Cold Rooms - Chapter 1

cold rooms

Chapter 1 - Evening interrupted TIME: FALL 2008 SETTING: SAM MAXWELL, A SENIOR 20 SOMETHING ANESTHESIOLOGY RESIDENT AT COOK COUNTY HOSPITAL CHICAGO, ILLINOIS - IS FINISHING HIS RESIDENCY. SAM IS TRYING TO DECIDE ON A CAREER PATH - BATTLING WITHIN HIS MIND BETWEEN A HIGH END SUBURBAN JOB V. DOCTORS WITHOUT BORDERS. SAM LIVES WITH KERI - WHO HE MET AT WEAGHMAN’S PARK - A WISCONSIN THEME ESTABLISHMENT AND 20 SOMETHING HANGOUT AT THE CORNER OF CLARK AND ADDISON IN FRONT OF WRIGLEY FIELD. KERI AND SAM MET DURING THE CUBS MAGICAL 2008 SEASON - WHICH ENDED IN AN UNFORTUNATE EARLY PLAYOFF EXIT. THE OR ( OPERATING ROOM ) AND WEAGHMAN’S PARK ARE THE SCENES OF SCRIPT CHATTER - EXTENSIVE NARRATIVE DIALOGUE ABOUT MEDICINE AND SURGERY, CHICAGO SPORTS, AND OTHER IMPORTANT CHICAGO CULTURE AND EVENTS. FOLLOW ALONG AS EACH EPISODE BUILDS WITH EXCITING RELATIONSHIPS AND CONTROVERSIAL TOPICS. SAM HEY KERI - I WON’T BE HOME UNTIL LATE TONIGHT ANOTHER TRAUMA WHICH I’M OBLIGATED TO HANDLE. MY CELL PHONE IS A BIT WEAK. KERI NO PROBLEM - I’M TIRED AND GOING TO BED - EVEN SOCIAL WORK CAN WEAR YOU OUT - EVEN THOUGH IT DOESN’T PAY. SAM BUT YOU ARE DOING GOOD FOR YOUR CLIENTS - YOU MUST FEEL GOOD ABOUT THAT. KERI OH YES - WITH THIS ECONOMY - NO ONE CAN AFFORD ANYTHING - AND TRYING TO FIND EVERYTHING FROM DIAPERS TO COUNSELING IS REALLY ROUGH. MAKES US FEEL WEALTHY - EVEN THOUGH WE ARE ALSO IN CONSIDERABLE DEBT. SAM THOUGH WE ARE IN DEBT - WE HAVE EACH OTHER. THAT IS WHAT MATTERS. KERI WELL THAT IS TRUE - BUT MONEY DOES MATTER TO A SIGNIFICANT DEGREE AND WE HAVE A GREAT OPPORTUNITY AT LAKE FOREST HOSPITAL TO END OUR DEBT AND KEEP 2

THE LOAN COMPANY FROM CALLING US AND ASKING US TO BEGIN PAYMENTS. SAM WELL WE ALL KNOW IF WE DO GOVERNMENT OR NOT FOR PROFIT CHARITABLE WORK OVERSEAS - THE LOAN BY FEDERAL LAW IS PUT ON HOLD. KERI THERE IS SOME DISPUTE ABOUT THAT ACCORDING TO THE INTERPRETATIONS I’VE BEEN READING. LET’S SAY “ DOCTORS WITHOUT BORDERS “ ACTUALLY LOSES IN A LEGAL RULING WHILE YOU ARE OVERSEAS. YOU ARE THEN OBLIGATED TO PAY BACK YOUR DEBT PAYMENTS IMMEDIATELY. WHAT WOULD HAPPEN ?

