AN ANESTHESIOLOGIST’S SALARY

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

How much money does an anesthesiologist earn? What is a physician anesthesiologist’s salary in today’s marketplace?

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Let me begin by offering two anecdotes:

  • I was an invited visiting anesthesia professor at a major university this year, and following one of my lectures an anesthesiology resident approached me for a discussion. During our conversation he revealed that his student loan debt was $300,000. In 2014 the published average student loan debt for a physician was $183,000. I believe a higher estimate is not unusual, particularly if the student doctor attended private medical school and/or college.
  • I recently received an email from a medical student who was considering anesthesia as a career specialty, but his concern was: is the bottom about to fall out for anesthesiologists’ salaries? Should he perhaps avoid a career in anesthesiology?

Each anecdote concerns the issue of how much anesthesiologists earn, and what will that number be in the future?

The good news for the future of anesthesia careers is that the number of surgeries in the United States is expected at increase as the Baby Boomers age. The demand for anesthesia services will grow. Who will provide these services, and what will they be paid?

How much money do anesthesiologists currently make?

It depends.

If you do a Google search on this question, most of the published answers vary from $275,000 to $360,000 per year.

This sounds like a lot of money, but recall that to reach that salary, an anesthesiologist must finish 4 years of medical school and a 4-year anesthesia residency. At a minimum these young anesthesiologists are 30 years old. The deferred gratification is significant. Had they gone to work after college at age 22 and been promoted in a business job for 8 years, that individual might own a home, be saving for their children’s college educations, and would not have the debt from 4 years of medical school.

Let’s assume an individual does persevere and finish their anesthesia residency at age 30, and is now seeking an anesthesia job with that aforementioned average salary of $275,000 to $360,000 per year.

The first question: is that advertised salary a number prior to deductions for the big three of pension plan, health insurance, and malpractice insurance? If an anesthesiologist earns $300,000 per year, but must subtract these three expenses (let’s estimate pension plan at $45,000, health insurance at $24,000, and malpractice insurance at $20,000) then the income drops to $300,000 minus $89,000 = $211,000 per year, or $17,583 per month before taxes. Subtract again for student loan payments, and the income level continues to decrease. So a critical first question to ask is if the big three benefits are/are not part of the promised salary.

What specific factors determine how high the anesthesiologist’s salary will be? An operating room anesthesia practice is somewhat akin to being a taxi cab driver. You earn income for each ride/anesthetic, and your income depends on how many rides/anesthetics and how long they last. More complex anesthetics such as cardiac cases pay more, but the largest determiner is the duration of time one spends giving the anesthesia care. If you work in a physician anesthesiology practice where an MD stays with each surgical patient 100% of the time, then the only way to increase income is to do more cases or more hours. If you work in a practice which utilizes an anesthesia care team, where one physician anesthesiologist may supervise, for example, 4 Certified Registered Nurse Anesthetists (CRNAs), then a physician’s income is increased because he or she is billing for and supervising care for multiple concurrent surgeries.

Different payers pay different sums per unit time. The top payers are insured patients of less than Medicare age (<65 years old). Among the lowest payers are uninsured patients (who often pay zero), Medicaid and Medicare patients, and Worker’s Compensation patients. Medicare patients routinely pay only 13-20 cents on the billed dollar, and Medicaid pays even lower, so a practice heavy with Medicare and Medicaid patients will compensate their anesthesiologists poorly. Insurance companies (i.e. Blue Cross, Blue Shield, Aetna, United Healthcare) pay whatever rate they have contracted with that anesthesia group. If a particular insurance company pays a low rate, an anesthesia group may refuse to sign a contract with that insurance company. This leaves the anesthesiologist out-of-network with that company, which can mean a higher payment or co-payment for the patient as a result of the insurance company’s refusal to negotiate a fair reimbursement.

Just as taxi cab drivers are being supplanted by Uber and Lyft, cheaper models of anesthesia care are popping up, and the penetration of these models into the future marketplace is unknown. One model is having a CRNA do the anesthetic independently without any physician anesthesiologist present. This is currently legal in 27 states (see map). At the current time, in my home state of California, independent CRNA practice is legal, but the penetration of this model in the marketplace is very minimal. The Veterans Affairs hospitals are currently pondering a move to allow CRNAs to practice independently without any physician anesthesiologist present. You can expect to see a higher penetration of the anesthesia care team, where one physician anesthesiologist may supervise, for example, 4 CRNAs, and a decrease in practices where an MD anesthesiologist stays with each patient 100% of the time.

To be blunt, my impression is that the future marketplace is unlikely to pay for a physician anesthesiologist to do solo anesthesia care for each and every surgical patient.

In the current marketplace a young graduate anesthesiologist may enter one of several different models of anesthesia practices. Each has a different level of salary expectation. The various models are listed below, in roughly a higher-income-per-anesthesiologist to lower-income-per-anesthesiologist order:

  1. A single-specialty anesthesia group that shares income fairly. This group may be as small as 5 or as large as hundreds of physician anesthesiologists, with or without additional CRNAs. Such a group usually has an exclusive contract with a hospital or hospitals to provide all anesthesia services, which can include trauma, obstetrics, and 24-hour emergency room coverage. A very large single-specialty anesthesia group may contract with many hospitals in a geographic area. In a single-specialty model, that single-specialty group receives all the anesthesia billings, and the income is divided, usually in some form of “eat-what-you-provided” formula. Those MDs who worked the most receive a proportional increase in their income. A new MD may have a one-year try-out before they become a partner, after which they are entitled to an equal income per unit time. This model where anesthesiologists are partners, is typically more lucrative than models where the anesthesiologists are employed by another entity. A survey by Medscape on anesthesiologists’ salaries in 2016 showed that male self-employed anesthesiologists (model #1) earned an average income of $413,000, while male anesthesiologist employees (see models #2 – #8 below) earned an average income of $336,000.
  2. A single-specialty anesthesia group in which a chairman (or a small oligopoly of MDs) collect the money, and then employ and grant a salary to everyone below them in the company. New hires are paid less, often with no potential to increase their income. This type of system preys on junior anesthesiologists.
  3. A multispecialty medical group. A multispecialty medical group has a bevy of primary care physicians who refer internally to their specialist surgeons, who then utilize their internal group of anesthesiologists. This is a secure job for anesthesiologists because the stream of cases is guaranteed by the physicians within their multispecialty group. A disadvantage is that incomes from lower paying specialties (primary care MDs) and higher paying specialties (i.e. cardiologists, surgeons, and anesthesiologists) are pooled. The lower paying specialists usually have their salaries raised, and the anesthesiologists will be subsidizing them.
  4. An HMO. In California the Health Maintenance Organization (HMO) Kaiser Permanente has a large share of the marketplace. The entity known as the Permanente Medical Group is the multispecialty integrated medical group which works at the Kaiser hospitals and clinics. The reimbursement model will be similar to that described in #3 above.
  5. University anesthesia groups. A university employs MDs as a multispecialty medical group, and the model is similar to #3 above. A difference is that university groups have various taxes and fees on their income that go to the betterment and growth of the medical school and the university hospital system. In addition, some university hospitals provide care to indigent populations that may have higher percentage of poor payers such as Medicaid or uninsured patients.
  6. National anesthesia companies. In this model, a national company obtains the anesthesia contract for a hospital or multiple facilities, and then that national company hires and employs anesthesiologists. The company bills for the anesthesia services provided, pays their employee anesthesiologists whatever sum they’ve agreed to pay them, and the difference between the received monies and the owed salaries is profit that goes to stockholders of the national company. This model is problematic for our specialty, because a percentage of the anesthesia fees goes to stockholders who had zero to do with performing the professional service.
  7. Veteran’s Affairs (VA) hospital anesthesia groups. At the present time, VA hospitals are staffed by anesthesiologists who are employees of the VA system. As mentioned above, there are politicians pushing for the VA to allow CRNAs to practice independently, unsupervised by physician anesthesiologists. The American Society of Anesthesiologists is opposed to this change, believing that our veterans deserve physician anesthesiologists.
  8. Locum tenens assignments. These are part-time, week-long, or month-long anesthesia duties, paid for at a daily rate. A typical fee for a full day’s work may be a pre-tax payment of $1200/day (not including the big three of pension, health or malpractice insurance).

As stated above, the good news for the future of anesthesia careers is that the number of surgeries in the United States is expected at increase as the Baby Boomers age. The demand for anesthesia services will grow. The unknown fiscal factors for the future of our specialty are:

  1. What will insurers/Medicare/Medicaid/the Affordable Care Act pay for these anesthesia services? Will a single payer government health plan ever arrive, and if it does what will anesthesiologists be paid?
  2. Who will be giving these services? Physician anesthesiologists, anesthesia care teams involving physician anesthesiologists plus CRNAs, anesthesia care teams involving physician anesthesiologists plus Anesthesia Assistants, or independent CRNAs?
  3. The American Society of Anesthesiologists is attempting to rebrand the practice of anesthesiology with the concept of the Perioperative Surgical Home (PSH), in which physician anesthesiologists are responsible for all aspects of preoperative, intraoperative, and postoperative medical care for patients around the time of surgery. This expanded role includes preoperative clinics and postoperative pain control and medical management. To what degree can/will the PSH change the job market for graduating anesthesiologists?

In any case, as I wrote on the Home Page of theanesthesiaconsultant.com website, “the profession of medicine offers a lifetime of fascination, and no specialty is more fascinating than anesthesiology.” If a college student or a medical student is truly interested in a career in anesthesia, I remain encouraging to them, regardless of these uncertainties regarding the future.

 

The most popular posts for laypeople on The Anesthesia Consultant include:

How Long Will It Take To Wake Up From General Anesthesia?

Why Did Take Me So Long To Wake From General Anesthesia?

Will I Have a Breathing Tube During Anesthesia?

What Are the Common Anesthesia Medications?

How Safe is Anesthesia in the 21st Century?

Will I Be Nauseated After General Anesthesia?

What Are the Anesthesia Risks For Children?

 

The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:

10 Trends for the Future of Anesthesia

Should You Cancel Anesthesia for a Potassium Level of 3.6?

12 Important Things to Know as You Near the End of Your Anesthesia Training

Should You Cancel Surgery For a Blood Pressure = 178/108?

Advice For Passing the Anesthesia Oral Board Exams

What Personal Characteristics are Necessary to Become a Successful Anesthesiologist?

 

 

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Check out . . . THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

41wlRoWITkL

 

LEARN MORE ABOUT RICK NOVAK’S FICTION WRITING AT RICK NOVAK.COM BY CLICKING ON THE PICTURE BELOW:

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DENTAL ANESTHESIA DEATHS . . . GENERAL ANESTHESIA FOR PEDIATRIC PATIENTS IN DENTAL OFFICES

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

GENERAL ANESTHESIA FOR DENTAL OFFICES CASE PRESENTATION: A 5-year-old developmentally delayed autistic boy has multiple dental cavities. The dentist consults you, a physician anesthesiologist, to do sedation or anesthesia for dental restoration. What do you do?

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DISCUSSION:  Children periodically die in dental offices due to complications of general anesthesia or intravenous sedation. Links to recent reports include the following:

3-year-old girl dies in San Ramon, CA after a dental procedure in July 2016.

A 14-month-old child, scheduled to have 2 cavities filled, dies in an Austin, TX dental office. The dentist and an anesthesiologist were both present.

A 6-year-old boy, scheduled to have teeth capped at a dental clinic, has anesthesia and dies after the breathing tube is removed.

Another 6-year-old boy, scheduled to have a tooth extracted by an oral surgeon, dies after the oral surgeon administers general anesthesia.

Pediatric dentists use a variety of tactics to keep a typical child calm during dental care. The child is encouraged to view a movie or cartoon while the dental hygienist or dentist works. The parent or parents are encouraged to sit alongside their child to provide emotional support. If a typical child requires a filling for a cavity, the dentist can utilize nitrous oxide via a nasal mask with or without local anesthesia inside the mouth.

These simple methods are not effective if the child has a developmental delay, autism, behavioral problems, or if the child is very young. Such cases sometimes present to a pediatric hospital for anesthetic care, but at times the child will be treated in a dental office. Possible anesthesia professionals include a physician anesthesiologist, a dental anesthesiologist, or an oral surgeon (who is trained in both surgery and anesthesia).

 

HOW WOULD A PHYSICIAN ANESTHESIOLOGIST ANESTHETIZE A CHILD IN A DENTAL OFFICE?

There are a variety of techniques an anesthesiologist might use to sedate or anesthetize a young child. The correct choice is usually the simplest technique that works. Alternative methods include intramuscular sedation, intravenous sedation, or potent inhaled anesthetics.

