Toxin

TWO

Friday, January 16th

All twenty-five of the University Medical Center 's operating rooms were identical. Having been recently renovated and re-equipped, they were up-to-the-minute in every way. The floors were a white composite that gave the impression of granite. The walls were gray tile. The lights and fittings were either stainless steel or gleaming nickel.

OR twenty was one of two rooms used for open-heart surgery and at four-fifteen it was still in full operation. Between the perfusionists, anesthesiologists, circulating and scrub nurses, the surgeons and all the necessary high-tech equipment, the room was quite crowded. At that moment the patient's still heart was in full view, surrounded by a profusion of bloodstained tapes, trailing sutures, metal retractors, and pale green drapes.

"Okay, that's it," Dr. Kim Reggis said, as he handed his needle holder to the scrub nurse and straightened up to relieve the stiffness in his back. He'd been operating since seven-thirty that morning. This was his third and final case. "Let's stop the cardioplegia solution and get this ticker going."

Kim's command resulted in a minor flurry of activity at the console of the bypass machine. Switches were flipped. "Warming up," the profusionist announced to no one in particular.

The anesthesiologist stood and looked over the ether screen. "How much longer do you estimate?" she asked.

"We'll be closing here in five minutes," Kim said. "Provided the heart cooperates, which looks promising."

After a few erratic beats, the heart picked up its normal rhythm.

"Okay," Kim said. "Let's go off bypass."

For the next twenty minutes there was no talk, everyone on the team knew his job, so communication wasn't necessary. After the split sternum had been wired together, Kim and Dr. Tom Bridges stepped back from the heavily draped patient and began removing their sterile gowns, gloves, and plastic face shields. At the same time the thoracic residents moved into the vacated positions.

"I want a plastic repair on that incision," Kim called to the residents. "Is that understood?"

"You got it. Dr. Reggis," Tom Harkly said. Tom was the Chief Thoracic resident.

"But don't make it your life's work," Kim teased. "The patient has been under long enough."

Kim and Torn emerged from the OR into the operating-room corridor. Both used the scrub sink to wash the talc off their hands. Dr. Tom Bridges was a cardiac surgeon like Kim. They had been assisting each other for years and had become friends although their relationship remained essentially professional. They frequently covered for each other, especially on weekends.

"That was a slick job," Tom commented. "I don't know how you manage to get those valves in so perfectly and make it look so easy."

Kim's practice over the years had evolved into mostly valve replacement. Tom had gravitated more toward bypass procedures.

"Just like I don't know how you can sew those tiny coronary arteries the way you do," Kim answered.

Leaving the sink, Kim interlocked his fingers and stretched them high over his six-foot-three-inch frame. Then he bent down and put his palms on the floor, keeping his legs straight to stretch out his lower back. Kim was an athletic, trim, sinewy type who'd played football, basketball, and baseball for Dartmouth as an undergraduate. Because of the demands of time his current exercise had been reduced to infrequent tennis and lots of hours on a home exercise bike.

Tom, on the other hand, had given up. He, too, had played football in college, but after years of no exercise, the muscle bulk that he'd not lost had turned mostly to fat. In contrast to Kim, he had a beer belly despite the fact that he rarely drank beer.

The two men started down the tiled corridor, which at that time of day was relatively peaceful. Only nine of the OR's were in use, with two more available for emergencies. It was about standard for the three-to-eleven shift.

Kim rubbed his stubbled, angular face. Following his normal routine, he'd shaved that morning at five-thirty, and now, twelve hours later, he had the proverbial five-o'clock shadow. He ran a hand through his long, dark brown hair. As a teenager in the early seventies he'd let his hair grow beyond shoulder length. Now, at forty-three, it was still on the long side for someone in his position, though it was nowhere near as long as it had been.

Kim looked at his watch pinned to his scrub pants. "Damn, it's five-thirty already, and I haven't even made rounds. I wish I didn't have to operate on Friday. Invariably it cuts into any weekend plans."

"At least you get to have your cases run consecutively," Tom said. "It's sure not like it used to be when you ran the department over at the Samaritan."

"Tell me about it," Kim said. "With AmeriCare calling the shots and with the current status of the profession, I wonder if I'd even go into medicine if I had it all to do over again."

"You and me both," Tom said. "Especially with these new Medicare rates. Last night I stayed up and did some figuring. I'm afraid I'm not going to have any money left after I pay my office overhead. I mean, what kind of a situation is that? It's gotten so bad Nancy and I are thinking of putting our house on the market."

"Good luck," Kim said. "Mine's been on the market for five months, and I haven't even had a serious offer."

"I already had to pull my kids out of private school," Tom said. "But hell. I went to public school myself."

"How are you and Nancy getting along?" Kim asked.

