Chapter 3
Serious but stable.
Dr. Luna's words still ring in my mind while I stand outside of the operating theater.
Inside, all the equipment, including the table on which dad is lying, has been covered by plastic. Even the poles holding the IV solutions are wrapped to prevent the fast-corroding agent that contaminated the well from ravaging everything in this room. Failure to protect the material could cost the patient's life and neutralize the hospital. I'm well aware of that, but seeing the red biosafety signs and the improvised decontamination zone inside the O.R. is scarier to see than I thought it would be.
"We're keeping your father in there until the inflammation and the infection have reduced enough to allow us to properly clean all the metallic shards from his wound. He is lucky that the rod held tight for so long."
Dr. Luna's grave, confident voice gives me just enough sense of control to stay on my feet as he helps me put on all the ppe above my surgical scrubs.
"Dr. Yates and nurse Hathaway will monitor him closely all night. He's in excellent hands." The chief of surgery gives my shoulder a slight squeeze. "You're all set, Dr. Robinson."
"Thank you, Dr. Luna. Thank you for coming with Victor."
With my elbow, I push open the curtain and step inside the operating theater. Instantly, my jaw clenches like a clamp. Here I am, breathing through a straw again. Under the crude light, Dad looks even worse than he did when they pulled him out of the well. Calm down. He's alive.
He is still intubated and a drainage catheter, protruding from under the gauzes covering his abdomen, sucks a yellow-pink-red mix of pus and blood into a collection bag secured to the frame of the table. It's half full. Ice packs have been placed on his body to lower his temperature (How high did it go?). A blue sheet has been thrown across his hips. His skin is a patchwork of deathly paleness, black grime, and dark red dried blood, especially on his stomach and left thigh. Nurse Hathaway is busy cleaning him up after the surgery. The washcloth in her hand comes out a darker brown after each swipe on his head, face, and neck. So much dirt.
His back turned to me, the chief anesthesiologist is listening to dad's lungs with his stethoscope. He glances over his shoulder quickly. "Dr. Robinson, please, join us. We're just starting to wake your father up."
"I'm Julia, this is Dr. Yates," the nurse says as I approach closer. "He's a bit bossy and arrogant, but he doesn't bite. Although he'll try to get you to do your internship in anesthesiology. Don't let yourself be impressed, by him or Dr. Luna," she adds quietly.
"I heard you, nurse Hathaway," Dr. Yates says.
"I know, dear," Julia says, pressing the cloth gently on Dad's forehead as she tries to dislodge dirt encrusted in a bruise.
Concerned, I step closer.
And all my relief at seeing him stable goes in the trash.
How many times can he hit his head without developing chronic traumatic encephalopathy?
As soon as I think about this disease, my brain automatically starts screening for symptoms like impaired judgment– does not calling for our birthdays and abandoning us be an early sign? But I know it's unlikely. No, he doesn't have CTE. For once, I would have noticed any significant memory loss and confusion over the last seven months. He never experienced mood swings either and never raises his voice, no matter what. He is the most emotionally stable man on Earth, or wherever we are now.
"Which specialty you choose is your choice alone," Julia adds.
"I'm already accepted in pediatrics."
Dr. Yates casts me a sideways glance. "My patients breathe gasses, Dr. Robinson, not me, and I can inform you, that this man whom you intubated a few hours ago – on your first try I was told – is way older than eighteen."
"Can I see his chart?" I blurt. "Please?"
The Chief anesthesiologist stares at me seriously for a few seconds before nodding at the nurse. Julia grabs the tablet on the side table and holds it out to me. "Thanks."
A single glance at the numbers and my diaphragm locks. There's not one value in a normal range. His temperature nearly reached 106 and his heart rate dropped below 40 twice.
"Breathe, Dr. Robinson," Dr. Yates says, "Don't forget to breathe."
Breathe, sure. All that fright wasn't just in my head. We truly averted a catastrophe today.
While Dr. Yates focuses on listening to Dad's lungs, I take his hand in mine and give it a gentle squeeze. His fingers twitch but there's no strength in them yet. He was wearing thick gloves but the blood soaked through anyway.
