Rupture Page 25

  “Yeah, hold up,” Kanter said. “She’s bradycardic. I’m giving atropine.”

  Smoke from the electrocautery drifted above the table as Korinsky, on autopilot, sliced through Margaret’s subcutaneous tissue. The smell of electrocautery filled the room and for the first time in his career, it made Eli sick. Korinsky was no longer making an attempt to control the bleeding.

  “This is the future, Branch,” Korinsky said. “If she doesn’t make it, the next one will.”

  Kanter scrambled to infuse medicine and fluid. “Damn it, Korinsky, I said to hold up. Get me some blood, Virginia. This little girl needs blood, now.”

  Static crackled from the intercom and Fisher’s voice boomed through. “The tissue’s ready, I’m bringing it down.”

  “Back away from the table, Korinsky,” Eli demanded.

  Korinsky turned to face Eli, the scalpel out in front of him now with Margaret’s blood wet on the tip.

  “I can’t let you kill a child just to save RBI.”

  Kanter hung a unit of blood. “RBI? What’s this about?” Then he saw the scalpel pointed at Eli. “Virginia?”

  “Security’s on the way.”

  Eli extended his hand toward Korinsky. “Give me the knife.”

  Korinsky held his position and turned to look at Margaret. Then, he flipped the scalpel so he could present it to Eli handle first.

  Eli reached for the knife but Korinsky cut a quick slice across Eli’s forearm.

  Eli felt a tendon snap and his blood splattered the floor.

  “Stop it!” Virginia yelled and she pulled against Korinsky’s arm. But Korinsky kept at him, swinging the scalpel.

  Eli backed up against the electrocautery unit, stepping on the cord that ran along the floor to the handheld control on the operating table.

  During the brief struggle, Eli pulled the bottle of alcohol from his back pocket, unscrewed the top, and dropped it at Korinsky’s feet.

  Korinsky pushed Virginia off and she crashed into a kick bucket on the floor. When he turned the scalpel back on Eli, Korinsky stopped. Eli held the electrocautery control in his hand. Korinsky glanced at the clear liquid beneath his shoes.

  “Don’t move,” Eli said. “It can all stop right here.”

  With the smell of rubbing alcohol filling the room, Korinsky rushed forward, and Eli bent and touched the metal electrocautery tip to the expanding pool.

  Flames shot up Korinsky’s scrubs until his waist was engulfed. He fell against the table, pulled the sterile drapes that surrounded Margaret, and tried to extinguish the flames by wrapping himself in the cloth.

  Eli grabbed the extinguisher from the side of the anesthesia machine and covered Korinsky in blasts of white powder and foam. He kicked the scalpel into the corner. But Korinsky was in no shape to use it again. He writhed in pain on the floor, his scrubs melted onto his back.

  Fisher bumped the door open with his butt and turned, unaware, holding a metal specimen basin in front of him. He stopped at the smell of burning flesh and the sound of Korinsky screaming on the floor.

  Over the intercom, a frantic voice called, “Code Blue, Room Eight, Dr. Fisher—Code Blue, Room Eight, Dr. Fisher.”

  The chairman of surgery looked at Eli. “Damn it,” Fisher said. He dropped the basin and burst from the room.

  Eli moved to Margaret’s side and told Roberta to hold a sterile pad against the open incision.

  “I have her stabilized for now,” Kanter said. “What the hell, Branch?”

  “I’ll explain later.” He turned to Virginia and said, “I’m going to Room Eight.”

  CHAPTER FIFTY-SIX

  GATES MEMORIAL HOSPITAL

  9:00 A.M.

  As a shortcut, Eli ran through the central supply area.

  I should have known. I should have known. When he entered Room Eight, Fisher was nowhere in sight. Landers stood over the patient, his hands submerged in an abdomen overflowing with blood. There were no drapes, no sterile gowns. The intern’s scrub top was drenched, his eyes wild with fear.

