“Benson, where’s that key?” Creighton griped once when she was motionless for a particularly long time.
Thorny, worried himself, shot a cold look at the surgeon. The nonstandard chest opening was a good test, but he didn’t want to see Linda open like that any longer than absolutely necessary. But when the heart was finally exposed, he snuck a look at the time and relaxed a bit. Actually, they were right on schedule; it had only seemed longer because of the uneven pace.
“Well, let’s take a look here,” Creighton said. His gloved hands disappeared inside Linda’s chest. “It’s just as I thought. Everything else looks OK, but her left ventricle is shot. Well, we knew that. Looks like she’s going to need a new heart.” He glanced up at Thorny. “We’ll put her on full cardiopulmonary bypass, and then start.” Without a glance at Angel, he added, “Robot, cannulate the superior vena cava.”
Angel didn’t move.
“What’s the problem, Angel?” Thorny asked.
“I only see a small contusion involving the anterior wall. The rest of the left ventricle may just be stunned. If we can use an assist device, we might be able to tide her over until her heart recovers on its own. There have been several good review articles in the past year on the management of myocardial contusion in the Journal of the American College of Cardiology and—”
“Is,” Creighton hissed, “this machine questioning my judgment?”
“Angel,” Thorny said as smoothly as he could, “is providing data. She has up-to-the-minute access to the literature—”
“And so does a freshman medical student with a computer, but that doesn’t make him qualified to give an expert opinion on something like this.” Creighton’s pupils flared above his surgical mask. “I’ve never seen any patient like this survive without a transplant, and, Old Boy, no pseudo-gynecological toy is going to tell me otherwise. Now either program this thing to follow my instructions, or get it, and yourself, out of here and I’ll finish the operation!”
Angel turned to him, and reality set in. Thorny wasn’t an expert in this area. He couldn’t tell if a heart needed to be replaced by looking at it. Dr. Tunman, the cardiologist, was qualified to argue with Creighton—but they never had been able to reach him. And a decision had to be made now.
Linda Coombs was precious to him. He didn’t want her to become one of Creighton’s statistics if her heart wasn’t replaced. Still, he wondered whether they would really be doing her a favor by giving her a mechanical heart. That choice had the potential of saving her life, if a donor heart could be transplanted later. But in the meantime she would have to live with the constant threat of a crippling stroke from a blood clot, or dying suddenly—or worse, perhaps a lingering, painful death on life support—if the device malfunctioned.
He thought Angel might be right about the lack of serious damage, but there was no way for him to enforce that. If he told her not to do it, she wouldn’t—but Creighton would; and Angel would probably never get another chance. That wouldn’t help Linda at all. Damn!
“Angel, we’ll talk later. Right now, I think the best thing for Linda is for you to follow Dr. Creighton’s direction to the best of your ability.”
“I feel bad about this. Very well.”
Once decided, her fingers, and those of here teleoperated assistants moved quickly and surely. Linda Coombs’s heart was on a tray and the latest Rockwell in her chest in minutes. Thorny checked the telemetry to see that its glucose/hemoglobin fuel cells were up to full voltage, and nodded to the two surgeons. A charade for Creighton’s benefit; Angel, of course, already knew the device was ready.
The rest of the operation was anti-climactic. Angel disconnected the heart-lung bypass, and the new heart took over. Both she and Creighton seemed satisfied by the readings. A special-purpose telop, bristling with microwaldos, descended from the OR ceiling like a spider, and Angel used it to identify and ligate a few small bleeding vessels. Creighton seemed to lose interest about that time, mumbling something about the rest of the operation being routine and that he would check Linda again when she reached Recovery. Thorny, however, took a mild stimulant and stayed, fascinated with the repair work despite the hour.
Tireless Angel continued to work, closing Linda’s chest. She applied a coral-based cement to the sternum and rib fractures that set in minutes, and would be stronger than the adjoining bone until it was replaced by regeneration.
They finished at four A.M., and Angel bounced out to the Recovery Room as bright and cheery as always. Thorny followed her, considerably less energetically.
“Except for her heart, Linda will be just as good as new in a few weeks!”
“Except for her heart, her baby, and her husband.” Thorny reminded Angel. “And she doesn’t know she’s lost any of that yet, except maybe she got a look at her husband before she lost consciousness.”
“Post-trauma depression candidate, then?” Angel replied, her voice full of serious concern intonations.
“Angel, I’ve known Linda all her life. She’s sensitive, passionate, drives herself hard and takes things hard. I’m not sure how she’s going to take all this; everything she was living for is gone.”
“That could be serious.” Angel agreed. “The reason isn’t known, but depression has been associated with an increased risk of implant clotting. We could reduce that risk by 50 percent with a tetracyclic antidepressant. At least, that’s what Withers, Yung, and Zegrov reported in last month’s Archives of—”
Thorny held up a hand. “First, it’s too late for me to think like that. Let’s just get her to the ICU and keep her asleep for another twenty-four hours at least so we, I mean I, will be ready for her. Second, antidepressants can have some nasty side effects, like dropping her blood pressure. Her Rockwell won’t help very much with that.”
“You’re right. Why didn’t I think of that? The data’s there. I just don’t always create the right question.”
“You can’t anticipate everything, Angel. Look, Creighton’s right about some things. There’s a hell of a lot more to practicing medicine than just quoting articles. Every patient is unique. ‘Cookbook’ medicine works most of the time, but it takes judgment and experience to know when the usual rules don’t apply—and those are the kinds of things you can’t program. That’s why you’re doing this residency.” Thorny winced at what he had to say next, but he had to be fair. “And we can’t judge Creighton on his phony personality. Many people actually like that style, and he really is an outstanding surgeon.” He was trying to convince himself as much as Angel.
She nodded, seriously.
“I’m awfully tired.” Thorny sighed. “These are late hours for a sixty-seven-year-old. I’ll be back in the office about eleven, I suspect. I hope you don’t mind answering phones.”
“Not at all, Thorny.” This time he got a hug that was a little scary in its intensity. “I never forget a message. Good night.”
“Yeah. Night.”
He left the recovery room and called his car, which met him by the time he’d walked down the stairs and out of the lobby. The east was already gray. Talk about the lullaby of Broadway! Looked like another snowstorm on its way, too. Suited his mood.
Angel’s performance, he thought as he dozed off on the freeway, was the only saving grace in a very bad day, but it had only gotten her a fifty-fifty acceptance with the hospital staff, in his estimation. And that was equating Nurse Miles with the chief of surgery. And God help Linda Coombs when she finally woke up. And what would pathology say about her heart in the clear light of twenty-twenty hindsight?