One Day At A Time




Helen hurried down the overcrowded corridors of County Hospital toward the Surgical Waiting Area. She flagged down one of the nurses, after several attempts.

"Could check to see if John Carter is out of surgery yet?" Helen asked in her most polite tone.

The nurse looking hassled replied, "You'll know when he's out, someone will come and speak with you."

"No, no, you don't understand, I wasn't here when he went into surgery, Dr. Corday doesn't know I'm out here."

"I'll let them know." She replied with a condescending smile.

"You know, I'm a little worried. I work here, in ICU, and I overslept, I didn't get to see the patient before surgery and I would like to have an update." Helen curtly retorted.

"Oh, I see, hang on, I'll check for you." The nurse's tone had changed quite drastically. Helen hated to have to pull, the "I work here" thing, but she felt it was the only way to get her attention.

The nurse walked toward the closed OR doors, and Helen watched as she gowned up and looked on the big board to see where this patient was located. Duly noting the operating suite number, she walked down the long hall out of Helen's sight.

Helen waited by the desk, she didn't want to take the chance of getting out of the nurse's sight. It was almost 8:45 a.m., he should be out of surgery and in the recovery room by now. Dr. Corday had said an hour in surgery at most. Helen anxiously awaited the nurse's return, strumming her fingers nervously on the top of the desk. She never considered herself a patient waiter, for good reason...she wasn't. She was feeling more than a little guilty that she wasn't here when John was taken down to surgery. They had seen each other through so much in the past year, and not being here, well, it just wasn't like her. She hoped John could forgive her. Well, maybe if she brought him in a pizza and a Mountain Dew...

**************************

"Damnit what Robert? Would someone please shut off that damned alarm! We know the blood pressure is too high must that be a constant reminder?" Elizabeth was getting stressed.

"I think I nicked the renal artery...I need some suction here, I can't see a thing!"

"You think?" Elizabeth shot back.

"Lizzie we need to convert this now before he loses any more blood!"

"All right, all right, have it your way then!"

"Get some Betadyne in here and I need a 15-blade..."

Within seconds the abdomen was opened and the two surgeons surveyed the current situation...

"Dr. Corday?" The nurse called from the doorway.

"We're busy in here!" Romano shot back.

"Sorry Dr. Romano, but your patient has a family member who would like an update."

"Who is it?" Elizabeth called.

"An older lady, gray hair, says she works here in ICU."

"All right, all right...tell her we had to convert to an open procedure, but we have things under control. He should be in recovery in about half an hours time." Elizabeth said.

"Thank you."

************************

The nurse walked toward the desk, and by the look on her face, Helen knew things had not gone as easily or as planned as Dr. Corday had predicted.

"They had to convert to an open procedure...." She started.

"Why?" Helen interrupted.

"I'm not sure, they were very busy in there, but...are you a nurse?" She asked.

"Yes, ICU." Helen replied, "But I worked in surgery for almost 20 years."

"Okay, well..." She hesitated a moment.

"Well?" Helen replied irritated.

"It looked like he lost a good amount of blood. I counted three empty blood bags, and another one hanging. They had the alarms turned all the way down. I did glance at the monitor and his blood pressure was pretty high. Dr. Corday said they have things under control though, and to expect him in recovery within a half an hour."

"Did the situation look 'in control' in your opinion?" Helen asked.

"I'm sure Dr. Corday has the situation well in hand, Dr. Romano is assisting as well." She replied.

"That is not what I asked you." Helen retorted.

Again, the nurse hesitated momentarily..."It looks a little iffy to me, Romano practically bit my head off when I walked in the door."

"Well, that's not that unusual...how was Corday?"

"She seemed a little stressed but okay."

"Thanks, and could you keep me posted? I'll wait out here, but I would appreciate it." Helen said.

"Sure, no problem." The nurse went back behind the desk to check on labs for other patients and Helen found a seat in the busy waiting area.

********************

"Cauterize this please?" Elizabeth cauterized the bleeders and inspected the field.

"Okay, bleeding is under control, now let's get the rest of this tumor out of here."

