Trauma

CHAPTER 3

Carrie arrived to scrub fifteen minutes late, expecting to see Dr. Stanley Metcalf already gowned and glowering. Next to medical incompetence, Dr. Metcalf despised tardiness most of all. She was surprised and more than a little relieved to discover he had yet to show up for Leon Dixon’s brain surgery.

In addition to making sure the circulating and scrub nurses were at their stations and ready to go, it was Carrie’s responsibility to get the patient prepped, properly positioned, and draped correctly. The only part of the pre-op routine Carrie did not oversee belonged to Dr.Lucas Fellows, the anesthesiologist, who would take care of getting the patient anesthetized and intubated. Surgeons and anesthesiologists did not always play nicely in the same sandbox, each guarding their turf with vigor.

Still, when it came time to put scalpel to skin, Dr. Metcalf was the general in charge. Most surgeons with a reputation like his came with a plus-sized ego. The man could be bombastic, often arrogant, always meticulous, and so demanding of his assistants that a healthy dose of fear was advisable for any underling assigned to him.

Despite his intimidating reputation, the advantages of working with Dr. Metcalf were undeniable. He offered the best opportunity for growth and learning, and for that alone, Carrie was grateful to be his foot soldier. But having incurred Dr. Metcalf’s wrath once before, Carrie was glad to have a few extra minutes to set up the OR.

Still, she’d have to hurry.

Thinking of Beth, Carrie finished scrubbing in a daze. Breaking bad news was a part of the job, but that did not make the task any easier. Beth’s sister, Amanda, had been told the surgery should not take longer than three hours, so she knew something had gone terribly wrong before Carrie set foot inside the waiting room.

“I’m sorry, but I have some bad news.” Carrie had been taught to use that phrase, but still, there were few words a doctor despised saying more than those.

I’m sorry …

Valerie had accompanied Carrie into the cramped conference room where she had taken Amanda to consult with her in private. Because of Carrie’s back-to-back surgeries, Valerie offered to hold the conference with Dr. Michelson instead, but Carrie believed the privilege of caring for sick people came with the added burden of being the messenger.

“Is she going to live?” Amanda had asked after Carrie finished.

Amanda was a sweet-faced woman, five years younger than Beth, and the strain in her kind eyes put a lump in Carrie’s throat.

“We’re doing everything possible to make sure that she does,” Carrie said.

Amanda bit at her lower lip, but could not hold back the rush of tears in her eyes. In response, Carrie reached across the table and clutched the young woman’s trembling hand.

“I’m so sorry, Amanda, we’re doing everything we can. Please know that. I’m deeply sorry for what’s happened here.”

A single nod sent Valerie off to get Amanda some water. Carrie did her best to answer Amanda’s many questions, though she suspected the young woman would retain little of it. Carrie spoke frankly but compassionately, and promised to follow up with the hematology team looking after Beth as soon as she could.

In the OR, prepping for the next patient, Carrie struggled to push Amanda’s tears, Beth’s three children, and the complexity of Beth’s case out of her mind. A man with a serious brain tumor was waiting for her in the OR, and he deserved her undivided attention.

Margaret, the circulating nurse, was on her first day at BCH, so she was shy and quiet as she assisted Carrie with her surgical gown and gloves. It was just as well. Carrie’s guilt and exhaustion left her in no mood for small talk.

Scrubbed and gowned, Carrie entered the OR and headed straight to the viewbox. The films weren’t there. She looked around and saw that X-ray had delivered them, but Margaret hadn’t put them up, probably because she was new and nervous.

Though the task was the new nurse’s, it was easier for Carrie to do it herself. Carrie grumbled under her breath as she removed the MRI image from the protective envelope.

Dammit!

The moment her gloved hand came in contact with the film, Carrie realized her mistake. She had broken scrub by touching a nonsterile object with her sterilized gloved hand. She’d have to go through the sterilization procedures all over again. It would mean being even more rushed during prep than she already was. Dr. Metcalf could arrive at any second, and if he did not see everything in pristine order, ready to drill, there would be serious fireworks.

For now, it was back to Leon’s film.

Carrie had given him only a cursory examination previously, but she remembered that Leon had exhibited cognitive and behavioral problems, some muscular control issues, memory problems, and difficulty controlling his temper.