  Only Landers and a young female nurse-anesthetist were in the room. No scrub nurse or circulator. The monitors screeched a wild, erratic rhythm so fast that the beeps coalesced into one. Nothing was being done to correct the situation. The anesthetist stared at two bottles of medicine, her hand shaking, otherwise paralyzed. Eli looked down at the bleeding patient, Henry, his brother. Henry’s face was mottled, the color drained from around the endotracheal tube in his mouth. For the first time before performing an operation, Eli did not take his extra moment. He did not close his eyes or bow his head. He did not even put on gloves.

  Landers spoke, his voice cracking. “Dr. Fisher was out of control!”

  With one hand, Eli pulled the instrument table close and ripped open a pack of laparotomy pads.

  “I know,” Eli said. “Listen to me, Landers. We’re going to do the same maneuvers that we did with Scott Tynes. Evacuate the blood, find the bleeder, and stop it.”

  Landers nodded and stared at the deep, bleeding gash on Eli’s arm. Two fingers on his mentor’s hand hung limp from the severed tendon.

  “But you have to tell me, what did Fisher do?”

  Landers looked down at the pool of blood. “He cut out the pancreas, a big chunk of it, right out of the center. He didn’t even try to stop the bleeding.”

  So that’s it, Eli thought.They’re transplanting stem cells into Margaret to treat her diabetes, using my brother’s pancreatic tissue to feed the cells and keep them alive until they become engrafted.

  Eli went straight to the source, sliding his hands over Landers’s, deep into his brother’s abdomen, until the laceration on Eli’s arm submerged in the pool of blood.

  Encased in a web of vessels and nerves, Henry’s pancreas could be bleeding from any number of tributaries, Eli assumed. But the midsection of the pancreas lay on top of two major vessels, the portal vein and the superior mesenteric artery. If either one was injured, Eli knew he would likely not be able to save his brother.

  Landers responded like an upper-level resident, scooping out partially clotted blood to gain the exposure Eli needed. From the rate at which blood refilled the abdominal space, Eli knew a major vessel had been torn. And from the darker maroon color, it was most likely the portal vein, a vessel that drained the entire blood return from the intestine to the liver.

  “Call your staff now,” Eli told the anesthetist, who immediately grabbed the phone. “And hang all the blood you can find.”

  He turned to Landers. “Where’s the sucker?”

  “Dr. Fisher said he didn’t need one.”

  Eli glanced at the instrument tray and removed a large angled vascular clamp.

  “We’ve got one shot,” he told Landers.

  Eli lifted Henry’s mesentery from the wound. He inserted the clamp across the mesenteric neck where the veins joined the major portal system.

  “If we can slow the inflow of blood, maybe we can see the hole.”

  Eli closed the ratcheted clamp with three metallic clicks.

  “Won’t that cut off supply to the bowel and cause ischemia?”

  “Not if we’re quick.”

  The clamp slowed the blood loss considerably. There was only back bleeding, and Landers managed to evacuate it. Eli reached up and positioned the overhead light to illuminate the wound. He extended an open hand toward the anesthetist.

  “Give me your sucker.”

  “What?” she said. “It’s been in his mouth, it’s not sterile.”

  “Do I look sterile?” Eli responded, his patience gone. “Give it to me!”

  She complied, and Eli suctioned the remaining pool of blood until he could see a tear in the side of the thin-walled portal vein.

  At least it’s not completely transected. Eli needed a small bit of fortune on his side.

  He placed Landers’s hands in the position of retraction and instinctively called out, “Four-O Prolene on an RB-one.” Even as he said this, he knew there was no circulatin
g nurse. He went to the suture cabinet, kicked it open with his foot, and selected the thin monofilament suture on a curved vascular needle.

  “Hold the sucker just off the hole,” he told Landers. “I’ll close it primarily.” But when Eli tried to clamp the needle with needle driver, the suture fell from his injured hand to the floor. He bent, clamped the needle directly off the tile, and inserted it at the apex of the bleeding hole, closing it with a running suture, over and over. In less than a minute, he was finished with the repair and released the clamp to allow return of flow to Henry’s intestine.

  “Wow,” Landers said.

  There was only minor residual oozing from the needle holes. The continuous beep from the monitor separated as Henry’s accelerated heart rate slowly began to normalize.

