“I hope he was randomized into the beta strength of the drug.”
“Thankfully, he was. Hey, how’d you like to meet him? We live only a few miles from here. Meeting you would brighten Jack up considerably. I guarantee it. You can even watch me administer his Vasclear. I’m giving it to him at home.”
“If you think he’d like it.”
“He’d love it, believe m—”
“What’s the matter?”
“My beeper! I just realized that I don’t have it. I’m never without—Oh, I remember. I changed my pants at the hospital. The beeper’s wrapped up in my bag in the car. I’ll just call and tell him we’re coming.”
“I’ll hit the ladies’ room and meet you back here.”
Brian found the pay phone in the front entryway. After four rings, he heard his own voice on their answering machine.
“Hello, you’ve reached the Holbrooks—”
He hung up, his heart beginning to pound, and waited an interminable twenty seconds for the machine to clear. Then he called again. Same result.
He raced out to the LeBaron and fumbled with the trunk. His beeper was hooked to the belt loop of his pants, inside his overnight bag. The LED displayed a call from home.
“Jesus,” he muttered, racing back to the phone. “Come on … answer.… Answer, dammit!”
Three rings, then the answering machine again.
“Pop, I’m on my way home,” he blurted after the beep. “I’m on my way right now!”
CHAPTER EIGHTEEN
BRIAN CHARGED BACK INTO THE RESTAURANT JUST AS Teri returned to their table.
“There’s something wrong,” he said. “There’s no answer at home. Jack would never not be there and we had help tonight to boot. And he did try to page me. Dammit. I can’t believe this. The one night I don’t have my beeper.”
He threw two twenties on the table, took Teri’s hand, and hurried her outside.
“Do you want me to follow you home?” she asked.
“No! I mean, maybe you should. Sure.”
Brian sped off with his focus alternating between the road and the rearview mirror. He squealed around the corner of his street expecting to see rescue squad vehicles parked outside the house. But except for the living-room light the place looked deserted. Without waiting for Teri, he raced inside. There was a note taped to the lamp beside Jack’s chair—a note from the neighbor who was watching him.
Brian,
9:00 P.M. We tried paging you, but your beeper must be off. Your father is having severe chest pain and he’s refused to call the ambulance because he wants to go to Boston Heart and he thinks they’ll take him to Suburban. He was going to call a cab, so instead Harold and I drove him in. He said to tell you he took an extra aspirin just like you told him to.
Sally Johansen
Brian handed Teri the note and called the ER at White Memorial. It was several anxious minutes before a resident answered.
“Dr. Holbrook, I’m Stu Meltzer, first-year resident. Your father’s here, but he’s in tough shape. He’s had an extensive anterior MI, and we’re having trouble holding his pressure.”
Extensive anterior MI—a massive coronary involving the muscle of the left ventricle, the major pumping chamber. Next to a rupture of the heart wall, it was just about the worst of all cardiac disasters.
“Damn,” Brian said. “Is he conscious?”
“In and out.”
“Who’s with him?”
“Right now, the on-call team, but I’ve been told Dr. Jessup is on her way in, and Dr. Randa’s just arrived down here.”
“Thank you. Stu, tell my dad I’m on the way in.”
“Will do.”
“And Stu?”
“Yes?”
“Do whatever’s necessary.”
“I understand.”
Brian looked to Teri.
“He’s in big trouble.”
“I heard. You go ahead in. I’ll find my way to the Radisson. Call me as soon as you know anything.”
“I can’t believe this is happening! I just can’t believe it. Oh God, poor Pop.”
As he turned to go, she called his name. Then she reached up, pulled him down to her, and kissed him lightly on the mouth.
“Would it help if I drove you?” she asked.
“No, no. I’ll do okay. If I can, I’ll call you at the hotel as soon as I know how he’s doing.”
“Call later tonight or else first thing in the morning.”
“Okay. Come on. Follow me onto the highway, then you’re on your own. And Teri, thanks for tonight.”