 

ANESTHESIA INDUCTION:

The first decision is how to begin the anesthetic on an uncooperative child. Options for anesthesia induction include:

  1. Intramuscular sedation. A typical recipe is the combination of 2 mg/kg of ketamine, 0.2 mg of midazolam, and .02 mg/kg of atropine. These three medications are drawn up in a single syringe and injected into either the deltoid muscle at the shoulder or into the muscle of the anterior thigh. Ketamine is a general anesthetic drug that induces unconsciousness and relieves pain. Midazolam is a benzodiazepine which induces sleepiness and decreases anxiety. Ketamine can cause intense dreams which may be frightening. Midazolam is given because it minimizes ketamine dreams. Atropine offsets the increased oral secretions induced by ketamine. Within minutes after the injection of these three drugs, the child will become sleepy and unresponsive, and the anesthesiologist can take the child from the parent’s arms and bring the patient into the operating room. Most anesthesiologists will insert an intravenous catheter into the patient’s arm at this point, so any further doses of ketamine, midazolam, or propofol can be administered through the IV.
  2. Oral sedation with a dose of 0.5-0.75 mg/kg of oral midazolam syrup (maximum dose 20 mg). If the child will tolerate drinking the oral medication, the child will become sleepy within 15- 20 minutes. At this point, the anesthesiologist can take the patient away from the parent and proceed into the operating room, where either an intravenous anesthetic or an inhaled sevoflurane anesthetic can be initiated.

 

MONITORING THE PATIENT:

  1. The patient should have all the same monitors an anesthesiologist would use in a hospital or a surgery center. This includes a pulse oximeter, an ECG, a blood pressure cuff, a monitor of the exhaled end-tidal carbon dioxide, and the ability to monitor temperature.
  2. The anesthesiologist is the main monitor. He or she will be vigilant to all vital signs, and to the Airway-Breathing-Circulation of the patient.

 

MAINTENANCE OF ANESTHESIA:

  1. Regardless of which anesthetic regimen is used, oxygen will be administered. Room air includes only 21% oxygen. The anesthesiologist will administer 30-50% oxygen or more as needed to keep the patient’s oxygen saturation >90%.
  2. Intravenous sedation: This may include any combination of IV midazolam, ketamine, propofol, or a narcotic such as fentanyl.
  3. Local blocks by the dentist. The dentist may inject local anesthesia at the base of the involved tooth, near the superior alveolar nerve to block all sensation to the upper teeth, or near the inferior alveolar nerve to anesthetize all sensation to the lower jaw.
  4. Inhaled nitrous oxide. The simplest inhaled agent is nitrous oxide, which is inexpensive and rapid acting. Used alone, nitrous oxide is not potent enough to make a patient fall asleep. Nitrous oxide can be used as an adjunct to any of the other anesthetic drugs listed in this column.
  5. Potent inhalation anesthesia (sevoflurane). Most dental offices will not have a machine to administer sevoflurane. (Every hospital operating room has an anesthesia machine which delivers sevoflurane vapor.) Portable anesthesia machines fitted with a sevoflurane vaporizer are available. A colleague of mine who worked full time as a roving physician anesthesiologist to multiple pediatric dental offices leased such a machine and used it for years. The advantages of sevoflurane are: i) few intravenous drugs will be necessary if the anesthesiologist uses sevo, and ii) the onset and offset of sevo is very fast—as fast as nitrous oxide. The administration of sevoflurane usually requires the use of a breathing tube, inserted into the patient’s windpipe.
  6. The anesthesiologist will be present during the entire anesthetic, and will not leave.

 

AWAKENING FROM ANESTHESIA:

  1. With intramuscular and/or intravenous drugs, the wake-up is dependent on the time it takes for the administered drugs to wear off or redistribute out of the blood stream. This may take 30-60 minutes or more following the conclusion of the anesthetic.
  2. With inhaled agents such as sevoflurane and nitrous oxide, the wake-up is dependent on the patient exhaling the anesthetic gas. The majority of the inhaled anesthetic effect is gone within 20-30 minutes after the anesthetic is discontinued.
  3. The patient must be observed and monitored until he or she is alert enough to be discharged from the medical facility. This can be challenging if a series of patients are to be anesthetized in a dentist’s office. The medical staff must monitor the post-operative patient and also attend to the next patient’s anesthetic care. It’s imperative that the earlier patient is awake before the anesthesiologist turns his full attention to the next patient.

 

THE ANESTHETIC FOR OUR CASE PRESENTATION ABOVE:

  1. The anesthesiologist meets the parents and the patient, and explains the anesthetic options and procedures to the parent. The parent then consents.
  2. The anesthesiologist prepares the dental operating room with all the necessary equipment in the mnemonic M-A-I-D-S, which stands for Monitors and Machine, Airway equipment, Intravenous line, Drugs, and Suction.
  3. The anesthesiologist injects the syringe of ketamine, midazolam, and atropine into the child’s deltoid muscle. The child becomes sleepy and limp within one minute, and the anesthesiologist carries the child into the operating room.
  4. All the vital sign monitors are placed, and oxygen is administered via a nasal cannula.
  5. An IV is started in the patient’s arm.
  6. The dentist begins the surgery. He or she may inject local anesthesia as needed to block pain.
  7. Additional IV sedation is administered with propofol, ketamine, midazolam, or fentanyl as deemed necessary.
  8. When the surgery is nearing conclusion, the anesthesiologist will stop the administration of any further anesthesia. When the surgery ends, the anesthesiologist remains with the patient until the patient is awake. The patient may be taken to a separate recovery room, but that second room must have an oxygen saturation monitor and a health care professional to monitor the patient until discharge.

CHALLENGES OF DENTAL OFFICE ANESTHESIA:

  1. You’re do all the anesthesia work alone. If you have an airway problem or an acute emergency, you’ll have no other anesthesia professional to assist you. Your only helpers are the dentist and the dental assistant.
  2. The cases are difficult, otherwise you wouldn’t be there at all. Every one of the patients will have some challenging medical issue(s).
  3. You have no preop clinic, so you don’t know what you’re getting into until you meet the patient. I’d recommend you telephone the parents the evening before, so you can glean the past medical and surgical histories, and so you can explain the anesthetic procedure. Nonetheless, you can’t evaluate an airway over the phone, and on the day of surgery you may encounter more challenge than you are willing to undertake.
  4. It’s OK to cancel a case and recommend it be done in a hospital setting if you aren’t comfortable proceeding.
  5. The anesthesiologist usually has to bring his or her own drugs. The narcotics and controlled substances need to be purchased and accounted for by the anesthesiologist with strict narcotic logs to prove no narcotics are being diverted for personal use. All emergency resuscitation drugs need to be on site in the dental office or brought in by the anesthesiologist.
  6. If a sevoflurane vaporizer is utilized, dantrolene treatment for Malignant Hyperthermia must be immediately available.

 

BENEFITS OF DENTAL OFFICE SEDATION AND GENERAL ANESTHESIA:

  1. The parents of the patients are grateful. The parents know how difficult dental care on their awake child has been, and they’re thankful to have the procedures facilitated in a dental office.
  2. The dentist and their staff are grateful. They don’t have a method to safely sedate such patients, and are thankful that you do.
  3. Most cases are not paid for by health insurance, rather they are cash pay in advance.

 

HOW SAFE IS ANESTHESIA AND SEDATION IN A DENTAL OFFICE?

No database can answer the question at present. In 2013 the journal Paediatric Anesthesia published a paper entitled Trends in death associated with pediatric dental sedation and general anesthesia. (1) The paper reported on children who had died in the United States following receiving anesthesia for a dental procedure between1980-2011. Most deaths occurred among 2-5 year-olds, in an office setting, and with a general or pediatric dentist (not a physician anesthesiologist or dental anesthesiologist) as the anesthesia provider. In this latter group, 17 of 25 deaths were linked with a sedation anesthetic.

Another study analyzed closed claims databases of 17 malpractice claims of adverse anesthesia events in pediatric patients in dental offices from 1992 – 2007. (2) Thirteen cases involved sedation, 3 involved local anesthesia alone, and 1 involved general anesthesia. 53% of the claims involved patient death or permanent brain damage. In these claims the average patient age was 3.6 years. Six cases involved general dentists as the anesthesia provider, and 2 involved local anesthesia alone. The adverse event occurred in the dental office in 71% of the claims. Of the 13 claims involving sedation, only 1 claim involved the use of vital sign monitoring. The study concluded that very young patients (≤ 3-years-old) were at greatest risk during administration of sedative and/or local anesthetic agents. The study concluded that some practitioners were inadequately monitoring patients during sedation procedures. Adverse events had a high chance of occurring at the dental office where care is being provided.

If general anesthesia or deep sedation are performed in a dental office, the anesthetist must practice with the same vigilance and standards of care as they would in a hospital or surgery center. Either a physician anesthesiologist, an oral surgeon (acting as both the dental surgeon and the anesthetist), or a dental anesthesiologist may perform the anesthesia. There are no data at this time to affirm that a physician anesthesiologist is the safest practitioner in this setting.

Note: This column addressed the office practice of pediatric dental anesthesia as seen from a physician anesthesiologist’s point of view.

References:

(1) Lee HH et al, Trends in death associated with pediatric dental sedation and general anesthesia. Paediatr Anaesth. 2013 Aug;23(8):741-6.

(2) Chicka MC et al, Adverse events during pediatric dental anesthesia and sedation: a review of closed malpractice insurance claims. Pediatr Dent.2012 May-Jun;34(3):231-8.

 

The most popular posts for laypeople on The Anesthesia Consultant include:

How Long Will It Take To Wake Up From General Anesthesia?

Why Did Take Me So Long To Wake From General Anesthesia?

Will I Have a Breathing Tube During Anesthesia?

What Are the Common Anesthesia Medications?

How Safe is Anesthesia in the 21st Century?

Will I Be Nauseated After General Anesthesia?

What Are the Anesthesia Risks For Children?

 

The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:

10 Trends for the Future of Anesthesia

Should You Cancel Anesthesia for a Potassium Level of 3.6?

12 Important Things to Know as You Near the End of Your Anesthesia Training

Should You Cancel Surgery For a Blood Pressure = 178/108?

Advice For Passing the Anesthesia Oral Board Exams

What Personal Characteristics are Necessary to Become a Successful Anesthesiologist?

 

 

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Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

41wlRoWITkL

LEARN MORE ABOUT RICK NOVAK’S FICTION WRITING AT RICK NOVAK.COM BY CLICKING ON THE PICTURE BELOW:

DSC04882_edited

 

 

SERIALIZATION OF THE DOCTOR AND MR. DYLAN… CHAPTER SIX

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

6) MR. DYLAN’S BLUES

Johnny and I ate breakfast together at 6:30 a.m. It was a complex meal—we split a six-pack of powdered sugar donuts from the Seven-Eleven and washed them down with two glasses of orange juice. The talc-like sugar dusted Johnny’s upper lip and the collar of his San Francisco Giants T-shirt. The kitchen was quiet as a library. The only sounds were our glasses clacking against the tabletop. It was Johnny’s first day of school and my first day to report to the local hospital. We were each journeying into the unknown, and the tension connected us.

I broke the silence. “Nervous?” I said.

“Nope.”

I didn’t believe it. Johnny’s eyebrows cast dark shadows, shielding his sunken eyes in blackness. I waited a minute for a sequel to his monosyllabic teenage offering, but no conversation followed.

“Want me to walk over there with you?” I said. “Make sure the paperwork is all OK for your transfer?”

Johnny scoffed. “Are you kidding? I’m 17 years old, Dad, not 7. I’ll figure it out.” He pushed away from the table and left the kitchen. I watched him pace back and forth across the living room floor like a skydiver awaiting his turn to jump out of the plane. Then he grabbed the front door knob and said, “I hope this school doesn’t suck, for both of our sakes.” The door slammed shut, and I looked out the front window to see Johnny hopping through last night’s frozen footprint holes in the snow. Steam rose from his wet hair. He wore a fleece turtleneck over a pair of cotton sweat pants, and no gloves, hat, or boots. I watched him bound two stairs at a time up the entryway of Hibbing High School.

I needed to be at Hibbing General Hospital before 7:30. I’d filled out all the necessary paperwork online. I’d already secured my medical staff privileges and my appointment to the anesthesia service. I wanted to arrive early to check out the facilities and meet the people I’d be working with in the coming months.

I dressed myself in a pair of Sorel boots, a North Face jacket, and one of Dom’s Minnesota Vikings knit caps. A puff of wind from the north scorched my face as I headed out into the winter morning. The stark chill woke me up faster than two espressos. The hospital was a three-block hike from Dom’s house, so it made sense to leave the battered BMW on the curb and walk to Hibbing General.

The hospital was an aging three-story building made of yellowed stone. The front doors were tall brown slabs flanked by two white Doric columns. I smiled at the polished surface of the brown wooden doors. I’d worked summers as a maintenance helper at the General during my college years. One day my foreman gave me a can of red paint and told me to paint these very doors. The next day the hospital administrator chewed our heads off for painting the hospital front doors the color of blood. He dispatched me to the front of the building with a paintbrush and a gallon of brown paint. The doors were still brown this very day.

I found the surgical locker room, a small space one-tenth the size of the men’s locker room at Stanford. I selected a set of scrubs off the shelf and changed out of my street clothes. At Stanford the scrubs were bright royal blue. In Hibbing the scrubs were faded green and looked like they’d been in use since the day I was born in this very building.

