Dr. Valeria Mesmerich is going over a month's worth of morbidity and mortality reports, shaking her head in utter dismay. It's 4:00AM, an hour before she's scheduled to go on duty at the big, fancy, prestigious hospital where she worked very hard to get a job.
Four years of medical school, five years of a residency in cardiothoracic anesthesiology (she saw lots of beating and flopping hearts during that stint), and post-doc work all led to her huddling over a laptop in a tiny, windowless cubicle, tallying the number of sick, dead, and dying patients she's been privileged to work on.
Hmm. She starts reading about Patient B, who was rushed in with a blood clot early in the week. Not good. The patient turned out to be a poster child for bad health: diabetes, balky heart, high blood pressure, benign tumors, flat feet, what have you. Valeria had prepped him for general anesthesia for surgery to repair a leaky heart valve. It had all been well and good until the patient hadn't woken up.
Valeria feels her blood pressure go up. She reads further, knowing what's in store. It turns out the patient had an allergy to one of the drugs in the anesthetic cocktail she'd dripped into his veins. The report concludes that the patient will wake up—eventually. Well, they may not know when, but "eventually" is a lot better than "never."
Valeria flips to the next page. Heart transplant patient. The meds were fine, the patient died.
Next page. Lung cancer surgery. Yes! Valeria allows herself a self-administered back pat. The right meds. The right outcome. The patient lives.
Valeria shelves the reports and readies herself for a full day in the hospital. As the chief anesthesiologist for the heart-lung transplant team, she's one busy doctor. She does pre- and post-op care for patients in the intensive care union, and added to that (and to her huge income) is a partnership in a big cardiovascular anesthesia and critical care medical practice.
"Calling Dr. Mesmerich, calling Dr. Mesmerich."
The voice screeches over the hospital PA system. Valeria leaps out of her chair—why can't she ever be on time for anything?—and heads off to meet her first patient. It's 5:00AM.
Minutes later, she's in the room of Jeff Link, a sixty-five-year-old smoker with, as he puts it, "a bit of a drinking problem." He has hardening of the arteries and a heart on its way out. He's not the best candidate for a heart transplant, but he has money, political clout, and a donor match.
Key members of transplant team are already assembled, including the chief surgeon, Dr. Herman Stormtroup.
"Dr. Valeria. I'm touched we have the pleasure of your company." Stormtroup is looking at her as if she were a lower form of life. Valeria lets it go. He's a jerk of a surgeon who happens to be a genius at his job, though his attitudes about gender haven't made it out of the 19th century.
Maybe one of these days he'll start referring to her by her last name. Valeria smiles at him, then launches into an explanation of her plan of action for surgery.
Jeff interrupts her just as she's explaining how she's going to insert the pulmonary artery catheter. "Doc, will I die? Will all this hurt? Is there gonna be a hole in my chest? Give it to me straight."
Valeria knows the patient is losing it, psychologically, and soft-pedals the truth. Well, sugarcoats it.
"Mr. Link," she says, adopting her most soothing and honeyed tone. "All operations have risks, but each of us is highly trained and will do nothing that'll expose you to unnecessary risk. You'll wake up and remember nothing about the operation. That's what general anesthesia can do. And you'll have a brand-new heart. You're a very lucky man."
Jeff looks skeptical, but happier, and lapses into a smoker's coughing fit.
"And Mr. Link, remember: no more smoking."
Jeff coughs in agreement.
Valeria leaves just as Stormtroup starts his spiel, hurrying to her physician's lair to set it up with drugs, drips, lines, and anesthesia equipment. Just as she finishes, Jeff's wheeled in and she intubates him. The anesthetics are administered, and he goes out like a light.
Then it's off to the surgical theater, where she monitors Jeff's blood pressure, adjusts the medication, and controls his breathing. She and the team are totally in sync, like a well-oiled surgical machine, and the operation is a success. No complications. It only took five hours, but who's counting?
It's 2:00PM. Valeria grabs a bite to eat from the hospital vending machine (Lunchables—hey, she has to have some vices) and types out a report on the transplant surgery for the intensive care nurse. Nurse Dina Summer is a no-nonsense woman who rules over intensive care with all the warmth and zeal of a prison warden. Dina listens as Valeria gives her a rundown of that day's surgical slice-and-dice.
"So, A-okay?" Dina says.
"Yes, even the..."
"Fine. Thanks. Bye. I have work to do."
Dina marches off to the ICU. Valeria makes sure to check on Jeff: he's groggy, but alive. She checks his vitals. They're fine. And then just like that, she's off to her next transplant patient. Same protocol, same team. With any luck, Valeria will make it home by 11:00PM.
But then again, she's a doctor, and her time isn't her own. She's on call for virtually her entire life, so she may get a call at 4:00AM to get to the hospital for a transplant emergency. Not after a few more hours of sleep; now. Some weeks she may work thirty hours, other weeks it might be a hundred. And forget scheduling time with friends and family, because who knows when she'll have free time or how long it'll last. Good thing she's single with only a cranky Persian cat to worry about.
But that's small potatoes, she reminds herself. She's in the business of taking away pain and saving lives. What could be better than that?
As it happens, her surgery does end on time, but before walking out she sees that stack of morbidity and mortality reports eyeing her from the shelf in her office. She sighs, puts down her bag, and opens to the next report.
If it has to be done either now or at 4:00AM, she might as well work a bit longer now and take the extra-morning-sleep payoff. After all, she doesn't see her first patient until 7:30AM tomorrow—that means sleeping in, in Valeria's world.