WHERE DEATH IS A HUNTER
Hannah Fâtier is a thirty-two-year-old physician fresh out of residency training. She’s just started her first job as an anesthesiologist at Deaconess Hospital in San Francisco, she’s bought a new home, and she’s engaged to be married.
In short, life is good for Hannah--until, one day, tragedy strikes. A patient under her care dies unexpectedly during a routine operation. An investigation into the case reveals the cause of death to be a basic medical error committed by Hannah. Wracked with guilt, Hannah falls into a malaise of depression and self-castigation. Yet the more she ponders where she went wrong, the more she realizes that something about the way her patient died doesn’t add up. Digging deeper into the records of the case, Hannah discovers a number of puzzling inconsistencies. She begins to suspect someone has framed her for a fatal medical mistake she didn’t make. But who would do such a thing and why? And, more importantly, why did her patient really die that day on the operating table?
Where Death Is a Hunter is a medical mystery dealing with hospital death, a dark enigma, one doctor’s self-doubt, and the search for redemption.
asystole (ā-sĭs′-tō-lee) [a neg + Greek systole contraction]
without contraction; cardiac standstill or arrest.
On a damp, foggy morning in mid-January, Debora Thein’s heart stopped beating. It happened at 8:37 in operating room Suite 3 at Deaconess Hospital in San Francisco. We know the exact time because it’s marked on the electronic heart tracing, time-stamped to the exact second for digital perpetuity. 8:37:14, to be precise. That’s when Debora Thein’s heart tracing went flat.
We didn’t formally pronounce her dead for another forty-six minutes. We did everything possible to bring her back to life: electrical shocks, chest compressions, high-flow oxygen, blasts of intravenous adrenaline. All of it useless. It was as though an electrical switch controlling her heart beat had been flipped OFF, and nothing we could do would turn it back ON. We marked the official time of death as the time we stopped the resuscitation efforts, 9:23. But the real time of death was 8:37:14.
It was supposed to be a routine plastic surgery case: bilateral breast augmentation with saline implants followed by, for good measure, “touch up” lipoplasty (liposuction) of the lower abdomen. The surgeon was Dr. Thad Merleson, and I was the anesthesiologist on the case. I’d done anesthesia for Thad a number of times before. We did a lot of plastic surgery at Deaconess Hospital.
Debora Thein was forty-two-years-old and in perfect health. She was a jogger, she did yoga, and she was a health-food enthusiast. She took no medications, and she had no drug allergies. She’d had surgery under general anesthesia several times before (a face lift, a nose job, and an appendectomy) without complication.
My boss, Dr. Linh Vu, had asked me to do the anesthesia. The request took me by surprise. At the time, I’d only been working at Deaconess for three months. I was thirty-two-years-old and just five months out of my anesthesia residency. A week before Debora Thein’s operation, Linh Vu called me into her office.
“It’s Martin Thein’s wife,” she said. “You know Martin, of course.”
I knew of Martin Thein, but I didn’t know him personally. He was the Chief of Dermatology at Deaconess. He was a bit of a big shot at the hospital. For one thing, he sat on the hospital’s board of directors.
“I’ve been to a couple of his noon conference lectures,” I said. “But, I’ve never actually met him.”
“He asked me to assign someone I trust to do the anesthesia. I’m going to assign you, Hannah.”
I was honored that Linh would put her trust in me, especially when I’d only been working at Deaconess for such a short time. “Wow,” I said, “I’m… flattered.”
“Besides,” Linh said, “Martin says his wife prefers a female anesthetist.”
“Ah!” I said as the balloon lifting up my briefly buoyed ego burst. Out of a department of twenty-one, Linh and I were the only female anesthesiologists at Deaconess. I didn’t bother to ask why Linh, herself, hadn’t volunteered to do the case. “Sure,” I said, “I’ll be happy to do it.”
The operation was on a Friday, January 14th. Debora was our first case of the day, and we wheeled her into OR Suite 3 at eight o’clock sharp. Dr. Merleson, the surgeon, was already in the scrub room lathering up his arms with antiseptic soap.
