Pennsylvania's Finest, page 20
At exactly seven o’clock in the evening Dr. Knight appeared at the entrance of the McDuff suite. Wearing a starched long white coat he was accompanied by chief resident Larson and intern Polk. Both young physicians stood stoically behind Dr. Knight. Lastly a tall, thin young woman of striking beauty accompanied the group. She was nearly six foot tall with high heels on, and wore a long white coat. Her complexion was dark by nature as was her straight black hair. Holding a clipboard in her hand she trailed somewhat confidently behind the three physicians.
Upon entering the McDuff room all of the matriarch’s assistants stood up and stepped to the side. Katherine was on a cell phone looking out over the night skyline of the city. She quickly told her caller that she had to go and terminated the call. She then turned to her surgeon with a smile while throwing her arms widely overhead. She stepped towards the entering team.
“My young heart doctor,” was her cry as she strongly shook the hand of Knight. “So wonderful to see you.”
“Good evening Katherine,” was the polite and calm reply by Knight. “It’s very good to see you.”
Before Knight could go any further the patient peered around him saying, “Who are these fine young men behind you?”
Knight then introduced Peter Larson and Richard Polk to the head of the McDuff Food Corporation. He explained the role of each resident and the fact that they would constantly be monitoring her progress. Dr. Polk then informed her that he always enjoyed eating the companies crème filled cup cakes that were universal to any convenience store. Katherine McDuff then promised a whole carton of cupcakes would be delivered to him as her assistants jotted down his name. They were later shocked to discover that his home address was in the basement of the hospital complex.
Lastly, Katherine McDuff sidestepped the male entourage and stood directly in front of the young female who accompanied the team. She then said, “And who may this young, beautiful woman be Richard?”
“This is Olivia Casey, my physician assistant,” said Knight in a proud, fatherly tone.
“Olivia Casey,” said Katherine looking the young female in the eyes. “What a beautiful name to match such a beautiful and intelligent young girl.”
“Thank you,” said Olivia extending her hand, “It’s a pleasure to meet you.”
“My pleasure indeed,” said Katherine with a handshake and coy look at Dr. Knight. “I know that Casey is Irish but your beautiful dark complexion is not from the Emerald Isle.”
“I’m half Irish,” said Olivia with a smile. “My mother is from Spain.”
“Ah, thus the reason for your beautiful dark complexion, you are blessed,” said Katherine as she gently touched the cheek of Knight’s new assistant. “You are truly blessed.”
“Thank you,” said the twenty four year old recent graduate from the hospital’s physician assistant program.
McDuff then turned toward Dr. Knight saying, “Richard, you are a lucky man to have such young, handsome and energetic people working with you.”
“Yes I am,” said Dr. Knight with a smile and glancing look at Katherine McDuff’s female attendants.
Knight and his team spent the next full hour in the McDuff suite. An explanation was given for every step of the surgical and postoperative process. All of Katherine McDuff’s questions were answered in detail. The discussion was exhaustive in scope. At exactly eight o’clock a tired, yet satisfied Katherine McDuff, excused the medical team from her room with appreciation. She would spend the next two hours getting her affairs in order, preparing for surgery the following morning.
At exactly seven o’clock the following morning, the scalpel of Dr. Knight hit the skin of Katherine McDuff. Knight had moved up her surgical time to magnify the importance of the case. At his side was nurse Ella Frey. Across the table was intern Polk who was slowly establishing himself as a trusted assistant. At the lower half of the table was chief resident Larson and P.A. Casey, harvesting a vein graft. It was understood by all physicians that the inexperienced Casey would stay away from the chest cavity and play a minimal role in the case. No medical students were allowed in the room. The chairman of the anesthesiology department, along with a more competent assistant professor, managed the airway of the patient. Dr. Knight was at his surgical best, completing the case with perfection. No other cases were scheduled that day, allowing the team to micromanage her SICU care that day. Her postoperative course was unremarkable over the next 24 hours. Word then spread throughout the hospital that the surgery was a success. The passionate matron of the McDuff family had done well and was resting in stable condition.
