1:10 p.m. Custom-designed birth. It's an ordinary C-section, but 17-year-old Brittney King is not an ordinary patient. She was three months pregnant last December when her Pontiac Sunfire flipped off a slick road and slammed into a creek, crushing her spinal cord and paralyzing her below the midchest. Pregnant patients like King are rare—even in a heavily trafficked hospital like Vanderbilt, doctors might deliver two or three a year with such severe spinal-cord injuries.
Obstetricians and anesthesiologists huddled; a C-section was scheduled. It would be risky. The main connection between King's brain and most of her body was gone, but normally painful or uncomfortable sensations—perhaps the touch of the surgeon's knife or pressure from a full bladder—could reach the brain through other pathways. Her blood pressure would shoot up, and the brain, unable to signal her body below the chest, would be helpless to damp it down. She could have a seizure or a killer stroke. Mining published case reports, obstetric anesthesiologist Jill Boyle settled on a combination of spinal and epidural anesthesia to completely block all potentially deadly impulses. The scheme worked. Just-born Kaydence rests on the pillow, next to her mother's tired but glowing face.
3:27 p.m. More than a haircut. "Whatever you do, don't touch the controls on that bed," Emma Harris orders 63-year-old Jerry Siers with mock sternness as she snips his silvery mane. The proprietress of the Vanderbilt Medical Center Hair Salon has come to Siers because he is too weak—he has idiopathic pulmonary fibrosis, a progressive condition that stiffens the lungs—to make an appointment in her domain. "Sideburns about halfway down and square in the back," huffs Siers, who is being assessed for a possible lung transplant. "That's how Elvis did it, and that's how old I am."
Harris is a legend, and not just because in 31 years at Vanderbilt she has coiffed uncounted local celebs, like Vanderbilt alum Will Perdue, a former NBA championship player. She is undeterred by barriers that hospitalization puts in the way of a decent haircut: She'll disinfect the salon and wear gloves and a mask to protect a weakened immune system. She'll wash and cut the hair of patients adorned with a halo, a metal frame screwed to the skull to prevent movement following some spinal surgeries. Right now she is trimming Siers's mustache, working around the oxygen-delivering fixture below his nose. In a place that can feel lonely, Harris offers a dose of dignity. "I just appreciate getting you up here," Siers murmurs as she applies finishing touches. "Very much."
3:51 p.m. Musical moment. Yesterday, a tractor ran over Dennis Caldwell, breaking his pelvis and lacerating his face. Helicoptered to Vanderbilt, about 140 miles from a hospital in Paducah, Ky., Caldwell, 57, is propped up in the trauma ICU awaiting surgery to mend his pelvis. He is attached to many tubes and his face is scraped, but he beams and taps his fingers as two young men with guitars spiritedly knock out a country song at his bedside. "We hope we rocked your day a little bit," says David Oakleaf. LB & Oakleaf, as the two are known professionally, have serenaded patients in the trauma, dialysis, and transplant units for the past couple of hours. They are volunteers with "Musicians On Call," a nonprofit group that brings live and recorded music to patient bedsides. The organization started a Nashville chapter last year, and Vanderbilt sponsors the visits. "It lifted my spirits," says Caldwell. "It gets boring lying in this bed all day long."
Day 2
8:57 a.m. Timeout. Only the left leg and hip of the man on the OR table are uncovered. A dark "geh" on his hip, scrawled by orthopedic surgeon Ginger Holt with a black Sharpie an hour earlier, is unmistakable. Activity stops. The clink of surgical tools being laid out is silenced. Holt and her team run down a checklist, announcing the patient's name, diagnosis, and procedure—excision of a tumor from his buttock—and verify that it is on the left side. These "timeouts" were made mandatory at Vanderbilt in 2003 (there were two "wrong-site surgeries" in the previous two years, neither involving amputation or removal of the wrong organ) and are now standard practice at many hospitals. But Vanderbilt tacked on extra precautions: Patient and site verification and timing of infection-preventing antibiotics and initial incision are entered into a computer and time-stamped for later analysis. Following implementation of the timeout protocol, there has been one operation on the wrong portion of the spine. This represents a wrong-site rate of 1 per 185,000 cases across the entire facility. "I see my initials," says Holt, the last check before she cuts. "We're ready to operate."
