Робин Кук: Charlatans

“I can feel that medication already,” Bruce admitted as he watched the recessed ceiling lights pass overhead. The fear he’d had moments earlier had miraculously already vanished. He felt the need to talk. “When do I get to see Dr. Mason?”

“Soon. I was told he is waiting on us, which is why I’m taking you down to your operating room myself without waiting for an orderly.”

If someone had asked him, Bruce would have said he felt a little tipsy as he entered OR 8 and glanced around at the scene. Almost a year ago he’d had a tour of the new hybrid operating rooms when they had been completed, so he wasn’t surprised by the exotic cream-colored booms hanging from the ceiling or the banks of video monitors or the window looking out at the central desk. As the gurney was guided alongside the operating table, he saw that the scrub nurse was already gowned and masked and busy arranging instruments. He didn’t recognize her with so little of her face visible, but he did recognize the tall circulating nurse, Dawn Williams, who he knew drove a white Ford Fusion. She recognized Bruce in return.

“Welcome, Mr. Vincent,” Dawn said cheerfully as she came around the end of the gurney to help Ava transfer Bruce onto the operating table. “We are going to take especially good care of you just like you do with all our cars.” She let out a bit of muffled laughter.

“Thank you,” Bruce said, as he put his legs over the side of the operating table to face the doughnut-shaped support for his head. His eyes scanned the room for Dr. Mason, but the surgeon was not there. “Where is Dr. Mason?”

“He will be here as soon as we let him know you are all ready for him,” Dawn said.

“Is he still in on his first case?” Ava asked as she and Dawn helped position Bruce with his head in the support. It was a general rule that anesthesia was not started until the surgeon was physically present and part of what was called the “pre-op huddle,” when the surgeon, the anesthesiologist or anesthetist, and the circulating nurse went over the case to make sure everyone was on the same page with all the details. Unfortunately, that was not always the situation with Dr. Mason and a few other members of the surgical hierarchy who were known to flaunt some of the rules in favor of maximizing their productivity. The problem was: They got away with it.

“Yes. Dr. Mason is still in OR fourteen,” Dawn said, “but the OR supervisor said Mason wants us to go ahead and get Mr. Vincent ready for him.”

“Okay,” Ava said with resignation. She donned sterile gloves and began the prep of Bruce’s lower back. She wasn’t happy about starting the case before having laid eyes on Mason, and it wasn’t the first time she’d been put in the same uncomfortable position with him. On five previous occasions, he had insisted she start anesthesia before he was even in sight, much less in the room. Ava liked to do things by the book, believing it was key to patient safety, and starting anesthesia before the surgeon was physically present was a definite violation of her sense of good medical practice.

If truth be told, Ava did not like working with the egotistical Dr. Mason. She was uncomfortable that he felt entitled to bend the rules due to his professed superstar status. Intuitively, she knew that if there was ever a problem on a case, he would not take responsibility and that she would undoubtedly have to bear the burden as the fledgling anesthesiologist. Yet as bad as this concern was, it was not the only reason she wasn’t fond of working with him. She was one of the few single female anesthesiologists on staff and certainly the youngest, and Mason had come on to her on more than one occasion, just as he had done with some of the female anesthetists and OR nurses. He had even called her at home on several occasions, supposedly about discussing upcoming cases, and suggested he “pop” over since he was in the neighborhood, though Ava had always demurred. Although appalled at this behavior, Ava had not communicated her true feelings, as she was afraid to make an enemy of the man. Nor had she said anything to the chief of anesthesia, Dr. Madhu Kumar, who had hired her, since he, too, was in Dr. Mason’s league as a titan in his field, and the two were close. It was Dr. Kumar who did the anesthesia for Dr. Mason’s VIP patients from around the world, just as he was doing that day. Yet for Mason’s less highfalutin patients who were below Dr. Kumar’s interest, such as Bruce Vincent, Mason usually asked for Ava.

The first thing Ava did after the prep of Bruce’s lumbar region was to raise a small wheal with local anesthetic at the site where she would place the spinal needle. After checking to make sure the stylet was properly seated, Ava skillfully pushed the spinal needle into Bruce’s back. “You will feel a little pressure,” she said to him. Within seconds she felt the first pop as the needle penetrated the ligamentum flavum, and a moment later the second pop when it went through the dural covering of the spinal canal. When she was certain as to the proper position of the needle, she introduced the spinal anesthetic bupivacaine. As usual for Ava, the procedure went entirely smoothly. A moment later, she and Dawn helped Bruce lie back down on the operating table.

“My legs don’t feel any different,” Bruce said. He was clearly worried that the anesthesia wasn’t going to work on him.

“It takes a few minutes,” Ava explained as she attached Bruce to all the monitoring devices she had at her disposal. When she was finished and everything was entirely normal, including the ECG, breathing rate, and level of anesthesia, she added a proper dose of propofol as a hypnotic. At exactly 9:58 A.M., Bruce Vincent lost consciousness and fell asleep. By reflex, Ava glanced again at the continuous recordings of Bruce’s vital signs. Nothing had changed, and she began to relax. The beginning of a case was always the most anxiety-producing for her.

Over the next forty minutes, Ava found herself getting increasingly irritated. Despite repeated inquiries out to the OR desk as to Dr. Mason’s ETA and multiple reassurances that his presence was imminent, he still hadn’t appeared. As the time dragged on, Ava faulted herself for having started the spinal when she did. Although she was confident the dose she had given could last as much as two hours more, which was plenty of time for a simple hernia repair, she thought it was inconsiderate for the patient to be waiting for the surgeon, who should have been there from the beginning.

“Dawn!” Ava called out finally, her patience at an end. “Go out to the main desk and demand to know exactly what the hell is going on and when Dr. Mason is going to appear! Talk to Janet Spaulding directly. Let her know the patient’s spinal has been in place for more than a half hour.” Janet Spaulding was the supervisor of the OR and a force to be reckoned with. If anyone could get results, Janet could. She was a fixture in the OR and didn’t take grief from anyone.

Ava exchanged an exasperated glance with Betsy Halloway, the scrub nurse, who had been standing motionless the entire time with her gloved hands clasped over her chest. She had the instruments laid out and covered with a sterile towel. She’d been ready for even longer than Ava had.

Ava scanned Bruce’s data. Everything was normal, including his body temperature. Ava had Dawn put a warm blanket over him when it had become clear Mason was going to be delayed.

Dawn returned quickly. “Good news,” she reported. “Wild Bill will be here momentarily. He is out of OR fourteen. There had been some sort of an unexpected congenital abnormality of the biliary tree in his first patient that required him to spend more time than he’d planned.”

“Good Lord,” Ava mumbled. She looked over her shoulder and through the window to see if Dr. Mason was at the scrub sink, but no one was there. “So where the hell is he?”