Search For Reason (State Of Reason Mystery, Book 2)

by Miles A. Maxwell

  He stared at her, shocked, and not sure why.

  When they finished eating, he helped her back to the car. She’d taken half her sandwich to go.

  “How do you eat like this and stay in such good shape?” she asked.

  “I don’t know. High metabolism, I suppose.”

  Are You Sure?

  Teddy Baker shook his hands over the scrub sink and looked over as if to say, Are you really sure, Dale?

  To Teddy’s unvoiced question Dale Rass stared back beneath dark eyebrows. Bounced out two quick nods.

  It had already all been said.

  Once they began, no matter what happened, Dale knew Teddy would never ask, “How do we continue like this?” Teddy would never get disgusted or feel what they had to do was futile or hopeless. It would always be, “What’s the next step?” They might have their disagreements beforehand, but once inside with the team and the operation under way, no matter what came, Ted would be unstoppable.

  They were about to perform a critical operation while the hospital was on its backup generator, an extraordinarily complex procedure done in a very unusual way. No administrator in the hospital had sought to stop Dale. No one had even voiced an objection. Trenton Memorial was so damn busy — and no one outside the seven-person operating team knew. The operating room was theirs. Let the repercussions come later if they failed.

  Dale and Teddy walked through the OR doors together.

  Highlighted in the brilliant halogen operating beam, on the stainless table, folded in surgical drapes lay a fifty-year-old heavyset black woman named Enya Curhan.

  “How is she?” Dale asked his anesthesiologist.

  “Hanging in there,” he answered. “Stabilized some. Twenty-three minutes since she coded last.”

  “Ninety-four degrees,” Sue Childs, his perfusionist, added. The patient wasn’t yet hooked up to the machine, but Sue was applying ice packs, already dropping the woman’s body temperature.

  “Okay.”

  Dale took a deep breath and looked at Ted. “Surgery plan clear?”

  “I start the harvest on our donor,” Teddy nodded toward a second table, a stainless gurney near the wall. “We make sure the organ is okay —”

  They turned back to the woman. Dale picked it up —

  “I open her up while you’re removing the donor heart. Just let me get a look in before you excise, okay?”

  “I’m with you, Dale,” Teddy answered, a final reassurance, and went to the gurney.

  Dale turned a raised eyebrow to their only cardiac nurse, Sarah Maine.

  “I’m to assist Dr. Baker over there to start with,” Sarah said.

  Outside an operating room, Sarah was as close a long-time personal friend as Dale and Teddy had on the nursing staff. Outside, she called them Dale and Ted. Dale and Sarah had prepared his tool layout together, planned the order of everything ahead of time. Sarah had talked a med-student named Sunny into handing him his tools.

  “Then both of you will scrub,” Dale continued, “change gown and gloves, and help me over here.”

  Donor and recipient were as far from each other as the room would physically allow. Though extremely unusual — two procedures in a single OR at the same time — Dale felt assured aseptic sterility would be maintained by the strong flow of highly filtered air moving ceiling to floor by the room’s excellent laminar system.

  It was far more than he’d had in some of the field ops he’d performed in the service.

  Though it was Dale’s ball game, he waited and watched ten feet back while Teddy touched his blade to the man’s chest. A blood trail followed his scalpel. No reason to change gown and gloves. Ted can more than handle this part himself.

  There was no need for an anesthesiologist on that side either. The thirty-five-year-old man was brain-dead.

  His tissue type was one of three potential matching donors — all AB blood. Two of them had been in their teens, hearts too small for the big woman. Based on the man’s weight and that of the woman, barring anything unusual, he expected the man’s heart would fit pretty well.

  “Eighty-four degrees, Doctor,” Sarah called out. “Heart rate dropping.” The donor was surrounded by an ice saline bath contained by a shallow tray that ran the length of the table. They were dropping the man’s body temperature even faster than Enya’s.

  “Seventy-eight degrees. Rate fifty-five.”

  In a smooth changeover Teddy had the rotating circular saw in hand and was cutting straight down the man’s sternum, bone dust wafting upward before being suddenly sucked down the air intake.

