cold rooms CHAPTER 3 - sudden arrival 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 O.R. ( 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 GREAT JOB LAST NIGHT KERI - YOU KNOW YOU PASSED OUT AT WEAGHMAN’S PARK ? KERI NO WAY. SAM YES - I THINK YOU SAW MELANIE, AND THEN JUST PASSED OUT AFTER DRINKING ALL THAT LEINIES. KERI WELL I’D DO IT AGAIN. I CANNOT STAND THAT DESPICABLE LADY - HOW CAN YOU WORK WITH HER SAM ? SAM KERI YOU NEED TO GET OVER THIS HATRED OF MELANIE SHE IS NICE - SO WHAT IF SHE HAS CHASED ME FOR A FEW MONTHS - WE NEVER HAD ANYTHING GOING. KERI DID YOU EVER GO OUT WITH HER SAM ? SAM KIND OF.
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KERI WELL YOU EITHER DID O.R. DIDN’T SAM - THERE IS NO IN BETWEEN. SO YOU DID. SAM WE WENT TO A LITTLE BAR AFTER WORK ONE NIGHT NOTHING HAPPENED. SERIOUS. KERI OK - SO WHY DOES SHE PERSIST IN CHASING YOU ? HOW DID SHE END UP AT WEAGHMAN’S PARK ? WHAT IS THAT ALL ABOUT ? SAM I DON’T KNOW IF SHE IS CHASING ME ? SHE IS JUST A FRIEND - YOU NEED TO GET OVER THIS KERI - DEAL WITH IT. WE WILL HAVE ALL KINDS OF THINGS THAT WILL CONFRONT OUR RELATIONSHIP AND MARRIAGE FOR YEARS. KERI WHAT - YOU ARE TALKING MARRIAGE ? COME ON SAM. SAM NO IN TIME WE WILL MARRY. DON’T YOU THINK ? KERI NO - I’M GONE IN 36 HOURS - I HAVE A UHAUL COMING OVER SOON. I’M OUT OF HERE. SAM PLEASE DON’T LEAVE KERI - RESIDENCY IS JUST TOO TOUGH AND I CANNOT MAKE DIFFICULT DECISIONS. KERI OK THAT SETTLES IT - I’M JUST NOT WAITING AROUND SAM - JUST WON’T - WE COULD REALLY BE A GREAT COUPLE BUT YOU WON’T FOLLOW THROUGH. IF PROPOSING AND SETTING A DATE IS THAT BIG OF A DEAL - WELL THEN ONE OF US JUST ISN’T READY AND IT WON’T WORK. I WANT COMMITMENT - NOT HALF WAY STUFF O.R. TALK. I HAVE TO CHECK ON A CLIENT. SAM MY BEEPER JUST WENT OFF - I’M NEEDED IN THE O.R. STAT - SEE YOU TONIGHT. KERI ENJOY MELANIE. SAM OK GET THE PYXIS DRUG MACHINE REP IN HERE STAT - I CANNOT GET INTO MY DRUGS - ALL THIS GREAT 3
TECHNOLOGY CAN LEAD TO PROBLEMS IF YOU DON’T HAVE ACCESS. GLENDA WE DON’T HAVE TIME - THE PATIENT IS ABRUPTING - SHE NEEDS A GENERAL ANESTHETIC - NO TIME FOR SPINAL. SAM OK - PLEASE GET ME FROM ANOTHER CART 200 MG PROPOFOL, 100 MG SUCCINYLCHOLINE, 5 MG VERSED, AND 250 MICROGRAMS OF FENTANYL. I HAVE MY DIRECT LARYNGOSCOPE, 7.0 ENDOTRACHEAL TUBE AND A BACKUP CLARUS SCOPE SINCE SHE IS HUGE. HER AIRWAY MAY BE A PROBLEM. GLENDA MELANIE IS COMING UP TO ASSIST YOU WITH INDUCTION. THE OB NURSES HAVE THEIR HANDS FULL. YOU NEED AN EXPERIENCED CIRCULATOR. YOUR STAFF IS TIED UP WITH A MAJOR LEVEL ONE TRAUMA DOWNSTAIRS. YOU ARE ON YOUR OWN. HERE COMES THE PATIENT. SAM MY GOD THERE IS BLOOD EVERYWHERE ! DON’T EVEN PUT THE MONITORS ON - WE’LL JUST INDUCE AND SECTION THIS BABY OUT STAT. MOM, HERE BREATHE THIS OXYGEN FOR A FEW SECONDS. THESE ROOMS ARE COLDER THAN ICELAND. CAN WE TURN UP THE TEMPERATURE A BIT GLENDA ? GLENDA OH HERE COMES MELANIE - SHE CAN PUSH THE DRUGS. WE’LL TURN UP THE TEMPERATURE SAM. REMEMBER YOU DON’T WEAR THE SURGICAL GARB AND HAVE HOT SURGICAL LIGHTS ON YOU. SAM OK MELANIE - GIVE THE ENTIRE SYRINGE OF PROPOFOL, AND 80 MG. SUX. STAT. MELANIE OK DONE - SHE’S FASCICULATING. I’M PERFORMING BOTH THE BURP AND SELLECK MANEUVERS. CAN YOU SEE THE CORDS ? SAM NO GIVE ME A DIFFERENT BLADE........STILL CANNOT SEE HER LARYNX. MELANIE DO YOU WANT THE CLARUS SCOPE SAM ?
