Pennsylvania's Finest, page 7
“So the take home message is watch your step,” said Phil.
The medical students nodded their heads and understood. Roden then spoke, “Today is Melissa’s birthday.”
Melissa Bankart blushed and pushed Charles Roden’s shoulder.
“Happy Birthday,” said Larson. “Sorry you have to spend it in the OR today.
“No problem,” said Melissa. “At least I’m not on call tonight.
Larson then checked his clock. “Let’s roll, better get Knight off to an early start today.”
The team arrived in the OR suite earlier than usual. Upon entering the room nurse Ella Frey greeted them with her usual warm smile. Ella was happy when Dr. Knight was back in town. She was oddly comfortable in his presence.
On the table was a 57 year-old patient named William Brown. Mr. Brown was a black male with a long time history of uncontrolled diabetes. Over the past three decades he smoked and drank with the best of them. Last night while walking past the PGH he experienced chest pains and collapsed. The EMT squad brought him to the ER and the cardiology team admitted him. An emergency cardiac catheterization was performed identifying critical blockages of his arteries. Emergency surgery was recommended and Knight was the only CT surgeon in town. The other cardiac surgeons were at the shore enjoying quality time with their wives that week. Mr. Brown had no insurance. His friends called him Willie.
The pre-op process was ahead of schedule as Knight roared into the room. He moved quicker than usual with aggression in his step.
“Good morning Dr. Knight,” said Ella Frey.
“Good morning Ella,” barked Knight.
“How was vacation?” was her next question to Knight as he picked up the patient’s chart. Nurse Frey had a smile on behind her surgical mask.
“It was horrible,” said Knight not lifting up his head up from the chart. “I’m going to write a book titled “The Shore, Its Overrated, Overpriced and Overcrowded.” Knight paused and then looked up saying, “We evolved from the ocean, why does everyone try to swim back in?”
Ella smiled. She knew that Knight abhorred the New Jersey shore.
Before Nurse Frey could continue her questioning Knight spoke, “How did I get stuck with this staffer?” He was referring to Willie Brown on the table. “For God’s sake he is a piss poor piece of protoplasm who is going to try and cag on my record.” The word “cag” was hospital slang used in place of death or dying.
No one spoke because they all knew the answer. A hospital could not deny care to a local indigent who nearly dropped dead on their doorstep. It was by luck of the draw that Knight was the only CT surgeon in town.
“This case is going to screw up my whole schedule today,” barked Knight. “I had to push back my normal schedule to accommodate Mr. Brown here.”
Larson and the CT team kept quiet and moving while prepping the patient. No one dared speak as Knight continued, “I can’t wait until the government mandates a national health care program.” He paused then spoke again, “Once that occurs Mr. Brown would be deemed too expensive for the system. Surgery would be denied. He would then be put in a ward with ten other men and fed soup and crackers until he died. Just like they do in Europe.” Knight paused as he walked toward the intubated patient at his mercy.
“Where the hell is Ranier?” yelled Knight.
“She is back in the sterility room looking for your favorite needle driver,” said Ella Frey. “The team who picked your instruments last night didn’t put it into the tray.”
“Idiots,” said Knight shaking his head slowly. “I’ve been doing the same case for the past 25 years here and they still can’t get it right.” Knight turned to walk out of the room saying, “I can train a pack of monkeys to do a better job than the night shift team.”
Then as Knight left the room to begin scrubbing P.A. Ranier entered the surgical theatre through an opposite door.
“Found it,” was her energetic comment as she opened up Dr. Knight’s prized needle driver and placed it onto nurse Frey’s table.
Throughout the past several weeks the cardiothoracic team enjoyed Jennifer Ranier’s presence. She calmed Knight in moments of tension and helped move all the cases along. She worked well with scrub nurse Ella Frey while assisting both Knight and the residents. On the floor she helped to expertly manage the postoperative patients in the cabbage patch. The entire house staff appreciated her presence and her most pleasing presentation. In homage to her looks, Dr. Polk constantly referred to her as “easy on the eyes.”