  “Retract, nurse?” Ted asked.

  Sarah responded with a look — Of course — I’ve seen you guys do it enough times.

  “Seventy degrees. It’s stopping Doctor.”

  Sarah began spreading the man’s chest — a job typically not hers.

  Right next to Dale, Enya’s rhythm suddenly went.

  Dale forgot about the donor. Concentrated on his patient. Already intubated, the anesthesiologist was on it, pumping additional oxygen into the woman’s lungs. She’d seemed so stable. Apparently not!

  “Can you spare your ace assistant there!” Dale yelled. “I’m going to need to move a lot faster!”

  “Alright, nurse,” Teddy glanced at the temperature output. “Seventy-two. I can manage here. Go ahead. Change up!”

  “Yes, Doctor.”

  Sarah Maine walked swiftly across the OR, peeling off light-green gown and gloves in one swift, efficient motion. And was out the door.

  On the monitor the code was clear. Ventricular fibrillation. The anesthesiologist was already performing the rhythmic compressions of CPR.

  “Temperature?” Dale asked.

  “Ninety!”

  Dale shook his head. Not cold enough.

  Crash cart charged at the head of the table, Dale rapidly applied circles of electrode paste. One on the lower sternum, the other around the side of Enya’s chest.

  As Dale reached out to adjust the current, he was interrupted by his technician’s voice. “I’ve got it. Two hundred joules?”

  Dale nodded, moved back and picked up the paddles instead.

  “Okay, everybody off!”

  The big woman’s chest arched with the electric jolt.

  The trace on the monitor shot straight up. A blip. Another.

  “She’s going again, Doctor,” his tech said.

  “She won’t last long,” Dale yelled over at Teddy. “Maybe long enough to get in. How’s it going? It better be the one.”

  “I’m looking at her new heart — perfect!” Teddy responded. “Shall I cut?”

  “Do it,” Dale said softly at Ted’s left shoulder.

  Second Look

  Ralph stepped quickly back inside his Junior Minister’s office and closed the door. He had to have another look right now!

  There they were, still there on the corner of Franklin’s desk. White pages stapled together.

  He studied the long column of figures.

  Nothing about money coming in! Only going out. Good, good. Don’t worry about it, he told himself. I haven’t done anything wrong. Not really. Just let it go. Wherever it’s coming from won’t matter.

  He left as quietly as he’d come in.

  Through The System Let Blood Flow

  “Ready to go, E!” Right told him at the Nicola fence. The Thomas transformer was in too, the line to Thomas complete. As Everon hurried for Juniata Control, a boxy white ambulance barreled in. The first thing he thought was: Enya!

  There was no phone service to the hospital yet. What happened?

  A man in a set of coveralls jumped out by himself. His eyes were wide, lips compressed — a look of desperation on his deep black face. “Our backup generator’s about out of fuel — again!” he shouted. “I don’t know who to go to.”

  Then Everon saw the name badge on his coveralls and remembered: Al. The hospital’s head mechanic.

  “Ken Flagler?” Everon
suggested.

  Al shook his head. “Mr. Flagler gave us his personal reserves three hours ago. I tried two fire departments. They’re out too. You guys have any?”

  “Just what’s left in the generator tanks.” 1,500 gallons, Everon thought. “But we’re trying to get some power to you.”

  “How soon?”

  “It’ll be the next half hour, with any luck.”

  “I don’t know if we can last that long.” Al rushed inside after Everon. “Can’t you send power to the hospital now?”

  “We don’t even have power here yet ourselves.” Everon’s breath trailed on the air. It was frosty cold inside Juniata’s reception area. Down to only a single backup generator, the control center still didn’t have electricity to run more than a few small space heaters. The electronics didn’t mind. Not so good for people. “We’ve only got a single combustion turbine running and it’s almost out of fuel. We’re hoping to switch over to our big coal unit in a few minutes.”

  Inside the control room, seated at the huge console, Lama in his heavy white chef jacket blew on his fingers, then continued typing furiously.

