ADRENALINE: New 2013 edition (6 page)

Doug remembered very well when this change had come to Keystone Anesthesia Associates. Early in his employment, the
group had voted on more physician anesthesia and less supervision. He had been thrilled. After just two years of supervising CRNAs at Mercy, he could easily make the transition back to administering his own cases. To someone like Raskin, however, this must have been his worst nightmare.

Raskin was a very intelligent man and surely realized what was happening. But again, Raskin’s innate laziness prevailed and prevented him from taking any meaningful steps to remedy his situation. It must’ve been just easier to let someone else do all the work, and deceive himself into thinking that he could’ve done it himself.

Doug often wondered how much Raskin actually realized. Did he understand the depth of his fears and incompetence? Or had he, after lying to himself for so many years, come to believe his own lies?

Doug felt uncomfortable with his own skills when he took a two-week vacation. When he came back, the first day he was a bit rusty and might blow an IV or something before getting back into the swing of things. He couldn’t imagine a twenty-year vacation.

The real irony of the situation was that Joe set foot in the ORs only when he was summoned to help out in an emergency. Doug thought this was especially ridiculous. How is the guy who hasn’t intubated anyone in a year going to waltz in and do the one the experienced CRNA cannot? Invariably, the answer was he could not. So another anesthesiologist, frequently Raskin’s friend, Bryan Marshall, came in and bailed him out.

In addition to losing skills he’d once possessed, Raskin also became deficient in techniques that hadn’t even existed when he’d trained. All branches of medicine progressed rapidly, and the highly technical field of anesthesia was no exception. New procedures, techniques, and monitors were constantly coming on the scene with the rapid growth of microchip technology. New drugs were also constantly appearing. Doug knew that the
anesthetic of 1999 bore little resemblance to an anesthetic of the 1970s.

Raskin’s knowledge didn’t actually become obsolete. Raskin prided himself on keeping up with all the latest, through reading extensively in journals and attending numerous meetings. Raskin could carry on a wonderful discussion of any of the cutting-edge techniques or pharmacodynamics of modern day anesthesia. This was where the talk the talk part came in and served as a highly effective smokescreen.

What Raskin really lacked was the technical expertise, gained only from hands-on experience, to apply the new technology. But more than that, Doug surmised, what he really suffered from was fear, a deep-seated fear, approaching phobic proportions. He avoided any hi-tech, complicated case like the plague.

Doug often speculated on the enormous effort Raskin expended manipulating the schedule. Wouldn’t it just have been easier to learn the newer techniques and do the cases, then to constantly avoid them and live in perpetual fear that he would be assigned to one that he couldn’t weasel out of? The constant fear surely took its toll. He became meaner and nastier, prone to temper tantrums and displays of rage. His interaction with the patients and the nursing staff suffered. Whereas Omar Ayash’s file was thick with reports of incompetence, Raskin’s file was filled with patient and staff complaints.

As hard as Raskin’s predicament was to understand, what was even more difficult to comprehend was why Bryan Marshall put up with Raskin. Marshall didn’t suffer
anyone
lightly. Did having a yes-man for all occasions justify his forbearance? Doug had gnawed on this one for years but had never come up with a truly satisfactory explanation.

Doug turned off the water and stepped out of the shower. He toweled off his six-foot-two-inch frame, wrapped the towel around his waist, and got ready to shave. He studied his image in the steamy mirror for a moment. He was comfortable with what
he saw, but he chuckled when he thought it had not always been so. Throughout his teens and early twenties, Doug had believed his nose was too big and chin too small. But over the years he had come to accept that maybe his initial assessment, perhaps skewed by his shyness, had been harsh. It seemed that women were indeed attracted to his features. His wife, Laura, insisted he was handsome. He still didn’t quite get it, but had moved beyond the questioning state.

The steam did a good job hiding the gray sneaking in at his temples and the bags developing under his eyes. He knew his looks and youth were following the well-worn trail to middle age. He couldn’t quite figure out how much it bothered him.