I was edgy, even though I was overqualified to work at this little community hospital. At Stanford every nurse, doctor, and janitor knew my name. Here I’d have to earn the respect of dozens of people who’d never heard of me. Medical careers don’t travel as well as business careers. A businessman in California could be promoted to a CEO job in Minneapolis, but doctors who moved from one state to another started at the bottom of the ladder, behind physicians who had reputations and referral patterns already established in the new community.

I entered the hallway of the operating room complex. Hibbing General had only six operating rooms, compared to the 40 rooms at Stanford. The schedule for the day was posted on a white board across from the central desk. My old med school classmate, Michael Perpich, the Chief of Staff at Hibbing General, was the surgeon working in operating room #1. Dr. Perpich was repairing an inguinal hernia on a 43-year-old man—a routine case. I could pop in and say hello without distracting Perp from his task.

I put on a surgical hat and mask and pushed open the door into O.R. #1. The operating room was small, a compact 30 feet by 30 feet. The linoleum floor showed brown stains from old iodine spills. The faded turquoise tile on the walls had witnessed thousands of hernia surgeries. Michael Perpich was bent over the patient’s abdomen. He saw me walk through the door, and said, “Nico Antone. The Tone. Get your ass over here.” A surgical mask covered his face, but I knew my friend was grinning.

“They said you needed some help to fix this hernia,” I said.

“You’re a God damned gas-passer. You couldn’t fix this hernia if I held the book open for you.”

“I’m here to see if your hands shake as much as they used to, Perp.”

“I came here straight from the card room at the Corner Bar at dawn. Never felt better.”

“You’re so full of shit.”

“Did you guys get situated over at Dom’s?”

“We did. Johnny wasn’t thrilled about waking up at 6 a.m., but he ran up the high school steps two at a time this morning.”

“So he’s a gunner. Just like his dad.”

“I got by.”

“You opened a textbook once a week in med school, and you still finished number one in our class. I can’t believe you came back. When you left for California you said never wanted to see a snowflake again.’”

“Things change, Perp. My kid needs an upper-Midwest high school diploma.”

“California kid comes to the wilderness to go to the head of the class, eh? I’ll tell you one thing: the Hibbing teachers will shape him up. I had sergeants in the Army who were more mellow than the Hibbing faculty.”

The scrub tech, a blonde woman wearing too many layers of blue eye shadow, said, “My son is a sophomore. He studies four hours every night.”

“Nico, meet Heidi, my right-hand woman,” Perpich said. “She’s my assistant, my psychotherapist, and the encyclopedia of all gossip great and small in the village of Hibbing.”

“Nice to meet you,” I said.

“Heidi, this is Dr. Nicolai Antone, a welcome addition to the anesthesia staff. Dr. Antone and I went to med school together. He was an anesthesiologist in California, but now he’s one of us, the slightly-better-than-average staff of Hibbing General. So you left Alexandra behind?”

“I did.”

“Good move. Not much up here for princesses.”

“You’re married, Dr. Antone?” Heidi said.

“I am. My wife is back in California.”

She fluttered mascara-laden eyelashes at me and said, “Welcome to Hibbing General. I look forward to working with you.”

Perpich looked up toward the head of the operating room table and said, “Bobby, did he get his antibiotic?”

A wisp of a man—narrow and bony—stood at the head of the operating room table in the anesthesia cockpit of machines, monitors, intravenous drips, and drug cabinets. The man said, “She did. One gram of Kefzol at 7:45.”

“Nico, I want you to meet Bobby Dylan, our Director of Nurse Anesthesia,” Perpich said.

My head snapped back. I wondered if I trusted my ears. Bobby Dylan? The same name as the legendary musician? Here in Hibbing?

The nurse anesthetist ignored Perpich’s cordial introduction and said nothing to me. I was miffed. Who did this guy think he was? He was only a nurse anesthetist. Why the ingratiating attitude toward me, a board-certified anesthesiologist physician?

It was a small hospital, and despite my negative first impression I felt compelled to meet my fellow anesthesia colleague. I walked around the operating room table and entered the anesthesia station. A blue paper hat and mask covered Dylan’s face. His sole facial features were the recessed caves that housed his glossy fish eyes, and the speckled black and gray eyebrows that floated above them.

I extended my hand and said, “Greetings. I guess we’ll be working together.”

Dylan turned his back on me. The beep, beep, beep of the patient’s pulse rate hung between us. He reached over and turned the knob on the anesthesia machine that titrated the oxygen flow. He coughed twice—loud, harsh, barking sounds, and said, “We opted out here, Mac.”

“What?” I said. I wasn’t sure what I had just heard.

“We opted out,” Dylan repeated. He still wasn’t looking at me. He picked up his clipboard and made some notations on the patient’s chart with a pen.

I was getting more and more pissed off. My first impressions were confirmed. This guy was a dick. I didn’t care if this was Dylan’s anesthetic, his operating room, and his hospital. I was unaccustomed to this degree of condescension within two feet of an anesthesia machine. He turned up the intravenous propofol infusion and continued to ignore me, even though I was close enough to smell the staleness of his body odor.

I checked the settings on the anesthesia machine and monitors, looking for some sign that Dylan was as incompetent as an anesthetist as he was as a conversationalist. He was using routine concentrations of standard anesthetic drugs. The ECG, blood pressure, and oxygen saturation numbers all showed normal values. Dylan wasn’t a doctor, but at the moment he was delivering a routine anesthetic in a safe fashion.

I thought to myself, Fuck you, you dirtball. If this Bobby Dylan character wanted to be left alone, I was going to leave him alone. I said, “Hey Perp, I’ll catch you when your case is done, OK?”

“Will do. I’ll meet you in the lounge. Give me 30 minutes.”

“See you there.” My feathers were ruffled. It was great to see Michael Perpich again, but if my initial contact with this nurse anesthetist was any indication, my welcome in the Hibbing medical community was going to be as chilly as a January dawn. I made my way to the operating room lounge, a stark room with four walls of undecorated peach-colored wallboard. The sole furnishings were two long tables and a dozen chairs. All the chairs were empty. Sections of the Duluth News Tribune and the Hibbing Daily Tribune were strewn over the tabletops. The aroma of fresh brewed coffee filled the air. I poured myself a cup and selected a glazed doughnut from a platter.

I felt like a midcareer misfit, stuck in somebody else’s workplace. I missed Stanford. On a professional level, this move to Minnesota looked to be a near-death experience for me.

Michael Perpich’s clogs hammered the floor when he walked in. He pinched the back of my neck, snatched two doughnuts for himself, and plopped down in a chair across from me. “It’s great to see you, Tone,” he said. “I still can’t believe it.”

I hadn’t sat eye to eye with Perp for years. With his surgical cloaking removed, he looked ten years older than me. The top of his head had more dandruff than hair, and the creases around his nose and mouth were deep and long. His smile was genuine, and I chose to disregard the ancient appearance of the only acquaintance I had within a thousand miles.

“Glad you’re here,” I said. “I’m counting on you to be my lifeline at this place.” I waved my hand at the desolate room. “Does anybody else work here?”

“Of course. We have a full staff, like any other community hospital, but we’re light on anesthesiologists. Your timing is perfect. Our last two anesthesiologists retired and moved to the Sun Belt in November. We have six nurse anesthetists, but for tough cases we need an M.D. anesthesiologist in town. Now we’ve got you.”

“So the rest of the anesthesia staff is all nurses?”

“Yep. Six nurse anesthetists. They’re a solid group. I haven’t had too many problems with them.”

I was unconvinced. Nurse anesthetists were registered nurses with a year or more of intensive care unit experience, followed by two or three years of training in a nurse anesthesia program. They learned how to anesthetize patients, but they weren’t medical doctors. In some hospitals, anesthesiologists worked with nurse anesthetists in anesthesia care teams, a team model in which one M.D. anesthesiologist might supervise four nurse anesthetists working in four separate operating rooms. Because this hospital had no anesthesia doctors, the nurse anesthetists were working unsupervised.

“What’s the deal with the Bobby Dylan guy?” I asked. “He stopped one step short of open hostility. Is he a prick, or what?”

“Sometimes he is.”

“He didn’t give me the time of day.”

“It’s a turf thing. This is his hospital. You’re an outsider. The guy doesn’t want you here.”

“He’s a nurse. How does he get off giving me a hard time?”

“Minnesota is an opt-out state, Nico. The Minnesota governor opted out of the requirement for a medical doctor to supervise nurse anesthetists. Bobby Dylan can give anesthesia here, just the same as you can, even though he’s not a doctor.”

We opted out here, Mac. The words Dylan had uttered to me. Opted out.

“So it’s legal here for a nurse anesthetist to give an anesthetic without being supervised by a physician?”

“That’s right.”

“That’s substandard care, if you ask me, and it still doesn’t make this Bobby Dylan guy a doctor. If you had enough physician anesthesiologists in town, would you still let jokers like him give anesthetics alone, or would you replace him with a doctor?”

Perpich threw up his hands. “That’s never going to happen, so who cares? Dylan has been here a long time. He hasn’t had any deaths, he’s kept his nose clean, and he’s not going anywhere.”

“Why is he named Bobby Dylan? That can’t be for real.”

Perpich shrugged again. “I don’t know what his real name is, and I don’t care. He showed up in Hibbing 8 or 10 years ago, and his license and paperwork all identified him as Bobby Dylan. I asked him if that was his real name or if he’d changed his name.”

“And he said?”

“He said his name was Bobby Dylan. Period. He dodged any questions about his past. He was a nurse anesthetist in the Afghanistan War. He’s got a wife and a daughter. He plays guitar and sings at a bar downtown. Plays all the original Dylan songs. People tell me he’s pretty talented. Maybe he was a huge Bob Dylan fan and he just wanted to move to Dylan’s hometown, take Dylan’s name, and get a job here. If so, he’s done all three.”

I shook my head. “That’s pretty weird stuff.”

“It gets more weird. He bought the old Zimmerman house.”

“You’re kidding.”

“Nope.”

“He’s a psycho,” I said.

Perpich’s eyes twinkled. “Up here, there are a lot of characters. Get used to it. He’ll grow on you, once you accept the fact that he’s your peer.”

“My peer? I’ll never accept that.”

As if summoned by their conversation, Bobby Dylan came in through the doorway, poured himself a cup of coffee, and sat in the opposite corner of the room. He peeled off his surgical hat to reveal a fuzzball of curled black and gray hair. He took out a pen and started filling out a crossword puzzle from the morning paper. His mouth stretched into a long yawn. It was just another day for him. My presence was of no consequence.

“I’m going to make rounds on my patients upstairs on the surgical wards,” Perpich said. “Will you be home tonight?”

“Where else would I be?”

“I’ll drop by. I’ve got some housewarming presents for you.”

“I hope it’s a digital video recorder. Dom doesn’t have one.”

“No DVR. Just make sure you’re hungry.”

“Sounds good. See you later.”

Right after Perpich left, I heard a rumbling voice behind me say, “Doctor Antone?”

I turned. It was Mr. Dylan. His facial expression was a cross between a smirk and an all-knowing smile.

“Yes?” I said, puzzled at the encounter.

“I dissed you back there in the operating room. Sorry about that. I was concentrating on my patient, and no one told me you were coming to town. I expect this place is big enough for both of us. No hard feelings?”

I was suspicious. The curl of Dylan’s upper lip seemed to say, I don’t like you one bit, but I’ll pretend that I do just to fuck with you. Before I could answer, he sat on the tabletop in front of me and asked, “Why does a California guy like you move to the Iron Range?”

“I grew up here. I missed the ice fishing and deer hunting.”

“Bullshit.”

“My son transferred into the 11th grade. We want him to graduate from Hibbing High.”

“Let me guess. You think he’ll be the smartest kid in town.”

“I have no idea. We just got here.”

Dylan twirled a wisp of his moustache between his fingers and thumb. “I’ll bet $1000 you and your kid are gone by next January. This ain’t no place for boys from Californ-eye-aye. No place at all.”

“We’ll adjust.”

“You OK working here, where nurse anesthetists are your equals?”

I bit the inside of my cheek. “I’m not sure nurses and doctors are equal. I expect I’ll get used to the fact that nurses can give their own anesthetics here.”

“Of course you will. Just remember, you’ve got no power over me here. No power at all.” Dylan winked and said, “Now, if you’ll pardon me, I’ve got to go make me some money.”

He walked away, and his words echoed in my ears: No power over me at all. My first impression was reconfirmed. This Bobby Dylan was trouble.

It was break time, and the lounge was filling up. An attractive woman sat down at the adjacent table. She had the palest of green eyes that precisely matched the color of her scrub shirt. She had flawless skin and adorable dimples, and the knack of smiling nonstop as she chatted.

I smiled to myself, and forgot about the onerous Mr. Dylan. The sight of a beautiful woman trumped all of life’s ills.

It really did.

