Under The Knife

From her position at the patient’s head, Kate followed their progress, her ear tuned the whole time to Ellen’s heart rhythm. Everything was going well, with no crises on the horizon. This was when she enjoyed her work most—when she knew she had everything under control. In the midst of all this stainless steel, she felt right at home. For her, the whooshes of the ventilator and the beeps of the cardiac monitor were soothing background music to the performance now unfolding on the table.

Guy made a deeper incision, exposing the glistening layer of fat. “Muscles seem a little tight, Kate,” he observed. “We’re going to have trouble retracting.”

“I’ll see what I can do.” Turning to her medication cart, she reached for the tiny drawer labeled Succinylcholine. Given intravenously, the drug would relax the muscles, allowing Guy easier access to the abdominal cavity. Glancing in the drawer, she frowned. “Ann? I’m down to one vial of succinylcholine. Hunt me down some more, will you?”

“That’s funny,” said Cindy. “I’m sure I stocked that cart yesterday afternoon.”

“Well, there’s only one vial left.” Kate drew up 5 cc’s of the crystal-clear solution and injected it into Ellen’s IV line. It would take a minute to work. She sat back and waited.

Guy’s scalpel cleared the fat layer and he began to expose the abdominal muscle sheath. “Still pretty tight, Kate,” he remarked.

She glanced up at the wall clock. “It’s been three minutes. You should notice some effect by now.”

“Not a thing.”

“Okay. I’ll push a little more.” Kate drew up another 3 cc’s and injected it into the IV line. “I’ll need another vial soon, Ann,” she warned. “This one’s just about—”

A buzzer went off on the cardiac monitor. Kate glanced up sharply. What she saw on the screen made her jump to her feet in horror.

Ellen O’Brien’s heart had stopped.

In the next instant the room was in a frenzy. Orders were shouted out, instrument trays shoved aside. The intern clambered onto a footstool and thrust his weight again and again on Ellen’s chest.

This was the proverbial one percent, the moment of terror every anesthesiologist dreads.

It was also the worst moment in Kate Chesne’s life.

As panic swirled around her, she fought to stay in control. She injected vial after vial of adrenaline, first into the IV lines and then directly into Ellen’s heart. I’m losing her, she thought. Dear God, I’m losing her. Then she saw one brief fluttering across the oscilloscope. It was the only hint that some trace of life lingered.

“Let’s cardiovert!” she called out. She glanced at Ann, who was standing by the defibrillator. “Two hundred watt seconds!”

Ann didn’t move. She remained frozen, her face as white as alabaster.

“Ann?” Kate yelled. “Two hundred watt seconds!”

It was Cindy who darted around to the machine and hit the charge button. The needle shot up to two hundred. Guy grabbed the defibrillator paddles, slapped them on Ellen’s chest and released the electrical charge.

Ellen’s body jerked like a puppet whose strings have all been tugged at once.

The fluttering slowed to a ripple. It was the pattern of a dying heart.

Kate tried another drug, then still another in a desperate attempt to flog some life back into the heart. Nothing worked. Through a film of tears, she watched the tracing fade to a line meandering aimlessly across the oscilloscope.

“That’s it,” Guy said softly. He gave the signal to stop cardiac massage. The intern, his face dripping with sweat, backed away from the table.

“No,” Kate insisted, planting her hands on Ellen’s chest. “It’s not over.” She began to pump—fiercely, desperately. “It’s not over.” She threw herself against Ellen, pitting her weight against the stubborn shield of rib and muscles. The heart had to be massaged, the brain nourished. She had to keep Ellen alive. Again and again she pumped, until her arms were weak and trembling. Live, Ellen, she commanded silently. You have to live….

“Kate.” Guy touched her arm.

“We’re not giving up. Not yet….”

“Kate.” Gently, Guy tugged her away from the table. “It’s over,” he whispered.

Someone turned off the sound on the heart monitor. The whine of the alarm gave way to an eerie silence. Slowly, Kate turned and saw that everyone was watching her. She looked up at the oscilloscope.

The line was flat.

* * *

KATE FLINCHED AS an orderly zipped the shroud over Ellen O’Brien’s body. There was a cruel finality to that sound; it struck her as obscene, this convenient packaging of what had once been a living, breathing woman. As the body was wheeled off to the morgue, Kate turned away. Long after the squeak of the gurney wheels had faded down the hall, she was still standing there, alone in the O.R.

Fighting tears, she gazed around at the bloodied gauze and empty vials littering the floor. It was the same sad debris that lingered after every hospital death. Soon it would be swept up and incinerated and there’d be no clue to the tragedy that had just been played out. Nothing except a body in the morgue.

And questions. Oh, yes, there’d be questions. From Ellen’s parents. From the hospital. Questions Kate didn’t know how to answer.

Wearily she tugged off her surgical cap and felt a vague sense of relief as her brown hair tumbled free to her shoulders. She needed time alone—to think, to understand. She turned to leave.

Guy was standing in the doorway. The instant she saw his face, Kate knew something was wrong.

Silently he handed her Ellen O’Brien’s chart.

“The electrocardiogram,” he said. “You told me it was normal.”

“It was.”

“You’d better take another look.”

Puzzled, she opened the chart to the EKG, the electrical tracing of Ellen’s heart. The first detail she noted was her own initials, written at the top, signifying that she’d seen the page. Next she scanned the tracing. For a solid minute she stared at the series of twelve black squiggles, unable to believe what she was seeing. The pattern was unmistakable. Even a third-year medical student could have made the diagnosis.

“That’s why she died, Kate,” Guy said.

“But— This is impossible!” she blurted. “I couldn’t have made a mistake like this!”

Guy didn’t answer. He simply looked away—an act more telling than anything he could have said.

“Guy, you know me,” she protested. “You know I wouldn’t miss something like—”

“It’s right there in black and white. For God’s sake, your initials are on the damn thing!”

They stared at each other, both of them shocked by the harshness of his voice.

“I’m sorry,” he apologized at last. Suddenly agitated, he turned and clawed his fingers through his hair. “Dear God. She’d had a heart attack. A heart attack. And we took her to surgery.” He gave Kate a look of utter misery. “I guess that means we killed her.”

* * *

“IT’S AN OBVIOUS case of malpractice.”

Attorney David Ransom closed the file labeled O’Brien, Ellen, and looked across the broad teak desk at his clients. If he had to choose one word to describe Patrick and Mary O’Brien, it would be gray. Gray hair, gray faces, gray clothes. Patrick was wearing a dull tweed jacket that had long ago sagged into shapelessness. Mary wore a dress in a black-and-white print that seemed to blend together into a drab monochrome.