Code 15 (6 page)

“Is there any chance of working things out?”

“I don’t think so.”

“What about counseling?”

“Kevin doesn’t believe in it.”

“You could go alone.”

“I did.”

“And?”

“It’s like getting on a seesaw by yourself. It’s tough to make much progress,” she explained, tossing the wrapper from the crackers into the trash. “Let’s not talk about Kevin anymore. It may bring back my nausea.”

Ben grinned. “Are you going to stop flying?”

“Not a chance.”

“Good,” he said. “How about Saturday?”

“What time?”

“How does one sound?”

“I’ll be there.”

Just before he reached the door, he said, “Look, Morgan. I’m hardly an expert on relationships but if you need somebody to talk to . . . I mean, all you have to do is pick up the phone.”

“I appreciate the offer, Ben.”

“Congrats again,” he said, heading for the door. “I’ll give you a call later.”

Ben followed a short corridor to the back stairwell. He yanked open the door and started down three flights of gray concrete stairs. He thought about Kevin and the two times he had approached him to invest in one of his wild enterprises. Being savvy enough to recognize blue smoke and shady business ethics when he saw them, Ben had politely passed both times. The experience had left him wondering how Morgan could be married to such an unprincipled individual. He never discussed his negative impression of Kevin with her, but he suspected she knew how he felt.

Reaching the ground floor, he pushed open the heavy metal door that accessed the street. Ben considered himself an introspective man who was well aware of his shortcomings. Being dishonest with himself wasn’t one of them. He couldn’t deny that a part of him felt true remorse for the emotional trauma Morgan would face going through a divorce. But a larger, perhaps more selfish, part was gladdened by the prospect of Morgan being single. He never denied his romantic feelings for her, but he always played by the rules and kept them in check.

Walking along the side of the hospital to the crosswalk, he gazed skyward. It was a perfect day for flying. When the light changed, he started across the street. Was it not for his well-developed sense of self-restraint, he would have surely smiled from ear to ear.

DAY TWO

 

 

At ten minutes past seven in the morning, a deeply sedated Tony Wallace was wheeled into operating room number three.

A native Floridian, the talented reporter for the Fort Lauderdale
Sun-Sentinel
had spent his career moving from one assignment to the next at a pace that reflected how many unpaid bills lay stacked upon his desk. Fifty-nine years of age and forty pounds overweight, Wallace had been smoking two packs of Camels a day since he had enlisted in the navy a week after his eighteenth birthday.

In spite of his ill-advised lifestyle and laissez-faire attitude toward his health, he had never had a serious problem until two years ago when he began having chest pain. After an extensive evaluation and a lengthy trial of controlling his coronary artery disease with medications, his family doctor referred him to Dr. Kirby McBride for surgical evaluation. After several meetings, Wallace decided to proceed with the bypass procedure.

Thirty minutes after his patient had been placed on the operating table, Dr. McBride, scalpel in hand, was ready to begin. The only thing delaying him from making an incision was the go-ahead from the anesthesiologist, Mike Quintana.

After checking his equipment and measuring Wallace’s vital signs one last time, Quintana looked up and said, “We’re good to go.”

In the next instant, McBride made a deep incision directly down the middle of Tony’s chest. He then used a special air-powered high-speed saw to divide his breastbone and expose his heart. The final step before going on bypass was to place the large plastic tubing into the heart and the aorta, the largest artery in the body.

When McBride was finished, he looked over at Todd Ket tering, the chief pump technician.

“Are we ready?” he asked him.

Todd gave him the thumbs-up and answered, “You’re good to go, Boss.”

McBride, short in stature but long on confidence, looked over the top of the anesthesia screen at Quintana.

“Go ahead and give him the heparin. Let me know when he’s fully anticoagulated.”

“Ten thousand units going in,” Quintana answered as he pushed five cc’s of the heparin into the IV tubing.

A minute passed. Dr. McBride looked over his shoulder at Todd. “Can we go on bypass?”

