Robin Cook: Host

As Carl Vandermeer eased into a hot shower, Dr. Sandra Wykoff leaped out of her BMW X3. She was in a hurry not because she was late but because she was enamored with her work. Unlike Carl Vandermeer, she loved medicine so much that she had not taken a real vacation in the three years she’d been on staff at the Mason-Dixon Medical Center. She was a board-certified anesthesiologist who had trained across town at the older Medical University of South Carolina. She was thirty-five years old, a workaholic, and relatively recently divorced after a short marriage to a surgeon.

From her reserved parking spot on the first floor of the parking garage, she avoided the elevator and took the stairs. It was only one flight, and she liked the exercise. The state-of-the-art operating rooms of the medical center, which was built just after the millennium, were on the second floor. In the surgical lounge she gazed up at the monitor displaying the image of the operating room’s white board. She was assigned to OR 12 for four cases, the first being a right anterior cruciate repair with a patellar allograph by Gordon Weaver under general anesthesia. She was pleased. She particularly liked Gordon Weaver. Like most of the orthopedic guys, he was a gregarious fellow who enjoyed his work. Most importantly, from Sandra’s perspective, he didn’t dawdle and was vocal if there was more blood loss than expected. To her, such communication was important, but not every surgeon was as cooperative. Like all anesthesiologists, she knew that she was the one responsible for the patient’s well-being during an operation, not the surgeon, and she appreciated being informed if anything occurred with the surgery that was out of the ordinary.

Using her tablet PC, Sandra typed in the patient’s name, Carl Vandermeer, along with his hospital number and her PIN to access his nascent EMR, electronic medical record. She wanted to look at his pre-op history. A moment later she knew what she was dealing with: a healthy twenty-nine-year-old male with no drug allergies and no previous anesthesia. In fact there had been no previous hospitalizations for any reason whatsoever. It was going to be an easy, straightforward case.

After changing into her scrubs, she made her way into the OR proper, passing the OR desk commandeered by the extraordinarily competent OR supervisor, Geraldine Montgomery. On her right she passed the entrance to the PACU, which used to be called more simply the recovery room. The pre-operative holding area was on the left. There was a lot of frenetic activity in both rooms. A bevy of nurses and orderlies were preparing for the soon-to-begin and inevitably busy Monday-morning schedule.

As a generally friendly although private person, Sandra greeted anyone who caught her eye, but she didn’t stop to chat or even slow down. She was on her usual early-morning mission. She was eager to check out the anesthesia machine she would be using for the day, something all anesthesiologists and nurse anesthetists were required to do. The difference was that Sandra was more conscientious than most and couldn’t wait to start.

Sandra worshipped the newer anesthesia machine, which was essentially computer driven. In fact it was the expanding role that the computer played in anesthesia that had attracted her to the specialty in the first place. As her father’s daughter, Sandra was also attracted to most everything mechanical. Her father, Steven Wykoff, was an automotive engineer brought to Spartanburg, South Carolina, from Detroit, Michigan, by BMW in 1993. The fact that computers were destined to become more and more involved in medicine was the reason she went to medical school. It was during her third-year surgery rotation that she was introduced to anesthesia, and she was captivated from the start. The specialty was a perfect blend of physiology, pharmacology, computers, and mechanical devices, all of which suited Sandra just fine.

Entering OR 12, Sandra greeted Claire Beauregard, the assigned circulating nurse, who was already busy setting up for the case. But there was no conversation. Sandra stepped over to her trusted mechanical partner, with which she was going to spend most of the day. It bristled with varicolored cylinders of gas, multiple monitors, meters, gauges, and valves. The machine, like all the equipment in the relatively new hospital complex, was a state-of-the-art computer-controlled model. It was number 37 out of nearly 100 total. The number was on a sticker on the machine’s side, which also included its service history.

From Sandra’s perspective the apparatus in front of her was a marvel of engineering. Among its many features was an automatic checklist function that satisfied what the FDA required before use, akin in many respects to the checklist required in a modern aircraft before takeoff to make certain all systems functioned properly. But Sandra did not turn on the machine immediately to initiate the automatic checklist. She liked to check the machine the old-fashioned way, particularly the high-pressure and the low-pressure systems, just to be 100 percent certain everything was in order. She liked to physically touch and operate all the valves. Her hands-on inspection made her feel much more confident than relying on a computer-controlled algorithm.

Satisfied with what she found, Sandra rolled over the stool that would be her perch for the day, sat down, and pulled herself directly up to the anesthesia machine’s front. Only then did she turn on the machine. Spellbound as usual, her eyes stayed glued to the monitor as the apparatus went through its own automated checklist, which included most of what she had already done. A few minutes later the machine indicated all was in order, including the alarms for trouble, such as changes in the patient’s blood pressure and heart function or low oxygen levels in the blood.

Sandra was pleased. When something was amiss, even a minor thing, she was obliged to contact the Clinical Engineering Department, which serviced the anesthesia machines. She found the technicians to be a weird bunch. Those she had had interaction with were all expat Russians with varying fluency in English, most of whom seemed like the teenage computer nerds of her youth. She particularly did not like Misha Zotov, who had sought her out in the hospital cafeteria to engage her in conversation the day after she’d gone down to the department to ask a simple service-related question. He gave her the creeps, even more so by calling her at home a few days later to ask her to have a drink with him. How he’d gotten her unlisted number she had no idea. Her response was to fib and say she was in a committed relationship.

With the anesthesia machine ready to go, Sandra then began checking her supplies and pharmaceuticals with equal diligence. She liked to touch everything she might need so she would know where it was. If there was an emergency, she didn’t want to search for anything. She wanted everything at her fingertips.

Want me to park and come in with you?” Frank Giordano asked Carl as he turned into the Mason-Dixon Medical Center a few minutes after seven. They had been driving in silence. Initially Frank had tried to make conversation as they started northward up King Street, but Carl wasn’t holding up his side. Frank guessed that Carl was stressed out about his upcoming surgery, especially after Carl admitted he was as nervous as hell before they had started out.

“Thanks, but no,” Carl said. “I’m a little late, which I hope means I’m not going to be sitting around.” It was clear he was agitated.

“Hey, man,” Frank said, “you got to relax! It’s no big deal. I had my tonsils out when I was ten. It was a piece of cake. I remember being told to count backward from fifty. I got to about forty-six and the next thing I knew I was being awakened, and it was all done.”