Cold Rooms - Chapter VIII

cold rooms

CHAPTER VIII - “REVIVAL” TIME: FALL 2009 SETTING: SAM MAXWELL, A SENIOR 20 SOMETHING ANESTHESIOLOGY GRADUATE RESIDENT AT COOK COUNTY HOSPITAL - CHICAGO, ILLINOIS HAS TAKEN A CAREER JOB ON THE NORTHSIDE OF CHICAGO AT LAKE FOREST HOSPITAL. SAM STRUGGLED DECIDING ON A CAREER PATH - BATTLING WITHIN HIS MIND BETWEEN A HIGH END SUBURBAN JOB VERSUS DOCTORS WITHOUT BORDERS. SAM STAYED ON AT COOK COUNTY WHERE HE IS CONTINUING HIS DOCTORS WITHOUT BORDERS WITHIN A CHICAGO WEEKEND MEDICAL SETTING AT COOK. SAM RECENLTY SPLIT WITH KERI, A LONG TIME GIRLFRIEND, WHO HE MET AT WEAGHMAN’S PARK. WEAGHMAN’S PARK IS 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 CHICAGO TOPICS. SAM

WOW...WHAT A HELLUVA SEASON THE BEARS ARE HAVING. DR.HANSON

YES I KNEW IT. DENVER GOT THE BETTER END OF THE DEAL WITH THE TRADE ORTON FOR CUTLER. SAM

AND WE LOSE A FIRST ROUND DRAFT PICK IN 2010 BECAUSE OF THIS ROTTEN TRADE. DR.HANSON

MY, LOVIE WILL BE STRUGGLING TO HANG ONTO HIS JOB. THERE IS LITTLE EMOTION ON THIS BEAR BENCH. PLAYOFFS ARE A LONG WAY OFF FOR THE BEARS. A FANTASY. SAM

IT SEEMS WE DON’T DO ANYTHING WELL CONSISTENTLY INCLUDING BLOCKING, TACKLING, CATCHING, AND..........

GLENDA

EVEN THE CHEERLEADERS SUCK THIS YEAR. THERE IS LITTLE EMOTION IN THEM AT SOLDIER FIELD. 2

SAM

SOLDIER FIELD HAS TO BE THE COLDEST PLACE IN ILLINOIS OTHER THAN THESE ORS AT COOK. DR.HANSON

WELL WE ARE GLAD YOU STAYED ON AND DID YOUR DOCTORS WITHOUT BORDERS IN CHICAGO. WERE YOU NOT DOING THAT FOR KERI? GLENDA

DR. HANSON, LET THE RESIDENTS CLOSE THE BELLY. YOU NEED TO QUIT ASKING PERSONAL MATTERS OF FORMER RESIDENTS WHO ARE NOW STAFF PHYSICIANS. THEY MAY LEAVE US. DR.HANSON

ALL I ASKED WAS ABOUT KERI. NOTHING MORE. SHE WAS ALL WE TALKED ABOUT LAST YEAR, AND NOW I DON’T HEAR HER NAME. GLENDA

WELL MAYBE IT IS OVER. SAM MAY HAVE MOVED ON. WE DON’T KNOW. SAM

KERI AND I ARE OVER AT LAST CHECK. GLENDA

SORRY TO HEAR THAT SAM. WHAT HAPPENED? SAM

OH IT WAS THE DOCTORS WITHOUT BORDERS STUFF, LIVING TOGETHER WITHOUT A COMMITMENT, AND JUST FUNDAMENTAL DIFFERENCES. DR.HANSON

BUT YOU ENDED UP IN LAKE FOREST HOSPITAL. LAKE FOREST IS UP AND COMING, BUSY, AND WITH SOME ADDED VERY GOOD STAFF PHYSICIANS. SAM

AGREED. KERI AND I WENT THROUGH A LONG BATTLE OVER THE DOCTORS WITHOUT BORDERS STUFF, AND I TOOK HER ADVICE THAT I’VE BEEN DOING DOCTORS WITHOUT BORDERS AT COOK COUNTY FOR YEARS. GLENDA

SAM, YOU ARE STILL DOING IT. NOT MANY PHYSICIANS WANT THESE WEEKEND COOK COUNTY TRAUMA SHIFTS. WE ARE GLAD YOU CAME BACK AS PRN* WEEKEND STAFF – HELPING THE RESIDENTS. *PRN = “AS NEEDED”

3

DR.HANSON

AMEN. WE COULD USE SOME MORE YOUNG BLOOD IN THESE COLD OR ROOMS. GUYS AND GALS THAT NEED TO BE MADE TOUGH FOR MEDICINE. GLENDA

