Trapped (33 page)

Chapter Sixty-Five (Week 34)

Jack was sitting at the nursing station reviewing Lisa’s labs, when Harvey Russo entered.

“What’s up, Jack?”

“Clinically, she’s bleeding inside the uterus, from her IV sites, and into her skin.” Holding up the lab printout, he continued, “her hemoglobin and blood platelet count are down, and the clotting studies are consistent with disseminated intravascular coagulation. It’s your call, Harvey, but I think we better get that baby out.”

Harvey
went to Lisa’s bedside, and held her hands. “We’ve got to deliver this baby.”

“Please, Harvey. Can’t we wait longer, until
his lungs have matured?”

“I’m sorry, but there’s too much risk to both you and your baby. He’s showing signs of distress
, and if we don’t get him out…”

Just then, Phoebe arrived. She hugged Lisa.

“Harvey going to deliver the baby, now,” Lisa said, sobbing. “We don’t have a choice.”

Phoebe placed her hands on her hips, faced Harvey
, and said, “What’s going on?”

Harvey and Jack filled in the details
, and Phoebe turned to Lisa. “We’re going to see your son, and I mean soon.”

Jack ordered fresh blood, platelets and other clotting factors in preparation for surgery.

Phoebe held Lisa’s hand until the last moment
as they rolled her into the elevator to take her to surgery. “I’m going to keep Nora and the girls company for a while, and then I’ll be down to see you and the baby. I love you, sweetie. I’ll see you soon.” The elevator doors closed.

They moved Lisa into the chilly operating room. The place bustled with scrub nurses and technicians arranging the monitoring equipment and surgical supplies.

Brad Rosin and Sharon Bridges, one of NICU’s most experienced nurses, prepared the incubator for Lisa’s baby.

Brad came over, pulled his mask down, and kissed Lisa on the cheek. “Don’t worry. Sharon’s here. We’re ready. ”

“Please, Brad
, I just want him to be healthy.”

“We’re ready to count fingers and toes.
Have you given him a name?”

“Aaron
, for Mike’s father.”

It took Harvey, Jack, and Brad to hold Lisa in place sitting up with her body curved over a pillow. As Mickey Katz, Brier’s most experienced anesthesiologist, scrubbed Lisa’s back with Betadyne antiseptic, Lisa gasped.

“I’m
sorry,” Mickey said. “Normally, we try to keep it warm.”

“It’s okay. I don’t know how long I can sit this way. I’m dizzy.”

“I should have it in a second. If not, I’ll do it while you’re lying on your side.”

“Harvey, I’m feeling…
”

“Got it,” Mickey
said. “Let her down. I’ll adjust the surgery table to the right position.”

“How are you feeling, Lisa?”

“Getting numb.”

“Good,” Mickey
said. “If you have any difficulty breathing, or if anything bothers you, I’m right here.”

“Her blood pressure and the filling pressures in her heart are low, Jack. I’m going to give her a unit of whole blood, if that’s okay?”

Jack nodded. “Better get this show on the road, Harvey.”

Harvey and his partner, Neville McDermott
, entered the room, arms raised. The scrub nurse handed each a towel, and helped them with their sterile gowns and gloves.

“Lisa,” Harvey
said, “how are we doing?”

“I don’t know about you, Harvey, but I’m about to jump out of my skin.”

“I can ask Mickey to give you something to take the edge off.”

“No thanks. I want to be alert when
the baby comes.”

The circulating nurse scrubbed Lisa’s abdomen with a soapy solution,
and then Harvey followed with antiseptic and then he draped her belly with sterile green towels. Harvey pinched Lisa’s skin with a forceps, and asked, “Do you feel that?”

“Feel what?” Lisa
replied.

Suddenly, Lisa said, “I
’m going to be sick,” and then, she vomited.

“Her pressure’s coming down,” Mickey
said. “The baby’s showing definite signs of fetal distress. I’m giving more blood, but let’s get that baby out.”

Harvey abandoned his usual Bikini incision
, and drew his blade straight down Lisa’s abdomen. The wound bled profusely, as the nurse assistant suctioned the blood away, and he and Neville quickly clamped and tied off the major bleeders.

