Corruption in the Or Read online

  Corruption in the O.R.

  by Barbara Ebel, M.D.

  The Outlander Physician Series

  Book One: Corruption in the O.R.

  Copyright © 2019 by Barbara Ebel, M.D.

  All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

  Paperback ISBN-13: 978-1-7324466-6-3

  eBook ISBN-13: 978-1-7324466-7-0

  This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.

  Contents

  CHAPTER 1

  CHAPTER 2

  CHAPTER 3

  CHAPTER 4

  CHAPTER 5

  CHAPTER 6

  CHAPTER 7

  CHAPTER 8

  CHAPTER 9

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  CHAPTER 14

  CHAPTER 15

  CHAPTER 16

  CHAPTER 17

  CHAPTER 18

  CHAPTER 19

  CHAPTER 20

  CHAPTER 21

  CHAPTER 22

  CHAPTER 23

  CHAPTER 24

  CHAPTER 25

  CHAPTER 26

  CHAPTER 27

  CHAPTER 28

  CHAPTER 29

  CHAPTER 30

  CHAPTER 31

  CHAPTER 32

  CHAPTER 33

  EPILOGUE

  FROM THE AUTHOR

  CHAPTER 1

  “Hi, I’m Dr. Viktoria Thorsdottir. Sometimes I go by ‘Doctor Viktoria.’ Makes it easier on everyone.”

  Helen Grant popped her head up from the glowering stare she gave the IV in her hand. A nurse had stuck her five times to make a catheter spear into a feeble vein, and she was ready to call all health care workers incompetent. Her sullen annoyance intensified when she laid eyes on the thirty-nine-year-old physician.

  “I’d like to see the male, silver-haired attending, please.”

  “That doctor you spoke to is the emergency room physician. He doesn’t practice anesthesia.”

  “Of course, you do?” She shook her head as if to eject lice crawling around in her scalp. “Just my luck.”

  “Yes, Ma’am. I’m the anesthesiologist.”

  The woman yanked the sheet up on the hospital gown covering her breasts. “Humph,” she interjected, barely audible. “Just so you know, I’m no novice. I’ve been through this before. Damn diabetes causes the skin on my foot to disintegrate and pus-out like some rancid scene in a horror movie.”

  “That can’t be easy on you.”

  “You’re damn right.”

  “May I ask you some questions?

  “My husband’s not here right now.”

  “Do you need him around in order to talk to me? Your surgeon has put you on the OR schedule before his first patient who is late to arrive. I would hate for your case to be delayed. Apparently, you have a nasty infection in your foot which needs attention.”

  Mrs. Grant pondered the question while Viktoria continued a more thorough visual summary of the woman’s appearance. Along with being an aged sixty-two years old, the patient was bordering on morbid obesity and her exposed skin was tough and dry, like a reptile who basked in the hot Florida sun.

  Helen Grant shoved her cursed right foot out from the side of the sheet, as if showing off a trophy. “All right then. Go ahead. Same old questions, I’m sure.”

  Viktoria asked the woman the pertinent questions she needed answered, but she didn’t learn any surprises from Mrs. Grant’s health history and physical exam. She surmised that her patient was a bit of a rarity because Type II diabetics nowadays were, in general, under better control than years ago.

  Mrs. Grant, however, lived her days the way she wanted, chugging down canned sodas, sugary snacks, and TV dinners. She expected her oral hypoglycemic medication and recent insulin prescription to manage her glucose all by themselves, and she had grown a huge wall of denial that her own lifestyle was to blame.

  The ER record noted that the woman was found eating a bag of pretzels after she’d been evaluated, but it didn’t stop Viktoria from redundantly asking the relevant question. “When did you last eat or drink?”

  “I don’t know.”

  “Mrs. Grant, if you’re a frequent flier, any anesthesiologist in the past would have told you that recent food in your stomach is always a concern to us.”