Debora was to have her operation under general, of course, and as soon as we got her in the suite I began administering the initial anesthesia meds (Dilaudid and propofol for deep sedation, Pavulon for paralysis). Once Debora was unconscious, I slipped a plastic tube down her throat, hooked her up to a breathing machine, and turned on the gas. The “gas” was “desflurane,” a standard anesthesia gas delivered via the breathing tube mixed in with oxygen. It would keep Debora asleep and unconscious until the operation was over and the gas was turned off.
Thad came into the suite as I administered the drugs, and the scrub nurse helped him into his surgical gown. I remember he told a joke—he often did that, his “joke of the day” as he called it—as he was gowning up.
“A lawyer is standing in line at the box office.” Mrs. Thein, of course, was unconscious at this point. “Suddenly, the lawyer feels a pair of hands massaging his neck and shoulders. He turns around and says, ‘What the hell are you doing?’ The man behind him says, ‘Don’t worry, I’m a chiropractor. I’m just keeping in practice while we’re waiting in line.’ ‘A chiropractor?’ the lawyer says. ‘Well, keep your hands off me. I’m a lawyer, but you don’t see me screwing the guy in front of me, do you?’”
Thad came over to the operating table and barked out an order to the nurses. “Ancef, one gram IV. Now.” There was nothing unusual about the Ancef order. Ancef is an antibiotic, and surgeons commonly give patients a dose of an antibiotic just before an operation in order to prevent infections.
There were two nurses with us in the suite, the scrub nurse and the circulating nurse. Lisa Andrada was the scrub, and she would directly assist Thad while he operated. Justin Barnes was the circulating nurse; his job was to bring in supplies as needed during the operation. Justin got the Ancef and hung it up on an IV pole.
Thad began prepping Debora’s skin for the surgery. He was going to do the breast augmentation first. Using a sponge soaked with antiseptic soap, he scrubbed Debora’s chest, breasts, and abdomen.
I sat just above Debora’s head next to the several monitor screens with blinking lights, tracings, and number displays, like a pilot sitting at the controls of an airplane. Checking all the monitors, everything was going fine at that point. Debora’s oxygen saturation was perfect at 100%. Pulse in the seventies. Blood pressure 118/74. The neon heart beat coursed across the monitor screen in even, regular beats. VSS, “vital signs stable,” as we say. The desflurane gas flowed; Debora Thein was nicely anesthetized. It was just another routine day in the OR at Deaconess Hospital.
Until, suddenly and unexpectedly, the alarm sounded.
It was the heart alarm that sounded first. Just before it went off, I noticed something on the monitor screen out of the corner of my eye, an irregularity on the heart tracing. I turned toward the monitor and saw that the reassuring zig-zag of Debora Thein’s normal heartbeat had been replaced by a furious line of wide, spiked heart beats at 170 beats-per-minute. The heart alarm began clanging, echoing through the suite: BLING! … BLING! … BLING!
My first thought was it must be a false alarm. Thad Merleson had been scrubbing Debora’s chest skin near where the heart leads were attached, and the scrubbing movement, itself, could cause the heart tracing to look irregular on the monitor. I’d seen this exact thing happen before.
“Stop the scrub,” I said to Thad. “Is this artifact?”
“I’m not scrubbing!” Thad shouted. He held his hands up in the air and stepped back from the table. The wide, fast beats persisted on the monitor.
I jammed my index and middle fingers into Debora’s neck to feel for a pulse. There was no pulse. Debora Thein was in cardiac arrest.
“This is real!” I said. “Call a Code!”
The scrub nurse rushed to the phone, dialed the hospital operator, and announced a Code Blue in the Operating Room, Suite 3.
“Chest compressions!” I said. “Get the crash cart!”
As the anesthesiologist, I was in charge of running the Code Blue. Thad, the plastic surgeon, had no expertise in running Codes, and he stepped off to the side of the room, a look of panic in his eyes. The scrub nurse stepped up to the table, crossed her hands over Mrs. Thein’s sternum, and began doing chest compressions. Over the intercom, the hospital operator announced, “Code Blue, Operating Room, Suite 3! Code Blue, Operating Room, Suite 3!” By calling the Code, we would get the full Code Blue team to assist us, including the ER doctor.
