records system, so I
don't want to rely on the information in there. Let's get a blood type and a chest X-ray right
away.»
While blood was drawn, Jane did a quick preliminary examination. The gunshot wound was a
tidy little hole right next to some kind of scarification on his pectoral. A rivulet of blood was all
that showed externally, giving little hint of whatever mess was inside. The knife wound was
much the same. Not much surface drama. She hoped his intestines hadn't been nicked.
She glanced down the rest of his body, seeing a number of tattoos-Whoa. That was one hell of
an old groin injury. «Let me see the X-ray, and I want an ultrasound of his heart-«
A scream ripped through the OR.
Jane's head snapped to the left. The nurse who'd been stripping the patient was down on the floor
in full seizure with her arms and legs flapping against the tile. In her hand she had a black glove
the patient had been wearing.
For a split second everyone froze.
«She just touched his hand and went down,» someone said.
«Back in the game!» Jane clipped. «Estevez, you see to her. I want to know how she is
immediately. Rest of you get tight. Now!»
Her commands snapped the staff into action. Everyone refocused as the nurse was carried over to
the bay next door and Estevez, one of the residents, started to treat her.
The chest X-ray came out relatively fine, but for some reason the ultrasound of the heart was of
poor quality. Both, however, revealed exactly what Jane expected: pericardial tamponade from a
right ventricular gunshot wound: Blood had leaked into the pericardial sack and was
compressing the heart, compromising its function and causing it to pump poorly.
«We need an ultrasound of his abdomen while I buy us some time with his heart.» With the more
pressing injury ascertained, Jane wanted more information on that knife wound. «And as soon as
that's done, I want both machines checked. Some of these chest images have an echo.»
As a resident went to work on the patient's belly with the ultrasound wand, Jane took a twenty-
one-gauge spinal needle and plugged it into a fifty-cc syringe. After a nurse Betadined the man's
chest, Jane pierced his skin and navigated the bone anatomy, breaching the pericardial sack and
drawing out forty ccs of blood to ease the pericardial tamponade. Meanwhile, she gave out
orders to prepare OR two upstairs and get the cardiac bypass team on the ready.
She gave the syringe to a nurse for disposal. «Let's see the abdominal.»
The machine was definitely misbehaving, as the images were not as clear as she'd like. They did,
however, show some good news, which was confirmed as she palpated the region. No major
internal organs appeared to be affected.
«Okay, abdomen appears sound. Let's move him upstairs, stat.»
On her way out of the chute, she put her head into the bay where Estevez was working on the
nurse. «How's she doing?»
«Coming around.» Estevez shook his head. «Her heart stabilized after we hit her with the
paddles.»
«She was fibrillating? Christ.»
«Just like the telephone guy we had in yesterday. Like she'd been hit with a load of electricity.»
«Did you call Mike?»
«Yeah, her husband's coming in.»
«Good. Take care of our girl.»
Estevez nodded and looked down at his colleague. «Always.»
Jane caught up with the patient as the staff wheeled him down the chute and into the elevator that
went to the surgical suite. One floor up she scrubbed in while the nurses got him onto her table.
At her request, a cardio thoracic surgical kit and the heart/lung bypass machine had been set up,
and the ultrasounds and X-rays taken downstairs were glowing on a computer screen.
With both hands latexed and held away from herself, she reviewed the chest scans again. Truth
be told, both of them were subpar, very grainy and with that echo, but there was enough to orient
herself. The bullet was lodged in the muscles of his back, and she was going to leave it there:
The risks inherent in removing it were greater than letting it rest in peace, and in fact, most
gunshot victims left the chute with their lead trophy wherever it ended up.
She frowned and leaned in closer to the screen. Interesting bullet. Round, not the typical oblong
shape she was used to seeing inside her patients. Still, appeared to be made of garden-variety
lead.
Jane approached the table where the patient had been hooked up to the anesthesia machines. His
chest had been prepped, the regions around it draped in surgical cloth. The orange wash of
Betadine made him look like he had a bad fake tan. «No bypass. I don't want to use up the
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