Miracle Cure (23 page)

You should have listened to me, Brian. I told you to go with Randa
.

“Apparently your father was awake when friends got him here,” Jessup said to him, as the surgical team got to work inserting the uninflated, sausage-sized balloon into Jack’s right femoral artery and up into his aorta. “But he had a pressure of only ninety and evidence on EKG of an evolving extensive anterior MI. Shortly after they got him into bed, he began losing his pressure. Now his rhythm’s unstable. This was the first time we’ve had to shock him.”

“He’s going to surgery?”

“If we can get him there. I wanted to try the cath lab and see if we could open the obstruction with anticoagulants or a probe. But I heard evidence in his chest that his mitral-valve function has been badly impaired by the coronary. Ultrasound confirmed mitral papillary-muscle dysfunction. The valve’s going to have to be replaced along with the bypasses if he’s going to make it.”

If he’s going to make it
.

Brian stared down numbly at the narrow gurney where his father lay, his eyes closed, his rugged, angular facial features already beginning to puff. There was a nasogastric tube snaking up into his nose and down into his stomach, and a much larger endotracheal breathing tube through his mouth and down between his vocal cords into his trachea. His color was a frightening dusky gray.

Coach
.

Randa’s surgical fellows were quick and skilled. The intra-aortic balloon, wrapped around a thin catheter, was inserted and sutured in place in minutes. It was electrically synchronized to inflate in between each of Jack’s heartbeats, forcing extra blood into the left ventricle—the pumping chamber. The small increase in filling volume kept the coronary arteries open as wide as possible and was often the difference between life and death.

Come on, Jack. Hang in there. Hang in there
.

“We’ve got to get going,” the surgical fellow said. “Dr. Randa’s waiting.”

The IV poles, monitor, and balloon assist pump were positioned for travel, and almost before Brian could react, Jack was gone. There was nothing he could do now but wait.

Immediately, the nurses began cleaning up the debris, which covered the floor. Room 4 had to be cleared out quickly and readied for the next crisis. Carolyn Jessup led
Brian out to the hall. She had obviously raced into the hospital from home, and wore no makeup. Her shoulder-length ebony hair, which she invariably wore in a loose knot, was clipped back on each side. For the first time since Brian had met her, she was looking her age.

“We’re doing everything we can,” she said.

Brian looked at his feet.

“I know. Thank you. And thank you for not saying I told you so.”

“I never thought your father had enough time to rely on Vasclear.”

“I feel awful now that I didn’t listen to you. He didn’t want surgery, though, and everything I could find out gave reasonable hope the drug would work for him if we could ever get him on it.”

“I understand. I want to be sure you know that even if we had started him on Vasclear a week earlier, as you requested, it wouldn’t have been enough time.”

Brian nodded. No point in telling her the truth now.

“Thanks for all you’ve done,” he said.

“I wish it could have been more. I’ll be up to observe in a few minutes. Then, once I know Randa’s gotten him on the pump, I’m going to have to go home. I’ll check on how Jack’s doing as soon as I wake up in the morning.”

Brian thanked her again, then made the incredibly lonely walk over to Boston Heart. On the way, he stopped and made two phone calls. The first was to Phoebe, who made him promise to call with the results of the surgery regardless of the hour. The second call was to Freeman Sharpe.

“Freeman, it’s Brian,” he said. “Jack’s had a massive coronary and a cardiac arrest. They’ve just taken him to the OR at Boston Heart for emergency surgery.”

“I’ll be right over,” was all Sharpe said.

Brian checked the time—nearly midnight. It was too
late to call Teri, he decided. Instead, he left a message for her at the hotel that Jack was in surgery and he would call in the morning. Then he hurried to the OR observation area on the third floor.

Like everything else at BHI, the OR gallery was modern, plush, and high-tech. Observers could watch the surgery directly through Plexiglas canopies covering the two ORs or via TV monitors mounted on the wall. There were also high-powered binoculars on chains through which minute details within the incision could be observed.

