Update is here. Thanks, yet again to the (now) four stooges (Krows, Anime, NY Gal and of course, Ragni-the-rambler!).
Thanks for reviews and thanks for reading.
Chapter 74
Shit had finally hit the fan!
That was Billy who probably coughed out a lung and was pale as hell, his neck veins engorged all over again.
"GET POTTER AND PAGE FRANK BURNS AND CATE O'HARA!" I yelled at the top of my voice as I grabbed another long needle and attempted aspiration. That bought us a few minutes in which another large bore IV was started with saline and then replaced with plasma. All these were stopgap measures and the kid needed surgery, stat. The source most likely was a myocardial rent.
By the time I shifted Johnson to OR, Cate had arrived and was looking angry as hell. I told her to scrub up as I started doing it myself. It was either that or let him bleed to death since Frank hadn't made an appearance as yet. Frank was his usual tardy, inefficient self and Johnson was not ready to wait for him.
"You are not going to operate on him." She spoke with constrained heat.
"Watch me! Now scrub up, Lieutenant!" I dried my hands and entered the OR. Kid was asleep and was looking younger than his age, just like a baby after a bad bout of flu.
I donned the gown, mask and gloves and did not wate for Cate to join me before I made the incision.
"You are doing a median sternotomy." She said that with incredulous fury. What had Frank done to her. I shook my head as I opened the sternum and applied the rib spreader.
"Give the woman a cigar! OK, where are you, my little sucker." I started visualizing the pericardium when a spurt ruined my vision.
"DAMN." I tried to keep my eyes open, wishing for a pair of glasses right now. "You keep a hand on the bleeder, Cate. Stevens, clean my eyes. Hurry." It took a few seconds, precious seconds before I was able to see again.
"Hawkeye, pressure is dropping." Came the voice of Tundra, the gas passer.
"Hold on." I took a needle and did aspiration again.
"Ninety systolic, Hawkeye."
"What the hell are you doing, Pierce!" That was Frank.
"Good God, Frank. Scrub up. We don't have time!"
"What did you do to him?" Frank and his petulance could win awards.
"ME? Damnit Frank, wash up." I was trying to not jostle the bleeding point as I searched for it. "And get me a pair of glasses too. HURRY UP, FRANK."
"This is your mess, Pierce. You clean it. I left him stable."
"Eighty systolic, Hawkeye."
"Let me clamp descending aorta, Tundra. Frank, this is a kid. Get off your ass and come help. Done! Time me, Tundra. Twenty minutes. How's the pressure?"
"Ninety and holding but not for long. Why can't you find the bleeding point?"
"I'm trying, T. Sonofabitch is hiding. How much blood?"
"Third and counting, Hawkeye. Pulse is 110."
"Damn! Got it. DAMN. Its the right pulmonary artery, T. DAMN!" It was a long tear, ascending on the posterior surface of the heart and I could see a small pool of blood in the mediastinal gutter. Maybe not so small.
"Tundra, Cate, I will have to manipulate the heart a little. He may go into arrhthmia. And he may bleed. Keep pumping blood. And Cate, you ...DAMN!" The damn finally gave way to a gush of blood.
"Suction! SUCTION!. Artery clamp. Long fingers. Damn. Suture. Not that, Cate. Atraumatic. Goddamnit!" What was I thinking when I asked for her?
Cursing myself, I yelled Frank's name at the top of my voice.
It took me a long time to suture the rent in the pulmonary artery and the pericardium. And Frank never showed up in that duration.
"What's the pressure now?" I asked Tundra while tried to search for any piece of stray shrapnel around here. It was a lost cause, not knowing how many I was looking for. There was at least one, though. And I was going to find it.
"Seventy five systolic, Hawkeye."
Cate just worked quietly all along. I had no time to focus on her emotional turmoil. I knew she was shaken. I knew I was shaken.
"Not good, Tundra. I'm not removing clamp from descending aorta till you give me a better number. Hand pump blood into him, Tundra. And tell me how many units left? I'm searching for the shrapnel."
"One more after this one."
"Pierce! I still think you ..." Frank entered and was startled by the scene.
"Frank, replace Cate. Cate, you go get Potter and also, check fridge for more O and A neg and then page for donors. HURRY!"
"You cannot order me around like that, Pierce." Frank spoke in his petulant manner. Good thing I wasn't holding the scalpel.
"Frank!" Cate spoke his name quietly and he shut up. That was good. After the adrenaline rush, I was feeling woozy, ready to drop. It was taking all my will power to not collapse right here, right now and could do without a whining Frank.
I just wanted this kid to make it. I had promised his friend I would take care of him.
"Pierce, you shouldn't..." Frank replaced Cate as she left, shaking.
"Frank! Not now. Just leave it alone, alright!" I groped around for the damned piece of metal hiding around here somewhere.
"Don't shush me, Pierce."
"Major Burns, please!" That was Tundra. I looked at him with thanks and a question.
"Eighty five systolic."
"Pulse?"
"Ninety five."
"How many units?"
"This was the sixth."
"Time?" I asked for cross clamping time.
"Sixteen minutes."
"Found it!" I informed anybody who was listening as I brandished a rather large sized piece of shrapnel at Frank before continuing again, "I'm gonna release the clamp now. Pump this one fast. We may need pressors." And with that, I let go of the clamp. Pressure dipped as his heart went into overdrive in front of our eyes.
This kid was not looking good.
"Seventy five and holding. Pulse one thirty five."
"Elevate his legs, Frank. Its time to get outta dodge!" Daintily, I started removing clamps and sponges. I had to wait for Cate before I could close though. In my urgency, I forgot to ask how many sponges she had used. After a through search, I hadn't found any in the bed but with everything having a dark shade of red, it was not a judgment call I was going to make.
"Stevens, count the sponges." I asked the nurse aide standing silently on the side. He seemed catatonic.
"STEVENS!"
"Yes sir."
"Gauze pieces. Today! Frank, get me a chest tube and a drain." Frank was silent too. I was glad.
I put in a mediastinal drain and then a chest tube on the left side.
Gauze pieces and sponges accounted for, I started closing the kid. It took much longer than I had expected and it was during skin closure that Potter entered the OR. He looked livid.
"WHAT THE HELL IS GOING ON HERE, PIERCE."
"Skin closure!" I informed him, feeling the numbness in my fingers, my eyes only for Johnson.
"Why in the name of Holy Cimarron did you operate when I gave you clear orders..."
"Not now, Colonel!" I told him as I finished suturing and looked at Tundra.
"Eighty five systolic, pulse is one ten."
"Stevens, note the drain levels. I will make notations of procedure and post-op orders. You will give them to Nurse Kellye and no one else. Tundra, he remains tubed. Get the respirator working in post op. I am watching him for five minutes." And with that, I undid my gown and gloves, threw away the mask and started making notifications on his chart.
PS: More medicalese. Lemme know if you want some explanation. Its all accurate!