Mitt turned the corner and started along the north-facing ICU rooms. As he got closer to 8 North, he found himself purposefully slowing, as if by doing so he could influence reality. But it didn’t work. The moment he reached the door and looked in #8, his hopes of a positive clinical turnaround were dashed — Elena Aguilar was still on the ventilator and obviously not breathing on her own. Her eyes were taped shut. And she was completely motionless save for the slight rise and fall of her chest with each mechanical respiration. The assigned nurse was busy on the right side of the bed, adjusting the flow from a cluster of intravenous containers hanging from the IV pole.
“Can I help you?” the nurse asked, catching sight of Mitt standing frozen in the doorway.
Mitt went through the same explanation he’d given to Perez’s nurse that morning to emphasize his status as a three-day-old surgical resident. He then asked how the patient was doing since her arrival in the ICU.
“She’s been reasonably stable, yet that’s not much to write home about,” the nurse said with a series of nods as if agreeing with herself. Mitt tried to see the woman’s name tag, but it was partially covered up by a surgical gown she was wearing backward over her scrubs. The ICU was kept at a lower temperature than the rest of the hospital, and Mitt had noticed most of the nurses wore a variety of such cover-ups over their scrubs. “Her pupils, although reactive, are sluggish in my book, but that hasn’t changed,” the nurse continued. “Of particular importance, she had some premature beats a few minutes ago. The second it happened, I let the Cardiology fellow know. Other than that, she’s been stable in terms of BP and oxygen saturation. I’d been told that the O2 had dropped in the PACU, but down here it’s been fine provided the ventilator volume and pressure are maintained.”
“Has the Cardiology fellow come to see her?”
“No, but he said he’d be by shortly. He did up her beta-blocker and told me to call him back if there are any more PVCs.”
“I see,” Mitt said. He recognized that he didn’t even know enough about the ventilator to ask any pertinent questions. “What about the electrolytes? Up in the PACU, I’d been told by the nurse they’d gotten out of whack and had to be adjusted.”
“Yeah, we heard about that,” the nurse said. “So, we ran electrolytes the minute she got here. They came back reasonable, maybe a tad low on potassium, but otherwise within normal limits. We also did a chest X-ray, and it was clear.”
“I’m on call tonight, so I’ll be around,” Mitt said, silently gritting his teeth. The last thing he wanted was to be called to the ICU, yet he felt responsible for Elena, especially since he didn’t have a good feeling about the woman’s near future.
“What’s your name again?” the nurse asked. She tried to make out Mitt’s name on his ID tag but couldn’t.
“Fuller,” Mitt said, purposefully leaving out the doctor title. “Michael Fuller.”
“Okay, I got it, Dr. Fuller. I’ll give you a shout if there’s any marked change. Because she’s making absolutely no attempts to fight the ventilator, I’m not feeling optimistic there’s going to be a lot of change. The only thing that seems to keep changing is this damn IV.” She’d been watching the drip chamber as she’d been talking to Mitt, and now she went back to adjusting the IV. “If you want to call me at any time until I leave at eleven, just dial ICU bed 8 North,” she said over her shoulder. “I’ll pick up if I can. If I can’t, leave a message, and I’ll call you right back.”
“Okay, will do,” Mitt said. He liked that. It meant he had the option of checking on Elena without having to come into the intensive care unit, and that sounded like music to his ears. Turning on his heels, he hurried back toward the relative safety of the hospital proper. Thinking of the news he’d just gotten, he realized the ICU was certainly living up to his worst fears, with Bianca Perez dead and Elena Aguilar hanging onto the edge of the precipice with just the tips of her fingers.
Reaching the elevator lobby, he knew he had to think about something other than death and statistics. Luckily his gnawing hunger provided a distraction, and he started wondering exactly what he was going to have for his upcoming dinner.
Chapter 20
Wednesday, July 3, 10:45 p.m.
Mitt’s phone jolted him out of a dead, dreamless sleep, and he bolted upright. For a brief moment he was disoriented, but he quickly acclimatized to his surroundings. With a bit of a struggle, he got his strident phone out of his jacket pocket, and before he connected the incoming call, he checked the time. It was a quarter to eleven, meaning he’d gotten a bit more than three hours of uninterrupted sleep, more than he had expected but not nearly enough. It took him a moment to even focus on the phone.
When he’d come back to the on-call area just after seven, he’d gone directly into his room, purposefully avoiding going into the lounge area to join other on-call residents who were sitting around socializing. Following Dr. Singleton’s advice, he wanted to try to maximize sleep opportunities early in the evening. Again, like Monday night, once he was in his room, he didn’t shower or do anything else that might have given him a second wind. All he did was stretch out on the bed in his scrubs and white coat and attempted to think about nothing. Apparently it had worked like a charm.
“Hello?” he said, hoping the call might be some minor issue such as a dosage question or the need for a sleep-medication order, both of which he was becoming progressively adept at handling over the phone. But it wasn’t to be. The caller sounded hurried, even frantic. “Is this Dr. Fuller?” she questioned.
“It is,” Mitt responded, throwing his feet onto the floor. His flight-or-fight reaction had now been fully awakened by the sound of the urgency in the woman’s voice.
“I’m calling about Latonya Walker. She is your patient, is she not?”
“She is,” Mitt said, feeling an added jolt. “What’s the problem?”
“She’s had an arrest,” the nurse barked. “The crash team is here on Fifteen West, but I thought you’d want to know.”
“Good grief,” Mitt said. In the next instant he was holding a dead phone. Pocketing it and leaping to his feet, he had to momentarily put his hand against the wall to steady himself to weather a fleeting spell of dizziness. He then shoved his feet into his loafers, quickly exited the room, ran through the now-empty lounge area, and headed out into the elevator lobby.
After his early dinner, Mitt had made it a point to visit all six nurses’ stations on floors fifteen, sixteen, and seventeen, saying hello specifically to the head nurses but other nurses as well. His goal was to generally make his presence known in an attempt to head off having to deal with pesky issues like laxative requests later. All the surgical inpatient floors had been exceptionally busy, presumably due to the holiday the following day. Not only were there lots of visitors but also plenty of residents and attendings making rounds. But most important, he’d confirmed that there were no looming clinical problems. During his meet-and-greet, he’d run into Dr. Madison Baker, who was rounding on her own patients. She gave him the excellent news that from her perspective things were looking good for the night. She said the sickies she’d worried about Monday night had all dramatically improved.
During his walk-around Mitt had also made a point of stopping in to see the two ward patients he had, Diego Ortiz and Latonya Walker. Both had been doing fine, particularly Ms. Walker, who had eaten a decent meal and didn’t seem to have much pain. Her drain showed almost no drainage and her incision looked fine beneath the paper tape. As well as she’d been doing, a cardiac arrest now seemed hard to believe. As far as he could remember, she’d had no personal or family history of any cardiac issues whatsoever.