The Dispatcher by John Scalzi
I take it as a given that no one really likes to see me in my official capacity. But Dr. Chao seemed more annoyed than most when I showed up for the open heart surgery she was performing.
“Tell me that’s not the person I think it is,” Chao said, to Sheila Reeves. Reeves, a hospital administrator, had accompanied me into the scrub room. Chao was scrubbing up and after the initial glance refused to look at me. Several other members of the operating team were in the scrub room as well, prepping for the operation; they seemed happy to be thinking about other business.
“Helen,” Reeves began.
“You know my policy on non-essential personnel in my operating room.”
“He’s technically not non-essential.”
“Yeah?” Chao said, and then addressed me, without looking my way. “You. What’s your name?”
“And you’re a doctor, right? A specialist in heart surgery.”
“An anesthesiologist, then.”
“I’m not a doctor of any sort.”
“Then you’re a nurse. A surgical nurse.”
“No. I’m not a nurse either.”
“So, not a doctor, not a nurse.” Chao pressed a dispenser with her elbow to get more soap on her hands. “Seems like he has no reason to be in my operating room, Sheila.”
“You know that’s not how it works, Helen.”
“It’s my operating room. It is how it works.”
“The insurance company insists on it. If he’s not in the operating room, they won’t pay.”
Chao glowered quietly for several seconds. I stood, also quiet. Years of practice told me the best thing to do in moments like these is not to speak unless spoken to.
Which I was, a second later. “Where’s Jimmy Albert?” asked another woman, to me. She was hovering over Chao, which made me assume she was a nurse or assistant of some sort. “Jimmy’s usually the one of you who works this hospital.”
“He was called away on a personal emergency,” I said. “Or that’s what he told me. I was on call this weekend so this got handed to me.”
“You’ve worked hospitals and operations before,” Reeves prompted me.
“Of course. A dozen hospitals at least and hundreds of operations. It’s our primary job responsibility at this point.”
“And how many people have you killed, doing your ‘job’?” Chao asked me. I could hear the quotation marks around the word ‘job’ in her voice.
“None so far. That’s actually the point of my job, Dr. Chao.” I had gotten her name from the assignment sheet I’d received a half hour earlier. Being on call meant catching up quickly. Notes from others who had worked with her mentioned she had a tendency toward hostility, which is why I stopped by Reeves’ office and asked her come up with me to the scrub room.
“This is crap, Sheila,” Chao said. She was done scrubbing and turned off the water with her elbows. “You know it’s crap. Check my record. I’ve never had cause for one of them,” she jerked her head in my direction, “to interfere with my work.”
Reeves had one of those set looks of patience that suggested to me that this was not the first time she’d had this discussion with Chao. “It’s not up to me, Helen, and you know it. The insurance insists on it. The family signed off on it. The law says that we have to allow him to be present in the operating room.”
“And to interfere with the operation.”
“He’s allowed to intervene if necessary, yes.”
“Intervene, hell. Interfere.” Chao jabbed an elbow at me. “This jackass has no medical experience at all. He’s not even a nurse—no offense,” she said to the nurse near her, who gave the briefest of nods, “and you’re trying to tell me he’s in some way competent to make a medical judgment?”
“I checked his rating, Helen. He’s exemplary in all categories. Across the board.”
“And that means exactly nothing, because he’s not a doctor. You’re taking away my right to give the best care I can to my patients, and all you have to say to me about it is ‘the insurance insists on it.’ It’s crap, Sheila. It’s crap and I shouldn’t have to work this way. No surgeon should have to.”
“You and I don’t disagree, Helen. But the point is it doesn’t matter whether I agree with you or not. It doesn’t matter if you like the policy. We have to allow him into the room. If we don’t and something goes wrong, the hospital is open to being sued for negligence. And so are you. We have this argument every single time. It doesn’t change.”
“You could make it hospital policy not to allow them in surgery at all.”
“We could, yes. And then we’d go bankrupt because insurers wouldn’t refer their patients to us and the U.S. Government wouldn’t allow us to handle Medicaid cases. As you know.”
Chao stared angrily at Reeves and then finally looked over to me. “Your name again,” she said.
“Where’s your instrument?”
“I was told there was one in the operating room already.” I looked over to the nurse by Chao, who nodded.
“When you’re in the room, I want you well out of the way.”
“I always am.”
“I don’t want to hear a peep out of you. No talking to the team unless you’re directly spoken to.”
“If you distract any of us I’m going to have you hauled up in front of a review board so fast you won’t know what hit you.”
“If you do anything I deem disruptive I’m going to have you thrown out of the room.”
“Helen,” Reeves began.
I help up a hand and looked at Reeves. “It’s all right.” I turned back to Chao. “Doctor, I get it. You don’t want me here and you don’t want me getting in your way. And I agree. I shouldn’t be getting in your way, or in the way of your team. You have my word that I am going to stay out of your hair. Like I said, I’ve been present at hundreds of operations. I’ve gotten very good at making like a hole in the air. It’s not my job to get in your way. You’ve said it yourself, you’ve never needed one of us to step in. In which case, you won’t even know I’m here. You can get in, do your job, and get out without acknowledging I’m even in the room. I don’t mind.”
She glowered at me some more. “What do you do while we work?”
“Sometimes I read a book off my cell phone.”
“I don’t allow cell phones in my operating rooms. They’re a distraction and they can introduce pathogens.”
“Then I’ll stand around quietly.”
Chao was now fully prepped for the operating room. She looked over again at Reeves, gave me the barest of nods, and then turned and went away to get gowned and gloved, starting what was obviously her plan to ignore me through the rest of the day.
