Chapter 1
Lucy Wagner knew exactly when she would hold the heart in her hands, its hard muscle churning against her palm, its moist heat warming her fingers. Knew when its rhythmic twisting would stagger and fall silent as the drugs brought it to a standstill. Frozen in time.
She just didn’t know it would be this heart or under these circumstances.
John Doe changed everything. John Doe couldn’t wait. John Doe bumped her 7:30 elective coronary bypass until later. Probably much later.
Thirty-five minutes earlier, Doe had been found down, face down, on the ER entry ramp at the Remington Medical Center. Purple, breath coming in shallow gasps, pulse barely palpable, and spiraling toward death. Circling the drain in medical slang. The heroic efforts of ER Director Dr. Jeffrey Dukes and his staff, pumping Doe full of fluids and blood, restoring just enough blood pressure to feed Doe’s weak but tenacious spark of life, somehow stabilized him long enough to reach Lucy’s operating table in OR Suite 3.
Now, the scalpel she held in her rock-steady hand hovered near the old man’s flesh. Tinted reddish brown by the hasty pre-op Betadine scrub, the parchment-thin skin and its underlying age-wilted muscles were all that separated the blade from the torn aorta and the massive pool of blood she knew waited within Doe’s abdominal cavity. A cardiovascular surgeon’s worst nightmare. The elderly man had little chance of getting through this alive but absolutely none if Lucy didn’t jump right in. As one of her fellowship mentors at Vanderbilt had been fond of saying, “They’re are times to contemplate and times to slash and grunge.”
This was slash and grunge time.
Prayer wouldn’t hurt.
Scrub nurse Rosa Lopez adjusted the round bank of overhead lights to better illuminate the surgical field. Across the table stood Dr. Herb Dorsey, Remington’s oldest and most respected general surgeon. He had been in the OR, waiting for his elective gall bladder case to begin, and had volunteered to help.
“How’s he doing, Raj?” Lucy asked anesthesiologist Dr. Raja Singh.
Raj peered over the curtain of surgical drapes that separated his little world of monitors, anesthetic gas and oxygen canisters, and whooshing ventilator tubes from the sterile field that was Lucy’s domain. “BP up to eighty, heart rate one-thirty, sinus tach. Four units of blood in. Two more on the way.” He shrugged. “Not too bad considering.”
Lucy smiled into her mask. Typical Raj. Always understated, always unflappable. She looked at Herb. “You ready to dive in?”
He nodded.
Rosa picked up the suction cannula, an angulated plastic nozzle connected by a clear plastic tube to a suction bottle near her feet. “Crank this baby up all the way,” she shot over her shoulder to the circulating nurse. “It’s going to be a gusher.”
Damn right, Lucy thought. John Doe’s atherosclerosis had finally caught up with him. His hard and brittle aorta had cracked and split and ripped and pumped nearly his entire blood volume into his abdomen, swelling it to pregnant proportions. He was, as the locals say, “As swollen as a chigger on a blue-tick hound.”
It was going to be bloody.
God, she loved this. Always had. The adrenalin rush that had enticed her into surgery in the first place. As far back as high school she had thought being a surgeon would be cool. Even the word surgeon was cool. When she shared these dreams with her classmates, most nodded politely and told her that was a wonderful ambition. But she knew they believed she’d never do it. She was a marginal student, interested in athletics and boys more than academics. Track and softball were her sports. Things changed in college where she majored in chemistry and focused on her grades. Straight A’s opened the door to medical school.