  “My husband took away the pretzels at 3 a.m. It’s boring spending the middle of the night in an ER waiting for all the tests, and watching people come in and out and poke on you. But I ain’t ate nothing since then. The snacks gave me something to do. But you’ve never been on the other side of hospital care. You’re just a baby. How long you been working here anyway?”

  “This is my first day.”

  Helen’s eyes shot wide open. “You’re joking.”

  “No. I provide staffing assistance for anesthesia departments that are short-handed, especially in under-served areas. Don’t worry, I’m an experienced anesthesiologist.”

  “Get out!” Helen rolled her eyes. “Like I said, just my luck. Not only are you a woman doctor, but you wouldn’t know where the life-saving oxygen is.”

  “The tanks are green and I’m not color blind. They’re the same everywhere and in the usual places, like hooked into anesthesia machines. But I can ask the person in charge of the anesthesia schedule today to turn over your case to someone else if you’re uncomfortable with me.”

  “That’ll delay my surgery?”

  “Most certainly.”

  Helen pouted her lips. “Never mind. Let’s get on with it.”

  “A general anesthetic would be preferable for your case,” Viktoria said. She explained the risks and benefits as she scrutinized Helen’s IV. It was a small-bore catheter and was only seeded halfway in the vein. By the looks of the woman’s arms, the nursing staff had done as good a job as possible.

  Mrs. Grant withdrew her hand. “Over my dead body. Not again. Don’t even think about making me your pin cushion.”

  “Your veins have seen better days. For your case and your postop care, chances are you will need something bigger. I’ll do my best to put you to sleep with this one, but I may need better access after you’re asleep, such as a central line.”

  “They told me that need would come someday.”

  “Those lines carry a greater risk of infection, injury to a lung, or bleeding.”

  Helen twisted her dry lips. “But you said you’re experienced.”

  “Every medical procedure carries a risk no matter who does it.”

  “All right. Be careful, in particular since you don’t like me.”

  “I didn’t like vegetables when I was growing up. Tasteless vegetables and people are two different things.”

  Much to Dr. Thorsdottir’s intent, Helen’s face went blank as she tried to sort that out, so Viktoria took the opportunity to slip out. She took an elevator upstairs, made her way past the OR front desk, and rechecked the day’s schedule.

  Written in magic marker on a white board in the hallway, the changing schedule was the gospel itinerary for the OR staff, anesthesia department, and surgeons. Same as earlier, Helen Grant had been written into Room 7, taking the place of a “no show” elective case. With the help of the anesthetic tech, Viktoria had previously set up her room with the necessary anesthetic
equipment and drugs, but now she added a central line kit.

  Her first patient had been correct, however, about the need to find out where everything was. Since it was Viktoria’s first day at the community hospital in northern Pennsylvania, she still needed to check out the preop area and recovery room. She noted the open door to the preop area where elective patients were waiting to go back to the OR, and then she strolled into the recovery room and sat behind the long counter. Several nurses were preparing for the day, but two of them were at the bedside of a patient being checked in. One nurse swiftly applied monitors to a male adult while the other one listened to the report from the CRNA who had just done his case.

  The pretty woman holding an anesthetic record was a CRNA, or certified registered nurse anesthetist. She did not wear a plastic name badge like the anesthesiologists Viktoria had already seen in the hallway. The woman wore a deep red unisex three-pocket scrub jacket and from where she sat, Viktoria could make out, “CRNA” embroidered after her name.

  A nurse leaned over for a pen and Viktoria smiled. “Is that case from the middle of the night?”

  “Yes,” the woman said. “Car accident. Lucky guy to only suffer an arm fracture. Are you this week’s hired help in the anesthesia department?”

  “I signed on for a month.”

  After glancing at her name tag, Viktoria wondered if Sally was going to welcome her. It was always a crap shoot what strangers on the job told her: “This is a great place to work for stable people,” or “Everyone here is so nice, but we are a close-knit bunch.” Sometimes it was more like, “Are you not board certified to work for a permanent group?” or “What makes you not settle down in a real job?”

