Lover Unbound

seat at a small table to record everything. Two others were on standby to bust out supplies at Jane's direction, and a fourth got ready to cut off the patient's leather pants. A pair of residents hovered to watch or help as needed.

'I got the wallet,' the paramedic said, handing it over to the nurse with the scissors.

'Michael Klosnick, age thirty-seven,' she read. 'The picture on the ID is blurry, but… it could be him, assuming he dyed his hair black and grew the goatee after it was taken.'

She handed the billfold over to the colleague who was taking notes and then started removing the leathers.

'I'll see if he's in the system,' the other woman reported as she logged onto a computer. 'Found him-wait, is this… Must be an error. No, address is right, year's wrong.'

Jane cursed under her breath. 'May be problems with the new electronic records system, so I don't want to rely on the information in there. Let's get a blood type and a chest X-ray right away.'

While blood was drawn, Jane did a quick preliminary examination. The gunshot wound was a tidy little hole right next to some kind of scarification on his pectoral. A rivulet of blood was all that showed externally, giving little hint of whatever mess was inside. The knife wound was much the same. Not much surface drama. She hoped his intestines hadn't been nicked.

She glanced down the rest of his body, seeing a number of tattoos-Whoa. That was one hell of an old groin injury. 'Let me see the X-ray, and I want an ultrasound of his heart-'

A scream ripped through the OR.

Jane's head snapped to the left. The nurse who'd been stripping the patient was down on the floor in full seizure with her arms and legs flapping against the tile. In her hand she had a black glove the patient had been wearing.

For a split second everyone froze.

'She just touched his hand and went down,' someone said.

'Back in the game!' Jane clipped. 'Estevez, you see to her. I want to know how she is immediately. Rest of you get tight. Now!'

Her commands snapped the staff into action. Everyone refocused as the nurse was carried over to the bay next door and Estevez, one of the residents, started to treat her.

The chest X-ray came out relatively fine, but for some reason the ultrasound of the heart was of poor quality. Both, however, revealed exactly what Jane expected: pericardial tamponade from a right ventricular gunshot wound: Blood had leaked into the pericardial sack and was compressing the heart, compromising its function and causing it to pump poorly.

'We need an ultrasound of his abdomen while I buy us some time with his heart.' With the more pressing injury ascertained, Jane wanted more information on that knife wound. 'And as soon as that's done, I want both machines checked. Some of these chest images have an echo.'

As a resident went to work on the patient's belly with the ultrasound wand, Jane took a twenty-one-gauge spinal needle and plugged it into a fifty-cc syringe. After a nurse Betadined the man's chest, Jane pierced his skin and navigated the bone anatomy, breaching the pericardial sack and drawing out forty ccs of blood to ease the pericardial tamponade. Meanwhile, she gave out orders to prepare OR two upstairs and get the cardiac bypass team on the ready.

She gave the syringe to a nurse for disposal. 'Let's see the abdominal.'

The machine was definitely misbehaving, as the images were not as clear as she'd like. They did, however, show some good news, which was confirmed as she palpated the region. No major internal organs appeared to be affected.

'Okay, abdomen appears sound. Let's move him upstairs, stat.'

On her way out of the chute, she put her head into the bay where Estevez was working on the nurse. 'How's she doing?'

'Coming around.' Estevez shook his head. 'Her heart stabilized after we hit her with the paddles.'

'She was fibrillating? Christ.'

'Just like the telephone guy we had in yesterday. Like she'd been hit with a load of electricity.'

'Did you call Mike?'

'Yeah, her husband's coming in.'

'Good. Take care of our girl.'

Estevez nodded and looked down at his colleague. 'Always.'

Jane caught up with the patient as the staff wheeled him down the chute and into the elevator that went to the surgical suite. One floor up she scrubbed in while the nurses got him onto her table. At her request, a cardio thoracic surgical kit and the heart/lung bypass machine had been set up, and the ultrasounds and X-rays taken downstairs were glowing on a computer screen.

With both hands latexed and held away from herself, she reviewed the chest scans again. Truth be told, both of them were subpar, very grainy and with that echo, but there was enough to orient herself. The bullet was lodged in the muscles of his back, and she was going to leave it there: The risks inherent in removing it were greater than letting it rest in peace, and in fact, most gunshot victims left the chute with their lead trophy wherever it ended up.

She frowned and leaned in closer to the screen. Interesting bullet. Round, not the typical oblong shape she was used to seeing inside her patients. Still, appeared to be made of garden-variety lead.

Jane approached the table where the patient had been hooked up to the anesthesia machines. His chest had been prepped, the regions around it draped in surgical cloth. The orange wash of Betadine made him look like he had a bad fake tan. 'No bypass. I don't want to use up the time. Tell me we have blood for him on hand?'

One of the nurses spoke up from the left. 'We do, although his blood didn't type.'

Jane glanced across the patient. 'It didn't?'

'The sample reading came back unidentifiable. But we have eight liters of O.'

Jane frowned. 'Okay, let's do this.'

Using a laser scalpel, she made an incision down the patient's chest, then sawed through the sternum and used a rib spreader to pull open the heart's iron bars, exposing-

Jane lost her breath. 'Holy…'

'Shit,' someone finished.

'Suction.' When there was a pause, she looked up at her assisting nurse. 'Suction, Jacques. I don't care what it looks like, I can fix it-provided I get a clear shot at the damn thing.'

There was a hissing sound as the blood was removed, and then she got a good gander at a physical anomaly she'd never seen before: a six-chambered heart in a human chest. That 'echo' she'd seen on the ultrasounds was, in fact, an extra pair of chambers.

'Pictures!' she called out. 'But make it quick, please.'

As photographs were taken, she thought, Boy, the Cardiology Department is going to go nuts over this. She'd never seen anything like it before-although the hole torn in the right ventricle was totally familiar. She'd known a lot of them.

'Suture,' she said.

Jacques slapped a pair of grips into her palm, the stainless-steel instrument carrying a curved needle with a black thread clipped onto the end. With her left hand, Jane reached in behind the heart, plugged the back end of the hole with her finger, and stitched the front impact site closed. Next move was to lift the heart out of its pericardial sac and do the same underneath.

Total elapsed time was under six minutes. Then she released the spreader, put the rib cage back where it was supposed to be and used stainless-steel wire to close the two halves of the sternum back together. Just as she was about to staple him from his diaphragm to his collarbone, the anesthesiologist spoke up and machines started to beep.

'BP is sixty over forty and falling.'

Jane called out the heart-failure protocol and leaned down to the patient. 'Don't even think about it,' she snapped. 'You die on me and I'm going to be really ticked off.'

From out of nowhere, and against all medical rationale, the man's eyes blinked open and focused on her.

Jane jerked back. Good God… his irises held the colorless splendor of diamonds, shining so bright they