ANNA BROKE ALL SPEED RECORDS FOR A QUICK CHANGE INTO SCRUB clothes. Soon she stepped away from the scrub sink, her dripping arms held before her, her mind focused on the operation she was about to perform. "Let's go, Matt. That'll have to do."
She bumped through the door into OR Six, and then it hit her. This was where it all started—with Eric Hatley's operation and the events that followed in rapid-fire succession, events that now threatened to end her career. Well, she'd go out fighting. The place didn't matter. What mattered was what she did here.
As she gowned and gloved, Anna studied her surgical team. Karen, the scrub nurse, chose instruments from a sterile pan and arranged them on the green-draped rolling tray that would be placed across the operating table for easy access. Anna nodded to herself. Karen was a battle-tested veteran of the surgical wars, someone who could be depended on not to crack under pressure. But when she saw the circulating nurse, Anna winced. Keisha was a new hire, fresh out of nursing school. Would she panic at a critical moment?
Matt stepped to his spot across the operating table from her. Below his surgical mask, his Adam's apple moved twice. His shoulders rose and fell, and Anna could hear the sigh. She knew what he was feeling. She'd been there herself once. Anna breathed a silent prayer. Time to get moving. "Okay, prep and drape. Keisha, give her belly a couple of passes with Betadine. Matt, help Karen with the drape sheet. Anesthesia, are we ready?"
Anna focused on the man sitting at the head of the operating table. Even with the surgical mask covering the bottom of his face, the voice and the eyes confirmed his identity: JeffMurray, the junior resident who'd given Eric Hatley's anesthetic.
"Jeff," Anna said, "where's your staffman?"
"He . . . He's in the next room. We have every available OR going, so he has to stafftwo cases. But I'll be fine, Dr. McIntyre. Don't worry." The words expressed confidence that the eyes didn't back up.
No time to quibble. This was the team she had. "Okay, Jeff. Keep her as light as possible. Watch her blood pressure—I mean, watch it closely. Keep the fluids going, push the blood until we get the bleeding controlled."
"Right. She's got Ringer's running in one arm, a unit of unmatched O negative in the other, and the cross-matched blood is on its way up." He met her gaze. "I'm on top of this one. Really."
Anna turned back to the operative field. She picked up a gauze sponge with her left hand and held out her right."Scalpel."
She felt the familiar pressure as Karen slapped the instrument into her palm. "Matt, get a clamp in one hand, a sponge in the other. Clamp the largest skin bleeders. We can deal with them later. As soon as we get the abdominal cavity open, be ready with the suction. There'll be a lot of blood, and you have to keep it cleared out so I can see."
Anna could see the drops of sweat already dotting Matt's forehead. He'd done well as a medical student on her service, but she was asking him to take a huge step up in responsibility. Well, he'd either sink or swim, and she couldn't waste time worrying about it.
Now she worked on automatic pilot. Skin incision, through the subcutaneous fat—thank goodness the girl was thin. Separate the muscles. "Self-retaining retractor." Matt was doing well, better than she'd hoped.
"How's her pressure holding up?" Anna asked.
Murray's voice was steady. "She was shocky when we brought her in, but with fluids she's holding at about a hundred over sixty. One unit unmatched O negative already in, first unit of cross-matched blood going in now."
"Keep me posted," she said. "Here we go. Opening the peritoneum. Matt, ready with the suction. Karen, we'll need a stack of lap pads—"
"Already up, Doctor."
"Thanks." Anna grabbed one of the large gauze laparotomy pads. "We'll need a bunch."
She incised the peritoneum, the tough but thin covering around the abdominal contents. Immediately, dark blood welled into the incision. "Left upper quadrant, Matt. Looks like a ruptured spleen."
In a moment, the bleeding area was packed off. Now Anna was able to identify the problem: a laceration running diagonally across the spleen. This was what she'd hoped for, one of the best possible scenarios. The spleen was important but people could live quite nicely without one, since other parts of the body would take over its function of making blood cells and antibodies. All Anna had to do was clamp offthe blood vessels supplying the spleen and remove it. Problem solved.
Anna finally relaxed a bit. "Matt, you got a permit for splenectomy?"
"Splenectomy, partial resection of liver, bowel resection, whatever might be necessary."
"Good man. Okay, Karen. Let's get that spleen out of here. Bring up the vascular clamps." With the problem diagnosed and a solution in sight, Anna swung into teaching mode. "Matt, we're looking for the region where the blood vessels feed into the spleen. Tell me what it is and the procedure."
