Richard Mabry - Diagnosis Death

Elena wondered why she was so hesitant to hear Will say the name. Maybe it was because to this point the midnight caller was only a disembodied voice, popping up once a week to torture Elena. But once Will gave the name, the voice would become a real person, someone she had to deal with. She wasn't sure she was ready for that. She knew it wasn't logical-but what was logical about the merry-go-round her life had become?

The ring of her cell phone brought her up short. She looked at the display and started to ignore the call. Not now, David. But she pushed the button. "Hello, David."

"Elena, I need your help. This is an emergency."

She sat up straighter and pressed the phone to her ear so hard it hurt. "What?"

"I'm doing an induction on Mrs. Gomez. She's the lady you referred, the one with preeclampsia."

"I remember. What's the emergency?"

"We started the Pitocin drip this afternoon. Things were slow at first, then she started making some progress. But now she's bleeding and having constant contractions. Fetal heart tones are rapid and getting fainter."

Elena quickly connected the dots. Abruptio placenta. A premature separation of the placenta, the organ that nourishes the fetus, from the wall of the uterus. More common with preeclamptics. "Abruption?"

"Grade three. I don't think we can deliver her fast enough to save her or the baby. I'm taking her for a stat C-section."

"What do you need from me?"

"I need an assistant. My partner's delivering breech twins, and has another woman in labor after that. The other OB in the area, Tom Denson, is tied up in Bridgeport."

"I just talked with Marcus Bell. Call him."

"I did. While I was on the phone with him, he got a second call-a patient with a perforated peptic ulcer. He's probably on his way to the OR by now."

Elena was already on her feet. "Guess it's me, then. I'll be there in fifteen minutes."

She saw the puzzled looks from Will and Cathy. Elena rattled off a brief explanation as she snatched up her purse and headed for the door.

"Here," Will ripped the page off his pad and stuffed it into her purse. "You can read this later."

The tension in the operating room was like an over-tight violin string.

"How's the baby?" David worked to keep his voice steady.

The pediatrician didn't look up from the fetal monitor. "Fetal heart tones weaker and slowing. We need to get that baby out of there."

The anesthesiologist's voice was strained. "Her pressure's dropping, pulse up to one twenty. I'm running a unit of blood in each arm, full open."

David held out his hand, and the nurse slapped a scalpel into his palm. He looked across the operating table. "Ready, Elena?"

She nodded. He knew she was nervous. But he also knew she was well prepared. This wasn't her first C-section, nor was it his. But still, his pulse was racing, and he suspected the same held true for Elena.

"Fast as you can, David," the pediatrician said. "This baby's in trouble."

David did what he'd always done in emergency situations. He put his mind on automatic pilot and let muscle memory and hours upon hours of study translate to actions. Elena kept up with him, step-by-step, her hands working in unison with his.

"Opening the uterus," David said. A gush of blood spilled out into the operative field.

The anesthesiologist said, "I can't get the blood and fluids in fast enough to keep up."

David willed himself to work steadily. In a moment, he held up the baby, clamped and cut the cord, and passed the infant into waiting arms. "Okay, let's get this bleeding under control."

David removed the placenta, but the bleeding continued unabated. "Are those coagulations studies back?"

The reply came from the anesthesiologist. "Yep. No abnormalities. And I'm having a hard time keeping her stable. BP's at shock levels."

"Emergency hysterectomy?" Elena asked.

"Not if I can help it. This is a young woman. Maybe she and her husband want a brother or sister for this baby." He pointed with a hemostat. "Find the aorta and compress it."

Elena reached gingerly into the abdominal cavity.

David tapped the back of her hand with the instrument. "Don't be tentative. Find it by feeling for the pulsations, then use gentle pressure to shut off blood flow. Just be careful. We don't need a ruptured aorta to deal with."

Seconds passed like hours until Elena said, "Got it."

In a moment the bleeding slowed. David quickly identified and tied off first one uterine artery, then the other. Smaller vessels would nourish the organ, but ligating these arteries should stem the tide. "You can release your pressure now." He held his breath.

Elena withdrew bloody, gloved hands from the wound and let them rest, clasped together, at her waist.

Blood still oozed into the operative field, but it was nothing like the flood of five minutes before. David exhaled, then refilled his lungs. "That's better. Now let's clean up all the other bleeders and get this wound closed."

Elena showered in the nurses' locker room and changed into street clothes. She borrowed a white coat from a hook on the wall and headed for the ICU. David was at the bedside of Maria Gomez. The breathing tube was still in her throat, and a ventilator puffed oxygen into it at a steady sixteen breaths per minute.

"What do you think?" David asked.

The anesthesiologist shook his head. "Her pressure got pretty low. I tried to keep her well-oxygenated, but with the blood loss and poor perfusion, there's no way to know how much brain damage there might be."

"I'll keep the blood going until we get her back to more normal levels. Will you be around if I need you again tonight?"

The anesthesiologist yawned. "Sure. You've got my cell phone number." He extended his hand to Elena. "I'm Charlie Tandy."

"Nice to meet you. I didn't know I was signing on for this when I came to Summers County General."

"We're large enough to have every specialty you might need, but small enough that the docs sometimes have to pitch in when it's crunch time." He grinned. "You did fine."

Elena dropped into a chair at the doctor's charting station. In a moment, David joined her. He nodded toward the door leading to the waiting room. "Now I've got to go out there and tell Maria's husband that his baby girl is fine, but there's a chance his wife won't wake up from the operation."

"You did everything you could," Elena said. "All you can do is play the cards you're dealt. And we don't know yet what the outcome will be." She ran her fingers through her still-wet hair. "You'll keep her here in the ICU, won't you?"

"Yeah. One nice thing about this hospital-we have lots of ICU beds." He managed a wry grin. "Of course, this is going to drive Nathan Godwin up the wall. The payment we get for an uninsured OB isn't much, and there's no way it's going to cover time in the ICU."

"So, what are you going to do?"

"What's best for the patient, of course. Our esteemed administrator can go fly a kite." David flashed a grin. "But there's no need for you to worry. It's me he'll come after."

"He's already after me," Elena said. She told him about her visit in the administrator's office earlier. "I've talked with Marcus Bell. He told me not to worry, but that's hard to do." She picked up a pencil from the desk and started tapping out a nervous rhythm on a metal chart cover. "Why is Nathan so uptight about insurance and payments?"

"I can answer that," David said. "My associate told me the whole story when I first interviewed here. Marcus was doing a good job as chief of staff, but he wasn't riding herd on payments. You and I both know that most doctors aren't wired that way. So the hospital board hired Nathan. His contract specifies that Summers County General has to show a profit within two years, or he's gone. And the contract only has a few more months to run."