By the time Joseph realized the boy was not breathing, the medical emergency team arrived. They worked feverishly but to no avail. After fifteen minutes, a reluctant Dr. Joseph Riggin was led away to have his hand sutured while Sally Marcheson removed the misplaced X rays.
As Thomas Kingsley scrubbed, he felt the surge of excitement that always possessed him before an operation. He had known he was born to be a surgeon the first time he’d assisted in the OR as an intern, and it hadn’t been long before his skill had been acknowledged throughout the hospital. Now as Boston Memorial’s foremost cardiovascular surgeon, he had an international reputation.
Rinsing off the suds, Thomas lifted his hands to prevent water from running down his arms. He opened the OR door with his hip. As he did so, he could hear the conversation in the room trail off into awed silence. He accepted a towel from the scrub nurse, Teresa Goldberg. For a second their eyes met above their face masks. Thomas liked Teresa. She had a wonderful body that even the bulky surgical gown she was wearing could not hide. Besides, he could yell at her if need be, knowing she wouldn’t burst into tears. She was also smart enough not only to recognize that Thomas was the best surgeon at the Memorial but to tell him so. Thomas methodically dried his hands while he checked out the patient’s vital signs. Then, like a general reviewing his troops, he moved around the room, nodding to Phil Baxter, the perfusionist, who stood behind his heart-lung machine. It was primed and humming, ready to take over the job of oxygenating the patient’s blood and pumping it around the body while Thomas did his work.
Next Thomas eyed Terence Halainen, the anesthesiologist.
“Everything is stable,” said Terence, alternately squeezing the breathing bag.
“Good,” said Thomas.
Disposing of the towel, Thomas slipped on the sterile gown held by Teresa. Then he thrust his hands into special brown rubber gloves. As if on cue, Dr. Larry Owen, the senior cardiac surgery fellow, looked up from the operative field.
“Mr. Campbell is all ready for you,” said Larry, making room for Thomas to approach the OR table. The patient lay with his chest fully opened in preparation for the famous Dr. Kingsley to do a bypass procedure. At Boston Memorial it was customary for the senior resident or fellow to open as well as close such operations.
Thomas stepped up to his position on the patient’s right. As he always did at this point, he slowly reached into the wound and touched the beating heart. The wet surface of his rubber gloves offered no resistance, and he could feel all the mysterious movement in the pulsating organ.
The touch of the beating heart took Thomas’s mind back to his first major case as a resident in thoracic surgery. He had been involved in many operations prior to that, but always as the first assistant, or second assistant, or somewhere down the line of authority. Then a patient named Walter Nazzaro had been admitted to the hospital. Nazzaro had had a massive heart attack and was not expected to live. But he did. Not only did he survive his heart attack, but he survived the rigorous evaluation that the house staff doctors put him through. The results of the work-up were impressive. Everyone wondered how Walter Nazzaro had lived as long as he had. He had occlusive disease in his main left coronary artery, which had been responsible for his heart attack. He also had occlusive disease in his right coronary artery with evidence of an old heart attack. In addition he had mitral and aortic valve disease. Then, as if that weren’t enough, Walter had developed an aneurysm, or a ballooning of the wall, of his left ventricle of his heart as a result of the most recent heart attack. He also had an irregular heart rhythm, high blood pressure, and kidney disease.
Since Walter was such a fund of anatomic and physiologic pathology, he was presented at all the conferences with everyone offering various opinions. The only aspect of his case that everyone agreed upon was the fact that Walter was a walking time bomb. No one wanted to operate except a resident named Thomas Kingsley, who argued that surgery was Walter’s only chance to escape the death sentence. Thomas continued to argue until everyone was sick of hearing him. Finally the chief resident agreed to allow Thomas to do the case.