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CHAPTER IX “RELIVING THE PAST” THE SCENE IS COOK COUNTY HOSPITAL IN CHICAGO, ILLINOIS. SAM MAXWELL - NOW A STAFF ANESTHESIOLOGIST WHO HAS RECENTLY BROKEN UP WITH KERI - RUNS INTO AN OLD FLAME, MELANIE. MELANIE HAS JUST BEGUN THE EVENING SHIFT AT COOK AFTER BECOMING BORED AS A SURGICAL NURSE AT A SOFTER NURSING JOB. FOLLOW ALONG AS AN OLD RELATIONSHIP STARTS AGAIN, CHICAGO SPORTS IS DISCUSSED INTENSELY, AND AMIDST ALL THE SCRIPT CHATTER A TRAUMA PATIENT COMES INTO THE O.R. AFTER FALLING OFF THE DOWNTOWN TRUMP TOWER.

MELANIE OK SAM, WHEN WILL YOU BE DONE TONIGHT? SAM I DON’T KNOW. HOPEFULLY SOON. MY TRAUMA STAFF REPLACEMENT IN ANESTHESIA IS APPARENTLY SICK. I MAY GET A DOUBLE SHIFT. MELANIE THAT SUCKS. THERE IS A TON OF STUFF FROM LAST NIGHT COMING TO THE O.R. SAM WELL HOPEFULLY HE’LL SHOW UP. FOR MOST OF US TO CALL IN SICK WE MUST BE IN THE HOSPITAL AS A DOC OR PATIENT. THAT IS THE CREED WHICH I TRAINED UNDER. MELANIE MOST OF THOSE THINGS HAVE CHANGED. I STILL ASCRIBE TO THE EITHER BE HERE AS A PATIENT OR STAFF MEMBER. NO IN BETWEENS. SAM WELL I KNOW DR. HANSON AND GLENDA DO AS WELL. I’VE SEEN THEM IN HERE FOR YEARS WHEN THEY COULD HARDLY STAND UP WITH VIRUSES. MELANIE THAT MAY NOT BE RIGHT, BUT IT IS HOW IT IS WITH ALL DEDICATED TRAUMA PERSONNEL. THEY ARE TRULY DEDICATED.

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SAM AND FIND IT SOFT AND UNREWARDING IN ANY OTHER ARENA OF MEDICINE. MELANIE SO ANYWAY I JUST GOT TEXTED, AND MY REPLACEMENT WILL NOT BE IN FOR A COUPLE HOURS EITHER - SHE MAY BE ADMITTED HERSELF FOR PNEUMONIA. SAM SO WE ARE BOTH STUCK. WHY DON’T WE HEAD TO THE CAFETERIA FOR A BITE BEFORE THE ONSLAUGHT BEGINS? I KNOW ORTHO HAS THREE CASES THAT ARE COMING UP. MELANIE AND WITH FIRST AND SECOND YEAR RESIDENTS DOING THESE TOUGH CASES, WE’LL BE HERE FOR A WHILE. SAM COULD YOU PLEASE PASS THE KETCHUP? SO WHERE DID YOU GROW UP MELANIE? ROCKFORD.

MELANIE

SAM I HEAR A TON ABOUT ROCKFORD, BUT HAVE NEVER KNOWN ANYONE THAT HAS GROWN UP THERE. MELANIE IT IS PRETTY DULL. ONCE IN A WHILE YOU GO TO THE DELLS, THAT IS ABOUT IT. SAM YOU’RE ON THE I90 CORRIDOR. RIGHT ON THE BORDER WHERE ALL THOSE FANS THAT GO TO WEAGHMAN’S PARK COME FROM. THEY COME TO WEAGHAM’S PARK SO THEY CAN GET SOME OF THAT CHEESE. THE OLD ZUERCHER’S IN WISCONSIN IS UP THERE RIGHT ON THE BORDER IN GREEN COUNTY.