In my need to feel useful, I put down the tablet on the table on my right, tear open a wash bag and pour the antiseptic lotion on the cloth.
"During transport, you told Dr. Luna that your father suffered a bronchospasm a few days ago. But there's no mention of asthma in his medical profile," Dr. Yates says while I start cleaning dad's fingers.
"He was exposed to a sub-freezing toxic atmosphere briefly twice in the past week."
"How toxic?"
"About 92% nitrogen, 6.5% methane, the rest hydrogen cyanide and benzene. Oxygen therapy eased all symptoms after a few hours both times. Is there anything wrong with his lungs?" I ask, suddenly concerned, but Dr. Yates is too focused to answer, and when he talks again, it's to ask me a quiz question:
"Dr. Robinson, could you tell me what the main peripheral pulses are?"
A quizz? Now, really?
"Temporal, carotid, apical, brachial, radial, femoral, popliteal, Posterior Tibial, and Dorsalis Pedis," I answer quickly.
"Excellent. Would you please check the apical."
The request catches me off guard. "Er… I don't have a stethoscope." Julia scurries to the shelves at the back of the room and returns with one. "Thanks."
Okay. I gently press a finger on Dad's neck. Locate the sternal notch, here. Angle of Louis. Here. Second intercostal, then fifth. Midclavicular line. "I've got it." I look up at the digital clock above the shelves and start counting for a full minute. "79 bpm, but..." I hesitate slightly as I move the stethoscope and listens some more.
"But?" Dr. Yates asks.
"Diminished sounds on the left lung and a grating sound on the right."
"There were grating sounds on his left, too, just before you came in. Which means?"
My mouth opens slackly as my heart starts pounding faster. Oh no.
"Developing pleural effusion on the left lung and perhaps pleurisy on the right lung."
Dr. Yates nods gravely. "Excellent, Dr. Robinson. Let's check this diagnosis before we extubate your father, and let's do this fast because he's going to wake up and he's not going to like this at all. Nurse Hathaway?"
"I'm on it." Julia throws her washcloth in the biosafety trash, changes her gloves, then rolls the portable ultrasound machine from the right corner of the room. As she pours gel on the transducer, I walk around Dad to have a better view of the screen.
I hadn't expected this development and it scares me. Dad really doesn't need this. But breathing dust – infected or not with an alien pathogen – for four hours could have caused an inflammation. Or did I miss something when I auscultated him two days ago? I should have checked his lungs again before letting him go to that dusty drill site.
The first view of his right lung appears on the screen.
Breathe.
"Dr. Luna had only praise for you during the surgery, you know," the chief anesthesiologist says while Julia moves the transducer on Dad's chest. "The most steady hands under pressure he'd ever seen, he said. That's no small feat, Dr. Robinson, to impress our Chief of surgery on your first day back. But if I may say so, beware of the man. Like all charismatic speakers, you listen to him and the next thing you know, you're performing open heart surgery."
"And here he goes…" Julia mutters, glancing from Dad's chest to the black and white video on the screen while Dr. Yates stands behind her, arms crossed over his chest, staring straight at the ultrasound image.
"Don't get me wrong. Surgery is a very noble specialty but they cannot do anything without us anesthesiologists."
"Unless it's the other way around..." Julia muses.
"We are the last friendly face the patient sees before going under and the first they see when they wake up. After the anesthesiologist nurse, it's the most human position to occupy in an operating room."
"Oh, so nice of you to say, Dr. Yates."
"We are here before, during, and after, when our patients are at their most vulnerable. Surgeons come after the patient is sedated, show off their skills, then leave before they wake up. They're highly specialized mechanics with as much empathy as a spark plug."
"Pray Dr. Luna doesn't hear you say that."
"Spark plug?" I ask as Dr. Yates unfolds his arms and leans closer to the screen for a few seconds, then stands back again.
"Old car mechanics term. And Steven knows exactly what I think of his discipline because I told him the day I declined to follow in his glory. The truth is, no matter how much progress we've made, and all the technology we have to make our job easier and more efficient, at the end of the day, the pain, emotional and physical, is the same as it was when man first walked the Earth. Hold it there for a sec," the Chief anesthesiologist says suddenly.