As a compromise for speed, Harvey made a low horizontal incision in the wall of Lisa’s uterus.
Seconds later, Harvey held a tiny, blood-covered baby boy in his hands. He smiled, and said, “It’s a boy! Ten fingers and ten toes—a good start.”

Harvey handed the baby to the nurse
, who, in turn, handed him to Brad Rosin.

“Is he okay?”
Whispered Lisa from behind the green-sheeted barrier. “Can I see him?”

“He’s small,” he paused, and then continued, “all of 2124 grams. Let’s make sure he’s okay, and then I’ll bring him over.”

“What’s his scoring on the APGAR scale?” Lisa asked.

“It’s low,” Brad
said, “but give us a few minutes then we’ll see if his score is any better.”

“Harvey, how is my baby?”

“I’m sorry, Lisa,” Brad said. “We’re taking him to NICU.”

“No, Harvey, please my baby. Let me see him before
it’s too late!”

Brad paused at the head of the surgery table. Lisa looked at the tiny inf
ant, and reached out to touch him.

“Don’t, Lisa. No time,” Brad
said, as he and Sharon wheeled the incubator through the door.

“Harvey,” Mickey
said. “Lisa’s crashing. Her pressure’s down to 54/30—she’s going to code if we don’t do something. Harvey—Jack—” cried Mickey, as he pushed the code blue button, and the throbbing sound of the alarm echoed through the surgical suite.

PART III

Chapter Sixty-Six

As Brad and Sharon wheeled the incubat
or to the elevator, they kept their eyes on Lisa’s baby.

Brad felt his abdomen tightening as he watched the tiny red-pink newbo
rn struggle to breathe. The space between the ribs retracted with each breath and the baby grunted and struggled to breathe. His lips were now blue.

Sharon felt sick as she alternately stared at the baby
, and watched the red numbers on the elevator as it slowly descended into the basement where they waited.

When the elevator stopped at the second floor, Brad shouted, “God
damn these fucking elevators!”

Finally, the elevator arrived
, and Sharon inserted her key into the control panel so that nothing would stop them on their way to the 4th floor, and the NICU.

As they entered the NICU, Sharon shouted, “He’s not breathing
—he stopped breathing.”

Brad placed the tiny oxygen mask over the baby’s face
, and delivered several small breaths. “Get ready to intubate this baby, and then get a chest x-ray and blood gases.”

After a short prayer, Brad inserted the small tube into the baby’s trachea, breathed for him several times more
, and then attached the end of the tube to the ventilator.

The pulsating code blue alarm continued to resound through the operating room.

Harvey had his hands poised over Lisa’s chest, ready to perform external cardiac massage.

“Can’t you do something about that damned code blue alarm?” Harvey yelled. “It’s driving me crazy.”

After the circulating nurse silenced the alarm
,
Mickey Katz, the anesthesiologist, said, “Hold it a minute, Harvey. Her tracing shows a rapid, but regular beat. I’m taking her blood pressure. Can you feel a pulse?”

Harvey reached to Lisa’s groin, held it
over her femoral artery for a moment, and then moved his hand to her neck. After what seemed a lifetime to all in the room, he said, “Yes. I can feel a weak pulse. What’s her pressure?”

“It’s 60 over nothing,” Mickey
said.

“Pump that blood in as fast as it will go,” Jack Byrnes
said. “I’m getting a Dopamine infusion ready to raise her pressure, if the blood doesn’t do it.”

Harvey had packed the open incision with sterile towels to apply pressure to the uterus with both hands.

After five minutes, Lisa’s pressure stabilized at 84/50. Her pulse raced at 160 beats per minute.

“What’s going on?” Jack
asked.

“She’s bleeding. I’m controlling it with pressure, but we must get back in to take a look.”

“Wait until this unit of blood is in, then go ahead,” Jack said.

As Harvey released the pressure on the towels and removed them, the incision boiled over with dark blood. “Suc
tion the blood, Neville. We gotta find the source of the bleeding, or I may have to perform a hysterectomy.”