  On Lama’s right, Nick had two heavy sweaters under his black ski jacket. Sam’s head was wrapped in scarves, only his face exposed.

  A voice from somewhere down the hallway pulled Everon’s attention back to the wide open main doors. The sound of a man on the verge of screaming:

  “I’ve got two missing guards, Hunt! I don’t know if they’re alive or dead. Our computer relays won’t operate. My officers are having a devil of a time getting prisoners into lockdown! They’ve moved some into our old manual-release death-row cells. I shouldn’t even be here, but my captain says if we don’t get power soon, we’ll have a mass breakout.”

  At least old Bryce isn’t here to hear this, Everon thought.

  “The damn perimeter alarms aren’t working!” The voice was getting louder. “Our backup power is down. My people have the beginning of a full-on riot on their hands! Our radios are going out and I’ve got prisoners in the yard with makeshift weapons!”

  “We’ll get power to you as soon as we possibly can, Michael!” Hunt’s voice not sounding too calm. He hasn’t had any sleep in three days either, Everon figured.

  A blocky, tough-looking man in a dark overcoat and hat rushed into view. He turned, framed by the control room doorway. He looked both worried and pissed off at the same time. “At least let us have a couple hundred gallons out of your diesel tanks for our emergency generator, Hunt.”

  “I’m sorry, Michael, we can’t! If we did, we wouldn’t be able to get you any power for weeks.”

  The man turned and huffed off.

  Everon hurried out of the control room, Al right behind. They came around the corner, colliding with Hunt, and would have knocked him down, but Everon’s hand shot out, steadied the older executive’s elbow.

  “By the sound of that I’m guessing you want us to route Whitpain Prison first,” Everon said. “But you ought to know, Trenton Hospital’s almost out of fuel. No matter what you say, Hunt, we’re connecting the hospital first.”

  Hunt stared at them. He’d been pressured hard but gave a slight nod. “No, it’s okay. I understand.”

  Connections

  Toni Sena, bundled in winter wear, followed Everon, Al and Hunt back to the control room. Hunt’s diminutive secretary had been using boiling water to melt ice forming in Juniata’s toilets. Nan and Andréa came in, too cold and nervous even to bicker among themselves. Without much fuel left in the choppers, there was little they could do anyway.

  “All set, Lama? Nick?” Everon asked. He felt ready to fall over, so exhausted he wasn’t even sure he was tired anymore. And if the line guys don’t get some sleep soon, they’ll start making mistakes when they energize circuits.

  “We’re ready,” Nick said.

  “Ready,” Lama agreed.

  In Everon’s head Mercer’s digital display dropped to 1,000 GALLONS. Two priorities remained: Get Big Mombo to full power. And get that power to the hospital.

  But according to Turban, Big Mombo’s steam wasn’t hot enough yet.

  Everon couldn’t wait any longer. The Thomas line was repaired. He had to make sure the Nicola and Thomas transformers were functional. And get Mercer’s data stream into Juniata, to see those numbers — voltage, current, the rest of it — to know exactly what was going on at Mercer. They were going to have to connect the circuits they’d repaired before Big Mombo was online.

  Hunt studied the first of six new computer monitors along the top of the console.

  All six displayed nothing but zeros, and would until the switches were closed, connecting the circuit to them at Juniata.

  “The left screen is our input?” Hunt asked.

  Nick looked up from his calculations. “That’s Mercer’s transformer. Our input will show up on the second screen.”

  “Rani?” Everon radioed, “Check Mercer’s inputs.” Everon had Rani stationed in the yard at Mercer.

  “All open here, E. Circuits clear.”

  In the power industry, open meant disconnected. Closed meant the circuit was connected and power could flow.

  “Mercer Internal Buss charged and steady at 23,000 volts,” Rani added. The Mercer transformer would up that by a factor of ten.

  “Deters? Bryce?”

  “Deters here, E. Nicola input switches are also open.” Disconnected.

  “The Nicola-Thomas outputs are open, Mr. Student.” Bryce’s voice. By radio, Holmes confirmed the same over at Thomas Substation.

