Second Opinion by Michael Palmer Read Free Book Online

condition that had caused it. And with the populations she was caring for, there was no shortage of lethal underlying conditions.
    Suddenly, she was at the bedside, delivering a sharp blow to Petros's sternum with the side of her fist, and beginning chest compressions over the same spot.
    'Niko, you outweigh me by seventy-five pounds,' she said over her shoulder. 'You should be doing this, not me.'
    There was no response from her brother.
    'Oh, Niko,' she groaned.
    A burly resident entered the cubicle.
    'What do you need?' he asked
    'Some good, strong compressions,'Thea said, stifling the white-hot burn she was feeling toward her brother.
    The resident moved in and began what Thea felt was adequate pumping, rhythmically squeezing Petros's heart between the underside of his breastbone and his spine. She set two fingers on her father's groin and felt a soft-but-definite jet of blood with each compression. Not great, but good enough provided it did not take too long to reverse the fibrillation.
    The code clock swept past forty seconds.
    'Two hundred joules,' Tracy said.
    'Amiodarone in,' the other nurse reported.
    Thea took the paddles of the defibrillator, placed one to the left of Petros's sternum and the other lower and farther to the left. Then she glanced back at her brother, who hadn't moved.
    'Two hundred joules! Everybody clear!' she called out.
    The muffled pop of electricity jerked Petros's restrained arms upward. Then just as quickly, they dropped back to the bed.
    'Sinus rhythm,' Musgrave called out excitedly. 'Nice going, Doctor.'
    'I've got a pulse,' Thea said.
    The normal rhythm lasted only twenty or thirty seconds before deteriorating, once again, to ventricular fibrillation.
    'Resume compressions, please,' Thea said to the resident. 'One milligram of epinephrine IV, please, Tracy. Prepare to shock at three hundred.'
    'Three hundred,' the ICU nurse said, setting the defibrillator.
    'Three hundred,' Thea said, now totally immersed in the resuscitation and in replaying the algorithms in her mind. 'Ready, clear!'
    Again the odd pop; again the marionette-like jerk of Petros's arms; again the short-lived appearance of a normal rhythm before the reversion to fibrillation.
    Thea felt the tension building once again. The sweeping second hand on the code clock passed two and a half minutes. On the bed, Petros lay rather serenely, his eyelids taped down, the ventilator supplying oxygenated, humidified air with a steady, repetitive whoosh. They would continue until there was no effective heartbeat and no hope of getting one, but unless something was done to deal with whatever was keeping the normal rhythm from rapidly deteriorating, the conclusion of this affair was foregone.
    'Resume compressions, please. Could someone send for the ultrasound tech and bring me the kit for doing a pericardial tap?' Thea asked.
    She wondered if her voice sounded as strained to everyone else as it did to her. She also wondered what people thought of Petros Sperelakis's cardiac-surgeon son, who remained a statue outside the crowd around the bedside.
    / can't let him go like this, she was thinking. I have to f ind the answer.
    Thea pressed her fingers into her father's groin once more. The pulse being generated by the resident was significantly less forceful.
    Where was the intensivist?
    'Are you getting tired?' she asked the resident.
    'A little.'
    Niko, what are you doing? Help us!
    'Just give me one more good minute,' she said.
    'You've got it.'
    The compressions intensified and the resulting pulse became sharper. Three and a quarter minutes.
    'Pericardiocentesis tray is ready, Doctor. Gloves are right here. Six and a half okay?'
    'Perfect.'
    Don't die like this, Dad … Don't die like this.
    Was it worth waiting for the ultrasound to demonstrate that there was or wasn't fluid pressing in around the heart? Absolutely not. Even with adequate CPR, there was ongoing brain cell death by the second. The pericardial tap had to be done now. The