As soon as the restraints were removed, Will brought his hands together and pretended to be writing on an imaginary pad. Donna left and quickly returned with a stack of progress-note paper on a clipboard and a Bic pen. At that moment, internist Ken Millstein moved in next to Anne. He was a slight, Harvard-trained doc about Will’s age, but half a foot shorter, with a rapidly receding hairline and a penchant for baggy suits. He and Will and their wives had been friends from their earliest days at Fredrickston General, and the Millsteins had been one of the very few couples who hadn’t found it necessary to side with one or the other of them after the divorce.
“Eventful day,” Millstein said.
I guess, Will wrote. How long have I been here?
“Two hours, give or take. You had us worried for a while there.”
How is my patient?
“Gordon is still in the OR with him. I think he called Jim Katz in to help finish the procedure. Apparently you got a ten from the Russian judge for that dive you took.”
Very funny.
“Any idea what could have happened? Because I sure don’t.”
None. I have never passed out before.
“Will, you didn’t just pass out. You stopped breathing. Your blood pressure was heading south when Steve Edelstein in the ER decided to go ahead and intubate you.”
Good man.
“Any medical history we should know about?”
Asthma as a child.
“Meds?”
None.
“Feel okay now?”
Groggy.
“No surprise there.” Millstein checked Will’s pupils, then examined his heart and lungs. “I’ll tell you what,” he said. “I’ve run so many labs that your HMO is probably going to put a bounty on my head. As soon as I have most of them back, I’ll get anesthesia in here and we’ll pull that tube.”
How about the catheter?
“First the tube. Sorry. You want the nurses to give you something?”
Just a little, Will wrote this time.
“Five of morphine, Donna. Repeat it as needed.”
Thanks.
“Just bear with us, my friend,” Millstein said. “We’re going to get to the bottom of this.”
With the help of the intravenous morphine, Will drifted in and out of a comfortable haze. At times he dreamed-a high-speed auto chase, a green-faced judge sentencing him to prison for something, swimming in perfectly blue Caribbean water alongside a woman who looked vaguely like Patty Moriarity. At one point, in the middle of a disturbing vignette in which his hands were about to be chopped off by someone, he awoke to see Gordo Cameron looming over him.
“Greetings, lad,” he said. “You sure gave me and the gang in the OR one hell of a fright there. I’m glad you’re coming around.”
How’d you do with the case?
“He should make it through the next few hours, but that’s all I can say at the moment. Jim came to the rescue and assisted. We had to repair a couple of torn vessels, then we went ahead and did the Whipple. He lost a fair amount of blood and dropped his pressure a couple of times.”
Did I tear the vessels?
“Your head hit the incision like a bloody meteor. Some vessels were bound to rupture. But, really, it was manageable. Once we got the bleeding controlled, we irrigated everything like crazy. There’s bound to be infection, but that’s what we have antibiotics and infectious-disease specialists for. Plus you just don’t look like someone with a lot of devil germs on his face. What on earth do you think happened?”
No idea.
“Well, don’t use up your energy writing. We can talk after that tube comes out. Who’s takin’ care of you?”
Millstein.
“Good man, Millstein. A little scrawny by my standards, but sharp. Well, lad, I’m going to head on over to the recovery room to check on our boy.”
Thanks, Gordo.
“Just don’t ever do that again. My poor knickers had to be permanently retired.”
Donna Lee appeared and pulled Cameron aside, beyond Will’s field of vision.
“I don’t believe it!” Will heard Cameron say. “I don’t-”
Will envisioned the nurse stopping Cameron short with a finger to her lips. He banged on the bed rail to get her attention.
What’s up?
“Nothing.” Donna’s tone was icy. “Dr. Millstein will be up to speak with you.”
Tube very uncomfortable. . could I have a little medication until he arrives?
“He’ll be here before long. Just close your eyes and relax until he gets here. And don’t touch that tube.”
The woman was gone before Will could write anything further. What could she have said that Gordo didn’t believe? Why was she refusing even a small amount of medication to help him deal with the tube? Why the sudden coldness? He shifted his position in bed and tried as best he could to ignore the discomfort in his throat and bladder.
For a time he lay there, trying to divert himself with thoughts of Kurt Goshtigian. He had a decent enough patient-physician relationship with the man, but their history was not a long one. Even if Goshtigian fully recovered from his Whipple procedure, a lawyer could certainly make a good case for Will having caused the need for additional surgery and powerful, potentially life-threatening antibiotics, as well as prolonged time under anesthesia. Still, no judge or jury could find him negligent when clearly some medical problem beyond his control or knowledge had caused the incident in the OR. Will took pride in the fact that despite a high-risk specialty, he had never yet been sued, but he hardly took the fact for granted. As a surgeon, the specter of a malpractice action was always hovering not far away.
Even without medication, Will began to drift off. Images of the OR floated about for a time, then gave way to a comforting darkness. Everything was going to be okay, he told himself. The diagnostic tests he would undergo over the days and weeks ahead would show no brain tumor, no vascular anomaly within his skull, no hemorrhage, and no irregular cardiac rhythm. The incident would be written off as a simple faint, caused by a virus, fatigue, dehydration, or factors never to be determined. Such a faint was known technically as vasovagal syncope, the sort of physiologic reaction that commonly accompanied stresses such as horrible news or a grisly sight. In such instances a sudden, powerful discharge of electricity along the large vagus nerve caused rapid dilation of the veins in the abdomen and legs and marked pooling of blood in those vessels. The resultant drop in blood pressure produced an instantaneous loss of consciousness. Fainting was the brain’s effort to protect its critical circulation by “insisting” that the body lie down.
Vasovagal syncope, Will thought, as sleep enfolded him. Yes, that’s it. That’s what they’re going to conclude.
“Will?”
Ken Millstein stood by Will’s left hand. Standing beside Millstein, Anne Hajjar looked down at Will with the stony impassivity of a sphinx. On the right side of the bed was anesthesiologist Ramon Bustamante, also looking grim.
Will opened his eyes and managed a weak thumbs-up, to which neither the nurse nor the physicians reacted.
Something’s wrong, he thought. Something’s. .
“Will, Dr. Bustamante’s here to remove the tube; after that we’ll talk.”
The Philippine anesthesiologist moved forward and used a syringe to deflate the balloon cuff that held the tube in place below Will’s vocal cords. The inflated cuff also prevented him from aspirating his stomach contents into his lungs.
“Mrs. Hajjar, you have the backup tube ready?” Bustamante asked.
“Right here.”