Public Anatomy (4 page)

“Your cart, the two-by-four sticking up. Bring it to me.”

Benjamin did as Eli said. He dislodged the plank and shuffled into the room with it.

Eli took the piece of wood and inserted it sideways between the ribs. Then, in one quick motion, he twisted it at a right angle and wedged the ribs apart. There was a pop and grind as ribs cracked and costochondral junctions tore.

Eli jammed his right hand through the gaping ribs, all the way to mid-forearm, and grasped the boy’s heart.

With no blood in the muscular pump, the heart felt deflated like a balloon. He needed light to see into the boy’s chest. An overhead procedure lamp hung from tracks on the ceiling, and he tried to knock the beam into place with his injured hand. But the light fixture was frozen. Without illumination, Eli had to find the problem by feel. His finger happened to slip inside a large hole in the pericardial sac. The bullet had entered the right ventricle and ripped a hole through the muscle. Eli plugged the hole with his finger. He felt the fine tremors of fibrillating cardiac muscle. The electrical impulse was intact but there was no blood in the heart to pump.

“I need two twenty French Foley catheters. And start charging the defibrillator.”

Janice peeled plastic off the urinary catheter tubes and handed one to Eli. He inserted the tube through the hole in the boy’s heart and inflated the balloon at the catheter’s tip with fifteen cc’s of water. Then, Eli pulled the tube and balloon back against the hole, effectively sealing it. With his fingers, he located the exit hole in the back of the heart and did an identical maneuver with the second catheter.

Eli knew this was a long shot. An incredible long shot. At the best of trauma centers, fully manned and stocked and waiting for a victim like this with penetrating cardiac trauma, the majority of patients would die anyway—despite the all-out effort.

And here I am
, with a piece of nonsterile wood wedged in this guy’s chest and a couple of bladder catheters in his heart.

He had no idea why the boy had been shot. It was easy to think the reason was crime related. A drug deal gone bad, a robbery attempt. But
Eli didn’t care, at least not right now. He had to believe that each patient was an opportunity to make a difference. This was the boy’s only chance. Eli was giving it to him.

“Charge to two hundred,” Eli yelled.

Janice presented the defib paddles to him. “You’re going to shock the heart directly?”

He knew, of course, that the paddles were made to be applied externally on the chest. Direct cardiac defibrillation was accomplished only with special intraoperative paddles used in cardiac surgery. Eli positioned the paddles for insertion through the rib opening. “Got a better idea?”

Janice shook her head. “I think all this is crazy if you ask me. The boy’s dead.”

“Everybody stand back,” Eli ordered. The med tech student continued to squeeze the bag, so traumatized by the situation that he was on autopilot, like a robot.

“Drop the bag and get back, I said.” This time he shouted his order.

He did exactly what Eli asked, then ran from the room.

Eli placed the paddles on opposite sides of the boy’s heart. If there was some sporadic electrical impulse still present, maybe the shock would synchronize the currents and initiate contraction.

With the first shock, the heart flopped up, convulsed once, then nothing.

Janice charged to three hundred. Eli repeated the shock, with the same result.

“Turn it up all the way,” Eli said. “This is his last chance. Eli repositioned the paddles, pressed hard, and delivered the final shock.

The boy’s heart bucked, and then bucked again.

The cardiac monitor recorded this activity. Beep. Beep-beep.

No one moved. Everyone expected the heart to stop again. But it didn’t. The bucking turned into regular, rhythmic contractions.

“Well I’ll be damned.” Janice wagged her head.

“Call the ambulance and get the trauma center on the line,” Eli ordered. “For real this time.”

•    •    •

During all this resuscitation, another observer went unnoticed. Once the center of attention, he was now all but forgotten. Norman “Tobogganhead” Felts stood just within the doorway of the trauma room. Rather than watch the emergency thoracotomy, he was eyeing the boy’s cell phone the nurse had removed from a blood-soaked pocket and placed on a side table. It was one of those fancy phones that could do all kinds of things—play songs, take a picture, probably order groceries for you.

But he didn’t care about the phone. It was the wad of cash rolled under the clip that Tobogganhead was interested in. He eased over to the corner, and with two pincer-like fingers to avoid the not-yet-dried blood on the casing, he picked up the phone. Then he slipped out of the ER, past the nurse’s desk, and out into the sultry night.

At the same time that Eli Branch was inserting tubes in the boy’s heart, a black sedan traveled south on Interstate 240 toward the community hospital in Whitehaven where Branch was on call. The driver had a tiny speaker clipped over his left ear, and his passenger dialed through frequencies of a police radio scanner. Both occupants were in their early fifties, wore dark suits, and had a recent shine on their black shoes. They were fit, kept in shape as part of their job, but in the sitting position, guts bulged over their belts a little more than they wanted. They did more traveling now, more talking about the days when they saw real action.

During the drive, they listened to various calls on the scanner: a warehouse fire in Southaven, a domestic dispute at the Majestic Gardens apartment complex. Nothing out of the ordinary, nothing too exciting.

They listened more out of habit—or maybe boredom. They didn’t care for music. Talk radio was fairly dead that time of night unless you wanted to hear that the garbage strike was a racial issue with mounting implications for Memphis politics.

The suits were from Washington, D.C., and neither could care less about political tensions in the Mid-South. The healthcare scene was foremost on their minds. Or at least one recent episode of care that had ended in the death of a patient during robotic surgery.

Static on the scanner crackled, then a clear voice came through.

