“Truthfully, your patient didn’t cause me any grief other than the first moments of panic when I arrived in her room. I had the presence of mind to realize I was in way over my head when faced with a patient with no blood pressure, a weak pulse, pale as a ghost, and a tense, swollen abdomen. I had Dr. Wu immediately paged. Seeing all the blood in the drain container, I ordered a transfusion, but that was all I did, meaning I was just standing there wringing my hands. Luckily for me, Dr. Wu arrived within minutes, took over, and arranged for the patient to be rushed into surgery. She also contacted Dr. Rodriguez and the attending, Dr. Sanchez. Most important, she got Dr. Rodriguez on his way into the hospital.”
“What was found at surgery?”
“I don’t really know.”
“Why not? Weren’t you there? Didn’t you have to scrub in, too?”
“No, I didn’t. Dr. Wu did. She and Dr. Rodriguez operated and wanted me to be available to handle any problems that might pop up with the other inpatients while they were tied up doing the case. Luckily for me, nothing did, although I was worried something might. Anyway, I just went back to the on-call room and fell asleep. I ended up getting a total of about six hours, which was more than I expected, especially after hearing about your night.”
“Whoa, I’m jealous,” Mitt admitted. “But I suppose I’m also encouraged. Maybe my first night was an outlier and tonight won’t be so bad.”
“Let’s hope so,” Andrea said.
At that moment, the door opened and in came a large group of residents and Dr. Van Dyke, all noisily chatting. Some were carrying paper coffee cups. The moment Dr. Van Dyke saw Andrea and Mitt, she came directly over to talk to them.
“How was your first night?” Dr. Van Dyke asked Andrea.
“It was fine,” Andrea said.
“Wonderful,” Dr. Van Dyke said. “And I heard there was some excitement with a postop patient hemorrhaging, but I understand you handled it well. Kudos, Dr. Intiso.”
“Thank you, but I didn’t do much. Dr. Wu handled it.”
“You did what you needed to do. But that was then and this is now. Today you both have three surgeries. I should also mention that there is a Journal Club in this room at three p.m., and you are encouraged to come if your surgery schedule permits. Well, you’re more than encouraged. If you are free, it is a command performance. Okay?”
Both Mitt and Andrea nodded in unison.
“Now I wanted to talk briefly about tomorrow. I trust that you both are aware it is the Fourth of July, meaning the hospital will be in holiday mode. There will be no scheduled surgery, only emergencies. As for you two, the on-call schedule determines your coverage. Dr. Fuller, you are on call tonight, so that means you will be officially off tomorrow. Dr. Intiso, holiday coverage will fall to you. Understood?”
Both Mitt and Andrea again nodded. Mitt was mildly surprised. He’d completely forgotten about the Fourth of July although he shouldn’t have. During his childhood it had always been a high point, marking the beginning of summer. With everything that had been going on, the idea of being off for a day and a night seemed tantalizingly welcome, like a sudden, unexpected cease-fire in the middle of a pitched battle.
“As for the surgery schedule on Friday,” Dr. Van Dyke continued, “I will be assigning you three cases each as per usual. Although most of the USA thinks of Friday as part of the Fourth of July weekend, we here at Bellevue do not. That means that admission histories and physicals will need to be done tomorrow. For you, Dr. Intiso, that will be easy since you will be here. For you, Dr. Fuller, you’ll have to decide what you want to do, meaning whether you want to come in and do the H&Ps or have Dr. Intiso do them. Various first-year residents handle holidays differently. It’s up to you guys.”
Once again, Mitt and Andrea nodded.
“Okay, that’s it,” Dr. Van Dyke said. “Enjoy your surgeries today, and I’ll hope to see you at Journal Club this afternoon.” She then moved off, immediately engaging in conversation with some of her resident colleagues.
“I’m happy to do the H&Ps,” Andrea graciously said.
“Thank you, but I live around the corner. I’ll come in. I don’t want to add to your burden of having to cover for the holiday.”
At that moment, exactly 6:30 a.m., the door to the hallway burst open and in swept Dr. Vivek Kumar in his inimitable, commanding style. He was, as usual, impeccably dressed in his whites, with his thick, black hair combed to a tee. He was trailed by Dr. Geraldo Rodriguez and the other fourth-year surgical resident, Dr. Kevin Singleton. Dr. Kumar went directly to the podium and commanded: “Okay, everybody, let’s get down to business!”
Once started, morning surgical rounds were carried out in an efficient style. First Dr. Vivek called out the name of an inpatient, then the more junior resident involved in the case gave a rapid synopsis and the current up-to-the-minute status. This was immediately followed by comments from a more senior resident also connected to the case. If there was a complication, the team thoroughly but quickly discussed the issue and decided whether the patient should be rapidly seen by the team. When Bianca Perez was brought up, Mitt swallowed his nervousness and gave a rapid review including her present status of being comatose in the ICU.
“This is a strange but interesting case,” Dr. Rodriguez said, taking over after Mitt’s brief summary. “During the re-op early this morning, something rather odd was discovered. The polypropylene ligature on the inferior mesenteric artery had seemingly become untied. There it was, loose in the abdomen. I’ve never seen anything like it. I’d tied it and secured it myself.”
“That is curious,” Dr. Kumar agreed. “Has the attending been notified?”
“Yes, for sure,” Dr. Rodriguez said. “She’s equally mystified, as she, too, had checked the ligature.”
“What about the issue that the patient’s deteriorating status wasn’t recognized until the blood pressure had fallen to near zero?” Dr. Kumar asked.
“That is an important consideration,” Dr. Rodriguez agreed. “I’m scheduled to meet with Helen Straus, head of nursing, this afternoon to figure out what happened. The patient was under the usual postop protocols. Seemingly, the event was remarkably precipitous, as the patient had been documented doing well minutes before the blood pressure alarm sounded.”
“You’ll let us know what you learn?” Dr. Kumar asked.
“Absolutely,” Dr. Rodriguez said.
“All right, let’s move on,” Dr. Kumar said. He called out the next patient’s name.
So progressed morning surgical rounds. Mitt got a chance to present the three cases he was assigned to for surgery that morning, as did Andrea with her cases. Other residents did the same for an extremely rapid review of the day’s upcoming surgeries. A brief mention was made of the previous days’ surprising deaths of Mitt’s two patients, causing him to stiffen, fearing he’d be called upon to say a few words, but he wasn’t, to his great relief.
At that point morning rounds were terminated and the whole group marched off to visit the few patients where there was any type of controversy involving future treatment options. When those rapid visits were over, the residents scheduled for the first cases, which included Mitt and Andrea, headed off en masse to the surgical suite on the eleventh floor.
As Mitt watched the elevator’s digital floor indicator during the descent, he found himself hoping that the cases he’d been assigned today would go smoothly in contrast to what had happened the day before. But then he made the mistake of actually asking himself the question directly, and the moment he did, he sensed that there was going to be trouble of some sort. But at least the paresthesia sensations were mild, so he hoped that whatever was going to happen wouldn’t be anything like yesterday.