“Okay,” Ava said with resignation. She donned sterile gloves and began the prep of Bruce’s lower back. She wasn’t happy about starting the case before having laid eyes on Mason, and it wasn’t the first time she’d been put in the same uncomfortable position with him. On five previous occasions, he had insisted she start anesthesia before he was even in sight, much less in the room. Ava liked to do things by the book, believing it was key to patient safety, and starting anesthesia before the surgeon was physically present was a definite violation of her sense of good medical practice.
If truth be told, Ava did not like working with the egotistical Dr. Mason. She was uncomfortable that he felt entitled to bend the rules due to his professed superstar status. Intuitively, she knew that if there was ever a problem on a case, he would not take responsibility and that she would undoubtedly have to bear the burden as the fledgling anesthesiologist. Yet as bad as this concern was, it was not the only reason she wasn’t fond of working with him. She was one of the few single female anesthesiologists on staff and certainly the youngest, and Mason had come on to her on more than one occasion, just as he had done with some of the female anesthetists and OR nurses. He had even called her at home on several occasions, supposedly about discussing upcoming cases, and suggested he “pop” over since he was in the neighborhood, though Ava had always demurred. Although appalled at this behavior, Ava had not communicated her true feelings, as she was afraid to make an enemy of the man. Nor had she said anything to the chief of anesthesia, Dr. Madhu Kumar, who had hired her, since he, too, was in Dr. Mason’s league as a titan in his field, and the two were close. It was Dr. Kumar who did the anesthesia for Dr. Mason’s VIP patients from around the world, just as he was doing that day. Yet for Mason’s less highfalutin patients who were below Dr. Kumar’s interest, such as Bruce Vincent, Mason usually asked for Ava.
The first thing Ava did after the prep of Bruce’s lumbar region was to raise a small wheal with local anesthetic at the site where she would place the spinal needle. After checking to make sure the stylet was properly seated, Ava skillfully pushed the spinal needle into Bruce’s back. “You will feel a little pressure,” she said to him. Within seconds she felt the first pop as the needle penetrated the ligamentum flavum, and a moment later the second pop when it went through the dural covering of the spinal canal. When she was certain as to the proper position of the needle, she introduced the spinal anesthetic bupivacaine. As usual for Ava, the procedure went entirely smoothly. A moment later, she and Dawn helped Bruce lie back down on the operating table.
“My legs don’t feel any different,” Bruce said. He was clearly worried that the anesthesia wasn’t going to work on him.
“It takes a few minutes,” Ava explained as she attached Bruce to all the monitoring devices she had at her disposal. When she was finished and everything was entirely normal, including the ECG, breathing rate, and level of anesthesia, she added a proper dose of propofol as a hypnotic. At exactly 9:58 A.M., Bruce Vincent lost consciousness and fell asleep. By reflex, Ava glanced again at the continuous recordings of Bruce’s vital signs. Nothing had changed, and she began to relax. The beginning of a case was always the most anxiety-producing for her.
Over the next forty minutes, Ava found herself getting increasingly irritated. Despite repeated inquiries out to the OR desk as to Dr. Mason’s ETA and multiple reassurances that his presence was imminent, he still hadn’t appeared. As the time dragged on, Ava faulted herself for having started the spinal when she did. Although she was confident the dose she had given could last as much as two hours more, which was plenty of time for a simple hernia repair, she thought it was inconsiderate for the patient to be waiting for the surgeon, who should have been there from the beginning.
“Dawn!” Ava called out finally, her patience at an end. “Go out to the main desk and demand to know exactly what the hell is going on and when Dr. Mason is going to appear! Talk to Janet Spaulding directly. Let her know the patient’s spinal has been in place for more than a half hour.” Janet Spaulding was the supervisor of the OR and a force to be reckoned with. If anyone could get results, Janet could. She was a fixture in the OR and didn’t take grief from anyone.
Ava exchanged an exasperated glance with Betsy Halloway, the scrub nurse, who had been standing motionless the entire time with her gloved hands clasped over her chest. She had the instruments laid out and covered with a sterile towel. She’d been ready for even longer than Ava had.
Ava scanned Bruce’s data. Everything was normal, including his body temperature. Ava had Dawn put a warm blanket over him when it had become clear Mason was going to be delayed.
Dawn returned quickly. “Good news,” she reported. “Wild Bill will be here momentarily. He is out of OR fourteen. There had been some sort of an unexpected congenital abnormality of the biliary tree in his first patient that required him to spend more time than he’d planned.”
“Good Lord,” Ava mumbled. She looked over her shoulder and through the window to see if Dr. Mason was at the scrub sink, but no one was there. “So where the hell is he?”
“He went into OR sixteen, where his second team is opening up his second pancreatic patient.”
“Which means he is responsible for three patients under anesthesia,” Ava said derisively.
“But Janet said he will be here in a second. She promised.”
“Where is Dr. Kumar?”
“No idea. Probably going back and forth between the two rooms. He does that sometimes.”
“Give me a break,” Ava said to herself, thinking it was a good thing the general public didn’t know this kind of thing went on in a major teaching hospital. Out of the corner of her eye she saw movement in the scrub room. Turning her head, she saw Dr. Mason putting on a surgical mask while talking and laughing with another younger man whom Ava did not recognize. Ava took a deep breath to calm herself.
Five minutes later Dr. Mason breezed into the room. “Hello, everybody,” he said with alacrity. “I want you all to say hello to Dr. Sid Andrews. He is to be my new fellow starting July first, but he generously volunteered to come in today to give me a hand with this hernia repair. It has been a while since I’ve done a hernia, so I thought it couldn’t hurt.” He laughed as if he’d just said something absurd about him needing help.
Dr. Andrews had come in behind Dr. Mason, holding his hands up toward the ceiling in front of his chest as surgeons do after scrubbing. He waved to the group. He was a tall, slender man in his late twenties with a face as tan as Ava’s. In just about every respect except height he was the antithesis of Dr. Mason, who was stocky and broad-necked, with heavy forearms and particularly large hands and thick fingers, appearing more like a construction worker than a renowned surgeon. He was also more than twice Andrew’s age and sported a moderately protuberant belly.
“Sid is an Aussie,” Dr. Mason continued as he allowed Betsy to help him on with his gloves. He glanced over to Ava. “Have you ever been Down Under, honey?”