He walked into the bedroom where Laura was still sound asleep. She looked especially pretty; her face was so peaceful, framed by her long black hair. Snuggled up next to her was Anthony, their three-year-old little boy, vigorously sucking his thumb. He was the youngest of their three sons. Anthony had a habit of climbing into their bed early in the morning. Doug smiled as he remembered twelve years ago, when their first son, Teddy, was a baby. They had discouraged him from sleeping in their bed, believing that their marriage bed was no place for little children. It might foster hard-to-break habits of dependency likely to warp a child’s development. Being first time parents was not easy. Now, he looked forward to Anthony snuggling with them and believed this sense of comfort and protection would only help the child in later life.

Doug loved to take Anthony out to breakfast after being on call. The older boys were in school, and Laura appreciated the opportunity to get some housework done unimpeded. The two generally gravitated to the Country Oven, a little coffee shop just down the road off the interstate. Anthony especially liked to retrieve the
USA Today
from the “slamming door,” and to sit on the stools at the counter rather than at the booths or tables. He also enjoyed taking his toy-du-jour to show the waitress and paying the bill with Dad’s help.

At times like these, when the house was so quiet and everyone was still asleep, Doug was overwhelmed with love, thankfulness, and serenity. Sadly, guilt also surfaced. Just this past weekend, Laura and he had had another monster fight, this time over something really critical, like did he have time to go the gym. Strange how minor issues could explode into nasty fights so easily. This worried Doug almost as much as the fact their fights had become more frequent.
What was happening?

Doug shook off this worry only to have uglier thoughts replace it. Would someone die today at his hands? Would this be the day the sleeping serpent reared its ugly head and sank its fangs into him? Strange thoughts for the Iceman. Doug smiled briefly. He didn’t believe he was as cool as they thought he was. He wasn’t sure anyone really could be. He was thankful for his experience and knew he was stronger for it, but he could never be absolutely sure of himself. How’s that expression go? Past performance is no guarantee of future results.

Over the years he had dealt well with these fears, banishing them quickly whenever they appeared. They barely grazed his consciousness, as he kept them imprisoned in the subterranean depths of his subconscious. However, because of Mike’s unfortunate case Monday, his fears were launching a bolder assault.

Doug arrived at the hospital at 7:05 a.m., the same time he always did. He slid his plastic card into the slot to activate the security gate into the doctor’s parking lot. To this day, he was slightly embarrassed to park in this special lot. One of the OR nurses said that as long as they had Doctors’ parking lots, it would be hard to have much sympathy for all the doctors’ whining about dwindling reimbursement. She was referring of course to all the shiny new Mercedes, BMWs, and Lexus’s that inhabited this particular lot. She had a good point.

Doug maneuvered his eight-year-old, 120,000 mile Toyota 4X4, which he was secretly proud of, next to Ken Danowski’s
Explorer. He knew everyone’s vehicle. One could glean a surprising amount of information from a quick glance around the lot. He saw Dr. Marshall’s car and realized he must’ve been called in last night. Undoubtedly he was still working on an emergency case. He also saw Dr. Johnson’s Lexus and because he was an OB-GYN specialist, the case was most likely a cesarean section or less likely a ruptured ectopic pregnancy.

Doug grabbed his gym bag, hopped out of the truck, and strode briskly to the back entrance to the hospital. Cold still gripped the air and Doug breathed out large plumes of vapor. He glanced at the eastern sky and wondered if the sun was frozen somewhere below the horizon and might never rise. He knew as late man today, he didn’t have a prayer of seeing it on the way home.

Doug looked forward to seeing some of his co-workers in the locker room where they changed into scrubs. The locker room was one of the few places where everyone showed up at once and had several minutes to talk. First on the agenda was the previous call-person’s tale of woe. This was particularly interesting because your turn in the barrel was never far off. Doug entered the locker room wondering again how Mike was holding up.

“Hey Doug, good morning,” Ken Danowski offered cheerfully. “How are you?”

“Not bad,” responded Doug. “Sounds like you’re getting a cold, though.” Doug peeled off his bulky jacket and stuffed it in his locker.

“Yeah, the baby’s picked up some crud, and I always seem to get it,” Ken said, punctuating his remark with a loud snort into his handkerchief.

Doug picked out some scrubs and proceeded to change. “Feels like we just left.”

“Yeah, I know. Nothing like an emergency evening meeting to screw up a week. Looks like Marshall’s here doing a case.” Ken glanced around quickly and added at half volume, “Too bad.”

“Yep, it’s a damned shame,” Doug echoed.

“What did you think of the meeting last night?” Ken asked.

