With a reflexive urge to do something in the face of a growing catastrophe, Mitt shifted sideways to allow him to place the palms of his gloved hands along the sides of the progressively opening incision to try to push the edges together to keep further sutures from bursting open. But his effort was to no avail. The abdomen continued rapidly to swell, and the sutures continued to open, with some not untying but cutting through the skin. And now it wasn’t only the skin sutures. The deeper-layer catgut sutures were audibly popping open in the interior of the wound, same with the even deeper and stronger wire sutures as the man’s abdomen kept ballooning.
Before Mitt or Helena could react, the entire wound burst open with a sudden, pulsating geyser of bright red arterial blood. It came in gigantic spurts as each one of Benito’s heartbeats pumped out his life’s blood, drenching himself, the bed, Mitt, and even running down onto the floor.
Helena leaped backward, howled, and then disappeared from the room as Mitt continued to try ineffectually to hold the edges of the wound together, with the misguided idea that he could possibly stem the flow. In the next instant Helena and a bevy of other nurses came dashing back into the room carrying a host of sterile towels. Not sure what to do with them, Mitt grabbed them and jammed them blindly down into the gaping incision in hopes of stemming the blood loss. He was literally up to his elbows in gore, the sleeves and front of his white coat and his scrubs soaked in bright red blood.
At least Mitt’s pressure with the towels was working, or so he thought, since the blood flow significantly decreased and then appeared to stop. That was until one of the newly arrived nurses said that the patient had no blood pressure although there was a weak pulse. It was then obvious to everyone that Benito Suárez had bled out.
“What the hell are we going to do?” Helena yelled at Mitt.
Mitt stood up and pulled his blood-soaked arms out of the wound and looked blankly at Helena, as confused as ever. Before he could respond, Madison Baker came dashing into the room like a godsend. “Good God!” she voiced with a shake of her head as she confronted the scene.
All the nurses now turned to Madison as she rushed up to the bed, her eyes taking in the entire disaster. “Let me be sure: This was today’s abdominal aneurysm case, correct?” she demanded.
“Yes,” Helena fired back.
“Okay, cool it!” Madison ordered. Instead of barking orders as Mitt and the nurses expected, she pulled out her phone and then disappeared from the room.
For a few seconds, all the nurses and Mitt exchanged confused glances, then all but Helena and three others left. Mitt didn’t know what to say or what to do until he decided to at least remove his blood-smeared surgical gloves. As soon as he did, Madison returned.
“Okay, I spoke with Geraldo Rodriguez and told him what happened. He wasn’t at all surprised. He said the patient’s aorta was in super-sad shape, and he was surprised they had been able to attach the graft at all. Actually, I had already heard that from Nancy Wu, so when I ran in here, I wasn’t about to pull out all the stops for a full-scale resuscitation and order up an emergency surgery. Dr. Rodriguez fully agrees. Obviously, the abdominal aorta blew. Whether it was the anastomosis or another part of the aorta, we’ll have to wait for the autopsy to find out. Anyway, that’s all she wrote. It’s now a medical examiner case. Get housekeeping up here, ladies, please, and, Mitt, you do the paperwork. Okay?”
“Okay,” Mitt said, feeling shell-shocked. He didn’t know what doing the paperwork required, but he was reasonably sure the nurses would fill him in. He followed Madison out into the hallway. Helena and the three other nurses stayed back in the room, starting the cleanup. Mitt took off his blood-soaked coat and balled it up with the bloodiest parts on the inside.
“How long were you in the patient’s room before the shit hit the fan?” Madison questioned en route to the nurses’ station. To his surprise her tone was remarkably normal, similar to how she’d sounded down in the cafeteria.
“Not long,” Mitt said, finding his voice with some difficulty. He felt traumatized.
“Why didn’t you call me immediately?” Madison continued to question him matter-of-factly. “Why did you wait? Hell, that must have been a horrendous experience for you. More trial by fire, I’d have to say.”
“I was trying to handle it myself,” Mitt admitted sheepishly. “I suppose I should have called you. I don’t know why I didn’t. I’m afraid it is all a steep learning curve. I just wish I was better prepared, for the patient’s sake and my own.”
“Amen!” Madison responded as they arrived at the nurses’ station. “We’ve all had to go through what you are going through. It’s a bit of the luck of the draw. But chin up! Get the paperwork done and try to get yourself some sleep! You’ve got a full day of surgery ahead of you in a matter of hours. If there are any other problems tonight, I’m available if you need me.”
“Okay,” Mitt managed.
Madison gave Mitt an encouraging tap on his shoulder and a fleeting smile of encouragement before heading down the long, dark corridor toward the bank of elevators.
For a moment, Mitt watched her go. He felt decidedly envious of her experience and apparent sangfroid. Would he ever obtain a similar confidence in such a circumstance? He didn’t know, but he hoped so.
Chapter 9
Tuesday, July 2, 3:03 a.m.
Mitt’s eyes scanned down to the next line on the death certificate form and paused. Up until that moment he’d been doing reasonably well as he filled in the various blanks with relative ease despite his pulse still pounding in his temples and his hand visibly shaking. The pounding had begun the second Benito Suárez’s aorta, or its connection to the graft, had burst — although as he relived the event, he recognized that his general anxiety had skyrocketed the moment he’d entered the man’s room. Somehow he had anticipated the catastrophe.
Mitt’s sense of utter panic hadn’t eased up for at least a half hour after the event, not until after Madison Baker had called a halt to any resuscitation attempts. All in all, the experience had been the worst twenty or thirty minutes of his life. It had started innocently enough with confusion in trying to help the man with his pain, but then rapidly descended into sheer terror. Being literally up to his elbows in blood during his first night on call was way beyond anything he could have imagined and his worst fears.
Mitt was sitting on one of the wheeled chairs at the central desk. In contrast to the relatively dark corridors illuminated with dim baseboard lighting, the central desk was ablaze with a distinctly white light coming from ceiling-mounted LED fixtures behind translucent panels. Although the light afforded great illumination, Mitt thought it made everyone appear washed out, and as tired as he was, he couldn’t imagine how bad he looked.
“Excuse me!” Mitt called to Helena, who was using one of the nearby monitors to file her own report on the episode, which he could tell had disturbed even the nurses. He was interrupting Helena because he was stumped as to how to fill out the next blank on the form. It asked for the time of death, and he had no idea what to put down. In the thick of the ghastly event, noting the time had been the last thing on his mind.
“The patient died when you say he died,” Helena said without looking up.