by J. R. McLeay
“Jesus, Rick,” Mac said, surprised by Rick’s unusual precautions. “This place is like an armed camp today—are you expecting an insurrection?”
“I hope not, but you’ve all been briefed about the unique circumstances of this patient. His father is opposed to the operation, and you may have noticed some of his supporters outside the front gate this morning.”
“How could we miss them?” Nurse Benson said. “They were pretty aggressive—some of us had to duck in the back entrance to make it in here.”
“It appears that hospital security has got the situation under control, but I don’t want to take any chances. I’d like to proceed as expeditiously as possible if you don’t mind. Let’s get this job finished before anyone has any opportunity to intervene.”
“I’m with you,” Mac agreed, struck by Rick’s uncharacteristically serious tone.
As Mac proceeded to intubate Elias’s lungs, Rick checked the equipment table to ensure everything was ready. The extensive array of stainless steel instruments glistened under the bright surgical lamps: long flexible endoscopes to provide close-up video of the interior sella structures; nasal specula for spreading and widening the narrow internal passageways; microdissectors and curettes for cutting and scaling tissues; clamps and hypodermic needles for temporarily closing and desensitizing organs; and aspirators and sponges for removing excess blood and other bodily fluids. Most of these instruments connected via attachments with the overhead robotic trolley, whose movement Rick would control using sensitive multi-functional joysticks. Also attached to the trolley was a bank of video screens, which Rick and the other operating personnel would use to monitor every step of the operation.
When Mac gave the ‘all clear’ sign, Rick attached one of the endoscopes to the trolley, and glided the equipment near Elias’s nose.
“Right—let’s get started.”
Rick carefully began to thread the thin articulated cable holding the illuminated camera and laser dissector up Elias’s left nostril using the multi-directional joystick. Toggling the wand delicately between his thumb and forefinger while concentrating on the image displayed by the endoscope on the video monitor, the first obstacle he encountered was the inferior turbinate, a soft flap of tissue controlling airflow into the upper sinuses. Gently pushing the fold aside, Rick could see the sphenoid ostium, looking like the keel on the underside of a boat, marking the base of the sphenoidal sinus cavity. Pressing a small red button on the tip of the joystick, the endoscope emitted a short pulse of ultraviolet laser light, which quickly penetrated the thin layer of cartilage. Peering inside the brightly illuminated cavity, Rick saw the distinct convex shape of the sella turcica—Turk’s Saddle—which housed the pituitary. Positioning the microdissector mere millimeters away from the carotid sulcus, the eggshell-thin covering of the interior carotid artery, he proceeded to make a cross-shaped incision on the fleshy protuberance.
How ironic, Rick thought before pulling the folds back to expose the omnipotent gland, that the gateway to the organ that gives and takes life away should be etched with the universal symbol of Christianity.
The distant chants of Calvin’s Garden of Eden group echoing through the halls pulled Rick back to reality, and he quickly handed the computer controls over to his assistant neurosurgeon, Dr. Scott.
“Half way there,” Rick exhaled, looking up in the viewing gallery to see Jennifer wink at him. “Now, let’s pluck that fruit.”
Moving the second microdissector into position at the base of Elias’s right nostril, Rick began to repeat the procedure, as he slowly wound the apparatus past the familiar structures on the right side of Elias’s nasal cavity, adjusting the joystick ever so slowly and microscopically.
As before, nobody in the room uttered a word.
Just as he reached the entrance to the lateral sphenoid sinus, Rick heard a disturbance from the hall. There were loud shouts, and in his periphery he saw the two security guards stationed outside the door move quickly in the direction of the noise.
Everybody looked at Rick nervously.
Christ—just what I need at this precise moment, he thought. We’re almost there!
The sounds grew fainter and more distant, and Rick took this to mean that the security personnel had dissuaded the apparent protestors from advancing any further. Rick looked over at Mac, who quickly nodded for him to proceed. It would only take another few minutes or so to complete the operation.