Per protocol, I turned off the desflurane gas and unhooked Debora from the ventilator machine: the cardiac arrest could be due to a reaction to the anesthesia or to a malfunction of the ventilator. I also asked that all IV drips be turned off, including the Ancef antibiotic. I attached an oxygen bag to the end of Debora’s breathing tube, and, squeezing the bag, I began pumping in 100% oxygen by hand. I watched the rise and fall of her chest as I squeezed the bag.
“Take over on the oxygen,” I said to the circulating nurse. “I’m going to defibrillate.”
I pulled the defibrillator paddles from the crash cart and charged the paddles. Everyone stepped away from the table as I placed the paddles on Debora’s chest and discharged a jolt of electricity. Debora’s back arched up slightly with the shock and then fell back to the table. We all stared at the heart monitor to see if the shock had worked, to see if it had restored a regular heartbeat. It had not. In fact, the tracing was now worse. It now showed no heart activity whatsoever, not even the chaotic, saw-toothed line. I stared at the monitor in disbelief as a wave of nausea passed over me. The tracing was now flat-line.
“Asystole!” I said. “Resume compressions!”
I pulled a pre-filled syringe of adrenaline out of the med drawer. Adrenaline is a heart stimulant used in cardiac arrest; my hope was that an intravenous blast of the drug would get Thein’s heart going again.
Thad Merleson stood off to the side of the room watching and looking to be in a state of disbelief. “What the hell is happening?” he said as our eyes met.
“I don’t know,” I said. “She was fine. Everything was fine. I don’t know!”
I injected the adrenaline, and we watched the heart monitor. The adrenaline had no effect. Debora’s heart remained flat-line. I could feel the sweat forming on my forehead; I’d just stepped into a terrible nightmare: my patient—who happened to be the wife of Deaconess Hospital’s chief dermatologist—was trying very hard to die. For no apparent reason. And it was all under my responsibility: the surgeon hadn’t even made his first cut with his scalpel. This could not be blamed on “surgical mishap.” The only thing Debora Thein had received so far was her anesthesia—from me.
The doors to the suite burst open, and Linh Vu, my boss, rushed into the room. “What the hell is happening?”
“She’s Coding,” I said.
“Why?” Vu screeched coming over to the table.
“I don’t know!”
“What are you giving for gas?” Linh asked.
“Turn it off!”
“I did. I turned off all the meds.”
A moment later, the Code team arrived, and suddenly there were ten people in the room. The ER tech—a young, muscular man—took over on the chest compressions, and the respiratory tech took over on the oxygen. The ER doctor was Bob Hansen. I knew Hansen a little: gaunt and bald, he’d been doing emergency medicine at Deaconess for over thirty years. I gave a quick summary of what had happened. Hansen asked if we’d given adrenaline.
“Yes,” I answered.
“Another dose?” he suggested.
The Code Blue pharmacist handed me a fresh syringe of the heart stimulant, and I injected it intravenously.
Bob Hansen asked the ER tech to hold compressions so he could look at the heart tracing. The tracing was still flat, so flat that it could have been drawn with a ruler running across the screen. Dr. Hansen was as stymied as I was.
“This should not be happening,” I said as a bead of sweat dripped down the side of my face.
We continued the chest compressions and gave a third dose of adrenaline. Nothing changed. With each passing minute, the chances of Debora Thein coming out of the arrest diminished. Linh Vu was now standing with Thad Merleson off against the far wall watching. Thad was wringing his hands and pacing back and forth. I’d never seen him lose his cool before. Then, again, I’d never had one of his patients do a death spiral right before our eyes, either.
At the ER doctor’s suggestion, we decided to try shocking Thein’s heart again. Normally a heart shock is not indicated for a flat heart tracing. There needs to be some sort of heart activity for a heart shock to work, and, according to the heart monitor, Thein’s heart had no activity at all. However, sometimes there can be a tiny amount of quivering going on in the heart that the monitor doesn’t pick up. In that situation, a heart shock could help. So, we tried it. There was nothing left to lose.
