Adrian reviewed the day's surgery schedule: hernia, hernia, gallbladder, breast biopsy. His eyes scanned down the names with the same tedium of thousands of times before: Jackson, Silver, Rodriguez, Bernstein...wait! Silver? Jack Silver! As in "Long" John Silver, the present Chairman of the Federal Reserve Bank? He looked at the birthdate: 7/29/53. The age was about right. Could it really be he? He decided to take the 30 seconds before setting up his room to peek in the waiting area. Sure enough, surrounded by what looked like two security detail dudes in suits, sat the Chairman, all 6 foot 6 inches of him, -- bespectacled, slim, with gray hair, an aquiline nose and a pinstriped suit with open collar and polished oxblood wingtips on his outsized feet.
He chuckled to himself. Adrian knew he had anesthetized many VIPs before; actors, sports figures, journalists, even a senator, but never someone who wielded such power. A simple raise of the eyebrow or a vague comment from such a figure could send any number of world exchanges to convulse in spasms of confusion. With ever growing anticipation, he felt his wet armpits stick to the scratchy, starched green scrubs, his throat drying and his hands tremble ever so slightly. It was difficult to concentrate on Jackson's hernia repair....he even forgot to spike the IV bag with antibiotics when Goldfarb, the general surgeon, called for it. (Only later did he sneak them into the IV bag in the recovery room.)
He consciously told himself to settle down as he set up his anesthesia cart for the next case. Since Goldfarb did all his hernia repairs under sedation anesthesia, Adrian knew he wouldn't need to prepare too many meds for Silver's case. Midazolam for relaxation ( 2 milligrams IV on the way to the OR Suite), fentanyl (50 micrograms for pain) and propofol (infused at about 10milligrams per 30 seconds, after a loading dose of 70 milligrams) to keep Silver asleep. This time he won't forget the cefazolin when Goldfarb asks for it, he told himself.
Adrian rushed himself to the pre-op area where Silver now lay on a gurney, his big feet sticking out from under the warmed blanket. Only one security flunky, the black guy with muscular build, stood stiffly by the stretcher.
Adrian introduced himself and went over Silver's medical record in the computer. No known allergies, six foot six, 210 pounds, only medical problems were mild asthma and a history of cataract removal and minor skin surgeries. Married, nonsmoker, social drinker, two kids and chairman of perhaps the most powerful governmental economic entity in the modern world.
Silver was affable, cooperative, even genial. "Do people talk under this kind of anesthesia?" he joked. Adrian told him no, not often, although it was common for women to say that they were worried about what they might say about their husbands and, if so, not to repeat anything. Silver chuckled, his perfectly white teeth standing out against his tanned face. The circulating nurse informed Adrian that the room was ready so with her at the foot of the bed, and Adrian at the head, they began wheeling the gurney down the hall to OR 11. "Time for a cocktail", Adrian smiled, as he slipped the 2 milligrams of midazolam into the IV tubing. Within 30 seconds, silver said 'Wow! You weren't kidding! Does feel like a cocktail! Even two!" The circulator smiled as she and Adrian instructed Silver to scoot himself over to the OR table. Once on the table, Adrian placed the BP cuff, EKG leads and pulse oximeter on Silver and attached nasal oxygen at a rate of 2 liters per minute. Adrian got his first set of vital signs, entered them into the anesthetic record and settled into the swivel chair at the head of the bed.
The scrub nurse, Jennifer Talisker, blond, 34, fit and Adrian's onetime short - term girlfriend, greeted Silver with a sunny hello. Ever since Adrian had broken off things with her, they had been able to maintain a civil but icy détente. They agreed to never let their personal differences interfere with their work and patient safety. Nurse Aweke, the circulator who had helped bring Silver to the OR answered the phone that had just rung in OR 11. It seems that the surgeon was going to be delayed 15 minutes due to an emergency in the ER. Aweke left the room to assist with OR 10's case, where an extra hand was needed to help transport blood products for transfusion. Talisker, realizing the delay of 15 minutes really meant 30, decided to break scrub and take her pee break when she could. That left Silver and Adrian alone in OR 11.
Silver snored comfortably as Adrian, bored, glanced at his cellphone. The Redskins beat the 49ers, 27 to 21....Metro announced delays on construction of the Purple Line...President Goddard announced she would be visiting Russia for three days, aiming to improve relations and, most interestingly, the Federal Reserve Bank was to hold it meeting on interest rates two weeks hence. Adrian's heart skipped a few beats. He glanced over at the drowsing figure laid out on the table. There lay the man who could shake the world, at least temporarily, with a grunt and a gesture. Adrian looked around. Nobody in the hall. Nobody anywhere. He swallowed hard against a dry throat.
"Mr. Silver, how's it going?" Silver awoke, snorted a little and mumbled "Oh, oh, just fine, was dreaming...takin' a nap... or...or...ahhh". Adrian looked around again. Coast still clear. Without hesitation, Adrian picked up the fentanyl syringe and gave just 1/2 cc to Silver, along with 20 milligrams of propofol. In 45 seconds, Silver was smiling, then snoring. Bringing his mouth close to Silver's right ear, the oxygen making its gentle hissing sound around his patient's nostrils, Adrian whispered: "Mr. Chairman, which way will interest rates be going?" Silver smiled ever so slightly, and with a short hiccup exclaimed" Oh up. They are going up! Way up!"
Adrian sat back in his chair, scratched his scalp through his paper surgical cap, and watched the flickering greens and reds flow across the live stock market chart that he always kept running on the upper right corner of the anesthesia station computer. He looked back at the sleeping Silver, leaned back in the swivel chair and blew a deep breath from his puffed out cheeks. Staring into space, he was startled by nurse Aweke's entry to the room. "Goldfarb's on his way!" she said. "I'll call Jennifer back!"
Adrian could not wait until the case was over.
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