Tess Gerritsen - The Surgeon

Hands slick on his weapon, heart thudding, Moore edged toward the door. Gave it a nudge with his foot.

The smell of blood, hot and foul, washed over him. He found the light switch and flicked it on. Even before the image hit his retinas, he knew what he would see. Yet he was not fully prepared for the horror.

The woman’s abdomen had been flayed open. Loops of small bowel spilled out of the incision and hung like grotesque streamers over the side of the bed. Blood dribbled from the open neck wound and collected in a spreading pool on the floor.

It took Moore an eternity to process what he was seeing. Only then, as he fully registered the details, did he understand their significance. The blood, still fresh, still dripping. The absence of arterial spray on the wall. The ever-widening pool of dark, almost black blood.

At once he crossed to the body, his shoes tracking straight through the blood.

“Hey!” yelled Rizzoli. “You’re contaminating the scene!”

He pressed his fingers to the intact side of the victim’s neck.

The corpse opened her eyes.

Dear god. She’s still alive.

Catherine jerked rigid in bed, heart slamming in her chest, every nerve electric with fear. She stared at the darkness, struggling to quell her panic.

Someone was pounding on the door of the call room. “Dr. Cordell?” Catherine recognized the voice of one of the E.R. nurses. “Dr. Cordell!”

“Yes?” said Catherine.

“We have a trauma case coming in! Massive blood loss, abdominal and neck wounds. I know Dr. Ames is covering for trauma tonight, but he’s delayed. Dr. Kimball could use your help!”

“Tell him I’ll be there.” Catherine turned on the lamp and stared at the clock. It was 2:45 A.M. She’d slept only three hours. The green silk dress was still draped over the chair. It looked like something foreign, from another woman’s life, not her own.

The scrub suit she’d worn to bed was damp with sweat, but she had no time to change. She gathered her tangled hair in a ponytail and went to the sink to splash cold water on her face. The woman staring back at her from the mirror was a shell-shocked stranger. Focus. It’s time to let go of the fear. Time to go to work. She slipped her bare feet into the running shoes she’d retrieved from her hospital locker and, with a deep breath, stepped out of the call room.

“ETA two minutes!” called the E.R. clerk. “Ambulance says pressure’s down to seventy systolic!”

“Dr. Cordell, they’re setting up in Trauma One.”

“Who’ve we got on the team?”

“Dr. Kimball and two interns. Thank god you’re already in-house. Dr. Ames’s car conked out and he can’t get in….”

Catherine pushed into Trauma One. In a glance she saw the team had prepared for the worst. Three poles were hung with Ringer’s lacate; IV tubes were coiled and ready for connection. A courier was standing by to run blood tubes to the lab. The two interns stood on either side of the table, clutching IV catheters, and Ken Kimball, the E.R. doc on duty, had already broken the tape sealing the laparotomy tray.

Catherine pulled on a surgical cap, then thrust her arms into the sleeves of a sterile gown. A nurse tied the gown in back and held open the first glove. With every piece of the uniform came another layer of authority and she was feeling stronger, more in control. In this room, she was the savior, not the victim.

“What’s the story on the patient?” she asked Kimball.

“Assault. Trauma to the neck and abdomen.”

“Gunshot?”

“No. Stab wounds.”

Catherine paused in the act of snapping on the second glove. A knot had suddenly formed in her stomach. Neck and abdomen. Stab wounds.

“Ambulance is pulling in!” a nurse yelled through the doorway.

“Blood and guts time,” said Kimball, and he stepped out to meet the patient.

Catherine, already in sterile garb, stayed right where she was. The room had suddenly gone silent. Neither the two interns flanking the table nor the scrub nurse, poised to hand Catherine surgical instruments, said a word. They were focused on what was happening beyond the door.

They heard Kimball yell: “Go, go, go !”

The door flew open, and the gurney wheeled in. Catherine caught a glimpse of blood-soaked sheets, of a woman’s matted brown hair and a face obscured by the tape holding an ET tube in place.

With a one-two-three ! they slid the patient onto the table.

Kimball pulled off the sheet, baring the victim’s torso.

In the chaos of that room, no one heard Catherine’s sharp intake of breath. No one noticed her take a stumbling step backward. She stared at the victim’s neck, where the pressure dressing was saturated a deep red. She looked at the abdo- men, where another hastily applied dressing was already peeling free, spilling trickles of blood down the naked flank. Even as everyone else sprang into action, connecting IV’s and cardiac leads, squeezing air into the victim’s lungs, Catherine stood immobilized by horror.

Kimball peeled off the abdominal dressing. Loops of small bowel spilled out and plopped onto the table.

“Systolic’s barely palpable at sixty! She’s in sinus tach—”

“I can’t get this IV in! Her vein’s collapsed!”

“Go for a subclavian!”

“Can you toss me another catheter?”

“Shit, this whole field’s contaminated….”

“Dr. Cordell? Dr. Cordell?”

Still in a daze, Catherine turned to the nurse who’d just spoken and saw the woman frowning at her over the surgical mask.

“Do you want lap pads?”

Catherine swallowed. Took a deep breath. “Yes. Lap pads. And suction…” She re-focused on the patient. A young woman. She had a disorienting flashback to another E.R., to the night in Savannah when she herself had been the woman lying on the table.

I won’t let you die. I won’t let him claim you.

She grabbed a handful of sponges and a hemostat from the instrument tray. She was fully focused now, the professional back in control. All the years of surgical training automatically kicked into gear. She turned her attention first to the neck wound and peeled off the pressure dressing. Dark blood dribbled out and splattered the floor.

“The carotid!” said one of the interns.

Catherine slapped a sponge against the wound and took a deep breath. “No. No, if it was the carotid she’d already be dead.” She looked at the scrub nurse. “Scalpel.”

The instrument was slapped in her hand. She paused, steadying herself for the delicate task, and placed the tip of the scalpel on the neck. Maintaining pressure on the wound, Catherine swiftly slit through the skin and dissected upward toward the jaw, exposing the jugular vein. “He didn’t cut deep enough to reach the carotid,” she said. “But he did get the jugular. And this end’s retracted up into the soft tissue.” She tossed down the scalpel and grabbed the thumb forceps. “Intern? I need you to sponge. Gently! ”

“You going to re-anastomose?”

“No, we’re just going to tie it off. She’ll develop collateral drainage. I need to expose enough vein to get suture around it. Vascular clamp.”

Instantly the instrument was in her hand.

Catherine positioned the clamp and snapped it over the exposed vessel. Then she released a sigh and glanced at Kimball. “This bleeder’s down. I’ll tie it off later.”

She turned her attention to the abdomen. By now Kimball and the other intern had cleared the field using suction and lap pads, and the wound was fully exposed. Gently Catherine nudged aside loops of bowel and stared into the open incision. What she saw made her sick with rage.