A/N – I do have a medical background, but this isn't a medical primer, it's a work of fiction written by an amateur author, so consider yourself forewarned. I have actually seen the surgical procedures and complications described in this chapter but I don't know if they would do an ultrasound like this in the OR. Oh, and we see Sam too. Within the next few chapters, the focus of the story will change to rehabilitation.
Soft music was piped in over the speakers in OR number 3. House lay on his back on the operating room table covered in sterile sheets and towels save for a small square area over his right thigh. The needle site where the arteriogram had been done was bruising and oozing blood. After a normal arteriogram, pressure would have been held to the needle site for a certain period of time after the procedure in order to prevent bleeding from the needle stick site. When the aneurysm ruptured, House was rushed into surgery and the radiologist ran alongside House's bed holding pressure to the needle stick site until House was on the operating room table and prepped for surgery.
Dr. O'Malley made the initial incision and clipped the bleeding aneurysm. House's leg pinked up but they were a long way from being out of the woods yet. O'Malley knew this was not going to be a quick procedure and was prepared for the long haul. House would need close monitoring in the OR and quite probably, the aneurysm would still have to be bypassed.
In the radiology waiting room, the radiologist came out to talk with whoever was there for House. Looking over all the crying kids, people with casts on their arms and old people with aching joints, the radiologist saw a brown-haired man who was obviously, at one time earlier today, dressed to the nines, but currently his expensive tie was wrapped and wadded up in his hands. His Brooks Brothers shirt-tails were no longer tucked neatly into the waistband of his dress pants, and the contents of his various pockets were piled up on a table as if he'd been nervously playing with all the little trinkets. Magazines were haphazardly piled up around him. He had been nervously playing with his nice dress loafers, and when the radiologist came into view, Wilson was so anxious for an update that he shot up out of the chair and one of his shoes fell off completely. "How's he doing?" Wilson blurted out.
"He has a femoral aneurysm. The aneurysm had clotted. We tried an embolectomy, but the aneurysm ruptured. Dr. O'Malley has him in the OR now. I don't know any more than that. I'll have the OR staff keep you updated as soon as they are able." The radiologist patted Wilson on the back and said "He's lucky to have you with him. Does he have any brothers or sisters?" Wilson answered "No, just his girlfriend and his parents. Oh, there's Stacy now – that's his girlfriend." Both men saw a nicely dressed woman enter the waiting room. She was running as well as she could in heels and clearly starting to cry. She was wearing a crucifix on a necklace around her neck. The hospital volunteer in the waiting room saw the necklace and asked if the woman needed a priest. "God, no. I need those guys" said the woman, rushing past the volunteer toward Wilson and the man standing next to him who was obviously also a doctor. "Wilson, what in hell's going on? How is he? Can I see him?"
The radiologist escorted Wilson and Stacy to the surgery waiting area right next door. The room looked even warmer and more comfortable than the radiology waiting room, which was nice, considering most of the people who would be using that room would be occupying it for hours at a time waiting on their loved ones in surgery. The trio found the quietest corner in the room and the radiologist spoke first. "I can't really go into a lot of details because honestly I don't have much I can tell you right now. He has an aneurysm in his right femoral artery. There was a clot in the aneurysm. I've seen these kinds of things before. If there's enough collateral circulation, and the aneurysm isn't too big, sometimes we just need to do an embolectomy. We did an embolectomy and the aneurysm ruptured. He's in the OR with Dr. Daniel O'Malley now. The OR staff will update you when they are able. That's really all I can tell you right now. It was a good thing he got attention so quickly. I guess if I could say there was anything lucky about any of this, it was that he wound up with three vascular surgeons on the course with him."
With that, the radiologist left Wilson and Stacy in the surgery waiting room. Wilson no longer felt the need to nervously pace the room and play with everything now that Stacy was here. "God, this is awful. I mean I deal with stuff like this every day as a doctor, but it's a completely different story when bad stuff happens to people I love."
Stacy did a double take when she heard that one, but didn't say anything. Wilson continued, "Geez, I can't stand it that he's in there without you or me. They don't have an observation deck in the OR he's in now. Even if they did, I don't know if I could stand seeing them cut him open."
