Scarcity (Jack Randall #3) (41 page)

“We paged him a few minutes ago, he hasn’t answered.”

“Okay . . . you stopped the balloon pump?”

“Yeah, what can we do?”

“Just get ready. If it ruptures before we can clamp it off, it’ll be over real quick. I’d start by getting some blood and platelets ready. Say, at least six units.”

A tech returned with the echo machine and a minute later Dryer had the sensor in Oscar’s esophagus. The gray image rotated on the screen until he had the view he needed. Splashes of color showed the blood flow.

“There it is. Call the OR and tell them to get ready, soon as Dayo sees this we’re coming back down.”

Donna left to make the call and Dryer craned his neck out to look down the hall.

“You sure you paged him?”

“Yeah.”

“Call the operator and overhead page him this time.”

“Okay”

Sharon cycled the BP cuff again and Jen bit her lip waiting for the number.

“Damn it, he’s still dropping.”

“That new heart didn’t like low pressures in the O.R,” Dryer informed them.

“Restart the balloon pump?”

“I wouldn’t.”

“Then what? We need to stop it.”

“
We
can’t crack his chest, Jen! We wait for Dayo.”

As if to punctuate the statement, the overhead speaker toned out once, followed by the operator’s calm voice.

“Dr. Dayo to CVICU, stat, Dr. Dayo to CVICU, stat please.”

Jen crossed her arms and scowled at the monitor before turning to Sharon.

“Let’s get the Open Chest Cart in here now, and a crash cart.”

“500 of saline. Squeeze it in,” Dryer ordered.

They both stewed while the nurses acted and the operator continued to page over the speaker, each of them wondering the same thing.

Where the hell was their surgeon?

•      •      •

Manuel leaned closer to the phone.

“
Qué?
”

“I am running things now. You understand?”

“Yes.”

“I want you to ignore what that idiot Rico told you. If you find Jimmy, you tell him to call me, okay?”

Jimmy watched closely as Manuel’s thoughts played across his face. Finally, he looked Jimmy in the eye before leaning even closer to the phone and spoke. “You’re too late.”

“What?”

“I said you’re too late. Our friend . . . he’s in the Gulf.”

They held each other’s gaze as a string of profanity spewed forth from the phone. It took some time before Pablo was ready to speak again. “That fool! He’s dead and he’s still fucking things up! I should have shot him weeks ago!”

They patiently waited through another string of profanity. Eventually Pablo calmed down and spoke again. “This is not your fault Manuel. You did as you were told. Your partner was a good man. But what’s done is done. Stay by the phone, I have work for you.”

“
Si.
”

Manuel ended the call, but did not lower his gun. Jimmy watched his eyes. They looked tired. Tired and old. Too old for a man of his age. They were eyes that Jimmy knew. He saw them in the mirror everyday.

Jimmy slowly flicked the safety on before lowering his gun. Manuel hesitated, but soon followed, sitting back heavily in the chair with a loud exhale. He rubbed the sweat from his eyes and pulled the stray hair from his forehead.

He shook his head at what he had just done, barely able to believe it himself.

“Where will you go?” he asked.

Jimmy shrugged. “It’s a big ocean.”

Manuel just nodded. He really didn’t wish to know. He rose on tired legs and walked past Jimmy. The pistol now hung loosely in his hand and bounced against his leg. His sweat-soaked shirt clung to his muscular frame. He ignored the growling dog and slowly climbed the stairs as if all of his strength had left him.

“Hey, kid?”

Manuel tensed and slowly turned, but Jimmy’s gun was now resting on the table.

“Be careful eh . . . don’t become an animal.”

He got a nod and a lopsided grin for a reply before turning and climbing out of the boat. Jimmy watched him as he made his way down the dock, making no effort to hide the pistol in his hand. A group of drunken boaters gave him a wide berth as he walked through them without even acknowledging their presence. Jimmy kept watching, ready to give a final wave, but Manuel just crossed the lot to the rental car, got in, and drove away.

