While Cindy watched, I spoke slowly and didn't look at her. I nodded toward the bunk room. "The bag beneath the bed." I kept a small first-aid kit beneath our bunks in the event that either of its ever got cut or hurt in the workshop.
Cindy flung herself into the bunk room and just as quickly returned, dropping the bag on the ground and kneeling opposite me, awaiting orders.
I looked at her. "Do you trust me?"
She nodded and placed her hands along Annie's sides, as if to brace her for whatever I was about to do. I thought about Annie's body and how what I was about to do would ravage her body with infection. The only hope we had was that the stepped-up doses of antibiotics could hold off whatever would creep into her system until we could get her into a sterile field.
I pulled off the top of Annie's bathing suit, ran my fingers along her sternum, found the point I was looking for, and slammed the needle down and into her chest. When it pierced the pericardium, it showered me in Annie's blood, releasing the pressure. I pointed toward the toolbox and said as calmly as I could. "Second drawer, blue-handled pliers."
Cindy ripped open the drawer, fumbled through eight or ten different sets of pliers, until she found the angled wire cutters I was looking for. I turned Annie on her side and slit the skin along her rib. It was about that time Charlie climbed through the debris and out of the lake. He had a cut on his face, another cut somewhere on his head, and his left arm was hanging limp and lifeless. He spoke softly, "Stitch, what do you need?"
I knew from the look of the trees around me that there was no way I could get the Suburban down the drive and out onto the hard road. "I need a ride out of here." In the distance, I heard the high-pitched whine of a jet Ski screaming across the lake. "Get to the edge of the lake and wave your arms. If that's Termite, I need him."
Charlie disappeared, and the fear across Cindy's face told me all I needed to know. Annie had started breathing, but I had about one minute to patch the hole in her heart before I lost all ability to keep it pumping. I pointed at the bottle of Betadine and nodded at Cindy. "Cover my hands."
The sound of the Jet Ski approached, stopped, then screamed away as quickly as it had appeared. In ten seconds it was gone, and in all probability, Termite was traveling somewhere around ninety miles an hour across a lake littered with nail-split debris. Cindy doused my hands, turning them an ugly yellowish brown. I washed in Betadine and looked at her. She held out the pliers and nodded.
I opened a suture pack and bit the thread like a seamstress. I grabbed the pliers, clipped the rib, spread open the cavity, cut the pericardium, and there before me lay Annie's disease-ridden, sick and dying heart. With blue skies above and no roof or tree limbs to obstruct it, light was not a problem.
I found the small hole, which was not difficult, made five quick stitches, and pulled the purse string tight. Unlike Emma's, Annie's tissue was not brittle. Her youth might just get her to the hospital.
Annie's heart fibrillated, twitched violently, and jolted, pumping weakly but pumping. It held. Looking at the mess around me, we had fifteen minutes on the outside. After which Annie would most likely bleed to death if her heart didn't quit first.
I motioned to the cell phone on my belt. Cindy picked it up and dialed Royer without having to be told. Three seconds later she had him on the line. She nodded and held the phone for me to speak. My tone of voice told him as much as anything.
"Royer, transmural rupture with pericardial tamponade." In the distance I heard a ski boat screaming toward us. "We've got no fluids, and ten minutes max. Tell Life Flight I'll meet them on the meadow next to the trout hatchery."
"The what?!"
`Just tell them! They'll understand. And tell the folks at Rabun to get the pump up and running."
Annie's loss of fluids was about to become a problem, and I had no lactated Ringer's. I looked around. Think, Reese! Think!
Charlie reappeared, his left arm dangling. The picture of him, hurt and holding his arm, reminded me. I motioned again at the contents of the medical bag scattered around Cindy on the floor.
"That plastic bag there."
She picked it up, bit off a corner, and pulled out the IV tubing from inside.
"Good," I said. "Now, insert those needles into each end."
