Page 6 of Night Shift

“Dr. Thorin, you’re doing it again,” Sam said, once again interrupting my thoughts. Admittedly, it was necessary. The idea of me fucking her mouth was not something I needed to be distracted by before we performed this procedure. Routine. Structure. Patient safety, I reminded myself.

I couldn’t let this firecracker sidetrack me from performing my duties. My infatuation was something I would revisit later.

I headed for the procedure room, Sam in tow.

Once we arrived, I stopped at the foot of the patient’s bed and explained our plan to him. “All right, Mr. Stewart, we have our team ready.” Using the chart in my hand as a reference, I pointed at each person as I introduced them. “This is your nurse, Samantha; Brian, our pharmacist; Jake, one of our ED techs who will help me stabilize your arm while I pull traction; and Kat, our respiratory therapist. We’re going to be performing a procedural sedation. We’ll begin by administering some propofol to relax you, allowing you to sleep. You don’t have any allergies to medications, correct?”

“No, sir. Well, not that I know of,” Mr. Stewart said.

“Good. We’re going to monitor you as we administer the sedative, and once we see you’re comfortably sedated, I’m going to apply traction to your arm, set your radial bone, and then the tech will splint your arm while you’re still under. By the time you’re awake, we’ll have taken a subsequent X-ray to make sure everything looks good, and then we can get you discharged. Does that sound like a plan, Mr. Stewart?”

“Sounds like a plan,” he echoed.

“Mr. Stewart, how much do you weigh?” the pharmacist asked.

“About one hundred seventy-five pounds.”

“Perfect,” the pharmacist noted. “Okay, last question. Have you ever been sedated with propofol before?”

“No, sir,” Mr. Stewart said.

“Let’s start him at point five milligrams per kilogram,” I said, but Sam looked at me quizzically, as if I had suggested the wrong dose.

“Do you have something to say, Samantha?”

She paused, taking a deep breath in. “I think we should start Mr. Stewart on a lower dose since he’s never had propofol before, maybe point two five milligrams per kilogram?”

I nearly bit into my lower lip. Sam, perhaps inadvertently, was questioning my dosage in front of everyone.

“And what exactly is your rationale for starting at a lower dose, Samantha?” I asked, my voice coming out terser than I had intended.

“Well, I’m trying to be the patient advocate that Mr. Stewart deserves. I figured if we started at a lower dose and he doesn’t respond to it, we can always increase the dosage,” she said, taking another deep breath to gather her thoughts. “And if we give too much propofol, Narcan or Romazicon aren’t effective reversal agents, so we would have to use physostigmine, which isn’t a perfect solution either.”

“Well, I’m glad you know your drugs and your reversal agents, Ms. Sheridan, but I think I know what I’m doing,” I said with a sharpness that cut through the tension of the room. “Now that we’re done questioning the people who have actually done procedural sedations, shall we get started?”

Sam’s face turned bright red as her eyes fell to study the edge of the bed. My comment had apparently struck a chord in her. Perhaps I might have been too firm with her, but I wasn’t used to being questioned, especially not in front of staff and patients.

However, she had made a good point.

I looked over at Brian and glanced at Sam. “Let’s start with point two five milligrams per kilogram and see how Mr. Stewart responds. If need be, we can continue with subsequent doses of point five milligrams per kilogram until he’s out. Does everyone agree with this?”

“Sounds good,” Sam responded immediately, her face breaking into a gratified smirk.

I turned to the patient. “Okay, Mr. Stewart, I want you to count backward from one hundred. We’ll begin as soon as you’re under.”

“Are you sure I’m going to be okay? You guys are the medical professionals, but that whole conversation about giving me too much sedative and reversal agents has me a little freaked out right now,” he said.

Sam leaned in and gently placed a hand on his shoulder. “You’re going to be just fine. You have a great team at your bedside. We’ll have you fixed up and out of here before you know it. Now, how about we start that countdown, Mr. Stewart?”

He took a deep breath in just as the pharmacist began pushing the propofol. After a slow exhale, there was nothing. No counting. No chest rise.

The moment I saw Mr. Stewart’s chest cease its rhythmic rise and fall, my heart sank. The patient was apneic.

“Apnea,” I announced sharply.

The room snapped to a heightened state of alert. Sam was right by my side, her expertise as an emergency nurse evident in her swift response.

“How much did you give him?!” I shouted at the pharmacist.

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