"To be honest: not great," Tom said. "There've been a lot of bad feelings."

"I'm sorry to hear that," Kim said. "I sympathize since I've been through it, it's a stressful time."

"This is not how I expected things to be at this stage in my life," Tom said with a sigh.

"Me neither," Kim said.

The two men stopped just beyond the OR desk at the entrance to the recovery room.

"Hey, are you going to be around for the weekend?" Tom asked.

"Yeah, sure," Kim said. "Why? What's up?"

"I might have to go back in on that case you helped me with Tuesday," Tom said. "There's been some residual bleeding and unless it stops, my hand is forced. If that happens, I could use your assistance."

"Just page me," Kim said. "I'll be available. My ex wanted the whole weekend. I think she's seeing someone. Anyway, Becky and I will be hanging out together."

"How is Becky doing after the divorce?" Tom asked.

"She's doing fantastic," Kim said. "Certainly better than I am. At this point she's the only bright light in my life."

"I guess kids are more resilient than we give them credit for," Tom said.

"Apparently so," Kim agreed. "Hey, thanks for helping today. Sorry that second case took so long."

"No problem," Tom said. "You handled it like a virtuoso. It was a learning experience. See you in the surgical locker room."

Kim stepped into the recovery room. Hesitating just beyond the threshold, he scanned the beds for his patients. The first one he saw was Sheila Donlon. She'd been his immediately preceding case and had been particularly difficult. She'd needed two valves instead of only one.

Kim walked over to the bed. One of the recovery room nurses was busy changing an almost empty IV bottle. Kim's experienced eye first checked the patient's color and then glanced at the monitors. The cardiac rhythm was normal, as was the blood pressure and arterial oxygenation.

"Everything okay?" Kim asked as he lifted the recovery-room chart to glance at the grafts.

"No problems," the nurse said without interrupting her efforts. "Everything's stable and the patient's content,"

Kim replaced the chart and moved alongside the bed. Gently he raised the sheet to glance at the dressing. Kim always instructed his residents to use minimal dressing. If there was unexpected bleeding, Kim wanted to know about it sooner rather than later.

Satisfied, Kim replaced the sheet before straightening up to look for his other patient. Only about half the beds were occupied, so it didn't take long to scan them.

"Where's Mr. Glick?" Kim asked. Ralph Glick had been Kim's first case.

"Ask Mrs. Benson at the desk." the nurse responded. She was preoccupied putting her stethoscope in her ears and inflating Sheila Donlon's blood pressure cuff.

Mildly irritated at the lack of cooperation, Kim walked over to the central desk but found Mrs. Benson, the head nurse, equally preoccupied. She was giving detailed instructions to several housekeeping workers who were there to break down, clean, and change one of the beds.

"Excuse me," Kim said. "I'm looking…"

Mrs. Benson motioned to Kim that she was busy. Kim thought about complaining that his time was more valuable than the housekeepers, but he didn't. Instead he rose up on his toes to look again for his patient.

"What can I do for you, Dr. Reggis?" Mrs. Benson said as soon as the housekeepers headed off toward the recently vacated bed.

"I don't see Mr. Glick." Kim said. He was still scanning the room, certain he was overlooking the man.

"Mr. Glick was sent to his floor," Mrs. Benson said curtly. She pulled out the controlled-substance log and opened it to the appropriate page.

Kim looked at the nurse and blinked. "But I specifically asked he be kept here until I finished my final case."

"The patient was stable," Mrs. Benson added. "There was no need for him to remain and tie up a bed."

Kim sighed. "But you have tons of beds. It was a matter of…"

"Excuse me, Dr. Reggis," Mrs. Benson said. "The point is Mr. Glick was clinically ready to go."

"But I had requested he be kept," Kim said. "It would have saved me time."

"Dr. Reggis," Mrs. Benson said slowly. "With all due respect, the recovery-room staff doesn't work for you. We have rules. We work for AmeriCare. If you have a problem with that, I suggest you talk to one of the administrators."

Kim felt his face redden. He started to talk about the concept of teamwork, but he quickly changed his mind. Mrs. Benson had already directed her attention to the loose-leaf notebook in front of her.

Murmuring a few choice epithets under his breath, Kim walked out of the recovery room. He yearned for the old days back at the Samaritan Hospital. Stepping across the hall, he stopped at the OR desk. With the aid of the intercom, he checked on the progress of his last case. Tom Harkly's voice assured him the closure was proceeding on schedule.

Leaving the operating suite, Kim marched down the hall to the newly constructed family lounge. It was one of the few innovations AmeriCare had instituted that Kim thought was a good idea. It had come from AmeriCare's concern for amenities. The room was specifically designated for the relatives of patients in the operating or delivery rooms. Prior to AmeriCare's purchase of the University Medical Center, there had been no place for family members to wait.

