“She might be hemorrhaging,” he said, bending down to lift Lisa’s eyelids. What he saw was what he’d feared. The pupils were dilating. “I’m sure she’s hemorrhaging,” he yelled.
The two residents stared at each other over the patient. Their thoughts were the same. “Mannerheim’s going to be furious,” said Dr. Newman. “We better call him. Go ahead,” he said to Nancy Donovan. “Tell him it’s an emergency.”
Nancy Donovan dashed over to the intercom and called out to the front desk.
“Should we open her back up?” asked Dr. Lowry.
“I don’t know,” said Newman nervously. “If she’s hemorrhaging inside her brain it would be better to get an emergency CAT scan. If she’s bleeding into the operative site, then we have to open her up.”
“Blood pressure still rising,” said Dr. Ranade with disbelief as he watched his gauge. He prepared to give her more medication to bring the blood pressure down.
The two residents remained motionless.
“Blood pressure still rising,” shouted Dr. Ranade. “Do something, for Christ sake!”
“Scissors,” barked Dr. Newman. They were slapped into his hand and he cut the sutures he’d just finished placing. The wound spontaneously gaped open as he got to the end of the incision. As he pulled the scalp flap back, the section of skull they’d removed for the craniotomy pushed up at them. It seemed to be pulsating.
“Let me have the four units of blood that’s on call,” shouted Dr. Ranade.
Dr. Newman cut the two hitch sutures holding the bone flap in place. The piece of bone fell to the side before Dr. Newman picked it up. The dura was bulging out with an ominous dark shadow.
The OR door burst open and Dr. Mannerheim came flying in, his scrub shirt was unbuttoned save for the bottom two.
“What the hell’s going on?” he shouted. Then he caught sight of the pulsating and bulging dura. “Jesus Christ! Gloves! Let me have gloves!”
Nancy Donovan started to open a new pair of gloves, but Mannerheim snatched them away from her and pulled them on without scrubbing.
As soon as a few sutures were cut, the dura burst open, and bright red blood squirted out over Mannerheim’s chest. It soaked him as he blindly cut the rest of the sutures. He knew he had to find the source of the bleeding.
“Sucker,” yelled Mannerheim. With a rude sound, the machine began to draw off the blood. Immediately it became apparent that the brain had shifted or swelled because Mannerheim quickly encountered the brain itself.
“The blood pressure is falling,” said Ranade.
Mannerheim yelled for a brain retractor to help him try to see the base of the operative site, but blood welled up the moment he took the sucker away.
“Blood pressure …” said Dr. Ranade, pausing. “Blood pressure unobtainable.”
The sound of the cardiac monitor, which had been so constant during the operation, slowed to a painful pulse, then stopped.
“Cardiac arrest!” shouted Dr. Ranade.
The residents whipped up the heavy surgical drapes, exposing Lisa’s body and covering her head. Newman climbed up on the stool next to the OR table and began cardiac resuscitation by compressing Lisa’s sternum. Dr. Ranade, having obtained the blood, hung it up. He’d opened all his IV lines, running fluid into Lisa as fast as possible.
“Stop,” yelled Mannerheim, who’d stepped back from the OR table when Dr. Ranade had shouted cardiac arrest. With a feeling of utter frustration, Mannerheim threw the brain retractor to the floor.
He stood there for a moment, his arms at his sides with blood and bits of brain dripping from his fingers. “No more! It’s no use,” he said finally. “Obviously some major artery gave way. It must have been from the God-damned patient pushing in those electrodes. Probably transected an artery and put it into spasm, which was camouflaged by the seizure. When the spasm relaxed it blew. There’s no way you can resuscitate this patient.”
Grabbing his scrub pants before they fell, Mannerheim turned to leave. At the door he looked back at the two residents. “I want you to close her up again as if she were still alive. Understand?”