Cindy plugged the needle-tipped ends of the IV into the ends of the tubing, then held it out to me. Dipping it in Betadine, I inserted one end into my right arm, and immediately the tube filled with blood. When it began running out the other end, I dipped the other end in Betadine and inserted it into the large vein in Annie's right groin. The advantage of using so large a vein was that it would carry large amounts of my blood directly into Annie's heart.
I pulled the watch off my wrist and handed it to Cindy. "Tell me when eight minutes are up." I lifted Annie off the ground, made sure the line wasn't crimped, and walked quickly to the beach. When I got there, Termite was docking what looked like a cigarette boat. It was probably twenty-eight feet long, had two engines on the back, and looked like it would travel a hundred miles an hour. By the looks of Termite's face and hair, it had.
I stepped into the boat, Cindy and Charlie did likewise, and Termite looked at me. Panic and disbelief riddled his face.
"Termite," I said, "I need you to get us to the ramp at the hatchery."
He looked at Annie and nodded. I laid Annie down in the boat, her head toward the engines, and knelt above her. I was counting on gravity and the angle of the boat in the water to pull the blood more quickly down into her chest cavity-and brain.
"Termite," I said, looking up from Annie, "now. "
He threw the boat into reverse, backed us out of the finger, and then pushed the stick forward, never stopping. He slammed the stick as far forward as it would go. Cindy and Charlie braced in the seats next to me, I knelt over Annie, and the boat screamed across the glassy lake. When I saw the speedometer, we were moving at eighty-seven miles an hour.
Three minutes later, Termite turned the corner, slowed the boat to maybe thirty miles an hour, cut the engines, and trimmed them above the waterline. When they were clear, we hit the boat ramp square in the middle. The ramp launched us up along the carpeted runners and into the grassy meadow next to the playground along the hatchery. The boat slid along the grass and into the soft sand of the playground, where it dug in and slowed to a tilted stop.
I laid Annie on the grass and waited for the sound of the helicopter. Cindy tapped me on the shoulder, biting her lip. She held out my watch. It'd been eight and a half minutes. Charlie knelt nearby, running his hands along Annie's legs. When he got to the IV, he ran his other hand along my right arm. When his fingers hit the tape, he pointed his face toward mine.
He said, "How long you been doing that?"
I was growing light-headed. "About ten minutes."
Charlie ripped off his shirt and held out his arm. If Annie was to have any chance at all, I had to get that tube out of my arm. I pinched the tube, pulled it out of my vein, and immediately thrust it deep into the vinelike vein running down Charlie's arm. He never winced.
Annie's eyes searched the world as if the light around her were growing dim.
"Annie, honey. Hang on." I hovered over her, trying to force her eyes to focus on mine. "I need you to hang on a few more minutes. Do you understand me?"
She swallowed and tried to nod, but her eyes rolled back in her head, and she coughed. I pulled the pill container from around her neck, emptied the pills onto her chest, and nodded at Cindy. She held one to her teeth to bite it in half, and I shook my head.
"No, not this time. We need the whole thing."
She placed the nitroglycerin tablet beneath Annie's tongue, and within ten seconds some color returned to Annie's face. In the distance, I heard the chopper. I looked at Termite, who stood wide-eyed and open jawed above me. Then I nodded toward a Coke machine some hundred yards away.
"Think you can get a couple of Cokes out of that machine?"
Termite disappeared, only to ret
urn with two Mountain Dews about the time the helicopter landed in the grass next to us. Charlie had given Annie about eight minutes of his own blood when the chopper arrived. I lifted Annie up into the bird, pinched the IV tube, and immediately spliced into it the IV line running from a bag of lactated Ringer's that hung from the top of the helicopter. The medic immediately started squeezing that bag to increase the pressure and flow into Annie's heart.
The door shut behind us, and as the pilot pulled skyward, I looked back at the three of them, Charlie, Cindy, and Termite, standing together against a backdrop of green grass, a trail of Annie's blood, and somebody's one-hundred-thousand-dollar cigarette boat that now lay beached like a dying whale. Just before we cleared the treetops, Cindy covered her mouth and buried her head in Charlie's shoulder.
