A Surgeon’s Knot Read online

  A Surgeon’s Knot

  William Lynes

  © Copyright William Lynes 2020

  Black Rose Writing | Texas

  © 2020 by William Lynes

  All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the publishers, except by a reviewer who may quote brief passages in a review to be printed in a newspaper, magazine or journal.

  The final approval for this literary material is granted by the author.

  First digital version

  All characters appearing in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

  Print ISBN: 978-1-68433-432-2

  PUBLISHED BY BLACK ROSE WRITING

  www.blackrosewriting.com

  Print edition produced in the United States of America

  I would like to acknowledge the artwork on the back cover, a beautiful image by Tom Paluch, Surgeon, Savage Artist, humble Sculptor of Human Flesh. San Diego, California.

  Thank you so much for reading one of our Psychological Thrillers.

  If you enjoyed our book, please check out our recommended title for your next great read!

  The Tracker by John Hunt

  “A dark thriller that draws the reader in.” –Morning Bulletin

  “I never want to hear mention of bolt-cutters, a live rat and a bucket in the same sentence again. EVER.”

  –Ginger Nuts of Horror

  PRAISE FOR

  A SURGEON’S KNOT

  A Surgeon's Knot is a compelling story of heartbreak and redemption. Dr. Lynes has the uncanny knack of the use of adjectives that go beyond descriptive and draws you in to the point that the reader feels a part of the pages. The author paints a picture of each character as they are introduced to you that elicits a chuckle and a memory. This is a rare talent that most writers strive for. Jackson is inserted into the psyche of the bibliophile and you are living as him! I strongly recommend this gripping tale.

  - W. D. Stauffer, Printer, retired

  A Surgeon's Knot is a complex story with a cast of many characters manifesting deep imperfections that can be healed by careful medical treatment without inducing shame and healers who have come to the proverbial ends of their ropes, with most finding love and acceptance and eventual healing. It is a gripping story that moves the reader with compassion and understanding."

  - Rebecca Farnbach, Author of Dancing with Prayers in My Feet

  For readers who would enjoy an intimate look inside the overly stressed life of an intern and the medical profession, this is the book for you. Be prepared to be shocked, however, by the realistic portrayal of events. I found the intern’s story, and his girlfriend heroine emotionally enveloping.

  - Pascal Imperato, M.D., Author of Truth Wars

  A Surgeon’s Knot sheds a crucial light on the arduous occupational, emotional, and physical demands of physicians. Through Jackson Cooper’s experience in his first year medical internship, the reader feels firsthand not only the pressures endured, but also the internal struggles of the protagonist. Dr. Lynes’ descriptive writing style and swift storytelling paints a picture of the difficult experiences faced by doctors and their potentially devastating impact. A Surgeon’s Knot is a tragic but hopeful story that illuminates the importance of recognizing stress and reaching out for help.

  - Linda Duong, License Marriage & Family Therapist

  5 Stars! A magnificent page-turner! Lynes pens a remarkable story in A Surgeon's Knot. This is the first book of this writer's that I've read, and I must say that I enjoyed it tremendously. I found Dr. Cooper to be a very unique and interesting character. The story had a lot of details, and it is important to read it from cover to cover. Some situations seemed like they mirrored real life, and it gave a lot of credibility and logic to an amazing and thrilling story. The plot was filled with ups and downs, regrets and triumphs, life and death, along with many twists. I couldn't put it down until the very end. I look forward to reading more by this author.

  - Amy's Bookshelf Reviews.

