Читать книгу Hunting for Hippocrates - Warren J. Stucki - Страница 13

As Moe entered Howard’s room while making early morning rounds, he noted that his pre-op orders were being carried out. An intravenous of D5LR had been inserted in Howard’s right arm and two grams of Ancef were already being piggybacked into the line. Poised with a razor, an attractive middle-aged nurse was bent over preparing to shave him for surgery. Howard feigned dismay as the nurse informed him that she had to shave all his abdominal hair, including pubic hair.

“Goddamn it Doc, you didn’t say anything about that,” Howard whined, then winked at Moe.

“Sorry bout that,” Moe grinned. “But that’s nothing, wait till she puts in the Foley catheter.”

“The what!” Howard exclaimed.

“Just seeing if you’re awake,” Moe chuckled.

“I hope you’ll at least wait till I leave the room,” Connie laughed.

“Didn’t see you there in the corner.” Moe turned to Connie. “Yeah, we’ll wait on the catheter until you’re in the operating room, Howard, and asleep.”

“I trust you slept well and are feeling sharp,” Connie said, flashing a smile.

“I slept as well as I ever do and what you see is what you get,” Moe said with a smile, then turned again to Howard. “Sorry about that bowel prep last night Howard. You probably didn’t get any sleep either?”

“That’s okay, Doc, but I suspect my colon would pass a drill sergeant’s white-glove inspection today. Anyhow, I’ll get plenty of sleep pretty soon.”

Moe glanced at Connie again. She was wearing wash-faded Levis and a tight, red-knit sweater. She looked good, even at 6:30 in the morning. “Do either one of you have any questions about the procedure, or did we pretty much cover everything in the office?”

Connie reached for her father’s hand. “How long will the surgery take? Where shall I wait?” she asked.

“The surgery will take from one-and-a-half to two hours, not counting anesthesia time,” Moe said, arching his back, trying to relieve the chronic muscle knot. “There’s a waiting room just outside the surgery suite. If you want to wait there, I’ll talk to you as soon as the surgery is over.”

“Uhmm,” the white uniformed nurse still razor in hand, cleared her throat and looked at her watch. “Dr. Mathis, if I’m going to have the patient prepared for a seven-thirty start, I better get going.”

“Oh, I’m sorry. See you in a few minutes, Howard. Connie, it’ll be two and one half hours before I’ll see you again, so don’t start watching the clock in an hour and wonder what’s taking so long.”

“I’m sure if the surgery runs long, it’ll be because you’re telling one of your famous stories,” Connie chuckled.

The surgery suite was located on the third floor of the hospital. It had six brightly lit operating room pods, each extending from a supply hub that formed the central core and each operating room had a window. At the time of construction, ten years ago, windows in the operating room were considered fairly controversial. When the hospital was built, the size of the operating rooms was considered more than adequate. However, with the unprecedented burgeoning of medical technology, each room rapidly filled with bio-technical machines. Now the operating rooms looked cluttered, messy and small.

For example, the new anesthesia machines monitored the partial pressure of each gas that flowed through them. Hence, they were much larger and required twice as much space. Then there was the obligatory pulse oxymeter to monitor what percent of hemoglobin was bound to oxygen in the patient’s blood and the anti-thrombic pump device that delivered alternating mechanical compression to the calves of the patient, trying to prevent blood clots and the more ominous pulmonary emboli. The old, dependable electro-cautery machine was still present, but now it was augmented by an even larger machine, the argon-beam photocoagulator, also used to stop surgical bleeding. The newest addition was another large machine to deal with bleeding, the harmonic scalpel, that vibrated with such high frequency that it cut and sealed blood vessels at the same time. To add to the confusion, each room had a large storage rack on wheels that contained the equipment necessary for the increasingly popular percutaneous and endoscopic procedures.

