"Now comes the tedious part, Dr. Kreger. We run the intestines looking for any sign of perforation or nick," the surgeon looked over at the Chief Resident.
"Doesn’t appear to be any injury to it." Dr. Kreger challenged. "I don’t think we’ll find a thing to worry about."
An eyebrow arched high on the forehead and icy blue eyes shot like daggers. Garrett’s voice dropped to a low tone. "This, Dr. Kreger, is my patient. I will do whatever I feel is necessary to assure the success of this operation now and for the future. If you don’t agree, then I suggest you assign yourself to a different trauma fellow after today."
Beads of perspiration gathered across the Chief’s forehead. ‘No!’ his heart screamed ‘You are the one, I want to learn from you.’ He let his eyes drop in submission and nodded his head. "I’m sorry," was all he could verbalize.
He knew that out of the three Fellows, Trivoli had the skills and surgical expertise that he wanted, but her overall manner with the staff left much to be desired. She seemed to pit herself against them at every turn. He’d have to remember not to pick up those habits.
"Good! Then you won’t make that mistake again." Her voice was calloused and cold, rivaling the room’s temperature for sending a chill straight to the bone.
His eyes shot up to meet hers and he wondered if he would be able to withstand her condescending attitude for the year to come. He had been told that he could learn many things from this Fellow but no one had mentioned her brash and arrogant ways.
Painstakingly slow but ever so diligently the two surgeons examined the loops of intestines for damage. They could find no defects but something kept the Fellow on guard, instinct was taking over again.
"Vitals, Please."
The O.R. staff was beginning to hate the sound of the word ‘please’ coming from the tall surgeon’s mouth. It was evident that she had no idea of the courtesy she was extending in the polite mannerism. It came off sounding more like a suffix to the word before it.
"Heart rate 98, BP 100 over 64, respiration’s 16," the anesthesiologist reported.
Garrett could not shake the feeling. "Raise the pressure to 120."
The anesthesiologist pulled a syringe off the tray at his workstation. He uncapped the needle and proceeded to inject one milligram of the drug into the port of I.V. line. "Should take just a few minutes," he reassured the surgeon, "before we can see some results."
"While we are waiting for that to take effect, let’s mop up this abdominal cavity of any free fluid."
The circulating nurse silently kept watch of each sponge that entered the young man’s abdomen and patiently retrieved them as they were discarded.
"Seventeen used inside," she announced, "seventeen out."
"Pressure is now 122 over 70."
"Ok, let us do this one last time." The surgeons inspected each loop of bowel thoroughly, slowly checking for any sign of injury.
"There!" The Chief Resident pointed out. "I see a drop."
Trivoli’s eye was caught by the glistening appearance. There, upon wiping the site, one could see another droplet forming within a few seconds. It had paid off. The skilled hands of the Fellow manipulated the area of bowel to reveal a small one-millimeter perforation in the wall.
"1-0 Silk on a curved needle."
Garrett took the needle and put a stitch or two in to hold the area closed. Kreger clipped the silk and proceeded to dab the area; both surgeons waited to see if the stitch would hold.
Rob Kreger silently studied the surgeon across from him and waited for the "I told you so." But it never came. He would have closed without ever checking and risked numerous complications that could have killed the young man that they worked so hard to save. ‘This one is the best,’ he silently thought. ‘I’m going to learn a lot this year.’
Several minutes passed and the evidence was conclusive, the stitch would hold. The surgeons continued their final inspection. Both were satisfied when no other warning signs of injury could be found.
"Is the sponge count correct?" The tall Surgeon waited for an answer.
All eyes were on the circulating nurse as she made her final count.
"I don’t have all day here, nurse, and neither does my patient." Garrett’s voice was antagonistic in nature.
"Yes, Doctor Trivoli, eighteen in and eighteen out." The nurse looked over with eyes turning from shock to that of shooting darts at the brash surgeon. She was an experienced O.R. nurse and didn’t appreciate being treated in this manner.
"Great! Now let’s close and see how he does in recovery." Trivoli motioned for the Chief Resident to do the honors.
Rob Kreger felt a sense of acceptance by the gesture. Here was a surgeon who strived at perfection and the task of closing was offered to him. It was something that was usually given to first year residents as a practice procedure; but right now it felt very much an honor coming from Garrett Trivoli. No matter how small or monotonous the task, the Chief Resident was sure the Fellow would be meticulous down to the last detail. It was that frame of mind Dr. Kreger kept as he sewed the layers of surgically severed muscle and flesh together.
The operation over now, Garrett addressed the other participants in the young man’s fight to stay alive. "I want to say thank you for the expertise that each of you brought to this arena today, and I will expect nothing less from you in the future. I’m looking forward to working with you again." She turned away from the group of people huddled around the dramatically illuminated form on the surgical table.
"I’ll be opting out of her cases for the next year." The circulating nurse spoke softly under her breath to the scrub nurse who nodded in agreement.
"Rob, page me if anything changes, I’m going to see if any family members are here for Lucky."
Kreger nodded his head in affirmation as he began to take off his gloves and gown. "I’ll stay with him in recovery for a while."
Stripping her mask off with one hand, Trivoli gave a small wave with the other hand and proceeded through the door. Above the O.R. desk the large wall mounted clock read 1458. ‘Seven and a half-hours of surgery, not bad for my first day. It will be even better once I have them all broken in the right way.’ Garrett thought about her empty stomach and remembered that food and drink would be necessary soon. A bathroom break and quick shower might be nice, too.
The family came first, that is if one was found. It was Trivoli’s customary ritual to meet and inform the family immediately after any surgery. It was one way that the surgeon could help to put them at ease during their traumatic experience.
Garrett approached the O.R. desk and waited for the Supervisor’s attention.
"Hello, I’m Dr. Trivoli. Can you tell me if Lucky Doe has been identified yet?"
"Sorry, doc." The older woman shook her head. "But there is a message for you from Dr. McCormick in the E.R. to call him when you are done."
"Thanks," Garrett motioned to use the phone at the desk.
"Go ahead, it’s extension 2744."
The surgeon punched in the numbers and waited for someone to answer.
"Dr. Trivoli returning a call to Dr. McCormick."
A pause, then, "Have him page me at 1048 when he has a moment to talk then." The surgeon replaced the phone, acknowledging the woman at the desk with a slight nod of the head. "I can trust that after today you won’t have to call in to my Operating Theater to ask my name, now will you?"