Could I Have This Dance? (28 page)

She looked for an ambu bag, then, seeing none, lowered her lips to the small girl’s face and gave her four quick breaths. She felt for a pulse. Nothing. “Wendy!”

Overhead, the operator’s voice began sounding the code. “Code blue, CT scanner one. Code blue, CT scanner one.”

The door from the waiting room flew open as Claire started chest compressions. Dr. Overby bounded in, sweat glistening from his forehead. “What happened, Claire?”

“I’m not sure. After the scan, I walked in and found all this blood.”

The chief resident pulled away the blanket so he could see. “The central line is disconnected from the IV tubing.” He looked at the position of the IV pole at the head of the table. “You can’t put the IV pole up there and expect the tubing to stretch this far! Weren’t you watching?”

Wendy grabbed the IV pole and pushed it around the table so it would reach. She hooked it back to the central line.

Roger Jones was standing in the doorway, his eyes frozen on Claire. Behind him, his wife was sobbing. “No, no, no.”

Ron gently put his hand on Mr. Jones’s shoulder. “Come on, we’d better let the doctors work.”

Claire was relieved to see the door close again. She wasn’t sure she could stand to hear Mrs. Jones’s agony.

“She’s probably had an air embolism, from sucking air back into the disconnected IV,” the O-man explained. “We need to put her back on the stretcher so we can tip her head down and put her on her side.”

He scooped her in his arms and lifted her to the waiting stretcher. The members of the code team arrived as Claire resumed chest compressions.

Dr. Overby put a syringe on the central line and pulled back the plunger. Bubbles of air filled the syringe. “Bingo,” he said. “Let’s roll her on her left side. We’ve got to see if we can float the air lock out of her pulmonary outflow track.” He tried the maneuver again. This time, he only withdrew dark blood.

“Get me an endotracheal tube,” he barked.

Josef arrived with blood. The O-man slipped a tube in Sierra’s trachea. Claire continued chest compressions. They gave blood. More blood. Lidocaine. Bicarbonate. Calcium. Multiple defibrillations. Minutes passed. Dr. Overby paged urgently for Dr. Walter Andrews, the pediatric surgery attending on call. Dr. Andrews arrived twelve minutes later and listened to the summary given by the chief resident.

They transfused more blood and continued CPR. For a full hour they worked, even inserting a transvenous pacing wire to try and capture the heart, to force it to beat normally again.

Dr. Andrews surveyed the scene with compassionate eyes. He pulled off a pair of disposable gloves and wiped the sweat from his brow. “You’ve done all you can, Overby.”

Sierra Jones was dead on her seventh birthday.

“Let’s call it.” The O-man looked at his watch. “Time of death: 10:05 P.M.”

Ron handed the chief resident a hard copy of the CT scan. He sighed and looked at the team. “Thanks.”

Claire couldn’t hold back the tears.

The chief resident put his hand on her shoulder. “She lost a lot of blood from the liver, Claire. Even without the air embolism, I doubt she’d have ever made it through surgery.”

She couldn’t respond. She was numb. Her patient had died because she hadn’t been paying attention.

“Here,” he said, handing her a tissue. “Wipe your tears. We have to face the parents.”

She walked out behind Dr. Overby, who followed closely behind Dr. Andrews.

They found the family huddled together in the corner of the waiting room. They stood as they saw Claire approaching. “Well?” the father said.

Dr. Andrews grasped Roger Jones’s hand. “I’m Dr. Andrews, a pediatric surgeon.”

Celia stood beside her husband, her face ashen, her eyes swollen. “How’s Sierra?”

Dr. Andrews shook his head without speaking.

“I’m sorry,” Dr. Overby responded. “We did everything we could to save her.”

“No!” Mr. Jones yelled. He pointed at Claire. “You said she was going to be fine! You went in there with her. She was alive. What have you done to Sierra?”

Celia grabbed her husband’s arm. He shook it free.

Dr. Overby frowned and introduced his massive frame between the agitated father and Claire. “Mr. Jones, your daughter’s liver was badly damaged. A drunk driver took the life of your child, not Dr. McCall.”

Claire backed away. “I’m so sorry. So sorry.” She pivoted and rushed from the room, her hand to her mouth. She found her way to her call room without thinking. There, she sunk to her knees and dissolved into tears.