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SAM NO - GIVE ME A # 5 LAM. THAT WILL WORK. IT SLIDES IN EASILY - GOOD AIRWAY EXCHANGE - CUT ! MELANIE LOOKS GOOD - DR. HANSEN WHAT ARE YOU DOING UP HERE IN OB. DR. HANSEN WELL THE OB GUYS WANTED A GENERAL SURGEON TO ASSIST - THIS MASSIVE OBESITY MAY BE A PROBLEM WITH EXPOSURE. SAM WELL THIS KID NEEDS TO GET OUT OF THERE NOW O.R. WE’LL HAVE PROBLEMS - IS NEONATOLOGY HERE ? MELANIE NO - BUT THEY ARE ON THE WAY. SAM WHAT ? WE STARTED A SECTION WITHOUT NEONATOLOGY ? MELANIE WE HAVE NO CHOICE - WHICH MEANS SAM YOU’LL HAVE TO TAKE CARE OF MOM AND BABY UNTIL THEY ARRIVE. SAM I DON’T KNOW - MOM’S BP IS LOW - I NEED MORE EPHEDRINE AND PHENYLEPHRINE - GOT MY TRUSTY DRIP GOING. BLOOD LOSS IS INCREDIBLE. GIVE US O NEGATIVE 3 UNITS TO START. I’VE SENT A SAMPLE - WE’LL TAKE TYPE SPECIFIC TO START IF THE BLOOD BANK CAN GET IT UP HERE QUICKLY. DON’T WORRY ABOUT THE CROSSMATCH. DR. HANSEN I’D BE CAREFUL SAM WITH HYPOTENSION AND UNCROSMATCHED BLOOD. YOU MAY DO HER IN. JUST PUSH THE FLUIDS, GIVE METHERGINE AND PITOCIN IN HIGH DOSAGES AFTER WE GET BABY OUT AND WE’LL LIVE WITH A LOW HEMATOCRIT FOR A BIT. GLENDA I DON’T KNOW DR. HANSEN. MY AIRWAY IS SECURE. BP IS COMING UP SLOWLY, AND SHE IS BEGINNING TO LOOK BETTER. SATS ARE IMPROVING. DR. HANSEN HANG IN THERE SAM - WE’RE APPLYING SUCTION AND FORCEPS TO THE HEAD - THIS KID IS HUGE. OK EVERYONE PUSH FROM ABOVE. 5
MELANIE OH MY GOD SAM THIS BABY DOESN’T BREATHE EITHER. I’M BAGGING THE INFANT - GET OVER HERE AND INTUBATE - THE HEART TONES ARE SLOW AND WEAK. HYPOXEMIA. KID IS BLUE AS CAN BE. LOW APGARS. SAM NOT BAD FOR A SURGICAL NURSE. OK TUBE IS IN 30 - 40 BREATHS PER MINUTE - 100 % OXYGEN - KEEP BABY WARM - GET AN UMBILICAL LINE READY. GLENDA WE CAN’T STOP MOM’S BLEEDING - HERE IS O NEGATIVE BLOOD, HEMABATE, AND FFP AND PLATELETS ARE ON THE WAY. THIS IS QUITE AN ABRUPTION. DR. HANSEN I DON’T SEE PROGRESS HERE. THIS UTERUS IS MASSIVELY BLEEDING - WE NEED TO MAKE A DECISION WHETHER TO KEEP IT. SAM MY BLOOD PRESSURE IS AWFUL - 50S - TAKE IT - WE NEED TO SAVE LIVES HERE. DR. HANSEN OK - I’M CLAMPING THE LIGAMENTS AND REMOVING THIS UTERUS IN 5 MINUTES. THIS WILL BE TOUGH BUT IT LOOKS LIKE THE BABY IS COMING AROUND. WE HAVE NO CHOICE. SAM THERE GOES MY VITALS - GIVE ME AN AMP OF EPI, BEGIN AN EPI DRIP, GET THE LEVEL ONE TRANSFUSION DEVICE