“Okay,” Dr. Rodriguez said. “Dr. Wu and I will close the fascia with wire. After that Dr. Wu and you, Dr. Fuller, can close the subcutaneous layer followed by the skin. What do you guys say?”
“Sounds like a plan,” Dr. Wu said with a nod.
“Sounds good to me,” Mitt said. He was encouraged, thinking that maybe the day could be salvaged as a decent teaching day after all.
Chapter 7
Monday, July 1, 6:35 p.m.
Mitt pushed his food tray forward on the stainless-steel railing that ran along the front of the glass-enclosed cafeteria food service line and stopped at the drink offerings. Back at the main-course selections he’d chosen meat loaf and mashed potatoes, and the aroma drifting up from his plate was making him salivate. A few hurried bites of a bagel that morning in his apartment had been the only food he’d had all day, and he was understandably starved.
The last forty minutes of his first surgical case as a resident had gone reasonably well. As planned, after Dr. Rodriguez and Dr. Wu had closed the abdomen’s midline incision with wire, he and Dr. Wu had closed the subcutaneous layer with gut sutures. Dr. Wu had placed the first two, then handed the needle holder to Mitt. Self-conscious under the supervision of two more senior residents, Mitt had struggled to a degree but managed to imitate Dr. Wu’s placement for his first suture as a resident. When no one said anything to make him question what he’d done, Mitt fumbled with tying the knot. With commendable patience despite the length of time the operation had been going on, Dr. Rodriguez instructed Mitt on the proper technique and how to keep tension on both ends of the suture while running down and securing the second tie.
After observing the placement of several more subcutaneous sutures, Dr. Rodriguez followed Dr. Washington’s lead and left the OR. From then on, Dr. Wu watched Mitt finish with the subcutaneous level and begin the silk sutures for the skin.
“Try to roll your wrist when placing the skin sutures,” Dr. Wu had suggested, and she demonstrated what she meant. “The idea is to close the skin by just having the edges come together so as not to pucker out or roll into the wound.”
“I get it,” Mitt had said. When he’d finished, the skin edges were just “kissing.”
“Not bad,” Dr. Wu had said.
When the case had finally been over, Mitt hung around at Dr. Wu’s suggestion to help the nurses and the anesthesiologist move the patient onto a gurney for the trip to the Post-Anesthesia Care Unit, or PACU. By that time, the patient was awake and responding to his name and his vital signs were normal. Once in the PACU, Mitt also participated with Dr. Wu in writing the postoperative orders.
A few minutes later, while staring at his clothes hanging in his open locker, Mitt made a sudden decision not to change but rather merely to put his white coat over his scrubs. He had no idea what the evening and night would bring, but he thought he’d be more prepared in scrubs, come what may. What he was secretly hoping was that he would be able to get some rest, and he thought the scrubs could serve a dual function as pajamas as well as hospital work clothes.
When he’d finally left the operating suite, hunger pains forced him to head to the cafeteria before going around to introduce himself at the various inpatient wards as well as locate the three patients he needed to work up. No matter what, it was going to be a long night, and he definitely needed calories to face it.
“Can I help you?” the food service woman said, seeing Mitt pause before the drink selection apparatus.
“Thank you, but I’m just having trouble deciding what I want,” Mitt said. The choices were legion: all manner of soft drinks, various types of milk, and sparkling and still water. Although he didn’t usually drink sodas due to their overabundance of sugars, he thought a bit of caffeine in a cola might stand him in good stead as he faced his first night on call. Deciding on a diet cola, he proceeded to fill one of the large paper cups. Since the dispenser functioned so quickly, the cup brimmed before he was ready, and a small amount spilled over the top.
“Oops, sorry,” Mitt said to the food service woman standing behind the counter and watching him.
“Not a problem,” the woman said. “It happens all the time.”
Still feeling like a klutz, Mitt lifted the overfilled cup and placed it on his tray. Letting go of the cup, he was about to push the tray on to the dessert selection when the full cup of cola tipped over, flooding his entire tray with soda, including drenching his meat loaf and mashed potatoes.
“Oh, shit!” Mitt said by reflex before remembering where he was. With a sense of shock, because this had happened although he had not yet touched the tray, he reared back with his hands raised at chest level as if he expected the tray itself to do something equally unexpected.
Having witnessed the accident, the food service woman immediately came out from behind the cafeteria counter to lend a hand. “Not a problem,” the woman reiterated graciously. She used a dish towel that she had slung over her shoulder to sop up some of the cola from the brimming tray before taking it to the nearby soiled-dishes window.
Although Mitt had lowered his hands, he hadn’t moved, feeling dumbstruck as his mind replayed the episode. Had he touched the tray? He must have to cause the cup to tip over, yet he was certain he hadn’t. Was his mind playing tricks on him? Was his blood sugar that low from not having eaten anything for twelve hours? Even more unnerving, the incident reminded him of the curious forceps episode in the operating room.
Stepping back to get out of the way of people moving along the food line, an embarrassed Mitt watched a janitor who had appeared with a mop clean up the small amount of cola that had spilled onto the tiled floor. A moment later the food service woman pressed a clean tray into his hands and directed him back to the beginning of the cafeteria line.
The next time Mitt stepped in front of the drink dispenser with the new tray and a second serving of meat loaf and mashed potatoes, he made certain to fill the cup far short of the brim. This time he put the cup on the tray and let go of it slowly, watching it intently, ready to grab it if it showed any inclination to tip over on its own accord. As expected, it stayed perfectly upright, making him believe he must have inadvertently and unknowingly hit the previous cup. Attributing the entire episode to a combination of fatigue and hypoglycemia, he moved on to the dessert section. He wasn’t a big dessert guy, but having no idea when he might eat again, he decided on a wedge of apple pie.
Picking up his tray, Mitt scanned the room. It was moderately crowded, reminding him that Bellevue Hospital was a huge operation 24/7, with a support staff of over five thousand people, including more than a thousand doctors, one of which he was for the next two months. After spotting an empty table against the far wall, he headed toward it. He wasn’t being asocial. His plan was to wolf down his meal and get started on his evening’s work. He was well aware that doing three admission workups would take considerable time and effort, and that job was on top of being on call. He really had no idea of what the evening’s demands were going to be and whether he was up to the challenge. In short, he felt nervous as hell.
“Excuse me,” a cheerful, clear voice said about twenty minutes later, halting a forkful of apple pie en route to Mitt’s mouth. He looked up into a tanned oval face framed by a nimbus of remarkably curly blond hair. Her surprisingly dark eyes were bright in contrast to her hair, and her expression was cheerful but questioning. “Are you Michael Fuller?”