Ren didn’t see Dani for the rest of the night or the following day. The surgery schedule was packed, and she was either in the OR, checking patients in between cases, or stopping by the pediatric intensive care unit to review Leo’s progress. He was awake intermittently, but his fever was still high despite aggressive antibiotic therapy. Just before she signed out after sending all the residents on her service home except Zoey, who was on night call, she tracked down the infectious disease fellow at home to ask about the antibiotic regimen.
“I’m just sitting down to dinner,” he said. “Can it wait till morning?”
“I don’t think so,” Ren said as pleasantly as she could. It was only six thirty in the evening. She didn’t understand why he sounded so cranky. “He’s still febrile, and his white count isn’t coming down much.”
“We still don’t have all of the anaerobic cultures results,” he said, “but everything else is pretty much covered with what we’ve got him on.”
“Yes, I see that was the treatment plan.” Ren ignored his mildly condescending tone as she swiped through the screens on her tablet, correlating all of Leo’s recent lab results with his current medications. She didn’t mention that pretty much was not her idea of good enough. “At least one of these was started pre-op, though, and considering what he’s growing out so far, a fourth-generation might have a little more power. What do you think?”
She half expected him to say that he thought he was the infectious disease expert, but after a moment of silence, he said, “Well, I can’t see any reason not to make the change. I’ll call it in.”
“That’s all right, I’m right here. I’ll write the order.” She confirmed the appropriate dose with him and put the order through. “Thanks again.”
“Uh. Sure.”
“Good night.” She hung up to let him get back to his interrupted dinner. Now that she finally felt satisfied that all her clinical responsibilities were over for the day, she headed to the research building to finish the much-delayed revisions the editors had requested on several tables for a paper about to be published. She worked steadily for a couple of hours and, after uploading the new PDFs to the journal portal, retrieved her phone from the pocket of her lab coat hanging on the back of her chair to check her texts. She didn’t expect to find anything, as she would have heard the message ping, but she still registered a pang of regret to see that there was nothing from Dani. Although, to be fair, she had pretty much told Dani that she wasn’t open to a relationship right now. But dinner wasn’t a relationship, was it? Even sex wasn’t necessarily a relationship, if both people agreed to the limits. Right?
She sighed, not being in the habit of gaslighting herself or anyone else. Dani was only doing what she’d asked, and she appreciated that Dani wasn’t pushing. She simply needed to come to terms with the disappointment from having gotten what she wanted…or at least what she thought she needed. She just didn’t feel very good about it.
“Enough,” she muttered as she punched in a text.
Hi. If you’re up, do you feel like a game?
After two minutes with no reply, she didn’t expect Axe to answer. Axe almost always replied right away if she was free. Ren blew out a breath. She had no one else to contact to save her from her own introspection, at least, no one she wanted to talk to about any of this. Certainly not Zoey, who was the first person who came to mind. Axe was the closest person she had to a friend right now.
When the phone vibrated, she snatched it up.
Axe, after all. Sorry I’ve been out of touch. Traveling.
I understand. Not a good time?
Can’t play. Only have a few minutes. How are you?
That was nice, that Axe was asking, even when she was clearly busy. Axe sounded off, though—usually even Axe’s texts radiated energy and high spirits. Tonight she seemed…sad. Ren might not have asked if she hadn’t sensed that wistful tone. And she might not have admitted she wasn’t having all that great a time either. Tough few days here. You too?
Yeah. Personal stuff. Sorry.
Hey, that’s all right. Ren hesitated to take the next step, but she cared that Axe was unhappy. Wasn’t that what people did when they cared? Reached out? Axe could always just leave. I don’t mind listening.
It’s complicated.
Ren grimaced. LOL. If it’s personal, when isn’t it?
I’m laughing here. True. I haven’t laughed in a couple of days. Thanks.
You’re welcome. And I really don’t mind listening.
Where are you?
Ren paused. What do you mean?
I know, weird question. I don’t mean in your head. I mean geographically.
That was weird. Although, not really. They’d passed the point of anonymous online gaming handles sometime in the last few weeks, when she hadn’t really noticed. East Coast. You?
Pennsylvania.
Ren stared. Really? You’re not making that up?
