Chapter Three--A Surgeon's Triumph
They passed the waiting room on their way to the ICU. Jackson grabbed Lee W., his friend and attending, and directed him into the room. People were milling and sitting around as the two moved to chairs in the corner.
Next to his wife, Patrice, Jackson considered Lee W. his dearest friend. The urology professor was the best man at the couple’s wedding four years before. “Lee W., would you pray with me?”
The two bowed their heads. Their prayer was short, but they asked for the healing and protection of their loved ones. Jackson embraced Lee W. “Thanks, my friend.”
***
Kevin Whitaker, MD., was writing a note at the ICU nurse’s station when Jackson and Lee W. arrived. Jackson knew the attending internist well; they had been medical school friends in Boston six years before.
“Kevin, what’s going on? How’s Patrice and the baby? I was in the OR; I don’t know anything at this point.”
“Jackson, I am glad you are here. Hi, Lee W.” Handshakes completed their introductions. “Pull up chairs and sit down.”
Lee W. secured two rolling stools, and they sat alongside the internist.
Whitaker began presenting the day’s course. “Jackson, they’re okay, but we’re concerned.” The internist placed Patrice’s chart in the rack and continued speaking. “The story is that Patrice was leaving Lucy Winter’s office about two hours ago. I guess she has felt ill for a while, especially today. Lucy gave her some Keflex for what appears to be a UTI. She became quite weak, with dizziness and nausea, so one of the hospital volunteers wheeled her to the ER in a wheelchair. When she stood up at the nurse’s station, she collapsed. I happened to be there seeing a patient of mine. Patrice had only an 80 systolic blood pressure and was having trouble breathing. We got her on a gurney and started an IV. She was slightly better after a bolus of IV fluids and some nasal cannula oxygen. She needs to be in the ICU, Jackson. I think she has septic shock, probably from that UTI.”
“What’s her BP now, Kevin?”
“Her blood pressure is still a little low. Her last reading was 105 over sixty. You know, Jackson, she has had high blood pressure throughout her second trimester. I saw a reading of 140 over 78 at her last OB appointment.”
“I know, Kevin. 105 is very low for her. Does she have a fever?”
“Yes, 101 orally. Also, she can’t void. I think she is not making much urine, and her bladder is just empty. I am going to catheterize her with a Foley. I wanted to wait, however. Lucy Winters is seeing her right now.”
“I will wait for Winters, but I really need to see her and the baby. How is her breathing?”
“That is a problem, Jackson.” Whitaker stood and motioned for the two to follow him to the physician’s lounge.
“Here is her portable chest x-ray, Jackson.” Whitaker snapped the film onto a wall-mounted view box. Pointing at the film, he said: “There are white fluffy infiltrates in both lung fields, consistent with ARDS.”
Acute respiratory distress syndrome, or ARDS, is a common finding in sepsis. The condition results in white areas or infiltrates on the chest x-ray and poor lung function.
“Her O2 saturation on that nasal cannula oxygen was only 85%. I have her on more oxygen now, four liters by facemask. It is still low at 92%.”
In sepsis with ARDS, the lungs do not exchange oxygen properly. Oxygen saturation (O2 sat) measures the percent of blood hemoglobin carrying oxygen. Normal values are 96 to 100 percent and are generally measured with a finger O2 monitor transducer. The findings on the chest x-ray and Patrice’s low O2 sat were consistent with sepsis.
“Jackson, your wife needs a Swan.” A Swan-Ganz (SGC) is a long IV placed in septic patients to monitor heart function.
“I will ask Ben Thompson in surgery to place it, Kevin.”
***
The three exited the physician’s lounge. Dr. Lucy Winters was now sitting at the nurse’s station, writing a note in Patrice’s chart. She stood and shook hands with Jackson, Lee W., and Whitaker.
“Dr. Winters, thanks so much for coming. Did you examine my wife and baby?”
“Yes, Jackson. Call me Lucy, would you? I saw her a few hours ago in my clinic. I thought she had another UTI, so I gave her some Keflex. She did not look septic then, but now she appears to be so. The good news is that the baby is quite stable. I know you both have elected not to know the sex, so we’ll call the baby, Baby Cooper. Baby Cooper seems very stable and strong. There were good fetal movements, and I heard a strong heartbeat. Now Patrice had a maternal ultrasound this morning. The baby was healthy, in a good position, and had adequate umbilical cord and brain blood flow. Jackson, the baby’s fetal weight has not progressed quite as I would like it. That is one reason that I put her on maternity leave today. Now, however, well, she is in the ICU, but the baby seems strong.”
“Kevin, what antibiotics have you put Patrice on?” Antibiotics were required for sepsis, and Jackson was concerned about their effect on the baby.
“Well, we usually start triple antibiotics until we know the culture results. Lucy, I chose ampicillin and clindamycin. I know they are both safe in pregnancy. Usually, in sepsis, we add gentamycin as well, but there is a risk of hearing loss in the baby. She needs the drug, however, so I gave her a loading dose. We will monitor the gentamycin blood levels. Lucy, what do you think?”
