Lethal Incision Excerpt 1:

The beeping and hissing sound of the cardiac monitor filled the air in Trauma One on Monday evening like a time bomb counting down. A rapid sinus rhythm raced across its screen, the mirror of a desperate heart holding on for dear life. Zora Smyth, the fifth-year surgical resident-on-call, took a quick scan of the patient—a young man, probably in his thirties, who lay still on the gurney except for the rise and fall of his chest.

A narrow tube snaked from his mouth and was held in place with stripes of tape. IV poles stood at a salute on either side of the patient’s head, one line of Ringer’s lactate running into a central line, the other into a vein on his arm. Bruises in explosive colors of red, black, and purple covered his face and torso in abstract patterns; the EKG pads on his chest provided a colorful contrast. His abdomen appeared slightly distended.

“What do we have here?” Zora asked as she grabbed a pair of gloves and snapped them on. Five sets of eyes looked back at her.

Thomas Stewart, the junior surgical resident-on-call, gave her a quick report. “Rick Williams, traveling with his pregnant wife, hit in a car accident by a drunk driver. Wife has been rushed to the labor room. Arrived unconscious to the ER.

“Pupils are equal and reactive, lungs are clear, but the abdomen is distended; no bowel sounds. BP is seventy over thirty. Paracentesis showed blood in the abdomen. CT scan showed a possible splenic rupture. Blood has been sent for STAT results and cross-match, and we are waiting for fresh blood and frozen plasma.”

Zora put on her stethoscope to confirm what the resident said. The abdomen was quiet—silent like a grave. Not good. She checked his lungs; they were well ventilated, the endotracheal tube properly placed. She listened to his heart, which was barreling against the chest wall. Rapid sinus, but no murmurs. She replaced the stethoscope back on her neck.

“Any medical history?” she asked.

“Wife confirmed none that she knew of,” the resident responded.

A nurse called out. “V-fib! He’s in V-fib! I can barely feel the pulse!”

Time seemed to pick up at a frantic pace.

Zora shot a glance at the monitor screen. The rhythm was rapid, unorganized, and barely discernible. “Start CPR. Stewart, you are in charge of the code.”

Zora could see that the nurse had started pumping the patient’s chest.

“We’ve got blood and frozen plasma!” someone called out.

“Let’s hang them up,” Zora said.

Fresh blood and plasma now replaced the Ringer’s lactate dripping into the patient. Every drop and every second counted.

“Paddles ready?” Stewart asked. “One hundred joules.”

Another nurse placed the defibrillator paddles on the chest. “Everyone step back!” she yelled.

The paddles discharged and the patient jerked off the gurney and back.

“Still in V-fib!” the first nurse responded. The air cackled with uncertainty.

“One milligram of epinephrine IV, then shock again at one hundred,” Stewart called out.

The epinephrine slid through the central line. The torso jerked again at another shock of the paddles.

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