UP HERE - WE’RE IN A WORLD OF HURT. GLENDA I’VE CALLED FOR MORE ANESTHESIA SUPPORT. THEY ARE ALL TIED UP. SAM WE JUST KEEP FIGHTING AND EVENTUALLY WE WILL WIN THE BATTLE - MOM’S VITALS ARE RETURNING. THE UTERUS IS COMING OUT. BLOOD LOSS IS ENDING AND BLOOD REPLACEMENT IS GOING IN. WE’RE ON THE MEND. MELANIE I HOPE SO - I’VE HAD ENOUGH EXCITEMENT FOR A YEAR JUST TODAY - WITH THAT TRAUMA DOWNSTAIRS AND NOW THIS SECTION. MAYBE I SHOULD BE A PREOP NURSE.
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DR. HANSEN THAT IS PRETTY SOFT STUFF MELANIE. YOU’D BE BORED........ WE ARE CLOSING UP. MELANIE GOOD JOB SAM. SAM SAME TO YOU MELANIE. DR. HANSEN I’M OUT OF HERE. REPLACE ALL MOM’S BLOOD PRODUCTS SAM AND GET HER TO THE ICU DIRECTLY. CALL THE INTENSIVIST. I MAY GO TO A BULLS GAME THIS WEEKEND - IT’S HARD FOR ME TO GO TO CHICAGO STADIUM AFTER LAST YEAR MELANIE BUT WE HAVE ROSE - WE WON A ONE POINTER THIS WEEK AND I THINK THINGS ARE ON THE MEND. GLENDA MY KIDS ARE BEGINNING TO SHOW INTEREST IN GOING TO SOME GAMES - BUT AFTER THAT 42 POINT LOSS RECENTLY - I JUST DON’T KNOW. THINGS WILL NEVER BE THE SAME AGAIN AFTER JORDANS LEFT TOWN - NOTHING LASTS FOREVER. GOOD JOB EVERYONE. MELANIE WELL THIS NEW CREW OF COACHES, TRAINERS, NUTRITIONISTS, PLAYERS, WELL THE WHOLE THING SHOULD BE REFRESHING THIS YEAR. SAM I DON’T KNOW IF THE BULLS CAN QUITE GET OVER THE HUMP. I THINK WE CAN - WE JUST CANNOT HAVE THE LONG LOSING STREAKS WHERE EVERYONE GETS ETERNALLY FRUSTRATED. MELANIE WELL WITH VINNY AS HEAD COACH AND HARRIS, BICKERSTAFF, OCIEPKA, MYERS, AND WILHELM AS ASSISTANTS - WE SHOULD HAVE GREAT TEAM WORK AND CHEMISTRY. SAM I AGREE - BUT SPECIFIC GUYS LIKE NOCIONI, SEFOLOSHA, SIMMONS, THOMAS, RUFFINS, HUNTER, ALL GOOD PLAYERS WHO COME OFF THE BENCH FOR A SPARK. THEY ALL NEED TO REALLY STEP UP. NOT JUST COLLECT A PAYCHECK. FIGHT FOR MORE PLAYING TIME. GLENDA HOW MANY OF THESE GUYS WALK DOWN THE FLOOR ? 7
MELANIE I DON’T THINK THEY WILL THIS YEAR - IN FACT I’VE SEEN THE BULLS WITH ROSE HUSTLING MORE THAN THEY EVER HAVE IN YEARS. WE CAN PLAY - WE JUST NEED AN ENTIRE TEAM EFFORT. SAM WELL WE’LL SEE WHAT HAPPENS. THE SCORING AND DEFENSE STILL NEED TO IMPROVE TO TAKE ON LA O.R. BOSTON - THE LEADING TEAMS. MELANIE WE WILL SEE - WE CAN ONLY GO, PRAY, AND ROOT FOR OUR BULLS TEAM. I MEAN IN WINTER WHAT ELSE IS THERE TO DO IN CHICAGO. DR. HANSEN