Dad's fingers twitch in my hand. We all freeze, watching his eyelids flutter for a few seconds. After we all exchange a tense glance, Julia resumes the ultrasound.
"Go down a little but be careful with his ribs," Dr. Yates says.
"There's a problem with his ribs?" I ask.
"His X-rays showed hairline fractures on his right 5th and 6th which I don't quite understand considering the angle of impalement. Any idea how he did that?"
I look at the bruise on his right side and realize that it is indeed a few days old already. Why didn't he show me this? I would have done X-rays sooner and, between that and his lungs, I would have forbidden any physical activity for three weeks. He wouldn't have gone into the well. Damn him. "He fell from a mast four days ago."
"A mast? As in a sailboat mast?" Dr. Yates asks, his keen eyes bulging above his mask.
"Long story…"
"How high?"
"Fifteen feet."
"All right. So two falls in a week. Your father lives a dangerous life, Dr. Robinson."
You have no idea. "He was a Navy Seal. Back on Earth."
"Better and better. But at least that explains why he has GSW scars on his left arm."
"What? This? No. This is from a vaccine he got in the Navy. He never got shot."
Julia and Dr. Yates both stare at me like I said the dumbest thing they ever heard before refocusing on the ultrasound images.
"First year interns…" The chief anesthesiologist mutters.
"I found another one on his right thigh earlier," Julia says, "Entry, no exit."
You've got to be kidding me... Dad got shot twice and I didn't know it? I mean... Mom had to know and I understand that they wouldn't tell Penny or Will. But me? Why?!
"Here," Dr. Yates says. "What do you see, Dr. Robinson?"
"Er…" I quickly look back at the screen. Oh no… "That's pleurisy."
"Yes, it is." Dr. Yates nods in concern as Julia investigates how widespread it is. Not too much, thankfully. "All right. Let's examine his left lung before he wakes up."
Dad's hand relaxes as Julia moves the transducer away from his bruised ribs.
"What attracted you to medicine, Dr. Robinson?" Dr. Yates asks while the nurse resumes her exam.
"I wanted to save people. Why?"
"I don't know. Perhaps because your father has, or had, a violent job, and medicine can be violent too. It's two tough career choices. Emotionally speaking, and physically as well. You can't stop in the middle of an operation because you're tired or you want to go home to your family. As your father's responsibility was to his team, yours will be to your patients. And it gets tough sometimes."
"I know what sacrifice is, Dr. Yates."
"Because you lived it, yes. That's what makes your dedication to this career interesting and valuable, and makes me wonder why you choose pediatrics over surgery. You were offered a spot in surgery, am I right?"
"Yes but how do you know?"
"Quite simply, Dr. Robinson, I was on the selecting committee."
"Oh." Of course. That makes sense. And it explains why I feel like I'm being evaluated since I stepped in the O.R.. Although thinking about my career right now doesn't seem the best moment. Even if Dr. Yates does think it is.
"If you asked me why I chose anesthesiology over surgery, I would tell you that, though surgery can be a very gratifying occupation, the patient only remembers the one friendly face they see when they wake up. And when you make eye contact with them at that instant, you see their soul and they see yours. Not everybody is strong enough to be reminded of their own vulnerability every single day. Not even a larger-than-life man like Dr. Luna."
Dr. Yates's low, controlled voice calms my nerves but his words chill my heart. What Dad lived through down there, trapped alone in that well for hours, must have made him feel terribly vulnerable, and he is even now. Medically speaking, a deep, open wound is at risk of surinfection. All this plastic around us is finally deeply reassuring.
"Are you calling Dr. Luna a wimp?" Julia asks.
"He admitted it one evening, after a few beers," Dr. Yates continues, "Before calling me an overpriced bartender."
"A bartender?"
"Yes, Dr. Robinson. A bartender. Can you believe this? Although, he was right. Being around people who wake up from anesthesia, is indeed very much like being behind a counter: some patients, they're happy to wake up and eager to share their joy with everyone around them. Some are sad–"
"Some vomit," Julia adds.