YES I AGREE. AND MANY PHYSICIANS NEED TO MAINTAIN THEIR TOUGHNESS WITH THESE HORRENDOUS WEEKEND SHIFTS. SAM

SO WHY DO YOU AND DR. HANSON KEEP WORKING THESE DEMORALIZING SHIFTS AT COOK COUNTY ON WEEKENDS? DR.HANSON

WE JUST LOVE TAKING CARE OF POOR PEOPLE IN HIGH NEED OF GOOD SURGICAL CARE. IT IS MEDICINE’S HIGHEST HONOR - TO SERVE THE POOR. GLENDA

I’VE NEVER KNOWN ANYTHING ELSE. I’VE BEEN HERE AT COOK SINCE NURSING SCHOOL AND WOULD NOT PRACTICE ANYWHERE ELSE. THERE ARE PLENTY OF SOFT PLACES TO PRACTICE, BUT IT’S NOT MY STYLE. SAM

I JUST WISH THE BEARS WOULD BE AS TOUGH AS YOU TWO. THESE FRIGID OPERATING ROOMS ARE WHAT THE BEARS NEED TO TOUGHEN UP. DR.HANSON

I FRANKLY DON’T UNDERSTAND THIS TEAM. WE HAVE THE HORSES TO WIN. OUR CHEMISTRY IS SO BAD THOUGH. WE CANNOT STRING TOGETHER DRIVES COMBINING RUNNING AND PASSING. ALWAYS WAITING FOR HESTER TO MAKE A BIG PLAY. NO ONE HAS KICKED TO HIM FOR YEARS. GLENDA

I SEE THE BEARS OVERHAULING THE ENTIRE SYSTEM NEXT YEAR. THEY MAY EVEN DUMP CUTLER IF HE DOESN’T PRODUCE. HECK BEFORE THE SEASON GOT GOING HE WAS CRITICIZING MANY OF HIS OWN TEAMMATES. THAT IS A GOOD WAY TO START AND BRING ON A GOOD SEASON. SAM

I FEEL THE COACHES HAVE BEEN TOO LAX ON JAKE. COACHES NEED TO GET THE VERY BEST OUT OF PLAYERS. I DON’T SEE THAT HAPPENING WITH THE BEARS. DR.HANSON

ALL YOU 20 SOMETHINGS THAT HANG OUT AT WEAGHMAN’S PARK - THAT 20 SOMETHING WISCONSIN THEME BAR AT 4

CLARK AND ADDISON - PROBABLY FEEL THAT THE BEARS COACHES HAVEN’T BEEN GETTING IT DONE EITHER. GLENDA

LUKE BUTKUS CANNOT GET THAT OFFENSIVE LINE TO BLOCK IF HIS LIFE DEPENDS ON IT. I FEEL THEY NEED TO BRING DICK BUTKUS BACK. SAM

AND RON TURNER HASN’T BEEN THE OFFENSIVE GENIUS WITH THE BEARS HE IS PURPORTED TO BE. I DON’T GET IT WITH ALL THESE WEAPONS ...

DR.HANSON

YES WITH BENNETT, FORTE, OLSON, KNOX, AND HESTER WE HAVE ALL THE WEAPONS WE NEED TO CATCH PASSES. GLENDA

AND MATT FORTE HAS NEARLY 600 YARDS RUSHING. NOT BAD FOR A POWER RUNNER. SAM

I COULD DO WITHOUT ALL THE INTERCEPTIONS BY CUTLER. I FEEL HE SHOULD BE THROWING THE BALL AWAY MORE AND NOT TRYING TO SLICE IT IN BETWEEN DEFENSIVE BACKS. OUR QUARTERBACK COACH, PEP HAMILTON, SHOULD BE ALL OVER CUTLER LIKE THE VIKINGS ARE OVER FAVRE. IT IS NOT FREE REIGN OUT THERE. LOOK AT WHAT THE VIKES HAVE DONE WITH FAVRE. DR.HANSON

I AGREE FULLY. LOOK AT FAVRE TODAY. HE ONLY STRIKES WHEN THERE IS AN OPENING. NO MORE FORCED BALLS. SAM

THE VIKES ABSOLUTELY KILLED US THIS PAST GAME. IT WAS OVER AFTER THE NATIONAL ANTHEM. GLENDA

YES, THE BEARS WERE ACTING AS IF THEY WERE SCARED OF MINNESOTA. THIS IS RIDICULOUS. THIS IS THE SAME TEAM THAT DOMINATED NO ONE A YEAR OR TWO AGO. I WOULD HAVE RUN FORTE UP THE MIDDLE UNTIL HE WAS IN THE ICU. DR.HANSON

