“Batting a thousand?” Madison questioned, staring directly at Mitt with confusion. “What on earth are you talking about?”
“Maybe you don’t know this yet, but Bianca Perez also had an arrest and died tonight in the ICU. And with Latonya Walker’s earlier arrest, this fellow, Diego Ortiz, is my only living patient after three days of surgery, and I think you’ll admit, he’s on the edge of the precipice.”
Madison’s mouth slowly dropped open as her tired mind came to understand exactly what Mitt was saying. She shook her head in disbelief. “All right, I’m getting your point. That is big-time weird. How many patients are we talking about?”
“So far, six out of seven are dead,” Mitt said. “And this one ain’t looking so good.”
At that moment the resuscitation team came flying into the room, pushing their noisy crash cart, forcing Madison and Mitt to move farther out of the way to give them access. Then after a quick conversation with Dr. Phillips to get the details, they took over the resuscitation from the medical residents. Mitt watched with interest, hoping against hope that such an experienced, first-class team might be successful on this attempt, but in his heart of hearts he knew it wasn’t going to happen. Like it or not, he was going to be forced to deal with a shocking 100 percent mortality statistic.
For a few minutes, both Mitt and Madison silently watched the frantic activity as the resuscitation team determined that the heart was in ventricular fibrillation, and as soon as the defibrillator was set up and charged, it was used, but it wasn’t successful. Before they tried again, they started epinephrine and lidocaine. They also intubated the patient and switched to 100 percent oxygen to improve his respiration, which was critical, as his saturation was below 50 percent.
“Okay,” Madison said, looking back at Mitt to resume their conversation. “I can understand you feeling a little weird and maybe even victimized by chance with what’s happened to the patients you’ve been arbitrarily assigned, but I certainly don’t understand you feeling paranoid and thinking that it is any way your fault. To me that smacks of a bit of megalomania since you happen to be low man on the totem pole.
“Listen! You are obviously doing your best, and from my vantage point, you are doing extremely well. If anyone is guilty of setting you up, it would have to be Dr. Van Dyke because she’s the one assigning the cases, but that’s an absurd notion. So, for goodness’ sake, ease up on yourself! I know the first days of residency are hard until you get the swing of things, but I can assure you that you are almost there. All of us have gone through what you are going through, namely a period of questioning our capacity to handle what is a very difficult job, especially when first starting out. Believe me, it’s going to get better. In fact, it is going to get a lot better a lot quicker than you imagine from where you are standing right now. Trust me!”
“Thank you for the pep talk,” Mitt said sincerely.
“You’re welcome,” Madison said emphatically. “With that said, what do you have in mind to do at the moment?”
Mitt looked at her questioningly. “What do you mean?”
“I mean, are you going to hang here while the medical guys and the resuscitation people try to handle this problem, which, like you said, is probably doomed to failure with a body temperature of 111 degrees? Me, I’m going to head back to the on-call room and get some shut-eye. Selfishly enough, I have a beach barbecue scheduled out on Long Island tomorrow, and I’d prefer not to be a zombie. Maybe you should do the same, meaning go get some sleep. They can always call you back to do the paperwork if need be. If perchance the medical people are successful, which I sincerely doubt, they’ll be responsible for following the case and undoubtedly transferring the patient to the medical ICU.”
For a moment, Mitt studied Madison’s face. Her apparent insouciance in the face of Ortiz’s real-time life-or-death struggle surprised him, and he wondered if after a single year he might develop the same nonchalance. From his present perspective, it seemed like a rather large transition. “I’m going to hang,” he said finally, borrowing her particular word choice.
“Suit yourself,” Madison said. “But do me a favor and skip any more ridiculous paranoid ideation. Deal?”
“I’ll try,” Mitt said.
“That’s all I ask,” Madison responded. She gave Mitt’s shoulder a reassuring squeeze before heading for the hallway.
Mitt watched her leave before turning his attention back to the resuscitation attempt. Building up his courage, he advanced to the foot of the bed, avoiding the vomit on the floor. After multiple bouts of ventricular fibrillation and defibrillation, the resuscitation team was now dealing with no cardiac electrical activity at all. The monitor was monotonously tracing a straight line and nothing seemed to be working. Mitt wasn’t surprised.
A few minutes later, the clearly frustrated resuscitation team leader happened to cast a distracted glance in Mitt’s direction and then did a double take. “Hey,” she said, staring directly into his face. “You look familiar. Haven’t I seen you on several unsuccessful cases tonight?”
“You have,” Mitt admitted. “One on this same floor and another in the ICU. I’m a first-year surgical resident, and unfortunately I assisted on all three of these patients’ surgeries.”
“Whoa!” she voiced. “All three? Well, thank you for thinking of us. We appreciate the business, but maybe it would be best if you slowed down a tad. Either that or at least provide us with a case that we can cheer about. The amount of cardiopulmonary failure involved with this one didn’t give us much to work with. Without doubt it’s the worst case of thyroid storm I’ve ever seen. Of course, that’s not saying much since it is only my second case, but it’s so much worse than the first to seem like a completely different physiological phenomenon.”
“It was totally unexpected,” Mitt said. “Especially since the patient’s history was hypothyroid not hyper.”
“I guess he’d been saving up,” she said, attempting a bit of dry humor. Then turning back to the group, she called out: “That’s it, guys! Hold up on everything. We’re done here, and we need to move on!” She handed the defibrillator paddles she’d been holding back to the resident manning the machine.
Once again ignored, Mitt stepped away from the bed and watched the resuscitation team and the three on-call medical resident consults work together to start packing up the crash cart and other paraphernalia and clear the debris they’d caused. As they worked, there was a fair amount of general camaraderie and even joking despite the presence of the recently deceased. It surprised Mitt to a degree, just as Madison’s indifference had, and he wondered again if he was destined to respond similarly when he became more acclimated to being a resident. At the moment, it seemed doubtful, but what did he know.
In a kind of daze, Mitt left the patient room and walked back to the nurses’ station, where he requested and was given the appropriate death papers to fill out. Since he was having so much practice with the forms, it took him no time at all to get started, at least compared to his first experience. While he was working, he also made it a point to avoid thinking about his patient-mortality track record as Madison had recommended. Besides, he reasoned, he’d have plenty of time to mull it over during the upcoming holiday that was now just a few hours away.
Some forty minutes later Mitt had finished the forms and was about to head back to his on-call room when it popped into his mind to return to Diego Ortiz’s room one more time to try to come to peace with the situation and deal with the residual feelings of guilt and responsibility that were hounding him despite Madison’s lecture. As he headed back in that direction, he wondered if he was doing the right thing or just being masochistic. There was no way to know.