Added to all this was the storage space required for daily expendable items such as sponges, dressings, sutures, syringes, needles and scalpel blades. Finally, allowing space for small tools that were used on an almost daily basis, there was hardly enough room for the manual laborers, the surgeon, the anesthesiologist, a circulating nurse and a scrub nurse. And the patient—the patient looked almost inconsequential in this high tech arena.

After scrubbing his hands at the stainless steel sink, Moe entered this electronic maze promptly at 7:30 a.m. He was never late. Moe’s mood immediately improved when he noticed Judy would be his scrub nurse today, then it plummeted when he saw Judy and Rusty engaged in what appeared to be a private conversation. The two of them were sequestered in the corner of the operating room behind the harmonic scalpel, just out of earshot.

“Morning Moe.” Dr. David Dalby, the anesthesiologist said smiling broadly. “He’s asleep. I think I’m finally getting the knack of this anesthesia stuff.”

“I’m pretty sure Medicare would allow you to charge a higher fee if you could only learn to wake them up,” Moe jested, but felt his mood sour.

He waited a minute with his hands held upright and dripping water, then he barked, “Judy, if you have a minute, you could give me a towel and put on my gloves. Rusty, you might just as well start draping.”

“Certainly, Dr. Mathis,” Judy said just a little too formally, as she broke from her huddle with Rusty.

“Didn’t hear you come in,” Rusty said sheepishly. “Are you going suprapubically or perineally?”

“When’s the last time you’ve seen me use the perineal approach? You know I like to get the lymph nodes.”

Rusty shrugged, and started placing the sterile paper drapes on Howard, leaving the abdomen exposed. Moe walked to the left sided of the operating table.

Without looking at Judy he held out his hand. “Knife,” he commanded, then turned to Dr. Dalby. “Okay for me to start, David?”

“As far as I know,” Dr. Dalby grinned.

Moe made an incision with one uniform motion in the midline from two centimeters below the umbilicus to just above the pubis. The electro-cautery was used to stop the sub-cutaneous bleeding, then Moe used the scalpel to incise the midline fascia and enter the Space of Retzius. The peritoneum and abdominal contents were retracted superiorly and medially to expose the pelvis. Following this, the lymph nodes were harvested from the external iliac, internal iliac and obturator chains, then sent for frozen section. In fifteen minutes they would get a pathology report on the nodes. Using the argon-beam, Moe photo-coagulated the pubo-prostatic ligaments, then carefully cut them with Metzenbaum scissors. If bleeding was going to be a problem, it almost always started at this point in the operation.

Even though the distinct musky aroma of fresh blood filled the room, the bleeding was minimal and the operating field remained relatively dry. Not waiting for the pathology report on the nodes, Moe proceeded to incise the right endopelvic fascia, then handed the long-handle scalpel to Rusty to do the same on the left side. Dissection was then carried anteriorly down to the apex of the prostate, and the urethra was transected at this level; a few drops of urine dripped into the pelvis and were promptly removed by the hand-held Yankar suction. So far, so good. There did not appear to be much bleeding and there was no evidence of obvious spread of cancer beyond the prostate.

“How much blood have we lost?” Moe hunched his shoulders back, trying to work on his recurrent back spasm.

“Dusty, like St. George in August—maybe 300 cc. Dry surgery, just like they do it in Texas, huh Moe?” Dr. Dalby chuckled. “How did you like the residency program down there in the land of red necks, white lightnin’ and the Lone Star Beer?”

“Don’t forget the Dallas Cowboy Cheerleaders. David, why do I always feel like you’re trying to bait me?”

“Nah, I just want to know about residency training in Texas,” Dr. Dalby said, winking at Judy.

“Yeah, it was good training, but I almost didn’t finish,” Moe remarked. He was one of those rare surgeons who could talk and work at the same time. “Did I tell you about the time I got suspended?”

Meanwhile, Rusty rolled the prostate superiorly toward the bladder, and Moe took down the lateral vascular attachments, cut and clamped the ejaculatory ducts, and freed up the seminal vesicals.