Stacy said "If they had an observation deck, you know you'd be up there with the intercom on trying to direct everything they're doing. You'd be bossing them around just like he would if he were in your place. Stay out of it and let them do their jobs. Please!" As soon as Stacy uttered those words, Wilson realized she'd stopped her crying and had her lawyer's game face back on. Ever the pro, he thought. She thinks she's the strong one. Talk about bossy. She's the queen of bossy.
"How can you just act like you're back in the office telling one of your clients to sue the ass off someone? You act like this is just business as usual. Trust the doctors, let them do their job, is what you're saying. Geez, that's House in there! *I* said I couldn't stand him being in there alone without either of us. Why aren't you saying the same thing?" Wilson asked.
"Hey, calm down. I'm just as worried about him as you are. I don't want it to look like we're trying to step all over their toes. That's why I said to stay out of it and let them do their jobs. Oh look, someone's coming out now." Stacy and Wilson both looked anxiously at a brunette woman wearing surgical attire, coming their way.
"Hi, are you with Dr. House?" Stacy and Wilson nodded yes. "I'm Anne, one of the circulating nurses in the operating room. He's still in surgery. Dr. O'Malley clipped the aneurysm. They are watching him to check his collateral circulation. His leg pinked up but they're going to be in there awhile longer. I'm scrubbing back in now. One of us will be out to update you again as soon as we are able."
It's going to be a long, long, long evening, thought Wilson. "Are you going to stay? It may be awhile. I can go down and get us some coffees or something to eat if you're hungry," Wilson said. Stacy replied "No, I'm already jumpy enough without the additional coffee and I'm sure as shooting not hungry. I had clients this morning and all I did was down one coffee after another with my clients. Yes, I know it's Saturday. I had to work and Greg went to the driving range at the links. I didn't know he wanted to play 18 holes today. I thought he'd just be at the driving range. He told me he was just going to hit balls at the driving range for an hour or so and then he'd call me about lunch. When I didn't hear from him I called his cell, but he never called back."
"Yeah, he was probably in the ambulance by then," Wilson said instinctively, and then immediately wanted to take those words back. He saw the hurt look on Stacy's face. "Hey, I'm sorry. I don't know why he wanted them to call me instead of you. Let's just focus on him. We can deal with the 'why's' later on."
The short but tense period of waiting in the OR while they re-checked his circulation was over. Something had gone wrong. He had lost the pulses in his right foot again. The pink had gone away, and the skin was turning cyanotic again. "Looks like we're going to have to bypass it anyway," O'Malley said. "Leave him open."
From the OR, Dr. O'Malley ordered an ultrasound of his left leg. They needed to find a vessel suitable to take a piece of in order to bypass the aneurysm in his right leg. The circulating nurse made the call to radiology, and was informed that the original radiologist had gone off duty. His partner in the radiology practice was on call the rest of the weekend, and was on her way in at the moment.
In the surgery waiting room, Wilson got a text message on his cell phone. "Got called in to work. Might be awhile. C U when I get home."
30 minutes later, Dr. Samantha Carr Wilson came in through the employee entrance, up the back elevators, scrubbed up and walked into OR number 3.
"Oh my God, it's House," she said out loud. "You know him?" O'Malley asked. "Yeah, he's my husband's best friend. What are we looking for here? He has an aneurysm?" "Oh, so we're looking for a vessel to take a piece of to use to bypass the aneurysm. Ok, let's get to work." She applied the gel to his left leg and expertly guided the ultrasound over his left thigh. The saphenous vein looked good. His left leg was scrubbed and draped and an incision was made. A section of his left saphenous vein was harvested for use in bypassing the aneurysm in his right thigh. Both thighs would have incisions.
The right femoral arterial aneurysm was bypassed. His lower leg pinked up again, and circulation was double- and triple-checked through the bypass. No leaks, no bleeding, no problems with the clip on the aneurysm. Pulses were all palpable in his right lower leg. And there were no immediate problems in the left leg at the saphenous vein incision. After four hours of emergency surgery, it was time to close House up.