Tess Gerritsen - The Surgeon

Iphigenia is still alive, her eyes rolled back in horror as the blood pumps from her neck. The human body contains five liters of blood, and it takes time for such a volume to be discharged from a single severed artery. As long as the heart continues to beat, the blood pumps out. For at least a few seconds, perhaps even a minute or more, the brain functions. The limbs thrash.

As her heart beats its last, Iphigenia watches the sky darken, and feels the heat of her own blood spout on her face.

The ancients say that almost immediately the north wind ceased to blow. Artemis was satisfied. At last the Greek ships sailed, and armies fought, and Troy fell. In the context of that greater bloodshed, the slaughter of one young virgin means nothing.

But when I think of the Trojan War, what comes to my mind is not the wooden horse or the clang of swords or the thousand black ships with sails unfurled. No, it is the image of a girl’s body, drained white, and the father standing beside her, clutching the bloody knife.

Noble Agamemnon, with tears in his eyes.

It’s pulsating,” said the nurse.

Catherine stared, dry-mouthed with horror, at the man lying on the trauma table. A foot-long iron rod protruded straight up from his chest. One medical student had already fainted at the sight, and the three nurses stood with mouths agape. The rod was embedded deep in the man’s chest, and it was pulsing up and down in rhythm with his heartbeat.

“What’s our BP?” Catherine said.

Her voice seemed to snap everyone into action mode. The blood pressure cuff whiffed up, sighed down again.

“Seventy over forty. Pulse is up to one-fifty!”

“Turning both IV’s wide open!”

“Breaking open the thoracotomy tray—”

“Somebody get Dr. Falco down here STAT. I’m going to need help.” Catherine slipped into a sterile gown and pulled on gloves. Her palms were already slippery with sweat. The fact the rod was pulsing told her the tip had penetrated close to the heart — or, even worse, was actually embedded in it. The worst thing she could do was pull it out. It might open a hole through which he could exsanguinate in minutes.

The EMT’s at the scene had made the right decision: they had started an IV, intubated the victim, and brought him to the E.R. with the rod still in place. The rest was up to her.

She was just reaching for the scalpel when the door swung open. She looked up and gave a sigh of relief as Peter Falco walked in. He halted, his gaze taking in the patient’s chest, with the rod protruding like a stake through a vampire’s heart.

“Now that’s something you don’t see every day,” he said.

“BP’s bottoming out!” a nurse called.

“There’s no time for bypass. I’m going in,” said Catherine.

“I’ll be right with you.” Peter turned and said, in an almost casual tone, “Can I have a gown, please?”

Catherine swiftly opened an anterolateral incision, which would allow the best exposure to the vital organs of the thoracic cavity. She was feeling calmer, now that Peter had arrived. It was more than just having the extra pair of skilled hands; it was Peter himself. The way he could walk into a room and size up the situation with just a glance. The fact he never raised his voice in the O.R., never showed a hint of panic. He had five years’ more experience than she did on the front lines of trauma surgery, and it was with horrifying cases like this one where his experience showed.

He took his place across the table from Catherine, his blue eyes zeroing in on the incision. “Okeydoke. We having fun yet?”

“Barrel of laughs.”

He got right down to business, his hands working in concert with hers as they tore into the chest with almost brutal force. He and Catherine had operated as a team so many times before, each automatically knew what the other one needed and could anticipate moves ahead of time.

“Story on this?” asked Peter. Blood spurted, and he calmly snapped a hemostat over the bleeder.

“Construction worker. Tripped and fell on the site and got himself skewered.”

“That’ll ruin your day. Burford retractor, please.”

“Burford.”

“How we doing on blood?”

“Waiting on the O neg,” a nurse answered.

“Is Dr. Murata in-house?”

“His bypass team’s on its way in.”

“So we just need to buy a little time here. What’s our rhythm?”

“Sinus tach, one-fifty. A few PVC’s—”

“Systolic’s down to fifty!”

Catherine shot a glance at Peter. “We’re not going to make it to bypass,” she said.

“Then let’s just see what we can do here.”

There was sudden silence as he stared into the incision.

“Oh god,” said Catherine. “It’s in the atrium.”

The tip of the rod had pierced the wall of the heart, and with every beat fresh blood squirted out around the edge of the puncture site. A deep pool of it had already collected in the thoracic cavity.

“We pull it out, we’re going to have a real gusher,” said Peter.

“He’s already bleeding out around it.”

The nurse said, “Systolic’s barely palpable!”

“Ho-kay,” said Peter. No panic in his voice. No sign of any fear whatsoever. He said to one of the nurses, “Can you hunt me down a sixteen French Foley catheter with a thirty cc balloon?”

“Uh, Dr. Falco? Did you say a Foley ?”

“Yep. A urinary catheter.”

“And we’ll need a syringe with ten cc’s of saline,” said Catherine. “Stand by to push it.” She and Peter didn’t have to explain a thing to each other; they both understood what the plan was.

The Foley catheter, a tube designed for insertion into a bladder to drain urine, was handed to Peter. They were about to put it to a use for which it was never intended.

He looked at Catherine. “You ready?”

“Let’s do it.”

Her pulse was throbbing as she watched Peter grasp the iron rod. Saw him gently pull it out of the heart wall. As it emerged, blood exploded from the puncture site. Instantly Catherine thrust the tip of the urinary catheter into the hole.

“Inflate the balloon!” said Peter.

The nurse pressed down the syringe, injecting ten cc’s of saline into the balloon at the tip of the Foley.

Peter pulled back on the catheter, jamming the balloon against the inside of the atrium wall. The gush of blood cut off. Barely a trickle oozed out.

“Vitals?” called out Catherine.

“Systolic’s still at fifty. The O neg’s here. We’re hanging it now.”

Heart still pounding, Catherine looked at Peter and saw him wink at her through his protective goggles.

“Wasn’t that fun?” he said. He reached for the clamp with the cardiac needle. “You want to do the honors?”

“You bet.”

He handed her the needle holder. She would sew together the edges of the puncture, then pull out the Foley before she closed off the hole entirely. With every deep stitch she took, she felt Peter’s approving gaze. Felt her face flush with the glow of success. Already she felt it in her bones: This patient would live.

“Great way to start the day, isn’t it?” he said. “Ripping open chests.”

“This is one birthday I’ll never forget.”

“My offer’s still on for tonight. How about it?”

“I’m on call.”

“I’ll get Ames to cover for you. C’mon. Dinner and dancing.”

“I thought the offer was for a ride in your plane.”

“Whatever you want. Hell, let’s do peanut butter sandwiches. I’ll bring the Skippy.”

“Ha! I always knew you were a big spender.”

“Catherine, I’m serious.”

Hearing the change in his voice, she looked up and met his steady gaze. Suddenly she noticed that the room had hushed and that everyone else was listening, waiting to find out if the unattainable Dr. Cordell would finally succumb to Dr. Falco’s charms.