“Ampicillin and clindamycin are fine. Gentamycin has a small risk of ototoxicity in the fetus. However, the benefit outweighs the risk. Keep her levels on the low end. Jackson, what do you think?”
“We got to go for it, everyone. Patrice is sick. I approve of the addition of gentamycin.”
***
Sally, Patrice’s nurse, was leaving her room when Jackson entered. “Hi, Dr. Cooper, she said quietly. They are doing alright. I will be at the nurse’s station. You can use her call button if she needs me. It is in her right hand.”
The private room was quiet, and the overhead lights were dimmed. The fetal monitor could be heard whooshing away. It sounded regular and strong. Patrice lay quietly, her legs slightly elevated in the Trendelenburg position. IV bags hooked to IVAC delivery devices dripped along. Her face was covered with a facemask, delivering a flow of oxygen. An EKG monitor traced away above her. An O2 sat transducer on her finger read 93% on the monitor. A Foley catheter had been inserted. The bag was nearly empty.
She was sleeping when Jackson walked up to the bed. He reached for her hand, which was cool to the touch. Patrice slowly opened her eyes. A small smile could be seen through the oxygen mask.
“I love you, Patrice. You are going to be okay now.” Jackson reached down and kissed her hand.
Patrice smiled. “Is the baby doing okay, Jackson?”
“Hear the monitor, Patrice? That’s Baby Cooper’s heartbeat. It is strong and regular.”
Patrice smiled. “That steak last night was excellent, Jackson. Did Charlotte get the scraps?”
Jackson smiled. Charlotte was their golden retriever. The steak dinner she was mentioning occurred last week. Jackson had barbequed on the little hibachi grill on the small patio of their condo. “Today’s Wednesday, Patrice. We barbequed last week, on Saturday. Remember you baked potatoes and tossed a salad. No wine for either you or I, though. Me, I am an addict, and you are pregnant.”
Sepsis affect’s all the body’s organs. In the case of Patrice, the lungs and kidneys. It was obvious that her brain was not functioning smoothly as well. Jackson learned to calm the patient with gentle reminders.
“Charlotte made out like a bandit. Remember. You didn’t finish your New York strip. She did. That reminds me. I need to get home soon. She will need to go out, and I will need to feed her.”
“What time is it, Jackson? Is it really Wednesday? I was supposed to see Dr. Winters today, I think.”
“You did. You have a UTI, and she gave you some Keflex. Do you remember being in the ER?”
“Ya, that is right. Gino wheeled me into the back. I don’t remember much more.”
***
“Is Mary around?”
“Yes, Dr. Cooper. I’ll page her.” The nurse spoke into the intercom. “Mary, Dr. Cooper is at the front desk.”
Jackson began examining the big board. It looked as if his day of cases was progressing.
“Dr. Cooper. How is your wife and baby?’ Mary appeared and questioned Jackson.
“Hi Mary. She is stable. Baby Cooper is doing as well as can be expected. Is Dr. Hickok around?”
“I believe he is in the lounge. He finished Mr. Saunders, and the next case as well. We put Mr. Kat in room three, and Dr Nelson and Fielding finished quite a while ago.”
***
Lee W. was asleep in his favorite lounge chair when Jackson entered the surgeon’s lounge. Tedla, the anesthesiologist, was exiting the lavatory, and he stopped when he saw the chief resident. “Jackson, how is Patrice?”
“Thanks for asking, Tedla. She is stable.” Jackson looked at his friend and chuckled. “I wish I could sleep like him.”
Tedla nodded to the two urologists. He tapped Jackson on the shoulder as he exited the lounge.
Jackson sat on the couch. He was, as always, exhausted. The stress of the day was overwhelming, and he was so concerned about Patrice and Baby Cooper. He turned to his friend and gently jostled him awake. “Lee W. So sorry, man.”
Lee W. sat up startled. “Jackson. Wow, I just dropped off. Hey, how is Patrice?”
“She’s okay, but I am so worried, Lee W. Her O2 sat is in the low 90s on four liters of O2. She’s not putting out much urine, and her pressure is still low. Lee W. I need to ask you to see her as a urology consultant. I don’t know why she is so sick. You see, she had some UTI’s during the pregnancy, but this is different. Would you check her out for me?”
Lee W. grabbed Jackson’s hand. “I would be honored big buddy. Your cases are being done. Saunders went well. I think just one case is left.”
“Great. I will do it with Mike. Lee W. It is an orchiopexy on a six-month-old. Man, I hope the testis is in the groin.”
An orchiopexy is an operation performed when a boy’s testicle is not in the scrotum. The testicle is generally found in the fold of the leg, or groin, and brought down into the scrotum. Sometimes, however, the testicle is actually high in the abdomen. The procedure to find the abdominal testicle is complicated. Jackson hoped today for the simpler procedure.
“I will do the case with Mike, and then I have to run home. My dog’s bladder, Charlotte, is probably bursting by now.” Jackson looked at his watch tied on his scrub draw string along with his wedding ring. “Man, Lee W. it is 6:30. Patrice usually let’s her out around five pm. While I am doing that orchiopexy, could you see Patrice for me?”
William Lynes, M.D.. 1/2025
Comments