The initial laparoscopic evaluation went smoothly and showed what Will had prayed it would-no evidence for spread of cancer into the organs adjacent to the pancreas. Throughout the procedure, though, Will sensed a very mild fuzziness to his thinking, and he also noticed that, on and off, especially with fine movements, his hands shook ever so slightly. Low blood sugar? he wondered. He had eaten as usual, so the possibility seemed remote. A virus of some sort? No symptoms to go along with the mild light-headedness. In fact, on the whole, he still felt upbeat and positive.
“Ready, everyone? Well, okay. Number-ten blade, please, Beth.”
“Again, please?” the scrub nurse asked.
Will felt a spark of irritation.
“I called for a ten, a number-ten blade.”
There was more of an edge to his voice than he had intended. The nurse in turn, glaring at him from above her mask, slapped the blade into his palm with more force than usual for her. Across the table from Will, Cameron immediately reacted to the rocky start.
“Okay, Willy,” he said, “a-cutting we shall go.”
The incision Will made, though quite large, was precisely the length he had planned. After bleeders were clamped and cauterized, he sliced open the peritoneal membrane, exposing the structures beneath. So far so good, except that Will was beginning to sense things weren’t good at all. He was feeling nauseated now, and his light-headedness was more constant. For the first time, he wondered if he was going to be able to continue with the operation.
Using large clamps and retractors, he and Cameron pulled the margins of the incision wide apart. The intestines, arrayed just beneath where the peritoneum had been, were moved aside with damp towels, exposing the blood-tinged structures of the operative field, glistening under the harsh saucer lights overhead.
Will’s mouth now felt desert dry. He peered down at the organs-pancreas, stomach, liver, gallbladder-and at the arteries, veins, nerves, and ducts servicing each one. In his mind, he had mapped out almost every second of this procedure. Now he couldn’t remember where he was to start.
“Everything okay, there, Willy?” Cameron asked.
Will glanced up at him from over his mask.
“I. . all of a sudden. . I’m not feeling so good.”
“You need a basin?. . Need to step away?”
“Huh?”
“Will, look over at me. Kara, take those glasses off him. Let me see his eyes. . ”
“I’m. . okay. . just. . need. . moment to. .”
Will felt the light-headedness intensify and a profound dizziness set in as well. His knees became rubbery, and his vision began to darken. He tried to speak, but only guttural sounds emerged from beneath his mask. Clutching at the sterile drape, he lurched to one side, then pitched forward heavily, landing facedown in the gaping incision.
CHAPTER 12
The inestimable blackness was pierced by sound-garbled voices captured by Will’s gradually increasing consciousness. Next came the ghastly sensation of choking-a tube the size of a redwood, clogging his throat.
Will tried to move his arms but met immediate resistance at the wrists. From his earliest days as a med student in the hospital, he had watched patients be intubated and put on a ventilator-some comatose, some semiconscious-and wondered what it could possibly have felt like. He had even asked some of them after they were on the way to recovery and had concluded that the degree of helplessness, pain, and horror of the situation was a function purely of how much medication they had received. From time to time, especially with emphysema cases, the relief of being able to get in enough air made the breathing tube tolerable. But mostly, the discomfort was quite frightening, especially in the initial hours, before there was any chance to learn to cope.
Will knew he would never again have to ask a patient about the sensation.
He thrust his tongue against the hard rubber airway that had been slipped into his mouth next to the tube and then taped in place to keep him from biting down. Awareness was rapidly returning, along with swirling memories of becoming sick, terribly sick, in the OR. He must have stopped breathing, or come damn close. The fact that the discomfort and panic seemed manageable suggested he was being medicated. Was this the first time he had been awake? With no little effort, he forced his eyelids apart. Even before his focus sharpened, he knew that he was in the ICU. The fluorescent lights over him were midday bright. Across the cubicle, two nurses were talking.
Was it a stroke, he wondered? Is that what had happened to him? A cerebral hemorrhage of some sort? Methodically, he tested his hands and arms, then his feet and legs. No problem moving anything.
The incision! He had gotten horribly dizzy and toppled over into the incision. He could envision the blood and the coils of intestine as he pitched downward toward them. But there the images stopped.
How long had he been out? What happened to his patient?
He opened his eyes wider. As his consciousness grew, so did the suffocating discomfort in his throat. He also became aware of another unpleasant sensation-the desperate need to pee. Easy, easy, he told himself. There was no way he could have been unconscious on a respirator in the ICU and not have had a catheter inserted to drain his bladder. Easy. The pressure and urgency was almost as dreadful as the tube. He had never been a hospitalized patient before. Now he wondered if he had been sympathetic enough with those who were.
The nurses were two whom he knew well, Anne Hajjar and Donna Lee. He banged the back of his hand against the guardrail.
Donna rushed over, clearly pleased to see him awake. Sharp features and close-cut blond hair, she was a new wife in her late thirties and a hardened veteran of the ICU wars. Like the other unit nurses, she called all but the most unapproachable physicians by their first name.
“Will, hi there, it’s Donna. Welcome to the land of the living.”
Will nodded that he understood.
“Are you in any pain?”
He twisted his hand and pointed toward the tube.
“Ken Millstein is taking care of you. Your blood gases are looking pretty good, so maybe he’ll be able to pull that tube out after all the labs are back. Meanwhile we can keep you medicated.”
Will shook his head. No. No medication. I can handle this. . just not too long.
“Okay, but you sort of woke up a little while ago and started tearing at the tube. That’s why we medicated you and put those restraints on.”
I understand.
“Go after the tube again like that and we’ll have to beat you with a stick. Do you know what happened to you?”
No.
“Apparently, you had a seizure of some sort while you were doing a case. You immediately lost consciousness, and then a few minutes later you stopped breathing altogether. You were rushed down to the ER, and they put the tube in there. Your EKG is normal, so it doesn’t look like a coronary, and your chest X-ray doesn’t show any sign of aspiration. Is there anything you need right now?”
Will wriggled the fingers on both hands and pointed back at the restraints.
“Anne?”
Anne Hajjar, willowy, brown-eyed, and eternally lighthearted, materialized at the opposite side of the bed from Donna and squeezed Will’s hand. Of all the nurses in the hospital, she was his favorite.
“Hey, big boy, we’re glad you’re coming around,” she said. “We were a little worried when they dragged you in here.”
“He wants the restraints off,” Donna said. “I told him if he pulled that tube out it would not go well for him.”
“I suspect it would be the last thing that shape he ever pulled,” Anne said, undoing the Velcro cuff and strap on her side.