Trauma

CHAPTER 22

It was dark when the alarm went off. Cocooned in her bed, Carrie thought about hitting the snooze button, but decided to get an early start. Despite the aches in her body and neck — the result of a buildup of lactic acid and inflammation — she managed to arrive at the VA a little after seven thirty. She wanted to check on Abington before her day officially started. Even though the med ICU staff was more than capable, she had done the invasive procedure and felt ultimately responsible for his outcome. It could be that all she did was give them her thanks and a pat on the back, but she had to do something. Either way, she had to know the outcome.

Carrie had just flashed her security badge at the front desk when her phone began to vibrate. To her surprise, it was a text message from Dr. Sandra Goodwin, head of neurosurgery. Come see me as soon as you arrive. I’m in my office now. The text came across as a bit edgy. Carrie belonged to Dr. Finley, head of neurology and his DBS program, so even though surgery resided under Dr. Goodwin’s purview, the line of responsibility to her was a dotted one at most, and thus far Carrie had had little interaction with the woman. Still, Abington could wait. Carrie stopped by the cafeteria for coffee before making her way to Dr. Goodwin’s second-floor office.

Seated behind a metal desk that had probably been manufactured in the 1970s, Dr. Goodwin eyed Carrie with contempt. Carrie had not expected to see Dr. Evan Navarro, who ran the residency program, there as well. Navarro sat on one of two uncushioned folding chairs set in front of Dr. Goodwin’s desk. The concrete brick walls were painted a sorry shade of yellow, and the low ceiling covered with cheap acoustic tiles made Carrie feel uncomfortably confined. Other than a couple of struggling plants, Dr. Goodwin’s home away from home had all the life of a pathology lab.

Dr. Navarro turned the chair next to him slightly and offered it to Carrie. She sat down gingerly, which had more to do with Navarro’s hard stare than with her aching knee. Dr. Navarro was short — Carrie probably had two inches on him — but he had a reputation for being pugnacious and for bringing residents to tears. His dark hair was gelled back, showing off a prominent widow’s peak.

Dr. Goodwin looked every bit her fifty-five years. She wore her hair in a bob that called attention to her face’s sharp features, and nothing warm or fuzzy showed in her hazel eyes. She was all business and all about maximizing every minute in her day. Wearing a white lab coat over a set of blue scrubs, her clothing implied she would touch a scalpel at some point in the day, which Carrie highly doubted. Dr. Goodwin was an administrator. But maybe she liked looking the part of a surgeon.

Dr. Goodwin spoke bluntly. “I heard you went to see Steve Abington in the neuro recovery floor yesterday.”

No “Hello.” No “How are you adjusting to the new job.” No “I heard you almost got killed.” Dr. Goodwin was as efficient with her words as she was with her time.

“I did.” Carrie did not know what else to say.

Dr. Goodwin’s glowering expression said that the chief of neurosurgery did not approve. “Yes, I see,” Dr. Goodwin replied. “I heard about yesterday, and I’m aware of the circumstance. I’m sorry that happened, though I do believe Dr. Finley expressed to you beforehand that the PTSD patients should never be seen without accompaniment.”

Carrie felt a bit ashamed by the accusation, but she bristled. It sounded like victim-blaming.

“I guess I didn’t fully appreciate the need for the warning,” Carrie said.

“That may be,” Dr. Goodwin replied coldly, “and because of the extenuating circumstances here, Evan and I thought it would be appropriate to review our department policies with you with respect to post-op care, among other things.”

“That’s the job of the residents,” Navarro said in a sharp tone. “You may think of yourself as one of the gang, but you’re not.”

Dr. Goodwin shot Navarro an admonishing look, perhaps to call back her attack dog. “What Evan is trying to say, Carrie, is that you are basically an employee of Dr. Finley. Your situation here is highly unique. Unusual, is the word I would choose to describe it. To be blunt, the hospital has a well-organized residency program, and you’re not part of it. Surely you understand that we have procedures in place for patient care, and a hierarchy for addressing emergent situations. You show your face and nurses don’t know who to call if there’s a problem. Do they call you? You’re not even insured here if something does go wrong. You expose this program to added risk by this behavior.”