The following morning found Mrs. McDuff alert and strong. Knight and what appeared to be the entire surgical staff evaluated her at 7 A.M. A decision was made to remove her from the ventilator at eleven o’clock that morning. Katherine tolerated this well and by lunchtime was breathing on her own and asking for a cigarette. This demand was her only request not permitted up until that point. When the clock struck noon an army of caterers entered the hospital with a lavish lunch provided by the McDuff Corporation. The honorees were the physicians and nurses of the cardiothoracic program. Katherine’s attendants had arranged the luncheon at her specific request. Occupying the center of the gourmet table was a delicious array of cheesecakes, which made her company famous over the past century. It was a cherry topped cheesecake that Rick Polk went for first.
“That’s right, a whole crate of Creamy Cup Cakes was outside the door of the Polk Lounge this morning,” said Polk. He was loading a huge chunk of cake on his plate. “Like Santa Claus appeared the night before with it.”
Phil was layering his tray with a hot entrée of chicken potpie and a garden salad. He responded to Polk saying, “Did it have your name on it? If not it’s the property of the entire intern team.”
“No way,” said Polk, “Katherine said it was for me. I have witnesses.”
“Katherine? I see,” responded Phil. “On a first name basis with Mrs. McDuff?”
“As a matter of fact yes,” smiled a proud intern Polk. “When you caress someone’s broken heart in your hand, you earn the right to call them by their first name.”
Intern Fred Riles then stepped into the conversation saying, “Glad the old dame is doing O.K.” He was placing a vegetarian wrap on his plate.
“I agree,” said Phil Drummer. “The old man has been uptight regarding this one.”
“Tight as a gnat’s behind,” said Polk starting off the feast with his dessert.
Phil was acutely aware of Knight’s relationship with Katherine McDuff. Jennifer Ranier had the good fortune of attending a McDuff mansion social event under the cardiothoracic department umbrella. Her description of the mansion’s opulence and grace was stunning. Ranier also described Knight’s passion for the McDuff family with all of its fortune and fame. She truly believed Knight would suffer a mental breakdown if anything bad occurred to her during the hospital stay.
“How’s the new P.A. doing?” asked Phil while looking at Polk.
“Incompetent but gorgeous,” replied Polk.
“Wasn’t that the case with his last one?” asked a constantly unaware Fred Riles.
Both interns looked at their colleague realizing the limits of his social I.Q. level. By November of that year it was common knowledge throughout the institution that Ranier and Drummer were an item.
Just then upper level residents Pete Larson and Randy O’Keefe appeared at the banquet.
“Wow, the whole department is here,” said O’Keefe looking around at the crowd.
“A beggar’s banquet,” said chief resident Larson with a smile. “Thanks to the expert skills of our super intern,” was his next line as he patted Polk on the back. “The old gal really loves you.”
“What’s not to love,” said a proud intern Polk rubbing his stomach. The group broke into laughter, which unfortunately was to be short lived that early November afternoon.
“Code Blue, Surgical ICU,” pierced over the hospital public address system. “Code Blue Surgical ICU.”
“Oh no,” said Larson as he dropped his plate and bolted out the conference room door. The remainder of the residents and interns rushed behind him.
“Code Blue Surgical ICU,” continued as they raced down the hall towards the ICU.
“Anyone but Mrs. McDuff!” rang collectively through their heads as they turned the corner into the ICU.
“Code Blue Surgical ICU.”
As the herd of physicians entered the SICU proper they saw a frantic nurse Cruise rushing a cardiac crash cart into the room of Katherine McDuff. The grand dame of the McDuff Corporation was in full cardiac arrest. It was 1:23 PM.
“What happened?” yelled Larson as he entered the room.
“Was doing fine,” said Nurse Cruise. “Just flipped into a V-tach and the alarms went off.”
Larson then looked down at Mrs. McDuff who was turning a deep pale blue. He glanced at the overhead monitor, which displayed a dysfunctional heart rhythm. A blood pressure reading was incompatible with life.
