Dark as Daylight Ch. 18

"Come here you pain in the butt."

"Hello daddy. Hang in there. Don't give up on Jemma, she is a fighter. You know that as well as I do. Just remember her Boston accent on the day you met. That will keep a smile on your face, at least the cube with the yellow panties, with your signature on them will"

William laughed. "Yes, if there is one thing my bride knows how to do it is fight. I'll be back later, don't go anywhere."

"I just got here. Stephano has to feed me."

"Did you fly your new helicopter here, all by yourself?"

"William told me it was an emergency. My flight crew wasn't around. I wasn't going to drive down; the roads are unsafe. I hopped in the helicopter, strapped Stephano in, and flew down here while he prayed."

"That's exactly what I did dad. We just bought a new helicopter; it's not three months old. She's not familiar with it at all. It has twin turbo fan engines, and flies at 236 mph. We made it down here in 40 minutes. I don't know how many air traffic control rules she violated, but I know they are going to be looking for her tomorrow. She is a hazard both on the ground and in the air."

"I am not, daddy. As for the FAA coming to look for me, it will never happen. I never turned on my transponder."

"Patricia, you are as reckless as I am. Take care of everyone until I return."

She kissed her father and told him she would do as he asked.

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

Matti Williams finished detaching all the veins and arteries of the heart and attached them to the Heart-Lung Bypass machine. Now she cut through the heart wall just below the area where the tricuspid valve is located, leaving enough flesh to sew the new valve in place. There are many tiny veins that are attached to the bottom of the tricuspid valve. These were sealed using the electrocautery tool she used to cut through Jemma's skin at the beginning of the operation but at a lower power setting.

"How is she doing Cilia?"

"I'm not talking to you, until I get an invitation to Agnes' dinner party."

"Cilia, you're not supposed to get me angry at you, you have to get Agnes angry at you to get an invitation. Now, how is our patient doing?"

"I wish all our patients were doing as good as she is."

"That's good to hear, because after I put in the valve, there's another problem I must take care of, while I have her open."

"You're going to need a clamp for the artery?"

"You guessed it. The way it's positioned, it will be putting too much pressure on the chamber, and cause the implant to fail prematurely. This is the reason the valve failed in the first place."

"I could've told you that before you opened her up."

"Why didn't you?"

"Because it was of no value. She needed a new valve, and the reason would become evident after you opened her up. Any competent doctor would see the problem, and repair it prior to closing."

"What would you have done if I left it alone."

"I would have pointed out your error, and asked you to close that artery."

"Cilia, I am not going to close the artery, I am going to restrict the flow of blood coming out of it."

"Don't you run the risk of causing an embolism behind the restricted area?"

"Since I consider myself 'A Competent Doctor', I will make sure that does not happen."

"Ouch, I think you just smacked me."

"You are correct, and I will see what I can do about getting you an invitation to Agnes's party."

"Thank you, doctor."

"Cilia, you are a pain in the ass."

"Why thank you Doctor, those are the nicest words you've ever said to me."

"Ductus clamp."

"No, not this one, 3 cm."

"Thank you.

"Now the DeBakey clamp."

"Thank you.

"Richardson retractor."

"Another one please."

"There we go, I have a clear field of view for the entire valve now. Get the replacement ready, while I remove this one."

"Put your glasses on, or look away while I use the laser."

No one wanted to look away during this procedure, so everyone put their dark glasses on to watch the laser cut around the periphery of the tricuspid valve. On the lowest setting, the laser cut through the skin, sealing the edges of both sides of the tricuspid valve instantly as it went along, leaving a membrane of skin 1/64 of an inch for her to cut manually. She found it easier this way than watching the valve descend into the pulmonary ventricle itself, and she would have to search for it.

After making a complete circuit around the valve, and handing the laser to her nurse, Doctor Williams asked for a hemostat and grabbed the valve through the middle. It was still attached to Jemma's body but only by a hair's width. Using a Mayo-Hegar blade she went around the heart following the indentation made by the laser and removed the Tricuspid valve. She placed it in a sterile dish and her nurse covered it.

"Send that to the lab, please."

"Have we heard from any of my residents yet?"