SAM WE WOULD TAKE OUT A LOAN TO PAY THE LOAN. NO BIG DEAL. OTHER PHYSICIANS HAVE DONE IT. THAT IS THE PRICE YOU PAY TO BE A PHYSICIAN. KERI WELL LAKE FOREST ISN’T HOLDING THE JOB FOR YOU SAM. I KNOW THAT - ONE OF THE PARTNERS WIVES SAID THIS AT THE DINNER MEETING WE ATTENDED. AND SINCE WE AREN’T MARRIED - AND WITH EVERYONE KNOWING WE ARE LIVING TOGETHER - WELL IT IS AWKWARD FOR ME - I DON’T EVEN HAVE AN ENGAGEMENT RING - SO WE ARE AGAIN IN LIMBO REGARDING MARRIAGE, YOUR CAREER, AND OUR LIVES. I JUST DON’T KNOW SAM. SAM YOU AREN’T BEING FAIR KERI - NOT AT ALL. KERI WELL WHAT AM I TO DO WITH YOU IN LIBERIA OR THAILAND OR SIBERIA OR THE NORTH POLE - I CANNOT MAKE LOAN PAYMENTS, MY LIFE IS ON HOLD, YOU ARE OUT THERE SAVING THE WORLD - GOOD GOD YOU HAVE TAKEN CARE OF EVERY CHICAGOAN FOR YEARS FOR FREE - ISN’T THAT ENOUGH - IF IT REALLY MATTERS TO YOU - VOLUNTEER AS STAFF PART TIME AT COOK COUNTY. GOOD GOD THEY NEED ALL THE HELP THEY CAN GET. SAM EVERYONE I KNOW SAYS IF YOU HAVE ANY INKLING TOWARDS GOING ABROAD AND ACTUALLY PRACTICING MISSIONARY MEDICINE - DO IT RIGHT AWAY AFTER FORMAL TRAINING. IT’LL BE 25 YEARS BEFORE YOU’LL ACTUALLY HAVE ANOTHER CHANCE - BECAUSE OF FAMILY AND PRACTICE CONSTRAINTS.

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KERI OK SAM - GO AHEAD AND DO THIS - SEE IF YOU CAN PRACTICE WITH “ DOCTORS WITHOUT BORDERS “ FOR SIX MONTHS - THAT WOULD WORK. SAM THE MINIMUM TIME FOR FULL MISSIONARY WORK IS ONE YEAR. THIS PUTS YOU IN A LEAD POSITION WITH YOUR HOSPITAL GROUP AND IS THE BEST EXPERIENCE. KERI OK - THEN I’M FLAT OUT COMING SAM THEY DON’T ALLOW WIVES, RELATIVES, OR FAMILY. IT IS TOO DIFFICULT. IT’S SIMILAR TO A MILITARY ASSIGNMENT. KERI WELL THEN JUST JOIN THE MILITARY - I CAN HANDLE THAT - BESIDES YOU ARE MORE PROTECTED THAN THE BORDER GUYS - THERE ISN’T A BATTALION OUT THERE WITH RIFLES PROTECTING THE BORDER GUYS HOSPITAL. YOU KNOW SOME OF THESE PLACES HAVE BEEN OVERWHELMED TERRORISTS KILL - THEY DON’T CARE. SAM EVERYDAY AT COOK COUNTY HOSPITAL THERE IS A BAD EVENT WITH A GUN, KNIFE, THREAT, ATTACK, OR A NEAR MISS. HECK I COULD DIE EVEN IN LAKE FOREST HOSPITAL. KERI WELL THEY WERE ALL BREATHING AND SEEMED ALIVE WHEN WE WENT TO THE LAKE FOREST ANESTHESIA PARTNERS BUSINESS MEETING. SAM OK - I’LL JUST DUMP MY DREAMS, GET MARRIED, MOVE TO THE NORTHERN GOLD COAST AND................

KERI BE MISERABLE !

SAM RIGHT - I’D MAYBE BE MISERABLE. SO..........

KERI SO GO AHEAD AND GO TO SIBERIA. I’LL WORK IT OUT MYSELF - WE’VE BEEN DEALING WITH THIS FOR MONTHS - IT WON’T WORK - WE HAVE DIVERGENT INTERESTS....I KNOW THAT NOW AND I’LL JUST HAVE TO DEAL WITH THIS.

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SAM BUT WAIT KERI............

KERI SAM MY CELL IS DYING - I NEED A CHARGE IN MORE WAYS THAN ONE. I’LL SEE YOU TOMORROW. KEEP THE PATIENT OXYGENATED. YOUR VOICE IS DYING. SAM OK - I WANT A NUMBER 8 FRENCH SHEATH SWAN INTRODUCER, FEMORAL ARTERIAL LINE, AND LEVEL ONE TRANSFUSION DEVICE SET UP IN THE ROOM STAT. CALL UP THE JUNIOR RESIDENT FOR IMMEDIATE HELP AND HAVE THE DIFFICULT INTUBATION CART OUTSIDE THE ROOM. WE’RE PLANNING A RAPID SEQUENCE INTUBATION AND THEN BALANCED TECHNIQUE. BAG RECOVERY - WE’LL GO STRAIGHT TO TRAUMA ICU POST OP IF WE GET THERE. TRANSFER THE PATIENT STAT. HAVE ALL RESUSCITATION EQUIPMENT AVAILABLE AND IN ROOM. LET’S GO !

