“What about right now?”
Tiger shook his head. “It’s a terrible surgical risk.”
“But every minute of waiting makes it worse, right?”
“That’s right.”
“Then I think we’ll stop waiting,” Dal said. “We have a prosthetic heart in condition for use, don’t we?”
“Of course.”
“Good. Get it ready now.” It seemed as though someone else were talking. “You’ll have to be first assistant, Tiger. We’ll get him onto the heart-lung machine, and if we don’t have help available by then, we’ll have to try to complete the transplant. Jack, you’ll give anaesthesia, and it will be a tricky job. Try to use local blocks as much as you can, and have the heart-lung machine ready well in advance. We’ll only have a few seconds to make the shift. Now let’s get moving.”
Tiger stared at him. “Are you sure that you want to do this?”
“I never wanted anything less in my life,” Dal said fervently. “But do you think he can survive until a Hospital Ship arrives?”
“No.”
“Then it seems to me that I don’t have any choice. You two don’t need to worry. This is a surgical problem now, and I’ll take full responsibility.”
The Black Doctor was watching him, and Dal knew he had heard the conversation. Now the old man lay helplessly as they moved about getting the surgical room into preparation. Jack prepared the anaesthetics, checked and rechecked the complex heart-lung machine which could artificially support circulation and respiration at the time that the damaged heart was separated from its great vessels. The transplant prosthetic heart had been grown in the laboratories on Hospital Earth from embryonic tissue; Tiger removed it from the frozen specimen locker and brought it to normal body temperature in the special warm saline bath designed for the purpose.
Throughout the preparations the Black Doctor lay watching, still conscious enough to recognize what was going on, attempting from time to time to shake his head in protest but not quite succeeding. Finally Dal came to the bedside. “Don’t be afraid,” he said gently to the old man. “It isn’t safe to try to delay until the ship from Hospital Earth can get here. Every minute we wait is counting against you. I think I can manage the transplant if I start now. I know you don’t like it, but I am the Red Doctor in authority on this ship. If I have to order you, I will.”
The Black Doctor lay silent for a moment, staring at Dal. Then the fear seemed to fade from his face, and the anger disappeared. With a great effort he moved his head to nod. “All right, son,” he said softly. “Do the best you know how.”
Dal knew from the moment he made the decision to go ahead that the thing he was undertaking was all but hopeless.
There was little or no talk as the three doctors worked at the operating table. The overhead light in the ship’s tiny surgery glowed brightly; the only sound in the room was the wheeze of the anaesthesia apparatus, the snap of clamps and the doctors’ own quiet breathing as they worked desperately against time.
Dal felt as if he were in a dream, working like an automaton, going through mechanical motions that seemed completely unrelated to the living patient that lay on the operating table. In his training he had assisted at hundreds of organ transplant operations; he himself had done dozens of cardiac transplants, with experienced surgeons assisting and guiding him until the steps of the procedure had become almost second nature. On Hospital Earth, with the unparalleled medical facilities available there, and with well-trained teams of doctors, anaesthetists and nurses the technique of replacing an old worn-out damaged heart with a new and healthy one had become commonplace. It posed no more threat to a patient than a simple appendectomy had posed three centuries before.
But here in the patrol ship’s operating room under emergency conditions there seemed little hope of success. Already the Black Doctor had suffered violent shock from the damage that had occurred in his heart. Already he was clinging to life by a fragile thread; the additional shock of the surgery, of the anaesthesia and the necessary conversion to the heart-lung machine while the delicate tissues of the new heart were fitted and sutured into place vessel by vessel was more than any patient could be expected to survive.
Yet Dal had known when he saw the second cardiogram that the attempt would have to be made. Now he worked swiftly, his frail body engulfed in the voluminous surgical gown, his thin fingers working carefully with the polished instruments. Speed and skill were all that could save the Black Doctor now, to offer him the one chance in a thousand that he had for survival.
But the speed and skill had to be Dal’s. Dal knew that, and the knowledge was like a lead weight strapped to his shoulders. If Black Doctor Hugo Tanner was fighting for his life now, Dal knew that he too was fighting for his life—the only kind of life that he wanted, the life of a physician.
Black Doctor Tanner’s antagonism to him as an alien, as an incompetent, as one who was unworthy to wear the collar and cuff of a physician from Hospital Earth, was common knowledge. Dal realized with perfect clarity that if he failed now, his career as a physician would be over; no one, not even himself, would ever be entirely certain that he had not somehow, in some dim corner of his mind, allowed himself to fail.
Yet if he had not made the attempt and the Black Doctor had died before help had come, there would always be those who would accuse him of delaying on purpose.
His mouth was dry; he longed for a drink of water, even though he knew that no water could quench this kind of thirst. His fingers grew numb as he worked, and moment by moment the sense of utter hopelessness grew stronger in his mind. Tiger worked stolidly across the table from him, inexpert help at best because of the sketchy surgical training he had had. Even his solid presence in support here did not lighten the burden for Dal. There was nothing that Tiger could do or say that would help things or change things now. Even Fuzzy, waiting alone on his perch in the control room, could not help him now. Nothing could help now but his own individual skill as a surgeon, and his bitter determination that he must not and would not fail.
But his fingers faltered as a thousand questions welled up in his mind. Was he doing this right? This vessel here . . . clamp it and tie it? Or dissect it out and try to preserve it? This nerve plexus . . . which one was it? How important? How were the blood pressure and respirations doing? Was the Black Doctor holding his own under the assault of the surgery?
The more Dal tried to hurry the more he seemed to be wading through waist-deep mud, unable to make his fingers do what he wanted them to do. How could he save ten seconds, twenty seconds, a half a minute? That half a minute might make the difference between success or failure, yet the seconds ticked by swiftly and the procedure was going slowly.
Too slowly. He reached a point where he thought he could not go on. His mind was searching desperately for help—any kind of help, something to lean on, something to brace him and give him support. And then quite suddenly he understood something clearly that had been nibbling at the corners of his mind for a long time. It was as if someone had snapped on a floodlight in a darkened room, and he saw something he had never seen before.
He saw that from the first day he had stepped down from the Garvian ship that had brought him to Hospital Earth to begin his medical training, he had been relying upon crutches to help him.
Black Doctor Arnquist had been a crutch upon whom he could lean. Tiger, for all his clumsy good-heartedness and for all the help and protection he had offered, had been a crutch. Fuzzy, who had been by his side since the day he was born, was still another kind of crutch to fall back on, a way out, a port of haven in the storm. They were crutches, every one, and he had leaned on them heavily.