Robin Cook - Host

“But the important point is that there was some documented hypoxia,” Michael said. “The O 2level fell for a couple of minutes, and the ECG changed.”

“But not much. The O 2only fell to ninety-two percent briefly and then went back up to ninety-seven percent. That is not a huge fall and probably about what people experience getting off the plane in Aspen, Colorado. And it was only for three minutes.” Lynn pointed to where it was noted in the handwritten summary.

“Then how come the ECG showed the T wave changes?”

Lynn shrugged. “I don’t know enough to even guess.”

“Let’s check out the machine-generated record.”

Michael turned to the relevant page of the three-page anesthesia record. What they were interested in was the intra-operative portion. Both knew that the modern anesthesia machine was computer driven and kept track of all the variables in real time, including what was portrayed on the monitor. At the end it printed it all out in graphic form. Everything that had happened was recorded, including gases, drugs, fluids used, and all the monitoring parameters.

“And what are you people doing?” a voice questioned. It was not antagonistic but definitely authoritative.

Both Lynn and Michael looked up. Looming over them was Gwen Murphy, the head nurse. She was a stout, ample woman with flame-red hair and rosy cheeks.

Without skipping a beat, Michael said, “We have been sent by anesthesia to check out this case of delayed emergence from anesthesia.”

Gwen eyed Lynn for a moment, then nodded as if buying Michael’s explanation. “The patient is scheduled for an MRI this afternoon.” Without elaboration she turned around and went back to her post in front of all the monitors.

Lynn leaned over to Michael and whispered: “How did you come up with that?” She was impressed. Knowing that what they were doing was more than merely frowned upon by the authorities, Gwen’s sudden appearance and challenge had scared her. She knew she would have tripped over her words had she tried to say anything. So she had been glad Michael had spoken up. She and all the other medical students had been warned they were not permitted to look at charts or electronic medical records, EMRs, unless specifically authorized, most specifically including those of friends or even family members. Patient confidentiality was taken quite seriously by the administration, and looking at records under false pretenses was a serious and punishable offense.

“Practice, I guess,” Michael said. “Did you notice she didn’t look at me?”

“Now that you mention it, I guess I do. I can tell you; she definitely stared at me. I thought it was because I was feeling so guilty that it showed.”

“I don’t think so,” Michael said. “I believe her not looking at me is that unconscious discrimination at work that I’ve mentioned to you. Senior staff, both doctors and nurses, often don’t look at me. But it is okay. I’m used to it. And sometimes it helps, like letting us get away with what we’re doing right now.”

“I’m sorry,” Lynn said.

“Hey, it’s not your fault. And it doesn’t bother me anymore. Anyway, let’s get back to why we’re here.”

Without another word, the two students turned their attention back to the printed anesthesia record. Both could plainly see where the oxygen saturation suddenly fell to 92 percent. Running their eyes down to the associated ECG recording of the heart, they could appreciate the changes that coincided.

“Is that a hypoxic change on the ECG?” Michael asked.

“I believe so,” Lynn said. “I’ll need to find out for sure. I certainly have my work cut out for me.”

“What do you mean?”

“Just what I said. I’m going to figure out why this happened.”

“I’ve seen a case just like this before.”

Lynn looked up at Michael. She was surprised. “Really! When?”

Without answering, Michael looked over at Gwen and Peter. Both were occupied. Taking advantage of the situation, Michael pulled out his smartphone. After quickly turning off both the sound and the flash, he took a photo of the anesthesia record. In the next instant the phone disappeared.

“Jesus!” Lynn croaked in a forced whisper. “Why did you risk that?” Nervously she glanced back at Gwen and Peter. She was relieved to see that Gwen was involved in a conversation with another one of the ICU nurses, and Peter was on the phone busily taking dictation.

“We may need it,” Michael said cryptically. “Are you finished with the chart?”

“I’d like to read the neurology consult, even though I already have a pretty good idea what it says.”

“Let’s do it and hightail it out of here. Then I’ll tell you about the other case.”

Monday, April 6, 12:55 P.M.

As soon as the heavy ICU door closed behind them, Lynn peppered Michael with questions about the supposedly similar case, wanting to know exactly how similar it had been.

“It was exactly the same,” Michael said as they walked along the crowded sixth-floor hallway, skirting lunch carts.

“Was it a delayed emergence from anesthesia?”

“Absolutely. I’m telling you, it was just the same.”

“When was it?”

“About three months back, when we were on pediatrics.”

Lynn was about to ask how Michael had known about the case when she looked ahead. Coming toward them was Dr. Gordon Weaver and, most alarmingly, Markus and Leanne Vandermeer, Carl’s parents.

Like a scared rabbit, Lynn froze. They had not yet seen her, as they were far enough away and there was enough commotion in the corridor between them to create a significant distraction. For a second Lynn thought about turning and running in the opposite direction. Having yet to come to terms with her own raw emotions by any stretch of the imagination, she didn’t know how she would respond should there be any criticism or blame. There was little doubt in her mind that they would be as devastated as she was.

Sensing Lynn’s reaction, and recognizing the parents, Michael firmly grabbed her arm. “Play it cool, sister,” he whispered.

“I’m not sure I’m ready to deal with this,” Lynn croaked. She tried to pull out of Michael’s grasp, but he held on.

“Hang!” Michael said definitively. “You can handle it, and it’s better to get it over with here in the hospital.”

Her pulse racing, Lynn watched them approach. The first to recognize her was Leanne. She was a slight woman wearing a gray, conservative suit, looking like the elementary school teacher she was. When she caught sight of Lynn, her drawn face revived from grief to concerned sympathy. Without the slightest hesitation she came directly at Lynn and enveloped her in a sustained embrace. Lynn was pleasantly surprised. Previously Leanne had never given her more than a slight kiss on the cheek.

“How are you managing, my dear?” Leanne asked, still holding on to Lynn’s arms after the lengthy hug. She was a good six inches shorter than Lynn and had to look up into her face. “Now, I want you to promise me you are going to take this bump in the road in stride. He’ll be waking up soon. Trust me! Everything is going to work out just fine. I’m sure of it. I know how busy you are. Patients are depending on you. You have to take care of yourself and get back to your work.”

Lynn glanced at Michael for support. Thanks to Carl’s descriptions, she was aware Leanne was controlling, but this seemed beyond the pale. The woman was telling her how to respond to the disaster.

“I’m so sorry for you this mild complication had to occur,” Leanne said. “But it will be over soon. I’m certain.”

“I’m sorry, too,” Lynn said. Leanne’s apparent denial of the reality of Carl’s condition was such a surprise that it made it easier for Lynn to control her emotions. Lynn had feared censure and blame but was experiencing empathy. She was both relieved and thankful.