberately. He checked off every procedure in his anesthesia record once it had been performed. In sharp contrast to most other doctors, Jeffrey prided himself on his exquisitely legible handwriting.
After hooking up the EKG leads, he attached the pulse oximeter to Patty's left index finger. He was replacing Patty's IV with a more secure intracath when Sheila returned.
'Here you go,' she said, handing Jeffrey a 30 cc glass vial of.5%
Marcaine. Jeffrey took the drug and, as he always did, checked the label.
He set the vial on top of his anesthesia machine. From the drawer, he took out a 2 cc ampule of spinal grade.5% Marcaine with epinephrine and drew it up into a syringe. Maneuvering Patty onto her right side, Jeffrey injected the 2 cc's into the epidural catheter.
'How's everything going?' a booming voice called out from the door.
Jeffrey turned to see Dr. Simarian holding a mask to his face while he held open the door.
'We'll be ready in a minute,' Jeffrey said.
'How's the little one's ticker?' he asked.
'At the moment, fine,' Jeffrey answered.
'I'll scrub up and we'll get this show on the road.'
The door swung shut. Jeffrey gave Patty's shoulder a squeeze while he studied the EKG and the blood pressure readout. 'You okay?' he asked her, moving the oxygen mask to the side.
'I think so,' she said.
'I want you to tell me whatever you feel. Understand?' Jeffrey said. 'Do your feet feel normal?'
Patty nodded. Jeffrey went around and tested her sensation. Coming back to the head of the table and checking the monitors again, he was sure that the epidural catheter had not moved and had not penetrated either the spinal canal or one of the pregnancy-dilated veins of Bateson.
Satisfied that all was in order, Jeffrey picked up the via] of Marcaine
