“It’s a boy,” Patty said. “His name is Mark.” She smiled weakly. Her lids had become a little droopy. The tranquilizer was clearly taking effect.
, The transfer from the delivery area to the OR suite was accomplished without incident. Jeffrey kept Patty on oxygen by mask during the short trip.
The OR had been advised as to the decision to do a Caesarean. By the time
Patty was transferred, the room was almost set up for the procedure. The scrub nurse, already scrubbed, was busy laying out the instruments. The circulating nurse helped guide the gurney into the room and transfer Patty to the OR table. Patty still had the fetal monitor on, which was left in place for the time being.
Jeffrey wasn’t as familiar with the evening personnel, and he hadn’t met the circulating nurse before. Her name tag read: Sheila Dodenhoff.
“I’m going to need some.5% Marcaine,” Jeffrey told Sheila as he changed
Patty from portable bottle oxygen to oxygen delivered through his Narcomed
III anesthesia machine. He then reapplied the blood pressure cuff to
Patty’s left arm.
“Coming up,” Sheila said cheerfully.
Jeffrey worked quickly but deliberately. He checked off every procedure in his anesthesia record once it had been performed. In sharp contrast to most other doctors, Jeffrey prided himself on his exquisitely legible handwriting.
After hooking up the EKG leads, he attached the pulse oximeter to Patty’s left index finger. He was replacing Patty’s IV with a more secure intracath when Sheila returned.
“Here you go,” she said, handing Jeffrey a 30 cc glass vial of.5%
Marcaine. Jeffrey took the drug and, as he always did, checked the label.
He set the vial on top of his anesthesia machine. From the drawer, he took out a 2 cc ampule of spinal grade.5% Marcaine with epinephrine and drew it up into a syringe. Maneuvering Patty onto her right side, Jeffrey injected the 2 cc’s into the epidural catheter.
“How’s everything going?” a booming voice called out from the door.
Jeffrey turned to see Dr. Simarian holding a mask to his face while he held open the door.
“We’ll be ready in a minute,” Jeffrey said.
“How’s the little one’s ticker?” he asked.
“At the moment, fine,” Jeffrey answered.
“I’ll scrub up and we’ll get this show on the road.”
The door swung shut. Jeffrey gave Patty’s shoulder a squeeze while he studied the EKG and the blood pressure readout. “You okay?” he asked her, moving the oxygen mask to the side.
“I think so,” she said.
“I want you to tell me whatever you feel. Understand?” Jeffrey said. “Do your feet feel normal?”
Patty nodded. Jeffrey went around and tested her sensation. Coming back to the head of the table and checking the monitors again, he was sure that the epidural catheter had not moved and had not penetrated either the spinal canal or one of the pregnancy-dilated veins of Bateson.
Satisfied that all was in order, Jeffrey picked up the via] of Marcaine
Sheila had brought him. Using his thumb, he snapped off the top of the sealed glass container. Once again he checked the label, then drew up 12 cc’s. He wanted anesthesia to extend at least to T6, and preferably to T4.
As he put the Marcaine down, his eyes caught Sheila’s. She was standing off to the left, staring at Jeffrey.
“Is something wrong?” Jeffrey asked.
Sheila held his gaze for a beat, then spun on her heels and left the OR without speaking. Jeffrey turned to catch the eye of the scrub nurse, but she was still busy setting up. Jeffrey shrugged. Something was going on that he didn’t know about.
Returning to Patty’s side, he injected the Marcaine. Then he capped off the epidural catheter and returned to the head of the table. After putting down the syringe, he noted the time and the exact amount of the injection in the record. A slight quickening of the beep of the pulse brought his eyes up to the EKG monitor. If there was to be any change in the heart rate, Jeffrey expected a slight slowing from progressive sympathetic blockade. Instead, there was the opposite. Patty’s pulse was speeding up. It was the first sip of the impending disaster.