"You'll take good care of me, right?"

That was the question she asked me. Though there was a hint of embarrassment in her voice her eyes were dead serious. It was a question I get asked often in my profession. People were nervous before surgery. It was completely normal. At the time I was still a student, still trying to hide the nervousness myself.
"Of course I will", I replied, smiling. Compared to other patients I had had of late, this one was exceedingly healthy. She was in her mid-40's, and she had no other health problems other than the small aneurysm, or bulge, in one of her arteries. Most likely it had been picked up in a routine physical. Tomorrow a stent would be placed in the artery, diverting bloodflow away from the bulge. Routine surgery. She would be home the next day. Her husband sat by the bedside.
The next morning the surgery started out routine. Actually, it was a bit boring. In anesthesia boredom is a good thing. It means that nothing is going wrong. It means your patient is stable. I was sitting there watching the monitors. Before the operation I had put an arterial line into the patient. This type of line is hooked to a pressure transducer and allows a beat by beat reading of the blood pressure, rock solid stable: 110/65, 112/64, 109/65.
I was sitting there watching the monitors: 110/66, 108/64, 102/58, 95/50, 91/48.
I stood up and looked toward the surgeons over the surgical drape. "Everything okay over there?" I asked.
88/45, 84/41, 78/38.
The next instant one of the surgeons yells "Oh shit!", then turning to me: "Get some help in here now!"
71/34, 66/29, 60/22.
Less than 5 seconds has passed since the blood pressure started to drop. In anesthesia boredom is a good thing. The next two hours were not boring at all. The surgeon had accidentally punctured a major artery, and the patient was bleeding into her stomach, massively. Help arrived. More lines were put into the patient. Blood and fluid and medicines were given. The next two hours passed in a flash. We did a lot, all that we could, but it wasn't enough. The patient survived, but the blood pressure was too low for too long, and she suffered a massive heart attack. Instead of extubation the breathing tube was left in. Instead of going to the floor and heading home the next day she went to the intensive care unit.
I only went to see her once, late on the next day. Her husband was not there. I didn't expect her to be awake, didn't want her to be awake, but she was. She smiled around her breathing tube. She squeezed my hand as I mumbled a sort of apology, (I'm so sorry, but we tried. We really tried. It just happened so fast, and now I don't think you'll ever leave this room) not knowing at all what to say. I can't remember what I said. I only remember her smiling.
I didn't go back in there. I should have, but I was a coward. I read her chart, though, looked her up on the computer from the operating room. Followed her progress from a safe distance. She was able to get her breathing tube out two days later, but something again went wrong shortly thereafter. Her heart was too weak. It failed, and she went into shock. The next day she died.
She was the first, and so far, thank God, only patient I've had in the operating room where something has unexpectedly gone so wrong. I am not a stranger to death. Several patients have come through not expecting to live (shot, stabbed, etc.) and we kept them alive long enough to get them to the intensive care unit where they promptly met expectations. Before, working in the intensive care unit, death at times was even a blessing.
"You'll take good care of me, right?" Its been a long time since that woman asked me that question, and I've been asked that question many times since. Many times with that same embarrassment that happens when you let your guard down.
"Of course I will," I still reply, remembering that patient and her smile. Remembering how quickly the routine can become something very far from routine. "Of course I will."