Rise and Fall

Dr. Eugene Westphal  sat forward in his chair, elbows on his knees.  He started to speak, paused, and then made sure he was looking the Chief of Staff directly in the eyes.   “So you’re firing me.”

“Of course not,” said Dr. Marcus Jansen, leaning back.  “I was hoping you’d consider taking a spot on the board.”

Dr. Westphal’s left eye twitched, the usual sign he was holding back.  “You know I don’t belong there.   I’m a surgeon, dammit, not a paper pusher.  Besides, those bastards are the reason why we’re sitting here, right?”

Dr. Jansen sighed.  “It’s not just the board.  You’ve been making mistakes, Gene.  The sponge you almost left inside Mrs. Hansen.  The cut on Mr. Cartwright you started in the wrong spot.  The…”

“I’m quite aware of my performance.  If we’re going to sit here and count surgical errors I’m sure I’m still miles ahead of most of my residents.”

“Gene.”  Dr. Jansen sat forward again, clasping his hands on the desk.  “We’ve known each other for almost forty years.  I consider you a friend.  And as your friend, I have to be honest with you.  I think your memory is slipping.  And I don’t mean dementia, Christ no.  But these past few months I’ve…”

“Fuck you, Marcus.  And fuck the board, too. ”  Dr. Westphal rose from his chair and headed towards the door.  “I’ve got a little girl’s life to save.”

Dr. Jansen hung his head, hands still clasped.


Clara Carthon was eight years old.  She was bright, eager, and had the jump-rope record at Edgerton Elementary.  She also had a mitral valve that was leaking blood into her lungs.

“Needle driver,” called Dr. Westphal.  The surgery was progressing smoothly.  Clara’s heart had reacted to the bypass machine with ease.  The mechanical replacement tested perfectly.  All that was left were the sutures and her transition off the machine.

“Doctor, her heartbeat is increasing.  Blood pressure dropping.”

“Shit!” He handed the driver back to the nurse.  “There’s massive clotting in the CBP circuit.  Increase Heparin to two-hundred!”

“You sure?” said the nurse.  “All the way up from ten?”

“It was at ten?  What the hell?  No, it should have been one-hundred.”

“So, you…”

“One-hundred!  Now heads-up people.  This could be touch-and-go.”

Though appearing calm to the lay observer, the surgical team worked desperately for an hour and a half.  The clot dissolved and the patient’s vitals slowly returned to normal.  Transition off the bypass machine went without a hitch, and after closure, the patient was transferred to recovery.

Furious at his team, Dr. Westphal washed up in silence.  Ready to lay into the next person who opened their mouth, he glanced at Clara’s chart and noticed the pre-op orders he had written this morning:

HEPARIN:  10 units/mL

His heart sank.


The nurse entered Dr. Westphal’s office, appearing guarded.

“I apologize if I was harsh with you in the OR,” he told her.  “It was entirely my fault, the Heparin.  I missed a zero.”

“Doctor Westphal” the nurse choked.  “I’m sorry.  Clara isn’t waking from the anesthesia.  Her vitals are fine.  We think it’s a coma.”

He sat motionless, afraid to breathe.

“I thought you should know before we tell the family.”

“No.”  He couldn’t look at her.  “I’ll tell them.”

It only took a minute to reach Clara Carthon’s family in recovery, but it was the longest walk of Dr. Westphal’s career.  He’d delivered worse news than this, many times.  But this time was different.  As he approached, he could sense the family’s apprehension, as if he were holding a scythe at his side.

“Your daughter’s new valve is working, as is her heart.  Unfortunately, she is not waking as soon as we expected.”

Dr. Westphal could feel his chest tighten.

“We’re afraid she may have slipped into a coma.”

The words hung in the air like a fog, growing more dense the longer no one spoke.  His left eye twitched.

Clara’s father was the first to break the family’s stunned silence.  “What do you mean, coma?  It’s just temporary, right?  She’ll wake up?  How did this happen?”

Dr. Westphal usually offered generalities and platitudes in response to this question.  Today was not usual.

“Your daughter’s blood clotted during the surgery.  While this is always a risk during this type of surgery, it could have been attributed due to an order I…”

“Mr. Carthon?  Mrs. Carthon?” Dr. Xiong interrupted.   “Your daughter is waking up now.  You can see her if you like.  She can’t talk just yet, but she appears to be alert and oriented.”

“Oh thank God!” screamed Mrs. Carthon, hugging Dr. Xiong.

Dr. Westphal watched as Clara’s family hurriedly followed the surgical resident.  He should have felt relief.  He wanted to feel relief.  He felt nothing.

“Dodge a bullet?” he heard behind him.  It was a kid in scrubs.  He didn’t recognize him.

“Here,” said Dr. Westphal, placing his name badge in the intern’s hand.  “Give this to Dr. Jansen.”


Dr. Westphal walked towards the exit, his head bowed to the floor.  His eye stopped twitching.

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