Chapter 53
e landed at Rabun amid a flurry of well-meaning medical personnel who had little to no idea how to handle a Level 1 trauma. The only one with any wits about her was the medic who had just picked us up.
I looked at her. "You got any trauma experience?"
"Grady Memorial, four years, weekend shift."
"Good enough. Follow me."
We rolled Annie inside, where people in white coats and multicolored scrubs were scurrying about like ants after someone had just poured gasoline on their hill. At the center of the room stood Sal Cohen, barking orders like a drill sergeant.
He pointed toward the hospital's only operating room. I nodded, rolled Annie inside, and saw the perfusionist readying the heart-lung machine. When I turned around, Sal was jamming his right hand into a rubber glove and looking at me for direction.
I looked at both him and the female medic from the copter. "I need a sternal saw."
The medic turned to the perfusionist, who held up a finger, disappeared around the corner, and then reappeared carrying an antiquated saw. Sal spread Annie across the operating table and began swabbing her chest with Betadine. Annie's radial pulse was nowhere to be found, and her carotid pulse was vague at best.
Time was out.
An anesthesiologist appeared out of nowhere. Annie was mostly unconscious already, but he quickly injected her and made sure she wouldn't wake up anytime soon. He pushed the free end of a long tube, the other end of which was attached to a ventilator, into Annie's mouth, down between her vocal cords and into her windpipe. The ventilator rhythmically blew air down her endotracheal tube, breathing for her.
With Annie's air supply operative, and drinking in oxygen-rich air, I slit her chest alongside the older scar, cut the sternum up to the base of her neck, and stepped aside as the medic inserted the chest spreader and cranked open Annie's chest. I pulled aside the pierced pericardium and immediately went to work freeing the scar tissue that surrounded it. With every pull, I feared my purse stitch would give. It did not.
Annie's previous open-heart had left a lot of scar tissue that slowed me down. I put one suture into the ascending aorta, then two sutures in the right atrium. I injected a drug called heparin directly into the heart to keep her blood from clotting as it passed through the oxygenator and bypass machine, then inserted tubes called cannulas through these three new purse-string sutures, in order to connect Annie to the heart-lung bypass machine. I stitched them in, and as I did, Annie's heart flatlined. I nodded to the perfusionist. "Your turn."
She nodded, opened the lines, and immediately the plasma filled Annie's deflated frame. Within seconds, her arteries and veins flowed, oxygen reached the far corners of her body and, at least for the time being, Annie was alive.
What I wouldn't know for some time was how long she'd been dead, or, when she woke up, if she woke up, how much damage had been done to her brain. I pushed the sweat-streaked hair out of her face, stepped back, and stumbled under my own lightheadedness. I'd worry about the damage in the days to come. Right now I had to find a heart.
Sal instructed a team of nurses and doctors to sterilize everything from Annie's chest outward. I watched the machines that monitored Annie's life and realized that, though sleeping, she was more alive at that moment than she had been in years. While I thought about how to get Annie and myself out of the mess I'd just got us into, a nurse tapped me on the shoulder.
"Doctor?" she whispered.
"Yes."
She pointed toward a phone along the wall just outside the room. "Line one."
I looked to Sal. "Think you can keep things in here under control 'til I get back?"
He nodded and continued directing the medics and nurses, who were looking at me as if I'd just lost my mind.
I stepped into the hall, scrubbed my hands in the sink, and picked up the phone. "Talk to me."
"How's our girl?" It was Royer.
"Alive."
"How long you think we've got?"
I considered. "We've got some time. I just put her on pump a few minutes ago."
I could see Royer looking at his watch, noting the time.
"Good, keep her that way. I'm headed to Nashville. Might have a heart."
The sound of "might have a heart" resonated through me like the plasma now coursing through Annie's body. In my mind, I saw her standing on her toes, arching her back, yellow ribbon bouncing on the wind, and screaming "Lemonaaade!" for all the world to hear. "What do you know?"
"Not much, but I'll call you when we touch down and I get a look ... say in about twenty-seven minutes."