“He’s got a blood pressure right now but I doubt it’ll last. He’s been down a long time.”

“What are you doing to keep him alive? Over.”

“I’ve got two Foley balloons inside his heart.”

After a brief silence. “Excuse me? You’ve got what?”

“Just have cardiac surgery ready to go. This guy needs to go straight to the OR if we can get him there alive.”

“Will do, Dr. Branch. Good luck.”

The driver of the black sedan peeled off his ear piece. “Did she say Branch?”

“That’s what I heard.”

He checked his sideview mirror as though he might change lanes, or direction. “You think it’s our Branch?”

“Balloons in a patient’s heart? Has to be.” The passenger shook his head. “Branch could pull off something like that.”

“Yeah, like the fire he started in the OR a couple of months ago. Used the flames as a weapon to take down his adversary and then extinguished it like a grease fire in the kitchen.”

The men had hoped to connect with Eli during middle-of-the-night dead time at the small ER. “Now, we’ll have to intercept him at the medical center,” the driver said as he pulled into the right lane. He took the nearest exit and started to double back toward downtown.

“What’re they talking about, balloons in the heart?”

“Hell if I know. But that’s why we need him on this investigation. He can pull off that kind of shit.”

“Trouble seems to follow that guy, you think?”

The driver gained speed on a straight stretch of highway that ended with the first glimpse of lights from downtown Memphis. “Yeah, but he has no idea the trouble we’re bringing.”

Outside the trauma rooms of Mid-South Medical Center, chief surgical resident Susan Morris disconnected from the ambulance call and punched in the pager number of the on-call cardiac surgeon. She turned to her third-year trauma resident, who was eating donut holes like popcorn.

“Remember Dr. Branch?”

Donut Hole looked up from his bag of breakfast left over from the day before.

“The guy who got stabbed in the neck? Had his arm slit open in a fight with that biotech company?”

He said this while spewing plumes of powdered sugar with each hard consonant. “He was all over the news. Who doesn’t remember him?”

“You won’t believe what he’s bringing in,” said Dr. Morris.

“Oh shit, what?”

“He’s doing an ER shift somewhere in the boondocks. Gets a drop-off GSW to the chest. Cracks him open. Sticks two Foley catheters in the heart.”

“No way the guy’s alive,” he said, popping his last donut hole.

“Branch shocked his heart with external defibrillator pads.”

“Damn, I didn’t know that was possible.”

“It’s not supposed to be. But he says the guy has a pulse.”

“How far out?”

“Whitehaven, below the 240 loop. Ten minutes.”

Donut Hole stood, brushed the white dusting off his green scrubs. “I’m calling the interns and medical students. They’ve got to see this.”

The black sedan caught up to the ambulance on Interstate 240. The agents had learned from the police scanner of the ambulance’s route and followed it to the medical center. Knowing it would be a while before they could approach Dr. Branch, they parked, leaned against the sedan, and watched the ambulance back into the trauma bay. When the ambulance doors swung open and the stretcher rolled out, Eli Branch was sitting on top of it, straddling the patient, his arms and scrubs covered in blood. A rush of people pushed the stretcher and it disappeared inside Gates Memorial. The feds waited.

“His pressure’s starting to drop,” Eli said as the back doors of the ambulance opened.

When he looked up, he saw a mass of medical personnel standing in the receiving area of Gates Memorial’s Emergency Department, as though awaiting his arrival. He was glad to see the familiar face of Susan Morris among them.

“Hope you got an OR ready.” Eli held up both catheters, the patient’s lifelines. “I’m not sure how much longer this will hold him.”

“Go straight up,” Dr. Morris said. They pushed the stretcher inside the emergency room and Morris pointed to an open elevator at the far end of the room.

Eli noticed camera phones pointed his way. A young woman with a more professional appearing camera was clicking off flash shots.

As Eli rode past on the stretcher, a surgical resident sporting a thin mustache of powdered sugar explained to a group of interns and medical students how Dr. Branch had devised a way to keep the patient alive—despite a lethal cardiac injury. One of the female medical students grimaced at the blood that covered Branch’s arms and legs and had sprayed about his face. “If the patient has hepatitis or AIDS,” she said, “that doctor’s hosed.”

Like spectators at the eighteenth hole, the crowd closed in around the elevator as the cardiac surgery team maneuvered the stretcher with Eli still straddling the patient. The emergency department became quiet as the doors closed and the elevator ascended to the third floor operating rooms.

Ten minutes later, the cardiac surgeons took over the care of Eli’s
patient. After washing the dried blood off his arms and face at the scrub sink, Dr. Eli Branch entered the surgeons’ lounge. He felt strange doing so, having been terminated from the medical center only two months earlier. Except for a resident lying face down on the couch, the lounge was empty. He relived the brief time as a new faculty member when he was greeted here by his fellow surgical colleagues as they congregated in the lounge between surgical cases.

Without rising from his stupor, the sleeping resident flopped sideways on the couch. Eli remembered how exhausted he’d felt during surgical residency at the end of a thirty-six-hour shift. In many ways, it was a good feeling—to be physically depleted after successfully accomplishing the task. Problem was, as a resident, the task came every third night. You were either pre-call, post-call, or on-call all the time. At times, after a particularly grueling shift, he had made it as far as his apartment and lain down for the night on the floor just inside his door. Once, he fell asleep in his car in the hospital garage, his forehead against the steering wheel for several hours until a security guard knocked on the window.