“The ACT’s greater than four-eighty. The patient’s fully anticoagulated. We can go on whenever you’re ready,” Todd assured him.

“What’s the heparin for?” one of three medical students standing behind Todd whispered.

Continuing to check his systems and without looking at her, he asked. “What happens to your blood if you cut your finger?”

“It bleeds,” she responded.

“Forever?”

“No. Until it clots.”

“Exactly,” Todd said. “This heart and lung bypass machine that you’re looking at is just like a giant water pump that makes a fountain work. What do you think would happen to our imaginary fountain if we were pumping hundreds of gallons of water and, all of a sudden, that water turned to ice?”

“I guess the pump would jam and the fountain would stop.”

“That’s right. And the same is true here. If Mr. Wallace’s blood should clot, we wouldn’t be able to circulate it. That’s why we give heparin. It thins out the blood and prevents it from clotting.”

Dr. McBride said, “What do you say, Todd? If today’s lecture on heparin’s over, I’d like to get on with this operation.”

Todd had known McBride for years and was well aware that his sarcastic sense of humor was harmless.

“We’re ready,” he answered.

“Here we go,” McBride said, releasing the large clamps on the tubing. The result was to immediately allow the blood to flow from Tony Wallace’s heart, through the tubing, and into the pump where it would receive oxygen before being returned to his body.

“We’re up to speed on the flow,” Todd said.

“Go ahead and give the cardioplegia,” McBride told Quintana, who then injected a highly concentrated solution of ice-cold potassium into Tony’s bloodstream. The effect was to bring his heart to a complete standstill.

“Why do they have to stop the heart?” the student asked Todd.

“Because it’s delicate work trying to sew the grafts in. It would be impossible to do with the heart pounding away.”

With his magnifying glasses in place, McBride began sewing in the three separate vein grafts that would bridge Tony’s blocked arteries. Forty-five minutes after he had placed the first stitch, he tied the final suture.

“I’m done here. Let’s give him a couple of units of blood and start re-warming.”

The process generally took a few minutes and would be the necessary last step before Quintana and McBride would work together to start Tony’s heart beating on its own again.

It was at this point that McBride felt comfortable enough to step back from the table and relax for a few minutes.

“Have you started the nitroglycerine drip yet?” he asked Quintana.

“Just hanging it now,” he answered.

With his arms crossed in front of him, McBride closed his eyes and took a few deep breaths. His mind drifted to the Mediterranean cruise he and his wife were scheduled to take next month. It was a vacation he felt he deserved and one that his wife insisted he desperately needed.

McBride opened his eyes and glanced down at the operative field.

“Shit,” he yelled. “I’ve got huge blood clots in the pericardial well. What the hell’s going on, Todd?”

Todd’s voice and manner were equally distressed.

“I don’t know, Boss, but I got the same thing here in the tubing. This guy’s making clots like crazy. The whole God damn pump’s clotting off.”

McBride’s eyes flashed back to Quintana. “You said you gave the heparin.”

“I did,” he insisted, scanning the monitors and checking his IV lines. “This shouldn’t be happening.”

“We gotta get this guy off bypass right now,” McBride shouted at Todd, knowing that was the one small chance Tony Wallace had of surviving. “He’ll need to go back on as soon as you’ve changed all the tubing.”

“I’m already working on it,” Todd answered.

“He’s too cold,” McBride said, pounding his fists together. “His heart will never start on its own. We’ve probably already stroked him out by showering his brain with clots. I’m clamping the tubing. I’ll massage the heart until you get the circuit changed and we can go back on bypass.”

McBride and Quintana exchanged a desperate glance. McBride knew they were both thinking the same thing; Tony Wallace’s chances of making it out of the operating room were rapidly approaching zero. “Give him another bolus of heparin right now,” McBride said.

Quintana held up an empty syringe. “It’s already in.”

Cradling Tony’s lifeless heart in both of his hands, McBride continued to squeeze the flaccid organ once every second.