GLENDA OK DR. MAXWELL WE HAVE EVERYTHING EXCEPTING A TRAUMA PATIENT. SAM WE ARE IN THE GOLDEN HOUR - EVERY MICROSECOND COUNTS REGARDING TIME TO REPAIR THE TRAUMA DEFECT - COLD, ACIDOSIS, LACTATE, BLOOD LOSS, ELECTROLYTE LOSS, FLUIDS, YOU NAME IT. LET’S JUST GO GET THE PATIENT OURSELVES. THE ER MUST BE FLOODED !

GLENDA OH MY GOD DR. MAXWELL. THIS GUY IS REALLY IN ROUGH SHAPE - HE’S POURING OUT BLOOD EVERYWHERE, HE IS ABSOLUTELY PANCAKED, AND HE IS AS BLUE AS THE SKY, UNCONSCIOUS, MINIMAL VITAL SIGNS ON LARGE PRESSORS. ¬ER DOCS SAY HAVE AT IT - HIS GLASGOW COMA SCORE IS AWFUL, THERE IS NO SOFT TISSUE OR BONY STRUCTURE THAT HAS BEEN SPARED. SAM OK - WE ARE GOING FOR IT - UPON ARRIVAL IN THE OR I WANT O NEGATIVE BLOOD TO START, THEN TYPE SPECIFIC, THE CROSSMATCHED - ALL IN THE LEVEL ONE TRANSFUSION DEVICE. GLENDA GOT IT.

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SAM WE NEED TO IMPROVE HIS VENTILATION - GET SOME GASES AFTER I LINE HIM. PREP UPPER AND LOWER EXTREMITIES - I THINK WE CAN GET A FEMORAL LINE IN HIM. GLENDA DONE - KEEP GOING !

SAM GIVE ME A UNIT OF BICARB - LIMIT HIS FLUIDS TO BLOOD REPLACEMENT AND KEEP HIM ON PRESSORS TO STABILIZE HIS RHYTHM - HIS HEART MAY BE THE ONLY ORGAN THAT IS SPARED. GLENDA WE HAVE JUST EPINEPHRINE GOING AT 10 MICROGRAMS PER MINUTE NOW. NOT BAD. SAM WELL HIS YOUTH MAY INDEED SAVE HIM. I NEED THE TRAUMA SURGICAL FELLOW TO PLACE CHEST TUBES IN BILATERALLY - HE HAS A FLAIL CHEST WITH BLOOD AND AIR IN BOTH LUNGS. GLENDA DONE - SHOULD I HAVE DR. HANSON SCRUB ?

SAM IMMEDIATELY - HE’LL PROBABLY NEED TO PACK THE LIVER IMMEDIATELY. I’LL GET FRESH FROZEN PLASMA - 4 UNITS - A 20 PACK OF PLATELETS, AND GIVE HIM SOME CALCIUM NOW. HE IS SWALLOWING - SO HIS BRAIN MAY BE OK. GLENDA I DON’T KNOW - HIS CT SHOWED SOME PARENCHYMAL AND VENTRICULAR BLOOD WITH CONSIDERABLE SWELLING. SAM WE’LL NEED A NEURO GUY UP HERE SOON TO PLACE AN INTRACRANIAL PRESSURE MONITOR - I’M GIVING STEROIDS, MANNITOL, AND LASIX - HIS KIDNEYS DESPITE THE INJURY WILL HAVE TO WORK. DR. HANSON HERE I AM - MR DOWNTOWN CHICAGO TRAUMA STAFF SURGEON - WHAT DO WE HAVE TONIGHT FOLKS ??

SAM YOU’D BETTER SCRUB DR. HANSON - THIS IS FAR WORSE THAN WHAT THE ER SAID IT WAS - MUCH WORSE.

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DR. HANSON DO WE HAVE ALL THE PROTOCOLS GOING ? I’LL NEED MY ENTIRE RESIDENT AND FELLOW STAFF GUYS IN HERE GLENDA STAT PAGE ALL THESE GUYS TO COME DIRECTLY TO OR 20.