"Some are just totally dazed. They can't help it. It's just the effects of the drugs we gave them on their body. We poured the sleepy potion. So, yes, we are responsible for their emotions at that moment. We reassure them, we listen to them, we talk to them–"
"What is said in PACU stays in PACU. His right lung seems clear."
"I know what I've stopped hearing. Place the transducer further to his side, between his fifth and sixth ribs."
Julia puts some more gel on the transducer.
"Most have been NPO for at least half a day if not more, so the first thing that starts thinking is their stomach. We have a bet running. How many burgers will be asked for each week. What do you think your father will ask for, Dr. Robinson? Is he a burger or a steak type of man?"
"Steak, I think."
"Oh, an aggressive one. But I guess that's part of the job description. I, personally, would be the salad type."
"I've never heard anyone asking for a salad," Julia says as she stretches her arm to reach dad's other side.
"That's exactly why I would ask for it. Stop right here!"
Along with Dr. Yates, I lean closer to the screen again. It's small but it's there.
"Help me put him on his right side," Dr. Yates asks as he grabs Dad's left arm.
Quickly, Julia sets down the transducer and positions herself behind Dad's head.
"Dr. Robinson, your job is to make sure the drainage catheter doesn't go out. Ready? At three. One, two, three."
We're barely done securing Dad on his side when a gagging sound escapes from his throat.
Oh no, no, no. His eyes are wide open. "Dr. Yates!" I call as I try to keep him from pulling the tube out.
"Don't let go of the drain!" The chief anesthesiologist urges me as he grabs Dad's arm again. "John. I need you to listen to me. I know that tube in your throat is unpleasant but I must ask you not to pull it out or you're going to injure yourself. Do you understand?"
Grabbing at Dr. Yates's arm, Dad's eyes squeeze tight as he gags and coughs. His face is turning red and shivers shake his body.
"Dad, please, listen to me, do not fight the tube. Breathe with it." I turn my head toward Dr. Yates. "Should we put him under again?"
"Julia, 10mg Diazepam, IV. Quickly."
"I'm on it," she says as Dad regains control of his legs and frees his arm again. Dr. Yates holds him tighter. "John, please, calm down. Dr. Robinson, I need you to talk to your father. Reassure him, calm him down."
After injecting the anxiolytic in the IV line, Julia puts her hand on mine. "I'll hold the catheter, come over in front of him."
We quickly exchange places.
Dad's eyes are darting all around the room. I put my hand on his face and force him to look straight at me.
"Dad, look at me. Look at me. I'm here, I'm right here, look at me. Don't fight the ventilator. Just breathe with it."
We lock eyes, and I see pain, confusion, and fear, and that hits me right in the gut.
Fear and Dad are two words that I have never associated before. Fearless and Dad, yes, those two go together. Along with tough, solid, and robust.
"Dad, just calm down, I know you can," I tell him as his movements become more sluggish. "That's it, just breathe. You're doing fine."
"Tell him I'm going to extubate him and he needs to lie as still as possible," Dr. Yates whispers to me.
As I transmit the message, Julia taps my shoulder and hands me a few gauze pads that I use to clean Dad's chin.
"Here we go. Tell him to exhale deeply."
The next few minutes make my heart ache as I watch him struggling to breathe through painful coughs and gags after the removal of the tube. All that dust he breathed in the well is getting out now.
"It's done…It's okay, just breathe normally now," I say while Julia injects a non-opioid analgesic in his IV line, and Dr. Yates places a high-flow mask on his face. Dead worried, I look at the screen displaying his vitals. His oxygen is not good.
Just breathe. That's what he kept on telling me after the robot pulled me out of the ice. Just breathe.
And now I'm telling him the same thing, stroking his head like he did for me, to calm me down as I struggled to breathe and stop from crying after almost suffocating to death in the ice. Tears sting my eyes and I force the painful memory away. I keep my hand on his face to tell him I'm here, although I wonder if the gesture doesn't reassure me more than him.
After two long minutes, the crisis ebbs and his spO2 climbs back to 94 and stabilizes at 97 a few seconds later.
A sigh of relief escapes all our lips.
"We're not done yet," Dr. Yates warns.