Chapter Nineteen

C
laire washed her face, pushed the event aside, and completed the night with mechanical numbness. She managed to steal away to a call room at three A.M., but images of a purple birthday bicycle with a handlebar basket and bell prevented any hope of sound slumber.

In the morning, Claire’s duties shifted. She walked with Beatrice in silence, looking for the O-man, their chief resident. They found him in the ER teaching a battle-weary group of medical students. She handed her beeper to him with a ceremonial salute. He patted her shoulder and held her gaze for a brief moment. “You’ve had a strong start, Claire. I’ve liked working with you.”

She nodded. She felt like crying. She’d fought in the trenches side by side with this man, and in spite of his sometimes humiliating tactics, she’d learned more from him in a month than she had during a year in medical school. She wanted to grab his white coat and hang on, to stay with him another month, listening to his stupid rules, and watching him step in and rescue patient after patient. She didn’t want to choke on her words now. “Thanks, Dr. Overby,” was all she could say.

She turned and walked away, listening as the O-man said good-bye to Beatrice. As the doors to the ER closed behind her, she heard him joking about first blood.

She padded on heavy feet to the Cardiothoracic Intensive Care Unit, the CT ICU, where she was scheduled to meet her new team. She looked at her watch. It was almost six in the morning.

She was joined by fellow intern, Martin Holcroft, MD, PhD, a Harvard Medical School graduate. Martin was softspoken and geeky with a reputation for methodical slowness in completing his scut list. Scut, the grunt work on any hospital service, consisted of minor procedures like drawing blood or inserting IVs or running down the myriad of labs and necessary X rays for rounds. Scut work was usually handled by the medical students, which gave rise to the designation which most of them despised: “Scut monkeys.”

Martin had on a white shirt and tie beneath his white coat. His pockets were filled with necessary accessories. Pens, a stethoscope, and several clinical manuals crowded his pockets. Claire had adopted more streamlined apparel. One pen, one stethoscope, and a pack of cheese crackers were the only necessities she carried.

Martin wiped his hand through his stringy brown hair before offering it to Claire. “Hi.” He smiled, revealing a small gap between his front teeth. “I heard I’d be working with you this month.”

She took his hand. “Hi, Martin. What service did you come from?”

“Plastic surgery at the VA.” He frowned. “I haven’t even seen the inside of an OR yet. How about you?”

“I was on the trauma service here at the university. I got to do a few cases, nothing too major.”

They looked up as Robert Rosenthal approached. Robert was the cardiothoracic surgery fellow on the service. He was Dr. Rosenthal to the interns, as he had already completed his general surgery residency and was now in his second year of his CT fellowship.

Dr. Rosenthal looked at the intern duo and tugged on the lapels of his heavily starched lab coat. “Morning,” he said. He held out his hand to Claire.

“I’m Claire McCall.”

He nodded and held his hand out to Martin.

“Martin Holcroft.”

Dr. Rosenthal pointed to an empty bed in the eight-bed CT ICU. “Let’s sit down for a minute to go over the rules.”

Martin and Claire sat on the bed. Rosenthal stood and seemed to be sizing them up.

Claire thought his jacket looked too starched. She wondered if he could sit even if he wanted to.

“We have two CT attendings. Dr. Lewis and Dr. Blanton. They are easy to please if you follow their rules. We will do morning rounds at six, starting here in the ICU. You will be on every other night.” He looked at a notepad in his hand. “Claire, you’ve been assigned odd-night calls. All call is in house and you are expected to be inside the ICU for the night following any day we’ve done open-heart cases in the OR. We do open-heart cases on Monday, Tuesday, Thursday, and Friday. Wednesday is our clinic day. Scrub attire is permitted only in the OR. Dr. Lewis is particularly persnickety about this. If you are on rounds with Dr. Lewis, you’d better wear a white lab coat and a tie.” He paused and looked at Claire. “Uh, in your case, you should wear a dress.”

Claire looked down at her scrubs. “Uh oh.”

Rosenthal made a clicking noise with his cheek. “Make sure you change by the time we round with Dr. Lewis after today’s cases.”

Claire winced. “This is all I have here. I just came off the trauma service. This is what we wore all the time.”

“Well, this isn’t trauma, it’s hearts, and here, the attendings want you to look the part of well-dressed professionals.” He looked at Claire for a moment longer and made a few more clicking sounds. “Can you get home and back in thirty minutes?”

