He turns his gaze forward again, and we take the next few steps in silence. “It was fine,” he finally clips, and I do an internal fist pump at the progress of our small talk before venturing into the morning report.
“Rita Johnson, presented yesterday afternoon with severe abdominal pain, bloating, and emesis. Found to have a bowel obstruction with perforation which was repaired by Dr. Divani. No complications overnight, hemoglobin stable, tolerating a clear liquid diet. Samuel Hasselbun, presented around 1800 with hemoptysis, appeared to be in shock. Had a history of bleeding ulcers so was rushed to the OR and Dr. Divani completed an endoscopy to find and repair the bleed. Patient currently receiving his second unit of blood, and I have orders in to check a CBC afterwards.”
He nods at the end of each patient report, and I sneak a peek at his side profile as I talk. His eyes always stay focused ahead, cobalt-blue daggers that never falter. He doesn’t nod or smile at the nursing staff as we pass and he doesn't stop to make small talk with anyone. I wouldn’t be surprised if he doesn’t even know the names of most of the staff he has worked with for the last ten years.
“What else?” he commands.
I pause, wondering if I missed a patient on our list, but when I scan the names and room numbers, I’m sure I covered everyone. “What else is there?” I ask with hesitation.
He sighs heavily, pausing briefly to toss his coffee cup in the nearest garbage bin as we take the final steps to the first floor. He punches the gray automatic door button with the side of his fist and the double doors to the ER swing open on us. “Well, we are about to round on a seven-year-old boy with abdominal pain; I would have hoped you knew that.”
I’ve already consulted on this patient; a young boy came in through the ER early this morning with intense abdominal pain. Imaging showed a ruptured appendix, and we bumped back our first scheduled case so his operation could be completed first.
A majority of the patients I’ve worked with in residency have been children. While some surgeons, if they aren’t in a pediatrics specialty, cringe at the thought of operating on a child, it’s what I’m used to. The resilience of some of the children I have seen over the years still breaks my heart. Kids that don’t know any other life besides pain or poverty will come to our makeshift clinic unable to walk because of infection or deformity and are so grateful for any support we can offer.
Mothers will traipse down the muddy mountainside to carry their child to the port, all with the hopes of getting basic care for what we would consider a life-threatening infection. The children are so brave. My heart broke with every child we saw, but their strength was enough to simultaneously break my heart and fuel the fire within me to keep going.
“I did.” I don’t give him time to venture into whatever asshole comment he was about to fire off. “Charlie Smith, woke up with severe abdominal pain and vomiting. Parents brought him to the ER around 0400 today. Ultrasound showed—”
He halts his stride and turns toward me with his hands on his hips. “Ultrasound? Why didn’t you order a CT for what is bound to be a ruptured appendix?”
I prop my hands on my hips, mirroring his position. “Because he’s seven and I wanted to avoid radiation and contrast dye if I could. Ultrasound gave us the same results. He’s running a fever, vomiting, has elevated WBC and CRP, the CT would have been overkill.”
His jaw flexes back and forth for a moment, nostrils flaring, and while he’s been lukewarm with me since the day we met, he hasn’t yet ripped me a new one in front of a crowd. Today might be the day.
“He’s a kid,” I say again, my voice a little softer this time. “We both know the diagnosis is obvious. Less invasive first, always. I won’t budge on that.”
Colt’s eyes bore into me, and I force my gaze to meet his. I dig my fingers into my hips, begging the faint tremble that’s been plaguing me all morning to stop, or at least stay small enough he won’t notice. He opens his mouth to speak, but he is interrupted by the sound of retching coming from the glass door at our side. He tilts his head to the right, my cue to enter the room first.
With a hesitant knock, I rap my knuckles on the glass and reach for a clean blue puke bag as I enter the room. I pull the curtain back, and my heart immediately aches at the sight of the little boy lying in the hospital bed with his mom curled up behind him. She rubs his back in soothing, gingerly strokes as his dad is on his other side, holding a plastic tub in front of his son.
“Hi, Charlie,” I say in my most calm voice. “I’m Dr. Keeton, this is Dr. Andrews; it sounds like you’re feeling pretty crummy, hey?”
Charlie slowly nods his head, his pale face nearly transparent in the dim morning light. His mom reaches out a hand, and I shake hers firmly before turning to shake his father’s hand. Dr. Andrews does the same as I take a seat at the foot of the bed, giving Charlie and his parents a brief overview of what the test results showed. During my early morning meeting with them, I let them know what was suspected, but this is the first time they are hearing it confirmed and finding out that Charlie will be going into surgery in a few minutes.
“Dr. Andrews and I promise to take great care of you. You’ll get to take a short nap, and when you wake up, I think you’ll feel a lot better.”
Charlie’s face stays flat, not feeding into my optimism. I see a sliver of blue plastic underneath the hospital blanket and reach a hand up to playfully peek under the fabric by his shoulder. “Who do we have tucked under here?” He adjusts his arm, letting the blanket fall and reaching the other hand to grasp his toy, lifting it for my reveal.
“Don’t judge me, I’m a little rusty with my Transformers, but this is…” I take in the blue helmet, the red body armor, and rack my brain for the memory.
I almost choke on my own saliva when the voice behind me booms, “Optimus Prime.”
Charlie smiles as he looks past me to where Dr. Andrews is standing, and his mom chuckles at the sight.
“Optimus Prime, that’s it! Would it make you feel better if Optimus Prime could come with you in the room when we fix your belly?”
I faintly hear Dr. Andrews clear his throat behind me, probably looking for me to turn so he can shake his head no, but that’s not his choice. While the actual table in the operating room and sterile field is serious business, letting Optimus Prime stand on the circulating nurses' desk won’t cause any harm. Dr. Grump can chill out.
Charlie nods, and I reach a hand out to squeeze his leg. “Today is your lucky day, Charlie. Optimus Prime is Dr. Andrews’favoritesuperhero of all time. Having him in the room with us will give the extra strength we need to make sure your surgery is perfect.” I stand from his bed and turn to his parents. “They will come to get you in a few minutes to take you to pre-op.” Pointing a finger at Optimus, I tell Charlie, “Remember to bring that guy, we might need his power in there.” I ask Charlie’s parents if they have any other questions, and when they shake their heads no, I excuse myself and turn to leave the room.
I reach out to grab some hand sanitizer and slowly rub it between my palms. I continue to walk out of the room, feeling the heat radiating from Dr. Andrews’ body with each step. Once we are out of earshot from the family, he grips my elbow to halt my steps.
“I don’t allow toys in my OR.”
I feign surprise at his gruff words, letting my bottom lip pop open. “But I thought Optimus Prime was your favorite superhero?”
His grip on my elbow tightens and he pulls me to the side out of the walkway.
