times, like now, she used her height to advantage, casting an intimidating shadow, looking down at an adversary with a hard gaze that seemed to say better-listen-to-me-or-I-might-peck-your-eyes-out-mister. Jonas was two inches taller than Kari, so she couldn't actually look down at him, but few women were that close to being able to give him even a level-eyed stare, and the effect was the same as if he had been five-feet-two.
Jonas looked at Ken, seeking support.
The neurologist was having none of it. “In fact the body temperature could have fallen below freezing
“If he's only forty-six degrees
Every cell in the human body is composed primarily of water.
The percentage of water differs from blood cells to bone cells, from skin cells to liver cells, but there is always more water than anything else. And when water freezes, it expands. Put a bottle of soda in the freezer to quick-chill it, leave it too long, and you're left with just the exploded contents bristling with shattered glass. Frozen water bursts the walls of brain cells — all body cells — in a similar fashion.
No one on the team wanted to revive Harrison from death if they were assured of bringing back something dramatically less than a whole person. No good physician, regardless of his passion to heal, wanted to battle and defeat death only to wind up with a conscious patient suffering from massive brain damage or one who could be sustained “alive” only in a deep coma with the aid of machines.
Jonas knew that his own greatest weakness as a physician was the extremity of his hatred for death. It was an anger he carried at all times. At moments like this the anger could swell into a quiet fury that affected his judgment. Every patient's death was a personal affront to him. He tended to err on the side of optimism, proceeding with a resuscitation that could have more tragic consequences if it succeeded than if it failed.
The other four members of the team understood his weakness, too. They watched him expectantly.
If the operating room had been tomb-still before, it was now as silent as the vacuum of any lonely place between the stars where God, if He existed, passed judgment on His helpless creations.
Jonas was acutely aware of the precious seconds ticking past.
The patient had been in the operating room less than two minutes. But two minutes could make all the difference.
On the table, Harrison was as dead as any man had ever been. His skin was an unhealthy shade of gray, lips and fingernails and toenails a cyanotic blue, lips slightly parted in an eternal exhalation. His flesh was utterly devoid of the tension of life.
However, aside from the two-inch-long shallow gash on the right side of his forehead, an abrasion on his left jaw, and abrasions on the palms of his hands, he was apparently uninjured. He had been in excellent physical condition for a man of thirty-eight, carrying no more than five extra pounds, with straight bones and well-defined musculature. No matter what might have happened to his brain cells, he
A decade ago, a physician in Jonas's position would have been guided by the Five-Minute Limit, which then had been acknowledged as the maximum length of time the human brain could go without blood-borne oxygen and suffer no diminution of mental faculties. During the past decade, however, as resuscitation medicine had become an exciting new field, the Five-Minute Limit had been exceeded so often that it was eventually disregarded. With new drugs that acted as free-radical scavengers, machines that could cool and heat blood, massive doses of epinephrine, and other tools, doctors could step well past the Five-Minute Limit and snatch some patients back from deeper regions of death. And hypothermia — extreme cooling of the brain which blocked the swift and ruinous chemical changes in cells following death — could extend the length of time a patient might lie dead yet be successfully revived. Twenty minutes was common. Thirty was not hopeless. Cases of triumphant resuscitation at forty and fifty minutes were on record. In 1988, a two-year-old girl in Utah, plucked from an icy river, was brought back to life without any apparent brain damage after being dead at least sixty-six minutes, and only last year a twenty-year-old woman in Pennsylvania had been revived with all faculties intact seventy minutes after death.
The other four members of the team were still staring at Jonas.
Death, he told himself, is just another pathological state.
Most pathological states could be reversed with treatment.
Dead was one thing. But
To Gina, he said, “How long's he been dead?”
Part of Gina's job was to serve as liaison, by radio, with the on-site paramedics and make a record of the information most vital to the resuscitation team at this moment of decision. She looked at her watch — a Rolex on an incongruous pink leather band to match her socks — and did not even have to pause to calculate: “Sixty minutes, but they're only guessing how long he was dead in the water before they found him. Could be longer.”
“Or shorter,” Jonas said.
While Jonas made his decision, Helga rounded the table to Gina's side and, together, they began to study the flesh on the cadaver's left arm, searching for the major vein, just in case Jonas decided to resuscitate. Locating blood vessels in the slack flesh of a corpse was not always easy, since applying a rubber tourniquet would not increase systemic pressure. There
“Okay, I'm going to call it,” Jonas said.
He looked around at Ken, Kari, Helga, and Gina, giving them one last chance to challenge him. Then he checked his own Timex wristwatch and said, “It's nine-twelve P.M., Monday night, March fourth. The patient, Hatchford Benjamin Harrison, is dead … but retrievable.”
To their credit, whatever their doubts might have been, no one on the team hesitated once the call had been made. They had the right — and the duty — to advise Jonas as he was making the decision, but once it was made, they put all of their knowledge, skill, and training to work to insure that the “retrievable” part of his call proved correct.
Dear God, Jonas thought, I hope I've done the right thing.
Already Gina had inserted an exsanguination needle into the vein that she and Helga had located. Together they switched on and adjusted the bypass machine, which would draw the blood out of Harrison's body and gradually warm it to one hundred degrees. Once warmed, the blood would be pumped back into the still-blue patient through another tube feeding a needle inserted in a thigh vein.
With the process begun, more urgent work awaited than time to do it. Harrison's vital signs, currently nonexistent, had to be monitored for the first indications of response to therapy. The treatment already provided by the paramedics needed to be reviewed to determine if a previously administered dose of epinephrine — a heart- stimulating hormone — was so large as to rule out giving more of it to Harrison at this time. Meanwhile Jonas pulled up a wheeled cart of medications, prepared by Helga before the body had arrived, and began to calculate the variety and quantity of ingredients for a chemical cocktail of free-radical scavengers designed to retard tissue damage.
“Sixty-one minutes,” Gina said, updating them on the estimated length of time that the patient had been dead. “Wow! That's a long time talking to the angels. Getting this one back isn't going to be a weenie roast, boys and girls.”
“Forty-eight degrees,” Helga reported solemnly, noting the cadaver's body temperature as it slowly rose toward the temperature of the room around it.
Death is just an ordinary pathological state, Jonas reminded himself. Pathological states can usually be reversed.
With her incongruously slender, long-fingered hands, Helga folded a cotton surgical towel over the patient's genitals, and Jonas recognized that she was not merely making a concession to modesty but was performing an act of kindness that expressed an important new attitude toward Harrison. A dead man had no interest in modesty. A dead man did not require kindness. Helga's consideration was a way of saying that she believed this man would once more be one of the living, welcomed back to the brotherhood and sisterhood of humanity, and that he should be treated henceforth with tenderness and compassion and not just as an interesting and challenging prospect for reanimation.
