Peter Clement - The Inquisitor

Finally, she thought dazedly.

He dashed from view and returned with a needle to take another blood test.

Jesus. She felt furious at him again.

Janet reappeared back at her side. "We're heading to the OR now!"

Everyone scrambled frantically to pile what they'd need for the trip onto the bed- monitors, oxygen tanks, IV poles.

"Give her an IV shot of phytonadione," Stewart ordered.

Jane knew that stuff- it was another name for vitamin K. In ER they used it to reverse the effects of Coumadin, a drug that thins the blood by interfering with the role vitamin K and other components play in normal clot formation. "But I've never taken Coumadin in my life-"

"Relax," he interrupted. "You were probably born with low prothrombin levels. That mimics a Coumadin overdose on testing, and phytonadione will shore up the effectiveness of the bit you have. People deficient in it often don't find out until a time like this. Do you normally bleed a lot when you cut yourself?"

"I don't know if I'd say that."

"How about your periods? Are they heavy?"

"Sometimes, but-"

"Hi, J.S.," said another familiar voice, putting an end to Deloram's annoying questions. Then a gloved hand, warm even through the latex, grabbed hers.

"Hey, Jimmy," she replied, her own words sounding like a distant echo. "Tell me this isn't a professional call."

His eyes crinkled at the corners. "No, I'm here just as a friend."

"I need a friend."

"Then I'm your guy."

"You're sure, now that I've practically got a scarlet A on my forehead?"

His grip on her hand tightened. "Hey, enough of that. We'll soon be having coffee together as usual."

Just twelve hours ago they'd been sharing a pot of tea in the lunchroom set aside for ER staff.

"And when you're better, I want a match to this." He flicked his earring with a gloved fingertip. "You've no idea what a hit it makes me with the old ladies in Geriatrics."

She tried to grin at him. No one had given her a mask. He might be the last person on earth to see her smile.

Janet leaned in close again. "Okay, here's the score. In the OR I'll do a D and C, and once the plasma kicks in, the bleeding will stop. Bottom line, you're not going to die, and there will be more babies."

Shivering, she felt her head swim again. "Sure hope so."

"And if these ER cowboys are finished spearing you," Janet continued, but much louder, "perhaps we could get the lady a blanket?"

She started to lose consciousness, and tightened her grip on Jimmy's hand, but he couldn't hold her out of the darkness.

Janet dashed through the corridor, guiding the stretcher around corners, the race a deadly earnest repeat of what they'd done in jest through the streets of Buffalo two Saturdays ago.

Even Jimmy helped, setting intravenous bottles swaying in the turns as he muscled their precious cargo along.

Stewart Deloram adjusted IV rates on the run.

Janet continued to utter a steady stream of comforting words- reassuring J.S. that all would be well, that they'd beaten these odds many, many times before, that this would soon be little more than an unpleasant memory. But she couldn't be sure her patient even heard, and she estimated they had ten minutes to stop the flow of blood or J.S. would die.

They commandeered an elevator and seconds later were met by a team of nurses and an anesthetist who ushered them into an OR.

The bleeding continued.

Changing, scrubbing, then redonning sterile gowns, gloves, and masks cost more precious minutes.

"Pressure's down to sixty-two," called out one of the OB nurses.

Stewart rushed to open up the IVs as wide as they'd go.

Jimmy hustled back to J.S.'s side. No stranger to keeping out of the way, he hovered discreetly by her head, holding her hand and talking quietly to her, until a nod from the anesthetist indicated she'd finally been put under. He then stepped back into a corner, apparently determined to stay and observe, his dark eyes glistening.

Janet recognized in them what she'd never seen him show before: fear.

My God, he's in love with her, she thought.

"Ready for you, Doctor," said the anesthetist, his voice clipped and urgent. "Pressure's falling, sixty over zip." He had the requisite wisps of gray hair sticking out from under his cap to tell her she hadn't pulled a rookie.

The nurses secured J.S.'s legs in stirrups and positioned an OR stool adjusted for Janet's height between them. Taking her seat, Janet prepared to do the definitive treatment- scrape any pieces of afterbirth off the inner lining of the uterus. With nothing left in the way, the organ could clamp down tight on itself and tamponade the bleeding sites, like pressure on a cut.

The os of the cervix hung open, pouring blood, and tissue trailed out its orifice, debris caught in a stream.

"Suction," she ordered.

Catheters drained everything away with the sound a straw makes at the bottom of a milk shake, and the crimson flow receded.

Janet quickly inserted a dilator to widen the passage, then went into the vault with a curette to clean out any remaining material.

"Still sixty over zip, and pulse climbing to one sixty. You may not have much time." The anesthetist spoke the grim warning with glacial cool.

"Keep calling out the readings." She retrieved only small amounts of tissue, yet blood continued to pour over her hands, warm and fluid with not a clot in sight.

Definitely something wrong with her coagulation.

"Any repeat on the INR?" she asked.

"Still high, but the rest is okay," Stewart replied. In other words, low prothrombin remained the problem, not the more horrific DIC, at least so far.

He continued to work frantically with the IVs- replacing spent packets of red cells and plasma, binding the new ones in pneumatic cuffs that accelerated their flow, hanging up more liters of saline to pour in as much volume as possible- all to keep her circulation from collapsing completely. The dread in his eyes said, I'm losing!

"Fifty-five over zip."

Janet finished raking the curette over the inner uterine wall and pulled out the last segments of the afterbirth, none of it enough to explain such a copious hemorrhage. There should have been some improvement by now.

Unless…

"BP down to fifty, pulse is still high… one fifty-five… one sixty…"

She'd soon arrest.

A cold sweat crept up Janet's back.

Either the coagulation problem hadn't corrected at all, or in doing the curettage, she'd shoved the instrument right through the uterine wall and opened up a new bleed. Pliant enough to expand and accommodate the size of a baby, the tissue is delicate, and a curette could penetrate it without her ever feeling the pop of the metal tip punching all the way through. She'd never made the mistake before, but shit happens when you least want it.

She'd have to go in and check.

"A number eleven scalpel," she ordered, removing the curette. "Prepare for a laparotomy and a repair of a possible uterine puncture."

She heard the indrawn breaths as everyone's pupils pulsed wider, but nobody said a word. From now on she'd be the only one to speak.

The nurse at her side snapped a pointed blade onto a stainless-steel handle and laid it flat in her outstretched hand.

Her colleagues shoved the additional instrument trays they'd need into easy reach and whipped off the sterile covers. One of them quickly prepped the area she'd be cutting.

Stewart slid a nail-sized needle under J.S.'s collarbone and into her subclavian vein to start a sixth IV.

"Get ready to tamponade the incision with gauze, and give me suction, plenty of it."

In a single move Janet made a four-inch horizontal slice through the skin into a yellow layer of subcutaneous fat, following along the top of the pelvis, the so-called bikini cut. Immediately the trench filled with blood, but the nurses' fingers pulled the edges apart and pressed folded white gauze into the incision, soaking up the flow as fast as it appeared.