An excerpt from A Surgeon’s Knot.
The phone jarred Jackson Cooper, MD’s weary, anxious brain into consciousness from the edge of sleep. He jumped up, dropping the receiver on the cold floor of the call room. “Hello,” he said, tension entering the new intern’s mind.
“Dr. Cooper,” the nurse’s voice said nervously. She almost stuttered as she spoke. “It . . . it’s . . . Mr. Simpson, he’s bleeding. I think he’s going to die!”
She was crying by now, the suggestion of sobs pulsing over the twisted line. “I think I killed him,” she forced out in a strained voice. “I’m new, you know. He’s a carotid, and the dressing . . . I didn’t mean it. The bleeding . . .”
He pulled his pants on and bounded out the door, grabbing his white coat and leaving the receiver dangling by his rumpled bed. The call was from the surgical ward, west 3B. “Simpson,” he muttered to himself as he ran. Straining his memory to bring up the on-call report, he remembered the man as a post-operative carotid endarterectomy patient. The surgery had occurred several days ago, the main artery to the brain opened and cleaned of plaque. If he was bleeding, the result could be catastrophic. On his first internship day—he wasn’t sure what to do.
He struggled to put on his coat as he ran down the hall to the stairway. At one point his stethoscope fell to the floor with a crash, rolling around for him to retrieve later. Jumping two stairs at a time now, he flew with fierce strides, his breaths left for a more appropriate moment. “Code Blue, West 3B” began blaring over and over above him as the hospital awakened from its taciturn sleep.
The nurse’s nametag, now bloody, was a crooked piece of white tape on her breast pocket. Written in black ink was the name “Julie.” Blood covered her white outfit. Terrified, she looked like a Valentine’s Day sacrifice as she frantically met Jackson in the doorway.
“What do you mean he’s going to die?” Jackson asked as he rushed through the door, afraid that he already knew the answer.
Mr. Simpson, an elderly black man, was lying on his back, his hand pressing on a bloody mess over his left neck. The floor was wet with blood, and Jackson slipped and fell to his knees, striking the bedside. Standing, he replaced the man’s hand with his.
Mr. Simpson was breathing through pursed lips. His eyes were wild with fright. Looking into the patient’s tortured face, Dr. Cooper said, “It’s OK, Mr. Simpson,” though he knew that it wasn’t.
Turning his gaze to the foot of the bed where the horrified Julie stood, he yelled, “Trendelenburg, now!” The nurse responded by placing the bed in Trendelenburg position, cranking the foot of the bed up as far as she could.
Jackson removed his hand from the wound. As he did, a spray of warm blood shot high in the air, hitting the ceiling and splattering his face, drops landing in his open mouth. A frenzied team of nurses and doctors poured into the room with a mixture of dread and fervor. The anesthesiologist, dragging a medicine cart, yelled, “What happened here?”
A doctor , with curled black hair in a bun dressed in a white coat tossed over a green pair of scrubs, yelled instructions. “I need a pressure! Is he on a monitor?” She hurried to the man’s side, feeling for a femoral pulse. “Shi**t, no pulse,” she spit.
Simpson closed his eyes, only to begin rhythmically shaking in a seizured frenzy. “He’s a post-op carotid with a blow-out!” Jackson placed pressure again on the wound, grabbing the man with his free hand, trying to calm the seizure contractions while shouting for a hemostat clamp.
Julie rushed to the bedside and placed a blood pressure cuff on Mr. Simpson’s shaking left arm. “Oh no—I can’t get a pressure, Dr. Cooper.” She reached into her pocket and removed a clamp, handing it to the embattled intern. Jackson took the hemostat and desperately thrust it into the man’s neck, grabbing nothing but blood. He dug in the wound with an ungloved finger, clamping again and again in futility.
“CPR! Get him on a board!” the senior doctor yelled. The team swarmed around the patient, slipping a wooden board under his back. One man in scrubs jumped to Mr. Simpson’s side and began violent chest percussions. Another moved to the head of the bed and placed an Ambu bag placed over his face, ventilating the man with force.
“Stop CPR,” ordered the senior doctor. The group stopped and watched the monitor, a rapid arrhythmia tracing its pattern on the screen. She felt for the absent pulse. “Start CPR! One mg of epinephrine. Is his IV working? Call Doctor Canes?” The anesthesiologist indicated that the infusion was flowing. A nurse reported,” Canes is in the OR. Ferry is coming!”
“Amiodarone, 300 mg, IV.” The anesthesiologist pushed a syringe of the heart arrhythmia drug through the IV. A surgeon dressed in rumpled scrubs and a paper cap raced into the room to the head of the bed, pushing Jackson away. He brought a covered surgical tray that he dropped on the foot of the bed. A similarly dressed nurse who followed him opened the tray with gloved hands.
The surgeon removed Jackson’s hemostat, dropping it on the floor. “Scalpel,” he yelled. With the knife, he sliced open the wound covering Mr. Simpson’s neck. Using his bare hands, the surgeon scooped a wad of fresh clot out a deep incision, tossing it on the floor. “Peon,” he said to the nurse. She handed him a large, curved clamp. With difficulty, he clamped the carotid artery near the skull. “Another,” he said, and she slapped another Peon clamp into his hand. A second clamp on the lower carotid slowed the blood flow.
“Stop CPR,” the senior doctor yelled. Without CPR, the monitor showed a rapid fibrillation. “No pulse! Paddles!” They wheeled the defibrillator to the senior doctor, who took the two paddles and yelled for everyone to clear. Mr. Simpson writhed as she shocked him. “No pulse. Start CPR.”