GLENDA DONE - A COUPLE SURGICAL RESIDENTS MAY BE TIED UP WITH ANOTHER TRAUMA THAT IS PROBABLY COMING UP HERE WITH TEAM B. DR. HANSON MY GOD WHAT IS GOING ON TONIGHT - NOBODY IS SAFE ANYMORE. GLENDA I FEEL WE MUST USE RAPID TRANSIT - ONE CANNOT DRIVE A CAR SAFELY IN CHICAGO THESE DAYS - TOO MANY CRAZIES OUT THERE. DR. HANSON I AGREE - BUT LET’S GET DOWN TO BUSINESS AND DO WHAT WE CAN TO SAVE THIS GUY - WHO KNOWS - HE’S PROBABLY AN INNOCENT VICTIM. SAM HE IS ACCORDING TO THE ER NURSES - A BYSTANDER. DR. HANSON WELL I’VE TAKEN CARE OF HUNDREDS OF THESE GUYS AND MANY DO WELL - HIS LIVER IS SMASHED AND HIS SPLEEN IS ON THE WAY OUT. I’M TAKING OUT HIS GALLBLADDER TO GET TO THIS UNDERNEATH RETROPERITONEAL BLEEDING. GLENDA YOUR FELLOWS HAVE THE CHEST TUBES IN AND THEY ARE ON SEAL AND SUCTION - WORKING WELL. SAM HIS OXYGENATION IS IMPROVING - FROM 70 % SATS TO NOW ABOUT 88 % - HE MAY LIVE. DR. HANSON NOT SO FAST SAM - HIS LIVER MAY NOT SURVIVE. I’M DOING WHAT I CAN TO SAVE THIS - OH MY GOD - HE HAS A MAJOR VENA CAVA INJURY - I JUST DON’T KNOW. GLENDA DO YOU WANT THE VASCULAR GUYS CALLED IN DR HANSON ?

DR. HANSON YES - STAT. 7

SAM ARE YOU PACKING FOR NOW AND THEN REGROUPING ?

DR. HANSON YOU GOT IT SAM. I’M LAYING IN A NEW AUTO SUTURE ANASTOMOSIS ON THIS LARGE VEIN TEAR. THAT MAY WORK. WE JUST ARE NOT GOING TO HAVE TIME TO DO A FANCY REPAIR NOW. SAM WE’VE GOT AN ICP GOING IN NOW - HIS PRESSURES ARE OFF THE METER. DR. HANSON NOT GOOD - BUT AGAIN HE IS YOUTH AND I’VE SEEN WORSE WALK OUT OF HERE AND BE MORE PRODUCTIVE THAN YOU CAN IMAGINE - I HAVE LETTERS UPON LETTERS OF THANKFUL FOLKS FROM ALL OVER ILLINOIS AND BEYOND. GLENDA WE CANNOT KEEP UP WITH THE BLOOD LOSS. IT’S INCREDIBLE - WE’VE GIVEN EVERYTHING - RBCS, FFP, PLATELETS - GO AHEAD AND GET SOME FACTOR VII - RIGHT SAM ?

SAM YES - THE BLOOD BANK KNOWS TO THAW OUT CRYOPRECIPITATE AND FACTOR VII - THE IRAQ WAR MIRACLE BLOOD PRODUCT. DR. HANSON DO YOU PEOPLE HAVE ANY IDEA WHAT FACTOR VII COSTS ?

GLENDA A TON - I KNOW THAT. DR. HANSON $10,000 A VIAL. BUT IF IT WORKS - WELL IT’S WORTH IT. SAM WHAT ABOUT THE LONG BONE FRACTURES - ORTHOPEDICS IS TIED UP IN ANOTHER ROOM. DR. HANSON CAN THIS GUY HANDLE ANY MORE SURGERY SAM ?

SAM YES - LET’S LESSEN THE OR TRIPS - CAN YOUR RESIDENTS PLACE A FEMORAL AND HUMERAL ROD ?

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DR. HANSON YOU BET - THEY’LL GET IT DONE - IF THEY CANNOT - I WILL WE NEED TO CLEAN UP - PLAN ON BRINGING HIM BACK IN 24 - 36 HOURS, MAINTAIN A BARBITURATE DRIP - KEEP HIM COOL - AND BY ALL MEANS MAKE CERTAIN HIS ACID BASE STATUS IS PERFECT. SAM DONE - HE’S CLIMBING INTO THE 90S WITH HIS O2 SATURATION. THINGS ARE BEGINNING TO LOOK FORWARD. DR. HANSON DID ANYONE TALK TO THE FAMILY ?

