Compromised, p.18
Compromised, page 18
part #1 of MetroGen Forbidden Love Duets Series
The intern stared blankly at her, not ready for the rapid speed of the ER. “You can tell all that from an IV?”
Yates hid his face behind his hand. Not his intern’s best showing.
“You have a patient with an acute abdomen with awful vitals. Are you going to keep her in the ER? Where would you want to send her next?” Angela asked.
“ICU or OR,” the intern answered correctly.
“And how will you determine which one?” Angela pulled the computer order over and ordered a normal saline bolus and IV Zosyn.
“Ultrasound…”Angela shook her head slightly, and the intern immediately changed course. “CT. Sorry.”
“CT right now. Shove people out of the way to get there,” Yates agreed.
“Yes, sir,” the intern, eager to redeem getting caught flatfooted, said. “Okay, let’s get rolling. Rock and roll to CT.”
“Call us if she crashes!” Yates called out, watching his staff whisk off the patient.
The poor intern gave them a horrified look. Yates waited until he was out of sight to start laughing. “I couldn’t resist. It’s his first shift of his first ER rotation. He has a lot to work on.”
“Does he know you can get a STAT CT in less than five minutes?” Angela asked.
“He’ll figure it out. Did you order the sepsis lab panel?” Yates asked.
“I did,” the charge nurse said. “Who wants to cosign?”
“You’re actually working,” Angela said to Yates, skimming the lab orders. Serum lactate, CMP, cardiac enzymes, CBC with diff, PT/PTT/INR, D-dimer and cbg/chem 7.
The nurse already printed off the cbg. It was a super-fast snapshot of her respiratory and metabolic status, which could be ran in less than a minute.
“As soon as they come back, we need 50 ml of D50.” Angela handed the slip to Yates to let him read her hypoglycemia. “What do you think CT is gonna find?”
“Not pregnant, acute abdomen, no signs of heart failure, good lungs, and a firefighter? Narrows down the differential some. Probably not a heart attack. Perf’ed appy. No scars on her abdomen for small bowel obstructions.”
“Too high up for perf’ed peptic ulcer,” Angela agreed.
“I can get my Magic 8-Ball if we need it,” Yates suggested. He was an easygoing married guy known to make snap decisions and occasionally check the outcome of the Magic 8-Ball he kept in his desk. “Let’s add some Diluadid for pain and norepi to help out the BP.”
The charge nurse stuck her head back in. “CT called. Free fluid in right para colonic gutter. Consistent with perf’ed appy. And also, firefighters on their way with some broken bones.”
“In the firefighters?” Yates requested clarification.
“No, the patients. House fire. Smoke inhalations too,” the nurse added.
“Fabulous. I hate to ask this, but can you make sure newbie calls surgery down here? And don’t let them eat him.”
Ten minutes later, the surgery resident, Dr. Weiss, announced, “Start the party. Surgery has arrived.”
Erin Hudgens’s blood pressure was improving, which was good for her. Dr. Weiss was accompanied by his medical student, Michael, which was bad for Angela.
“This is Erin Hudgens, 29 today, ruptured appendicitis.” The intern presented the case to surgery with more confidence. “Peritoneal signs, CT shows free fluid in the right paracolic gutter.”
Michael and Weiss started to examine her. She moaned, “No, not you.”
“What’s wrong with her?” Michael asked.
“She has a ruptured appy,” the intern repeated.
“I heard you before. My question is, why is she so out of it?” Michael snapped.
“I found her in the snow, dehydrated, hypothermic with almost unpalpable BP. This is an improvement,” Angela said from her spot near the computer. “Then we gave her a dose of diluadid on top of her fluids, and Zosyn.”
“Sounds good for a trip to the OR. Harper, open or closed?” Weiss asked his student.
“Ten years ago, I believe it would have been open. Now, closed, which is an exploratory laparotomy,” Michael answered correctly.
“Bing. Open surgery is reserved for overly dramatic TV shows with models playing doctors and patients so unstable they can’t survive CT. Trauma, gunshot wounds. Lots of gunshot wounds because you need a wide field to find the bullet.”