"No Doctor, not yet."

"Dammit. Okay, it's time to insert the valve. 10 inch DeBakey needle holder, with curved needle, and polypropylene."

As Doctor Braverman said, Matti Williams was one of the best needle pointers he had ever seen. She went around the periphery of the heart opening where the valve would be seated, faster than a Singer sewing machine would have gone at full speed, leaving 3 inches of polypropylene standing tall after each stitch. She would make a knot, of impossibly small size, pierce the skin downward, and bring the thread up from the inside of the heart, piercing the skin again.

She looked at the 'Porcine Valve' to make sure it was perfect. Then she began needle pointing on the tiniest scale. It did not take her six minutes to do 80 tiny knots, and when she was done, she clipped off the excess string, and you could barely make out where her sutures were.

She looked at the 'Porcine Valve' on the video and said, "Poor little piggy didn't make it to market this time. Did anyone get a pork roast from this little piggy?"

The operating room burst into "Boos."

She had used these same lines so many times, they were expecting it from her.

"Okay, okay, I'll try something new the next time."

Cilia said, "You must be going senile, Matti. You've promised us a change for the past seven operations. Should we staple a note to your next patient to remind you of your promise?"

"I think it would be better if you wrote it backwards on the inside of my visor. It would obscure my vision, and I would have to make note of it."

"Your wish is my command, Doctor."

"If you do that Cilia, I'll grab your nose with a 'Mosquito Forceps' and locked them tight."

"I will sue you."

"Like all good doctors, my lawyer has all my money locked away in corporations. I believe I have $3000 in liquid capital available, at any one time, for people like you who wish to take advantage of a hard-working doctor. Now if you would allow me to get back to work, please.

Will someone start calling my residents to see if they've gone two dinner, instead of looking for 12 inches of a good aorta tissue."

"Time, please?"

"4 hours 37 minutes."

"Right on time. I am getting ready to close her heart, count your toys, boys and girls."

"Our count is correct, Doctor."

"Curved needle with monoclonal nylon, and a DeBakey 10-inch holder, please."

She had closed over two thousand hearts, since she started medical school, and as she closed this one, she kept looking up at the aorta, wondering what to do about the diseased tissue. It was less than one inch from the heart, and that wasn't a great distance, considering the chest wall would touch both if there was an incident, like a car crash, or a severe fall. She stopped what she was doing and shook her head.

Doctor Reynolds saw her indecision. He wondered if she was tired, so he asked, "Matti, are you all right?"

"Yes, Harvey, I am fine. I was just thinking about the aorta, and what to do about it as I closed. I don't have any answers, do you?"

"How much movement do you have with the heart?"

"What do you mean, Harvey?"

"How much movement do you have with the other vessels?"

She understood what her colleague was asking, and gently moved Jemma's heart to the upper right, towards the aorta.

"I can move the heart an inch, maybe an inch and one quarter, but that's about it."

As she was holding the heart from the bottom, it did not feel right. She turned it on its side to get a good look at it.

"Oh God, no; what do I do now?"

Harvey changed sides so he could look at it from a better angle.

Then he said, "I think you were right in the first place, Matti. You must play God. She is doomed if you do nothing, but if you can take ¼ la of an inch of muscle off her back of her heart, as if it was fat, you will give her a fighting chance to live until tomorrow; and possibly, longer."

"Put her very deep, Cilia, one way or another, we are going to be here for a long time."

"Matti, the next time I work with you, I am bringing my hemorrhoid cushion."

"You should have told me you had hemorrhoids, Cilia. It would be my honor to put you on a table, and hoist your bottom into the air, stick a probe up your ass, and band all those little suckers so they won't bother you anymore."

"You're just a pervert, Doctor."

"You are just finding that out now?"

"Sylvia, call the waiting room and have them get the next of kin here please. I have to discuss this with them."

"Yes doctor."

Sylvia picked up the phone and waited for it to be answered.

"Surgical waiting room, this is Louise."

"Louise, this is Sylvia Atkins, Doctor Williams surgical nurse. We need to speak to Mrs. Zabo's next of kin, as soon as possible please."

"I'll take care of it Sylvia."