  Table of Contents

  Title Page

  Copyright

  Recommended Reading

  Praise

  PREFACE

  CHAPTER ONE

  CHAPTER TWO

  CHAPTER THREE

  CHAPTER FOUR

  CHAPTER FIVE

  CHAPTER SIX

  CHAPTER SEVEN

  CHAPTER EIGHT

  CHAPTER NINE

  CHAPTER TEN

  CHAPTER ELEVEN

  CHAPTER TWELVE

  CHAPTER THIRTEEN

  CHAPTER FOURTEEN

  CHAPTER FIFTEEN

  CHAPTER SIXTEEN

  CHAPTER SEVENTEEN

  CHAPTER EIGHTEEN

  CHAPTER NINETEEN

  CHAPTER TWENTY

  CHAPTER TWENTY-ONE

  CHAPTER TWENTY-TWO

  CHAPTER TWENTY-THREE

  CHAPTER TWENTY-FOUR

  CHAPTER TWENTY-FIVE

  CHAPTER TWENTY-SIX

  CHAPTER TWENTY-SEVEN

  CHAPTER TWENTY-EIGHT

  CHAPTER TWENTY-NINE

  CHAPTER THIRTY

  CHAPTER THIRTY-ONE

  CHAPTER THIRTY-TWO

  CHAPTER THIRTY-THREE

  NOTE FROM THE AUTHOR

  ABOUT THE AUTHOR

  BRW INFO

  PREFACE

  A Surgeon’s Knot, while not a true story, comprises an accumulation of real people, patients, and medical personnel. Mark Twain said: “It is true that the truth is stranger than fiction.” If you find a character or scene strange, realize that I base the great majority of characters and scenes upon real-life experiences.

  Physician burnout and the resulting suicide epidemic and substance abuse that is so plentiful in the medical profession are not a new phenomenon. I suppose that these tragic conditions were present before 1981, but they have progressed to the point of epidemic proportions during the years of my practice and since my retirement because of burnout in 2003.

  Training in the surgical specialties, has always been a tough undertaking. I practiced 100 to 110-hour weeks, day after day, month and year after month and year. We expect doctors to do so, and yet they make critical decisions continually. Medicine is a noble profession, but it is a profession that is hurting.

  I discuss many measurements and doses in this book. By choice, the unit values are consistently inconsistent. In American medicine we interchange the metric and English systems. We measure drugs in milligram metric units, but we measure size and depth in inches of the old English system.

  The story tells and describes many medical technicalities. I have tried to introduce and explain these details to the level needed to understand the scene.

  I hope that this story is an entertaining and yet a meaningful one.

  William Lynes, MD

  June 2019

  “Truth is stranger than fiction, but it is because

  Fiction is obliged to stick to possibilities; Truth isn’t.”

  ~Mark Twain, Following the Equator: A Journey Around the World (1887).

  CHAPTER ONE

  The phone jarred Jackson Cooper, MD’s weary, anxious brain into consciousness from the edge of sleep. He jumped up, dropping the receiver on the cold floor of the call room. “Hello,” he said, tension entering the new intern’s mind.

  “Dr. Cooper,” the nurse’s voice said nervously. She almost stuttered as she spoke. “It . . . it’s . . . Mr. Simpson, he’s bleeding. I think he’s going to die!”

  She was crying by now, the suggestion of sobs pulsing over the twisted line. “I think I killed him,” she forced out in a strained voice. “I’m new, you know. He’s a carotid, and the dressing . . . I didn’t mean it. The bleeding . . .”

  He pulled his pants on and bounded out the door, grabbing his white coat and leaving the receiver dangling by his rumpled bed. The call was from the surgical ward, west 3B. “Simpson,” he muttered to himself as he ran. Straining his memory to bring up the on-call report, he remembered the man as a post-operative carotid endarterectomy patient. The surgery had occurred several days ago, the main artery to the brain opened and cleaned of plaque. If he was bleeding, the result could be catastrophic. On his first internship day—he wasn’t sure what to do.

  He struggled to put on his coat as he ran down the hall to the stairway. At one point his stethoscope fell to the floor with a crash, rolling around for him to retrieve later. Jumping two stairs at a time now, he flew with fierce strides, his breaths left for a more appropriate moment. “Code Blue, West 3B” began blaring over and over above him as the hospital awakened from its taciturn sleep.