*
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Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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SERIALIZATION OF THE DOCTOR AND MR. DYLAN… CHAPTER FOUR

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

4) HIGHWAY 61 VISITED

I drove the black bullet of my BMW up Minnesota Highway 61, one hour north of Duluth and two hours short of the Canadian border. Johnny and I flew in from San Francisco to the Twin Cities that morning, and picked up the car from an interstate driving service in Minneapolis.

Our send-off in California was bitter. Alexandra dropped us off at the curb at San Francisco International Airport. She gave Johnny a big hug and said, “I love you, John-John. Call me every night.”

“Love you too, Mom,” he said. I watched their exchange with intrigue. Although he was eager to move thousands of miles away from her, Johnny still loved his mother. What can you say? She was the best mom he’d ever had.

As for me, I wasn’t going to profess any love this morning. Alexandra faced me, her eyes vacant and cold. “Are you going to be OK without us?” I said.

“I’ll be better than OK without you,” she said, her voice dripping with its customary arrogance. “If I’m lucky, you’ll never come back.” She grabbed the door handle of her Aston Martin, jutted her chin toward the sky and said, “Go.”

That’s the way it ended. I watched her drive off, and I was jolted by an unexpected surge of glee. I felt an unfamiliar sense of freedom, like a captive hawk unhooded and released from its tether. I had no idea when I would see her again, and I wasn’t in a hurry to find out.

Ten hours later, Johnny and I were driving north on a spectacular Minnesota winter day, with the blue expanse of Lake Superior sprawling ocean-like on our right and the setting sun disappearing behind the infinite expanse of pines on our left. I detoured up Highway 61 for the novelty of the famous road, so my son could witness the world’s largest freshwater lake. The scenery was world class, but for me the highlight was spending time with Johnny uninterrupted by the distractions of a television, an Xbox, or cell phone calls. Exiled from California, Johnny had no friends except me, and I liked it that way.

He slumped in the passenger seat and stared out the side window. Despite the winter temperatures, he’d rolled down his window and the icy breeze from Highway 61 fluttered through his hair. I was in control of the music. For this occasion, it had to be Bob Dylan. I cued up “Highway 61 Revisited,” and blasted the title song though the speakers. I belted out the lyrics in a nasal twang: “Well Abe says, ‘Where do you want this killin’ done,’ God says, ‘Out on Highway 61.’” My “61” came out as a screeching “sexty-waawn,” mimicking Dylan to the best of my ability.

“Bob Dylan wrote that song about this highway?” Johnny said.

“He did.”

“It’s a pretty creepy lyric. And you’re screaming it out like it’s an anthem. He’s singing about killing a son?”

“It’s from the Old Testament. God told Abraham to sacrifice his only son.”

“So? Did he kill his son?”

“No. He was prepared to do it, to obey God, but at the last minute God sent an angel to stop him. Instead of killing his son, Abraham sacrificed a ram.”

Johnny shook his head. “What kind of song is that? Sorry, Dad. I can’t get into the Dylan thing. It’s so hard to listen to the guy’s voice. That screeching is pretty awful.”

“Bob Dylan is one of the most imitated vocalists of the last hundred years. He gave every singer with a less-than-perfect voice a blueprint of how to sneer and twist off syllables.”

“He’s all mumbles to me.”

“Try to get past the sound of his voice, and listen to the words. Dylan was the first songwriter to turn poetry into popular music.”

“Who cares about poetry?”

“What is rap and hip-hop music but poetry? What do Jay Z or Kanye West do but chant some simple rhymes over a drum beat?”

Johnny looked unconvinced.

“Bob Dylan changed music forever. Before Dylan, the top singers were crooners like Frank Sinatra and Elvis Presley, guys with silky voices who performed songs written by unknown people. Then along came Dylan, coughing out “Blowin’ in the Wind” with a voice like sandpaper on wood. He jammed his songs into your ears with that raspy nasal twang, and crossed you up with changes in inflection no one ever heard before.”

“Why would anyone ever listen to that?”

“Great songs. ‘The Times They Are A-Changin’,’ ‘Mr. Tambourine Man,’ ‘Like a Rolling Stone.’ Songs that influenced every writer that followed after him.”

“It doesn’t make sense to me. How can a guy who changed the world come out of all this?” Johnny said, waving his hands at the endless forests. “From up here in the sticks?”

“God only knows where genius is born, but education had something to do with it. Hibbing High School. The same classrooms and hallways you’ll be in tomorrow.”

I spun the steering wheel to the left as we departed Highway 61 and veered west toward the heart of the Superior National Forest. Lake County Highway 15 was a curving two-lane highway that slalomed over gentle hills and carved through wilderness untouched by 21st-Century development. It connected the two metropolises of Silver Bay and Hoyt Lakes, each with a population of about 2,000. The road was smooth and the setting was desolate. We hadn’t seen another car in ten minutes. I compressed the accelerator pedal and watched the speedometer climb. “Hang on, son. We’re going for triple digits.”

When our speed hit 100 miles per hour, I looked over at Johnny. There was no trace of fear—he was loving it.

A sudden blaze of brown fur streaked across the road as the deer jumped out of the forest 100 yards in front of our car. “Shit!” I yelled, and stomped on the brakes so hard I thought my foot would break through the floorboard. Our car fishtailed counterclockwise. The rear wheels made a skid into the dirty snow on the side of the road, and our front fender slammed into the deer’s flank. I heard the crunch of crumbling steel, and saw the deer’s white tail slide up the windshield and over the top of the car. The airbags deployed, and twin balloons of white fabric blotted out the sun. The rear of the car wracked into something solid and stopped with a resounding thump.

I reached down and turned off the ignition. My hands were shaking. We’d hit the deer broadside at 100 mph. Highway 15 was now graced with one dead deer, one smashed-up BMW, and two happy-to-be-alive Antones. I took census of my four limbs and my vital functions. I didn’t seem to be injured. I feared for Johnny. I elbowed my air bag aside, and looked over at the passenger seat. There was movement behind Johnny’s air bag. I pushed the fabric aside, and saw my son crouched forward with his head between his knees.

“Are you all right?” I said.

Johnny was hyperventilating—a violent wind entered and exited his gaping mouth. Blood dripped from the right side of his chin. “Are you nuts, Dad?” he screamed. “You almost killed me. That was the scariest thing I’ve ever seen.”

I was reeling. What kind of father was I? I’d almost offed us both. “I’m sorry,” I said. “I didn’t think…”

You didn’t think? Do you ever think? Oh, what the hell am I doing up here?” Johnny buried his face in his hands and wailed, “Everybody I know is in California. My mother is thousands of miles away. I’m up here in the woods with you, stuck in a ditch in outer Mongolia. We’re going to freeze to death and die right here. I should never have left home.”

I didn’t know what to say. I started to reach out toward my son to comfort him, but Johnny grew more agitated, turned away, and wrestled with the airbag until he found the door latch. He pushed the door ajar, and burst out into the sub-freezing air outside.

I opened my own door and twisted my way out of the car. The right front quarter of the vehicle was buckled like an accordion. The deer lay mangled on the roadside at the rear of the car, its glassy eyes staring skyward into the void. Blood seeped from its ears, nose, and mouth. Its thorax was buckled, concave and deformed.

What a waste.

Behind me, Johnny said. “Dead deer. Totaled car. Stranded in the middle of nowhere. Great job, Dad.”

“It all happened so fast…”

“No. You were driving like a maniac, and now we’re stuck. We’re so stuck. There’s no people in these woods but lumberjacks. Lumberjacks who would be hunting this deer if you hadn’t killed it.” Johnny shook his head. He stuck out his jaw, square and resolute. “I’m done. I changed my mind. I want to go home.”

I’d heard enough. “No. We’re going to Hibbing,” I barked. “It’s what you and I decided to do. Together, that’s what you and I decided.”

“I’m un-deciding.”

“It’s too late for that. I’m pulling rank on you. We’re in Minnesota, and we’re staying in Minnesota.” I walked back to the driver’s door, unsheathed a small Swiss Army knife from my key chain, stabbed the point of the blade into the airbag, and slashed a 10-inch gouge in the material. I squeezed the remainder of the air out, compressed the bag into a dense lump the size of a basketball, and stuffed it back into its housing inside the steering wheel. I repeated the same treatment on the passenger airbag, and pushed the deflated fabric back into the dashboard.

“Get in,” I commanded.

“You don’t understand, Dad. What’s the point of getting into this wreck of a car, marooned ass-end first in a snow bank?”

I ignored his sky-is-falling attitude, and pushed the ignition button. The engine sprang to life. I floored the accelerator pedal, and listened to the roar of the motor echo off the virgin pines around us.

“Get in,” I repeated.

Johnny looked both ways on the deserted highway, and his shoulders slumped. He climbed into the passenger seat, with a look of hopeless resignation etched on his face. We were miles from the nearest town, and the deformed car was our only hope to limp out of the wilderness. I shifted the transmission into Drive and wondered if the right front tire would move within the mangled fender. With a lurch, the BMW rolled forward out of the snow bank. Lucky us. I whistled through my teeth and turned the automobile back onto Highway 15 for the last leg of our trip toward Hibbing.

I vowed that the next time I saw God, I’d run a little slower. Abraham sacrificed a ram instead of killing his son.

I settled for a deer.

*
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Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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SERIALIZATION OF THE DOCTOR AND MR. DYLAN … CHAPTER THREE

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

3) QUEEN ALEXANDRA APPROXIMATELY

I drove my black BMW M6 convertible up the semicircular driveway to our Palo Alto home after work, and parked behind my wife’s silver Aston Martin One-77. Together, the value of the two cars approximated the gross national products of some third world nations. Our home was a 7,000-square-foot Tuscan villa built on a hilltop west of the Stanford University campus. The Antone estate encompassed three acres of tranquility, and towered above an urban area of seven million Californians, most of whom were mired in less-than-tranquil rush hour traffic at that very moment.

Our living room featured thirty-foot-high ceiling-to-floor windows overlooking San Francisco Bay. The décor included opulent white Baker couches no one ever sat on and a Steinway grand piano no one ever played. I sped through the formal room at flank speed. I couldn’t remember ever spending more than five minutes hanging out in this museum piece of showroom design.

I carried a large bag of Chinese take-out food from Chef Chu’s, and set it down on the stainless steel countertop of our spotless, never-used kitchen. I made a beeline for the refrigerator, popped the top off a Corona, and chugged half the bottle. I was still vibrating from my day in the operating room. I looked out the French doors toward the back patio.

Alexandra was lying on a lounge chair and sipping a tall drink through a straw. A broad-brimmed Panama hat graced her swirling mane of black hair. She wore a white one-piece swimming suit. It was an unseasonably warm day for January, and my wife never missed an opportunity to bronze her lanky limbs.

I walked up behind Alexandra, wrapped my arms around her neck, and kissed her left cheek. She held a cell phone against her right ear, and she pushed me away while she continued her conversation. I frowned and said nothing. Was it so hard for Alexandra to pretend she loved me? I sank into a second chaise lounge beside her, closed my eyes and listened.

“That property is overpriced at $6.5 million,” she said. “I know we can get it for 6.2. Put in the bid tonight and tell the seller they need to decide by tomorrow morning or the deal’s off. Got it? Call me back when they cave. Ciao.”

Alexandra set her phone down and lit a Marlboro Light 100. She inhaled with a violent effort, exhaled the smoke through her nostrils, dragon-like, and turned toward me. She wore broad Ray-Ban sunglasses. I couldn’t tell if she was looking at me or if she was looking out over San Francisco Bay, a vista Alexandra may well have considered far more interesting.

“How are you?” she said.

“I had a busy day. Today I was in the neuro room…”

Her phone rang again, and she waved me off while she took the call. My heart sank anew. She listened for an extended time and then she said, “I’ll be there at 5. No problem. Thanks.” She hung up and thrust her fist into the air. “Got a whale on the line,” she said. “There’s a couple from Taiwan who want to see the Jorgensen house tonight. Their agent drove them by the property this morning. They are very, very interested, and very, very wealthy. It’s an all-cash deal. A blank check.” She took a second long drag on her cigarette, and leaned toward me. At this angle, I could see my own reflection dwarfed in the lenses of her sunglasses. “This is big, Nico.”

“How much is the Jorgensen house listed for?”

“Just under 8 mill. That’s a quarter of a million dollar commission for yours truly.”

Her monomaniacal pursuit of money baffled me. Alexandra Regina Antone was one of America’s top real estate agents. Because of her explosive earning power, we lived in one of the nation’s most expensive residential neighborhoods, a zip code where Silicon Valley’s multimillionaire CEO’s and venture capitalists lorded in their castles. The residential properties Alexandra bought and sold for her clients were in the $3 million to $10 million range, and she earned a 3% commission on each sale. She sold one or two houses each month, and her income for the past year topped $9 million.

Alexandra’s salary dwarfed mine. None of my medical peers lived in this kind of luxury. To Alexandra, another $240,000 commission was headline news. It wasn’t about the cash—this was about the glory of Alexandra and her talent. It was about the Queen of Palo Alto rising higher and higher on the pedestal she’d erected for herself.

