Welcome back, pt 1

She stood at the sink, bracing her hands on the wide metal lip of the deep basin. Her head was lowered in silent prayer, her mouth in constant motion with her unvoiced plea. The fluorescent lights bounced off the hollows of her face, deepening the already dark circles under her eyes. Her hands lifted to the nape of her neck to readjust the tie of the tight surgical cap, its itchy closeness far more constricting than the bouffants that used to contain her unruly hair. While one hand scratched her scalp through the coarse cotton, the other plucked a plastic-shielded mask from the box above the sink. Expertly pinching the reinforced bridge to a comfortable rest across her nose, she stared through the window into her operating room. She slowly knotted the top straps of her mask, idly observing the graceful, rhythmic motions of her scrub nurse’s preparations when the double doors to the OR were pushed open by the circulating nurse. She scrambled away from the sink, the lower ties of the mask dangling across her scrub top and entered the room.

The anesthesiologist lifted his head at her arrival, “Welcome…” She lifted her hand tersely, stopping him mid-sentence and pointed to the patient. The stretcher was being wheeled into place, abutting the narrow padded steel table draped in crisp green sheets.

“Dr. Shipley!” Her eyes were drooping slightly from the mild anxiolytic she’d been given in pre-op holding. She raised her finger and flicked the tie dangling near Beverley’s chin. “In a rush, doc? You missed a step.” Her giggle warmed the room, dispelling the stiffly clinical clicks and beeps emanating from the equipment being readied for her procedure.

Beverley took her hand. “Oh, I’ve still got lots of steps, Jane. But, let’s get you ready for this, okay?” She released her hand and walked to the far side of the surgical bed, careful to avoid the sterile instrument trays being opened and inventoried. She leaned over and took the plastic bag of fluids currently streaming into her patient’s vein.

“Scoot on over here to me. I’ve got your IV line. It’s just like we talked about. Lots of people running around doing what they need to do to get ready for you.” She stretched to hook the plastic bag to the OR pole and propped her hands on her hips, moving to Jane’s waist to avoid hovering over her.

“You met Marsha and Dr. Gunn.” The circulating nurse looked up and smiled as she tucked blankets around Jane’s legs. “She’s going to get you all strapped in and safe, and he’s going to start putting some monitors on you.”

Beverley pointed to the briskly efficient blue blur hovering over the sterile field. “Mrs. Lucas is all dressed up now, but you met her earlier this morning. She’s going to help me and Dr. Wiles.” The woman still had her back turned and raised one finger, finishing a critical part of her count before turning and waving.

A frown crossed Beverley’s face. “Marsha, have we seen Dr. Wiles?”

“I saw him in pre-op about an hour ago.” Marsha and Mrs. Lucas exchanged a look.

“Once we get Mrs. Ackmann settled, could you please page him to the room?”

“Yes, Dr. Shipley.”

Dr. Gunn stood at the head of the bed whistling and affixing syringes to various IV ports. Beverley smiled.

“Dr. Gunn is ready now. We’ve got a couple of things to do first, it’s going to sound a little silly.”

Marsha had a clipboard in her hand. “Time out. Mrs. Ackmann, can you please tell me your name?”

“Jane Elizabeth Ackmann.”

“Date of birth?”

“July 20, 1958”

“Dr. Shipley, the consent reads right lumpectomy, right sentinel lymph node biopsy, possible axillary node dissection, possible simple mastectomy”

“Yes.”

“Ms. Ackmann, you agree?” Jane gripped Beverley’s hand.

“Yes.”

“Patient, procedure and laterality confirmed. Is everyone agreed?”

As the chorus of affirmations rang through the room, the grip on Beverley’s hand grew tighter.

“Beverley, I’m scared.”

Beverley closed her other hand around Jane’s. “Hey, it’s just like we talked about. I’m going to do what’s best for you. I’m not going to do anything I don’t have to do. And I’m going to scrub out and talk to Mark if I get surprised by anything.”

Jane’s eyes misted over as she grinned, “Mark… my beautiful, strong Mark.”

“Focus on Mark. Close your eyes and picture him.” She nodded to Dr. Gunn who began a careful dance with the syringes he had positioned earlier, pushing one medication then another into her veins, speaking softly to Jane before placing a ventilation mask over her mouth and nose.

“A couple of deep breaths, Mrs. Ackmann. Now count backwards from 100.”

“100…99…” Her mouth fell open, and her grip on Beverley’s hand slackened as her body fell into a deep slumber. Beverley moved closer to the head of the bed, lending a hand to Dr. Gunn who completed a smooth intubation.

“Marsha, did Simon answer his page?”

“Yes, he’s on his way.”

“How nice of him to join us.”

Marsha and Beverley quickly began prepping and positioning the patient for her procedure. When Marsha began a sterile wash of the operative area, Beverley stood back and tied her mask securely. Dr. Gunn picked up his clipboard and began charting vital signs. He grinned at her over Marsha’s ministrations. “Welcome back, by the way.”

“Thanks.”

Simon burst through the double doors, holding a mask to his face.

“Why if it isn’t young Dr. Wiles.”

“Yes, Dr. Shipley.”

“Are you not a second year surgical resident, Dr. Wiles?”

“Yes.”

“Are you not, in fact, my surgical resident this month?”

“Yes.”

“Then can you please explain to me why our patient is asleep and was almost completely prepped before you graced us with your presence?”

“I, umm, I pre-op’ed her this morning.”

“Do you intend to operate on her?”

“Yes, ma’am.”

“You just might. One question. What is her name?”

“I, umm, I…” His eyes glanced around the room. Marsha stood in front of the white board on which she had been documenting the patient’s information, effectively blocking any attempt on Simon’s part to cheat his way out of his current predicament.

“Marsha, Mrs. Lucas, please double drape. We’ll do the sentinel node first. She got her injection this morning.”

Beverley walked past Simon and held open the door on her way to the scrub sink. A quick jerk of her head, and Simon ran out before her.

“Simon. I know you’ve not worked with me before, and I have been on leave since you before you finished your internship. But, I know my colleagues have expectations not much different than mine.”

“Yes, ma’am.”

She rolled her neck, stretching the tense muscles. “You don’t respect your patients.” He began to stammer with apologies and excuses. “I know you’re busy, I didn’t expect you to remember a lot, just a name.” She bounced her hip off the lever to start the water and grabbed a foil-wrapped clorhexidine sponge. She ripped it open and began her scrub ritual. “And if you had a better relationship with the OR nurses, they would’ve helped you out. Don’t think I didn’t notice.”

He watched as she washed compulsively. Ten strokes over the palm, ten over the back of the hand. She was on her left pinky finger when she startled him.

“Page your intern. She’ll be scrubbing with me, and you’ll do her floor work.”

“Yes, ma’am.” He threw his mask in the garbage and turned to walk away.

“Simon?” His sneakers squeaked on the sparkling floor as he came to a halt. “I have two cases tomorrow. I’d love to have the opportunity to teach you, don’t let me down.”