"It was childish."
"And… I'll "And it was dumb." gcand… "And it didn't work."
"Jared!"
"And I'm sorry. I really am. The devil made me do it, but I went and let 'im."
He opened the door. She stopped, hesitated the obligatory few seconds, and got in. The scenario was over, Through it, a dram of purulence had been drained from their marriage before it could fester. Energy no longer enmeshed in their anger would now be rechanneled, perhaps to a joint attack today on the pile of unsplit wood in the yard and later to a battle with the Times crossword puzzle. As likely as not, before the afternoon was through, they would make love. Eyes closed, Kate settled back in her seat, savoring what she had just heard. I'm sorry. He had actually said it. Apologizing has been bred out of Samuels men was yet another teaching from the philosophy of J. Winfield Samuels. Kate had suffered the pain of that one on more than one occasion. She thought about Jared's vehement reaction to the possibility of her taking over the chairmanship of her department. The morning, she had decided, had been a draw, Dad I. Wife I. "Now, Dr. Engleson, you may proceed with your report."
Tom Engleson's groan was not as inaudible as he would have liked. "Your patient is still bleeding, sir. That's my report." During his year and a half of residency on the Ashburton Service at Metropolitan Hospital of Boston, Engleson had had enough dealings with D. K. Bartholomew to know that he would be lucky to escape with anything less than a fifteen-minute conversation. Dr. Donald K. Bartholomew held the receiver in his left hand, adjusted the notepad in front of him, and straightened his posture. "And what is her blood count?"
"Twenty-five. Her crit is down to twenty-five from twenty-eight."
Engleson pictured the numbers being shakily reproduced in black felt tip. "She has had a total of five units transfused in the last twenty-four hours, two of whole blood, one of packed cells, and two of fresh frozen plasma." He closed his eyes and awaited the inevitable string of questions. For a few seconds there was silence. "How many fresh frozen did you say?"
"Two. The hematology people have been to see her again. Her blood is just not clotting normally." He had decided to keep the complicated explanation for Beverly Vitale's bleeding problem out of the conversation if at all possible. A single request from Bartholomew for specifics, and the phone call could drag on for another half hour. In fact, there was no good explanation even available. The hematologists knew what-two of the woman's key clotting factors were at critically low levels-but not why. It was a problem the surgeon should have at least identified before performing her D and C. "Have they further tests to run?"
"No, sir. Not today, anyhow." Getting D. K. Bartholomew to come into the hospital on a Sunday morning was like getting a cat to hop into the tub.
"They suggested loading her up with fresh clotting factors and perhaps doing another D and C. They're afraid she might bleed out otherwise."
"How long will it take to give her the factors?"
"We've already started, sir."
There was another pause, "Well, then, " Bartholomew said at last.
"I guess the patient and I have a date in the operating room."
"Would you like me to assist? " Engleson closed his eyes and prayed for an affirmative response. "For a D and C? No, thank you, Doctor. It is a one-man procedure, and I am one man. I shall be in by twelve o'clock.
Please put the OR team on notice."
"Fine, " Engleson said wearily. He had already scheduled Beverly Vitale for the operating room. He hung up and checked the wall clock over the door of the cluttered resident's office. Only eight minutes. "A record, " he announced sardonically to the empty room. "I may have just set a record."
Moments later, he called the operating suite. "Denise, it's Tom Engleson. You know the D and C I scheduled for Dr. Bartholomew?…
Vitale. That's right. Well, I was wondering if you could switch it to the observation OR. I want to watch… I know you're not supposed to use that room on a weekend. That's why I'm asking in such a groveling tone of voice… Bartholomew doesn't want anyone assisting him, but he can't keep me from watching through the overhead… I owe you one, Denise. Thanks."
Looking down from behind the thick glass observation window into the operating room, Tim Engleson exchanged worried looks with the scrub nurse assisting Dr. Donald K. Bartholomew. The dilatation of Beverly Vitale's cervix and subsequent curettage-scrapidg-of the idner surface of her uterus was not going well. She had gone to the emergency ward three days before because of vaginal bleeding that started with her period but would not let up. For several years, she had been receiving routine gynecologic care through the Omnicenter-the outpatient facility of the Ashburton Women's Health Service of Metropolitan Hospital. As her Omnicenter physician, D. K. Bartholomew had been called in immediately.
In his admission physical, Bartholomew had noted a number of bruises on the woman's arms and legs, but elected nevertheless to proceed with a D and C-commonly done for excessive bleeding. He did not order blood clotting studies until after his patient's bleeding worsened postoperatively. Now, with the woman loaded with fresh clotting factors, Bartholomew was repeating the curettage. Beverly Vitale, a thin, delicate young cellist with straight jet hair and fine, artist's hands lay supine on the operating table with her eyes taped shut and her head turned ninety degrees to one side. A polystyrene tube placed through her mouth into her trachea connected her with the anesthesia machine. Her legs, draped in sterile sheets, were held aloft by cloth stirrups hooked beneath each heel. Overhead, in the observation gallery Tom Engleson watched and waited. He was dressed in standard operating room whites, with hair and shoe covers, but no mask. As he watched the level of suctioned blood rise in the vacuum bottle on the wall, Engleson wondered if D. K. Batholomew was considering removing the woman's uterus altogether. He cursed himself for not throwing protocol to the winds and inviting himself into the OR. The prospect of the old surgeon moving ahead with a hysterectomy brought a ball of anger to the resident's throat. Much of his reaction, he knew, had to do with Beverly Vitale.
Though he had only spoken with her a few times, Engleson had begun fantasizing about her and had become determined to see her when she was released from the hospital. Now his thoughts added, if she was released from the hospital. He glanced again at the vacuum bottle and then at Bartholomew. There was a flicker of confusion and uncertainty in the man's eyes. "Her pressure is dropping a bit."
Engleson heard the anesthesiologist's voice crackle through a barely functional speaker on the wall behind him. "Young lady, get me the freshest unit of blood we have, and see if the blood bank can send us up ten units of platelets."
"Yes, sir, " the nurse said. "Dr. Bartholomew, blood loss so far is four hundred and fifty cc's."
Bartholomew did not respond immediately. He stood motionless, staring at the steady flow of crimson from Beverly Vitale's cervix.
"Let's try some pitocin. Maybe her uterus will clamp down, " he said finally. "Dr. Bartholomew, " the anesthesiologist said, an even tenseness in his voice, "you've already ordered pitocin. She's been getting it. Maximum doses."
Engleson strained to see the older surgeon's face. If he rushed into the OR and the man did not need assistance, a formal complaint was' sure to … Before he could complete the thought, the bellboy hanging from his waistband emitted the abrasive tone signaling a transmission. "Dr.
Engleson, call two eight three stat. Dr. Engleson, two eight three stat, please."
An anxious check of the scene below, and the resident rushed to the nearest phone. It was a rule of the Ashburton Service that all stat pages were to be answered within sixty seconds. Telephones had even been installed in the residents' bathrooms for such purposes. The call concerned a postop patient whose temperature had risen to 103, not a life-or-death situation. By the time Engleson had listened to the nurse's report, given orders for evaluating the patient's fever and returned to the observation window, Bartholomew had begun swabbing antiseptic over Beverly Vitale's lower abdomen. Engleson switched on the microphone by his right hand. "What's going on? " he asked. Below, no one reacted to his voice. "Can you hear me? " Again no response. Through the door to the scrub area, Engleson saw Carol Nixon, a surgical intern rotating through the Ashburton Service, beginning to scrub. Apparently Bartholomew had called her in to assist, perhaps when Engleson could not be found.