by Anthology
Tiger checked his blood pressure and listened to his heart. "It will only take a few hours to get help," he said. "You rest and sleep now. There's plenty of time."
He joined Dal and Jack in the corridor. "I'm afraid he's right, this time," he said. "The damage is severe, and he hasn't the strength to hold out very long. He might last long enough for a surgeon and operating team to get here, but I doubt it. We'd better get the word off."
A few moments later he put the earphones aside. "It'll take six hours for the nearest help to get here," he said. "Maybe five and a half if they really crowd it. But when they get a look at that cardiogram on the screen they'll just throw up their hands. He's got to have a transplant, nothing less, and even if we can keep him alive until a surgical team gets here the odds are a thousand to one against his surviving the surgery."
"Well, he's been asking for it," Jack said. "They've been trying to get him into the hospital for a cardiac transplant for years. Everybody's known that one of those towering rages would get him sooner or later."
"Maybe he'll hold on better than we think," Dal said. "Let's watch and wait."
But the Black Doctor was not doing well. Moment by moment he grew weaker, laboring harder for air as his blood pressure crept slowly down. Half an hour later the pain returned; Tiger took another tracing while Dal checked his venous pressure and shock level.
As he finished, Dal felt the Black Doctor's eyes on him. "It's going to be all right," he said. "There'll be time for help to come."
Feebly the Black Doctor shook his head. "No time," he said. "Can't wait that long." Dal could see the fear in the old man's eyes. His lips began to move again as though there were something more he wanted to say; but then his face hardened, and he turned his head away helplessly.
Dal walked around the bed and looked down at the tracing, comparing it with the first one that was taken. "What do you think, Tiger?"
"It's no good. He'll never make it for five more hours."
"What about right now?"
Tiger shook his head. "It's a terrible surgical risk."
"But every minute of waiting makes it worse, right?"
"That's right."
"Then I think we'll stop waiting," Dal said. "We have a prosthetic heart in condition for use, don't we?"
"Of course."
"Good. Get it ready now." It seemed as though someone else were talking. "You'll have to be first assistant, Tiger. We'll get him onto the heart-lung machine, and if we don't have help available by then, we'll have to try to complete the transplant. Jack, you'll give anaesthesia, and it will be a tricky job. Try to use local blocks as much as you can, and have the heart-lung machine ready well in advance. We'll only have a few seconds to make the shift. Now let's get moving."
Tiger stared at him. "Are you sure that you want to do this?"
"I never wanted anything less in my life," Dal said fervently. "But do you think he can survive until a Hospital Ship arrives?"
"No."
"Then it seems to me that I don't have any choice. You two don't need to worry. This is a surgical problem now, and I'll take full responsibility."
The Black Doctor was watching him, and Dal knew he had heard the conversation. Now the old man lay helplessly as they moved about getting the surgical room into preparation. Jack prepared the anaesthetics, checked and rechecked the complex heart-lung machine which could artificially support circulation and respiration at the time that the damaged heart was separated from its great vessels. The transplant prosthetic heart had been grown in the laboratories on Hospital Earth from embryonic tissue; Tiger removed it from the frozen specimen locker and brought it to normal body temperature in the special warm saline bath designed for the purpose.
Throughout the preparations the Black Doctor lay watching, still conscious enough to recognize what was going on, attempting from time to time to shake his head in protest but not quite succeeding. Finally Dal came to the bedside. "Don't be afraid," he said gently to the old man. "It isn't safe to try to delay until the ship from Hospital Earth can get here. Every minute we wait is counting against you. I think I can manage the transplant if I start now. I know you don't like it, but I am the Red Doctor in authority on this ship. If I have to order you, I will."
The Black Doctor lay silent for a moment, staring at Dal. Then the fear seemed to fade from his face, and the anger disappeared. With a great effort he moved his head to nod. "All right, son," he said softly. "Do the best you know how."
* * * * *
Dal knew from the moment he made the decision to go ahead that the thing he was undertaking was all but hopeless.
