The Doctor and Mr. Dylan (6 page)

I found the surgical locker room, a small space one-tenth the size of the men’s locker room at Stanford. I selected a set of scrubs off the shelf and changed out of my street clothes. At Stanford the scrubs were bright royal blue. In Hibbing the scrubs were faded green and looked like they’d been in use since the day I was born in this very building.

I was edgy, even though I was overqualified to work at this little community hospital. At Stanford every nurse, doctor, and janitor knew my name. Here I’d have to earn the respect of dozens of people who’d never heard of me. Medical careers don’t travel as well as business careers. A businessman in California could be promoted to a CEO job in Minneapolis, but doctors who moved from one state to another started at the bottom of the ladder, behind physicians who had reputations and referral patterns already established in the new community.

I entered the hallway of the operating room complex. Hibbing General had only six operating rooms, compared to the 40 rooms at Stanford. The schedule for the day was posted on a white board across from the central desk. My old med school classmate, Michael Perpich, the Chief of Staff at Hibbing General, was the surgeon working in operating room #1. Dr. Perpich was repairing an inguinal hernia on a 43-year-old man—a routine case. I could pop in and say hello without distracting Perp from his task.

I put on a surgical hat and mask and pushed open the door into O.R. #1. The operating room was small, a compact 30 feet by 30 feet. The linoleum floor showed brown stains from old iodine spills. The faded turquoise tile on the walls had witnessed thousands of hernia surgeries. Michael Perpich was bent over the patient’s abdomen. He saw me walk through the door, and said, “Nico Antone. The Tone. Get your ass over here.” A surgical mask covered his face, but I knew my friend was grinning.

“They said you needed some help to fix this hernia,” I said.

“You’re a God damned gas-passer. You couldn’t fix this hernia if I held the book open for you.”

“I’m here to see if your hands shake as much as they used to, Perp.”

“I came here straight from the card room at the Corner Bar at dawn. Never felt better.”

“You’re so full of shit.”

“Did you guys get situated over at Dom’s?”

“We did. Johnny wasn’t thrilled about waking up at 6 a.m., but he ran up the high school steps two at a time this morning.”

“So he’s a gunner. Just like his dad.”

“I got by.”

“You opened a textbook once a week in med school, and you still finished number one in our class. I can’t believe you came back. When you left for California you said never wanted to see a snowflake again.’”

“Things change, Perp. My kid needs an upper-Midwest high school diploma.”

“California kid comes to the wilderness to go to the head of the class, eh? I’ll tell you one thing: the Hibbing teachers will shape him up. I had sergeants in the Army who were more mellow than the Hibbing faculty.”

The scrub tech, a blonde woman wearing too many layers of blue eye shadow, said, “My son is a sophomore. He studies four hours every night.”

“Nico, meet Heidi, my right-hand woman,” Perpich said. “She’s my assistant, my psychotherapist, and the encyclopedia of all gossip great and small in the village of Hibbing.”

“Nice to meet you,” I said.

“Heidi, this is Dr. Nicolai Antone, a welcome addition to the anesthesia staff. Dr. Antone and I went to med school together. He was an anesthesiologist in California, but now he’s one of us, the slightly-better-than-average staff of Hibbing General. So you left Alexandra behind?”

“I did.”

“Good move. Not much up here for princesses.”

“You’re married, Dr. Antone?” Heidi said.

“I am. My wife is back in California.”

She fluttered mascara-laden eyelashes at me and said, “Welcome to Hibbing General. I look forward to working with you.”

Perpich looked up toward the head of the operating room table and said, “Bobby, did he get his antibiotic?”

A wisp of a man—narrow and bony—stood at the head of the operating room table in the anesthesia cockpit of machines, monitors, intravenous drips, and drug cabinets. The man said, “She did. One gram of Kefzol at 7:45.”

“Nico, I want you to meet Bobby Dylan, our Director of Nurse Anesthesia,” Perpich said.

My head snapped back. I wondered if I trusted my ears. Bobby Dylan? The same name as the legendary musician? Here in Hibbing?