Returning his attention to the monitors, Rick moved the joystick forward slightly and advanced the microdissector through the right ostium into the narrow passageway flanked by the carotid artery. Just as he was about to move past the primary blood vessel supplying oxygen to the right hemisphere of the brain, he heard the sound of rapidly approaching footsteps coming from the opposite direction of the initial disturbance. Seconds later, he heard a loud crash, as something slammed into the door.
Looking up reflexively, he saw Calvin staring at him through the safety glass with a crazed look, shaking the doors violently, trying to break into the room.
“Let go of my son, you butcher!” he screamed through the glass. “You have no right! Give back my child!!”
Fortunately, the locked doors held firm, but Calvin began banging against the glass panels with his fists, causing them to splinter, sending shards flying across the room.
From the observation deck above, Jennifer quickly ran from the room in search of assistance.
Turning his attention momentarily back to the video monitors in an attempt to secure his patient, Rick was horrified by what he saw. A nervous bump of the operating joystick had apparently pushed the microdissector through the narrow covering of the carotid sulcus, rupturing the artery, and Rick could see that it was hemorrhaging violently.
“Mark,” he called out to his assistant, “I need a clamp—stat!!”
Dr. Scott, who was controlling the equipment inserted in Elias’s left nostril, had already begun to retract the clamp as soon as he saw the severed artery.
“Mac!” Rick quickly motioned to his anesthesiologist. “Stop that man! We can’t let him in here. This patient’s condition is critical—I need to focus all my attention on him.”
“What do you want me to do, Rick?” Mac asked, incredulously. “We don’t have any weapons in the room other than a few scalpels—and he’s twice our size and three times as strong!”
“I don’t care what you do—just stop him!!”
As Calvin began to break through the glass panel and reach around the inside of the door attempting to unlock it, Mac frantically searched the equipment table for anything he could use to slow down the intruder. Thinking quickly, he picked up a long hypodermic needle from the equipment tray, and jammed it into the intravenous bag hanging from the stand beside Elias’s bed. Swiftly pulling back the syringe handle and filling the needle’s reservoir with the clear viscous fluid, he moved around the operating table and tentatively approached the door. As Calvin reached out and tried to grab him, Mac carefully timed his thrust and caught Calvin squarely on the forearm, plunging the needle deep into his flesh.
Calvin roared, retracting his arm, while Mac simultaneously moved away from the door defensively. Calvin was still pushing against the door and trying to unhinge it from the inside with wild flailing motions—but his screams and thrashing were rapidly diminishing. Within thirty seconds, he fell away from the door and collapsed on the ground, just as three security guards rushed to the scene.
On the operating table, Rick and Dr. Scott were working furiously to quell the arterial rupture. Dr. Scott had successfully clamped the tear, but Elias’s nasal sella had quickly filled with blood and coated the lenses of the endoscopes, blinding the two doctors’ line of sight. Rick knew that if the artery was not sealed soon and the blood evacuated, it would put dangerous pressure on Elias’s brain and cut off essential oxygen, potentially causing a stroke or death.
“Marg,” he shouted to the head nurse, “we need to aspirate—hand me the vacuum!”<
br />
Nurse Benson, who had just finished patching the sprouting leak in the I/V bag made by Mac’s needle, quickly located the laparoscopic vacuum tube on the equipment tray and passed it to Rick. But first he had to remove the blocking microdissector from Elias’s right sinus without the benefit of visual guidance from the occluded endoscopes, and somehow insert the aspirator back into the cavity without further damaging the carotid artery or any of the other sensitive organs. Thankfully, the disturbance at the door was no longer a distraction, since the security personnel had carried the now unconscious Calvin away, and police reinforcements had mobilized in the hall to block access to the operating room from any other potential intruders.
