This is from the thirty-second, and last chapter from my best-selling book, Bryson City Tales. I hope that you’ll enjoy going back to Bryson City with me each week, and that if you do, you’ll be sure to invite your friends and family to join us.
HOME AT LAST (PART 2)
As we hightailed it to the car, two city policemen were running up the walk. Don and Billy were pulling their gurney out of the ambulance.
“Walt, my car’s right here,” Ray instructed.
We jumped into Ray’s car and took off for the hospital. “My, he’s good,” muttered Ray. “Gotta be a ruptured ectopic. Gotta be.”
“How could he know?”
“Young woman. In great health. Married about four months ago. No birth control. They want lots of kids. Faints in a church that is cool, not overheated. Just finished Sunday school. We had refreshments. She couldn’t be dehydrated or hypoglycemic. Exam shows her conjunctiva to be pale, meaning she’s got a mean anemia, and pressing on her lower abdomen caused a pain response. Blood irritates the peritoneum.”
We were quiet as Ray raced the car up Hospital Hill. We could hear the siren behind us.
“They probably just scooped and ran,” guessed Ray—describing an emergency approach in which paramedics scoop a critically ill patient onto the stretcher and then run to put them in the ambulance.
“Bet Mitch will have an angiocath in her subclavian vein by the time they get to the hospital. Wouldn’t be surprised if he’s got her blood drawn for the lab and a liter of fluid in her by the time we see him.”
My mind was racing. The way Ray presented the case made sense, but I wasn’t sure I would have reached the same conclusions had I been there alone.
My thoughts frightened me. I probably would have interpreted this as a simple faint. I could hear myself trying to reassure the pastor and congregation: Pastor Hicks, it’s probably just a vasovagal episode. Very common. Not dangerous. Let’s just give Susie a few minutes. I’m sure she’ll be OK.
Would I have kneeled at her side, expecting her to awaken after five or ten minutes while an unrecognized hemorrhage drained her of her life? I could hear Gary Ayers on Monday morning: “New young doctor watches patient hemorrhage to death in front of his eyes while reassuring her pastor that she was medically stable.”
Ray screeched to a halt just outside the ER entrance. We ran inside, past a wide-eyed group of family members in the hospital waiting room. In the doctor’s lounge we pulled our scrubs over our Sunday clothes, pulled on shoe and head covers and facial masks, and ran together to the OR.
We turned on the faucets at the scrub sink, ripped open scrub sponges of Betadine antiseptic, and began our scrub. Through the window looking into the OR we could see Kim at the head of the OR bed, anesthesia machine ready, drawing up her anesthetics into several syringes. IV fluids were hanging and ready, and the monitors were turned on.
Nancy was scrubbed and preparing the OR equipment. Peggy and Louise were quickly bringing Nancy equipment and sponges. As we scrubbed, Nancy and Peggy completed the instrument count, a procedure that was carried out before any surgery. This count of each piece of equipment and sponge would also be performed after the surgery, as a way of ensuring that nothing was left inside the patient that should have been removed.
Just then there was a crash as the doors of the OR suite flew open. Don and Billy raced Susie toward the OR. Mitch was nowhere to be seen, but a nearly empty bag of IV fluid was sitting on Susie’s chest. Louise and Peggy met the team at the door.
“Thanks, guys. Great job. We’ll take her from here,” Peggy barked as she and Louise rolled Susie into the OR and began to transfer her to the table. As Ray and I finished scrubbing, they would cut off her remaining clothes, insert a catheter into her bladder, and cover her with warming blankets.
In the meantime, Kim would start additional IV lines and fluids and begin the blood transfusions. She would also begin to administer an IV agent to paralyze Susie. After Susie was immobilized, which would take only seconds, Kim would have to place a tube in her trachea to ventilate her. Kim would have only a few moments to complete the intubation. If Kim experienced delay or failure, Susie’s brain cells would begin to die from loss of oxygen.
“What are her vitals, Billy?” asked Ray, finishing his scrub.
“Doc, she’s afebrile. Actually a bit cool at 97 degrees axillary. We put some blankets on her. Pulse 140 when we scooped, but Mitch got the central line in, and by the time we were here, he had a liter in her and the pulse was 120. Respirations 24 and shallow. BP 60 palpable. Glad she wasn’t in the national park or too far out when this happened.”
“Me, too,” said Ray.
“She was on her way out, huh, Doc?” Don’s statement was half question and half statement.
“I suspect she’d have bled to death in just a little bit.”