The nurse anesthetist ignored Perpich’s cordial introduction and said nothing to me. I was miffed. Who did this guy think he was? He was only a nurse anesthetist. Why the ingratiating attitude toward me, a board-certified anesthesiologist physician?

It was a small hospital, and despite my negative first impression I felt compelled to meet my fellow anesthesia colleague. I walked around the operating room table and entered the anesthesia station. A blue paper hat and mask covered Dylan’s face. His sole facial features were the recessed caves that housed his glossy fish eyes, and the speckled black and gray eyebrows that floated above them.

I extended my hand and said, “Greetings. I guess we’ll be working together.”

Dylan turned his back on me. The beep, beep, beep of the patient’s pulse rate hung between us. He reached over and turned the knob on the anesthesia machine that titrated the oxygen flow. He coughed twice—loud, harsh, barking sounds, and said, “We opted out here, Mac.”

“What?” I said. I wasn’t sure what I had just heard.

“We opted out,” Dylan repeated. He still wasn’t looking at me. He picked up his clipboard and made some notations on the patient’s chart with a pen.

I was getting more and more pissed off. My first impressions were confirmed. This guy was a dick. I didn’t care if this was Dylan’s anesthetic, his operating room, and his hospital. I was unaccustomed to this degree of condescension within two feet of an anesthesia machine. He turned up the intravenous propofol infusion and continued to ignore me, even though I was close enough to smell the staleness of his body odor.

I checked the settings on the anesthesia machine and monitors, looking for some sign that Dylan was as incompetent as an anesthetist as he was as a conversationalist. He was using routine concentrations of standard anesthetic drugs. The ECG, blood pressure, and oxygen saturation numbers all showed normal values. Dylan wasn’t a doctor, but at the moment he was delivering a routine anesthetic in a safe fashion.

I thought to myself,
Fuck you, you dirtball
. If this Bobby Dylan character wanted to be left alone, I was going to leave him alone. I said, “Hey Perp, I’ll catch you when your case is done, OK?”

“Will do. I’ll meet you in the lounge. Give me 30 minutes.”

“See you there.” My feathers were ruffled. It was great to see Michael Perpich again, but if my initial contact with this nurse anesthetist was any indication, my welcome in the Hibbing medical community was going to be as chilly as a January dawn. I made my way to the operating room lounge, a stark room with four walls of undecorated peach-colored wallboard. The sole furnishings were two long tables and a dozen chairs. All the chairs were empty. Sections of the
Duluth News Tribune
and the
Hibbing Daily Tribune
were strewn over the tabletops. The aroma of fresh brewed coffee filled the air. I poured myself a cup and selected a glazed doughnut from a platter.

I felt like a midcareer misfit, stuck in somebody else’s workplace. I missed Stanford. On a professional level, this move to Minnesota looked to be a near-death experience for me.

Michael Perpich’s clogs hammered the floor when he walked in. He pinched the back of my neck, snatched two doughnuts for himself, and plopped down in a chair across from me. “It’s great to see you, Tone,” he said. “I still can’t believe it.”

I hadn’t sat eye to eye with Perp for years. With his surgical cloaking removed, he looked ten years older than me. The top of his head had more dandruff than hair, and the creases around his nose and mouth were deep and long. His smile was genuine, and I chose to disregard the ancient appearance of the only acquaintance I had within a thousand miles.

“Glad you’re here,” I said. “I’m counting on you to be my lifeline at this place.” I waved my hand at the desolate room. “Does anybody else work here?”

“Of course. We have a full staff, like any other community hospital, but we’re light on anesthesiologists. Your timing is perfect. Our last two anesthesiologists retired and moved to the Sun Belt in November. We have six nurse anesthetists, but for tough cases we need an M.D. anesthesiologist in town. Now we’ve got you.”

“So the rest of the anesthesia staff is all nurses?”

“Yep. Six nurse anesthetists. They’re a solid group. I haven’t had too many problems with them.”