“So, you were telling me about your day,” Alexandra said, as she stretched her arms toward the sky and stifled a yawn.

“I did a craniotomy with Judith Chang. One case. It took all day.”

She took a final drag on her Marlboro, shivered in disgust, and said, “Judith Chang is such a stiff. Always bragging about her robotic daughters. I don’t know how you can do that job, locked in a windowless room with her hour after hour.” Alexandra had zero interest in listening to medical stories. She changed the topic at once. “Did you hear about Johnny’s report card?”

“I did. He’s pretty upset. Johnny wishes his grades were better. I wish his grades were better. He said you yelled at him.”

“Johnny’s a slacker. God knows I tried to light a fire under him years ago, but you taught him how to watch ESPN instead of pushing academics.”

“He said you called him a lazy shit.”

“I did. He is a lazy shit.”

“He’s your son, for God’s sakes. Johnny loves you and looks up to you. How do you think he feels when his mother says that?”

“I don’t give a fuck how he feels. Johnny needs to hear it, and he needs to change. Clue in! You don’t seem to get it, either. You think he’s fine just the way he is. Well he isn’t, Nico. Johnny’s a spoiled brat, living in luxury on top of this hill. He has no incentive to work hard. He thinks he can live off my money forever.”

Alexandra was dogmatic about the pathway to success. She was an unabashed academic snob—a graduate of Dartmouth College and Harvard Business School—and she’d have tattooed her Ivy League diplomas across her cleavage if she hadn’t been too vain to disfigure her silicone orbs. I wasn’t going to fight with her—I never won.

I shifted gears. “Dr. Chang had an interesting take on Johnny’s grades. She said Johnny could get into any college he wanted to if we lived in South Dakota.” I explained how Dr. Chang’s nephew from Sioux Falls was accepted to Princeton.

Alexandra removed her hat, shook out her hair, and took off her sunglasses to reveal flashing brown eyes. “For a change, Judith Chang is right. Johnny’s chances for success are slim on his current path. He has no chance at the Ivy League coming out of Palo Alto with his B average.” She chewed on the earpiece of her Ray-Bans as she contemplated. “Why don’t we send him to Minnesota to live with Dominic?”

“You’re kidding,” I said. My Uncle Dominic had a home near the Canadian border, in Hibbing, Minnesota, where I graduated from high school. Hibbing was a great place if you wanted to hunt partridge or ice fish for walleye pike, but the tiny village was a subarctic outpost light-years removed from the opulence Johnny grew up with in California.

“I’m not kidding. Johnny needs a gimmick for college admissions, and he has none. Hibbing could be his ticket.”

“He can’t just move up there with Dominic. Johnny’s 17 years old. And Dominic moved to Arizona. His house is empty.”

“Then take a year off. Go up there with him. Get your ass out of that windowless tomb of an operating room and take your son back to your childhood home.”
I frowned. “What about you?”

“Are you kidding? I’m not going anywhere. My friends are here, my job is here. But you go right ahead, Nico.”

Now it was my turn to stare off at the blue expanse of San Francisco Bay. Move back to the Iron Range of Northern Minnesota, to the land of rusted-out Fords and beer-swilling Vikings fans? What had my marriage come to? Before Johnny was born, Alexandra and I used to sit in these same chairs and drink margaritas together. Naked dips in this same pool led to nights of laughter and hot sex. Our current sex life had declined to hall sex, when I murmured “fuck you” under my breath after Alexandra walked past me in the hallway on her way to the second bedroom where she slept alone.

Alexandra was unrelenting. “Don’t give Johnny an option. Tell him you’re taking him to Minnesota to turn his life around, get some A’s, and graduate number one in his class from Hibbing High School. Call Dominic tonight and make the arrangements. It’ll be the best decision you’ve ever made. Trust me.”

Trust me. Alexandra could sell bikinis to Eskimos. “You’re OK with your husband and son moving 2,000 miles away?” I said.

She wrapped her arms around herself in an absurd parody of self-love and said, “Of course I’ll miss you.” Then she laid back onto the chaise lounge, the top third of her breasts busting out of her swimsuit top. She knit her hands behind her head, pushed her cleavage out into the January sunshine, and grinned in silence.

I watched the spectacle of her arching self-absorption and winced. Move 2,000 miles away? I was 2,000 miles away from this woman already.

“Hey guys,” came a voice from behind us. Johnny was home from school. He walked onto the patio and stood between us. My mood improved at once. Our son was tall and muscular with perfect skin, dark wavy hair, and striking blue eyes. He wore his usual uniform of gym shorts and an oversized T-shirt. My love for Johnny was unlike any emotion I’d ever felt. Romantic love for a woman was a wonderful abyss—the subject matter of a million songs, books, movies, and television shows. I’d watched romantic love drift off into the ozone as years passed, but with my son I was in love forever. If Alexandra and I ever divorced, I’d carry on. If my son ever shut me out, I’d need electroshock therapy.

Johnny wasn’t smiling. His shoulders drooped, his chin scraped his chest, and his gaze was locked onto the slate tiles under his well-worn Nike athletic shoes.

“How’s the Boy with the B’s doing?” Alexandra said.

Johnny regarded her through hooded eyes—James Dean with a cause. His upper lip curled skyward in a look of contempt. He was already smoldering from a bad day, and she was throwing kerosene on his fire.

She forged on, hawking optimism now. “Dad and I have a great plan for you that should make your report card problem of no consequence.”

“Great plan?” Contempt turned to suspicion.

“Johnny, are you happy that your grades rank you in the middle of the pack at your school?” she said.

“You know I’m not,” he sneered. I didn’t have a 42-inch monitor displaying Johnny’s vital signs, but I knew my son’s blood pressure was escalating.

“Would you like to be accepted into a top college?”

“Duh. Of course, Mom.”

“What if we told you there was a way for you to graduate at the top of your class and go on to one of America’s best colleges?”

“I’d say you were smoking too much weed.”

“No weed.”

“How am I going to jump to the head of my class at Palo Alto Hills High?”

“Not Palo Alto Hills High School, Johnny. Hibbing High School.”

Johnny looked from me to his mother and back again. “You two are messed up. Hibbing? Where the hell is that?”

“Hibbing is in Northern Minnesota. It’s where your dad grew up. It could be worse. We’re not sending you off to some military school in the badlands of Utah where you don’t know anyone. Your dad will move to Minnesota with you.”

“That’s ridiculous… Dad?” he said, panic in his voice.

I opened my mouth, but Alexandra didn’t give me a chance to weigh in. “There are consequences for your lack of effort in school, Johnny,” she said. “We want you to get out of Palo Alto and compete for grades with the sons and daughters of some iron ore miners. Right, Nico?” She turned to me for affirmation.

Johnny’s jaw sagged. “Dad?” he said again.

“I’m overdue for my sabbatical at the University,” I said. “My Uncle Dominic has a house in Hibbing. With your brains, your test scores, and a lot of hard work, you could be a top student up there. Instead of being a middle-of-the-pack Palo Alto student, you could be….” At this point I decided to gamble and appeal to my son’s ego and vanity, “You could be the valedictorian.”

“Can the best students from a school like that get into a top college?”

“They can. When I was a senior at Hibbing High, two kids were accepted to Harvard. It’s got to be the best high school in the northern half of Minnesota.”

“Whoa. Harvard?”

“Yes, Harvard.”

Johnny looked over at his mother. She smirked, as if she’d single-handedly masterminded a strategic maneuver worthy of Machiavelli.

“I’ll have to think about this,” Johnny said.

“I’ve got to shower and get ready for my meeting,” Alexandra said. “Nico, you guys are on your own for dinner. Johnny, I’m sure you’ll love Minnesota.” She rolled off her lounge chair as Johnny covered his eyes and pressed his thumbs into his temples.

She walked away, and I admired the swagger of her slender hips and the bounce of her long tresses. I never got tired of looking at Alexandra, but it wasn’t much fun living with a woman whose best friend was her mirror.

I turned to Johnny. “Want some Chinese food?” I said.

“I’ll eat it in my room, Dad. I have a ton of homework. I’m really pissed off about everything and I don’t want to talk anymore. First I get the crappy report card, and now you guys want to ship me off to the Yukon. All you guys care about is grades. You don’t give two shits about whether I’m happy or not.”

“That’s not true.”

“It is true. Just leave me alone. I’m going to my room. This B-student has a date with Hamlet.” Johnny walked away, and I let him go. My B-student son needed more dates with the Danish prince.

I dished out a plate of Szechwan prawns and General’s Tso’s chicken, and popped the top off a second Corona. The Golden State Warriors were playing the Miami Heat at 6 p.m. A second Corona, some Schezwan prawns, and the basketball game sounded like a decent evening.

After halftime, Johnny came shuffling down the hallway. He stretched out on the couch opposite me, and opened his laptop. He was humming to himself, and his fingers were flying.

I was happy to see he’d cheered up. “Feeling better?” I said.

“Yep. The Chinese food hit the spot.”

I waited for more conversation, but none was forthcoming. The Warriors connected on an alley-oop and an outrageous dunk. Johnny didn’t look up.

“How’s Amanda?” I said, trying to stoke up a dialogue. Amanda Feld was Johnny’s girlfriend, a petite cross-country runner who gazed at Johnny like he was a Greek god. She hadn’t been over for a couple of weeks, and Johnny hadn’t brought up her name for longer than that.

“Amanda’s history,” Johnny said.

“History?”

“I broke up with her a month ago, Dad.”

“What happened?”

“Nothing happened. It didn’t work out.”

“She was cute.”

“Yep.”

I waited for more of an explanation, but none came. Amanda’s fate paralleled all the other breakups of the past year, when Johnny ended relationships with Samantha the cheerleader, Emily the debate star, and Jenna the girl across the street. Johnny seemed to attract girls by repelling them. The less interest he showed, the more the women orbited him. I was envious.

Johnny said, “The report card and class rank bullshit really wore me down today. Why should my whole future revolve around some alphabet letters on a page?”

“It doesn’t. Your life is much more than your grades.”

“Yeah, like what?”

I pointed my two forefingers at my son just like I had a thousand times in his life, and said, “You’re a great kid. Don’t ever forget it.”

“Why do you always have to say that to me, Dad?”

“Because it’s true. I want you to imprint it in your brain and never doubt it.”

“Even if I can’t get an A in one class?”

“Even if you can’t get one A.”

“I want to get A’s. All A’s. But transferring to Minnesota?” Johnny tapped the screen of his laptop and said, “I’m looking at the Weather Channel website. It’s minus five degrees and snowing in Hibbing right now.”

“Yep. That’s why I left. In the winter the sun sets at 3:30 in the afternoon.”

“That’s insane.”

“It ain’t California.”

He shook his head. “I’m going to sleep.”

“Good night, son. I love you.”

“Love you, too,” Johnny said, and then he headed off toward his room.

I welcomed the tranquility from the two beers. My eyelids grew heavy, and I faded toward unconsciousness. My cell phone rang and woke me. I didn’t recognize the number. I answered the call, and a male voice said, “Alexandra?”

“No, this is her husband’s number. Who’s calling?”

There was a click as the line went dead. The heaviness in my eyelids was gone. I found myself mistrusting my wife.

Again.

I woke in the middle of the night. I’d dozed off in my chair in front of the flickering television. A Seinfeld rerun was playing. I turned off the TV, tried my best to stay asleep, and stumbled down the hallway toward my bedroom. The door to Alexandra’s bedroom was open, and her bed was untouched. I looked at my watch. It was 2:07 a.m.

A surge of annoyance ran through me. Where the devil was she at 2 o’clock in the morning on a Thursday night? My hopes for a quick return to slumber were dashed. I was full of adrenaline, and I wasn’t going back to sleep anytime soon. I walked into her room and laid down on her bed. The familiar smell of her hair from the pillows jolted me. It had been a long time since we’d touched the same sheets together.

I heard a car door slam outside. A minute later, Alexandra stood in the bedroom doorway. She carried her high heel shoes in one hand and wore a black spaghetti strap cocktail dress. Those spectacular legs were glistening from mid-thigh on down.

She was startled to see me. “What are you doing in my room?” she said.

“Waiting up. Where were you?” My voice quivered with resentment.

“Oh, Jesus, Nico. I’m not a sixteen-year-old girl, and you’re not my dad. I went out with the girls and had a couple of drinks and some laughs. It was fun. You should try it sometime.”

“I don’t believe you.”

“Believe whatever you want. Can you get out of my room now so I can go to sleep?”

I turned on the overhead lights, and examined the illuminated spectacle of Alexandra Antone. Her arms were crossed, and she was smirking down at me. A streak of red lipstick stretched from her upper lip across her right cheek. Was she was playing kissy-face with the girls?

I lost it. “Are you playing me?” I said.

“What are you talking about?”

“Are you playing me for a fool? Who were you with?”

She turned her back on me and walked into her closet. “You are such a buzzkill,” she called out. “You always hate it when I have fun. I have a life. I’m sorry you’re jealous.”

