Before Sandra could say anything, Misha pushed past her and engaged Fyodor in an animated conversation in Russian. Fyodor peered around Misha as Misha spoke. Sandra wondered what in God’s name Misha was talking about since she’d said next to nothing to him. Finally Misha finished and stepped to the side. Fyodor stood up and gestured to the straight-back chair Misha proceeded to pull over. “Please, Dr. Wykoff, sit down.” In contrast to Misha, he spoke with very little accent, and his English was very good. “I remember you. You came down to ask how often we did routine service on the anesthesia machines.”
Sandra sat and glanced over at Misha, hoping he would leave, but he didn’t. He was content to just stand there with a kind of smirk on his face, as if he expected some favor from her for having accompanied her into Fyodor’s office. As pushy as he was, she was glad she had not run into him alone upstairs.
“I have another question,” Sandra said, directing her attention to Fyodor.
“We are at your service, Doctor,” Fyodor said. As far as Sandra was concerned, even he exuded a suggestion of insincerity that made her uncomfortable.
“There was a very unfortunate anesthesia incident yesterday...” Sandra began, but then hesitated. She felt she needed to give some background, although Rhodes’s orders about not talking about the case made her reluctant to say very much. Yet she was talking to the people responsible for the performance of the anesthesia machine she had used, and she needed to be reassured.
As if sensing her quandary, Fyodor said, “We have heard about the event from Dr. Rhodes. First, we want to reassure you that the machine you were using had been serviced appropriately and in a timely manner. All its paperwork was in order. And as soon as we heard about the event, and following Dr. Rhodes’s orders, we brought the machine back here to our service center. We went over it extensively. I can assure you that it checked out perfectly, and it is back in service. There was no problem with the machine or its monitors, and Dr. Rhodes has been informed of this.”
Sandra nodded. Fyodor’s little spiel was more than she had expected. She didn’t know that Rhodes had asked to have the machine checked by Clinical Engineering, but it made sense. Perhaps she should have asked herself, but it didn’t matter, as it had been done.
“Do you have any additional questions?” Fyodor said.
“I think that covers it,” Sandra said, and started to rise. But then she hesitated. Settling back onto her chair, she said, “There is one other thing.”
“Please,” Fyodor said agreeably. He even managed an unctuous smile.
Similar to what she had said to the two medical students, Sandra then went on to describe the jump, or blink, or blip — she really didn’t know how best to describe it to these professionals — that she had seen on the monitor when the surgeon had begun drilling into the tibia. As she spoke, she sensed from his expression that Fyodor was disbelieving that such a thing could occur. In response, Sandra said that it could actually be seen on the machine-generated anesthesia record. “It is a very small change, but it is visible. If you bring up the Vandermeer anesthesia record on your terminal, I’ll show you.”
After a quick glance between Fyodor and Misha, which included a nod from Fyodor, Misha went to the computer monitor on Fyodor’s desk, brought up the record, and then stepped aside. Sandra then took over. As she had done when she’d been with the medical students, she zoomed in on the tracing of the vital signs. She pointed to the place fifty-two minutes into the case, where all the tracings notched upward. “There,” she said, pointing. “See the vertical jump? And when it happened, the monitor blinked, which caught my attention. It made me worry I was about to lose my feeds.”
“Interesting,” Fyodor said, leaning closer to the monitor. “I see what you mean. What do you think it is?”
“You are asking me?” Sandra questioned. “I don’t know. You people are the experts. To be truthful, I’m not all that knowledgeable about electronics. I came down here to ask you.”
Fyodor sat back and looked up at Misha for a beat. “I don’t know what it could be, but it can’t be anything significant.” Then his attention went back to the monitor. “The tracings all look totally normal before and after. What do you think, Misha?” Fyodor leaned back and caught Sandra’s surprised expression and explained, “I might be the department supervisor, but Misha is our key anesthesia machine technician. We brought him from Russia specifically to work on the anesthesia machines. He did a lot of the original coding for the model that we have here at the Mason-Dixon. He is what you say in English the go-to guy.”
Sandra was impressed by this news since she thought so highly of the anesthesia machine, although it still didn’t influence her negative visceral reaction to the man.
Misha made it a point to bend over and study the image on the monitor.
“I know it is small change,” she went on to explain, “but I had never seen it before, and since the case turned out to have such a terrible outcome, I just want to make sure it has no significance. I mean, if the patient had awakened after the case, I might not even have remembered it happened. Well, maybe that’s not totally true, since it did scare me about the possibility of losing my electronic monitoring.”
“It’s not important,” Misha said. He stood back up.
“But what was it?” Sandra persisted.
“It’s just a frame offset,” Misha said. “It’s nothing. It could happen from a number of things, like...” He gestured with his hands in the air, struggling to express himself with his English.
“Like what?” Sandra asked.
“What you have to remember is that the machine’s computer is constantly compressing data,” Fyodor said, coming to Misha’s aid. “You have no idea how much data is being constantly generated. So seeing little changes on a monitor is not surprising. There can be blips from hardware malfunction, like one of the hundreds of capacitors prematurely discharging, or from a software problem confronting momentary input overload or even from just too many applications running at the same time.”
Sandra nodded as if she understood. She didn’t, but it was clear they did not think a frame offset had any real significance. She was about to thank them and leave when the two men suddenly launched into an animated and spirited conversation in Russian. For Sandra it was like momentarily watching a Ping-Pong game up close, her eyes darting from one man to the other. Then, as suddenly as the heated discussion had started, it stopped.
Fyodor smiled. “Sorry, it is rude for us to speak Russian. We disagree on a small issue. No matter. The important point is that whatever caused this small frame offset you noticed certainly didn’t affect the anesthesia machine’s function.” He smiled again. “Is there anything else we can help you with, Doctor?”
“That’s it for the moment,” Sandra said. She stood up. “Thank you for your time.”
“We are here to serve,” Fyodor said. “Anytime you have a question, please come down or call. As you know, we have technicians available twenty-four hours, seven days a week.”
As she left the supervisor’s office, Sandra fully expected Misha to follow her. She had been mildly concerned about getting away from him, the way he had glommed onto her when she had first arrived. To her surprise and relief, he stayed inside the office with Fyodor.
Heading back to the elevators, Sandra thought she would go back up to the OR and see what she had been assigned for the following morning. If any of them were inpatients, she would go check them out. She would review the nascent electronic medical record for the ones having same-day surgery to get an idea of what the day would be like. The episode with Carl was making her more compulsive than ever. When she finished all that, she would head for home.