“Thank you,” she called out as he raced to the LeBaron. “Be careful driving.”
Brian waited until he heard the engine on Teri’s rental turn over, then peeled away and sped toward 1-93 and Boston. Extensive heart damage, blood pressure dropping, Laj Randa at the bedside … Brian had rolled the dice of his father’s health at three-to-one odds. Now, it was clear, he had lost. The only question remaining was, how badly.
The White Memorial ER was in its usual state of hyperactivity. Brian knew exactly where to go and rushed to room 4 in the back. Nothing he had ever seen or done in medicine fully prepared him for the sight of his father at the center of the most extreme of medical dramas, a cardiac arrest.
“Clear!” Carolyn Jessup cried out.
Brian heard the pop of high-voltage electricity as the paddles discharged their energy into Jack’s body. Through the crowd of fifteen or so technicians, nurses, and physicians, he saw Jack’s arms flap upward, then drop. The cardiac tracing on the overhead monitor showed several seconds of an absolutely straight line, then fairly well-organized complexes began moving across the screen—very slowly at first, then faster.
“Looks like some kind of nodal rhythm.”
“I’ve got a pulse. I’ve got a pulse.”
“He’s in sinus now. Regular sinus rhythm.”
“Pressure’s seventy.”
“Up the Levophed,” Jessup ordered. “Get an epi drip ready. Forget the cath. As soon as we can, we’re going straight over to the OR at BHI.”
Before Brian could get to the bedside, two of Laj Randa’s surgical fellows charged into the room, bristling with authority.
“Dr. Randa wants an intra-aortic balloon assist put in right now,” one ordered. “He says the heart-lung bypass pump tech is in and we’ll be ready for this man in the OR in fifteen minutes.”
Brian worked his way around rather than through the crowd. Carolyn Jessup glanced up from her work, spotted him, and shook her head. Maybe her expression was neutral, but Brian read his own grim thoughts into it.
You should have listened to me, Brian. I told you to go with Randa.
“Apparently your father was awake when friends got him here,” Jessup said to him, as the surgical team got to work inserting the uninflated, sausage-sized balloon into Jack’s right femoral artery and up into his aorta. “But he had a pressure of only ninety and evidence on EKG of an evolving extensive anterior MI. Shortly after they got him into bed, he began losing his pressure. Now his rhythm’s unstable. This was the first time we’ve had to shock him.”
“He’s going to surgery?”
“If we can get him there. I wanted to try the cath lab and see if we could open the obstruction with anticoagulants or a probe. But I heard evidence in his chest that his mitral-valve function has been badly impaired by the coronary. Ultrasound confirmed mitral papillary-muscle dysfunction. The valve’s going to have to be replaced along with the bypasses if he’s going to make it.”
If he’s going to make it.
Brian stared down numbly at the narrow gurney where his father lay, his eyes closed, his rugged, angular facial features already beginning to puff. There was a nasogastric tube snaking up into his nose and down into his stomach, and a much larger endotracheal breathing tube through his mouth and down between his vocal cords into his trachea. His color was a frightening dusky gray.
Coach.
Randa’s surgi
cal fellows were quick and skilled. The intra-aortic balloon, wrapped around a thin catheter, was inserted and sutured in place in minutes. It was electrically synchronized to inflate in between each of Jack’s heartbeats, forcing extra blood into the left ventricle—the pumping chamber. The small increase in filling volume kept the coronary arteries open as wide as possible and was often the difference between life and death.
Come on, Jack. Hang in there. Hang in there.
“We’ve got to get going,” the surgical fellow said. “Dr. Randa’s waiting.”
The IV poles, monitor, and balloon assist pump were positioned for travel, and almost before Brian could react, Jack was gone. There was nothing he could do now but wait.