I GUESS THAT IS WHY YOU ARE NOT COACHING GLENDA. BUT I AGREE - IT HAS BEEN SO LONG SINCE WE HAVE HAD A WINNER AROUND HERE. I WOULD DO ANYTHING FOR CHICAGO TO HAVE A WINNER. LOVIE IS A DAMN GOOD COACH. HE ISN’T BEING BACKED BY POSITIVE PLAY HOWEVER; AND IN SOME GAMES HE ISN’T EVEN COMPETITIVE. THERE MAY BE WHOLESALE CHANGES COME JANUARY IF NOT BEFORE. 5

SAM

I JUST KNOW IN DENVER THAT THE BRONCO PLAYERS DESPITE CUTLER’S ABILITY - WERE NOT CRYING WHEN HE LEFT. GLENDA

URLACHER’S COMMENTS IMPLYING ORTON WAS MORE OF A WINNER THAN CUTLER REALLY MEANT SOMETHING. SAM

I THINK THAT WAS JUST FRUSTRATION. MY BEEPER JUST WENT OFF. WE HAVE A MULTI CAR COMING IN WITHIN 10 MINUTES. WE HAD BETTER PREPARE THE LEVEL ONE TRANSFUSOR AND CHECK OUR STATUS OF O NEGATIVE BLOOD AFTER THE LAST CASE. DR.HANSON

I JUST TALKED TO PATHOLOGY. THEY HAVE PLENTY OF ALL TYPES OF BLOOD, FRESH FROZEN PLASMA, PLATELETS, AND FACTOR VII CONCENTRATE - THE IRAQ MAGIC. GLENDA

BUT FACTOR VII IS $10,000 PER PATIENT. WE CANNOT AFFORD THIS AS A SOCIETY. SAM

ALL I KNOW IS THAT IT STOPS BLEEDING. WE EITHER PAY FOR THIS STUFF OR PATIENTS DIE FROM BLOOD LOSS COAGULOPATHY. DR.HANSON

AMEN. I’LL PAY IN TAXES FOR WHAT THIS STUFF COSTS. MANY CHICAGOANS ARE WALKING AROUND TODAY BECAUSE OF FACTOR VII. SAM

WELL THE FIRST VICTIM IS HERE FROM THE STEVENSON. HE IS COMING STRAIGHT TO THE OR. NO REST FOR THE WEARY. HERE WE GO. GLENDA

THE VITALS REALLY ARE NOT THERE. WE NEED CPR DRUGS SAM. DR.HANSON

I’LL HELP. I’VE GIVEN TWO AMPS OF EPI, FOUR UNITS OF O NEGATIVE BLOOD, AND WE ARE INFUSING SOME ALBUMIN FOR INTRAVASCULAR VOLUME EXPANSION. SAM

HE ISN’T OXYGENATING WELL. DR. HANSON I DON’T HAVE BREATH SOUNDS ON THE RIGHT. PLACE A CHEST TUBE AND OPEN THE BELLY. 6

GLENDA

WE HAVE NO CT SCAN TO ASSIST. THERE APPARENTLY WASN’T TIME. THIS IS LIKE OLD DAYS WHEN WE CLINICALLY HAD TO PRACTICE TRAUMA. DR.HANSON

IT MAY BE THE BEST. QUICKLY GRAB A COUPLE RESIDENTS FOR THE LONG BONE AND PELVIC FRACTURES IF WE CAN STABILIZE THIS PATIENT. I’M CLAMPING THE SPLENIC VESSELS AND PACKING THE LIVER. SAM

WE ARE STILL NOT OXYGENATING WELL. WE NEED TO CONSIDER LOOKING INTO HIS CHEST. THE RIGHT LUNG ISN’T EXPANDING DESPITE THE VENTILATORS POSITIVE END EXPIRATORY PRESSURE MAXIMIZED. DR.HANSON

I’LL HAVE THE CARDIAC FELLOW GET HIS FEET WET. GET IN THERE DOCTOR AND YOU’LL FIND A SUBSTANTIAL PULMONARY INJURY - POSSIBLY CARDIAC. GLENDA

IT USUALLY IS A MAJOR PULMONARY ARTERY AFTER WATCHING THESE FOR YEARS. YES THAT IS IT. I KNEW IT. WE’LL BE BETTER AFTER THIS VESSEL IS CLAMPED. YES. GREAT JOB. I CAN SEE SAM SMILING AS HIS OXIMETER SHOWS BETTER OXYGENATION READINGS. AGAIN GREAT JOB. SAM

