Dead Still Read online

  It was ridiculous and she knew it. Annabel had prepared herself to be where she was and now some senior resident was making her hormones act up. She had to focus on the rotation, on her patients, and on her exams and take Robby Burk right out of the equation.

  When she began to redirect her thoughts, she realized what a scary and provocative day it had been. A death on the wards. A woman who was at home two days ago and now dead after a ‘simple’ cholecystectomy. That seemed inexcusable and awful, yet unpredictable things can and do occur. People always turn their heads and hope it happens to someone else and not them. And the burn patient and his history … she closed her eyes tight and imagined his patches of absent skin and ruined body. Mr. Kingman would live with what happened either physically or mentally the rest of his life.

  Annabel slowly raised herself from the chair and looked out the front window. One lone tree with a solid trunk had been allowed to grow in a square hole in the sidewalk and its limbs dangled in front of her view. Her solid first two years were behind her and now, like the limbs before her, the rotations were needed to complete her growth. She decided to call it a night - no more reading, she would postpone calling her family, and she would not think of Robby Burk anymore. Tomorrow was her first medical on-call night ever in her career and, if today were any indication, she’d better be up for it.

  -----

  Robby Burk leaned back in his office chair, propped his feet on the desk, and stared at the downtown buildings and flat roofs below. He thought he’d never get to this point: the last year of his general surgery training. Although in no hurry, he had already contacted a few groups with job openings in the south for next summer. But his heart wasn’t settled yet.

  He had whittled down his school loans to a small amount and now felt less financially burdened. The practical thing to do was to begin a real job, earn a real salary, and begin establishing a respectable reputation in his field. So why was he dragging his feet just thinking about it?

  Robby had never done what some of his friends in college did. They packed up and traveled for a year in Europe before getting their professional job or going back to school for their masters or doctorate. He had headed to medical school for the long grind and had parted ways with their more carefree existence.

  He tapped his red pen on his knee. There were ongoing humanitarian crises around the world and a specific need in areas of Africa where they lacked the basics of healthcare besides clean water and shelter. Ebola had taken its toll and there were caretakers who had done more than their share. It’s almost like being drafted, he thought. Like giving a year of service to your country, you should pay back society with the services you’re trained in. The most diverse employer he had in mind was Global M.D.s. They always needed physicians. Plus, he had heard they were flexible with their volunteers’ commitments for time and their contracts.

  He yanked his soft leather shoes off the desk, scooted forward to his laptop, and went to his bookmark ‘Global M.D.s.’ After finding ‘contact us,’ he requested a packet with all the necessary information required for him to learn more, and to possibly apply for a position.

  -----

  When Robby got up to go home, it was dark outside. He’d been sitting too long so he wrapped his hands behind his neck and flexed his arms and shoulder blades. Rather than pack up to leave, he decided to check on Mr. Kingman in the ICU. They had not reordered his full pain medication yet because they wanted to wait for the effects of anesthesia and their narcotics to wear off to access his mental status. Then Robby or Marlin could start him back on his regular scheduled morphine.

  He went to the team’s office and peeked inside. Marlin Mack was throwing his lab coat on a chair.

  “Hey,” Robby said. “You must have had a lot of loose ends to take care of. I’m surprised to still see you here.”

  “I had to wait to give the on-call resident my patient list and report. He had been tied up with an emergency. But I’m leaving right now. At least I had dinner in the cafeteria while I waited.”

  “You’re ahead of me then. How is Mr. Kingman? Perhaps I don’t need to swing by there.”

  “Uh …,” Marlin stuttered. “I figured he was still under anesthesia’s care in the unit so I wasn’t going to go see him again. Plus, I gave a detailed report about him to the night-call resident.”

  “I guess it’s good night then,” Robby said. “I’ll check to see if he can respond to commands yet and then order his morphine.”

  “Dr. Wallace left like two hours ago,” Marlin added sarcastically. He fumbled at his hip, making sure his cell phone was in its cradle, and walked towards the door.

