I waited for a while with Cindy, in the pre-op holding area, and then went back into Greg Rauscher's room to see how the case was going. Greg was still struggling to close that leak in the vena cava and the patient's blood pressure kept rising and falling as he placed the sutures, until at one point, completely exasperated, he threw a vascular clamp half-way across the room where it hit the wall and clanged onto the floor. It left a deep purple mark on the green tile wall, as if someone had smashed a bunch of grapes against it. At moments like these, an intern knows enough to say nothing, breathe softly and simply become invisible. After a few more tense minutes I backed quietly out of the room and returned to the holding area. Cindy was visibly more uncomfortable and her fever had spiked to 102 degrees. I made a few calls.
"So am I gonna lay up here all night?" she said.
"I'm trying to find an available surgeon. Rauscher's occupied and the on-call attending has a bowel obstruction going in Room 3 with the fourth-year resident. I just put in a call to Kottmeir but he hasn't answered yet.
"The pediatric surgeon?"
"Yep. He's next on the call list. You're not that far from puberty, anyway."
"You're funny," Cindy said.
I was actually getting a little worried. The cases going on now were life or death, for sure. But still, I didn't want Cindy to end up with a perforated appendix, a long hospitalization and an open wound - and the longer we waited, that became more of a probability.
Finally Peter Kottmeir called back. "Jesus, I'm in my summer place in Long Beach," he said (well, it was the summer). "It'll take me at least an hour to get there. You start if there's no one else available. You've done appendectomies?"
"Come on now. It's a simple operation for God's sake. Just start. I'll be there. Where is the chief?"
"He's in with a knife wound."
"But he's there?"
"Okay then. If something happens just get him."
"But this a nursing student......"
And he was gone. Just like that.
"Okay," I said to Cindy. "Dr. Kottmeir is on his way as we speak. One of the best surgeons in this place, as you know. So you got lucky after all."
"A goddam baby doctor," she shook her head. I unlocked the gurney, grabbed her chart and started rolling her down to Room 4, which was set up and ready to go. "Aren't we waiting for him?" Cindy said.
"Don't worry. He'll be here in a jiff."
Now, I want to say that Peter Kottmeir arrived just as Cindy went to sleep. Or that he arrived in time to make the first incision, or separate the oblique muscles, or cut open the peritoneum, feel around for the appendix and flip it up into the surgical field, or tie off the inflamed appendix and snip it out and watch it plop into the steel basin. But he didn't. Instead, it was me and Sherman, a black surgical tech with twenty years under his belt, and a shock of gray hair barely contained beneath a psychedelic surgical cap, who ended up removing Cindy's appendix. Needless to say, I was terrified from beginning to end. Thank God-almighty for Sherman, who could have done an appendectomy with his foot and blindfolded, and who started out by asking me where McBurney's point was (look it up!), where I would make the incision, what I would do if the appendix was normal and what seemed like a thousand other questions, and then took me through every step of the procedure down to the ritual dabbing of the remaining appendiceal stump with some betadine.
(Sometimes I think back on my time at Kings County and find it hard to believe that interns and residents were doing cases like this and much bigger ones than this, basically unsupervised. But somehow we managed to get through them and everything turned out OK. At least that's how I remember it. I think it was because people like Sherman were around to make sure of it. I don't think this still happens, but I'm glad I had the experiences I did and I know it made me a better and more confident surgeon in the long run.)
Just as the dressing was placed and I had peeled my gloves off, and given Sherman a big hug for saving me (and Cindy), Peter Kottmeir poked his head into the room. "You Palumbo?" he said.
"I believe so."
"See?" he said. "It's an easy operation. Good job."
I came to understand, after a while, that "good job" simply meant the patient was still alive when you were finished. It had nothing to do with the actual 'quality' of the job you had done.
"Everything OK with that appendix?" Greg Rauscher asked me a few hours later. He was obviously exhausted and in the dumps after he failed to save that young guy with the torn vena cava.
"All OK," I said.
"Good job," he said.