getting an internship here.'
'well, just tell him it's time to be a goddam doctor.
That's what he came here to be. Anyhow, it sounds like this diver's going to be just another D.O.A. Tern, for chrissakes, don't make that face. Okay, look, I'll be over to help him as soon as- Wait, there's Subarsky.
If things go the way I hope, we may be done before the diver arrives.'
Dave Subarsky lumbered into the room, hauling a cart laden with complex machinery. Subarsky had a PhD. in biochemistry from M.I.T but at six foot two or three, with a full beard and massive gut, he looked more like a professional wrestler. He and Eric had grown up just a few doors from each other in Watertown. And although they had entered grammar school the same year, by the time Eric graduated from high school, Subarsky was in his third year of college. It was an unexpected perk of Eric's residency appointment to find his old friend doing independent research in one of White Memorial's labs.
'Ye, David,' Eric called out. 'You have the right dye? Great.
Run into your boss at all? No? Perfect.
Okay, then, set up right there. We're going to go for it.
June, is that arterial line in yet?'
'Right now,' she answered. 'One more second and… Voila!'
A low, rapid wave-tracing appeared on the oscilloscope beneath Russell Cowley's E.K.G pattern. Next to it were the numbers 50 and 0.
Systolic and diastolic pressures. Cowley himself had lost consciousness, but his respiration remained steady and reasonably effective. The violet in his face, however, had deepened.
'Call the O.R. and have them mobilize the cardiac surgical team,' Eric said. 'If this doesn't work, we'll try a needle. But they'd best be ready to open this man's chest.' 'Okay, David, this is it. Everybody listen up. This is Dave Subarsky. He's a biologist from M.I.T and this is a new kind of laser he's helped develop.
We're going to use it to open a window in this man's pericardium and drain the blood out from around his heart and into his chest cavity, where it will simply get absorbed.'
'Is it dangerous?' one of the nurses asked.
'Not in David's hands. It was developed for vascula work, but I got the idea to adapt it for pericardiocentesis- I have total confidence in our ability to do this. We-Dave and I-have been doing animal work with it for months, mostly at three or four in the morning-'
Dave Subarsky, adjusting the dials on the machine, smiled behind his beard.
As soon as it received F.D.A approval for general use, the combination X-ray and coaxial, flash-lamp, pumped-dye lasers would, Eric hoped, become known as the Subarsky/Najarian laser.
First, though, the technique had to work.
'I want you all to know,' Eric went on, 'that this procedure is virtually noninvasive-far safer and more accurate than the needle approach you're all familiar with. In that lower machine, there, we are using a dye specific for the protein in the pericardium. 'This upper component is an X-ray laser beam that will carry the dye laser beam through the intervening structures, right to the pericardium.'
'What should we expect to see?' the same nurse asked.
'well, for starters, a drop in his CVP, and something a little more effective than a systolic pressure of fifty,' Eric replied, barely masking his growing irritation with the woman. 'Now, if you'd all just move back.' 'a-I,' Tern Dillard hurried into the room.
'Eric, the other Priority One is in Six. Gary Kaiser's working on him.'
'What's his temp?'
'Ninety-six two.'
'E.K.G?'
'Straight-line with a rare agonal beat.' god.'
'Tell Kaiser to pronounce the guy if that's all he's-' 'Yes, but-'
'Is the cardiac team on standby for this man?'
'Eric, we just lost his pressure,' June Feldman said. 'Do you want me to start CPR?' the wave formation on the oscinoscope was a straight line. The systolic and diastolic readouts both showed zero. The heart rate began to slow.
Cowley's respiration grew shallow.
'Damn,' Eric whispered. 'Okay, everyone, this is it. Tern, you'll just have to tell Kaiser to do his best.
Then call the cardiac people and get them down here.
We may have to open his chest right here. Also, get some blood.
They should have him typed by now. Tell them to forget the cross-match on two units and get them over. June, keep a finger on his carotid.
Ready, David?'
'Ready.
'Go for it.'
Dave Subarsky hit one switch, then another. A faint blue beam shot from the upper laser, followed almost instantly by a red one from the lower.
The beams intersected at a spot just above Russen Cowley's lowest left rib, and disappeared into his chest.
For five seconds, ten, there was nothing.
Eric shifted nervously and moved forward with the cardiac needle.
'More power?' he asked.
'I don't think so, Doc,' Subarsky replied.
'Jesus. Okay, I'm going in,' Eric said. 'Someone page the cardiac people. Stat.'
'Wait!' June Feldman was staring down at her fingertips. 'Wait… Yes, I've got a pulse. I've got a pulse.' At virtually the same instant, the central venous pressure level began to drop. The arterial pressure monitor kicked in at 70 over 30. Seconds later' it read 90.
Subarsky, cool as snow, nodded as if the wholeaffair were routine, but two of the nurses began to applaud.
'I've never seen anything like that in my life,' one of them exclaimed.
'Never.'
'Neither have I,' Eric muttered, softly enough for no one to hear.
Russell Cowley's coloring improved almost as dramatically as had his blood pressure and CVP. His breathing grew strong and steady. And within two minutes, his eyes fluttered open.
NO One spoke- Eric studied the faces around him.
Their expressions were a wonderful mix of awe and jubilation, It was the prolonged silence of a concert audience who had just experienced the music of a master.
And Eric relished every bit of it.
Through the open doorway, he saw Tern Dillard approaching.
No, not yet, dammit, his thoughts hollered. This is my moment.
Not yet.
':Everything okay?' Tern asked.
'Look for yourself.'
He motioned toward Cowley.
'Nice going. Eric, the cardiac people are on their way down.
You've really got to come in and help Kaiser.'
'Lord. Any change in the diver?'
'No.'
'So what's to help?'
'Eric, please.'
'Okay, okay. June, have the cardiac service admit this guy to them with ortho as consult. I'll be back in a few minutes.' He glanced over at Tern. 'Maybe sooner.
Gary Kaiser annoyed Eric more than any resident he had ever known.
He was immature, indecisive, and nervous as hell in all but the most routine situations.
