Toxin (3 page)

“Her father's not terribly happy,” Tracy said. “But to be honest, I'm relieved.”

“Why is that?” Kelly asked.

“That level of competition extracts a high price from anyone, much less a prepubescent child. It's not always mentally healthy. It's a lot of risk without a lot of payoff.”

“Hmmm,” Kelly said. “I'll have to give that some thought. But, meanwhile, I've got a more pressing problem. I'm trying to do a piece for tonight's eleven o'clock news since today's the sixth-month anniversary of AmeriCare's merger of the Samaritan with the University Med Center. What I wanted was the community's reaction, but I've run into a lot of apathy. So I'd love to get your husband's feelings on the issue since I know he'd have an opinion. By any chance is he coming here to the rink this afternoon?”

“No,” Tracy said with a giggle, as if Kelly had suggested an absurdity. “He never leaves the hospital until six or seven on weekdays. Never!”

“Too bad,” Kelly commented, while her mind rapidly processed various contingencies. “Tell me, do you think your husband would be willing to talk with me?”

“I really have no idea,” Tracy said. “You see, we've been divorced for a number of months, so I couldn't guess how he feels about you at the moment.”

“I'm sorry,” Kelly said with sincerity. “I didn't have any idea.”

“No need to be sorry. It was best for everyone, I'm afraid. A casualty of the times and a clash of personalities.”

“Well, I can imagine being married to a surgeon, particularly a cardiac surgeon, is no picnic. I mean, they think that everything pales in importance compared to what they do.”

“Hmmm,” Tracy responded noncommittedly.

“I know I couldn't stand it,” Kelly said. “Egotistical, self-centered personalities like your former husband and I don't mix.”

“Maybe that's saying something about you,” Tracy suggested.

“You think so?” Kelly said. She paused for a moment, recognizing she was dealing with a gentle but quick wit. “Maybe you're right. Anyway, let me ask you this: Would you have any idea where I might find your former husband right now? I'd really like to talk with him.”

“I can guess where he is,” Tracy said. “He's probably in surgery. With all the fighting for OR time at the med center, he's had to do all three of his weekly cases on Friday.”

“Thank you. I think I'll head right over there and see if I can catch him.”

“You're welcome,” Tracy said. She returned Kelly's wave and then watched the woman walk swiftly back around the rink. “Good luck,” Tracy murmured to herself.

Friday, January 16
th

A
ll 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 Tom 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 being . . .”

“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.”