Dr. Robert Billing was engrossed with his machine. It was a tangle of stainless steel, upright manometers, and a few colorful cylinders of compressed gas. A brown bottle of halothane stood on top of the machine. On the label was written: “2-bromo-2-chloro-1,1,1-tri-fluoroethane (C2HBrClF3).” An almost perfect anesthetic agent. “Almost” because every so often it seemed to destroy the patient’s liver. But that rarely happened, and halothane’s other characteristics far overshadowed the potential for liver damage. Dr. Billing was crazy about the stuff. Somewhere in his imagination he pictured himself developing halothane, introducing it to the medical community in the lead article of the New England Journal of Medicine, and then walking up to receive his Nobel prize in the same tuxedo he had worn when he was married.
Dr. Billing was a damned good anesthesiology resident, and he knew it. In fact, he thought most everyone knew it. He was convinced he knew as much anesthesiology as most of the attendings, more than some. And he was careful, very careful. He had had no serious complications as a resident, and that was indeed rare.
Like a 747 pilot, he had made himself a checklist, and religiously he adhered to a policy of checking off each step of the induction procedure. This meant having Xeroxed off a thousand of the checklists and bringing a copy along with the other equipment at the start of each operation. By 7:15, the anesthesiologist was right on schedule at step number 12: that meant hooking up the rubber scubalike tubing to the machine. One end went into the ventilating bag, whose four- to five-liter capacity afforded him an opportunity to inflate forcibly the patient’s lungs at any time during the procedure. The other end went to the soda-lime canister in which the patient’s expired carbon dioxide would be absorbed. Step number 13 on his list was to make sure the unidirectional check valves in the breathing lines were lined up in the right direction. Step number 14 was to connect the anesthesia machine to the compressed air, nitrous oxide, and oxygen sources on the wall of the OR room. The anesthesia machine had emergency oxygen cylinders hanging from the side, and Dr. Billing checked the gauge pressures on both cylinders. They were fully charged. Dr. Billing felt fine.
“I’m going to place some electrodes on your chest so we can monitor your heart,” said Gloria D’Mateo while pulling down the sheet and pulling up the hospital gown, exposing Nancy’s midriff to the sterile air. The gown just barely covered Nancy’s nipples. “This will feel cold for a sec,” added Gloria D’Mateo as she squeezed a bit of colorless jelly onto three locations on Nancy’s exposed lower chest.
Nancy wanted to say something, but she couldn’t deal rapidly enough with her ambivalent attitudes about what she was experiencing. She was grateful, because it was going to help her, or so she had been assured; she was furious because she felt so exposed, literally and figuratively.
“You’re going to feel a little stick now,” said Dr. Billing, slapping the back of Nancy’s left hand to make the veins stand out. He had placed a piece of rubber tubing tightly around Nancy’s wrist, and she could feel her heart beat in the tips of her fingers. It was all happening too fast for Nancy to assimilate.
“Good morning, Miss Greenly,” said an ebullient Dr. Major as he whisked through the OR door. “I hope you had a good night’s sleep. We’ll get this affair over with in a few minutes and have you back to your bed for a restful sleep.”
Before Nancy could respond, the nerves from the tissues on the back of her hand became alive with urgent messages for her pain center. After the initial thrust, the intensity of the pain increased to a point and then dissipated. The snug rubber tourniquet disappeared, and blood surged into Nancy’s hand. She felt tears well up from within her head.
“I.V.,” said Dr. Billing to no one, as he made a black check next to number 16 on his list.
“You’ll be going to sleep shortly, Nancy,” continued Dr. Major. “Isn’t that right, Dr. Billing? Nancy, you’re a lucky girl today. Dr. Billing is number one.” Dr. Major called all his patients girls no matter what age they were. It was one of those condescending mannerisms he had adopted unquestioningly from his older partner.