  They nodded good-bye and Robby continued on his way. His two residents would be in the hospital earlier in the morning than he would so he couldn’t blame Mack for wanting to finally leave. Sometimes it seemed as if the more senior he became, the more responsibility and time he took to oversee the big picture.

  At the end of the hallway, Robby pressed the elevator button and waited patiently. When the door opened, two fresh medical students from the on-call team came out.

  “That was unbelievable,” one of them said nervously. “My first chest compressions ever. It’s a good thing I didn’t throw up; it was just awful looking at him.”

  “I don’t know how you did it,” the taller one said. “I’m glad I didn’t get there before you.”

  The students rounded the corner and were out of sight. Robby stepped in and got off on the sixth floor.

  When he went through the burn unit doors, he immediately sensed trouble. An anesthesia resident stood talking with an ER doc outside of Mr. Kingman’s room. The only way an ER physician would be up here, Robby thought, was if he helped out with a code because the on-call docs were tied up somewhere else.

  “Dr. Burk!” An ICU nurse stopped in her tracks going into the room. “We assumed your team was gone and beeped the call resident but they’re working in the OR with an emergency.”

  He peered in to notice the ventilator wasn’t cycling and no endotracheal tube protruded from his patient’s mouth. Mr. Kingman was still.

  “I ran a full code, Robby,” the ER doctor said. “But I was too late. The nurse also called anesthesia because your patient needed to be re-intubated … so Dr. Gill was here first.”

  Robby looked at the anesthesia resident’s coat to verify his name and rubbed his right temple in despair. He wished he had come up sooner.

  “Dr. Burk,” the nurse said, “Mr. Kingman’s anesthesia and pain meds were wearing off. He was moving his hands a bit and acknowledging what I said to him by blinking and moving his head. The respiratory therapist had come in and had changed his ventilator settings based on orders because he had begun breathing on his own. But about fifteen minutes after that, he was struggling to tell me something and, when I had my back turned, he pulled out his breathing tube. I contacted the call team but then had to call anesthesia because it was apparent that he deteriorated after the tube came out. Then he couldn’t tell me whatever it was.”

  Robby frowned and looked at Dr. Gill.

  “It was a scramble to re-intubate him,” the resident said.

  “And I called the ER as backup,” the nurse said. “But before we knew it, we saw V-tach and then he was flatline.”

  “I’m sorry,” the ER doc said. “This is a sad ending to an already tragic medical situation.”

  Robby nodded. “Thank you all for your help.”

  “I’ll go write a note in the chart,” Dr. Gill said.

  “I’ll do the same,” the ER doctor said, “and fill out the paperwork. And I’ll put respiratory arrest on the death certificate.” He gave Robby a sincere look. “You’re not the general surgery chief resident on call. Why don’t you go home now?”

  “Thank you,” Robby replied. “I must admit it’s time for me to step away from patient care for the night. But first, I’ll notify the next of kin.” His shoulders sagged as he stepped closer to Mr. Kingman’s disheveled bedside for one
more look. Although they had done an expert job on some skin grafting that day, the tissue on his chest had been disrupted due to chest compressions. His body was in ruins. Now he joined his grandmother, Robby thought, whose life he had first tried to save. The man had died a hero.

  -----

  Annabel woke with a start. She panicked, thinking she had missed the ringing of her alarm clock but, instead, she was early by a half hour. She wiggled her toes and flexed her thighs and swung to the side of the bed. Good. She’d have time to make her own coffee instead of buying it at the coffee stand on the ground floor of the hospital. What they charged was ridiculous anyway. It was one thing her parents were paying for most of her tuition and rent, but it was another thing to spend money when she didn’t need to.

  She put on a one-cup serving, went back to her little bathroom, and brushed her teeth. Looking in the mirror, she relaxed into a small smile. For twenty-three, she looked a little bit older. Her white smile was perfect after earlier orthodontic work and her hair was just like her mother’s – medium blonde but peppered here and there with darker highlights. Today it had medium waves to her shoulders, not like the high-humidity days where it tightened up into curls. She finished by washing her face and dabbing on moisturizer.

