Eight Ball Justice

“Tim,” asked Preston, “what’s her pressure?”

“Sixty, but holding steady,” said Tim.

“How much blood so far?”

“Ten units, plus four units of platelets, and one unit fresh frozen plasma.”

“Her chemistries okay?”

“No problem.”

“Leslie, hold this ligature.”

“Tim, is the bypass machine ready to go?”

“Yes.”

“It’s still a mess back here,” said Preston while he continued to work on the posterior aspect of Roxy’s heart. “She must have been falling backward when she was struck by the object.” There was clearly a rostral to caudal progression of the projectiles. This one nicked her pulmonary vein, penetrated her left atrium, and exited the tip of her left ventricle. As soon as I’m finished patching up this nick in her pulmonary vein, we can take a break so you can stabilize her, then we can hook her up to bypass. All I’ve done so far is first aid. She probably needs a new valve and a better repair of her pulmonary vein.” Preston paused a moment as he placed a particularly difficult suture. “Nick, how are you doing?”

“I’ve plugged the big holes. I don’t think I can save her spleen.”

“Tim, did you give the Vancomycin yet?”

“Done.”

“Is she still making pee?”

“Not much. I’m going to start a low dose Dopamine drip. Might help perfuse her kidneys a little better.”

Preston heard the monitor rate accelerate suddenly. He looked up in time to see a short run of ventricular tachycardia.

“I can’t believe this lady lived long enough to get to the OR,” said Preston. “If she didn’t have a pericardium, she would have bled to death at the scene. Okay, Mayos.”

Preston clipped the suture with the scissors and removed his hands from the chest cavity.

“Tim, let’s see if we can get her pressure up a little now.”

Preston maintained his position at the table but relaxed his shoulders and listened to REO Speedwagon belt out “Ridin’ the Storm Out.”

Over the next five minutes, Preston watched the blood pressure slowly creep up to 105/50.

“Tim, I think we’re ready for by—”

Before Preston could finish, blood suddenly filled the chest cavity and spilled out onto the floor of the surgical suite. Roxy’s pressure immediately plummeted. Instinctively, Preston grabbed the suction catheter and reached blindly into the pool of blood. He groped around the arch of the aorta looking for the source of the bleeding. Preston knew the only thing that could fill a chest that fast, short of a ruptured myocardium, was a hole in the aorta.

“Damn it! She must have nicked her aorta, too. Must have given way when we got her pressure up.”

“Cross clamps?” asked Leslie.