Second Opinion by Michael Palmer Read Free Book Online Page A

problem was that except for working on a cadaver in medical school, she had never done one. The anatomy presented no problem, but the technique might.
    In her mind, Thea opened the instruction pages she had once studied in a syllabus on procedures and techniques. Then she gloved and put the special cardiac needle together. Did she go up under the sternum, or down between the ribs? Did it make any difference? Under, she decided. The syllabus she had memorized ten years ago said under .
    Where's Ultrasound, dammit?
    Her mouth dry, but her focus sharp, Thea snapped an alligator clip to the near end of the long cardiac needle, and attached one of the EKG leads to it. When the tip of the needle hit the heart muscle, there might be a noticeable change in the fibrillation tracing. Then she could withdraw the needle just a little and be in the space between the pericardial membrane and the heart muscle. Otherwise, the best she could hope for was getting fluid before hitting the heart. It all seemed perfectly logical—at least on paper it did.
    'All right, let's try shocking him one more time at three hundred and sixty,' she said, with surprising determination and force, 'then we'll go for the tap.'
    This time the shock produced no return at all to a normal rhythm—only a change in the ventricular tachycardia from a rough, sawtooth-like pattern to a form of V-tach where the irregular spikes were smaller. Petros's heart was giving out. Thea ignored the fear and anxiety that continued clawing at her, and prepared to perform a pericardiocentesis for the first time on a living patient, driving a thick four-inch needle up under the tip of her father's breastbone and into his heart, hoping to avoid piercing the left lobe of his liver along the way.
    'You need to have the catheter ready, sis,' Niko said suddenly.
    'I have it right here. You want to do this or not?'
    'It isn't going to make any difference.'
    'Then you have nothing to worry about, Niko.'
    'That jungle certainly toughened you up.'
    'This day has toughened me up more than all those years in the jungle ever did. Yes or no?'
    Niko worked his way through the bedside crowd and confidently pulled on a pair of latex gloves.
    'You were doing well, Thea,' he said.
    Thea glanced up at the code clock. Four minutes.
    'Keep pumping until Dr. Sperelakis asks you to stop,' she told the resident. 'So far, you and you alone have saved this patient with your excellent CPR.'
    In the hands of a skilled cardiac surgeon, the pericardiocentesis took just seconds. The return of a striking amount of blood-tinged serum from beneath the pericardial membrane was diagnostic.
    'Well, I'll be,' Niko said. 'You got me, sis. You got me good. Resume pumping, Tim, until I get this catheter sewn in place to keep the drainage going… Great. Now, let's try once more at three hundred and sixty joules. Ready… and… clear!'

CHAPTER 7

    Wagner's 'Ride of the Valkyries' exploded through four suspended mega-speakers the moment Thea opened the door and stepped into the subdued light of the carriage house. The structure, large enough for half a dozen carriages at least, featured dark paneling, post-and-beam construction, and an expansive loft. Throughout her childhood, Thea had usually been frightened to enter the place, perhaps responding to the sensory defensiveness that had influenced so much of her life—in the case of the carriage house, an aversion to the dim lighting and dark corners, as well as to the broad staircase leading up to the unknown gloom of the loft.
    Later, as it became more and more the domain of her older brother, she allowed him to coax her inside for mock dragon battles and role-playing games. In her best school years, Thea still had few close friends, just a couple of them of her gender. Dimitri did better in that regard, often hosting the 'Nerd Squad'—a gang of boys and an occasional girl who closed themselves in the carriage house, playing countless hours of computer games and intricate