I delivered the shock. Once again, Thein’s lifeless body arched up from the jolt of electricity, like an epileptic corpse going into a fit. We all looked at the heart monitor, hoping, hoping…
Nothing. No change. Debora Thein’s heart remained utterly without life.
Bob Hansen looked at me. “Let’s get a chest x-ray,” he said. “Maybe she popped a pneumo on the vent. Our only hope is to find some explanation for this. Something we can fix.”
It was a good idea given the desperation of the situation. “Popping a pneumo” meant Thein might have gotten too much air volume on the respirator, and she might have a burst lung (a “pneumothorax” or “pneumo,” for short). I couldn’t imagine how this could happen as I’d placed the respirator on all the standard settings. Nevertheless, it was worth a check. A sudden burst lung was one of the few things that could cause a patient to suddenly crash the way Debora Thein had crashed.
The x-ray tech jumped in and took a chest x-ray. Within seconds, the x-ray image was electronically displayed on the computer screen in my work area at the head of the bed. We scanned the x-ray looking for a collapsed lung.
“Normal,” I said looking at Hansen for confirmation.
“Agreed,” Bob said. “No pneumo.”
Suddenly, Thad Merleson began screaming. “This is Martin Thein’s wife!” he said. “Do you understand that? This is Martin Thein’s God damn wife!”
Hansen looked at me with raised eyebrows. “Christ,” he whispered. “Really?”
+ + +
We worked on Debora Thein for another thirty minutes. According to Code Blue protocols, survival becomes highly unlikely after fifteen minutes in the continuous absence of a heartbeat. Efforts beyond fifteen minutes are deemed unlikely to succeed. We worked on Debora for three times that time. No one could accuse us of not going all out for her.
But we could not bring her back. Bob Hansen stopped offering suggestions. Linh Vu had nothing to add save the angry scowl etched across her face. Thad Merleson stopped pacing, and he stopped screaming. The respiratory tech kept squeezing the oxygen bag, and the ER tech kept doing chest compressions. But there was a look of hopelessness on everyone’s face; at that point, we were all just going through the motions. Lisa, the scrub nurse stood at the foot of the bed, eyes closed—I think she was praying. We were flailing a dead body, and we all knew it.
Finally, I spoke out loud what everyone in the room was thinking: “It’s been over forty-five minutes. I don’t… I don’t think we’re going to get her back.”
All eyes in the room were on me.
Thad Merleson took off his surgical hat and let it drop to the floor. He turned on his heels and walked quickly out of the suite. Linh Vu stood against the far wall frozen like a glowering statue. I looked at the ER doctor. Hansen nodded his head solemnly: he agreed, there was no point in going on.
“Okay,” I said in a whisper, nodding at the tech. He stopped the chest compressions. The respiratory therapist stopped squeezing the respiration bag; she reached up and turned off the oxygen at the flow valve. The room was suddenly enveloped by a leaden stillness.
“We did everything we could,” I said after a moment of silence. “I just don’t know what happened. Her heart, it just… stopped.”
People started to slowly shuffle out of the room. I looked up at the clock on the wall: it was 9:23. That was the time I made it official. 9:23. That was the time I pronounced Debora Thein dead.
I’d wanted to be a doctor for as long as I can remember. As a young girl, my favorite book was Germs Can Make You Sick, a rhyming book with charts and amusing illustrations of colorful germs with bulging eyes and monster teeth. I read the book over and over until I’d memorized the rhymes from cover-to-cover:
Viruses in your nostrils
Bacteria in your cheese,
Some germs are good for you
Others make you sneeze.
Biology was my favorite subject in school. In sixth grade, I designed a class science project that involved growing bacteria on agar plates. I showed how, upon repeated exposure to antibiotics, the bacteria evolved into “super bugs” that could not be killed by conventional means. My project won third place in the state-wide science competition that year.
It’s hard to say where my love of science came from. My parents had not pressured me to go into medicine. They were both musicians, and they valued the arts over the sciences. I grew up in an environment colored more by Miles Davis and Mozart than by Darwin and Pasteur.
