“Mark,” called one of the ICU nurses. Her name was June Shergood. She had thick luxurious blonde hair and intelligent eyes that looked through rather thick glasses. She definitely was attractive and Susan’s’ keen eye could detect a certain change in Bellows’s demeanor. “Wilson has been having a few runs of PVCs, and I told Daniel that we should hang a lido-came drip.” She walked over to the desk. “But good old Daniel couldn’t seem to make up his mind, or … something.” She extended an EKG tracing in front of Bellows. “Just look at these PVCs.”
Bellows looked down at the tracing.
“No, not there, you ninny,” continued Miss Shergood, “those are his usual PACs. Here, right here.” She pointed for Bellows and then looked up at him expectantly.
“Looks like he needs a lidocaine drip,” said Bellows with a smile.
“You bet your ass,” returned Shergood. “I mixed it up so I could give about 2 mg per minute in 500 D5W. Actually it’s all hooked up and I’ll run over and start it. And when you write the order include the fact mat I gave him a bolus of 50 mg when I first saw the runs of PVCs. Also maybe you should say something to Cartwright. I mean, this is about the fourth time he couldn’t make up his mind about a simple order. I don’t want any codes in here we can avoid.”
Miss Shergood bounced over to one of the patients before Bellows could respond to her comments. Deftly and with assurance she sorted out the twisted I.V. lines to determine which line came from which bottle. She started the lidocaine drip, timing the rate of the drops falling into the plastic chamber below the bottle. This rapid exchange between the nurse and Bellows did little to buoy the already nonexistent confidence of the students. The obvious competence of the nurse made them feel even less capable. It also surprised them. The directness and seeming aggressiveness of the nurse was a far cry from their rather traditional concept of the professional nurse-physician relationship under which they all still labored.
Bellows pulled out a large hospital chart from the rack and placed it on the desk. Then he sat down. Susan noticed the name on the chart N. Greenly. The students crowded around Bellows.
“One of the most important aspects of surgical care, any patient care really, is fluid balance,” said Bellows, opening the chart, “and this is a good case to prove the point.”
The door to the ICU swung open, allowing a bit of light and hospital sounds to spill into the room. With it came Daniel Cartwright, one of the interns on Beard 5. He was a small man, about five seven. His white outfit was rumpled and blood-spattered. He sported a moustache but his beard was not very thick and each hair was individually discernible from its origin to its tip. On the crown of his head he was going bald rather rapidly. Cartwright was a friendly sort and he came up to the group directly.
“Hi, Mark,” said Cartwright making a gesture of greeting with his left hand. “We finished early on the gastrectomy so I thought I’d tag along with you if I may.”
Bellows introduced Cartwright to the group and then asked him to give a capsule summary on Nancy Greenly.
“Nancy Greenly,” began Cartwright in a mechanical fashion, “twenty-three-year-old female, entered the Memorial approximately one week ago for a D&C. Past medical history entirely benign and noncontributory. Routine pre-op workup normal, including negative pregnancy test. During surgery she suffered an anesthetic complication and she has been comatose and unresponsive since that time. EEG two days ago was essentially flat. Current status is stable: weight holding; urine output good; BP, pulse, electrolytes, etcetera, all OK. There was a slight temperature elevation yesterday afternoon but breath sounds are normal. All in all, she seems to be holding her own.”
“Holding her own with a good deal of help from us,” corrected Bellows.
“Twenty-three?” asked Susan suddenly while glancing around at the alcoves. Her face reflected a tinge of anxiety. The soft light of the ICU hid this from the others. Susan Wheeler was twenty-three years old.