Nothing Lasts Forever

chapter Twenty-six
Lou Dinetto was ready to check out of the hospital. Kat went to his room to say goodbye. Rhino and the Shadow were there.

As Kat walked in, Dinetto turned to them and said, "Get lost."

Kat watched them leave the room. Dinetto looked at Kat and said, "I owe you one." "You don't owe me anything." "Is that what you think my life is worth? I hear you're setting married." "That's right. To a doctor." "Yes."

"Well, tell him to take good care of you, or he'll have to answer to me." "I'll tell him." There was a small pause. "I'm sorry about Mike."

"He'll be all right," Kat said. "I had a long talk with him. He'll be fine."

"Good." Dinetto held out a bulky manila envelope. "A little wedding present for you."

Kat shook her head. "No. Thank you."

"But ..."

"Take care of yourself."

"You, too. You know something? You're a real stand-up broad. I'm going to tell you something I want you to remember. If you ever need a favor - anything -  you come to me. You hear me?"

"I hear you."

She knew that he meant it. And she knew that she would never go to him.

During the weeks that followed, Paige and Jason spoke on the phone three and four times a day, and were together every time Paige was not on night call.

The hospital was busier than ever. Paige had been on a thirty-six-hour shift that had been filled with emei-gencies. She had just gone to sleep in the on-call room when she was awakened by the urgent shrill of the telephone.

She fumbled the phone to her ear. "H'lo?" "Dr. Taylor, will you come to Room 422, stat?" Paige tried to clear her mind. Room 422. One of Dr Barker's patients. Lance Kelly. He had just had a mitral valve replaced. Something must have gone wrong. Paigfc stumbled off the cot and walked out into the deserted corridor. She decided not to wait for the elevator. She ran up the stairs. Maybe it's just a nervous nurse. If it's serious, I'll call Dr. Barker, she thought.

She walked into Room 422 and stood in the doorway, staring. The patient was fighting for breath and moaning. The nurse turned to Paige in obvious relief. "I didn't know what to do, doctor. I ..."

Paige hurried to the bedside. "You're going to be fine," she said reassuringly. She took his wrist between two fingers. His pulse was jumping wildly. The mitral valve was malfunctioning.

"Let's sedate him," Paige ordered.

The nurse handed Paige a syringe, and Paige injected it into a vein. Paige turned to the nurse. "Tell the head nurse to get an operating team together, stat. And send for Dr. Barker!"

Fifteen minutes later, Kelly was on the operating table. The team consisted of two scrub nurses, a circulating nurse, and two residents. A television monitor was perched high in a corner of the room to display the heart rate, EKG, and blood pressure.

The anesthesiologist walked in, and Paige felt like cursing. Most of the anesthesiologists at the hospital were skilled doctors, but Herman Koch was an exception. Paige had worked with him before and tried to avoid him as much as possible. She did not trust him. Now she had no choice.

Paige watched him secure a tube to the patient's throat, while she unfolded a paper drape with a clear window and placed it over the patient's chest.

"Put a line into the jugular vein," Paige said.

Koch nodded. "Right."

One of the residents asked, "What's the problem here?"

"Dr. Barker replaced the mitral valve yesterday. I think it's ruptured." Paige looked over at Dr. Koch. "Is he out?"

Koch nodded. "Sleeping like he's in bed at home." I wish you were, Paige thought. "What are you using?"

"Propofol."

She nodded. "All right."

She watched Kelly being connected to the heart-lung machine so she could perform a cardiopulmonary bypass. Paige studied the monitors on the wall. Pulse 140 ... blood oxygen saturation 92 percent... blood pressure 80 over 60. "Let's go," Paige said. One of the residents put on music. Paige stepped up to the operating table under eleven hundred watts of hot white light and turned to the scrub nurse. "Scalpel, please ..." The operation began.

Paige removed all the sternal wires from the operation the day before. She then cut from the base of the neck to the lower end of the sternum, while one of the residents blotted away the blood with gauze pads.

She carefully went through the layers of fat and muscle, and in front of her was the erratically beating heart. "There's the problem," Paige said. "The atrium is perforated. Blood is collecting around the heart and compressing it." Paige was looking at the monitor on the wall. The pump pressure had dropped dangerously. "Increase the flow," Paige ordered. The door to the operating room opened and Lawrence Barker stepped in. He stood to one side, watching what was happening.

Paige said, "Dr. Barker. Do you want to ...?"

"It's your operation."

Paige took a quick look at what Koch was doing. "Be careful. You'll overanesthetize him, dammit! Slow it down!"

"But I ..."

"He's in V-tach! His pressure is dropping!"

"What do you want me to do?" Koch asked helplessly.

He should know, Paige thought angrily. "Give him lidocaine and epinephrine! Now!" She was yelling.

"Right."

Paige watched as Koch picked up a syringe and injected it into the patient's IV.

A resident looked at the monitor and called out, "Blood pressure is falling."

Paige was working frantically to stop the flow of blood. She looked up at Koch. "Too much flow! I told you to ..."

The noise of the heartbeat on the monitor suddenly became chaotic.

"My God! Something's gone wrong!"

"Give me the defibrillator!" Paige yelled.

The circulating nurse reached for the defibrillator on the crash cart, opened two sterile paddles, and plugged them in. She turned the buttons up to charge them and ten seconds later handed them to Paige.

She took the paddles and positioned them directly over Kelly's heart. Kelly's body jumped, then fell back.

Paige tried again, willing him to come back to life, willing him to breathe again. Nothing. The heart lay still, a dead, useless organ.

Paige was in a fury. Her part of the operation had been successful. Koch had overanesthetized the patient.

As Paige was applying the defibrillator to Lanct Kelly's body for the third futile time, Dr. Barker stepped up to the operating table and turned to Paige. "You killed him."