  The nurse’s
nametag, now bloody, was a crooked piece of white tape on her breast pocket. Written in black ink was the name “Julie”. Blood covered her white outfit. Terrified, she looked like a Valentine’s Day sacrifice as she frantically met Jackson in the doorway.

  “What do you mean he’s going to die?” Jackson asked as he rushed through the door, afraid that he already knew the answer.

  Mr. Simpson, an elderly black man, was lying on his back, his hand pressing on a bloody mess over his left neck. The floor was wet with blood, and Jackson slipped and fell to his knees, striking the bedside. Standing, he replaced the man’s hand with his.

  Mr. Simpson was breathing through pursed lips. His eyes were wild with fright. Looking into the patient’s tortured face, Dr. Cooper said, “It’s okay, Mr. Simpson,” though he knew that it wasn’t.

  Turning his gaze to the foot of the bed where the horrified Julie stood, he yelled, “Trendelenburg, now!” The nurse responded by placing the bed in Trendelenburg position, cranking the foot of the bed up as far as she could.

  Jackson removed his hand from the wound. As he did, a spray of warm blood shot high in the air, hitting the ceiling and splattering his face, drops landing in his open mouth. A frenzied team of nurses and doctors poured into the room with a mixture of dread and fervor. The anesthesiologist, dragging a medicine cart, yelled, “What happened here?”

  A doctor , with curled black hair in a bun dressed in a white coat tossed over a green pair of scrubs, yelled instructions. “I need a pressure! Is he on a monitor?” She hurried to the man’s side, feeling for a femoral pulse. “Shi**t, no pulse,” she spit.

  Simpson closed his eyes, only to begin rhythmically shaking in a seizured frenzy. “He’s a post-op carotid with a blow-out!” Jackson placed pressure again on the wound, grabbing the man with his free hand, trying to calm the seizure contractions while shouting for a hemostat clamp.

  Julie rushed to the bedside and placed a blood pressure cuff on Mr. Simpson’s shaking left arm. “Oh no—I can’t get a pressure, Dr. Cooper.” She reached into her pocket and removed a clamp, handing it to the embattled intern. Jackson took the hemostat and desperately thrust it into the man’s neck, grabbing nothing but blood. He dug in the wound with an ungloved finger, clamping again and again in futility.

  “CPR! Get him on a board!” the senior doctor yelled. The team swarmed around the patient, slipping a wooden board under his back. One man in scrubs jumped to Mr. Simpson’s side and began violent chest percussions. Another moved to the head of the bed and placed an Ambu-bag over his face, ventilating the man with force.

  “Stop CPR,” ordered the senior doctor. The group stopped and watched the monitor, a rapid arrhythmia tracing its pattern on the screen. She felt for the absent pulse. “Start CPR! One mg of epinephrine. Is his IV working? Call Doctor Canes?”

  The anesthesiologist indicated that the infusion was flowing. A nurse reported, ”Canes is in the OR. Ferry is coming!”

  “Amiodarone, 300 mg, IV.” The anesthesiologist pushed a syringe of the heart arrhythmia drug through the IV. A surgeon dressed in rumpled scrubs and a paper cap raced into the room to the head of the bed, pushing Jackson away. He brought a covered surgical tray that he dropped on the foot of the bed. A similarly dressed nurse who followed him opened the tray with gloved hands.

  The surgeon removed Jackson’s hemostat, dropping it on the floor. “Scalpel,” he yelled. With the knife, he sliced open the wound covering Mr. Simpson’s neck. Using his bare hands, the surgeon scooped a wad of fresh clot out a deep incision, tossing it on the floor. “Peon,” he said to the nurse. She handed him a large, curved clamp. With difficulty, he clamped the carotid artery near the skull. “Another,” he said, and she slapped another Peon clamp into his hand. A second clamp on the lower carotid slowed the blood flow.

  “Stop CPR,” the senior doctor yelled. Without CPR, the monitor showed a rapid fibrillation. “No pulse! Paddles!” They wheeled the defibrillator to the senior doctor, who took the two paddles and yelled for everyone to clear. Mr. Simpson writhed as she shocked him. “No pulse. Start CPR.”

