Tess Gerritsen - The Surgeon

I focus on his electrolytes. His potassium levels have been steadily climbing. 4.5 two weeks ago. 4.8 last week. 5.1 yesterday. He is old and his diabetic kidneys are struggling to excrete the everyday toxins that accumulate in the bloodstream. Toxins such as potassium.

It will not take much to tip him over the edge.

I have never met Mr. Herman Gwadowski — at least, not face-to-face. I go to the rack of blood tubes which have been sitting on the counter and look at the labels. The rack is from 5 East and West, and there are twenty-four tubes in the various slots. I find a red-top tube from Room 521. It is Mr. Gwadowski’s blood.

I pick up the tube and study it as I slowly turn it under the light. It has not clotted, and the fluid within looks dark and brackish, as though the needle that punctured Mr. Gwadowski’s vein has instead hit a stagnant well. I uncap the tube and sniff its contents. I smell the urea of old age, the gamey sweetness of infection. I smell a body that has already begun to decay, even as the brain continues to deny the shell is dying around it.

In this way, I make Mr. Gwadowski’s acquaintance.

It will not be a long friendship.

Angela Robbins was a conscientious nurse, and she was irritated that Herman Gwadowski’s ten o’clock dose of antibiotics had not yet arrived. She went to the 5 West ward clerk and said, “I’m still waiting for Gwadowski’s IV meds. Can you call Pharmacy again?”

“Did you check the Pharmacy cart? It came up at nine.”

“There was nothing on it for Gwadowski. He needs his IV dose of Zosyn right now.”

“Oh. I just remembered.” The clerk rose and crossed to an in box on the other countertop. “An aide from Four West brought it up a little while ago.”

“Four West?”

“The bag was sent to the wrong floor.” The clerk checked the label. “Gwadowski, Five-twenty-one-A.”

“Right,” said Angela, taking the small IV bag. On the way back to the room, she read the label, confirming the patient’s name, the ordering physician, and the dose of Zosyn that had been added to the bag of saline. It all appeared correct. Eighteen years ago, when Angela had started work as a newly minted nurse, an R.N. could simply walk into the ward’s supply room, pick up a bag of IV fluid, and add to it the necessary medications. A few mistakes made by harried nurses, a few highly publicized lawsuits, had changed all that. Now even a simple IV bag of saline with added potassium had to come through the hospital pharmacy. It was another layer of administration, another cog in what was already the complicated machinery of health care, and Angela resented it. It had caused an hour’s delay in this IV bag’s arrival.

She switched Mr. Gwadowski’s IV tubing to the new bag and hung the bag on the pole. Through it all, Mr. Gwadowski lay unmoving. He’d been comatose for two weeks, and already he exuded the smell of death. Angela had been a nurse long enough to recognize that scent, like sour sweat, that was the prelude to the final passing. Whenever she detected it, she would murmur to the other nurses: “This one’s not going to make it.” That’s what she thought now, as she turned up the IV flow rate and checked the patient’s vital signs. This one is not going to make it. Still, she went about her tasks with the same care she gave to every patient.

It was time for the sponge bath. She brought a basin of warm water to the bedside, soaked a washcloth, and started by wiping Mr. Gwadowski’s face. He lay with mouth gaping open, the tongue dry and furrowed. If only they could let him go. If only they could release him from this hell. But the son would not even allow a change in the code status, and so the old man lived on, if you could call this living, his heart continuing to beat in its decaying shell of a body.

She peeled off the patient’s hospital gown and checked the central venous line skin site. The wound looked slightly red, which worried her. They had run out of IV sites on the arms. This was their only IV access now, and Angela was conscientious about keeping the wound clean and the bandage fresh. After the bed bath, she would change the dressing.

She wiped down the torso, running her washcloth across the ridges of rib. She could tell he had never been a muscular man, and what was left now of his chest was merely parchment stretched across bone.

She heard footsteps and was not happy to see Mr. Gwadowski’s son come into the room. With a single glance, he put her on the defensive — that’s the sort of man he was, always pointing out mistakes and flaws in others. He frequently did it to his sister. Once Angela heard them arguing and had to stop herself from coming to the sister’s defense. After all, it was not Angela’s place to tell this son what she thought of his bullying. But she need not be overly friendly to him, either. So she merely nodded and continued with the sponge bath.

“How’s he doing?” asked Ivan Gwadowski.

“There’s been no change.” Her voice was cool and businesslike. She wished he would leave, would finish his little ceremony of pretending to care, and let her get on with her work. She was perceptive enough to understand that love was but a minor part of why this son was here. He had taken charge because that’s what he was accustomed to doing, and he wouldn’t relinquish control to anyone. Not even Death.

“Has the doctor been in to see him?”

“Dr. Cordell comes in every morning.”

“What does she say about the fact he’s still in a coma?”

Angela put the washcloth in the basin and straightened to look at him. “I’m not sure what there is to say, Mr. Gwadowski.”

“How long will he be like this?”

“As long as you allow him to be.”

“What does that mean?”

“It would be kinder, don’t you think, to let him go?”

Ivan Gwadowski stared at her. “Yes, it makes everyone’s life easier, doesn’t it? And it frees up another hospital bed.”

“That’s not why I said it.”

“I know how hospitals get paid these days. The patient stays too long, and you eat the costs.”

“I’m only talking about what’s best for your father.”

“What’s best is that this hospital does its job.”

Before she could say anything she regretted, Angela turned and grabbed the washcloth from the basin. Wrung it out with shaking hands. Don’t argue with him. Just do your job. He’s the kind of man who’ll take it all the way to the top.

She placed the damp cloth on the patient’s abdomen. Only then did she realize that the old man was not breathing.

At once Angela felt the neck for a pulse.

“What is it?” asked the son. “Is he okay?”

She didn’t answer. Pushing right past him, she ran into the hall. “Code Blue!” she yelled. “Call a Code Blue, Room Five-twenty-one!”

Catherine sprinted out of Nina Peyton’s room and rounded the corner into the next hallway. Personnel had already crowded into Room 521 and spilled out into the corridor, where a group of wide-eyed medical students stood craning their necks to see the action.

Catherine pushed into the room and called out, over the chaos: “What happened?”

Angela, Mr. Gwadowski’s nurse, said: “He just stopped breathing! There’s no pulse.”

Catherine worked her way to the bedside and saw that another nurse had already clapped a mask over the patient’s face and was bagging oxygen into the lungs. An intern had his hands on the chest, and with each bounce against the sternum he squeezed blood from the heart, forcing it through arteries and veins. Feeding the organs, feeding the brain.

“EKG leads are on!” someone called out.

Catherine’s gaze flew to the monitor. The tracing showed ventricular fibrillation. The chambers of the heart were no longer contracting. Instead, the individual muscles were quivering, and the heart had turned into a flaccid bag.