"Dr. Corday, blood pressure is 190/120." The anesthesiologist reminded the two surgeons as he was ordered to turn the alarms down, against his better judgment, he had complied with the request.

"Give me another two minutes." Elizabeth replied.

"Lizzie, there are adhesions from the adrenal gland onto the posterior renal artery." Romano stated as he suctioned out the rest of the oozing blood. "The renal artery is awfully friable back here."

"What do you suggest Robert?"

"Adrenalectomy, after all he's got another one. Besides, this tumor is a hell of a lot bigger than either one of us thought, it's wrapped so tightly around the artery and throughout the adrenal gland we'll be here for days trying to dissect this piece by piece and for what? You're patient will end up being a gorked out vegetable after stroking out from a cerebral artery bleed, if he doesn't go into V-fib and arrest first, of course. But, it's up to you Lizzie, just offering you my assessment of the situation."

Elizabeth sighed heavily, "put a call into vascular surgery stat."

******************

The nurse answered the phone at the desk, and overhead paged the vascular surgery fellow stat to OR 7...she looked up the patient's name...then got up to look for Helen. It didn't take long, as soon as Helen heard the overhead page, she was making her way toward the desk.

"Problems?" Helen asked.

"I just wanted to let you know, they paged vascular in. I would suspect they have a renal artery bleed at this point, but that's only a guess."

"Thank you." Helen couldn't sit at this point, she nervously paced the floor, waiting for word..."simple procedure...no problems...I do not foresee any difficulty....hmmph..." she knew personally of patient's having simple appendectomies who have died on the table from 'unforeseen complications.'

******************

Three hours later....

"Helen?" A very tired looking Elizabeth Corday caught Helen's attention.

"Yes? How's he doing?" Helen asked alarmed at Elizabeth's fatigued appearance.

"Well, Dr. Romano is finishing closing up, he'll be in the recovery room shortly."

"What happened?" Helen asked.

"The tumor was wrapped tightly around the renal artery and the renal artery was tightly adhesed to the adrenal gland, making it impossible to save the adrenal gland. We had to remove it, and reanastomose the renal artery because of the adhesions, the renal artery was in quite a fragile state. Basically, we couldn't cut anywhere close the artery without the artery bleeding profusely, honestly, I'm surprised it held up this long. Anyway, we took out most of the tumor independently, but when we tried to dissect it off of the adrenal gland, the renal artery began to give way. He lost a lot of blood, but we transfused four units and his crit is stable. We decided that a complete adrenalectomy was the best possible choice as the tumor was still invading the adrenal gland itself, and it was quite impossible to dissect it and maintain the integrity of the renal artery. Mind you, the adrenal gland, the tumor and the renal artery were, for all intent and purpose, almost completely fused together. The vascular surgery fellow, Dr. Gibbons, repaired the renal artery. He had problems with oozing for quite sometime, but the field was completely hemostatic when I left the operating room."

Helen digested this information for a moment, "When can I see him?"

"He should be in recovery any minute now, and I'll let you in as soon as they get him settled. I did want you to know, that I want him in the ICU at least overnight. He has lost a good deal of blood, and I just want to keep a close eye on him."

"And his blood pressure?"

"Right now, with all the blood loss, is a little on the low side, but that should come up. I also want to keep an accurate record of I & O's, so the Foley is to stay in at least overnight as well." Elizabeth said.

Helen rolled her eyes.

"I know..he won't appreciate that, but as I said, he did lose a large volume of blood and well, I just want to make sure all is well."

"I can understand that, but your patient, will not." Helen replied.

"Let me go check on their progress, and I'll be back in a few minutes." Elizabeth made her way toward the recovery room, and her patient, who would not be very happy with her.

*********************

John could hear voices around him, and opened his eyes briefly...the bright lights...he was confused...where was he? He tried to move his arms and legs, and for some reason, he couldn't even feel his limbs, let alone move them. He saw no familiar faces, just nameless medical personal scurrying around him...he closed his eyes against the harsh lights, and tried to move again...pain...bad thing...stay still...