I looked around at the near-uncontrolled chaos of scurrying doctors and nurses around me. "I'm not going anywhere until you get here with a heart, or"-I paused, thinking for the first time about the possibilities-"until you don't."
Royer was quiet for a minute. "Twenty-six minutes. Keep the lines open. And keep your eyes open for our team. They should be there shortly. They'll take care of everything. All you need to do is lead them to Annie."
"Will do."
I hung up the phone and looked at a tech, who was furiously scribbling on a chart nearby. "You busy?"
"No, sir, not really."
"Good. I want you to sit right here and make sure that nobody, and I mean nobody, not even the president himself, gets on this phone. Clear?"
He stood, stepped in front of the phone, crossed his arms like a bouncer, and said, "Yes, sir."
Just then I heard a woman screaming in the waiting area of the emergency room. I heard a scuffle, something slammed into the wall, and Cindy came running through the double doors and down the hall toward me. She was headed for the operating room when I stepped in front of her. We collided, and she sent us both to the floor, hard.
She put her finger in my face. "Reese! You tell me right now! Tell me right now!"
I pulled her to me, tucked her arms inside mine, and wrapped my hand around the back of her wet head. "She's alive."
Cindy pounded my chest and then gripped my shirt, pulled me to her and her to me.
I could see the thought hadn't registered, so I pointed toward the OR and said it again. "She's alive."
"How?" she asked.
I shook my head. "Not now." I nodded toward the phone. "Royer just called. He's got a heart. He's en route and he's calling back in ..." I looked for my watch, which wasn't on my wrist. "In twenty minutes or so."
Cindy placed her hands to her face, composed herself, and I saw my Omega flipping about on her wrist. I gently unclasped it and then fastened it about mine.
She looked at me. "What do you need?"
I thought about myself for a moment. I tried to smile. "I need some lemonade."
Cindy dropped her head and nodded. "Me too."
We sat on the floor, and I cradled her in my arms while medical personnel scurried around us. Once she caught her breath, I said, "I need to get an IV in me, to put back some of the fluid I lost, and then I need to eat something. We've got a long couple of hours coming up, and I'm going to need a bit more energy than I've got right now."
Cindy wiped her eyes and set out for the cafeteria.
I found Charlie and Termite in the waiting room and esco
rted them back to the lounge, where the medic from the helicopter ran two IVs, first Charlie's and then mine. I ate a Clif bar while she monitored us both. She washed and examined Charlie's cuts, which were deep and still bleeding, and then looked at me.
"You better take a look at this."
I studied Charlie's face and head and knew he had taken a pretty big blow. The medic returned with some #3 monofilament, and I put a total of twenty-seven stitches in two places on his cheekbone and scalp. He'd heal, but he might be sore awhile. Not to mention his dislocated left shoulder.
After Charlie was patched up and our fluid levels topped off, Cindy returned with some pasta covered in red sauce and cornered by four large meatballs. I ate slowly, watching the phone and begging God to make it ring.
Minutes later, it did. My phone guard stuck his head in the door and pointed to the phone on the counter. "Line two."
I picked it up, and Royer spoke before I said a word. "We're a go. I cut in ten, then back on the plane in twenty, and I touch down there in less than ninety. Have the chopper waiting."
"Will do."
"Think she can hold on until I bring the Pepsi?"
I looked across the hall toward the OR, where I knew Sal had sewn up the incision I'd made across Annie's rib cage. "Yeah, she'll hold." A few seconds passed. "Royer?"
"Yeah," Royer said in little more than a whisper.
I turned away from Cindy, making it difficult for her to hear. "It's now or nothing."
He took a deep breath. gust have the chopper waiting and blades turning."
I hung up the phone, saw the first members of Royer's team run through the doors toward the OR, and felt Annie's golden sandal burning hot against my chest.
I took a long, hot shower, changed into some clean scrubs, and ate some more spaghetti. In my mind, I went through the operation. Every stitch, every possible problem, not the least of which was transplanting a patient in a hospital not designed to perform a transplant. I shook my head. The odds were not in our favor. Not in our favor at all.
When Crickets Cry Page 28