I ran to her like a wild bull. I grabbed her by the arm and swung her around to face me.

“Are you having an affair?” I screamed.

Dull eyes stared back at me. Alexandra blinked twice, shook her head in disgust, and said, “No, I’m not. And get your hands off of me, Nico. You’re still the same small-town hick you’ve always been.”

Her defiance infuriated me further. “I’m sick of you, and I’m sick of our bogus marriage.”

She laughed at me and said, “You need to find somebody else. Someone who likes listening to your boring medical stories. Someone who wants to cook meat and potatoes for you. Someone who enjoys staying home and watching TV with you.”

“I’m married to you. I’m not finding anybody else while I’m your husband.”

“Are you my husband, Nico? Or my dependent?”

I saw flames. I picked up her six-foot-tall cast iron coat rack and rammed the shaft through the closet wall. The metal hung there, cleaving the room between us.

“Are you crazy?” Her shriek was ear-splitting.

“At least I’m not a whore.” With those words, I’d crossed the line. As of that moment, I knew I could no longer live with the woman. “If you want to stay out half the night like a tramp, don’t bother to come home at all.”

“I’m not going anywhere,” she screeched. “You’re the one who needs to move out. I paid for this damn house.”

The hardwood floor creaked behind me, and a voice bellowed, “Shut the fuck up! Both of you!” It was Johnny, standing in the doorway in his undershorts. My world stopped. Alex and I stared at our son, and no words were offered.

Alexandra spoke at last. She said, “Whatever. Can you two get out of my bedroom now?”
Johnny shook his head and disappeared into the darkness of his own room. I was so embarrassed and furious I found it hard to breathe. The two most important relationships in my life were imploding before my eyes. I left Alexandra’s room, and she shut her door behind me. I leaned against the closed door of Johnny’s bedroom and said, “I’m sorry, son. I’m sorry you had to hear that.”

“Then stop talking about it,” he said. I waited there for five minutes. He made no further sound. I walked away, back to my isolation in the master bedroom.
I lay in the dark with a pillow over my eyes and replayed what had just gone down. My life was ridiculous. My separate-evening, separate-bedroom, give-your-husband-shit-whenever-possible marriage was ridiculous. How could Johnny have a healthy adolescence under these circumstances?

I had no answers. I was angry, depressed, and reeling. I reached into the drawer of my bedside table, pulled out my bottle of Ambien, popped two, and chased them with a swallow of water from last night’s glass. I was an expert at anesthesia, even when I was the patient.

The next day I dragged myself through five routine surgeries although I was so angry it took all my will to concentrate on my craft. When I returned to my house that evening, Johnny was stretched out in my lounge chair. He was watching TV and typing into his laptop. He’d been asleep when I left for work that morning, so I hadn’t seen him since the screaming session in the hallway. Alexandra was nowhere to be seen.

“Hey, Dad,” Johnny said without looking up.

“Hello, son. Did you get some sleep after that whole episode last night?”

“I did. Mom gave me a ton of crap this morning for swearing at her and being disrespectful.” His face soured. If there was more to say, he wasn’t going there. He closed the laptop and said, “Other than that, it was a good day. I’ve been researching a lot of stuff about Hibbing on the Internet.”

He had my attention.

“That was excellent Chinese food last night, wouldn’t you agree?” he said.

“It was.”

“It’ll be our last decent Chinese food for awhile, Dad. I don’t think there’ll be any outstanding Chinese restaurants up there in Hibbing. I want to do it.”

“Do it?”

“I want to get away from Palo Alto Hills High, away from Amanda Feld, and away from Mom.
I want to go to Minnesota. Will you take me?” He held out his hand toward me. I stared at it and contemplated the implications of the gesture. Johnny was an impulsive kid, capable of making radical and irrational decisions in a heartbeat, but he’d never made a decision that impacted his life to this degree.

“You mean it?”

“I do. Can you walk away from your anesthesia job?”

“Well…” My thoughts were jumbled as I pondered the coin spinning through the air. Heads, I honored my love for my son and joined him in this adventure. Tails, I maintained my love for the warmth of California and my stable university job.

The tipping point was Alexandra. She was a toxic presence in my life. More than a marital separation, I needed an exorcism. It wasn’t a question of love. I didn’t even like her.
The coin landed on heads. I clasped Johnny’s outstretched hand and said, “Let’s do this, son. Let’s move.”

“Can’t wait, Daddy-O,” Johnny said.

“I’ll call Uncle Dominic in the morning and set things up.”

Johnny smiled and repeated again, “Can’t wait.”

*
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Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

41wlRoWITkL

Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

DSC04882_edited

 

 

DSC04882_edited

SERIALIZATION OF THE DOCTOR AND MR. DYLAN… CHAPTER TWO

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

2) A PHARMACIST’S SON IN SOUTH DAKOTA

Eight months earlier

My cell phone pinged with a text message from my son Johnny. The text read:

911 call me

I was administering an anesthetic to a 41-year-old woman in an operating room at Stanford University, while a neurosurgeon worked to remove a meningioma tumor from her brain. I stood near my patient’s feet in an anesthesia cockpit surrounded by two ventilator hoses, three intravenous lines, and four computer monitor screens. Ten syringes loaded with ten different drugs lay on the table before me. My job was to control my patient’s breathing, blood pressure, and level of unconsciousness, but at that moment I could only stare at my cell phone as my heart rate climbed.

                                                                       911 call me

911? My son was in trouble, and I was stuck in surgery, unable to leave. I wanted to contact Johnny as soon as possible, but my patient was asleep, paralyzed, and helpless. Her life was my responsibility. I scanned the operating room monitors and confirmed that her vital signs were perfect. I had to make a decision: should I call him now, or attend to my anesthetic and call after the surgery was over? My patient was stable, and my son was in danger. I pulled out my cell phone and dialed his number. He picked up after the first ring. “What is it, son?” I said.

“I’m screwed,” Johnny wailed. “I just got my report card for the first semester and my grades totally suck. Mom is mega-pissed. She’s going ballistic, and I’m screwed.”

My shoulders slumped. This was 911 for a 17-year-old? “How bad were the grades?”

“I got six B’s. I didn’t get one A. I just met with my counselor and he says I’m ranked #101 in my high school class. I’m so doomed. Mom is so pissed. She called me a lazy shit.”

I resisted my initial urge to scream at Johnny for scaring the hell out of me. The kid had no insight into what I did minute-to-minute in the hospital. Did he think his report card trumped my medical practice? Did he really think his report card full of B’s was an emergency?

“I’m not sure what’s worse, the grades or Mom’s screaming about the grades,” he said.

I imagined my wife having a temper tantrum about Johnny falling short of her straight-A’s standard of excellence, and I knew the answer to that question. My wife could be a total bitch. “I’m sorry Mom got mad, Johnny, but…”

“No buts, Dad. You know Mom’s idea of success is Ivy League or bust, and I’m a bust.”

“Son, four of your six classes are Advanced Placement classes, and those grades aren’t that bad.”

“Dad, almost everyone in the school takes four AP classes. Every one of my friends got better grades than me. Ray, Brent, Robby, Olivia, Jessica, Sammy, and Adrian all got straight A’s. Devon, Jackson, Pete, and Rod had all A’s and one B. Even Diego had only two B’s.”

“But you…”

Johnny cut me off. “There’s no ‘buts,’ Dad. I’m ranked in the middle of the pack in my class. I’m cooked. I’m ordinary. Forget Harvard and Princeton. I’m going to San Jose State.”

My stomach dropped. Johnny was halfway through his junior year at Palo Alto Hills High School. The competition for elite college acceptance was on my son’s mind every day, and on his mom’s mind every minute. Johnny was a bright kid, but the school stood across the street from Stanford University and was packed wall-to-wall with the sons and daughters of Stanford MBA’s, Ph.D.’s, lawyers, and doctors. Johnny’s situation wasn’t uncommon. You could be a pretty smart kid and still land somewhere in the middle of the class at P.A. Hills High.

“Everything will work out,” I said. “There are plenty of great colleges. You’ll see.”

“Lame, Dad. Don’t talk down to me. You stand there with your doctor job at Stanford and tell me that I’ll be all right. I’ll be the checkout guy at Safeway when you buy your groceries. That’s where I’m heading.”

Catastrophic thinking. Johnny Antone was holding a piece of paper in his hand—a piece of paper with some letters typed after his name—and he was translating it into an abject life of being average.

“Johnny, I can’t talk about this any more right now. My patient …”

“Whatever,” Johnny answered.

I heard a click as he hung up. I hated it when he did that. In the operating room I had authority, and respect was a given. With my family, I was a punching bag for of all sorts of verbal blows from both my kid and my wife.

I reached down and turned off my cell phone. For now, the haven of the operating room would insulate me against assaults from the outside world.

Judith Chang was the neurosurgeon that day. Dr. Chang was the finest brain surgeon in the western United States, and was arguably the most outstanding female brain surgeon on the planet. She peered into a binocular microscope hour after hour, teasing the remnants of the tumor away from the patient’s left frontal lobe. Dr. Chang always operated in silence, and her fingers moved in precise, calculated maneuvers. A 50-inch flat screen monitor on the wall of the operating room broadcast the image she saw from inside her microscope.

I paid little attention to the surgical images, which to me revealed nothing but incomprehensible blends of pink tissues. My full attention was focused on my own 42-inch monitor screen which depicted the patient’s electrocardiogram, blood pressure, and oxygen saturation, as well as the concentration of all gases moving in and out of her lungs. Everything was stable, and I was pleased.

It had been five hours since the initial skin incision. Dr. Chang pushed the microscope away and said, “We’re done. The tumor’s out.”

“A cure?” I said.

“There was no invasion of the tumor into brain tissue or bone. She’s cured.” Dr. Chang had removed a 5 X 10-centimeter piece of the patient’s skull to access the brain, and began the process of fitting the piece back into the defect in the skull—the placement not unlike finishing the last piece in a jigsaw puzzle. As Dr. Chang wired the bony plate into place, she said, “How’s your family, Nico?”

She hadn’t said a word to me in five hours, but once she was finished with the critical parts of surgery, Judith Chang had a reputation as a world-class chatterer. Some surgeons liked to listen to loud rock n’ roll “closing music” as they sewed up a patient. Some surgeons preferred to tell raunchy jokes. Judith Chang enjoyed the sound of her own voice. We hadn’t worked together for months, so we had a lot to catch up on.

“They’re good,” I said. “Johnny’s in 11th grade. He’s going to concerts, playing video games with friends, and sleeping until noon on weekends. Alexandra is working a lot, as usual. She just sold a house on your street.”

“I heard about that property,” Judith said. “You’re a lucky guy. That house sold for close to $5 million. Her commission is more than some doctors earn in a year. In my next lifetime I’ll be a big-time realtor like Alexandra. Does she give you half her income to spend?”

“In theory half that money is mine, but she invests the dough as soon as it hits her checking account.”

“Smart. Is Johnny looking at colleges yet?”

Her question had eerie relevance, because I’d been ruminating over Johnny’s phone call all morning. “That’s a sensitive point. Johnny just got his mid-year report card, and he’s freaking out.”

“How bad was it?”

“Six B’s. No A’s. He’s ranked #101 in a class of 480 students.” I spilled out the whole story while Dr. Chang twisted the wires together to affix the bony plate into the patient’s skull. I left out the “lazy shit” label from Johnny’s mom.

Dr. Chang had no immediate answer, and I interpreted her silence as tacit damning of Johnny’s fate. She opened her mouth and a flood of words began pouring out. “You know my twin daughters Meredith and Melody, who are sophomores at Stanford? They worked their butts off in high school. They were both straight-A students. Meredith captained the varsity water polo team, played saxophone in the jazz band, and started a non-profit charity foundation for an orphanage in Costa Rica. Melody was on the debate team and the varsity tennis team, and for three years she worked with Alzheimer patients at a nursing home in Palo Alto. Meredith and Melody were sweating bullets waiting to hear if Stanford would accept them, even though they were both legacies since I went to undergrad and med school here.

“The college admission game is a bitch, Nico. It’s not like when we were kids. It’s almost impossible to get into a great school without some kind of massive gimmick. It’s a fact that Harvard rejects 75% of the high school valedictorians that apply. Can you believe that?”

I could believe it. And I didn’t really care, since my only kid was at this moment freaking out because his grades qualified him for San Jose State, not the Ivy League. I didn’t care to hear any more about the Chang daughters right now, either. To listen to Judith Chang, her daughters were the second and third coming of Judith Chang, destined for world domination. I was envious of the Chang sisters’ academic successes—what parent wouldn’t be? But I didn’t want to compare them to my own son.

“What are Johnny’s test scores like?” Dr. Chang said.

Ah, a bright spot, I thought. “He’s always excelled at taking standardized tests. His SAT reading, math, and writing scores are all at the 98th percentile or better. His grade point average and class rank don’t match his test scores.”

“Does he have many extracurricular activities?”

“Johnny’s extracurricular activities consist mostly of watching TV and playing games on his laptop. At the same time,” I said, as if the combination of the two pastimes signaled a superior intellect.