“No, I don’t believe I’ve heard that one,” Dalby smirked.

Moe was obviously feeling better, now that the surgery was going so well and the bleeding was sparse.

“I was stationed at the Veterans Administration Hospital in Temple. It was a thousand bed hospital and I was running my ass off. Not only did I have to do all the surgery, but I had to take care of all the inpatients, do all the consults, cover the E.R. and see all of the clinic patients as well. You see, they had just fired the resident from the year ahead of me, so I didn’t have a minute.”

As he talked, the prostate was dissected from the bladder neck, totally freeing it of all attachments, then it was sent along with the seminal vesicals and a portion of the ejaculatory ducts to pathology.

“One day, I was working in the clinic, must of had thirty patients waiting, and the medical records department sent me a nasty letter through that pneumatic-vacuum tube system, threatening me that if I didn’t get my charts completed, they were going to suspend me. It’s not like I had a lot of spare time. Hell, I hadn’t slept more’n four hours a night for a month and considering what they paid me, it worked out to about sixty cents an hour. The more I thought about it, the more pissed I got. As I was seeing patients, I was getting myself worked up; slavery is still alive and well in America.”

As the story progressed, Moe and Rusty continued to work. The transected urethra was re-anastomosed to the bladder neck using 2-0 chromic catgut suture.

“So when I finished doing a prostate exam on this grizzly old veteran, I was fuming. You know, feeling awfully picked on. In a rage, I jerked off my soiled glove—it really wasn’t that bad, a brown smear and maybe a couple of little chunks—and flung it in the little tube, then vacuumed it back to the records department. Needless to say, the sons-a-bitches couldn’t take a joke and had me suspended.” Moe laughed as he put a Foley catheter in the bladder and two penrose drains deep in the pelvis.

“I wonder why? I’ll bet, that’s the only communication the records department ever got they had to call the biological hazards unit to dispose of!” Dr. Dalby was shaking with laugher. “How did you squirm out of that one, Moe?”

“They eventually saw the light and realized slave labor wasn’t that easy to come by in the twenty-first century It’s been over a hundred and fifty years since the civil war, so they took me back,” Moe said. “You don’t think for a minute that those attending physicians wanted to do all that work, do you? Especially, after they had just fired one resident.”

The pathology report on the nodes came back negative and the surgery was drawing to a close. Moe closed the fascia with #1 PDS suture, that left only the skin to close. At this point in the operation, Rusty broke scrub and turned to leave the operating room. As he walked away, Moe noticed Rusty made eye contact with Judy in what appeared to be some form of silent communication.

“Rusty, don’t forget we’ve got a penile prosthesis next—Mr. Calley,” Moe said.

“Huh? I almost forgot,” Rusty replied. “Rigid or inflatable?”

“Inflatable. AMS-700.”

“Okay, but I’m supposed to be in the office by ten.”

“I guess, you’d better call Sally then, and tell her you’ll be a little late.”

Rusty glanced one more time at Judy, then left the operating room.

“Great job, Moe.” Dr. Dalby turned down the flurane gas knob on the anesthesia machine. “Very little blood loss. The patient did fine.”

“Thanks, David, you can start waking him up, all I got left is to close the skin.” Turning to Judy, he added, “How about some Addison forceps and some skin clips.”

Judy handed Moe the instruments, then quietly said, “Can I talk to you for a minute after surgery?”

“Sure,” Moe replied. “Let me write some orders, and talk to the patient’s family, then I”ll meet you back in the surgery lounge—say twenty minutes.”

After he helped Dr. Dalby wheel Howard’s gurney to the recovery room, Moe sat at a small writing desk, scrawling his usual barely legible post-op orders. Ten minutes later, after finishing with the orders, he walked briskly for the family waiting room to find Connie.

As Moe entered the waiting room, there were two of them, two Connie’s. Both of them looked up at him with a unique mixture of stress, nerves and stunning beauy.

