Chapter 33
Chapter Thirty-Three
Josie was nervous. Okay, make that terrified. She had seen this surgery done half a dozen times by Dr. Hayes, but today she was going to be holding the scalpel.
She shouldn’t be intimidated, she told herself firmly as she walked down the hall to meet with the patient. During her stints in ER trauma, she’d done minor solo surgeries as well as several under the tutelage of Dr. Sheinberg.
She knew the procedure inside and out. Dr. Hayes was going to be right next to her guiding her through the whole surgery, every step of the way.
Maybe that was part of the problem. She knew that despite his allowing her to operate, he was only doing so out of necessity. He had never trusted her, and probably still didn’t. But she was his ticket into the OR.
Without her as an excuse, he would probably just be seeing patients and viewing X rays, which he clearly did not want to do for a number of reasons. Mainly that Houston did not yet want to face the future and his possible inability to operate.
Staying at home day and night would leave him nothing but time to think about the future in all its grim possibilities, ranging from a teaching job to the lowest of the low for a surgeon—being a professional malpractice expert.
Here at the hospital, he could pretend he was simply recuperating, assisting in surgery until he could take his rightful place front and center in the OR.
So Josie was stuck with the unpalatable position of getting to do what she had wanted to for three months, but for all the wrong reasons. Houston might be letting her operate, but not because he wanted to, and she was going to have to do a bang-up job to prove to him she belonged in orthopedics.
And to herself.
Because a nagging little voice in the back of her mind pointed out ruthlessly that she didn’t actually belong in surgery, but she ignored it. There was no sense in having doubts this late in the game. She had a promise to keep and a boatload of student loans to repay.
Taking a deep breath, she entered the pre-op room where Ruby Frenske was waiting to be wheeled into surgery. Josie liked the setup at Acadia Inlet Hospital. Each patient was pre-oped in their own room, sitting up in a comfortable easy chair that was then rolled on wheels directly to the OR.
It made the patients feel less panicky than a gurney would, and Ruby was reclined back in her chair, holding her husband’s hand and looking fairly relaxed.
“Good morning, Mrs. Frenske.” Josie had met Ruby several weeks earlier when she had been to Dr. Hayes’s office for pre-op testing.
Tuesdays and Thursdays were Houston’s office hours, where he saw his patients pre and post surgery. Josie had only had the opportunity to pop in two or three times but had really enjoyed the chance to interact with the patients.
She recalled that Mrs. Frenske had been in a great deal of pain and had been using a walker, even though at seventy she was still relatively young to need that level of assistance.
“Good morning. Dr. Adkins.” Ruby’s voice was a bit slurred from the medication she had been given to relax her.
“Are you all set, ready to go?”
“Yes, as ready as I’ll ever be.”
“Do you have any last-minute questions?”
“No, I don’t think so.”
“Well, okay then. I’m going to get scrubbed up.
Dr. Hayes and I will see you down the hall in a minute or two.
The nurse will bring you on down.” She squeezed Ruby’s arm in reassurance.
“When this is all over, you’ll be much better off, trust me.
When you’re walking on your own, you’ll be glad you had the surgery. ”
Ruby nodded, her eyes a little unfocused. “I hope so.”
“How are you, Mr. Frenske?” Josie noticed that Ruby’s husband looked worried as he sat next to her, clutching his wife’s hand.
“I’ve been better,” he said gruffly. “Hey, who’s doing the surgery with you, Dr. Adkins? Ruby and I saw on the news that Dr. Hayes got attacked by a shark.”
Josie fought the urge to wince. Oh, that would just thrill Houston.
“I can’t believe they put Dr. Hayes on the news.
” “Oh, yeah. Every time someone gets bit by a shark they stick it on the news. The bigger the bite the longer the coverage. They showed Dr. Hayes’s picture and said his name and everything.
” He pushed up his glasses and added, “Seventh bite this year.”
Ruby made a sound of contempt. “Fred keeps count. Dr. Adkins. I think it’s just gruesome. Is Dr. Hayes all right?” “He’s fine.” Josie spoke forcefully. “In fact, he’ll be sitting in on the surgery, assisting. You’re his patient after all, and he wants to keep a close eye on you.”
Or on Josie. Depending on how you looked at it.
