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There was no time to rescrub. From sterile packages the circulator dropped gown and gloves on a back table. Mike gowned and regloved, waiting for a look from Clayton. But Clayton worked mechanically with his eyes down, refusing to acknowledge Mike’s presence. This was Clayton Otherson, his professor and mentor during training, nationally prominent for his bold innovations and unmatched results for so many years, his senior partner for the last twelve years, now floundering in indecision, unable to find the right choices to save his patient’s life. Unthinkable.

The anesthetist, her face frustrated and angry, turned the monitor so he could see. The pulse was 138.

“I think I got it,” Clayton mumbled

Denial. The most dangerous response of the impaired physician.

“More blood’s coming,” Paul said directly to Mike, making adjustments to an IV, his gaze intent and away from Clayton.

With a firm nudge of his elbow, Mike moved the resident farther away from the action to gain a better view and access to expose the error. Clayton glared at him for the first time with red, rheumy eyes with a mixture of fear and humiliation.

Mike repositioned the retractors in the resident’s hands, opening the abdominal wall incision by three inches. Emerging thick layers of fat gleamed above pools of arterial blood that had lost its healthy hue. Suction and irrigation isolated the artery that was cut through. With a tie, Mike stopped the bleeding.
He could feel Clayton’s humiliation, the humiliation of needing help that eroded confidence and self-image, and that would never fade. But this was no time for sympathy. Clayton was in no condition to continue, and with his eyes Mike indicated to the resident to act as assistant from his position, without making Clayton move away from the table, to let him preserve some dignity.

With the bleeding sources stopped and the field dry, Mike finished the repair and started closure. Clayton left the table to take off his gown and leaned against a back wall, his head down. The anesthetist turned a stopcock on an IV line and adjusted gas flow percentages. She glanced at Mike with relief. The monitors changed pace slightly. As the resident completed the last sutures, he waited to be sure the blood pressure was safe, then told the resident to remove the drapes and dress the incision.

“I’ll dictate,” Clayton said to the resident, without looking at Mike.

Clayton yearned to turn back the clock, to be in control again. Mike paused before leaving but there was nothing he could say to comfort Clayton, and he hurried out of the room.

At seven o’clock that evening on the administrative floor, Mike looked up as his office door opened without a knock. Paul Smythe, the anesthesiologist, handed him a folder with four stapled sheets of paper.

“It’s an incident report,” Paul said. “On Otherson.”

“Take it to Pat or Margaret, Paul,” Mike said. Paul looked worried and angry.

“Read the goddamn report, Mike. I don’t want any errors.”

The report detailed Clayton’s morning case. He looked up when he finished.

“Is this really necessary?”

“He’s impaired, Boudreaux. If you see something I’ve written that’s not right, change it.”

“You can’t know he’s impaired, Paul. One case is not a trend. And it’s a tricky label to put on any surgeon.”

“This is not the first. I’ve seen other cases of his that have gone wrong. He doesn’t know he’s in trouble, and then he freezes.”

“He’s the best there is. I’ve spent a career trying to achieve what he has.”