Tess Gerritsen: The Surgeon

“By the time we get the coag studies, it’ll be too late. We’ve got to move now .” She nodded to the nurse. “Give it.”

The nurse plunged the needle into the IV’s injection port. Heparin was a desperate toss of the dice. If Catherine’s diagnosis was correct, if the patient was suffering from DIC — disseminated intravascular coagulation — then throughout his bloodstream, massive numbers of thrombi were forming like a microscopic hailstorm, consuming all his precious coagulation factors and platelets. Severe trauma, or an underlying cancer or infection, could set off an uncontrolled cascade of thrombus formation. Because DIC used up coagulation factors and platelets, both necessary for blood to clot, the patient would begin to hemorrhage. To halt the DIC, they had to administer heparin, an anticoagulant. It was a strangely paradoxical treatment. It was also a gamble. If Catherine’s diagnosis was wrong, the heparin would make the bleeding worse.

As if things could get any worse. Her back ached and her arms were trembling from the effort to maintain pressure on the liver. A drop of sweat slid down her cheek and soaked into her mask.

Lab was back on the intercom. “Trauma Two, I’ve got STAT results on John Doe.”

“Go ahead,” the nurse said.

“The platelet count’s down to a thousand. Prothrombin time’s way up at thirty, and he’s got fibrin degradation products. Looks like your patient’s got a roaring case of DIC.”

Catherine caught Barrows’s glance of amazement. Medical students are so easy to impress.

“V tach! He’s in V tach!”

Catherine’s gaze shot to the monitor. A whipsawing line traced jagged teeth across the screen. “Any pressure?”

“No. I’ve lost it.”

“Start CPR. Littman, you’re in charge of the code.”

The chaos built like a storm, swirling around her with ever more violence. A courier whooshed in with fresh frozen plasma and platelets. Catherine heard Littman call out orders for cardiac drugs, saw a nurse place her hands on the sternum and begin pumping on the chest, head nodding up and down like a mechanical sipping bird. With every cardiac compression, they were perfusing the brain, keeping it alive. They were also feeding the hemorrhage.

Catherine stared down into the patient’s abdominal cavity. She was still compressing the liver, still holding back the tidal wave of blood. Was she imagining it, or did the blood, which had trickled like glossy ribbons through her fingers, seem to be slowing?

“Let’s shock him,” said Littman. “One hundred joules—”

“No, wait. His rhythm’s back!”

Catherine glanced at the monitor. Sinus tachycardia! The heart was pumping again, but it was also forcing blood into the arteries.

“Are we perfusing?” she called out. “What’s the BP?”

“BP is… ninety over forty. Yes! ”

“Rhythm’s stable. Maintaining sinus tach.”

Catherine looked into the open abdomen. The bleeding had slowed to a barely perceptible ooze. She stood cradling the liver in her grasp and listened to the steady beep of the monitor. Music to her ears.

“Folks,” she said. “I think we have a save.”

Catherine stripped off her bloody gown and gloves and followed the gurney bearing John Doe out of Trauma Two. The muscles in her shoulders quivered with fatigue, but it was a good fatigue. The exhaustion of victory. The nurses wheeled the gurney into the elevator, to bring their patient to the Surgical Intensive Care Unit. Catherine was about to step onto the elevator as well when she heard someone call out her name.

She turned and saw a man and a woman approaching her. The woman was short and fierce-looking, a coal-eyed brunette with a gaze direct as lasers. She was dressed in a severe blue suit that made her look almost military. She seemed dwarfed by her much taller companion. The man was in his mid-forties, and threads of silver streaked his dark hair. Maturity had carved deeply sober lines into what was still a strikingly handsome face. It was his eyes that Catherine focused on. They were a soft gray, unreadable.

“Dr. Cordell?” he asked.

“Yes.”

“I’m Detective Thomas Moore. This is Detective Rizzoli. We’re from the homicide unit.” He held up his badge, but it might as well have been dime-store plastic. She scarcely looked at it; her focus was entirely on Moore.

“May we talk to you in private?” he asked.

She glanced at the nurses waiting with John Doe in the elevator. “Go ahead,” she called to them. “Dr. Littman will write the orders.”

Only after the elevator door had closed did she address Detective Moore. “Is this about the hit-and-run that just came in? Because it looks like he’s going to survive.”

“We’re not here about a patient.”

“You did say you’re from Homicide?”

“Yes.” It was the quiet tone of his voice that alarmed her. A gentle warning to prepare herself for bad news.

“Is this — oh god, I hope this isn’t about someone I know.”

“It’s about Andrew Capra. And what happened to you in Savannah.”

For a moment she could not speak. Her legs suddenly felt numb and she reached back toward the wall, as though to catch herself from falling.

“Dr. Cordell?” he said with sudden concern. “Are you all right?”

“I think… I think we should talk in my office,” she whispered. Abruptly she turned and walked out of the E.R. She did not look back to see if the detectives were following her; she just kept walking, fleeing toward the safety of her office, in the adjoining clinic building. She heard their footsteps right behind her as she navigated through the sprawling complex that was Pilgrim Medical Center.

What happened to you in Savannah?

She did not want to talk about it. She had hoped never to talk about Savannah to anyone, ever again. But these were police officers, and their questions could not be avoided.

At last they reached a suite with the plaque:

Peter Falco, M.D.

Catherine Cordell, M.D.

General and Vascular Surgery.

She stepped into the front office, and the receptionist looked up with an automatic smile of greeting. It froze half-formed on her lips when she saw Catherine’s ashen face and noticed the two strangers who had followed her in.

“Dr. Cordell? Is something wrong?”

“We’ll be in my office, Helen. Please hold my calls.”

“Your first patient’s coming in at ten. Mr. Tsang, follow-up splenectomy—”

“Cancel it.”

“But he’s driving all the way from Newbury. He’s probably on his way.”

“All right, then have him wait. But please, don’t put any calls through.”

Ignoring Helen’s bewildered look, Catherine headed straight to her office, Moore and Rizzoli following right behind her. Immediately she reached for her white lab coat. It was not hanging on the door hook, where she always kept it. It was only a minor frustration, but added to the turmoil she was already feeling, it was almost more than she could handle. She glanced around the room, searching for the lab coat as though her life depended on it. She spotted it draped over the filing cabinet and felt an irrational sense of relief as she snatched it up and retreated behind her desk. She felt safer there, barricaded behind the gleaming rosewood surface. Safer and in control.

The room was a carefully ordered place, the way everything in her life was carefully ordered. She had little tolerance for sloppiness, and her files were organized in two neat stacks on the desk. Her books were lined up alphabetically by author on the shelves. Her computer hummed softly, the screen saver building geometric patterns on the monitor. She slipped on the lab coat to cover her bloodstained scrub top. The additional layer of uniform felt like another shield of protec- tion, another barrier against the messy and dangerous vagaries of life.