Dark as Daylight Ch. 18

Tell me, doctor, what is your favorite fantasy or dream? What is the one thing you have dreamed about that would make your life complete. Do you want a home on the Des Champs Elyseés? You can have it. Do you want a vineyard in Italy? It's yours. Would you like a chalet in Switzerland? I'll send you to a designer, and an architect, and between the three of you, you can design and build the most beautiful one in all of Switzerland. What would make your life complete, doctor?"

"I already have a beautiful condominium overlooking Central Park. I would never give that up. However, I have always envied the people I've seen in the expensive travel magazines, who travel on those boutique luxury ships that sail around the world continuously. They stop at only the most exotic ports of call, where the huge ships with their 3000 passengers can't sail into. These ships have huge luxury suites, and once you step on board, everything is included, except shopping, of course."

William Junior laughed. "Dad, we own those two boats."

"I know son. They are the Esplanade, and the Raffaele."

Matti Williams exclaimed, "That's correct! You own those ships?"

"Yes Doctor, we own the companies that own the ships. The Raffaele sails to the setting sun, while the Esplanade sails to the rising Sun. Their decor is designed with those motifs in mind. You save my wife, and you will have the largest suite on either ship for a year. It sleeps eight, if you want to travel with guests."

"You will excuse me, Mr. Zabo, I have a miracle to perform, God willing."

"Go with God, doctor."

As she walked back into the surgical area, struggling back into her spacesuit, Matti yelled, "Sylvia, please get Doctor Chikwe down here. I want her to do the aorta resection, while I work on the bottom of Mrs. Zabo's heart."

"As you wish, Doctor."

"Harvey, I'm going to need help from you with this."

"How are you going to do it? Are you going to use a scalpel, or the laser?"

"I have two hands, and you have two hands, I'll use a scalpel in my right hand, and the laser, in my left hand. You use the Ellis tissue forceps in your left hand, and the hemostatic mixture forceps in your right. If all else fails, we will drop our tools, and use our nails to scrape the shit off."

"You are out of your mind, doctor."

"You always were nice to me, Harvey. I'll see if I can get you an invitation to Agnes, too, if you want."

"Shoot me first."

Cilia said, "Can I have his invitation?"

"It's fine with me Cilia. I love her food; it's her incessant talking I can't take."

"I do not talk too much at my parties."

"How would you know, Agnes? You can't hear anybody else talking over your shrill voice."

"Quiet people, I'm going to lift her heart, turn it over, and place it on the tray. Do we have enough line on the bypass machine?"

"We have plenty of line, doctor."

"Before you do that, I might as well give you the rest of the bad news for today."

Matti said, "Agnes, I fucking hate you."

"Don't hate me, I'm only the messenger. It's your patient that's the problem."

"Go ahead, kill me. I am as dead as I can be any way."

"She has the worst of it, Matti. Polymicrobial NF Gram Negative. It's nearly impossible to cure, but it can be controlled, if you cut it all out, and I do my part. The CDC is going to hate me, but I am going to hit it at both ends of the spectrum, and hope that that this lady catches a break."

"What are you going to hit her with?"

"Everything! Vancomycin gram-positive and Cephalosporin. Then I'll go gram-negative with Clindamycin and Piperacillin-Tazobatan, at the other. If those two don't confuse and kill that stupid bacteria, I'm going to hit it with a huge influx of good old penicillin."

Harvey laughed. "Give that lady a gold star for thinking outside the box. Way to go Agnes, two drugs that go after gram-positive's, two that go after gram-negative's, and one drug that's not supposed to work against anything anymore. What else could any patient ask for?"

"That's why I thought of it. It's not supposed to work against any bacteria we know of. They have all become resistant to it. That's why I put it in. I hope this woman lives to be 100. Go to work Matti. Give her a chance."

"That's why we work in hospitals, Agnes, to give our patients a chance."

"Harvey, get ready to come over to my side, as soon as Joanna arrives. I want her to work on the aorta as quickly as possible."

"Do I get travel time?"

"Only if you measure it in centimeters. What is the temperature of the blood?"

"66°, doctor."

"How long has she been under?"

"5 hours and 47 minutes."

"Is Joanna on her way down?"

"Yes, doctor, she is scrubbing in now."