“I think so.”

“Good. After rounds, get home and get changed. If the interns aren’t properly attired, it’s my back that gets riding by the attendings.”

Rosenthal lifted his hand and gestured toward the occupied beds in the unit. “These are our post-op open-heart patients. This is the pinnacle. Everything you’ve seen in general surgery up until now was just a warm-up. The CT surgeons actually cut and modify the human heart. Every open-heart case we do is actually an artificial suspension of life. We still the heart, and pump the patient’s blood with a cardiopulmonary bypass machine. If you get your floor work done efficiently, you are welcome to come into the operating theatre and observe. But don’t be hanging out in the OR if your scut list isn’t complete.”

Claire glanced sideways at Martin. She hoped he wasn’t as slow as she’d heard. She wanted desperately to get in the OR where the action was.

“Questions?”

The interns shook their heads silently.

“There will be three students on this service, but, unfortunately, since this is August, it’s the very beginning of the year for them, so they won’t have had any practical experience. They are in an orientation until ten this morning. When they show up, you can divide up the patients on the service and assign them to the medical students. Since they are new, they’re going to need a lot of help with case presentations. Work with them. Buff them up as much as you can. When they look good, the attendings think the interns are teaching them, and they like that. If the students look good, you look good. And if you look good, I look good. Got it?”

Claire nodded numbly. The only thing more worthless than an intern on her first day was a third-year medical student on her first day.

Dr. Rosenthal smoothed the front of his jacket. “Then let’s have at it.”

After rounds, Claire made a beeline for her house to grab a dress. While she was there, she listened to her phone messages.

Her mom had called. Clay had a court date for a DUI. Her mom wanted Claire to pray that the judge would be lenient and let him keep his license. The last thing she needed was to have to run him to work, in addition to caring for Wally. Claire shook her head. After watching Sierra Jones die, the last thing Claire felt like praying for was leniency for a drunk driver. Let Clay take his medicine like everyone else.

John called. Just wanted to hear her voice. Claire shook her head. How many times had she told him she was taking odd-night call? He should know she wouldn’t be home.

Brett called. He hadn’t seen her for a few days and was just wanting to see how she was doing. That was sweet.

She opened her closet and sighed. She hardly ever wore dresses. She had a few party dresses, but they weren’t exactly the professional look that the CT surgeons wanted. She settled on a navy skirt and a white blouse and made a promise to herself that she would go shopping.

She changed, picked out a fresh blouse for the morning, and rushed back to the hospital. She wrote daily notes and went over the patient charts so she could present them on rounds to Dr. Lewis. By noon, the first coronary bypass patient was out of the OR and in the ICU, so Claire was expected to be at the bedside. “Here,” Dr. Rosenthal remarked, handing her a small blue notebook. “These are the most common medications we use on the service. It also has all the protocols for most of the problems we encounter in caring for the open-heart patients.”

She flipped through the pages of small print.

“Commit it to memory,” he said casually. “But the best way to learn how the drugs work is to watch them in action when you are helping adjust the drips with the nurses.”

Claire nodded, and introduced herself to Diana Strasburg, the nurse assigned to the first open-heart patient of the day. Diana busied herself adjusting the IV drips and recording the data from the monitor screen and the collecting chambers of the chest tubes and the urinary catheter. Claire took a seat on a stool at the foot of the bed and tried to concentrate on the small manual in her hand.

It was then that she realized she hadn’t eaten since before Sierra Jones had died. And, other than a few catnaps after three, she hadn’t slept. And she was supposed to sit in this ICU all night to take care of the open-heart service. “God help me,” she whispered. Thankfully, the O-man had taught her something, and she found a pack of cheese crackers in her lab coat.

She had just finished the crackers when Martin Holcroft arrived. He was out of breath, and his tie was askew.

She looked up. “What’s going on, Martin?”

“They need you in ER.”

“Who?”

“They paged me to see a twenty-year-old guy with a pneumothorax. He needs a chest tube.” Martin ran his hand through his hair. “I’ve never done one, so I called Dr. Rosenthal to help, but he’s in the OR doing a mitral valve replacement with Dr. Lewis, so he suggested I talk to you. I guess he figured that since you’ve already done your trauma rotation, you’d be more comfortable with the procedure.”