Critical

8

It had not been a good day for Ramona Torres, age thirty-seven, mother of three children ranging in age from five to eleven. Her husband had awakened her at the first blush of dawn in order to drive her to the Angels Cosmetic Surgery and Eye Hospital for her surgery. It was so early that she had to wake the children to say good-bye. Once at the hospital, he had had to drop her off at the posh entrance, where the doorman had relieved her of her overnight bag. She had waved as he pulled away to return home to the Bronx and see that the children had their breakfast before school. She really would have preferred that he'd come in with her to lend moral support.

Ramona had always had a general fear of hospitals, but her fears had been significantly magnified during her last hospitalization by the difficult delivery of her youngest child. The rocky, postpartum course during which she had almost died had required emergency surgery. Although it had been carefully explained to her after the fact that the venous embolism she'd suffered had not been anyone's fault and that everything had been done to avoid such a complication, Ramona had still blamed the hospital. Even Ramona's husband, an attorney, had been unable to change her opinion, such that when Ramona had entered the hospital that morning, her heart had been beating faster than usual and the perspiration dotting her forehead had not been from being too warm.

As Ramona had changed out of her clothes and donned the traditional hospital garb in the same-day-surgery area, she had been tense and had tried to hide her trembling from the nurses and nurse's aides. If someone had asked her what she was afraid of, she wouldn't have been able to tell them, although suffering another venous embolism would have been high on the list. Also on the list was undergoing anesthesia. The idea of another person, no matter how well trained, being in control of whether she lived or died was enormously unsettling. Mistakes happened, and Ramona did not want to be another mistake. As a medical secretary, she had had more than enough knowledge of all that could go wrong.

With such a mind-set, Ramona had almost changed her mind about having the surgery while she had waited on the gurney in the admitting area. But then her vanity had intervened. With her last child, she'd experienced a significant weight gain, which had never melted away as it was supposed to; in fact, it had substantially worsened to the point that Ramona herself admitted she was obese. Although Ricardo, her husband, had never said anything about being disenchanted, she knew he didn't like it. She didn't like it herself, especially when her oldest, Javier, said it embarrassed him. Since Ramona had struggled to restrict her caloric intake, she had reluctantly decided on liposuction, which a friend had had with great success. Hoping for a similar result, Ramona had visited her friend's plastic surgeon, and she'd been scheduled.

After a three-and-a-half-hour operation, Ramona had awakened vomiting, and as unpleasant as that had been, things got progressively worse. The only high point had been a quick visit with Ricardo, who'd taken time off from the office to visit when Ramona had been moved from the post-anesthesia unit to her luxurious room. He'd not been able to stay long, which Ramona did not regret because she'd been remarkably uncomfortable. She'd not been able to find a position that didn't aggravate her pain, and her painkillers, which she could self-administer, seemed to have no discernible effect whatsoever.

Then, a half-hour after Ricardo left, she'd suffered a shaking chill, the likes of which she'd never experienced. It started in the core of her body and then spread out to the very tips of her fingers. Alarmed at such a development and with her teeth chattering, she'd immediately called the nurse, who had responded quickly with a blanket. The nurse also had taken Ramona's temperature and recorded it as 101.8 degrees, a respectable fever.

"It's not uncommon," the nurse had said. "With an extensive liposuction like yours, it's as if you have a very large wound, even when all you can see are the small incisions on your skin."

Ramona had been content with that explanation until the moment when more disturbing symptoms emerged. All at once, she was aware of a vague feeling of pressure in her chest, an urge to cough, and a sense that she couldn't quite get a full breath of air. If Ramona had not had the experience with venous embolism after her last delivery, she might not have panicked as she did. She reached for her call button and pressed it repeatedly.

"Mrs. Torres, you only have to ring once," the nurse admonished, as she quickly came into the room and arrived at Ramona's bedside.

Ramona explained her symptoms and her fear of having a pulmonary embolism. The nurse rapidly retook her temperature which had climbed only a tenth of a degree, and retook her blood pressure, which was mildly lower.

"Am I having an embolism?" Ramona anxiously asked.

"I don't think so," the nurse said. "But I'm going to call your surgeon just the same."

At that moment Ramona coughed, which she had been trying to avoid, because any movement aggravated the postoperative pain When she coughed and expectorated into a tissue, she saw something that alarmed her even more. It alarmed the nurse as well. The considerable mucus was bloody through and through, and not merely streaked.