Chapter Ten
Everyone in the city seems to be in the emergency room today. There’s hardly a bed available, and I’ve been on my feet for six hours already without a break. A code blue is called through the speakers, and Dr. Parse turns to me. I haven’t seen Dr. Lanson since the knee-touching incident. When I came to work the next day, I was informed that he’d been reassigned to other residents, and I’ve been mostly with Dr. Parse ever since.
“Dr. Oliver, follow me.”
A man lies on the table with no pulse, and the machines buzz out in all directions. Dr. Parse rushes to his side, as medical staff try to stabilize the patient.
“He’s in V-Fib,” Dr. Parse calls out. “Dr. Oliver, grab the paddles.”
Upon administering a single shock, the patient achieves a normal sinus rhythm. A woman, who looks to be about my mom’s age, cries in the corner, and her sobs reverberate through the room until a nurse removes her. Dr. Parse gets his stethoscope out and studies the EKG.
“Do you hear that, Dr. Oliver?” His eyes meet mine, and I step closer.
“Yes,” I say through a deep exhale. “I hear a fourth sound.”
“Okay,” he says. “What do you suggest we do?”
“Let’s run some labs and get the patient in for an echo.”
“You heard the doctor,” Dr. Parse says, and everyone sprints into action.
I follow the patient into the ultrasound room. He’s stable but heavily sedated. The tech puts gel on the transducer, and when the heart comes up on the monitor, the sound of it beating echoes out.
A tech comes into the room and hands us the labs. Dr. Parse pages the on-call cardiologist to look at the films, and then Forest walks into the room.
He studies the screen and points. “It looks like hypertrophic cardiomyopathy, and there is no outflow from the left ventricle.”
Forest looks at me and Dr. Parse. “Dr. Oliver, go talk to his mom and make sure his records are sent our way. I need to examine the tests further, but it looks like he’s in advanced heart failure.”
I locate the patient’s mom, still sitting in the corner of the room we have recently transferred her son from. She sits in a chair, her head tucked into her hands, and her chest visibly quivering.
“Hi,” I say, and she looks up at me. Her face is blotchy, and her eyes are red-rimmed and swollen. “Are you Noah Anderson’s mom?”
“This can’t be happening. Not again.” Her face is pale, with black drips of mascara in vertical lines down her face. “He was playing soccer with a friend in our backyard and just went down. Like a ton of bricks.”
“We’re going to need his medical records. Do you have a history of any heart disease in the family? Sudden cardiac death?”
She stands up. “His dad died at thirty-five. Cardiac arrest.”
I nod. “We’re doing everything we can to keep your son comfortable and to get some answers. We sent him for a Cardiac MRI and then will review his films. I’m going to come find you as soon as we have a clearer picture.”
Mrs. Anderson lets out a desperate sob, and I rush out of the room and head down to where he’s getting the MRI. When I walk into the imaging room, Keegan, Forest, and Dr. Parse study the films.
“You were unfortunately right, Dr. Oliver.” Keegan glances at Forest. “His left ventricle is barely pumping blood.”
Dr. Parse looks at me. “Did you talk to his mom?”
“Yes,” I say. “His charts are being sent over, but he hasn’t been diagnosed with any heart disease up until this point. The only other significant history is that his dad died of cardiac arrest at the age of thirty-five.”
“That’s a sick heart. We need to get him on the transplant list immediately,” Keegan says as he once again looks at the films. “His heart isn’t going to last until there’s a match though.”
Dr. Parse turns to Keegan. “Can we put him on ECMO?”
Keegan shakes his head. “He’ll never get off of it. He needs a heart.”
I look between Keegan, Forest, and Dr. Parse. “Is medication an option?” I ask.
“If this was caught earlier, maybe. His heart is too sick for a septal myectomy too.” Keegan shakes his head.
Keegan glances at me. “Have the operating room prepped and page the VAD rep.”
Keegan and Forest rush out of the room, and I get into action by calling down to the OR to get it prepped. Dr. Parse and I get the team ready and have them page the rep and ask someone to update his mom.
We arrive at the operating room at the same time as Keegan. He looks at me. “Do you want to scrub in?”
“Really?” I nod vigorously. “If there’s room. Sure.”
He then looks at Dr. Parse. “Dr. Parse, you in?”
We go to the prep room to wash up. I watch Keegan as his dark hair vanishes under his surgical cap, and his face disappears under his mask. I put mine on too. A tech wraps us in our surgical gowns and then slides our gloves on.