There was little or no talk as the three doctors worked at the operating table. The overhead light in the ship's tiny surgery glowed brightly; the only sound in the room was the wheeze of the anaesthesia apparatus, the snap of clamps and the doctors' own quiet breathing as they worked desperately against time.
Dal felt as if he were in a dream, working like an automaton, going through mechanical motions that seemed completely unrelated to the living patient that lay on the operating table. In his training he had assisted at hundreds of organ transplant operations; he himself had done dozens of cardiac transplants, with experienced surgeons assisting and guiding him until the steps of the procedure had become almost second nature. On Hospital Earth, with the unparalleled medical facilities available there, and with well-trained teams of doctors, anaesthetists and nurses the technique of replacing an old worn-out damaged heart with a new and healthy one had become commonplace. It posed no more threat to a patient than a simple appendectomy had posed three centuries before.
But here in the patrol ship's operating room under emergency conditions there seemed little hope of success. Already the Black Doctor had suffered violent shock from the damage that had occurred in his heart. Already he was clinging to life by a fragile thread; the additional shock of the surgery, of the anaesthesia and the necessary conversion to the heart-lung machine while the delicate tissues of the new heart were fitted and sutured into place vessel by vessel was more than any patient could be expected to survive.
Yet Dal had known when he saw the second cardiogram that the attempt would have to be made. Now he worked swiftly, his frail body engulfed in the voluminous surgical gown, his thin fingers working carefully with the polished instruments. Speed and skill were all that could save the Black Doctor now, to offer him the one chance in a thousand that he had for survival.
But the speed and skill had to be Dal's. Dal knew that, and the knowledge was like a lead weight strapped to his shoulders. If Black Doctor Hugo Tanner was fighting for his life now, Dal knew that he too was fighting for his life--the only kind of life that he wanted, the life of a physician.
Black Doctor Tanner's antagonism to him as an alien, as an incompetent, as one who was unworthy to wear the collar and cuff of a physician from Hospital Earth, was common knowledge. Dal realized with perfect clarity that if he failed now, his career as a physician would be over; no one, not even himself, would ever be entirely certain that he had not somehow, in some dim corner of his mind, allowed himself to fail.
Yet if he had not made the attempt and the Black Doctor had died before help had come, there would always be those who would accuse him of delaying on purpose.
His mouth was dry; he longed for a drink of water, even though he knew that no water could quench this kind of thirst. His fingers grew numb as he worked, and moment by moment the sense of utter hopelessness grew stronger in his mind. Tiger worked stolidly across the table from him, inexpert help at best because of the sketchy surgical training he had had. Even his solid presence in support here did not lighten the burden for Dal. There was nothing that Tiger could do or say that would help things or change things now. Even Fuzzy, waiting alone on his perch in the control room, could not help him now. Nothing could help now but his own individual skill as a surgeon, and his bitter determination that he must not and would not fail.
But his fingers faltered as a thousan
d questions welled up in his mind. Was he doing this right? This vessel here ... clamp it and tie it? Or dissect it out and try to preserve it? This nerve plexus ... which one was it? How important? How were the blood pressure and respirations doing? Was the Black Doctor holding his own under the assault of the surgery?
The more Dal tried to hurry the more he seemed to be wading through waist-deep mud, unable to make his fingers do what he wanted them to do. How could he save ten seconds, twenty seconds, a half a minute? That half a minute might make the difference between success or failure, yet the seconds ticked by swiftly and the procedure was going slowly.
Too slowly. He reached a point where he thought he could not go on. His mind was searching desperately for help--any kind of help, something to lean on, something to brace him and give him support. And then quite suddenly he understood something clearly that had been nibbling at the corners of his mind for a long time. It was as if someone had snapped on a floodlight in a darkened room, and he saw something he had never seen before.
He saw that from the first day he had stepped down from the Garvian ship that had brought him to Hospital Earth to begin his medical training, he had been relying upon crutches to help him.