“I wouldn’t worry too much about Pinnacle. We don’t have all the facts yet.”

“That’s easy for you to say. You’re not low man on the totem pole,” Ken said, grinning.

“Yeah, you’re right. Better worry.” Doug paused to smile, then asked, “What’re you doing today?”

“I’m a regular guy,” Ken said as he pulled a scrub shirt over his head, “but I got the frigging vascular room with Shindler. I’ll be here till the cows come home and then some.”

“You’re breaking my heart.” Doug liked Ken and thought he was much more animated and personable when Marshall or Raskin weren’t around. He was a good addition to the group, just what they needed—some new blood.

The locker room door opened and an unfamiliar face entered. The face belonged to a young, clean-cut kid in his early twenties with short, cropped red hair and med student written all over him.

“Uh, hi, I’m Rusty Cramer. I’m here to see, uh, Dr. Bryan Marshall, the chief of anesthesia.”

“Hi Rusty.” Doug held out his hand to shake. “I’m Doug Landry, the real chief of anesthesia around here,” Doug said, as he broke out into laughter. Rusty gave him a firm hand and smiled clumsily.

“You must be our med student for this rotation,” continued Doug.

“Yes, that’s right Dr. Landry.”

“Call me Doug. I believe the good Dr. Marshall is involved in a case right now. We’ll meet him shortly. And that’s Ken Danowski over there.” Doug grinned and lowered his voice slightly for effect. “He’s kinda low man. You want to avoid him at all costs.”

“Pleased to meet you, Rusty,” said Ken. “Just ignore that turkey,” he said motioning at Doug. “He’s been sniffing the gas for so long it’s rotted his brain. Why don’t you suit up and join us for a fun-filled exciting day. The scrubs are over there. You can use
this locker over here.” Ken paused to sneeze. “Stick with me and I’ll show you some
modern
anesthesia.”

“OK, thanks.” Rusty laughed nervously again and appeared slightly confused. Doug realized that coming from the Penn State University Medical Center, Rusty was no doubt accustomed to a more formal interaction with his staff men.

“So, you’ve come from the mecca to mingle with the peasants,” Ken said.

“The mecca?” Rusty stripped down to his T-shirt—the front of which was emblazoned with a large picture of the Amazing Spiderman. Doug had to work hard to suppress a grin.

“That’s how we peasants refer to the big university teaching hospital—to show proper homage,” Ken said.

“Oh, I see,” Rusty said, smiling. He hesitated for a moment, then added, “You may kiss my hand now.” Doug and Ken both snorted in laughter.

The locker room door opened again and Mike Carlucci stalked in.

“Hi Doug, Ken,” Mike said. He ignored Rusty.

“How’s it going, Mike?” Doug asked, grimacing slightly. He could tell immediately from Mike’s agitated tone, haggard appearance, and tense body movements that things were far from all right.

“Bad, Doug. They filed suit already!” Mike spit the words out as he flung his locker door open with a clang. “I just got the notice last night. Ten fucking million dollars!”

The playful mood in the locker room evaporated, being replaced by a cold gloom. Doug suddenly found the pattern of cracks in the linoleum floor mesmerizing.

When the long day finally ended, Doug walked out wearily to his truck. The sun had set several hours earlier and darkness was descending in earnest. It had been a typically busy Wednesday with lots of scheduled cases and a slew of emergency add-on cases. He hadn’t seen much of anybody all day and felt like he
had been chained in his room. They were short nurses and breaks had been scarce.

Doug glanced around the virtually empty parking lot. Ken’s truck was gone; so was Mike’s. They had been lucky and escaped earlier. Doug unlocked his door and hopped up onto the vinyl seat. It felt like he was sitting on a block of ice. He vowed his next vehicle would have heated seats. Doug wondered what the day must’ve been like for Mike. It had to have been hellish. Doug had never been sued, but knew it could happen at any time. Mike was an extremely conscientious individual and seemed to be taking his patient’s death quite hard. Although, he thought, maybe that was unfair. Who could say how they would react to playing such an intimate role in another’s death? Doug shook his head. He hoped never to have to answer that one. At least there were no emergencies today, thank God. No patients arresting in the OR, no difficult intubations, no bloodbaths. Maybe with Christmas just around the corner, things would settle down for a bit. They could all use a break.