Chapter Four #3
The lab gets busy fast. The simple diagnostic coronary angiogram I allowed the floor team to add on to my schedule during lunch turns out to be a nasty lesion that takes me and my fellow, Aaron, an hour and a half to fix up.
Then our first patient of the day sits up too early in postop and opens his femoral artery access site, and it takes Aaron almost forty-five minutes of holding pressure to stanch the bleeding.
Miraculously, we make it through the rest of our cases before five thirty. I rip off my gown, tear the shoulder strap off on my lead apron, and am about to step into the control room, home free, when Pamela’s voice rings into my headset.
“Keep your lead on, Sullivan,” she says. “I think they might need you in the other room.”
I peer through my window, across the control room, and into Brandon’s. I can’t see much around the equipment, but I can see Brandon’s movements, frantic and harried, his gown soaked through with blood.
Before I can make sense of the chaos, the side door to the supply room blasts open and Leila and Larry rush out, hands full of unopened gear.
“What’s going on?” I ask, following them into Brandon’s room, where shit is most definitely hitting the fan.
“RCA dissection,” Leila explains, handing a package over to the nurse who is running Brandon’s lab. “What’s your glove size?”
“Six,” I say, and she scrambles to retrieve a set for me as I open up a gown.
“Is that Sean?” Brandon says, from behind the table. “Thank god. I need a hand.”
He gets me up to speed as he works—“Proximal RCA CTO, got the wire past the lesion, definitely in the true lumen, dissected to the first acute marginal after we ballooned”—and together we talk through the plan and delegate tasks: “I’ll prep a balloon pump.
” “What do you think? Covered stent?” But as we do, I make a few troubling observations.
This case is a two-man job at minimum, but Brandon’s fellow is nowhere to be found.
The images Brandon flicks through of his attempts to fix the blockage demonstrate that this was a predictably tough case, and yet he appears woefully unprepared.
There are no necessary meds on the table, no venous access site, none of the safeguards we lecture our fellows about every other week.
It’s unlike him. For all his faults, Brandon is a damned good interventional cardiologist, and a careful one too. Of all my colleagues, he’s the one I’d trust the most to work on my mother. This feels…reckless for him. Haphazard.
I look to Leila. She stands a few feet away from the table, her hands tucked into the top of her burgundy lead apron, stone-faced, irritated, and colder than I’ve ever seen her. As if he can’t help it, Brandon looks up to meet her gaze. She pulls her own away.
Brandon’s movements slow. Even among the chaos, I can sense his despondency behind his mask.
All the while, the patient’s blood pressure is plummeting.
“Brandon,” I hiss, just as Larry shouts, “Pressure!” into the mic from the control room.
The patient’s heart rate drops: within a few beats, I know he’s in complete heart block. I curse, grab a needle, jab into the vein in his groin.
“Pads on the chest,” I tell the nurse, and then, to Leila, “Get me a pacing wire. Now.”
An hour and a half later, we finally leave the lab. The patient, now stable, is transferred to intensive care for monitoring. Complications happen, and this case was high-risk; the patient has known Brandon for many years and is understanding.
But I am pissed.
“Thanks for jumping in,” Brandon says, giving me a wolfish grin and a pat on the shoulder. “Just like old times—”
I shrug his hand off.
“It was not like old times, because you definitely know better now,” I hiss. “Why didn’t you have backup access? Where were your meds? Where was your fellow?”
There’s a beat of silence between us, a moment when I know that I have hooked into a nerve and strummed. But then Brandon’s gaze turns glacial.
“I asked for your help, Sean,” he says. “Not your judgment.”
“I’m trying to understand what happened in there,” I say. “I know you, Brandon. We all make mistakes, sure, but—”
“Exactly. We all make mistakes. So maybe instead of putting on your typical, self-righteous, ‘I’m the only one who actually cares about people’ act, you can cut me some slack,” Brandon interrupts.
There’s a warning in his tone, a promise that if I push, he will take us to a place from which we can’t return.
He holds my gaze for a second that feels like it stretches into eternity, then wipes the sweat from his brow and looks behind him at Leila. “Come on, babe. Let’s go.”
They walk out. Only Leila looks back at me, eyebrows turned up in a helpless apology.
The instant the door clicks shut, a hand lands on my shoulder. It’s Pamela.
“For what it’s worth,” she says, in a softer tone than I’m accustomed to, “I’m on your side.”
I squeeze her hand with one of mine, pull out my phone with the other. I am buzzing with an ugly, roiling sort of adrenaline, and I need a distraction—a mindless cat video, a quick scroll through a social media feed.
I get something better: a text from Julian.
You’ve left me hanging, Sean. Am I taking you out, or are you turning me down?
I am about to complain when I see the time: eight p.m., a full eight hours after he asked. I bite my lip. You know what, why the hell not. Then I respond: All right. I’ve been convinced. It’s a date.