As Julia returns to the ultrasound machine, I shudder. Can't he rest a little first?
"I'm sorry, John, it's going to be cold on your back," Julia gently says as she pours gel on the transducer again.
Dad's back arches at the touch and his eyes open wide again. Panic fills them once more as he lets go of my hand and reaches for the bed sheet.
I quickly cover him up to his stomach and press a firm hand on him to keep the bed sheet from sliding again. "You're doing okay. You're going to feel much better very soon."
He raises his hand to his face and dislodges his mask.
I bend toward him to understand what he's saying. "What's with all the plastic?" I ask for confirmation as I replace his mask.
He blinks.
"The drill collapsed because of a waterborne agent that causes metal to break down. The rod you impaled on was contaminated so we don't want this agent to spread in the hospital. That's why there's plastic everywhere and why we're all dressed up. Don't worry about that, okay? It's just protocol."
No blink.
"You remember falling in the well?"
One blink. And a wince of pain. The nurse is pressing the transducer between his ribs.
As I look over my shoulder, I catch them looking at the ultrasound images, Dr. Yates, intense, Julia, worried.
"Keep talking to him, please," Dr. Yates tells me.
Dad is looking at them too, tears of pain in his eyes.
"You're okay. Don't worry. Dr. Yates is just checking that you didn't hurt your lungs in your fall. It's just a precaution. You breathed in a lot of dust. It inflamed your lungs and that's what makes you cough so hard."
He removes his mask once more. "It hurts…"
"Where?"
"Everywhere…"
"We'll give you something stronger for the pain very soon, John, but for now, I need you to try to hold your breath once more," Dr. Yates says. "When you're ready. Take your time. We don't want to trigger another cough, all right?"
As Dad nods, I quickly turn my head so he cannot see my tears. I can't let my emotions take over right now. I'll cry later. Right now, he needs me to be strong and be with him.
Fortunately, Dr. Yates and Julia didn't notice my sudden turmoil. After taking a deep breath, I look at Dad again, resuming stroking his face.
"Hey… do you remember when we removed the training wheels on my bike? And I fell so often that I didn't want to hear about it anymore?"
A blink. And tears.
"You told me back then that some things don't come easy, but that doesn't mean you give up. And you kept running next to me for days until I built up my strength and confidence and I finally got it. Like you knew I would. Now it's my turn to stand next to you, and like you back then, I know that you're going to be okay even if you don't feel like it right now. So you trust me when I tell you that everything is going to be fine, all right?"
One more blink and more tears. But his breathing, though still raspy, is slowing down. He tries to dislodge the mask again.
"Did I poop..."
Dr. Yates straightens. "First time I hear this."
An irresistible urge to laugh seizes me. I can't believe Dad has the strength to joke in the middle of all this. "No, you didn't poop out on me, old man. You're still ticking."
"Good… 'cause Navy Seals–" A cough interrupts him. "Don't poop…" More coughing. And his heart rate spikes above a 100 again.
"Hey, hey, just breathe," I tell him as Dr. Yates squeezes his shoulder.
"Why don't you let your daughter do all the talking for the next few minutes? If you want to communicate, one blink for yes, two for no, all right?"
A tearful blink.
"Awesome. You're doing great, John," the chief anesthesiologist encourages. Although I know that aside from being positive to reassure my father, the chief anesthesiologist is also checking for any degradation in Dad's level of consciousness.
"Just breathe slowly and it's going to be okay," I remind him after placing his mask back over his face.
He nods then squeezes his eyes tight again, wincing of pain.
Fighting an urge to check if the ultrasound images are easier to interpret now that Dad is calm, I keep stroking his face, now thinking about the times when Will was sick. Doesn't matter how old you are, there are moments in life where you need to be cuddled and have someone take your hand, even former elite soldiers that seem otherwise as tough and insensitive as a brick wall.
"Okay. Let's do a thoracentesis." I hear the Chief anesthesiologist whisper to the nurse. Then, as he steps closer to me and Dad. "You're doing well, John, but after your exposure to a freezing, toxic atmosphere, breathing all that dust caused a bit of inflammation in your lungs and fluid buildup in your pleural cavity. There's not much but that's what makes breathing hard and painful. Now I'm sure you've helped your daughter do her homeworks when she was younger and you did a great job, so what do you think about bringing parental duty to the next stage?"
