Робин Кук - Charlatans

“Hardly a VIP,” Bruce responded, but he was pleased. As he had assumed, having Dr. Mason as his surgeon was a major plus. He just hoped his being late wouldn’t screw things up.

Calvin deposited Bruce in the pre-anesthesia holding area in a cubicle defined by curtains. As soon as he left, two nurses appeared: Connie Marchand and Gloria Perkins. Bruce knew both of them, because both commuted to and from the medical center by car. After a bit of banter, mostly about Bruce’s children, Gloria left. Connie went over the paperwork, checked the inked X on Bruce’s right hip, and went through the same questions Martha and Helen had asked. Satisfied that all was in order, Connie gave Bruce’s arm an endearing squeeze and told him that she would let anesthesia know that he was there. “I imagine one of the anesthesiologists will be by right away,” Connie said. “We’ve gotten a few calls about your whereabouts. Dr. Mason doesn’t like to wait.”

“So I hear,” Bruce said. “My bad! Sorry! I was a bit late to Surgical Admitting. Will everything be okay?”

“It should be all right,” Connie assured him.

A few minutes later the curtain was pulled aside and a youthful woman with arctic-blue eyes and tanned skin came to Bruce’s side. She was dressed in blue scrubs, including a hood that completely covered her hair. In a direct and pleasant fashion, she introduced herself as Dr. Ava London, one of the staff anesthesiologists, and then added: “I will be helping Dr. Mason take care of you this morning, Mr. Vincent, while he fixes your hernia. I must say it is a pleasure to meet you. I’ve heard that you are quite a popular guy and that the darling photos I’ve seen on the cafeteria bulletin board are your children.”

“I oversee hospital parking,” Bruce explained, already liking this attractive and personable anesthesiologist. “I am surprised I haven’t met you. Are you new to the staff?”

“Relatively new,” Ava said. “But it is coming up on five years.”

“That is not new,” Bruce said, a tad chagrined, as he prided himself on his knowledge of the medical center’s staff. “I guess you don’t use the garage.”

“No need. I’m able to walk to the hospital,” Ava said as she looked through the paperwork on the clipboard at the foot of Bruce’s gurney. “I live nearby, on Beacon Hill.” She immediately noticed there was no corroborating note by a junior surgical resident. She asked Bruce why.

“Martha Stanley felt there was no need, because Dr. Mason’s fellow had done the history and physical just a few days ago. Truthfully, it was my fault. I was late getting to Surgical Admitting. They wanted to get me over here ASAP.”

Ava nodded. A fellow, having already completed his surgical residency, was certainly more qualified than a junior surgical resident. She glanced through the history and physical. It was totally negative for any medical problems except the run-of-the-mill inguinal hernia. Satisfied that all was in order, she put the clipboard back onto the gurney and reestablished eye contact with Bruce. “So it seems you are in good health.”

“I think so. Can we speed this up? I don’t want Dr. Mason upset that I was a bit late checking in.”

“It is important to do this right. I need to ask you a few questions. I see there is no history of medical problems, particularly no problems with your heart and lungs.”

“None.”

“And you have never had anesthesia?”

“Never.”

“And you haven’t eaten since midnight.”

“Dr. Mason’s fellow said I was going to have spinal anesthesia.”

“That is correct. Dr. Mason’s secretary specifically let us know that the doctor requested spinal anesthesia. Are you okay with that? You know what it is?”

“I do. Actually, I know most of the anesthesiologists and nurse anesthetists, who have told me all sorts of things about anesthesia.”

“An informed patient! That’s helpful for sure. But you realize we have to have consent to use general anesthesia in case there is any problem with the spinal.”

“What kind of a problem are you talking about?”

“The chances of a problem are very small, but we have to be prepared. For instance, if the surgery takes longer than expected and the spinal begins to wear off, we must be prepared to give you general anesthesia. For that reason, we need consent just to cover all the bases. That’s why we are interested in whether you have any problems with your lungs.”

“No problems with my lungs.”

“How about reflux disease?”

“I’m fine! Really, I am. Are you sure we are not holding Dr. Mason up?”

“There is no problem about holding up Dr. Mason, believe me. Now, let’s talk about the spinal. Do you know that we have to put a needle in your back to enable us to give you the anesthetic agent?”

“Yes. I know all about it. Dr. Mason’s fellow gave me the complete rundown and assured me that I won’t feel anything.”

“That is correct. You won’t feel any pain during the operation. I will make absolutely sure of it. But tell me: Do you have any back problems that I should know about?”

“Nope. Back’s fine.”

“Good. What will happen is that when we get you in the room, you will be asked to sit on the side of the operating table with your face and head resting in a support. You will feel a pinch when I put some local anesthetic into the skin of your lower back before putting in the spinal needle. Once the medicine has been introduced into your spine, we will help you lie back down on the table. Now, a question for you: During the operation, do you want to be awake and possibly watch if Dr. Mason is okay with it, or would you prefer to be asleep? Either way, you definitely will feel no pain, and I will be with you for the whole procedure.”

“I want to be asleep! I don’t want to watch anything.” As comfortable as Bruce was with being in the hospital, there was no way he wanted to watch someone cut into him.

“Okay, fine. Then you will be asleep. Now I ask again, have you eaten anything since midnight?”

“No.”

“And you have no known allergies to any medication?”

“No allergies.”

“And you are not taking any drugs, prescribed or otherwise?”

“No drugs.”

“Excellent. Now I will start an IV and get you down to the operating room. I’ve been told Dr. Mason is nearly ready for you. Do you have any questions for me?”

“I can’t think of any,” Bruce said. For the first time, a slight shiver of fear raised a few hackles on the back of his neck. The reality of what he was facing was finally sinking in: He was in the hands of the surgical team and no longer in control of his life.

Dr. London started the intravenous line with such skill and rapidity that Bruce was surprised when it was done. As comfortable as he was with the hospital environment, he fully admitted he never liked venipuncture and always turned his head to the side. “Wow!” he commented. “I hardly felt that. I guess you have started a few IVs.”

“A few,” Ava said. She knew she was good at it, just like she knew she was good at anesthesia in general. She was also sensitive to her patients’ mental state and detected a slight shift in Bruce’s demeanor. “How do you feel? Are you anxious?”

“A bit nervous,” Bruce admitted. His voice, which had been strong and self-assured, now wavered slightly.

“I can give you something to calm you down if you would like,” Ava said, hearing the hint of anxiety.

“I would like,” Bruce said without hesitation.

With a syringe and a medication vial she had in her pocket for this very reason, she quickly gave Bruce four milligrams of her favorite premedication drug, midazolam. Then she disposed of the paraphernalia she’d used to get the IV going, released the brake on Bruce’s gurney, and without waiting for an orderly, pushed Bruce out into the main room, heading for the OR suite.