Immediately, the nurses began cleaning up the debris, which covered the floor. Room 4 had to be cleared out quickly and readied for the next crisis. Carolyn Jessup led Brian out to the hall. She had obviously raced into the hospital from home, and wore no makeup. Her shoulder-length ebony hair, which she invariably wore in a loose knot, was clipped back on each side. For the first time since Brian had met her, she was looking her age.
“We’re doing everything we can,” she said.
Brian looked at his feet.
“I know. Thank you. And thank you for not saying I told you so.”
“I never thought your father had enough time to rely on Vasclear.”
“I feel awful now that I didn’t listen to you. He didn’t want surgery, though, and everything I could find out gave reasonable hope the drug would work for him if we could ever get him on it.”
“I understand. I want to be sure you know that even if we had started him on Vasclear a week earlier, as you requested, it wouldn’t have been enough time.”
Brian nodded. No point in telling her the truth now.
“Thanks for all you’ve done,” he said.
“I wish it could have been more. I’ll be up to observe in a few minutes. Then, once I know Randa’s gotten him on the pump, I’m going to have to go home. I’ll check on how Jack’s doing as soon as I wake up in the morning.”
Brian thanked her again, then made the incredibly lonely walk over to Boston Heart. On the way, he stopped and made two phone calls. The first was to Phoebe, who made him promise to call with the results of the surgery regardless of the hour. The second call was to Freeman Sharpe.
“Freeman, it’s Brian,” he said. “Jack’s had a massive coronary and a cardiac arrest. They’ve just taken him to the OR at Boston Heart for emergency surgery.”
“I’ll be right over,” was all Sharpe said.
Brian checked the time—nearly midnight. It was too late to call Teri, he decided. Instead, he left a message for her at the hotel that Jack was in surgery and he would call in the morning. Then he hurried to the OR observation area on the third floor.
Like everything else at BHI, the OR gallery was modern, plush, and high-tech. Observers could watch the surgery directly through Plexiglas canopies covering the two ORs or via TV monitors mounted on the wall. There were also high-powered binoculars on chains through which minute details within the incision could be observed.
Brian arrived just as Randa, standing on what looked like a hydraulic platform, had finished sawing through Jack’s sternum to expose the heart. Randa’s fellows had already placed the arterial and venous tubes used to attach Jack to the bypass pump, and were at work harvesting veins from the leg that hadn’t been used in the first operation. The cardiopulmonary bypass technician had her heart-lung machine at the ready. In moments, Jack’s circulation and oxygenation would be turned over to her. An icy potassium solution would then be infused into Jack’s coronary arteries, paralyzing his heart.
From that moment on, there would be no reason to stop the surgery until it was completed. The critical variable, then, was Randa’s skill and speed. The longer Jack was on the bypass pump, the more difficult it was going to be to get him off—provided, of course, there was enough heart muscle left to get him off at all. With numerous bypass grafts to be sutured in on the surface of his heart, and the mitral valve between the left atrium and ventricle to be replaced, the procedure would probably take at least four hours, or possibly even much longer.
This was one of dozens of bypass surgeries Brian had observed or scrubbed in on. From where he was standing, his father’s head was screened from him by a surgical sheet. Deprived of that connection, Brian felt strangely detached from what he was watching. He thought about going over to the OR waiting room, but knew he couldn’t leave this spot. As long as there was the procedure to focus on, he felt as if he could keep from exploding. At that moment, Randa glanced up and spotted him. Then, just as quickly, the surgeon turned his attention back to the operating microscope.
“It is not my custom to allow family members to observe the surgery on their loved ones,” Randa said through the speakers, without slowing in his work.
“I’m okay, if it’s all right with you, Dr. Randa,” Brian replied. “I’d really be a mess pacing around the family waiting room.”
“Very well. But I think you should know that I am not optimistic. I have no way of knowing how much heart muscle this man lost before we got him here.”
“I understand.”
“The papillary muscle holding his mitral valve in place is no longer functional. We are going to replace the valve.”
“I know.”