GLENDA YES - HIS CO - HABITATOR WAS IN THE SURGICAL WAITING AREA - I TALKED TO HER - SHE WAS JUST CRYING - SAID SHE DIDN’T GET A SCRATCH - NOR DID THE DRUNK DRIVER OR ANYONE ELSE. SHE DIDN’T THINK HE’D LIVE - WAS IMMEDIATELY UNCONSCIOUS. DR. HANSON HE’S PROBABLY A GOOD GUY ALSO - MAIN TRAUMA PRINCIPLE IS THAT THE FOLKS WITH NO MORALS WALK THROUGH BOMBS WITHOUT A TRACE - AND GOOD PEOPLE REALLY GET DINGED. I’VE SEEN IT FOR MANY YEARS NOW. GLENDA YES - THE SO CALLED CO - HABITATOR SAID THEY WERE JUST THINKING OF GETTING MARRIED - SHE WISHED THEY HAD GONE AHEAD - REAL LOVE. DR. HANSON SAM CAN TELL US ALL ABOUT THAT SITUATION - AREN’T YOU CO - HABITATING NOW WITH THE GAL I MET IN THE LOUNGE WHO BROUGHT YOU COOKIES - LET ME SEE - KERI ?

SAM SORT OF - I MEAN WE HAVE AN UNDERSTANDING. GLENDA WHAT KIND OF GAL GOES FOR THAT - I MEAN THAT SOUNDS PRETTY WEAK. SAM WELL - WE’RE IN LOVE AND ALL THAT - BUT I’M STILL STRONGLY CONSIDERING DOCTORS WITHOUT BORDERS AFTER I FINISH HERE AT COOK.

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DR. HANSON THAT IS ADMIRABLE - BUT YOU MUST ALWAYS PUT YOUR FAMILY FIRST AND CAREER SECOND - I FOUND OUT THE HARD WAY - I KID YOU NOT. SAM WHAT DO YOU MEAN BY THAT DR. HANSON ?

DR. HANSON WELL I WAS YOUNG ONCE - AND I HAD ALL THESE DREAMS OF PURE MEDICINE - SAVING FOLKS, WINNING AWARDS, ACCOLADES, PEER PRESSURE, THE WHOLE THING - BUT I SLOWLY DISCOVERED THAT I REALLY LET MY WIFE AND KIDS DOWN - I WASN’T THERE FOR BIRTHDAYS, HOLIDAYS, BAND CONCERTS, BACK TO SCHOOL NIGHTS, OR BOY SCOUTS - IT WAS ALWAYS MY DAD HAS A HIGHER PURPOSE TO FILL AS THE MAIN TRAUMA SURGEON AT COOK. GLENDA SO WHAT HAPPENED ?

DR. HANSON I CAME HOME ONE NIGHT LATE - AND COULDN’T GET IN THE HOUSE - KEYS AND GARAGE DOOR DIDN’T WORK. I CLIMBED INTO THE HOUSE THROUGH THE BACK WINDOW USING A KEY I HID YEARS AGO. SAM THEN WHAT ?

DR. HANSON WELL THE HOUSE WAS EMPTY - TOTALLY !

GLENDA SO WHAT DID YOU DO - NO CLOTHES, FOOD, ANYTHING I GUESS. DR. HANSON WELL EVEN THE UTILITIES WERE SHUT OFF - NO WATER, LIGHTS, HEAT - NOTHING - AND IT WAS THE MIDDLE OF JANUARY. SAM WOW - THIS IS QUITE A STORY - UNEXPECTED FROM SUCH A SETTLED DOC AS YOU ARE. DR. HANSON WELL THE NEIGHBOR CAME OVER AND SAID I THOUGHT YOU MOVED - LIKE THE BALTIMORE COLTS DID IN THE MIDDLE OF THE NIGHT TO INDY YEARS AGO. NO ONE KNEW. THE MOVING TRUCKS JUST LEFT.

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SAM WHERE DID THE MOVING TRUCKS AND YOUR FAMILY GO ?

DR. HANSON ROCKFORD! GLENDA WHY ROCKFORD ?

DR. HANSON BECAUSE BETSY HANSON GREW UP THERE, HER ENTIRE FAMILY STILL LIVES THERE, AND WE GO THERE EVERY HOLIDAY - AND USED TO GO THERE EVERY WEEKEND WHEN I WASN’T ON CALL. WHAT A LIFE - I CAN TELL YOU THERE IS ABSOLUTELY NOTHING TO DO IN ROCKFORD. GLENDA YOUR TRAUMA BEEPER IS GOING OFF AGAIN - DR. HANSON GO TO THE ER STAT - FINISH THIS STORY LATER - I’LL HAVE YOUR RESIDENTS ROD THESE LONG BONE FRACTURES. SCOOT !

SAM WOW - I CAN’T WAIT TO HEAR THE END OF HANSON’S STORY. LET THE ICU KNOW WE’LL BE THERE IN AN HOUR NO LONGER - HAVE A VENTILATOR AVAILABLE TURNED ON. LET’S FINISH THIS GUY UP.

End - Chapter 1, cold rooms

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