“Dr. Mathis, this my older,” Connie emphasized the word older, “sister, Elizabeth, from Seattle. She just got in.”

Moe reached out and shook Elizabeth’s hand. “Nice to meet you. You certainly don’t look older. In fact if I had to guess, I’d say Connie’s got you by ten years,” Moe joked.

“As usual, Connie is modifying the truth,” Elizabeth said. Her smile was dazzling. “Regardless of what she says, I’m two years younger.”

“Whatever!” Connie grinned, then turned serious. “How did it go?”

Moe really had to concentrate. Connie and Elizabeth were so distracting. “It went great. We did just as we had planned. First we took out the nodes. They’ve already been checked by freezing the tissue and were negative. We’ll get a final report in a couple days, but I don’t expect any changes. Then we took the prostate and sewed the bladder and urethra back together. No problems with his heart or lungs, no bleeding or blood transfusions.”

“So you think you got all of it?” Elizabeth asked.

“Yes, as best I can tell.”

“Will he need further treatment?” Connie inquired, brushing a wisp of blonde hair from her eyes.

“No, I don’t think so,” Moe answered. “On the final report, if the surgical margins are clear, then we should be done except for routine checkups.”

Connie’s eyes welled with emotion. “Thanks,” she said, kissing Moe on the cheek.

Even though Moe knew it was a harmless “thank you” kiss, it somehow felt like more. He blushed and told Connie and Elizabeth that Howard would be in the recovery room for about thirty minutes, then they would be able to see him. Lastly, Moe assured them he would keep a close watch on Howard and if anything unexpected occurred, which he doubted, he would call them.

Prompted by Moe’s statement, Connie retrieved a business card from her purse, wrote her and her father’s phone number on the back and gave it to Moe in the unlikely event he did have to call. She told Moe that she and Elizabeth would be staying at her father’s house for the next few days. After putting the card in his wallet, Moe said goodbye, then backtracked to the operating suite looking for Judy. He found her in the break room sipping a diet Coke and for a change, not flirting with anyone.

“Have you packed yet? I’m still trying to get all my clothes washed and ironed, but all we really need are swimming suits, T-shirts and shorts,” Moe said, as he sat down beside Judy.

Judy took a deep breath, then turned to face Moe. “I feel really bad about this, Moe. I know how much trouble you went to arrange this trip, but I’m afraid I won’t be able to go. I’m really very sorry.”

“Are you sure?” Moe said, his voice heavy with disappointment. “It’s too late for me to cancel the hotel reservations and the airline tickets.”

“Yes, Moe, unfortunately my mother is quite sick—with her gall bladder I think. Anyway, she’ll probably be going to surgery next weekend, so I’ve got to go back to Salt Lake that week. I hate to do this, but my mother really needs my help.”

“Well, I hope your mother does well. Maybe we can do something another time,” Moe said vaguely. What else could he say? This obviously was an excuse, but what was the point in arguing? He did not want to look like a groveling fool, and it was obvious Judy wasn’t going to change her mind, not after going to all the trouble to fabricate this elaborate lie. Moe just patted her hand and got up and left. He had more surgery to do.

Somewhat to Moe’s relief, Judy was not the scrub nurse for the penile prosthesis. She had been assigned, probably at her request, to another room.

Mr. Calley’s surgery went fine. As with all prostheses, Moe and Rusty were meticulous with sterile technique. They wore the helmeted “space suits,” scrubbed their hands and the patient’s skin for ten minutes, then double-gloved. After making a five centimeter penile-scrotal incision, Moe quickly performed a corporaotomy and measured the length of the corpora cavernosum—nineteen cm. He then inserted the cylinders (eighteen centimeters with a one centimeter rear tip extender), then placed the reservoir up the right inguinal canal and pump in the scrotum. Finally, all the tubing was connected by the quick-connect system and the incision was closed. As was his routine, Moe then tested the apparatus. By squeezing the pump, he forced saline from the reservoir to inflate the cylinders. Mr. Calley achieved a magnificent erection, then he turned to his new scrub nurse, Jeannie. Blushing, she confirmed that it would work just fine.

