For a few beats, Mitt stared at the made-up but vacant bed with mounting concern, trying to fathom why she had been moved and where. He even glanced in at all the other occupied beds in the room to be sure she wasn’t in one of them. She wasn’t.
With growing unease because of what had happened to his other patients, he turned around with the intention of heading to the nurses’ station to find out where Bianca Perez was. But as he reached the hallway, he remembered that a few single rooms near the nurses’ station were reserved for patients who might need closer attention. Mitt immediately felt better and thought there was a reasonable chance she’d been put in one of them since her surgery had been so late in the afternoon.
Just around the corner, he ran into a nurse heading in the opposite direction. He stopped her and asked if she knew where Bianca Perez was.
“Oh, yes,” she said. “I certainly do. She’s down on ten in the surgical intensive care unit.”
“What?” Mitt stammered. “Why the ICU? What happened?”
“As far as I know, she apparently bled out into her abdomen. No one had any idea until her blood pressure suddenly went to zero. We called the on-call doctor, who immediately called the second-year resident. The patient ended up being rushed down to surgery. Then we heard she was going to the ICU after she left the recovery room.”
“Good God,” Mitt voiced.
“I wasn’t the nurse on the case. That was Elenore Williams. She’s back at the nurses’ station at the moment, and I recommend you speak directly with her if you want more details.”
“That’s okay,” Mitt said, suddenly feeling weak. Although he certainly wanted to find out more about what happened last night, he specifically needed to learn what Perez’s current status was so he could present the case at the upcoming morning rounds. As a major complication, it was obviously going to be one of the most important cases to be discussed. Without another word, he turned on his heels and hurried back toward the elevators. As he ran, he felt an overwhelming sense of unreality, as if he were in a dream. This was his fourth patient, and it sounded as if she might be in extremis. The nurse had said bled out. Could that be possible? He didn’t know, but he needed desperately to find out.
Chapter 15
Wednesday, July 3, 6:10 a.m.
Mitt got off the elevator on the tenth floor and with great trepidation walked into the ICU. Just across the threshold, he felt overwhelmed. He’d visited it briefly on the rapid Monday-morning tour with Andrea and Dr. Van Dyke, but that was different. Now he was alone and dressed like the doctor he was supposed to be, but he was inwardly terrified that someone would ask him a critical question or, worse yet, to actually do something. Not only would he invariably not be able to respond but how little he knew would be exposed to the world at large. In truth he felt like a total charlatan in his white resident’s outfit and wished he were invisible.
His plan was to check on Bianca Perez as quickly as possible and then get the hell away. But first he had to find out where she was. The layout of the ICU was similar to the inpatient floors, eighty or so patient rooms located around the periphery, with windows and natural light, while all the support services were sited in the core of the floor. Here, though, the nurses’ stations weren’t centralized but rather dispersed, small discrete stations that served only the two adjacent patient rooms or patient slots. He didn’t even know if they called them nurses’ stations.
Mitt found the ICU intimidating because not only were all the patients in a critical clinical state, but it was also an UpToDate medical-technological wonderland that had already gone through a total renovation since the Bellevue high-rise had opened. Mitt had only a vague idea of the function and details of some of the important equipment, like the ventilators that were breathing for those patients who couldn’t adequately breathe on their own. If a nurse were to ask him even a simple question about one of them, he’d be lost.
The ICU was also an inordinately busy place with numerous technicians, other support staff, and nurses for each patient such that the whole floor was in a kind of anxious frenzy, with people coming and going in constant activity. Also unique, most everyone was dressed in surgical scrubs, making the place visually very egalitarian. On the positive side, Mitt knew there were a number of intensivist residents and attendings mixed in with everyone else since Critical Care was a medical specialty in its own right.
Building up his courage, Mitt stopped a woman carrying some blood tubes, apparently on her way to the laboratory. “Excuse me,” he said. “How do I find a specific patient?”
She pointed off to Mitt’s left toward a central station of sorts where there were a number of monitors. “The easiest way is just type in the name and hospital number. It should pop up.”
Mitt thanked the woman and wondered why he hadn’t thought of the idea himself. Although most of the monitors were in use, he found one that was free. He didn’t bother sitting down. He typed in Bianca Perez, and even without the need to add the hospital number, her ICU room number, 10 South, appeared. Immediately he turned off the monitor and headed toward the designated room, even though he knew he could probably find out what had happened to her from the EHR. As upsetting as it might be, he needed to see Bianca Perez so he could say he’d done so at morning rounds. He couldn’t quite believe that his sole patient had had a major postoperative complication.
Just getting to 10 South was a little like broken-field running in football with all the people he confronted. It seemed that every bed was surrounded with caregivers, and as Mitt passed down the row of patient rooms, he was beset with a continued low cacophony of monitors beeping and ventilators functioning, like the soundtrack of a science fiction movie.
Mitt stopped at the entrance to 10 South, and at first glance, it did not look good. Bianca was intubated and a ventilator was cycling through positive and negative pressure like an auditory seesaw. Multiple IV bags were hung on poles at the head of the bed. Even from the doorway, he could see that her eyes were taped shut. A woman, presumably a nurse, dressed in scrubs including a surgical cap was on the left side of the bed using a blood pressure cuff. A bank of monitors hung from the ceiling with one tracing an ECG across its screen and beeping with each heartbeat. At least that appeared normal. Mitt took in a deep breath to try to prepare himself and walked in along the empty right side of the bed. The nurse glanced up at him and nodded a greeting but didn’t say anything, as she had the earpieces of a stethoscope in her ears and was obviously listening.
While he waited for the nurse to finish taking the blood pressure, Mitt lifted the sheet covering the patient enough to gaze at her abdomen. A new, large midline incision was covered by a narrow dressing. From the bottom of the dressing a drain emerged that was connected to a container that hung under the bed on Mitt’s side. There was a small amount of blood visible in the clear tubing and the container. The five small incisions that had been made during the colectomy that Mitt had helped on all looked fine under their simple transparent paper-tape coverings.
“Can I help you?” the nurse asked in a no-nonsense but friendly tone as she took the stethoscope’s earpieces from her ears.
“I hope so,” Mitt said before introducing himself as a first-year surgical resident. He then confessed it was only his third day. He now could see her name tag, Gabriela Martinez. “I’m sorry to bother you, but what happened to Ms. Perez? I helped with her surgery yesterday afternoon, which went entirely smoothly. When I went to visit her in her room, I was shocked to hear she was down here in the ICU.”