Nope. :-)
Axe could have only one reason for asking. If they met, what would it mean? Ren had to think about that. Things would change if they did that. Would that be bad? What if they didn’t like each other? Would she lose a friend? She huffed. What kind of friends could they be if they didn’t actually like each other in real life? Until now, everything was safe and secure. At a distance.
Just the way she liked things. Just like she was trying to do with Dani…
And like with Dani, she only had pieces of a relationship with Axe. But were pieces all she really wanted from another person? She closed her eyes. Axe could be her friend. I’m not that far away.
It would be nice to talk in person
Ren gripped her phone. Did she really want another new distraction in her life? Could she afford it? One thing was for sure—she didn’t want any confusion. Hey—I guess I should say I’m involved, sort of?
Oh, whoa. Yeah. Sorry—I didn’t mean to come off that way
Ren hurried to answer. No. You didn’t. I just wanted you to know. And I’m not really
LOL. You’re not sure?
No, Ren texted. I’m sure. I’m not. But, friends?
Yes, totally. I gotta go…connect later?
For sure. Have a safe trip. Ren stared at the silent screen a moment longer, wondering what Dani was doing before she slipped her phone away.
* * *
Ren finished late in the lab and found an open on-call room where she could spend the rest of the night. She’d just stretched out, still in her scrubs, in the small room with its single bed and the sliver of light sliding in under the door, when her phone vibrated. At this hour it could only be a problem. She rolled over, checked the message. Zoey’s name at the top of the screen.
If you’re in the hospital call me 911
She hit the return call rather than texting, and Zoey answered on the first ring.
“Ren?” Zoey said, the adrenaline sharpening her voice.
“What’s going on?” Ren stepped into her clogs and grabbed her lab coat.
“I’m in the SICU. One of the post-op hearts is crashing. I need to open the chest, and I need a hand.”
“Where’s the CT fellow?” Ren asked, even as she yanked open the door and raced for the stairwell.
“In the OR with Harkins, doing an emergency CABG. They’re having trouble and can’t get free.”
“What’s the situation with the patient?” Ren shouldered her way into the stairwell and consciously blocked out everything except Zoey’s voice, including the thundering of her own heart.
“Three-vessel CABG with aortic valve replacement this afternoon. The chest tube drainage was on the high side all evening, but that seemed to have been slowing down. Now it’s stopped, and his pressure is bottoming out despite the pressors.”
“Harkins want you to open?”
“He said yes, if we can’t get his pressure up in the next couple of minutes.” Zoey’s voice dropped. “I’ve never done it before in an emergency.”
Neither have I.
“I’m a minute away. Have the nurses irrigate the chest tubes again to make sure they’re not clotted, increase the pressors, and make sure there’s plenty of blood available.”
“Got it.”
Ren dropped her phone into her pocket, exited the stairwell, and sprinted for the SICU. She had no time to wonder if she was the right person to call. She was the most senior person available, and Zoey needed her help.
* * *
Ren didn’t have any trouble finding the right patient in the SICU. A cacophony of voices came from behind the closed curtains around a bed in the center of the long row of curtained-off beds. Bright lights illuminated that part of the room despite it being after midnight. Usually, the only sound at that time of night was the rhythmic whoosh of the ventilators and the occasional murmured voices of nurses and PAs discussing patients. Now, as she hurriedly pulled on a cover gown, snippets of terse conversation reached her.
Open it up all the way. Zoey’s voice, taut with tension, but still controlled.
We’ve got no pressure.
Nothing from the chest tubes.
A monitor emitted a loud, steady peal as an alarm went off.
Ren jerked the curtain open enough to get through and hastily yanked it closed behind her. Zoey stood on the patient’s right side, her attention fixed on the monitor that registered no blood pressure. The EKG tracing continued to flicker rhythmically, but even as Ren watched, more and more erratic beats appeared.
“Open a thoracotomy tray,” Zoey said, glancing at Ren, relief showing above her mask.
Ren tied hers in place and, muttering, “Excuse me, excuse me,” pushed her way through the gaggle of ICU staff to face Zoey across the patient’s chest. The dressings were off, and Zoey slathered Betadine haphazardly over the surgical incision in the center of the sternum. Ren didn’t have to ask for an update. The patient would code any second, and everyone knew it. “Ready?”
