Robin Cook - Host

“I’m counting on not having a problem, provided we don’t act hesitant or indecisive.”

“What is it you want to do, exactly?”

“Mainly I just want to look at the chart. But we’re not just going directly to the desk and grab the chart without checking out the patient. That’s not cool. It’s not the way it’s done. You know what I’m saying? Do you remember where Carl is? That would be a help. We don’t want to draw attention to ourselves by acting lost.”

“He’s in cubicle number eight, I believe, but I could be wrong. My mind’s in turmoil.”

“All right, here’s the plan. We head directly into cubicle eight. Provided it’s the right address, we check out Carl’s current status. If it’s not, we find him, fast! You okay with that? You don’t have to do anything. Just hang. I’ll do something appropriate to make it look official.”

“All right,” Lynn agreed, although she wasn’t entirely sure her emotions wouldn’t take over.

“Let’s do it!” Michael said with conviction.

With Michael half a step ahead and moving at a quick pace, they passed the busy sixth-floor central desk and headed for the ICU. At the door Michael hesitated for a split second to glance at Lynn, arching his eyebrow. Lynn assumed he was questioning her mental state, so she nodded. She was as ready as she was going to be.

Michael pushed through the heavy door. Inside was a different world. Gone were the noise of the lunch carts, the babble of voices, and the sense of commotion. In its place were the muted electronic sounds of the monitoring and the to-and-fro cycle of a couple of ventilators. Otherwise a heavy stillness reigned. The patients were all completely immobile.

As he had said, Michael made a beeline for cubicle 8. Lynn’s memory had served her well. Carl was in the bed and momentarily alone. The half dozen nurses and an equal number of aides on duty were occupied with other patients.

Michael went to Carl’s right, and Lynn to his left. Carl appeared to be sleeping as he had before, save for the jerking of his free leg. Again Lynn had to suppress the almost irresistible urge to reach out and shake him awake. For the briefest moment she felt a twinge of anger, as if Carl were doing this on purpose.

“Deceptively peaceful,” Michael said.

Lynn nodded. Tears again threatened. She tried to think objectively about what might be going on in Carl’s brain. She watched as Michael took out his penlight. After raising both of Carl’s upper lids, he shined the light alternately in each eye. “Pupils are equal and maybe sluggish, but both react. Nothing to ‘fatmouth’ about, but it is something. At least the brain stem is still working.”

Lynn nodded again but didn’t speak. As a defense mechanism she thought about the doll’s eye movement that the neurology resident had shown her, and its implications.

“Vital signs are normal,” Michael said.

Lynn followed his gaze up to the monitor. Everything was as it had been earlier, including the oxygen saturation, at 97 percent.

“All right,” Michael said, lowering his voice and looking across at Lynn. “So far, so good.” The busy nurses seemed indifferent to their presence. “Let’s mosey over to the central desk. And try to relax, girl! You look like you are about to rob a bank.”

Lynn didn’t bother to answer. She tolerated his mildly disrespectful language just as he allowed her to call him “boy” on occasion. It was only when they were certain no one else was listening that they used such slang. It was another sign of their closeness and shared understanding of discrimination.

The circular central desk was usually dominated by the duo of the head nurse, Gwen Murphy, and the very capable long-term clerk, Peter Marshall, who had been around so long he felt proprietary. From their neurology rotation Michael and Lynn remembered both of them as efficient and professional and very helpful. At the moment only Peter was present. As usual, like all ward clerks, he was on the phone, but he raised his eyebrows questioningly as he gave them a once-over. At the moment Gwen was apparently occupied elsewhere.

Under the lip of the surrounding countertop were flat-screen monitors displaying the readouts of the vital signs of each patient. Lynn’s eyes went directly to 8. Everything was normal. On top of the countertop was a rotating chart rack.

“Hey, dude,” Michael said to Peter as a greeting, evoking a roll of the eyes on Peter’s part. Not giving him a chance to respond, Michael turned his attention to the chart rack, which he gave a deliberate spin. He stopped it so the slot for cubicle 8 was facing him. Without the slightest hesitation Michael withdrew the chart, grabbed a couple of chairs, and pulled them off to the side. He motioned to Lynn to take one, and he sat in the other. He opened the chart and rapidly leafed through to the anesthesia record.

As Michael was doing this, Lynn watched Peter out of the corner of her eye. As Michael had anticipated, he seemed to ignore them, at least until he finished his current phone conversation. Then he said, “Hey, can I help you guys?”

“We were told to check out the anesthesia record on Vandermeer,” Michael said. “And we got it right here. Thanks! Take a look, Lynn!”

Michael positioned the chart so that Lynn could see. There was a handwritten note by the anesthesiologist, Dr. Sandra Wykoff, as well as the three-page printed version done by the anesthesia machine. They read the handwritten note, which was thankfully easy to read in contrast to a lot of notes that they had had to read by doctors in hospital charts over the last couple of years:

Healthy 29 year old Caucasian male in excellent health scheduled for anterior cruciate repair of right knee under general anesthesia. Anesthesia machine function checked both manually and automatically. Some pre-op anxiety. Pre-op medication Midazolam 10mg IM at 7:17 am with good result. Patient relaxed. Intravenous catheter placed without difficulty. Breathed 100 % oxygen with face mask beginning at 7:22 am. Induction with 125mg Propofol IV at 7:28 am. 100 % oxygen given by face mask before laryngeal mask airway LMA 4 placed and inflated with no problems. Isoflurane, nitrous oxide, and oxygen began at 7:35 am. Eyes taped shut. Vital signs normal and stable. ECG normal. Oxygen saturation stable at 99–100 %. Spontaneous respiration with normal volume and rate. Operation commenced with placement of tourniquet on right leg. No changes in vital signs, ECG, and oxygen saturation. Fifty minutes into the case at 8:28 am as requested surgeon communicates he is within forty minutes of completion. At 8:38 am isoflurane shut off. Nitrous oxide and oxygen continued. At 8:39 am low-oxygen alarm sounds as oxygen saturation falls precipitously from 98 % to 92 %. At same moment ECG shows tenting of T waves. Oxygen flow increased. Oxygen saturation rapidly climbs back to 97 % at 8:42 am. Low-oxygen alarm shuts off. ST waves on ECG return to normal. Nitrous oxide flow reduced at 8:44 and ventilation assist started. At 8:50 am decorticate leg hyperextension with both lower extremities noted by the surgeon and pupils noted to be dilated with sluggish reaction to light. Nitrous oxide stopped at 8:52 am and pure oxygen maintained. Ventilation assist turned off at 8:58 am as patient’s breathing returned to normal volume and rate. Surgeon removes tourniquet and completes the case at 9:05 am. Patient fails to wake up. Chief of anesthesia, Dr. Benton Rhodes, called in on the case. Under his direction Flumazenil given in 0.2mg increments X 3 with no observable result. At 9:33 am patient taken to PACU while continuing to breathe 100 % oxygen. Emergency neurology consult called. Vital signs, ECG, and oxygen saturation remain normal and stable.

Michael and Lynn finished at almost the same moment and looked up at each other. “I don’t know much about anesthesia,” Lynn said. “We only had that one lecture about the basics in our surgery rotation. I’m going to have to do some research to understand it all.”