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MELANIE MY GRANDPARENTS USED TO DRIVE UP TO GREEN COUNTY TO GET ZUERCHER’S CHEESE. NOW THEY GET IT RIGHT HERE IN CHICAGO AT ZUERCHER’S. SAM WELL WEAGHMAN’S HAS MADE A KILLING SELLING LEINENKUGEL BEER AND ZUERCHER CHEESE. ALL YOU CAN GET AT ZUERCHER’S IS TAP SEASONAL OR REGULAR LEINE’S, NOTHING FURTHER AS FAR AS BEER GOES. PEOPLE AROUND HERE DRINK IT LIKE WATER. MELANIE YES, I’VE HAD THAT CHEESE. IT IS UNBELIEVABLE, BUT NOT THE BEST FOR WEIGHT CONTROL. SAM NO KIDDING. YOU MEAN A PERSON CAN’T EAT CHEESE FREELY WITHOUT WEIGHT GAIN? MELANIE A GIRL ONLY HAS TO LOOK AT FOOD AND WEIGHT COMES ON. SAM OK, SO WHAT ELSE HAPPENS IN ROCKFORD? THE ROCKFORD RAMS? MELANIE THEY ARE DEFUNCT. THEY CAME AND WENT WHEN I WAS BARELY BORN. PEOPLE STILL TALK ABOUT THEM. IN FACT THE MODERN DAY FIRST ARENA FOOTBALL GAME WAS HELD AS AN EXPERIMENT IN ROCKFORD. SAM HMMM. I’VE NEVER HEARD THAT ONE. I KNEW THEY HAD A FORMER TEAM IN THE MINOR PRO BASKETBALL LEAGUE UP THERE. DIDN’T BOYKINS AND BOWEN COME OUT OF THERE? MELANIE YES THEY WERE STARS. BUT THE TEAM MOVED ON ABOUT FIVE YEARS AGO DUE TO ATTENDANCE PROBLEMS, AND THE NBA HAS SINCE GONE 4


TO THE D LEAGUE. THE BULLS FARM TEAM AS YOU KNEW GREW OUT OF THIS AND IS VERY SUCCESSFUL IN CEDAR RAPIDS. SAM WOW! I DIDN’T KNOW YOU WERE SO ON TOP OF SUCH TRIVIA IN SPORTS. MELANIE WELL WHEN YOU HAVE NO STEADY DATES, OR ARE NOT SEEING SOMEONE, YOU DO WHAT YOU HAVE TO DO TO AVOID BOREDOM. BESIDES GUYS LIKES SPORTS AND GIRLS LIKE SLEAZY GOSSIP FOR THE MOST PART. SO IF I TALK TO A GUY I MIGHT AS WELL TALK SPORTS. I MIGHT HAVE A FIGHTING CHANCE THEN. SAM DO FOLKS STILL GO TO THE WAGON WHEEL UP THERE? MELANIE ARE YOU KIDDING? WHERE DID YOU GET THAT? THE GRAND OLD DAME OF NORTHERN ILLINOIS RESORTS IN ROCTON, ILLINOIS CLOSED IN 1989. I DISTINCTLY REMEMBER MY PARENTS DISCUSSING IT. THEY HAD FRIENDS WHO WORKED THERE. SAM ALL I REMEMBER WAS MY PARENTS DISCUSSING A SKATER, JANET LYNN, WHO WON A BRONZE MEDAL AT THE 72 OLYMPICS COMING FROM THERE. MELANIE WOW, THERE MUST NOT HAVE BEEN MUCH GOING ON FOR CHICAGO PEOPLE TO BE TALKING ABOUT THE WAGON WHEEL. SAM SO ROCKFORD IS PRETTY DEAD NOW? MELANIE NO WAY THANK YOU VERY MUCH. THE ROCKFORD ICEHOGS ARE A BIG ATTRACTION. THEY ARE A DIVISION OF THE BLACK HAWKS - MINOR PROFESSIONAL HOCKEY. BIG DRAW IN ROCKFORD.

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SIMILAR TO MINOR LEAGUE BASEBALL. IT IS FUN. I’VE BEEN TO A FEW GAMES. SAM WHO DO THEY PLAY...MUSKEGON? MELANIE NO - GRAND RAPIDS. EVEN PEORIA HAS A TEAM. SAM SO FOLKS IN ROCKFORD WATCH HOCKEY FOR FUN. MELANIE TONS OF IT. BOY THIS COOK FOOD HAS NOT IMPROVED IN A HUNDRED YEARS. SAM WELL WOLF IT DOWN BECAUSE WE HAVE A TRAUMA I COMING TO THE O.R. STRAIGHT FROM CT SCANNER. GUY WASHING WINDOWS ON TRUMP’S TOWER JUST FELL. AND HE’S LIVING? NOT BY MUCH!

MELANIE SAM

MELANIE SO WHY WOULDN’T HE GO TO LOYOLA OR NORTHWESTERN? SAM BECAUSE THEY WANT THE BEST - US. THE AMBULANCES ARE VERY PARTIAL TO COOK COUNTY. MELANIE I’LL SEE YOU UP THERE. HANSON IS ON HIS WAY IN, AND THE O NEGATIVE BLOOD IS ON ITS WAY TO THE O.R. SAM I’VE BETTER DRAIN MY BLADDER BECAUSE WE’LL BE IN THE O.R. FOR A WHILE.