Louise approached the Zabo's, and said, "The surgery unit has asked for a family representative to speak with the doctor about Mrs. Zabo. Which one of you would like to go?"

William said, "Would you please page radiology. Find Mr. William Zabo, and allow me to speak to whomever is administering his test. Please do it rapidly."

Louise back away from him, and replied, "Yes, Mr. Zabo."

Gwen grabbed William's arm. "You didn't have to tear her head off."

"I didn't realize I did."

"I'm just glad it wasn't Patty that spoke to her. There would be blood all over the walls."

"Is that a nice thing to say about your sister-in-law?"

"It might not be nice, Patty, but it was true."

Stephano said, "You should have seen her cut off the helicopter preparing to land at the heliport. That pilot must have a lot of hours on that chopper, because he pulled a really good maneuver to avoid us."

Patty asked, "How would you know, you had your eyes closed during the entire event?"

"I must have holes in my eyelids, because I saw the entire thing."

"I will sew your eyelids closed so it doesn't happen again. You will be safer the next time I do it."

"...and you two are still married after all these years!"

Stephano said, "Gwen, you have no idea how good makeup sex can be, until you've had a real knock down-drag out fight, with a person you absolutely hate, at that moment. It is almost like consensual rape, but she doesn't win in bed. I may walk away with scratches on my skin, but she has to crawl to the bathroom, because she can't walk when I'm done with her."

"Liar!"

"Keep your voice down, Patti. You are a little old to be walking around a hospital waiting room, with a sock in your mouth."

"You wouldn't dare."

He stopped all movement, and stared down into her eyes. He must've stayed that way for more than a minute without saying a word to her.

She cowed. "All right; I'll behave for now, but you haven't heard the end of this."

"Thank you, but I am going to ruin your day; possibly your month. I'm ordering you to remain quiet, because we are in the hospital. If you want to take this outside to discuss this personally, I will be more than happy to accommodate you."

"I'd rather wait until we get home, dear."

"Do I hear clucking in the room?"

"You're pushing your luck, Stephano."

"I'll hold the door open for you if you'd like?"

"Say what you are going to say and get it over with, because nothing you have to say will disturb me."

"You will turn redder then a ripe tomato or a red delicious apple when I finished. Everyone listen to me for a moment. My darling wife received her pilot's licenses five years ago, on June 17, to be exact. She is fully licensed by the FAA to fly all our corporate jets, and helicopters. I know she loves keeping this a secret from all of us, just to keep us on edge, while she is in the flight deck. I let her do this, because she is having fun doing it, and it helps her relax. It also has another benefit she doesn't realize. It keeps her out of the back of the aircraft, so those of us who know her secret can have a good time.

Now, I don't want to hear another word out of you, until we see your dad, or unless you're falling to the ground, gravely injured."

She mumbled, "Bastard!"

"Patty, let's step outside, I must give you an attitude adjustment."

"I want to stay here and wait for my father."

"You should have thought about that before you disobeyed me."

"I'm sorry, I will not say another word, until my father gets here."

"You're lucky you put that caveat in that sentence, because here is."

"What is the problem, William?"

"The doctor requested a family representative to meet with her at the operating theater. I knew you would want to be that person, but I am going with you."

"Yes, William, I am going to need your support."

"Louise, I am ready to wheel my father to the operating room. I am also sorry that I jumped at you."

"Mr. Zabo, you are not the first one, and you will not be the last one to do that to me. Please follow me; your wife is in operating theater number 9."

William Senior asked, "How is she?"

"I don't know, sir. The doctor will talk to you about her health."

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

As they were walking to the surgery, the phone in the operating theater rang continuously. Four out of five of her resident teams had acquired the needed length of aorta tissue, and were returning to the hospital as fast as they could. The fifth team had not checked in yet.

The same thing was happening in the surgical waiting room. Gwen was receiving phone calls from their agents advising of their success in acquiring the needed length of the blood vessel, and they were racing back to the hospital now.

She ordered the agents not to get into accidents, while they were returning. She took off running after William, and her husband to tell them the good news. She caught them before they reach the operating room.

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

"Dad, you can tell Doctor Williams that our people were able to obtain the needed length of the artery mom needs for the operation. She will tell you the rest. This is good news dad, this is very good news."