DR. HANSON I FEEL WE SHOULD JUST STABILIZE THIS GUY INSTEAD OF MAJOR REPAIRS BY RESIDENTS ON HIS LONG BONES AND PELVIS. I DON’T FEEL HE’LL SURVIVE SURGERY FOR MANY MORE HOURS. DR.HANSON

YES, HIS PELVIS IS ALSO SMASHED. WE NEED TO GET HIM STABILIZED, STOP THE BLOOD LOSS AND GET HIM TO THE ICU. SAM

HANG ON - HE JUST WENT INTO VENTRICULAR TACHYCARDIA. GLENDA GET THE PADDLES. 360 JOULES - NO MESSING AROUND. GLENDA

CLEAR. SHOCK. DYSRHYTHMIA IS CLEARED. WHICH DO YOU WANT- AMIODARONE OR LIDOCAINE SAM? SAM

I’LL TAKE THE OLD STAND BY - LIDOCAINE.

7

GLENDA

2 MG. MINUTE DRIP SAM? SAM

NO 4 MG. MINUTE. THIS PATIENT IS IN AND OUT OF V - TACH. GLENDA

THERE HE GOES AGAIN. WE NEED TO SHOCK HIM. GIVE HIM SOME BICARB, EPI., AND MORE BLOOD. DR.HANSON

I’VE GOT TO GO BACK IN. THIS LIVER IS OOZING SO BADLY. MORE FFP, PLATELETS AND FACTOR VII. I DON’T CARE ABOUT THE COST. THIS GUY IS 31 YEARS OLD. WE REALLY NEED TO GIVE HIM THE REST OF HIS LIFE. I WON’T LET THIS GUY BLEED TO DEATH. JUST WON’T. STAY WITH HIM SAM. SAM

OK DR. HANSON. I’VE GOT TWO RESIDENTS IN HERE UP TO THEIR EARS IN THIS CASE. DR.HANSON

GET THOSE BLOOD PRODUCTS IN HERE. WE NEED TO KEEP THIS GUY’S CIRCULATION AND COAGULATION GOING. WE NEED TO REALLY STAY ON TOP OF THIS PATIENT. THE INTENSIVISTS WILL HAVE THEIR NIGHT OCCUPIED WITH THIS GUY. GLENDA

WHAT’S HIS PRESSURE SAM? SAM

IT IS DOWN AGAIN IN THE 60S. OUR FEMORAL LINE IS REALLY DAMPED. DR.HANSON

MORE VOLUME SAM. WE’LL CHASE IT OUT OF HIM LATER WITH LASIX BUT FOR NOW WE NEED INTRAVASCULAR VOLUME. SAM

HIS LUNGS ARE ALREADY WET. ALL WE CAN DO IS PEEP AND LASIX. KEEP THE VOLUME GOING. CHECK HIS ARTERIAL BLOOD GASES AGAIN. STAY WITH HIS ACIDOSIS. GLENDA

WE ARE CLIMBING. THE LEVEL ONE GIVES A UNIT OF BLOOD PER MINUTE. DR.HANSON

IS THE BLOOD WARM?

8

GLENDA

YES. AND WE ARE CHASING THIS WITH CALCIUM. DR.HANSON

GOOD. STAY WITH HIM. LET’S GET HIM TO THE ICU. CHEST TUBES ARE SECURED AND THE LIVER IS LOOKING BETTER. I SEE CLOT. SAM

I GUESS THIS IS DOCTORS WITHOUT BORDERS RIGHT HERE IN CHICAGO. GLENDA

I THINK THE RESIDENTS CAN GET THIS GUY TO THE UNIT. TIME FOR A COKE AND A SANDWICH. DR.HANSON

I’M HEADING HOME. MY SHIFT IS NEARLY DONE. I DON’T KNOW HOW MUCH LONGER I CAN DO THIS HIGH IMPACT BLUNT TRAUMA. IT WEARS ON YOU. BUT LOOKING BACK AT THINGS WE AS A TRAUMA SURGICAL TEAM COULDN’T HAVE DONE ANY BETTER. EVEN THOUGH WE WON’T SLEEP TONIGHT MUCH, WE WILL ALL KNOW THAT WHAT WE HAVE DONE HAS NO HIGHER CALLING. WE ARE DOING WHAT PHYSICIANS ARE SUPPOSED TO DO. SAM

NO DOUBT. WE MET A HIGHER CALLING WITH THIS PATIENT. STAYING AND PLANNING AHEAD WITH THE TRAUMA GOLDEN HOUR WITH THIS PATIENT REALLY HELPED. I COULD NOT BE HAPPIER. GLENDA