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MELANIE YES – THINK I’LL GO TOO. SAM OK I HAVE NO RESIDENTS TO ASSIST TONIGHT, MY STAFF REPLACEMENT HAS NOT COME IN DUE TO H1N1, AND WE HAVE NO BLOOD PRODUCTS GREAT. GLENDA WE’LL GET YOU THROUGH THIS SAM. WE HAVE DR. HANSON A COUPLE OF MINUTES OUT, MELANIE IS BACK, AND WE HAVE THE STAFF NEUROSURGEON IN HOUSE. SAM THAT IS COMFORTING. THE GUY IS COMNG IN, NOT BREATHING, SAT MONITOR (Oxygen Saturation) SO LOW AND NOT PICKING UP, AND........ MELANIE SHUT UP AND INTUBATE THIS GUY. HERE IS AN ESCHMANN STYLET. THE GLIDE SCOPE IS SET UP. WE ARE GOING. I’VE GIVEN SUX* 160 MG. BALTIMORE SHOCK TRAUMA INSTITUTE PROTOCOL. THE RESIDENT IS READY TO TRACH IF YOU CANNOT GET THIS AFTER A COUPLE TRIES. *(Suxamethonium, also know as succinylcholine. Used to induce muscle relaxation prior to an endotracheal intubation). SAM OK, THE ET IS IN. SCRUB AND CUT. OH HERE IS DR. HANSON, GOOD OLD MR. RELIABLE. GLENDA HE’S RELIABLE, BUT I DON’T KNOW HOW OLD. DR. HANSON I AM OLD, RELIABLE, AND HAVE H1N1 DESPITE THE VACCINATION. MELANIE WELL THE CT SHOWS EVERYTHING IS WRONG. THERE IS BLOOD IN THE BRAIN TISSUE, VENTRICLES, AND THE BRAIN IS SWOLLEN. THERE 7


ARE NO LONG BONES NOT FRACTURED, AND THE SPLEEN IS CRUSHED. DR. HANSON WHAT ABOUT THE LIVER? DO WE HAVE A CUT ON THIS STRUCTURE? GLENDA YES, IT IS #47. LOOKS AWFUL. I’VE OPENED THE LIVER PACKING. SAM OUR VITALS REALLY SUCK. HE’S ON EPI (Epinephrine) MEDIUM DOSE, I’VE GIVEN BICARB, BLOOD, CALCIUM, AND LIMITED LR (Lactated Ringer’s solution). DR. HANSON HE’LL NEED MORE THAN THAT. WHILE I’M OPENING HAVE AN INTRACRANIAL PRESSURE MONITOR PLACED. GET NEUROSURG IN HERE STAT (immediately). DESPITE WHAT I’M DOING IF WE DON’T PROTECT HIS BRAIN, THIS WILL ALL BE FOR NAUGHT. MELANIE THE ICP (Intra Cranial Pressure) IS SET UP, AND THE FELLOW AND STAFF NEUROSURGERY GUYS ARE ON THEIR WAY. SAM I’M LOSING THIS GUY. OPEN HIS CHEST. MY PULMONARY COMPLIANCE IS TERRIBLE. DR. HANSON DONE. I’M SEALING THE PULMONARY LEAK. THE HEART IS BRUISED, BUT CAN RECOVER. GLENDA HERE IS YOUR CHEST TUBE DR. HANSON. THE RESIDENTS HAVE OPENED THE ABDOMEN WITH A MIDLINE INCISION. DR. HANSON CLAMP THE SPLENIC ARTERY ASAP. PACK THE LIVER SO WE CAN GET CONTROL OF THE

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SITUATION. IS THERE BLOOD IN THE URINE? GIVE THIS GUY A CHANCE. URINE IS PINK.

