Radclyffe - Turn Back Time

"No. Dzubrow...one of the other fourth-years...did it with the chief." There was no satisfaction in her voice. The double doors to the ICU were closed, so she swiped her ID through the card lock and punched in the code. "3442," she said for Wynter's benefit.

"Got it."

The doors swung open and they entered the controlled chaos of the surgical intensive care unit. Twelve beds were lined up along the far wall, separated only by curtains and the minimum amount of room to allow a nurse to move in between them. Tables at the foot of each bed were covered with charts and graphs and lab reports. Flexible plastic tubes connected ventilators to many of the motionless patients in the beds. The lights were too bright, the beeping and clatter of machines too loud, and the atmosphere far too impersonal for the severity of the illnesses housed within.

It looked exactly like every other SICU that Wynter had ever been in. "Which one is she?"

"Bed five."

When they reached the bedside, Pearce leaned over the bed rail and smiled at the anxious woman in the bed. "Hi, Mrs. Gilbert. What's going on?"

"I think I sprang a leak, dear."

"This is Dr. Thompson. She's going to check you out." Pearce eased away from the bed and signaled Wynter to move closer. "See what you think."

Wynter pulled on latex gloves and lifted the sheet. "Mrs. Gilbert, I'm going to remove your dressings so I can get a look at the incision.

"Are you having any pain?"

"It's sore. No worse than this morning, though."

"Did this happen while you were coughing?" Wynter lifted one corner of the sterile gauze that covered the midabdominal incision as she talked. A little conversation often helped to distract the patient during the examination.

"Right after that, I think. They told me coughing was good for my lungs. Do you think I shouldn't have done it?"

"No, I think it's important to keep your lungs clear after surgery.

You did fine." Wynter had a good idea of what she would find, and she wasn't surprised to see a glistening pink loop of bowel protruding through the central portion of Mrs. Gilbert's abdominal incision. She gently replaced the bandage.

"Dr. Rifkin and I are going to talk for a minute, and then we'll be right back," she said and turned away. She met Pearce's gaze. "Did you see it?"

"Yep. Looks like we're going to have to do a little repair job. I'll call the chief. You get her ready to go."

"Okay." Wynter turned back to explain to Mrs. Gilbert that her incision had partially opened and that they would need to go back to the operating room to reclose it. She didn't tell her any more, because it wouldn't change the procedure to be done and would only frighten her.

Although it looked gruesome, it wasn't a serious situation as long as they took care of it before infection set in or the bowel was injured. By the time she had the consent signed, Pearce was finishing on the phone.

"Are we all set?"

"Well, the chief is in the middle of the aneurysm, and after that he's got a colon resection waiting."

"She shouldn't sit around here for a few hours," Wynter said quietly.

"That's what I said."

Wynter waited, catching the glint in Pearce's eyes. "And...?"

"Looks like it's you and me, Doc."

Doc. No one else had ever called her that with quite the same mixture of teasing and respect. Wynter smiled.

"Well then, let's go do it."

CHAPTER SIX

"What have you got?" Ambrose Rifkin asked as he backed through the swinging door of the operating room, his gloved hands held at chest level. He'd shed his gown and used gloves after the last case, but kept his freshly gloved hands uncontaminated before he scrubbed again. It allowed him to cut down his time between cases.

Pearce waited several feet away from the operating table, already gowned and gloved, while Wynter prepped the patient's abdomen with Betadine, taking care to avoid the surface of the exposed loop of bowel with the caustic solution. "Mrs. Gilbert, a sixty-three-year-old female, three days post gastric bypass. She dehisced her wound about forty-five minutes ago."

"Any precipitating event?"

"Probably coughing."

"Huh." He walked to within three feet of the table, took one quick glance at the patient's abdomen, and then swept an eye over the monitors at the head of the table. He nodded to the anesthesiologist.

"Everything okay, Jerry?"

"She's fine, Am."

Pearce's father regarded Wynter across the table. "What's your plan here, Dr. Thompson?"

Putting a resident on the spot by asking them to outline a procedure that in all likelihood they would not do was a tried-and-true technique that quickly identified lazy or inferior candidates. It was axiomatic that a resident never came to the operating room without understanding both the problem and the solution, even when they did not expect to be performing the surgery.

Surprised that the chairman even remembered her name, Wynter made a last swipe over the stomach with the prep solution. "We need to extend the incision and do a thorough intra-abdominal washout as well as a visual inspection of the gastric plication." As she stripped off her prep gloves and extended her arms for the sterile gown which the scrub nurse held out to her, she continued, "We ought to culture the wound too."

"What makes you suspect infection?"

The chairman's tone was level, but his inflection suggested that he disagreed with her.

She shrugged, snapping on her sterile gloves. "I don't. But we're here, and it's a simple test to do, and if we miss an early necrotizing fasciitis we're going to look pretty stupid tomorrow."

He laughed. "And we wouldn't want that, would we."

"I don't know about you, sir," Wynter's eyes sparkled above her mask, "but I wouldn't like it."

"Very well, then. Just make sure you use something that's not going to come apart this time."

"I was planning on a nonabsorbable," Wynter said, wisely refraining from pointing out that she had nothing to do with the previous complication. Culpability was not the issue. Correcting the problem was. "O-prolene should be sturdy enough to hold her together."

"Make sure you interrupt the suture every few inches, because I don't want her back here again." As quickly as he had entered, he turned to leave. With his back to the room, he said, "Call me if you have any problems, Dr. Rifkin. I'll be in eight doing the colon."

"Yes sir," Pearce said as the door swung closed behind him. She reached for the sterile sheet that the scrub nurse held out and passed it across the operating table to Wynter, who waited on the opposite side.

"You like to live dangerously," she said low enough that the others couldn't hear.

"Why?"

"That remark about infection--you'd probably be safer with him sticking with protocol."

"Thanks for the tip," Wynter said, meaning it. In many ways, residents bonded and protected one another, very much like other closed societies such as the military or police. They covered for each other, and they very rarely laid blame, knowing next time they could be the one whose actions were being scrutinized.

"He seemed to take it well enough."

"That's because you're a bit of a cowboy, and he likes that. You wanna be careful, though, because that kind of confidence can backfire if you're wrong."

Wynter snapped the sterile drape down over the patient's feet and picked up the next one that would cover her head. "Well, you should know. You've got hot dog written all over you, and I don't mean with chili and mustard."

"Maybe," Pearce said lightly, "I'm just really good."

"And maybe," Wynter said, "so am I."

"Let's find out."

When they'd finished draping off the sterile field, leaving only a square of abdomen around the open incision exposed, Wynter automatically circled the foot of the table to the left side, to the assistant surgeon's position. When Pearce didn't move out of her way, she stopped in puzzlement. "What?"