"She's crashing!" yells the second year anesthesiology resident.
His high pitched voice slices through the alarms that pierce the green tiled operating room. His forehead creases, and his eyes are wild as he rapidly glances from his patient to the monitor. His meaty hands awkwardly search for the phone. Fumbling, he can't dial the numbers in his haste. He throws it down to the floor, yelling expletives and breaking the cheap plastic into pieces. The monitor continues to alarm, and everyone hears the rapid staccato beeping of the heart monitor.
Frantically, the resident turns to me. "Overhead page anesthesia to OR 15 STAT!" he commands.
I reach for the phone next to my computer to overhead page. "Anesthesia staff to OR 15 stat. Anesthesia staff to OR 15 stat."
Striding to the head of the bed, I say, "It's ok, John, we got this."
"I've never had a patient crash during surgery," John says quietly, fear dancing in his light brown eyes. Sweat soaks through his light blue surgical cap.
"I'll help you through it, ok?" I say, locking eyes with him.
John and I work in silence as he adjusts the Isoflurane and increases the O2. Ripping off the cap to a 20 ml syringe with my masked covered teeth, I use both hands to draw up emergency medications as I watch the monitor. I point to the Propofol pump and gesture to him to stop the infusion. I quickly hand off the drawn up meds to John, calling out the dosage of each medication. Softly, I remind him to push the meds slowly and to watch the monitor as he pushes the medication. I notice that his eyes are glued to the monitor after he delivered the medication through the IV. I give him a gentle nudge, and nod toward the patient.
"Don't forget to watch your patient. The monitor only shows a chapter of the story. Your patient shows you the novel," I whisper to John.
Echoes from the monitor permeate the cavernous operating room. The surgeons, with their masked faces and blood drenched gowns, work feverishly in the open abdomen. Smoke from the electrocautery fills the room, and the sound of liquid pouring into the suction canister sends shivers of ice up and down my spine.
A young man whom I have never seen rushes into the OR, breathless and sweating. "What do you need?" he announces to the room, his eyes scanning the bloody floor. John, dutifully focused on his patient, adjusts the rate of the IV. He does not hear the young man's request.
I look at the young man and inwardly groan. Now is not the time to explain in detail what I need. I mentally brace myself for the lack of comprehension that was sure to come. His skin reminds me of my morning coffee, light brown and creamy. He is barely my height, and his scrubs drape across his slight frame, making him look like a child dressed in Daddy's clothes.
"Who are you?" I ask, spitting out the needle cover from my masked mouth.
"I am the new anesthesia tech. My name is Ben. What do you need, lady?" he asks again, face full of irritation.
"Get two units of FFP and 6 units of blood," I demand. I sigh in relief when Ben nods his head.
"I'm on it!" he yells over his shoulder as he turns and runs out of the room.
"Stay two ahead, Sam?" I ask the surgeon. She pushes a lap pad into the abdomen to staunch the bleeding. Without raising her steel blue eyes from the surgical field, she nods her head.
"And Canes, find Dr. Singh. He needs to get his butt in here. He turfed this patient to me at the last minute, the jerk," Sam says. Bending her masked face over the open abdomen, she pulls out a blood soaked lap pad. A spray of blood arcs onto her gown, and she quickly reaches for another lap pad.
"Dang it! This was my best gown! Now what am I going to wear to the prom?" she says without looking up.
The young intern begins to lose focus, her head bobbing as she looks up at the monitor and then back to the blood filled abdomen.
"Watch the field! Never look up!" Sam barks at the intern. "If you look away from the field, you then have to re-acclimate yourself. Trust your team, and trust that your assistant will dissect and clear the field for you. "
"I will guide you, but you must never take your eyes from the field," Sam instructs, handing the intern the suction.
"Here, you suction for me, and I will find the tear," Sam says, calmly. With a shaky hand, the intern grasps the Yankauer suction. I hear Sam's calm directions to the intern as they isolate the bleeder.
"Two-oh Vicryl!" Sam shouts. I hear the slap of the needle driver hit her open palm.
Leaving John's side, I text page Dr. Singh from my computer, my fingers flying across the keyboard.
"I need more laps!" the surgical tech shouts.
Swiftly, I move from my computer to the glass cabinet doors, and find a pack of laps. I rip the package open and toss it onto the sterile field. The tech and I quickly count the sponges as she places one into Sam's open palm. I pull the cap off of the dry erase marker to add the laps to our surgical count, displayed on the whiteboard.
"Ten laps added to the field," I announce.
"Canes, I need Surgicel now!" Sam demands.
I rush to the drug box and find the small strip of Surgicel. It is encased in foil wrapper, and I open it onto the sterile field like one would open a Band-Aid.
Ben slams through the OR door, carrying the cooler of blood. He places the cooler on the floor next to John.
"Yo, Canes. I need you to check this blood with me," John says as he pulls the first unit out of the cooler.
John and I repeat to each other the patient's name, medical record number, date of birth, blood type, unit number and expiration date. The phone rings just as I sign the blood slip. Picking up the phone, Dr. Singh's smooth, melodic voice greets me. "So what's the problem?" he asks.
Dr. Singh has always been an enigma to me. He is engaging, yet fiercely private. I imagine him sitting in his ornately decorated office, his feet perched on a rich mahogany desk, leaning back in a tufted leather chair while staring out the window. For some reason, his calm manner sends a rush of fury through me.
"You know the 'simple' ex-lap that you didn't want to do? The one that you gifted to Sam?" I ask, my voice barely containing contempt. I didn't wait for his response, adrenalin coursing through me.
"Turns out that it isn't quite so simple. This lady has adhesions out the wazoo, and when the surgeons were dissecting adhesions off the mesentery, the superior mesenteric artery tore. You should probably cancel the rest of your day and get your butt in here."
John lifts the second unit of blood from the cooler and motions to me, drawing a check mark in the air.
"Hang on, I have to check blood," I say into the phone. John and I quickly run through the routine of checking blood, and I pick up the receiver again.
"Singh, we are going through blood quickly. This woman is bleeding out." I say, cradling the phone between by head and shoulder while scrawling my signature on the transfusion slip. Dr. Singh is slow to respond, as if he is distracted.
"I cannot--"
Cutting him off, my anger rears its ugly head, and I am surprised at the forceful words that come out of my mouth. "No, you can't get out of this one. We need you right now!" I spat.
I hear John shouting for the surgeons to stop, as the monitor's green lines display a nasty show of atrial fibrillation.
"Canes, uh...I must tell you this," he says softly.
I need to get off the phone already and help this patient, I thought. My anxiety mounts as I see the young anesthesia tech push the crash cart into the OR.
"You must tell me what? You're on the way, right?" I ask, as I watch Ben and John deftly place gel pads on the patient's chest. Silence greets me.
"Charge to 200!" John commands.
"Doc, you there?" I ask, impatiently. I am milliseconds away from just hanging up.
"I am here," he responds. I hear him take a deep breath. "Canes, I am so sorry. I cannot come. This patient is my mother."
