The Unfortunate Event
By Andy Siegel,
Author of Cookie's Case
"Scalpel," repeats the nurse. She delivers it with just the right authority.
The neurosurgeon slits his patient's throat in one fluid motion. The incision is quick, decisive and skillful. A seeping red river fills the canal.
"Give me some suction here."
"Suction," repeats the nurse. She vacuums the blood. Unexpectedly, Dr. McElroy breaks into song, "Stairway to Heaven."
The nurse looks at him, taken aback. His a cappella is as good as his surgical technique, but she disapproves of the buds in his ears.
"Doctor," she asks, "do you really think you should be listening to Led Zeppelin while performing surgery between the jugular and the base of this young woman's brain?"
Ignoring her, the surgeon proceeds to carry out the necessary dissection through the various layers of soft tissue which will take him where he needs to be. He uses his arrival at a deep ligament as a natural breaking point where he can respond.
"Nurse, tell me your name again."
"Nurse Molina," he says, as blood collects, "a study almost published in the New England Journal of Medicine presented correlations indicating that certain harmonies in this song were shown to elevate serotonin levels. Serotonin plays an important role as a neurotransmitter for the regulation of mood -- and it relaxes me. Of course, skeptical peer reviewers claimed the study was based on unreplicable methodology. There's always a divide among the members of the medical community, isn't there?" Then he adds, "You were off on your landmarks, by the way. I'm nowhere near the base of this girl's brain, anatomically speaking, that is. Now give me more suction."
"Suction," she repeats, clearly annoyed.
McElroy resumes the song but is finished with the scalpel. With a long reach in front of Molina, he returns the blood-tinged instrument to the surgical tray. It would be possible to perceive this bypassing of Molina, the surgical nurse, as a snub. He breaks off his singing.
"Retractors here . . . here . . . here . . . and here." He points to four spots along the edges of the incision.
"Retractors," repeats Nurse Molina, applying them, two on each side. She's unhappy about their exchange -- and about the snub -- but understands a good working relationship in the OR takes time to develop. Nonetheless, she regards this young doctor as a cowboy, given his decision to perform spine surgery through the front of the neck.
"Give me a little more exposure with those retractors, Nurse." Pause. "That's better. Now more suction."
"Give me a fifteen blade."
"Fifteen blade," she repeats. She hands it to him.
McElroy inserts the blade, crooning, "Oooooh . . . ," transitioning from the song's mellow front end into its up-tempo crescendo in perfect pitch.
"Pay attention!" bursts out Nurse Molina. She can't help herself. "To what you're doing," she finishes, in a more collected tone. "I think you nicked her."
"Thank you, Nurse."
"No, I mean I think you accidentally cut through the lining of her spinal cord, the dura into the arachnoid."
"Thank you for defining the medical terms, Nurse."
Frustrated, she tries again. "Doctor, I mean lower on her neck. Near the fourth cervical vertebrae, away from where you're operating up at C2." Molina points to the lower aspect of the exposed surgical field. "Over here."
"Thank you, Nurse," McElroy responds in a firm tone. He is dismissing her.
Molina takes two determined steps, nudging Reggie, the physician's assistant, who is keeping mum, out of the way. She moves closer to McElroy, invading his space. This is a clear violation of the unwritten rules and regulations of operating room decorum. He stops and withdraws. She looks deep into the neck cavern where glistening white vertebral bones are visible. Molina points and counts, "C2, C3," as she moves down the stack. "Right here, Doctor, at C4, there's a fluid leak. That shouldn't be."
She points to a clear liquid slowly leaking out of a thin layer of tissue, one microdrop at a time. Drip . . . drip . . . drip.
The above is an excerpt from the book Cookie's Case by Andy Siegel. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.
Copyright © 2015 Andy Siegel, author of Cookie's Case
Andy Siegel is a personal injury and medical malpractice attorney in New York City. A graduate of Tulane University and Brooklyn Law, he grew up on Long Island and now lives in Westchester County. In 2008 he was elected to the board of the New York State Trial Lawyers Association. Cookie's Case (2015) is the second novel in the Tug Wyler series. The first, Suzy's Case, was published in 2012 and selected as a Poisoned Pen Bookstore 2012 Best Debut Novel and a Suspense Magazine Best Book of 2012. In 2013 it was named a People.com Best Beach Reads.
For more information please visit http://andysiegel.com, and follow the author on Facebook and Twitter.