  On the top of her bed, she assembled overnight items to stay in the hospital and a change of clothes for the next morning. After getting dressed, she sipped her steaming hot southern pecan coffee and skimmed over the list of her patients. She was assigned to four patients and their care was also split between the two residents, Brandy and Marlin. But more than the names on her index cards, she thought about Mr. Kingman and the effort Dr. Burk and the OR team had made yesterday to make him look and heal like normal. The next six weeks should be interesting to watch his transition.

  Annabel finished the last sip and wondered if this would be one of the quietest moments of her day. She gathered her things, locked the door behind her, and enthusiastically went down the narrow two flights of stairs to her car.

  -----

  In the office, Annabel slipped her backpack off her shoulders as Bob Palmer entered.

  “Good morning,” he said. “Here, I’ll stash that in the corner if you’d like.” With his own bag, he grabbed hers, leaned over a chair, and dropped them.

  “Thanks, Bob.”

  “Are you as nervously excited about today as I am?”

  “I’m glad I’m not the only one,” she said surprised. “I feel like a little bug under a microscope among these Alexander Fleming-like doctors.”

  “I can’t claim to be old with a cloudy memory,” he said smiling, “but I have no idea who Fleming is.”

  “Oh, sorry, he discovered penicillin.”

  “Don’t be sorry. You’re probably as smart as Da’wan … I just scrape through medical exams.”

  “Bob, anyone who gets into medical school isn’t exactly not smart. But for me, my dad’s an M.D. and my uncle is a paramedic who’s really close to us. So…I’ve heard medical lingo and information for years.”

  “My dad’s an electrician and my mom is a retired nurse. So I know where the transformer box is at home and I know how to do proper dressing changes.”

  Annabel laughed and slipped on her lab coat. “Your mom has taught you more than you think.”

  “Yeah, she told me not to do sleepovers with women until I get to know them. But we’re going to have an overnight together, so I hope we have a jammed-packed day so I know you by then and don’t break my mom’s rule.” He broadened his smile and she smiled back.

  “You know it’s not the kind of sleepover your mom referred to,” she said.

  “Yeah, I know,” he said despondently.

  “And the way I understand it,” she said, “if any of us spend time in that call room tonight, we’ll be lucky.”

  “Actually, we should mention it to Da’wan and Ginny. When any of us gets called out for an admission or a problem on the floor, we should come and go stealthily so as to not wake anyone else.”

  “Count me in. That’s a no-brainer.”

  “Okay,” he said, following her lead out the door. “My obvious idea takes hold.”

  Annabel only had to make a left and go into the first room. It was a double occupancy room and she passed the first bed where loud snoring came from a patient lying on his side.

  On the other side of the drape was Mr. Newman; he was a complicated GI patient on bowel rest and sporting a nasogastric tube or NG tube, thin tubing going from his nose down into his stomach. He was awake yet groggy and they both forced a little smile because his next-door neighbor mumbled while in the throes of a dream. Annabel picked up the bedside chart and checked vital signs for any abnormalities. She better know if Mr. Newman had spiked a temperature overnight so she could report it on rounds.

  She stepped alongside the window next to his bed as he raised it forty-five degrees with the electronic button. “Did you have a good night?” she asked.

  “Would you have a good night if someone woke you up and then squeezed a blood pressure cuff so tight around your arm that it practically squirted your bone out like toothpaste?”

  She could barely contain laughing. “I’m sorry it hurt. That doesn’t sound like any fun.”

  “You bet your shiny stethoscope in a poker game that wasn’t any fun,” he said, pushing a stray nightgown string off his neck.

  “I’m glad I don’t play poker. May I listen?”

  He put his head back down on the pillow and she put her stethoscope on his belly. Bowel sounds were present, putting her at ease.