We lived in the North Beach district of San Francisco. Although North Beach is the so-called “Italian District” of the city, neither of my parents are of Italian ancestry. My last name, “Fâtier,” is French in origin. My French-African-Haitian paternal grandfather immigrated to California from Haiti. My dad retained the accent circonflexe, the â in Fâtier, as an “artistic touch.” My three other grandparents were immigrants as well: Dad’s mom was from Taiwan, and my mother’s parents were Russian Jews. I suppose my heritage makes me the poster child of the American melting pot: a Black-Asian-Russian-Jewish American. With my green eyes and unruly, dark-brown hair, I’m constantly being asked about my ethnic background. I wish I had a dime for every time someone’s asked, “Where are you from?” I’d be rich.
Dad was a jazz pianist; he made a living playing nightclubs throughout the Bay Area, but the work was never steady for him. As a result, we—my brother, sister, and I (I am the youngest)—grew up poor. Dad died after a long battle with leukemia when I was nine. He and I were close, and his death hit me hard.
My mother worked as a back-up violinist for the San Francisco Symphony. She played with the symphony when first-line players called off sick or when a performance called for a particularly large orchestra (Mahler’s “Symphony of a Thousand” comes to mind). Typically, she would play with the sympathy two or three times a month, and, after Dad died, she made just enough money to keep us afloat. We lived in a two-bedroom apartment where I shared a room with my sister (my brother slept on the couch in the living room). Most of our clothes were hand-me-downs, and the kids at school—particularly in high school—would tease us about that.
In addition to science, my other great love growing up was music. My father taught me to play the piano on the old, battered Yamaha upright at home. Like Dad, my preferred genre was jazz, and my piano heroes were the likes of Bill Evans, Herbie Hancock, Paul Bley, and Keith Jarrett. When I turned seven, my father wrote a piano piece just for me, a piece called “Sea Love, for Hannah.” It’s a slow, beautiful jazz melody. Dad played it in nightclubs, and it was a hit. It became his signature piece before he got sick. My dad and I would sit together at the piano at home and play it as a duet, with me playing the high notes and Dad playing the bass. I miss my dad.
I went to UCLA for pre-med studies. I’m not a big fan of Los Angeles (terrible smog and traffic), but I liked UCLA. I made a lot of friends there. I majored in biology and played the piano with the UCLA jazz ensemble. We—the ensemble and I—traveled to Europe during my junior year and gave performances in Paris and in Munich. It was a great way for a financial aid student, like myself, to finagle a trip to Europe.
Med school was in Baltimore, Johns Hopkins. I thoroughly enjoyed studying medicine. I am fascinated by the human machine, by what it takes to keep the machine well-tuned and running, and by the myriad ways in which that machine can break down. For me, the most difficult part about med school was deciding which area of medicine to go into. I had considered surgery, but most of the surgeons I knew were overworked and unhappy. Their days started before dawn and proceeded through most of the day in the OR; then there were patient rounds in the evening; then overnight call every third or fourth night doing emergency operations. As much as I liked medicine, I wanted to go into a specialty that didn’t devour my existence. I had hobbies that I enjoyed (playing the piano, for example), and I hoped someday to get married and have children. I actually wanted to watch my kids grow up. I didn’t want to be one of those doctors who hired nannies to raise the kids, and I didn’t want my kids to refer to me as “the lady who sleeps here sometimes.”
In the end, I chose anesthesiology. I got a glimpse of the anesthesia lifestyle during my senior rotation in “gas” (“gas” is medical student slang for anesthesiology). On a normal work day, you got assigned two or three OR cases. You arrived to the hospital at 7:30 in the morning and typically got to go home at 3:00 or 4:00 in the afternoon after your last case. No rounding on patients in the evening. No clinic. Most anesthesiologists do take occasional night call, but with fifteen to twenty anesthetists on staff, you only need to take call once every two or three weeks. In addition, anesthesiologists are well paid. That’s not why I ultimately chose the specialty, but, at the same time, I’m not complaining that an anesthesiologist makes twice what an internist makes—and works half the hours.