I FORGOT MY BEEPER. IT’S SAD WE DON’T HAVE A BOERWINKLE ON THE TEAM - THE 7 FOOTER FROM TENNESSEE - WHO STILL HOLDS THE ALL TIME BULLS REBOUNDING RECORD OVER A 10 YEAR SPAN. SAM YES - HE WAS GREAT MY PARENTS SAID - COULDN’T SHOOT, PASS, RUN, O.R. DRIBBLE - BUT HE COULD CERTAINLY REBOUND. NOT A BAD JUMPER FOR HIS DAY. GLENDA THIS GUY NOAH WON’T BE A BOERWINKLE - BOERWINKLE WAS SO DOMINANT BACK IN THE 60S AND 70S - WE DON’T HAVE TOUGH GUYS LIKE VAN LIRE O.R. SLOAN - O.R. A SHOOTER LIKE BOB LOVE. MELANIE THAT IS SOMEWHAT ANCIENT HISTORY GUYS. WE NEED TO RAMP UP WITH TODAY’S GAME - WHO DO WE HAVE TO TRADE BASKETS WITH KOBY, O.R. PIERCE O.R. NASH ? WE JUST DON’T HAVE THE FIREPOWER. SAM HUGHES AND DENG CAN SCORE IN BUNCHES - BUT HECK - THEY ARE ALWAYS HURT O.R. THEIR HEADS AREN’T INTO THE GAME. GLENDA BUT THESE OLDER GUYS DEFINE CHICAGO BASKETBALL. TOUGHNESS. REMEMBER CHET WALKER - TOUGH. MELANIE I DIDN’T REALIZE YOU WERE SO INTO THE BULLS GLENDA ?
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GLENDA WHAT ELSE CAN YOU DO IN A CHICAGO WINTER - I GUESS GO UP ACROSS THE BORDER, GO TO ALPINE VALLEY - SKI A BIT AND FREEZE YOUR RUMP OFF. SAM WOW - GLENDA - YOU ARE REALLY OPENING UP. GLENDA WELL I WAS YOUNG ONCE AND WE WENT THROUGH WINTERS IN CHICAGO JUST LIKE YOU GUYS - WE ALL HAD FUN. I THINK THE ENTIRE SURGICAL GROUP SHOULD GO UP TO LAKE GENEVA AND ALPINE VALLEY FOR A WEEKEND - WOULD BE A GREAT TRIP FOR MORALE - NOT MORALS. MELANIE OK - I’LL PLAN IT - A COOK COUNTY SURGICAL CREW WINTER GET AWAY TO WISCONSIN. SOUNDS FUN - I’LL SEND OUT A FLYER TOMORROW. MAYBE WE’LL SPLIT A 4 DAY SPAN SO EVERYONE CAN GET AT LEAST TWO DAYS IN. COMING GLENDA ? GLENDA I MAY - DEPENDS IF THE BEARS ARE IN THE PLAYOFFS. DR. HANSEN SO YOU ARE A BEAR FAN ALSO GLENDA ? GLENDA I NEVER MISS A GAME. NEVER ! SAM SO DO YOU THINK WE WILL MAKE THE PLAYOFFS THIS YEAR GLENDA - SINCE YOU ARE NOW OUR SECRET SUPER SPORTS NURSE. GLENDA IT WILL COME DOWN TO THE LAST SUNDAY OF THE SEASON - WE NEED TO WIN RIGHT NOW AND PUT IT AWAY. I’M MORE WORRIED ABOUT MINNESOTA THAN GREEN BAY. BUT YOU NEVER KNOW. A ONE GAME LEAD IS NOTHING AND THE PACKERS HAVE A TIE BREAKER OVER US - WITH THE BEARS GETTING BLOWN OUT A WEEK AGO BY THE PACK. MELANIE I’M UNEASY ABOUT THE BEARS - STILL NO CONSISTENT QB PLAY - EVEN THOUGH O.R. TON HAS BEEN SOMEWHAT BETTER. OUR DEFENSE HAS BEEN A TOUCH INCONSISTENT. SAM BUT FORTE AND PETERSON HAVE BEEN REALLY GOOD RUNNERS THIS YEAR. I KNOW VASHER IS OUT FOR THE 9