He never looked back.

“Jimmy?”

He turned to find the boy and his mother at the bottom of the stairs.

“It’s over. We’re free now.”

•      •      •

“Blood pressure is down to sixty!”

“Damn. Give one milligram of epinephrine and start the blood running,” Dryer ordered.

“Get a board under him.”

Jen broke the seals on the Open Chest Cart and pulled out a surgical gown sealed in plastic. She tossed it to Donna. “Get some gloves on and suit me up!”

Dryer opened his mouth to say something, but held his tongue when he saw the look on her face. It wouldn’t hurt to be ready, he decided.

“Squeeze in another unit when that one’s done.”

“Another BP.”

“Where’s Dayo?”

“No answer yet.”

“Send someone to find him. Check the office. If he’s not there, then page Dr. Fong!”

“BP down to 51 systolic!”

“That’s not enough, start CPR.”

Ed was the biggest nurse on the floor. He stepped up to the bed and placed his hands on Oscar’s chest. Before he could start, Jen spoke up.

“Ed wait . . . I don’t know . . . just . . . just be gentle if you can.”

“Got it.”

They all held their breath and watched as Ed began pumping on Oscar’s chest. The crack and pop of his wired sternum was audible, and they half expected the drains to run bright red with blood. But the flow only increased a little.

“The sutures are holding,” Dryer observed.

“But for how long,” Jen countered.

“Hopefully until Dayo gets here.”

Jen let her frustration come out. “Nobody’s found him yet? Tell that operator to keep paging him until we call and tell her to stop!”

“Do you want to move him back to the OR?”

“No, they’re not ready yet anyway. Better here than on the elevator.”

“We have to get it clamped.”

“Wait for Dayo!”

“Who’s the trauma doc on duty tonight?”

“Dr. Balzano, I think he’s in the ER with a gunshot wound. Should I page him?”

Dryer cut Jen off before she could reply. “No, not yet. Dayo will be here.”

Jen spun in a circle, her fear level was rising. “Can I get another BP?”

They all fell silent again as the machine did its job. Even Ed followed the numbers as he pumped on the chest. Sweat was already forming on his forehead.

“No change.”

“Look at the drains.”

The trickle of blood had now increased slightly, and now both tubes showed a small but steady amount flowing to the water seals that Sharon had taped to the floor.

“Hang two more units!”

“Gloves!”

“Jen, you can’t! Wait for Dayo.”

“He’s not answering! You remember what
he
said!”

Only Dryer knew what she was referring to—Oscar’s threat in the OR. He fought to keep his face under control.

Ed turned his head to follow the conversation and his shoulders followed slightly. It was enough to change the angle he was pumping at. He felt it more than he heard it. Oscar’s chest suddenly offered less resistance.

“Jen!”

Jen turned to look at Ed and followed his gaze to the drains. They both gushed bright red blood as fast as it could flow.

“He’s ruptured!”

“Hang more blood!”

“Off the chest, Ed! Drape!”

Sharon threw a sterile drape across Oscar’s chest and Jen ripped the sterile dressing off to exposed the sutures she had placed less than an hour ago. She sliced through them without finesse until the sternal wires gleamed back at her.

“Cutters!”

Sharon slapped the instrument into her hand and she made quick work of snipping the wires free. Sharon grabbed each one as it popped loose and discarded it. Blood began bubbling up through the widening gap.

“Spreaders!”

Jen pulled her hands free in time for Sharon to place the device and crank the handle. Oscar’s chest was barely open when she reinserted a hand and began pumping on the heart. The pool of blood that was Oscar’s chest all but hid her small hand, and more blood overflowed out with each pump to run down the sides of his body.

“Suction! I can’t see anything!”

“Keep pumping, it’s coming.”

“I need a clamp!”

“What kind?”

“I don’t care . . . gimme an Alice.”

