Nick
Stepping into an operating room is like crawling into a timeless vortex, a medical sanctuary of chrome and antiseptic.
Pungent odors from various alkaline solutions greet me as the dry, frigid air dissipates the moisture in my eyes and skin.
The surgical lights refract a ghastly hue that can only be seen within these walls.
I love it.
This is my arena, my turf, the place where I balance a patient between mind and medicine in order to save their life. The amount of power and responsibility that comes with anesthesia is why we're a cocky field.
Helping Ainsley onto the operating table, the circulating nurse and I position her onto her back and apply warm blankets to relieve her goosepimples and chattering teeth.
After an anesthesia time-out, Eugene, the CRNA assigned to this case with me, applies an oxygen mask to Ainsley's face and tells her to take some deep breaths.
As the surgery team finishes setting up the room and scrubbing in, I grab our drawn up medications and hook them up to her IV. “Alright, Ainsley, I want you to—”
“Count back from one hundred?” A mischievous glint twinkles in her knowing eyes.
I playfully scoff. “Listen, Miss Almost Thirteen, I see what you're doing, already trying to take my job. I wasn't born yesterday—”
“Or this century."
This little shit.
We chuckle, her giggles muffled by the mask; however, something is off. Her expression is somber, fear washing over her as she takes in these final moments before her life-changing surgery.
I take her small hand in mine, her fingers instantly finding my thumb like it did so many years ago. She grips tightly, holding on like a lifeline, and hell, if it doesn't crack my chest wide open … My heart constricts as the memories flood back in pieces.
I can do this on my own …
But you don't have to. I could be here … for you both.
I clear my throat, giving a reassuring nod to Ainsley. I slowly push in her medications while she counts backward, her hand relaxing in mine. I give it one last squeeze, her eyes fluttering closed.
Eugene adjusts the mask.
Clearing his throat, he moves it again.
Then he repositions her jaw.
“Crawford,” he calls out, his tone clipped and urging. “I suspect a laryngospasm.”
My head snaps up to the monitor at the mention of her airway constricting. This could affect her intubation which would compromise her oxygenation. Fortunately—for now—her saturation remains stable at 100%.
Saddling up to Eugene, I take over, my hands swiftly replacing his. I grip under Ainsley’s jaw, lifting it forward and extending her neck. “Ventilate.”
Eugene compresses a balloon-like reservoir bag connected to our anesthesia cart—at least he tries. “It’s … shit, it’s pretty tight, sir.”
“Hold that pressure.” My eyes lock on her breathing, her vitals in my periphery. “Steady, Gene. Stay with it.”
“She’s at 96 now.”
I nod. With her oxygen saturation starting to decline, I sift through my options. Since her vocal cords are rigid, the goal is to make them relax. “Let’s give another dose of Propofol.”
Without hesitation, Eugene administers the anesthetic, then promptly checks the inflated reservoir bag, hoping he can squeeze the mixed gases into her lungs. “Still tight. And … she’s hovering at 94.”
C’mon, Ainsley. “Sux. Now.”
Eugene nods, quickly drawing up and pushing the paralytic. “Succinylcholine in—”
An alarm trills, a red light beckoning for our attention.
The OR falls deathly silent as we all watch—no, we all beg for Ainsley’s airway to open.
91 …
90 …
Fuck, don’t do this, sweetheart.
“Cric kit,” I bark at Eugene. “Now. From the cart.”
The circulating nurse steps forward. “Want me to get—”
“Yes, please.” I nudge my head toward the scrub room, not letting her finish. “Get the surgeons in here.” I can manage a difficult airway on my own, but I’m not too proud not to call for help if it’s available. Not when a life is on the line.
Not when her life is on the line.
The room swirls into choreographed chaos. Quick, hushed steps, the opening of packages, the clank of surgical steel against steel. Eugene hands me a cricothyroidotomy tray as I take a brief look at Ainsley’s vocal cords with a scope.
85 …
83 …
78 …
Shit, she’s clamped down.
“I can’t intubate, and—” I try to ventilate her myself—“fuck, I can’t oxygenate. Let’s move, people.” I snap on a new pair of gloves, retrieving my supplies from my CRNA.