Phil Drummer also enjoyed her presence in the operative suite. She frequently stood next to Phil at the surgical table, with a constant physical contact between their bodies. Phil noticed that Ranier had an ability to lean one way or the other to maximize that contact for the benefit of the patient, and seemingly himself. She wore a pair of purple clog shoes and firm fitting scrub pants that complemented her physique. A surgical mask that covered her mouth and nose, accentuated her energetic blue eyes. She wore a tight surgical cap that only allowed a few strands of blonde hair to escape and dangle free. Most pleasing of all was her scent, the scent that Phil first appreciated a few weeks ago, which had an unmistakable texture of sensuality.
“Keep moving,” yelled Larson. “Don’t push his buttons today. Remember beach vacation,” was his next comment as the team headed to the scrub sink to join Dr. Knight.
At 0740 hours Borodin’s Symphony #2 started five minutes ahead of schedule. Under protest Dr. Richard Knight began his self-proclaimed charity work on Mr. William Brown. All was going well until he went to harvest the patient’s internal mammary artery.
“Look at this piece of crap,” was his comment to the crowd. He cocked his head back while looking through his magnification loops at the patient’s internal mammary artery. “This IMA is as hard as a rock.”
Phil and Ranier were on the other side of the table and didn’t speak.
“This guys been smoking since second grade and now I’m supposed to resurrect his arteries,” said Knight. He was referring to intense plaque build up in the patient’s artery making the outer wall rock hard. He then went to pass a suture through the vessel wall and the tip of the fine needle bent somewhat. “Look at this, my needle is bending. You see something new every day,” yelled Knight sarcastically as he applied more pressure onto his favorite needle driver.
At that moment the suture needle skipped off the hardened arterial wall and Dr. Knight’s right hand follow through was more forceful that usual. In a split second the needle driver in his right hand drove the sharp needle into the index finger of his left hand which was holding a pair of pick up tweezers. Dr. Knight immediately felt the intense pain of a needle stick that all surgeons feel throughout their career. That sharp down to bone searing pain that is over in a nanosecond yet lingers for a long time.
“Ah!” yelled Knight as he threw the needle driver and suture onto the floor. “Betadine,” was his cry as he took off the double gloves on his left hand. Within a few seconds nurse Frey was pouring antiseptic betadine directly over Knight’s left index finger as the entire OR team looked at him. Knight then squeezed his left index finger tip between the adjacent thumb and long finger. A fine drop of blood oozed out of the puncture site. Knight shook his head is disgust.
Then like all surgeons Knight’s mind registered one word, with that word being “hepatitis”. “I knew it,” said Knight as nurse Frey reapplied two sterile gloves to his left hand. “I knew the only thing I would ever get out of this case was a lawsuit or hepatitis.” Knight looked up to the anesthesiology team and spoke again, “Send his blood for a hepatitis panel and HIV.”
Then Dr. Knight continued, yet his mind remained focused as it always did on a needle stick. As a surgeon needle sticks were common as a resident and young practicing surgeon. As a surgeon’s skills matured the needle sticks became less frequent yet still occurred. The fear was always of the HIV positive patient suffering from AIDS. However the bigger fear among surgeons was that of hepatitis, especially hepatitis C. This virus was prevalent in the populace and transmitted by blood-to-blood contact. Many patients with the disease were unaware of their infectious state. Therefore they do not appear physically ill to their treating medical team. There was no complete cure for the disease and it frequently progressed to liver failure, being the most common cause for liver transplants in the country.
Unknown to Willie Brown was the fine print in the surgical consent that his brother signed prior to the case. A clause just permitted by the PGH legal team had recently been inserted regarding a needle stick. It permitted the involved surgeon to draw the patient’s blood during the surgery and send it off immediately for testing. It was a controversial clause since it theoretically did not protect the rights of the patient. Certainly the legal argument could be made that the patient actually acquired the disease from the surgeon’s blood that they were exposed to during the incident.