Marshaling all of his concentration, Rick slowly began retracting the equipment from Elias’s right sphenoid. Fortunately, his years of experience performing this operation enabled him to conduct the procedure mostly by feel. Closing his eyes, he expertly worked the joysticks, while everyone in the room held their breath. Millimeter by millimeter the long tube slowly began withdrawing from Elias’s inner sinus. When the end of the tube finally emerged from his nostril, a torrent of blood gushed out of his nose, and nurse Benson immediately moved into position to place a sponge against the opening to arrest the flow.
“No, Marg,” Rick instructed. “Let it flow—it will ease the cranial pressure and make it easier to insert the aspirator.”
Quickly disconnecting the microdissector and attaching the aspiration tube in its place, Rick moved the new device back into Elias’s right nostril. Knowing that his sightlines into the sellar region would be blocked by the blood still filling the cavities, he placed a superficial nick on the outside of the tube with a scalpel to mark the precise length needed to reach the sphenoid sinus. With precious seconds separating life and death, Rick moved the joystick handles delicately but purposefully, as the tube slowly sank back into Elias’s nose.
Nobody uttered a sound while everybody held their breath.
When the mark on the catheter got to the base of Elias’s nostril, Rick flicked a switch on the base of the joystick, initiating a loud suction sound. Suddenly, a river of dark red blood spilled out of the tube, as nurse Benson grimly directed the evacuation end into a white sink.
After a few seconds, Rick began to see some spotty images emerge on the monitor from the blood-splattered endoscope, and he could see Dr. Scott’s clamp still holding the carotid artery closed.
“What now?” asked Mac, whose attention was once again fully focused on the operation.
“Unfortunately,” Rick advised, “we’re in no position to complete the operation as planned. The pituitary removal will have to wait. Right now we need to figure out how to keep this patient alive for the next few hours—never mind a lifetime. We need to seal that wound quickly and re-oxygenate the right hemisphere before it’s too late. The problem is, I’m not sure fibrin glue alone will be enough to arrest the flow once the clamp is removed.”
Knowing the alternative would mean permanently disfiguring his patient with open-face surgery, Rick could barely utter the words.
“We may need to go in and directly suture the wound with a transfrontal intracranial operation,” he said.
Looking up to the observation theater, he saw that Jennifer had returned, looking on in shock.
“Jen,” he announced, “will you notify the hospital Chief of Staff and ask him to send an emergency standby team down here right away?”
Jennifer nodded and quickly left the viewing room again.
“All right, Mark,” Rick motioned to Dr. Scott as he began to thread another tube up Elias’s right nostril. “I’m going to try sealing the wound with fibrin, but be ready to re-clamp if it doesn’t hold.
“On my mark,” Rick said, taking a deep breath, “I want you to release the clamp. Here we go…”
31
Tian Yin woke up in a sweat Saturday morning after a restless night of strange dreams. She’d dreamt she was on a deserted beach on a tropical island, walking alone along the water’s edge with the warm ocean waves lapping over her bare feet. As she peered into the distance, she could see a figure walking toward her—though in the midday haze, she couldn’t at first make out who it was.
But as they got closer to one another, the familiar face of Dr. Ross came into focus, and he smiled at her. Trying to remain nonchalant, Tian struggled to maintain her leisurely pace, as if this were just another casual encounter with anyone else she might meet on the beach. But her legs betrayed her, and she unconsciously began walking faster. Surprisingly, Rick appeared to be having the same reaction, and as they got closer and closer they increased the speed of their gait—until they virtually ran into each other’s arms.
Rick picked Tian up out of the surf in a hearty embrace, kissing her firmly on the lips, and they both fell to the sand in a heat of passion. As Rick’s hands explored Tian’s body and began to unhinge her bikini top, Tian felt an odd sensation. Rick was cupping and kissing her breasts—large breasts—that she hadn’t had before. It was a foreign feeling, but she rather liked it, and so, apparently, did Rick. When he then untied her bikini bottom and removed his own trunks, she unconsciously parted her legs in anticipation of the union she had long fantasized about.