Brian arrived just as Randa, standing on what looked like a hydraulic platform, had finished sawing through Jack’s sternum to expose the heart. Randa’s fellows had already placed the arterial and venous tubes used to attach Jack to the bypass pump, and were at work harvesting veins from the leg that hadn’t been used in the first operation. The cardiopulmonary bypass technician had her heart-lung machine at the ready. In moments, Jack’s circulation and oxygenation would be turned over to her. An icy potassium solution would then be infused into Jack’s coronary arteries, paralyzing his heart.

From that moment on, there would be no reason to stop the surgery until it was completed. The critical variable, then, was Randa’s skill and speed. The longer Jack was on the bypass pump, the more difficult it was going to be to get him off—provided, of course, there was enough heart muscle left to get him off at all. With numerous bypass grafts to be sutured in on the surface of his heart, and the mitral valve between the left atrium and ventricle to be replaced, the procedure would probably take at least four hours, or possibly even much longer.

This was one of dozens of bypass surgeries Brian had observed or scrubbed in on. From where he was standing, his father’s head was screened from him by a surgical
sheet. Deprived of that connection, Brian felt strangely detached from what he was watching. He thought about going over to the OR waiting room, but knew he couldn’t leave this spot. As long as there was the procedure to focus on, he felt as if he could keep from exploding. At that moment, Randa glanced up and spotted him. Then, just as quickly, the surgeon turned his attention back to the operating microscope.

“It is not my custom to allow family members to observe the surgery on their loved ones,” Randa said through the speakers, without slowing in his work.

“I’m okay, if it’s all right with you, Dr. Randa,” Brian replied. “I’d really be a mess pacing around the family waiting room.”

“Very well. But I think you should know that I am not optimistic. I have no way of knowing how much heart muscle this man lost before we got him here.”

“I understand.”

“The papillary muscle holding his mitral valve in place is no longer functional. We are going to replace the valve.”

“I know.”

Randa was hanging crepe—preparing Brian for the very worst. Brian had done the same thing with patients himself, many times. Boldly promising good results in a difficult case was asking for trouble. Even a surgeon with Randa’s hubris knew better.

Brian sensed what was coming from Randa next. But he had to wait several minutes for the delivery. By that time, Freeman Sharpe had been led to the observation area by a security guard, and was standing quietly beside him.

“So,” Randa said coolly, “how long has it been since I recommended surgery for your father, three weeks?”

“Just about.”

“And what have you been doing for him all this time?”

Brian had to clear his throat before he could speak.

“Standard medical management,” he said, “plus Vasclear.”

“Well, I can report unequivocally that your miracle drug did not work in this case. Your father’s arteries are like rosary beads and his aorta is stiff with arteriosclerosis and calcium deposits.”

“I feared that was the case.”

“Going that route was a very unfortunate decision on your part.”

Freeman grimaced at the surgeon’s insensitivity. Brian, unable to respond immediately, shook his head helplessly and looked away.

“I took my father’s desires and what I knew about Vasclear into consideration, and I made the choice I thought was right,” he managed to say at last.

“The doctor who cares for himself or his family has a fool for a physician and a fool for a patient.”

Freeman whispered into Brian’s ear, “How do you turn this mike off?”

Brian pointed to a switch by the glass and Sharpe threw it.

“Where did you dig him up?” he asked.

“You don’t need tact to make it into the Surgeons’ Hall of Fame. Besides, he’s right. I
am
a fool.”

“I’ve heard your father talk about his last surgery. I don’t think you’re any kind of fool. How’s he doing?”

“He’s on a heart-lung bypass machine. It’s going to be impossible to tell anything until the surgery’s done and they try and get him off it. We’ve still got hours to go.”

“You take anything?”

Brian looked at his sponsor incredulously.

“Freeman, why would you even ask that?”

“Well, believe it or not, taking drugs
has
been known to happen with addicts—in situations stressful or non. Besides, asking that question’s part of my job.”

“No. The answer is no. Freeman, I can’t believe this is happening.”

“I know, pal. What the little goon down there said before about your making the wrong decision—you believe that?”

“I don’t know what to believe. In medicine, where someone’s life is at stake, I’d always take doing the right thing for the wrong reason over doing the wrong thing for the right reason.”

