“Sounds like a good plan to me,” Dr. Singleton said. “And this is certainly your area of expertise, not ours.”
They arrived at the PACU and pushed in through the double swinging doors. Mitt immediately hazarded a glance over to Elena Aguilar’s bed, and his heart missed a beat. She was gone! With everything else that had been happening, he took her absence as a very bad sign. Things were looking better when he looked in Latonya Walker’s direction. She was sitting up in bed sipping ice water through a straw. Her color was good. Mitt imagined she’d soon be heading back to 15 West.
While Dr. Singleton headed to the central desk, Mitt stayed with Mr. Ortiz along with Dr. Carpenter and the assigned PACU nurse to get the patient situated. Although fearful of what he was going to hear, the moment Mitt had an appropriate opportunity, he asked the nurse if she had any idea what had become of Elena Aguilar.
“Yes, I do,” the nurse said. “A bed opened up in the ICU, so she was transferred.”
“Was she doing better?” Mitt asked.
“I wouldn’t say better,” the nurse said. “Let’s just say not worse.”
“Okay, thanks,” Mitt said. He was partially relieved. Although he would have preferred to hear she’d been sent back to her room, at least she was still alive. The ICU wasn’t auspicious, especially since he found going in there so damn stressful, but as he already needed to go in there because of Bianca Perez, he tried to reassure himself it wasn’t all that bad.
A few minutes later, Mitt said a quick hello to Latonya Walker before joining Dr. Singleton at the central desk. Just as he’d done for the previous two patients, Mitt, with Dr. Singleton’s aid, typed Ortiz’s postoperative orders into the EHR. When he got to the end and was about to press Enter, Dr. Singleton tugged on his arm and reminded him about the levothyroxine.
“Oh, right!” Mitt said. “Sorry! What exactly should I put in here about that?”
“Just type in what Dr. Carpenter told us.”
Mitt did as he was told. When he was completely finished and they both stood up, he mentioned to Dr. Singleton that Elena Aguilar had been moved to the ICU.
“Good to know,” he said. “I’ll make it a point to check her out sometime this afternoon. Let’s hope the pulmonary and medical people can do some magic. At least she doesn’t have varicose veins any longer.” He gave a half laugh at his own stab at black humor.
Mitt tried to force a laugh but couldn’t quite manage it.
“I’ve got a pile of work, but before I take off,” Dr. Singleton said, lowering his voice and assuming a more serious tone, “did you want to say anything more about that little episode of yours back in the OR when we were waiting for the frozen section results? For a second there you appeared... I don’t know how to describe it, but maybe ‘terrified’ is the right word or something in that vein.”
Mitt stared at the fourth-year resident as his mind processed this surprising question. He intuitively liked this man and trusted him, and despite his suggesting he be addressed by his given name, Mitt saw him as a definite authority figure. So he hesitated. As much as he would have liked an experienced person to offer his opinion about what Mitt’s mind was conjuring up on occasion, he intuitively worried more about what Dr. Singleton might think, whether he might decide that Mitt was losing it and was a potential handicap for the program. Mitt was fully committed to becoming a surgeon, and he knew enough about the system to understand that if he got asked to leave NYU for having weird hallucinations, he’d probably not be able to get in elsewhere. All in all, it was too big a risk.
“All I can think of is that I momentarily fell asleep,” Mitt said, reiterating his previous explanation and trying to sound convincing. “There’d been a pause in the procedure, and maybe I kind of let myself relax too much or something along those lines.”
“Okay! You’re probably right,” Dr. Singleton said with a shrug. “And at least you didn’t violently jerk like I did when I fell asleep in surgery my first year. To make matters worse, at the time I was holding a retractor, which I ended up yanking out of the incision. Anyway, it’s water over the dam. Tell me! Are you on call tonight?”
“I am,” Mitt admitted.
“Well, I recommend you try to get as much rest as you can. Really! Get yourself to the on-call room early on and relax. If you are able to get some sleep in the beginning of the evening, it won’t be so bad if you end up being called to the floor in the wee hours. That was the trick that was so hard for me to get through my thick skull back when I was in your shoes. Too often I was out in the evening trying to scare up trouble. Well, not really trouble, but you know what I mean. I did spend a lot of time in the simulation lab when I should have been sleeping.”
“Good point! I’ll take your advice and try to get some sleep early on,” Mitt said, and meant it. The one helpful circumstance was that he wasn’t facing three admission H&Ps like he’d had on the first night he was on call. “And even if it is a busy night, at least I’ll be off tomorrow on the Fourth!”
“Oh, that’s right. It’s a holiday. Good for you. Enjoy it! Sleep all day if you can.”
“I will,” Mitt said, which was a lie. He fully intended to come into the hospital.
“We will have another day of surgery together on Friday,” Dr. Singleton continued. “You’ll be assigned three more cases, which I’m certain will be different from the cases you’ve had so far, since Dr. Van Dyke is making a concerted effort to give you a taste of the breadth of general surgery during your first week. As for today, let me compliment you. Your suturing technique is good for a beginner, but your knot tying needs some serious attention. I’m sure you know this, which is why I suggested you spend some time in the simulation lab.
“And one more thing: If you have any difficult management conundrums about the patients we operated on today while you are on call tonight, you’re welcome to call me directly no matter the hour. Walker and Ortiz should do perfectly fine, but Elena Aguilar is another story. I don’t know what it is with her, but there’s something going on we don’t understand. But medicine in general and surgery in particular can be like that. You do everything right and do it the same way you’ve done it successfully in the past, and some patients go south no matter what you try. Anyway, enough philosophizing. Good luck tonight and see you again on Friday.”
To Mitt’s surprise, Dr. Singleton stuck out his hand, and Mitt shook it. Dr. Singleton then tapped his surgical hat with the tips of his right-hand fingers in a kind of abbreviated form of a salute before heading toward the swinging doors. In the next moment he was gone.
Mitt turned and headed back toward Diego Ortiz’s bed as he was expected to, to make sure the attending nurse didn’t have any questions about or possible addendums to the postop orders. If all was copasetic, then Mitt would be able to get to the surgical locker room and prepare himself for the night on call. As he thought about the coming evening and night, his prognostic abilities sent him the unwelcome message that it was not going to be a picnic by any stretch of the imagination, especially as he could feel the hairs on the back of his neck rise as he thought it. What that meant, he had no idea and was pretty sure he didn’t want to guess.