Carrie’s face felt hot. “I was simply curious to see how my first DBS patient was doing.”

“That’s understandable,” Dr. Goodwin said. “Which is why we’re having a friendly chat about it.”

Doesn’t feel friendly, Carrie thought.

“If the residents think you’re undermining them, it will throw my entire program into disarray,” Navarro said.

“It was certainly not my intention.”

“Yes, well, our best intentions may have unintended consequences.”

“Well, how is Abington doing?” Carrie asked. “All I know is that he was moved to medical ICU.”

“And that’s all you need to know,” Navarro answered curtly.

Dr. Goodwin held up her hand again. Navarro apparently needed an even shorter leash.

“I guess I’m a bit confused,” Carrie said. “I just wanted to see how my patient was doing after my surgery.”

Dr. Goodwin’s intense expression ticked up a few notches. “Let me take a moment to clarify your role here,” she said. “You are the DBS surgeon. Period. You did your surgery just fine. Dr. Finley brought you on board exclusively for that purpose. And I, for one, did not support your appointment.”

No kidding.

“I would have preferred we bring in somebody who had gone through a formal residency program successfully,” Dr. Goodwin continued. “But Dr. Finley is the one who has the funds, and he insisted your skills as a surgeon trumped any concerns we may have had regarding your … unfortunate history.”

Carrie tensed at the reference, and in doing so caused a stab of pain in her aching knee.

“Your job is to do the DBS installations, and that’s it,” Dr. Goodwin said.

“And the next link in that chain is me,” Navarro added.

Carrie felt like she had just been body-slammed.

“So you see, Carrie, you’re here because the DBS surgeries are lengthy and do require a dedicated resource. You’re quite simply a hired hand, and it’s best if you keep your involvement to that.”

Carrie’s cheeks flushed. She could feel her anger starting to percolate. Digging deep, she mustered restraint. “I understand.” She directed her attention to Navarro. “Would you mind giving me an update on Abington’s condition? I understand he’s been moved to the medical ICU. I did the procedure. I feel a responsibility for the patient outcome. I think I deserve that professional courtesy.”

Dr. Goodwin and Navarro exchanged an inscrutable look.

“Let’s make sure we got this clear, Carrie,” Dr. Goodwin said. “You do the surgery and you’re done. The residents and Dr. Navarro will do the post-op care. If a patient is moved to another unit, that patient becomes the responsibility of others. Not us. We take care of our responsibilities as they apply to neurosurgery, and do not go chasing after patients when they become the province of a different department. This is the way our organization is effectively maintained. Do I make myself clear?”

Carrie was shocked. She could not believe the tone Dr. Goodwin was using with her, the utter disdain. It was as if Carrie, by acting in a thoughtful and caring manner toward a patient, had violated some sacred oath and thereby single-handedly put the entire system in a state of dysfunctional disrepair.

Carrie knew all about “turfing,” the idea that a patient who was moved off one floor and brought to another became OPP, other people’s problem. But she had never worked in an environment where the hush-hush practice was so openly supported and, in fact, endorsed. The notion made Carrie sick to her stomach. This was not what she had signed up for, and she had every intention of making her feelings known to Dr. Finley.

For now, the best, most politically expedient strategy for this meeting was to appear compliant and retreat. Never poke an angry bear.

“You’ve made yourself clear,” Carrie said. “So if I’m not scheduled to do any DBS surgeries, what then?”

“As long as you respect our procedures, that is not my concern. You do what you feel is best for you and your career, Carrie,” Dr. Goodwin said.

Dr. Goodwin’s smile held all the warmth of a snow cone. Carrie didn’t have to be told to stand; this meeting was clearly adjourned.