I was unconvinced. Nurse anesthetists were registered nurses with a year or more of intensive care unit experience, followed by two or three years of training in a nurse anesthesia program. They learned how to anesthetize patients, but they weren’t medical doctors. In some hospitals, anesthesiologists worked with nurse anesthetists in anesthesia care teams, a team model in which one M.D. anesthesiologist might supervise four nurse anesthetists working in four separate operating rooms. Because this hospital had no anesthesia doctors, the nurse anesthetists were working unsupervised.

“What’s the deal with the Bobby Dylan guy?” I asked. “He stopped one step short of open hostility. Is he a prick, or what?”

“Sometimes he is.”

“He didn’t give me the time of day.”

“It’s a turf thing. This is his hospital. You’re an outsider. The guy doesn’t want you here.”

“He’s a nurse. How does he get off giving me a hard time?”

“Minnesota is an opt-out state, Nico. The Minnesota governor opted out of the requirement for a medical doctor to supervise nurse anesthetists. Bobby Dylan can give anesthesia here, just the same as you can, even though he’s not a doctor.”

We opted out here, Mac
. The words Dylan had uttered to me.
Opted out.

“So it’s legal here for a nurse anesthetist to give an anesthetic without being supervised by a physician?”

“That’s right.”

“That’s substandard care, if you ask me, and it still doesn’t make this Bobby Dylan guy a doctor. If you had enough physician anesthesiologists in town, would you still let jokers like him give anesthetics alone, or would you replace him with a doctor?”

Perpich threw up his hands. “That’s never going to happen, so who cares? Dylan has been here a long time. He hasn’t had any deaths, he’s kept his nose clean, and he’s not going anywhere.”

“Why is he named Bobby Dylan? That can’t be for real.”

Perpich shrugged again. “I don’t know what his real name is, and I don’t care. He showed up in Hibbing 8 or 10 years ago, and his license and paperwork all identified him as Bobby Dylan. I asked him if that was his real name or if he’d changed his name.”

“And he said?”

“He said his name was Bobby Dylan. Period. He dodged any questions about his past. He was a nurse anesthetist in the Afghanistan War. He’s got a wife and a daughter. He plays guitar and sings at a bar downtown. Plays all the original Dylan songs. People tell me he’s pretty talented. Maybe he was a huge Bob Dylan fan and he just wanted to move to Dylan’s hometown, take Dylan’s name, and get a job here. If so, he’s done all three.”

I shook my head. “That’s pretty weird stuff.”

“It gets more weird. He bought the old Zimmerman house.”

“You’re kidding.”

“Nope.”

“He’s a psycho,” I said.

Perpich’s eyes twinkled. “Up here, there are a lot of characters. Get used to it. He’ll grow on you, once you accept the fact that he’s your peer.”

“My peer? I’ll never accept that.”

As if summoned by their conversation, Bobby Dylan came in through the doorway, poured himself a cup of coffee, and sat in the opposite corner of the room. He peeled off his surgical hat to reveal a fuzzball of curled black and gray hair. He took out a pen and started filling out a crossword puzzle from the morning paper. His mouth stretched into a long yawn. It was just another day for him. My presence was of no consequence.

“I’m going to make rounds on my patients upstairs on the surgical wards,” Perpich said. “Will you be home tonight?”

“Where else would I be?”

“I’ll drop by. I’ve got some housewarming presents for you.”

“Can you bring us a digital video recorder? Dom doesn’t have one.”

“No DVR. Just make sure you’re hungry.”

“Sounds good. See you later.”

Right after Perpich left, I heard a rumbling voice behind me say, “Doctor Antone?”

I turned. It was Mr. Dylan. His facial expression was a cross between a smirk and an all-knowing smile.

“Yes?” I said, puzzled at the encounter.

“I dissed you back there in the operating room. Sorry about that. I was concentrating on my patient, and no one told me you were coming to town. I expect this place is big enough for both of us. No hard feelings?”

I was suspicious. The curl of Dylan’s upper lip seemed to say,
I don’t like you one bit, but I’ll pretend that I do just to fuck with you.
Before I could answer, he sat on the tabletop in front of me and asked, “Why does a California guy like you move to the Iron Range?”