Dark as Daylight Ch. 18

"Yes Doctor."

Running is not allowed in hospitals... NORMALLY, but this was not a normal situation. Jemma was taken for a CAT scan immediately, and while she was undressing, a technician from the lab took six assorted vials of blood from her.

They slid her into the machine for the first series, pulled her out, injected her with a radioactive isotope, and slid her back in for another scan.

While all this was happening, Gwen told Manolo what to do when her father-in-law asks why Jemma is not with him.

He agreed without question.

Within moments of one another, the three surgeons who were called in arrived, and were given updates on what was known so far. They walked to radiology to look at the preliminary scans to see what they were up against.

The chief radiologist, Doctor Michael Recht was looking at the nuclear scan as they walked in.

He asked, "How did we miss this? She comes here every year for her physical. The valve barely meets, blood is flowing through there unimpeded. Matti, I think you should go scrub up and get ready for a valve replacement immediately. She's going to have to go on a heart-lung machine before she strokes, and that could be very soon.

It also looks as if she has endocarditis on the underside of the valve. How that got there I'll never know, because it's supposed to be on the opposite side. Gwen, you just saved your mother-in-law's life, because there is something else here you must see. Look at the Aorta. It appears something is eating it from the inside. It may be the same bacteria that is causing the endocarditis on the valve. We can start her on a high dosage of antibiotics, immediately, and then become more specific with an antibiotic as soon as we know what we are fighting.

As soon as Matti opens her up, I want multiple swabs of that area taken, and I want the valve brought to the lab immediately after its removed for comparison. If it's one and the same bacteria, then we will know what to fight it with."

Gwen was watching the screens as they were talking and then as one they froze.

She screamed, "MOM!"

She burst through the door from the technical room into the examining room, pushed the emergency button that started retracting Jemma from the inside of the tube. When Jemma was out, Gwen's fingers went immediately to her carotid artery. There was no pulse, and it was obvious Jemma was not breathing.

She jumped on to the table, and with Jemma between her thighs, raised both hands in a fist above her head.

She screamed, "You bitch, not today."

She brought her fists down viciously onto Jemma's lower chest, and then began chest compressions immediately: one 1000 2 1000 3 1000 4 1000 5 1000. 1 1000 2 1000 3 1000 4 1000 5 1000...

The other doctors were in the room with her, as well as the emergency room team with the crash cart ready to take over. The only problem was Gwen had other ideas. She was screaming at Jemma at the top of her lungs, until finally, they pulled her off and could check Jemma out.

She was breathing, and they put an oxygen cannula in her nose.

When her eyes fluttered open and she felt the pain in her chest, her first words were, "Ow, who hit me?"

Gwen moved over to her, cupped their hands together and said, "The next time you code on me, I'll kill you myself, I won't wait for dad to do it."

"What happens now?"

"You're going to get a new heart valve in a few hours. You're going up to surgery now. Don't you dare do anything stupid, mom, or I'll raise our kids as nudists."

Jemma laughed, until she started coughing.

Manolo moved in.

"I'm glad you two are having a good time. I must take care of your husband, Jemma. He will miss me if I'm not around during his testing. I leave you in great hands. Matti Williams is a great surgeon. She is one of the finest needle pointers I have ever met. You may still be able to wear a bikini when this is over."

"Fuck the bikini. I want to die in bed with my husband, when he is 130 years old."

"I'll work on it. I'm not promising you anything, but I will work on it. Off you go, I'll say a prayer for you."

Jemma moaned, "Oh no, a fucking doctor, who prays for luck."

******************

As soon as Jemma was clear of the room, Gwen asked, "Don't fuck with me Manolo, tell me about my father-in-law?"

"It's very easy, Gwen. He is healthier than she is. I found no traces of serious heart defect so far. He has all the signs of arterial sclerosis for a man his age, but he is in better shape than most men in his age group. There are still more tests to come back, but right now, I have no problem saying he's healthy."

"So, if I told him Monday morning that mom had open heart surgery, I wouldn't kill him."

"Let's do that together, at 11 AM Monday morning. Is that okay with you? All the tests will be in, and analyzed by the board by then. If there are no surprises, I have no problem with it."

