With my sterile apron off, I raced towards the intensive care unit. I kept thinking about poor Mr. Jacobs and the torture he was going through, inside operating room number seven. Soon he would be parked in the intensive care unit next to Mr. Sullstein. Unfortunate Mr. Sullstein, something bad must have happened to him. I looked at my watch. It was midnight already. But for Mr. Sullstein, it was the beginning of a long and dark journey, a journey to death or to recovery. Either way I was to guide him through.
His alarmed nurse, Karen, met me in front of his room.
"Doctor Baldi, he hasn't been able to talk since nine this morning. The nurse who took care of him during the day thought the narcotic for pain control had clouded his mind. But he has been off it now for seven hours. I just noticed that he has not been moving his left side. Doctor Baldi, I think he's in trouble. He's getting worse by the minute..."
"Calm down, Karen. Just calm down. There is no reason to get all excited. As long as he has blood pressure and he's breathing, there's no need to freak out," I responded.
I walked into the room. Mr. Sullstein, a dairy farmer from Minnesota, was lying in bed. His head was tilted towards his right side, his eyes shut, his lips partially open with saliva drooling all over. His respiration was occasionally irregular. His heart rate was normal, and his blood pressure quite adequate. I approached the left side of the bed and gently placed my hand on his forehead.
"Mr. Sullstein, are you there? Can you hear me? Please open your eyes and look at me," he opened his right eye. He looked at the ceiling.
"Sir, talk to me. Please talk to me. Do you know where you are?" I asked him as I rubbed his chest. No response. I took him by the shoulders and shook him a couple of times.
"Moo. Maa. Moo. Maa, " he finally uttered.
"Sir, please tell me where you are," I asked him again.
I put my right index and middle fingers in the palm of his left hand.
"Mr. Sullstein, can you squeeze my fingers with your left hand?" No response. "Sir, squeeze my fingers with your left hand."
"Moooooo. Maaaaaaa," he mumbled as he squeezed his right hand. His left side was indeed immobile.
"Shit. This is horseshit. This is shit full of shit. Damn," I cursed as I left the room. The nurse galloped behind me like a horse.
"What do you think, Doctor Baldi?" she asked me.
"It's cow shit. He's a cow. He thinks he's a cow. Didn't you hear the Moo's and Maa's?" I said upset.
The nurse was furious. She gave me a disgusted look.
"What do you think, Karen? Can't you see? He fried the right side of his brain. Brain tissue is like a chicken egg. Once you fry it, it's fried. We need to image his brain. He needs a neurologist to examine him," I pointed out to her as we stood next to the unit secretary's desk.
"Call transport. He's going downstairs for a head scan," I ordered the unit clerk.
"The C.A.T. scanner is down. It won't be up until tomorrow night. We can get an emergency C.A.T. scan at the other hospital in town."
"When it rains, it pours. Let's ship his fried brain now. Call transport." I turned to the nurse. "Call Mr. Cow's wife. I mean Mr. Sullstein's wife. Tell her she needs to come here now. I need to speak with her. I'm going back to the operating room to talk with the boss. He's not going to like this shit." Dr. Harshberg had not seen Mr. Sullstein since his operation. As a matter of fact, Dr. Harshberg rarely saw the patients after cutting them. I knew that I would be blamed for what happened. I was scared to go back in the operating room. But I had no choice.
"What do you think is going on, Rastus?" asked Dr. Harshberg. "Sir, he burned his right brain. It must have happened over the last three hours or so. Doctor Ungaman and I checked on him during our evening rounds and at that time he was moving his left side."
"Oh, dear. Our friend, Mr. Sullstein," he paused. "What a bastard! He thought that vascular surgery was as simple as milking cows. Do you remember seeing him in clinic with me?"
"Yes, sir. I do remember quite well," I answered.
"What did I tell him, Rastus?"
"Sir, you told him that he didn't need the surgery. You told him that he had pain in his leg but that you were not afraid that he was going to lose it. You advised him against the surgery. You told him that his risks for a complication were quite high, especially with his heart and lung problems." "Rastus, I always thought that you were half brain dead. But I'm amazed that you remembered. Now, Mr. Sullstein insisted on having the operation, didn't he?" asked Dr. Harshberg.
"Yes, sir, he did."
"Well, son, shit happens. Post operative complications are not totally unexpected. They are part of the job. I have learned to live with them. It's a price every surgeon pays. Operations mean complications. I told you, Rastus, when you first came, I have sick patients. Now you see it. What do you want to do now?" questioned Dr. Harshberg.
"Sir, I would like to get a C.A.T. scan of his brain. The machine is down at our facility. So I'll arrange for him to be shipped to another institution tonight to get the scan. I want to call the neurologist on duty to consult with him. With your permission, of course."
"Rastus, you don't need my permission. He's your patient. You're in charge. You're responsible for him."
"Yes, sir. Sir, if it's a blood clot in his brain that caused his stroke and not a bleed, can I dissolve it? This may improve some of his paralysis," I eagerly suggested.
"I don't know, Rastus. He's your patient. Discuss it with the neurologist. He knows more about the brain than I will ever know or care to know. Go fix him. Come back as soon as you can. We need you in here. We're lost in Mr. Jacobs' shitlands!"
Much to my surprise, Dr. Harshberg was nice about the whole situation. He was finally showing me some respect. I liked that.
I was about to fly out the operating room when he suddenly shouted "RASTUS!"
"I like the way you snap the SIR. Would you give up your radiology training next year and consider surgery? You would be a good surgery resident. You are a SIR man!"
"YES, SIR!" I shouted as I left the room with everyone laughing.
|Chapter Three||Chapter Five|
Copyright © 1996 Maher Abbas, M.D. All rights reserved