The first thing Dr. Van Dyke had shown them was the on-call rooms, which were both simpler and nicer than Mitt had expected, especially with their modern en suite bathrooms and even showers. Encouragingly enough, there was also a resident lounge with a television, although both he and Andrea wondered if it had ever been used since the remote was nowhere to be seen.
Next they were given a short tour of the all-important staff cafeteria, which they were assured was open 24/7. With their every-other-night on-call schedule they would most likely be eating most of their meals there. From the cafeteria, they were taken to see all the surgical inpatient wards, where they met a lot of the day staff. Everyone from nurses to various aides and even housekeepers were super friendly and welcoming. Mitt was pleasantly surprised, particularly by the nurses. He’d always thought that they might resent the new residents, whom they would have to help become oriented. Mitt even tried to commit some of the day-shift nurses’ names to memory but soon gave up because there were simply too many. Next, he and Andrea were shown around the surgical ambulatory clinics before heading to the ICUs on the tenth floor. There, both newbies were seriously interested in the tour, but at the same time felt cowed by the state-of-the-art technology and the precarious conditions of the patients.
The final aspect of the tour had been the OR suite, including the OR lounge and locker rooms. And then, once they’d changed into scrubs, they had been shown the operating rooms and given specific instructions on how to scrub their hands before going into surgery. After that, they’d been assigned ongoing cases, with Mitt being sent into OR #12 for the abdominal aneurysm while Andrea was to join a team doing a laparoscopic gallstone removal in OR #8.
At first Mitt thought he’d won out since the aneurysm case was far more intriguing than a mere laparoscopic gallstone removal. But after two hours, Mitt’s opinion changed. Now his presence seemed more like a burden than an opportunity, underlying in real time the conflict between education and service in the hospital residency programs. After the first half hour, Mitt hadn’t learned a thing. In fact, if anything, his arrival seemed to have heralded a negative change in the OR’s atmosphere and hence the flow of the procedure.
When Mitt had first arrived, everyone on the OR team was busily engaged, seemingly finding contentment if not pleasure in their efforts, particularly with the understanding that they were literally saving someone’s life. Having an abdominal aortic aneurysm, especially a large one with a dangerously thin wall like the current patient had, was akin to having a death sentence. At any given moment, perhaps with just a bit of exertion involving the abdominal muscles, the aneurysm could rupture, instantly causing rapid exsanguination into the abdomen and almost instantaneous death.
But then, right after Mitt had joined the group and been handed the retractor, small annoying things began to occur, eventually changing the dynamic from a contented team to a group of people on edge. First the scrub nurse handed Dr. Washington a pair of dissecting scissors that were somehow not up to his standards. With irritation, he brandished the instrument in front of the scrub nurse’s face, complaining that she should have checked it, seen that it was defective, and never handed it to him. He then tossed the offending scissors over his shoulder onto the floor, evoking a negative response from the circulating nurse, who shook her head as she bent over to pick them up.
“Sorry,” the scrub nurse had said, but in a tone that suggested she wasn’t all that sorry. “I wasn’t aware there was anything wrong with them.”
“Well, you should have known,” Dr. Washington had snapped.
Mitt, who’d been in the room for only a few minutes, sensed that Dr. Washington was on edge because he was having operative difficulty, which was aggravated by the supposedly defective scissors. The surgeon subsequently did explain what the difficulties were. After he’d removed the section of the aorta with the aneurysm, which had occurred prior to Mitt’s arrival, he’d had to remove progressively more of the proximal aorta, meaning closer to the heart, because the vessel’s wall was also visibly abnormal. “That’s going to make sewing the proximal part of the graft a challenge,” the surgeon had announced, which certainly had proved to be the case.
About a half hour after the scissors incident, there’d been a bit of a mix-up between the scrub nurse and Dr. Washington during the exchange of a small piece of the aorta, which the surgeon wanted Clinical Pathology to look at and confirm it was normal enough to hold sutures. Whether this second incident was the scrub nurse’s fault or the surgeon’s was unclear, but the result was that the biopsy fell onto the sterile drapes that covered the patient and then onto the floor, requiring the circulating nurse to retrieve it.
“Good Lord!” Dr. Washington snapped. “What the hell? Pay attention, for Christ’s sake!”
“I had my hand out for the biopsy,” the nurse complained. “But you missed!”
Mitt had actually seen what had happened. The nurse did have her hand out, but as she redirected her attention to reach for the container she was going to put the biopsy in with her other hand, her outstretched hand had moved. At the same moment, Dr. Washington had prematurely looked back into the wound as he released the pressure on the forceps he’d used to pick up the piece of tissue. It was as if some nefarious spirit had willed the episode to occur.
“I’m paying full attention!” the scrub nurse said indignantly. “Are you?”
For a few tense moments, the nurse’s rhetorical question hung in the air like a bank of dark clouds threatening a summer thunderstorm. Everyone in the room held their breath, tensely wondering what kind of reaction Dr. Washington would have. Mitt would later learn that the surgeon had a notoriously short fuse. But on this occasion, perhaps tempered by the challenge at hand, he chose not to say anything further and just went back to work.
The final minor episode was the strangest of all, since Mitt believed he saw it happen yet couldn’t explain it like he could the others. Unable to see any of the operation and with his mind wandering, he found his vision did as well. One minute he’d be watching the clock, the next watching the scrub nurse, and the next glancing at the anesthesiologist, who seemed to be in his own world beyond the anesthesia screen.
Suddenly, in front of Mitt’s eyes, a pair of forceps fell from the instrument tray, causing Dr. Washington to literally jump as they hit his arm before falling onto the drapes. “What the hell?” he bellowed as he straightened up, grasped the wayward forceps, and tossed them back onto the instrument tray, whose contents the scrub nurse was continuously adjusting to make sure she could anticipate the surgeon’s needs and requests.
“What the hell are you doing?” Dr. Washington demanded, again seemingly using the minor episode to give vent to his frustrations about the case.
“I’m doing what I always do,” the scrub nurse said defiantly. “I’m trying to anticipate your needs.”
“I didn’t ask for forceps,” the surgeon snapped.
“I was loading the needle holder,” the scrub nurse responded. “I didn’t touch the forceps.”
“Oh yeah, sure!” Dr. Washington spat. “They just jumped off the instrument tray on their own accord.”
At this point in the tense exchange, Mitt tried to remember what he’d seen. At the moment of the incident, he’d been looking in the scrub nurse’s direction but with unseeing eyes because his mind had been elsewhere, worrying about his first night on call. From Dr. Kumar’s comments, he was going to be the first line of defense, and with the sheer number of patients involved, it would be a huge responsibility. To make matters worse, one of the patients he’d be covering was going to be Benito Suárez, whose difficult surgery he was currently experiencing but not seeing.