Eric Dimbleby: White Out

“You need to stabilize him before I can take him!” He was shouting again.

She hoped she could keep the contempt out of her voice. “He has been on Imipenem and Vanc since he’s been in. I added metronidazole last night. I cannot expand coverage any more than that. I can’t put him on an antifungal without evidence with his kidneys and liver failing. He has Kleb growing in the blood and they called me last night with an anaerobe that turned up in his blood. That is two bugs in the bloodstream. That is evidence of a communication between the gut and the vascular system. I cannot help him with antibiotics, so you need to open him up, find the abscess and drain it.”

“Is it KPC?” He was accusatory again.

“No.”

“How do you know?” Now he was mocking her.

“The C&S is in the chart,” Dr. Nakshband answered, “it’s pan-sensitive.”

“So you’re telling me that now I have to worry about this guy bleeding on the table with an entero-vascular fistula? If I drain that abscess and there’s an artery in there, he’s gonna spew.” Slagle was getting angrier.

“It looks that way,” she said.

“I don’t need this guy dying on the table! I don’t need an inquiry!” Now he was screaming. “He’s too unstable! Anesthesia won’t do it!”

“I spoke with Heidelberg, he’ll do it,” Nakshband answered calmly.

She could tell the surgeon was furious. “Oh, I see you covered your bases, leaving me with MY balls on the table. You need to stabilize him!” Slagle ordered.

“I can’t,” she responded calmly, “the source of infection has to be removed.”

“Thought you were some Ivy League whiz kid?” Slagle taunted.

Deeta really had the mind just to lay into him. It was Slagle’s hesitance that caused the patient to deteriorate. His insistence they find the abscess before he went to surgery, and that delay in surgery is what is killing this patient. “If he doesn’t go to surgery,” she thought, “this guy will die, and you, Slagle, are the largest liability on this case. And when we get sued, I will paint a huge fucking target on your forehead. This guy needed to go to surgery the day he was admitted. I said so, the pulmonologist said so, the cardiologist said so, and the nephrologist said so. Even the fucking ER physician said so. Three days of notes, saying this guy needs surgery before he tanks, and you’re holding out because you wanted him more stable. That’s five against one, all with better minds than you, and you’ll not find any credible expert witnesses that will justify your temporization. Oh, yeah, open up your checkbook, motherfucker, this one is going to cost you. Your balls on the table? What balls? You don’t have any balls to put on the table.”

However, Nakshband knew she couldn’t say it. Countless other physicians had pissed him off before, and he would sign off the case and she could not risk that now. No other surgeon would accept a patient in an emergency like this, not with a greater than 50% risk of mortality in the OR. Administration would have to assign another surgeon or force Slagle to stay on. More than likely the latter. If Slagle remained on the case, he’d hold his ground, and delay surgery until the patient died. If they forced another surgeon to take this case, the patient would die before one was assigned.

“Look,” she said in her best understanding voice, “we tried stabilizing before surgery, this was the risk. We cannot delay it further. Without this surgery, he dies TODAY. Is the wife there?” Deeta asked.

“Yes,” he answered.

“If I explain to her that he will more than likely die in surgery, and she accepts this risk, will you take him to surgery?”

“What about my numbers?” he asked.

“I can’t do anything about that,” Nakshband replied.

“No you can’t, can you?” He paused. “Get the wife,” he said to the nurse.

She half expected him to hang up the phone. A female voice came on the phone. “Mrs. Callenetti, this is Dr. Nakshband.”

“Who?” The woman answered.

“Deeta,” Dr. Nakshband clarified.

“Oh, oh, I’m so sorry. I only know you as Dr. Deeta. I have a bad problem with foreign names, I’m so sorry, I know it’s improper,” Mrs. Callenetti said trailing off.

“No, no, it’s okay,” Deeta replied, “everyone calls me that. Listen, your husband is very sick. He has an infection in his abdomen and we need to get it out. We tried to get him healthier before the surgery with antibiotics, but the infection was too far advanced when we started. If he doesn’t have surgery, he will die.”

“Dr. Slagle says he’s too sick to take to surgery,” Mrs. Callenetti answered.

“Well, he is,” Deeta answered. “Usually, someone this sick, we wouldn’t take to surgery. We would try to get him more stable. However, we are already doing all that we can and he is getting worse. I can’t give him any more drugs and turn him around. What I need you to understand is that there is a very good chance he will die in surgery, but it is our only chance to save him. He WILL die if he doesn’t have surgery.”

“Oh, I see,” after a long pause, “I need to call my daughter.”

“Mrs. Callenetti,” Deeta started, “what are you going to tell her? I need to know you fully understand what is happening with your husband. Tell me exactly what you are going to say to her.”

Mrs. Callenetti paused, “Daddy is really sick.” Then she began to cry. Through the sobs, she continued, “He will die if he doesn’t have surgery, and he might die during the surgery, but it’s the only chance we have to save him.”

Deeta was tearing. “Yeah, that’s it,” she whispered. It was as strong as her voice could get, “you got it.”

“Okay, I’ll call her,” Mrs. Callenetti said.

The next voice she heard was Slagle. “We should just put this guy on comfort measures.” There wasn’t enough time for his wife to be out of earshot when he said it.

Deeta came unglued. “He’s 56 years old! Younger than you! His youngest kid is in High School! Do your fucking JOB! You should have done it three fucking days ago, you stupid, prickless son of a BITCH!”

“HEY…” The doctor shouted as she turned off the cell phone.

“That was probably a mistake,” she thought.

Janelle sat quietly, listening.

“Fucking asshole,” Deeta responded.

“You know it’s conversations like that, which have all those cell phone/driving laws in place,” Janelle chirped.

“Just another day at the office,” Deeta sighed. Janelle wanted the details but it could wait. Eventually, she would find out if this guy made it, what happened. They’d talk about it over dinner when she got back.

“American,” Janelle said referring to the airline.

“I’d walk you to security, but I need to get back there,” Deeta said as she was pulling to the drop off.

“I’m a big girl. I can get there myself.” Janelle got out of the car and walked to the rear. Deeta popped the trunk and yelled, “Be safe,” through the open passenger window. Janelle turned and waved with a smile. Deeta pulled back into traffic and drove away from the airport.

Deeta Nakshband moved to Connecticut from India when she was eight. Her parents were not doctors. They owned franchised doughnut stores, six of them. She was able to attend Yale as expected, and her parents footed the bill. She was accepted at UCONN for medical school, but she was also accepted at Yale. Although she was more than happy to go to public school, her parents preferred prestige over economy. Deeta, the practical one, could not put this kind of burden on her parents. She still had a brother in his sophomore year at MIT and a sister in law school when she was accepted. Deeta joined the United States Navy and served eight years in order to finance her own education. After the Navy, she did her Infectious Disease fellowship at Columbia in New York, and then returned to Connecticut to be near family and build her practice.