“Yes,” Zoey said.
“Someone notify Harkins we’re opening,” Ren said, holding out her hand. “Suture scissors.”
A pair of scissors slapped into her palm, and she gave a silent thank you that someone knew how to assist. She clipped the sutures at the top and bottom of the incision, grabbed one of the loose ends with a hemostat, and yanked the sutures out.
“Zoey, go ahead.”
“Wire cutters,” Zoey said.
Ren spread the skin and subcutaneous tissues to expose the breastbone, and Zoey cut the loops of wire that held the two halves of the sternum together.
“Rib spreader.”
Ren shoved the wide blades into the gap in the bone and rapidly cranked it open. Blood welled into the incision as soon as she did, bright red and pulsating. Obscuring everything. Somewhere in the depths of the incision, the heart struggled to beat.
“Hang the blood,” Zoey ordered. “All lines. Pump it in by hand.”
“Suction,” Ren said. “We need more suction.”
“Hell,” Zoey said, looking at Ren. “The valve is loose.”
Ren saw the tear in the suture line. “Someone call the OR. Tell Harkins we need him here now.”
“He says ten minutes,” a voice called an eternity later.
Only they didn’t even have two minutes. The patient was going to bleed out through the tear at the base of the aorta if they didn’t do something.
“We need a vascular clamp.” Ren stared into the depths of the wound as the sound of someone digging through the instrument tray clattered beside her.
“I’ve got it, I’ve got it,” someone announced breathlessly.
“Zoey, I don’t have an angle,” Ren said. “Can you get it?”
“I…yes, I think so,” Zoey gasped.
“Here, here,” a man said and pushed a clamp in Zoey’s direction. The fine teeth on the jaws were specially designed not to tear the fragile tissue of the blood vessels when applied.
Ren directed the suction at the base of the aorta where the valve had been sutured in place. It was rocking with every heartbeat, and blood gushed through a half-inch tear. “Clamp it. Clamp it.”
“What if I…”
“Clamp it, Zoey,” Ren ordered sharply, and Zoey, her hand steady, slid the clamp on either side of the tear and closed it down.
The bleeding slowed. A collective breath went out of everyone standing around.
“Keep the blood coming,” Zoey said. “What’s the blood pressure?”
“Seventy over nothing,” a nurse said.
“Go up slowly on the pressors,” Ren said. “We don’t want to blow this clamp off.”
Thirty seconds later, Zoey said, “It’s eighty over fifty, Ren.”
Her voice held a note of wonder.
“That should be enough to keep his brain and his kidneys alive.” The vise of tension squeezing Ren’s chest eased.
Someone shouted, “Harkins is on his way.”
“I didn’t think to do that,” Zoey said, staring at Ren across the table as Ren irrigated the wound and draped the incision with a sterile towel.
“You would have.”
“I was going to try to suture it.” Zoey grimaced.
“We still might have to.” Ren glanced at the ICU nurse next to her. “Load up a four-oh vascular suture, and keep the suctions ready.”
“You got it.” The nurse shook her head. “What a ride, and no thank you, not again.”
Zoey and Ren stood motionless at the patient’s side, Ren watching the chest cavity, waiting for the dressings to suddenly bloom and overflow with blood, Zoey staring at the monitors.
“So, what do we have,” a brisk voice said after what felt like a week.
Ren glanced at Zoey and signaled for her to go ahead. Her patient, her case.
Zoey half turned to the cardiothoracic surgeon, an impressively large man with a florid complexion, cobalt-blue eyes, and a surprisingly relaxed expression.
“We lost his pressure after the chest tubes clotted. We couldn’t get it up again. We…” Zoey glanced at Ren. “We opened his chest.”
“How much blood had he lost by then?”
“Almost everything. We’ve given him ten units so far.”
“Huh.” As he spoke, he pulled on gloves, asked for suction, and carefully removed the dressings. The clamp was still in place.
“That’s one way of handling it,” he said. “Who put the clamp on?”
Before Zoey could speak, Ren said, “I made that call.”
He glanced at Zoey. “You put it on?”
“Yes.”