"I agree. Needless to say, I'll be sleeping at the hospital tonight."

"That's funny, so will I."

"No, you cannot sleep with me; William will not approve."

"Can I sleep with William?"

"He snores, and he farts in his sleep."

"I'll sleep alone."

"I thought you might, unless you wanted Olivia to join you?"

"I have thought of that often, but that child is only 16 years old. I prefer being a doctor on the outside of jail, rather than on the inside."

"The way she looks at you, she would sign a release giving you her virtue willingly."

"Again, Olivia is only 16. She cannot sign a legal document, unless cosigned by a parent or guardian. I will continue to tease her for the next few years to keep her interested in me, and at the instant of her 18^th birthday, I will alleviate her of her maidenhood on video for posterity. I will treasure it for my lifetime."

"How many others do you have on video tape?"

"Do you really think I am that perverted?"

"I do."

He smiled. "Two, while I was in Germany; three, while I was in France; and zero, while I was in England. Those English maidens keep their legs tied very tightly together, until they reach college age. By that time, they stop volunteering at hospitals. It is truly a pity, because many of them are so much hotter than their climate."

"What are you doing while waiting for dear Olivia to come of age?"

"NYU is a teaching hospital. Do you know how many aspiring young doctors, and nurses come through here each year?"

"How often do you get yourself tested?"

"I get tested every three months, and I never go anywhere without a raincoat on. Even when I'm sure the lady in question is virginal, you never know who she may have kissed. There are orally transferable diseases, unfortunately, and I must be certain I am healthy at all times."

"I guarantee you that your patients appreciate the way you care for your body, and them, Manolo."

"My patients are what I live for. My sex life comes second, a very close second."

Gwen hit him on his arm and laughed.

*************************

Doctor Matti Williams looked down at Jemma and took her hand in hers.

"Mrs. Zabo doesn't all this high-tech stuff look foreboding?"

"It sure does, especially from my position, Doctor."

"Let me relax you, before we put you to sleep. This is Doctor Cilia. She is your anesthesiologist. Your daughter-in-law has signed your paperwork allowing her to assist in the surgery. If I was lying on that table, I would want her taking care of me, because there is no one better in this country, or in my estimation, in the world. She has written more books on anesthesiology than anyone else. She has the patent on the process we are using on you today.

Everyone in this room is the finest on this hospital's staff, and that means they are the best of the best in the world. I will be repairing of your heart using my hands, instead of using our robot. I want to get a good look Aorta. It didn't look right on your CAT scan and x-rays. Whatever it is, I will fix that also, or I will call in Doctor Joanna Chikwe to do it. She is a specialist in Aortic surgery, and while you are on the bypass machine, it should be a piece of cake for her to repair.

When you wake up in six hours, your heart will be like new, and we will go from there to get you healthy again. I'm going to have a quick breakfast, and then scrub in, while Doctor Cilia starts the process of putting you to sleep. We don't lose patients, Jemma we heal them. We will heal you today. That is not a guess, it is a promise. You will walk out of this hospital in five or six days. If We don't find anything else catastrophically wrong with your heart except the valve, you will be running your half marathons in four months.

My staff and I have no place to go today. You are our priority. The heart-lung machine can keep you alive for days, if necessary, but everything we saw in your scan tells us you will be awake in six hours, and telling me you're hungry."

Jemma sighed. "Thank you, Doctor. Let's get this fucking thing over with, please. I don't want to scare my husband, when he finishes his testing today, and asks where the hell I am."

"Jemma, you are amazing. You have a life-threatening situation to deal with, and you are only worried about your husband. I'll make sure he knows it one month from now.

Cilia would you please put our patient to sleep."

"I believe I will, if you move your ass out of the way Matti."

"Okay, bacon, sausage, and eggs, here I come."

A doctor, of African-American descent, moved into Jenna's line of sight.

"Hello, I am Doctor Cilia. I won't say my first name, because you will not be able to pronounce it properly. Everything I'm going to do for you, and to you is very simple. You already have all the intravenous lines introduced into your veins. I'm injecting Diprivan into one of the tubes now. As I am talking to you, you will feel a burning sensation in your hand. I want you to tell me when you feel it."