Black Doctor Arnquist had been a crutch upon whom he could lean. Tiger, for all his clumsy good-heartedness and for all the help and protection he had offered, had been a crutch. Fuzzy, who had been by his side since the day he was born, was still another kind of crutch to fall back on, a way out, a port of haven in the storm. They were crutches, every one, and he had leaned on them heavily.
But now there was no crutch to lean on. He had a quick mind with good training. He had two nimble hands that knew their job, and two legs that were capable of supporting his weight, frail as they were. He knew now that he had to stand on them squarely, for the first time in his life.
And suddenly he realized that this was as it should be. It seemed so clear, so obvious and unmistakable that he wondered how he could have failed to recognize it for so long. If he could not depend on himself, then Black Doctor Hugo Tanner would have been right all along. If he could not do this job that was before him on his own strength, standing on his own two legs without crutches to lean on, how could he claim to be a competent physician? What right did he have to the goal he sought if he had to earn it on the strength of the help of others? It was he who wanted to be a Star Surgeon--not Fuzzy, not Tiger, nor anyone else.
He felt his heart thudding in his chest, and he saw the operation before him as if he were standing in an amphitheater peering down over some other surgeon's shoulder. Suddenly everything else was gone from his mind but the immediate task at hand. His fingers began to move more swiftly, with a confidence he had never felt before. The decisions to be made arose, and he made them without hesitation, and knew as he made them that they were right.
And for the first time the procedure began to move. He murmured instructions to Jack from time to time, and placed Tiger's clumsy hands in the places he wanted them for retraction. "Not there, back a little," he said. "That's right. Now hold this clamp and release it slowly while I tie, then reclamp it. Slowly now ... that's the way! Jack, check that pressure again."
It seemed as though someone else were doing the surgery, directing his hands step by step in the critical work that had to be done. Dal placed the connections to the heart-lung machine perfectly, and moved with new swiftness and confidence as the great blood vessels were clamped off and the damaged heart removed. A quick check of vital signs, chemistries, oxygenation, a sharp instruction to Jack, a caution to Tiger, and the new prosthetic heart was in place. He worked now with painstaking care, manipulating the micro-sutures that would secure the new vessels to the old so firmly that they were almost indistinguishable from a healed wound, and he knew that it was going right now, that whether the patient ultimately survived or not, he had made the right decision and had carried it through with all the skill at his command.
And then the heart-lung machine fell silent again, and the carefully applied nodal stimulator flicked on and off, and slowly, at first hesitantly, then firmly and vigorously, the new heart began its endless pumping chore. The Black Doctor's blood pressure moved up to a healthy level and stabilized; the gray flesh of his face slowly became suffused with healthy pink. It was over, and Dal was walking out of the surgery, his hands trembling so violently that he could hardly get his gown off. He wanted to laugh and cry at the same time, and he could see the silent pride in the others' faces as they joined him in the dressing room to change clothes.
He knew then that no matter what happened he had vindicated himself. Half an hour later, back in the sickbay, the Black Doctor was awake, breathing slowly and easily without need of supplemental oxygen. Only the fine sweat standing out on his forehead gave indication of the ordeal he had been through.
Swiftly and clinically Dal checked the vital signs as the old man watched him. He was about to turn the pressure cuff over to Jack and leave when the Black Doctor said, "Wait."
Dal turned to him. "Yes, sir?"
"You did it?" the Black Doctor said softly.
"Yes, sir."
"It's finished? The transplant is done?"
"Yes," Dal said. "It went well, and you can rest now. You were a good patient."
For the first time Dal saw a smile cross the old man's face. "A foolish patient, perhaps," he said, so softly that no one but Dal could hear, "but not so foolish now, not so foolish that I cannot recognize a good doctor when I see one."
And with a smile he closed his eyes and went to sleep.
CHAPTER 14
STAR SURGEON
It was amazing to Dal Timgar just how good it seemed to be back on Hospital Earth again.
