Under The Knife. Tess Gerritsen

Guy,” she whispered. “You promised. No scar….”

      “Did I?”

      “Yes…you did…..”

      Guy winked at Kate. “Didn’t I tell you? Nurses make the worst patients. Demanding broads!”

      “Watch it, Doc!” one of the O.R. nurses snapped. “One of these days we’ll get you up on that table.”

      “Now that’s a terrifying thought,” remarked Guy.

      Kate watched as her patient’s jaw at last fell slack. She called softly: “Ellen?” She brushed her finger across Ellen’s eyelashes. There was no response. Kate nodded at Guy. “She’s under.”

      “Ah, Katie, my darlin’,” he said, “you do such good work for a—”

      “For a girl. Yeah, yeah. I know.”

      “Well, let’s get this show on the road,” he said, heading out to scrub. “All her labs look okay?”

      “Blood work’s perfect.”

      “EKG?”

      “I ran it last night. Normal.”

      Guy gave her an admiring salute from the doorway. “With you around, Kate, a man doesn’t even have to think. Oh, and ladies?” He called to the two O.R. nurses who were laying out the instruments. “A word of warning. Our intern’s a lefty.”

      The scrub nurse glanced up with sudden interest. “Is he cute?”

      Guy winked. “A real dreamboat, Cindy. I’ll tell him you asked.” Laughing, he vanished out the door.

      Cindy sighed. “How does his wife stand him, anyway?”

      For the next ten minutes, everything proceeded like clockwork. Kate went about her tasks with her usual efficiency. She inserted the endotracheal tube and connected the respirator. She adjusted the flow of oxygen and added the proper proportions of forane and nitrous oxide. She was Ellen’s lifeline. Each step, though automatic, required double-checking, even triple-checking. When the patient was someone she knew and liked, being sure of all her moves took on even more urgency. An anesthesiologist’s job is often called ninety-nine percent boredom and one percent sheer terror; it was that one percent that Kate was always anticipating, always guarding against. When complications arose, they could happen in the blink of an eye.

      But today she fully expected everything to go smoothly. Ellen O’Brien was only forty-one. Except for a gallstone, she was in perfect health.

      Guy returned to the O.R., his freshly scrubbed arms dripping wet. He was followed by the “dreamboat” lefty intern, who appeared to be a staggering five-feet-six in his elevator shoes. They proceeded on to the ritual donning of sterile gowns and gloves, a ceremony punctuated by the brisk snap of latex.

      As the team took its place around the operating table, Kate’s gaze traveled the circle of masked faces. Except for the intern, they were all comfortably familiar. There was the circulating nurse, Ann Richter, with her ash blond hair tucked neatly beneath a blue surgical cap. She was a coolheaded professional who never mixed business with pleasure. Crack a joke in the O.R. and she was likely to flash you a look of disapproval.

      Next there was Guy, homely and affable, his brown eyes distorted by thick bottle-lens glasses. It was hard to believe anyone so clumsy could be a surgeon. But put a scalpel in his hand and he could work miracles.

      Opposite Guy stood the intern with the woeful misfortune of having been born left-handed.

      And last there was Cindy, the scrub nurse, a dark-eyed nymph with an easy laugh. Today she was sporting a brilliant new eye shadow called Oriental Malachite, which gave her a look reminiscent of a tropical fish.

      “Nice eye shadow, Cindy,” noted Guy as he held his hand out for a scalpel.

      “Why thank you, Dr. Santini,” she replied, slapping the instrument into his palm.

      “I like it a lot better than that other one, Spanish Slime.”

      “Spanish Moss.”

      “This one’s really, really striking, don’t you think?” he asked the intern who, wisely, said nothing. “Yeah,” Guy continued. “Reminds me of my favorite color. I think it’s called Comet cleanser.”

      The intern giggled. Cindy flashed him a dirty look. So much for the dreamboat’s chances.

      Guy made the first incision. As a line of scarlet oozed to the surface of the abdominal wall, the intern automatically dabbed away the blood with a sponge. Their hands worked automatically and in concert, like pianists playing a duet.

      From her position at the patient’s head, Kate followed their progress, her ear tuned the whole time to Ellen’s heart rhythm. Everything was going well, with no crises on the horizon. This was when she enjoyed her work most—when she knew she had everything under control. In the midst of all this stainless steel, she felt right at home. For her, the whooshes of the ventilator and the beeps of the cardiac monitor were soothing background music to the performance now unfolding on the table.

      Guy made a deeper incision, exposing the glistening layer of fat. “Muscles seem a little tight, Kate,” he observed. “We’re going to have trouble retracting.”

      “I’ll see what I can do.” Turning to her medication cart, she reached for the tiny drawer labeled Succinylcholine. Given intravenously, the drug would relax the muscles, allowing Guy easier access to the abdominal cavity. Glancing in the drawer, she frowned. “Ann? I’m down to one vial of succinylcholine. Hunt me down some more, will you?”

      “That’s funny,” said Cindy. “I’m sure I stocked that cart yesterday afternoon.”

      “Well, there’s only one vial left.” Kate drew up 5 cc’s of the crystal-clear solution and injected it into Ellen’s IV line. It would take a minute to work. She sat back and waited.

      Guy’s scalpel cleared the fat layer and he began to expose the abdominal muscle sheath. “Still pretty tight, Kate,” he remarked.

      She glanced up at the wall clock. “It’s been three minutes. You should notice some effect by now.”

      “Not a thing.”

      “Okay. I’ll push a little more.” Kate drew up another 3 cc’s and injected it into the IV line. “I’ll need another vial soon, Ann,” she warned. “This one’s just about—”

      A buzzer went off on the cardiac monitor. Kate glanced up sharply. What she saw on the screen made her jump to her feet in horror.

      Ellen O’Brien’s heart had stopped.

      In the next instant the room was in a frenzy. Orders were shouted out, instrument trays shoved aside. The intern clambered onto a footstool and thrust his weight again and again on Ellen’s chest.

      This was the proverbial one percent, the moment of terror every anesthesiologist dreads.

      It was also the worst moment in Kate Chesne’s life.

      As panic swirled around her, she fought to stay in control. She injected vial after vial of adrenaline, first into the IV lines and then directly into Ellen’s heart. I’m losing her, she thought. Dear God, I’m losing her. Then she saw one brief fluttering across the oscilloscope. It was the only hint that some trace of life lingered.

      “Let’s cardiovert!” she called out. She glanced at Ann, who was standing by the defibrillator. “Two hundred watt seconds!”

      Ann didn’t move. She remained frozen, her face as white as alabaster.

      “Ann?” Kate yelled. “Two hundred watt seconds!”

      It was Cindy who darted around to the machine and hit the charge button. The needle shot up to two hundred. Guy grabbed the defibrillator paddles, slapped them on Ellen’s chest and released the electrical