"Agnes, please tell me the other reason you're here is that you brought us the tissue for the resection?"

"Why would I do something as useful as that?"

"Possibly, because I would make sure you were the loneliest person in this hospital, for the rest of your natural life."

"I guess I brought up 16 inches of clean tissue for an aorta transplant."

"Okay Harvey, let's get to work."

"Why don't you start right over the area where Joanna is going to need room to work on the aortas attachment to the heart. It will give her easier access to it?"

"Excellent idea, I will use the scalpel for the initial incision to see how deep the diseased tissue has gotten."

"I need a dish, please. Look how easily the muscle cuts. I'm going to have to go lower to find healthy muscle, without accidentally cutting in to an atria or ventricle, which would be unrepairable. How far do you think I am now, Harvey?"

"I would say 5/16 of an inch, I wouldn't go any deeper, you bound to break into one of the chambers if you do. At this point, I wish you hadn't closed the heart. You could have used a finger to feel for the blade as you are moving it across the exterior of the heart."

"There is no sense going backwards, Harvey. She's been under almost 6 hours already, and that's pushing it for our weak she's going to be when she comes out from under anesthesia."

"I'm glad you're working on her. No one else in this hospital is qualified to do what you're doing."

"Sylvia, what time is it?"

"It's 4:10."

"Would you see if there's anyone left in the hospital. Get this woman on the transplant list: Post Haste."

"You got it, Doctor."

"Would you grab this flap for me please Harvey, and I'll only use the laser to cut it off."

"Seal that bleeder, hurry."

"I got it. I must have gone down too far. I'm right at the entrance to the pulmonary ventricle. If I slid just scalpel down another hair, we would have been done for today, and I would have done irreparable harm to her heart. I would have killed her."

"Matti, stop thinking bad thoughts, you are going to help this woman live."

"I'm sure not going to give up on her, after half a day, Harvey."

"There's my girl, the power of positive thinking."

"I really don't think it matters. The diseased flesh is right there at the top of the chambers. Either I get it all, or she's dead. I will tell the family, when we are finished, that her chances of survival are less than 10%. I am the doctor in charge Harvey, it's my job to do it."

"I know it is, but sometimes the circumstances are stacked against you."

"I know, Harvey, I just wish there was something else we could do for her."

"I'm just going to cut the remainder of the slack flesh off using the laser to keep her from bleeding."

Joanna Chikwe burst into the operating room and called out, "Did someone call for the best vascular surgeon in town?"

Matti replied, "Yes, we did, but they sent you instead. Get your ass over here, and start removing the diseased part of this woman's aorta, and resection the new tissue back to her heart, as quickly as possible."

As Doctor Chikwe moved into position and looked down into Jenna's chest. She stopped and said, "That's Necrotizing Fasciitis; how the hell did it get in there?"

"Doctor, we have been asking ourselves that question for the last six hours. However, instead of standing here doing nothing, my residents have gone out to the surrounding area, and brought back lengths of healthy tissue to replace that diseased portion. Now please, 'Do Your Job'! I would like to be able to go to dinner at a reasonable hour."

Joanna asked, "Who put a bug up her ass today?"

Harvey replied, "Have a look at the back of her patient's heart, Joanna."

Joanna Chikwe looked over Harvey's shoulder, and saw what Matti was doing with the laser.

"Oh crap, it's eating away the entire rear musculature of this woman's heart. I'm sorry Matti, I didn't realize this case was so serious."

"It's okay, just take care of that artery, please."

"Barring any complication, it will be done in 50 minutes."

"Don't rush, do it perfectly."

"It will be perfect. If you're not happy with my work, I'll do it over again."

The OR was silent except for the changing of instruments. Matti finished removing the diseased tissue from the back of Jemma's heart. Then she used the laser like a blowtorch going over the entire area, of the back of the heart, again, hoping to kill any residual bacteria that may have survived the lasers initial onslaught.

She did not give Jemma much hope of living. There was hope, there was always hope. She would not lift Williams hopes up. It was not right to lift a man's heart up, even a little, only to have it crash down on him within a few days.

Joanna said, "Matti, I finished."

