Robin Cook: Toxin

"I might have to go back in on that case you helped me with Tuesday," Tom said. "There's been some residual bleeding and unless it stops, my hand is forced. If that happens, I could use your assistance."

"Just page me," Kim said. "I'll be available. My ex wanted the whole weekend. I think she's seeing someone. Anyway, Becky and I will be hanging out together."

"How is Becky doing after the divorce?" Tom asked.

"She's doing fantastic," Kim said. "Certainly better than I am. At this point she's the only bright light in my life."

"I guess kids are more resilient than we give them credit for," Tom said.

"Apparently so," Kim agreed. "Hey, thanks for helping today. Sorry that second case took so long."

"No problem," Tom said. "You handled it like a virtuoso. It was a learning experience. See you in the surgical locker room."

Kim stepped into the recovery room. Hesitating just beyond the threshold, he scanned the beds for his patients. The first one he saw was Sheila Donlon. She'd been his immediately preceding case and had been particularly difficult. She'd needed two valves instead of only one.

Kim walked over to the bed. One of the recovery room nurses was busy changing an almost empty IV bottle. Kim's experienced eye first checked the patient's color and then glanced at the monitors. The cardiac rhythm was normal, as was the blood pressure and arterial oxygenation.

"Everything okay?" Kim asked as he lifted the recovery-room chart to glance at the grafts.

"No problems," the nurse said without interrupting her efforts. "Everything's stable and the patient's content,"

Kim replaced the chart and moved alongside the bed. Gently he raised the sheet to glance at the dressing. Kim always instructed his residents to use minimal dressing. If there was unexpected bleeding, Kim wanted to know about it sooner rather than later.

Satisfied, Kim replaced the sheet before straightening up to look for his other patient. Only about half the beds were occupied, so it didn't take long to scan them.

"Where's Mr. Glick?" Kim asked. Ralph Glick had been Kim's first case.

"Ask Mrs. Benson at the desk." the nurse responded. She was preoccupied putting her stethoscope in her ears and inflating Sheila Donlon's blood pressure cuff.

Mildly irritated at the lack of cooperation, Kim walked over to the central desk but found Mrs. Benson, the head nurse, equally preoccupied. She was giving detailed instructions to several housekeeping workers who were there to break down, clean, and change one of the beds.

"Excuse me," Kim said. "I'm looking…"

Mrs. Benson motioned to Kim that she was busy. Kim thought about complaining that his time was more valuable than the housekeepers, but he didn't. Instead he rose up on his toes to look again for his patient.

"What can I do for you, Dr. Reggis?" Mrs. Benson said as soon as the housekeepers headed off toward the recently vacated bed.

"I don't see Mr. Glick." Kim said. He was still scanning the room, certain he was overlooking the man.

"Mr. Glick was sent to his floor," Mrs. Benson said curtly. She pulled out the controlled-substance log and opened it to the appropriate page.

Kim looked at the nurse and blinked. "But I specifically asked he be kept here until I finished my final case."

"The patient was stable," Mrs. Benson added. "There was no need for him to remain and tie up a bed."

Kim sighed. "But you have tons of beds. It was a matter of…"

"Excuse me, Dr. Reggis," Mrs. Benson said. "The point is Mr. Glick was clinically ready to go."

"But I had requested he be kept," Kim said. "It would have saved me time."

"Dr. Reggis," Mrs. Benson said slowly. "With all due respect, the recovery-room staff doesn't work for you. We have rules. We work for AmeriCare. If you have a problem with that, I suggest you talk to one of the administrators."

Kim felt his face redden. He started to talk about the concept of teamwork, but he quickly changed his mind. Mrs. Benson had already directed her attention to the loose-leaf notebook in front of her.

Murmuring a few choice epithets under his breath, Kim walked out of the recovery room. He yearned for the old days back at the Samaritan Hospital. Stepping across the hall, he stopped at the OR desk. With the aid of the intercom, he checked on the progress of his last case. Tom Harkly's voice assured him the closure was proceeding on schedule.

Leaving the operating suite, Kim marched down the hall to the newly constructed family lounge. It was one of the few innovations AmeriCare had instituted that Kim thought was a good idea. It had come from AmeriCare's concern for amenities. The room was specifically designated for the relatives of patients in the operating or delivery rooms. Prior to AmeriCare's purchase of the University Medical Center, there had been no place for family members to wait.

By that time of day it was not crowded. There were a few of the omnipresent expectant fathers pacing or nervously flipping through magazines while waiting for their wives to have Caesareans. In the far corner a priest was sitting with a grieving couple.

Kim glanced around for Mrs. Gertrude Arnold, the wife of Kim's last patient. Kim wasn't looking forward to talking with her. Her peppery and truculent personality was hard for him to bear. But he knew it was his responsibility. He found the late-sixties woman in the opposite far corner away from the grieving couple. She was reading a magazine.

"Mrs. Arnold," Kim said, forcing himself to smile.

Startled, Gertrude looked up. For a nanosecond her face registered surprise, but as soon as she recognized Kim, she became visibly irritated.

"Well, it's about time!" Mrs. Arnold snapped, "What happened? Is there a problem?"

"No problem at all," Kim assured her. "Quite the contrary. Your husband tolerated the procedure very well. He's resting."

"But it's almost six o'clock!" Gertrude sputtered, "You said you'd be done by three."

"That was an estimate, Mrs. Arnold," Kim said, trying to keep his voice even despite a wave of irritation. He'd anticipated a strange response, but this was more than he'd bargained for. "Unfortunately the previous case took longer than expected."

"Then my husband should have gone first," Gertrude shot back. "You've kept me waiting here all day not knowing what was happening. I'm a wreck."

Kim lost control and in spite of a valiant effort, his face twisted into a wry, disbelieving smile.

"Don't you smile at me, young man," Gertrude scolded. "If you ask me, you doctors are too high and mighty, making us normal folk wait all the time."

"I'm sorry if my schedule has caused you any distress," Kim said. "We do the best we can."

"Yeah, well, let me tell you what else happened," Gertrude said. "One of the AmeriCare administrators came to see me, and he told me that AmeriCare wasn't going to pay for my husband's first day in the hospital. They said he was supposed to be admitted this morning on the day of surgery and not the day before. What do you say to that?"

"This is an ongoing problem I'm having with the administration," Kim said. "When someone is as sick as your husband was before his surgery, I could not in good conscience allow him to be admitted the day of surgery."

"Well, they said they weren't going to pay," Gertrude said. "And we can't pay."

"If AmeriCare persists, then I'll pay," Kim said.

Gertrude's mouth dropped open. "You will?"

"It's come up before and I've paid before," Kim said. "Now, about your husband. Soon he'll be in recovery. They'll keep him there until he's stable, and then he'll go to the Cardiac floor. You'll be able to see him then."

Kim turned and walked from the room, pretending not to hear Mrs. Arnold calling his name.

Retreating back up the hall, Kim entered the surgical lounge. It was occupied by a handful of OR nurses on their breaks and a few of the staff anesthesiologists and anesthetists. Kim nodded to those people he recognized. Having been working at the University Medical Center only since the merger six months previously. Kim didn't know all the staff, particularly the evening and night people.