I AGREE. THIS WAS A REALLY TOUGH CASE. SENDING THIS GUY TO A CT SCAN WOULD HAVE PUT US THAT MUCH FURTHER BEHIND. SAM

THE CT MAY HAVE HELPED WITH THE EXTENSIVE LIVER AND LUNG INJURY. BUT I AGREE WE COULDN’T WAIT ANY LONGER AND HE WOULD HAVE DIED OF INTRAVASCULAR VOLUME DEPLETION. DR.HANSON

AGREED. EXPERIENCED TRAUMA SURGEONS DON’T REALLY NEED SCANS. TRAUMA SURGEONS DIAGNOSE AND TREAT DESPITE WHAT A CT SCAN SHOWS. GLENDA

I’M JUST GLAD THIS GUY MAY HAVE A FUTURE LIFE. LOOKING AT THESE FOLKS COMING BACK IN AFTER A YEAR OF TRAUMA REHAB FOR SOME SIMPLE PROCEDURES, IT IS REALLY AMAZING. THEY APPEAR AS IF NOTHING HAS HAPPENED. IT 9

APPEARS THAT THESE FOLKS REALIZE HOW PRECIOUS LIFE REALLY IS. DR.HANSON

AND HOW IT CAN LEAVE IN A MILLISECOND. SAM

I’VE SEEN ENOUGH. I’M HEADING HOME SOON ALSO. THE BEARS GET ST. LOUIS TOMORROW. HOPEFULLY THAT WILL RESULT IN A WIN. ALL THE RAMS HAVE IS STEPHEN JACKSON. MELANIE

BUT HE IS A TON TO BRING DOWN. SAM

MEL, WHAT ARE YOU DOING HERE? I THOUGHT YOU TOOK A JOB AT NORTHWESTERN? MELANIE

I DID. BUT I MISSED COOK. IT IS SO SOFT UP THERE. THEY ARE VERY BUSY IN MANY DEPARTMENTS - ESPECIALLY OB, BUT I’M A TRUE BLUE SURGICAL TRAUMA NURSE. SAM

LIKE GLENDA. MELANIE

TOTALLY. SAM

SO WHAT ARE YOUR SHIFTS? MELANIE

OH SINCE I CAME BACK I HAVE TO WORK MY WAY UP THE LADDER. I’M ON WEEKENDS AGAIN FOR A BIT UNTIL SOME OF THE WEEKDAY NURSES RETIRE OR MOVE ON. SAM

INTERESTING SINCE THAT IS MY SHIFT. MELANIE

WELL WE AGAIN WILL BE SEEING AND WORKING WITH EACH OTHER A TON. SAM

I CAN HANDLE THAT. MELANIE

I HOPE SO. DON’T WORRY ABOUT ME. I’LL LEAVE YOU ALONE. I KNOW YOU AND KERI ARE PROBABLY MARRIED BY NOW.

10

SAM

WELL WE ARE...............

MELANIE

NOT MARRIED? STILL LIVING TOGETHER NEAR WRIGLEY? SAM

YOU MUST NOT HAVE BEEN TO WEAGHMAN’S PARK RECENTLY. MELANIE

RIGHT. JOSH AND I HAD A THING GOING AND THEN POOF LIKE ALL OTHER GUYS WHEN THEY SEE IT GETTING SERIOUS THEY WIN THE 100 METER SPRINT. AMAZING HOW IMMATURE MOST GUYS ARE. SAM

WELL KERI AND I ARE NO LONGER. MELANIE

INTERESTING. IT IS A SMALL WORLD. I ACTUALLY HEARD THAT AT BERNIE’S ONE NIGHT, BUT I DIDN’T BELIEVE IT. \ I ALWAYS KNEW SHE WAS DATING AND MAYBE MARRYING UP. SAM

I CAN’T STOP GALS FROM HAVING CONSTANT TUSSLES. I REALIZE MOST OF YOUR SPECIES TAKES NO PRISONERS. MELANIE

I KNOW - WE ARE TRULY AWFUL. WELL ANYWAY MY BEEPER IS GOING OFF, YOU NEED TO GO HOME, AND IF I GET ANY SLEEP I HAVE AN EXTRA TICKET TO THE BEARS GAME. IT’S YOURS IF YOU CAN HANDLE IT. SAM

SOUNDS GOOD. I’LL SEE YOU AT THE FRONT MAIN GATE 15 MINUTES BEFORE THE GAME. MELANIE

BUT WE ARE NOT GOING TO WEAGHMAN’S PARK AFTER THE GAME. MAYBE BERNIE’S. SAM

GET SOME SLEEP. STAY WARM IN THOSE COLD ROOMS.

END - COLD ROOMS VIII

11