“There’s no blood in the damn heart. It’s all clots. Does he have a blood pressure?” McBride asked.

“Of course not. The guy’s blood has turned to cement,” Quintana answered with equal frustration. “You need blood that circulates to have a pressure.”

“God damn it, Todd. How much more time do you need?”

“I’m changing the circuit as fast as I can, but it’ll take another four or five minutes.”

Kirby McBride felt his own heart racing. Todd might as well have told him he needed seven or eight hours because it wasn’t going to make a particle of difference. With sweat pouring down the back of his neck, McBride took a deep breath and continued squeezing the motionless heart.

Another five minutes passed. He looked over at Todd who was still working feverishly to replace the tubing. Finally, he gazed up toward the ceiling as if he were somehow seeking divine intervention. Without anybody having to say anything, the bedlam in the operating room changed to an eerie silence.

The heparin hadn’t worked. All of Tony Wallace’s blood had clotted.

McBride turned his eyes toward Quintana and asked in a defeated voice, “Is it possible that he accidentally got the protamine too soon?”

“C’mon, Kirby. I’m not a rookie, for God’s sake. We never reverse the heparin until the patient’s off the pump.”

“I’m . . . I’m sorry, Mike. I had to ask.”

McBride had done almost four thousand open-heart cases in his career and he had seen every mishap, complication, and disaster known to cardiac surgery. He was both knowledgeable and experienced on the subject of operating room calamities. Most of all, he knew the difference between a fixable complication and an irretrievable catastrophe. A heart and lung machine clotting off in the middle of a pump run was a clear example of the latter. He knew the moment he saw the first blood clot that irrespective of what he did, Tony Wallace’s fate had already been sealed.

McBride stood silently in front of his patient, his eyes trained on the operating table.

Finally, he cleared his throat and announced, “We’re stopping. Please note the time.”

He looked over the top of the sterile drapes at Mike Quintana, who nodded and said, “I agree.”

McBride pulled off his gown and gloves and tossed them into a large bin. Walking toward the door, he knew the details of what had just happened would spread through the hospital like a brush fire in a high wind. He heaved a breath of despair and wondered how he’d tell the people waiting for news of Mr. Wallace’s operation that he had been killed by an inexcusable surgical debacle.

DAY THREE

 

 

The moment Morgan Connolly walked into the waiting room of her father’s office, her mind was showered with painful images of his funeral.

Hundreds of Allen Hawkins’s friends, colleagues, and patients had crowded into the cathedral that he devotedly attended every Sunday to offer their respects to a much-loved man and a revered member of the community. Although it was the most difficult thing Morgan had ever done, she delivered a tender eulogy to the man who had always been her hero.

“Hi,” Annalisa Gregory said, snapping Morgan out of her dreamlike state. Annalisa had been her father’s office manager for the past ten years. Nobody knew Allen Hawkins’s professional side better or admired him more than she did. “How are you?”

“Things are starting to get back to normal,” Morgan answered.

Annalisa took her by the arm. “I was so happy you called. Let’s go back to my office. We can talk there.” Annalisa directed Morgan to a small love seat and then pulled up a chair and sat down directly across from her. They talked for a few minutes about the impact of her father’s death on the office and how different things were now. Although there were two other orthopedic surgeons in the practice, they were all business with respect to both their patients and the staff.

“You mentioned on the phone that there was something specific you wanted to talk to me about.”

Relieved that Annalisa had been the one to broach the topic, Morgan said, “I have some questions about what happened the day my father died.”

Annalisa looked circumspect. “Are you sure you want to talk about this, Morgan?”

“I’m sure.”

“Okay. I’ll answer whatever I can.”

“Can you tell me what you remember from the moment you knew something was wrong?”

“I was in my office when I heard all the commotion in the hall. I came running out and went straight to the exam room. We did CPR until the paramedics arrived.”

“According to the police, the man identified himself as Stuart Artesian,” Morgan said.

“That’s right.”