A blink.
"Excellent. Dr. Robinson, will you please explain the procedure to your father before we begin?"
Explain? Right. Okay. Thoracentesis. Thank god that's one that can be done under local anesthetic. While Dr. Yates and Julia prepare the material, I recite my lesson, but I'm not sure Dad hears me anymore. The Diazepam is taking effect, and so is the pain medication. He doesn't react this time when Julia presses the transducer on his back.
I'm staring intensely at the screen as Dr. Yates inserts the needle into my father's back and pushes it into the pleural cavity slowly but surely.
"You're in," I say with way too much excitement in my voice. It's improper. What am I doing here? I glance at Dad. He's still staring quietly at me but his eyes are glassier. Which is better. Maybe he won't even remember any of this. I really wish he won't.
Wow. I can see the liquid being sucked out of his pleural cavity. What color is it?
A minute later, Dr. Yates removes the needle from Dad's back and gives the syringe to Julia who sets it aside for analysis. The pain in my shoulder eases immediately. The fluid color, clear, pale yellow, is normal. No infection.
"You can lie down now, John. You did great," Dr. Yates finally announces with audible relief while Julia wipes the gel off Dad's back.
We set him up more comfortably. His eyes flutter a few times, then close.
Dr. Yates checks his lungs again with his stethoscope and nods in satisfaction. "Now that our patient is stable and resting, I'm going to take a small break, bring this to the lab, and find myself a coffee. Anyone want anything?"
"The usual for me," Julia replies while she replaces the hypotonic solution.
"And you Dr. Robinson?"
"Er… I'll take a coffee too, please."
"Cream and sugar?"
"Cream no sugar. Thank you."
"No worries. So, an usual for Nurse Hathaway, and cream no sugar for Dr. Robinson. I'll be back in fifteen minutes."
As Dr. Yates walks out of the isolation room, and I return to my father's side, Julia points her finger to the table frame and smiles. "Coughing is good for the body, eh?"
Oh, thank God! Feeling dead on my legs, I pull a chair from a corner next to Dad and collapse in it.
Working kidneys, no pneumothorax, an early detected pleural effusion and mild inflammation in his lungs that with proper treatment should resolve in a couple of days; heart rate, blood pressure, respiratory rate, oxygen, all in normal range. Save for his fever which refuses to go under 101.6, he's good. He already looks better than when I entered the room one hour ago.
Don't you ever dare scare me like that again, I reproach him silently as I watch him sleep.
He's never been sick. Not even a cold. When he took sick days, it was because one of us was ill, like when I was five and I'd caught that nasty cold at school. He'd stayed home with me for four days, which worried me because, at that age, I thought his job was to save us from bad guys. I remember asking him if he wasn't missing anything important for me at his job.
He'd said no, because he needed to take a break from diving anyway.
Why? I'd asked.
Because it's exhausting.
More than running?
Oh, yeah.
Why? I'd insisted on understanding and he'd ended up explaining dive tables and nitrogen narcosis. That's why he was taking a break and could watch over me. Come to think of it, that was my first physiology lesson.
I was little and he was a larger-than-life dad. How could I not admire him?
But why did he have to take a break from diving? He'd slept a lot those four days with me. We even made a contest of who would take the longest nap. He won. Mom had come home with Penny and asked who was watching who exactly. But he wasn't sick. Not runny-nose-coughing-sneezing-feverish sick at least. Was he?
Decompression sickness...
I turn toward the tablet on the table on my right. The answer is right there. Along with the report about his two gunshot wounds. His whole medical history. Which could help shed a light on his life.
As his doctor, the situation is not acceptable. However, as his daughter, he made it clear that he didn't want me to know this side of him.
Do I obey my father or do I take care of my patient?
After the last ten hours, the answer should be obvious. And yet, I'm uncertain.
All I know is that tonight, it's my turn to watch over him while he's sick. Tonight, it's my turn to care for my dad.