21. Rohit
I t feels forever since I’ve been back in the ICU, but it’s only been a few days. One of my patients is Rhonda, so I know I’m in for a day with plenty of chatting.
The day starts with rounds, where the providers on the ICU team go room by room and discuss each patient’s current status and the plans for the day. Between the interns, residents, nurse practitioners, pharmacist, ICU fellow, ICU attending, and the two rolling computers they round with, they are a formidable sight.
When the team gets to Rhonda’s room, I listen attentively. Maddie, one of the second year residents, steps forward to present the case. She glances briefly down at her notes and then begins speaking confidently.
“Bed 10, Smith, sixty-five-year-old female initially admitted with DKA, stabilized in the ICU and transferred to the floors. Went back into DKA and returned to the ICU. CT abdomen showed a pancreatic mass. CT chest was done for staging, no evidence of disease. EUS was done and biopsy of the mass showed pancreatic adenocarcinoma. Since the disease is only in the pancreas, she can have a surgery to completely remove the tumor. Surgery and anesthesia are coming today to discuss with the patient.”
Winston nods his approval to Maddie, and then the attending physician begins his barrage of questions.
“Is her gap closed?” Dr. Reddy asks, without looking up from the computer screen.
“Yes, and she’s off the insulin drip, but we are doing frequent glucose monitoring and giving insulin as needed,” Maddie answers without hesitation. Dylan would be proud.
“What stage is she?” Dr. Reddy looks at Maddie intently, knowing this is a difficult question for a resident to answer.
Maddie looks up thoughtfully. With her head tilted, she thinks out loud. “Her tumor is only 1.8 centimeters, and there are no lymph nodes, and no disease anywhere else, so I think she’s a stage I.” She glances at her paper to confirm with her notes, where she’s gone over all of this in advance to be prepared for this very question.
“Excellent.” Dr. Reddy is pleased, but he’s clearly not done with his Socratic method. “After surgery, is she cured?” he asks in a whispered tone, since Rhonda is awake and could actually hear us, as opposed to the other patients who are on ventilators.
“Yes, technically, but pancreatic cancer has a high recurrence rate and she will likely need chemo,” Maddie answers with softness in her voice. We all know the stats, and don’t really want to think about them.
Dr. Reddy seems satisfied and he enters the room to examine Rhonda. Winston, Maddie, and I follow, but the rest of the team remains outside. Once Dr. Reddy is done with his exam, the team moves on to the next patient. I stay in the room to check on Rhonda.
She looks up at me, a nervousness in her eyes, and sighs.
“Rohit, they are going to have to cut me open,” she says while staring at the flowers on the windowsill.
“Yes, but it’s actually a good thing,” I say as I lean against the large window. “They are going to cut the cancer right out of you, so you can go see that grandbaby be born.” I smile at Rhonda and she returns the gesture, but her smile doesn’t reach her eyes.
“You remembered, you sweet thing.” She holds her hand out to me, and I take it as her wanting me to come closer. I approach the bed and take her hand. It’s frail and trembling in my grip. “I’ve never had surgery,” she confesses, with glassy eyes.
I gently place my other hand over our interlaced ones. “I know it’s daunting, but I often find it’s helpful to think about things like this one step at a time. Would you like me to go through it with you?” She nods. “First, the surgeon and the anesthesiologist will come in and explain the procedure to you. Then you have time to think and ask questions.” I pat her hand, noticing her lower lip quivering. “Let’s just start with that for now, okay? But try not to worry because the doctors here are top-notch, and you’re in good hands.”
There’s a knock on the glass door as it is slowly pulled open. I see Hannah Zoltowski, one of the surgical chief residents, and Miley enter the room. I start to draw away to excuse myself, but Rhonda holds me firmly in place. “Stay, please,” she pleads. I nod and stay rooted in place.
Hannah looks only at Rhonda, but Miley glances in my direction. I can’t help smiling when I see her. Memories from Friday night flood my mind. My eyes quickly roam her body as I remember how she felt, pressed against me on the dance floor. I feel a twitch in my cock. When my eyes meet hers, Miley holds my gaze for a moment, and I notice a slight flush in her cheeks, but she averts her eyes quickly.
“Ms. Smith, I’m Dr. Zoltowski, from the surgical team. I’m here to talk to you about surgery. I believe the medical team has told you about the tumor and that we’d like to remove it.” Hannah waits for Rhonda to acknowledge that she knows about the cancer. Surgeons are generally not known for their bedside manner, but Hannah is always professional even if she’s not warm.
“Yes, I am aware, but I don’t know much about how you are going to take it out. How do you say your name again?” Rhonda’s eyes flit from Hannah to Miley and then back to Hannah. Miley stays silent for now.
“Dr. Zoltowski, but you can call me Dr. Zo,” Hannah says, like it’s rote, like she does this every time she meets a new patient. She takes a deep breath and continues, “Because your tumor is small, we are fortunate that we can take it out completely. The procedure is called a Whipple. It involves removing the head of the pancreas, the first part of the small intestine, the gallbladder, and the bile duct. It’s a big procedure, but we can do it in a minimally invasive fashion. The recovery time is approximately four to six weeks, but you would not have to stay in the hospital longer than a few days depending on how you recover and your other medical conditions. There are standard risks of bleeding, infection, and having to convert to a bigger, open procedure, but overall, I think you will tolerate the procedure well.”
Rhonda’s hand tenses in mine, and I give her a reassuring squeeze.
“I’ve been told I’m in good hands,” Rhonda says, nodding at me. I give her hand another squeeze. Rhonda turns back to Hannah. “Listen, everyone knows I have a grandbaby coming, so you do what you have to do so I can meet that baby.”
Rhonda lets go of my hands to sign the consent paperwork that Hannah has brought with her. My eyes wander and find Miley, who is regarding me closely, until she realizes it is her turn to address Rhonda.
Miley steps forward. “Ms. Smith, I’m Dr. Chen, from anesthesia. It’s my job to make sure you’re sedated safely for the procedure. I’ll also be monitoring your glucose levels closely, given the diabetes.” Miley steals a glance at me.
“Do you know my Rohit?” Rhonda asks, narrowing her eyes suspiciously.
Miley looks from me to Rhonda. I stand a little straighter and pipe in, “Yes, Dr. Chen is a friend of mine.”
Miley blinks at me, and then returns her attention to Rhonda, who smiles as she accepts the paperwork Miley hands her.
Rhonda thanks Hannah and Miley as she returns the consent forms. “When is this surgery going to happen?”
“Tomorrow morning, so you cannot eat after midnight,” Hannah answers promptly. She then turns to me for the first time. “NPO after midnight, no blood thinners, morning labs at five AM.”
I nod curtly to acknowledge her verbal instructions, but I know she will enter all the orders in the computer as well. She is meticulous.
Hannah exits the room first, with Miley close behind. Just before leaving, Miley looks over her shoulder and quickly meets my eyes one more time. She leaves wordlessly, however, and I am left with Rhonda, who is raising one eyebrow at me.
“What’s up, Rhonda?” I ask, making my way to the door as well. I still have another patient to check on.
“You’re friends with that pretty doctor.” Rhonda’s Cheshire cat smile is not lost on me.
“Yes, Rhonda,” I groan, opening the door and turning to look at her one last time. “I’m friends with the pretty doctor. I mean Dr. Chen. I’m friends with the highly competent Dr. Chen.” I run my hand over my beard, flustered by my uncharacteristic lack of poise.
The only thing I can hear above the beat of my own heart is Rhonda’s cackle, following me out of the room as I close the door behind me.