1

The Beginning of the End

“What’s the fucking ACT?” Dr. Porter yelled as he stormed into room 3 of the pediatric cardiac intensive care unit at Children’s Hospital of Biloxi.

“The ACT is 140, sir!” replied the perfusionist managing the ECMO circuit.

“I told you I wanted the ACT to be 160–180. Why isn’t it 160–180?”

“Well, sir, we are getting some conflicting orders regarding the ACT goal. Due to the massive amount of bleeding from the chest tubes, we had been told that we were not adjusting the heparin infusion based on ACT,” explained the respiratory therapy supervisor.

“What is your name, son?” Dr. Porter asked rhetorically. As Gary opened his mouth to reply, he was rudely interrupted by the words, “Never mind your name. Who told you to think? I give the orders and you follow them, that’s how this works,” screamed Dr. Porter.

I had just walked through the entryway doors leading to the pediatric cardiac intensive care unit to meet Dr. Slovak, one of my cardiac intensive care colleagues, so that she could provide patient hand off, as I was taking over service responsibilities for the week. We looked at one another as we heard the commotion that appeared to be coming from room 3 of the CICU, so we both rushed down the hall to see what was going on. Astrid and I arrived at the doorway of room 3 to discover a scene best described as a hybrid between a low-budget horror film due to the massive amount of blood hemorrhaging from the patient, and a 1980s human resource video showing an extreme example of workplace violence. Astrid and I looked at one another with shock and disdain as we witnessed Dr. Porter’s tyrannical behavior, his face cherry red, radiating unfathomable rage, in such an uncontrollable manner it screamed pathologic, suggesting a source housed deep within. His surgical mask rested misplaced, exposing his somewhat long, pointed nose with beads of sweat tumbling down until finally reaching the tip and falling to the floor, as if drops of water dripping one at a time from an aged, leaky farmhouse faucet.

“Phil!” I said, attempting to get his attention, but there was no response. “Phil!” I repeated in a much louder voice, again vying to capture his attention and break him from this trance of rage.

T