'This is ridiculous.'
Sarah took a calming breath. Over four years of medical school and two years of training, she had never had a clash of this sort with a professor. But there could be no backing down. 'Dr. Stoddard, Lisa's pressure is dropping, her bleeding is getting worse, and it may already be too late for the baby.'
'Why, you arrogant, ignorant-'
'Just a minute, Helen,' Blankenship cut in. 'You can say anything you want when this is over, but right now we have a girl who is going down the tubes, and we've got to focus on her. Dr. Baldwin is right. The heparin's not doing anything for the clots yet, and it's sped the bleeding up to the point where we're falling behind in our transfusions.'
'Do this and I'm off this case,' Stoddard said.
'Helen, you're one of the best hematologists I've ever known, and one of the most dedicated doctors. I can't imagine you ever allowing anything to get in the way of what's best for a patient.'
'But-'
'And deep down, you know that the few minutes it will take Sarah, here, to try what she knows will make little difference to the outcome.'
'But… all right, dammit. But after this is over, regardless of what happens, this hospital had better clarify its policy on medical quackery, or I am off the staff.'
'We'll do that, Helen. I promise. We'll do that. Sarah, how can we help?'
'Well, first give Lisa the protamine.'
'Helen?'
'Damn you, Eli. Okay, okay… This is ridiculous,' she muttered as she headed back to administer the heparin antidote. 'Absolutely ridiculous.'
'Now,' Sarah continued, sensing her pulse beginning to race, 'please just leave Heidi with me, pull as many people away from the bedside as possible, and keep all noise to a minimum.'
'Done. Anything else?'
'Just one. Please turn off the overhead lights.'
Lisa cried out as another contraction took hold. Sarah stroked her forehead, then knelt beside her.
'Lisa, close your eyes and listen to me,' she said softly. 'We've got work to do. This is the moment we practiced for in all those sessions. Do you understand?… Good. Let's just start with the easy things, the scenes, okay? Use them during your contractions. I'll help you, and Heidi is here to help you, too. In between contractions, I want you to concentrate on my voice and start trying to visualize what is happening in your bloodstream and your heart. Everything's moving too fast… too fast. There may be blood clots forming there, too, clogging your arteries. Try to relax and see them, too. Just relax… Just relax…'
Heidi continued whispering in Lisa's ear as Sarah briefly consulted a thin, frayed booklet. Having assured herself of the acupuncture points she wanted to stimulate, she set her first needle by twisting it in just below Lisa's left collarbone. Then, one at a time, she set five more of the steel needles in various points, trying to compensate for the limitations placed on the technique by Lisa's bandages and supine position.
An eerie silence had taken over the room, broken only by the muted churning of the suction apparatus and the soft beep of the cardiac monitor.
'Look,' Sarah heard someone whisper. 'I think the bleeding's letting up already.'
Sarah glanced at the suction bottle. In fact, the drainage did seem to have significantly lessened.
'Lisa, relax,' Sarah said again, pleasantly but firmly. 'Slow your heart… slow your blood… and just relax. You have the power…'
One minute passed. Then another. Lisa lay motionless now, her eyes closed. A contraction hit, visibly knotting her abdomen. She remained motionless and serene.
'Her heart rate's down from ninety to fifty, Sarah,' Blankenship said. 'The oozing from her IV and venapuncture sites may have stopped altogether. Randall, do you want to get ready?'
'Everything's set,' Snyder said. 'Anesthesia's standing by upstairs. Just say the word.'
The nasogastric tube was now draining only small amounts. All oozing had stopped. Carefully Sarah twisted out the six acupuncture needles. For ten seconds, fifteen, all was quiet.
'Go for it,' she said.
CHAPTER 5
July 2
Sarah ordered the operating table up two inches and screwed sterile handles into the parabolic overhead lights. Her eyes burned a bit; she'd been up and running for twenty-four hours without so much as a catnap. But her concentration, as always when she was in the OR, was as sharp as her scalpel. After centering the focused beams, she cradled the blade in her right hand, minutely adjusting its position until it felt a part of her. With her left, she tensed the skin along what had been the upper margin of the pubic hair escutcheon. Then, with a single, steady stroke, she opened the abdominal wall and separated the thin saffron layer of subcutaneous fat. She next handled what few bleeders there were by snapping each with a hemostat and touching the steel instrument with an electrocauterizer. Finally she cut the peritoneal membrane, exposing the bulging, gravid uterus.
'Everything all right?' she asked the anesthesiologist. 'Stable.'
'Okay, here we go.'
Sarah scored the surface of the uterus with her scalpel, then made a small opening in it. Inserting her index fingers, she pulled the beefy muscle fibers apart. Then, with the touch of her blade, she opened the amniotic membrane.
'We're in,' she said at the first gush of amniotic fluid. 'Suction, please.'
Time now was critical. The powerful uterus could clamp down at any moment, making the delivery of the baby within it anything but routine. For ten seconds Sarah's breathing, and it seemed her heart as well, stopped as she felt deep in the pelvis for the baby's legs, trying at the same time to assess the position of the umbilical cord. Gently her fingers closed about the spindly legs and drew them up through the incision. Next the torso and gently, ever so gently, the shoulders and arms. Finally she cradled the eggshell skull in her palm and guided it up through the incision. And just like that, the infant was born.
Quickly Sarah cleared its nose and mouth with a suction bulb. Moments later the expectant hush of the delivery room was pierced by the newborn's bleating cry. And instantly the tension in the room evaporated.
'It's a girl, Kathy,' Sarah said too flatly. 'A beautiful girl. Congratulations. Dad, if you'll step around over here, you can cut the cord.'
The father, just out of high school, sidled over nervously, did as she instructed, and then hurried back to the head of the bed where his young wife was alternately crying and laughing for joy. Swallowing at the sudden, unpleasant fullness in her throat, Sarah handed the perfect newborn over to the pediatrician. She hoped no one in the room could tell how close she was to tears herself-tears not of joy but of sorrow for the stillborn death of Brian Summer some seventeen hours before.
It was six o'clock in the morning, following an incredibly stressful, roller-coaster day and night during which Sarah had presided at two normal vaginal births and now this breech-presentation cesarean. But shortly after one o'clock the previous afternoon, the exhilaration of playing a major role in slowing Lisa Summer's bleeding had given way to the inestimable sadness of assisting in the extraction of her baby-dead before they had even reached the delivery room.
Like the infant of the previous DIC patient, Brian Summer had succumbed to massive bleeding within the placenta and premature separation of the placenta from the uterine wall. Had he been delivered even half an hour earlier, he might have survived. The agonizing choice, though, had been to channel all efforts toward saving Lisa, who almost certainly would have bled to death had the procedure not been delayed.
With an unfamiliar sense of distraction and detachment, Sarah watched her hands deliver the young woman's placenta, then begin closing the incisions she had made. The decision to try to save Lisa's life had been the correct