  “By the way,” he asked, “are you the one who is going to give me a new IV? They said this one has to come out.” He nodded toward his hand at the taped hep-lock IV where he’d been receiving antibiotics.

  “We’ll discuss it on rounds,” Annabel said. “See you soon.” She gulped as she turned away. It looked like today would be the first time ever that she would stick a catheter into a patient’s vein. It better be a skill that comes naturally, she thought. She couldn’t imagine what it would be like for Mr. Newman to be the pin cushion for a green medical student.

  Chapter 4

  After seeing her four patients, checking their charts, and digging up lab work, Annabel went to the office. Robby stepped in last, his humble air of confidence and clinical experience trailing with him. His warm eyes glanced around as he checked on the attendance of his students and residents.

  “Good morning,” he said. The students chirped back their hellos while Robby began writing an agenda on the blackboard. “Since we’re on call starting now, this will be our master list. Patients to be seen in the ER and admitted will be rotated among Dr. Mack and Dr. Wallace and each time a student will accompany them. Dr. Mack and Dr. Tilson are up first.”

  “Did you all bring an overnight bag?” he asked.

  All of them nodded as Robby leaned on the desk. “Good. That means none of you are as apprehensive as I was on my first call day. I left my house without clothes and toiletries and the attending had to excuse me to make some purchases nearby. Since I was then absent from rounds and had been scatterbrained to leave my bag at home, I was nicknamed ‘Dr. Absent.’ They didn’t use that endearing term in front of patients, but you can imagine how much they rubbed it in after that.”

  The students chuckled and mumbled their understanding. It was nice to have a chief with a sense of humor and a candidness about his flaws, Annabel thought.

  “Now,” he said solemnly, “we won’t be starting rounds in the burn unit this morning. Mr. Kingman passed away last night.”

  Annabel’s eyes widened. What had happened after his successful surgery yesterday? The surprise news didn’t register with Dr. Mack or Dr. Roth but then she realized they would have known it already if they’d gone this morning to see their patient.

  While Marlin was busy stroking his mustache and looking at the clock above the doorway, Annabel felt heavyhearted and upset. All that Mr. Kingman had suffered through and endured had been
for naught.

  “Dr. Burk,” Da’wan asked, “was it from something like we talked about yesterday? From an electrolyte disturbance or from the huge fluid shifts causing dehydration and hypotension?”

  Robby looked to Marlin for him to answer the question, especially since his preoccupation was either watching the clock or smoothing out the sleeve of his lab coat.

  “After evaluating the chart,” Marlin said, “talking to Mr. Kingman’s nurse, and looking at the death certificate, I can tell you for sure. First of all, there are two interrelated takeaway lessons for you students. The first is to never underestimate an airway. You need two things to live; a beating heart and breathing lungs. Without one or the other, you’re a goner. Our burn patient lost his breathing tube so his lungs were deprived of oxygen. Hence his circulation and tissues became anoxic.”

  “And the second takeaway point?” Da’wan asked.

  “I’m sure Dr. Burk won’t mind me telling you this because you’ll probably hear some of them from him as well. There are ten top surgery or operating room-related phrases that are infamous in the profession. One of them - and it’s the second point, Dr. Roth - is to ‘blame it on anesthesia.’”

  Da’wan quickly considered that. “I cannot believe that’s a noted phrase. It wouldn’t seem prudent to point fingers at another specialty.”

  “Okay, Dr. Mack,” Robby interjected, “your bluntness is a bit more than what’s necessary. And Da’wan, it is an amusing phrase but not pertinent in this situation nor is it ever appropriate except in jest. The truth is, as far as I can surmise from being in the unit last night after all this transpired, that Mr. Kingman awoke and wanted his endotracheal tube out. That is not uncommon for patients who are starting to breathe well on their own and when sedation has worn off. He pulled the tube out himself but too much time elapsed before it was discovered as he struggled for air; it was an anesthesia resident who showed up and attempted to put it back in.”