And a scalpel.
Steady, Nick.
Stabilizing her larynx, I slice through the skin before making an incision through the delicate membrane of the cricothyroid. Blood oozes from the shallow cut, the warm crimson impairing the visualization of the field.
Following her anatomical structures, I slip my finger through the cut and in between the cartilage, creating a pathway into her trachea. With the help of the bougie in my freehand, I guide the endotracheal tube into the windpipe, then hastily connect it to an ambu bag and compress.
After a few seconds, I squeeze again.
Ainsley’s lungs fill with each rhythmic squeeze, and after a few cycles, her chest begins to rise and fall.
I glance at the vitals monitor, at the low steady number of her pulse ox and wait for her body to catch up.
71 …
72 …
C’mon, Ainsley girl. Rebound. You can do it.
The stillness of the room is heavy; the anticipation, stifling. The moment stretches uncomfortably around us as we all forget to breathe with Ainsley.
Suddenly, the monitor chirps, her oximetry jumping rapidly to 84%. Then to 94. Her clammy skin pinks to a more lively hue. The entire OR sighs with cautious relief as we relish in the quiet wooshes of air.
Crisis averted. For now.
After explaining to the surgeons about what happened, they were pretty pissed—not necessarily at me, but the fact that it even had to happen. It’s rare; what I was forced to do is much rarer, and unfortunately, it’s going to take some time for her body to recover from this.
Which means no surgery today.
Eugene takes over ventilation, but I remain at Ainsley’s side as she peacefully sleeps. Tucking a curl back into her surgical bonnet. A lone tear slowly trails across her temple and into her hairline. My thumb—the one she's held twice—quickly catches it, wiping it away.
While I know I saved her life, I'm disappointed. No one is at fault … but she was in my care, and that alone gnaws at me. That alone makes me wish there was something—anything—I could've done to avoid this. She's already tackled so much; she didn't need this.
I’m so sorry, kid. I’m so sorry I let you down.
“You okay, Crawford?” Eugene pats me on the shoulder.
I croak out a yes—quickly clearing my throat. “I’m fine.”
“Are you sure? Because I can—”
I nod, placating him with a grin. “I’m fine. Just … give me a second.”
***
The physician’s lounge is empty, the lights dim save for a few emergency lights. Most of the day surgery cases are finished, those doctors are already home with their loved ones while the on-call team takes over and makes rounds.
And then there's me.
Still here.
I keep telling myself just five more minutes, but sitting here in the dark as a warm September storm blows in is strangely therapeutic. It's like a mirror to my melancholy, like the universe showing sympathy to my shit-show of a day.
I could've lost her. Technically, I can lose any patient any day, and any life lost is a tragedy.
But this is her. I could've lost Ainsley, a little girl who's presence taught me that maybe I'm not such a shit-person, that maybe there is some good in me somewhere.
The St. Jameses were naturally grateful, singing my praises of saving their baby girl.
So why am I so—I don't know—defeated? This doesn’t feel like a win.
At least, I don’t feel like a winner.
The lounge door swings open. A distinct gait in leather loafers that I have heard since medical school heads toward me.
The couch shifts under his weight as he takes a seat next to me.
He doesn't rush into a conversation—of my best friends, he's the quiet intuitive one.
Thoughtful. Wise. It's what makes him a good doctor and a pretty amazing Chief of Medicine.
“I thought you'd be home by now,” I break the silence. “Is your wife on-call tonight?”
Jonathan gives a lopsided grin. “Took her and the nightshift crew some coffee. Lots of babies coming tonight.”
“Ah.” I nod. “I'd imagine so with this storm rollin’ in.”
We chuckle, falling back into comfortable silence.
“You … wanna talk about it?” Jonathan asks.
I fold my hands, resting them casually in my lap. “Not really.”
He rests a hand on my shoulder. “You saved a life. Don't forget that.”
“I cric’d a kid.” I exhale heavily, slouching back. “A fucking kid, man—”
“Which must’ve been awful,” Jonathan states, his words laced with sympathy. “These little ones shouldn’t have to face such awful complications.”
