“Excuse me! I’m Dr. Fuller, and I’m looking for Helena Santos. Any idea where she might be?”
“I think she’s over in 1504,” one of the nurses said. She was the only one of the three who looked up in Mitt’s direction. “At least that’s where she was a few minutes ago.”
“Okay,” Mitt said. “If she appears, tell her I’m down there.” The nurse nodded but didn’t verbally respond.
As he headed down the darkened hallway with the muffled sounds of monitoring devices emanating from various rooms, he hoped that the nurse would still be there. He was counting on her offering suggestions of what to do. Otherwise, he might have to call Madison, which he’d rather not do for something as trivial as adequate pain medication. If and when he called her, he wanted it to be about something serious. He didn’t want to become known as someone who cried wolf over insignificant details.
As he reached 1504, he noticed the door was completely open and the rare single room was moderately illuminated. Entering, he could see that it wasn’t from the overhead lights but rather from a reading light behind the bed that cast long shadows across the rest of the room. There was also some light coming from the open bathroom doorway.
Benito Suárez was propped up, with his torso slightly raised by pillows behind his head and shoulders. Both side rails of the bed were up. An intravenous bag was hanging from a pole attached to the head of the bed, and the tube ran down into the man’s forearm. He was a stout, heavily built man in his late thirties who appeared much older. He had a ruddy complexion with short dark hair and rounded facial features that were currently pulled into a grimace of pain. Both hands were gripping the sheets on either side of his body. Save for the dressing over his abdominal incision, which was held in place with paper tape, he was naked from the waist up. A narrow tube that Mitt knew functioned as a drain snaked out from beneath the paper tape and was connected to a small clear container hanging beneath the bed. Beads of perspiration dotted the man’s forehead.
Feeling nervous and inadequate but pretending otherwise, Mitt walked up to the right side of the man’s bed, glancing at the drainage container as he did so. He noticed there was a small amount of bright red blood in its base, yet since the container and the connecting tube were mostly empty, he gave it little thought. He assumed the nurse on the opposite side of the bed was Helena. It had been apparent they were conversing when Mitt arrived but now both looked in his direction.
“Hello, Mr. Suárez,” Mitt began. “I understand you are experiencing some discomfort.” He purposefully tried to minimize the situation in hopes it would solve itself.
“Muita dor, Doutor. Muito! Muito!” he managed through a clenched jaw.
Mitt glanced over at Helena although he had a pretty good idea of the meaning.
“He says he has a lot of pain, Doctor,” the nurse said. “Too much.”
Mitt nodded in understanding. “And, just to be certain, he’s had all his prescribed narcotic, correct?”
“Absolutely. As I mentioned on the phone, besides his own pain meds, I gave him an additional dose just a little more than an hour ago, but it hasn’t touched him, as you can plainly see. He’s not due for another dose for another three hours.”
“Okay,” Mitt responded, as much for himself as for the others. His mind was in high gear, trying to decide exactly what to do. Short of calling Madison, the only thing that came to mind was possibly taking a peek at the incision and maybe gently palpating the man’s abdomen. At least it was something. He said as much to the patient, using gestures and very simple English, trying to ask if it would be okay.
“Por favor faça alguma coisa, Doutor. Por favor!” Benito managed.
“He said okay, go ahead,” the nurse translated.
As gingerly as he could, Mitt began to pull the upper edges of the paper tape off Benito’s abdomen, hoping not to make the man’s discomfort worse. Slowly he succeeded, and eventually he was able to fold the entire dressing down toward the foot of the bed, exposing most of the sutured incision that Mitt had done under Nancy Wu’s supervision. At the lower end, the drain tube issued forth, again with a tiny amount of bright red blood in its lumen but not a lot. From Mitt’s perspective everything looked normal, with the “ladder-rung” sutures crossing the incision every centimeter or so. At Dr. Wu’s direction they had all been snugged up but not too tight. The circulation of the tissues appeared fine.
“Do you need some gloves?” Helena questioned.
“That would be a good idea,” Mitt said, embarrassed he’d not thought of it.
The nurse immediately disappeared, leaving Mitt and the patient alone in the room. Benito looked up at him with what Mitt interpreted as a pleading expression. The problem was that Mitt still had no idea what to do.
“I’m sorry you are having so much difficulty,” Mitt said, feeling the need to say something while they waited for the nurse’s return.
“Eu não entendo,” Benito groaned.
“He says he doesn’t understand,” Helena explained as she came back into the room. She handed Mitt a package of sterile gloves. He was impressed by her speediness even though he knew this room was relatively close to the nurses’ station and hence to all the supplies.
“I assumed as much,” Mitt said as he tore open the package and struggled to don the gloves while maintaining their sterility. As he fumbled through the process in front of an audience, he thought that the proper technique for donning surgical gloves was yet another one of those little, practical things he should have been taught in his four years of medical school.
When he was ready, Mitt leaned over the patient and examined the sutured incision by gently palpating its edges. Everything felt normal, without any localized lumps that might suggest a hematoma or collection of blood. Then another idea occurred to him. Maybe he should press on the sides of the abdomen very carefully to get an idea of the man’s intra-abdominal pressure and explore the possibility that the drain was clogged. If that had happened, he asked himself, might fluid possibly build up and cause the acute pain the man was experiencing? It seemed like a plausible idea, yet as he continued to carefully palpate, the abdomen didn’t seem to be as tense as he would have expected if that were the case. On the contrary, it seemed to be as soft as normal even with the man tensing by reflex when Mitt gingerly pushed in.
Mitt straightened back up to his considerable full height. As potentially intellectually rewarding as the concept of a blocked drain had momentarily been, it now seemed out of the question. The problem was that he needed to come up with yet another theory as to what was going on to cause the man so much discomfort despite adequate narcotics.
While Mitt’s mind grappled with the issue at hand, he noticed something strange. The light in the room seemed to flicker. Mitt glanced at the source, the reading light at the head of the bed. When that was clearly as steady as normal, he wondered if the origin had been inside his own exhausted brain. Remembering his earlier, very weird phantosmia, Mitt shifted his gaze to the nurse for confirmation, and she, too, appeared momentarily addled, staring at the reading light. Seeing her reaction made him change his mind; maybe there’d been a blip in the power in the entire building.
But then Mitt was distracted by a strange popping sound, diverting his attention away from both the nurse and the flickering light back down to Benito’s incision. To Mitt’s surprise and shock, the uppermost suture of the midline incision had opened with a pop, as if the knot had just suddenly been untied by some mysterious internal force. Before Mitt could react to this strange phenomenon, the same thing happened to the second suture and then the third. It was as though the incision was unzipping. Even more alarming, at the very same time the sutures were spontaneously untying, Benito’s belly began obviously and rapidly swelling, akin to a balloon inflating.