The resuscitation continued. CPR, defibrillation, IV drugs, and intracardiac epinephrine were fruitless. “Stop CPR,” the senior doctor said for the last time. The EKG had flatlined. Several began to clear the room in silence.
“Gladys, we need to stop,” the surgeon said to the senior doctor. She nodded her head in agreement and sadly turned to leave the room. Nurses began to remove all the surgical paraphernalia in the room. They tried to clean the man’s face and neck. The surgeon grabbed the patient’s chart and wrote a quick note, turned and headed out of the room.
“Dr. Ferry,” Jackson said as he chased the man down the hallway.
Dr. Ferry turned to him and said, “Write a death note. What’s your name?”
“Jackson—Jackson Cooper. I’m the intern on call. The family . . . what should I say?”
“Oh? Are they in the waiting room, Jack?”
Jack was a nickname he’d always detested, but he pushed down his irritation. “Yes, I heard that they called the wife and maybe a daughter.”
“Tell them he died, Jack, and that Canes will talk to them. He’s in the OR exploring a neck though!” Dr. Ferry turned and rushed down the hallway.
Jackson stood watching him go. Covered in blood, he shook his hands, splattering some on the wall. He returned to the nursing station and washed up as well as he could. Grabbing the patient’s chart, he realized that he needed to write a death note. Not knowing what that entailed, he wrote some details about the death as best he could. He turned to see Julie standing by his side.
“Mrs. Simpson and the daughter, Macy, are in the waiting room. I called Room Seven, and Dr. Canes is hours from finishing surgery. Could you talk to them?”
Jackson looked down at the chart. He felt trapped and a little like running. He capped his pen and placed it in his white coat. Standing, he attempted to kick some dried blood from his cowboy boots. “Yeah, I’ll try.”
The hallway was longer than he remembered. Walking slowly past the site of the resuscitation, he thought of things to say. It seemed silent now, with all the staff gone and the overhead speakers playing a quiet silly tune. The waiting room was at the end of the hall through two closed doors, which opened noisily. Once through the doors, he saw two women sitting on wooden chairs. The older black woman with graying hair sat neatly dressed in a navy blue dress, black flats, and thick glasses. She sat looking up at Jackson with an old Bible on her lap. The younger woman was obviously the daughter; she had a medium-length afro and was wearing jeans and short boots. The two rose as he approached.
“I am Dr. Cooper,” he said, gently shaking Mrs. Simpson’s hand. “Doctor Canes is in the OR.”
“What happened, Doctor? Is my husband all right?” She pushed her glasses up the bridge of her nose and looked at Jackson intently.
Jackson looked at Mrs. Simpson and then turned to eye her daughter. He glanced down at the floor, realizing that blood on his boots was still visible. “I’m Macy, Dr. Cooper.” He considered telling them his first name but thought better of it. He was having a hard time realizing that he was a doctor. “Yes, glad to meet you,” he said quietly, shaking her hand.
He turned back to Mrs. Simpson and asked her to sit down. She began crying. Macy comforted her, tears in her eyes as well. “Mr. Simpson had some bleeding, Mrs. Simpson,” Jackson said quietly. “His carotid artery burst, and we couldn’t stop the bleeding. We tried . . . did CPR and everything, but he’s gone.”
“Oh—oh, no,” the wife said. She began to sob. Looking up at Jackson through her tears, she asked, “Did he suffer?”
Jackson vividly recalled Mr. Simpson’s terrified eyes. The man’s neck exploration would have been agonizing. “No . . . he was OK at the end, ma’am.” Lying was not in Jackson’s nature, but he just couldn’t be truthful about this with her. He couldn’t believe this was happening on his first day as an intern. It was the first day people could call him a doctor, and he was so proud in the morning when the nurses used that title. Confronted with a crying widow, he realized at that moment that the title of doctor often brought responsibilities he would rather not have.
Mrs. Simpson gently reclaimed her Bible. She slowly opened the worn pages to reveal a small object folded in a piece paper. Taking it in her hands, she unwrapped the item with obvious care and love, revealing a simple gold wedding band. “Will you give this to him, Dr. Cooper? He has worn this on his ring finger for 53 years. I took it from him just before his surgery . . . I know he wants it. I don’t want him to be afraid!” She slowly lifted the precious ring from the package and placed it in Jackson’s outstretched hand.
Mr. Simpson was cold and blue when Jackson entered his room to replace the ring. Housekeeping was scrubbing the walls; one man was on a ladder cleaning stains from the ceiling. Jackson approached the bed, looking at the patient. He was tall, distinguished man of 73 with a two-day scruff of a beard. Dressed now and cleaned as well as possible, the hospital-issued pajamas were stained with blood. The nurses had dressed the large gaping wound in his left neck, and he looked like he could be sleeping. Curiously, Jackson reached to his pocket for his stethoscope, anxiously wanting to make sure there was no heartbeat. He then remembered his race from the on-call room and vowed to retrieve the dropped instrument later. Mr. Simpson was very dead anyway, he reassured himself.
Jackson looked around the small room. He moved to the window and opened the blinds to the early morning sun. There were some fresh lilies in a vase sitting on the nightstand, a get-well card addressed to Papa proudly standing by. Returning to the man, Jackson reached into his breast pocket and retrieved the package. What he thought was just a tissue turned out to be a page of personal stationery, flowers decorating the thoughtful bundle. In small, perfectly penned letters was the phrase: I love you, Herman. Wait for me, my dear. Yours forever, Sarah.
Jackson placed the ring on the man’s stiffening finger.