Dr. Chang grew quiet again. More silent condemnation of my son’s prospects. “Listen to me,” she said. “My brother is a pharmacist in Sioux Falls, South Dakota. His son got accepted to Princeton, and let me tell you, my nephew isn’t that bright. His test scores aren’t anywhere near as high as Johnny’s. But he just happens to live in South Dakota. He just happens to be a straight-A student in a rural state. He just happens to be one of the best students in South Dakota.”

“How much do you think that matters?”

“It matters big time. The top schools want geographic variety in their student body. Stanford wants diversity. The Ivy League wants diversity. Princeton can find fifty kids from Palo Alto who meet their admission requirements. They want kids from all walks of life. They want … the son of a pharmacist from Podunk, South Dakota. If Johnny lived in South Dakota, with those test scores he’d be a shoo-in with the Ivy League admissions committees.”

Judith Chang turned her back on the operating room table, and peeled off her surgical gloves. The bony plate was back in place, and her patient’s skull was intact again. The surgical resident would conclude the task of sewing the skin closed. Dr. Chang paused for a moment, turned her palms upward, and said, “Just move to the Dakotas, Nico.”

I stroked my chin. She made it sound so easy.

*
*
*
*

Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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SERIALIZATION OF THE DOCTOR AND MR. DYLAN… CHAPTER ONE

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

1) GOING, GOING, GONE

            first-degree murder n. an unlawful killing which is deliberate and premeditated (planned, after lying in wait, by poison or as part of a scheme)

My name is Dr. Nico Antone. I’m an anesthesiologist, and my job is to keep people alive. Nothing could inspire me to harm a patient. Alexandra Antone was my wife. Alexandra and I hadn’t lived together for nearly a year. I dreaded every encounter with the woman. I wished she would board a boat, sail off into the sunset, and never return. She needed an urgent appendectomy on a snowy winter morning in a small Minnesota town. Anesthetist options were limited.

Life is a series of choices. I chose to be my wife’s doctor. It was an opportunity to silence her, and I took it.

Before her surgery, Alexandra reclined awake on the operating room table. Her eyes were closed, and she was unaware I’d entered the room. She was dressed in a faded paisley surgical gown, and she looked like a spook—her hair flying out from a bouffant cap, her eye makeup smeared, and the creases on her forehead looking deeper than I’d ever seen them. I stood above her and felt an absurd distance from the whole situation.

Alexandra opened her eyes and moaned, “Oh, God. Can you people just get this surgery over with? I feel like crap. When is Nico going to get here?”

“I’m three feet away from you,” I said.

Alexandra’s face lit up at the sound of my voice. She craned her neck to look at me and said, “You’re here. For a change I’m glad to see you.”

I ground my teeth. My wife’s condescending tone never ceased to irritate me. I turned away from her and said, “Give me a few minutes to review your medical records.” She’d arrived at the Emergency Room with abdominal pain at 1 a.m., and an ultrasound confirmed that her appendix was inflamed. Other than an elevated white blood cell count, all her laboratory results were normal. She already had an intravenous line in place, and she’d received a dose of morphine in the Emergency Room.

“Are you in pain?” I said.

Her eyes were dull, narcotized—pinpoint pupils under drooping lids. “I like the morphine,” she said. “Give me more.”

Another command. For two decades she’d worked hard to control every aspect of my life. I ignored her request and said, “I need to go over a few things with you first. In a few minutes, I’ll give you the anesthetic through your IV. You won’t have any pain or awareness, and I’ll be here with you the whole time you’re asleep.”

“Perfect,” she oozed.

“When you wake up afterward, you’ll feel drowsy and reasonably comfortable. As the general anesthetic fades and you awaken more, you may feel pain at the surgical site. You can request more morphine, and the nurse in the recovery room will give it to you.”

“Yes. More morphine would be nice.”

“During the surgery you’ll have a breathing tube in your throat. I’ll take it out before you wake up, and you’ll likely have a sore throat after the surgery. About one patient out of ten is nauseated after anesthesia. These are the common risks. The chance of anything more serious going wrong with your heart, lungs or brain isn’t zero, but it’s very, very close to zero. Do you have any questions?”

“No,” she sighed. “I’m sure you are very good at doing this. You’ve always been good at making me fall asleep.”

I rolled my eyes at her feeble joke. I stood at the anesthesia workstation and reviewed my checklist. The anesthesia machine, monitors, airway equipment, and necessary drugs were set up and ready to go. I filled a 20 cc syringe with the sedative propofol and a second syringe with 40 mg of the paralyzing drug rocuronium.

“I’m going to let you breathe some oxygen now,” I said as I lowered the anesthesia mask over Alexandra’s face.

She said, “Remember, no matter how much you might hate me, Nico, I’m still the mother of your child.”

Enough talk. I wanted her gone. I took a deep breath, exhaled slowly, and injected the anesthetic into her intravenous line. The milky whiteness of the propofol disappeared into the vein of her arm, and Alexandra Antone went to sleep for the last time.

*
*
*
*

Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

41wlRoWITkL

Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

DSC04882_edited

 

 

CALIFORNIA SOCIETY OF ANESTHESIOLOGISTS ONLINE FIRST: BOOK REVIEW OF THE DOCTOR AND MR. DYLAN AND INTERVIEW WITH THE AUTHOR

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

This post is a link to an article originally published in the California Society of Anesthesiologists Online First Blog, Authored by Dr. Michael Champeau (current Treasurer of the American Society of Anesthesiologists, as of October 2017): Book Review of THE DOCTOR AND MR. DYLAN

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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An Anesthesia Suspense Novel by Rick Novak, MD – An Interview with the Author

I’m writing to recommend a page-turning suspense novel that stars a physician anesthesiologist as its protagonist. Authored by CSA Member and former District 4 Delegate Rick Novak, MD, The Doctor and Mr. Dylan is a mystery novel recently published by Pegasus Books that centers on the professional and personal rivalries between physician anesthesiologist Nico Antone and nurse anesthetist Bobby Dylan.

Most of us are too busy with our careers to even imagine spending our personal time reading a medical novel, but the first lines of The Doctor and Mr. Dylan will convince you this book is unlike those you’ve read before:

My name is Dr. Nico Antone. I’m an anesthesiologist, and my job is to keep people alive. Nothing could inspire me to harm a patient. Alexandra Antone was my wife. Alexandra and I hadn’t lived together for nearly a year. I dreaded every encounter with the woman. I wished she would board a boat, sail off into the sunset, and never return. She needed an urgent appendectomy on a snowy winter morning in a small Minnesota town. Anesthetist options were limited.

Life is a series of choices. I chose to be my wife’s doctor. It was an opportunity to silence her, and I took it.

The Doctor and Mr. Dylan is a medical thriller, a legal thriller, and an ode to musical icon Bob Dylan, all interwoven into a single plot line. In brief, Dr. Nico Antone is unhappily married and imagines a life without his tormenting wife, a Silicon Valley real estate tycoon whose income far outstrips his own. He’s also convinced that his son, a teenager enrolled at Palo Alto Hills High, would gain an advantage in college admissions if their family moved to the rural Midwest.  As a result, Dr. Antone moves with his son Johnny to Hibbing, Minnesota in hopes that he will graduate at the top of his class and be accepted into a prestigious Ivy League university. Johnny becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged nurse anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. The operating room death of Mrs. Antone rocks their world, and the anesthesiologist stands trial for murder—a murder he believes Mr. Dylan committed.

The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps and courtroom confrontation, and concludes in a final twist that few will see coming. The prose is witty and funny, and I found myself chuckling repeatedly at unexpected times.

The book brings the issue of independent nurse anesthetist practice to a national audience, and the conflict that this at some times engenders drives the plot. Most of all, The Doctor and Mr. Dylan is a head-scratching mystery, guaranteed to keep you riveted until the last page. I read the last third of the book in a single post-midnight sitting, not able to wait for the resolution.

By way of full disclosure, Dr. Novak is one of my partners in the Associated Anesthesiologists Medical Group in Palo Alto. He has spent the past thirty-plus years at Stanford, where he served as an intern, a resident in internal medicine, an emergency room faculty member, an anesthesia resident, and finally as an Adjunct Clinical Associate Professor of Anesthesia. Rick’s writing career blossomed in the role of Deputy Chief of Anesthesia at Stanford, where he authored a monthly column on private practice anesthesia in the department newsletter. As a friend, colleague and reader, I recently interviewed Rick to gain insight into his new writing career:

Q: How long did it take you to write the novel?
A: Three years. One year to write the manuscript, one year to edit it and improve the storytelling, and one year to obtain an agent who then sold it to Pegasus Books.

Q: When did you find time to write?
A: I wrote late at night, early in the mornings, on rainy weekends and on sunny weekends—whenever I had a free hour with my laptop. I had a compulsion to write the story that first year. I didn’t sleep much.

Q; Why did you choose to write fiction?
A: I’ve been penning creative short stories, skits, and speeches since high school. I had written more than seventy non-fiction columns in the Stanford anesthesia department newsletter over the past twelve years, but I wanted to write something more substantial and more entertaining. I believe a lot of people are curious about anesthesia, and I know there are stories to be told.

Q: Describe the style of this book.
A: My aim was to write a fast-paced page-turner that would appeal to both non-medical as well medical audiences. After the first draft, I edited the manuscript and cut out every scene and every sentence that wasn’t essential to the story. My style is conversational. The book is written in the first person and it reads as if the narrator is telling you an oral story. The dialogue is genuine—characters talk the way people really converse in an operating room, in a tavern, or in a courtroom.

Q: What can an anesthesiologist learn from the book?
A: First off, it’s a mystery that anesthesiologists and physicians will have an advantage in solving, because of our experience and training. Beyond that, you’ll learn about life and medicine in small town Minnesota, you’ll learn about the history and legend of Bob Dylan, who grew up in Hibbing, Minnesota, and you’ll learn to love the memorable characters who populate the pages.

Q: Any advice to other aspiring anesthesiologist authors?
A:

  1. Write what you enjoy writing, whether your dream is to create fiction or medical non-fiction. I’ve spent thousands of hours writing columns for the Stanford anesthesia department, for my website, and penning this novel, yet not one minute of the time felt like work to me.
  2. I chose to read 15 – 20 books on the art of writing fiction and also on the business of querying an agent. I didn’t have the inclination or the time to enroll in a Creative Writing Master’s of Fine Arts program, so these resource books were my database for learning. I also picked the brain of every published author I ever met, in an effort to learn the craft and the business.
  3. You’ll need perseverance, because the publishing industry is based in New York City, not California, and every one of us is an unknown in their industry. I received 207 rejections from agents before I was offered a contract, and I think that’s not an atypical experience for most first-time authors.
  4. Once you’ve completed and polished your manuscript, invite every friend who has any interest to read it and critique it. You don’t want your first critical audience to be an agent or a publishing house. Get as much as advice and input as you can before you submit your work to the professionals.
  5. Read a lot of the genre you’re interesting in writing, to develop an feel for what successful plotting, pacing, and dialogue look like.
  6. And lastly, read The Doctor and Mr. Dylan … to see what kind of tale a fellow anesthesiologist weaves about operating rooms, courtrooms, murder, music, success, failure, life, and love in our 21st century world.

Read further articles on the California Society of Anesthesiologists Online First Blog at http://members.csahq.org/blog

 

The most popular posts for laypeople on The Anesthesia Consultant include:

How Long Will It Take To Wake Up From General Anesthesia?

Why Did Take Me So Long To Wake From General Anesthesia?

Will I Have a Breathing Tube During Anesthesia?

What Are the Common Anesthesia Medications?

How Safe is Anesthesia in the 21st Century?

Will I Be Nauseated After General Anesthesia?

What Are the Anesthesia Risks For Children?

 

The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:

10 Trends for the Future of Anesthesia

Should You Cancel Anesthesia for a Potassium Level of 3.6?

12 Important Things to Know as You Near the End of Your Anesthesia Training

Should You Cancel Surgery For a Blood Pressure = 178/108?

Advice For Passing the Anesthesia Oral Board Exams

What Personal Characteristics are Necessary to Become a Successful Anesthesiologist?

 

 

Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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TEN REASONS NURSE ANESTHETISTS (CRNAs) WILL BE A MAJOR FACTOR IN ANESTHESIA CARE IN THE 21ST CENTURY

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

 

My debut novel, The Doctor and Mr. Dylan features a nurse anesthetist in the starring role of Mr. Dylan. Nurse anesthetists have provided anesthesia care in the United States for nearly 150 years, and CRNs will be a major factor in the future.

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In the beginning, anesthesia care for surgical patients was often provided by trained nurses under the supervision of surgeons, until the establishment of anesthesiology as a medical specialty in the U.S. in the 20th century.