“Start the code protocol!” yelled Larson. The surrounding team then jumped into action. Polk applied an oxygen mask to her face as Phil began cardiac compressions. Randy O’Keefe opened up all of her IV fluid bags and directed intern Riles to draw some blood. Nurse Cruise rapidly opened the code cart to begin drawing up the appropriate medications. At that moment the hospital cardiac arrest team arrived in the room.
The arriving anesthesia resident then rushed to the head of the bed saying, “All non essential personnel please leave the room.” He repeated his demand watching a few confused medical students leave the room. Within two minutes he had a breathing tube down the patient’s airway to provide oxygen.
An intelligent looking medical resident soon appeared, declaring responsibility for running the code. He calmly said, “Can someone please give me a history on this patient and a list of her medications?”
“I’m running the code,” said a frantic Pete Larson. “I know the patient well.”
“Not according to protocol,” said the medical resident.
“I said I’m running the code,” was Larson’s response. He then ordered the appropriate IV medications for the patient. Nurse Cruise rapidly administered the drugs into Katherine McDuff’s veins. Larson then asked Phil to stop his compressions. The team looked up at the monitor hoping for a spontaneous cardiac rhythm from the patient. There was none.
“Continue CPR,” yelled Larson. Phil started the chest compressions watching intern Riles struggle to draw blood from the patient’s groin area.”
“I am responsible for this code,” said a defiant medical resident. “I demand responsibility or my chairman is going to hear about it!”
Larson turned quickly to the resident at the end of the bed saying, “Listen hear you little piece of…” His voice suddenly seized up, as did his body. Behind the slightly framed medical resident stood Dr. Richard Knight with a scowl on his face.
“I’m running this code,” yelled Knight stepping past the medical intern. “Get out of my room,” was his last response to the intern. Knight then dispensed the young physician with a backwards shove of his arm.
Knight peered up at the monitor in disbelief. He then looked around the room seeing nurse Cruise administer drugs and Phil continue with the compressions. The anesthesiology resident rhythmically applied pressure to an oxygen bag with his hand.
“What have you given her so far?” said Knight to Larson.
“Round one protocol,” was his response.
“Stop compressions,” was Knight’s next demand directed at Phil.
The room again went quiet as everyone looked up at the monitor. No heart rhythm was seen.
Knight then looked at Nurse Cruise saying, “Open the chest cart!” He looked back at Phil saying, “Continue compressions!”
Within sixty seconds Nurse Cruise returned to the room with several other SICU nurses. They were pushing in a large cart filled with surgical gowns and instruments. Chief resident Larson then began pouring betadine antiseptic solution all over the chest wall of the patient. Knight turned towards the nursing team seeing that O.R. nurse Frey was now present. Surgical gloves were quickly placed on Knight and Larson as they began applying sterile sheets across the chest of Katherine McDuff. The nursing team rapidly hooked up suction tubing to a canister connected to the wall. Phil and his fellow interns realized that Knight was about to crack open the patient’s chest right there in the SICU.
As Knight reached for the scalpel he noticed a commotion under the surgical sheets in the patient’s groin area. It was intern Fred Riles still trying to draw blood. His attempts were unsuccessful up until that point.
“What the hell is going on under there?” barked Knight.
Fred Riles slowly lifted his head up from above the sheets. At that moment nurse Frey hooked up a portable head light atop Dr. Knight’s surgical cap. The light peered into the frightened face of the young Dr. Riles.
“Just trying to get blood, sir” was his timid response. Knight noticed that his hand was trembling.
“Get out of my room,” was his terse demand to the intern. Riles quickly obliged bolting out of the room to join the crowd of bystanders in the SICU center.
“Polk, draw that blood and make sure you get it,” snapped Knight. Rick Polk took to the task immediately finding the femoral artery and sending several vials of blood to the lab.