  Of course, what they were normally thinking was “She must be a terrible anesthesiologist or something’s wrong with her. No stable anesthesia group would dare hire her because she must be no good at what she does.”

  Sally’s attention drifted to the stretcher across from them, and she ignored Viktoria. The male patient contorted his face with pain. His blood pressure reading popped up on the screen as 152/86 and the nurse pushed more contents of a syringe into his IV.

  The nurse anesthetist beside him pulled off her OR bonnet and silky, dark shoulder-length hair fell to her shoulders. As she added the final notes to her record, the automatic doors opened, another CRNA entered, and he sauntered straight over to his colleague. Viktoria realized the woman was leaving after night call and the young man was fresh on duty for a regular day schedule. After pleasantries at the patient’s bedside, the CRNA pulled out a thick tissue from her pocket, but changed her mind about using it. She shoved it back in as the male nurse nodded. After good-bye smiles, they both left through different doors.

  “You must be the temporary hired help, the locum tenens anesthesiologist.” A man with thin lips and a hawkish nose leaned against the counter and gave her intermittent eye contact. “I’m Dr. Berry, the surgeon for your morning cases. The anesthesiologist running the schedule, Dr. Huff, told me to find you here. No doubt you met my patient who qualifies for a loyalty-hospital program discount. However, she has earned a reputation for being ‘difficult.’ The internal medicine service will also be caring for her in the postop period for her out-of-control diabetes. We’ll need dependable access for antibiotics.” On second thought, he added, “What’s your name?”

  “Viktoria Thorsdottir. Sounds like a central line would be helpful for everyone involved.”

  “And no better time to put it than when she’s asleep. She can’t complain, and we won’t have to hear about it.”

  Viktoria nodded as Dr. Berry tapped the counter top.

  “Do you do central lines with what you do,” he asked, “going around to different places and avoiding big cases? I can ask Dr. Huff to make himself available for a few minutes during the case and put it in.”

  “That would be a shame. The group wouldn’t be getting their money’s worth out of me if he did that.”

  “Suit yourself.”

  The nurse overseeing the recovery room patient stepped next to Dr. Berry and scowled across the counter. “Don’t mean to interrupt, but you must be the temporary anesthesiologist. Can you give me an additional order for pain for my patient over there, over and above the standing order? He’s had ten of morphine.”

  The man across from them grimaced and wiggled uncomfortably on the bed and his blood pressure had scarcely improved.

  “Is he allergic to any medications?”

  “No.”

  “Give him 15 MGS of ketorolac IV.”

  “Thanks. What’s your name for the order?”

  “Dr. Thorsdottir.”

  “Ugh. How do you spell that?”

  “T-H-O-R-S-D-O-T-T-I-R.”

  She grabbed a notepad on the desk, wrote it down, and glanced at Dr. Berry.

  He spoke for the both of them. “That’s an unusual name.”

  Viktoria rose. He’d be one angry surgeon if she wasn’t ready for his patient upon her arrival in Room 7. She pushed in the rolling chair. “See you back there.”

  -----

  The stainless-steel double doors to Room 7 clunked open and the stretcher carrying Helen Grant rolled in. “Let’s get this over,” the patient mumbled. “I don’t want to be here anymore than any of you. I’m a born southerner. Made the mistake of coming here to this God-forsaken town because one of our kids moved here.”

  Viktoria supported Helen’s shoulders and head while a nurse and orderly each grabbed the sheet from both sides and at the end of the stretcher. They all lifted her over to the OR table. Viktoria had injected one mg of midazolam into her patient’s IV, but it seemed to have little effect.

  “If you don’t care,” Helen barked, “I’ll take a blanket.”

  “I’ll fetch you one. That’s not that doctor’s job,” the nurse responded, flicking her head towards Viktoria.