"Dr. Carter? Dr. Carter?" Someone was calling to him, "are you in pain?"

He groaned again, trying to verbalize something, anything, only a groan came out.

"Okay, don't try to move just yet, I'm giving you some morphine."

His eyes opened briefly again to the sound of a familiar voice.

"Well, Dr.Carter, or should I say Sleeping Beauty, nice to have you back among the land of the living. Having some pain?"

John groaned again and closed his eyes, his throat felt so dry and scratchy, and the last person he wanted to see was Romano.

"Okay, well I can tell by that grunt that it would be a yes...the morphine should kick in any time now. Just try to relax."

"How's he doing?" Elizabeth asked.

"He was awake briefly, opened his eyes at least, blood pressure is 80/50, pulse..." Robert consulted the flow chart on the end of the bed, "66, respiratory rate 10. We'd better be careful with that morphine until his respiratory rate and blood pressure go up a bit, wouldn't you say Dr.Corday?"

"Yes, I would concur with that." Elizabeth checked the incision site, no drainage on the dressings, but there was about 30 cc of bloody fluid in the JP drain, and no urine output in the Foley bag. Elizabeth looked up at Romano, and held up the Foley bag, "no output as of yet?"

"No, but we just increased the IV fluids, give it another half hour, I'm sure we'll see some output....All in all, it really went well Elizabeth." Robert stated, "considering all that could have gone wrong, it turned out okay. Good job."

As he walked on to the next patient, Elizabeth sat down heavily in the chair beside the bed. She picked up John's hand, looking at how pale his skin appeared, on reflex, she checked the capillary refill, a bit slow.

"Carter you scared the living hell out of me..." Elizabeth spoke quietly, "now you rest, I'm going to get Helen, she's been waiting for quite sometime, and is rather anxious to see you."

She let go of his hand setting it on the top of the sheet, his skin was almost the same color as the sheet. She turned to leave the recovery room to escort Helen back, her hand on the curtain to pull it back when she heard it. The voice was so low and groggy sounding, it was barely audible.

"Sorry."

Elizabeth turned back abruptly, "Carter, did you say something?" She stepped close to the bed and leaned her head in.

"Sorry." He said again.

"Sorry? You're sorry? Oh for goodness sakes, it wasn't anything you could help. Do you want to hear about your procedure before I bring Helen back?"

John shook his head slightly in the affirmative.

"Okay, well, I'm sorry, but we had to convert to an open procedure. That's why your belly is causing you some pain. Your blood pressure was dangerously high, and you were losing blood through the renal artery..."

"Why?"

"Let me just explain, you try to save your throat all right?"

John shook his head very slightly again in the affirmative.

"You had massive adhesions in your abdomen, around the kidney and renal artery. It made it quite challenging to say the least. We made every attempt to lyse the adhesions, and had been successful, until we ran into some difficulty dissecting the tumor off of the renal artery. The adhesions were extremely dense and the artery, in the posterior region, was extremely friable. The more we tried to dissect, the more the artery was literally breaking apart in our hands. At that point, we had to convert to an open procedure. You were losing blood much to quickly for us to replace in time for us to finish the procedure safely laparoscopically. We had to have vascular surgery come in, and anastomose the artery together where it was stronger. Dr. Romano is of the opinion that the tumor had actually weakened the artery in this area, that, and the adhesions from your previous procedure. Nevertheless, vascular surgery successfully anastomosed the artery, and we were able to completely remove the tumor. Unfortunately, it necessitated the removal of the adrenal gland. It was quite impossible to dissect the tumor, even in sections, from the gland, it was densely adherent to the adrenal gland. But, as soon as it was removed, your blood pressure drastically improved as did your pulse rate. I believe this will successfully solve the problems you have been having. I'm sorry that I had to break my promise, but I believe, given the situation, you'd have made the same decision if it was me on the table and you were the surgeon."

John let the information sink in a few moments, "Let's hope we never find out."

"Yes, let's." Elizabeth agreed.

"Are you having much pain?"

