The Six-Liter Club : A Novel

by Kraus, Harry, M.D.

• ISBN13: 9781416592624
• ISBN10: 1416592628
• Copyright: 2010-04-06
• Publisher: Simon & Schuster

Excerpts

1

MEDICAL COLLEGE OF VIRGINIA, 1984

MY HEART BEAT with the exhilaration of knowing I hid in enemy territory—a woman in a men’s bathroom. Moments before, I had blown in to make a poignant statement about this sexist university, but right now, I felt a bit short-winded, like I needed to recover an ounce of the passion that had fueled my daily survival in this hospital for the greater part of the past decade.

There were trite metaphors to describe what I had just done. Threw down the gauntlet. Drew a line in the sand. Aunt Jeanine would have called it career suicide, but I never did give much for her opinion of my actions.

Thirty seconds before, I had thought my statement was precisely what this stodgy establishment needed. But at this moment, on the day I had become the first woman surgeon to join the prestigious Six-Liter Club, I cowered in a stall of the men’s bathroom, desperate to find the fire that had emboldened me to barge into this inner sanctum of testosterone. I peered through a crack looking into the doctors’ locker room, appreciating only a small vertical slice of the room at a time. It was much like the nurses’, except larger, and it smelled a bit like my sweat socks after a run in the Virginia heat. I leaned forward until my forehead touched the cool surface of the metal door, tuning my ear to the voice of Dr. Bransford, my mentor and the chief of general surgery.

I closed my eyes and began to gloat in near euphoria. The Six-Liter Club! It wasn’t exactly where I had expected to be on this first day as a surgery attending, but a coveted milestone nonetheless. I knew graying surgeons who, respected and dignified as they were, would never know the thrill of successfully pulling a patient back from so far over the precipice during his plunge into the next world. Oh, they’d often snatched patients back from the edge, made some “good saves,” but rarely from six liters of blood loss—a hemorrhage of more than the circulating blood volume of medicine’s prototypical normal human. “Normal” in the medical literature meant male, probably white, seventy kilograms, three-fourths fluid, five liters blood, one brain, one heart, and two testicles.

But today I cared little about the prejudiced medical literature. I’d fought for the arrival at this pinnacle every day for the past decade, slogging through four years of medical school and six more grueling years of surgery residency. Every day I had strived to be seen for something other than my physical equipment in a surgery world dominated by men who thought a woman’s role should be assisting them toward greatness. But now, in 1984, I’d done what no other woman had ever done. I was the first female in the department to join the club on the first day as an attending. If I played according to the rules, the crack in the door would widen. If I failed, I’d confirm their suspicions, and the door would shut again for another decade of bigotry. Women were celebrated in other areas of medicine. Pediatrics. Obstetrics. But surgery remained the last holdout for the boys. I was determined to show them that a woman could be a cutter, too. I could play their game. Today I’d proved it.

Did I sense destiny, that I was the point of a spear thrust into the heart of a crusty, male-dominated field? Yes.

Was I up to the task? Today, I’d convinced myself that I was.

I listened to the chatter from the boys as they entered the locker room from the hallway and the operating rooms beyond. They talked about the Richmond Braves, a pitcher who was sent back from Atlanta to see if he could find his game again. I loved baseball, but today I was listening only for the approval of my hero. Certainly Derrick would tell him of my coolness under pressure, the swiftness with which I’d gained the upper hand against the hemorrhage. The Six-Liter Club was a definitive step toward gaining the respect of the guys.

Derrick was a brother, the best scrub tech I’d worked with, able to keep up with the quickest surgeons, handing them what they needed often before they uttered their request. He’d slipped into the banter of the hood, a relaxed style punctuated with his own laughter. I listened for my name as I inspected my nails. They were kept short, but manicured. Not polished. That’s a no-no around here, another concession I’d made to enter this boys’ club of surgery.

There was blood under my right index fingernail. It didn’t surprise me after the bloodbath in room five. I knew the patient only as John Doe, the assigned name for anyone who came in the ER without an established identity. I’d taken time only for the essentials before rushing him to the OR. He didn’t have the chance to give me his name before his blood pressure became a real problem. We focused our attention on the critical business of saving his life rather than the fluffy extras like name, age, and whether he liked basketball or soccer.