“And you told me yourself that patients who are re-operated on have a much poorer prognosis than they did the first time.”

“Exactly. And this time I had the numbers—the statistics regarding Vasclear and re-bypass—to say nothing of Jack’s history and his passion not to have more surgery. The choice seemed like a lock to me.… Freeman, thank you for being here with me. I feel so alone.”

Sharpe put his arm around him.

“Well, you’re not, pal,” he said. “And as long as you have those beautiful girls of yours, and your faith, and me to keep you on the straight and narrow, you never will be.”

“Five bypasses are done,” Randa said. “We’re moving on to the valve.”

Brian glanced at the time. Less than an hour and a half. In a patient previously bypassed,
three hours
for this part of the operation wouldn’t have been surprising. He closed his eyes.
Go ahead, Randa, feel free to be as much of an asshole as you want
, he was thinking,
so long as you keep going like this
.

The cardiac surgical fellows and Randa functioned like a finely tuned special-forces unit. The way they were huddled around Jack, there wasn’t much to see without using the binoculars or checking the overhead monitor. Freeman chose to do neither.

“I saw enough open chests in Nam,” he said.

Another hour passed as Randa worked on the mitralvalve replacement. For a time, Freeman tried diverting Brian’s focus with small talk, then he simply sat back and let Brian dictate what little conversation passed between them.

For Brian, the detachment that had protected him from coming apart in the early stages of the procedure was rapidly wearing away. Replacing it was a kaleidoscope of images. The one that stuck out was of his dad’s face at Brian’s peewee games. Jack couldn’t have been more excited if it had been the Super Bowl. It wasn’t until Sharpe passed over some tissue and set his arm around his shoulder that he realized he was crying.

“Okay, everyone, heart’s closed, let’s get ready to come off the pump. Dr. Holbrook, you still there?”

Brian flicked on the microphone at the same time as he checked the clock. Not yet three hours. A repeat quintuple bypass and mitral-valve replacement in 175 minutes. The diminutive Sikh was a magician.

“I’m here,” Brian answered.

“You have been very quiet.”

“I’m very worried.”

“You have every reason to be. The surgery has gone well technically, but I cannot promise what we will find when we try to start your father’s heart up again.”

“I understand.”

“And you want to stay?”

Brian glanced over at Freeman.

“I’d rather stay than wait someplace else,” he replied.

“We have inserted an esophageal ultrasound probe to give us continuous monitoring of cardiac muscle contractility.”

Brian picked up the binoculars and affirmed that he could get a good look at the ultrasound screen.

“Thank you for letting me stay,” he said hoarsely, gripping the edge of his high-backed stool.

“Begin to slow the pump. Pacemaker on,” Randa said.

“Coming off pump.”

“Pacer at seventy-five. No capture yet.”

“He’s fibrillating. He’s fibrillating.”

“Bad sign. Turn the pump up. Paddles, please. Twenty joules.… Clear!”

“Flat line.… No, wait, there are complexes. Paced rhythm at seventy-five.”

“Contractions minimal. No effective circulation.”

Through the binoculars, Brian examined the ultrasound tracing and felt his hopes sink.

“Bypass pump up,” Randa said.

The surgeon looked up at Brian and shook his head. Round 1 was over. Over and lost. Jack was not going to come off the pump easily. But even more disturbing was the ultrasound. There just didn’t seem to be enough heart muscle left to generate a blood pressure. Fifteen eerily silent minutes passed before Randa ordered the pacemaker to be turned up again and the bypass pump to be geared down. Again Jack’s heart fibrillated. Again it was shocked into a paced rhythm. Again there were weak contractions and no effective movement of blood. Again Randa called for the bypass pump to be turned up. Round 2, lost.

Twenty minutes more. Brian knew in his gut that this would be the last try. The ultrasound continued to show profound weakness of the pumping-chamber muscle. But a test was just a test, he thought. Every patient was different
from every other, and Jack Holbrook had once played part of a football game with a broken fibula.

Come on, Pop. Come on, you can do it
.

The voices transmitted from the operating room echoed through the observation area, as Laj Randa communicated with his team.