Hospital Privileges

The page came in as Dr. Graham was running the bowel for the second and final time on his third gunshot wound of the evening.  He knew instantly what teh message would be when he dialed the numbers on the electronic print out.  He hurried along towards the ileocecal valve and told his senior resident to close.  A small smile spread across his face as he removed his gown and gloves.  Sure, he had saved three lives that night, but now he was about to witness the entrance of a whole new life.

He spoke into the phone on the operating room wall.  “This is Dr. Graham returning a page.  Yes, I’ll hold.  Yes. Yes.  I’m on my way.”  He hng up the phone and told his team, “Sandra has gone into labor.  She is delivering at Roosevelt Memorial.  Dr. Collins will cover for me.  I’m outta here.”

Jane, the head ER nurse on the evening shift, said, “Congratulations, Max.  I’m so happy for you.  And to think, I’ve known you since  you were a single intern who couldn’t even talk to women without having a panic attack.”

Breaking into an even larger grin, Dr. Graham said, “Six years in the trenches prepares you for anything, even the horrors of asking out the girl of your dreams.  I’ll call and let you know the facts later.”  He waved good-bye and headed straight for the locker room.

The picture of his wife, Sandra, caused his smile to return as he opened his locker.  It was true.  This was the girl of his dreams.  He had met her during the third year of residency on one of his rare days off.  His parents’ anniversary had passed unnoticed a week before and he was compensating with a too-pricey gift that needed to be shipped from the post office.  As he prepared to send off the package she walked in to buy a book of stamps.  She noticed the large package in his hands and asked if he wouldn’t mind if she went first, seeing as how her transaction would be brief.  He would on the condition that she go out with him that night for dinner.  That dinner led to more nights out, then a small apartment they could only afford together on his resident’s salary and her teacher’s wages.  Two years later they married.  He resisted her urgings towards children for a while, but once he felt secure in his position as the new trauma surgeon at the County Hospital, he relented.  She understood that his duties would occupy most of teh day and night and agreed to spend her time with the baby.  It appeared that everything would work out nicely.  They had already begun plans on a modest house outside of the city.  As the pregnancy went on he began to realize how much he wanted this child and how positive it would be in his life.  With residency over and his career settled he wanted to face new challenges, ones that he could share with Sandra and not bear entirely on his own.

He snapped his locker shut and strode quickly towards his car.  His wife wanted to have the baby at Roosevelt Memorial rather than the County Hospital, and Dr. Graham couldn’t say that he blamed her.  He knew that the delivery rooms were so busy at County that they hardly had any time to clean them.  The only problem was that he would not be in house when the moment came.  She had been in early labor for a few hours when he left for work that day.  In spite of her asking him to stay with her, he insisted on working.  Dr. Collins already had agreed to cover for him while he was with his wife and he knew his residents could be relied upon to take care of business, but he didn’t want to burden the others too much.  As a new attending he felt he still needed to establish respect within the hospital and the best way to do that was to put in the hours.  Besides, it was only a twenty-minute trip to Roosevelt and he knew first babies never come too quickly.

He didn’t even catch a red light on the way to the hospital.  His Explorer slid into the special labor and delivery parking lot and soon he found himself entering an airy atrium.  At the front desk he asked for Labor and Delivery and was directed to the eleventh floor.  The call he had received earlier from one of the L & D nurses told him that his wife was in room four.  He stepped out of the elevator and pushed the door open.  Immediately a shrieking alarm went off. Shit, he thought, they always have alarms on these places.

A nurse said, “Sir, you cannot just walk in here.  Please return to the lobby and I will sign you in.”

He glared at the nurse for a second but decided that discretion was called for and returned to the small waiting room outside of the delivery suite.  The nurse disabled the alarm and said, “All right.  Name, please.”

“I’m here for Sandra Graham.  I believe that she is in room four.  I’m Dr. Graham.”

“Dr. Graham…Dr. Graham.  I’m not sure that I’ve seen that name before, nor do I think I’ve met you.  Which obstetrical practice are you with?”

Grinning, he said, “Actually, I’m a trauma surgeon.  My wife’s obstetrician is Dr. Ralph, I believe.”

Frowning slightly, the nurse said, “Oh, I see.  Well, come on in.  We have a small waiting room with refreshments and a television.  I will check on your wife.”

“I was actually hoping to go in and see her.  This is our first child and I want to be with her.”

“I understand that, but hospital policy is to not allow people inot the delivery rooms until the expectant mother has agreed to their presence.  I hope you understand.”