When I asked who shot him, he looked around with wide eyes as if he expected his assailant to jump from behind the curtain. The look of sheer terror faded from his face only as he slipped into unconsciousness. His mumbled reply was, “Some dude.” It was a statement I’d heard hundreds of times in the last five years of surgery training in downtown Richmond, Virginia. Everyone assaulted was always minding their own business when some dude shot them. Or else they knew him and were afraid to say. The way this John Doe looked when I asked the question, I’d say it was the latter. Something had made my patient very afraid. And he came within a breath of seeing the other side as a result.

If my patient’s fears were justified, and we found out there was a credible threat on his life, we’d admit him under an assumed name for his protection. It was all part of a day’s work on the trauma service at the Medical College of Virginia.

I paused, thinking about the look of terror on my patient’s face. I’d seen fear in the eyes of patients who were about to die before, but there was something different in the eyes of my newest John Doe. And something told me that I hadn’t seen the end of his terror.

This John Doe appeared to be a young teenager. A thin African American with a pitiful growth of tangled chin hairs signifying a teen who wouldn’t shave. He’d come in with three entrance and two exit wounds, a belly swollen like one of those obnoxious ticks I found on Max, my boyfriend’s German shepherd. John Doe lived because the residents put in four big IV lines so we could squeeze blood in as fast as it flowed out of the injury to his vena cava, the mother of all veins. He lived because he was young and his heart could still compensate for the stress. He lived because I had the best anesthesiologist the U had available. He lived because an OR was open the very moment he had arrived, and because I was nimble at isolating and repairing his injuries. So no, I didn’t fool myself by thinking I deserved all the credit, but attending surgeons were known to be forgetful of the little people around them. I was determined not to be one of them.

The locker room door snapped open with a thud and the sheer tenor voice of Ellis Hamilton overtook the baseball chatter. Ellis was a geeky white boy who served as the fourth-year resident on my service. He was book smart, author of over twenty papers in the surgical literature, and the nephew of one of the biggest names in academic surgery.

I wouldn’t let him operate on my dog.

I heard hand slaps and peered through the crack next to the stall door. Ellis clasped his hand around Derrick’s, his fingers curled around Derrick’s thumb as if he were his homey. This didn’t compute for me. Derrick hated arrogant white doctors. He tolerated them because it was his job. He even led the ones who fumbled in the OR without their attendings, helping them through their surgical cases. Once outside, he returned to his downtown hood, and they drove the opposite way to the west end or a stately home in the fan on Monument Avenue.

Derrick grinned at the resident. “You’re one bad dude, Doc. What color are your drawers?”

Ellis wore a tentative smile and looked down.

Seth Patterson, another tech, rolled his scrub top into a ball and swished the laundry hamper. “He don’t get it.”

Ellis’s face reddened. “My drawers?”

Seth chuckled and said something too low for me to hear from my hideout. Derrick roared.

Ellis didn’t give up. “What?” He slumped onto the bench beside Dr. Bransford, his only advocate.

Bransford patted the young surgeon on the thigh. “Your shorts, Ellis. No resident ever scrubs on his first six-liter case and comes out with white underwear.”

“My wife always complains about the blood on my clothes.”

Derrick shook his head. “We ain’ talkin’ ’bout blood.”

I sighed, tiring of this drivel. My thoughts drifted to Ellis’s wife. God only knew what she saw in him.

Seth’s next remark brought me right back.

“I’ll bet Camille’s are dry.”

Derrick snickered. “You are dreamin’ now, bro. You wish you could check that lady’s black lacy bikini—”

My mind whirled. Black lacy underwear? How would they know? My thoughts stopped short as I clutched the neck of my male-cut scrub top. In my haste to rescue John Doe, I’d forgotten to pin the neckline! For years I’d worn men’s large scrub tops that would fit comfortably over my ample chest, but I always pinned the neckline to avoid . . . Ugh! They must have certainly gotten an eyeful today.

My eyes fell to the drawstring holding up my pants. Bloodstains. Nothing new for a trauma surgeon, but I hated it that I’d thrown away three pairs of panties in the last month. I loosened the string and peered in before shaking my head in disgust. Make that four. I dropped my scrubs and slipped off the stained pair, rolling the black lace into a ball to drop into the trash can—if I ever summoned the courage to leave.