The room became silent.

“Harvey,” Mickey said, “with her clotting problems, her instability, and the size of her uterus, do you really want to try a hysterectomy?”

“No, God
damn it, but if we can’t get this under control, she’s going to bleed out.”

“Jack?” Harvey
pleaded.

“Let me load her up with fresh clotting factors,” Jack
said, “and let’s see if the bleeding stops. Nobody wants a woman of this age to lose her uterus, so let’s try everything.”

“If that doesn’t work,” Harvey
said, “I’ll try to get control of the major blood vessel to her pelvis, and then we’ll get the uterus out as quickly as possible.”

“There’s one other possibility,” Jack
said.

All eyes turned to Jack
, as he said, “Bernie Myers may be the best interventional radiologist in the bay area. Let’s get him down here, and see if he can find the bleeding vessel and put a clot in it.”

Twenty minutes later, with Harvey still applying pressure on Lisa’s belly, the operating room was filled with radiological equipment and staff. The room looked like a platform full of commuters, as the train pulled into its first stop.

Bernie prepped Lisa’s left groin area
, and then inserted a long, tan catheter into the femoral artery. When he moved the catheter deeper into her body, he squirted small amounts of dye to visualize his location. As the catheter reached the approximate location of the arteries to the uterus, he injected a large bolus of dye, and took several images.

Three minutes later, Berni
e brought the images to the screen. “I don’t see any bleeding,” he said.

“Let’s have Harvey release the pressure on her abdomen for the next set of pictures,” Jack
said.

Bernie again manipulated the catheter into place. He grabbed a large syringe filled with radio contrast dye,
and then said, “Any time you’re ready, Harvey.”

Harvey leaned back, lifting his bloody hands from the incision.

Bernie injected the dye as he stared at the image on the video screen. “There it is!” He shouted, as he pushed and twisted the catheter. “I’m going to inflate the balloon to block the vessel, until I see the films. That may give us control of the bleeding.”

In another th
ree minutes, his tech brought up the images on the screen. “There it is,” Bernie said. “See the catheter and the white blush beyond its tip? That’s blood leaking from the open blood vessel.”

“How’s
she doing, Mickey?” Harvey asked.

“Pressure is holding at 74/52.”

Mickey had drawn a syringe-full of Lisa’s blood at the beginning of the procedure.
He squirted the partially clotted blood into a sterile basin. Bernie selected an appropriate sized clot, and then said, “I’m going to pull back, inject the clot, and try to get a picture right away to see if we’ve blocked the artery.”

Bernie turned to his tech
, and said, “Do twenty shots as quickly as possible on my count.”

“Ready?”

He pulled back on the catheter, and then said, “I’m injecting the clot,” as he grabbed a new syringe filled with dye, and injected it. “Shoot,” he cried as the machine rumbled like a Xerox machine on amphetamines.

After t
hree more minutes, they looked at the images.

“God
damn it,” Bernie said, as the blood was still leaking from the artery.

“She’s crashing,” Mickey
said. “Her pressure’s down to 60 over nothing, and her pulse is racing.”

“Pump the blood in as fast as it will go,” Jack
said.

“Let me try
, again,” Bernie said. “I’ll use a larger clot, this time.”

“We’re out of time,” Harvey
said. “I can’t stand here and let Lisa bleed to death. I’m going in.”

“Her pressure’s coming up,” Mickey said
, as the new unit of blood ran in.

“Let’s let Bernie take another pass at it,” Jack
said.

“That’s it,” Harvey
said. “Then we’ll get that uterus out as quickly as possible.”

Bernie took several clots
, and squeezed the largest one he could into the catheter. “Are you ready?” He asked his tech.

“Ready.”

Bernie again injected the clot, and then, seconds later, followed it with, “Ready—shoot,” as he injected the dye.

After an agonizing t
hree minutes, the series of images appeared.

Bernie smiled as he saw a clear outline of the uterine artery. The visualized vessel traveled three inches beyond the catheter tip
, and stopped. They could see no bleeding from the artery, which was now sealed with Lisa’s own clot.

The room filled with applause and laughter.