“What an occupation,” said Knight. “We work ungodly hours for less and less money. The government is breathing down our necks. Plaintiff lawyers are flooding television reruns of Gomer Pyle with lawsuit commercials as we speak.” He then paused and shook his head continuing to work on the IMA, “And I have a good chance of getting a fatal blood borne disease from Mr. Brown who will then die on my behalf.” The martyrdom speech then finished with the statement, “Of course his family will then sue me for not saving his decadent life.”
“Not much of a family,” said Ranier knowing she would be allowed to speak. “His brother had to be tracked down by hospital legal to sign the consent. He looked like a street person. No other family in site.”
“I’m not sure what the transmission rate is for a closed bore needle stick,” said Larson. “I know it is lower than an open bore needle.” Larson was referring to the type of needle Knight stuck himself with. A surgical suture needle, or closed bore needle, is solid tipped since it only has to pass through tissue. A needle used to draw blood from a vein has to be hollow inside. This is referred to as an open bore needle.
Knight looked up at Ranier and Larson garnering some solace from their well-crafted comments. Suddenly a voice from the lower end of the table was heard.
“It’s the rule of 3’s,” said medical student Roden.
The entire surgical team looked towards Roden at the end of the table. He was helping Phil harvest a vein for the coronary bypass.
“Who the hell is he?” said Knight implying that Roden’s physical presence over the past month didn’t register with him.
“The third year medical student,” said Larson looking directly into Roden’s eyes pleading him to stop.
Before anyone else spoke third year med student Roden continued, “It’s the rule of 3’s,” he said again. “With an open bore needle stick the rate of transmission of hepatitis B is 30%, hepatitis C 3% and HIV 0.3%.” Roden looked up from the field with an innocent look on his face. “I just read it yesterday in a journal.”
Knight stepped back from the table and paused looking directly at Charles Roden. “But if I get hepatitis from this staffer the rate is 100% and my career is over!” he shouted. “Who the hell are you to be lecturing me?”
Roden and the rest of the team froze up. No one moved. The circulating nurse turned down Borodin ever so softly to appreciate the coming attraction.
“I’m the chairman of cardiothoracic surgeon you miserable student. I probably wrote that article you read,” was his next shout. The only movement in the room was nurse Frey shaking her head as she looked at the student. The anesthesiologist’s face slowly arose above the surgical drapes at the head of the table. No one wanted to miss the ensuing ejection.
“Get the hell out of my room,” barked Knight as Roden stepped back from the table. Melissa Bankart stepped into his place to assist Phil harvest the vein. “I’ll give you such a bad grade you will be doomed to a career of popping pimples as a dermatologist.” Knight’s face began to turn a dark red as he turned back to the chest cavity.
Roden quickly exited the room looking back through the glass partition at the scrub sink. He was intelligent enough not to say another word.
Then as if the Greek Goddess of Chaos reached her hand into the room a chirping sound went off.
“What the hell was that?” said Knight quickly, again stepping back from the table. The chirp went off again. “Turn the music down,” said Knight.
Again the chirping sound went off as all eyes looked at medical student Melissa Bankart. Attached to her waist beneath her surgical gown was a cell phone that she forgot to take off prior to the case. Unknown to her the caller was her father wanting to wish her a happy birthday. He lived in Cincinnati and was very proud of his daughter who was a medical student at Penn.
“Is that a cell phone?” yelled Knight. The phone chirped again. “Is that a god damn cell phone?” said the red faced Knight stepping towards Bankart.
“Yes,” said a timid voice from Bankart. “I forgot to turn it off.”
Knight motioned to the circulating nurse, “Help this student answer her phone nurse. It may be something critically important.” Knight hated cell phones and text messaging. “Thanks goodness for cell phones to keep us all connected. That way we will never miss another emergency.”
The circulating nurse reached into the back of Bankart’s scrub gown and felt her cell phone attached to her waist. She lifted the phone out and looked at its face. The caller ID said “Daddy” but the scrub nurse knew better than to speak.