I pulled my scrubs back up and listened again as Dr. Bransford finally stroked my fragile ego. “She is cool under fire.”

Seth grunted his agreement, but was stopped short by a backhand slap to the chest by Derrick. “That girl is outta your league.”

Ellis jumped in. “Way, way out of your league!”

Dr. Bransford sighed heavily.

Derrick slapped his back. “Out of your league, too, ol’ man.”

I took a deep breath, trying to digest the exchange I’d just witnessed. Here, in this locker room, all normal vestiges of status evaporated in maleness. Derrick was talking trash and slapping the chief of general surgery—a man old enough to be his father—someone he would always honor with the title “doctor” in every other social arena. But here their common male bond dominated, swelling like a tidal wave to dwarf the ripples of social status. I didn’t understand. Outside, Derrick and Seth always called me Dr. Weller. Here, I was Camille, or “that girl,” and Dr. Bransford was “ol’ man.” The weasel resident was praised for his role in my save. He was “one bad dude.” They should have been praising me, not fantasizing over my lacy undergarments! I found myself wanting to shout, What about me? Aren’t I a bad dude?

Fortunately I composed myself and took another breath. A deep, cleansing breath. I wanted to make a statement about the stupid sign on the door outside, not eavesdrop on adolescent BS. I was a doctor, a surgeon, to be exact. I had two X chromosomes, not one like all the other surgeons here. It seemed that somewhere in our evolutionary past, the Y must have taken a dive into the shallow end of the gene pool. I nodded my head in a confidence I didn’t feel. Here goes nothing.

I opened the door and casually sauntered past the overflowing trash can, where I shoved my panties below the first layer of paper towels. No use showing everyone how right Derrick was about my taste in underwear. I tipped my head forward toward the male quartet, now all standing with slackened jaws. “Afternoon, boys.”

“Cami—uh—Dr. Weller!” Derrick pulled on a T-shirt emblazoned with an emblem of the Richmond Braves.

Ellis was wild-eyed, backing quietly toward the door. It was as if I’d somehow contaminated their turf. Now he was in full retreat, a cat running from a mouse in a dog costume.

After a moment, Dr. Bransford found his voice. “Dr. Weller, would you mind explaining what you’re doing here?”

“You hired me, sir. I’m working here as a part of the attending surgical staff.”

Derrick and Seth retreated one step behind the senior surgeon. Both were trying not to smile.

“Camille,” he began again, this time in the fatherly voice I adore. “This is the men’s changing area. You know what I’m ask—”

“This is the doctors’ locker room,” I interrupted. “Do you want me to change in the nurses’ locker room down the hall?”

Dr. Bransford gave me a stern look. “Don’t do this.”

“This?”

“Come in and start making waves your first week.”

“What, I should wait a year before I change in the doctors’ area? Then everyone would wonder why it’s OK now, but not last week or last month.” I kept my chin high and solid. “I decided I’d better start right from the beginning.”

“Camille—”

“The door has a sign on it.” I pointed to the one Ellis was touching. “It says ‘Doctors.’ Well, that’s me.” I fixed my gaze on Seth and Derrick for emphasis. “So why are you two in here?”

Derrick was poking Seth’s ribs with his elbow, and deep dimples were forming at the corners of his mouth. “What’re you doing?” he mocked.

“I’m going to get changed. It’s been a long enough day.”

Dr. Bransford sighed. “Camille, you can’t just come in here and—”

“Then change the sexist sign on the door. If you mean men, say men. If you mean doctor, say doctor.”

My mentor shook his head slowly. I knew I was skating on thin ice. I’d been changing in the nurses’ locker room ever since I arrived at the Medical College of Virginia as a student. The sign had always bugged me, but it wasn’t a med student’s or a resident’s place to make waves. I had planned on bringing it up at a department meeting, but I’d surfed the high from joining the Six-Liter Club right down the OR hallway and into the doctors’ locker room. It was just one of those split-second, on-your-feet decisions that surgeons were supposed to be able to make to succeed in a life-or-death career. One second I was in the hall looking at that goofy sign. The next, I was marching into the nurses’ lounge to get my clothes. And two minutes later, I had invaded Testosterone Central and was seeking refuge in a bathroom stall.