By that time of day it was not crowded. There were a few of the omnipresent expectant fathers pacing or nervously flipping through magazines while waiting for their wives to have Caesareans. In the far corner a priest was sitting with a grieving couple.

Kim glanced around for Mrs. Gertrude Arnold, the wife of Kim's last patient. Kim wasn't looking forward to talking with her. Her peppery and truculent personality was hard for him to bear. But he knew it was his responsibility. He found the late-sixties woman in the opposite far corner away from the grieving couple. She was reading a magazine.

"Mrs. Arnold," Kim said, forcing himself to smile.

Startled, Gertrude looked up. For a nanosecond her face registered surprise, but as soon as she recognized Kim, she became visibly irritated.

"Well, it's about time!" Mrs. Arnold snapped, "What happened? Is there a problem?"

"No problem at all," Kim assured her. "Quite the contrary. Your husband tolerated the procedure very well. He's resting."

"But it's almost six o'clock!" Gertrude sputtered, "You said you'd be done by three."

"That was an estimate, Mrs. Arnold," Kim said, trying to keep his voice even despite a wave of irritation. He'd anticipated a strange response, but this was more than he'd bargained for. "Unfortunately the previous case took longer than expected."

"Then my husband should have gone first," Gertrude shot back. "You've kept me waiting here all day not knowing what was happening. I'm a wreck."

Kim lost control and in spite of a valiant effort, his face twisted into a wry, disbelieving smile.

"Don't you smile at me, young man," Gertrude scolded. "If you ask me, you doctors are too high and mighty, making us normal folk wait all the time."

"I'm sorry if my schedule has caused you any distress," Kim said. "We do the best we can."

"Yeah, well, let me tell you what else happened," Gertrude said. "One of the AmeriCare administrators came to see me, and he told me that AmeriCare wasn't going to pay for my husband's first day in the hospital. They said he was supposed to be admitted this morning on the day of surgery and not the day before. What do you say to that?"

"This is an ongoing problem I'm having with the administration," Kim said. "When someone is as sick as your husband was before his surgery, I could not in good conscience allow him to be admitted the day of surgery."

"Well, they said they weren't going to pay," Gertrude said. "And we can't pay."

"If AmeriCare persists, then I'll pay," Kim said.

Gertrude's mouth dropped open. "You will?"

"It's come up before and I've paid before," Kim said. "Now, about your husband. Soon he'll be in recovery. They'll keep him there until he's stable, and then he'll go to the Cardiac floor. You'll be able to see him then."

Kim turned and walked from the room, pretending not to hear Mrs. Arnold calling his name.

Retreating back up the hall, Kim entered the surgical lounge. It was occupied by a handful of OR nurses on their breaks and a few of the staff anesthesiologists and anesthetists. Kim nodded to those people he recognized. Having been working at the University Medical Center only since the merger six months previously. Kim didn't know all the staff, particularly the evening and night people.

Pushing through the door into the men's surgical locker room, Kim pulled off his scrub top and threw it forcibly into the hamper. He then sat on the bench in front of the bank of lockers to unpin his watch from the waistband of the pants. Tom, who'd taken a shower, was busy putting on his shirt.

"It used to be when I finished a case I felt a certain euphoria," Kim commented. "Now I feel a vague, unpleasant anxiety."

"I know the feeling," Tom said.

"Correct me if I'm wrong," Kim said. "This all used to be a lot more fun."

Tom turned from facing the mirror and chuckled. "Excuse me for laughing, but you say that as if it were a sudden revelation."

"I'm not talking about the economics," Kim said. "I'm talking about the little things, like getting respect from the staff and appreciation from patients. Nowadays you can't take anything for granted."

"Times are a-changing," Tom agreed. "Especially with managed care and the government teamed up to make us specialists miserable. Sometimes I fantasize about one of the responsible bureaucrats coming to me for a bypass, and I make him get it from a general practitioner."

Kim stood up and pulled off his scrub pants. "The sad irony is that all this is happening when we cardiac surgeons have the most to offer the public."

Kim was about to toss his pants into the hamper by the door, when the door opened and one of the women anesthesiologists, Dr. Jane Flanagan, stuck her head in. Catching sight of Kim's skivvy-clad body, she whistled.

"You came mighty close to having these sweat-soaked pants draped over your noggin," Kim warned.

"For such a view it would have been worth it," Jane joked. "Anyway, I'm here to inform you that your public awaits you out here in the lounge."

The door closed and lane's perky face disappeared.

Kim looked at Tom. "Public? What the hell is she talking about?"

"My guess is you have a visitor," Tom said. "And the fact that no one has come in here leads me to believe it must be female."

