The Surgeon Read Online Free PDF Page A

Because DIC used up
coagulation factors and platelets, both necessary for blood to
clot, the patient would begin to hemorrhage. To halt the DIC,
they had to administer heparin, an anticoagulant. It was a
strangely paradoxical treatment. It was also a gamble. If
Catherine's diagnosis was wrong, the heparin would make
the bleeding worse.

As if things could get any worse. Her back ached and her
arms were trembling from the effort to maintain pressure on
the liver. A drop of sweat slid down her cheek and soaked into
her mask.
Lab was back on the intercom. "Trauma Two, I've got STAT
results on John Doe."
"Go ahead," the nurse said.
"The platelet count's down to a thousand. Prothrombin
time's way up at thirty, and he's got fibrin degradation
products. Looks like your patient's got a roaring case of DIC."

Catherine caught Barrows's glance of amazement. Medical
students are so easy to impress.
"V tach! He's in V tach!"
Catherine's gaze shot to the monitor. A whipsawing line
traced jagged teeth across the screen. "Any pressure?"
"No. I've lost it."
"Start CPR. Littman, you're in charge of the code."
The chaos built like a storm, swirling around her with ever
more violence. A courier whooshed in with fresh frozen
plasma and platelets. Catherine heard Littman call out orders
for cardiac drugs, saw a nurse place her hands on the
sternum and begin pumping on the chest, head nodding up
and down like a mechanical sipping bird. With every cardiac
compression, they were perfusing the brain, keeping it alive.
They were also feeding the hemorrhage.
Catherine stared down into the patient's abdominal cavity.
She was still compressing the liver, still holding back the tidal
wave of blood. Was she imagining it, or did the blood, which
had trickled like glossy ribbons through her fingers, seem to
be slowing?
"Let's shock him," said Littman. "One hundred joules--"
"No, wait. His rhythm's back!"
Catherine glanced at the monitor. Sinus tachycardia! The
heart was pumping again, but it was also forcing blood into
the arteries.
"Are we perfusing?" she called out. "What's the BP?"

"BP is . . . ninety over forty. Yes! "
"Rhythm's stable. Maintaining sinus tach."
Catherine looked into the open abdomen. The bleeding
had slowed to a barely perceptible ooze. She stood cradling
the liver in her grasp and listened to the steady beep of the
monitor. Music to her ears.
"Folks," she said. "I think we have a save."
Catherine stripped off her bloody gown and gloves and
followed the gurney bearing John Doe out of Trauma Two. The
muscles in her shoulders quivered with fatigue, but it was a
good fatigue. The exhaustion of victory. The nurses wheeled
the gurney into the elevator, to bring their patient to the
Surgical Intensive Care Unit. Catherine was about to step
onto the elevator as well when she heard someone call out her
name.
She turned and saw a man and a woman approaching her.
The woman was short and fierce-looking, a coal-eyed
brunette with a gaze direct as lasers. She was dressed in a
severe blue suit that made her look almost military. She
seemed dwarfed by her much taller companion. The man was
in his mid-forties, and threads of silver streaked his dark hair.
Maturity had carved deeply sober lines into what was still a
strikingly handsome face. It was his eyes that Catherine
focused on. They were a soft gray, unreadable.
"Dr. Cordell?" he asked.
"Yes."
"I'm Detective Thomas Moore. This is Detective Rizzoli.
We're from the homicide unit." He held up his badge, but it
might as well have been dime-store plastic. She scarcely
looked at it; her focus was entirely on Moore.
"May we talk to you in private?" he asked.
She glanced at the nurses waiting with John Doe in the
elevator. "Go ahead," she called to them. "Dr. Littman will write
the orders."
Only after the elevator door had closed did she address
Detective Moore. "Is this about the hit-and-run that just came
in? Because it looks like he's going to survive."
"We're not here about a