When we get into the room, anesthesia has already been started, and the patient is intubated. Keegan makes about a three-inch incision on the left side of the patient’s body. He looks up at me, and all I can see are his big blue eyes.
“I’m going to do a thoracotomy. The left ventricular assist device is only a bridge to transplant. Our patient is going to need a new heart, and it’s challenging to do a sternotomy when one has already been done, so I want to leave him with a virgin chest for whoever puts in his new heart someday.”
His voice is low and calm as he teaches. The room is silent as everyone listens to the brilliant Dr. Baldwin as he takes time to walk us through each step of the surgery. The surgical light he wears on his head points in the direction of the incision, and he starts putting a lead through and watches the patient’s heart on the screen.
“The VAD,” he continues, “Is going to help his ventricles until we can get him a heart. It will assist the heart to pump oxygenated blood to the body.”
Keegan holds up the device for me to see. “The impeller within the pump spins thousands of times a minute, resulting in continuous blood flow. Not all surgeons like to use VADs, but it can buy someone time in situations like this and will get our patient out of the hospital while he waits for a heart.”
He gets the device in the right location and continues to look at the screen. He screws it in place, and the left ventricle of our patient’s heart starts beating normally.
“When he gets a new heart, they’ll do a sternotomy, and the device will be removed along with the sick heart.”
Keegan’s voice is soothing. It has a gentle and reassuring quality to it, and I immediately feel at ease. Even as he performs the delicate task of placing a device on a man’s heart, his voice remains calm and composed, radiating a sense of confidence and professionalism.
As I watch him work, I am struck by the precision and skill of his hands. Every movement is deliberate and measured, as he dexterously threads the lead to the device with the utmost care and attention to detail. His hands seem almost weightless as they move effortlessly.
After checking the settings on the VAD, Keegan observes as I help close the patient up. When I’m done, Keegan checks my work and then walks out of the room. Dr. Parse follows, so I do too.
We remove our surgery gear and throw everything in the hamper. Keegan looks over Dr. Parse’s head and toward me. “Would you like to speak to the patient’s mom with me?”
“Yeah.” I nod. “Of course.”
“Good work today, Dr. Oliver,” Dr. Parse says, patting Keegan’s back, then mine, before he walks out.
The elevator doors glide open, and we step inside, standing side by side. Warmth emanates from his body. In this confined space, the air around us seems to vibrate with a quiet intensity.
My eyes stay glued onto Keegan, and he turns to me, and a faint smile flickers across his lips. His eyes soften, and for a moment, it’s like there is no one else in the world but the two of us.
“Thanks for letting me scrub in for that.” I finally break the silence from my thoughts.
“You did great in there, Luna. I always knew you’d make an excellent surgeon. Maybe you shouldn’t discount cardiothoracic.”
The elevator door opens, and I follow him to the waiting room.
“I don’t think so,” I say quietly. “But it was fascinating getting to observe your work. But I think I’m going to avoid the heart at all costs. That was intense.”
When we reach the patient’s mom, Keegan does all of the talking and I observe. Mrs. Anderson looks both relieved and distraught. Her son’s life was saved, but she also hears the difficult news that he needs a new heart. Keegan’s voice is soft when he delivers the message and I think of how many times he needs to talk to the loved ones of the patients he both saves and those who die. This is where I want to shine too. As surgeons, we can’t always control the outcome, but we can control the compassion we give.
“Your son is in the ICU, but you should be able to visit him soon.” Mrs. Anderson reaches her hand out and squeezes Keegan’s, and we walk away.
We both see Dr. Lanson standing down the hallway, and Keegan says to me. “Good work today, Dr. Oliver.” He then heads in a different direction.
Dr. Lanson raises an eyebrow when our eyes connect, and I glance at my watch. I’m now on my eleventh hour of this shift.
“Not all first years get to scrub into a VAD surgery with a cardiothoracic surgeon.” He narrows his eyes. “Dr. Baldwin must like you a lot.”
I shrug. “I’m not going the cardiac route, but it was so educational to get to witness.”
We turn down another hallway. “Interesting, the attention he’s paying you.”
Luckily, I don’t have to respond, because the emergency room door swings open with our next life to save. And instead of feeling panic about the latest trauma coming our way, I’m relieved that I won’t have to answer Dr. Lanson’s questions.