“What about an attempt at open-chest cardiac pacing?” Dr. Winthrop finally asked Dr. Reston; both men, along with Dr. Rodriguez and Mitt, were still watching the unfolding drama from the sidelines, maintaining their sterility. Two of the anesthesiologists who had responded to the emergency had left, but not Dr. Winthrop or the two who had originally been in on the case. One of those was back to giving closed-chest massage. The consulting cardiologist was also still in the room.
“I don’t know,” Dr. Reston said with a shrug. “What does Cardiology think?”
“It couldn’t hurt,” the cardiologist said, “but I sincerely doubt it will help. I’m astounded we’ve been unsuccessful in getting any response. It almost seems like something’s going on here that I don’t understand. It’s weird.”
“As a G.I. specialist, it’s been a long time since I opened up a chest,” Dr. Reston said.
“I participated in one just this morning,” Dr. Rodriguez chimed in.
“Well, there you go,” Dr. Reston said. He gestured toward the patient. “Be my guest.”
“Fine by me,” Dr. Rodriguez said. He turned to Caroline. “Get us a chest pack, fresh drapes, and we’ll give it a go.”
Mitt watched the preparations with a growing sense of unreality. He intuitively knew he was witnessing a very unusual series of events on just his second day as a surgical resident.
It took Caroline and Kathy only a few minutes to get everything ready, and while they were busy accomplishing what needed to be done, the closed-chest massage continued unabated, and the ventilator continued to alternately inflate the lungs, maintaining the blood oxygenation at an appropriate level.
“Okay,” Dr. Rodriguez said to Dr. Reston and Mitt when all was prepared to his liking. “This has got to be fast. The second the closed-chest massage is stopped, Caroline will quickly paint the chest with chlorhexidine, after which you two quickly drape the patient. Then I’ll move in immediately with a scalpel followed by the bone saw. Obviously, there’ll be no bleeding with no heartbeat, so that’s not going to be a problem. Then, as soon as I expose the heart, Dr. Reston, how about you be prepared to start open-heart massage. While you are doing that, I’ll get the pacemaker ready to function. Are we good to go?”
“Good to go,” Dr. Reston said.
Mitt, who felt he was completely out of his element, tried to follow Dr. Reston’s lead in helping to drape the patient the second Caroline finished with the antiseptic. Luckily the draping was just rudimentary, so Mitt’s inexperience wasn’t apparent. There was no attempt to bother creating an anesthesia screen.
As he promised, Dr. Rodriguez moved in practically before the drapes had completely settled, slicing open the skin down to the bone in one determined swipe. Next, the bone saw made short work of cutting through the sternum lengthwise, sending tiny bits of flesh flying in all directions. With a pair of dissecting scissors, he opened the pericardium. A second later, Dr. Reston shoved in his gloved hand, grasped the heart, and began to compress and release it. The open-chest massage was effective enough that the patient’s skin tone improved a shade even though it had never truly gone pallid thanks to his being respired with 100 percent oxygen.
Unfortunately, it was soon obvious to everyone involved that despite all their efforts, the heart was not about to cooperate and recommence beating.
“I’ve run out of ideas,” the cardiologist said while spreading his hands apart, palms heavenward.
“I’m going to stop the open-chest massage,” Dr. Reston announced.
“I would,” the cardiologist agreed.
“What actually happened before I got in here?” Dr. Winthrop asked the original assigned anesthesiologist loud enough for everyone to hear as Dr. Reston withdrew his hand. The attending surgeon stepped back from the OR table and began taking off his gown and gloves.
“Nothing that could have predicted this,” the anesthesiologist said. “The induction and intubation had been entirely normal, and I was about to give the green light to start the case when there were a couple of premature ventricular contractions. Then there was a series, which made me call in Ralph and then you. You saw how the PVCs led to fibrillation despite the beta-blockers. I’m at a loss,” he said, throwing up his hands. “It was as if something cardiotoxic had been suddenly injected into the IV, but obviously nothing had been injected. And there was no history of heart disease and the preop ECG was entirely normal. It’s all a mystery to me.”
Dr. Rodriguez followed Dr. Reston’s lead by pulling off his gown and gloves. But he did it angrily. “I can’t believe this,” he said to no one in particular. “Good God! This is my second operative death in the same day, and I’ve never had one before in the entire four years I’ve been a surgical resident.”
“Caroline, let the front desk know what’s happened in here,” Dr. Reston called out to the circulating nurse. She responded with a thumbs-up.
Dr. Reston, Dr. Rodriguez, the anesthesiologists, and the cardiologist all walked out as a group still loudly carrying on about the case, leaving Mitt and the two nurses in a sudden silence after the OR door closed. Caroline used the intercom to report to the front desk what had happened. Kathy turned her attention to all the instruments that needed to be separated since those from the abdominal pack and chest pack had become intermixed.
Mitt again felt shell-shocked, like he had after Ella Thompson’s case and the Benito Suárez fiasco. Standing there motionlessly, still wearing his sterile gown and gloves, he couldn’t stop staring down into Roberto Silva’s open chest wound with the man’s lifeless heart in plain sight. He was seized by an almost irresistible urge to reach out, grasp the organ, and try his hand at open-chest massage, desperate to see if by any slim chance he could get it to function.
Tormenting him in the background was the realization that he, Mitt Fuller, was the only connection all three cases shared at the moment of their death, other than all being in the same hospital. Such a disturbing thought begged the question of how and why, but he had no answers. Instead, he merely shook his head at having to face a third death in his initial three surgeries as a resident: the first one hours after the surgery, the second near the end of the surgery, and this one before the surgery could even start. Was this the beginning or the end of a very dubious and upsetting record? He would have been totally shocked to hear that any other surgical resident had ever had such an experience.
“Dr. Fuller?” Caroline questioned. “Are you okay?”
“Umm, yes, I’m okay,” Mitt managed while forcing a weak smile behind his face mask. Caroline’s question had pulled him out of his trance.
“Sorry to be a bother, but would you mind removing your gown and gloves so I can take care of them with all the others?”
“Oh, of course not. I’m sorry,” Mitt said. He untied the front as Caroline reached up to do the same with the tie behind his neck. She then helped him pull off the gown. Mitt removed the gloves and handed them over. “Thank you. I’m sorry. I’m a little bummed out.”
“We all are,” Caroline said.
As Mitt headed for the OR door, he untied his face mask and let it fall onto his chest, as it was still tied behind his neck. Pulling open the heavy door, he stepped out into the main OR hallway. As he headed for the surgical lounge, all he could think about was the upcoming surgery on Bianca Perez. Was she going to die, too?
Chapter 12
Tuesday, July 2, 7:15 p.m.
Mitt pushed through the swinging doors leading into the staff cafeteria and immediately began searching for Andrea. He’d phoned her the moment he got into the surgical lounge to change out of his scrubs following Bianca Perez’s colectomy. Since he’d hardly had time to talk to her for some thirty-six hours, he was hoping to meet, even for fifteen or twenty minutes. Although she’d already had her dinner by the time he called, she was eager to sit and catch up with him in the cafeteria provided she wasn’t paged for some emergency.