第二十一章

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When Kat walked into his room, he snapped, "It's about time you got here. Did the damned electrolyte reports come back?"
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"I ran into a little bad luck." Mallory smiled. "But you can all start getting your money ready."
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"You're lucky. They're the worst patients in the world. They know too much."
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In the doctors' dressing room, half a dozen doctors were waiting for Ken Mallory to appear.
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Kat and Paige were getting into scrubs.
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"No."
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Dr. Mervyn Franklin was a man in his sixties, thin, bald, and irascible.
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When he walked in, Grundy said, "Hail the conquering hero! We want to hear all the lurid details." He grinned. "But the catch is, buddy, we want to hear them from her."
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"Who says so? I don't trust the damn lab. Half the time they don't know what they're doing. And make sure there's no mix-up on the blood transfusion."
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"Dr. Mervyn 'Don't Hurt Me' Franklin."
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"I'll need it."
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"Have you ever done a procedure on a doctor?" Kat asked.
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"Good luck."
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"Who are you operating on?"
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"Yes," Kat said. "They're normal."
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"I'll make sure," Kat said patiently.
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"I like you, too. Did the nurse give you a sedative?"
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"And get me the names of the nurses in the OR. I want to check them out."
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"Dr. Franklin…"
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"Dr. Jurgenson is very capable."
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"I believe it's Dr. Miller."
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"That quack? I don't want him. Get me someone else."
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"I know he is, or I wouldn't let him touch me. Who's the anesthesiologist?"
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"All right. We'll be ready in a few minutes. Is there anything I can do for you?"
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"Who's doing the operation?"
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"All right."
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Kat said gently, "Then why don't you let us handle it?"
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"Whose brain are they operating on, yours or mine? All operations are risky. You know why? Because half of the damned surgeons are in the wrong profession. They should have been butchers."
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Kat looked him in the eye. "Would you prefer to do the operation yourself?"
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"What?" He stared at her a moment, then smiled sheepishly. "I guess not."
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"Okay. You know something? I like you."
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"Yes."
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"Dr. Jurgenson and I. Dr. Franklin, I promise you, there's nothing for you to worry about."
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"Get me someone else. See if Haliburton is available."
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"Kat, are you almost through here?"
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"And make sure you have a top scrub nurse in there."
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"I'm aware of that," Kat said patiently.
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"Let's have some fast music on during the operation. Keep you all on your toes."
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"We're just wrapping it up."
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And on and on it went.
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"Right."
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"Right."
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When the opening in Dr. Franklin's skull was drilled, Kat said, "I see the clot. It doesn't look too bad." She went to work.
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"Right."
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"Yeah. Teach my stupid nurse where my veins are located."
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"Now mind you," he said, "minimal anesthetic. The brain has no feeling, so once you get in there, you won't need much."
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Three hours later as they were beginning to close the incision, George Englund, the chief of surgery, came into the operating room and went up to Kat.
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In OR Four, the brain surgery on Dr. Mervyn Franklin was going perfectly. He had complained every step of the way from his room to the operating theater.
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"And see that the temperature is kept down to forty degrees. That's maximum."
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"Let Dr. Jurgenson take over. We need you fast. There's an emergency."
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"A Mr. Dinetto."
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Kat walked out with George Englund. "What's happening?"
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The Shadow grabbed her arm. "Then do it! But remember what we told you. Keep him alive."
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Kat looked at him aghast. "Dinetto?" If Mr. Dinetto dies, you and your fucking family are gonna be wiped out.
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"No problem."
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"You were scheduled to do an operation later, but your patient has started to hemorrhage. They're taking him to OR Three now. It doesn't look as though he's going to make it. You'll have to operate right away."
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Kat hurried down the corridor that led to OR Three. Approaching her were Rhino and the Shadow.
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Kat's mouth was so dry that it was difficult to speak. "Mr. Dinetto started hemorrhaging. We must operate right away."
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Because of the change in schedule, Dr. Vance was doing the operation with Kat. He was a good surgeon. Kat began the ritual scrub: a half minute on each arm first, then a half minute on each hand. She repeated it and then scrubbed her nails.
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Kat nodded. "Coming." She turned to Jurgenson. "Will you finish up here?"
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Kat pulled away and hurried into the operating room.
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"What's going on?" Rhino demanded.
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"Who?"
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"Fine," Kat lied.
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Lou Dinetto was wheeled into the operating room on a gurney, semiconscious, and carefully transferred to the operating table. His shaven head was scrubbed and painted with Merthiolate solution that gleamed a bright orange under the operating lights. He was as pale as death.
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Dr. Vance stepped in beside her and started his scrub. "How are you feeling?"
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The team was in place: Dr. Vance, another resident, an anesthesiologist, two scrub nurses, and a circulating nurse. Kat checked to make sure that everything they might require was there. She glanced at the wall monitors -- oxygen saturation, carbon dioxide, temperature, muscle stimulators, precordial stethoscope, EKG, automatic blood pressure, and disconnect alarms. Everything was in order.
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The procedure began.
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Kat was reporting aloud. "There's an area of damage in the middle of the brain, caused by a clot that's broken off the aorta valve. It's blocking a small blood vessel on the right side of the brain and extending slightly into the left half." She probed deeper. "It's at the lower edge of the aqueduct of Sylvius. Scalpel."
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Dinetto was asleep before the third breath.
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The anesthesiologist strapped a blood pressure cuff on Dinetto's right arm, then placed a rubber mask over the patient's face. "All right, now. Breathe deeply. Take three big breaths."
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Dr. Vance started suction on soft cotton patties that were placed on the dura. The oozing veins on the surface of the dura were identified and coagulated.
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"It looks good," Vance said. "He's going to make it."
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Kat said, "Get some more blood into him!"
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The scrub nurse handed her the electric forceps.
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And at that instant, Lou Dinetto stiffened and his body went into spasm. The anesthesiologist called out, "Blood pressure's dropping!"
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A tiny burr hole about the size of a dime was made by an electric drill to expose the dura mater. Next, Kat cut open the dura to expose a segment of the cerebral cortex that lay underneath. "Forceps!"
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Kat picked up the bovie and started to cauterize the bleeders. "We're going to control it."
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Kat breathed a sigh of relief.
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"There's a hell of a lot of bleeding," Vance said.
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The incision was held open by a small retractor which maintained itself in place.
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They were all looking at the monitor. The curve was rapidly flattening out. There were two quick heartbeats followed by ventricular fibrillation.
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Dinetto's chest heaved up once and then fell.
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Desperately, Kat tried one last time. The body rose higher this time, then fell again. Nothing.
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"Shock him!" Kat snapped. She quickly attached the electric pads to his body and turned on the machine.
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"No heartbeat!" the anesthesiologist called out a moment later.
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Kat tried again, raising the dial.
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Once again, there was a quick convulsive movement.
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"No heartbeat!" the anesthesiologist cried. "Asystole. No rhythm at all."
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"Inject him with epinephrine! Quick!"
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"He's dead," Dr. Vance said.
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