Peter Clement - The Inquisitor

In a second pass she cut deeper, parting the yellow globules where she'd left off down to the glistening white fascia that lined the abdominal muscle. Across this layer she made a third sweep with just the tip of her blade, and the diaphanous sheet sprang open, permitting strands of maroon-bellied muscle to bulge out. Handing back the scalpel, she quickly separated them with her fingers, working around the catheters that noisily sucked out the blood, making her way down to the pearl-gray membrane that lined the pelvic cavity. Without needing to be asked, two nurses assumed the task of holding the tissue apart with small stainless-steel claws as she went.

Once she'd cleared enough space, a third nurse slapped a pair of pointed tweezers into Janet's left hand and surgical scissors into her right. Using the former to snag the membrane, she lifted it enough to make a tiny tent and snipped another four-inch opening.

Retracting the edges with her fingers, she brought the dark maroon surface of the pear-shaped uterus into view. Gleaming like new, it lay in a blood-free bed of ligaments and ocher-colored membranes.

Perhaps she hadn't perforated it after all. To be sure, she delicately explored the slippery contours with her fingertips, checking for any tiny holes.

None.

She watched it for leakage.

Crimson seepage from severed vessels in the skin flowed into the space, but nothing else. The exterior remained intact, giving the appearance of a womb as ready to receive and grow life as always.

But from its interior the unrelenting flow persisted, silently coursing out between J.S.'s legs to spatter noisily into the most recent steel basin the nurses had placed there.

After the rush of activity, Janet felt overwhelmed with helplessness. She'd reached the limit of what she could do.

More vitamin K wouldn't help. It took hours to work.

Removing the uterus would produce more hemorrhages.

The sole hope for survival rested with the fresh frozen plasma- if the clotting factors kicked in soon enough.

She prepared herself for the hardest task a surgeon had to endure: to stand by and let time decide life or death.

"Pressure?"

"Fifty-five," the anesthetist reported, his voice as ice-smooth as ever.

No one else said a word.

In the silence, each squeeze of the ventilation bag seemed to become louder.

The tiny intervals between the rapid stream of beeps from the heart monitor grew so infinitesimal that the noise approached a continuous scream.

And the spatter of blood filling yet another basin ran steady as a faucet.

One of the nurses emptied it and recorded the amount.

Others counted the blood-soaked gauzes that lay in foot-high piles on the surrounding trays, estimating each to hold a twenty-cc loss. J.S.'s heart would either find enough volume of blood to pump or collapse in on itself, empty. And even if she continued to have a pulse, whether the rest of her vital organs- brain, kidneys, liver- could scavenge enough molecules of oxygen from the sparse circulation to survive intact, Janet had no idea.

With nothing to do but wait, she drew on raw nerve honed by years of experience to just stand there, outwardly calm but seething inside, suffocated under a sense of dread that she'd lost J.S.

Then she thought of Jimmy and what he must be going through.

When she glanced in his direction, he remained as still as a sentinel, yet gave her a nod, as if to say it would be all right.

J.S. went into full cardiac arrest at 4:10 a.m.

Stewart cracked open her chest, slid his gloved hand into the cavity, and did open-heart massage.

As he worked, the bleeding slowly subsided.

Because she's dying, Janet told herself.

Nearly five minutes later the anesthetist said, "You're getting a good pulse."

Thirty seconds after that the heart resumed pumping on its own, coming back to life in Stewart's hand.

As Jane's pressure climbed, everyone waited for the bleeding to resume.

It didn't.

Later that same morning, 7:30 a.m. The roof garden, St. Paul's Hospital

"I tell you, Earl, he was terrific," Janet said, throwing her arm around Stewart's shoulders. "Absolutely terrific."

The man reddened, but the corners of his eyes betrayed a smile. "Janet's the one who called the shots," he said, unusually muted in the face of praise.

Falling to the status of pariah and then reclaiming the mantle of hero in less than a day can have that effect on a person, even a resident prima donna, Earl thought, not exactly comfortable with Janet heaping such unqualified accolades on a man who still had a lot to answer for.

Stewart seemed uneasy as well, having difficulty looking him in the eye.

The sounds of morning traffic floated up from the street below, and overhead an azure sky stretched out over Lake Erie to where water and air became indistinguishable and the horizon disappeared in a blue haze. The coming day would be a scorcher, and as at the start of most shifts since the roof garden opened, a lot of staff had gathered here to talk and savor the coolness while it lasted. While some still gave Stewart a stink-eye scowl, many of the nurses who'd done the same yesterday now came up to him and said, "Thanks for saving her."

As for J.S., she lay in ICU, still unconscious, but, with her vitals stable and blood chemistry normal, expected to recover. Even the problematic INR had returned to a reasonable level, probably thanks to the vitamin K. The hematologists would be keeping an eye on it. "Thank God she'll be okay," Earl said to Stewart, his tone guardedly neutral. "Who got her pregnant?" he then asked, wanting to shift the conversation.

Janet's eyes sparkled. "You're going to love this. As soon as his shift in ER ended,

Thomas Biggs showed up at her bedside, attentive as hell. Looks like you had a discreet romance under your nose."

"Thomas?"

"That's right. Surprised me too. For a moment, I even thought it might have been Jimmy, the way he stuck to her-"

"Well, if you'll excuse me, I'm going home," Stewart interrupted, sounding tired as he unfolded his tall frame from the bench. "At least now I ought to be able to sleep."

"You deserve it," Janet said warmly, giving his arm a squeeze.

"You're awfully friendly with him," Earl said after he'd left. He hadn't had a chance to talk with Janet privately since the events at death rounds yesterday morning.

"You believe what that Monica Yablonsky's saying?" she asked, the skeptical arch of her voice and eyebrows making her own opinion clear.

"I'm not sure."

"Only not sure? Come on!"

"Well, I agree that he wouldn't be so stupid as to rig a bunch of near-death experiences."

"But?"

"Even if he had nothing to do with that, I don't know how far he'd go to try and prevent that story from coming out."

Janet frowned. "You mean to say you think he knocked off the patients who reported those stories?"

"It's a terrible thought, but… yes."

"Jeez!" She looked out over the lake, her blue eyes darkening, growing as deep and faraway as the distant water. "I know he can sure get prickly over what people say about him, almost paranoid at times." She shook her head. "But to actually silence people, cause them to die or slip into comas… that's a hell of a leap." She exhaled hard, inflating her mask around her cheeks. "But the trouble with thinking the worst about someone is that once you start, it's hard to stop."

"Tell me about it. Better yet, tell me I'm wrong."

She breathed out a second time, hard, as if doing her breathing exercises in preparation for labor. "I can't say I don't know what you mean. Stewart has always been a difficult read. And if anyone could tweak a patient over the edge without leaving a trace, he's got the skills." A shudder passed through her. "As wonderful as what he pulled off with J.S. might be, it always kind of scared me, seeing how he throws himself into a case on the brink. There's a desperation to it. Oh, I know anyone in our business who's really good has to be obsessive about getting all the details right- we all are- but I don't think I realized before just how consumed he is by what he does. It's like he hides in it. But would he kill to protect his right to play God?" She again shook her head. "I just don't know."