"Not too bad, as long as I don't move or breath." John smiled, which consisted of raising one corner of his mouth.

"You will get another unit of blood this evening, you've lost a good amount of blood. Your last hematocrit was still a bit on the low side, and you'll still be on IV's for a few more days, until you're able to take p.o. liquids. And there's something else I need to tell you."

John eyed her suspiciously, he had no idea what on earth could be any worse than what he had already heard. He glanced tiredly in her direction, "what else?"

"Well, we had to leave a drain at the incision site. There was still a bit of oozing, and we needed to keep the Foley in, just for a few days, to measure your I's and O's, I'm sure you understand."

"Oh man."

"Yes, well, I know it's most unpleasant, but as a physician, you know as well as I that keeping track of your fluid levels is critical. I am sorry about that, but it couldn't be avoided."

"My throat is killing me, how long..." He coughed and flinched at the pain it caused him in his abdomen. "How long was I in surgery?"

"About five hours, give or take."

"Five hours? I thought you said 45 minutes, and hour at most!"

"As I said, we ran into some unforeseen complications. Would you like an ice chip?" She asked trying to remain pleasant.

"Gee thanks."

Elizabeth left briefly to get a 30 cc medicine cup and fill it with exactly one ice chip. She handed it to John.

"You're too generous."

"Don't want to give you a belly ache, until bowel sounds return, this is about it. Bon appetite."

The ice felt good in his throat and was gone all too quickly, making the raw feeling twice as bad when it returned.

"Now, shall I collect Helen?"

"Okay, she been here the whole time?"

"Mostly. She is anxious, so I'd better go get her."

Elizabeth left the recovery room, feeling somewhat better that John was awake and talking, at least she had that information to give to Helen.

*****************

John closed his eyes, every part of his body hurt. He felt like he's been run over by a truck, actually, being run over by a truck couldn't possibly hurt this much, that actually sounded pleasant comparatively. He tried to move up in the bed, his back was killing him in this position. He held on to the siderails and attempted to scoot himself up.

He bit his lip as the searing pain ripped through his abdomen and chest, bad idea, "stay put, wait for Helen to get here." He thought to himself. His belly felt like it was on fire. He took quick pants in order to breath, anything more than that hurt.

He closed his eyes against the pain, willing it to go away...he didn't want Helen to see him all squinty-eyed and looking like death warmed over, although, she had seen him at his worst, as he had her, Still, he didn't want to upset her further, she had had enough for one day.

He tried to breathe more normally as the pain from his stupid move up in the bed started to abate slightly.

******************

Elizabeth walked purposefully toward the surgical waiting area, Helen was one of only five others waiting. She signaled for her to come with her, and Helen readily obliged, quickly making her way down the hall with Elizabeth to see how John was. As they rounded the corner, Elizabeth said, "He's awake and talking, but he's still quite weak."

"So, did you tell him?" Helen asked.

"Tell him what? Oh, that...yes I did." Elizabeth replied.

"And? He was uh...okay with that?" Helen asked.

"Not especially thrilled about the Foley, but he did see the point."

"I guess that's all we can as for." Helen rounded the corner and was taken aback. John was as white as the sheet he was laying on, his lips even looked white. She noticed another bag of blood was hanging, and a damned good thing too! He looked like death.

"Hey there mister, feeling a little peaked I see?" Helen said as she sat in the chair next to the bed.

"Not too bad, although, I have been better. Gotta little bit of a belly ache for some reason." He gave her a better smile than he had given Elizabeth earlier, "and someone thought it was a good idea to leave this damned catheter in."

"Damned surgeons." Helen quipped.

"You can say that again."

Helen picked up his hand and gave it a squeeze, "you know you scared the heck out of me today."

"So I heard." He paused, "sorry about that."

"No need, just don't do it again or I'll really be mad."

"I'll do my best." John closed his eyes, he was so tired he couldn't keep his eyes open another second.

The nurse came in with another 10 mg of morphine, which he gladly accepted, and sleep overtook him within minutes.

He never remembered being moved from recovery.



Part 14
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