As Rick positioned himself over her and slowly lowered himself onto her body, she could feel his excitement against her flesh. At the moment he entered her in a passionate flourish, a warm surge of ocean water came up between her legs and enveloped her hips in a moist and sticky pool.
Tian jerked awake, disappointed she was unable to consummate the act in her dream. As she lay on her bed, breathing heavily from the arousal she was still feeling, she began analyzing the vision. What did it mean? She already knew that she had a strong visceral attraction to Rick. But why did she have fully developed breasts—and what was the significance of the sticky water? As she closed her eyes and tried to imagine herself back in Rick’s embrace, her hand slowly wandered between her legs, where she was still wet with excitement. But it was unusually thick and sticky—unlike anything she’d felt before. And it wasn’t just her body—the sheets were wet and sticky also.
Sitting up suddenly, Tian wondered what happened. Had she really been this aroused? Turning on the bedside lamp and throwing back the covers, she couldn’t believe what she saw: in the middle of her bed, staining her white Egyptian cotton sheets, was a bright red pool of blood. Instantly looking between her legs, she saw where it came from.
At first, she wondered if her bleeding was some kind of psychosomatic reaction to her dream: maybe her vulva had unconsciously bled as if Rick had taken her virginity? Or maybe she’d been groping herself while she was asleep, and torn something. Then she looked at her breasts and gasped.
Oh my God! Tian cried out loud, upon seeing the swelling buds and enlarged nipples.
Another possibility instantly entered her mind—an awful, irreversible possibility, which now seemed all too real. Somehow—though Tian couldn’t yet possibly imagine how—she’d crossed during the night over the threshold of puberty and experienced menarche, the unmistakable milestone heralding the transition into adulthood for girls.
But Tian also knew it signaled something far more ominous. The blood in her sheets meant she had suddenly lost her youth—and her immortality.
32
At eight-thirty Sunday morning, Jennifer’s phone bounced loudly on her bedside night table. Reaching over groggily to pick up the vibrating device, she squinted through sleepy eyes at the display. The message was from Mount Sinai’s Chief of Staff, Joe Morgan.
Emergency Room swamped. Unusual endocrine disorders. Come in immediately.
“What is it?” asked Rick, who’d stayed over after an exhausting forty-eight hours dealing with the aftermath of Elias’s interrupted surgery.
“I don’t know. Joe says there are an unusual number of cases in the ER this morning, mostly hormone-related. He wants me to come in as soon as possible.”
“That’s odd,” Rick said, sittin
g up. “I wonder what’s going on—did you have a chance to run some tests on the e-patch?”
“I took some samples in to the lab on Friday morning then completely forgot about it after the disruption in the OR. But the technicians said they probably wouldn’t have the results back until Monday.”
“I think we need to see the results as soon as possible; there’ve been far too many unusual incidents this week.”
“Do you think they’re connected?”
“They have to be. First the extreme aggressiveness demonstrated by Calvin’s sect at the U.N. then the heightened libido on display at the Hippodrome—and now this.”
“Let’s hope it’s not being caused by some malfunction of the hormone patch,” Jennifer said as she began to get dressed. “We’re dependent on these things to keep everything in check. If there’s a defect or it’s been tampered with, we could all be in trouble.”
“Perhaps we should ask our lab techs if they can expedite their analysis and at least give us a preliminary report before tomorrow?”
“Good idea—I’ll ask Joe to get on it right away.”
Rick nodded, as his focus drifted to the floor.
“Was something else on your mind?” Jennifer asked. “You look a little distracted this morning.”
“I was just thinking about Friday’s operation.”
“I know you’re upset about what happened, Rick, but it’s not your fault. Nobody could have predicted or prevented that calamity. Calvin obviously had the whole thing planned; you did everything humanly possible to protect yourself against it.”
“It’s not me I’m worried about.”
“But you repaired the rupture and stabilized your patient.”
“For now, but he’s still in serious condition. The wound could reopen, or become infected, or a clot could cause an embolism.”
“You’ve done everything you can. You shouldn’t beat yourself up too much over this.”