  The nurse’s name tag said “Alice Coleman, RN.” She threw Dr. Thorsdottir another look, making Victoria wonder if the stethoscope draped around her own neck resembled a snake.

  Viktoria methodically attached her patient to all the necessary monitors and secured the oxygen mask over her mouth. After a bit more sedation to her patient, she said, “Nurse Coleman, please apply some cricoid pressure on Mrs. Grant’s neck as she drifts off to sleep. She’s a full stomach and a diabetic. Let’s try to prevent any possible food regurgitation during induction to slip down into her airway.”

  Alice drew in her lips and her eyes rolled to the side. Viktoria said good-night to Mrs. Grant and slid the diprivan and succinylcholine into her IV. After she verified the endotracheal tube’s correct placement and secured it in place, Alice let out a huff and stepped away to prepare the patient’s leg.

  Dr. Berry stood nearby as he watched his patient go to sleep, and then he stepped out to scrub. As if on cue, Dr. Jay Huff came in and stood between the door and the anesthesia machine.

  Since Helen’s vital signs were stable, Viktoria prepared the central line kit and her patient for the procedure. Since Dr. Huff was also available, she figured there was an extra set of anesthesia hands in the room in case the woman’s anesthetic needed to be adjusted.

  She palpated her patient’s carotid artery and felt the internal jugular vein next to it. Skillfully, the seeker needle and then the guide wire went in smoothly. She inserted the large bore IV, removed the guide wire, and sutured it in. Next, she dressed the area with a sterile cover. Fluids began dripping into the new access and she de-gloved.

  Viktoria glanced at the head physician of the anesthesia department. He was a stocky man with narrow shoulders and a wrinkled forehead. If the anesthesia machine had not been the barrier between them, his breath would have been right down her neck into her scrubs. No doubt, she thought, he wasn’t really there to help, but to offensively oversee what she was doing.

  She tucked a piece of stray hair into her patient’s head bonnet as the bellows of the anesthesia machine whisked up and down. “Dr. Huff,” she said, “di
dn’t the locum tenens agency advise you of my credentials?”

  “I believe so.”

  “I’m a board-certified anesthesiologist just like you.”

  “I’ll remember that,” he said over his shoulder as he left.

  Dr. Huff held one side of the door open for Dr. Berry. The surgeon had intermittently gazed through the windows over the scrub sink, and now held his clean, scrubbed hands in the air while coming in.

  “Holler if you need me,” Dr. Huff said softly to Darryl Berry as they passed each other.

  “If you ask me,” Dr. Berry said, “this Dr. Thors-something-or-other inserted the patient’s central line and made the procedure look like the apotheosis of how it should be done.”

  CHAPTER 2

  Helen Grant’s case quieted down to a steady pace with little to no chit chat. For a Monday morning, Viktoria found that strange. Didn’t these people do anything over the weekend that they talked about on resuming work for the new week? That’s how it went in most ORs on Monday mornings: banter about some daughter’s soccer game on Saturday; or some new restaurant that opened up; or the worst local wanna-be pop group performance at the local community center. Sometimes it would be the male surgeon making jabs at his wife’s weekend honey-do list, and he wished he’d been on call instead of being home.

  She jotted down a new set of vital signs on the iPad anesthetic record. It was fortunate the woman was under a general anesthetic. Had she qualified for sedation and a regional block on her lower extremity, Mrs. Grant may have kept up the negative innuendos like Viktoria being a ‘woman’ doctor. Where she came from, gender equality was the highest in the world, even going as far as electing the world’s first female president back in 1980. Viktoria grimaced. Although the United States had been her home for a long time, the country still had a long way to go.

  She glanced again at the time. The case was deep into its third hour and, rather than being close to being finished, the surgeon was slower than a box turtle deciding which direction to take. In Viktoria’s experience, the slowest surgery cases took place in teaching institutions, not by attending physicians in private practice who were accountable to multiple facets of healthcare oversights and reimbursement policies.