One nurse cracked. “Transthoracic lead therapy with air conditioning.”
The internal medicine resident snorted, catching the joke. “Funny.”
“Family contacted?” Weiss asked.
“We tried her emergency contact. No answer.”
“She know she’s going to surgery?”
“Hasn’t been super with it,” the intern said.
Weiss and Michael went to the head of the bed. The resident said, “Ms. Hudgens, you are very sick right now. Your appendix ruptured, and we need to take you up to surgery. Do you understand?”
Erin’s eyes rolled backward. “No.”
“Yes,” Michael said. “You need surgery.”
“The crockpot. Love you. No… ah.”
Michael glanced at Angela, and she wished she was wearing her nice new clothes instead of the dorky bouffant cap. He made scrubs work, a feat many men could not pull off.
It would have been better to run into him dressed in her best. Nice hair, showered, and preferably with a competent ER resident eating out of her hand.
“She doesn’t mean she loves me,” Michael said quickly.
“I think No-ah is a person. She’s repeated it several times.”
“Oh, that makes more sense,” Michael said. “The crockpot?”
“She borrowed my crockpot over Thanksgiving and keeps apologizing for not returning it,” Angela explained, more irritated at the memory. Michael had been late to her house post call and she’d been waiting for him to show up.
He blinked hard once, and she guessed he too was remembering. He showed up a few days later, and gave her a strip show to make up for it.
“I’ll call Kandal and get her rolling to the OR. Seems pretty open and shut.” Weiss took out his BAT phone to make the calls.
“Okay, then I’m heading out.” Angela stood up.
“You’re leaving?” Michael’s tone was full of reproach.
“I found her, I called 911, got her here and resuscitated her. Now I’m passing her off to people who are actually at work and more equipped to do this job. I am a cardiologist, not a surgeon.”
“Hmm,” Michael grunted.
How dare he imply she was uncaring? Couldn’t he understand she had gone above and beyond by staying until Ms. Hudgens had a clear disposition? She put in the freaking IV, but now she was handing off the patient, no different than what the ER would do normally.
The division of cardiology would expect her to be on service tomorrow no matter what—even if she’d found Ms. Hudgens frozen to death outside her door this morning.
Angela hissed at him. “Anything else you want to say, medical student?”
“No. I’m sorry. I just know her, and I don’t want her to be alone.”
“I’m sure she had people. The firefighters are a tight-knit group,” Angela reminded him.
“Of course, Doctor,” he said.
Angela calmed down. She was a grownup, and she needed to keep perspective. Michael had a tendency to over-empathize with the patient. He had not yet learned to maintain a healthy distance or else he internalized their issues, too.
“Harper, focus on the patient and the next steps. She needs that from you more than anything.”
Michael took a deep breath. “You’re right. Thank you.” He rejoined the side of his resident, more relaxed than before.
This was a good time to exit stage right. “I’m calling an Uber. You good here?”
The intern gave her a thumbs up. “We’ll get her teed up to head to the OR. Thanks for the help.”
Chapter 32
Michael scrubbed with Weiss, feeling more centered. He was pretty thrown to run into Angela in the ER.
Worse, Erin Hudgens, who he did like, was deathly ill. Since he’d seen her a month ago, she must have lost at least ten pounds. She’d extended a hand of friendship when he’d needed it, and to see her hypothermic, dehydrated, and septic was difficult.
This needed to stop. Angela was right. He couldn’t keep suffering with every patient he liked. Projecting his past failures onto his current patients wasn’t making him a better doctor or a better person.
“You do this pretty well,” Judah said, noting Michael’s automatic movements of the scrub.
“OB was last month. There were a billion C-sections.”
Kandal was already scrubbed in. This was a more urgent surgery because Hudgens was already draped and ready to go. Anesthesia had intubated her, placed an arterial line, and upped her pain meds.
“This is Erin Hudgens getting an ex lap for presumed ruptured appendicitis. It happens to be her twenty-ninth birthday. Did we get ahold of her emergency contact?” Kandal asked.