Seconds later, Jemma said, "Oh yes Doctor, I feel it. It's not uncomfortable or anything, but I feel it."

"First, I would like you to say good night. After that, count back from 5 to 1. Begin."

"Good night, Doctor Cilia. Five..." Then she went unconscious.

Doctor Cilia laughed. "The polite patients always make that mistake. I only asked her to say good night. Once she adds my name, she was lucky to add the number 5. Okay people, let's start earning our paychecks.

The nurses removed Jenna's gown exposing the center of her chest, but leaving her breasts covered by separate sterile towels. The midline incision would start just between them. The rib spreader would both spread and raise the ribs away from the heart making it easier for the surgeon to use her hands to maneuver her heart, as needed, to detach the arteries and veins, while attaching them to the appropriate lines to the Heart-Lung Bypass machine.

Many surgeons equated this to being like a skilled mechanic doing a tune-up on a car. Remove spark plug wire number one 2 inches from the heart, and attach it securely to the intake valve number one of the Heart--Lung Bypass machine.

Doctor Cilia took her position at the head of the table. A safety screen was put in front of her, just in case blood splattered during the operation. She was wearing a spacesuit safety garment, which covered her from head to toe. Everyone in the O.R., including Michelangelo, the residents, interns, nurses, and the nurse trainees were protected just as Doctor Cilia was; there were no exceptions.

Even though this was supposed to be a simple Valve Replacement, the gallery was even filling up. Apparently, Jemma's name sparked interest far above the technical aspect of the operation.

The temperature in the operating room was 82°. Doctor Cilia pulled Jemma's head back, used a tong like instrument to pull her tongue forward, and inserted a tube into her lungs to intubate her. She opened the oxygen valve first, followed quickly exact amounts by Sevoflurane and Nitrous Oxide. She watched the values very closely, until her nursing assistant said, "Doctor, she is under."

At that point, Doctor Cilia decreased the amount of Sevoflurane to .0062mlhr Turned off the nitrous oxide, and added Enflurane at .013mlhr to bring Jemma into a deep coma like state. When this was accomplished, and all the values, including her heart rate, blood pressure, and cerebral blood flow were within the prescribed parameters she inserted a second tube that went into Jemma's stomach. This tube would stop any air or liquid from collecting inside her. This way her patient would not feel sick or bloated when she woke up. You didn't want a patient vomiting after heart surgery. Her last step was to increase the oxygen rate that would keep Jemma's mind active while listening to music during surgery, even though she would never remember anything she dreamed about, or that happened to her during the surgery.

Seven minutes after she started, Cilia's patient was resting comfortably, her respiratory rate, blood pressure, heart rate, cerebral blood flow and oxygen intake were in line for this procedure. Now her job was to keep her there for the next 5 ½ hours, while Matti opened her chest, put her on the Heart-Lung Bypass machine, replaced the Tricuspid Valve of her left ventricle, with one from the young pig, which gave its' life for medical research, and probably several hearty meals for the staff at the research facility.

Medicine required sacrifice from its practitioners, and participants. The young pig lived an idyllic life, in pristine conditions, until the last second of its life. It never knew what happened to it as it entered its private shelter as it normally did every day. On this day, however, it just ceased to exist. It didn't feel anything as it passed from this life to the next. Its life was cut short, so it's heart valves could save the lives of as many as four human lives.

In this case, Jemma was going to be a 'guinea pig' for one of its valves. In 12 to 15 years, if she lived that long, another pig would have to make the same sacrifice for her, because the valves only lasted so long.

Jewish and Muslim recipients of heart valves receive the mechanical type, because of their religious objections to pork. The valves make a constant clicking sound as they do their work. Many recipients find it very disturbing as they try to go to sleep at night. Some become psychotic, because of it. They wind up going to a psychiatrist. Their doctor tells them they have a choice: learn to live with the clicking, because it's the sound that's keeping you alive; or have it replaced with the 'OTHER' kind, and learn to live with something that is anathema to their religion.