Here are 10 reasons why certified registered nurse anesthetists (CRNAs) will be a major factor in anesthesia care in the 21st century:

1. Rural America is dependent on CRNAs to staff surgery in small towns underserved by MD anesthesiologists. CRNAs are involved in providing anesthesia services to about one-quarter of the American population that resides in rural and frontier areas of this country. Despite a significant rise in the number of anesthesiologists in recent years, there is no evidence that they are attracted to practice in rural areas.
2. Obamacare will increase the demand for mid-level healthcare providers, e.g. nurse practitioners, physician assistants, and nurse anesthetists. These mid-level providers are perceived as a cheaper alternative to MD health care.
3. Seventeen states have opted out of the requirement for physician supervision of CRNA anesthetics. These states are Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, and Kentucky. In these states, it’s legal for a CRNA to give an anesthetic without a supervising anesthesiologist or surgeon.
4. For cost-saving reasons, hospital administrators will consider the lower hourly rate charged by CRNAs to be a saving over MD anesthesia care rendered by anesthesiologists alone.
5. Future trends such as the American Society of Anesthesiologists’ Perioperative Surgical Home or bundled payments to Accountable Care Organizations will seek out the cheapest way to manage anesthetic populations. A likely economic model for a healthy patient population is the anesthesia care team, e.g. a 4:1 ratio of four CRNAs supervised by one MD anesthesiologist. This model can be used to staff four simultaneous surgeries on four healthy patients having simple surgical procedures. More complex procedures such as open-heart surgery, brain surgery, major vascular surgery, or emergency surgery will be best served by MD anesthesia care. Extremes of age (e.g. neonates or very old patients) and patients with significant medical comorbidities will be best served by MD anesthesia care.
6. Certain regions of the United States, particularly the South and the Midwest, are already entrenched with anesthesia care team models of 3:1 or 4:1 CRNA:MD staffing because of anesthesiologist preference. An MD anesthesiologist’s income can be augmented by supervising three or four operating rooms with multiple CRNAs simultaneously. These physicians will have little desire to rid themselves of nurse anesthetists and to personally do only one case at a time by themselves.
7. The American Association of Nurse Anesthetists (AANA) presents a strong, well-funded lobby which promotes the continuing and increasing role of CRNAs in medical care in the United States.
8. The educational cost for a registered nurse to become a CRNA is significantly less than the cost of training a board-certified MD anesthesiologist. The median cost of a public CRNA program is $40,195 and the median cost of a private program is $60,941, with an overall median of $51,720.
9. A registered nurse can significantly increase their income by becoming a CRNA. A registered nurse with one year of intensive care unit or post-anesthesia care unit experience can become a CRNA with 2-3 years of CRNA schooling. The average yearly salary of a CRNA in America in 2011 was $156,642.
10. The increasing starring role of CRNAs in American fiction ☺. (See The Doctor and Mr. Dylan, below)

After perusing this list one might ask, are CRNAs and anesthesiologists equals?
No, they are not. Anesthesiologists are doctors, and their training of four years of medical school followed by a minimum of four years of anesthesia residency makes them specialists in all aspects of surgical medicine.

The American Society of Anesthesiologists’ STATEMENT ON THE ANESTHESIA CARE TEAM states “Anesthesiology is the practice of medicine including, but not limited to, preoperative patient evaluation, anesthetic planning, intraoperative and postoperative care and the management of systems and personnel that support these activities. In addition, anesthesiology includes perioperative consultation, the management of coexisting disease, the prevention and management of untoward perioperative patient conditions, the treatment of acute and chronic pain, and the practice of critical care medicine. This care is personally provided by or directed by the anesthesiologist.” (Approved by the ASA House of Delegates on October 26, 1982, and last amended on October 16, 2013)

Doctor J H Silber’s landmark study from the University of Pennsylvania documented that both 30-day mortality and failure-to-rescue rates were lower when anesthesia care was supervised by anesthesiologists, as opposed to anesthesia care by unsupervised nurse anesthetists. This study has been widely discussed. The CRNA community dismissed the conclusions, citing that the Silber study was a retrospective study. In a Letter to the Editor published in Anesthesiology, Dr. Bruce Kleinman wrote regarding the Silber data, “this study could not and does not address the key issue: can CRNAs practice independently?”

I’m not a fan of CRNAs working alone without physician supervision. In both my expert witness practice and in the expert witness practice of my anesthesia colleagues, we find multiple adverse outcomes related to acute anesthetic care carried out by non-anesthesiologists.

CRNAs will play a significant role in American healthcare in the future. That significant role will be best played with an MD anesthesiologist at their right hand.

The most popular posts for laypeople on The Anesthesia Consultant include:

How Long Will It Take To Wake Up From General Anesthesia?

Why Did Take Me So Long To Wake From General Anesthesia?

Will I Have a Breathing Tube During Anesthesia?

What Are the Common Anesthesia Medications?

How Safe is Anesthesia in the 21st Century?

Will I Be Nauseated After General Anesthesia?

What Are the Anesthesia Risks For Children?

 

The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:

10 Trends for the Future of Anesthesia

Should You Cancel Anesthesia for a Potassium Level of 3.6?

12 Important Things to Know as You Near the End of Your Anesthesia Training

Should You Cancel Surgery For a Blood Pressure = 178/108?

Advice For Passing the Anesthesia Oral Board Exams

What Personal Characteristics are Necessary to Become a Successful Anesthesiologist?

 

 

 

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Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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THE DOCTOR AND MR. DYLAN HITS #1 BESTSELLING ANESTHESIA BOOK IN THE WORLD AT AMAZON.COM

the anesthesia consultant

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

On October 2, 2014, my debut novel The Doctor and Mr. Dylan was the number one bestselling Anesthesiology book in the world on Amazon.com Kindle.

Click on this image of the book to reach the Amazon webpage:

 

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REVIEWS:

5.0 out of 5 stars The Doctor and Mr Dylan, March 3, 2015
By
prabha venugopal (chicago, il USA) – See all my reviews
Verified Purchase(What’s this?)
Gripping from the beginning to the end. Very well written, bringing to the forefront all the human emotions seen in an operating room spill over into real life. I cannot wait for Dr. Novak to wrote another book! As another physician in the same profession, my admiration for his book knows no limits.

Bang-Up Debut Novel, November 16, 2014

By Norm Goldman “Publisher & Editor of Bookpleasures”

This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.

This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.

TwinCities.com PIONEER PRESS Entertainment

by Mary Ann Grossman, Entertainment Editor, St. Paul Pioneer Press mgrossman@pioneerpress.com, January 4, 2015

“The Doctor & Mr. Dylan” by Rick Novak

Dr. Nico Antone doesn’t hide the fact he hates his wife, but he says he didn’t kill her during an operation. The authorities think otherwise and his trial is the riveting suspense in this novel that is part medical thriller, part legal thriller, part exploration of family relationships.

Nico is an anesthesiologist (as is the author) who leaves his wife, their plush life in California and his job at Stanford to move to his hometown of Hibbing so their son, Johnny, has a better chance of getting into a prestigious college. Johnny hates the idea of moving to a small, cold town, but he’s popular from the first day in school. Nico doesn’t do so well. He’s envied by Bobby, an anesthetist who’s jealous of the better-educated Nico. But it’s hard to take Bobby seriously, since he thinks he’s the young Bob Dylan and lives in the house where Bobby Zimmerman grew up. To complicate matters, Nico is attracted to the mother of the young woman his son is dating. When the two teens get in trouble, Nico’s furious, rich wife comes to Minnesota and needs an emergency operation that puts her on Nico’s operating table.

Novak grew up in Hibbing, where he worked in the iron ore mines and played on the U.S. Junior Men’s Curling championship teams of 1974 and ’75. After graduating from Carleton College, he earned a medical degree at the University of Chicago and spent 30-plus years at Stanford Hospital, where he was an associate professor of anesthesia and Deputy Chief of the Anesthesia Department. His courtroom scenes are based on his experiences as an expert witness.

The Physician’s Late-Night Reading List

Two Pritzker alums pen captivating tales

By Brooke E. O’Neill, University of Chicago Pritzker School of Medicine, editir, Medicine on the Midway Magazine

For most physicians, writing — patient notes, case histories, perhaps journal articles — is part of the job. But for anesthesiologist-novelist Rick Novak, MD’80, and neurosurgeon-memoirist Moris Senegor, MD’82, it’s a second career that consumes early morning hours long before they step into the OR.

Fans of John Grisham will find a kindred spirit in Novak, whose fast-paced medical thriller, The Doctor & Mr. Dylan transports readers to rural Northern Minnesota, where an accomplished physician and a deranged anesthetist who thinks he’s rock legend Bob Dylan see their worlds collide in the most unexpected ways.

Delivering real-life twists and turns — and a love letter to the Bay Area — is Senegor’s Dogmeat: A Memoir of Love and Neurosurgery in San Francisco (Xlibris, 2014), a coming-of-age tale chronicling the author’s away rotation with renowned neurosurgeon Charles Wilson, MD, at the University of California, San Francisco. Brutally honest, it spares no details of a time Senegor, who also served as a resident under the University of Chicago’s famed neurosurgery chair Sean Mullan, MD, describes as “one of the biggest failures of my life.”

One a vividly imagined nail-biter, the other an intimate peek into the surgical suite, both books deliver an ample dose of intensity and drama.

 

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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“I thought it was a novel way of killing someone,” said Rick Novak, Deputy Chief of Anesthesiology at Stanford University, describing the imagined hospital death that was the genesis of his dark thriller The Doctor & Mr. Dylan. A huge Bob Dylan fan — the rock icon was born in Novak’s hometown of Hibbing, Minnesota, where the story takes place — he then dreamed up a possible culprit: a psychotic anesthetist who thinks he’s Dylan.

From there, the words flowed. “I would write whenever I was with my laptop and had a free moment: in mornings, in evenings, in gaps between cases,” said Novak, who also blogs about anesthesia topics. “I don’t sleep much.”

After finishing the manuscript — one year to write, another to edit — came the challenge of finding a publisher. “In anesthesia, I’m an expert,” Novak said. “In the literary world, I’m an unknown.” After 207 responses of “no, thanks” or no answer at all, he landed an agent. Two months later, she informed him that Pegasus Books had bought his debut novel.

“I started crying,” Novak admits. “I have a third grader and at the time the big word the class was learning was ‘perseverance.’ That was it exactly.”

Dr. Joseph Andresen, Editor, Santa Clara County Medical Association Medical Bulletin, from the January/February 2015 issue:

BOOK REVIEW “THE DOCTOR AND MR. DYLAN”

This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel The Doctor and Mr. Dylan. Rick and I go way back. It was my first week of residency at Stanford when we first met. A newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely.

Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was new to me as I sat down and opened the first page of The Doctor and Mr. Dylan. I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words. “life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of and free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys.

Rick, I can’t wait for your next book. Bravo!

Hibbingite writes twisted medical tale

HIBBING — Readers who are looking for a whodunit that will keep them up all night are in for a treat.

Hibbing native Rick Novak recently released his first book “The Doctor and Mr. Dylan,” a fiction set in Hibbing that merges anesthesia complications, a tumultuous marriage and the legend of Bob Dylan.

“The dialogue is sometimes funny, and there are lots of plot twists,” he said.

Novak said the book will not only entertain readers, but teach them about anesthesiology, Dylanology, the stressful race for elite college admission, and life on the Iron Range.

“The book is very conversational and streamlined,” he said. “I try to write as one would tell a story out loud.”

Novak said “The Doctor and Mr. Dylan” took him three years to perfect. He is currently working on his second book.

5.0 out of 5 stars I Sense We Have Another F.Scott Fitzgerald Emerging on the Literary Scene, December 1, 2014
By
Deann Brady (Sunnyvale, CA USA) – See all my reviews
(REAL NAME)
I found Rick Novak’s first novel, “The Doctor and Mr. Dylan,” a most exciting combination of biting sarcasm, mystery and daily activity spun with fresh new phrases that made me turn my ear back to listen to the literary cadence of his words again and again even though, on the other hand, I was anxious to turn the pages to see what would happen next. His brilliant handling of scenes is reminiscent of The Great Gatsby by F. Scott Fitzgerald. A compelling read!Deany Brady, author of “An Appalachian Childhood”

By

allan mishra

This review is from: The Doctor and Mr. Dylan (Kindle Edition)

Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.

 

The most popular posts for laypeople on The Anesthesia Consultant include:

How Long Will It Take To Wake Up From General Anesthesia?

Why Did Take Me So Long To Wake From General Anesthesia?

Will I Have a Breathing Tube During Anesthesia?

What Are the Common Anesthesia Medications?

How Safe is Anesthesia in the 21st Century?

Will I Be Nauseated After General Anesthesia?

What Are the Anesthesia Risks For Children?

 

The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:

10 Trends for the Future of Anesthesia

Should You Cancel Anesthesia for a Potassium Level of 3.6?

12 Important Things to Know as You Near the End of Your Anesthesia Training

Should You Cancel Surgery For a Blood Pressure = 178/108?

Advice For Passing the Anesthesia Oral Board Exams

What Personal Characteristics are Necessary to Become a Successful Anesthesiologist?

 

 

Learn more about Rick Novak’s fiction writing at rick novak.com by clicking on the picture below:

DSC04882_edited