better get word back to Hospital Earth, and fast,” he said quietly. “He just waited a little too long for that cardiac transplant, that’s all. This is a bad one. Tell them we need a surgeon out here just as fast as they can move, or the Black Service is going to have a dead physician on its hands.”
There was a sound across the room, and the Black Doctor motioned feebly to Tiger. “The cardiogram,” he gasped. “Let me see it.”
“There’s nothing for you to see,” Tiger said. “You mustn’t do anything to excite yourself.”
“Let me see it.” Dr. Tanner took the thin strip of paper and ran it quickly through his fingers. Then he dropped it on the bed and lay his head back hopelessly. “Too late,” he said, so softly they could hardly hear him. “Too late for help now.”
Tiger checked his blood pressure and listened to his heart. “It will only take a few hours to get help,” he said. “You rest and sleep now. There’s plenty of time.”
He joined Dal and Jack in the corridor. “I’m afraid he’s right, this time,” he said. “The damage is severe, and he hasn’t the strength to hold out very long. He might last long enough for a surgeon and operating team to get here, but I doubt it. We’d better get the word off.”
A few moments later he put the earphones aside. “It’ll take six hours for the nearest help to get here,” he said. “Maybe five and a half if they really crowd it. But when they get a look at that cardiogram on the screen they’ll just throw up their hands. He’s got to have a transplant, nothing less, and even if we can keep him alive until a surgical team gets here the odds are a thousand to one against his surviving the surgery.”
“Well, he’s been asking for it,” Jack said. “They’ve been trying to get him into the hospital for a cardiac transplant for years. Everybody’s known that one of those towering rages would get him sooner or later.”
“Maybe he’ll hold on better than we think,” Dal said. “Let’s watch and wait.”
But the Black Doctor was not doing well. Moment by moment he grew weaker, laboring harder for air as his blood pressure crept slowly down. Half an hour later the pain returned; Tiger took another tracing while Dal checked his venous pressure and shock level.
As he finished, Dal felt the Black Doctor’s eyes on him. “It’s going to be all right,” he said. “There’ll be time for help to come.”
Feebly the Black Doctor shook his head. “No time,” he said. “Can’t wait that long.” Dal could see the fear in the old man’s eyes. His lips began to move again as though there were something more he wanted to say; but then his face hardened, and he turned his head away helplessly.
Dal walked around the bed and looked down at the tracing, comparing it with the first one that was taken. “What do you think, Tiger?”
“It’s no good. He’ll never make it for five more hours.”
“What about right now?”
Tiger shook his head. “It’s a terrible surgical risk.”
“But every minute of waiting makes it worse, right?”
“That’s right.”
“Then I think we’ll stop waiting,” Dal said. “We have a prosthetic heart in condition for use, don’t we?”
“Of course.”
“Good. Get it ready now.” It seemed as though someone else were talking. “You’ll have to be first assistant, Tiger. We’ll get him onto the heart-lung machine, and if we don’t have help available by then, we’ll have to try to complete the transplant. Jack, you’ll give anaesthesia, and it will be a tricky job. Try to use local blocks as much as you can, and have the heart-lung machine ready well in advance. We’ll only have a few seconds to make the shift. Now let’s get moving.”
Tiger stared at him. “Are you sure that you want to do this?”
“I never wanted anything less in my life,” Dal said fervently. “But do you think he can survive until a Hospital Ship arrives?”
“No.”
“Then it seems to me that I don’t have any choice. You two don’t need to worry. This is a surgical problem now, and I’ll take full responsibility.”
The Black Doctor was watching him, and Dal knew he had heard the conversation. Now the old man lay helplessly as they moved about getting the surgical room into preparation. Jack prepared the anaesthetics, checked and rechecked the complex heart-lung machine which could artificially support circulation and respiration at the time that the damaged heart was separated from its great vessels. The transplant prosthetic heart had been grown in the laboratories on Hospital Earth from embryonic tissue; Tiger removed it from the frozen specimen locker and brought it to normal body temperature in the special warm saline bath designed for the purpose.
Throughout the preparations the Black Doctor lay watching, still conscious enough to recognize what was going on, attempting from time to time to shake his head in protest but not quite succeeding. Finally Dal came to the bedside. “Don’t be afraid,” he said gently to the old man. “It isn’t safe to try to delay until the ship from Hospital Earth can get here. Every minute we wait is counting against you. I think I can manage the transplant if I start now. I know you don’t like it, but I am the Red Doctor in authority on this ship. If I have to order you, I will.”
The Black Doctor lay silent for a moment, staring at Dal. Then the fear seemed to fade from his face, and the anger disappeared. With a great effort he moved his head to nod. “All right, son,” he said softly. “Do the best you know how.”
*
Dal knew from the moment he made the decision to go ahead that the thing he was undertaking was all but hopeless.
There was little or no talk as the three doctors worked at the operating table. The overhead light in the ship’s tiny surgery glowed brightly; the only sound in the room was the wheeze of the anaesthesia apparatus, the snap of clamps and the doctors’ own quiet breathing as they worked desperately against time.
Dal felt as if he were in a dream, working like an automaton, going through mechanical motions that seemed completely unrelated to the living patient that lay on the operating table. In his training he had assisted at hundreds of organ transplant operations; he himself had done dozens of cardiac transplants, with experienced surgeons assisting and guiding him until the steps of the procedure had become almost second nature. On Hospital Earth, with the unparalleled medical facilities available there, and with well-trained teams of doctors, anaesthetists and nurses the technique of replacing an old worn-out damaged heart with a new and healthy one had become commonplace. It posed no more threat to a patient than a simple appendectomy had posed three centuries before.
But here in the patrol ship’s operating room under emergency conditions there seemed little hope of success. Already the Black Doctor had suffered violent shock from the damage that had occurred in his heart. Already he was clinging to life by a fragile thread; the additional shock of the surgery, of the anaesthesia and the necessary conversion to the heart-lung machine while the delicate tissues of the new heart were fitted and sutured into place vessel by vessel was more than any patient could be expected to survive.
Yet Dal had known when he saw the second cardiogram