She smiled at the Frenskes. “And if I don’t get going, we’ll never get this show on the road. See you in a few minutes.” Nervous about how Houston would treat her, Josie studied him carefully when she entered the OR.
But Houston was Dr. Hayes. He acted the way he always had in the OR, and no one would ever suspect they had spent a passionate night together. Which totally depressed her.
Of course she couldn’t expect him to discuss their relationship with two nurses, a surgical assistant, and an anesthesiologist in the room with them. Or their lack of a relationship.
Nor did he appear to be suffering any emotional distress about his injury and the relinquishing of his usual position as head surgeon. Josie was starting to think that if recovery could be based on willpower and sheer stubbornness, Houston would be one hundred percent in no time.
A high stool had been brought in for him to sit on immediately to Josie’s right, so when she came in, scrubbed and ready to go, he was already sitting there.
“Running late. Dr. Adkins?” he asked, his face expressionless.
“No. I was chatting with the patient.”
“Imagine that,” he muttered.
“Excuse me?” She looked at him, but there was nothing but cool, calm blue eyes staring back at her.
Mrs. Frenske was wheeled in then and Houston didn’t answer. Still very much in charge, despite his diminished role, he began directing the attending staff to place Mrs. Frenske on the table.
The anesthesiologist spoke calmly and carefully to the patient, advising her to count to ten as he placed the mask over her face and put her under. Mrs. Frenske only got to three before succumbing to the anesthetic.
Her vitals were monitored, equipment checked, she was positioned on her side, and the leg was scrubbed. Everything was ready.
For Josie.
Her hand shook just a little as she made the initial incision in the skin over the upper side of the buttock. Houston talked her through it, guiding her to the blood vessels that needed cauterizing to minimize the bleeding.
Sweat began to bead on her forehead.
The panic returned full force. What was she doing here? This dear sweet old woman’s life was in her hands and she was a totally inexperienced amateur. Her hand stilled.
The cold room turned hot. Sweat trickled down her breastbone, her throat closed up.
Houston gave her left shoulder a tap with his splint, careful not to use his good hand, which was scrubbed and sterile, should he need to assist.
“Hey,” he said. “You’re doing fine. Let’s go.”
Quickly she turned and caught his eye above his mask. He nodded again, and she saw confidence there. He did trust her. He wouldn’t have let her do this at all if he didn’t.
With a deep breath, she returned the nod and concentrated on opening up the fibrous capsule and the labrum of the hip socket so she could dislocate the head of the femur.
Josie had to saw off the diseased head of the femur and enlarge the cavity of the cup-shaped acetabulum to make room for the metal cup that would hold the new artificial hip.
It was straightforward. She just had to do it.
The voice of the nurse, reading off stable BP and oxygen levels, barely penetrated her absorbed brain.
She concentrated on holding her hands steady, working with precision, and moving along at a reasonable rate.
She tried to mimic the confidence that Houston had and minimize the number of times she paused in uncertainty.
They were using a cementless implant, so when she carefully placed the new cup into position she secured it with screws, which required a great deal of strength and arm muscle. It probably took her twice as long as it took Houston.
But she did it, and she sighed with relief.
As the nurse wiped the sweat from her forehead, she moved to the femur and began the delicate process of reaming out the long axis of the bone, using a broach instrument for the final shaping.
Houston murmured, “Good, there you go. You’ve got it.”
Josie tested a trial stem for fit, and decided on the correct size to use. Suddenly unsure, she looked to Houston for assistance. “Larger?” she asked through her mask.
“What do you think?”
“Larger. It’s not sitting in the canal snugly enough.”
He nodded again, shifting on his stool. “I think you’re right.”
From there it was a matter of fitting the stem and head prosthesis components together with a hammer, then reassessing the fit. Josie tested the hip to gauge its range of motion and stability.
The components were rechecked and the stem secured in place. She made sure there was no debris left in the area.
As Josie was backing away to allow the surgical assistant to close the wound, she felt an enormous relief surging through her.
Thank God it’s over, was all she could think. And I never want to do that again. Horrified at her unreasonable thoughts, she watched as the anesthetic was reversed, and Mrs. Frenske was readied to be transported to the recovery room to begin the process of adjusting to her new hip.