  The neighborhood outputs, including those to Trenton Hospital, had probably been opened by the bombs’ EMP — blown fuses, destroyed pole-top breakers. But it would be suicidal not to check each one. Linesmen were often killed by an accidentally energized line.

  Gib and the other Williams people — as Right, Holmes and Ortega no longer needed them — were scattered in trucks around the northeast end of the system, doing just that. Checking every circuit. Preparing for the power that would really put them into action. Turning people on again.

  Everon took a deep breath. “Close Mercer transformer input switch, Rani.”

  “Closing transformer input switch,” Rani radioed back.

  Everon asked, “Okay, Rani?”

  “Looks good, E.”

  “Close transformer input breakers.”

  “Breakers are . . . closed,” Rani transmitted. Connected.

  Up on the first screen, the numbers came to life. Voltage. Current. All of it.

  “Phase balance — good,” Nick said. “Power factor — 97 percent. Not quite resonance. 232.5 kilovolts — about where it should be.”

  Now they had data and control. They could run things from Juniata.

  All they needed was the power.

  What did we miss? Everon asked himself. What will blow? What unknown EMP damage from the bombs have we forgotten? Nearly half a minute went by before he radioed, “Get clear, Rani! Ready to close Mercer output breakers.”

  A moment later, static came back.

  “Say again?” Everon transmitted. At 230,000 volts, a wrong response could cost someone their life. “Are you clear, Rani?”

  “Rani here, E. I’m out. The yard is clear.”

  “Yard clear,” Everon confirmed. “Closing Mercer to Nicola!” He twisted a heavy black T-switch on the Juniata console. And way over at Mercer, remote interlocking relays connected the giant breakers.

  And out of Mercer’s yard, 230,000 volts shot down the line.

  The Generator

  One beat . . . two . . . three . . .

  Enya’s heart stopped, deflated like a limp bag.

  If there was one thing Dale knew was filling the hearts of the people from the Williams power crew right now, it wasn’t blood. It was hope.

  Hope their friend would come through.

  Hope I don’t screw up, thought Dale.

  Dale finished his final cut and lifted out the old diseased heart, leav
ing a two-fist-sized gap in the woman’s chest. He dropped the floppy-looking mass like so much butcher’s meat into a floor bucket.

  Without a pulse, technically, Enya Curhan was dead.

  But her blood still flowed. The electroencephalograph said her brain waves were still active.

  The rest of her body was alive.

  Teddy scooped the new heart from a bowl of frozen saline slush. Dale took from his friend what minutes ago had been a man’s heart and slid it gently into Enya’s waiting chest.

  It was two-thirds the size of the original. Not that the man’s was too small. Enya’s diseased heart had been too large.

  Dale preferred connecting the right atrial flap to the pulmonary veins first — without the big fat aortic artery in his way. Teddy had left the pulmonary atrial flap just perfect — a little large on the matchup. So Dale trimmed half-an-inch off each edge.

  Using a long sharp curved needle, he rapidly stitched the remaining piece to its mate in Enya’s chest.

  Needle in the air on an upstroke, Dale’s head jerked as the bright operating lights wavered, dimmed, went out. Background noise dropped, air rush fading from the overhead diffusers.

  Laminar airflow down!

  The generators!

  When the battery-powered emergency wall units flashed on a moment later, Dale’s head snapped to Sunny the med student.

  “Wheel the donor body out of here! Right now!” Without air flow, they were going to have a hell of a contamination problem.

  Perfusionist Sue Childs was already reaching for the heart-lung machine’s hand crank. The machine continued to operate on its own internal battery, but without power its backup would only last so long. Only hand cranking could keep it charged.

  Dale looked at his anesthesiologist.

  “Backup battery on line,” he told Dale. “Bispectral index looks steady. She’s okay.”

  Dale wondered if the other systems had enough juice to get them through. Down to the emergency batteries on each machine — suction, anesthesia, EEG, EKG — all beneath emergency lights designed to last long enough to get out of the room. Not the woman’s chest!