Randa was hanging crepe—preparing Brian for the very worst. Brian had done the same thing with patients himself, many times. Boldly promising good results in a difficult case was asking for trouble. Even a surgeon with Randa’s hubris knew better.
Brian sensed what was coming from Randa next. But he had to wait several minutes for the delivery. By that time, Freeman Sharpe had been led to the observation area by a security guard, and was standing quietly beside him.
“So,” Randa said coolly, “how long has it been since I recommended surgery for your father, three weeks?”
“Just about.”
“And what have you been doing for him all this time?”
Brian had to clear his throat before he could speak.
“Standard medical management,” he said, “plus Vasclear.”
“Well, I can report unequivocally that your miracle drug did not work in this case. Your father’s arteries are like rosary beads and his aorta is stiff with arteriosclerosis and calcium deposits.”
“I feared that was the case.”
“Going that route was a very unfortunate decision on your part.”
Freeman grimaced at the surgeon’s insensitivity. Brian, unable to respond immediately, shook his head helplessly and looked away.
“I took my father’s desires and what I knew about Vasclear into consideration, and I made the choice I thought was right,” he managed to say at last.
“The doctor who cares for himself or his family has a fool for a physician and a fool for a patient.”
Freeman whispered into Brian’s ear, “How do you turn this mike off?”
Brian pointed to a switch by the glass and Sharpe threw it.
“Where did you dig him up?” he asked.
“You don’t need tact to make it into the Surgeons’ Hall of Fame. Besides, he’s right. I am a fool.”
“I’ve heard your father talk about his last surgery. I don’t think you’re any kind of fool. How’s he doing?”
“He’s on a heart-lung bypass machine. It’s going to be impossible to tell anything until the surgery’s done and they try and get him off it. We’ve still got hours to go.”
“You take anything?”
Brian looked at his sponsor incredulously.
“Freeman, why would you even ask that?”
“Well, believe it or not, taking drugs has been known to happen with addicts—in situations stressful or non. Besides, asking that question’s part of my job.”
“No. The answer is no. Freeman, I can’t believe this is happening.”
“I know, pal. What the little goon down there said before
about your making the wrong decision—you believe that?”
“I don’t know what to believe. In medicine, where someone’s life is at stake, I’d always take doing the right thing for the wrong reason over doing the wrong thing for the right reason.”
“And you told me yourself that patients who are re-operated on have a much poorer prognosis than they did the first time.”
“Exactly. And this time I had the numbers—the statistics regarding Vasclear and re-bypass—to say nothing of Jack’s history and his passion not to have more surgery. The choice seemed like a lock to me.… Freeman, thank you for being here with me. I feel so alone.”
Sharpe put his arm around him.
“Well, you’re not, pal,” he said. “And as long as you have those beautiful girls of yours, and your faith, and me to keep you on the straight and narrow, you never will be.”
“Five bypasses are done,” Randa said. “We’re moving on to the valve.”
Brian glanced at the time. Less than an hour and a half. In a patient previously bypassed, three hours for this part of the operation wouldn’t have been surprising. He closed his eyes. Go ahead, Randa, feel free to be as much of an asshole as you want, he was thinking, so long as you keep going like this.
The cardiac surgical fellows and Randa functioned like a finely tuned special-forces unit. The way they were huddled around Jack, there wasn’t much to see without using the binoculars or checking the overhead monitor. Freeman chose to do neither.
“I saw enough open chests in Nam,” he said.
Another hour passed as Randa worked on the mitralvalve replacement. For a time, Freeman tried diverting Brian’s focus with small talk, then he simply sat back and let Brian dictate what little conversation passed between them.
For Brian, the detachment that had protected him from coming apart in the early stages of the procedure was rapidly wearing away. Replacing it was a kaleidoscope of images. The one that stuck out was of his dad’s face at Brian’s peewee games. Jack couldn’t have been more excited if it had been the Super Bowl. It wasn’t until Sharpe passed over some tissue and set his arm around his shoulder that he realized he was crying.
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