“Nice job. Tricky, though. If you’d torn the valve out, we would’ve had a hell of a mess.”
Zoey kept her gaze steady. “I didn’t think suturing—”
“Trickier still.” He straightened. “Call the OR, tell them we’re on our way. We need the pump tech to prime the pump to go on bypass. Send all the blood to the OR.”
“I’ll call,” the nurse said.
Harkins looked from Zoey to Ren. “So which one of you wants to come?”
“Both of us,” Ren said.
He made a sound that might’ve been a chuckle.
“There’s a surprise. All right, bring him over. I’m going to get a cup of coffee.” And with that he was gone.
Zoey looked at Ren. “Oh my God. I can’t believe we did that.”
“Well, we did.” Ren almost wanted to laugh. The relief made her dizzy. And the high—she couldn’t think of any other word to describe it—was incredible.
“I’ve never even seen it done before.”
Ren grinned. “Neither have I.”
* * *
They finished in the OR at four a.m.
“You might as well go home,” Ren told Zoey after they got the patient settled in the intensive care unit. “You’ll be off today anyway, and there’s no point staying for morning rounds.”
“I’m staying,” Zoey said. “I’ve got patients on the floor to see.”
“I can do that.”
Zoey fixed her with a stare as she pulled off her cap. Her hair fell down around her shoulders in a tangle that somehow looked artful as opposed to just messy. Ren ran a hand through her much shorter, wavy hair and had no doubt it was standing out in unappealing clumps. From Zoey’s expression, there was no point arguing about her leaving.
“All right, but after that you’re out of here.”
“I would’ve been screwed if you weren’t in the house last night,” Zoey said.
“Thanks,” Ren said, “but you would’ve been fine. You would’ve figured it out.”
“Yeah, maybe, but what if I hadn’t figured it out in time, or I’d made the wrong call.”
“Then you would’ve figured out it was the wrong call, and then you would’ve made the right one.”
“I’m trying to thank you here, Ren,” Zoey said with an edge.
“I know. That’s nice.” She paused. “I’d only read about it, and in the largest studies, they clamped if possible. There are other cases where suturing was recommended, but the outcome was at least eighteen percent poorer. I made an educated guess.”
Zoey gaped at her. “Tell me you thought that out during the case.”
“Well, not all of it,” Ren said. “I didn’t have time to actually go through all the conclusions.”
“You’re not kidding, are you?”
“Um, no?”
“It’s some photographic memory thing, right?” Zoey said.
Ren nodded, her stomach sinking. They were getting along really well. And maybe they might’ve been friends.
Zoey laughed. “Oh, well, lucky me that I called you. Jeez, Ren, don’t keep that thing a secret.”
“What?” Ren couldn’t quite decipher what Zoey meant. She never told anyone things like that—not when it always produced the same result. Suspicious uncertainty. As if she was somehow dangerous.
“Are you kidding me?” Zoey rolled her eyes. “If you want to save everybody on the service a lot of time, just tell us the facts when we need them. Then we can skip looking up all the studies.”
“Who’s looking up studies?” Ren scoffed. “We’re surgeons. You know, see one, do one, teach one.”
“Yeah, but sometimes, you know, we actually have to know things.”
Ren started to laugh, and Zoey did too.
“I can’t wait to tell Dani all about this when she gets back,” Zoey said.
Ren grew still. “She’s gone?”
Zoey grimaced. “Yeah. I guess she probably didn’t even have time to tell anyone. She had to go home. Some kind of a family emergency.”
“Oh, is it something serious?” Ren bit at her lip. Was Dani somewhere by herself, hurting? The idea made her ache.
“I don’t know any details. I guess it must be, if she left like that.”
“I hope she’s all right,” Ren murmured almost to herself.
“Well,” Zoey said with suspicious nonchalance, “you can always text her.”
“I…” She shouldn’t, should she? But they were friends. They’d agreed to that—or at least, she’d given Dani no other choice. “I’m not sure—”
“I am. I’m positive.”
Zoey’s intensity convinced her not to argue. Especially when she wanted to believe.
“I could do that,” Ren said.
“She’s in California.” At Ren’s look Zoey added, “You know, the time difference.”
In the morning, Dani’s morning, Ren thought. In the morning, I’ll text her.