After checking on Howard, who was in some pain, but otherwise doing well, Moe began the fifteen minute drive home. The day had been a mixed bag. Howard and Mr. Calley’s surgeries had gone very well and that had boosted his spirits. He remembered how Connie had thanked him for his efforts and had kissed him. Moe had to admit he enjoyed being around Connie. But the downer of the day was when Judy canceled the Cozumel trip with that flimsy excuse about her mother.

Earlier, Connie had hinted, probably in jest, about going to Cozumel with him, but that was probably just meaningless office chatter. Anyhow, it was pretty short notice and her father was in the hospital. By departure time, he would be home and he did have Elizabeth to care for him. But still, there was no way Connie would consider going to Cozumel. Or would she? By then Howard would be up and around, able to take care of himself and completely out of danger. And if he did need something, then Elizabeth would be there. Hell, he’d done this same operation on other single guys and they’d gone home and taken care of themselves.

Going to Cozumel with Connie might be a lot of fun, or possibly it could be just damn awkward. Even though they’d known each other quite a while, that was a lot of time to spend together for a first date. Also, the hotel reservations were for one room and one bed. What would Connie think about that? If he did call her, what would he tell her? How would he explain the reason for the late invitation, and how would he approach the sleeping arrangements? Moe was never very good at inventing stories, so perhaps, the best approach would be the truth.

On the positive side, he did have her home phone number, and what did he have to lose? One thing for sure, he was not going alone. So, it was either call Connie, or cancel the plane and hotel reservations with the attendant financial penalties.

After struggling with it for another thirty minutes, Moe made a decision. Reaching in his back pocket, Moe pulled out his wallet and Connie’s business card. The phone rang three times before he heard Connie’s voice, then suddenly he felt panicky, almost like he did in high school when calling girls for a date.

“Hell—hello, Connie, this is Moe Mathis. Hope I didn’t wake you.” He choked out the words.

“This is who?”

“I’m sorry Connie, this is Moe Mathis—you know—your father’s doctor.”

“Oh, Dr. Mathis,” Connie blurted, then her voice trembled with concern. “Is my father all right?”

“Yeah—yes, Connie, he’s fine.” Moe stumbled on. “I checked him about an hour ago, before I left the hospital, and he was doing really quite well. He was fully awake from the anesthesia, his vital signs were normal, and there wasn’t any bleeding. Other than a little pain, he was doing great.”

“Sorry, I didn’t recognize your voice. The Moe part threw me. I suppose, I just jumped to conclusions.”

“I guess—I guess the reason I dropped the doctor tag, this is kind of a—a social call.”

There was total silence on the line. Moe swallowed hard, then plunged on. “You’re not at all interested in going to Cozumel with me are you? That was—was just office chatter?”

“Yes, Moe, some day I would like to go to Cozumel.”

“I know this is awfully short notice, but what I mean is, would you like to go to Cozumel in about a week with me, on my vacation?”

Again there was silence. “Why is there such short notice, Moe?” Connie finally asked, sounding confused.

“This is a little embarrassing, but here goes. I was planning to go with Judy, an O.R. nurse, and had made reservations. Today she canceled out. Apparently, she has to go visit her sick mother.”

“Sounds like I was the last choice.”

“If I had known you when I made the reservations, you would have been my first choice.” Inwardly Moe groaned. This was going badly.

“But I’ve known you for over a year.”

“I know, but not like—uh—friends.”

“So you’re in the habit of asking non-friends to go on a week long vacations?”

“I’m sorry Connie, this was a bad idea.”

“Let’s talk a little more,” Connie said, a hint of amusement in her voice. “At least you’re honest. What about my father? I can’t just go off and leave him.”