Dr. Wykoff silently stared at Lynn long enough to make Michael think Lynn had finally done it. He girded himself for an outburst from the doctor, but it didn’t happen. Instead, to his surprise and relief, Dr. Wykoff said, “There was something, but it was very minor and can’t have been significant. It is not something I did, but something I noticed. It did bother me when it happened.”
“Like what?” Lynn demanded, again with a bit too much emotion.
Michael desperately tried to think of something to say to cover up Lynn’s insensitivity, believing her carping tone was asking for trouble, not only for her but for him, too. The reality was that they had already seriously violated HIPAA by looking at Carl’s and Scarlett’s charts and photographing the anesthesia records, and here Lynn was doing her best to alienate a woman who was being unexpectedly cooperative with a couple of medical students even though struggling emotionally herself. Michael sensed that the woman was deeply troubled by what had happened, which along the lines of “misery loves company” was probably the reason she was willing to talk with them at all.
“It involved the technical equipment,” Dr. Wykoff said. She spoke calmly, to Michael’s relief, and then paused to stare off into the middle distance.
“You mean with the anesthesia machine?” Michael said. He tightened his grip on Lynn’s arm to keep her quiet. From the sounds of her breathing he sensed she was about to say something.
“Not the machine per se,” Dr. Wykoff said. “But with the monitor. I happened to see it only because I was concentrating on looking at the monitor at the moment it occurred. It was when the surgeon began drilling into the tibia. I wanted to make sure that the depth of analgesia was adequate. Since the periosteum has a lot of pain fibers, I was watching the vitals closely.”
“And what happened?” Michael asked.
“Let me show you,” Dr. Wykoff said. “It is actually part of the anesthesia record.” Dr. Wykoff directed her attention to the screen of the computer terminal and began punching in commands.
While she was busy, Michael gave Lynn’s arm an extra squeeze to get her attention. “Cool it, girl!” he mouthed along with a harsh expression when she looked at him. He was serious. Lynn responded by trying to get her arm back, but Michael would not let go. Under his breath he said, “Let me do the talking! You’re going to get us thrown in jail if you keep up! Seriously!”
“All right, here it is,” Dr. Wykoff said, interrupting. The doctor angled the monitor’s screen more toward the students. It was the image of the anesthesia machine — generated record in graphic form of what had been on the monitor during the case, including blood pressure, pulse, ECG, blood oxygenation, end tidal CO2, expired tidal volume, and body temperature. Michael and Lynn stood up to get a better view, even though it was what they had already seen in Carl’s chart.
“Look closely,” Dr. Wykoff said. She enlarged the image and used a pen as a pointer. “Here is when the oxygenation fell from close to one hundred percent down to ninety-two. It’s at eight-thirty-nine, or sixty-one minutes into the operation. That was when the alarm sounded. And you can see the ECG simultaneously shows tenting of the T waves, suggesting the heart isn’t getting adequate oxygen. Now, that doesn’t make sense. An oxygenation saturation of ninety-two percent shouldn’t cause the immediate appearance of T waves in a normal, healthy heart. Also there’s no change in any of the other parameters, which would certainly happen if there was low enough oxygen to cause brain damage.”
“We saw that when we looked at the chart,” Michael said.
“It’s hard not to see it,” Dr. Wykoff said. “It jumps out at you, since the oxygenation tracing was essentially a straight-line until that instant. But the fall is not what I want to show you.” She used the cursor to move back along the oxygenation tracing to fifty-two minutes into the operation, where there was a slight vertical blip upward. “Do you see this?”
“I do,” Michael said. “It is a sudden notch upward, whereas the O2 tracing otherwise is like a flat, smooth sine wave, varying between ninety-seven and one hundred percent. What does it mean?”
“Probably nothing,” Dr. Wykoff admitted. “But notice the notch upward occurred with all the tracings on the monitor: blood pressure, oxygen saturation, everything. It scared me when it happened because I was actually closely watching the pulse rate. If a patient feels any pain when the surgeon drills into the periosteum, the pulse rate goes up, meaning the anesthesia is light. Well, the pulse rate didn’t go up. Instead, while I was watching, the whole monitor blinked at the precise moment the slight vertical jump appeared.”
“Blinked?” Michael repeated. “Does that happen often?”
“Not in my experience,” Dr. Wykoff said. “But then again we anesthesiologists don’t spend a lot of time staring at the monitor. None of us does unless there is a specific reason. When it happened, it scared me, which is why I remember it.”
“Why did it scare you?” Michael asked. It seemed inconsequential to him.
“What scared me was the worry of losing the feed from all my sensors, meaning I would be without electronic monitoring. I was relieved when it didn’t blink again.”
“You had never seen anything like that before?” Michael asked. He bent close to look at the image as the anesthesiologist magnified the section. To him it still looked trivial.
“No, I haven’t,” Dr. Wykoff said. “But that doesn’t mean it doesn’t happen. Maybe it happens often. I don’t know. It is such a small change. Electronics are not my thing. But it can’t have any significance since all the vital signs, as you can plainly see, stayed completely normal right up to the moment the oxygenation alarm sounded. As I said, the reason I remember it is that we anesthesiologists are accustomed to continuous electronic monitoring. Giving anesthesia without it would be like flying an airplane blind.”
“Do you see it?” Michael asked Lynn.
“Of course I see it,” Lynn snapped.
Michael rolled his eyes and again tightened the grip he had on Lynn’s arm as he made her step back from the monitor. He regretted trying to bring her back into the conversation for fear she would ruin the rapport that had been established with Dr. Wykoff and maybe get them in trouble after all. He knew it was time to leave. “We want to thank you, Dr. Wykoff, for—” He didn’t get to finish. The door to the corridor burst open, and a man charged into the room.
Yanking off a surgical face mask, the newcomer headed for a computer terminal, but, catching sight of the others, he stopped short. It was apparent he had assumed the room to be empty. He was a powerful-looking, golf-tanned Caucasian man dressed in scrubs. Adding to his physical stature were big hands and muscular forearms. At first his expression was one of perplexity, but it quickly changed to aggravation. He looked back and forth between Michael and Lynn. Both knew who he was from their third-year surgery rotation. He was Dr. Benton Rhodes, the volatile, New Zealand — born chief of anesthesia who was renowned for having little love for medical students.
“We were just leaving,” Michael said quickly. He turned back to Dr. Wykoff. “Thanks for your time and willingness to talk to us about such a disturbing case. We appreciate it.”
“What case?” Dr. Rhodes demanded with his Anzac accent.
“Carl Vandermeer,” Lynn said defiantly.
“Vandermeer?” Dr. Rhodes repeated as if shocked. “Who are you two?”
“We’re fourth-year medical students,” Michael said quickly, urging Lynn toward the door. She resisted, fanning his fear that this unexpected encounter might not end well.