MELANIE

DR. HANSON CALL UROLOGY AND HAVE THEM PERFORM A STAT RETROGRADE PYELOGRAM*. * (A radiograph or series of radiographs of the renal pelvis and ureter). SAM THE PATIENT IS NOT DOING WELL. I NEED MORE BLOOD VOLUME. STOP THE FAUCETS EVERYONE. DR. HANSON SAM, WHAT ABOUT HIS BRAIN? THE BELLY LOOKS PRETTY DRY NOW. HE MAY BE LOSING A TON FROM A MAJOR ARTERY IN THE CNS (Central Nervous System). GLENDA HERE IS THE CT OF HIS SKULL. DR. HANSON OH MY GOD, THIS GUY HAS A LARGE SUBDURAL ON ONE SIDE, AND AN EPIDURAL HEMATOMA ON THE OTHER SIDE. MELANIE DO YOU WANT THE DRILL? DR. HANSON YES, HAND ME THE DRILL AND QUICK PREP THE CRANIUM. MELANIE THE EPIDURAL IS ON THE LEFT AND THE SUBDURAL IS ON THE RIGHT PER THE NEURO-RADIOLOGY FELLOW. THE MOST IMPRESSIVE BLEEDING IS THE EPIDURAL HEMATOMA AREA ON THE LEFT WITH SUBSTANTIAL BRAIN AND BRAINSTEM SWELLING.

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DR. HANSON OK, DRILL, RELEASE, FLUSH, AND DRAIN. GOT IT. DRAIN IS IN. GLENDA ARE WE GOING TO THE OTHER SIDE? DR. HANSON YES. THE NEUROSURGERY GUYS WHO HAVE JUST ARRIVED CAN TAKE IT FROM HERE. SAM MY VITALS ARE INCOMPATIBLE WITH LIFE. HE IS ON DOPAMINE, EPI, LEVOPHED, AND PHENYLEPHRINE. I’M ADDING SOME MILRINONE. DR. HANSON TEAM, THIS IS A VERY YOUNG GUY WITH A HORRIBLE PROGNOSIS. YET DESPITE THIS WE ARE AT WAR WITH A DISEASE CALLED TRAUMA. WE ARE TO WIN BY DOING EVERYTHING CORRECTLY. MY RESIDENTS WILL PLACE ANOTHER LINE IN THE FEMORAL VEIN. I’M PLACING THE PATIENT ON THE INTRA-AORTIC BALLOON PUMP* 1:1. *(A mechanical aid to the circulatory function of the heart that acts to provide internal counterpulsation.) SAM OK, WE ARE GAINING. THE BALLOON REALLY HELPED HIS PRESSURE. DR. HANSON WE’LL LEAVE IT IN OVERNIGHT. THE ORTHO GUYS ARE RODDING HIS FEMURS IN A MATTER OF MINUTES FOR STABILIZATION, AND WE WILL PACK THE LIVER ONCE WE DO A FINAL CHECK ON THE GUT AND LIVER FOR BLEEDING. GLENDA HERE IS THE LAST OF THE BLOOD PRODUCTS. THE PATH LAB AUTOMATICALLY SENT UP FACTOR VII* CONCENTRATE AND CRYO. SHOULD WE GIVE IT? *(A blood procoagulant present in blood plasma) 10


DR. HANSON ABSOLUTELY. AGAIN WE ARE SAVING THIS GUY. I KNOW IT IS A TON OF MONEY, BUT WE ARE NOT PLAYING GOD OR MEDICAL ECONOMICS. GLENDA FACTOR VII IS GOING IN. THE CRYO IS ON ITS WAY. HEMOGLOBIN IS STILL ONLY 7.8. SAM WELL BLOOD IS POURING OUT THIS GUY’S NOSE. HE HAS A MAJOR BASILAR SKULL FRACTURE WHICH IS BLEEDING. DR. HANSON IF THE DRAIN IS IN, WE WILL OPEN HIS SKULL AND STOP THIS. THIS IS VERY SUBSTANTIAL BLOOD LOSS. PREP AND DRAPE THIS AREA. I’LL ASSIST. GET THE STAFF NEUROSURG GUY IN HERE STAT. SAM WE CANNOT KEEP UP WITH THE BLOOD LOSS. I’M HOVERING AT A PRESSURE OF 65 WITH A DAMPENED WAVE FORM. GASES ARE BORDERLINE. GLENDA WE ALMOST HAVE THIS UNDER CONTROL. WE WILL PACK THIS AREA FOR A FEW MINUTES, BOVIE* THE AREA WELL, PLACE SURGICELL, AND GO HOME. KEEP HIM GOING SAM. HE MAY DO OK. KEEP TURNING THE HEAT UP IN THE ROOM UNTIL WE SWEAT. NO COLD ROOMS FOR OUR PATIENTS. *(Medical term meaning to cauterize using a Bovie cautery machine, after the name of its inventor, Dr. William T. Bovie, 1882-1958) DR. HANSON THESE YOUNG GUYS IN A YEAR CANNOT BE IDENTIFIED AS MAJOR TRAUMA. THEY LOOK, ACT, AND FEEL NORMAL. I HAVE CHRISTMAS POSTCARDS DATING BACK TO THE 70S FROM THESE GUYS. MELANIE WE MUST NOT GIVE UP EVER. 11