“No,” Michael said. “Left a voicemail to call the hospital. The ER said they’ll keep trying.”
“Okay, time is tissue, so consent is assumed, and let’s save her life,” Kandal said. “All right, DJ. What are we playing tonight?” Kandal asked.
“Umm, Hanson’s greatest hits,” the circulating nurse recommended from the computer connected to the sound system.
“Don’t you mean ‘hit’? I am not listening to “MMMBop” on loop. No thanks.”
“How about Summer Party early 2000s?” The nurse clicked a few buttons.
“LFO, Shaggy, and Baha Men? We’ll let the dogs out, and I am in!” Kandal obviously had an excellent, easy relationship with her staff.
Michael waited for the surgical tech to direct him to stand on the left side of the patient. He was going to be driving the camera again.
“Survival odds?” Kandal said mildly, standing on Erin’s left.
“Her vitals were bad, but I’ve seen her before. She’s in excellent shape and has few co-morbidities,” Michael answered.
“Correct. The fluids and antibiotics are going to do a lot for improving her BP. Weiss, thoughts on how long this had been brewing?”
Judah took his place on the opposite side of Kandal. “Based on her age and demographics, several days to a week. Retrocecal position makes her symptoms less classic and would let it brew longer.”
“Especially if she masked her symptoms with Zofran or Motrin, which she’d have easy access to. Firefighters might be worse patients than doctors. I don’t blame Manika Gupta-Carver for being frustrated with her husband sometimes.”
They used the four trochars to enter the abdomen and immediately began suctioning out the infected fluid. Michael adjusted the camera a few times to visualize where the appendix was supposed to be.
Kandal said, “Crap, this isn’t going to be a twenty minute in and out. Harper, point toward the right posterior.”
Even from Michael’s vantage point, he could tell this wasn’t going to be easy. They couldn’t visualize the appendix because the bowel was stuck together from the infected fluid. The anatomical planes were lost.
“Okay, Weiss, tell me what to do now?”
“We’re going to have to separate the bowel from the appendix, peel it away, and rinse out this congealed fluid.”
“Exactly. It’ll take a flood of normal saline. Tell me why, Harper?”
“The solution to pollution is dilution,” he answered. It was one of surgery’s favorite sayings, right behind ‘all bleeding stops eventually’ and ‘time is tissue.’
Essentially, if you kept adding fluids, you could fix anything. Dehydration? Add some fluids. Too much infection? Add some fluid. Bleeding out? Add some fluid.
“Yep, ruptured appies can be all sorts of badness,” Kandal confirmed. “Fortunately, the bowel around it appears viable, so we should do pretty well once we get it sorted out.”
“Yes, ma’am,” Michael said.
“Harper, I believe I heard a most interesting story about you today,” Kandal said about twenty minutes into the procedure.
“Was it about my time as Bachelor Eleven on New Day Cleveland?” Michael suggested, since he technically wasn’t responsible for Dr. Austin’s surgical misadventure.
“No, though it does sound fun. I meant more how Dr. Austin Wilson got dropped kicked out of a surgery.”
“He tripped.” Michael took the diplomatic approach.
“Frantz’s scrub tech got him good,” the circulating nurse put in. “I hear he was trying to get a rise out of Harper by claiming Harper was gay.”
“Not that there’s anything wrong with being gay,” the scrub tech said, glancing at Judah.
“Wait, I’m gay?! No clue. Filled out a bunch of forms to date an ortho resident,” Judah faked outrage. “The gay cat is out of the bag.”
“Don’t shake the trochar. Bovie the blood vessel here,” Kandal told her resident. “You and Dr. Navarro have been going strong for quite a while, right?”
“Yeah, but he has job offers on the West Coast. I’ve got three more years here. Mom is worried about his long term potential,” Judah said.
“Long distance is hard when you live at the hospital,” Kandal agreed. “Back to Harper. I actually heard the male cat fight wasn’t over the gay cracks but over a certain cardiologist. I believe you are familiar with her?”