Carrie tossed the film up on the viewbox, a film she had seen only once before, briefly, in Dr. Nugent’s office. That felt like a lifetime ago. Based on visual characteristics, the brain tumor was probably an astrocytoma, the most common form of tumor, but pathology would have to confirm. From what Carrie could see, the mass was not characteristic of a systemic cancer, something that had metastasized to the brain. Good news for Leon. Still, she doubted it was a totally unsuspected abscess, something that surgery plus a prolonged course of antibiotics could essentially cure. Dr. Nugent had said something similar during his brief consult.

Regardless, it didn’t do any good to speculate. They would sample the tissue, get the pathology report, and go from there.

Carrie saw that the mass was located deep in the temporal lobe. It looked angry, with a good deal of edema. Leon would most likely need additional surgery to debulk the tumor, followed by radiation and chemotherapy treatments. He might get a few more quality years before the tumor came back to take it all away.

Carrie’s dry eyes ached from lack of sleep. At least this case would not be difficult for Dr. Metcalf, who had probably done a thousand of these procedures. She’d be home sometime after noon and asleep a few minutes after that. Assuming, of course, that Dr. Metcalf actually made it to surgery. Carrie had never worked a case before where he’d been so late, and she was beginning to wonder if he had the wrong date on his schedule. In an administrative behemoth like BCH, stranger things had happened.

Back at the sink, Carrie followed the proper protocol for the anatomical scrub, and had Margaret help her get gowned and gloved again. Precious minutes lost.

The scrub nurse, Sam Talbot, had done a fine job making sure the operating room was clean and ready for surgery. He had prepared the instruments and equipment and was double-checking his work when Carrie reentered the OR. Carrie was glad Talbot was on the ball so she could concentrate her efforts on Leon.

Leon was on the operating room table, already anesthetized and intubated. Dr. Lucas Fellows monitored vital signs and adjusted the combination of agents used to keep Leon in a state of blissful unconsciousness.

With Margaret’s help, Carrie positioned Leon on his back, elevated the head, and turned him toward his left side. Carrie prepped Leon’s shaved skull using antiseptic Betadine that turned his dark skin orange. As Carrie finished with her final swab, the OR door swung open and Dr. Metcalf bounded in, fully scrubbed. Margaret, caught by surprise, shrank a little in his presence. A bear of a man with a full beard, broad shoulders, and a barrel chest, Dr. Metcalf struck an imposing figure in the operating room — or anyplace, for that matter. He held up his arms for Margaret to get him gowned and gloved.

“Sorry for the late arrival,” Dr. Metcalf said in his deep, rich baritone. “There was a rollover on I-95 and traffic was backed up for miles. I thought we might have to reschedule, but a friendly cop gave me an escort down the breakdown lane. I can’t count the number of angry looks I got.”

Dr. Metcalf chuckled and Carrie felt at ease. He seemed to have already observed all of the hard work that had gone into surgical preparation and deemed it fit. He approached Leon and looked over his mask at Carrie, who was standing on the other side of the operating room table.

Dr. Metcalf’s brown eyes narrowed. “Goodness, you look terrible, Carrie,” he said. “Are you feeling all right?”

Carrie nodded. “Tough operation last night, that’s all,” she said. “I’m fine.”

The persistent throbbing behind Carrie’s temple suggested otherwise, but she knew her limits. She could handle one more case.

A few more hours … you can do it.

Dr. Metcalf scanned the OR and chuckled again. “Forgot I’m not at White Memorial for a second there. I was looking for the NeuroStation.”

Carrie smiled behind her mask. A NeuroStation was a state-of-the-art workstation for localizing brain tumors using a frameless stereotactic system that gave surgeons an unprecedented view into the operative field while relaying the location of instruments to the preoperative imaging data. It cost hundreds of thousands of dollars — well over a million when factoring in all the ancillary equipment. The fancy folks over at White Memorial could afford such luxuries, but BCH didn’t have enough funding for such an extravagant expense.

“No worries,” Dr. Metcalf said. “I remember when we used to do these operations without a Midas Rex drill. Hell, the drill and bit set we used during my residency looked like something you’d pick up at Sears.”

Everyone laughed politely.

“All right, Dr. Bryant,” he said. “We’ll be finished here in no time.”