SAM BLOOD PRESSURE IS RISING STEADILY. WE ARE IMPROVED. GREAT! GLENDA KEEP IT UP TEAM. WE SHOULD HAVE A BREAK. THE NEXT PATIENT WON’T COME UNTIL TOMORROW. HE’S IN ICU WITH THE INTENSIVIST* TEAM, AND HE HAD HIS EPIDURAL HEMATOMA DRAINED IN THE ER. *(Specialists in the care of critically ill patients) MELANIE SO ARE YOU GOING HOME SAM? GLENDA WELL THAT IS A HIT IF I EVER HEARD ONE SAM. DR. HANSON LEAVE THEM ALONE GLENDA. THEY ARE BABIES. LET THEM HAVE FUN. GLENDA THE LAST TIME THESE BABIES WERE HERE THEY WERE GOING TO A BEARS GAME. MELANIE WELL THE BEARS WILL BE IN THE THICK OF IT NEXT YEAR WITH AN IMPROVED CUTLER, PEPPERS, BETTER RUNNING AND DEFENSE. WE CAN HIDE DEVON. DR. HANSON I’LL BELIEVE IT WHEN I SEE IT. WE WERE REALLY BLOWN OUT OF SOME GAMES THIS YEAR. LUKE WILL BE GONE SINCE HIS LINE WAS A SIEVE. SAM WE SHOULD HAVE HAD LUKE’S UNCLE, DICK BUTKUS. HE WAS A REAL STAR. NO ONE COULD STOP HIM - A REAL MONSTER OF THE MIDWAY. GLENDA THE BEARS WILL CONTINUE TO MAKE CHANGES BUT I SUSPECT THERE WILL BE A TON OF INTEREST AT TRAINING CAMP THIS SUMMER IN LAKE FOREST, 12


BUT AFTER A FEW GAMES AND FALLING BEHIND THE VIKES AND PACKERS, NO ONE WILL CARE. SUPPER WILL BE AT THE REGULAR TIME SUNDAY EVENING LATER IN THE SEASON. MELANIE WE ALWAYS ATE AT THE GAMES. I MAY EVEN GO TO MINNEAPOLIS OR GREEN BAY FOR SOME OF THE GAMES THIS YEAR IF I CAN GET OFF. DR. HANSON WOW, YOU ARE A TRUE FAN. GOING TO AWAY GAMES. MELANIE I’VE ALWAYS LOVED THE BEARS. THERE IS SOME REAL MEANNESS ABOUT THEM EVEN IF THEY DON’T WIN. DR. HANSON YES, BUT THAT DOESN’T WIN GAMES. CUTLER CANNOT DRIVE THE BALL ALL THE WAY DOWN THE FIELD AND THEN UNLOAD IT TO THE OTHER TEAM. SAM I AGREE. WE NEED TO NOT JUST BEAT UP THE OTHER TEAM. WE HAVE TO WIN THE GAME. IN CHICAGO IT SEEMS THAT IF WE ARE MONSTERS OF THE MIDWAY AND BEAT THE OTHER TEAM UP HANDILY, WE HAVE WON. THE OTHER TEAMS ARE JUST LAUGHING AT US. WE NEED TO SCORE AND DEFEND. GLENDA SOUNDS LIKE THE BULLS COULD ALSO USE THAT ADVICE. IT HAS BEEN YEARS SINCE WE LOST 10 IN A ROW. SOMETHING HAS TO GIVE FOR THIS TEAM NOW IN THE NINTH SPOT FOR A PLAYOFF POSITION – AND THEY ONLY TAKE EIGHT. I HAVE AN EXTRA TICKET AT CHICAGO STADIUM TOMORROW NIGHT. MELANIE I’LL TAKE TWO, BUT NOT ONE.

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GLENDA OK YOU CAN HAVE TWO. MELANIE YOU UP FOR THE HOUSTON GAME SAM? SAM WELL WITH DENG, NOAH, AND ROSE ALL OUT OF THE LINEUP WE ARE NOT BEATING ANYONE. IT IS THAT SIMPLE. MELANIE I FEEL THEY HAVE HAD SPURTS OF GOOD CHEMISTRY THIS YEAR. WE JUST NEED TO SUPPORT THIS TEAM. I’M GOING. AND HITTING WEAGHMAN’S PARK AFTERWARDS. OK, I’M IN.

SAM

END - COLD ROOMS IX

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Cold Rooms Chapter IX