  Virginia opened the door and stepped into the room. During her span of thirty years at Gates Memorial, there was nothing she hadn’t seen. But she brought her hand to her mask and gasped when she saw Eli, ungloved, with blood up to the level of the severed tendon in his arm. She had no idea that it was the blood of Eli’s brother. She pointed behind her in the direction of Operating Room One. “There’s another surgeon operating on the little girl now.”

  Virginia’s voice carried an urgency that was unfamiliar to Eli.

  “Fisher?”

  “No, a female surgeon. Something’s wrong, Eli. I don’t recognize her.”

  “It’s all wrong, Virginia. All of it.”

  “Please come down there.”

  Eli knew that Virginia would not pull him away unless absolutely necessary. He looked at the monitor. The anesthesia staff had arrived and was hanging more blood. Even though he was still tachycardic, Henry’s blood pressure had stabilized. Eli placed a pack of laparotomy pads over the site of Henry’s vein repair. “Apply gentle pressure and let them catch up,” he told Landers. “I’ll be right back.”

  The intern watched as Eli left the room. He would hold pressure and wait for Dr. Branch, his mentor and friend, to return.

  CHAPTER FIFTY-SEVEN

  GATES MEMORIAL HOSPITAL

  OPERATING SUITE

  9:16 A.M.

  Eli rushed into Operating Room One to find a tall female surgeon, her back to him, bent over Margaret, working diligently to close the little girl’s abdominal incision. He had complete faith in the chief surgical resident, Susan Morris. Even though she was not a pediatric surgeon, Susan would adapt her skill to the delicate approach needed to handle the tissue of a child.

  Eli walked up behind her. “Susan, glad you’re here. How is she?”

  But Susan did not turn around, nor did she speak.

  From across the room, Virginia got Eli’s attention and shook her head. He stepped to the end of the bed for a clear view of the operative field. Rather than closing the incision, the surgeon had opened the wound more. She held a large syringe filled with pink cell culture medium. At the end of the syringe, a long spinal needle pierced the portal vein adjacent to Margaret’s pancreas.

  “What are you doing?” Eli yelled.

  Then he saw the aqua blue eyes above the rim of her mask.

  “Live, my darling,” Tsarina said. “Your mother tells you to live.” She continued to inject as though Eli was not there.

  “Stop,” Eli demanded and pulled her arm away from the field.

  A hospital security guard burst into the room. He wasn’t alone. Lipsky walked straight at Tsarina with his pistol drawn. He looked at Eli, his left arm hanging limp, with blood running off his fingers.

  Tsarina completed the injection of cells and turned to face Eli. “All I’ve ever wanted is a child,” she said, pleading with him. “Now, all that remains of my daughter will live on in this little girl.” Without warning, Tsarina pulled her hand out of Margaret’s abdomen and drove the long needle deep into the base of Eli’s neck.

  The last thing Eli heard was the blast from Lipsky’s gun.

  CHAPTER FIFTY-EIGHT

  GATES MEMORIAL HOSPITAL

  5:20 P.M.

  Meg Daily stood over bed thirteen in the surgical ICU. The medical personnel had left the room, even the nurse, after stabilizing the postoperative patient.

  This must be a good sign, she thought.

  Outside the room, a policeman kept watch.

  Meg had just returned from visiting her child in another intensive-care unit connected to the pediatric ward. There had been no internal damage, though a scar down the length of her daughter’s abdomen would remain as a lifelong reminder.

  Her scar will remind me every day, Meg thought, of how foolish I was.

  Now she worried about what had been injected through the syringe. It was confiscated as evidence, and analysis of the fluid and cells was underway.

  Dr. Korinsky had approached her after Margaret was admitted early Saturday morning in critical condition. Meg was told that a transplant was available for her daughter. It was a highly experimental combination of healthy donor pancreas and embryonic stem cells that would thrive in the transplant and produce insulin.

  Highly experimental.

  Yet there was a chance that her daughter would be cured forever. No more insulin shots, no more ambulance rides from day care. She had tried to contact Eli for his advice. After two hours of calling him with no answer, she became desperate and consented to the operation.