“She gonna make it, Doc?” asked Billy.
“I reckon she will, Billy. I reckon she will. In no small part due to you all’s response time. Good thing you all were at the station and not at church.”
“Yep, we’re usually up at Franklin Grove Baptist Church. Would’ve added at least ten to fifteen minutes—and the pastor hates it when we get called out during the sermon. He always thinks we do it on purpose.” Billy laughed.
“Well, that extra time was definitely not something we had. Thanks, Billy.”
“You both break a leg. We’re outta here. Heard on the way up there’s been a little fender bender on the four-lane. May be hauling some more business for you in a bit. Keep you guys outta trouble.” Billy smiled as he turned to go. I suspected we’d see him soon enough.
Ray and I finished washing off the soap and quickly backed into the OR, our hands held up and in front of us, water dripping from our hands down our arms and off our elbows. As the OR doors closed behind us, we saw Mitch, now donned in scrubs and mask, enter behind us.
“You gonna scrub, Mitch?” asked Ray as he quickly dried his hands. Nancy was already helping me gown. The answer surprised me.
“Naw. Just thought I’d watch you boys work together,” he bantered. “Besides, I’m off this weekend. You’re on surgical call, Walt’s on ER call. I’d probably just be in you all’s way.”
Ray looked at me and I at him. He had been planning to be first assistant and I the second. Now we had suddenly been bumped up to first class. No words were actually spoken, but a thousand unspoken words crossed the space between us. This was a pretty high compliment in the face of a highly public and life-threatening emergency. This kind of life-saving surgery was Mitch’s forte, his pièce de résistance, his reason for being and practicing. Something was up.
Mitch went on. “Once you guys clamp that bleeder, the show’s really over. Besides, Gay and I have lunch reservations up at the Frye-Randolph house. The Adamses are cooking up something special for us and serving us at the private table under the gazebo. Gay will kill me if I miss that. Now you two get to it!” he barked.
While Nancy helped us with our gloves and Peggy and Louise tied our gowns from the back, Kim had started two more IV lines and was running in fluid and three units of packed red blood cells. “OK to put her to sleep?”
“You bet, let’s move!” roared Ray.
We positioned ourselves across from each other. Ray quickly scrubbed the abdomen with Betadine. Normally he would take four or five minutes to do this. Today, less than ten seconds. I quickly prepared the drapes. “Boy, she’s distended,” he said, almost to himself.
“Lotta blood in there,” Mitch commented. He was now situated next to Kim at the head of the bed, where he could see the whole operation. Front-row seat, we called it. Best seat in the house.
When Ray nodded that he was done with the prep, I threw the sterile drapes into place. Nancy expertly handed us the clasps to hold the drapes, not only onto each other, but also onto the patient.
The OR door cracked open, and Betty Carlson, the head of the hospital lab, with a mask held tentatively over her face, shouted, “Ray, her hematocrit is 16, white count 25,000 with a left shift, lytes are OK, and blood is O positive.”
The hematocrit is the percent of the blood that contains red blood cells. Normally forty percent of the blood is red blood cells. Susie had lost over half of her blood into her abdomen.
A normal white blood cell count is ten to twelve thousand. An elevated number like this could mean infection, but most likely not in this case. We are created so that if we have a sudden stress or accident or bleed, the bone marrow will pour hundreds of thousands of white blood cells into the bloodstream. These cells are on the lookout for foreign invaders that they can attack and kill. So, like soldiers, some are on patrol in the blood vessels, while most await action in the barracks—the bone marrow. In Susie’s case, they were called into action, along with the reserve oxygen-carrying red blood cells of the bone marrow—all engaged in the effort to save a life that was quickly ebbing.
“Thanks, Betty,” shouted Ray. “Kim, run in the next three units of blood as fast as you can. Walt, let’s go.”
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1); (Part 2)
- Fly-Fishing (Part 1); (Part 2)
- Something Fishy (Part 1); (Part 2)
- A Good Day at the Office
- An Evening to Remember
- Another New Doc Comes to Town
- ‘Twas the Night Before Christmas (Part 1); (Part 2)
- A Surprising Gift
- The New Year (Part 1); (Part 2)
- The Home Birth (Part1); (Part 2); (Part 3)
- The Showdown (Part1); (Part 2); (Part 3)
- The Initiation (Part 1); (Part 2); (Part 3)
- Home at Last (Part 1); (Part 2); (Part 3)
© Copyright WLL, INC. 2017. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.