Kim stepped over to the cubbyholes filled with scrub tops and bottoms and took a clean set. "What now?" he questioned irritably.

At the door Kim paused. "If this is Mrs. Arnold, the wife of my last case, I'm going to scream.

Kim pushed out into the lounge. Instantly he saw it wasn't Gertrude Arnold. Instead, Kelly Anderson was at the coffee urn, helping herself to a cup. A few steps behind her was her cameraman with a camcorder balanced on his right shoulder.

"Ah, Dr. Reggis," Kelly exclaimed, catching sight of the surprised and none-too-pleased Kim. "How good of you to come to talk with us."

"How the hell did you get in here?" Kim asked with indignation. "And how did you know I was here?" The surgical lounge was like a sanctuary that even nonsurgical doctors were hesitant to violate. For Kim the idea of being confronted by anyone here, much less Kelly Anderson, was too much to bear.

"Brian and I knew you were here thanks to your former wife," Kelly said. "As for how we got up here, I'm happy to say we were invited and even escorted by Mr. Lindsey Noyes." Kelly gestured toward a gray-suited gentleman standing in the doorway to the hall who'd hesitated to come in himself. "He's from the AmeriCare – University Med Center PR department."

"Evening, Dr. Reggis," Lindsey said nervously, "we just need a moment of your time. Miss Anderson has graciously decided to do a story commemorating the six-month anniversary of our hospital merger. Of course, we'd like to assist her in any way we can."

For a moment Kim's dark eyes darted back and forth between Kelly and Lindsey. On the spur of the moment he wasn't certain who irritated him more, the muckraking journalist or the meddlesome administrator. Ultimately he decided he didn't care. "If you want to help her, then you talk to her," Kim said before turning to go back into the locker room.

"Dr. Reggis, wait!" Kelly blurted. "I've already heard the prepared AmeriCare side. We're interested in your personal view, from the trenches, so to speak."

With the locker-room door open a crack, Kim paused and debated. He looked back at Kelly Anderson. "After that piece you did on cardiac surgery, I vowed never to talk to you again."

"And why is that?" Kelly said. "It was an interview. I didn't put words in your mouth."

"You quoted me out of context by editing your questions," Kim fumed. "And you left out most of the issues I said were of primary importance."

"We always edit our interviews," Kelly said. "It's a fact of life."

"Find another victim," Kim said.

Kim pushed open the locker-room door and had taken a step within, when Kelly called out again: "Dr. Reggis! Just answer one question. Has the merger been as good for the community as AmeriCare contends? They say they did it for purely altruistic reasons. They insist it's the best thing that's happened to medical care in this city since the discovery of penicillin."

Kim hesitated again. The absurdity of such a comment made it impossible for him not to respond. Once again he turned back to Kelly. "I have trouble understanding how anyone could say such a ludicrous statement and have a conscience clear enough to sleep at night. The truth is that the entire rationale for the merger was to benefit AmeriCare's bottom line. Anything else they may tell you is rationalization and pure bull."

The door closed behind Kim. Kelly looked at Brian. Brian smiled and gave Kelly the thumbs-up sign. "I got it," Brian said.

Kelly smiled back. "Perfect! That was just what the doctor ordered."

Lindsey coughed politely into a closed fist. "Obviously," he said, "Dr. Reggis has given his personal view, which I can assure you is not shared by other members of the professional staff."

"Oh really?" Kelly questioned. She let her eyes roam the room. "Anybody here wish to make a comment concerning Dr. Reggis's statement?"

For a moment no one moved.

"Pro or con?" Kelly prodded.

Still no one moved. In the sudden silence, the hospital page could be heard like the backdrop of a TV melodrama.

"Well," Kelly said brightly, "thank you all for your time."

Tom slipped on his long white hospital coat and arranged the collection of pens, pencils, and flashlight in its upper front pocket. Kim had come into the locker room and, after removing his clothes and throwing them into the hamper, had gotten into the shower. He'd not said a word.

"Aren't you going to tell me who was out there?" Tom said.

"It was Kelly Anderson from WENE News," Kim said from the shower.

"In our surgical lounge?" Tom questioned.

"Can you believe it?" Kim said. "She was dragged up here by one of the AmeriCare admin guys. Apparently my ex told her where to find me."

"I hope you told her what you thought of that piece she did on cardiac surgery," Tom said. "After my car mechanic saw it, I swear he raised his rates. I mean talk about backwards; my income's plummeting and service people are upping their charges."

"I said as little as I could' Kim said.

"Hey, what time were you supposed to pick up Becky?" Tom asked.

"Six o'clock," Kim said. "What time is it now?"

"You'd better get a move on," Tom said. "It's already heading toward six-thirty."

"Damn," Kim said. "I haven't even done my rounds yet. What a life!"