Bad Blood
by
James Baehler
and by
Sheldon Cohen, M.D.
Copyright 2012 James Baehler,
All rights reserved.
Published in eBook format by eBookIt.com
ISBN-13: 978-1-4566-0733-3
No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems, without permission in writing from the author. The only exception is by a reviewer, who may quote short excerpts in a review.
PART ONE
THE HOSPITAL
CHAPTER 1
“Code blue! Code Blue!” echoed over the intercom at Barrington Community Hospital. When it was followed by “Surgical Intensive Care Unit,” Cliff Harris knew that whatever catastrophic event occurred had to involve the patient on whom he had just operated. It was 11:30 p.m. and his was the only patient admitted to surgery in the last hour. Dr. Harris was sitting in the surgical locker room sipping orange juice and fighting fatigue when he heard the Code Blue. He ran back to the intensive care unit. As soon as he entered he saw the two ICU nurses working frantically on his patient. “It’s your patient, Dr. Harris. I think he’s coding!”
Shaking his head to help prepare his mind for yet another emergency he said, “What happened?”
“He went into this rapid tachycardia,” said the younger nurse pointing to the cardiac monitor above the bed showing the accelerated heartbeat.
“Was he awake? Did he complain of any chest pain?” asked Harris.
The nurse said, “No, nothing like that.”
A glance at the cardiac monitor showed a heart rate over 140. At least it was a normal sinus rhythm and not a serious cardiac arrhythmia. Could this represent a cardiac insult such as a post-operative heart attack? The tracing did not show any obvious electrocardiographic evidence. Harris quickly listened with his stethoscope, but all he heard was a rapid and regular cardiac rhythm. The patient’s blood pressure on the monitor was 120 over 70. That was a surprise and a relief and it told Cliff that in spite of the rapid heartbeat, the patient was maintaining his blood pressure. He lowered Victor Wallberg’s bed sheet and found the abdomen distended even more than it had been before surgery. Victor’s skin, conjunctiva, and nail beds were pale. From all the diagnostic possibilities that whirled through his mind, Cliff focused on one: A post-operative bleed? How could that be? Things had gone so well; Wallberg had been dry and stable after the earlier surgery. Regardless of that, the man was now in serious peril. Something had to be done and it had to be done now. He turned to the nurses. “Let’s get him back to the OR, stat. Tell them we’re coming back. Call the lab. Get the blood I ordered earlier to the OR. How much urine in the Foley bag?”
The older nurse, after a quick check at the bag hanging on the other side of the bed, said crisply, “Thirty cc’s.”
“Empty and record the volume along with the exact time. I want to start surgery with an empty bag.”
“Yes sir.”
“Let’s move.”
This was no time for theorizing while his patient could be bleeding to death. If he was, it had to be stopped. On the way to the operating room Harris said to the nurses, “He’s bad. Something unusual has happened. I have to look for a bleeder.”
The operating team and the anesthesiologist were arriving as the patient was wheeled in to the OR. In less than five minutes Victor Wallberg was anesthetized and on the table. Harris opened the previous incision made at the first surgical procedure. He noted with surprise some oozing but had no time to tie off individual tiny bleeders in the subcutaneous fat. A few rapid and deft movements and the peritoneal layer became visible. It was blue and bulging with blood. His worst fears had been realized. He opened the peritoneum with a single delicate flick of his scalpel. Blood welled up from the abdominal cavity. Harris desperately tried to suction out the blood so he could identify the source of the bleeding. He was able to remove enough blood to evaluate his recently done small bowel anastamosis and it was intact. The reconnected ends of the small bowel showed no suture disruption. But that was about all he could discern as the blood seemed to appear from everywhere to obscure the surgical field. The more he suctioned, the more the blood seemed to flow.
Ten years of experience were brought to bear as Harris’s thought processes focused on the task at hand. He could find no bleeding vessel, admittedly a difficult task with what was happening to his patient. He knew he was headed for trouble. His lips were tightly closed, a look of intense concentration registered on his face.
Suddenly it hit him. He thought, ‘My God! This is a case of disseminated intravascular coagulation.’ He called to the anesthesiologist, “Sanjay, look at his fingers…quick.”
“Dark blue,” the anesthesiologist shouted back in alarm.
“Blood pressure?” asked Harris crisply.
“116 over 56.”
Still up, but lower thought Harris.
He called to the circulating nurse. “Check the Foley bag.”
She looked under the table and said, “Foley bag still empty.”
“Is blood dripping at a wide open rate?” Harris asked.
“Blood bag wide open.”
For a few seconds Harris continued his efforts. Just before he was about to call out his orders, the anesthesiologist said, “Blood pressure dropped. 70 over 40”
With that news, Harris knew his patient was going into shock. He had no time to lose. “Vasopressors,” he called. “Sanjay, get me a blood sample, stat? Then give…”
“I’m trying, but his veins are collapsing,” cried the anesthesiologist in dismay.
“Jugular, brachial, femoral. Get some blood from some place.”
“What blood are you needing?” asked the anesthesiologist anxiously.
“Platelet count, PT, APTT, fibrinogen, fibrin degradation products, type and cross match four more units, and hematocrit. And then…”
“I can’t get blood! I can’t get it!” cried the anesthesiologist.
Harris couldn’t wait. The patient was in extremis. He shouted, “Give him eight thousand units of heparin!”
The anesthesiologist stiffened. “What?”
“Heparin, eight thousand units…bolus, stat!” called Harris in a louder voice.
“The anesthesiologist shook his head