"The splenic artery and vein. After you ligate and divide those, you identify and clip the short gastric vessels."
As Matt described the anatomy involved, Anna's hands moved with efficiency and skill. This was what she knew, what she was good at, what she loved. It was good to be back.
She paused for a second as the thought crossed her mind. Soon, maybe as early as tomorrow, she'd be in an interview room with Dowling and Green. They'd already made it clear they were planning to charge her with the murder of Eric Hatley. It was very possible that she was performing her last operation. Well, if that was the case, she'd do a good job. And today she could add one more name to the list of patients who were alive because of her efforts.
"Rosa Hernandez. Fourteen years old. Exploratory lap, splenectomy. She's on her third unit of blood, just finishing her second bottle of Ringer's. Vitals are stable." As he gave his report to the nurse in the surgical Recovery Room, Dr. Murray's voice carried an authority Anna hadn't heard in it before. "Call me if you have any questions."
Anna wiped her palms on her scrub suit before offering her hand to Murray. "You did a nice job."
"Thanks, Dr. McIntyre." She noticed that his palms were still moist, but his handshake was firm. "I'm going to see if Dr. Jenkins needs my help in room four."
Anna watched him walk away. She knew that surviving the challenge of cases like this one supplied the building blocks of confidence that helped make a mature physician. She flashed on her own such experiences. She'd heard it said that to be a good trauma surgeon you had to be fearless. Her own opinion was that a little healthy fear never hurt. It was the doctors who were overconfident and thought they could do no wrong who always seemed to get into trouble.
"Dr. McIntyre?" Matt's voice at her elbow brought Anna out of her daydreaming.
"Yes, Matt?" "I've handwritten an op note. I guess you'll dictate the formal one. Do you want to write the orders?"
Speaking of performing well under fire, Matt had done well also. She might as well let him spread his wings a bit more."Why don't you write the orders, then show them to me? I'll sign offon them. While you do that, I'll talk with the family."
The Hernandez family was huddled together in a corner of the surgery waiting room. Anna tried to put a smile on her face as she approached them. She knew the anxiety, the empty feeling in the pit of the stomach that came when the doctor walked toward you with news that could wreck your life forever. She'd experienced it herself when her father was in Intensive Care after his stroke. No high-stakes poker player ever tried to read the face of his opponents with any more intensity than Anna did that day. But it was only when the doctor looked down at Anna and her mother and began, "I'm sorry" that the news became obvious. She'd vowed that, if she had good news to convey, it would be evident to the family as soon as she walked through the door.
"Is she all right?" Mrs. Hernandez looked up at Anna, her anguish and pain reflected in her eyes.
Mr. Hernandez sat grim-faced and stoic, obviously prepared to hear the worst and support his wife if the dread words were uttered.
"Rosa is fine." Anna had more to say, but the words were cut offwhen Rosa's parents jumped to their feet and embraced, first each other and then her. "Thank you, Doctor." Mrs. Hernandez wrung Anna's hand."Thank you for saving our daughter."
"Why don't you sit down and let me explain what we found?" Anna pulled up a chair so she'd be at eye level with Rosa's parents. "The force of the crash ruptured her spleen. We controlled the bleeding, then removed the spleen. It's a fairly common operation, sometimes done as an elective procedure for people with certain types of blood disorders. She'll function fine without it. We've replaced most of her blood loss, and she'll be able to build up the rest on her own."
They both began to speak at once. Anna held up a hand. "I'll answer all your questions, but first let me get back in and look at Rosa. She'll be in the Recovery Room until she's awake and stable. Either I or one of my staffwill look in on her a couple of times a day, and the nurses will notify us immediately if there's any change in her condition. Why don't you wait here? The nurse will come and get you when it's okay for you to see her."
Back in the recovery room, she found Matt writing in Rosa's chart. "How're you doing?"
"I think I've got it covered," he said. "See what you think."
She took the chart and scanned what Matt had written. It all looked good.
"Do you agree with the morphine pump for pain?" Matt asked. "I can change it to IM Demerol if you want to." He lowered his voice. "Some of the older staffstill like that, but I figure you—" It felt so good to be back in action that Anna had almost forgotten her problems. Now one of them came roaring back at her. Whether it was the look on her face or the way she shoved the chart back toward him, Matt's voice trailed off. "Dr. McIntyre?"
"Why don't you get Dr. Fowler to sign offon this?" Anna said.
"Did I do something wrong?"
"Matt, someone stole my DEA number and has been writing 'scripts for narcotics. I've had a hard time convincing the authorities to clear me, and even though they're supposed to have issued a new DEA number, I'm not sure the process is complete. Right now, I think it's best that someone else sign offon an order that involves narcotics."