In the time he had been away as a crewman of the Lancet, the seasons had changed, and the port of Philadelphia lay under the steaming summer sun. As Dal stepped off the shuttle ship to join the hurrying crowds in the great space-port, it seemed almost as though he were coming home.
He thought for a moment of the night not so long before when he had waited here for the shuttle to Hospital Seattle, to attend the meeting of the medical training council. He had worn no uniform then, not even the collar and cuff of the probationary physician, and he remembered his despair that night when he had thought that his career as a physician from Hospital Earth was at an end.
Now he was returning by shuttle from Hospital Seattle to the port of Philadelphia again, completing the cycle that had been started many months before. But things were different now. The scarlet cape of the Red Service of Surgery hung from his slender shoulders now, and the light of the station room caught the polished silver emblem on his collar. It was a tiny bit of metal, but its significance was enormous. It announced to the world Dal Timgar's final and permanent acceptance as a physician; but more, it symbolized the far-reaching distances he had already traveled, and would travel again, in the service of Hospital Earth.
It was the silver star of the Star Surgeon.
The week just past had been both exciting and confusing. The hospital ship had arrived five hours after Black Doctor Hugo Tanner had recovered from his anaesthesia, moving in on the Lancet in frantic haste and starting the shipment of special surgical supplies, anaesthetics and maintenance equipment across in lifeboats almost before contact had been stabilized. A large passenger boat hurtled away from the hospital ship's side, carrying a pair of Four-star surgeons, half a dozen Three-star Surgeons, two Radiologists, two Internists, a dozen nurses and another Four-star Black Doctor across to the Lancet; and when they arrived at the patrol ship's entrance lock, they discovered that their haste had been in vain.
It was like Grand Rounds in the general wards of Hospital Philadelphia, with the Four-star Surgeons in the lead as they tramped aboard the patrol ship. They found Black Doctor Tanner sitting quietly at his bedside reading a journal of pathology and taking notes. He glared up at them when they burst in the door without even knocking.
"But are you feeling well, sir?" the
chief surgeon asked him for the third time.
"Of course I'm feeling well. Do you think I'd be sitting here if I weren't?" the Black Doctor growled. "Dr. Timgar is my surgeon and the physician in charge of this case. Talk to him. He can give you all the details of the matter."
"You mean you permitted a probationary physician to perform this kind of surgery?" The Four-star Surgeon cried incredulously.
"I did not!" the Black Doctor snapped. "He had to drag me kicking and screaming into the operating room. But fortunately for me, this particular probationary physician had the courage of his convictions, as well as wit enough to realize that I would not survive if he waited for you to gather your army together. But I think you will find the surgery was handled with excellent skill. Again, I must refer you to Dr. Timgar for the details. I was not paying attention to the technique of the surgery, I assure you."
"But sir," the chief surgeon broke in, "how could there have been surgery of any sort here? The dispatch that came to us listed the Lancet as a plague ship--"
"Plague ship!" the Black Doctor exploded. "Oh, yes. Egad! I--hum!--imagine that the dispatcher must have gotten his signals mixed somehow. Well, I suppose you want to examine me. Let's have it over with."
The doctors examined him within an inch of his life. They exhausted every means of physical, laboratory and radiological examination short of re-opening his chest and looking in, and at last the chief surgeon was forced reluctantly to admit that there was nothing left for him to do but provide post-operative follow-up care for the irascible old man.
And by the time the examination was over and the Black Doctor was moved aboard the hospital ship, word had come through official channels to the Lancet announcing that the quarantine order had been a dispatcher's unfortunate error, and directing the ship to return at once to Hospital Earth with the new contract that had been signed on 31 Brucker VII. The crewmen of the Lancet had special orders to report immediately to the medical training council at Hospital Seattle upon arrival, in order to give their formal General Practice Patrol reports and to receive their appointments respectively as Star Physician, Star Diagnostician and Star Surgeon. The orders were signed with the personal mark of Hugo Tanner, Physician of the Black Service of Pathology.