Before starting his scrub at the sink outside of OR #4, he quickly glanced through the wire-embedded glass window into the operating room. At that exact moment, Dr. Rodriguez and Dr. Arthur Reston, the attending surgeon, whom he’d yet to meet, were in the process of draping Roberto Silva’s scrubbed and antiseptic-painted abdomen. As Mitt feared, he was going to be a bit late, which wasn’t the way he wanted to start a relationship with another of the Bellevue attending surgeons.
Although he was eager to get into the OR, Mitt scrupulously followed the scrubbing rules he’d been shown by Dr. Van Dyke the day before. Almost five minutes later, he pushed backward into the OR, holding his hands aloft and accepting a sterile towel from the scrub nurse. To his surprise, she introduced herself as Kathy, which was a first for Mitt. Kathy then helped Mitt don his sterile gown and gloves. In due course, the circulating nurse tied the gown behind his neck while introducing herself as well. Her name was Caroline. Although he was nervous about being late, he felt more relaxed after being welcomed by both nurses. That hadn’t happened on his first two cases.
Now completely prepared, Mitt approached the operating table. The patient had been fully draped, with just a small area on the upper part of the abdomen exposed. The attending surgeon was standing on the patient’s right side while Dr. Rodriguez was on the left. Both men had their hands crossed and pressed up against their chests, waiting. Mitt wondered if they had been waiting for him.
“I’m sorry I’m late,” Mitt said.
“No problem,” Dr. Rodriguez said. “As you can probably see, we’re in a holding pattern on orders from Anesthesia.”
Mitt nodded. When he’d entered, he’d noticed that instead of one anesthesiologist there were two, but at that very moment, Dr. Winthrop, whom Mitt had so recently met, also hurriedly entered the room, tying his face mask over the top of his head as he did so. He joined the others and the three gathered in hushed but tense conversation. Mitt could hear that the pinging of the cardiac monitor was not its usual metronomic rhythm but rather irregular, with short, distinct pauses.
“Dr. Reston, meet Dr. Michael Fuller, one of our first-year residents,” Dr. Rodriguez continued.
“Welcome to the program,” Dr. Reston said. He was a sizable man, even larger than Dr. Rodriguez, with a deep, gravelly voice. “Why don’t you go over to the other side and join Dr. Rodriguez. I think that’s where you’ll be the most help.”
“Certainly,” Mitt said. He skirted Kathy and her instrument tray and rounded the foot of the operating table. Dr. Rodriguez moved to the side, creating more space between himself and the anesthesia screen. As Mitt slipped into position directly across from Dr. Reston, he hoped he’d not end up being blocked by Dr. Rodriguez as he’d been on his first case. He’d heard that pancreatic surgery was difficult, and he was eager to be able to see how it progressed. Although the three hours of sleep he’d just gotten had definitely helped his situation, he knew he was still truly tired, and he feared how he’d respond if boredom became an issue.
“Dr. Rodriguez was telling me that you are a direct descendant of a number of Bellevue Hospital luminaries,” Dr. Reston said, looking directly across at Mitt. “I’m impressed. It must give you a lot of satisfaction to follow in their footsteps.”
“I’m not sure how I feel,” Mitt said truthfully. “Just this morning, I was told that they might have been reactionary on some important advances.”
“Oh, that’s not fair,” Dr. Rodriguez said, jumping in to defend Mitt’s ancestors. “We can’t judge our medical forebearers because of what we now know. They were doing the best they could with the state of science as it was at the time.”
“Dr. Harington said something similar about the unfairness of hindsight,” Mitt said. He appreciated Dr. Rodriguez’s support while at the same time feeling uneasy about his genealogy being out in the open, for good or bad. It was something he’d hoped to avoid. “But for me, it can’t help but color my feelings if it is true.”
“Dr. Rodriguez told me that one of your ancestors could do a mid-thigh amputation in nine seconds and another was only the second person in the world to perform a mitral valve fracture. Those are some pretty impressive facts, if I do say so myself.”
“I suppose,” Mitt said to be agreeable. He sensed that Dr. Reston had a very high opinion of himself. In hopes of changing the subject, Mitt added, “What’s the problem here? Is Anesthesia having some difficulties?”
“I’ll say,” Dr. Reston sniped, lowering his voice so as not to be heard over the anesthesia screen. “Somehow anesthesia has managed to create an arrhythmia. The patient’s ticker was just fine until they got ahold of him. But what can you do? They’re all a bunch of monkeys as far as I’m concerned.” He rolled his eyes for emphasis, making Mitt wonder if there were competitive feelings between Bellevue surgeons and anesthesiologists, at least from Dr. Reston’s perspective.
Almost as if responding to Dr. Reston’s snide comment, suddenly the cardiac alarm went off, replacing the irregular pinging of the cardiac monitor. Thanks to the tile walls and floor, the sound was particularly piercing. Everyone in the room started, nurses and doctors alike.
“My God!” Dr. Winthrop blurted loud enough for everyone to hear. “We’ve got ventricular fib! Call an arrest! Get the OR crash cart in here!”
While the anesthesiologists snatched off all the operative drapes and tossed them onto the floor, completely exposing the naked and intubated patient, Caroline dashed over to the intercom and depressed the button. “Code red!” she shouted into the speaker grate several times.
Both Dr. Reston and Dr. Rodriguez merely backed away from the OR table against opposite walls while keeping their gloved hands pressed up against their chests. Luckily they had not started the surgery. Mitt was aghast and momentarily paralyzed, with his eyes thrown open to their limits. Quickly recovering, he, too, retreated out of the way and joined Dr. Rodriguez.
The anesthesiologists didn’t waste any time. One of them rushed up alongside the OR table, pulling the anesthesia stool along with him. Then, after locking the stool’s wheels, he climbed up on it and began closed-chest cardiac massage. The ventilator was still functioning and breathing for the patient. A moment later, the door from the hallway burst open and two more anesthesiologists rushed into the room pushing the crash cart. One of them positioned the cart next to the operating table while the other plugged the defibrillating unit into a wall socket.
With trained efficiency and little need for talk, the defibrillator was prepared. Once it was ready, the anesthesiologist who had been giving the closed-chest cardiac massage stepped off the stool he was standing on and took the paddles. He placed one on the patient’s sternum and the other along the patient’s left rib cage. “Clear,” he called out before pressing the button.
The patient’s body convulsed. All eyes looked up at the ceiling-mounted cardiac monitor. The blip, which had been tracing erratic chicken scratches across the screen, disappeared with the defibrillator’s discharge. In a reverent silence, all waited for the blip to reappear, which it did almost immediately. Unfortunately, it was just as erratic, meaning the heart was still fibrillating.
The team of anesthesiologists recommenced the cardiac massage while the defibrillator reset itself. Then they repeated the process, but to no avail. The fibrillation continued. Various drugs were tried, and then a cardiologist arrived on an emergency consult. He offered some additional suggestions, but nothing worked. Presently the fibrillation indeed did stop, but what intervened was asystole, meaning no electrical activity whatsoever. At that point an external pacemaker was tried, but it failed to initiate a heartbeat.