Dr. Richard Knight then quickly took a scalpel and reopened Katherine McDuff’s sternal incision. Within seconds Larson was suctioning up blood that oozed from the wound. The surgical wires holding the sternum together were rapidly cut and removed. The click, click, click of Knight’s sternal retractor was heard by all as the chest cavity became visible to everyone. In the rear of the room a concerned Chairman Michael Barnes and CEO Howard Rineman appeared. Rineman had never seen an operation and soon had to leave the room.
“No bleeders,” said Knight to Larson. The chief resident nodded his head in agreement. “All the grafts look good,” was Knight’s next line as he rapidly rotated the heart from side to side.
“Get me the paddles,” was his next request as he looked up at the monitor. No functional heart rhythm existed.
Nurse Frey then produced a long sterile set of cardiac paddles. The two paddles were connected to a defibrillator next to the bed. Knight applied a paddle to each side of the patient’s heart and then instructed the nurses to discharge the device. A thump could be heard throughout the room as the matriarch’s heart was jolted by the electrical charge. The team peered at the heart muscle, which did not respond. Knight then again applied the paddles to the heart sending a second charge through it. Again, there was no response.
Knight then began massaging the heart with his right hand saying, “C’mon Katherine, C’mon Katherine. Don’t leave us.”
The cardiac massage continued for two minutes with no response. Sweat began to pour down his brow.
“Epinephrine,” was his next demand.
Nurse Frey then handed the doctor a large vial of epinephrine. Knight took the syringe and inserted the tip of the attached needle directly into the heart wall of Mrs. McDuff. He rapidly injected a large dose of the adrenaline directly into the cardiac musculature, attempting to energize it into action. Upon withdrawing the needle he continued a direct heart massage for several more minutes. Unfortunately there was no response.
For the next 30 minutes Dr. Knight frantically continued to cycle through a series of electrical defibrillations and cardiac massage. Nurse Cruise drained her supply of emergent intravenous medications. Throughout the ordeal Knight spoke to Katherine McDuff as if she could hear and respond to his pleas. He implored the Gods above to spare her life and respond to his demands. His prayers went unanswered. Approximately one hour after he entered the room, Knight suddenly felt a hand holding his right forearm down from behind. Turning backwards he saw Dr. Michael Barnes staring directly at him with a stern face.
“She’s gone Richard,” was Barnes comment. He continued to hold the heart surgeon’s forearm in an attempt to stop his actions. After a silent pause Barnes continued by saying, “She’s dead.”
Silence gripped the crowded room. Knight looked first at Larson who shook his head up and down, agreeing with the surgical chairman. He then looked around the room at all of the faces refusing to make direct eye contact with him. No one moved. Knight then looked up at the monitors one more time and then back into the chest cavity of his deceased patient.
“But that’s impossible,” was his sorrowful comment as he continued peering downward. “Impossible.”
“She’s dead Richard, you did all you could,” was Barnes reply. He paused for five more seconds holding the surgeon’s arm, only then saying, “I’m going to call the code. Time of death is 1432 hours.” He then released the forearm of his colleague.
Silence gripped the room.
Knight slowly blinked his eyes as he continued to stare down towards the floor. Next, he stepped back away from the patient’s bed. Nurse Frey unhooked his head light from a power box, allowing the cord to swing freely from the back of his head. He turned towards the doorway without removing his gown, gloves or head lamp. Blood covered his surgical gown and shoes in a blotchy pattern. He then looked up towards the door, pausing to orientate himself, and walked towards it. The crowd of faculty members, residents and interns parted to the side, clearing a path for the surgeon. Knight slowly left the confines of the room only to encounter an even larger group of hospital personnel outside. A silent and mournful crowd gave way to the doctor as he slowly walked through the intensive care unit. Turning to the left he headed alone, down the hallway, leaving the SICU. He sadly passed the conference room containing the complimentary luncheon sponsored by the deceased. An aroma of freshly baked goods engulfed Knight as he continued his exodus. A cluster of McDuff Corporation employees frightfully peered out of the room, staring at the dejected physician walking by. He did not acknowledge the group in passing. The despondent surgeon then turned right into a stairwell exit, vanishing from sight.