There are some drawbacks to anesthesiology, however. For one thing, you don’t get much respect. A lot of laypeople don’t look at anesthesiologists as “real” doctors. After all, we don’t treat disease, and we don’t perform operations. We just render people unconscious so the “real” doctors can do their job. The joke is all that anesthesiologists do is sit around all day long “passing gas.” Surgeons, in particular, give us no respect. They look upon us as their operating room lackeys, and they kick and scream if a patient is not fully anesthetized the moment they’re ready to operate.
But, all-in-all, I’ve been happy with my choice of specialty. Although a lot of patients don’t seem to appreciate us much (anesthesiologists don’t get a lot of Thank You cards), we are really a patient’s best friend. Really. The surgeon is merely a technician, a mechanic who knows how to wield a scalpel. The anesthesiologist, on the other hand, is a friendly wizard who turns a painful and frightening experience—the operation—into a painless, timeless dreamland.
+ + +
I think the hardest moment that morning of January 14th was when the two nurses, Lisa Andrada and Justin Barnes, placed Debora Thein’s body in the body bag. Standing there looking on, I suppose I was in a state of shock. Debora Thein was dead. It didn’t seem real. What had happened? What had gone wrong? I hadn’t a clue. I felt as though I was trapped inside a bad dream. Any moment, I would wake up, jump out of bed, take a shower, and head in for my real day of work.
“I guess I… I need to talk to Martin Thein,” I stuttered, looking at Linh Vu who was still with us in the suite.
“I’ll take care of it,” Linh said dryly. “I think it’d be better if I did it.”
Lisa zipped the body bag shut, and the OR tech came in with an empty gurney. There would be an autopsy, of course. An autopsy is automatic when death occurs in the OR and when the patient is young and healthy and when death comes without explanation. Lisa and Justin lifted the body off the operating table and transferred it to the gurney. In silence, the tech started to wheel the body out of the suite.
“I’ll go with you,” Linh Vu said. Then she turned back and looked at me. “I need to talk to you. Not now. After the autopsy. All right?”
“All right,” I said. “Yes.”
Linh walked to the front of the gurney and helped guide it out the doors of the suite. They headed off to the hospital morgue.
Lisa and Justin began cleaning up the room, picking up syringes, medicine vials, needles, the various detritus of the Code Blue. I sat down in the swivel chair at the head of the now-empty operating table. My arms and legs felt rubbery and numb. I couldn’t shake off the idea that I was somehow responsible for the tragic outcome of the operation. Operation? What operation? There’d been no operation. Thad Merleson had only just entered the room. He’d done nothing more than clean Debora Thein’s skin with antiseptic soap. He hadn’t spilled a drop of blood. He hadn’t even picked up his scalpel.
Lisa Andrada, the scrub nurse, slowly pulled off her surgical gown and her mask. She looked to be as shaken up as I was. She stared blankly ahead as she dropped her mask into the trash.
“It doesn’t seem real, does it?” I said.
“No,” Lisa said. “It doesn’t.”
“I just don’t get it,” I said. “What happened?”
“I don’t know, Doctor,” Lisa said. She folded her gown into quarters and placed it in the gown hamper. “Her heart just… stopped.”
I slumped down in my chair, and stared at the empty OR table. “How long have you been an OR nurse, Lisa?” I asked.
“Twenty-two years, Doctor.”
“Have you ever seen anything like it before, a patient die like that?”
“Not like that, no.”
I turned toward Justin Barnes who’d started wiping down the operating table with an antiseptic wipe. “You?” I said. “Any theories?”
“Bad reaction to the anesthesia,” he said as he continued wiping off the table.
“You think so?” I said.
“Gotta be,” Justin said. “I mean, what else?” He turned away and tossed his balled-up wipe ten feet through the air into the trash, like a basketball player making a free throw. It struck me as an inappropriate act of levity given the circumstances.
“You’re new here, aren’t you?” I said to Justin.
“When did you start?”
“A month ago.”
“Where did you work before?”
“San Francisco General.”
“Did you know that Mrs. Thein was the wife of one of our physicians?”
“Yeah. I heard.”
“I’ll bet you saw a lot of death at SF General,” I said. “Gunshot wounds, stabbings, trauma.”
