As a physician, Reed Marshall was good, very good; but he seldom stepped down from the pedestal of his position-seldom got 'dirty.' Eric was a barroom brawler. And although Tern knew nurses who had dated Eric, and even slept with him, she knew of none who had been able to compete with medicine as the love in his life.
'why's he in shock?' Eric muttered, asking the question primarily of himself. 'A spleen? A river?'
'Aortic tear?' tern ventured.
'Maybe…' His voice drifted off. 'It's in his chest,' he said suddenly.
'How could you know that?'
'I don't know it. I just feel it. God, I'd love to know what the steering wheel of that car looked like…
'The steering wheel?'
'Listen, I want you to do me a favor. Call Dave Subarsky's lab, extension four-eight-one-one, and see if you can get hold of him.
Ask him to come down here right away, and tell him… Better still, just get him on the phone. I'll talk to him.'
He raced off toward the radio. As Tern picked up the phone, she heard him raise the MedEvac helicopter and ask about the accident-particularly about seat belts and the condition of the steering wheel.
She knew from five years of watching him work, that with a Priority One just minutes away from arrival, Eric Najarian was operating in a zone few trauma specialists ever reached.
Within seconds of the MedEvac chopper's touchdown on the roof of the Richter Building, the battle was underway. June Feldman, the junior resident, began her evaluation on the way to the elevator and had her report ready for Eric by the time she and the rescue team exploded through the emergency room doors.
The prize at stake was the life of a man named Russell Cowley, the president of one of the region's larger high-tech firms. Eric's pulse had speeded up a notch at that news, This man's rescue and subsequent resurrection would be the stuff of front-page headlines.
According to the MedEvac crew, Cowley had been speeding north on the interstate, seat belt in place, when the right front tire of his Mercedes 450SL had blown. The car had careened through a snowbank and then the guardrail, sailed nearly fifty yards over an embankment, and then crashed into the base of a tree. The jaws of life had been needed to extricate him from the wreck. The steering wheel, bent almost in half, had pinned him to his seat.
'Cowley… Russell Cowley,' one of the residents had mused as they were awaiting the chopper. 'I could swear he's a trustee of this place.
In fact, I'm sure of it.' Eric had taken in the information without reaction, but the look in his eyes grew even more intense.
With Craig Norrell's abrupt dismissal and subsequent disappearance, the position of associate director of emergency services had suddenly come open. And everyone from the secretaries on up knew that only he and Reed Marshall were in the running for the job.
Now, with the search committee struggling for justification to choose one or the other of them, a trustee had been dropped in his lap.
You don't know it, Mr. Russell Cowley, he was thinking, but there is no way that you're going to die from this. Absolutely none.
The Corporate executive howled in pain as he was transferred to the hospital gurney. Crystals of windshield glass sparkled in his hair.
His face, beneath the smeared blood from several lacerations, was violet. He flailed his good arm and screamed again as a nurse inadvertently jostled his left leg. Gradually he drifted off, moaning softly, The orthopedic resident set about stabilizing the obvious fractures. Eric did a rapid exam and then stepped back. He had found nothing that argued against his notion that the impact of the steering wheel had bruised the man's heart, causing pericardial tamponade.
Blood was collecting between the cardiac muscle and the pericardial membrane that surrounded it. The mounting pressure of that hemorrhage was compromising the filling and pumping power of the heart, and causing progressive shock.
If that was in fact the case, then a pericardiocentesisrainage of the constricting blood-was in order. The standard procedure involved the insertion of an E.K.G-guided needle through the upper abdomen, just past the liver, then through the diaphragm, and finally through the pericardium-a tricky, potentially dangerous maneuver.
Eric had other plans. He glanced toward the 'doorway, wondering what was taking Dave Subarsky so damn long.
'Films first, films first,' he said, forcing calm into his voice.
'I need a good lateral of his neck right away.
Have them shoot a chest and pelvis as well. June, I don't think he needs a tube yet, but he might. He looks like hell. What's his pressure?'
June Feldman tried to find out with a cuff and Doppler electronic stethoscope, then shook her head.
'As soon as bloods are off to the lab, get an arterial line in him.
Then a catheter,' Eric ordered.
Feldman set to work cannulating the man's radial artery, while a second resident numbed a spot near his navel and thrust a tube into the abdominal cavity.
A flush of saline through the tube showed no evidence of internal bleeding.
Eric nodded. The test had ruled out a ruptured spleen or liver, and had made an aortic tear less likely.
The possibility of pericardial tamponade as the cause of Russell Cowley's shock had just increased severalfold.
Tern Dillard rushed into the room.
'How's he doing?' she asked breathlessly.
'No better, no worse,' Eric said. 'He's tamponading.'
'You sure?'
'Not yet, but almost. And if it's true, hold on to your hat.
'You're going to get to see something no one has ever seen-not even me.
That is, providing goddam Subarsky gets down here in time.'
'Well, I hope whatever it is happens quickly,' Tern said, 'because we just got a call on the Batphone.
Boston Rescue is on the way in with another Priority One-a man found in an alley in the North End. No pulse, no respiration. They're doing CPR.'
'A drift diver?' Eric asked, his concentration still focused on the residents and technicians.
The term referred to the derelicts pulled from snowdrifts throughout the Boston winter. Most of the time they were well beyond salvation.
'I think so,' Terrf said. 'The rescue people refuse to incriminate themselves over the radio, but they did say there was a nearly empty bottle of Thunderbird in the man's coat pocket.'
'Is he warm?'
'I have my doubts. Rescue made it sound like they were only working on him because their protocol demands: it.'
'E.K.G?'
'Essentially straight-line, with an occasional agonal beat.'
'Pupils?'
'Dilated and fixed.'
'Lord. Tern, isn't there someone else around to work on him?
This is big stuff going on here. This guy's the president of a company, a trustee of this hospital, and he's got treatable injuries.
I don't want him shortchanged while I go through the motions with a wino who probably died hours ago.'
Tern's eyes narrowed.
'You're the only senior person around,' she said coolly. 'If you need help, Dr. Kaiser is next door doing walk- ins.' 'tell him to take charge of the diver. If this guy needs his pericardium drained, I'm going to do it.
'En'c, come on,' she said. 'Gary Kaiser's been here a year and a half, and he gets flustered taking care of strep throats. I think his father must have endowed a building or something. There's no other explanation for his