“She’s so strong—” my voice cracks. “She always has to be so strong. I hate that this is just one more thing for her to overcome. One more setback—”
“But consider the alternative, Nick.”
I sigh. “I know …”
Jonathan offers a kind grin. “Because of your quick-thinking, she’s still here. She gets to overcome this. She gets to go on and live.”
I blow out another heavy breath. He’s right. I know he’s right, but something isn’t connecting.
“I may be overstepping …” Jonathan holds up his hands in surrender, carefully choosing his words. “I saw her birthday. She’s about thirteen, right?”
Almost thirteen.
Hesitantly, I nod. I already know where he’s going with this because it’s what I refuse to acknowledge. It’s what has been haunting me all day.
“Maybe—I don’t know … Maybe it’s time to see someone.”
“A shrink?” I chuckle humorlessly. “You of all people …”
He laughs under his breath. “Fair.” He stands, casually shoving his fists in his pockets.
“As much as I hate to admit this, therapy has been extremely helpful for us, for … well, everything. Just consider it.” He ambles to the door, stopping short to face me one last time.
“We support you regardless. You deserve to move on and be happy, too.”
I stare at him, his admission causing my heart to misfire.
Moving on seems impossible. That’s like getting away with murder, like I’m leaving something sacred behind.
If I allow myself to be happy, what does that say about everything that has been lost?
What does that say about my friendship with Jonathan?
“Hey—” he grabs my attention—“go home. Get some rest. More lives need that Crawford charm tomorrow.”
Yeah, yeah …
I grin, giving him a small salute. “Thanks, Chief.”
As soon as he leaves, I sling my duffel bag over my shoulder and exit through the front of the hospital where the walkways are covered. It’s longer this way, but at least I won’t get drenched from the downpour. Moseying down the west corridor to the main lobby, I wave bye to a few colleagues.
“Hey, Nick! Wait up!” Casey Frazier catches up to me, flouncing her hair over her shoulders.
“Hey—” I glance at my watch—“what are you still doing here?”
She chuckles, rolling her eyes. “Oh, you know. Paperwork and all that jazz.”
I hold the door open for her, and we fall into step, heading toward the parking garage.
“Listen,” she starts, “I heard you had a tough case today, and I wanted to make sure you were okay.”
I flash her a cordial grin. “I’m fine, but I appreciate the concern.”
“Sure—I mean, of course. So … um—” she brushes her fingers against my arm. “I also wanted to make sure you know that if you need anything … or a distraction, I’m here.”
I stop walking, rubbing a hand over my jaw and stare at her. A year ago—hell, six months ago—I may have gone along with it just to muffle the noise in my head. Meaningless hookups have served their purpose of mending my bruised heart many times before, but honestly now, it sounds exhausting.
Casey watches me carefully, her teasing smile fading. “I mean, no pressure or anything. I just thought maybe you’d like some company tonight.”
I sigh, pinching the bridge of my nose. “Casey, I—”
She waves me off. “It was just a thought. Forget I said anything.”
I stop her from walking away. “Hey, don’t do that. I do appreciate you, just … it’s not what I want tonight.”
She stares at her shoes for a beat. “Did I do something wrong?”
“What? No.” I shake my head. “Of course, not.”
“Then what is it?” she asks softly. “I swore I wouldn’t be this woman, but we haven’t done anything in well over a year. And that’s fine—we said no commitments, but—” she laughs sardonically—“you’ve left me hanging.”
“And that’s on me, not you.” I sigh. “I have a lot going on right now, and this? It’s not doing it for me anymore. Not with anyone.”
She slowly nods, crossing her arms. “So, that’s it then?”
“I think so.” We stare at each other for a beat, the sound of heavy rainfall filling the space. Puddles litter the sidewalk as streams cascade down the roof and awnings. Seeing her heels, I lean in and offer my arm. “C’mon. Let me walk you to your car.”
We hurry to the parking garage, and Casey doesn’t waste any time getting into her car. After she backs out, she tosses me a wave, and heads out for the night.
Watching her headlights disappear, I let out a heavy breath.
Jesus Christ. I need a fucking drink.