Reeves looked over to me. “Sorry about that.”
I smiled. “I’m used to it.”
“I suppose you might be. I don’t imagine you’re very popular with surgeons.”
“No, I’m not.”
“Is it because you remind them of their failures?”
“It’s because I remind them they’re not God,” I said. “And that if there is one, I’m closer to Him than they are.”
In Hour Seven the operation went to hell.
It wasn’t Chao’s fault as far as I could see. The patient was seventy-eight years old and, from what I read from the case file I was given, was not a great candidate for surgery anyway: old, frail, and had more than one operation before. In my opinion this operation wasn’t going to make him any better. All it was going to do was make sure the time he had left was going to be more awful. He was going to be recovering from massively invasive surgery rather than doing anything else he’d want to do with his life, which was probably anything else.
But Chao was right. I’m not a surgeon, or a doctor, or a nurse. I could be entirely wrong about the value of this particular operation. I wasn’t involved with, or didn’t pretend to understand, the intricacies of what they did with their hands inside the open cavity of this man’s chest.
All I had was my experience observing hundreds of operations, and at least a couple dozen just like Chao was now attempting. When the patient was wheeled into the room and my observation of him dovetailed into what I knew from the case file, my gut told me that the good doctor’s streak of not needing someone like me in the room was going to end.
To be fair to her, for six hours she was quite competently proving me wrong.
But Hour Seven was about the patient’s body showing Chao there was a limit to what competence could do confronted with a body that was actively trying to self-destruct. The patient began to react to the anesthetic. Then he began to seize. Then it became clear that the patient, as sometimes happened with open heart surgery, was having a stroke.
All of this happened within five minutes.
Chao was a good surgeon as far as my layman’s eye could see—good in the chest, good with her hands and good, if short, with her team. But after a few minutes of this, it stopped being about her or her obvious talents. It was about whether anyone anywhere could save this patient from the death that was so clearly on its way.
During these five minutes of turmoil, I was doing what I had been doing for the previous six hours: standing there quietly, being the hole in the air I promised Chao I would be. The difference was now I was no longer just standing. I was waiting. Waiting for the sign that would tell me it was time to get involved.
I waited, relaxed. It wouldn’t be long now.
A minute later, the scrub nurse, Jenny Soto, glanced over at me. The glance was almost certainly unintentional; you could probably say it was involuntary. It was my cue nonetheless. In an operating room, no one looks at me—no one looks at anyone in my profession—until they’re absolutely sure we’re going to be needed.
Soto looked over, and I knew. It was time.
I walked over to one of the storage tables in the room, the one I knew my instrument was in. The instrument was about eighteen inches long, thin, and curved, wrapped in packaging so that it would be sterile until the moment of use. We called it the applicator. Next to it, also wrapped in packaging, was a capsule containing compressed nitrogen, and a cartridge with what we simply called the payload. All of the terms we used were as neutral as humanly possible. I retrieved each of these, put them on top of the storage table, and began unwrapping them.
Behind me the operating room had become a frenzy as Chao and her team struggled to keep their patient alive. The patient clearly had other ideas on the matter. I could hear the rattling as the patient jerked and spasmed on the table—whether because of an interaction with the anesthesia or as a side effect of the stroke I couldn’t say. I turned, my instrument fully assembled, and watched their activity for a few more minutes. Then, when I thought it was time, I walked up to the operating table.
Chao saw me coming and wasn’t pleased. “Back off.”
“Call it, doctor.”
“Get out of my operating theater.”
“Your patient is beyond saving, Dr. Chao. You need to call it.”
“I said get out!”
“Doctor, until you call it, I can’t do my job.”
“I don’t need you to do your goddamned job.”
“Dr. Chao,” I said, as gently as possible. “This isn’t about you. And you’re killing your patient.”
Chao swore and backed off from the table. There was dead silence for a moment. Chao swore again and kicked a storage table. It rattled with her fury.
Then she turned back around and faced her team.
“I’m calling it,” she said, and looked at the clock on the wall. “Patient deemed unsalvageable at 15:13. 3:13 p.m.”
“Thank you, doctor,” I said. Then I turned to the anesthesiologist, Dr. Osirio. “Remove the tubes from his mouth and throat, please.” He did.
I nodded to Nurse Soto. “You assist me. Everyone else stand back.”
Soto stayed. Everyone else stepped away.
I returned my attention to Soto. “You’ve done this before?”
“Yes, of course.”
“Then this should be quick. Open the mouth, please.”
Soto reached over and gently opened the patient’s mouth, which was slack and mostly lifeless. “Do you want me to move the tongue out of the way?” she asked.
I shook my head. “It’s not going to matter.” I positioned myself for best access and then slid the applicator into the patient’s mouth, resting the end against the soft palate. I wedged the nearer end of the applicator against the lower jaw, to offer a bit of leverage. I looked up at Soto. She nodded and backed up a step.
“Delivering the payload,” I said, and pressed the button to prime the release. Some newer versions of the applicator automated the entire process and handled it by phone app, but I preferred manual control of the event. I waited the five seconds until the payload was primed, and pressed the button again.
The applicator released a burst of compressed nitrogen, forcefully driving the payload capsule through the soft palate and into the patient’s brain. After two seconds the applicator chimed, signaling it had received data from the payload confirming it was lodged in the brain.
“Activating the payload,” I said, and pressed the button a third and final time.
The payload exploded in the patient’s brain, killing him instantly.
I had purposefully and intentionally killed a man. I was the direct and immediate cause of his death.