Dr. Graham hesitated.  His instinct was to simply enter the room.  He had been going into patients’ rooms unannounced for years.  Hell, he had even examined patients on the sidewalk outside the entrance to the emergency room.  He felt as though there was no place that he did not have access to as a trauma surgeon.  Then he remembered the alarm and decided that if there was to be any peace here at all that he should acquiesce and wait in front of Conan O’Brien’s show while enjoying a stale donut.  “Fine.”

He sat down in the small room and again took stock of his situation.  What Jane had said earlier that night was true.  He had been a shy young man.  Studying surgery had provided him with a certainty that his earlier life had lacked.  He could not have successfully dated and married a woman as wonderful as Sandra before he had trained as a skilled surgical technician.  He chose a career in trauma in part because trauma cases were chaos that a skilled team could turn into calm.  People came to him in all sorts of ways that God never intended: Earlier that evening, his first gunshot wound had blown a man’s mouth off.  Some sort of gang-land activity that led to one guy getting a pistol shoved into his throat by another who had a little too much to prove.  The order of trauma, ABC, dictated that he establish an airway before moving on to the man’s crashing blood pressure.  Since there wasn’t much to work with above the mandible, he performed an emergent tracheostomy.  A simple matter of taking blade to throat and opening a small hole that could keep a man’s lungs working until the rest of him was put back togehter.  And it had even worked.  They managed to stop the bleeding and get the man to the ENT in time to save his life.  That kind of restoration of order, that control, was what he loved most about his job.

As he sat there musing, he realized that he had been waiting for about thirty minutes.  Suddenly a young doctor entered the waiting room.  He walked quickly, his long white coat encircling his steps, shifting from left to right with each rapid food fall, until he reached Dr. Graham.  He asked, “Sir, are you here with Sandra Graham?”

“Yes, I am.  I’m her husband.”

“My name is Dr. Oakenfold.  I am one of the resident anesthesiologists on call.  Your wife was given a spinal anesthetic in order to ease her labor.  At the time she was dilated to three centimeters and it looked as though she had a few hours left.  A few minutes after receiving the medication she developed respiratory depression.  Her breathing quickly deteriorated and an attempt at intubation was made.  The attempt was unsuccessful and your wife went into cardiopulmonary arrest.  All efforts were made to revive her but they were unsuccessful as well.  She expired at 11:05 this evening and her son was delivered via emergent Cesarean section at 11:12.  He is doing fine.  I am very sorry.”

Dr. Graham sat in his chair in disbelief.  He looked at his watch and saw that it was now 11:18.  He had been there the entire time.  While he sat in the waiting room, recollecting the lives he had saved that night, his wife passed away due to the doctor’s inability to establish an airway.  He finally managed to ask, “Did you attempt a trach?”  The young doctor cocked his head slightly.  “Sir, that is a very difficult procedure, and one that was not entertained during the difficult resuscitation attempt.  Why would you even consider it?”

“Because I’m a goddamned trauma surgeon, that’s why!  If you just would have come and asked me I could have done it right there.  You knew I was here.  Someone could have asked.”

The young doctor looked down at the floor, at the television, anywhere but Dr. Graham.   “Again, sir, I am very sorry, but it is hospital policy that only physicians with hospital privileges are allowed to practice on patients.  We knew that you were here, but even if you had been in the room you would not have been allowed access to the necessary equipment.  I’m sure you understand.  We have to maintain some control over our practices here.  Dr. Ralph will be out to discuss more about the case in a moment.  She will have all the details.  I’m terribly sorry.”  With that he quickly left the scene and returned to his duties.

Dr. Graham still could not rise from his chair.  He wanted to kill the idiot doctor who had just told him about his wife’s death.  He wanted to strangle the nurse who wouldn’t allow him into her delivery room.  He was even angry at his wife for wanting to have the damn child.  More than anything, though, he was overwhelmed by the feeling of helplessness, and for the first time in years he felt as though his medical training had been for naught.  All he had for an answer were tears, which came in a flood.

The obstetrician finally came and the case was discussed.  Dr. Graham eventually pulled himself together and went into the nursery.  The quivering pink object that was his son overwhelmed him.  He felt the baby’s tiny heart pounding through his chest and heard the strong cry of a hungry child.  Holding his son not as a physician but as a father, he could not imagine feeling less in control.  It was exhilarating.


Mike Marcangelo, Chicago, Class of 2002