“How so?” Michael asked. Angela had been crystal clear on never revealing their past relationship. Though he had behaved badly (or worse than badly, he admitted internally), he couldn’t believe she’d have told Dr. Kandal to ruin his surgery rotation.
“She and I are good friends, and Kayla Varma is my sister. Your name has come up in the past, most recently in conjunction with the doomed OB patient.”
“Dr. Perkins did try to save a patient with inoperable cardiac disease on OB.”
“The whole situation was legendary,” the circulating nurse shared. “Dr. Feldsher and Dr. Marin were the only two people who kept the situation from degrading into a bloodbath. The general surgeons are split on if the OB team went crazy to do a perimortem C-section.”
Kandal somehow moved her heard in a way to suggest a shrug without disturbing her hands engaged in the operation. “Surgery dumps a lot of shit on OB, claiming they’re awful surgeons. They train in a different way, and they face having to repeat the same surgery over and over again.”
“You do appendectomies over and over again,” Judah said.
“True, except I’ll only take out Ms. Hudgens’s appendix once. Many women will get two, three, four, five, six repeat C-sections. They have to open up the same scar multiple times, remove a human being, and sew it up to be usable again. We underestimate the skill and will it takes.”
Michael could see the nursing staff shifting closer to listen in.
“You may not be aware of my history, Harper. I did my intern year in OB before switching to General Surgery, so I know OB is plenty hard. And a perimortem C-section, with a cardiologist coding her, is not for the faint heart.”
“My med student teammate did the C-section. And Dr. Perkins… she was amazing. I can’t describe it,” Michael admitted now. He’d been angry at Angela for what she hadn’t done when he should have been respecting what lengths she’d gone to to help Tiffany.
“She took the death pretty hard, and I consulted on her new wardrobe. I gather it is having quite the effect based on the rumors,” Kandal said.
“Patient death to new wardrobe?” the tech asked.
“Better than changing her life for a guy,” Kandal said, and Michael noticed the nurses chuckling. “Hey, I didn’t change specialties for a guy. He was incidental.”
“Of course,” the scrub tech agreed readily.
“Enough about Angela, who looks fabulous now. Harper, you’re finishing your surgery rotation. Ignoring a few assholes in our ranks, how do you like surgery?”
“How do I like surgery?” Michael murmured. This was a question batted around by many of the surgeons in past cases. It was different, however, when it came from the woman who determined his grade.
“You’ve been here a month, and I expect you are independent minded enough to succeed in this corner of medicine.”
“Ma’am, we met two hours ago.”
“My instincts are excellent. Why would I believe a man who restarts his life ten years behind his classmates and can go toe to toe with a senior resident is an independent thinker? It’s not neurosurgery.”
The phone rang in the OR. One of the nurses listened and told them. “Next of kin is in the waiting room, finally.”
“They should probably get an update. Weiss, why don’t you go give it?” Kandal suggested.
“Me. You don’t want me to—” Judah seemed surprised he was being given the responsibility solo.
“I could send Harper here, but generally we don’t want the med student to be the one giving an update, no matter how old he is.”
“I can break scrub and go with him,” Michael volunteered.
“No, why would I do that? The update should be given by a doctor, and since you’re giving good news, Killer, it shouldn’t be that big of an issue. Harper here can pretend to be first assist even though the real first assist is Jenny my scrub tech.”
Now Michael remembered Kandal had named Weiss ‘Killer’ for dropping a scalpel in the body cavity during his fourth year of medical school. It was his preferred replacement over ‘18-gauge’ in reference to taking part in a live blood transfusion.
Another sign of a good teaching and teasing versus assholes.
Dr. Kandal was an excellent teacher, guiding Michael through the next steps of the operation. She made it simple, encouraging him and correcting him. It certainly made sense why she had such an important role in surgery for someone relatively young.
Judah came back about thirty minutes later. “Talked to two very hot firefighters in the waiting room. One was her emergency contact, Theo Jefferson, and he had the Fire Chief with him. Theo said she’d been working a lot and hadn’t realized she was that sick.”