I shrugged with casual nonchalance. I turned and looked at the locker I’d chosen. It was time. Game on, as they say. If I walked out now, I’d be just another poser. I touched the drawstring of my scrubs. I waited a few seconds, trying to find real courage behind my bravado. I closed my eyes.

I couldn’t do it. I couldn’t bring myself to drop my scrubs in front of a bunch of leering vultures—especially with the black lace tucked inside the trash can. But how could I save face? I cleared my throat, searching for an answer.

“Dr. Weller!”

I spun around to face the chairman of the department of surgery, James P. Gilles. He didn’t smile on a normal day. I’d personally seen him fire two residents, one just for being late to a morbidity and mortality conference. My eyes met his for a second, and in that moment I felt the weight of my fate.

For five years, I’d lived for the sparkle in this man’s eyes as we stood facing each other across an open body. Gilles could fry you, scare you, or send a resident’s heart soaring with confidence . . . with just one look. We’d all grown to know the eyes of the chairman. Above his mask, his eyes told the story of fulfillment or the demise of your dreams. He had the kind of eyes that seemed to look right through your clothes. Not lustful, but searching, able to detect a faltering constitution. I always felt bare beneath his gaze, yet at the same time, warmed by his approval.

But not today. His eyes were dead. I shivered and looked away. “Yes, sir.” Calling him “sir” was survival instinct. We were formal in surgery. All of our attendings were “doctor” or “sir.” We never bantered around with first names the way they did over in family medicine. Family doctors could afford to be casual. They probably had a case of sniffles to diagnose. Surgeons dealt with life and death, and we trained like soldiers.

“What are you doing?”

I cleared my throat again and looked at the blank faces of the boys. “The sign on the door says ‘Doctors,’ sir.” I winced. I was saying “sir” too much. Made me look rookie. Like the rookie I am. “I was just planning to change—”

“I’m not referring to right now. I’m referring to the bloodbath in room six. Your patient received twenty-three units of blood.”

I managed a small smile. “Yes, sir. A save, sir.”

“Why didn’t you call for help?”

The question caught me off guard. In retrospect, I should have seen it coming, but I was still blind, surfing the wave of exhilaration. I started to answer, but my brain couldn’t catch up to my mouth. Instead, I stood there, jaw unhinged, searching for a response.

“Arrogance leads to patient disasters, Camille. You may have stroked your ego, but at what expense? This is your first day,” he said, swinging his arms in emphasis. “You lost that much blood and you didn’t call for help!”

“He’s alive, sir.”

“Barely. And now he’ll fight a battle to overcome the profound effects of shock.” He shook his head. “This isn’t a game. A boy’s life is at stake and you’ve already turned him into some trophy.”

I tried to speak. I wanted to tell him it wasn’t a game to me, that the patient wasn’t a trophy, that I was a surgeon, but also a woman and capable of deep feeling, but his words had hit a sensitive mark on my soul. “I wasn’t—”

He raised his voice and cut me off. “For God’s sake, Camille, call for help!”

I nodded, suddenly numb and barely comprehending what had just happened. I’d taken my first lashing from the boss. My first day as a trauma attending, and already, I was cut down in front of a crowd. I turned and gathered my things. I needed to change, but I needed to retreat to the nurses’ locker room—and fast—before I started to cry.

I clutched a small handbag with such vigor that I whitened my mulatto knuckles. Heading for the door without uttering another word, I knew I was toast. Six-Liter Club on my first day or not, no one misbehaved in front of Dr. Gilles. I bit my lip in disbelief. I’d gone from Everest-high to Death Valley-low faster than anyone in MCV history.

The nurses’ locker room was empty, as was usual in the middle of a shift. I changed and scurried out at a surgeon’s pace. I hit the stairwell at a near-run just as the tears started to well over my mascara. Cursed X chromosomes! Surgeons don’t cry!

I descended to street level and headed toward the Broad Street exit. My last thought before facing downtown Richmond was, Maybe Derrick will tell Dr. Gilles I’m a bad dude and everything will be OK.

The languid air brought me back to my senses.

No one crosses the boss of the boys’ club and survives.

© 2010 Harry Kraus