SEASON WITH A FRACTURE AGAINST THE RAMS. HOWEVER WE ARE GETTING HESTER INVOLVED OFFENSIVELY. NO ONE WILL KICK TO HIM WITH THE GAME ON THE LINE. GLENDA YES - O.R. TON HASN’T BLOWN GAMES - HE IS REALLY GOOD AT NOT THROWING TO THE OTHER TEAM - 185 CONSECUTIVE PASSES WITHOUT AN INTERCEPTION - A NEW BEARS RECORD. MELANIE I WAS ALWAYS ON THE EDGE OF MY SEAT HOLDING MY BREATH WHEN REX WAS THROWING. HE COULD MAKE A HAND OFF EXCITING. GLENDA YOU SEE - WE HAVE ALL THESE GREAT TEAMS IN CHICAGO - COMBINED WITH A SKI TRIP TO ALPINE VALLEY - AND IT’S A GOOD CHICAGO WINTER. WITHOUT QUESTION SUMMER IS CHICAGO - CUBS, SOX, AND TONS OF FESTIVALS DOWNTOWN. THE BEST ANYWHERE. MELANIE MAYBE WE SHOULD ALL HIBERNATE IN WINTER HERE. SAM WE CAN ALL JUST HANG OUT AT WEAGHMAN’S PARK ALL WINTER - THAT WOULD SOLVE ALL OF OUR PROBLEMS. MELANIE RIGHT SAM - ISN’T THAT WHERE YOU MET KERI ? GOOD BYE DR. HANSEN - SEE YOU TOMORROW - ONLY ONE BIG CASE A WHIPPLE. DR. HANSEN GO TO ALPINE VALLEY - ENJOY CHICAGO EVEN IN THE WINTER - AND GO SOX. SAM GET OUT OF HERE QUICKLY - THE SOX ARE NOT EVEN WORTH DISCUSSING. DR. HANSEN WE DO BETTER IN THE PLAYOFFS THAN THE CUBS I’D SAY. I’LL ARGUE THIS TOMORROW. THE LEGACY WITH THE SOX IS MUCH STRONGER THAN THE CUBS. SAM WE NEED TO WORK ON HANSEN.
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MELANIE NO KIDDING. AND EVERYTHING ABOUT THE SOX REALLY SUCKS. GLENDA OK - I GET IT - THE 20 SOMETHING WEAGHMAN’S PARK GANG OVER NEAR WRIGLEY IS SO ONE SIDED CUBBIES. I TREASURE ALL OF CHICAGO BASEBALL. WE REALLY HAVE A GOOD THING GOING HERE IN CHICAGO WITH THE TWO TEAMS. CONSTANT BATTLE. MELANIE BUT GLENDA - THOSE SOX FANS ARE SUCH DESPICABLE PEOPLE, OZZIE IS A NUT, AND THEY CAN ONLY BUY PLAYERS - NO FARM SYSTEM. SAM THAT MAY BE A BIT ELITIST MELANIE. MELANIE I’M JUST TELLING IT LIKE IT IS. LOOK AT THOSE PEOPLE WITH THEIR PATHETIC MANNERS WHEN THEY COME TO WRIGLEY. NO ONE CAN DENY THAT THESE FOLKS ARE RIFFRAFF. GLENDA ONE MUST BE CAREFUL MELANIE - LOTS OF FOLKS AROUND HERE GREW UP WITH THIS SOX TEAM, AND YOU MAY REALLY REGRET SOME SPOKEN TONGUE IN THE PRESENCE OF SOME OF THESE SOUTH SIDERS. MELANIE I DOUBT IT - I’M OUT OF HERE.
End-Chapter 3, cold rooms
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