Radclyffe - Turn Back Time

"You're going to lose your foot."

"Well then, why don't you get started?"

"Yes sir. I'll do that." With a small smile, she picked up the wall phone and asked for Margaret Chung, the vascular surgeon, to be paged. Dr. Chung was a young surgeon who allowed the residents a fair amount of autonomy. She answered within five minutes, and Wynter explained the situation.

"Is Rifkin still on service?" Margaret Chung asked.

"Yes."

"Call her and tell her to give you a hand until I get there. Some tractor trailer dumped a load of hams on 95, and I'm going to be about forty-five more minutes."

"Will do. Thanks." Wynter redialed and asked the operator to find Pearce. Then she advised the patient of the plans. "Is there someone you want me to call?"

"You can call my daughter when you're done fixing things."

"She might want to be here before you go to surgery."

He shook his head. "She'll just fuss and worry. Worse, she'll probably cry."

"Well, it's a daughter's prerogative to cry over her father if she wants to. Would you rather she fuss a little bit before surgery, or fuss a lot afterward because we didn't call her?"

"You think that's the way it will be?"

Wynter laughed. "Oh, I can guarantee it."

With a long-suffering sigh, he relented. "Well then, go ahead and call her. But if she doesn't want to come in right away, that's just fine."

"Yes sir. I'll tell her that."

Wynter found his contact information on the chart, asked the operator for the outside number, and was listening to the phone ring when Pearce pulled the curtain aside and stepped in.

"What's up?" Pearce asked.

Wynter covered the receiver and said hurriedly, "This is Mr.

Samuels. His arteriogram is on the board over there. He's got an acute occlusion of the right superficial femoral and a badly ischemic foot....

Hello? Mrs. Rice?"

"Huh." Pearce looked at the films and then walked to the side of the stretcher. She held out her hand. "How are you doing? I'm Dr.

Rifkin. I need to take a look at your foot."

"Why not? Everyone else down here has."

Pearce grinned. "Yeah, but we're the only ones who count."

Mr. Samuels eyed her guardedly. "Don't they have any men doctors anymore?"

"There are a few around. We let them in when we can't find enough good women." As Mr. Samuels snorted and tried unsuccessfully to hide a laugh, Pearce lifted the sheet and placed her hand lightly on the top of Mr. Samuels's foot. It had the consistency and temperature of refrigerated chicken. "How long has it been like this, sir?"

"Since right after supper last night."

She looked up and met his eyes. "Your foot's in a bit of trouble here. You know that you need surgery, right?"

"The other doctor there explained it to me. You two planning on doing something about it?"

"We're going to take you up to the operating room and get things started. By then, Dr. Chung will be here. She's the vascular surgeon who will be in charge. Are you okay with that?"

"Have you ever done this before?"

"A few times." Pearce still held his gaze.

"You think you can be done before lunch? That one," he said, gesturing to Wynter who had hung up the phone and now stood with her arms folded, watching the conversation, "said I can't have anything to eat or drink."

"She's right. I can't promise you lunch, but you should be able to have dinner. Did you take any insulin this morning?"

"No."

"All right. We'll give you some sugar through the intravenous line while you're sleeping and insulin when you need it." She looked over her shoulder at Wynter. "Do we have labs and a consent?"

"We're just waiting on his CBC. I'll get his consent now. Then we're good to go."

"I'll meet you upstairs." Pearce patted Mr. Samuels's thigh. "See you later."

"See you, Doc." He leaned back and closed his eyes. "Did you talk to my daughter?"

"She's on her way."

"Good."

Three hours later, Wynter carefully rotated the tiny bulldog clamps that occluded the femoral vessel on either side of the opening they had made to remove the embolus. Then they had widened the narrowed area by meticulously suturing in a dime-sized vein patch. She studied the sutures she had just placed under Pearce's supervision. Dr. Chung had scrubbed out after Pearce had completed the first half of the anastomosis, leaving them to finish up.

"It looks pretty good, don't you think?" Wynter said.

"It's a thing of beauty," Pearce agreed. "Now let's see if it works."

She raised her voice and angled her head over the top of the ether screen. "We're going to take the clamps off now. You might see a little dip in his blood pressure."

"Go for it. He's stable," the anesthesiologist said.

"Okay," Pearce said to Wynter. "Let's see if your stitches will hold."

Carefully, Wynter released first the distal clamp to allow outflow and then the proximal one to allow the full force of the arterial pressure to stress the area of her repair. At first, thin rivulets of blood seeped between her sutures, but as her heart rate escalated into the stratosphere, the leakage quickly stopped. The artery danced in the depth of the wound as if resurrected. Not yet ready to celebrate, she said, "Can someone feel under the drapes and see if he's got pulses in his foot?"

"Stop worrying," Pearce whispered too softly for anyone else to hear. "It's perfect. You did a great job."

The circulating nurse called, "Plus four pedal and PT pulses. And his foot's warm."

Wynter looked across the table into Pearce's eyes. They were alight with pleasure, and--she couldn't be certain, but she thought- pride. "Fucking A."

"You got that right," Pearce said with a laugh. She glanced at the clock. "I've gotta go scrub on that hemicolectomy with the chief. You okay here?"

"I'm fine, but you're post call. Shouldn't you go ho--"

"Nice job, Doc." Pearce turned from the table, stripped off her gloves and gown, and was gone before Wynter could lecture her about never going home.

v Three and a half hours later, Pearce rolled her patient into the recovery room. She carried the chart to the counter at the nurses' station to write the postop orders. Ten stretchers with barely a foot between them lined the opposite wall, one nurse for every two postoperative patients. X-ray technicians trundled through with their heavy portable machines, shooting postoperative films. Lab techs swarmed around the beds collecting blood samples, and EKG and respiratory techs jockeyed for space around the patients, who were dwarfed by the plethora of monitoring devices and equipment.

Pearce was used to blocking out the cacophony of sound and the buzz of activity, so she wasn't aware of anyone nearby until her father spoke.

"I'd like to speak with you outside in the hall, Doctor."

Pearce finished writing the order she was working on and looked up. "Of course. I'll just be another minute with this."

Ambrose Rifkin, who somehow managed to look commanding even in rumpled scrubs, nodded. A minute later, Pearce joined him just outside the intensive care unit. Neither of them spoke until they walked to the far end of the corridor out of earshot and sight of visitors. If patients' family members saw them, they were likely to be accosted with questions. It was only natural that family members thought that the physicians' only concern was for their loved ones and that physicians were always available to discuss their care. It made accomplishing the work of the day difficult, however, unless one rationed one's time carefully.

"I'd like to speak with you about Dr. Thompson," Ambrose Rifkin said.

Pearce's stomach instantly tightened. "What about her?" She knew she sounded defensive, but she couldn't help it. Her immediate instinct was to protect Wynter.

"I need to know what your--"