"Agnes take this whole thing up to the lab. After you're finished examining it. Try to figure out how it started internally using our films. See if the CDC wants a piece of it. It could be a new strain. Don't forget to write up her orders."

"I'll take care of it, Matti."

"Okay, do your counts, then do them again. I don't want her to die because we left an instrument inside her."

"Doctor, we are short for sponges."

"Everyone step back from the table and look at the floor. Inspect the back of everyone else's suits, to see if there stuck. Then see if there's one pain in the ass doctor, who wants to get a rise out of you, after a long and trying day."

Matti opened her hand, and showed the four sponges that were missing.

"If no one has anything to do tonight, dinner is on me."

Harvey said, "I will not go to Burger King again."

"She took me to Red Robin last time."

"Okay guys, I mean dinner. A real Restaurant, one with a printed menu, linen tablecloths, napkins, silverware, and glasses you don't throw out when you leave."

"She must have coupons."

"I do not have coupons. Why can't I take my friends out after a hard day working?"

"Because we've worked with you for many years, and we know you so well."

"I promise this time will be different, okay?"

"Okay, we will give you one more chance."

Okay Harvey, let's close."

45 minutes later, Jemma was on her way to the recovery room. Doctors Williams and Chikwe were getting dressed after a shower, and not looking forward to talking to the Zabo family. At least Matti felt human, and not like a rung-out rat, as she did when she came out of the operating room.

Doctor Reynolds was waiting for them in the doctor's lounge. He wanted to make sure that Mr. Zabo understood how hard and long Matti labored over his wife in an attempt to save her.

When Matti and Joanne walked out and saw Harvey sitting there she said, "We are going to tell him the truth, Harvey. It's not going to be pretty, but it is going to be the truth."

"I know, Matti, but if he starts yelling at you for not doing the best to save his wife, I'm going to be there to tell him no one on this earth could have done any better than you did today. Our tapes will be there to back us up."

"Thank you, Harvey, that means a lot coming from you."

"Listen, you're paying for dinner. I want to see where you're taking us."

She hit him, before he could move out of the way. Men just don't move fast enough, when they know they deserve to get hit.

Gwen saw the three of them coming their way.

"Dad, here come the doctors."

William turned his head, as Patty turned his wheelchair to face them. He tried to read their faces, but they looked exhausted, even after a shower. For the first time in his life, he didn't know what to expect, and this was the most important event in it.

"Mr. Zabo, this is Doctor Chikwe and this is Doctor Reynolds. Doctor Chikwe did the resection of the aorta, and I will have her explain that portion of your wife's operation. Go ahead Joanna."

"Mr. Zabo, your wife's aorta was diseased from the entrance to her heart to 11.7 inches out. First, I have never seen 'Necrotizing Fasciitis' growing inside the human body. We are sending the entire piece to the CDC in Atlanta Georgia for examination and testing.

After removing the diseased piece, I was able to put a length of fresh tissue between the heart, and a non-diseased piece of the artery, 14 inches away. When Doctor Williams reattached all the arteries and veins that were on the heart-lung machine, and we verified there was no leakage anywhere, my job was done. I wish to say one thing more. While I was working on the artery, I watched Doctor Williams work tirelessly on the back of your wife's heart attempting to remove every speck of diseased tissue, while not breaching the inner wall of the valves, and chambers. Your wife is a very lucky woman to be alive at this moment. Matti performed miracles on the back of her heart, and I don't know of anyone on this planet who could have done any better."

William extended his hand and thanked Joanna for her work.

Harvey Reynolds introduced himself. "I was second fiddle today. I was there to back up the best of the best heart surgeon we have here at NYU. If you have a heart problem and you are assigned to Matti, you should kneel-down, and kiss the ground beneath you, because God has granted you the services of the best cardiac surgeon there is.

We have better technical surgeons. We had surgeons who leave straighter saw marks on your chest. However, if you are looking for a surgeon who knows what she's doing once she's inside your chest, you want Matti Williams. I watched her put in your wife's valve. She uses a stiffer thread than anyone else. I don't know how she does it, and she does it without looking, but when she is threading the area around the hole for the new valve, each of those threads are perfectly spaced, and they end up at the same height, every time. When I do it, I don't believe any two of my threads are the same height, or are in alignment.