  The resuscitation continued. CPR, defibrillation, IV drugs, and intracardiac epinephrine were fruitless. “Stop CPR,” the senior doctor said for the last time. The EKG had flatlined. Several began to clear the room in silence.

  “Gladys, we need to stop,” the surgeon said to the senior doctor. She nodded her head in agreement and sadly turned to leave the room. Nurses began to remove all the surgical paraphernalia in the room. They tried to clean the man’s face and neck. The surgeon grabbed the patient’s chart and wrote a quick note, turned and headed out of the room.

  “Dr. Ferry,” Jackson said as he chased the man down the hallway.

  Dr. Ferry turned to him and said, “Write a death note. What’s your name?”

  “Jackson—Jackson Cooper. I’m the intern on call. The family . . . what should I say?”

  “Oh? Are they in the waiting room, Jack?”

  Jack was a nickname he’d always detested, but he pushed down his irritation. “Yes, I heard that they called the wife and maybe a daughter.”

  “Tell them he died, Jack, and that Canes will talk to them. He’s in the OR exploring a neck though!” Dr. Ferry turned and rushed down the hallway.

  Jackson stood watching him go. Covered in blood, he shook his hands, splattering some on the wall. He returned to the nursing station and washed up as well as he could. Grabbing the patient’s chart, he realized that he needed to write a death note. Not knowing what that entailed, he wrote some details about the death as best he could. He turned to see Julie standing by his side.

  “Mrs. Simpson and the daughter, Macy, are in the waiting room. I called Room Seven, and Dr. Canes is hours from finishing surgery. Could you talk to them?”

  Jackson looked down at the chart. He felt trapped and a little like running. He capped his pen and placed it in his white coat. Standing, he attempted to kick some dried blood from his cowboy boots. “Yeah, I’ll try.”

  The hallway was longer than he remembered. Walking slowly past the site of the resuscitation, he thought of things to say. It seemed silent now, with all the staff gone and the overhead speakers playing a quiet silly tune. The waiting room was at the end of the hall through two closed doors, which opened noisily. Once through the doors, he saw two women sitting on wooden chairs. The older black woman with graying hair sat neatly dressed in a navy-blue dress, black flats, and thick glasses. She sat looking up at Jackson with an old Bible on her lap. The younger woman was obviously the daughter; she had a medium-length afro and was wearing jeans and short boots. The two rose as he approached.

  “I am Dr. Cooper,” he said, gently shaking Mrs. Simpson’s hand. “Doctor Canes is in the OR.”

  “What happened, Doctor? Is my husband all right?” She pushed her glasses up the bridge of her nose and looked at Jackson intently.

  Jackson looked at Mrs. Simpson and then turned to eye her daughter. He glanced down at the floor, realizing that blood on his boots was still visible. “I’m Macy, Dr. Cooper.” He considered telling them his first name but thought better of it. He was having a hard time realizing that he was a doctor.

  “Yes, glad to meet you,” he said quietly, shaking her hand.

  He turned back to Mrs. Simpson and asked her to sit down. She began crying. Macy comforted her, tears in her eyes as well. “Mr. Simpson had some bleeding, Mrs. Simpson,” Jackson said quietly. “His carotid artery burst, and we couldn’t stop the bleeding. We tried . . . did CPR and everything, but he’s gone.”

  “Oh—oh, no,” the wife said. She began to sob. Looking up at Jackson through her tears, she asked, “Did he suffer?”

  Jackson vividly recalled Mr. Simpson’s terrified eyes. The man’s neck exploration would have been agonizing. “No . . . he was okay at the end, ma’am.” Lying was not in Jackson’s nature, but he just couldn’t be truthful about this with her. He couldn’t believe this was happening on his first day as an intern. It was the first day people could call him a doctor, and he was so proud in the morning when the nurses used that title. Confronted with a crying widow, he realized at that moment that the title of doctor often brought responsibilities he would rather not have.