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pressure at all,” Lee reported. “Ventricular extra beats in pairs.”
    Sometimes you just got to do what you got to do, Matt was thinking.
    He attached a four-inch-long, wide-bore cardiac needle to a 20cc syringe and hooked an alligator clamp to the base of it. He would know he was wrong about there being pericardial blood only after he had driven the heavy needle through the tissue-thin pericardial membrane and into the base of Teague’s heart. The electrocardiogram would react immediately to the trauma, and hopefully, he would have time to stop and withdraw the needle before any major damage was done to the cardiac muscle. Hopefully. But if he pierced the muscle and hit a coronary artery, the resulting heart attack would give Teague almost no chance at all.
    Matt forced the needle through the skin at the V formed by Teague’s left lower ribs and the tip of his sternum. Then he angled it toward his left shoulder. Keeping the pressure constant, he advanced the needle through the diaphragm toward what he envisioned was the base of the heart.
    Slowly . . . slowly . . .
    “Lots of extra beats,” the nurse reported.
    “Are you hitting his heart right now?” Laura asked.
    Matt checked the monitor.
    I sure hope not, he thought.
    “No,” he said assuredly.
    “Are you sure?”
    Without warning, the syringe filled with blood.
    Yes!
    Matt switched the three-way valve on the syringe to empty and injected its crimson contents into a small glass cup. Then he withdrew another 25cc of blood from Teague and squirted it into a larger beaker.
    “How do you know you’re not drawing blood directly from his heart?” Laura asked.
    The woman simply wasn’t going to let up.
    Hal stepped forward.
    “Ms. Williams,” he said calmly, “it looks very much like Dr. Rutledge knows what he is about. There is one way to tell right here where that needle tip is. If that blood Dr. Rutledge just removed was sitting in this man’s pericardial space, it probably won’t clot. If it’s directly from the ventricle of the heart, it will.”
    “How long will that take to know?”
    Matt ignored the question and drew off another syringeful. Teague’s condition remained unchanged. To his left, Lee tried again to hear a pressure, then shook his head gravely.
    “If he’s in shock and you might be taking blood from his heart, won’t that make the situation even worse?” Laura asked.
    Back off! Matt wanted to scream. The nurse was quite obviously protecting herself against Robert Crook’s certain onslaught.
    I tried to reason with him, Dr. Crook, really I did.
    Matt slid a thin plastic catheter through the needle and into what he hoped was the pericardial space. Then, carefully, he withdrew the needle and fixed the catheter in place with a single suture through the skin of Teague’s chest. Blood oozed from the catheter opening and soaked an expanding stain into the sterile drape. For several seconds there was nothing but a tense silence.
    “Pressure’s still zero,” Lee reported at the moment Robert Crook charged into the room.
    A rotund, ruddy-faced man, Crook had dense, sandy-gray brows that always looked to Matt like giant woolly caterpillars about to do battle. Along the margin of his left jaw were several fresh clots from where he had nicked himself shaving, as well as a tiny, bloodstained flake of tissue paper. His response to the emergency at MCRH had clearly been to charge into the bathroom and break out his razor and shaving mug.
    “Rutledge, what’s going on?” he demanded.
    Matt shrugged.
    “He lost his blood pressure and I couldn’t figure out why. I decided he had a pericardial tamponade, so I tapped him.”
    “You . . . tapped him?”
    “Still no pressure,” Lee called out.
    “Be sure the dopamine is open all the way,” Matt ordered.
    “It is.”
    “Did you see pericardial fluid on his echo?” Crook asked, ignoring the sterile field and the thin catheter in order to listen with his stethoscope.
    “I . . . wasn’t