Dr. Eli Branch stood at the scrub sink and looked through the window into Operating Room One. He slung soap across his arms and hands while counting blood-drenched sponges that lay on the floor in piles. From the looks of the room he was about to enter, sterility was not a prime concern. Inside, a nurse hustled with bags of warm saline while another scrambled in with more absorbent sponges. The anesthesiologist hung two units of blood at the head of the table and forced the transfusion with a white-knuckled grasp. A figure gowned in blue bent over the patient, working frantically, deep in the abdomen, to quell the flow of blood.
Just twenty minutes earlier, Eli’s beeper had pierced his sleep.
Dr. Korinsky needs you in Room One.
A difficult case.
Cold water splashed off his arms and soaked his scrubs. His pulse quickened. As the newest member of the surgical staff at Gates Memorial, Eli knew to come running when paged, no matter what time of night, even when he wasn’t on call.
From the operating table, a pair of anxious eyes met his – a summons from Dr. James Korinsky, Chief of Vascular Surgery, ten years his senior. On the other side of the table, a surgery intern stared into the wound. An orderly rushed through the room with a cooler of blood, little packets stacked together like summertime drinks waiting to be spiked.
Eli held to one more quiet moment, as if watching a silent movie unfold before him. He closed his eyes briefly, a pre-operative routine that had developed not out of principle or theology but from a sense of necessity. Then, with water dripping from his elbows, he bumped the door open with his butt and walked on stage.
“I’ve got trouble here, Branch,” Korinsky said before the door fully closed. “Dumb shit over here doesn’t know an aorta from his asshole.”
Above his mask, intern Landers rolled his eyes and discreetly shook his head.
Although Eli was a board certified surgeon, he felt closer in rank to Landers. An awkward, sympathetic twinge grabbed him as the verbal barrage continued.
“I’ve seen monkeys with better hands.”
Eli approached the table and peered over Korinsky’s shoulder. Then he looked at Landers and winked. The intern took his first full breath since the start of the case.
“Damndest thing I ever saw,” Korinsky said, lifting a matted wad of intestines out of the wound as if handling a tangled ball of Christmas lights.
The scrub nurse draped a towel across Eli’s open palm. He quickly dried his hands while studying an X-ray of the patient’s abdomen that hung from a lighted view box on the wall. The culprit was immediately apparent, a metallic device embedded in the center of the patient’s abdomen, thin metal spikes projecting from the top of a cylindrical cage tilted at a deadly angle.
“Get over here!” Korinsky yelled. “If I needed a radiologist I’d have called one.”
Eli lingered at the view box. He had not scrubbed with Korinsky before and wanted another moment before fully committing himself with bloody hands.
Why does the top vascular surgeon in Memphis need my help on an aortic aneurysm? Especially when he has an assistant?
Then Eli considered the time of year.
The first half of the month, no less, when attending surgeons took vacation just to avoid the new interns who knew only enough to be dangerous, and the naive medical students in shock from sixteen-hour days that started with four A.M. rounds. A man has only so many Julys in him, one of his mentors used to say.
“What kind of endograft is this?” Eli asked, referring to the biomedical device.
“Hell if I know,” Korinsky said. “Some older model.” And then, as a disclaimer, “Not one of mine, I can tell you that.”
Eli peered closer at the X-ray. Surrounding a radiolucent inner fabric tube was an expandable steel mesh visible as a latticework of small V’s connected and stacked on one another, like a tube of interlocking paper clips. The device was used to replace the aorta at the site of ballooning or aneurysm, a newer innovation that could be deployed within the vessel itself, avoiding the morbidity of an open abdominal incision. The device was designed to prevent aortic rupture, to save a life. But as with any medical innovation, this one carried its own set of complications.
And this one is killing the patient.
“Some bastard from St. Screw-up put it in,” Korinsky said.
Though the design was outdated, there was something familiar about the device, a recognition that Eli could not fully identify. The metallic image lingered with him as Roberta, the scrub nurse, snapped his gloves into place.
The overhead monitor buzzed with a rapid heart rate and showed a hypotensive pressure of seventy-four. Eli’s waist met the patient’s arm tucked deep beneath the drapes and he submerged his hands among warm loops of intestine floating in blood.
“Can’t see a damn thing,” Korinsky said as he wrestled with the matted wad of bowel. Blood welled up from the retroperitoneum and he jammed the wand-shaped sucker deep in the rising pool. The tubing turned bright red from the column of blood snaking its way toward multi-liter canisters hanging on the wall.
The temperature of the room had been warmed to combat the patient’s progressive hypothermia, his abdomen an open medium for the escape of heat. The air above the operative table was thick and stale, compressed by another boggy southern night. Korinsky’s paper cap was plastered against his forehead, moisture forming a pool in the center. A drop of sweat dangled from the cap’s rim and threatened the open wound. Eli glanced at Roberta, who shook her head as if the situation was a lost cause. When Eli looked back at Korinksy, the drop was gone.