  Now, that man she was standing over had saved her daughter’s life. His eyes were open but unfocused. A long bandage applied to the left side of his neck had a line of blood seeping through.

  Injury to the carotid, his doctors had told her.

  His left arm was wrapped in a bulky bandage and elevated on two pillows. The tendons had been repaired simultaneously with the carotid artery repair in an operation that lasted over seven hours. The plastic surgeon said his strength would be fine, but he was unsure if Eli would ever regain the motor skills to be a surgeon.

  Eli blinked.

  “Hey,” Meg said, her voice cracking. “Thought I was going to find you on my autopsy table.”

  “I’m pretty tough,” he said, then had to clear his throat.

  “Yeah, it’s too bad. I was looking forward to seeing you naked.”

  “You’re sick.”

  “I know.” Meg leaned over and kissed him on the forehead. Her eyes were filled and wet.

  “Pathologists aren’t supposed to cry.”

  “A weak moment for me, I guess.”

  Eli waited for Meg to look at him again. “How’s Margaret?”

  “She’s okay. She’s going to be okay.”

  Then Eli was silent, hesitant to ask the next question. But his eyes sought the answer.

  Meg grasped his uninjured hand. “Your brother’s in critical condition, Eli. But they think Henry will live.”

  Relieved that his brother was still alive, Eli slept.

  CHAPTER FIFTY-NINE

  SURGICAL ICU

  MONDAY, JULY 17

  7:00 A.M.

  Eli kept his eyes shut and listened to the rhythm of normal beats from an overhead monitor. He could hear more distant monitors and the voices of nurses and respiratory therapists. His hearing seemed hyperacute, and from the background noise, he picked out Rosie, the male ward clerk who was humming and singing along with the radio.

  It was very tempting to continue lying this way, to play dead. All of the sounds swirled in his head, at once crisp and clear, then faded to static and back again.

  He remembered another voice. Meg.

  Margaret’s okay. Henry’s alive.

  Eli opened his eyes. His neck hurt and a dull ache throbbed down his arm into his hand. But inside, he felt relaxed and strong, as though he had slept for days and was newly refreshed. He reached beside the bed and pressed a lever that allowed the railing to fall. It banged and bounced as it caught in the down position, and Eli waited for the disturbance to attract the nurse.

  No such luck.

  His room faced the central nurse’s desk, where he could see an open-faced clock.

  T
hat’s why none of the nurses are here. It’s seven o’clock. Shift change. They’re in the lounge giving report.

  Beside the clock hung a white board with the roster of current surgical ICU patients written in bold black letters. The name Branch occupied the slot for bed thirteen. Rosie had written M.D. in tiny letters at the top right side, as though a trademark.

  Henry’s name will be coded, Eli thought. No one would know his identity.

  He scanned the roster.

  Two slots down, bed fifteen.

  Stat Romeo.

  Eli smiled at the random name they had chosen.That fits Henry perfectly.

  He swung his legs beside the bed and sat upright. The move was too fast and his head spun. He waited for the nausea to pass. Then he unhooked the IV bag, cradled it like a football, and walked into the hallway. His hospital guard stopped him.

  “My doctor has ordered me to ambulate,” Eli said.

  The guard looked confused about this but let him pass anyway. Eli walked to the open doors just two rooms from his.

  Room fifteen was a double room with a curtain divider. Eli looked on the right side and his guess was correct. Henry was covered up to his neck with thick blankets. His eyes were taped shut, an ET tube hooked to the bedside ventilator that hissed with each breath. Henry’s vital signs, as displayed by the monitor, were normal.

  He is going to make it.

  The patient on the other side of the curtain groaned. “Nurse.” Then he called again, this time drawing it out, “Nurrrse.”

  Eli parted the curtain.

  “Hey, man,” the patient said. “Could you get my pillow?”

  Eli saw that the patient’s pillow had fallen to the side and was caught between the mattress and the bed rail. His head lay awkward and flat against the bed. Eli dislodged the pillow, gave it a fluff as best he could with one hand, and waited for the patient to lift his head.