The very first thing that Noah did every morning after coming through the revolving door was board one of the elevators and head up to the surgical intensive-care unit located on Stanhope 4, the same floor with the operating rooms. Visiting the SICU was always number one on his agenda, whether he slept at home or in the surgical on-call facility, which was also on Stanhope 4. For obvious reasons, the patients in the intensive-care unit were the hospital’s sickest and most needy.
Like the Stanhope operating rooms, the intensive-care unit cubicles were arranged in a circle, defined by glass partitions, with a central desk from which the nursing supervisor could see into each cubicle by merely turning her head. The night shift supervisor was Carol Jensen, a certified critical-care nurse. She was no-nonsense like all the other supervisors, particularly when she was tired, and toward the end of a shift intensive-care nurses were always tired. It was one of the most demanding jobs in the entire hospital.
“You are a ray of sunshine, Dr. Rothauser,” Carol said as Noah came in behind the counter. The central desk, like the room, was circular.
“It is always nice to be appreciated,” Noah responded cheerfully. He took a seat in one of the swivel desk chairs. He understood what Carol mostly meant by her flattering metaphor: namely, that his arrival augured the ending of her shift and she would soon be on her way home. At the same time, he took it as a compliment. Noah had been told on more than one occasion, and even by Carol herself, that he was one of the nursing staff’s favorite residents. She’d explained that everyone appreciated that he was always available at a moment’s notice and was always cheerful, no matter the time of day or night, in contrast with other house staff who could be downright surly if they were exhausted, which they often were when on call at night. Even when Noah was in surgery, he’d made it known he didn’t mind talking over the intercom for an emergency consult on a patient. For nurses, particularly critical-care nurses like Carol, doctors being reachable was enormously important because problems could arise quickly and critical decisions had to be made or patients suffered. But what Carol didn’t say and what Noah was blissfully unaware of was that most of the other female nurses thought Noah was a bit of a mystery. As one of the more attractive, unattached male residents, he never gave even the slightest sexual spark or engaged in double-entendre wordplay, which was otherwise relatively rife within the hospital culture.
Noah’s eyes roamed around the unit. He saw that each cubicle had a nurse, some more than one, and all were busy. The patients were all totally bedridden, many with respirators as the only sign of life. For Noah, the fact that there were no doctors present was revealing and reassuring. “Looks like you have things wonderfully under control,” he said. The other reason nurses liked Noah was because he was appreciative of their role and the work they did. Noah often asserted that the nurses did nine-tenths of the work in the hospital and that residents were there merely to help.
“It has been a better night than usual,” Carol said.
“Any problems that I should know about?” Noah asked. He redirected his attention to the unit supervisor. He was surprised that she was staring at him.
“I don’t think so,” Carol said. “Let me ask you a question: How is it your white coat always looks so clean and pressed?”
“I change it often,” Noah said with a laugh.
“Why, exactly?”
“I think patients appreciate it. I know I would if I were a patient.”
“Curious,” Carol said. She shrugged. “Maybe you are right.”
“You’ll be getting several new surgical residents today,” Noah said.
“Don’t remind me.”
For nurses, July 1 was often a difficult time, especially in intensive-care units, where there was a steep learning curve for first-year residents. For a week or two the critical-care nurses joked that they had to direct almost the same amount of attention to the residents as they did to the patients to make sure the residents didn’t do anything untoward.
“Let me know if there are any problems,” Noah said.
Carol merely laughed. There would be problems. There always were.
“I mean any problems above and beyond the usual,” Noah added.
In the unit, Noah had two of his own patients whom he had operated on, both disaster cases that had had surgery at community hospitals and that had to be redone. Both patients had been airlifted in dire straits into the BMH and were now on respirators. Noah spoke with the nurses taking care of each one, checked the patients themselves briefly, particularly their sutured incisions and their drains, and then glanced at their SICU charts that hung off the ends of their gurneylike beds. Noah did all this in minutes but with attention to detail to be sure he wasn’t missing anything. While he was in the second cubicle, residents assigned to the SICU began arriving; their faces reflected their fatigue.
In terms of residents, the SICU was a kind of miniature United Nations. Critical Care had evolved into a specialty of its own, with its own residency program. At the same time, it was felt appropriate to continue to rotate junior surgical residents through the unit to gain the experience that it could provide. It was the same with anesthesia. What this meant for Noah was that a certain amount of diplomacy was necessary, as he technically did not have power over critical-care residents or anesthesia residents.
Lorraine Stetson and Dorothy Klim were the two surgical residents who had been assigned to the ICU for the previous month, and seeing Noah, they immediately came in to join him. Although the number of female surgical residents had climbed dramatically over the last ten years, it was rare for both ICU surgical residents on the same rotation to be female. Lorraine was a first-year resident who had miraculously transformed overnight into a second-year junior resident, thanks to it being July 1. Likewise, Dorothy was now a third-year senior resident. Noah got along well with both women, although Dorothy often made him feel uncomfortable. He didn’t know exactly why but assumed it had something to do with her appearance. In his mind, she looked more like a movie actress playing a role than a real surgical resident, even though he admitted such a thought was sexist.
“I’m sorry we were not here when you came in,” Dorothy said.
“Why?” Noah said. “Everything is copacetic here, and SICU rounds don’t start until six.”
“Still, I think we should have been available when you arrived.”
“No problem. It doesn’t matter. What matters is that you will be passing the baton to a brand-new first-year resident by the name of Lynn Pierce. Also to Ted Aronson, whom you obviously know. I want you to let me know if there are any problems whatsoever, particularly with Miss Pierce.” For first-year residents, starting off in the ICU before getting their feet wet in the program was often stressful for everyone.