“Scoop it out!”

“More suction!”

“His aorta’s shredded.”

“Clamp it.”

“There’s . . . nothing to clamp!”

“What the hell is going on here?”

The command voice cut through the chaos like a clap of thunder. They all turned to see Dr. Balzano standing in the doorway.

“His aorta’s ruptured!”

“Where’s Dayo?”

“We’ve been paging him and Dr. Fong. They haven’t answered.”

Dr. Balzano walked forward and took in the bloody mess on the table. Jen continued pumping with one hand while Sharon worked two suction catheters.

“Put the clamp down. There’s nothing to work with here.”

“But . . .”

“He’s done, Jen. That aorta’s unsalvageable. Who cracked his chest?”

“I . . . I did.”

Dr. Balzano just made a face and shook his head.

“Pronounce your patient.”

Jen couldn’t stop pumping.

“
Pronounce your patient, Jen
.”

Jen slowed to a stop before slowly pulling her hand free. She swallowed her fear twice before looking up at the clock.

“Time of death . . . 23:18.”

White House Czar Calls for End to ‘War on Drugs’
May 14, 2009—Wall Street Journal
 
 

—THIRTY-THREE—

R
ita Lamar sat as she had for the last several days, in a leather chair within arm’s reach of her daughter in the hospital bed. This room was new to them, and while still private, it sat in a different hall and lacked the glass wall of the CVICU. The nurses here came and went, but no longer hovered just steps away as they had before. Step-down they had called it. She had finally asked for an explanation for the term, and was told it was for patients recovering from heart surgery. Evidently you started in the operating room, only to step down to the CVICU, and then again to the Cardiac Step-Down unit. She had shrugged it off. Every discipline seemed to have its own language. Evidently the nurses didn’t realize that the term had a negative vibe to the people outside their profession. Why not Step-Up?

Her phone vibrated in her pocket and she fetched it with dread. Thumbing the icon open she read the text message. It was a reminder she didn’t need, and she quickly cleared the screen and returned it to her purse. She would deal with her own demons later Right now she had her daughter to worry about.

The sun was shining through the window and landing on Tessa’s face. She looked better. Her color was good. The majority of the medication drips were gone. A single one remained that would help her body accept the new heart and make it her own. The chest tubes were still in place and poked out from under the sheets, but they held little, and she had been told that the tubes would most likely be gone by the end of the day. The breathing tube was also gone, and they had all held their breath as they waited for Tessa to take her first breath without it. But she had started breathing as if nothing had happened, and Rita now worked to keep the drool from her daughter’s face.

Dianne, Tessa’s new nurse stuck her head in the door. She scanned the pump and the monitor unit before raising a questionable eyebrow at Mrs. Lamar. They had gotten friendly the minute they had wheeled her daughter into the room, and Rita appreciated the attention she was giving them. The floor was a busy one, but Dianne always seemed to have all the time in the world when they needed something or had a question. Rita smiled and silently waved her away. She only needed one thing right now. Dianne just nodded and left as quietly as she had come.

Their silent communication was not for the benefit of their daughter so much as it was for her father. He sat in the chair next to his wife, but his level of consciousness was on par with Tessa’s. Some ever-present paperwork lay in his lap, and his hand still gripped a page or two. It was one of many such naps he had taken over the last few days, but Rita never complained. He was here and that’s what counted. The sun was slowly creeping across the room, and when it hit his face it would no doubt wake him. She would intervene with the curtains before that happened.

Tessa flopped slightly in the bed and her hands twitched as if grasping for something. A few mumbled words escaped her lips before she lay still again. Rita sat up and took her hand, but the movements stopped as quickly as they had begun. Anytime now, she’d been told. Rita could wait.

“Anything?” her husband whispered behind her.

“No, she’s not ready yet,” she whispered back.

They sat quietly until Dianne appeared in the door again. She turned and nodded to an unseen presence and Dr. Fong followed her into the room.