Page 22 of Resuscitation

Chapter Twenty

Nothing like trying to perform a miracle in front of an armed audience, Sara thought.

Both Mercer and Brick stood, watching their every move, as Kelly and Nick prepped Connor for Sara’s exploratory surgery.

“This better work, Doc,” Mercer warned her.

As if she didn’t know the consequences.

“Yeah, he don’t look too good,” Brick added.

Great, another expert opinion chiming in.

But it was Connor who she concentrated on. Now masked, gloved, and gowned, she peered down at her patient, meeting his eyes. They were glassy, the nitrous doing its job. “You okay, Connor?”

“All good, Doc,” he said dreamily.

“Here we go, then.” She moved to his belly, Nick across from her and Kelly at her right, ready to supply Sara with whatever she needed.

Sara’s hands trembled ever so slightly as she raised her scalpel in one hand, a wad of gauze in the other. She exchanged a glance with Kelly and Nick. Both were pale, fear etched into their faces, but their eyes were steady. They all knew what was at stake here.

If Connor didn’t live through this, none of them would.

“Remove the pressure dressing,” she ordered.

Nick used a clamp to pull the gauze packing away. Blood—much too thin and watery—oozed from the gunshot wound.

Without hesitation, Sara began her midline incision, her scalpel slicing Connor’s skin and subcutaneous tissue from sternum down and around his umbilicus. Then she and Nick separated the wound edges, opening up her surgical field.

“Pack it,” she told Kelly as more blood rushed over the edges of the incision, dripping onto the floor. “Nick, retract the bowel.” He gathered the loops of intestine in a saline-soaked towel, cradling it to the side where it wouldn’t obstruct Sara’s view.

Connor gave a low groan that had Mercer tensing. But then Connor relaxed, and so did his older brother.

Sara glanced at the monitor, which confirmed what she already knew: Connor hadn’t relaxed because the nitrous was working, rather he’d slipped further into shock and was now unconscious. “Kelly, dial up the epi. Max it out.”

Kelly hesitated—not because she was unsure of Sara’s orders, she knew, but because she was fighting her training by contaminating one hand to touch the non-sterile IV pump. But she did it. “Done.”

Beyond the door came the sound of two gunshots. Everyone froze.

“Focus, people,” Sara murmured, despite her own churning fear.

Brick tensed, listening to his radio. “Gonna give the guys a hand in the waiting room,” he told Mercer.

“What happened?” Mercer’s attention was torn between Connor and whatever was going on outside in the rest of the ER.

“Don’t worry about it, boss,” Brick said. “I’ll call if we need you.”

Sara would have given anything for a working suction machine.

“Use the towels.” The gauze wasn’t cutting it.

“Pack the lower quadrants, let me get a look at the spleen.” A ruptured spleen she could at least do something about: clamp off the hilum vessels and stop the bleed.

There was clearly a lot more damage to address—including the perforated bowel leaking the stench of stool—but slowing Connor’s blood loss would keep him alive. For now.

She found a subcapsular bleed, but nothing serious.

To be on the safe side, she clamped the splenic vessels anyway, then turned her attention to Connor’s liver.

Nothing there beyond a few tiny bleeds, all easily dealt with, but they didn’t account for the ongoing bleeding coming from deeper inside his belly.

“Sponge.” Kelly slapped another wad of gauze into Sara’s waiting hand.

Sara finally was able to see. “Mesenteric vessels. Shredded.”

Nick gasped but covered it with a quick cough.

Mercer sensed something was wrong and stepped forward. “What’s going on?”

“The bullet damaged the large blood vessels connected to the intestines,” Sara told him, surprised by how steady her voice was. “I’m going to clamp them so the bleeding will stop.”

“And then you’re done? He’ll be okay?”

“And then I’m done.” It was no lie. There wasn’t anything she could do to save Connor. Kelly handed her a vascular clamp. Sara found an intact section of the artery and clamped it, then the vein as well. At least Conor’s blood loss would be slowed.

Mercer’s radio squawked. It was Brick.

“Mercer, come in.” He did not sound happy. Not at all.

Sara exchanged glances with Nick and Kelly. Who was dead this time?

“Good work, Doc,” Mercer said. “Finish up, I’ll be back.” Holding only his radio, he left, footsteps echoing down the hall.

Sara realized this might be their only chance. “Nick, Kelly,” she said. “Get out through the ambulance bay. Go.”

Kelly’s eyes widened. “We can’t just leave you?—”

“You have to,” Sara snapped, her voice sharp with command. “Get help. Go!”

Nick hesitated, but then Connor’s weak voice cut through the tension. “She’s right…you gotta get out of here. Run.”

The two exchanged glances. Then they both looked at Sara.

“Are you sure?”

Sara glared at them, making the message clear. “That’s an order. You guys might be our only hope.”

That got their attention. Kelly gave Sara the towel she was holding.

Nick went to the door, looked down the hall. “Coast’s clear.”

Not even bothering to strip free of their surgical garb, both gave Sara one last look, then ran out, their footsteps quickly fading away.

With the room now eerily quiet, Sara turned back to Connor. His eyes met hers.

“I can’t save you,” she said softly, her voice trembling slightly. “But we can save the hostages.”

Connor’s gaze didn’t waver. “How?”

“If I stop the blood flow to the rest of your body, your heart will pump what’s left to your brain, keep you conscious.”

“How long?” He hadn’t even hesitated. Did he understand that she was talking about killing him?

“Not long. You’ve already lost too much blood. Maybe ten to fifteen minutes. At most.”

He nodded, giving her permission to both condemn him and absolve herself. “Do it.”

Breaking every oath she had ever taken as a doctor was a knife twisting in her gut, but there was no other way.

She drew a deep breath, took the clamp from the vascular tray, and gripped it tightly, focusing on the grim task.

Carefully, she worked through the blood-soaked packing gauze to isolate the abdominal aorta.

She chose the largest vascular clamp, strong enough to hold the blood vessel closed, gentle enough not to rip its walls.

As she worked, Sara couldn’t help but think of all the lives she had helped save in this very room. Now she was deliberately ending one.

She locked the clamp into place, sealing his fate.

Connor’s gaze remained lucid as the increased blood flow to his brain kept him painfully aware, his breaths coming in shallow gasps.

She replaced his intestines and packed as many towels as she could into his abdominal cavity. Then covered him with a drape. Hiding the evidence.

Backing away from her dirty secret, she stripped free of her bloody gloves and gown, pulled her mask off so Connor could see her face.

“It’s done,” she told him. “How are you doing?”

“Better. Don’t feel much, just cold.”

“Your blood’s being replaced with IV fluids, and you’re in shock.” She hesitated, but she had to give him the option, it was only right. “If things get too bad, I can?—”

He shook his head, his oxygen mask slipping. “No. No.” Then he whispered, “I never wanted any killing. Never wanted it.”

His gaze locked with hers, and despite her shame for what she’d just done, condemning him, failing him, she didn’t look away. He deserved that much from her.

“Save them,” he ordered her.

“I will,” Sara vowed.