Anna couldn't read Matt's expression. Did he believe she was unjustly accused? Was he sympathetic or suspicious? Was she justifying herself in his eyes or feeding the rumor mill she knew existed in the medical center?
"I'd heard a little about that," he said. "And I think you ought to know that none of us ever thought you did anything wrong."
As though embarrassed by his statement, Matt looked down at the chart. "I'll get Dr. Fowler to sign offon this."
"Thanks, Matt. I appreciate it."
"Thank you for letting me help. I'm applying for a surgery residency here at the medical center. Would you mind if I listed you as a reference?"
"I'd be honored," Anna said. "Look, Glenn. You need to come clean on this one." Ross Donovan watched a drop of his sweat hit his desk blotter. He loosened his tie and moved the phone to his other hand. "I saw your name on the label. I know you're involved in this some way. I can make sure you go down for it, or I can try to keep you out of it. But I can't help you unless you tell me everything."
"Ross, you gotta believe me. I didn't think I was doing anything wrong. Honest." The last word came out like a strangled call for help.
The lawyer waited for more, but all he heard was heavy breathing. Okay, now it got tricky. How far could he push the man? "Tell you what. When's your next meeting?"
The answer came without hesitation. "Tonight at eight. The basement of St. Barnabas Church on McKinney."
"Okay, I know where that is. I'll be parked around the corner at seven-thirty. Find me and get in the car."
"I won't tell your employer about this. At least not yet. But I want the whole story. And you'd better level with me. If I find out you're lying, all bets are off."
After he hung up, Ross sat for a moment with his eyes closed. This was crunch time. If this meeting tonight worked out, he might be close to solving Anna's problems. Of course, if it didn't, he could be in big trouble, trouble that could have the police on him like fleas on a dog. It was times like this that had driven him to depend on courage in a bottle.
Ross pulled out the bottom drawer of his desk and probed without looking, ignoring everything else in the drawer, until his fingers found what he wanted. He pulled out a bottle and put it on the desktop. "Your Honor," he said, in his best courtroom voice, "I call to the stand Mr. James Beam. Mr. Beam is an old friend, one who has been with me through many difficult times."
Ross reached once more into the drawer and withdrew a glass. He held it up, and the rays of the noon sun passing through it cast a rainbow on the opposite wall. A bottle and a glass, companions he'd known for a long time. And oh, how he'd missed them.
One drink—one drink wouldn't hurt, would it? He knew what it would be like, could almost taste the smooth liquor rolling across his tongue, feel the burn as it hit his stomach, anticipate the feeling that followed. He uncapped the bottle and filled the glass almost to the brim.
Some ex-smokers carried a pack, testing their willpower and daring themselves to quit. Most didn't, though, because they knew that sometime, somewhere, they'd succumb to temptation. Stress, fatigue, even hunger were the enemies of the addict, whether their drug of choice was nicotine, alcohol, or narcotics.
Ross had decided to keep his stash intact, to test his willpower. His AA sponsor tried to talk him out of it. "Don't be around alcohol. Don't be around people who drink. Don't go into bars. Avoid cocktail parties. All you need is the opportunity, because believe me—the craving will always be there. Always."
If he ever needed some Dutch courage, though, now was the time. Ross was pleased to note that the surface of the amber liquid in the glass didn't move when he held it up. His hands hadn't always been this steady. He had things under control now. No problems.
He wasn't sure how long he sat there glass in hand, staring at the half-full bottle of bourbon. Then he walked to the window and raised the glass in a toast. To sobriety . . . or to oblivion?
Yesterday, he'd gone to an AA meeting and said, "I'm Ross. I'm an alcoholic, and I have ninety-nine days." If he went to a meeting tomorrow, would he be awarded a hundred-day chip? Or would he be saying, "I'm Ross. I'm an alcoholic. Yesterday I fell offthe wagon."
He took a deep breath, then another. Finally, he turned away from the window. At the desk, he put the glass down next to the bottle and stared at them as though they were a magic crystal ball, holding all the answers to his questions. Would bourbon rule him for the rest of his life? In a single motion he swept both glass and bottle offthe desk into the wastebasket. He heard the tinkle, smelled the fumes.
He shrugged. The cleaner would take care of the trash he'd created. Nothing could clean up the mess he had been about to make of his life.
Ross grabbed his coat and briefcase and left the office, not totally sure where he was going but knowing that wherever it was, he'd get there sober.