"If this is good news, what is the bad news?"

"I'll let the doctor tell you the bad news, dad. That's the reason she called you down here. The good news is the artery is here, and she can save mom's life with it."

"Why do I have a feeling I am not going to like this conversation."

"You would have liked it a lot less, if there had not been any artery available. Now that it is available, you cut the disease ends off, sew the healthy ends together, turn off the heart-lung machine, make sure there are no leaks, and you are home free. Go speak to the doctor, dad, it is all good from here."

"I hope so, Gwen, I truly hope so."

"We all do dad, we are all rooting for mom." She kissed him, and let him go through the automatic doors, with her husband, and the aide, not knowing the trouble that awaited them, on the other side.

Louise said, "The doctor will step out of the operating room, and stand in this circle. Air will rush down over her head and out towards you. It is negative pressure, which will keep her and the clothes she's wearing sterile. This way she will be able to see and speak to you, person to person. Please do not move forward, past this black line, or try to get by her. You are not allowed in the operating room, because you will contaminate the entire operating theater by your presence. If you touch the doctor, she must get completely undressed and put on a new set of greens, and a new space suit to finish the operation on your wife. Your wife is under general anesthetic, and the longer she is under, the more complications can set in. Do you understand?"

Both William and Junior said, "Yes."

Louise picked up the phone, and announced to the people in the operating room that Mr. Zabo, and Mr. Zabo Junior were here.

Moments later, Doctor Matti Williams exited the operating theater. When she took off the helmet to her spacesuit, she was soaked with sweat. Even though the suit is air-conditioned, the plastic trapped the bodies heat and humidity inside it, and forces the body to sweat. She used the towels she brought out of the room with her to wipe her head and face down.

"Hello Mr. Zabo, and you are?"

"William Zabo Junior."

"That makes things very easy, but it's the only thing that is going to be easy about this conversation. Mr. Zabo, your wife is a very sick woman. I have repaired the tricuspid valve, and that went very well. If that was the only thing wrong with her, she would be in recovery at this moment. Unfortunately, that is not the only thing we found, when we opened her up. My resident found an area on her aorta that was suspicious. The infectious disease doctor was called and diagnosed it as 'Necrotizing Fasciitis', or the flesh-eating disease. It does exactly what I said, it eats flesh. This is the first case I've heard of where it has started on the inside of a body, and not the outside. I sent all my residents to hunt in every hospital in the area, with a letter signed by me, asking for 12 inches, or more of this artery. I didn't care if it was male or female, I could always make size adjustments; it just had to be healthy tissue. I just received calls from four of my resident teams that they were successful, and they were on their way back to the hospital. This was good news for your wife. Then we ran into another problem. Unbeknownst to us, the disease had already spread to the back of the heart."

William Senior cried out, "No, I won't lose her. Please save her. Can you get her a new heart in time?"

"Mr. Zabo, we can always put her on the heart transplant list, she does qualify. However, without immediate intervention, she will not last until the end of the month. This disease is ferocious. It eats through skin like a hungry lion eats its latest catch. What I propose doing is to cut off between 1/16 and 1/8 of an inch, possibly a little bit more, if necessary, from the rear of her heart muscle. The muscle is already soggy, which means the disease has already invaded it, and the muscle is dead. It is not doing its job, it is not pumping blood. Heavy doses of antibiotics will kill this disease, eventually, but my colleague, Doctor Reynolds, and I, do not believe she has enough time for this to take place.

If I do this procedure, Jemma will become an invalid for three months to four months, at a minimum, and probably longer, while her heart heals. I know you are a very wealthy man. So, if you desire, she can rehabilitate at home, instead of a hospital, or in a nursing facility. She must not be allowed to do anything for herself. Even her checkups will be done at your home. That's how critical her health will be during this time frame. Can you arrange that for her?"

"Yes Doctor, I can arrange every comfort she will need at home. I want you to go back in there, and save my wife. I want you to use all your skills, and all your knowledge to save her. If you need help in any form, ask for it. I have more money than I will ever need in this lifetime, or the next. I cannot replace Jemma. She means more to me than air.