Psychiatrist wind up having a good paying patient for a very long time, because many patients cannot come to terms with either choice.

Doctor Matti Williams backed into the Operating Room, with her elbows against her chest, and her hands raised at a 45° angle. She was immediately glove by her assistant, and looked around the crowded room.

She said, "All my Resident's better be here."

They answered by name, instead of saying 'here.' There were 10 of them, seven women and three men. She wasn't sexist, but in the back of her mind, she thought about all the insults she took while climbing the ladder to where she was this day. She liked the fact that there were more young women under her wing, then there were men.

"Who is assisting me today?"

She knew who they were, because there was a rotation they followed. She wanted to see if anyone tried to break protocol. No one did.

Doctor Joanne Marx called out that she was in line to assist; as did Beverly Cascade.

Matti asked, "Are you gloved and ready to go?"

Both residents replied, "Yes Doctor."

"Who was in the bullpen?"

"I am Doctor. Gary Suchliki."

She would normally have one of her residents start this procedure, but not today, and not on this patient. She took a marking pen from the tray and felt up Jenna's rib cage. She placed a mark where the third rib joined, and put the marker down.

"Start the clock."

Using in Electrocautery device, she began cutting Jenna's skin from her mark down to the end of her rib cage, wiping away the little bit of blood that the machine didn't stop as it went along. When she finished, she handed the device to a nurse, and without asking was handed a Rochester Forcep, and a DeBakey knife.

She used the forcep to raise the skin away from Jemma's chest wall, and cut the remaining 3 inches of skin up to where the structure ended. Now she was ready to be a carpenter.

"Chest saw, please."

The chest is not made of bone, but cartilage. That means nothing when you are trying to cut through the center of it. It is the thickest point of the chest, and is designed to protect the heart, lungs, diaphragm, and liver. It is not designed to be broken, sawed through, or cut. It fights you every inch of the way. You must go very slowly and carefully, lest the saw bucks out of your hands. The blade will spin for about four seconds, and if it lands on the person you are operating on, or one of the doctors, nurses, or technicians that are trying to help you get a good result from this operation, it is the surgeon's fault, and no one else's.

It had happened before, and so one took this part of the operation for granted. Even with all the safety lectures, the only thing you could do at this moment was to be alert, and everyone was alert.

Doctor Williams was meticulous. It took her a full two minutes, plus a little to saw through Jemma's sternum, but the line of her chest was as straight as a laser could make it.

When she was finished cutting, she asked, "Wipe, please."

The hard part of the operation had not started, and she was sweating in a very cold room.

"Jack Daniels, please."

Everyone laughed as a nurse brought over a can of Hirers diet root beer, with a straw already inserted.

Matti never touched it. The straw went through a hole that opened on the side of her mask and to her lips. She drank slowly, but she finished the entire can. Then she remarked, "I'm good for three hours."

Everyone in the room cracked up.

She turned back to her patient and asked for the rib spreader. It looked like something you would make out of an 'Erector Set', but you would make it look better. Several moments later, there was Jemma's lungs, which were perfectly pink, and healthy.

"Marx, Cascade, what can you tell me so far? Marx's first"

"If the rest of her looks like her lungs, she could live for another 20 years without a doubt."

"Doctor Williams, I may be totally off base, but there is something wrong with her trachea. It looks diseased, and I have no idea what it is."

Matti had not looked that high on her patient, but she moved the lights up higher now.

"Magnifying glasses."

They were handed to her in an instant.

"Get me some sample dishes, and get infectious disease down here, stat. Good call Candy, I didn't see it. You get an 'A' in eyesight, but I don't think that's the trachea. I think her heart is twisted, and what we are looking at is her Aorta."

"Riley, I want an x-ray of this now please."

Matti took three samples, place them in sterile dishes, and sent them off to the lab for instant analysis.

Riley yelled, "Everyone back off please."

Riley rolled the portable x-ray machine over to the operating table. He established the parameters of the x-ray, from just below the heart to just below Jemma's eyes.

He backed off pulling the coiled cord with him and said, "Shooting."