Knight then grabbed the cell phone with his bloody hand. He cranked his right arm back and fired the phone across the room. It hit the opposite wall and upon impact shattered into several pieces. It continued to chirp and Knight strode over to the main phone component. He then stomped on it with his shoe until the chirping stopped. Mr. Bankart’s cell phone in Cincinnati immediately registered a lost call signal. A moment of angst seized him as he unsuccessfully attempted to recontact his daughter again.
He looked at Larson, “Get her out of here. You know the rules.”
Chief resident Larson nodded his head to the right looking at Bankart as she quietly left the room. She joined Roden outside the room where a small crowd of surgical personnel was forming.
Knight continued with the surgery. P.A. Ranier stepped down the table to now help Phil. Larson remained at the head of the table to help Dr. Knight. The Russian music was turned back up to its normal level.
Within five minutes Knight yelled again as Phil quickly looked up. Phil immediately saw a pulsating stream of blood spraying all over Knight’s chest and surgical mask. He had inadvertently transected the internal mammary artery while trying to reroute it to the heart.
“Crap,” yelled Knight. “Tie that thing off,” he said to Larson as he stepped back from the table. He turned around and the circulating nurse quickly wiped the blood off his mask and forehead area. Knight turned back to the table shaking his head. “We are going to need a lot of vein,” was his next comment to the team. “I don’t think God could have saved that artery.”
And so it went for the rest of the case. Phil and Ranier harvested extra strips of vein, which were peppered with holes. Knight swore like a sailor while patching up the leaks. He struggled suturing each bypass graft together. Each stage of the procedure failed to go smoothly and the case finished two hours behind schedule.
It was noontime before Knight began wiring Mr. Brown’s sternum back together. Per protocol Kate Smith was piped in over the intercom and began singing her rendition of God Bless America. Phil was sure Knight would continue on with the case and ignore tradition. However, like a true warrior, Knight stepped back from the table and put his bloodied right hand on his heart. All activity stopped at the moment in room four. Together the team paid respect to their beloved country. Phil looked at Knight and an odd sense of revere came upon him. He realized that the man standing in front of him had tremendous talent and drive. Although beaten down by the case he proudly stood tall in a moment of silence. He wondered what thoughts were going through Knight’s head.
Phil then looked across the table and saw Ranier staring directly back at him. Her eyes were fixated on his and Phil appreciated a smile behind her mask. Phil smiled back at her. He noted a fine line of sweat across her forehead that permeated her cap. The visual connection continued between the two as Ms. Smith completed her compelling rendition of the song.
After the case, Knight reminded the team that they had three more cases to go. It was going to be a long day for the team with a late finish. Thankfully for all, the next three cases went well as a string of blue bloods returned to the table. The medical students remained banished from the OR for the remainder of the day.
Post op rounds in the SICU started that evening at 7 PM. The CT team along with Knight and Ranier checked on each patient. Everyone was stable. Knight and Ranier then met with each patient’s family in a waiting area. Positive reports were given to each family. No family members were present for William Brown.
Knight’s final words to Larson mandated him to keep a close eye on everyone over night. Then, like a tornado heading out of town, he and Ranier quickly disappeared down the hallway.
“That’s the real Dr. Knight,” said Pete Larson as they headed down to the call room. “He smashed that phone into a million pieces.”
“That first case was jinxed from the start,” said Phil as the entered the call room area. “A curse was upon it.”
Both physicians entered the call area and dropped down onto adjacent couches. Although young in age, each physician was physically exhausted. Sitting in a chair next to them was intern Polk eating a bowl of ice cream.
“Don’t you ever go home?” asked Phil.
“You are in my new home,” replied Polk. “Why live anywhere else, and by the way, please wipe your feet the next time before entering.” Polk then explained to them that he walked out on his slum landlord and moved into the call room the previous night. “I’m here to stay,” was his proud exclamation. “Please don’t call it The Hole anymore. Its new name is The Richard Polk Lounge,” he paused and then said, “Adds a little class.”
