Natural Causes by Michael Palmer Read Free Book Online Page A

and others.
    “Where do we stand, Eli?” Stoddard asked without so much as a glance at Sarah.
    “Studies are off, ten units ordered.”
    “Platelets and plasma as well?”
    “As many of each as we can get.”
    Helen Stoddard completed a rapid exam of Lisa’s skin, mouth, and nail beds. The gauze surrounding the IV was now saturated. Blood dripped from it onto the stretcher sheet and floor. The venapuncture site from which blood had been drawn was also oozing.
    “No prior history of bleeding problems?” she asked Blankenship.
    “Absolutely none.”
    Stoddard thought for a few seconds. “We can’t wait for the lab. I think we hang up what platelets, blood, and plasma we can and heparinize her.”
    Randall Snyder and Heidi Glassman entered the room, both a bit breathless. Moments later Andrew Truscott arrived as well. Heidi took Sarah’s place at thebedside, while Truscott, Sarah, and Snyder stepped back to the doorway.
    “She’s in real trouble,” Sarah said.
    Snyder glanced at the fetal monitor.
    “So’s the baby,” he said. “Have you started Pitocin?”
    “In the ambulance. She’s still only five centimeters dilated.”
    “Jesus.”
    Truscott took a minute to examine Lisa’s arms, hands, and feet. Then, with impressive skill and speed, he injected some anesthetic into the skin at the side of her neck, located two bony landmarks with his fingertips, and slid a large-bore needle through the numbed spot directly into her internal jugular vein. Next he threaded a catheter through the needle and sutured it in place. A critical second IV route had been established.
    “One way or the other, I think we’re going to have to take her to the OR for that arm,” he said after returning to the doorway. “I still can’t tell about the left or her feet. Can you C-section her?”
    Snyder crossed to Helen Stoddard, held a brief, whispered conversation, and then came back shaking his head.
    “We may already be down to a mother versus fetus situation,” he whispered. “Helen and Eli have decided they can’t wait for laboratory confirmation of DIC. They’ve gone ahead with heparin. As things stand, they feel the girl has no chance of surviving a C-section.”
    Heparin for DIC
. To Sarah, whose practice as a surgeon was built on a bedrock of meticulous attention to the control of hemorrhage, the treatment was a terrifying paradox: the intravenous injection of a powerful anticoagulant to a patient who was already in danger of bleeding to death. The theory was to administer the drug to break up the pathological clots and restore blood flow to the compromised extremities and vital organs. At the same time, continuous transfusions would be used to chase lost blood volume and replace clotting factors. Itwas a therapeutic balancing act of circus proportions, and one that too often was doomed to fail.
    Sarah looked at the woman she had cared for over the past seven months, now barely visible within the clutch of nurses, physicians, and technologists. In just minutes, Andrew had contributed greatly to everyone’s efforts. She had yet to contribute anything. True, she acknowledged, he and the other medical players in this drama were all senior to her. But Lisa Summer was still her patient, and there were things the two of them had worked on, things they could try, that might help as well—provided, of course, that Helen Stoddard and Eli Blankenship allowed them the chance.
    She excused herself and raced down to the subbasement where a series of rather dimly lit tunnels connected all of the MCB buildings. Her locker was on the fourth floor of the Thayer Building, which housed the administration offices on the first three floors and the house staff sleeping quarters on the top two. Sarah took the elevator up. Minutes later she bounded down the six flights and sprinted back through the tunnels toward the ER. Cradled in her arm was the mahogany box containing her acupuncture needles. The box had been a gift from Dr. Louis