When she cuts into the muscle of the heart, it is always 2 inches. It is just enough for me, or who's ever assisting her to spread the muscle apart and for her to look inside to see what is going on.

You can trust technology, Up To A Point. There is no substitute for what the human eye can ascertain when the going gets tough. With all the testing done on Jemma before we operated, no one saw the diseased artery. The human eye saw it. The CAT scan, and the x-rays did not. If she had gone for an MRI, that would not have picked it up either.

Robotic surgery is the thing of the future, and I'm sure it will make things faster. I am not convinced it will make it better than Matti Williams. Thank you.

Matti Williams stood in front of the family and allowed them to hit the floor softly.

"My colleagues, my friends, have hinted at, and gone around the edges of the problem that faces Mrs. Jemma Zabo. I am the lead surgeon, and it falls to me to give you the very bad news. It is my estimation that Mrs. Zabo will not live for more than one month, if that long, unless we can get her a new heart. I had a member of my staff call the office and put on the transplant list as in emergency status. If I were you, I would use all your "Legal" powers to make the powers that be understand your plight.

Many years ago, a 75-year-old, extremely rich, former Vice President, with a history of other medical problems, including alcoholism, and drug abuse, managed to get a new heart, over many other younger, more vibrant, and deserving individuals. He received a new heart, and some of them died, because of it. I believed the system could not be swung by using political or financial power. I guess I was wrong.

Except for your wife's heart, she is a perfectly healthy woman. Her lungs are pink, her ovaries are fine, her kidneys are fine and her liver is perfect.

If she died, I would ask you to donate her organs so other people could live. She could enhance the lives of 14 people, and you could have the skeletal remains, for burial purposes.

Let me go back to your wife's surgery, for a moment. It started out as a simple valve replacement, 5 ½ hours of surgery, into the recovery room for two hours, and up to her post surgical room, until the day after tomorrow. She would be home three days after that.

We opened her up and found this awful disease on her artery, and all hell breaks loose. Your people go looking for replacement tissue, as well as my residents. We wind up with enough tissue, that we now have a supply in the freezer that will last us a year. Thank you very much for that. As I am sewing the front of the heart closed, I feel something on the back of her heart. The back is covered with this slime called 'Necrotizing Fasciitis' also. It is so bad that the heart no longer feels like a muscle, but like a sponge. I put everything down, speak with Harvey, and ask the nurse to have you come here.

We have our conversation, and I realize how much you love this woman. I would love to go on that cruise, but it has no place in my heart when it comes to my decision as to what to do. I consult with Harvey again, and decide how much muscle we may be able to cut off the back of her heart, and give Jemma a chance at life. Let me change that, 'give Jemma her best chance at life. Working as a team, Harvey and I peel away as much as we as we safely could from the back of Jemma's heart. We left only a paper-thin area of muscle that can regrow itself into a more substantial muscle. It will never be what it was before, but she will have a working heart. This is her only chance, until she gets a new heart, and only if she follows the strictest of rules. I understand that your wife was very active. After two months of lying down, she is going to hate everyone equally. From you Mr. Zabo down to her children, she is going to hate everyone because of the restrictions she's under. If she gets up to walk, she will fall within a few feet, and die. She will have increased her blood pressure, and burst the membrane in the back of her heart that was trying to grow into a muscle. She will die before you can get her here. You will not see any blood because it will be seeping out inside her. You must sit with her every day and make her understand how tenuous her life is. A new heart is a necessity for her to go back to an active lifestyle.

We will give you a diet plan for her. She must eat 6 to 8 small meals per day. Four times a day, she must eat medium rare red meat. Liver, steak, hamburger, kidneys, if it comes from a cow, feed it to her, cooked medium rare. She can also have lamb during those four meals. If she wants chicken it must be during one of the other four meals. She can have all the eggs she wants during those other four meals. All of this will be on her meal plan. Mr. Zabo, you will not believe how weak your wife is going to be during the next four months. Her heart is younger than a baby's heart, and she's carrying the weight of the full-grown woman. She is not allowed to walk. She must get physical therapy three or four times a day by a registered physical therapist. I would prefer a man, or woman the size and shape of a gorilla. I don't want them to go soft on her, because I don't want her to lose muscle tone or bone density.