“Yup, we did.”
“Well, it’s not so common here,” I said standing up. “Death, I mean. Especially when it happens to someone relatively young and healthy.”
Justin just shrugged his shoulders.
I started to walk out. When I reached the door, I stopped and looked back at Lisa. “You gonna be okay?” I said.
“I’ll be okay, Doctor. What about you?”
“I don’t know,” I said. “I’m going to need some time to wrap my head around this.”
“I know what you mean,” Lisa said. “Me too.” She walked over and gave me a hug.
While we hugged, I glanced over at Justin. He picked up a latex glove from the floor, and, stretching it, he shot it rubber-band-style into the trash can. I decided, then and there, that I did not like Justin Barnes. I exited the suite and headed for the locker room.
After changing into a new set of scrubs, I tried to contact Martin Thein. I knew both Thad Merleson and Linh Vu would have told him the terrible news, but I wanted to express my condolences as well. I looked for Martin in the family waiting area outside the OR, but he wasn’t there. I got his pager number from the hospital operator and tried paging him, but he did not respond.
I had two more cases that afternoon. I considered calling the OR charge nurse to say I wouldn’t be able to do any more cases that day. I didn’t know if I’d be able to concentrate and do a proper job. But, it’s almost unheard of for an anesthesiologist to call off a surgical case. Surgeons might call off a case for any of a variety of reasons (unforeseen delays in earlier cases, the patient has become unstable and going under the knife is too high-risk, a test has yielded an unexpected result that precludes surgery), but the anesthesiologist is supposed to be ready to go to the OR whenever the surgeon is ready. Perhaps, however, they could find a replacement for me.
In the end, I dragged myself to my two remaining cases—a noon appendectomy and a two o’clock hernia operation. Mercifully, the operations went without incident.
Following my last case, I went to the locker room to change into my street clothes. I wondered when the autopsy would be. I both wanted to know and dreaded to know what they might discover. I pulled on my blue jeans and went over to the wall phone next to the locker room door, and I tried paging Martin Thein yet again. Again, there was no call back. I just wanted to tell him how sorry I was. I even considered going over to the dermatology clinic to see if he was there, but I figured it was highly unlikely he’d be working after the events of this morning.
I finished getting dressed. I stuffed the brown paper bag containing my uneaten lunch into my backpack, and I headed out of the locker room for home.
On my way out, a strange thing happened. A very strange thing. The women’s locker room exists into the front area of the operating complex. This is the area where the OR charge nurse is stationed and where the scheduling board—the large, eight-by-eight-feet whiteboard showing all the day’s surgeries—is located. Looking at the board, I saw that Thad Merleson had an operation, a rhytidoplasty (facelift), scheduled at four o’clock in Suite 5. It was now five minutes to 4:00. I considered popping my head into the suite; if nothing else, I simply wanted to acknowledge to Thad this morning’s events. It struck me as odd that he and I had not talked since this morning.
As I stood there thinking, I heard someone coming out of the men’s locker room. It was Thad, wearing scrubs and a surgical hat. He was obviously headed to his 4:00 o’clock facelift.
“Hey, Thad,” I called out.
Thad stopped and turned.
“Terrible thing this morning,” I said walking over to him. “I’m still in a state of shock.”
Thad stood there, staring at me, but he said nothing.
“How about Martin?” I asked. “I’m sure you talked to him. How did he take the news?”
Bizarrely, Thad again made no reply. He just stood there like a frozen man staring at me. Then, without having uttered a single word, he abruptly turned and walked off. I watched in astonishment as he went down the corridor and disappeared into Suite 5.
I was dumbfounded. Given the tragedy of this morning, how is it that he would not even say a word to me? Was he angry at me? Did he blame me for what had happened? Was he so angry that he wouldn’t even talk to me? What other explanation was there? Standing there alone in the OR corridor, I felt as though I’d just been kicked in the stomach.
I don’t know how long I remained there staring at the doors to Suite 5. Eventually, I slung the strap of my backpack over my shoulder and walked out of the complex. I headed home to an untouched dinner and a night without sleep.
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